HomeMy WebLinkAboutNORTH WOODS UNIT 3 BLK 12 LT 7
Municipality of Anchorage
On-Site Water and Wastewater Program • (907)343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181152 PID Number: 051-732-16
Dwelling: ® Single Family (SF) [' Duplex (D) El Multiple (SF and/or D) Project: ❑ New ® Upgrade
Name:
DEBRA KARTH ABSORPTION FIELD - EXISTING
Address ❑ Deep Trench ❑ Shallow Trench CO Bed ❑ Mound
23023 Green Garden Dr., Chugiak, AK 99567 El Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
3 GPD/SF Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot Ft. Ft.
NORTH WOODS #3 12 7 Fill added above original grade Gravel length
Township Range Section Ft. Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES Ft. -- -- Ft.
To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches
From Tank Field Tank Line Ft2 -- -- Ft.
Well 200+ NA NA NA NA TANK ®Septic El S.T.E.P. ❑ Holding 0 Other
Manufacturer Capacity
Surface Water 100'+ NA NA NA Anchorage Tank 1250 Gal.
Material Number of compartments
Lot Line 5'+ NA NA NA Steel 2
NA LIFT STATION
Foundation 5'+ NA NA NA Manufacturer Capacity
Gal.
Curtain Drain NA NA NA NA
Remarks Pump on level at Pump off level at High water alarm at
*None known. New 1250-gal S.T.
installed per code & insulated. in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 Tank to 3034
Installer Northern Excavation drainfield
Drainfield CO/MT 3034
Inspector ARCTERRA BENCH MARK (Assumed elevation) 100 ft
Inspdates: 151 8/6/2018 2nd 8/8/2018 Location and description
3rd
4th Door Sill
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engin
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Conditional Approval: Date 1,..<S.
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eer's Stamp
Inspection Report_9-1-12.doc
AS-BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP181152
NORTH WOODS SUBDIVISI❑N UNIT III LOT 7 BLK 12 PID# 051-732-16
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'•- 1250-GAL S.T.
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3 B—D=33.3' _ _ _
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,. -,1� - 1 DEBRA J. KARTH °�' Mh
i; * ^ * 23023 GREEN GARDEN DRIVE'I'lv: 4 �� 4I Chuglak, AK 99567 /
t i� : FlELD BOOKS Co1PUTED ' *4 ) r§.is A
CE Aa / BOUNDARY:N/A DRAWN: BMW
1 ti$ - STAKING: NSA CHECKED: KMD •'•1 n°j
1 LL. LB '' ASBUILT: SLS DATE: 8/13/18 •�.,;».
A1'
\ SSIO6= DWG.F1LE: crab: NW1459 9ceFR c N� SjyClCfP
1. `__ ACAD FILE: FILE JOB No.: 18-156 i`FR �K 99577"'" 6
N0 ""', MUNICIPALITY OF ANCHORAGE
/ On-Site Water&Wastewater Program �o�ment
PO Box 196650 4700 Elmore Road `
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http://www.muni.org/onsite
tdrai�ca:
•
Depart!twnt
NHc,„ORPVE
On-Site Wastewater Disposal System Permit
Permit Number: OSP181152 Effective Date: 6/25/2018
Work Type: SepticTank Upgrade Expiration Date: 6/25/2019
Tax Code Number: 05173216000
Site Legal Address: NORTH WOODS UNIT 3 BLK 12 LT 7 G:1459
Site Mailing Address: 23023 GREEN GARDEN DR, Chugiak
Owner: KARTH DEBRA J Lot Size in Sq Ft: 27000
Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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
Received By: Date: 7 4)
Issued By: 12Q / ( )vttre/( Date:
MUNICIPALITY OF ANCHORAGE
•"'..
Community Development Department ., Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D.
051-732-16
Property owner(s) DEBRA J KARTH 907-406-8300
Day phone
Mailing address 23023 GREEN GARDEN DRIVE, CHUGIAK, AK 99567
Site address
23023 GREEN GARDEN DRIVE, CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) NORTH WOODS #3 B12, L7
Legal description (Township, Range & Section)
Lot Size 27,000 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑ Initial ❑ Single Family (SF)
(w/wo ADU)
Septic Tank Upgrade Duplex (D) ❑
Holding Tank Renewal ❑ Multiple Dwellings [ [
Privy (SF and/or D)
Private Well [l
Water Storage [ [
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
nature • property owner or authorized agent)
Permit/Rush Fees: 215 Waiver Fees:
Date of Payment: (o -2-1-10 Date of Payment:
Receipt Number: D62:a Receipt Number:
Permit No. n5f 18 1152- Waiver No.
Permit App_9-1-12.doc
Q* CTERRq
ARC TLRR.A
C'ONSUL'TING, INC'
4 212 E. 5151 Ave, Anchorage,AK. 99503
<I Office(907)868-3791, Fax(907)868-3793
49 c'vSUTaasT-A•
June 20, 2018
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: SEPTIC TANK UPGRADE PERMIT
NORTH WOODS UNIT 3 BLOCK 12, LOT 7
The owner has requested we proceed forward to obtain a septic permit to
upgrade the aged septic tank. We propose to decommission the existing 1000-
gallon septic tank per code and install a new 1000-gallon tank in the same
location to serve the existing 3-bedroom house.
The subject and adjacent lots are served by public water. There is no surface
water within 100' of the proposed tank. We do not expect there to be any
adverse effect on adjacent lots by the development of this tank. If you have any
questions, please contact me at 868-3791 / FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting, Inc. �� t-7 32-1 co
Kenneth M. Duffus, .E. Digo
osel r 1151
Attachments: On-Site Sewer Application
20441 PTARMIGAN BLVD • EAGLE RIVER,AK 99577-8736 • PH(907)868-3791 • FAX(907)868-3793
WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLAN
NORTH WOODS SUBDIVISI❑N UNIT III LOT 7 BLK 12
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DECOMMISSION EXISTING S.T.
9O. & INSTAL NEW 1000-GAL \ /
S S.T. W/ POST-TANK COs.
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EXISTING FIELD I 'L V),
SIT CO* l . \
MAINTAIN 5'+ CO
FROM STAIR SUPPORTS'''. FCO��\��� Q.
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- NO PUBLIC WELLS WITHIN 200' OF 'Q 6 WATER LINE IN 0 40
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PROPOSED S .
r"" NO PRIVATEYWELLS WITHIN 200' OF AS ti6 FRONT /
o PROPOSED SYSTEM EXCEPT AS NOTED. OF HOUSE
NO SEPTIC SYSTEMS WITHIN 200' OF
N PROPOSED WELL EXCEPT AS NOTED.
LI
U
2
m
2 AREA SERVED BY PUBLIC WATER Scale: 1'= 30'
v PAGE 1 OF 1
J.N
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0
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DESIGN DETAILS
0
1. DECOMMISSION EXISTING SEPTIC TANK & INSTALL 1000 GAL - INSULATE TANK IF <4' COVER.
O
O 2 CONTRACTOR WILL ENSURE MINIMUM 2X SLOPE INT❑ SEPTIC TANK, 10' TO FOUNDATION,
3 5' TO EXISTING FIELD & INSTALL 2 POST-TANK CLEANDUTS.
Et 3.. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT
io WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC...
U
W / g� �F •1Q,1 PREPARED FOR: % gcTER
• ,c� ' 1 DEBRA J. KARTH �
`y • \ `� 23023 GREEN GARDEN DRIVE a°� illil•c);_sa,o yE A TH * Chugiak, AK 99567 / �,mA �/ 7 0.�..s-Nv �Q. KEe 8FIELD BOOKS COMPUTED: rQ ` K� �.'I'',—'rl ��k / BOUNDARY:N /A DRAWN: BMWZ • 1.
0 1 L' r�.� $ STAKING' N/AI CHECKED: KMD �'1 n°'
/ //8 •/
AWAIT' SLS DATE: 6/19/18 I "� ... \ 06�
E \\ DWG'. FILE GRID: N W1459 (F 0'ps 1.1yG oft
``_ ACRD FILE ae No.: '�'L- SUI TING >�yb
Z FILE 18-156 AK,gg577�
~ ,~IUNICIPALITY OF ANCHORAGE
r~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE ,[~'N EW
LEGAL DESCRIPTION q
LOCATION NO. OF BEDROOMS
~,s.A.~..o:' Owelling
~ ~ No. of compartme~t~
~ ~ Manufacturer I Material
Liq. capacity in gallons Inside length Width Liquid depth
t~ IF HOMEMADE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O Z ~ Manufactu[er ' Material Liquid capacity in gallons
~ DISTANCE TO: W~m ~ni: Foundation ~ N~ar~l~ 0 n PE~j
-- Nc. of lines..~ Length of oaDD Total ,engF~nes Trenchwi~t~l~X COinches Dis~a~ betwe~ lines ~
~ ~ ~ Top of tile to~inish grade ~ Material beneath tile
kon~th ~idth Depth ~fiBMIT ~0.
~ ~ Type of crib Crib diameter , Crib depth Total effective absorption area
~ Well ~ Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
PiPE MATERIALS OTHER
SOIL TEST RATING
REMARKS ~ ~
DATE LEGAL
APPROV
ED
72-013 (Rev. 3/78)
Department of_Health and Environmental ~otection
~ 825 -~--~treet, Anchorage, AK.
264-4720
* * * HANDWRITTEN PERMIT ~ * *
Permit ~' '
WE~L AND/OR ON-SITE SEWER PERMIT
Applicant:...- ~_~!,~(..~ ~l~,~, ~ ~.~.[~_ ~y~ i~, Mailing Address:
Location: Phone Number:
Legal Description: ~'~ / ?~ '~?.!>'[ <. /i" ' ' ''
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed:
Lot Size:
Holding Tank:
Maximum Ntunber of Bedrooms: ~ Soil Rating(sq.ft/br) /~
The Requ~'red Size of the Soil Absorption System Is:
DEPTH ,~?/ LENGTH /~F'~ 11 ~ GRAVEL DEPTH 0 WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = / 6~7-Q GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the nua%ber
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this departmeni
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feel
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER ~1, 1 9 8 3 * * *
Z certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 b~oms. ,
swP/024
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRiPTiON: ZO 7
1
2
3
~--4
9
I0
11
12
13
14
15
16
17
18
19
20
SLOPE
COM M E NTS .~'~,~,~,,
PERFORMED
72-008 (6/79)
WASGROUND WATER
ENCOUNTERED? /~
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND ~ FT
C) U7
(3) CY)
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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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with ADEC & MOA guidelines and regulations. The reported results describe the performance of the system
under the conditions encountered at the time of the test, and separation distances measured to readily identifiable
features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that
may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside
the control of the evaluator of this system. All systems eventually fail, and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore, we
cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this
report is for the sole benefit of the owner listed above.
Name of Firm
Phone
Engineer’s Printed Name
Date
0
iaJ
2010'
151'
REENHOUS
SHED
C14
C14
LOT 7
1 N
CC)
BLK 12
ASBUILT OF:
NORTH WOODS SUBDIVISION UNIT III
LOT BLOCK 12 PIAT 83-68
;U
0
property
improvements situated hereon are within the property lines and no
qs
t7
enchroachmcrits exist other than noted.
%C?
z
*SEPTIC
C)
M
do not appear on the recorded subdivision plat. t Indcr no circumstance
should any information on this drawing be used for construction of
noes.
VENT
(tyP)
fences, structures, improvements, or for establishing boundary Ii
LS -104-08 i'lo
I 'lull
X
WM ORDER NUMBER: 1 AUG 13, 20
J pg
1-032 1 an MANEW,
8
JLS
I
'0
0
DECK 2' CANT
0
28.7* z_X
N I
I
46 0'
V)
9 EXISTING
FP
CANT HOUSE N
X—X-
26.6' 25.5' 0 20,5'
2 CANT
PAVED
()/w
KEYBOX
15' UTILITYIESMT
0
N50'00'00"E 120.00'
-GREEN GARDEN DRIVE
LAND
&
1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1466 office
(907) 274-4992 fax
ANCHORAGE RECORDING DISTRICT, ALASKA
ASBUILT OF:
NORTH WOODS SUBDIVISION UNIT III
LOT BLOCK 12 PIAT 83-68
SURVEY CERTIFICATE: 1. John L Schuller, Have conducted a
physical survey ofthis as shown on flus drawing and that the
property
improvements situated hereon are within the property lines and no
qs
t7
enchroachmcrits exist other than noted.
%C?
EXCLUSION NOTES: It is the owners responsibility to determine
the existence ofany easements, covenants, or restrictions which
do not appear on the recorded subdivision plat. t Indcr no circumstance
should any information on this drawing be used for construction of
noes.
............................
',.J-dHN L. SCHULLER.:
fences, structures, improvements, or for establishing boundary Ii
LS -104-08 i'lo
I 'lull
X
WM ORDER NUMBER: 1 AUG 13, 20
J pg
1-032 1 an MANEW,
8
JLS
NW1 459 180208
LAND
&
1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1466 office
(907) 274-4992 fax
•
• Municipality of Anchorage
On-Site Water and Wastewater Program e��'�
(907) 343-7904 SAFETY
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL.
Parcel I.D. 051-732-16 Expiration Date: C(r ( - ! `
1. GENERAL INFORMATION
Complete legal description NORTH WOODS UNIT 3 BLOCK 12, LOT 7
•
Location (site address) 23023 GREEN GARDEN DRIVE, CHUGIAK,AK 99567
Current Property owner(s) DEBRA J. KARTH Day phone
Mailing address 23023 GREEN GARDEN DRIVE, CHUGIAK,AK 99567
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY: Individual
Individual Well ❑ Holding Tank ❑
Individual Water Storage ❑ Community ❑
Community Class Well ❑ Public Sewer ❑
Public Water System
Waiver/Variance request for: Distance:
e J
Received by: Date: 1.71'4
COSA to be relea o t - ngineer,unless otherwise requested by the engineer.
COSA Fee $ 5210 Waiver Fee $
Date of Payment a ill frd3 Date of Payment
Receipt Number oqq92i) Receipt Number
COSA# 1i(`L 7`'f' Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the.Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 8/14/18
THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED
• WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with
ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested.
The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use,
local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the
system.•The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function
satisfactory for current or future occupants or can ArcTerra guarantee that no unseen
encroachments,deficiencies or discrepancies exist. OF 4L
�
`q4)
6. DSD SIGNATURE
� X� �TH /\ 9 ��
System #1 Approved for bedrooms. lien DAF: c
System #2 Approved for bedrooms. , v,r^ ' s .
BG GAi
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
..i b.
\"1\11'.'5% 1\\\1\
By: �'� Original Certificate Date: q_12`(
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory'
Septic System Advisory Arsenic Advisory, cLe.
Well Flow Advisory Other •
COSA blue sheet 10.10-12.doc
If more than 1 septic system is on the lot:
COSA Checklist# of_
Structure served by this system _
Certificate of On-Site Systems Approval Checklist
Legal Description: NORTH WOODS UNIT 3 BLOCK 12, LOT 7 Parcel ID: 051.732-16
A. WELL DATA-PUBLIC WATER
Well type If A, B, or C provide PWSID# Well Log (Y/N)
Date completed Sanitary seal (Y/N)Y Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height(above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic: ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 8-6-2018
Tank size 1250 gal. Number of Compartments 2 Cleanouts(Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N
Date of pumping NA-NEW TANK Pumper
C. ABSORPTION FIELD DATA
Date installed 7/16/1983 Soil rating (g.p.d./ft2 or ft2/bdrm) 100 System type BED
Length 26 ft. Width 18 ft. Gravel below pipe 0.5 ft.
Total depth 3.7 ft. Eff. absorption area 468 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 617/2018 Results(Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 0.5 in.
Elapsed Time: 10 min. Final fluid depth 0 in. Absorption rate >= 450 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 Manhole/Access (Y/N)
"Pump on" level at_in. "Pump off' level at_in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES -PUBLIC WATER
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation /'+ (d ' Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 200'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 200'+
F. COMMENTS •
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
0,,,47-s, OF L4
Engineer's Printed Name _. KENNETH M.DUFFUS �
Date 8/14/2018 *) 9TH �� ,
KENMEM.
• ! /
COSA canary sheet_2-6-15.docS 41
7 to
ss ota .r•
TRACT B-1
N50'00'00"E 120.00'
)IC
X
_ i
I
= x
I
X
24.0' 20.0' 15.1' 1
x
' REENHOUSE SHED I
N x
0 1
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II ..
N 16
NK N
N
co
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o BLK 12 o H
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VEN T
(typ) • 0 W
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W • 0
OO
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FP
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CANT'N04 N X—x—
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3
al
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KEYBOX 15' UTILITY ESMT
— 0e
N50'00'00"E 120.00'
in
N
GREEN GARDEN DRIVE
0111.10 MEM 01•11•1111=1
in
N
N
ANCHORAGE RECORDING DISTRICT,ALASKA
ASBUILT OF: •Q =FND 5/8"REBAR
NORTH WOODS SUBDIVISION UNIT III
LOT 7 BLOCK 12 PLAT 83-68 s__`"`\
SURVEY CERTIFICATE:1,John L.Schuller,Have conducted a .0"..c. Or Az�` 'ypLAND Ri'.
physical survey of this property as shown on this drawing and that the �/ �AI � .••'' �Q�, �� \C)5'*- f
improvements situated hereon are within the property lines and no cC, . '• ) '•.t'1 ..•74", t`'L'
enchroachments exist other than noted. / �: 49� / 1 N b ✓' GZ
h I * , a '9 1.
EXCLUSION NOTES:It is the owners responsibility to determine t! ',I,' r'
the existence of any easements,covenants,or restrictions which P L / / U • t"
do not appear on the recorded subdivision plat.Under no circumstance r 73 111 ``•, C�
should any information on this drawing be used for construction of 11�. •.J HN L. SCHULLER. �� • .-
fences,structures,improvements,or for establishing boundary lines. 11tiX LS-10408 .. .....-4......r. "
WORK ORDER NUMt �� SCALE 1 G P • �.&/ 1831 Talkeetna Street
AUG 13, 2018 1"=30' 1`a 'g:J1...I a' a, Anchorage, Alaska 99508
18-032 1AN 9Y a ago ORE MAWR /PA �\r°fession°� ��� (907) 227-1455 office
'CHECKED
JLS NW1459 180208 \\\���� (907) 274-4992 fax
., : ~ APPLIC--~JT FILLS OUT UPPER HAL '~")NLY
Property. Owner.
~/~ ~, Phone
Buyer
Address Zip Code
Address ~ ~/~ Zip Code
Street Locati~
Type of Resi~nce
~ingle Family
~ Multiplo [amily ~o. of Bodroo~q
~ Othor
Water Supply
~ Individual
~Community ~ ~ ~ ~ ~ A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975.
For wells drilled prior to that date, give well depth (attach log if available).
When Connected to Public guilty:
~ Holding Tank
FEE M~ST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN B~~I~ITIATED'
NOTE:
THE
INSPECTION
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
/~,UNiCiFALiTF OF .......
RECEIVED
(~) APPROVED BEDrOOm8 *OONDmON8 OF APP~OVAL
( ) D~SAPmOVED
( ) CO~T~ONA~P~V~'
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
~ -- I~ -- ~ Well to Tank Septic T~k Size
72-023 (3182)
