HomeMy WebLinkAboutT12N R4W SEC 10 LT 4 PTN (70' X 325')Onsite File T12N R4W :r -»;c a z, . m v TN 2115) MUNICIPALITY OF ANCHORAGE WATER & WASTEWATER UTILITY 3000 ARCTIC BLVD. PHONE:(907)564-2762 BLOCK/LOT/TRACT: LT 4 PTN/ SUBDV: T12N R4W SEC 10 TAX CODE: 01111103000 GRID: SW2224 STREET ADDRESS: 4803 W 80TH AVE Anchorage, AK 99502 OWNER: PARKER GERALD L & DEOBRAH M MAIL ADDRESS: PO BOX 221922 ANCHORAGE, AK 995221922 WASTEWATER CONNECT PERMIT z" I n � can S201322 DATE OF APPLICATION: 8/7/2020 SCHEDULED COMPLETION DATE: 12/31/2020 0 SINGLE FAMILY ❑ DUPLEX ❑ COMMERCIAL ❑ MULTI -DWELLING No. APTS 0 PHONE: CONTRACTOR: WILCO Contractors ASSESSMENTS ❑ Repair Existing Service Main Line Extension ❑/ On Property Only City Tap Have Been Levied ❑ Hydrant Only❑ To Be Levied i ❑ Main Tap - To Property Line Only Comments: ❑ Main Tap & On Property Connect f ❑ Disconnect Row No. ❑ R & R - Main Tap Only Owner iStairf CONNECT SIZE 6 in ISSUED WWMSR INSPECTION FEE $112.00 R] PAID ❑ CASH PERMIT FEE $77.00 [] CHECK RCC $1.69 \/ OTHER f, 'T '/ n REIMBURSABLE DEPOSIT $0.00 INSPECTED BY 1�'; I NUMBER TOTAL $190.69 DATE REMARKS PERMITTEE (Please Print) WILCO Contractors MAIL ADDRESS 16701 Ransom Ridge Anchorage, AK 99516 SIGNATURE EMAIL PHONE (907)345-6288 POST IN A CONSPICUOUS PLACE AT THE JOB SITE •/� -�� INSPECTOR COPY DATE 12/31/2020 TIME 12:00 AM INSPECTOR yam prG SCHEDULED SUBDIVISION T12N R4W SEC 10 BLOCK/LOT/TRACT LT 4 PTN/ INDICATE NORTH L{ BO -3 60 L), - 2 lL Fro n cur.+<✓ 41o..g� l C/o L- _3cA -3 cA 22o L4 7JC J. nn I "l' CoX � (zrU l`2� �q L. L— -- 2W EG?-. c + SIZE MAIN: TYPE MAIN: DEPTH AT MAIN: C AT PROP. LINE: CONNECT LOCATION: �29 Li Ga a n COMMENTS: l INSPECTED BY: DATE: Lo,,J, ,,c.,nr 37 ' .� �l" Svc, Fxis h� U" ceXL-( lrt�l�Lt✓ Bill To Gary Parker 4803 W 80th Anchorage, Ak. 99507 Invoice Item Description Quantity Rate Amount sales Installation of new sewrline with two cleanouts and deccommissioning exsiting septic tank per MOA standards and regulations. This estimate includes all materials,labor equipment and permitting. 9,759.00 9,759.00 sales Topsoil 240.00 240.00 $9,999.00 Date 08/14/20 Wilco Contractors 16701 Ransom Ridge Anchorage, Alaska 99516 Invoice No. 2042 P.O. Number Terms Due upon reciept Project Total Thank you for your business.Subtotal $9,999.00 Sales Tax $0.00 $9,999.00 MUNICIPALITY OF ANCHORAGE WATER & WASTEWATER UTILITY 3000 ARCTIC BLVD. PHONE:(907)564-2762 BLOCK/LOT/TRACT: LT 4 PTN / tv'1D' Y -,20�,' ) SUBDIVISION: T12N R4W SEC 10 Sand Lake Area Wastewater Extension TAX CODE: 01111103000 GRID: SW2224 STREET ADDRESS: 4803 80TH AVE Anchorage, AK 99502 OWNER: PARKER GERALD L WASTEWATER S091000 CONNECT PERMIT DATE OF APPLICATION: 10/28/2009 SCHEDULED COMPLETION DATE: 12/31/2009 MAIL ADDRESS: PO BOX 221922 ANCHORAGE, AK 995221922 ❑X SINGLE FAMILY ❑ MULTI -DWELLING No. APTS ❑ COMMERCIAL PHONE: CONTRACTOR TAM Construction ASSESSMENTS ❑ Repair Existing Service ❑ Main Line Extension ❑ On Property Only ❑ City Tap ❑ Have Been Levied Hydrant Only U To Be Levied XJ Main Tap - To Property Line Only Comments: ❑ Main Tap & On Property Connect Row No. Estimate - Trunk - $684, Lateral - $11,865 ❑ Disconnect ❑ R & R - Main Tap Only Owner Staff CONNECT SIZE 4 L2 /r ISSUED WWSAP INSPECTION FEE $ ❑ PAID ❑ CASH PERMIT FEE $ ❑ CHECK # $ ❑ OTHER REIMBURSABLE DEPOSIT $ NUMBER 551-0000004603 TOTAL $ INSPECTED BY DATE REMARKS PERMITEE (Please Print) MAIL ADDRESS SIGNATURE PHONE POST IN A CONSPICUOUS PLACE AT THE JOB SITE INSPECTOR COPY DATE SCHEDULED 12/31/2009 TIME 12:00 am INSPECTOR . SUBDIVISION T12N R4W SEC 10 BLOCK/LOT/TRACT LT 4 PTN / C'1 G'' x?�-,r,' j INDICATE NORTH Tµ Gw I P 41 I y l P 0 . SuN u SIZE MAIN: I TYPE MAIN: B fl --T ,T MAIN: -�� A T PROP. LINE: - !� CONNECT LOCATION: AT ?ROP. 1 Winn. b COMMENTS: at-V- (p" T E_ AL. y-'� �wINC-1 lF '. -4o.-I' w ' L . . INSEPECTED BY: DATE: O I OZ109 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: .~,~,,/ql 1~ '~'~) PID Number: gli- Nted:~~ ~ ~p Wastewater System: ~New D Upgrade Address: ~ 7~o ~ ~F~ ~ ~ ABSORPTION FIELD .,o.~: ~-~o m"o.o' ~DeepTrench ~ Shallow Trench gBed ~Mound UOther Total Depth from original grade: LEGAL DESCRIPTION SoilRating: , ~ GPD/Sq. Ft. Block: Subdivision: Depth to pipe bottom from odgi~al grade: Gravel depth beneath pipe LOt:. ~C~ ~ l / ' q. ~ Ft. ~ Ft. l ~ ~ ~ '" Ft. ~ O Ft. WELL: ~ New D Upgrade arave~ ~c;th::~ Number of lines: lo,stance between lines: ~ Ft. Classification (Private, A,B,C): Total Depth: Cased TO: Total absorption area: Pipe material: '~ ~J Ft. ~ Ft. ~ SO. Ft. ~ ~l~ Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: Cpsing Height Above Ground: ~O GPM Ft. SEPARATION DISTANCES , ~eptic U Holding n S.T.E.P. TO Septic Absorption Lilt Holding ~ublic/Pdvate Manufacturer: Capacity in gallons: From Tank Fie,d Station Tank Sewer Lines ~ ~ ,~ ~umbor of Gompa~mants: w~t~ ~ ~ LIFT STATION LineL°t ~ ~ [ ~ Size in gallons:~ Manufacturer: I Foundation CudainDrain ~ ~ ~ Pemp Make & Modelri Electrical Inspections performed by: Remarks: BENCH MARK Location and Description: ~GJNEER'S SERA[, Inspections performed by: Dates: 1st ~ J ;' ri:l) 2nd ~ Department of HeaDed .u~a~[ces' approyal .,~ ~ Reviewed and approve D~e ~ 72-013 (1/91) MOA 25 £0 SO SC,4LD I! = ?T, ~0 bO C,D 60' LoNG TRENCH MDNITDR TUBE SO' TRENCH I/EST EIGHTIETH AVENUE DBBEN SPURKLAND P,E. 203 W 15TH. AVENUE ANCH, AK, 99501 SAND LAKE SU£D, SECTIDN i0, T PN, R4~/ #1 SEPTIC SYSTEM ASDUILT I)ATE, AUG. ~0, ]gP;~ SHEET, ~0/2 GRID, PPP4 an £u~ I~- Standard french; 90' LONG 96' $' DF SEWER ROCK 4.5 FT. DF C£VER 6O. OO O Noni~or Clean Foundo~on Clean ou~ MiraF~ i40 5 £ee~ Of' Sep~Jlc Rock ~Z 84,00 79 1250 gal Septic ~ank ~.¢; .... , ,h~ Exls~, 6round 4' MIn Co. ver H ~'~ovem Ta.k ~4.1 TDBBEN SPURKLAND P,E, 203 W 15TH, AVENUE ANCH. AK. 9950! LOT 14, SAND LAKE SECTION 10, F12N, R3W GARY PARKER SEPTIC SYSTEM ASBUILT ]]ATE, AU~, ~°0~ J~92 SHEET, 2/3 GR]9, 2££4 SlX INCH WATER WELL DRILLED ......... OUT TO THE DEPTH OF 3°1 feet. DRILLED AT THE RATE OF .......... PER FOOT. Steel casing seatea to 301 '. PROPERTY OWNER ',~.r. Gary Parker 344-3~9u LOCATION OF WELL SITF, Sandla~e (8~th) DRILLER Ber~-ie Township 12N Range 4W Section 10 Parcel Claus of Rampa~t. Drilling Works 0 - 18' Silty sandy material. 20~ clay. 18 65' Sandy fine gravel with 45% clay. 65 145' A wet sandy clay. 15% fine gravel. 145 - ]8'?' A ce:tented gravel. Hardpan. Wet material. 1~7 248' - near ng wet sand ?~ i'ine gravel. 10% clay. 24~ - 29b' Hardpan with only about 20% coarse gravel. 29o - 301' Water bearing fine gravel. Producing a full 30gpm 50 feet off bottom, l~ery silty material in the water aquifer, however, after .two hours ol' pumping, the quality of water improved greatly. This %'~ater Well has proven to be a very good Well. One ho~se submersible pump can be installed from 160 to 180 feet, & still pump 10 to 15 gpm. ?;ater recovery is back up to within 110 feet of surface. Well paid for in full by Gary Parker. COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF ................ THANK YOU VERY MUCH. DATE ?[ay 1, ]992 BERNIE CLAUS OF RAMPART G WORKS SERV|CE CHARGE (~ F ~.,~% PER MO,'~'TH W~LL BE ASSESSED ON PAST DUE ACCOUNTS, ' ' ~/7.¢.¢~ &' MUNICIPALITY OF ANCF&ORAGE ~ c~%/~:~d¢ /¥/.z~,-~ ~/0¢/.~' J"¢'¢~ /)''' Department of Health & Human Services On-Site Sewer/Well Permit Application ~_.b~\ -- ~.\~. --~:Z)l NOTE: ,Application must be filled out completely. SINGLE FAMILY DWELLING Parcel Identification Number Property Owner Name Mailing Address Legal Description Lot Size Number of Bedrooms: ~'~¢C,.C ~_.z4.-" Day Phone Cod Block Su b¢~,sion~ ¢ J Inspections will be conducted by: ~ ~ C 5 ~ V ~ D Approved Engineering Firm MAY 21 t9~i Municipality (permit fee included) 3¥ q-~s-q o Section Acres/Sq Ft _ , , &',un,c:p,:,htyo, Anchoraaa Does your house contain any of the following: Hot Tub, Swimming Pool, Therapy t'ooh uEF~l~.~Health &Human Ser~]ces or Water Softener Unit? If yes, which one? This application is for: Sewer Only Sewer and Well ~. Sewer Upgrade __ Well Only I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and in accordance with applicable Municipal codes. Fees: l ¢ ¢ ~"~---'- Receipt# Property Owner/M/ell Driller Permit # 7?0 Tom Fink, Mayor unicip Hty of nchora ¢ Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 June 9, 1992 Gerald L. Parker 7750 Mayfair Drive #4 Anchorage, Alaska 99502-7217 Subject: T12N R4W Section 10 Parcel 11 Permit #SW910130, PID ~011-111-03 The subject permit, issued June 4, 1991 by this office for a single family well and/or on-site wastewater system, has expired as of June 4, 1992. A new permit must be obtained from this office for a w9ll and/or on-site wastewater system NOT installed by the ' expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $200.00 for on-site wastewater permit; $75.00 for a well permit and $275.00 for a combined on-site wastewater and well permit. an If you have any questions, Sin~relyr ~ ~ ~ohn SmitD/, P. E. ~ogram Manager On-site Services please call this office at 343-4744. enc: Copy of Permit PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE tf~l,^~Y~u~ DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ~'~:7/ ANCHORAGE, ALASKA 995 9-6650 PERMIT NUMBER:SWgl0130 DATE ISSUED: 6/04/91 ~ DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. EXPIRATION DATE: 6/04/92 OWNER NAME:PARKER GERALD L OWNER ADDRESS:7750 ~YFAIR NUMBER 4 ANCHORAGE AK 99502 PARCEL ID:01111103 LEGAL DESCRIPTION: T12N R4W SEC 10 PARCEL 11 LOT SIZE: 22800 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE TOTAL ABSORPTI(gN AREA OF THIS TRENCH MUST BE AT LEAST 750 SQ FEET, AND THE TOTAL DEPTH OF THE TRENCH MUST NOT EXCEED 9.5 FEET Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFOI~MED: LEGAL DESCRIPTION:' /-.t~ i Tewnship, Range, Section: SLOPE SITE PLAN 1 2 3 4 5 6 7- 8- 9- 10- 11 13- 14- 15- 16- 17- 18- 19- 20- WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? Depth to Water After , Monitoring? / e"_:"~ Date: Gross Net Depth to Net Reading Date Time Time Water Drop &,~';¢.,~( I: l,'- ~- ~2_L?TM .-- ~/'~i PERCOLATION RATE (~(2 (minutes/inch) PERC HOLE DIAMETER COMMENTS PER*ORMED.¥: ' OE.T,.T.^TT.,STESTWASPER*OR*O,. .'.COOROANCE'..',TH ALL S.'ATE A.D MU.,C,PAL ~U,DEL,.E*,. E.*EOT O. T.,* D^TE. DATE: 72-008 (Rev. 4~85) Tobben Spurkland P.E. --L.. o-~" IZ- 2.1. g' '~ o.& 3,,[/~..t Tobben Spurkland P.E. 1,1.50 Munlclpallly of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR:. LEGAL DE$CRIPTION:~}~r O~ I~O~, ~.0'~ 4 WAS GROUND WATEF~ ENCOUNTERED? IF YES, AT WHAT DEPTH? MoniWrinfl? ~¢~f . DATE PERFORMED: Township. Range, Section: SLOPE SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop J. ) ~;-/~ ~o ~/~ .~-'~ PERCOLATION RATE /~"' ~'' (minutes/inch) PERC HOLE DIAMETER __ 8 9 10 11 12 13 , '__ ~14 15 16 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR:~ LEGAL DESCRIPTION: ~,¢~'~===~1~ ~.-~.~.b,."'---~l °'~wnship' Range, Section: '~1 ~' I~\I ~- - SLOPE SITE PLAN Ho L~. 17 18 19 20, )UND WATER ENCOUNTERED? ,~'~ 0 IF YES, AT WHAT : O DEPTH? p E I',1oniloring? I ..-.-.-.-.-.-.-.-;~ Dale: _ . Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE .~- (minutes/inch) PERC HOLE DIAMETER ~'~"~ ¢ J TEST RU~ BETWEEN __FTAND -- FT COMMENTS PERFORMED BY: J CERTIFY~F~THAT THIS TEST WAS PERFOR IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ./'~ ~~'~ 72-008 (Rev. 4/85) ~751W. ~IHONO BLVD. SPECIFICATIONS FOR SEPTIC SYSTEM INSTALLATION LGT 14~-SA~ ~Ak:F RI~nD. ~1~ SEC 10 T12N R4W 1.0 SENERAL 1. J. Owner is Sary Parker'~ 7750 Mayd:ail'"~ ,154~ F:'hor~e 544-3590. :[.2 Engineer is the person or enti'f:.y hired by the Owner inspect: th~.s project. The Engineer must be recognized by '~he Munic:ipal:Lty o~: Anc:hc~rage~ Department (:)~ Health and Human Ser v:L ces. 1.3 Contractor is the per-son or entity hired by the Owner to install this project. The Contractor must be recegn:i, zed by the Municipality o¥ Anchorage~ Department o-~ Health and 1.4. 'Fhe Drawings~ sheets 1 thr'ough 3, shall be part o'~ this speci¥ication.. i.5 All mat. er":[als and wor'kmansh:[p shall meet the require .... merits o¥ the MLu'-~iclpality O'F Anclnorage~ Depai"tfRer]~] 0¢ Seal. th arid HLUllal] Services~ tine conditions o~ the perm:Lt.~ arid a:L1 app].ic:ab].e rules and r'egulatiorls currently in e-fYec:'t:. I~6 Ali. excavat:i, on dept. hs are adv:[sory, and are te be veri¥ied and may be modi~:ied in the .field by the Engineer. :[.7 It is the r"esponsibility of the Owner or the Contractor to adhere to the al:_*proved design, to veri~:y 'lihat the spec:i- -Fled separa'~:i, on d:i. stances are met.~ and that the required 1.8 The Contractor er the Owner shall report to the Engi- neer an'y observed condi~::ion which would put the sep'~:[c system in v:[olatien o~ State or Mt.iRi(:J. pa]. r(agula't:iens. 2.0 SEPTIC TANK 2.1 I-F there is an exist:i, ng sept_:i.c tank~ it it meets the capacity requirement ¥or the tanh: shall be :i. nspect, ed by the Engineer~ tightness and structural integrity shall be may be used r-esi denc. e. The and i ~.s waC. er' verid:ied. 2.2 A new sep'kic tank shall be one Yabricated by either' Anchorage Tank' and Welding or by Steer Tank The septic tank shall be a UF:'C-approved two-c:ompartment ,Sp ~a?c: i -~: :i. c a 1', i r:)l'-~ s 'f or s ep'l: i c: [..o'1:. 14 Sancl I.ake Sudv,, hi(.) system instal].ation 1 tank? c~nstructed of 12 gauge,j or better-, steel with bi't:u masti(: cc)a'~ir-~g. The t. ar~k shall be set. level on undis~urbed sell.The tank shall be covered with the equivalent feet or more., c)-~ so~.l. 2.3 ~eet The septic tacd.:: shall be ins'hailed a minimum of ~:ive 2.4 The seFrl:ic tank shall be a mir-~imum i:)~~ 100 feet ~r'om any well serving a single residerice; 100 .feet -From any body o~ wa'~:er'~ creeks or drainage di'~:ches wit. h ~lo~ing water; 150 ~:eet 'From Class "C' wells, and 200 feet fromm Class A or Class B we].ls. 2~5 Ali. pipe connect, locke '[~o the tank shall be mec:hanical watertight calder couplings. C].ean(~u'~s shall be installed as desig~ated and capped with air-tight rain c:aps. Clean- outs shall ex'lzend a minimum o~ 12 inches above final ground e].evation. Pr'ovisions shall be made ~or landscaping and impor-tation i'F topsoil. 3.0 ABSORPTION FIELD Z!:,.1 Grave]. used in '~:he abser'ption field shall be 0,,5 te 2.5 inch screened r"ock~ with less than 3% passing the No. 200 ~!L.2 Sand, used -For levelinl~ or' ~or ~il'~.er'ing, shall have an e'FYective grain size between No. 40 sieve and Ne. 18 sieve. Urli-Formit. y c:oe.f¥icient shall be lees than 4. Not more 'Ehan 5% by weight sha].l pass the No. 200 sieve. 3.3 4-:inch per'~ora'lzed pipe shall be ASTM F8;~0. Fc, r pres-" sure (~istr"ibutit~n~ p:i. pe shall be Schedule 4() PVC or' ABS. 3.4 Solid 4-inch pipe sl'lall be Cast Ir'on or ASTM D~;034. 3..5 Monitor standpipes shall be install, ed as shown. That section e'f the pipe pene'krating '[Rte gravel ~,ha].l be per¢-o- r'a'l'_ed~, either- by dri].ling (}.5" holes on 6--'inch centers or- by joining a sect:Lon o-f I:z810 per-For'a'~:ed pile 'Eo a solid sect:i, on of pipe,, 3,,6 Geete;,~t.:i. le !~¢ha].], be Mir'a,~i 140. Z!;.7 Ineulatic)n shall be extruded direct burial, po].ystyrene. De~,~ Chemical Styrofoam 3.8 Tops(:)i]. shall be a mixture o.F 40--6()% organ±c matter, 20-30% sand and more tha'~. 2G% si:l.'~t. All quantities are Grass seed shall be ~;:]entucky bluegrass,. Speci.f:ications for" septic system installatien Lot 14 Sand Lake Sudv. No i 4.0 INSTALLATION 4. 1 Lol:a'~:e al 1 under(~r our"~d ut i 1 i '~ii es ~ property 1 i nes ~ ways,; surface and sub sur'-Face cirainage ~acilities~ lakes~ ponds, and all other .facilities r-equiring eeparation dis'- tanc:es -From the proposed septic system. Noti~y Owner or Engineer o-~ any observed possible con~:l:[ct. 4.2 Stake al ignment exact locatil:)n o'~: well. 1 o.F syst. em with markers showing the ~rom wells and water bodies. Locate on I_ot I:.3,~< under buildir'~g). 4.3 Establish an elevat:Lon benchmar'k. -['his BM sl-lall be easily identi.Fiab!e, stable and permanent. An arbitrary elevation o-f 100 c:an be assigned. 4.4 Insta].l 'l.:he tank as shown on the drawings~ F;,'ec:ord the inlet and out. le~: elevations o'~ the tank. Tank shall be placed mn ur-~clisturbed r'lative soil. zj.~5 Ex[:avat:e the absorpt, ion field. Bottom o~ excavation sllal! be level and scarified. I¥ sidewalls smears, they shall also be scari.fied. Record elevat:i, on o~: begirtning~ midd].R and end (:)f trench. Record elew~r~i~n of each corner and center point o-F bed. Cerlstruction equil~ment shall riot operate on the ~;:l. oor a~ the excaw~tion,. Any material com- pacted by the mper'a'Eimr] o,f 'b. he cons'Er'uct:i, on eqLU[pffieFi(: shall r~fl]oved ar'id repl ac:ed wi. th LIR(:O~T~pa(:t'.ed mat;erials. 4.6 Place the rock to the dept:h speci-fied. Do ncrl: contain:i- t. ion. Lew~l thc_..! roc:k surYace (+- 1") be¥or"e installing the:, per¥or'ated pipe. 4..7 Inst. all the distribu'Eion pipe. Record the elevation of each joir~t. For pressure system solvent weld the joints. 4 ,, S Cover e;.~ c:avat i on i n su 1 at i c:n'"~ · bfwa distr:[but:[on pipe wit:h r'ock~ and cover the with gee)text:lie be'Fore bac:k'filling and plac:ing i4: required. 4.9 Record the 4:[nished grclund elevation at the beg:[nning~ mldclle and end o¥ ~:Pench. Record the .Finish ground eleva-. tien at each terrier arid a'[ the midpc)ir¥~: o-F the bed. 4,, 10 F'urnish a copy of all survey J-lete~-~ 'Lc) the Engineer. 5.0 INSPECTIONS 5. 1 A minimum (::,.F three inspections are requir'ed,, The · fir"st: ins,r.)~'_*ct:[c:,n will bte o-F t. he open e,'.:c,~.,,vatien. At t. hiz=, time the) sc)il r.:onditior~, will be observed and compared '~:e Spec:if lc:arlene 'For septic: system installation [.e'b 14 ,%and Lakl~:, SLu::lv. No I o c:~. :]; th~:~, I:~es:~(i:~l] assumpt:i, or~s. Ground water conditions or presence c)~: b¢?drcil::k w:~].l b~? verified. The sec(~nd inspectic~n will be a~ter pl~cement of ~;ravel ~ standpipes~ d:i. str:i, bu'~;ion piping~ tank(!i~;) and o'L~her compo- nents as ~:~pec:i'Fied. The th:i. rd inspect, ion will be a'Fter completi~;n o~,: the Any de',~iciencies will be noted and the C~ntractor notified. Such de',r-ic:iencies shall be corrected within ten days. 5,,2 All electrical v~or'k rec:lt.~ires either an MOA electrical i r-~spect i (~n or c:ert i ~:icatic~n by an licensed electrician. Submit proo'f o-F inspection or certi~ica'L~:Lon 'l~o the Engineer. 5.3 Subm:i.t c:atalog data I:)-F all me~zhanical equipment. 5.4 No~ci-~:y Engineer at least 24 I'-,ours :Ln advance of begin- ning any ~or~::. Specificat. il:)r~s for sept:i.c sys'~em :i. nstallation L..o'~: ]4 Sand t.ake ~3udv. No MUNM[ AUTY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 011-111-03 Certificate of On -Site Systems Approval Expiration Date: 12-2-a' 2 o 1. GENERAL INFORMATION Complete legal description T1 2N R4 W Section 10 Lot 4 PTN (70' X 325) Location (site address) 4803 W 80th Avenue Anchorage, AK Current property owner(s)_ Debbie Parker Day phone (907) 223-0511 _.._........_ s- -P--O- Box 221-922 Anchorage -AK -99522- - _ ._. _._._.._....._....._.._..._ _ . Halling addres- - Real estate agent Shands Rice 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ ' Multiple Dwellings (Single Family and/or Duplex) Day phone (907) 343-9659 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER.SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well FK Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer 0 Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ '� ( 0 Date of Payment �`� 2?_ W7'0 Date of Payment Receipt Number 0(019 Z.6 Receipt Number COSA# ()sC,?,y1 51 1-( 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. l 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 9/18/20 6. DSD SIGNATURE --- - -- System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved No. CE -4381 •' ZF �Pf 9/18/20 ©rAl,FESS\�®��©®� Conditional approval for bedrooms, with the following stipulations: .Mitt((((( at" By: Original Certificate Date: q 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 l Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: T12N R4W Section 10 Lot 4 PTN (70'X 325') If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 5/1/92 Total depth 301 ft Cased to 301 ft ❑ Sanitary seal is functioning correctly WE Wires are properly protected Casing height (above ground) '12 in. Date of flow test for COSA 9/14/20 Static water level at beginning of test 65.9 ft. Comments B. TANK DATA Lot is served by Public Sewer. Age of tank(s) years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Public Sewer 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 Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 011-111-03 Structure served by this system Well production at time of test 5.4 gpm Water storage tank volume None gallons Well disinfected for coliform test? ❑ Yes ❑ No 01 Coliform bacteria is Negative Nitrate mg/L R Nitrate less than MRL (ND) Arsenic 66.5 ug/L ❑ Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date of Sample 9/10/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results (j 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 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' NA if No Community Sewer Manhole/Cleanout > 100' r7Yes if No ft ✓❑ Yes if No Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25'7/1 Yes if No Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ❑✓ Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50'✓❑ Yes if No ❑✓ Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft ✓❑ Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required)- Lot is served by Public Sewer Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No _ Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: ❑ Yes Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No_ Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No _ Water Service Line > 10' ❑ 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) - Lot is served by Public Sewer Building Foundation > 10' ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS Lot is served by community sewer. 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 ©©p0\]l3 Ma O W°• • ��� co 49ih 0 �.... ............•.,.�.a,,... .............m.uu. u..................... ;r: : MICHAEL E. ANDERSGNIo Q No. CE -4-81 � o °°•. 9/21/20 00 ,0 PR..r ............... C��Ppm©� r©oBa©©Qat© ft ft ft ft ft ft ft ft ft ft MV UNHURAWTV OF Alo"ICHOPRA GE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On -Site water and wastewater Section 1 Jl Fax: 343-7997 www.muni.org/onsite Arsenic Advisory Certificate of On -Site Systems Approval # OSC201514 Subdivision: T12N R4W Sec10, Lot: 4 PTN (70'X 325') A water sample revealed an arsenic concentration of 66.5 micrograms per liter (ug/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org (LE)GEND ( MEASURED SAND LAKE WE WATER'S EDGE HTB HIGH TOP BANK a�O HOUSE DETAIL N.T.S. HEAVY AQUATIC M VEGETATION J HTB WELL J HTB r \ X100' riELL RADI O n N 15.8 O O O ON 1.0 O N l O 21.6 _ U O O < O O O Z Legal Deacrfption from recorded document 2010-005014-0: Commencing at the southeast comer of Lot 13, Send Lake Subdivision No. 1, according to plat P-112, thence in an easterly direction 70 feet; thence Northerly to the shore of Send Lake; thence along the meander shore line of Send Lake to the Northeast comer of Lot 13; thence Southerly 252 feet to the point of beginning, said parcel having a uniform width of 70 feet, located in Government Lot 4. Section 10, Township 12 North, Range 4 Asst, Seward Meridian, Anchorage Recording District, Third Judicial District, State of Alasks. This survey follows the legal description as much as possible. Lines Ll thru L4 are measured along the high tap bank where heavy vegetation prohibits getting to the waters edge. Some grading and filling on the property has altered the original waters edge. LOT 13 SAND LAKE SUBDIV15ION Ar - LINE CHART L1 N04'24'00"W 33.24 L2 N16'01'03"E 48.06 ®&W ® L3 N00"00 00"E 25.92 P a a L4 N14'38'52"W 19.77 L5 N62'1 2'29"E 16.71 (LE)GEND ( MEASURED SAND LAKE WE WATER'S EDGE HTB HIGH TOP BANK a�O HOUSE DETAIL N.T.S. HEAVY AQUATIC M VEGETATION J HTB WELL J HTB r \ X100' riELL RADI O n N 15.8 O O O ON 1.0 O N l O 21.6 _ U O O < O O O Z Legal Deacrfption from recorded document 2010-005014-0: Commencing at the southeast comer of Lot 13, Send Lake Subdivision No. 1, according to plat P-112, thence in an easterly direction 70 feet; thence Northerly to the shore of Send Lake; thence along the meander shore line of Send Lake to the Northeast comer of Lot 13; thence Southerly 252 feet to the point of beginning, said parcel having a uniform width of 70 feet, located in Government Lot 4. Section 10, Township 12 North, Range 4 Asst, Seward Meridian, Anchorage Recording District, Third Judicial District, State of Alasks. This survey follows the legal description as much as possible. Lines Ll thru L4 are measured along the high tap bank where heavy vegetation prohibits getting to the waters edge. Some grading and filling on the property has altered the original waters edge. LOT 13 SAND LAKE SUBDIV15ION Ar - X31 :1 Air vq m° O 00 ?rJ� qo as°m�c6� tm E'o�e O - It vm�gsAm wB°m�sm poa e L tj O '°gyp m'mmo Q N q q m 'm 73�'a9 U O o.�m0 R e mo�o 3p?m0_$ v O o «�S,'q q Aw q�mq� 65T,'°id�� >mo --^oa0a-Aq aaa i — --_ K [7 i 10' ELECTRIC EASEMENT----_ ril 171.03 ('M) M5 WEST. .80'r" AVENUE__ N 89`50'00 W. — a O �a w fn :g 4rii o� as z oz a " o E" a P LT ca Gt m