HomeMy WebLinkAboutSTOCKHAUSEN LT 21 PTNOnsite File
Stockhausen
Lot 21 PTN
#051-062-79
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201193 PID Number: 051-062-79
Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name
JOE ALTER
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
21219 GINGER LEE DR
❑ 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
Ft.
Gravel depth beneath pipe
Subdivision Block Lot
STOCKHAUSEN LT 21 PTN
Ft.
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
Holdin g
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ftz
Ft,
Well
100'x.
501+
TANK ❑e Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
Greer
Surface Water
100'+
1000 Gal.
Material
Number of compartments
Lot Line
10,+
NA
PLASTIC
2
Foundation
10,+
LIFT STATION
Manufacturer
Capacity
Remarks
Gal.
Alarm location
Electrical installed by
Installer
PIPE MATERIAL House to tank Tank to
3034 drainfield 3034
MIKE N ANDERSON, P.E.
Drainfield 3034 CO/MT
inspector MIKE N ANDERSON, P.E.
BENCH MARK (Assumed elevation) 101 ft
Inspection ection 1" 7/18/20 �d
2
Location and description
3,d 4,h
NE CORNER OF SIDING
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Conditional Approval: Date
0
P *, �, r •,� ft
'49TH •�1
.> 4-J
N ; ac
MICHAEL N. ANDERSOCE 9
14r
Septic Syste
Approved
Date�A
j
. ��.:
a %�3 v•'�.,`��
Note: this appro oes not include well permit requirements.
t'r^r�
(RPV 0sx9r1 uM
Permit No. OSP201193 Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorqge, Alaska 99519-6650 Telephone: 343-4744
On—Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: STOCKHAUSEN LT 21 PTN PID No.: 051-062-79
MARK A B
C01 10 -4
CO2 12 1
TC01 17 5
TCO2 /20 29 \
CO3 25 Z 1 \
C04 126 1 31
ELL
I I o
I
1
C01
\\ DRIVEWAY I
� I /
� I i
I
ASBUILT
SCALE: I"=50'
Y�tT
BENCH BOTTOM OF SI
ITC01 TCO2
0. 03
02 Ci i
i
NEW 1000 GALLON PLASTIC TANK
OLD TANK BURIED IN—PLACE
®®� )F q ®®
�•'' •.'•.;Y
e �
49TH �: ®®
' MICHAEL N. ANDERSON: iv
-
0 No. CE 9469 '
® 7-30-20
tm®it IMUIL�®®
8474J
LOT 13
Sheets Subd. /
LOT 22 I /
N89032'43"E 178.55 (D)
EAST 178.55 (P)
W 30 oWell
> co 10.7 N00007'1 0"W (P) 4.29 (D)
IQ 20.0 - 35.0 v 21.0 (Manhole o S00°36'31 "E 4.29 (D)
Q ^ o �l a `
W Carport o 1 Story Frame House 0 Septic vent (typ)
`,.• Q N N N
W `-� 6 6 20.0 66.7ry
0
N
W "'O
d
� �LOT 21 0Jz Gravel driveway,Zo CL
�pc
C) 6.5 r V `�
= 12.0
Shed
0
O O Cl? 20.1 `�5
M
Z z Carport c9 ,fL�
IV !\
5.9 G�`air
SCALE: 1 "= 40'
30 Note 1: The boundary of Portion of Lot 21 is described in the
EAST (P) 26.63 (D) Warranty Deed recorded June 14, 1982 in book 741,
Page 414. Said Deed refers to Plat P-450,
N89032'42"E 26.63 (D) Stockhausen Subdivision. The distances per deed are
identical to the plat on lines that are original to Lot 21 but
LEGEND the bearings are different.
(D) Record per deed
(P) Record per Plat P-450 Q
RECERTIFIED 7-22-20 !G
AS -BUILT NO CORNERS SET THIS DATE
OF , A ' I hereby certify that I have performed a Mortgagee's inspection
AW .S in accordance with ASPLS Standards of the following
A A 1F 0 '0" 49th
.'�9 6 described property: Portion Lot 21, Stockhausen Subd.,
4.9 th ,•4® (Warranty Deed book 741, page 414) See Note 1
00 4-. r ...... .j. Anchorage Recording Precinct, Alaska, and that the
X 00 G improvements situated thereon are within the property lines
• • •/uuu ® and do not overlap or encroach on the property lying
lizabeth L. Walatka . ,o f adjacent thereto, that no improvements on the property lying
�P• • 8036 - LS • Je,�
,, adjacent thereto encroach on the premises in question and
•
pF . • • 5 that there are no roadways, transmission lines or other
o io +� visible easements on said property except as indicated
MorESSIoNA�- VV, hereon.
®®0®®®� Dated at Anchorage, Alaska
EASEMENTS OF RECORD, OTHER THAN this 26th day of JUNE 2018.
THOSE SHOWN ON THE RECORDED ' �p�� FRED WALATKA & ASSOCIATES, L.L.C.
PLAT ARE NOT SHOWN HEREON. FB 20-4, pg 16 Engineers and Surveyors
UNLESS OTHERWISE NOTED FB 18-3, pg 45 BE 907-248-1666
This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey
and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any
fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a
later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the
preparer is limited to the amount of fees collected for services in preparation of this product.
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http:]/www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP201193 Effective Date:
Work Type: SepticTank Upgrade
Tax Code Number: 05106279000
Site Legal Address: STOCKHAUSEN LT 21 PTN G:1460
Site Mailing Address: 21219 GINGER LEE DR, Chugiak
Owner: ALTER JOE T 1/3 &
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
❑ Disposal Field 21 Septic Tank ❑ Holding Tank ❑ Privy
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms
„enc
fi
�� OR
- "11611
r,
!•
Department
6/30/2020
6/30/2021
15071
❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received B
Issued By:
0011",
V Date:
Date:
3
MUNICIPALITY OF ANCHORAGE
Development Senjices Department ; Phone: 907-343-7904
On -Site Water & Wastewater Section -/ Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-062-79 t
Property owner(s) TERRAY ALTER Day phone 952-4847
Mailing address 1142 STERLING CREEK ROAD, JACKSONVILLE, OR 97530
Site address 21219 GINGER LEE DRIVE, CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) STOCKHAUSEN; LOT 21, FTN
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF)
0
(w/wo AD U)
Septic Tank
Q
Upgrade R
Duplex (D)
❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: l
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: JI' (5� /-5 Waiver Fees:
Date of Payment: Date of Payment.
Receipt Number: DO 52 G Receipt Number:
Permit No. 05P201l ct:� Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201193, Rebecca Carroll, 06/30/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201193, Rebecca Carroll, 06/30/20
I
ME
30
LOT 22
N89032'43"E '1178.55 (D)
=A C" -r- -1-70 r_= IM
OWell Ip—
10.7
20,0 1 36.0 1 2TT
Carport
290
C I Story Frame House
6
667
N
rteLOT 21
UIravel uriveway,
�c J�
04A
'X
3.5
I i.0
Shed
2111
17 A 0 frit ell 12!e3 11`11
L -r -\%J i ki fX_%J.V'J kL-,/
N8903243"E 26.63 (D)
LEGEND
(D) Record per deed
(P) Record per Plat P-240
4k
\e VV XINNI
0�
8474f
1 OT 13
Sheets Subd.
N00'07'1 O"W (P) 4.29 (D)
S00036'31 "E 4.29 (D)
Note 1: The boundary of Portion of Lot 21 is described in the
Warranty Deed recorded June 14, 1982 in book 741,
Page 414. Said Deed refers to Plat P-450,
Stockhausen Subdivision. The distances per deed are
identical to the plat on lines that are original to Lot 21 but
the bearings are different.
4ft" OF AI I
AAI
49th -Y I
00 .......................
00 00
so ............... A#
f4 . Elizabeth L Walatko sW
A*�
8036 — LS jw
ci
� Vp'r,? -ftm-
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHO)AII'41HEREON,
UNLESS OTHERWSE NOTED FB 18-3, pg 45
AO-w=LT NO SET T1113 DATE
I hereby certify that I have performed a Mortgagee's inspection
of the following described property: Portion LOT 21,
STOCKHAUSEN SUBDIVISIW�F_an+ Deied_15661<
741, page 414; See Note 1)
Anchorage Recording Precinct, Alaska, and that the
improvements situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no improvements on the property lying
iiujduetd iifeoeW efiuUckfi un Vht: Viwtd=z� Ili qut:btivii aims
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this _ 26th —day of JUNE 2018.
FRED WALATKA & ASSOCIATES, LLC.
Engineers and Surveyors
907-248-1666
~"-'\ MUNICIPALITY OF ANCHORAGE
~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
(kd L~'~, ~)) ENVIRONMENTAL ENGINEERING DIVISION
~x'~ - ~.~.'/'~'~ ~/ 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
~ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
..... PHONE ~W
MAIUNG ADDRESS
LEGAL DESCRIPTION
LOCATION NO, OF B~OOMS
DISTANCE TO: ] ~'0~ ~ IAbs°r~ti°n aroa,:~- / Dwelling ,~--
~ I Material ~ No, of compartments
~ .~ Manufacturer ~J~ ~.~' ~ ~--~L
Liq. ca:a~acity in gallons ~OMEMADE: inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O ~ ~ Manufacturer Material Liquid capacity in gallons
a ~ ~%~*4 ~[~*tth Oriller 'Distance to lot line ~ PERMIT NO,
~ DISTANCE TO:
.
OTHER
PIPE MATERIALS ~
SOIL TEST RATING I0~,
INSTALLE~
72-013 (Rev. 3/78)
: PERMIT' ~ ':'"-'~: .
.NO, !, ,-,~-~.:----..-, -"
APF'LICFtNT MR BILL FILTER
'LOCRT I ON
~EGRL L21R STOCKHBUSEN
TYPE OF SOIL RBSORPTION SYSTEM IS:
MFtXIMUM NUMBER OF BEDROOMS
PO BOX 796 E. R 99577
PERr4~I T~
694-9150
LOT SIZE ~9999 SQURRE F%ET
TRENCH
SOIL RATING (SQ FT/BR)=
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: /~,~'~ ~3
[~EF,.i~H= 12 LENISTH: 42 6Rt%-'EL DEPTH: ~;
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF ~ TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFRCE OF THE
GROUND RND 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 OUTFRLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
REG~LII ~:E~l SEPT I C: l-tr-JK SIZE= :1250 13tLLO~JS
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THB
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
TW~] ( 2 ) I NSPEr:T I 0~4S iRE REC41J I RED
BRCKFtLLINO OF ~NY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
±00 FEET FOR R PRIVATE WELL OR ±50 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM R PRIVATE WELL TO A PRIVBTE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS RND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PER£4 IT E)<F'IRES C~EcE~BER Z;:L. :]LS~-82
I CERTIFY THAT
1: I AM~FRMILI~R WITH THE REQUIREMENTS FOR ON-SITE SEWERS 8ND WELLS AS SET
FORTH BY THE MUNICIPALITY OF 8NCHORBGE.
2: I WILL INSTBLL THE SYSTEM IN ~CCORDANCE WITH THE CODES.
~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE TH8N 4 BEDROOMS.
RPPLICANT MR BILL RLTER
O & E ENI~','NEERING & DEVELG. 'MENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-2774 SOIL LOG
Performed for: Name: /)~ /~ i c-~- /~/~"7--z=--/~
Mailing Address: ?Z~../_~). ~,~ 7'~'~/
Legal Description: ~---,~ '~ j -~
Earl Ellis
688-2280
Depth (feet)
Soil Characteristics
10__
16
Ground Water Encountered: Yes No / If yes, what depth
Proposed Installation: Seepage Pit Drain Field
Comments: -r~7,~
PLOT PLAN
PERC. TEST
...
~ ~v~ ~ %
'~;~2...
Performed by:
Parcel I.D. 051-062-79
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
U 5
g -A P c -F 7...
Expiration Date: 1.1 - 7 Z &?_0
1. GENERAL INFORMATION:
Complete legal description STOCKHAUSEN S/D• LOT 214 P 71
Location (site address) 21219 GINGER LEE DRIVE CHUGIAK, AK 99567
Current Property owner(s) TERRY ALTER Day phone 9524847
Mailing address 1142 STERLING CREEK ROAD JACKONVILLE, OR 97530
Real Estate Agent ALAN JONES Day phone 440-6929
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ -7 fa, 5o IGDLO -1
Date of Payment;2'0A0
Receipt Number 0 ( 2 ('0� G
COSA # DSC 2 b y 1 -
Waiver Fee $
Date of Payment
Receipt Number
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: Garness Engineering Group, Ltd (GEG) . Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: > 2
L
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system c ]: 1`v`l.�Y
in accordance with the guidelines and regulations established by the Municipality of Anchorage and �`C�,.• <
industry practices. The reported results describe the condition of the system/s on the date/s of the ✓ p :•' G�Ij
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or t
L
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including, but not limited to, soil conditions, (� • • • • • • • • . • • • • • • • • • • • • • • •
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the ft- f 6 G- rness
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of V/�? 70
the well or septic system. GEG makes no representation whether an altemative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to �1�° ar : ess,00ll'
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. DSD SIGNATURE
System #1 Approved for I.? bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms, with the
#AECC884
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ki
Original Certificate Date: Z 026
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Onsite 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 Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10.10-12.doc
COSA Checklist
Legal Description: STOCKHAUSEN; LOT 21A Parcel ID: 051-062-79
If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 1982 (ASSUMED)
Total depth UNK. ft
Cased to UNK. ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 6/23/20
Static water level at beginning of test 63.5 ft
Comments
Well production at time of test 5.1 gpm
Water storage tank volume NIA gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 2.46 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L Al Arsenic less than MRL (ND)
Collected by GEG,LTD.
Date of Sample 6/23/20
NEW SEPTIC TANK INSTALLED AND INSPECTED
B. TANK DATA BY MIKE ANDERSON, P.E. ON 7/18/2020.FT STATION
Age of tank(s) •NEw years ❑ Requir aintenance completed
Tank type/material PwsT'c Age of lift station ye
Measured operating fluid level in septic tank NEW Lift station material
❑ Standpipes/foundation cleanout per record drawing Comments*
Date of pumping NEW
D. ABSORPTION FIELD DATA DEEP TRENCH
Which system tested (date installed) 10127102
Adequacy test date 6/23/20
RM ALL standpipes present per record drawing
Results [DPass For 3 bedrooms
Total measured depth from grade *9 ft (max)
Fluid depth prior to test 0 in
Measured depth to pipe invert from grade 5.2 ft (min)
Water added 896 gal
❑ N/A — pressurized field
0
❑ Monitor tubes go to bottom of effective. If not, state
New depth in
0
depth into effective `3 8'
Elapsed time min
❑ Code -required soil cover over field
Final fluid depth 0 in
❑ System presoaked
Absorption rate 600+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) NONE
date of test)
Gallons introduced N/A gallons
If yes, enter date
Comments/Deficiencies: 'SUMP (MT) DOES NOT EXTNED TO BTTOM OF DRAINFIELD. DRAINFIELD SHOULD HAVE 6' OF EFFECTIVE.
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
[Z] Yes
if No
Community Sewer Manhole/Cleanout > 100'
Yes
if No
ft
0 Yes
if No ft
Neighboring Tank > 100' Yes
if No
ft
Private Sewer/Septic Line > 25' 0 Yes
if No ft
Absorption Field on Lot > 100' F�l Yes
if No
ft
Holding Tank > 100' 0 Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' 0 Yes
if No ft
0 Yes
if No
ft
ft
If septic tank is under driveway comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0 Yes
if No
ft
0 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
[Z] Yes
if No
ft
Surface Water > 100'
0 Yes if No ft
Property Line > 5'
✓0 Yes
if No
ft
Wells on Adjacent Lots:
Wells on Adjacent Lots:
Absorption Field > 5'
0 Yes
if No
ft
Private Wells > 100'
✓V Yes if No ft
Water Main > 10'
0 Yes
if No
ft
Community Wells > 200'
✓0 Yes if No ft
Water Service Line > 10'
0 Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
✓0
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
0
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
0
Yes
if No
ft
Private Wells > 100' 0 Yes if No ft
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that l 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.
COSA Checklist yellow sheet
#AECC884
8474J
LOT 13
Sheets SUM.
I LOT 22 ( /
N89032'43"E 178.55 (D)
EAST 178.55 (P)
f 30 }
> °well Co 10.7 N00°07'10"W (P) 4.29 (D)
0
20.0 , 35.0 `r v 21.0 anhole o o r rr
p o S00 36 31 E 4.29 (D)
.-�
Carport `�
U 1 p o p o 1 Story Frame House o Septic vent (typ)
W C_ p o N N
J N 20.0 66.7
f N - 6.6
W �o X01
CD ��
_z Gravel driveway. LOT 21
0
M 6.5[Shed
oeo 020.1 b` `'
ZO Carport
5.9
�G SCALE: V= 40'
I
30 Note 1: The boundary of Portion of Lot 21 is described in the
EAST (P) 26.63 (D) Warranty Deed recorded June 14, 1982 in book 741,
Page 414. Said Deed refers to Plat P-450,
N89°32'42"E 26.63 (D) Stockhausen Subdivision. The distances per deed are
identical to the plat on lines that are original to Lot 21 but
LEGEND the bearings are different.
(D) Record per deed
(P) Record per Plat P-450
RECERTIFIED 7-22-20
AS -BUILT NO CORNERS SET THIS DATE
m' OF I hereby certify that I have performed a Mortgagee's inspection
in accordance with ASPLS Standards of the following
mw A
described property: Portion Lot 21, Stockhausen Subd.,
49th (Warranty Deed book 741, page 414) See Note 1
! .:J... ....�. Anchorage Recording Precinct, Alaska, and that the
�/improvements situated thereon are within the property lines
cum / and do not overlap or encroach on the property lying
Nlizabeth L. Walatka , ,� ea adjacent thereto, that no improvements on the property lying
srF • . 8036 - LS . • •�� adjacent thereto encroach on the premises in question and
AW
that there are no roadways, transmission lines or other
g o pROFessIONA� •LP�'� visible easements on said property except as indicated
a
hereon.
��®ate' Dated at Anchorage, Alaska
EASEMENTS OF RECORD, OTHER THAN r� . this -26th day of JUNE 2018.
THOSE SHOWN ON THE RECORDED - �(%' 2�Zt�FRED WALATKA & ASSOCIATES, L.L.C.
PLAT ARE NOT SHOWN HEREON. FB 20-4, pg 16 Engineers and Surveyors
UNLESS OTHERWISE NOTED FB 18-3, pg 45 BE 907-248-1666
This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey
and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any
fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a
later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence Is discovered, the liability extent of the
preparer is limited to the amount of fees collected for services in preparation of this product.