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HomeMy WebLinkAboutT12N R3W SEC 22 LT 29 S132'Onsite File T12N R3W Section 22 Lot 29 S132' #015-521-29 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211495 PID Number: 015-521-29 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Q Upgrade Name April Tynan Revocable Trust ABSORPTION FIELD ❑ Deep Trench 0 Wide Trench ❑ Bed ❑ Mound Site Address 11021 Totem Road, Anchorage, AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade (907) 717-5491 5 0.6 GPD/SF 9.0/10.9 Ft. LEGAL DESCRIPTION Depth to pipe invert from original 6.0/7.9 grade Ft Gravel depth beneath pipe 3.0/3.0 Ft. Subdivision Block Lot Lot 29 S132' Fill added above original grade 4.4/3.2 Ft. Gravel length 2 @ 75 Ft. Township Range Section 12N 3W 22 Gravel width 5.0 / 5.0 p 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 1,293 Ft2 2 >6 Ft. Well >100' > 100' N/A N/A >25' TANK ❑Q Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1500 Gal. Surface Water >100' >1 00' N/A N/A Material Plastic Number of compartments 2 Lot Line >5' >10' NIA NIA NA Foundation > 10' >10' N/A N/A LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 GLW Enterprises Drainfield D3034 CO/MTD3034 Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspdection 15` 1/11/22 1/21/22 Location and description 2�d 1/25/22 Garage slab 3rd 4m ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp - A4, Conditional Approval: Date C7 •'� _ t� .: .' ,............ Septic Septic System Approved 7/ Ben � � ��sr��• C2/3/22g? Date . , • �����`, F�PROFESSO'� Note: this approval does not include well permit requirements. kmtev uoiuu 1 o/ x x x x x x 2 - 73' LONG x 5' WIDE x 3'EFFECTIVE DEPTHABSORPTION TRENCHESCO - CLEANOUT2CO - DOUBLE CLEANOUTFCO - FOUNDATION CLEANOUTFS - FLOW SPLITTERFD - FLOW DIVERTER VALVEMH - MANHOLEMT - MONITORING TUBESV - SEPTIC VENTTH - TEST HOLELEGENDPERMIT # OSP211495PID # 015-521-29AB1"=50'5-BDRM HOME T12N R3W SEC22, S132' OF N264' OF LOT 29FEET050100Benjamin SchillerCE 12592REGISTEREDPROFESSIONALENGINEER2/3/2022TOTEM ROAD33' PATENT ROADWAY& UTILITY RESERVESSHEDRETAINING WALLSEXISTING TANK DISPOSEDOF OFF SITE5505455405355301,500-GALLON SEPTIC TANK w/ 20" MANWAY5' MIN SEPARATION FROM CRIB CONFIRMEDEXISTING WELLw/ 100' RADIUS≥6'FDFSMTCOCOCOCOMTMTTH-1EXISTING WELLw/ 100' RADIUSALTERNATE SITE CAT IIISYSTEM: 22' LONG x 5'WIDE x 3' EFF DEPTHABSORPTION TRENCHAPP RATE 4.0 GPD/SF2CO1EXISTING CRIB TO REMAIN IN SERVICEPT-2MT2CO1SVMHFCOPLAN AS-BUILTABFCO48.92CO172.0MH74.2SV77.52CO280.4FD86.5FS134.024.283.588.692.395.2101.7140.8MT1160.6CO1160.0MT2148.8CO2149.6MT3174.3CO3173.3MT4163.1153.6153.2175.1175.5168.0167.2187.4CO4162.3186.9 PROFILE AS-BUILT (NO SCALE) 91.55 85.8 92.2 98.7FCOMH SV1500 GAL SEPTIC TANK 99.5 FINISH GRADE 75' DRAINFIELD ROCKMT TH#1NO GROUNDWATER 1/19/22 86.1 89.1 COCO76.1 86.1 89.1 95.1 ORIGINAL GRADE MT2CO91.4 Benjamin Schiller CE 12592RE GISTEREDPROFE S S I O N A LENGINEER2/3/2022 PERMIT # OSP211495 PID # 015-521-29 T12N R3W SEC22, S132' OF N264' OF LOT 29 2CONORTH TRENCH 100.3 FINISH GRADE 75' DRAINFIELD ROCKMT TH#1NO GROUNDWATER 1/19/22 86.2 89.2 COCO78.1 86.2 89.2 97.1 ORIGINAL GRADE MTSOUTH TRENCH Lot 3 BOYD SUBDIVISION \ BLM Lot 30 I PLOT PLAN —__ AS BUILT —X— SCALE 1=30__ GRID SW 2637-- Project No. ____21=7901A2 --- 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates inc. (907) 522-6476 Phone 000OpQ O (907) 522-4625 Fax o Professional Land Surveyors kenolongsurvey.como (� 9 Q ionothan®lanasurvev.com O .• O ~ `. S I hereby certify that I have surveyed the following described property: 5132' of N264' of BLM Lot 29, SECTION 22, T12N, R3W, SEWARD MERIDIAN, ALASKA Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this theHI _ Day of _J"'cs,(i��nc�"1'��__, of Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49TH y* "NNU LANGo i s� •. 2��(2Z� �4 9Fo •.. 5-5202.'' gJOG 0 aR '�. ... •� Npo 40n '�fSS100 o� AECC963 MUNICIPALITY OF ANCHORAGE �l»ent On -Site Water & Wastewater Program SO PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 Qn http://www.muni.org/onsite v De partrnent On -Site Wastewater Disposal System Permit Permit Number: OSP211495 Effective Date: 12/21/2021 Work Type: Septic Upgrade Expiration Date: 12/21/2022 Tax Code Number: 01552129000 Site Legal Address: T12N R3W SEC 22 LT 29 S132' G:2637 Site Mailing Address: 11021 TOTEM RD, Anchorage Owner: TYNAN APRIL A REVOCABLE TRUST Lot Size in Sq Ft: 42525 Design Engineer: FORGE ENGINEERING Total Bedrooms: 5 This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 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 ��cial Provisions: Portions of the proposed absorption field are outside the 30 ft radius of a percolation test. Additional percolation test(s) are required at time of construction to confirm application rate of accepting soil. If results require a design change, construction shall stop pending approval of a change order. Please submit results with the inspection report (or change order, if required). (,per : '�1 i Se`s• `rH IF 1 Ic�aPene� a,�cor� . 12M C_ 1�1gI2Z Received By: Date: Issued By: Date: ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-521-29 Property owner(s) April Tynan Revocable Trust Day phone 717-5491 Mailing address 11021 Totem Road, Anchorage, AK 99516 Site address Same Legal description (Sub'd., Block & Lot) Lot 29 S132' Legal description (Township, Range & Section) T1 2N R3W Sec 22 Lot Size 42,525 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: (® all that apply) Absorption Field ❑X Septic Tank ❑X Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade ❑X Renewal ❑ TYPE OF DWELLING: Single Family (SF) ❑X (w/wo AD U) Duplex (D). ❑ Multiple Dwellings ❑ . (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 5 5 Waiver Fees: Date of Payment: % 2 I2 2 �.2 a2 % Date of Payment: Receipt Number: 7 2QL> Receipt Number: Permit No. O S PZ 11 `i 9 5 Waiver No. Permit App_::- ::'-.,:c December 15, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 12/15/21 Subject: T12N R3W SEC 22 L29 S132 – 11021 Totem Rd Septic system design Dear On-Site Services Engineer: The owner of the above lot has a 5-bedroom home on the property with a septic system that is nearing the end of its life, so we are submitting this permit application for the construction of a new septic system. The attached site plan identifies the location of the home as well as the existing well, primary septic location and alternate site. The ground surface on the lot slopes toward the west gradually at less than 5%. There are no slopes greater than 25% within 50 feet downslope of either the primary or alternate site. Contours are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the septic tank. The alternate site is located more than 6’ away. Please refer to the attached test hole log, plan and profile pages for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211495, Rebecca Carroll, 12/21/21 i ~ o w i- )�- z 0 p Lo, - a Q J OZ W W Um W W Z W F- / OE-� OH / Bm �cn00�U0 -w'o LL.—ww — w v LL LL_ Cl)F- O O 00 . _ — -- t w U N LL LL. cG W I- V JW w J !n } D W LU co a:_� � N LL Z Z LL I Z t o Q � m oz O U) o O U O W = D ZLL U 1¢-W �Z� a�Q w l Ir U Q'_'Z W� fJ � W O _ P� ��w— l8= > im`` / m �J w cri\ w Z C1! U) Q W I_=- 1 Q U f U Z' / Q O OZ ww > Q Z O°� 3WOH Wa48 9 / w cn O Q?U) LLJ �n w} o Z O / CC > W W Z `' F- co O Z Z w U s>- cc cc N 12 C) O � Z U U) tLU N L l W\ _ o F U) cr) ! i w U)'^ Q U N \ (n Iwzw0�a- 0 r N/ LL Z o CL _ -i U) N / wNu-Och W = o U w� aw /` Qc"wt=w F=ji pzLo w/{ X L Q wm Ly ZD Cep Za' / jl ! C(A�`�CQ Z Ur ILOL w 3 F- / �� �C— c o w d H ® p' . ih= / N U — --- UI / W O c� atS` ® F- Cif � Q w elfO z z W C) O F- ( O w W w \ — OIO= -1O Z Z H Q LL_ TOTED ROAD �J xi-wJ ®®\®®®� lij w XYZ , :�N•:oor •� Owl ®�.• co ow V a ® n m � • m •• ��®® T12N R3W SEC22, S132' OF N264' OF LOT 29 C�A l DESIGN FACTORS: 750 GPD PEAK FLOW PERK RATE: 16 MIN/IN APPLICATION RATE: 0.6 GPD/SF SYSTEM REQUIREMENTS: SHALLOW TRENCH SYSTEM 1,500 -GAL SEPTIC TANK w/ 20" MANWAY 750 GPD / 0.6 GPD/SF /5' WIDE * 0.58 RED FACTOR (3' EFF DEPTH) = 145.8 LF TRENCH REQUIRED (146 LF SPECIFIED) BOTTOM OF TRENCH: 12' BELOW GRADE FLOW LINE ELEVATION: 9' BELOW GRADE TOP OF TRENCH: 6" ABOVE GRADE TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY )TEXTILE FABRIC 'ERFORATED PVC kINFIELD ROCK � 3 x E N G I N E E R I N G or - 4.04& k4 TH *i . ��. .......... • ' • • . . • • . Benja 'n Schiller ' 't�'�G�dI••• CE12592 2 92 •. A.A , �il���PROFESSIONP��� DEPTH (feet) 1 - 2 3 4 5 6 7 8 9 1 11 12 13 14 15 16 17 18 19 �tj -aF SOILS LOG AND PERCOLATION TEST E N G I N E E R I N G LEGAL DESCRIPTION: T12N R3W SECL2 L29 S132 PERFORMEDFOR: APRIL TYNAN DATE: 111212022 PARCEL ID#: 015-521-29 TEST HOLE 1 (DEEPENED TO 19') um DATE READING START TIME NET TIME (MINUTES) DEPTH TO WATER PERC TEST LOCATION f .. ML (SANDY SILT W/ SOME 11:06 COBBLES) 0 2-- 2 i- 2 12:07 30 BOH DATE READING START TIME NET TIME (MINUTES) DEPTH TO WATER NET DROP (INCHES) INCHES) 12/8/21 1 11:06 30 0 2-- 2 i- 2 12:07 30 0 1 is 1 is 3 12:38 30 0 1 is 1 is 6" DIAMETER TEST HOLE PRESOAKED PRIOR TO TESTING PERCOLATION RATE: 16 (MINANCH) SITE PLAN NO WAS GROUND WATER ENCOUNTERED? N/A IF YES « WHAT DEPTH? DRY DEPTH TO WATER AFTER MONITORING 1/19/22 DATE OF MONITORING TECHNICIAN: J. MILLETTE COMMENTS: DEPTH (feet) 1 - 2 3 4 5 6 7 8 9 1 11 12 13 14 15 16 17 18 19 ull LEGAL DESCRIPTION: T12N R3W SECL2 L29 S132 PERFORMED FOR: APRIL TYNAN DATE: 111212022 PARCEL ID#: 015-521-29 PERC TEST 2 COMMENTS: ML (SANDY SILT W/ SOME COBBLES) PERC TEST LOCATION WAS GROUND WATER ENCOUNTERED? IF YES a, WHAT DEPTH? DEPTH TO WATER AFTER MONITORING DATE OF MONITORING DATE READING START TIME NET TIME (MINUTES) DEPTH TO WATER (INCHES) NET DROP (INCHES) 1112/22 1 3:25 30 2 10 16 4 16 1 16 2 3:56 30 216 416 116 3 4:27 30 216 416 116 6" DIAMETER TEST HOLE PRESOAKED PRIOR TO TESTING PERCOLATION RATE: 26.6 . (MINANCH) SITE PLAN 1 "t, II / E LJ TECHNICIAN: J. MILLETTE LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST TECHNICIAN: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (feet) PROJECT No.: TEST HOLE 1 SLOPE SLOPE SITE PLAN DATE READING GROSS TIME (minutes) NET TIME (minutes) DEPTH to WATER NET DROP PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH) TEST RUN BETWEEN: FT. and FT. COMMENTS: (inches)(inches) l.tidwell DATE OF MONITORING: WAS GROUND WATER ENCOUNTERED? DEPTH TO WATER AFTER MONITORING: IF YES @ WHAT DEPTH?N/A 16 6 5 6 12/08/21 1 2 3 ML (SANDY SILT W/ SOME COBBLES) Professional Engineers Stamp: NO NONE 12/15/21 T12N R3W SECL2 L29 S132 12/08/21 015-521-29 APRIL TYNAN 11:061 2 3 0-21416 12:07 12:38 1' OB 30 Benjamin Schiller CE 12592R EGISTEREDPROFE S S I O N ALENGINEER 21416 0-113 1630 113 16 0-1141630 11416 12/15/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211495, Rebecca Carroll, 12/21/21 BLM Lot 30 I ILIA' "-•- - / I WEST 329.50 Lot 3 SUBDIVISION BOYD \ PLOT PLAN ----AS BUILT X_ SCALE 1" =30_— GRID _ SW 2637 _ Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone (907) 522-4625 Fax 000JppOO o OFA Professional Land Surveyors kenOlongsurvey.com y jonathanOlangsurvey.com o o ��.'.......... �5�4 PODG I hereby certify that I have surveyed the following described property:49TH*"...* Sec.7.2 p ` S132' of N264' of BLM Lot 29, T12N, R3W, SEWARD MERIDIAN, ALASKA, Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that aO rve edno improvements on the properly h I (n9 adjacent thereto encroach on the su KENNETH G. LAN " premises and that there are no roadways, transmission lines or other visible indicated hereon. o� O �Q c, s it(Z2� easements on said property except as ..LS -5202..-' Dated this the _ Zh___ Day of ___l`{�� saw n_ e� __ 't. v� at Anchorage, Alaska gJp� 40 4 R OFfSSIONAL �o•� 40pp0000� It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 GR --!TER ANCHORAGE AREA B( "OUGH Department of Environmental Quality 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION SEPTIC TANK: DISTANCE .~'© FROM WELL /9/~O¢9- INS DE LENGTH MAILING ADDRESS /~0. ~/'2¢O-'~ OODleS/()"l:~./]. ¢~5-OY PHONE MANUFACTURER L~7~dOck '~f~"f' ~O. MATERIAL NUMBER OF ,COMPARTMENTS NSIDE WIDTH -- LIQUID DEPTH -- LIQUID CAPACITY /,~-~0 GALLONS, SEEPAGE Pit: NUMBER OF PiTS / DIAMETER _ -- OR WIDTH '2'~-, LENGTH ~'~, DEPTH LINING MATERIAL ~? /-~AI~5 C. RFB SIZE: DIAMETER '~ DEPTH (~ DISTANCE FROM: · / TOTAL EFFECTIVE BUILDING FOUNDATION "~ NEAREST LOT LINE _ ~:'~'¥ ABSORPTION AREA (WALL AREA) (~ /2 WELL D,('~. /dO ' __ SQ. FT. ADDITIONAL ABSORPTION WELL: '~opo;~b TYPE //o~ilJ/bct/:}z" BUILDING FOUNDATION __ CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE -- OTHER SOURCES DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH SEPTIC TANK DISTANCE FROM: SEEPAGE ,SYSTEM DISTANCES: INSTALLED BY, k~.'¢ PIPE MATERIAL: LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM F/OdS~ Form PW-O2a DATE _L/)~l APPROVED G,A,A.B. (':;RE~,'ER ANCHORAGE AREA BOA,,.;UGH SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLA.,ON .OCAT,ON P .4 FINANCED THROUGH TO BE INSTALLED BY NOTE:: THIS PERMIT I$ NOT VALID WITHOUT HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. FINAL IN~PECTION~ 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE MINIMUM DIBTANCE:B, REQUIREMENTB FOUNDATION TO SEPTIC TANK . FOUNDATION TO SEEPAGE PIT . DRAIN FIELD £ /4) ~2 SEPTIC TANK SEEPAGE PIT TO NEAREST LOT LINE. ALSO CONS]DER AREA WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD SEEPAGE PIT SE~,D TAH~ SEE"AGE .,T. .~NTO AN.~D '~UT~OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION E PEET INTO UNDISTURBED SOIL. ~ 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND ~EEPAGE PiT FI~/'ED WITH AIRTIGHT REM~AIBLE C~PS. ~--~ HEALTH AUTHORITY OR LICENSED DESJGNER TYPE I CERTIFY THAT I AM FAMfLIAR WITH THE REQUIREMENTS OF (~REATER ANCHORAGE AREA ~OROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DATE . APPLICANT'S SIGNATURE REAT~:-r~ AN~,.HORA_,- AREA BOROUGH' SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PF. RMIT INSTALLATIO~ LOCATION - I ~ ~ ~>~ - 5 ft. SEPTIC~ TANK ~5 WATER MAIN TO SEPTIC TANK ].0 ft, SEEPAGE PH / (' f- / T.H.-I 10-18-72 0.0' ORGANICS W/SILT 0.5' ORGANIC SILT SILT TRACE SAND {ML) 6.0~ SILT W/SOME SAND (SM) ¢ SAND , MED. TO COARSE GRAIN ( S P) Note: No Water Table Hole excavated witl~ tractor mounted backhoe. ~ G~ological Con3ultant8 DATE 10--25-72 JSCALE I" = 2' /*-L%wN BY G.A.W. Tom Tyrian Property LOG OF TEST BORI4NG Anchorage Alaska M UMCB ,, UTY OF HCHO RZA GE � - r¢ Development Services Department � Phone: 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-521-29 Legal description T12N R3W SEC 22 LOT 29 S132' Site address 11021 Totem Road Anchorage Current property owner(s) April Tynan Revocable Trust Expiration Date: 3 2 X The On-site system(s) is/are approved for 5 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By Original Certificate Date: 2/13/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovaIjune 2022 MUMUPAUTY OF AHC HORAGE i� Development Services Department_ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-521-29 Complete legal description T12N R3W Sec 22 Lot 29 S132' Location (site address) 11021 Totem Road, Anchorage, AK 99516 Current property owner(s) April Tynan Revocable Trust Day phone (907) 707-1164 2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑■ Plastic ❑ Concrete ❑ Fiberglass Age 1 yr - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench J Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment a/ COSA# 0 SC P3/OAS Date of Payment Waiver # COSA Application—June 2022 T12N R3W Sec 22 Lot 29 S132'015-521-29 2.0 UKN UKN N/A UKN 18+ 11/22/21 Forge Engineering 64 01/31/23 66" *N/A 1/25/22 N/A N/A N/A > *Property has been vacant for 6 mo since installation, so pumping would not be beneficial at this point (907) 522-7773 Benjamin Schiller, P.E. Certificate of On -Site Systems Approval Parcel I.D. 015-521-29 1. GENERAL INFORMATION Expiration Date: JCtAf- f -7, /,,) DQE Complete legal description T12 N R3W Sec 22 Lot 29 S 132' Location (site address) 11021 Totem Road, Anchorage, AK 99516 Current property owner(s) April Tynan Revocable Trust Day phone 717-5491 Mailing address Same Real estate agent 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic ❑ 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 $ Waiver Fee $ Date of Payment 3 17 6� U ,�2 Date of Payment Receipt Number 0 % 06'6 Receipt Number COSA # Q S C a P 1 0 (O 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 Forge Engineering W) Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 3/16/2022 /*:49TH •* 6. DSD SIGNATURE %r t� .: .. : • : : System #1 Approved for 5 bedrooms Benjam'GSchiller % System #2 Approved for bedrooms 0���s�-�. CE s 2022, DisapprovedPR`ESSI Conditional approval for bedrooms, with the following stipulations: OF moi/i `?��i `. �Tv'�Ti CVS WATER AND m WASPEV,!ATLK J ANA `^ "'J 1 A/T SERv\G����,, BY JVOriginal Certificate Date: 3 7 /0? 0,;2 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 yellow sheet COSA Checklist Legal Description: Parcel ID: 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) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test?Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade 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 gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: T12N R3W Sec 22 Lot 29 S132' 015-521-29 2.0 UNKNOWN N/A -■ -■ ■ ■ ■ ■ 18+ Forge Engineering 11/22/21 64 2/24/22 <1 Septic/Plastic New ■ Installed on 1/11/22 Shallow Trenches 1/25/22 ■ 13.4/14.1 10.4/11.1 ■ ■ N/A NEW ABSORPTION FIELD COSA Checklist yellow sheet 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’ Yes if No ft Neighboring Tank > 100’Yes if No ft Absorption Field on Lot > 100’Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’Yes if No ft Holding Tank > 100’Yes if No ft Animal Containment > 50’Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to:(Please enter distances if less than required) Building Foundations > 10’Yes if No ft Property Line > 5’Yes if No ft Absorption Field > 5’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’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’Yes if No ft Property Line > 10’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft F. ENGINEER’S COMMENTS G. ENGINEER’S CERTIFICATION I 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. 3/16/2022 ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔