HomeMy WebLinkAboutT12N R3W SEC 33 LT 5 REMt
. Y
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP231161 PID Number: 018-181-04
Dwelling: ❑E Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name .
C/O KIM GAINES J ,�jw C? -
`{
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench 0 Bed ❑ Mound
Site Address ' " '
3700 DEARMOUN ROAD *ANCHORAGE, AK
❑ Other
Phone
Number of Bedrooms
Soil Rating
JTotal depth from original grade
907-903-5834
6
0.5 GPD/SFI
6.78 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
SEE DWG. Ft.
Gravel depth beneath pipe
0.5 Ft.
Subdivision Block Lot
N/A
Fill added above original grade
SEE DWG. Ft.
Gravel length
60 Ft.
Township Range Section
T1 2N R3W SECTION 33 LOT 5
Gravel width
30 Ft.
Beds: Number of Lines
6
Distance between lines
5 Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
1800 FF
-
-Ft.
Well
100'+
100'+
-
-
25'+
TANK Al Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
GREER TANK 1500/1000 Gal.
Surface Water
100'+
100'+
-
-
Material
Number of compartments
Lot Line
10'+
10'+
-
-
NA
PLASTIC
1/2
Foundation
10'+
10'+
_
_
LIFT STATION
Manufacturer
Capacity
Remarks PER CONTRACTOR OLD TANK WAS HAULED OFFSITE
Gal.
Alarm location
Electrical installed by
Installer
PIPE MATERIAL House to tank EXISTIN drainfield Tank to
D3034
WILCO EXCAVATION
Drainrield D3034 CO/MTD3034
Inspector GEG AND M.O.A.
BENCH MARK (Assumed elevation) 100.09 ft
Inspect ectioes: 15' 9/13/23 2n° 9/14/23
Location and description
3rd 9/19/23 4'h 9/21/23
TOP OF M H 1
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stalnp
0060041
o� OFDEQ
Conditional Approval: Date
4 p�
_T I *
.......................:....0
-
D
Septic Syste
Approved Date
of A. Gar ess.
p .
Q�9 �� CE -795
4pe� ,•101!.9•
N -e this approval does not include well permit requirem nts.
Opo �ofess�odo
�OOOOo
ME C8
01-4 I p1t 2123
PERMIT NUMBER: PARCEL ID NUMBER:
OSP231161 RECORD DRAWING 018-181-04
PIPE LOCATIONS WERE TAKEN FROM
.DWG FILE PROVIDED BY SURVEYOR
SIGNED .PDF ATTACHED). SWING TIES
WERE DERIVED IN AUTOCAD
NEW DRAINFIELD
N
SCALE:
V=40'
� NEW 1500 GALLON SINGLE
COMPARTMENT GREER TANK
\-NEW 1000 GALLON TWO
COMPARTMENT GREER TANK
GEG
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ENGINEERINGSALES 4 CONSULTING � 9
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3701E TUDOR ROAD. SUITE 101 'ANCHORAGE, AK 99507 • PHONE (907) 337-6179' FAX (907) 336.3246' WEBSITE: wwn.gamessen9neenng com
PREPARED FOR. PHONE NUMBER: PAGE NUMBER:
C/O KIM GAINES 907-903-5834 2 OF 4
LEGAL DESCRIPTION: DRAWN BY:
T12N R3W SECTION 33 LOT 5 REM D.J.G.
TYPE OF WORK: DATE:
ASEPTIC SYSTEM SITE PLAN RECORD DRAWING 10/19/2023
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BEDROOM HOUSE /
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COMPARTMENT GREER TANK
\-NEW 1000 GALLON TWO
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3701E TUDOR ROAD. SUITE 101 'ANCHORAGE, AK 99507 • PHONE (907) 337-6179' FAX (907) 336.3246' WEBSITE: wwn.gamessen9neenng com
PREPARED FOR. PHONE NUMBER: PAGE NUMBER:
C/O KIM GAINES 907-903-5834 2 OF 4
LEGAL DESCRIPTION: DRAWN BY:
T12N R3W SECTION 33 LOT 5 REM D.J.G.
TYPE OF WORK: DATE:
ASEPTIC SYSTEM SITE PLAN RECORD DRAWING 10/19/2023
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PERMIT NUMBER:
PARCEL NUMBER:OSP231161 RECORD DRAWING 018-181-04
TH#1
FINAL GRADE = 97.8550.40
MT CO CO 1 CO CO CO CO MT
t.5 FEET [-*- 5 FEET
RELATIVE ELEVATION AT BOTTOM OF T.H. = 03.90 (T.H. DRY ON 9112!1023)
FABRIC
5 FEET 5 FEET 5 FEET 2.5 FEEL
30 FEET
• ORIGINAL GRADE AT
HIGHEST POINT = 97.96
/ERT OF DISTRIBUTION
LINE = 92.70
TOP OF SAND = 92.20
BOTTOM OF EXCAVATION
= 91.20
ENGINEERING SALES.: CONSULTING zrzm, 1_.F.__ an;. ,....
3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507' PHONE (907) 337-6179' FAX (907) 338,3246' WEBSITE: x .gaf-nginccring.mm
PREPARED FOR:
PHONE NUMBER:
PAGE NUMBER:
C/O KIM GAINES
907-903-5834
4 OF 4
LEGAL DESCRIPTION:
DRAWN BY:
T12N R3W SECTION 33 LOT 5
D.J.G.
TYPE OF WORK:
DATE:
I,_DRAINFIELD PROFILE
10/12/2023
PERMIT NUMBER: PARCEL ID NUMBER:
-OS0231161 RECORD DRAWING 018-181-04
I•ill
TOP OF TANK AT INTLET = 94.83
INVERT OF BUNG AT INLET = 94.06
TOP OF MANHOLE = 100.93
FINAL GRADE = 100.56-100.67
2" INSULATION PER CONTRACTOR
TOP OF TANK AT OUTLET = 94.81
INVERT OF BUNG AT OUTLET = 93.98
NEW 1500 GALLON H.D.P.E. SEPTIC TANK - SINGLE COMPARTMENT
ST2
TOP OF TANK AT INTLET = 94.57
INVERT OF BUNG AT INLET = 93.87
GRADE = 100.49.100,54
2" INSULATION PER CONTRACTOR
- TOP OF TANK AT OUTLET = 94.57
INVERT OF BUNG AT OUTLET = 93.68
NEW 1000 GALLON H.D.P.E. SEPTIC TANK -TWO COMPARTMENT
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ENGINEERING a SALES,, CONSULTING
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3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507' PHONE (907) 337.6179 -FAX (907)338-3245 'WEBSITE:—gam—engineering
com
PREPARED FOR:
PHONE NUMBER:
PAGE NUMBER:
C/O KIM GAINES
907-903-5834
3 OF 4
LEGAL DESCRIPTION:
DRAWN BY:
T12N R3W SECTION 33 LOT.5
D.J.G.
TYPE OF WORK:
DATE:
ASEPTIC TANK PROFILE
10/12/2023
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--------------- DEARMOUN ROAD
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N 89 59' 03" E 2.96 4,q
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VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
SHOW ANY
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND I5
v
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
�
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN
U m
HEREON (UNLESS INDICATED)
•WELL j
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
_____________
184.1 ________ __ -____
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
34.9
522
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
SINGLE FAMILY FRAME HOUSE GRAVEL
DRIVEWAY
i
A7 0 ------
_ 25.0
--------
BLOCK WALKWAY------
U
W
... . .. %
O
W
h
W
W
0
SHED
N 89 58' 00" E 296.57
33'
I
I
I
AS�BUILTSURYEY f" =401
i
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
33' I LOT 5 SECTION 33 T12N
, , R 3W, S.M.
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
SHOW ANY
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND I5
EXIST OTHER THAN NOTED.
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
DATED AT ANCHORAGE, ALASKA THIS 10 TH DAY OF
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN
OCTOBER 2023.
HEREON (UNLESS INDICATED)
_ ,
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
HOLT LAND SURVEYING
9309 GROVER DRIVE
11694, FB 168-16 ANCHORAGE,AK 99507
907.223.8615
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: OSP231161
Work Type: Septic Upgrade
Tax Code Number: 01818104000
Site Legal Address: T1 2N R3W SEC 33 LT 5 REM G:3035
Site Mailing Address: 3700 DE ARMOUN RD, Anchorage
Owner: CISMOSKI ROSEMARY ANN
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
Effective Date
Expiration Date:
Ment S
G �
U �
v
Department
Lot Size in Sq Ft:
Total Bedrooms:
6/28/2023
6/27/2024
89536
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
0
Received By: ( S �� �'� C Date:
Issued By: /V\i Date: Z- 2 3
MUN11CIPALITY OF ANCHORLAGE
Development Services Department _...
Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 018-181-04
Property owner(s) C/O KIM GAINES Day phone 907-903-5834
Mailing address 3700 DEARMOLIN ROAD *ANCHORAGE, AK
Site address 3700 DEARMOLIN ROAD *ANCHORAGE, AK
Legal description (Sub'd., Block & Lot) T1 2N R3W SECTION 33 LOT 5 REM
Legal description (Township, Range & Section)
Lot Size
Sq. Ft.
Number of Bedrooms 6
APPLICATION IS FOR: APPLICATION IS AN:
(® all that apply)
TYPE OF DWELLING:
Absorption Field ❑ Initial ❑
Single Family (SF) 0
Septic Tank 0 Upgrade x
P9 ❑
(w/wo AD U)
Holding Tank El Renewal
Renewal ❑
(D) ❑
Privy ElMultiple
Dwellings ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
BED WIDTH VARIANCE
30 -FEET
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:Waiver Fees:
Date of Payment: 6�5�23 Date of Payment:
Receipt Number: 0-50 -1 Cr Receipt Number:
Permit No. 05PZ3116 I Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231161, Curtis Townsend, 06/28/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231161, Curtis Townsend, 06/28/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231161, Curtis Townsend, 06/28/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231161, Curtis Townsend, 06/28/23
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231161, Curtis Townsend, 06/28/23
c TH YpC
49
N SHANE A. HOLT �d G
P LS -6914
�nn°fessional �o
DEARMOUN ROAD
N 89 59' 03" E 296.48
33'
i
AS-BUILTSURVEY 1" =40'
i
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
33' LOT S, SECTION 33, T12N, R 3W, S.M.
N 89 58" 00" E 296.57 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY EXIST OTHER THAN NOTED.
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS: AND IS DATED AT ANCHORAGE,ALASKA THIS _1ST DAY OF
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. OCTOBER 2014.
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN _
HEREON( UNLE55 INDICATED)
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMINE HOLT LAND SURVEYING
PROPERTY LINES OR POSITION A DDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCE55IVE SNOW AND/OR ICE. 600 HIGHVIEW DRIVE
ANCHORAGE AK 99515
12694, FB 168-16 345-5513
I
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31
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li
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34.9
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------------
SINGLE
FAMILY FRAME HOUSE caaveL
oaiuEwa v
�
25.0
ti
o
W
Id
o,
0
SHED
01
�i,
SHED
z
33'
i
AS-BUILTSURVEY 1" =40'
i
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
33' LOT S, SECTION 33, T12N, R 3W, S.M.
N 89 58" 00" E 296.57 ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY EXIST OTHER THAN NOTED.
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS: AND IS DATED AT ANCHORAGE,ALASKA THIS _1ST DAY OF
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. OCTOBER 2014.
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN _
HEREON( UNLE55 INDICATED)
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMINE HOLT LAND SURVEYING
PROPERTY LINES OR POSITION A DDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCE55IVE SNOW AND/OR ICE. 600 HIGHVIEW DRIVE
ANCHORAGE AK 99515
12694, FB 168-16 345-5513
OiGREA
j r..R ANCHORAGE AREA BOR .,.,dH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
MANUPACTURER:¢.'/~ '< 'd';(>' MATERIAL.') ~'/ c¢' r' / COMPARTMENTS NUMBER OF
INSIDE WIDTH LIQUID DEPTH ____LIQUID CAPACITY //C~'4~ ~) GALLONS.
SEEPAGE PIT:
/ ':? :,_-; / ;2
NUMBER OF PITS DIAMETER _OR WIDTH ~ , LENGTH , DEPTH
LINING MATERIA I('¢'~b'- ¢ RIB SIZE: DIAMETER.__DEPTH ~-) _ DISTANCE FROM: WELL
, [ q'OTAL EFFECTIVE ',,,'~ O 4- ) .SQ. FT.
BUILDING FOUNDATION_ , NEAREST LOT LIN . ABSORPTION AREA (WALL AREA)
ADDITIONAL ABSORPTION
WELL:
TYPE
BUILDING
FOUNDATION
CESSPOOL
APPROVED ....
CONSTRUCTION
NEAREST
LOT LINE
OTHER SOURCES
DISAPPROVED
NEAREST
SEWER LINE
REMARKS
DEPTH DISTANCE FROM:
SEPTIC SEEPAGE
TANK __ SYSTEM
DISTANCES:
INSTALLED BY: ___
PIPE MATERIAL:_
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
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C.B. Duke & Sons
3701 Eureka, Space 4lA
Anchorage, Alaska
Subject: Soils Investigation for Sanitary Sewer System, Section Lot 5,
Section 33, T.12N., R.3W., S.M., Ak
Dear Mr. Duke:
At your request of May 6, 1977, we conducted a subsurface soils investiga-
tion at the proposed location of the sanitary sewer system on the subject
lot. The investigation complied with those procedures required by the
Municipality of Anchorage, Department of Health and Environmental Protec-
tion.
This investigation, which was accomplished on May 6, 1977, consisted of
a test hole excavated to a depth of 13 feet below the existing ground
surface. The location of the test hole is shown in attached Drawing A-
01. Excavation took place with a backhoe. Samples were taken at the
depths shown on the soils log in attached Drawing A-01.
These will be held in storage at our lab for approximately six months.
In addition, all material excavated was continuously monitored by an
experienced engineering geologist.
The topography at the excavation site is generally horizontal At the
time of the investigation the site had been cleared. The top of the
test hole was located at original ground surface.
The soils encountered in the excavation are shown in the test hole log
in Drawing A01. Groundwater was not encountered in the test hole.
Bedrock was not encountered. Subsurface conditions may vary in other
parts of the lot.
We appreciate this opportunity to be of service to you. Please contact
us if you have any questions concerning this letter.
Very truly yours
R & M/PCONSULTANTS, INC.
Seni~'r Geologist
Lynn Schraeder
Associate
GAS:LS:gld
LOCATION SKETCE
Distances shown are approximate
and have not been measured by
surveying methods.
TEST HOLE LOG
Scale: ~1"=3'
--7'
Groundwater was not encountered.
This log depicts subsurface soils
observed within the test hole at the
location shown.
See Drawings B-01 (and B-02/,B-02, and
B-03) for explanation of symbols.
LOCATION SKETCE AND
TEST EOL,E LOG
GRIO
j [DWG.NO. A-O1
#1: Time
Data
Insp
DRPARTME
'~UNICIPALITM OF ANCHOR?='~
~= HEALTH AND ENVIRONMEt'~ 2ROTECTION
[, Street, Anchoraaa. Alaska 99501
264-4720
Date Received: _S~tember 30~_ 1~977
#2: Time I~3: Time
Dahe Date
Insp Insp
REQUES_ FOR APPROVAI, OF INDIVIDUAL SEWER AND WATER NACILI[IEo
Lending Ins'LituhJ.on Request: Amfac Mortgage Corporatzon
Mailing Address: 705 West 6th Avenue Phone: 277-8588
Property Owner: Everette S./Rosemary A. Rude
Mailing Address: Star Route A Box 270H 99507
Phone: 349-4892
3. Legal DescrLp'nion: Lot 5 Section 33 T12N R3W
4: Single Family Residence: (x) Number o[ B(~,drooms: Four
Mu].tiple Family Residence: ( ) Number of Bedrooms:
5. We].l System: Individual well (x) ConmtunJty/l~ublJc Syst:em ( )
PermJ_k = 77266 Depth of We].l .............. We].]. Log on File (
Constructioa
Bacteria]. Analysis
o
Sewage Disposal
Permit {~
Septic Tank Size
Absorption Area
Sys~zem: On-.site System (x) ]?ublic Uti].ity )
Installed 1977 Install.er
1_2_50 ga %_lo_n s_ .......... Manufacturer
Soils Rate Mater J_a 1
7. Dzstauces: We],] ua Septic Tank
to Sewer Line Neares~ Lot .l.J.na
to Nearest ]Lot Line
~o Absorp'tion Area
Absorption Area
Two
Department of Ilea.'kth and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 5 Section 33 T12N R3W
Affadavit Attached: ( ) I,etter Attached: ( )
Disappr~w.~Jl: - Date:
Department Worksheet:
1, Type of Inspection:
2. Property Owner:
Mailing Address:
MUNICIPALITY OF ANCHOi':IAG
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" SLreet, Anchorage, Alaska 99503 -- 27,1 4561! '
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
CMRO VA XX FHA CONY
Everette S. Rude and Rosemary A. Rude
SRA Box 270H, Anchorage Ak 99507 Day Phone 349-4892
3. Name o[ Buyer: Same
Mailing Address:
4. Name of Lending Institution: Amfac Mortgage Corporation
Day Phone
Mailing Address: 705 West 6th Ave., Suite 201
Anchorage, Alaska 99501
Name of Realtor or Agent: n/a
Phone 277-8588
Mailing Address: Phone
6. Legal Description: Lot 5, in Section 33~ Township 12 North~ Ranqe 3 West, Seward Meridian
Location: Thunder Rd. & DeArmoun Rd.
7, Type of Facility to be inspected:
8. WaLer Supply
Type of Supply:
Sewer & Water
Public Utility
No. Bch-ms. _~ y Z'~'~
Individual XX
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System: Public Utility
If Individual, date of installation
Individual (on-site)
XX
037 (1/74)
MUNICIPALITY F ANCHORAGE
0A ,
Development Services DepartmentPhone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 018-181-04-000
Expiration Date:
Legal description T12N R3W SEC 33 LT 5 REM
Site address 3700 DE ARMOUN RD Anchorage AK 99516
Current property owner(s) CISMOSKI ROSEMARY ANN
X The On-site system(s) is/are approved for 6 bedrooms
Conditional approval for
Comments or advisories:
12/7/2024
bedrooms, with the following stipulations:
Original Certificate Date: 12/22/2023
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 Approvaljune 2022
c-
AUTY OF ANCHORAGE
Development Services Department Phone: 907-3A3-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 018-181-04
Complete legal description T12N, R3W, SECTION 33, LOT 5 REM
Location (site address) 3700 DEARMOUN ROAD, ANCHORAGE, AK 99516
Current property owner(s) ROSEMARY ANN CISMOSKI C/O KIM GAINES Day phone 907-903-5834
2. ON-SITE SYSTEMS SIZED FOR 6 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 R Plastic ❑ Concrete ❑ Fiberglass
Age NEW - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS 0 Bed ❑ Deep Trench ❑ 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 $ � 80 Waiver Fee $ _
Date of Payment 2z/ s �23 Date of Payment
COSA # D SGZ 319 7!' Waiver #
COSA Application—June 2022
COSA Checklist
Legal Description: T12N, R3W, SECTION 33, LOT 5 REM
Parcel ID: 018-181-04
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled *1977 Total depth **1512+ ft
Cased to LINK ft
A-1 Sanitary seal is functioning correctly
❑■ Wires are properly protected
Well production at time of test 7.3+ gpm
Water storage tank volume N/A gallons
Well d' infected for coliform test? E] Yes 0 No
Coliform bacteria is Negative
Nitrate Y. 1,(,, mg/L ❑ Nitrate less than MRL (ND)
Casing height (above ground) 18+ in. Arsenic ug/L Arsenic less than MRL (ND)
Date of flow test for COSA 12/7/2023 Collected by GEG, LTD.
Static water level at beginning of test 60.5 ft Date 12/7/2023
Comments *ASSUMED BASED UPON MOA RECORDS. PER GEG WELL TEST.
B. TANK DATA
Measured operating fluid level in septic tank NEW
Date of pumping NEW
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 9/13-21/23
M ALL standpipes present per record drawing
Total measured depth from grade 6.2 ft (max)
Measured depth to pipe invert from grade 5.2 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
R Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced _gallons date
Any rejuvenation treatment (past 12 months) N/A
If yes, enter date
Comments/Deficiencies:
COSA Checklist June 2022
FT STATION
❑ Require 'ntenance compl
Age of lift station ars
Lift station al
Adequacy test date NEW
Results Q Pass
Fluid depth prior to test NEW in
Water added NEW gal
New fluid depth NEW in
Elapsed time NEW min
Final fluid depth NEW in
Absorption rate 900 gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 6 in
Effective depth used 0 in
Effective depth remaining 6 in
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100'
Fm� Yes
if No *
Community Sewer Manhole/Cleanout > 100'
EYes
if No
ft
Q Yes
if No ft
Neighboring Tank > 100' no Yes
if No
ft
Private Sewer/Septic Line > 25' QYes
if No ft
Absorption Field on Lot > 100' a] Yes
if No
ft
Holding Tank > 100' FE] Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' Q Yes
if No ft
❑■ Yes
if No
ft
ft
If tank or field is under driveway comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' no Yes
if No
ft
Q Yes
if No ft
❑ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
Fm� Yes
if No *
ft
Surface Water > 100'
FNFI Yes if No ft
Tank to Property Line > 5'
Q Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
Q Yes
if No
ft
Private Wells > 100'
FN_1 Yes if No ft
Water Main > 10'
Fml Yes
if No
ft
Community Wells > 200'
Q Yes if No ft
Water Service Line > 10'
0 Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
*%TO DECK STAIRS
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Gamess Engineering Group, LTD. (GEG)
Engineer's Printed Name Jeffrey A. Garness
Phone 907-337-6179
Date
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in
accordance with the guidelines and regulations established by the Municipality of Anchorage and industry
practices. The reported results describe the condition of the system/s on the date/s of the evaluation.
Separation distances were measured to readily identifiable features. Hidden defects or encroachments may
exist that were not identified during the evaluation. The operational life of all wells and septic systems depend
upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate
during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing
the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not
guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regardini
the future performance of the well or septic system. GEG makes no representation whether an alternative well
or septic system can be installed on the property in the event either of the current systems fail to perform
adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG
to perform the evaluation. Reliance upon the information provided in this report by any other person or party
(including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever.
J r A. G ess:
CE—79
c�
NsE�OQac._ ess�o� o`er
COSA Checklist June 2022 #AECC884
SGS Ref.#
1236643001
Client Name
Garness Engineering Group, Ltd (GEG)
Project Name/#
3700 DeArmoun Rd
Client Sample ID
3700 DeArmoun Rd
Matrix
Drinking Water
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
12/12/2023 11:50
12/07/2023 11:03
12/07/2023 13:59
Stephen C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 B (<10) 12/08/23 12/11/23 HGS
Waters Department
Total Nitrate/Nitrite-N 4.76 0.200 mg/L SM21 450ONO3-F C (<10) 12/11/23 EBH
Microbiology Laboratory
E. Coli Negative 1 100mL SM21 9223B A 12/07/23 M.A
Total Coliform Negative 1 100mL SM21 9223B A 12/07/23 M.A
2of5
DEARMOUN ROAD
1
i
Q
1
1
N 89 59' 03 " E 296.48
J
a
a
W
N 89 58' 00" E 296.57
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS, AND IS
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN
HEREON ( UNLESS INDICATED)
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
NO CORNERS SET THIS [TATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 5, SECTION 33, T12N, R 3W, S.M.
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE,ALASKA THIS _10 TH DAY OF
-OCTOBER , 2023.
12694, FB 168-16
HOLT LAND SURVEYING
9309 GRAVER DRIVE
ANCHORAGE,AK 99507
907.223.8615