HomeMy WebLinkAboutKNIK HEIGHTS BLK B LT 7KnI*k Heights
Block B
Lot 7
#017-033-07
Municipality of Anchorage Page 1 of 2
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW990322 PID Number: 017-033-07
Name:LARRY HAGEN
Wastewater System: ❑ New ■ Upgrade
Address:
12700 RIDGEWOOD ANCH. AK, 99516
ABSORPTION FIELD
Phone:
(907) 345-4992
No. of Bedrooms:
3
■Deep Trench ❑Shallow Trench El Bed ❑Mound ❑Other
LEGAL DESCRIPTION
Soil Rating:
1.0
Total Depth from original grade:
8.5 — 9.0
GPD/sy, FL
Ft.
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
7 B KNIK HEIGHTS
2.5 — 3.0 Ft.
6.06 Ft,
Township:
Range:
Section:
Fill added above original grade:
Grovel length:
—
—
—
0.0 It
45.0 Ft.
WELL: ❑ New ❑ Upgrade
Grovel width:
2.5
Number of lines:
1
Dietonce between lines:
—
Ft.
Ft.
Classification (Private, A.B.C):
Total De
Cased To:
Total absorption area:
Pipe material:
Ft.
Ft.
545 so. FL
ASTM D-3034/F-810
Driller.
Dote Drilled:
Static Water Level:
Installer.
A+ HOME SERVICES
Date installed:
9/17/99 — 9/20/99
Ft
'field:
Pump Set At:
Cosing Height Above Ground:
TANK
GPM
FLFt
SEPARATION DISTANCES
. Septic ❑ Holding ❑ S.T.E.P.
To
Septic
Tank
Absorption
Feld
Lift
Station
Holding
Tank
Public/Private
sewer Lines
Manufacturer.
ANCHORAGE TANK
Capacity in gallons:
1000
From
Well
100'+
100'+
—
—
25'+
Material:
STEEL
Number of compartments:
2
Surface
100'+
100'+
—
—
—
LIFT STATION
Water
Lot
5'+
10'+
—
—
—
Size In gallons:
Manufacturer.
Line
'Pump on' level at:
Pump o at
High water alarm at
Foundation
5'+
10'+
—
—
—
Curtain
I
I
Pump Make el:
Electrical Inspections performed by:
Drain
NONE KNOWN
BENCH MARK
Remarks:
Location and Description:
BOTTOM OF SIDING, POINT "C".
Assumed Elevation:
109.84
F{.
ENGINEER'S SEAL
OQp�00 ,
.• ��Q4
Inspections performed by: AWWC, INC. Dates: 1st 9/17/99
C • .••
V�
2nd 9/20/99
3rd 9/21 /99
..... ....... ..........
' J ff A. ess,: �
0�4�@
Department of Health and Human Services approval
•. ; } -7953 •,'�`�G,00�
�441%°
Reviewed and approved by: 4J Date: d-
p�ofessiora1v-`��
00400���
72-013 Rev. 9 91 MOA 25
PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER:
SW990322 017-033-07
i
� A B
C I
�I
EXISTING ORAlNFlEID
TO BE USED AS A
ST1
ST2
78.3 —
84.6 —
31.5
34.9 I
` RESERVE srr8.
B N
35.8
I
dR; 7HRf f
i C
)BL1
B6.0 —
I
�OUsf
)BL2
86.9 —
36.8
'
FD
COt
88.0 —
121.7 —
37.9 I
65.1
I
DBL1 FCO B
I DB
MT1
120.8 f —
64.1 _
c' \ ,
79.4
65.5
I
ADO'
~
MT2
— 80.6
66.7 I
I
CO T1
J /\
1
�IVS
NEW 1000 GALLON\
SEPTIC TANK / �
FLOW DIVERTER �,FD)
\���'��
NEW DRAINFIELD
1---— MT2-02--I
lo' UTIUTY EASEMENT 1
993 (AVG.)
FINAL lkA • 10237-102,87
511 5f2
fop OF TANK -
Af IM.Ef - 98.69
r- fop of f"
AT anf - 98,91
N1000 GAI.I.ON
INVE�(OF fiDJG SW �NvW OF BttJG
Af INLET - 96,21 5�p11C f�K Af oUtl.Ef - 97,99
88,9 (AVG.)
ALASKA WATER AND WASTEWATER CONSULTANTS, INC.
6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504
PHONE: (907) 337-6179/FAX: (907) 338-3246
LEGAL DESCRIPTION:
KNIK HEIGHTS SUBDIVISION; LOT 7, BLOCK B
TYPE OF WORK:
AS —BUILT OF SEPTIC SYSTEM UPGRADE
PREPARED FOR: PHONE NUMBER:
LARRY HAGEN (907) 345-4992
DATE: DRAWN BY: SCALE: PAGE:
9/28/99 K.D.W. 1 = 40' 2 OF 2
Permit Number: SW990322
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
r.
ON -SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Sep 08, 1999
Expiration Date: Sep 07, 2000
Parcel ID: 017-033-07
Legal Description: KNIK HEIGHTS BLK B LT 7
Design Engineer: 0041 AK Water & Wastewater Consulta Site Address: 012700 RIDGEWOOD RD
Owner Name: Larry Hagen Lot Size: 43500 SQ. FT.
Owner Address: 12700 Ridgewood Road Total Bedrooms: 3 Permit Bedrooms: 3
Anchorage , AK 99507-0000
This permit is for the construction of:
✓❑ Disposal Field ✓❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: c/ !j_gc�
Date: n
Alaska Water & Wastewater Consultants, Inc.
6901 DeBarr Road, Suite 2B — Anchorage, AK — 99504
(907) 337-6179 — Fax (907) 338-3246
Consulting Engineers
August 27, 1999
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Sewer Upgrade for Knik Heights Subdivision; Lot 7, Block B.
To whom it may concern:
The existing 3 bedroom house is served by a private well and septic system. The existing septic
system is in a state of failure, and inust be upgraded prior to obtaining a Health Authority
Approval. Comments regarding the proposed upgrade are summarized as follows:
1. SOILS: Attached is a soil log which shows the soil profile, and the percolation test results.
Below the organics was a SM layer to a depth of 4 to 7 feet and then transitions to a GW/GM
with SW/SM material to a depth of 15.5 feet (bottom of test hole). Two percolation tests were
performed. The upper test was performed between 5.0 and 5.5 feet and found the rate to be 7.6
minute/inch. The lower test was performed between 7.5 and 8.0 feet and found the rate to be less
than 1 minute/inch. Ground water was not encountered during the excavation of the test hole .
2. TRENCH DESIGN:
I
C.
Percolation Rate: <1 and 7.6 minute/inch
Allowable Application Rate: 1.0 gallon/day/ft2 (Average)
Number of Bedrooms: 3
d. Design Flow: 450 gallons per day
e. Minimum Absorption Area: 450 ft
2
f. Maximum depth: 9 ft.
g. Effective Depth: 6 ft.
h. Width: 3 ft.
i. Length: 40 ft.
k. Effective absorption area = 480 ft2
4. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic
upgrade.
5. TOPOGRAPHY: As can be seen on the attached is a topography site plan. The slope runs
from northeast/east to southwest/west at approximately 20 to 25 percent slope. The trench is to
be installed parallel to the slope contours.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have/,,,any questions, please contact me at 337-6179, or at 244-9612. Thank you
for your assistance. //
.E., M.S.
Presi
I I �
i
I
( /
I f
LOT 12, BLOCK B
I
I
I I
I LOT 5, BLOCK B
KNIK HEIGHTS ,
KNIK HEIGHTS
I
I
I
I
I
I______--/—_ I
----------I
I--------�
I
I
I I C
( I
LOT 11, BLOCK B
\ LOT 6, BLOCR 13 �l
KNIK HEIGHTS
I
I \ KNIK HEIGHTS /
I
I EXISTING SEPTIC
I
I SYSTEM / r
— — — — --I .1 O 0' WELL RADIUS...
r
�\
Rj/
I
i \Jy i
LOT 10, BLOCK B—
_
KNIK HEIGHTS
TEST
PIT
_ err
EXISTING THREE
r — —
J
L_ — — ! _ — _ _ . _ 1/ BEDROOM HOUSE
\
_ / 1 . 100' WELL RADIUS
I
I -PROPOSED SEPTIC
—
UPGRADE. SEE PAGE
i
1 2 OF 2 FOR DETAILS \
LOT 9, BLOCK B
I
I \
KNIK HEIGHTS
I
I \
LOT 8, BLOCK B
i KNIK HEIGHTS
FAIRMONT ROAD
`_
I I
LOT 10. BLOCK G I I LOT 1, BLOCK G
KNIK HEIGHTS i I KNIK HEIGHTS
\ L
LOT 12, BLOCK A `r
KNIK HEIGHTS /
(PROPOSED WELL IN 95') /
1 /
I/
1\
1
LOT 11, BLOCK A \ `\
KNIK HEIGHTS
(PROPOSED WELL IN 95)
i
I
1 '-
1
(
1
LOT 10, BLOCK A t
KNIK HEIGHTS
11 1
f 1
LOT 9, BLOCK A
KNIK HEIGHTS
LOT 10, BLOCK H
KNIK HEIGHTS
ALASKA WATER AND WASTEWATER CONSULTANTS, INC.
6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504
PHONE: (907) 337-6179/FAX: (907) 338-3246
' .,��r�r,+
✓�
LEGAL DESCRIPTION:
KNIK HEIGHTS;
LOT 7, BLOCK B
TYPE OF WORK:
SITE PLAN FOR
SEPTIC SYSTEM UPGRADE
✓f�•�y
•.••
e f A. Garness,�
PREPARED O
LARRY HAGEN
ONE NUMBER:
(907) 345-4992
co
�-
•., —7953 ,• m
�j,C,`,`Q'
DATE:$ 27 99
DRAWN BY:
SCALE:
SCALE:1 = 100'
PAGE: 1 OF 2
rofessjov'ol-�—A�
|
/THE CONTRACTOR SHALL HAVE THE SOUTH PROPERTY
|LJNE, THE 100' WELL RADIUS FOR THE WELL SERVING
/THIS PROPERTY AND FOR THE 100' WELL RADIUS FOR
|THE WELL SERVING LOT 8, BLOCK 8 FLAGGED BY A
/REGISTERED LAND SURVEYOR PRIOR TO ANY
/
�
|
`---------
~`
.`
` 10' UTILITY EASEMENT
.
|
/
`
\
|
\ .
\
\
�
`
\
\
�
/
\
EXISTING unmwncuDTO
�
BE USED AS A
RESERVE SITE.
|
|
EXISTING TANK TO
�|
BE COMPLETELY
|
\
ABANDONED
�|
�|
\
CO
/
PROPOSED ~^~~E^~ EXCAVATE—/
|
A TRENCH THAT IS *o FEET
uzwn BY u.s rEcr wmc BY y
|
rsEr oscp MAX. ^oo s nccr or
/
CLEAN,*wanso oswcn
`
|
o*�NROx. INSTALL TRENCH
/
PARALLEL TO suopc cowroums
TEST PIT
|
/
`
-�o--
-l10'
�- --
-- -- -- -- -- --f-- -- -- -- --
-- -- --T
UTILITY EASEMENT
FLOW DIVERTER
ALASKA WATER AND WASTEWATER CONSULTANTS, INC.
LEGAL DESCRIPTION:
KNIK HEIGHTS SUBDIVISION; LOT 7, BLOCK B
TYPE OF WORK:
DESIGN OF SEPTIC SYSTEM UPGRADE
PREPARED FOR: PHONE NUMBER:
S
K. U�
' '-_-
\_~�
L
LOT 12, BLOCK A
KNIK HEIGHTS
(PROPOSED W 19J 951
r
LOT 11, OCK A
I41 KNIK HEI HTS
(PROPOSED WELL IN 95')
L T 1 B OCK
KNIK I S
LOT 9, B CK A
KNIK HEIG
\X�IRM R
LO 1 BLOC G L B C G L 10, BL H
K F IGHTS K IK HE H K
LAS W! W T W R ON // TAN S, IN
0 D R U E 2 RA E, AK. �9504
H (90 37 6 9/ —3246
LEG DESCRIPTION:
KNIK HEIGH LOT i�, BLO K B
TYPE OF WORK:
TOPOG APHICAL DRAWING
PREP RED FOR: PHO E N MBE )VI
RRY HAGEN 90 3� - 992
DA WN BY: SCALE: ll�
/ /99K.D1 100'!
1
LO
5, BL C B
LOT 2, B CK
K
El
KNI HEI HTS
Rpp�Js
�00
LOT 1, LOCK B
OT
BI�
B
KNI IGHTS
NIK
I
S P C
M
C
1 0`WEt1=-
DIUS
jJ
AR
�JS
L T 10, LO K B
NIK H IGHTS
IT
1571NG"TfIE3EE
B DR MHO E
100'
RA'
LOT 9, LOC B
Kt� H G
LOT Bl0 K
KNI HEIG S
.� INC.~~��~=�~^. ,,^.�~-~�~~ ,,^.~�~~,,^.�~~�~.�.~^,...~~~�^.^,�..,~^`~~
[SOIL LOG - PERCOLATION -T-E-ST-1
LEGAL DESCRIPTION: KN|K HEIGHTS SUBDIVISION; LOT7 BLOCK B
PERFORMED FOR: LARRY HAGEN
DATE PERFORMED: 8/20/99
DEPTH
(feet)
ORGANIC
1 (PACE 1 OF 2)
SOIL CLASSIFICATIONS
Is E P AN
GW ��
3GP ML
GM CL
4 SW GC 0L
�� MH
5 3p CH
3M OH
O SC
7 — DEPTH TO
GROUNDWATERDRY 8/20/99
O
11
12
13
14
15
16
17
18
1S
20—�--/
DATE
READING
CLOCK
TIME
I NET TIME
(MINUTES)
I WATER LEVEL
READING
� NET DROP
(INCHES)
8/23/99
PERC. HOLE WAS PRESOAKED 4+
HOURS PRIOR TO TESTING
PERCOL4T0NR4TE
TEST RUN BETWEEN
7'6 (MIN./INCH) PERC. HOLE D|�. O (INCHES)
COMMENTS: PERCOLATION DATA ON THIS PACE FOR LOWER BENCH PERC. HOLE ONLY.
PERFORMED BY ALASKA WATER 8: WASTEWATER. |. JEFFREY A. CARNES8, CERTIFY THAT THIS
ALASKA WATER & WASTEWATER CONSULTANTS, INC.
690PHONEE (907) 337 S61 9 * FAX (907)338 * ANCHORAGE, AK 9504
3246
SOIL LOG — PERCOLATION TEST
LEGAL DESCRIPTION:. KNIK HEIGHTS SUBDIVISION; LOT 7, BLOCK B
PERFORMED FOR: LARRY HAGEN
DATE PERFORMED: 8/20/99
(feet) TEST HOLE # 1
1 (PAGE 2 OF 2)
2
3
4
5
6-
7-
8— z
0
9
ui
0
10 =
f-
11 ui
ry
0
12 u`
z
0
13
LL
14 g
U
15
0
16 w
U)
17
18
SOIL CLASSIFICATIONS
GW
GP
GM
GC
SW
SP
SM
SC
r'
ORG
ML
CL
OL
MH
CH
OH
`
I I I w
I ,1,
n
N
U
IGROUN DEPTH WATOERI DATE
SITE PLAN
I" = 100'
- - � - - - - - - 1 00' WELL RADIUS
I I 1
zllll
I I J
I I / ♦ TH#1
-_
I (
DATE
READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
8/23/99
PERC. HOLE WAS PRESOAKED 4+
HOURS PRIOR TO TESTING
Pp�E�
R�EO
-50
P
19 PERCOLATION RATE
20 TEST RUN BETWEEN
COMMENTS:
<1 (MIN./INCH)
7.5 FT. AND
PERC. HOLE DIA. 6 (INCHES)
8.0 FT.
PERCOLATION DATA ON THIS PAGE FOR UPPER BENCH PERC. HOLE ONLY.
PERFORMED BY ALASKA WATER & WASTEWATER. 1, JEFFREY A. GARNESS, CERTIFY THAT THIS
WAS PERF M IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON
DATE:
~''
����� `� ANCHORAGE � �� � ���' `~,����
' "�mvu .m^ x�rv��� ux^� v�n^
Department of Environmental Quality
3330 CStreat
Anchorage, Alaska 99503
°
' INSPECTION REPORT ON -SITE SEWAGE DISPOSAL SYSTEM
LOCATION, LEGAL DESCRIPTION
SEPTIC TANK:
DISTANCE / ^
NUMBER OF
FROM WELL MANUFACTURER. MATERIAL 121/151e-'l COMPARTMENTS
INSIDE LENGTn_______INSIDE WIDTH -LIQUID DEpTH_____L|QU|DCAPACITY GALLONS.
SEEPAGE Pff--:7(Z4�(jC_d
NUMBER OpPITS
LINING MATERIAL
BUILDING FOUNDATION
ADDITIONAL ABSORPTION
DIAMETER
-OR WIDTH-,
LENGTH-,
DEPTH
CRIB SIZE: D/xMETER___DEpTy____DISTANCE FROM: WELL
' TOTAL EFFECTIVE
�&,
. mE�RESTLOT�|NE���� ABSORPTION AREA
/
WELL:
TYPE -CONSTRUCTION DEPTH -DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC � SEEPAGE �
FOUND*T|Om_____'. LOT L|ms.����_-. SEWER LINE ______. T*mn ' SYSTEM � .
CESSPOOL_______-. oTnERsouncss
*PPROVED_______DISAPPROVED
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
RExxAR
DIAGRAM OFSYSTEM
rih
DATE APPROVED
Form No. EQ-031
G.p.A.B.
GREATER ANCHORAGE AREA BOROUGH
g°� Q 6 i t DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO.
4g 3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
NAME OF APPLICANT Al-/00-1-- MAILING ADDRESS PHONE
INSTALLATION LOCATION
LEGAL DESCRIPTION
INSTALLATION OF: SEPTIC TANK SEEPAGE PIT z- DRAIN FIELD OTHER
TYPE AND SIZE OF FACILITY TO BE SERVE.
FINANCED THROUGH TO BE INSTALLED BY
SOIL TEST RESULTS NOTE. THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE
TYPE SEEPAGE AREA SIZE
MINIMUM DISTANCES, REQUIREMENTS
e-
FOUNDATION TO SEPTIC TANK -1)
FOUNDATION TO SEEPAGE PIT / —1 DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK , SEEPAGE PIT DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK — 42 — SEEPAGE PIT
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT
SEPTIC TANK,,-L SEEPAGE PIT DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL ]BACKFILL
CONFORM To BOROUGH REGULATIONS REGARDING INSTALLATION.
G.A.A.B.
OR
LICENSED DESIGNER
TYPE
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 26-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE APPLICANT'S SIGNATURE
Larry Hag�q
z:.I__,I,5, May -75
B
'Knd
,soil
The sediments were
fair
2
compact with a low
water
content. All contacts
were erratic with -this
profile representing ar.,
Gm
average.
7
Gw
9
Gm
P�erlqqlo_ --- ---- 15 - May 75
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Parcel ID 017 -033-07
Certificate of On -Site Systems Approval
OSC251017
Expiration Date: 12/3/2025
Legal description KNIK HEIGHTS BLK B LT 7
Site address 12700 RIDGEWOOD RD
Current property owner(s) HAGEN BARBARA J (TOD)
X The On-site system(s) is/are approved for 3 bedrooms
By:
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
Original Certificate Date: 3/6/2025
T is rtificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
�Stem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
Development Service 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 submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory X Arsenic Advisory
Other
MUNICIPALITY OF ANCHORAGE
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. 017-033-07
Complete legal description Knik Heights Block B Lot 7
Location (site address) 12700 Ridgewood Road, Anchorage, AK 99516
Current property owner(s) Barbara Hagen Day phone
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: ❑■ 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: t❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age 25 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWrS ❑ 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 $ 5
Date of Payment Z Z / Zo Z S—
COSA # 0 5 0 2 1017
Waiver Fee $
Date of Payment
Waiver #
COSA Application—June 2022
COSA Checklist_June 2022
COSA Checklist
Legal Description: Parcel ID:
If more than 1 well and/or septic system on lot, provide separate checklist. 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
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
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.
Per record drawings, field is insulated.
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)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
COSA Checklist_June 2022
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’
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
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’Yes if No ft
Tank to Property Line > 5’Yes if No ft
Field to 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
Wells on Adjacent Lots:
Private Wells > 100’Yes if No ft
Community Wells > 200’Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
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 Phone
Engineer’s Printed Name Date Benjamin Schiller, P.E.
.hefty n�ling, Ind.
Hefty Drilling Inc.
3540 Akula Dr. Anchorage, AK 9)516
345-0593
hefivdrillinenaaolxom E-mail
Ww . endrilllin t orsi
6104�
Sallee, Blowoff Valve
OF
Check Valve
Pressure Gauge
Pressure Switch
Pressure Tank Condition
Pressure Tank i r Charge
Date: I/ -ZS
Name: Pp-,ov i tj 1A 4$�
Site: 17 00
Well SComponents Inspection
Acceptable
V/
M 0 M -h 6 0 6 10
1p ID Rh qF qF & 41 qF M
Control Box
Electrical a r� t� �� .. ...... .
ti
Voltage .. ...... ■
Well Casing (18' above grade) + + .
Well Cap & Conduit
Comments
hispectioncorpItdb :..
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Needs replacement/repair
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i. i i F+ 7*■ k
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MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
On -Site Water and Wastewater Section
www.muni.org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval # OSC251017
Subdivision: Knik Heights Block:B, Lot: 7
907-343-7904
Fax: 343-7997
The septic tank for this property is 25 years old. The average life of an asphalt
coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more,
not including engineering, surveying, MOA permitting fees or site restoration.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
W
OF.A
CO 49 R `9
h'Ae�—
o
s SHANE A. HOLT �� G
LS -6914 y��4�
,\,°fessiona� �-Qo
N 89 58'E 299.84 ( PROP. ) ; 300.00 REC.
THESURVEYDATA AND MEASUREMENTS HEREONAREPREPARED FOR THE
OWNER OFRECORD AS OF THEDATE OF THIS SURVEY.
ANY USEOF THIS DRAWING BY THIRD PARTIES IS PROHIBITED UNLESS
WRITTEN PERMISSION IS PROV/DED.
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHON ANY
CONFLICTS BETYEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS
NOT TO SE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOYN
HEREON ( UNLESS INDICATED)
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRANINS ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES 09 POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOUN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOG/ AND/OR ICE.
O
O
r�
V
AS-BUILTSURVEY I" =30'
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THA T I HA VE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 7 BLOCK B KNIK HEIGHTS SUB.
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENT S SITUATED THEREON ARE WITHIN
THE PROPERTYLINES AND NO VISIBLE ENCROACHMENTS
EXIST OTHER THAN NOTED.
DA TED ATANCHORAGEA LASKA THIS 16 TH DAYOF
JANUARY 2025
16198 240-17
HOLT LAND SURVEYING
9309 GROVER DRIVE
ANCHORAGE,AK 99507
223-8615
