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HomeMy WebLinkAboutT12N R3W SEC 27 LT 4 S2Onsite File T12N R3W Section 27 Lot 4 S2 #017-051-21 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201040 PID Number: 017-051-21 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name JOHN MELHASE ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 5443 CANNON WOODS RD, ANCH ❑ other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. Fill added above original grade Ft. Gravel length Township Range Section T12N, R3W, SEC 27, LOT 4, S2 Ft. Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100,+ 50r+ TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity ANCH TANK/GREER 1250 Gal. Surface Water 100'+ Material Number of compartments Lot Line 10,+ NA PLASTIC 2 Foundation 10,+ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 MIKE N ANDERSON, P.E. Drainfield CO/MT 3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 100 ft Inspection ectio 1s` 3/17/20 2°d Location and description V 4"' MAN DOOR ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date s �= ^ 5'�=' ��° m ° m ° ; ' !h fa �f o o a o•••• o 00 • o° m m m a o m o o c o 'A `� ,° MICHAEL i;. A •.F; R,,- °'a— '>> Septic System ApprovedDate y �0.� CE 9169 `'% ,°. Note: this does • �% approval not include well permit requirements. rpo„ nsmgil AN Permit No. OSP201040 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: T12N R3W SEC 27 LT 4 S2 MARK A 8 c01 12 32 TC01 ( 15 32 TCO2 19 35 CO2 ( 21 36 CO3 22 37 BENCH Ai MAN DOOR //DRIVEWAY PID No.: 017-051-21 i I 1 I I `WELL HOUSE I I I I 1 1 1 / \ NEW SEPTIC TANK i 92�CO2�X — � � _ Cf31B�viT WELL ON LOT T12N R3W SEC 27 LT 6 N2 — — — — —/ GREATER THAN 200' AWAY — — — — — SEPTIC SECTION N.T.S. F 14 ®� 49TH _IrB 50.1-22 ..jo ........... :.MICHAEL N. ANDERSON;" No. CE 9469 •� 3-18-20 N89'56'50"W 330.47 124.79­ ttiX 1,P A (D A r ]CANNON 3 J/ WOODS N89*56'00',w330.40"- I Date Scale le 1 e� 227/2020 1" = 50, BOBBYE BU ETT Grid 2941 Carriage Drive SW 2937 kale Anchorage, Alaska 99507 Field Book (907) 350-5541 Drawn by Field Book BFB ASB2020 ROAD 0 0 0 0 Fri 01 HOUSE DETAIL N. T. S. GRAPHIC SCALE: 1 Inch = 50 Feet 25 O�2 7 50 100. Legal Desc!:jption. I hereby certify that the property described hereon has been surveyed SOUTH 1/2 LOT 4 by me, or at my direction, and that the improvements situated thereon are ertlines do or encroach SECTION 27, T12N, RM propertywithin lyingthe adjacent theretoand unlessnot otherwiseoverlap shown, That noon the S.M., ALASKA improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other easements on said property except as shown, MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201040 Work Type: SepticTank Upgrade Tax Code Number: 01705121000 Site Legal Address: T1 2N R3W SEC 27 LT 4 S2 G:2937 Site Mailing Address: 5443 CANNON WOODS RD, 19, Anchorage Owner: MELHASE JOHN Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: nt Department 3/11/2020 3/11/2021 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 4 All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing (Special Provisions: The engineer is to locate the well serving the lot to the south prior to installing the tank. If a ,design change is required, construction of the system will stop pending Onsite review and approval. The Record Drawing is to address the location of the well. r `- Received By: Date: Issued By Date: MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 017-051-21 Property owner(s) JOHN MELHASE Mailing address 5443 Cannon Woods Rd ANCH AK Site address 5443 Cannon Woods Rd Day phone Legal description (Sub'd., Block & Lot) T1 2N R3W SEC 27 S2 LOT 4 Legal description (Township, Range & Section) Lot Size 108,900 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank El Upgrade ED Duplex (D) ❑ Holding Tank ElRenewal ❑ Multiple Dwellings El12 Privy El g � /or D) Private Well ❑ Q� 89 Water Storage ❑ 0 Q �N .4y N r C THIS APPLICATION INCLUDES A WAIVER REQUEST FO d 8 s nce: 97� I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. /01k, (Signature of property owner or authorized agent) Permit/Rush Fees: 43&o Waiver Fees: Date of Payment: 31io/ ao 926 Date of Payment: Receipt Number: agg5; .0 Receipt Number: Permit No. 5 Pazi/0016 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc May 10, 2020 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic tank permit Legal: TI 2N, R3W, Section 27, South 1/2, Lot 4 To Whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. Sincerely 47p� Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 -tL*oqs se jdaoxa Slaadoad pTas uo, sluawasua aaqjo to saut .1 OWF9sv 9J9 uox8sTutsueal sSwApiaoa ou )aia aaaTp leql pue uotisanb ux sasrwaad T;�99-099 (406) aqj u.o q�weoxoua olajaql 4uaoief v �upCj Sliadoad aiql . UO SjU9MaAoadTux vxsvlv "W's )IOOG pl@Tj Sq umux(I 40966 'e)tselV '02uxQq3UV P -efp-a WutSl Slaadoad mcm 'MaTi, /_3 Mums iiing-sv ZC6? MS • ou laiqL -uAtoiqs asuijaqjo ssalun oj@jaqj juao 9AII(I OVULI-TUD lf,6� aqj uo qavoaaua jo dvlaa.w jou op pue sautl 9}aadoad 9TAI uiqlfA& a118 7 T uoalaTtl pallenlp sjuatuaAoadun aqj liRql pue uot aaup Sua IL, ao 'atu Sq 1, 10,1 Z/1 Hiflos MID LL -L PRSaAlng uaaq seg uoajaq paqijasap Sliadoid aqj Iexn SjTpao Cqaxaq 1 109 = I OWVI-31F, 7- uolldlaasa(l pwaq p .7 -ff j-, 6 V 1,A 09 sz 0 9 M V J 1 ,0"' Air dQ OV '0!� M,,00,99.62N . . .......... ....... .. . S(]OOm (IV 0 �l A Y j V NONNVO I V,, X n HU V AO 0, v CA -JAh LA 'v GO CD �q 0 --- 6z,t7z �G L4 0 Ilid 1 o", i J Ljj zp I Ln CD 3snolFo -1-13M 3MH iv4VHJ 000AA )Idois Oml x"J Lq Z -O�T M,,09,99.62N S1 IV -11V130 3snOH GRE/"-~!R ANCHORAGE AREA BOR/'-',!GH Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCA'nON ('~mon P-d. c~ D,. A rm,~, LEGAL DES~R,PT,ON 'gP~ ~P LO~ % g¢¢.~Tmu; P.S V,/ SEPTIC TANK: DISTANCE / C~ NUMBER OF FROM WELL 100 MANUFACTURER .reel,- MATERIAL S1Ceil' ~ COMPARTMENTS I (J.L, ~,p pro v~/ INSIDE LENGTH INSIDE WIDTH ~ LIQUID DEPTH .... .LIQUID CAPACITY ('2-GO GALLONS. SEEPAGE PIT: 19 ~nd NUMBER OF PITS J DIAMETER OR WIDTH~OI, LENGTH;~D,,I DEPTH LINING MATERIAL ~.OOJ ~~D(~CRiB SIZE: DIAMETER__DEPTH (~ / . DISTANCE FROM: WELL Z&' TOT^L EFFECT,VE 5 2 8 BUILDING FOUNDATION , NEAREST LOT LINE (~ C) / ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: Proposed pri w'+e~ TYPE CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK SYSTEM REMARKS DISTANCES: INSTALLED BY: PIPE MATERIAL: (J ~.-~0-~ LOT SLOPE: REMARKS: Form NO, E0-031 DIAGRAM OF SYSTEM GRf~ATI--R ANCHORAGI-' AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL GUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT FERMIT NO. FINAL INSPECTION: 2~ HOUR NOT~E REQUIRED. ~A~KFILLING OF ANY SYSTE~ WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS I FOUNDATION TO SEPTIC TANK ~' SEPTIC TANK TO SEEPAGE Pit WALL / 3-- WELLTO sePtiC TANK. 10~)l · DRAIN FIELD SEEPAGE PIT I-~0 SEEPAGE PiT ., DRAIN FIELD CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. DIAGRAM OF SYBTEM I CERTIFY THAI' I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-§8 AND THAT THE ABOVE DESCRIBED SYSTEM [S IN ACCORDANCE W[TH SAID CODE. R&M Civil Engineers ENC.,,qEERING & GEOLOGICi L CONSULTANTS 229 EAST 51st. AVE. -- P.O. BOX 6087 - ANCHORAGE, ALASKA 99503 TELEPHONE 907-279-0483 TELEX 090-35419 Geologists Land Surveyors .lAMES W. ROONEY. P. E. MALCOLM A. MENZIES. P.E., L.$. .lAMES H, WELLMAN. P,E. May 9, 'I973 No. 36606 RALPH R. MIGLIACClO Mr. Allan Dicks Star Route A, Box 337 Anchorage, Alaska Re: Test Hole and Soil Log Report for Sanitary System Lot 4, Section 27, T12N R3W SM Dear Air. Dicks: We are submitting herewith the test boring results and our comments regardhng soil conditions encountered at the subjec~ site. This investigation was performed in accordance with your request of May 7, 1973 and those procedures outlined in a letter dated September 13, I971 by 1VLr. Roll Strickland of the Greater Anchorage Area Borough, Department of Environmental Quality. A single test hole was put down within the Lot 4 area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor-mounted backhoe and the test hole was extended to a total depth of 7. 5 feet belov~ ground surface. The final log prepared for the test hole has been included Jn Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have ~ny questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & /VI ENGINEERING & GEOLOGICAL CONSULTANTS ~'James W. Rooney Partner JWR: wb E nclo sure xc: GAAB ANCHORAGE FAIRBANKS JU55AU T.H.- I 5-7-73 0,0~ SILT T RACE TO SCME CLAY (CH) 2.5' SANDY GRAVEL (SW) SILTY SANDY GRAVEL (GM) H No Water Table ?.5' T.D, DATE Allan Dicks Property Engineering ~Geological Consultants LOG OF TEST HOLE .Al.. A. ~ s A LA $ K A ~ u N ~ A u Anchorage Alaska A-OI GRE~r.~R ANCHORAGE AREA BOROUGHF~-'5 ~ '~' ~, DEPAR £NT OF ENviRONMEntaL OUA! ~ / CASE # 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 Performed For Allen Dicks Date Performed 9/23/71 Legal Description: Lot Block Subdivision This Form Reports Soils L~g x-- P~olatio'n Test T-12N R3W Sec 27 S 1/2 of Lot 4 SM Depth Feet Soil Characteristics Brown silty sand (SM) Gray silty sandy gravel and sandy gravel (GW) with cobbles and boulders (GM) W~s Ground Water Encountered? no If Yes, At What Depth? Reading Date Gross Time Percolation Rate Minute Proposed Installation: Seepage Pit Depth Of Inlet COMMENTS: Net Time Depth to H20 x Drain Field Net Dro Depth To Bottom Of Pit Or Trench 160 square feet of drainage area Jm Test Performed Byg. E. Carlisle ' Oata-~¥'~fied By:National Testing Services, Date: GI?'~TER ANCHORAGE AREA BOROI'~H HEALTH DEPARTMENT ~ 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 N.o $05 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ,,4 i1'c)' , MA,L,NG ~'~ ADDRESS ~ ~4~''~'''~'~ ~ D,STANCE ~ROM WE~ ~n ~r~~,~ ~:>~?~ ~U.~ O~1 ..... COMPARTMENTS ~/~/~ ~, ~, /~// LIQUID LIQUID CAPACITY ./~)~ GALLONS. INSIDE LENGT~ INSIDE WIDTH DEPTH SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAL NEAREST LOT LIN~/~/ SEEPAGE PIT: ~'/ I/ 'fi (- /17" BU,LD,NO FOUNDAT,O,~ , D~S~CE ~RO. W~ / TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ / ~ SQ. FL TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL FOUNDATION , NEAREST LOT LINE , OF LINES NU~BE ES ~-DI,~ TRENCH' IWIW~DT~' IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: TYPE ~ t / /; ,~DEPTH NEAREST LOT LINE , SEWER LINE DISTANCE FROM WATER rBU/LDI N G- F.~DU NDATION SAMPLE ., TANK~ ~ ~YSTEM DIAGRAM OF SYSTEM , NEAREST OTHER SOURCES__ DISTANCES: GREAYER ANCHORAGE AREA BORuUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUEIOR ROAE~ POUCH 6-6~O ANCHORAGE, ALASKA 99502 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT N f SEPTIC TANK ~ EEPAGE P T ~ DRAIN FIELD OTHER , SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK SEEPAGE PIT TO NEAREST LOT LINE, ~ WELL TO SEPTIC TANK ~ DRAIN Fi ELK) /3-/ ~ O DRAIN FIELD . SEEP EPIT. /%0 ALSO CONSIDER AREA WELLS. SEEPAGE PIT WATER MAIN TO SEPTIC TANK DRAIN FIELD /~ SEPTIC TANK,. , SEEPAge PIT t//~ ,DRA[N FIELD TO RIVER, LAKE, STREAM. CAST iRON INTO AND OUT OF SEPTIC TANK AND INTO CRIb3 CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOil. DIAGRAM OF SYSTEM 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit Fitted With AIRTight REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO LICENSED DESIGNER I CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 017-051-21 Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Re iSSveA I Expiration Date: 1. GENERAL INFORMATION Complete legal description T1 2N R3W SEC 27 LT 4 S2 Location (site address) 5443 CANNON WOODS RD ANCH, AK Current property owner(s) Mailing address Real estate agent JOHN MELHASE 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ SS ad Waiver Fee $ Date of Payment 20Zy Date of Payment Receipt Number 02— ©93 Receipt Number COSA # (95-C 2 d 1 1 UT Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 7-19-20 ' d DSD SIGNATURE ' 49LH- System #1 Approved for 4 bedrooms �......• • . • . , . System #2 Approved for bedrooms d.•fJt'CHAEL N. ANDERSONCE 94• i, . 9 `�-,,, Disapproved Conditional approval for bedrooms, with the following stipula,OROfESS10fk�� �ooe� 9-1-f y OF((��i� F21 y:Original Certificate Date: '- 2_02 0 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: T12N R3W SEC 27 LT 4 S2 Parcel ID: 017-051-21 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 7+ gpm Date drilled UK Water storage tank volume 0 gallons Total depth 40'+ ft Well disinfected for coliform test? ❑ Yes ® N Cased to 40'+ ft ❑Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate mg/L © Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) *0 in. Collected by MNA Date of flow test for COSA 3/17/20 Date of Sample 7/9/20 Static water level at beginning of test 35.6 ft. Comments * well is located in small house, inspected by Tim E. on April 3, 2020 B. TANK DATA C. LIFT STATION Age of tank(s) NEW years ❑ Required maintenance completed Tank type/material Plastic Age of lift station years Measured operating fluid level in septic tank NEW Lift station material ® Standpipes/foundation cleanout per record drawing Comments: Date of pumping NEW D. ABSORPTION FIELD DATA Wood crib system Which system tested (date installed) 518/73 ❑ ALL standpipes present per record drawing Total measured depth from grade 10.5 ft (max) Measured depth to pipe invert from grade 4.5 ft (min) ❑ N/A — pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 2000+gallons Comments/Deficiencies: NEW PLASTIC TANK INSTALLED COSA Checklist yellow sheet Adequacy test date 3/2/20 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 40 in Water added 600+ gal New depth 62 in Elapsed time 1440 min Final fluid depth 40 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) UK If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 7 Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft 7 Yes if No ft Neighboring Tank > 100' Q✓ Yes if No ft Private Sewer/Septic Line > 25' 7 Yes if No ft Absorption Field on Lot > 100' F- Yes if No ft Holding Tank > 100' F/ Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' F✓ Yes if No ft ❑✓ Yes if No ft Yes if No ft Water Service Line > 10' 7 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' Q Yes if No ft 7 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 7 Yes if No ft Surface Water > 100' R Yes if No ft Property Line > 5' Fv-1 Yes if No ft Wells on Adjacent Lots: ✓❑ Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' -1 Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' 7 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' F, Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓❑ Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' ❑✓ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet �•. ........... v MICHAEL N. ANDERSON• :%0 CE 9460 F� •. b 1�,��oFES Z" M u Nrct PALITY oF Ar*tcHoRAGE Development Services Department On-Site Water & Wastewater Section Certificate Parcet r.o. 017-051-21 Phone: 907-343-7904 Fax: 907-343-7997 of On-Site Systems Approval Expiration Date:2cpoo6 ,1. GENERAL INFORMATION Comprete legaldescription L2N R3W SEC 27 LT 4 Sz Location (site addressy 5443 CANNON WOODS RD ANCH, AK Current property owner(s) JOHN MELHASE Day phone Mailing address Real estate agent Day phone TYPE OF DWELLING: tr Single Family (w/wo ADU) f Duptex I Multiple Dweilings (Singte Famity and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System tr Tr T TYPE OF WASTEWATER DISPOSAL: Private Septic tr Holding Tank I Community tr Public Sewer tl Waiver request for Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer Date: COSA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number Waiver #COSA# wlnn" 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this appliiation, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E.Phone 727-9864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERION, P'E.pu1" 3-19-20 DSD SJ-6. 4 IGNATURE System #1 Approved for System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms --s #f'/tifu,oW&p",w, WATER AND tR--wAs-rEll4iFR 6a 4 Ah/t g-S ^$_iA\-- ^v:/q \\$ 5sR{r*.?i$t,t*t' ,r, {u/X'* (.^.*& originar certiricate on", lf tf,lol o The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representationsgiveninparagraph5byanindependentprofessional civil engineerregisteredintheStateofAlaska. TheMunicipalityofAnchorageis not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other   GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Apr±l 14, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Cony. 1. Approval requested by: Home Federal Savings and Loan Mailing Address: Pouch 7-008, 99510 ~ Phone: 272-1451 Property0wner: elenWard Phone: Mailing Address: ~\ ~ ~ 1 Le al Descri tion T12N R3 Sec i n 7 S½ of Govt Lo Lo:ation P '~ ~i~c~ A. Type ~ ~ / ~ B. Depth C. Construction . [9 D. Bacterial A~al~~'~ - Sewage Disposal Sys~fl ~-~i~e system ~ , A. Installed q ~ ~ B. Insta~~ D. Seepage Pit: l. ~.2]Ma~ E. Disposal Field: To th of lines Di stances: A. Well to: Septic tank , Absorption area , Sewer Lines , Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two page~ - Re~-~t for Approval'~of Individual ~-~,r & Water Facilities Le§al De'scripti6n -,T12N R3W Section 2~7 S½ of Govt Lot 4 Comments Approved Disapproved Date Approval~Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) April 121 1976 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C' Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO 2. Property Owner: Helen Ward VA FHA CONV XXXX Mailing Address: Name of Buyer: John & Brenda Melhase Mailing Address: P.O. BOX 4-598, ANC 4. Name of Lending Institution: Home Federal Savings & Loan Mailing Address: Pouch 7008, ANC 99510 5. Name of Realtor or Agent: Town & Country Realty Mailing Address: Day Phone Day Phone Phone Phone 272-1451 Legal Description: Location: South 1/2 of Government Lot 4, in Sec 27, Township 12 North, Range 3 West, Seward Meridian Ynn travel w~t nn DeArmoun past Shelburn and 132 Ave., take a right on Cannon Road, bear right at fork in road, house is on 1Pft hanH ~id~ nf ~h~ ~nad. Type of Facility to be inspected: Sing~l family No. Bdrms. 4 Water Supply Type of Supply: Public Utility Individual XXX If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) ×XX If Individual, date of installation EQ-037 (1/74)