HomeMy WebLinkAboutT14N R2W SEC 12 LT 10T14N R2W
Sec. 12
Lot 10
#050-273-12
Municipality of Anchorage
Community Development Department Page
On-Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number OSP121284 PID Number: 050-273-12 ❑ New
Fi
1 of 3
Upgrade
Name:
Edward Charles Willis Living Trust
ABSORPTION FIELD
Address
250 East Fireweed Palmer, AK 99645
❑ Deep Trench i
❑ Other
Shallow Trench •
Bed ❑Mound
Phone
Number of Bedrooms
2
Soil Rating
1.2 GPD/SF
Total depth from original grade
4.5 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Gravel depth beneath pipe
Subdivision Block Lot
1.5 Ft.
3Ft.
10
Fill added above original grade
Gravel length
Township Range Section
1 Ft.
50 Ft.
14N 2W 12
Gravel width
Beds: Number of Lines
Distance between lines
SEPARATION DISTANCES
5Ft.
FL
To
From
Septic
Tank
Absorption
Field
Lift Station
Holding
Tank
Sewer
Line
Total absorption area
310 Ft2
Number of trenches
One
Dist. between trenches
Ft.
Well
>100'
>100'
N/A
N/A
>25'
TANK ❑+ Septic ❑ S.T.E.P. ❑ Holding ■ Other
Manufacturer
Capacity
Surface Water
>100'
>100'
N/A
N/A
Greer Tank
1,000GaI.
NA
Material
Steel
Number of compartments
Two
Lot Line
>5'
>10'
N/A
N/A
Foundation
>5'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
None
Noted
Remarks
Pump on level at
Pump off level at
High water alarm at
in.
in.
in.
Pump make and model
Electrical Inspections performed by
Installer
PIPE MATERIAL House to tank D3034 Tank to 03034
drainfield
Stuart Gilbert
Drainfield HDPE CO/MT D3034
Inspector MEA
BENCH MARK (Assumed elevation) 100.0ft
Inspection 1,1Location
dates: 9/5/12 2- 9/6/12
and description
a'° 9/7/12 41'
Garage Slab
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Conditional Approval: Date
♦ r
Lc(06 s r • I �e'Sr,
n'
.f *• 49m tk et*it
®MUJMA�LL,,A,teom*ijtr tog
� JJ
Approved A • Date I -02 ("LZ
G
s1et Q-�`i ..
f� are
site sO
/ t ,
Inspection Repo rt_1-1-i2%loc
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number OSP121284 PID No. 050-273-12
Page 3 of 3
U
80.8
Original 8
Finished
Grade
Finished Grade
,000 Gallon
Septic Tank
80.1
81.1
Original Ground
2" Insulation and
Geotextile Fabric
78.6
Drainfield Rock
78.6
75.6 -'
30' (Total Effective Trench Length)
PROFILE AS -BUILT
No Scale
68.1
No Groundwater
9-15-2012
•
•
• ( 4�9•_th�jy/j_PM '., 0
•
1::$•RICHHEL E. ANDERSON ; f
.. f'. Npoo, CE. -._4_33l81 i
Permit
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT Page 2 of 3
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
Number: OSP121284 PID No. 050-273-12
LOT 10, SECTION 12, T14N, R2W
N89'59'58"W 329.78
ECM
M
K ¢ /Jai
3/0
Paved Driveway/
/\
Garg§e
/
/
NOTE
/
Existing Concrete Septic Tank
/
(.i
Decommissioned in Accordance
with Municipal Code.
W
0
300.54
(BlIV
'� Two Bedroom
Home
/
C
/
S1856/aNa%
G
52
wreak
/
Lang 5' Wide
(13.3' Effective Depth
Absorption Trench
M1
C8
0
TH1
A
B
S1
13.4
25.3'
S2
18.8'
31.4
C4
35.1'
46.8'
LEGEND
c5
66.4'
15.9'
MI
35.1'
45.3'
M1 — Monitor Tube
FCO — Foundation Clean Out
TH — Test Hole
C7 — Clean Out
329.67
FOOTHILL
DRIVE
OFr
g)e.
49th i \
•/
PLAN AS BUILT
•
,VkL MICHAEL f"
'
SCALE 1' = 50'
♦.4
's NO, CE-4381
��
��
♦�' 5E:ta„r••
On -Site Wastewater Disposal System Permit
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
Permit Number: OSP121284
Tax Code Number: 05027312000
Work Type: Septic Upgrade
Permit Effective Dates: September 07, 2012 to
Design Engineer: ANDERSON ENGINEERING
Subdivision: T14N R2W SEC 12
Site Legal Address: T14N R2W SEC 12 LT 10 G:0052
September 07, 2013
Owner/Address:
WILLIS EDWARD CHARLES LIVING
TRUST WILLIS EDWARD CHARLES/TRUSTEE 250 E FIREWEED PALMER AK 996450000
Site Mailing Address: 10235 WILLIS DR, Eagle River
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank
Lot Size in Sq Ft: 108900
Total Bedrooms: 2
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.
Received By:
Issued By:
Date: 7`?
Date: !/�Z
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
Mayor Dan Sullivan
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Phone: 907-343-7904
Fax: 907-343-7997
Parcel I.D. 050-273-12
Property owner(s): Charles Willis Living Trust Day phone:
Mailing address : 250 E. Fireweed Palmer, AK 99645
Site address: 10235 Willis Drive Eagle River, AK 99577
Legal description (Sub'd., Block & Lot):
Legal description (Township, Range & Section): T14N, R2W, Section 12, Lot 10
Lot Size: 108,900 Sq. Ft. Number of Bedrooms: Two
THIS APPLICATION IS FOR:
(I/ all that apply)
Absorption Field X
Septic Tank X
Holding Tank 0
Privy ❑
Private Well ❑
Water Storage ❑
THIS APPLICATION IS AN:
Initial ❑
Upgrade X
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.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 530 f 3 \ e Waiver Fees:
Date of Payment: 9.0/2 c\-kr1. Date of Payment:
Receipt Number: 0) 000 G J Receipt Number:
Permit No. OSP )2i22)t-( Waiver No.
C:\UsersWndEng\Desktop\Mike\T14N Willis\Permit Application.docC:\Users\AndEnglDesktop\Mike1T14N Willis\Permit
Application.doc
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
September 5, 2012
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 Elmore Road
Anchorage, AK 99519-6650
Subject: T14N, R2W, Section 12, Lot 10
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The existing septic system on the subject lot is undersized and must be upgraded
before a COSA can be issued on the property. We are therefore requesting a permit
be issued for the upgrade of the septic system to accommodate the two-bedroom home
on the lot. The attached Site Plan and backup documentation identify the location and
configuration of the existing and proposed septic system. The existing concrete septic
tank will be decommissioned in accordance with Municipal Code and a new 1,000
Gallon Septic Tank placed at the location shown. The existing absorption trench will be
abandoned in accordance with Municipal Code. Also identified on the plans are the
locations of the existing well on this and adjacent lots and adjacent septic systems. No
conflicts exist between the proposed septic system and the wells on this or adjacent
lots. Protective radii are shown to the adjacent wells. Drainage arrows are shown
indicating the current drainage patterns. The drainage patterns will be maintained after
construction.
The test hole placed on the lot indicated Well Graded Gravel with Sand and Silt
(GW/GM) the entire depth. The percolation rate was determined to be less than 5
minutes per inch. We have designed the new trench with an application rate of 1.2
gallons per date per square foot. Groundwater was found at 10' below the surface and
has remained at that elevation during the monitoring period. We are proposing to place
a 30' long trench by 5' wide with a 3' effective depth. The total depth of the system will
be 4' with the distribution line at 1' below the existing surface.
The ground surface on the lot falls at 25% to 35% from the grade break shown on the
Site Plan, but is virtually flat in the area of the proposed absorption trench. The trench
T14N, R2W, Section 12, Lot 10
September 5, 2012
Page Two
will be placed parallel to the contours of the ground as much as possible and in
conformance with design criteria. A minimum of 100' will be maintained between all
components of the septic system and the existing well and from any surface water in
the area.
If the system is constructed in accordance with our design the following statements
apply:
1. The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system -if-constructed-as-designedwill have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
.*,K\ A%.
. `' '4 t
- 0° 49th ; 0
• F• MICHAEL E. ANDERSON ��
•1,-(,,,, No. CE -4301 .. $9
LOT 10 SECTION 12, TION, R2W
1 N89'59'58"W 329.78
tt
Dag
® >
�I¢
3a
IW
J
E
0 /
Paved Driveway/
/ /
Curage
J /
/ r /
W
iiiiipin
Abondonced
Pit
�
Two Be9roam Home
../
f
W
o
300.54
\
2C8
i
/t; ,v, DecROM
Decommission
1,000 Gollon Septic
Septic Tank
G�eThreak
C0
Tank in
Municipal Code.
kR CDI
Existing
Accordance
8 ow.---
Concrete �od°/re
with
/
1
x30' Lon x 5' Wide
co 1
Absorption encch
1
1 TH1 1
Existing 40' Long NOTE
Absorption
inhAccordance No Separation Distance Conflicts Between
With Municipal Code. the Well and Septic System on This Lot
and Those on Adjacent Lots.
1 LR 1
1 1
329.67
FOOTHILL DRIVE
•
OF q
NE:
OT •• , • •••��.
No Areas of Excessive Slope Except as (��.�
Shown or Surface Water are Within 100' of ® `I�
Any Port of the New Septic System. 1L �' 49th��..�.��
•
j rt..t�aJL/
SITE PLAN �` .. MICHAEL E. ANDERSON t
••
f':. No. CE-4381
,
SCALE 1° = 50' # ...... .,' =ice
LOT 10, SECTION 12, T14N, R2W
DESIGN FACTORS:
Two Bedroom Home
Perc. Rate: 1-5 Min./Inch
Application Rate: 1.2 GPD/SF
SYSTEM REQUIREMENTS:
5' Wide Trench System
1,000 Gallon Septic Tank
3' Drainfield Rock
2 Bedrooms * 150 GPD/Bedroom = 300 SF Absorption Area
300 SF/1.2 GPD/SF/5 SF (Width) *.58 (Red. Factor)= 29 LF Trench Length
THEREFORE: Construct a 30' Long x 5' Wide x 3' Effective Depth Absorption Trench.
Flow Line Elevation in Trench to be 1' Below Original Ground Surface. Total Depth to be
4' Below Existing Ground. Provide 3' Cover Over Absorption Trench or 2' of Cover and
2" of Insulation. Place 4' of Cover Over Tank.
3'
5'
Geotextile Fabric
4" Perforated
PVC (Holes Down)
Drainfield Rock
TYPICAL 5' WIDE TRENCH SECTION
(NO SCALE) „.�P'(E•, ........ ,i
ZS A ` • �i.
NOTE: Grade Area Over Trench to Drain Away. :la i
Minimum 6' Separation From Bedrock. 7 : 49th P'M = i
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Private Wells in the Area. ol m ; M CHREL E. ANDERSON I L15.
Minimum 100' Separation From Surface Water or Streams. ��. Na CE -4381 :
••'4'tittstcr.*.
gym
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
DEPTH
(feet)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: LOT 10, SECTION 12, T14N, R2W
PERFORMED FOR: WILLIS
DATE: 8/30/2012
PROJECT No •
PARCEL ID#: TECHNICIAN- MEA
4
4
TEST HOLE 1
OB/OG
GRAVEL WITH
SAND AND SILT
GW/GM
BOH @ 12'
SLOPE
WAS GROUND WATER ENCOUNTERED/ YES
IF YES @ WHAT DEPTH/ 10'
DEPTH OF WATER AFTER MONITORING. 10'
DATE OF MONITORING' 9/6/2012
Professional Engineers Stamp:
SITE PLAN
SEE SITE PLAN
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH TO
WATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
9/4
1
2:30/2:40
10
2.25"/9.75"
7.50"
2
2:41/2:51
10
2.50"/9.50"
7.00"
3
2:52/3:02
10
2.25"/9.25"
7.00"
4
3:03/3:13
10
2.50"/9.50"
7.00"
5
3:14/3:24
10
2.25"/9.25"
7.00"
6
3:25/3:35
10
2 25"/9 25"
7.00"
PERCOLATION RATE: 1.4 (MIN/INCH) PERC. HOLE DIA. 10" (INCHES)
TEST RUN BETWEEN: 3.0 FT. and 4.0 FT.
COMMENTS' TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 9/5/2012
- AAB-HD-I
G 'LATER ANCHORAGE AREA BORQM2H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME
LOCATION .Cc?t�i/�i�-
MAILING
ADDRESS
3XLfna2
7
SEPTIC TANK: Cr)6C.S7.4/,$)
PHONF 2/3
6‘'i/617 sLt . /-��
LEGAL DESCRIPTION 'T /4N•
NUMBER OF
DISTANCE FROM WELL MATERIAL COMPARTMENTS
LIQUID CAPACITY
GALLONS. INSIDE. LENGTH INSIDE WIDTH
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH - LENGTH DEPTH
LINING MATERIAL DISTANCE FROM WELL BUILDING FOUNDATION
NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) 5Q FT
TILE DRAIN FIELD:
/ j C7 / QCT / * OF LINEL S � /
DISTANCE FROM WELL Ye, e..) 1#
-- NEAREST LOT LINE'
NUMBER OF LINES /�1 - DISTANCE BETWEEN LINES TRENCH WIDTH "�` IN TOTAL EFFECTIVE
ABSORPTION AREA
�J 6) SQ FT LENGTH OF EACH LINE /&e") /
/ d
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE_ IN ABOVE TILE
WELL:
J DISTANCE FROM j WATER /i/R
TYPEAcx-l�✓v , DEPTH d; , BUILDING FOUNDATION SAMPLE NEAREST
NEAREST SEPTIC/ SEEPAGE`.
LOT LINE 30 i , SEWER LINE TANK SYSTEM CESSPOOL
OTHER
SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
•
f mise
0
DATE 4e 7,fr
APPROVED._
HEALAUTHORITY
GAAB-IID-2
r 6.'
GREATEN.
327 Eagle St.
611
ANCHORAGE AREA \,DROUGH
HEALTH DEPARTMENT
Anchorage, Alaska 99501
to or bem
L
iet
Case No dab
279-2511 Pltp (,
6a.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT
RESIDENCE ADDRESS
Fa (raPAAr
7)
LEGAL DESCRIPTION
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY D
FINANCED THROUGH 4
n )
PERCOLATION TEST RESULTS IVT
S'o PHONE NO ���
MAILING ADDRESS
LOCATION OF INSTALLATION
tai- l0 fez l i T/4 iv42 frV 5fl
, SEEPAGE PIT , DRAIN FIELD , OTHER
dAn)
TO BE INSTALLED BY
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
7 4I r` AJn7c
THIS IS TO SERVE AS 414A, Wile"( , PERMIT TO INSTALLS" a -i, 0/"-m" �'�P ri / -
43 /
l!},_GQA.G U -S VJ
�
? A
?COD TYPE N:(1 t
AS DESCRIBED BEL_O_W,SIZE nF UNIT TO BE SERVED
SEPTIC TANK SIZ
$XSP577VC� i.1
/000 TYPE (twat SEEPAGE AREA
DISTANCES: <5ct65&&/27
,Rep/ac e.
60; d3
Ms.P 1_ 3
•' �ety
Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
OF SYSTEM
S‘,
724,4
D
acs
DATE
APPLICANTS SIGNATU
/)
(Y�
DEPARTMENT OF HEALTH AND ENVIRONMENTAL ...".~".^~N
925 L STREET, ANCHORAGE, AK 99501
264-4720
C3 —E3 Tr IEE PLAAI DYE: 5 5 PF" EE -11.
PERMIT NO: 860095
DATE ISSi)ED: 04/21/86
APPLICANT:
ADDRESS:
CONTACT PHONE:
LEGAL DESCRIP:
LOT SIZE:
EDWARD C. WILLIS
P,O"DOX 770402
EAGLE RIVER, AK 99577
b94-2213
SUBDIVISION: NA LOT: 10
SECTION: 12 TOWNSHIP: 14N RANGE: 2W
2,5A (SO -FT. OR ACRES/
BLOCK: NA
I certifythat: for on-site sewers and wells as set
1^ I am familiar with the requirements th St State of Alaska
-
2
Municipality Anchorage (MOA) e a"
:forth bytheand -
of- with all MOA codes and regulations,
7 I will install the system in accordance w a
' li with the design criteria of this permit"
and in compliance * State of Alaska require
3. I will adhere to all MOA anda erequirements for the set hack t m or public
distances from any existing well, wastewater disposal sys e
this sewerage system on is or any adjacent or nearby lot"=
SIGNED
APPLICANT:
ISSUE? D'
'��'Z-, ifel6
DATE:
(l1rrtifirb OriLtin ern
by
DOC. Co. tlba
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 6882759
OWNER OF LAND E✓Ja4aO w,L ,4' DEPTH OF WELL. fejt r7 n
ADDRESS tai /JDE\- 77o 4( .
LEGAL DESCRIPTION, I r) iiS /r� ! /tri ° LA)
STATIC LEVEL OF WATER Ft / /
DRAW DOWN FT.
DATE • Started./ r. C - Ended 6-7S2
GALS. PER HR 1) tic)
NUMBER ! - KIND OF CASING t`1J3"' o 49
KIND OF FORMATION:
From 0Ft. to 1) FL (n45,70G SSI t C �(J P From - Ft to Ft
From C]t Ft to / OE Ft A14,414 1O (Llq )✓ -4 �R✓9"e" From Ft to Ft.
. From 10 Ft. to 3/ Ft __ 'mil From Ft. to Ft.
From ^SI Ft to SO Ft. e7•el? ? 6t4✓EG From Ft. to Ft
From- CI) Ft to 'Lc FI .\ , o4Y C47' f: 4 a+'✓'•=L Fr n FMWMICIPALIWFr ANCHORAGE
DEPT. OF HEALTH &
From 1.:i Ft to FJ Ft 314/04 z 6 QFe»r c. 5/ From FtEMYIRONMENTPL PROTECTION
From Ft. to Ft. - GL 4I - t E / From Ft: tomrvtr�,,. ..F
r
From ;1 �.. Ft. to / 1? Ft. (%t o� %n ir / G 6,(24,-)6. L.. From Ft. to Ft.
From) I (S.. Ft. to /41 Ft. Sit 0 rg 11 U'- 7C^ 4 From Ft. to 8__�-_CE WE D
From Ft to FL eAl A r t 9 4 From Ft to
From FI. to Ft. From Ft to Ft
From Ft to - Ft. From Ft to Ft
From - - Ft. to Ft. - From Ft to Ft
From Ft. to Ft. From Ft to Ft
From Ft. to Ft. From Ft. to Ft.
From Ft. to Ft. From Ft. to Ft.
From Ft. to Ft From Ft to Ft
MISCL. INFORMATION:
DRILLER'S NAME
M &IL
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel LD. 050-273-12
1. GENERAL INFORMATION
Complete legal description T14N, R2W, SECTION 12, Lot 10
COSA# ID1'\2-°1
Expiration Date: Ia.- 1- i.2
Location (site address) 10235 Willis Drive Eagle River, AK 99567
Current Property owner(s) Edward Charles Willis Living Trust
Mailing address 250 East Fireweed Palmer, AK 99645
Day phone
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Two (2)
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 0 Individual On-site ❑✓
Individual Water Storage ❑ Individual Holding Tank ❑
Community Class Well ❑ Community On-site ❑
Public Water System ❑ 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. DSD 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 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.
Name of Firm Anderson Engineering Phone 522-7773
Address
P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
5. DSD SIGNATURE rr'�
Approved for .2. bedrooms.
Disapproved.
Date 9/17/2012
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Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
)Rev 11/05)
0
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Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
9-01-1a,
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 10, T14N, R2W, Section 12 Parcel ID: 050-273-12
A. WELL DATA
Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y
Date completed 5/86 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 141 ft.Cased to 141 ft. Casing height (above ground) >18 in.
FROM WELL LOG AT INSPECTION
Date of test 5/86 8/30/2012
Static water level 118 ft. 119.6 ft.
Well production 20
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL
Arsenic: N/D ug/I
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
g.p.m.
Nitrate 1.62 mg/L
Date of sample: 8/30/2012
4.9 g.p.m.
Collected by: B. Hippe
Date installed 9/13/2012
Tank size 1,000 gal. Number of Compartments Two Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping New Construction Pumper
C. ABSORPTION FIELD DATA
Date installed 9/11-12/2012
Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF
System type Shallow Trench
Length 30 ft. Width 5 ft. Gravel below pipe 3 ft
Total depth 5-6 ft. Eff. absorption area 310 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New Const.
Results (Pass/Fail)
For bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pump off" level at in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100'
Absorption field on lot >100'
Public sewer main N/A
Sewer /septic service line >25'
Animal containment areas >50'
Manhole/Access (YIN)
High water alarm level at
Meets alarm & circuit requirements?
in.
On adjacent lots >100'
On adjacent lots >100'
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excrete storage areas >100'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5'
Water main N/A
Absorption field >5.
Water service line >10' Surface water >100'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10'
Water Service line >10'
Curtain drain None Noted
Building foundation >10' Water main >10'
Surface water >100'
Wells on adjacent lots >100'
Driveway, parking/vehicle storage
>25'
F. COMMENTS:
G. ENGINEER'S CERTIFICATION
I certify that 1 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 Michael E. Anderson, P.E.
Date 9/17/2012
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COSA Fee $ ;so--^�
Date of Payment — t I j 1 I) v� (_ _
Receipt Number
(Rev. 11/05)
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Waiver Fee $
Date of Payment
Receipt Number
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FOOTHILL AVENUE
PLOT PLAN AS BUILT _ X SCALE 1" = 40' GRID
NW52 Project No. 12-183A1
Lang & Associates, inc.
Registered Land Surveyors
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
(907) 522-6476 Phone
(907) 522-4625 Fax
ken®langsurvey.com / jonathan®langsurvey.com
I hereby certify that I have surveyed the following described property:
LOT 10, SECTION 12, T14N, R2W 5.M•
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 the 1.44-11 Day of f rt,Tl,,,t>T , 2a 12 , at 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.
§,n •, KENN-5:202
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