HomeMy WebLinkAboutUPPER EAGLE RIVER ESTATES BLK 2 LT 2BOnsite File
Upper Eagle
River Estates
Block 2
Lot 2B
#050-781-13
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Pem-iit Number OSP201076 PID Number, 050 78113
Dwelling: H Single Family (SF) El with ADU 0 DUpleX (D) ❑ Two Single Family Project: El New N Upgrade
Name
Sullivan
ABSORPTION FIELD
R Deep Trench El Wide Trench R Bed F-1 Mound
SiteAddress
20136 Raven Dr
El Other
phone
Nurnt)er of'Brooms
_Soil Pating
1"row depth from original grade
688-2510
4
GPDYSFI
Ft,
LEGAL DESCRIPTION
Depth to pipe iri'vert from original grade
Ft.
Gra,.,el depth beneath pipe
FL
Subdimsion slock Lot
Upper Eagle River Estates 2 2B
Ft.
Gravel lerrgth
I Ft,
Towrzhip R tion
GrTiel Yfidth
Ft.'
16,ed&Nurnberodine
-
Distamebebrmerfir�5
- Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Hokfing,
Sewer
Total absorption area I
Number of trerch es
Dist- be-tviTa—en trenches
From
Tank,
Fie -Vi
Tank
Line
Fe
Ft
Well
JOQ'+
na
na
25'x-
TANK 4 Septic [I S,T, E,P. El Holcing [I other
Manufacturer
1,r
ceps*-.*
12 a0
Surface V;ater
100'+
na
na
Material
Nvm o er of com Pa rtme nis
Lotbre
10'+
na
na
NA
Plastic
2
Fouri - =-t io r,
10'+
n ai=n
a
loo.0
LIFT STATION
llantJacturer
C2P2CJtY
', I
Remarks Septic Tank Replacement- Cleanout
Gat.
addedbefore t nl
t rrr I t
Bectric-al mtalted by
Tan, k to
PIPE MATERIAL D 3 0 3 4 &4d D 3034
Dean
�_rajr
bra ii-fietc c o,7.TT D 30'
SENCH MARK (Assad etenration,,, 100 ft
tr tion vx 514r_70 5112120
L �xcatw, ard. descrptior�
tes 2"?
Front Door Landing
ON-SITE WATER AND WASTEWATER SECTION APPROVAL Ergineers:SMrp
Conidftional Approval- to
x(
A
Steve Eng
01
CE -62W
Septic Systemm
UtiVLU,, A�o
Approved Date
Note. this approval doenot include weil permit requirements-
__ _, 3- _T ft. �, I "'k k
Raven Drive
5I % Sl Tope
I 1
d
M
Q
1<
Well
AS -BUILT
MEASUREMENTS
A
B
dcol
46
33
ST1
43
37
ST2
40
42
dco2
38
44
R10
10' Utility Easement
L7A Septic
NOF? THRIM
ENGINEERING
SteveEng. com
PO Box 770724
Eagle River. Alaska 99577
907.694.7028
* :49Iki.� •
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Stm
-62M ;
5�1•9%2V
5I % Sl Tope
t i
3 BdrmNew 12 0 Gallon
Septic Tank w/DC❑'s
dcol L3 -A1 Well
ST1 Over 100'
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UPPER EAGLE RIVER
ESTATES B2 L2B
WASTEWATER UPGRADE
REPLACE SEPTIC TANK
RECORD
LAYOUT
5/19/20
1" = 40'
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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: OSP201076
Work Type: SepticTank Upgrade
Tax Code Number: 05078113000
Effective Date
Expiration Date
Site Legal Address: UPPER EAGLE RIVER ESTATES BLK 2 LT 2B G:0056
Site Mailing Address: 20136 RAVEN DR, Eagle River
Owner: SULLIVAN KATHARINA
Design Engineer: NORTH RIM ENGINEERING
This permit is for the construction of:
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
gent S,
�o�'
Dehal'tnient
4/28/2020
4/28/2021
Lot Size in Sq Ft: 51246
Total Bedrooms: 4
❑ 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.
ither:a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: '0410 Nv ea5ce+en
1. The well may be in an easement on the west side of the lot. I am checking with the municipal surveyor. A
Letter of Nonobjection from the utility may be required.
2. The existing fields may be within 1 00'of the well. A waiver may be required prior to IR approval.
Received By: Date:
Issued By: Date:
MUNICIPALITY OF ANCHORAGE
Development Services Department ^ �/ Phone: 907- 9 4
On -Site Water & Wastewater Section Fax: -
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 050-781-13
Property owner(s) SULLIVAN Day phone 688-2510
Mailina address 20136 Raven Dr
Site address same
Legal description (Sub'd., Block & Lot) UPPER EAGLE RIVER ESTATES BLK 2 LT 2B
Legal description (Township, Range & Section)
Lot Size 51,246 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
(® all that apply)
Absorption Field
❑
Septic Tank
0
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
D
d IJI\ lJ AUL
ti
� w
<<` 9C5�
OlSg(,
APPLICATION IS AN: TYPE OF DWELLING:
Initial ❑ Single Family (SF) El
(w/wo ADU)
Upgrade ElDuplex (D) ❑
Renewal EJDuplex
Dwellings ❑
(SF and/or D)
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signer of property ownerylr authorized agent)
Permit/Rush Fees: W -d -U f 6(O b ;1"J
Date of Payment: d2T Z
Receipt Number/: 6q? `b
Permit No. (-SPgb
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
COVID-9 9
�7 7, DISCOUNT APPLIED
;STI-'�' ISM --
ENGINEERING SteveEng.com
Date: 4/24/20
To: MOA On -Site Services
Steve Eng, PE, PH
907-694-7028
SteveEngPE@gmail.com
Number of Pages:
Subject: Upper Eagle River Estates Block 2 Lot 2B
Septic Tank Failure
The subject septic tank has failed- a new tank will replace the old one. The existing trench appears
to be working OK. Please issue a permit so the tank can be replaced. The existing trench will
remain. Please review as soon as possible.
If there is need for additional information or clarification please give me a call.
Thanks -Stec
ENGINEERING Upper Eagle River Estates Block 2 Lot 2B
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is an existing 3 -bedroom home; the existing septic
system is sized at 4 -bedrooms. Most of the neighboring lots are developed. The current
septic tank has failed- the trench still functions. This lot is over an acre and served by an
existing well. No adverse impacts are expected from tank replacement. The easements are
depicted on the lot. The slope is indicated in the area of the septic system. No conflicts to
neighbor properties, but very limited room available.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
• New 2- compartment, 1250 gallon septic tank. Watertight couplings on inlet & outlet.
• 5' minimum between the tank and trench. 10' to property lines & house.
• 4' of cover or insulation is required for tank; an equivalent of 1" insulation for F foot
soil cover. Tank & solid pipe must be set on well compacted, stable soil.
• No large rocks for tank bedding. Plastic/fiberglass tanks require special bedding per
MOA- sand or pea gravel.
• 4" diameter cleanouts with airtight caps are required F to 4' from foundation wall,
prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent
opposing cleanouts between the tank and the absorption field, not more than 10' from
the tank positioned to provide cleanout access towards the tank and towards the
absorption field.
• All cleanouts must extend to at least ground level.
• If no foundation cleanout, add double cleanouts prior to tank.
• In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
• Insulation must be placed over any pipe installed under driveways or parking areas.
• Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
• Sewer Service Line is minimum 2% slope.
• Septic Tank to be pumped every two years or when required.
• Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal)
Raven Drive
5% Slope
I l
1_7A I Septic
NOR THRIM
ENGINEERING
SteveEng. com
PO Box 770724
Eagle River, Alaska 99577
907.694.7028
UPPER EAGLE RIVER
ESTATES B2 L2B
WASTEWATER UPGRADE
REPLACE SEPTIC TANK
1" = 40'
DESIGN
LAYOUT
4/24/20 12 of 3
DESIGN NOTES:
1. Existing Trench Remains In Place.
2.
Sewer Service Line minimum 2% lope.
3.
Replace Septic Tank/Decommission Old
Tank Per UPC.
d
Connect New Tank To Existing Trench.
<
4.
Lots Served by Private Water Well.
�
5.
No Conflicts Within 200'.
kP
6.
Check Condition Of Sewer Service Lire—
Replace If Necessary.
7.
Measure Separation Prior To Construction.
8.
Add FCO or DCO Prior To Tank If I FCO
Absent. 5% Slope
9.
MOA Spec For Tank B dding/Riser.
Sand Or Pea Gravel o Plastic/Fibe
glass.
I
3 Bdrm Decommi
Sion ❑ld
Septic
Tank
PER qPG
I L3 -A1 Well
Over 100' J
New 6,50
I Gallon
Septic
Tank w/DC❑'s
Well
R10
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Utility Easement
0
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1_7A I Septic
NOR THRIM
ENGINEERING
SteveEng. com
PO Box 770724
Eagle River, Alaska 99577
907.694.7028
UPPER EAGLE RIVER
ESTATES B2 L2B
WASTEWATER UPGRADE
REPLACE SEPTIC TANK
1" = 40'
DESIGN
LAYOUT
4/24/20 12 of 3
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ANCHORAGE AREA BO[.,JGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
NAME C~
LOCATION
SEPTIC TANK:
DISTANCE
FROM WELL ~/L,~/'~
INSIDE LENGTH
REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LEGAL
DESCRIPTION
MATE R I AL
LIQUID DEPTH
L.NSPECTION
MAN U FACTU R E R ~/~v¢.¢
INSIDE WIDTH
NUMBER OF
COMPARTMENTS '~-
LIQUID CAPACITY (~"-~Y-)GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL FOUNDATION
NUMBER OF LINES L/ DISTANCE BETWEEN LINES
ABSORPTION AREA ~~/~" SQ. FT. LENGTH OF EAO. LINE
DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE
NEAREST LOT LINE
TOTAL LENGTH
OF LINES
· TRENCH WIDTH IN. TOTAL EFFECTIVE
IN. ABOVE TILE IN.
WELL:
TYPE
BUILDING
FOUNDATION__
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST NEAREST SEPTIC
LOT LINE__ SEWER LINE __ TANK
OTHER SOURCES
DISAPPROVED REMARKS
DEPTH
SEEPAGE
SYSTEM
DISTANCE FROM:
DISTANCES:
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE:
REMARKS:
DIAGI SYSTEM
G.A.A,B.
Form LQ-032
iu' i' { J. I..., .H.,! I
L.. FliP-.fIji
{_iF:'F'tii]t;~: Eil;::li]Jit...!J~] { . J. , Ix, . ~i~J:']' L(:l'l' ~: ]' ? ::'
'iJii'i~ I:;?.Eii(i:!I..I];Fi:tJE:, .;i~i?'.{Z ()l: 'T'HE SCi;IL. FlE'Zif'/i:?P'i"]'r'll~-J ........ ............. r: iL:Il ]:'JE;:
'llllii] I..l~:l'-.lCi'ttI i::;,IHIiEI'-,ISZ!:C:IN tJ]i; TI.it:El L[J;I'-,ICi'TH (]:i",l i: i~;El:E-I" :;, CiF "I"t'{D: Ft:;i:lif:l"J(];I..t C]I:~'. E;,I:;i:I:::I:i:NI:::':[IEI_.D.
i'!lli] i::,EF:'I'~I CiF i::1 TF:i:[:ZhlCH OIq: P]]T ]Z'Ji; THE D];STI::Ii'-,!CE E:ETkliZiEi'-,I 't'I-'IIE; ~!~;I..II:;;IFI:ICE~Z OF:' I't'IE]
(i:ii;J;Cii. JF,tD l:ff',!D 'iHiZ ~J:Ot"t'OF! OF "l-t~lt~J IE',:':;CI:IVFi-I';[ON (]iF,! I:::'EIZT).
'i I 'iE]F.~:[i~; ;~(;
I'li~; Ci!:;?.FIVI~]L I];,EI:::"i"H ][~:]; '1"1'11]~[ ~'I]1]1'.]]~I'i1_.1t'"1 DEF"I'H O1':' C)F;'.!::I',/IZL. EIETI.,!!FZIEF,~ THIE OUTI:::'I:::II.L i:::']tZl:::'i~;
F:iNiZ) ii'liE I~?,(:I't'TCH'"t
EE.['.,'IiEI:~: F::i i::t.lZl~;J~; ]: I:IF;]: ]:): t=',,St:: F:IFFFUZ.,IEE: I::I...I:::ll~'J'T I"lF:l"r' B~Z :[t",IS-t'FILI..ED.
MUNICIPALITY OF ANCHORAGE
Department of Health and Enwironmental Protection
SOILS LOG
PERCOI,AT ION TEST
Performed for Lee Sullivan Date PerfoKmed
Legal Description Lot 2~Block 2, Upper Eagle River Estates
9/2/76
o
2
4
6
8
]_0
]_2
~4
~6
~_8-
Gray-brown, silty, sandY2gravel (GM)
Perc rate = 225 ft. /bdrm.
Gray-brown, sandy gravel with some silt (GW) Perc rate = 110 ft.2/bdrm.
Gray-brown, silty, sandy gravel (GM)
Perc fane = 225 ft.2/bdrm.
Total Depth = 18 feet
No warier table encountered.
AVERAGE PERC RATE FROM SOILS LOG = 212 f%.2/bdrm.
Date Net Time
9/2/76 4 min.
16 min.
24 min.
39 min.
51 min.
121 min.
2O
Depth
10.75"
11.5"
12.25"
12. 625"
12.5
Net Drop
2.00 in.
4.25 in.
5.00 in.
5.75 ln.
6.125 in.
6.0 in.
210 ft. 2/bdrm.
minute s/inch
Percolation
Rate)~~ ~ - /I ~
I::'ER)9~ T NO.
DE.F'FIRI.'MENT C,''~,''~ E a _TH FIN ]:' E)'4V I RO[",IME)'4I.'FIL )* I'EC-I' 1 ON
2516 E. ,¢[.)OR F.'.D.., RNE:I4ORROE, RI'(.
276-;222::L
76450 )
FIF'PLICIqN'I.' I_EE SULLI'v'FIN PO BO)',; :.1..97 EF]GLE RIVER
LOC)II'ION RFI'v'EN LRNE
L. EGI::IL. ' "" '" '- ~
i L~:B,~: UF'F'E:R EFIGLE RI',/ER ESTFITE LOT =,Ie.E
54450 SDLIRRE FEET
T'¢F'E OF SOIL RBSORBTION S'T'S]"EM IS: TRENCH
),'IFIF:: I M UPI.
,.., - -, z. - -,
NJ['IE, EF OF E, Iz.[.[4. UU)tz, -
THE F::EI::.]I..I I RE):' .:,I ~E OF THE SO I L ~!E,.L~FJF.'F'TION S'¢_ TEi'4 I_.
/
THE LENGTH DIMENSIOt;4/.IS,~. ~ I.'HE LENGTH ,::IN F..E. EE:T) OF THE TRENCH OF.: [:,RRINFIELC,.
THE [:,EPTFI OF' R TF::ENCH OR F'IT IS.THE. /~;TBNCE BETWEEN THE SURF)ICE OF THE
I]I::::OUND RN[:, THE BOTI"OM OF TNE E,'~L. RVRrf'IO)'4 (IN
I.'NERE IS NO SET WIDTH FOR T)?.~[-,ICHES.
THE GRB'v'EL C, EF'TH ZS THE MINI'MLIM DEPTH OF' ~¢.¢/E-~.~'WEEN TNE OUTFFILL PIPE
FI,.,D OF
E ITI'..IER F, CLASS I OR II NSF Ft%F..'OV[{D F'LFI~-~BE INSTFtLLE[:,.
FI CON]'INUOUS MFtINTENFINC:E flGRE~~_ZREE:L tF R MR '4TENFINCE
FIGREEP'IENT iS NOT KEPT CLIRRENT "r'OU MBV BE REC]UIRED TO THE SOIL
HE,,_..F,I 9 .)..hi _, r_,'fEfi. HNE.,. UR %...J t~Mx E,E _,UB.JEI_.] TO
\
L. LH ..... t _,r_,lEi'l I_, U_,E[. l.llE LEI',I=IH t_, FEEl.'.
IF' Ft CLRSS II S"r'STEM IS USi YHE LEI'gOTH 0 FEE1''.
E:FICI<FiLLING OF' RNk' S"¢SI.'EM WITHOUT
DEPFIRTMENT WILL BE StJBJECT TO
RND RPPROk THIS
MiNIP1Lli'4 DISI.'FINCE BETWEEN FI WELl_ laND ON-SITE
±00 FEET FOR Fi F'RIVRI.'E WELL. OR 200 FEET
SF'ECiF'ICRTiONS FIND CONSTRUCTION [:,IRGRBMS
I NSTRLLRT I ON.
DISPOSBL TEN IS
WELL.
l'O INSURE PF ]PER
I CER"I'IF"? I'HFFF
:l.: I Ri'q FRNIL. IFIR WITH THE REQLIIRE)'IENTS FOR ON-E SEWERS RND WELLS RS SEI.'
FORI.'H B9.~ ]'HE MUNICIF'FtLII""/ OF' BNCHORRGE.
2: I WILL INSTFILL THE S'T'STEN IN FICCORDFINCE WITH THE CODES.
}J:: I U)qDERSI.'FIND THRT THE O)4-SI'f'E SEWER S'.r'STEM MR")' REL::!UIRE ENLFIRGEMENI.' IF TWE
RES I~C~;_~,,. '7/'~- REMODELED TO I)'4CLODE MORE TNBN 2~ BEDR00i'4S.
FIPFLICFINT /l(~ SULLi','tqN
'O~E
Russell Oyster
694-2774
Soils ~- Foundations
Performed for:
Legal Description:
Depth (feet)
GEO , ECHNI CAL
DEVELOPMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
SOIL LOG
Ear/Ellis
688-2280
Land Development
Tel. ,e. 4q J-' ?_~i~
So11 Characteristics
o
2
6
7~
8
lO
11
12
14
,0
15,
Ground Water Encountered: Yes No ~/ If yes, what depth
Proposed Installation: Seepage Pit Drain Field /
Comments: '~,~ ~J~-'~v,~<~/~ ~<~o~,~%~ e_._F ~%' ~ ~ ~
LOG OF DRV~.I'NG 'by A & L DRILLI'~G. C~AN'Y
OWNER OF LAND _. ~&C'~ ............... ~EPTH OF WELL .. /.P.~.-:: ........................................... ;~'
~ss _~_~.~ .................... 4 ............ ~_~.._Z.~:..~t~~ '~z~ 7~ '
~ R ~ s~c n~v~n o~ w~¢s~ re ......................................
~ ; .
DRAW DOWN FT .................................................................
GALS. PER HH ...... '~--?--~ .................................................
KIND OF CASING
FROM ......... --~-~... ......... FT. TO....::~ ............. FT.----f~- ¢~ '~ FROM ........................ FT. TO ........................ FT ...............................
, . , ~,,~,~
- '% -~ /~' =,., '~/~)~':]~'.~.Z~..~l~' m~'FROM .............. FT TO ........................ FT ...............................
FRO M._.__.~_~.. ............. FT. ~.'~' ....... ~' .............. ~*.--'~' .....................
FRo~..._..../.:,~..'t ........ F~. TO...-:--3t~: .......... FT..N. Zf_m~:~.~.~~'~'r FROM ........................ FT. TO ........................ F~ ...............................
3~ To ...... ~:~ ......... FT.....C_EZ,~L~,~?~_ ,,, Z?,~,~,o~,¢~- --
FROM........... ~, .......... FT. FROM ........................ FT. TO ........................ ~'T ...............................
~"' ~'~ TO )/~'~' FT'~ :~F'o 0 ~ (':~ ~/~/'~J'¢'" FROM ...................... FT. TO ........................ FT ...............................
FROM ........................ FT ............................................... '-
FROM---..~-:~. ............ FT. TO.._.r~". 'J) ............. FT,~,~--C/~ZI.~----~.'-:~-~?IJZ' FROM ........................ FT. TO ........................ FT ...............................
........... .., ~ . ~,,47~'~ 7~'?'w'
FROM 4~~' .. FT TO....~"-~'---~-------:---FT.-5-~-'~f~-!?'''''~''~:~'~'V~-~' ~ FROM .................... FT TO FT ..........
FROM ........................ FT. TO ........................ FT .............................. FROM ........................ FT. TO ........................ FT ...............................
MISCL. INFORMATION:
DRILLER'S NAMR /"~<" .~-~-.~ : -i---~- .........................
PERMIT NO.
l'ILIl'-,I TiE_: T PAl.__ 1' "F'-r" i-iF
DEPARTI'tEHT ,~ HEALTH AND ENVIRONi'IENTAL ,~p.'OTECTION
2510 E.~ UDOR RD., ANCHORAGE, AK. f' '~;07
L.~ELL F'ER~'~ I T
( 76242 )
~PF'LICANT LEE SULLIVAN P 0 BOX i~7 c._.4 c~,~,
LOL. MFILN ,,~R',,,'EN ST
LEGAL L.2t~I;~B2 UPPER EAGLE RIVER ESTS L. OT SIZE 6~000 SQUARE FEET
HINIMLIH DISTANCE BETWEEN R HELL AND RN'.r' OM-SITE =,EHFIaE DISPOSFIL .=.'?'S]'Ei'I IS
i00 FEE']' FOR R PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL.
WELL LOGS RRE REQUIRE[) RI".,ID i'IUz. T BE RETURNED TO THE DEPARTI'4ENT WITHIN ,E:D DRYS
OF THE WELL COi¥1F'LETION.
~PEC. IFICATIuNS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
iNSTALLATION.
IF' E [";-:.' f-1 I -r "..-"AL I P FC, R ONE
I CERTIFY THAT
l: I RM FAMILIAR WITH THE REQUIREMENTS FO SEWERS AND WELLS RS SET
FORTH B9 THE MUNICIPALIT9 OF ANCHORAGE.
2: I WILL I~TALL THE SYSTEM IN ACCORDRfm~e ~J~ THE CODES.
I ":;c;UEO ........... E ...............
COSA Checklist yellow sheet
COSA Checklist
Legal Description: Parcel ID:
If more than 1 septic system on lot: COSA Checklist # of 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 of Sample
Comments __________________________________________________________________________________
B. TANK DATA
Age of tank(s) years
Tank type/material
Measured operating fluid level in septic tank
Standpipes/foundation cleanout per record drawing
Date of pumping
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
Monitor tubes go to bottom of effective. If not, state
depth into effective
Code-required soil cover over field
System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Adequacy test date
Results Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
Comments/Deficiencies:
Upper Eagle River Estates B2 L2B 05078113
6+
11/10/76 0
101
101
0.8
18+NRimEng
9/23/19
77
4/24/20
new
GreerPlastic
new
new
10/12/76
same 5/12/20
4
11 6
5 600
15
60
8
600
no
✔
,' DATE RECEIVED
(NSPECTION APPOINTMENTS,. ~L~L~[~-~L~(-~ ~ ~
TIME TIME ~ .r,l,~I} TIME
DATE
DATE
DATE
INSPECTOR INSPECTOR INSPECTOR ~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~ICJPALi~ OF ANCHORAGE
825 L Street- Anchorage, DEPT. OF HEALTH &
Alaska
99501
ENVIRONMENTAL PROTECTION
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 0CT 6 1980
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW~~
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
MAILING ADDRESS
PROPERTY RESIDENT (If different from above) PHONE
MAILING ADDRESS
PHONE
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS
[] One [] Four
SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY ~ Three [] Six
[] Other
7. WATER SUPPLY
~ INDIVIDUAL* * ATTACH WELL LOG. A well Icg is required for all wells drilled
[] COMMUNITY since June 1975, For wells drilled 'prior to that date, give well
[] PUBLIC UTI LITY depth (attach Icg if available.)
8. SEWAGE DISPOSAL SYSTEM I~ INDIVIDUAL/ON-SITE** //~2.~/,:,~...-~'~a' YEAR ON-SITE SYSTEM WAS INSTALLED.
~ PUBLIC UTILITY
NOTE: THE INSPECTION FEE ~UST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) ~ ~
L
' THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
~31NDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified iNSTALLER
[]Septic Tank or [] Holding Tank
Size: if Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
~APPROVED FOR ~"~ BEDROOMS
[~] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY
72-010 (Rev. 6/79) "' ':