HomeMy WebLinkAboutT12N R3W SEC 33 LT 225BTI2N R3W
eC.
22
8- 332
-25
I)rilling 11-lermit -Number-:
parcei Identification N`MkUbcr: 01
Legal Description
TIN R3W Sec �31,
-
tiltip Installation Date: S -
Fullip Intake Depth c,Aolv TOP of i't'ch Casi.
pursjp �JauufiictureCs Nasnf.,__4 c
I'limp Model;
Pump SiZE, __.hj)
Pidess feet
A
pitiess Adapter Manuf2dd-rer s P1
'
pitiess.,viapter Instal'or:
Date (if' Issue:
F[ 'Ot `tame ame, S. ArJdrc-,,,s,.
-0
ITa?ell DisinfL-vWCi UP011 COny D N
Mcfljod of Disinfectiew
C'Ornineras:
-�z_e VVEII POT,[)
Pump lnsuMcr Name:
Company* A
c, )7-243-�7 42
M-lailing Add rr.-ss:
City-,
State: Zip:
) ' , Pull I
Attention. T.hc -unin instailer shall provij, a r,,;-�jp j-,jsjajjatj.z)rj log to DSDwithin 3V 4Y.3 ofl Wl�
L)zvelo,pm.ent Services DePar'I'Ment
g U5.ding Safety J)ivision
on_.Sit,e Water, & Wastewater Program
-1700 Elmore -Stre,&
P.O. Cox 11.96650
AnChcroge, AK 99519-6650
PA'ayor
907)) 343-7904
Pump Installation Log
I)rilling 11-lermit -Number-:
parcei Identification N`MkUbcr: 01
Legal Description
TIN R3W Sec �31,
-
tiltip Installation Date: S -
Fullip Intake Depth c,Aolv TOP of i't'ch Casi.
pursjp �JauufiictureCs Nasnf.,__4 c
I'limp Model;
Pump SiZE, __.hj)
Pidess feet
A
pitiess Adapter Manuf2dd-rer s P1
'
pitiess.,viapter Instal'or:
Date (if' Issue:
F[ 'Ot `tame ame, S. ArJdrc-,,,s,.
-0
ITa?ell DisinfL-vWCi UP011 COny D N
Mcfljod of Disinfectiew
C'Ornineras:
-�z_e VVEII POT,[)
Pump lnsuMcr Name:
Company* A
c, )7-243-�7 42
M-lailing Add rr.-ss:
City-,
State: Zip:
) ' , Pull I
Attention. T.hc -unin instailer shall provij, a r,,;-�jp j-,jsjajjatj.z)rj log to DSDwithin 3V 4Y.3 ofl Wl�
Municipality of Anchorage
Development Services Department ·
Building Safety Division
On-Site Water and Wastewater Program, 4700 Eimore St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: o%p [11 3l~ PIDNumber:
Name:
~V~ /~"~"~ WastewaterSystem: ~New ~Upgrade
Address:
t~o L~c L.~ ABSORPTION FIELD
Phone: Number o~ Bedrooms:
~ ~ep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other:
Soil Rating: _~ Total Depth from original grade:
LEGAL
DESCRIPTION
Block: Lot: Subdivision: Depth to pipe bottom from origin~ Gravel depth beneath~:ipe: ~
Township: Range: Section: Fil~ added above original grade: Gravel Length:
Gravel width: Number of lines: Distance between ~nes:
Well: ~ New ~ Upg~ ~,0 Ft. / ~ Ft,
Classification (Private, A, B, C):Total Depth: ~-Cased to: Total absorption area: P~pe Material:
Driller: Date Drilled: Static Water Leveh ~nstaller:
~~ Pump Set at: Casing Height Above Ground:
It. TAN K
GPM
Ft.
SEPARATION DISTANCES ~Septic D Holding B S.T.E.P. D Other:
TF~ Septic Absorption Lift Holding ~ublic/Private ivlanufac~urer: Capacby:
Tank Field Station Tank SewerLine ~¢ eR ~ ~ ~ Gal.
~ ~ Material: Number Ct Compartments:
SudaceWater /OOt~ '¢Ot~ ~ ~ Foundation Lot Line "O ~1~ I~ ~' ~ ~~ $1zu; in. fvt~uu r LIFT STATION
Gal.
,__ '~ump on level at: Fump oft
Curtain Drain *'/X. ~/~, ~ Pu ~ ~::pections pedormed :;:/ m.
Remarks:
Loca[ion eno MescrlpiioB:
Inspections peflormed by: ~l~~./~ Dates: 1st t~~l
Development Se~ices Depa~ment Approval
Conditional Approval.... Date: ~
Permit No. 0SPl11514 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: 545-4744
On-Site Westewater Disposel System end/or Well Inspection Report
Legal Description: T12N, R3W, SEC 3.3, LOT 225B
PID No.' 018-532-25
AND SEEPAGE CRIB
PUMPED AND CRUSHED
EXISTING WELL
EXISTING CONCRETE TANK /// TEST H~)L~
II
'~01
/
/
CO
IN CRAWL SPACE
_~BENCH,
RADIUS
I.JJ
ASBL
SCALE: 1
/
I
/
/
/
/
/
/
/
/
/
SET BACK
~MICHAEL N. ANDERSON.."
SEPTIC SECTION
N.T.S. 78.8
Michael N. Anderson, P.E.
Civil/Structural Engineering & Construction
4661 Natrona Avenue
Anchorage, Alaska 99516
Phone 345-3377
Fax 345-1391
Nov. 2, 2011
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: T12N, R3W, Section 33, Lot 225B
To Whom it may concern:
This is a request fbr a 4 foot lot line waiver on the above referenced lot. During the excavating of the leach
field it was discovered that better soils were located on the east side of the lot therefore the system was
shifted toward the east property line. None of the neighboring properties will be impacted by this upgrade
since the lots are large.
Please call me if you have any questions.
Sinc~
Micha'el'N. Anderson, P.E.
Municipality of Anchorage
P.O. Box 196650 · 4700 Elmore Road
Anchorage, Aiaska 99519-6650 · (907) 343-7904 · Fax (907) 343-7997
http:llwww.muni.or.qlOnsite
Development Services Department
On-Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
WaiverS: OSPl11322 COSA#: OSCl11434
PID#: 018-332-25
Legal Description: T12N R3W Sec 33 Lt 225B
Engineer: Mike N. Anderson
Permit~: OSP111314
Applicant: Joyce Hammons
Your request for a waiver of the required 10 feet horizontal separation fi.om the absorption field
to the property line has been approved. The approved separation distance is 6.0 feet.
This waiver approval applies to the existing absorption field only. Any future upgrade to the on-
site wastewater disposal system will require all separation distances be met or another approval
fi.om this department.
Waiver is Granted: X Waiver is not Granted:
Date:
Name of Revievygr
Rec#: 147491 Amount: $200.00 Date Paid: 11/3/11
**** VARIANCE/WAIVER REVIEW ****
Permit Number:
Tax Code Number:
Work Type:
On-Site Wastewater Disposal System Permit
OSPl11314
01833225000
Septic
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Upgrade
Permit Effective Dates: October 28, 2011 to October 27, 2012
Design Engineer: ANDERSON CONSTRUCTION & ENG'G
Subdivision: T12N R3W SEC 33
Site Legal Address: T12N R3W SEC 33 LT 225B G:3135
Owner/Address: HAMMONS JOYCE C
C/O CHERYL HOWDYSHELL 2467 MCKENZIE DR ANCHORAGE AK 995170000
Site Mailing Address: 15400 LOC LOMAN LN, Anchorage
Lot Size in Sq Ft: 40326
Total Bedrooms: 3
This permit is for the construction of:
Y Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N Water Storage
All construction must 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 must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Date:
Date:
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services Division
On-Site Water & Wastewater Program
Phone: 907-343-7904
Fax: 907-343~.7997
, Mayor Dan Sullivan ~J~.~
ON-SITE SEWER~ELL PERMIT APPLICATION
Parcel I.D. O[~ ~ ~' ~ ~ ~~
Property owner(s) ~ c~_ H~.~ Day phone
Site address
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section) 'T'/~Z/~t', ~/_.. ~t~ ~ ~.. '~"~
Lot Size ~ ~ "~ 2. 6 Sq. Ft. Number of Bedrooms ~'~
THIS APPLICATION IS FOR:
([F~ all that apply)
Absorption Field
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
THIS APPLICATION IS AN:
Initial []
Upgrade ~
Renewal []
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Sign perty owner or authorized agent)
Permit/Rush Fees: _~'~OtOn Waiver Fees:
Date of Payment: ~¢~//"? ~//C~ ?~ ~ Date of Payment:
Receipt Number: ~ L~"'~ %~ ~ Receipt Number:
Permit No. ~) ¢ '~ ~ ~ ~ Waiver No.
G:,Building,On Site, Forms,Client Forms, Permit App_O10411.doc ~ (5~ ~ - ~¢¢¢
(Rev. 1/11)
Michael N. Anderson, P.E.
Civil/Structural Engineering & Construction
4661 Natrona Avenue
Anchorage, Alaska 99516
Phone 345-3377
Fax 345-1391
Oct 25,2011
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: T12N, R3W, Section 33, Lot 225B
To Whom it may concern:
This is a request for a replacement septic system permit on the above referenced lot. The existing system
has failed and needs replacing. The test hole consisted of silty gravel (GM) for the entire 18 foot depth with
no water observed during the excavation or after the 7 day monitoring period. The perc rate was measured
a 12 minutes per inch. The attached site plan has the new layout for the installation of a deep trench 40 feet
long with 7 feet of effective located to the southeast of the existing system. The existing system is not
documented and will be abandoned per the MOA codes.
None of the neighboring properties will be impacted by this upgrade since the lots are large. The slope at
the site is 8 to 12 percent and has no cut banks or slopes over 25 percent existing with 200 feet of the
proposed installation.
Please call me if you have any questions.
Sincerely~,
Michael N. Andet!son, P.E.
DESIGN CRITERIA: ~MOUND OVER
3 BDRM X 150 -- 450 GPD -1' ORe
SOILS -- 450/0.8 -- 562 GPD --- Ri \ /~RLTER FABRIC
562 GA/14. = 40'
-2.0'- ~--------4 ¢ PIPE
) ~SEWER ROCK
(1) TRENCH CM
9.0' DEEP
7.0' EFFECTIVE ~ -9.o'
2.0' WIDE _2.0'
40' LONG -18'__ ' '
SEFIlC FIELD SECTION
~ ~,~-~D 0 R A AVE-/' ~,/~"
EXISTING SEPTIC SYSTEM ....% ,I I z
W/ UNDOCUMENTED ~ '~ { ~: /
,'
\
\~ t/ '
..... REPLACEMENT --~ Is~¢
EXISTING WELL OVER ~
150' SOUTH OF THE //
SITE /// "~
Septic Design Prepared for
LENN AWE
~ .'" /k ".. ~v~
~Y 49TH ~ %>'
T12N, R3W, SECTION 33, LOT 225B
Anchorage, Alaska
Michael N. Anderson P.E. DATE: 10/28/2011 .~.~.'..
~ [O,". No. C,E 94J¢'9 /._~--~-~_~"
ANCHORAGE, ALASKA 99516
345-3377 / FAX: 345-1391 SCALE: 1"=100'
/ -DORA AVE- /" 1
?Q~ER1Y LINE--~ ×//
/ /
SHORT S/D / m
LOT 225B /
/ /
SHORT S/D / /
LOT 225A I /
/ / T12N, R3W, SECTION
..... ~ ~ / / t LOT 224
SE~mC ~M ~ ~ ~ ~
~ m ~ m
~EeN ~O~l~E~ ~/o P~R~ ~ ~ / / ;~ / ~;.'/i
AND ~i~ ~ ~NDON~ PER ~~~'~ ~
-,, ........ ' ~ ~ ~ -PROPOSED 1,000
GALLON SE~IC TANK
~ SLOPE ~PW~:: .... ~
/
/
/// ~PROPE~ LINE
' II
Septic Design Prepared for
LENN AWE
~,;...' _ "..Z~
T12N, R3W, SECTION 33, LOT 225B
Anchorage, A, aska ...............
,
Michael N. Anderson P.E. DATE: 10/28/2011
ANCHORACE, ALASKA 99516
345-3377 / FAX: 345-1391 SCALE: 1":40'
Performed For:
Legal Description:
2-
3-
4-
5-
7-
8-
9-
19-
20-
COMMENTS
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
,,~o_; MICHAEL N. ANDEP,$GN
www.ci.anchora.qe.ak.us ~', ,-:
(907) 343-7904 ~ ~. , ~ -
Soils Log - Percolation Test ' ~- ~ ~" ""
~ ~ ~ Date Pedormed:
~, ~~ Township, Range, Section: '
~., V' ~ Z '~' ,~-~/1~, Slope Site Plan
' p(
WAS GROUND WATER
ENCOUNTERED? ~)¢%/~)
S
IF YES, AT WHAT DEPTH? L
O
Depth to Water After ,I P
Monitoring? ~1~ ~,' E
Date:/O/~
! ·
Reading Date Gross Time Net Time Depth to Water Net Drop
,,) &" Z,
PERCOLATION RATE ( ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN '~ .FT AND ~ FT
PERFORMED BY: ,,~ ~ I CERTIFY THAT THIS TEST,~/AS/,
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
~ '""'"~ ~ DORA AVENUE
L
z~. a.~-,~,c~ S89o 55, 40.E 114.84,
W~LL
~ I ~ EXISTING ~ll ~ I
o 0
LOT 225 A
z .o~
O
~8~° 5~' ~4"W ~34.77'
UNDER N0 ~RCUMSTANCES SHOU~ AN AS-BUILT BE USED FOR CONS~UC~ON OR FOR [ST~U~ING B~NOARY OR FENCE UN/S.
~E SUR~YOR TAKES RESPON~BIU~ FOR ~E INI~AL mANSAC~0N ~LY AND ASSUMES ~NAN~AL UABlU~ ONLY FOR ~E COST ~ ~E SURLY.
LIS~D DISTANCES PREVAIL O~R SCAUNG. REPR~UC~ON MAY CAUSE ERRORS IN SCA~.
LOT ~ SURVEY T~E SYMBOLS
F~NDA~ ~8UILT ' SET ERBAR ~ ~ DRAINAGE ~ ASPHALT
~ PLOT ~ . . . ~-BUILT... LOT ~Y . . . T~HY O FOUND ERBAR ~ ~ ~ ~D ~NCE ~ C0NCRE~
~ A~ILT... NO ~ ~T ~ ~RCA~ A~T... ~O ~ ~ ~ ASSUMED E~V. X X ~ METAL ~CE ~ WO~ DECK
PLOT PLANS ~ LOT SUR~YS NOTE:
IT IS ~E RESPONSIBILI~ OF ~E BUILDER OR O~ER, PRIOR TO ONLY ~OSE IMPRO~MENTS AeO~ GROUND AND ~SIBLE ~EL BE
CONS~UC~ON, TO ~RIFY PROPOSED BUILDING GRADE RELA~VE SHO~. FENCES. ~LLS, SEP~C CLEANOU~, S~DEWALKS, DRY.WAYS.
TO RNISHED GRADE AND U~LI~ CONNEC~ONS AND TO D[~RMINE ETC., ARE SHO~ IN ~EIR APPROXlMA~ LOCA~ON, ONLY. SNOW
~E EXIS~N~ OF ANY EASEMENTS, CO~NANTS OR RES~ICTIONS MAY PRE~NT SOME IMPRO~MENTS FROM BEING SEEN AND LOCA~D.
~ICH DO NOT APPEAR ON ~E RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
SURLY CER~RCA~ON _~~. Prepored by
47"% Robert E. Johns, Jr. & Assoc.
F~NDA~I ,., ~. I--.~, ~~=~.~__~~,~.,__~.~.~.~L__..AS_~iLT. ~ ' ~ ' ~ ~' ~"-'-"m'- ~~~~e~' ............. . "~~ ..... s~,.: Professional1" = ANCHORAGE.60,'7~ BrinkLandA~sKARec.Dri~.Lot Surveyors9950,s.F. Rec. Pier RIB No.
~ ~ m ~ ~ ~ ~ / Dote Sur~d: 0ra~ b~ Check~
~-- ~- ~., .... 10/10/11 REJ L
3 3s -355
~ ~ ~ ~ Date Oro~m Grid: W.O.
~----~-- ' T12N R3W SEC 33 LOT 225B
GAAB-HD-I
GP'=\~ER ANCHORAGE AREA BOROU"'~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
MAILING '~) ~ ~' ~. c~ ~/'b PHO~
ADDRESS ~ '~
LEGAL DESCRIPTION ~'~~~
DISTANCE FROM WELL ~/"
LIQUID CAPACITY / C~OO
MATERIAL_ ~'-/4.~ U~__~
GALLONS. INSIDE LENGTH
NUMBER OF
.COMPARTMENTS.
(~/~'~'~'~ /~XO LIQUID
INSIDE WIDTH DEPTH____
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
OUTSIDE DIAMETER
OR WIDIH / '~''
DISTANCE FROM WELL_ /C/
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA,
, LENGTH /~ r · DEPTH
BUILDING FOUNDATION
SQ. ET.
TILE DRAIN FIELD:
DISTANCE FROM WELl
NUMBED GE L NES
ABSORPTION ABE^
. FOUNDATION ~ ~ , NEAREST LOT LINE
.DISTANCE BETWEEN LINES ~' TRENCH WIDTH
SQ. FT. LENGTH OF EACH LINE '~ ''~ ~
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
.OF LINES
WELL: TYPE u/~/~;/[P-~ DEPTH f/'z('~I!
NEAREST SEPTIC
LOT LINE . SEWER LINE TANK
DISTANCE FROM WATER
BUILDING FOUNDATIO~ SAMPLE . NEAREST
SEEPAGE OTHER
SYSTEM · CESSPOOL . BOURCES
DISTANCES:
D AGRAM OF SYSTEM
APPROVED H~AL]H AUiHORi]Y
GREATEi'ANCHORAGE AREAi'gROUGH
HEALTH DEPARTMENT
327EagleSt. Anchorage, Ala&a 99501 279-2511
Case No. ~,~ ~
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT,>. /'" ~
MAILING ADDRESS ,~0,.~ ~", ,~,~.~C: PHOI~NO. ,
NAME OF A P P L I C A N ,T~/*~/V"~/*~'/* ~/2
LEGAL DESCRIPTION L~'~.~,~..~. ~c~ '~ ~ ~/.? ~, ~ 5 ~/
APPLICATION TO INSTALL: SEPTIC TANK ~ , SEEPAGE PIT ~ , DRAIN FIELD ,OTHER
TO SERVE THE FOLLOWING FACILITY ~ ~ ~C kC'e
FINAN_~ED THROUGH
~'TEST RESULTS
TO BE INSTALLED BY//~'/C~'/~"5~dE~/~ ~..',;~L/,c~'7~,~t¢/~ :i
ANTICIPATED OATE OF COMPLETION .~7/-/',>/~? ,,,'2/¢ ~¢'~'.
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS ~' ~-~ ~ , PERMIT TO INSTALL A ~T&
AS DESCRIBED BELOW, SlZEOF UNIT TO BE SERVED ~ ~d~. ~LE' b~
'G ~ ' DIAGRAM OF ~STEM
HEALTH AUTHORITY
OR
LICE~SE~ DESIGNER
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Oj~dinance No. 28-68 and that the
above described system is in accordance with said code. ,,~/g;, 7~ 1//]~//~-~ -~'~/g/~
DATE ~/)D APPLICABTS SIGNATUR~r~:~, ~ ~.... _ ' ~ n/~'/~z~.r -
~,GREATER ANCHORAGE ARt;A BOROUGM/"k,
HEAL'i'll DEPA}',:T;4ENT ~
327 EAGLE STREET '
ANCHORAGE, ALASKA' 99501
CASg #
This Form Reports a: So~ls Log ~ ..... · -~~6n Te~ .......
Depth
F~et
}fas Ground }later Encountered?
!f Yes, At.Wheat Depth~
Location Sketch
Reading Date Gross Time Net Time pepth To H2 Net Drop
Pro?ased Instal~Seepage Pit Drain Field
~,epth Of inlet, , ~,2'z Depth To Bottom Of Pit Or T~ench /,,~'/ '
COMMENT · ~ ~ ·
.. ~ . ~ ~ f~_~ .. ~e to ~e varmt~on ~n so~l ~es,
. ~,~ ~,m~ th~ mvar~ square fe~t of peKpo~at~pn area reqmred per,~droom will
,,, ~.,..~ ~. ~ ~ ~,~ ~f ~
Data Certified By:~G. ~rce]] Date:,. . 7:7-70
,,/ATER ANCHORAGE AREA BORO
DEPARTM, ENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99502
Performed For F~- ~L~ ~k/~(/o~e ~
Legal Descrietion: Lot22~ Block
This Form Reports Soils Log ~
Depth
Feet Soil Characteristics
1
2
6
7
8
9
10
CASE #
Date Performed
Subdivision $¢¢,%~)-1-~N~
Percolation Test
Was Ground Water Encountered? ~
If Yes, At what Depth?
Reading
Date Gross
Time
Net Time
Depth to H20
Net Drool
Percolation Rate Minute
Proposed Installation: Seenaqe Pit
Depth of Inlet Depth To
CnMMENTS: ~--o~ ~ ~A:k-ed ~v~3~Lo-~
Test Performed By~O,.~ ~Lo-~AF
Drain Field
Bottom Of Pit Or Trench
"o
o
%J
.!
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
Parcel I.D.
GENERAL INFORMATION
Complete legal description
Location (site address)
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
COSA# O <OC._.
Expiration Date: Z ~'~//~
_Loc
Current Property owner(s).
Mailing address
Lending agency
Day phone
Day phone
Mailing address
Real Estate Agent
Day phone
~ Mailing Address
Un/ess otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: ~
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding Tank []
[] Community On-site []
[] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent, professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wasteWater disposal and/or water
supply system. DSM also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private,or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. 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 out ned n the Certificate of On-S te Systems Approva Guidelines ~ this application
shows that the on-site wate! ~t~pply and/or wastewater disposal system is (are) safe, functional at~'d a equate
for the number of bedi~O°~s: and type of structure indicated herein. I ~urther verify that based (m :the~info~ma!ion
obtained from tl:te,~Mun~pahty of Anchorage files and from my ~nvesbgabon and inspection, the on-sEewv~ter
supply and/or w~St~water disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm
Address '4
Engineer's Printed Name
bedrooms.
5. 'DSD SIGNATURE
,//"'"" Approved for
Disapproved...
Conditional approval for
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(Rev, 11/05)
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original certificate Date: /[/~/////
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650 '
www. muni.org/onsite
(907) 343~7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: ~- [9..../~{I J~. ~/ ¢~'~r7 ~e-<~ L~ ~Z~' (~ Parcel ID:
A. WELL DATA
Well type {3¢,v~ [-<~,
Date completed tI~ ~ 0v,9~
Total depth ~1~ f.
IfA, B, or C provide PWSID #
Sanitary seal (Y/N). ~'.
Cased to ~ ft.
FROM WELL LOG
Date of test
Static water level J ft.
Well production J g.p.m.
WATER SAMPLE RESULTS:
Coliform .~ .colonies/100 mL Nitrate _~,mg/l_
Arsenic: ~f, ~ ~ug/L date of sample:
B. SEPTIC/HOLDING TANK DATA Tank Type/Material ,~, -~-~ e {~
Tanksize ]~tH3 gal. Number of Compartments
Foundation cleanout (Y/N) x/, ~' Depression over tank (Y/N) .
Date of pumping ~ Pumper.
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
.%.o ~
Collected by:
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
C. ABSORPTION FIELD DATA
Date installed /~/"t.9'/~// Soil rating (g.p.d./ft2 orft2/bdrm) ~ ~
Length ~/"/~fl. Width ~, O ft.
, ~'!~
Total depth ?,~,ft. Eft. absorption area Y/aClC, ft .'Monitoring tube ~ Depression over field
Di~te.,of adequacy test ' ~ Results (Pas.s/F{til) / For ~ bedrooms
Fluid depth in absorption::f~d, before test ~-'"'in. Water added ,,,,~al. ,. ~., ;.., New depth
Elapsed Time:~ min. Final fluid depth ~" in. Absorption rate >= ~ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) .j If yes, give date
System type
Gravel below pipe
D. LIFT STATION
Date installed Size in gallons ~/Access (Y/N)
"Pump on" level at in~t in. High water alarm level at
Datum~Cydes tested · Meets alarm & circuit requirements?
:E. SEPARATION DISTANCES
in.
Absorption field on lot.,
Public sewer main
Sewer/septic service line
Animal containment areas
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot /too / ~
t.~"/-
On adjacent lots ! oO ry..
On adjacent lots ! o O ( ./-
Public sewer manhole/cleanout
Holding tank ~/X,
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/~G TANK ON LOT TO:
Building foundation 'Z 5-/..~ Property line ~-0 (/- Absorption field
Water main /'J/~--~ Water service line ~'0 ~ ,L Surface water
Wells on adjacent lots [~,~) r4--
i~ot 4-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ~ t ~ ~'~'~¢ ~,=~ ~.~'*,{e
Building foundation ~0 t4-- ' Water main
Water Service line ..~D ~ ~- Surface water /{2 e ¢ ~ Driveway, parking/vehicle storage
Curtain drain h//~. Wells on adjacent lots /~,~ ~ +
~F; COMMENTS
COSA Fee $_
Date of Payment
Receipt Number
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.
Engineer's Printed Name f/fl I'~u"{tfi~-~ i[r'l'"*t~
~ P.1 O- 17..U.~S~' Waiver Fee $
(Rev. 4/10)
FROM :Alpine Drillin9
FAX NO. :90? 345 0202
Nov. O1 2011 09:28PM P1
Aarow Pump & Well Service, ILC
P.o. Box 110496
Anchorage, AK 99511
Office: {907) 346-9355 · Fax (907) 333-8976
Eagle River: (907) 622-9335
No. 9179
.CUSTOMER
F ,"~,~4,,~./ ,4'~/~,-~.o,, -1 F ./,.5.c,,,o~'
JOB SITE
L ~?-, D v',,Y-'3.3-;.7 d L J
I
I
LABOR ' HOURS RATE AMOUNT TOTAL MATERIAL
WOrK O~DE~ED.Y].DATE C6~'~ TOTAL
. LABO~
PAY TH!S AMOUNT
ThankYou
SIGNATURE
LOT
216
DORA AVENUE
0
S89'55'40"E 114.84'
5' REMAINDER J
BLM R.O.W. RESERVE
SHED
WELL
2.5'x24.7'
¢
SEPTIC
VENTS
· (typ)
LOT 225B
10' UTILITY ESMT
N 89'56'14"W 134.77'
LOT 247
30'
Z
O
ANCHORAGE RECORDING DISTRICT, ALASKA
AS-BUILT OF:
T15N R3W SEC33 S.M.
LOT 225B PLAT 75-57
SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance should
any information on this drawing be used for construction offences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
WORK
ORDER
NUMBER:
NOV 04, 2011 [ 1"=40' kndeng~k.net
11 --043
JLS [ 3135 110148
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MONUMENT