HomeMy WebLinkAboutT15N R1W SEC 8 LT 33 PTN
•
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 V MAYPage2 op#
ON-SITE WASTEWATER INSPECTION REPORT 11��
Permit Number: cJS P/7 1 6 4 et PID Number: QST 0'005"
Dwelling: Q'Single Family (SF) ❑ Duplex (D) ❑ Multiple(SF and/or D) Project: ❑ New Upgrade
Name: S'7/
STA- (41/A(C , R ABSORPTION FIELD €X t .c,(6
Address ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
2 f.S/i S lRcFfu oat Lad? ❑ Other
Pho ��-3 7 ro Number of Bedrooms Soil Rating Total depth from original grade
7 GPD/SF Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot Ft. Ft.
Fill added above original grade Gravel length
Township PIN/ c
Range Section p� Ft. Ft.
l / im (� L..3, PIN 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 /0014- /00 /f, -- , a 5+TANK Septic ❑S.T.E.P. ❑Holding ❑Other
Manuf`actt/�rerr �i / Capacity
Surface Water 00 /�loci �.r 4/Vl-i�`O,4 C6 74 / jOGal.
Material �� Number of compartments
Lot Line 16 /U�r - - ST6—_C--
I NA
i r LIFT STATION ikf hi
Foundation !G T- r p rt
Manufacturer Capacity
Curtain Drain 1. f k LiA,k - r Gal.
Remarks ,t J/> 2leik if C hump on level at Pump off level at High water alarm at
'vl'`� l� in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank 46.17t;010
Tank to]1����,,,3(f
Installer / drainfield 630
bmfri
Drainfield ex(S T7N(CO/MT 0y
Inspector 1/4 , /,/ Er, BENCH MARK (Assumed elevation) (""(.3(""(.30 ft
Inspection 1.c J 2n° / � Location and descripti i2 ncre L4.6
dates: ( �
3rd 4m
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL End'/ers,Siv*
- O 4..f Ali
Conditional Approval: Date ��� �•~•
° •�•'15:_
a 1? S.
t`' ' Steven W.Eng ,`;�,Qr
J'•'. P 655 ��i,rs
Approver � Date ^t I at 4'0PRRoFES ,,.;a`'
Inspection Report_9-1-12.doc
•
50' Easement
494, Decommissioned Did
c
h Septic Tank
w°da-4° — — °E17,--UPC — — — — — —
O,0
Ra Existing
Trench c
E
Flat ANor
E
�
Slope `c W
0
If,
A Flat
-mow _ NT Slope
A
v New 1000 Gallon
o eptic Tank w/DCO's
3 Bdrm �`O
B
Well Flat
Slope
R101 1
AS-BUILT MEASUREMENTS
A B
ST1 16 50
ST2 21 51
DCO 27 53
t,'; +° ` r
1' = 50'
-,7,....\- ' T15N R1W SECTION S
/ORTHR1M NGINEERING 49m _ LOT 33 PTN 'RECORD
20 Box 770724 ,;;a» LAYOUT
1 River, Alaska 99577 i N a I' WASTEWATER UPGRADE
)7.694. 7028 sfr (7 ' REPLACE SEPTIC TANK 429/17 12'�Tof 3
Foundation Cleanout Elevation @ 100'
Tank Cleanouts Elevation @ 94'
Fin ade Opposing Cleanouts Between Septic Tank & Trench
4 Foot Cover
or Equal
Elevation @ 93.5'
r—�
1000 Gallon Steel To Trench
levation @ 99' 'Anchorage Tank' Ele : tion @ 93.3'
.lid Pipe
Matched Elevations To
Existing FCO & Line
OF k
NORTHRIM *49m SEPTIC TANK RECORD T15N R11/1SECTIO\ 8
ENGINEERING 1*
+ SOT 33 PTN
PO BOX 770724
Eagle River, Alaska 99577 ++t . rt-Yat
~ MUNICIPALITY OF ANCHORAGE
, e } '~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-472(}
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
~NAME ~ ~ ]~ , ~NEW
LEGALMAILING ADDDEsCRiPTiONZr~ / ~>X 2~, ~ ? ~/r~ }¢~oo,,
LOCATION ~ B/*" J ~O* ~ O/ DwellinT¢ 5~ NO. OF SEDROO~
DISTANCE TO:
Manufacturer
~ ~fee~ ~a~ /' No. of compartments
Liq. ca cit 'n ~ Ions IF HOMEMADE: Inside length Width Liquid depth
0 Z ~ Manufacturer Material ~quM capaciW in ~allons
~ ~ ~ Top of til~ f~is~rade I ~t~rial~'/'~e'e~?' ~tite inchesinChes Total e, f ec~b~ption
Length Width Depth PERMIT
~ P Type of crib Crib tel effective absorption area
m Well Building foundation Nearest lot line
¢ DISTANCE TO:
~ 31ass~V ~ ~.'~ ~t~'~-- Driller Distance to lot line PERMITNO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO;
OTHER '~" ~, ).¢' "~,~ ~'~
AR R " ~ : DATE ~ LEGAL
(0~3 (Rev. 3/78) ~/f
MUNICIPALITY OF ANCltORAGF
Department _,f Health and Environments Protection
825 L ~treet, Anchorage, AK. 99501
264-4720 ~ \
* * ~l. I-IANDWRITTEN PERMIT * *
WELL AND/OR ON-SITS[ SEWER PERMIT
.- .......... ..........
?ype of Soil Absorption System Is:
Trench: Drainfield: ~ __._
~aximum Number of Bedrooms: _.,~_ Soil Rating(sq.ft/br) ___
The Required Si~of,the Soii ~sorption_ ~ System Is:
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a treDch 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 tile minim~ depth of grave], between the outfa[L1 pipe and
the bottom of the excavation(in feet).
~ * REqUIReD SEPTIC(HOLDING) TANK SIZE = .~. ~.'-_:~ GALLONS
!rmit applicant has the responsibility to inform this department during the
lstallation inspections of any wells adjacent to this property and the number
~ residences that the well will serve.
* * '~ TWO(2) INSPECTIONS ARE REQUIRED * * *
~ckfilling of any system without final inspection and approval by this department
Lll be subject to prosecution.
Lnimum distance between a wel~ and any on-site sewage disposal system is 100 feet
>r a private well or 150 to 200 feet from a public well depending upon the type
~ public well. Minim~ distance from a private well to a private sewer line
~ 25 feet and to a co.unity sewer line is 75 feet. Well ].ogs are required
~d must be returned to this department within 30 days of the well completion,
:her requirements may apply. Specifications and construction diagrams are
/ailable to insure proper insltallation. ' ....
~ * ~ PERMI'F EXPIRES DECEMBER ~1~ 1 9 ~ 1 ~ ~t
I certify that:
(1) I am f~iliar 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 enl. argem~t if
the residence is remodeled to include more that 3.~bedrooms.
Signe~: ,~ZL~.~t~ .,,:~¢~ Issued by: _.[~-, .....> _[[~.~_ 2~ _-
App ]_ic an& '" / ""
Date: , .
SWP/024 (l/S1)
MUNICIPALITY OF ANCHORAGE
Department : Health and Environmental 'rotection
82!3 L SEreet, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * * *
WELl AND/OR ON-S~IT. LE SEWER PERMIT
Type of Soil bsorption SysteI~ Is:
Trench: Drainfield: .~_ Seepage Bedl ~ Holding Tank:/~2~
Maximum N~ber of Bedrooms: '~ Soil Rating(sq.ft/br)
/
The Required Size of the Soil Absorption System Is:
DEPTH ~A~' ~-' ' -
LENGTH _ ~)~- GRAVEL DEPTH ~P' ~; ¢~F WIDTH ~]
The length dimension is the ~ength(in feet) of the trench or drainfield. The
depth of a %rench or pit is ~he 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 mini~ depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HObDING) TANK SIZE = /~-~'Z)GALLONS * *
Permit applicant has the responsibility to inform this department, during the
installation inspections of any wells adjacent to this property and the number
of residences .that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution~
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 2~0 feet from a public well depending upon the type
of public well. Minim~ ~istance from a private well to a private sewer line
is 25 feet and to a con, unity Sewer line is 75 feet. Well logs are required
and must be returned to this d~partment within 30 days of the well completion.
Other requirements may apply. :Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 3~ 1 9 8 1 * * *
I certify that:
(1) Z 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 th~ on-site sewer system may require enlargemest if
the residence is rembdeled to include more that 3 bedrooms. '
~/ Issued by ~ ,
Applican~
SWP/024(1/81)
SOILS LOG
~O-% MUNICIPALITY OF ANCHORAGE
i(e~e~ D I-'P ART M ENT OF HE A LTH AND ENVIRON M ENT AL PROTECTION []TEsTPERCO LATION
'/~ 825 b. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:_ /~"~Y'/~ q-' -- ~/~¢ DATE PERFORMED:
SLOPE SITE PLAN
2
5
6
7
8
10-
11
12
13
14
15
16
17
18
19
20-
ENCOUNTERED? 0
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
i
I~ERCO LATION RATE
(minutes/inch)
COMMENTS
TEST RUN BETWEEN
PERFORMED BY:
CERTIFIED
72-008 (6/79)
FT AND ---- PT
~une 6, 1972
~reater Anchorage A~ea Borough
3500 Tudor Road ~
Pouch 6-650
Anchorage, Alaska ~9502
Department of EnvirOnmental Quality
Reference yourlette:~ of 12 May, 1972.
Sub Ject:
Governmen'~~-~L°t 33, --~---~.-,Secti°n 8, ~.5~N~Ri~
The changes to the Well required by tha referenced letter have
been completed.
If I were going to continue to live in the house, or if I were
going to hold the m~rtgage, I would not have made thesa changes.
The fact that the b~yer could not obtain a VA loan without
Borough approval of Ithe system forced me to comply. This letter
is to inform all persons who are or will be involved with this
system that I have ~o responsibility for it.
The system you have~odified was in service since 1960 and was
completely trouble f~ee. The system as now constructed will
freeze. I have preplared two sketches showing conditions which
will prevail during a typical winter. Sketch 1 shows the sys-
tem as it was beforei. Sketch 2 shows the system as now modified
and Borough approvedi. You will note that I have assumed a depth
of frost of 6', and hn outside temperature of -30 degrees Fahr~
enheit. I'm sure yolu will concede that these are likely to
occur. In fact, there are times when a depth of frost of nine
:feet occurs, and temDeratures below -30 F are not uncommon.
With a well and septic tank system it is not feasible to leave
the water running toiprevent freezing. Heating cables are ex~
pensive and usually Fail when needed most. With below zero tem-
perstures surroundin~ the well, freezing is assured. You may luck
out for several years, but sooner or later the right combination of
light snow and sever~ cold will push the frost line down and 'the
well will freeze. NOte also that when the well freezes you
will be under pressuhe to make repairs immediately. The same
conditions which caused the freezing will be affecting the
Harry Hoerter
P. 0. Box 270
LaGrande, Oregon
Government Lot 33, Section 8, T15Ns
Page 2 of 2
septic tank, and about 3 days without a daily influx of warm
water should be sufficient to freeze it, too. This will be
your responsibilityI- you can hsrdly ask a contractor to stand
good for a septic tank which has been allowed to freeze.
When this oeeura, I!hope that there will be some way the new
owner can get financial relief. I feel if the Borough is going
to design and approve sewer and water systems, they should stand
liable for failures~
97850
cc: Mr. Staudinger
Ralph Doyle
Smiley's Realty
HH:lw
~J ,4./JeJ
,5'Z-elc,6 2. ,4/, ,Yea&'
I
I
GREATER ANCPIORAGF' AREA BOROUGPI
:9~5OO TUDOR ROAD
POUGH
JANCHORAGE, A LA~,~KA
:DE:PARTMENT OF ENVIRONME:N'FAI.:'QUALIT¥.~
M~y 12, 1972
HArry Hoerter
P!O. Box 1086
Eigle River, Alaska,
S ect. Government
Dear Mr. Hoerter:
Lot 33, Section 8, T15N, R1W
The well serving the subject property is located in a pit.
Before this Department's approval can be given for the
system, 'the well casing will need to be extended to at
least ground level; The pressure tank and other related
equipment located in the pit will need to be relocated
a~d the pit filled!in with dirt. The sewer system is an
a~proved system with the proper distances from the well.
If you have any questions regarding the above, please do
n~t hesitate to contact this office.
S~ncerely,
Efivironmental Specialist
c(t: VA Administration
Hay t,,, 1972
t,,,~an F:h;ara '¢y Office
A)l(:horaq() Alas,: '1
Lynn Coad
Envi roJ~mc, ntal S?eci~ltst
bh
cc: Harry )toerter
8;
GREASER ANCHORAGE AREA BOROUGH
Daparblent of ~nvironmental Quality
3500 Tudor Road Anchorage.~ Alaska 99507 279~8686
Da6e Received ~..
Time of In~pecBion
Date o'f ~nspec~ton
REQUEST FOR APPROVAL OF
INDIVIDOAL SE~ER a ~ATER FACILITIES
FOR
Aoproval Requested By~ -a
Address ~ [ Phone
Prooerty ~mer:
Legal Descripfiion:_~ ~ __~~
Tyoe of Facility to be Im~ ~ected:
Number of Bedrooms~ ..... ~. -
~el] Data
A. Type .........
C. Construction
Sewage Disoos~l System:
3eptlC lan~. -[- ~..zz .... - .....
I
Disposal P~eld: Total Length of Lines
Depth
gacter~a Analysis
Distances:
A. Well To~ Septic Tar
, Nearest
B. Foundation to Septi(
C. Abserption Area to
k_~O , Absorption Area , Sewer Lines
Lot line ~¢p 2-~ , Other Cor, tamination~_-7~,i
Tank -~P "~ Ab§Orption Area ..... ·
:az'est Lot Line ~m <
Request for Approval of 1 .
Page ,'r~o
idual Sewer & Water Facilitie
Approw~] Va
Greater Anchorage Area
I certify that the informatio~
and accurate representation ol
~sapproved
lid for One Year Frem Date Signed
Borough, Del~rtment of ~nviro~menta] quality
DIAGRAM OF SYSTEM
contained in ~his request for approval to be a true
the subject sewer and water facilities located at:
Signed Date
GREATER ANCHORAGE AREA BOROUGH
!
DEPARTMI:NT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANI:HORAGE, ALASKA 99507
279-8686
EQUEST FOR APPROVAL OF
INDIVI[UAL SEWER AND WATER FACILITIES
FOR
APPROVAL REQUESTED
ADDRESS:
PHONE'.
O A T E R E C E I V E D :.__~;2 ,/9
INSPECI':
LEGAL DESCR]'PTIgN:~Z()~ ;:/,~ //~Z'~/?j//~/}~.~'/d.~7/}
TYPE FACILITY TO BEi INSPECTED:
NUMBER OF BEDROOMS ~.~,7-
5. WELL DATA:
B. DEPTH
C. SIZE (:
D. CONSTRUCTION
E. BACTERIAL ANALY
6. SEWAGE DISPOSAL SYS
rEM:
SEPTIC TANK (If: HOMEMADE, SHOW DIAGRAM ON BACK)
- ~I 9, ,:. ,~.;., ' ~'~'"'~,~
3.
4v .. :
APPROVAL REQUEST
PA~GE TWO
B. SEEPAGE PIT
SEWER
& WATER FACILITIES
1. SIZE
2. LINING
DISPOSAL FIELD
1. NUMBER OF 'L~NES
2. TOTAL LENGT~
REQUIRED MEASUREMEN'
A. WELL 'FO SEPTIC
B. WELL 'ro SEEPAGE
S
ANK
PIT
D. WELL 'FO PROPERT~ LINE
E. WELL 'FO OTHER P(~SSIBLE
CONTAMINATION
F. FOUNDATION TO Si
G. FOUNDATION TO Si
H. SEEPAGE PIT TO
PTIC TANK
EPAGE PIT
ROPER'FY LINE
APPROVED:
DATE:
APPROVAL VALID FOR
GREATER ANCHOR/
NE
D I SAP P ROV E.D :~',,.
YEAR FROM DATE SIGNED·
GE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY
~ebruarv 29, 1972
P..O. Box 4-443
Anchorage, Alaska 99503
$~sh.)ect: DLM Lot )33 Section 8, ?I~N~ R1W, S.r~.
Dear Nr. and ~rs. i)oerter:
An inspection of i:~e sub.Ject property was made on February
25, 197~. The well ~a~ located 4,t ti)c) b~some){~. ,Acco~di~g
to ou~ files, a fi)al lnspnctton was not made on' the
s),stem which was tNstall(~d (n lg7). OefoPo this Department's
well will need to ~)e upgraded and a final inspection will
nee~) to be mad) on)the ~wer s/stA, m by this Departme~t.
If you haVe any qubsttons regarding the ubove, please do not
hesitate to contacZ this
Sincerely,
Lynn $. Coad
E)~vtronment,~l
.Specialist
cc: VA Adm'l nl.~;tra :t on
Alaska Mutual Savtn!!~ Dank
t~! GREATER JANCHORAGE AREA BOROUGH
~ ,
,N,T,ATED BY: ~,, ~: ,C..kl,,.~,ra, DATE OF MEMO~ N'~U, 4 >t
-m/~ L ~ DATE ANSWER
Th r~ ~^OT~ ;~ ~"~Jt~414~' REQU 'STED
"FOR INFORMAilON ONLY I PREPARE BACK-UP INFORMATION
FOR IMMEDIATE ACTION CALL ME BEFORE YOU ANSWER
:, ] FOR YOUR CONSIDERA[ION NEED YOUR RECOMMENDATION
OTHER
20 October lC~?l
Greater Anchorage Area Borough
Att. Mr. R. Strlckland
D~ar Sir:
Transmitted are 15 copies of apr. opo-,ed plat, together
~!th'~25 to cover tho cost of preliminary review.
In our phone conversation of 15 October you sng[~ested I
bring this in on 22 Corel,er to dlscu:~s it wi th you. However
I wi±l be out of to~l then.
I am tho o~.~er of lots A and B. Lot C was sold as the
"south 120 fo,~t e~ th,TM. an;~t 190 f~,)t," before there wns a
borouzh. Therefore this is nn "after tho facb" subd~vlsion.
The hesse on lot C is o~.~od by a Mr. Hucktns. It has a 6
inch cased ~11 72 foot dg~p, and prod~ccs better than 5 gallons
per minute. The septic tan1< was put in by ~,lallace Concrete
Company cf Chugfak in 19f~9-and should be aporovcd by the
borongh. Thc house on lot A-mine-has au 80 foot woll-6 inch
cased-an~ produces ~tter than ~ gal.lons per minute. A ne~.~
septic tankwas inst~lled tn 1970 by Ralph Doyle contracting
company of Chugiak, and it also should b~ borough approved.
Tho buildin[~ on lot B ~s n snml~ frnmc ~ruc~mre ~.~ th
plomblng of any sort. /
I hope this will bo su~'Flcfont ~rmatton to start this
plat on its. way. Of course I nm~.~rs~arod to furnish any
additional data rcq~ircd.
]Tarry }[oerter Re~t'Bterod Civil En~tn~ r' '
P/. O. Box 439
cr. ugi~l:, A.laskn 9956?
Phons
:/
/
/
i DTI002437 ?
Municipality of Anchorage •t •
On-Site Water and Wastewater Program o¢r '<
e tl c (907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-091-05 Expiration Date: 0.- ' 17
1. GENERAL INFORMATION
Complete legal description T15N R1W Section 8 Lot 33 PTN
Location (site address) 21516 Birchwood Loop
Current Property owner(s) Staudinger Day phone 688-3750
Mailing address Same
Real Estate Agent Owner Day..phorie 688-3750
2. TYPE OF DWELLING: \(-'
® Single Family (w/wo ADU) E i ' t ,...,,/
❑ Duplex �,Q /,
❑ Multiple Dwellings (Single Family and/or Duplex) �„./
'\ rl\ ✓ '
\aag 1, aj"
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual El
Individual Water Storage ❑ Holding Tank ❑
Community Class C Well ❑ Community ❑
Public Water System ❑ Public Sewer El
Received by: ' Date: _5N/7
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 54e, Date:
Date of Payment 67( /I_)r Date of Payment
Receipt Number ao a -1CtO Receipt Number
COSA# t 6GI 9-1157 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 NorthRim Engineering Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 5/1/2017
of
q"l� oa°o•.s. •
.:
���° .
CPl '1 r� _i�1
6. DSD SIGNATURE 4^
System #1 Approved for 3 bedrooms. '`
System #2 Approved for bedrooms. Ste• W. i`'C y
Disapproved. p4 '�U PE- 25 ;
g ae .ur
ppOrts
Conditional approval for bedrooms, with the following stipula 'l aal-
\>--; OF Mt,
reC' /
ON-SITE '
WATER A
�ip,STEWATER o'
1-<„,
PROGRAM &.)
C�p4/,'C.Arr Sco�1���5
By: t�._� ' Original Certificate Date: 17
The Municipality of Anchorage Devlopment 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
Well Flow Advisory Other
COSA blue sheet 9-1-12 doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Cerrtu rucate of On-Site Systems Approval] Checklist
Legal Description: Z(.54(RANI (Sec_ & LST 13 ?rel./ Parcel ID:(J51 C9/6S
A. WELL DATA
Well type P If A, B, or C provide PWSID# Well Log (YIN) __ -
* Date completed /14 7/ Sanitary seal (Y/N) y Wires properly protected (Y/N)
Total depth gQ ft. Cased to 50 ft. 11 Casing height (above ground) 3 d in.
Pr 4404 f"(1.� FROM WELL LOG AT INSPECTION
Date of test — /a/7
Static water level r ft. 3 ft.
Well production g.p.m. 5 g.p.m.
WATER SAMPLE RESULTS:
Coliform O colonies/100 mL Nitrate /. mg/L
Arsenic w.8 ug/L Date of sample: 7/7 Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC .7_31` Date installed et/Z6�.7
Tank size /1(56-6 gal. Number of Compartments z Cleanouts (Y/N) Y
Foundation cleanout (Y/N) _ Depression over tank (YIN) Al High water alarm (Y/N)
Date of pumping Aj6 Pumper
C. ABSORPTION FIELD DATA
Date installed ?V?/f/ Soil rating (g.p.d./ft2 o ft2/bdr /O o . System type Arc/r
Length 5 C ft. Width ft. Gravel below pipe ft.
Total depth ft. Eff. absorption areaz/OCI ft2 Monitoring tube ' Depression over field A/
Date of adequacy test 9./a / 7 Results (Pass/Fail) P For 3 bedrooms
Fluid depth in absorption field before test Q in. Water addedf$O gal. New depth V in.
Elapsed Time: 30 min. Final fluid depth 6 in. Absorption rate >= e '5-0 g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N & type) Ai If yes, give date
D. LIFT STATION NA
Date installed Size in gallons Manhole/Access (YIN)
"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
WELL ON LOT TO:
r
Septic tankllift station on lot/ 56 � On adjacent lots /o a
Absorption field on lot /Cc 47 On adjacent lots J JO ("-
Public sewer main /06 1-7` Public sewer manhole/cleanout . /0 C.) jt
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Sewer!septic service line 04-) 1-folding tank 4�a
Animal containment areas 50 I'* Manure/animal excrete storage areas /CC
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation /Q 17 Property line /G (-1" Absorption field Pir
Water main / fI Water service line /a (I" Surface water /6°
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Wells on adjacent lots /U0 7--
ABSORPTION
ABSORPTION FIELD ON LOT TO:
Property line / G f Building foundation /C) Water main /a f
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/GI Service line / � Surface water lfJ6- '''"/".'''"/". <
Driveway, parking/vehicle storage
Curtain drain 0A-J( Wells on adjacent lots /CC (f
F. COMMENTS
G. ENGINEER'S CERTIFICATION = _
1
'
certify that J have determined through field inspections and
review of Municipal records that the above systems are in F
conformance with MOA COSA guidelines in effect on this date. f w i;~ =.-
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Engineer's Printed Name 775-U At.) C d,
Date 5/V/7
'Wilt 7 .
COSA yellow sheet_2-6-15.doc
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BLM La-3L BLit Lot 32 I I
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i 50' R,O.W. RESERVATIONS II I
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50' R.Q.W> SERVATIONS I�
N 90'00'001330.00' j
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/ R=100' PROTECTIVE II1
�LL RADIUS
/ • . GRAVEL- n
o ea °22.8 iii' `MAILBOXES
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/ g� 37 15.1r.. 29.6' m SEPTIC
ELM Lot 34 • t STORY RESIDENCE PIPES c9
4.2'x6.0' CHIMNEY w "' w/ DAYLIGHT BSMT. I 73
37.2 70.3' 16.1'x20.1'
11 STORY BUILDING Pi
Z.. N:42. w/ 7.1' LEAN–TO _�
1 WELL Im
4.1'x7.0' WELL HOUSE „ J S / N 90'00'00"W 190.00' Q
" POWER POLE
10.4'x20.0' DECK TYE WE of— I�
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CHAIN–LINK FENCE a
/ g THE SOUTH 120' OF THE
rn EAST 190' OF BLM Lot 3 IZ
LOT 33 — LESS o M_ h
THE SOUTH 120' o i
OF THE EAST 190'
1.9S Acres
N 90'00`00114/ 140.00'
50' R.O.W. RESERVATIONS
BLM Lot 59 I BLM Lot 60
PLOT PLAN AS BUILT X SCALE 1" = 50' GRID NW 1357 Project No. 17-088/A1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associatesinc . (907) 522-6476 Phone • �ppd
Associates , (907) 522-4625 Fax o O F `��Q��
Professional Land Surveyors kenOlangsurvsy.com o�,�C�, . p
jonathanOlangsurvey.com Q
a� R'.' l_ :.1-110
I hereby certify that I hove surveyed the following described property: Cr): 49-111 '‘ .�
BLid LOT 33 – LESS THE SOUTH 120' OF THE EAST 190', SECTION 8. T15N, R1W. S.M., ALASKA * *
Anchorage Recording District, Alaska. and that the improvements situated thereon are i f
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 0� •::' ;s•" •" •• � '4.
premises and that there are no roadways. transmission lines or other visible f/Vn c,
easements on said property except as indicated hereon. On-‘131%. 4' 17 �i
• .4.5-5208. cJ,
Dated this the Day of A•P t-« , -- , at Anchorage, Alaska 't1 "o .•• a
4p��o
it is the responsibility of the owner to determine the existence of any easements, "`14
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covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963