HomeMy WebLinkAboutT15N R1W SEC 18 LT 95A Onsite File
T15N R1W
Section 18
Lot 95A
#051 - 172 - 45
SueMiT
Municipality of Anchorage WJUN 8 26 u
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191514 PID Number: 051-172-45
Dwelling: F0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade
Name
Visionary Homes, LLC
ABSORPTION FIELD
❑ Deep Trench X Wide Trench El Bed El Mound
Site Address
18132 Misty Falls Circle Eagle River, AK 99577
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
227-0762
1 4
1.2 GPD/SF
8.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
4.0 Ft.
Gravel depth beneath pipe
4.0 Ft.
Subdivision Block Lot
95A
Fill added above original grade
0.4 Ft.
Gravel length
50 Ft.
Township Range Section
15N 1W 18
Gravel width
5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
5O0 Ft z
1
Ft.
Well
>100'
>1 00'
N/A
N/A
>25
TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1,250 Gal.
Surface Water
>1
>1 00'
N/A
N/A
Material
Number of compartments
Lot Line
>5'
>10'
N/A
N/A
NA
Plastic
2
Foundation
>1 0'
>1 0'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks The garage is connected o the new system. The tank
and the line from the house to the tank are insulated.
Alarm location
Electrical installed by
PIPE MATERIAL House to tank D3034 Tank to
drainfield D3034
Installer
Guaranteed Services
Drainfield D3034 CO/MTD3034
Inspector J. Millette
BENCH MARK (Assumed elevation) 100 ft
Inspectio 15` 5/13/20 5/15/20
Location and description
2nd
Concrete slab at front door.
3'd 4th
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
®��E®OF
Conditional Approval: Date
a��P,,.••" ••:qS,�®®
•-
� 49th ®�
�
.... �.t•... . 0
MICHAEL E. ANDERSON'
�0
Septic Syste
�, : No. CE -4381 ;�
�® �F'°•.
Approved Date 6 /
5/28/20 ,,.•"f 4
�'•••...........•
Note: this does include
®
®��0®0OF®S®®UR �,O®
apprcal not well permit requirements.
(Rev 05/02/18)
Tl 5N R1 W SECTION 18 LOT 95A
PERMIT # OSP191514
EXISTING WELL ON \
I NEIGHBORING LOT.
/ 100' WELL RADII
,i
I r,
STAND PIPES THAT WERE -FOUND NEAR THIS
- LOCATION WERE REMOVED & FILLED.
/ *TION FOR PIPES COJULD_NOT BE -
` `CONFIRMED!NO TANK WAS FOUND.
LOT 95�
:50' EKLtJTNA.
' POIAIET�LiNE - l
1,F 'SEI I `ItJT SHED
WELL SERVICE LINE.
I
EX TING WELL SERVICING
DETACHED GA GE.
PID # 051-172-45
NOTE:
NO WELL OR SEPTIC SYSTEM ON THIS
LOT WITHIN 1 00'OF PROPERTY LINE.
BUA LOT
NEW 1,250 GALLON
SEPTICITANK W/2'oll
- M`ANWAY
-rte
UNDOCUMENTED 38' LONG x T WIDE x 2'
EFFECTIVE DEPTH ABSORPTION TRENCH FOR
MOBILE HOME ABANDONED IN PLACE. TRENCH
WAS EXPOSED & LOCATION VERIFIED.
3-BDRM FC
FiO1vtE \
NEW 50' LONG x 5' WIDE x
4' EFFECTIVE DEPTH
ABSORPTlQN TRENCH.
THN
FCO?/ p q
/ u \ \ THS,
EXISTING CRIB REMOVED & FILL \
WITH IN SITU RECEIVING SOIL. NE \
TRENCH WAS BUILT OVER TOI . \
EXISTING S�PTIC TANK
DECOMMISPIONED PER
EXISTING WELL MOA CODE. j
SERVICING HOUSE. r
L.;
{
1 WELL FOR THIS LOT IS
I »CO'AV AY FROM
f PROPE TY LINE r
33'R-. L. Mt, EXISTI G DRAIN FIELD IN TAC40R
RESERVA i\0N LINE ` --Peg ALTERNATE SITE ATTER — — — —
_ \OCUMEN- rA-TjON: CATEG 1if _
—D / TR/FA I MEN- SYSTEM. RPP. 6.0_ D/SF.
FC01
25.3
5.9
MH
31.6
17.2
SV
34.4
21.7
2CO _ _
3910
, 27.9
C.01
23.2
- 27.9
MT1
25.2
26.8"1
CO2
-
-73.7-7 - - -- - -
/MT2
66.5
71.6 ;
FCO2 /
54.1 44.3
ADRIAN VENUE
r _
~ \J —EXISTING WELL/� \
/ NEIGHBORING LOT.
/ILM
ENGI N E E RING I %)
PLAN AS -BUILT
0 50 100
FEET
1"=50'
LEGEND
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
Tl 5N R1 W SECTION 18 LOT
95A
PERMIT # OSP191514 PID # 051-172-45
LL U)
N
100.5
97.2
2" INSULATION
96.5 1250 GAL PLASTIC
SEPTIC TANK
96.35
91.8
O
U� 100.0 FINISH GRADE 99.6 ORIGINAL GRADE
v
95.6
95.6
DRAINPIELD ROCK
91.6
91.6
I® 50'
_
NO GROUNDWATER 11/15/19
c
=
85.1
OF,
49th
�.� nn....w.....m nuuunuu.n•..�.�
MICHAEL E. ANDERSON
PROFILE AS-BUILT
��®-sf% No. CE-4381 .'�f
®o�®t��
ENGINEERING
(NO SCALE)
�'®®�®
PROFESS............
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: OSP191514
Work Type: Septic Upgrade
Tax Code Number: 05117245000
Site Legal Address: T1 5N R1 W SEC 18 LT 95A G:1155
Site Mailing Address: 19625 ADRIAN AVE, Chugiak
Owner: DYKMAN MICHELLE KIM 50% &
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date:
51, �) "�o
�N S'
r
r
Department
1/3/2020
1/2/2021
Lot Size in Sq Ft: 38305
13o�
Total Bedrooms: "211*' y
❑ 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
Special Provisions:
1. The septic system that served the mobile home is to be decommissioned prior to IR approval.
2. The well that served the mobile home is to be decommissioned prior to IR approval. Submit the Well
Decommissioning Log.
3. Well testing for the October, 2019 title transfer COSA is to be completed prior to IR approval.
C O� 1 �crftkSn
PU ,4,ibe! O� W rcOm 5. A 15L uq U oGLtv►'l c�
iend5 locett'j.
Received By:
Date:
Issued By:��i�lji/l^uJ�' �i Date: v
EPL4?4JS
MUNICIPALITY OF ANCHORAGE
Community Development Department '/ Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water& Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-172-45
Property owner(s) Michelle Dykman Day phone 227-0762
Mailing address P.O. Box 770095 Eagle River, AK 99577
Site address 19625 Adrian Avenue Chugiak, AK
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section) T15N R1W SEC 18, Lot 95A
Lot Size 38,305 Sq. Ft. Number of Bedrooms Three (3)
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑X Initial [ Single Family (SF) ❑X
(w/wo ADU)
Septic Tank ❑X Upgrade ❑X Duplex (D) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
-0/L12,j2,_ E._a.„9--,
(Signature of property owner or authorized agent)
Permit/Rush Fees: S Waiver Fees:
Date of Payment: /111q /19 Date of Payment:
Receipt Number: G()'330 Receipt Number:
Permit No. 05P/q/S / Waiver No.
Permit App_:-: c
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
November 19, 2019
MOA Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: T15N R1W Section 18 Lot 95A – 19625 Adrian Avenue
Septic System Design
Dear On-Site Services Engineer:
The existing septic system on the subject lot has failed and must be replaced. We are submitting
this design and permit application for the construction of a new septic system. The attached site
plan identifies the location of existing wells in the area, the existing septic system and the proposed
septic location. No conflicts existing between the proposed septic system and all private wells in
the area.
The ground surface on the lot is virtually flat in the area of the septic system placement. Contours
are shown on the site plan showing the grade and direction of flow. Storm water drainage will not
impact this septic system. The new trench will be constructed parallel to the slope as much as
possible.
The existing septic tank will be decommissioned in accordance with Municipal Code. The new
tank will be a minimum of 10’ from the house foundation and 5’ from the proposed absorption
trench.
Please refer to the attached test hole log and plan and profile sheet for the septic design. If this
design is followed no adverse impacts will occur to adjacent properties.
Sincerely,
Michael E. Anderson, PE
11/19/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191514, Deb Wockenfuss, 01/03/20
Tl 5N Rl W SECTION 18 OT 95A C-0 ""(
/
EXISTING WELL Ow
NEIGHBORING LOT.
/
\
\| '/
|
\.
NOTE:
/ NOWELL ORSEPTIC SYSTEM ONTHIS
`` / LOT WITHIN 1OU'OFPROPERTY LINE.
UNDOCUMENTED 38' LONG x 3'WIDE x 2'
\'
EFFECTIVE DEPTH ABSORPTION TRENCH FOR
100'WELL�\ADII MOBILE HOME ABANDONED IN PLACE. TRENCH
_3A WAS EXPOSED & LOCATION VERIFIED.
\EF F
MOB
WAS
EFFECTIVE DEPTH
-EXISTING-1�250 GALLON- ABSORPTION TRENCH.
SEPTIC TANK w/20" MANWAY
3 -BEDROOM HOME
/
SHEDS
'50'EKLU, TNA
POWERLINE
^ ' -
FCO
UNDOCUMENTED LOG CRIB: Tx Tx 4'
GARAGE EFFECTIVE. TOTAL DEPTH 12'. REMOV , E
LL
AS MANY LOGS AS POSSIBLE & FI \
V03H MOA APPROVED MATERIAL.
EXISTING WELL SERVICING
DETACHED GARAGE.
/ DECOMMISSION EXISTING
----._—..---'�..
��r/u./��x,�xw^�a
/
K���U ~| / ' 000s
K�~~^�x��� \
|SERVICING HOUSE.'
33'B, L. M. KEEP EXISTING DRAIN FIELD IN T I ACT
RESERVATION LINE FOR POSSIBLE ALTERNATE SITE AFTER
DOCUMENTATION: CATEGORY III
NOTE: -ADRIAN AVENUE
NONE OF THE SHEDS OR COVERED STORAGE CONTAIN HABITABLE
LIVING SPACE. COVERED STOkAGE PROVIDES SHELTER FOR A - - - - - - - - -
'OT CONNE-CTED-TO-SE-WER-OR WATER
MOTOR HOME WHICH IS N
'�CLLITIES ON THIS LOT.
LOT 101A
NOSLOPES >25%WITHIN 50'ORSURFACE WATER WITHIN 1U0'DFTHE LEGEND
PROPOSED SEPTIC SYSTEM ======
CO-CLEANDUT
ALL WELLS ONSURROUNDING LOTS WITH IMPACTS TOTHIS 2CO'DOUBLE CLEANOUT
PROPERTY ARE SHOWN. NOCONFLICTS WITH WELLS ORSEPTIC FCO - FOUNDATION CLEAN(
SYSTEMS. FS'FLOW SPLITTER VALVE
O 50 100 MH'MANHOLE
WE ME
FEET �T-MONITORING TUBE
SV'SEPTIC VENT
1^=50' TH'TEST HOLE
Tl 5N R1 W SECTION 18 LOT 95A co �1
DESIGN FACTORS: SYSTEM REQUIREMENTS:
600 GPD PEAK FLOW 5' WIDE TRENCH SYSTEM
PERK RATE: 1-5 MIN/IN 1,250 GALLON SEPTIC TANK
APPLICATION RATE: 1.2 GPD/SF
600 GPD / 1.2 GPD/SF /5' WIDE -.5 (RED. FACTOR) = 50 LF TRENCH REQUIRED (50 LF SPECIFIED)
BOTTOM OF TRENCH: 7.5' BELOW GRADE
FLOW LINE ELEVATION: 3.5' BELOW GRADE
TOP OF TRENCH:.5' ABOVE GRADE
w
3'
6"
4'
4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
TYPICAL TRENCH SECTION
(NO SCALE)
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
E N G I N C E R I N G'
49th •�'
MICHAEL E. ANDERSON
No. CE -4381
pF •••'•...5115120 •'• <
'ti®
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
THN
SLOPE
SLOPE
SITE PLAN
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
TEST HOLE PRESOAKED PRIOR TO TESTING:
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
T15N R1W SEC18 L95A (ADRIAN)
11/8/19
J Williams
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING:
IF YES @ WHAT DEPTH? -
2.67 6
4 5
051-172-45
CLIENT
12:52 - 1:02
11/8/19
1
2
3
4
5
6
0 - 3 12
16
1:04 - 1:14
1:16 - 1:26
1:27 - 1:37
1:38 - 1:48
1:49 - 1:59
OB
Professional Engineers Stamp:
11/19/19
10
NO
None
11/15/19
SILTY SANDY GRAVEL
GM
3 12
16
0 - 3 13
16 3 13
16
0 - 3 13
16 3 13
16
0 - 3 12
16 3 12
16
0 - 3 13
16 3 13
16
0 - 3 12
16 3 12
16
10
10
10
10
10
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191514, Deb Wockenfuss, 01/03/20
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
THS
SLOPE
SLOPE
SITE PLAN
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
TEST HOLE PRESOAKED PRIOR TO TESTING:
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
T15N R1W SEC18 L95A (ADRIAN)
11/8/19
J Williams
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING:
IF YES @ WHAT DEPTH? -
2.86 6
4 5
051-172-45
CLIENT
12:14 - 12:24
11/8/19
1
2
3
4
5
6
0 - 3 8
16
12:25 - 12:35
12:37 - 12:47
12:48 - 12:55
12:59 - 1:09
1:10 - 1:20
OB
Professional Engineers Stamp:
11/19/19
10
NO
None
11/15/19
SILTY SANDY GRAVEL
GM
3 8
16
10
10
10
10
10
0 - 3 8
16 3 8
16
0 - 3 8
16 3 8
16
0 - 3 8
16 3 8
16
0 - 3 9
16 3 9
16
0 - 3 9
16 3 9
16
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191514, Deb Wockenfuss, 01/03/20
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N89° 39' 11"E 283.25 MEAS.
N89° 35' 52"E 283.73 MEAS.S17° 09' 20"W 141.24 REC.N89° 57' 30"W 262.90 REC.
S89° 57' 40"E 304.71 REC.
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$'5,$1$9(18(
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S89° 57' 30"E 283.50 REC.
Frederic W. Wagner
NO. L.S.-9946
PROFESSIONAL SEAL
Frontier Surveys, LLC Project No: 19-452 Date:
650 W. 58th Ave. Suite E Anchorage, Alaska 99518
As-Built Survey of:
www.frontiersurveys.com
Frontier Surveys, LLC
I, Frederic Wagner, hereby certify that this Mortgage Inspection Survey was performed by me, or
under my direct supervision on
Plat:Grid:Ordered By:
907.460.1686 - info@frontiersurveys.com
This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and
conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any
inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the
existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances
should this document be used for construction or for establishing a boundary or fence line.
November 4th, 2019.
Legend:
Scale 1" = 50'STA T E O F ALA
S
K
A49 TH
ROYEVRUSDNALLANOISSEFORP
DERE
T
S
IGER
11/6/2019
Lot 95A, T15N, R1W Section 18
General Notes:
1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws.
2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey.
3. All measurements/setbacks are to the visual/apparent building footprint.
4. All dimensions to property lines are plus/minus 0.1ft.
Chris Haines
11/4/2019
72-208 N/A
Gas Meter
Electric Meter/Outside Power
Deck
Sewer C/O Water Valve
Telephone Pole
Fence
Mailbox Overhead Utility
Light Pole
S
G
E Tel. Ped.MBT
E Elec. Ped.
W Water Well Concrete
F:'E]::/M ]: T
Ill] ','~ O 13 3
O 4. / 3 0 / 8 ',!~;
C;C)IxFI"f::IEN" PH(3NE:
S843
L. EE~AL.. :L I,,..,.,<,, 11 ,, SLI:EI:0':I:V];S]:ON: hl~ L..EIT: ?'iSA
!3E:CT :[ CIN: :1.8 'T'C)WNSH ]: F:':
L,,O'T' !3 :[ ZE: ',~ :::,!; EEl!; C1',5 (S(:;1 ,, F:"T' ,,
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
BILL SHEFFIELD, GOVERNOR
274-2533
April 26, 1985
S&S Engineering
SRB 196X
Eagle River, Alaska
99577
SUBJECT: Lot 95A; Section 18; T15N, R1W, Eagle River, Alaska
Dear Sir:
In reference to your letter addressed to us on April 15, 1985 we find
that drilling of a second well for trailer No. 2 will be acceptable
to us for allowing classification as a single family residence.
Since both of these residences will becmle single family, approval
should be done through the Municipality of Anchorage (MOA). If any
problems do arise with MOA since both of these residences lie on one
lot, please contact me at our Anchorage/Western District Office for
additional help.
Sincerely,
Michael P. Lewis
Environmental Engineer
MPL/msm
ROBERTA. SHAFER
April ].5, 1985
CIVIL ENGINEER
694 29/9
SEWER & WA~ ER
INSPECTION
SYSTEM DESIGN
WELL INSPECTION
& FLOW TEST
SITE PtANS
ROAD DESIGN
STRUCTURAL&
MECHANICAL
INSPECTIONS
State of Alaska
Department of Environmental Conservation
437 E Street
Anchorage, Alaska 99501
REFERENCE: Lot 95A7 Section 187 T15N: R1W
Lot 95A is currently owned jointly by two private
individuals. One of these individuals lives in a
trailer house noted on the attached sketch as No. 1.
The other i~dividual lives in the trailer noted as
No. 2. Each trailer is served by its own on-site
waste water disposal system, however, both trailers
are provided water from a common well. The horizontal
separation distance between the well and the on-site
waste water disposal system for' trailer No. 1 is ].ess
than that prescribed by 18AAC72 for a Class C well.
Based upon information available to us we cannot re-
commend a waiver in this case, therefore, we request
that you concur in the drilling of a second well
which will provide water to trailer No. 2. Each
trailer will then be served by a private~well and the
horizontal separation distances pr&scribed for a private
well will be met.
If we may be oil further service, please contact us.
/
Sin~~
ROBBRT A. SHAFER, P.E.
RAS/ss
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN SRB 196X EAGLE RIVER, ALASKA 99577
MUMCPA LJTY OF " HCHOR GE
Development Services Department`__� Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051 172 45
1. GENERAL INFORMATION
Expiration Date:
Complete legal description T1 5N R1 W SEC 18 LT 95A
Location (site address)
19625 ADRIAN AVE
Current property owner(s) DALTON
Mailing address
Real estate agent
2. TYPE OF DWELLING:
0 Single Family (w/ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
0
Private Septic
— Fx_j
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: N O N E Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 5,5 b -9- Z 5T Colla. Waiver Fee $
Date of Payment 71612.2 Date of Payment
Receipt Number _072-S (, Q Receipt Number
COSA # Q S C�), 2 1 3-30 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 C&M ENGINEERING Phone 8545558
Address 20182 TULWAR
Engineer's Printed Name CHARLES BALZARINI Date 7/1/22
Aft-�c OF Al49 TH
gsll
6. DSD SIGNATURE /• •••• ••••••
//
System #1 Approved for bedrooms ,r • CHARLES G BALZARII4I • j
System #2 Approved for bedrooms ����`���% CE -13854 • •. ����
Disapproved 1`il� PROFESSION?AW
Conditional approval for L4 bedrooms, with the following stipulations:
Iry(/
BY Original Certificate Date:
The Municipality of Anchorage Dev opment 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 Checklist blue sheet
AI -SITE
WAST=.=VIS D
m z
J�o-o GR
J. s AM
o
BY Original Certificate Date:
The Municipality of Anchorage Dev opment 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 Checklist blue sheet
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 __________________________________________________________________________________
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
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:
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
D.ABSORPTION FIELD DATA ______________________
Which system tested (date installed)
SEPTIC
7/18/22 - garage well
- both wells
91ft - garage well
+40 ft - garage well
both wells
unk - garage well
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’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Property Line > 5’ Yes if No ft
Absorption Field > 5’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10’ Yes if No ft
Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
If absorption field is under driveway comment below
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
F.ENGINEER’S COMMENTS
G.ENGINEER’S CERTIFICATION
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
C&M ENGINEERING SERVICES
Ph: 907-854-5558
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
RE: Proposed Septic System for T15N R1W Sec 18 Lot 95A
Dear Reviewer,
The auxiliary well on the subject lot is intended to be hooked up to serve the garage in the future.
The well has had a cap welded on per the MOA’s request.
We have sampled for bacteria and nitrates. The bacteria results came back negative for coliform.
The nitrate results are pending analysis. We are requesting that the COSA be issued, pending nitrate
results. Upon receipt the nitrate results will be submitted to the MOA.
This is justified because the well is not in use and it was tested 2-years ago with no nitrates.
The well serving the dwelling also has a history of low or no nitrates.
The well is capped and is not in an area that is exposed to hazards that would create a concern for high
nitrates.
Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854-
5558 or by email cgbalzarini@gmail.com with any questions or concerns.
Sincerely,
Charles Balzarini, PE
7/20/22
MUNICIPALITY OF ANCHORAGE
a _ i
Development Services Department `_ Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-172-45
1. GENERAL INFORMATION
Expiration Date:
Complete legal description T1 !�N R1 W Section 18 Lot 95A
Location (site address) 19325 Adrian Avenue Chugiak, AK
Current property owner(s) Visionary Homes Day phone (907) 830-9009
Mailing address
Real estate agent
18132 Misty Falls Circle, Eagle River, AK 99577
2. TYPE OF DWELLING:
9 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑■
Private Septic
❑i
Water Storage
❑
Holding Tank';
❑
Community Well
❑
Community ;
❑
Public Water System
❑
Public Sewer',
❑
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ ZBo - ZID
Date of Payment
110 ( f_�_%ZD2.b
Receipt Number C)ZL15QD
COSA# 65C260200
Date:
Waiver Fee $ _
Date of Payment
Receipt Number,
Waiver #
COVID-] 9
257o DISCOUNT APPLIED
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone 522-7773
Address 1399 W. 34th Avenue, Ste. 100 Anchorage, AK 99503
Engineer's Printed Name Michael E. Anderson, P.E. Date 6/14/2020
6. DSD SIGNATURE
_X__ System #1 Approved for 4 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
vvri i L --I-\ rXi v
Original Certificate Date: r �L-J' 2 0
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
Well Flow Advisory Other
COSA Checklist blue sheet
•
Legal Description: T12N R1 W SEC18 L95A
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 1985/Unknown
Total depth 54 / *91 ft
Cased to >40 / >40 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 28 / *24 in.
Date of flow test for COSA 6-2/*5-29-2C
Parcel ID: 051-172-45
Structure served by this system
Well production at time of test 4.31 •1.8 gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate / *ND mg/L ❑ Nitrate less than MRL (ND)
Arsenic / *9.26 ug/L ❑ Arsenic less than MRL (ND)
Collected by Forge Engineering / *MW Drilling
Date of Sample 6-2/*5-29-20
Static water level at beginning of test 29 / *34 ft.
Comments Well log is for the well that serves the home. Only the well serving home was disinfected.
*Flow rate, static level, total depth and water sample results for garage well completed by M -W Drilling - 5/2020.
B. TANK DATA
Age of tank(s) <1 years
Tank type/material Septic/Plastic
Measured operating fluid level in septic tank New
❑ Standpipes/foundation cleanout per record drawing
Date of pumping New Construction - 5/13/20 � ,/
D. ABSORPTION FIELD DATA 5' Wide Trench
Which system tested (date installed) 5/15/20
OR ALL standpipes present per record drawing
Total measured depth from grade 8.4 ft (max)
Measured depth to pipe invert from grade 4.4 ft (min)
❑ N/A — pressurized field
OR 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 N/A gallons
Commentsbeficiencies:
COSA Checklist yellow sheet
C. LIFT STATION
❑ Required maintenance completed
Age of lift station N/A years
Lift station material
Comments:
Adequacy test date New Construction
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
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'
0✓ Yes
if No
Community Sewer Manhole/Cleanout > 100'
Q Yes
if No
ft
❑✓ Yes
if No
Neighboring Tank > 100' 0 Yes
if No
ft
Private Sewer/Septic Line > 25' 0 Yes
if No
Absorption Field on Lot > 100' 0 Yes
if No
ft
Holding Tank > 100' R1 Yes
if No
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' M Yes
if No
M Yes
if No
ft
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0 Yes
if No
ft
M Yes
if No
ft
ft
ft
ft
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ✓l Yes if No ft . Surface Water > 100' Q✓ Yes if No ft
Property Line > 5'
0✓ Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
✓M Yes
if No
ft
Private Wells > 100' ✓1 Yes if No ft
Water Main > 10'✓0
Yes
if No
ft
Community Wells > 200' F✓ Yes if No ft
Water Service Line > 10'
F/ 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'
✓l
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'✓�
Yes
if No
ft
Private Wells > 100' ®✓ Yes if No ft
Water Service Line > 10'
F/
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
Ar
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PLOT PLAN _ AS BUILT _X_ SCALE_ i S0� GRID _ NW 1155_ Project No._ 20_-256 Al
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone �Qo0Op4O
(907) 522-4625 Fax
Professional Land Surveyors ken®Iangsurvey.com
Jonathan®longsurvey.com
I hereby certify that I have surveyed the following described property: OOH O
LOT 95—A, SUBDIVISION OF BLM SMALL TRACT LOT 95 (PLAT No. 72-208) 0 ¢ :` 49T" pp
Anchorage Recording District, Alaska, and that the improvements situated thereon are """•"""••"" p
within the property lines and do not encroach onto the property adjacent thereto, that 0
no Improvements on the property lying adjacent thereto encroach on the surveyed �P KE� •fid Q
premises and that there are no roadways, transmission lines or other visible o
easements on said property except as Indicated hereon. po s GnC lj1J� �vOO
Dated this the _ " _ Da of �u.v 2a PF •LS-5.... '
Day �_, � at Anchorage, Alaska p0 �,o �o 0
O�SSIONAL \To
It is the responsibility of the owner to determine the existence of any easements, �Opppoo�
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
------------
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date ~""
1. GENERAL INFORMATION ¢~.. ~.~---/~.)
(a) Legal Description (inclu'de lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name~"r~'L,~.c:, ~*'~l-~t.,=,~...~,~'~' Telephone: Home (-~' ~L~(~ Business
Applicant Address
(c) Applicant is (check one): Lending Institution []; Owner/builder ~-; Buyer []; Other [] (explain);
(d) Lending Institution
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) ~the HAA to the following address:
Telephone
TYPE OF RESIDENCE
Single-Family ~. Multi-Family []
Number of Bedrooms ~
Other
WATER SUPPLY
Individual Well~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status,
4. SEWAGE DISPOSAL
Onsite.~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72
for the number of bedrooms and type of structure indicated herein, t 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm
Address ,-,
Date
Telephone
Terms of Conditional Approval
Conditional
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professiona~ engineer's work.
Page 2 of 2
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
MUNICIPALITY OF ANCHOP, AGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
1985
Well Classification '~'~"'[~ ¢~'"f'~ If A. B. C, D.E.C. Approved (Y/N)
Well Log Present ~),N)"_ Date Completed ~'~''~'"¢' Yield
Total Depth ~'~.] ' G, ~' Casea to
Static Water Level -'~
Casing Height Above Ground /~ ~ r
Electrical Wiring n Conduit
Separation Distances from Well:
To SeptiC/Holding Tank on Lot /~c~
To Nearest Edge of Absorpuon Fiela on Lot
TO Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected Dy
Water Sample Test Results
Depth of Grouting
Pump Set At
Sanitary Seal on Casing
Depression Around Wellhead
: On Adjoining Lots
{oo ~ ~ : On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on
~ ~, Date
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed b"""-
Stand pipes i~/.J¢,)
Depression over
Pumping/Maintenance Contract on File (Y/N)
/
Holding Tank High-Water Alarm (Y/N}
Separation Distances from Septic/Holding Tank:
To Water-Supply Well /~ ~
To Property Line
To Water Main/Service Line
Course
Comments
Size /~'~"'¢ No. of Compartments
Air-tight Caps ~ Foundation Cleanout [I'
Date Last Pumpea '--~'-"/~' "/~'"' ~""-
:for
Temporary Holding Tank Permit [Y/N)
To Building Foundation ,~O' -r--
To Disposal Field -'¢',-~' #
To Stream Pond, Lake. or Major Drainage
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating m Absorption Strata
Date Installed
Width of Field
To Water-Supply Well
To Building Foundation
Lot
Square Feet of Absorption Area
Depression over Field.~.~
Results of Last Adequacy Test
Separanon Distance from Absorption Field:
'"
To Water Main/Serwce Line ~"O t ~,
To Stream/Pond/Lake/or Major Drainage Course
/
Length of Field
Depth of Field
Gravel Bed Thickness
~'~..'0 ~ Standpipes Present
Date of Last Adequacy
To Property Line
: On Adjoining Lots
To Cutbank (if present)
.~,~ ~4~
To Existing or Abandoned System on
To Driveway, Parking Area, or Vehicle Storage Area
Comments ,~r~,~)~s/u/~:~-/~ ~ ~ ~5' ~
D. LIFT STATION
Date Installed
Size in Gallons ,/
"Pump On' Leve~ at
High Water Alarm Level at
Tested for
Dimensions
~,lanhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles our~ng Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
Check Permitted Bedroom Rating Against HAA Request
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this i nspecnon
Date of Payment
Amount: $
Page 2 of 2
72-026 11/84)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
3
4
10
11
13-
14-
15-
17-
18-
19-
20-
COMMENTS
PERFORMED BY:
72-008 (6/79)
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
Ho, 1457-E
PERCOLATION RATE ~;~O r~
TEST RUN BETWEEN ~ FT AND ~" FT
CERT, ,ED