HomeMy WebLinkAboutT15N R1W SEC 18 LT 136
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 1
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP 241148 PID Number: 05123202
Dwelling: RN Single Family (SF) El with ADU R Duplex (D) El Two Single Family Project: R New OR Upgrade
Name
MEYERS
ABSORPTION FIELD
❑ Deep Trench RN Wide Trench R Bed R Mound
Site Address
19016 HIDDEN HILL CT
0 Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
13
1.2 GPD/SF
JTotal
6 Ft,
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3 Ft.
Gravel depth beneath pipe
3 Ft.
Subdivision Block Lot
T15N R1 SEC(8 LOT 136
Fill added above original grade
6 Ft.
Gravel length
50 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To Septic Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist, between trenches
From Tank Field
Lift Station
Tank
Line
431 Ft2
Ft.
Well +100i +100
+25
TANK S.T.E.P. -1
ANK in Septic [3 F-1 Holding ❑ Other
Manufacturer
GREEK
Capacity
1000
1
Surface Water + 100 +100
Gal.
Material
POLY
Number of compartments
2
Lot Line +101 +10
NA
Foundation 9 1+10
LIFT STATION
_Manufacturer
Capacity
I
Remarks TANK REPLACEMENT AND DOCUMENT
Gal,
EXISTING LEACHFIELD
Alarm location
Electrical installed by
PIPE MATERIAL House to tank F628 drainfield Tankto 3034
Installer
OWNER
Drainfield 3034 CO/MT 3034
Inspector C&M ENGINEERING
BENCH MARK (Assumed elevation) 100 ft
Inspection 1st 7112/24 7/19/24
Location and description
dates: 2nJ
SLAB AT BTMDECK STAIRS
3'd 4'n
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
. -"I"-
-,W#A.7 N
OF Ak.4 k�k4
Conditional Approval: Date
A;W: �11
co
STH
- ----__-_- -- - _-
Septic Syste
t;HARLES G BA LZARIM
Approved Date V. J.-
CE-13854
Note: this approvaoia�r/s not include well permit requirements.tt
3/10/2
(Rev 05/02/18)
CHARLES G BALZARINI
CE-13854R
E
GISTEREDPROFE S S I O N A L E N GINEER
8/1/24
C&M ENGINEERING SERVICES
Ph: 907-854-5558
Municipality of Anchorage
Onsite Water & Wastewater Program
4700 Elmore Rd Anchorage, Ak 99507
RE: Septic System for T15N R1W SEC 18 LOT 136
Dear Reviewer,
The above referenced property is currently served by an older septic system with a leaking tank that
needs to be replaced. The owner is seeking COSA after the tank is replaced. The existing septic system
was installed in 1993 or 1994 and was inspected by S&S engineering. A letter on file indicates that the
system was inspected, but the report was not submitted due to insufficient cover. Sufficient fill has since
been placed over the field.
The existing leachfield was tested, camera’d, and assessed to determine its condition and conformance
to the original design. The system generally matches the original design. Based on this information and
information provided by the owner-installer, it appears the system was installed per plan.
Significant fill has been added since the leachfield was constructed. The cut bank / steep slope shown on
the design drawings has been filled in to create sufficient cover over the leachfield.
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
8/1/24
Lot 136
T15N R1W SEC18
108,900 Sq. Ft. +/-
19016 Hidden Hill Court
2 Story Wood Frame House
With No Garage
;
;;;;;;;;;;;;;
;;;;;;;;
OHU
OHU
OHU
OHU
OHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHUOHU
OH
U
OH
U
OH
U
OH
U
OH
U
OH
U
OH
U
OH
U
OH
U
OH
U
OH
U
OH
U
OH
U
OH
U
OH
U
OH
U
OH
U
OH
U
OHU OHU OHU OHU OHU OHU OHU
W
G
E
S
"DETAIL A"
SCALE 1" = 20'
"DETAIL B"
SCALE 1" = 15'
SEE "DETAIL A"
SEE "DETAIL B"
FIREPIT & BENCHES
EDGE OF PAVEMENT 33' PATENT ROW RESERVE
BOOK 232 PAGE 148
33' PATENT ROW RESERVE
BOOK 236 PAGE 354
33' PATENT ROW RESERVE
BOOK 175 PAGE 182
33' ROW & UTILITY EASEMENT
BLM PATENT BOOK 235 PAGE 318
33' PATENT ROW RESERVE
BOOK 229 PAGE 244
1
0
0
'
W
E
L
L
R
A
D
I
U
S
LOT 135
70.5'
11
0
.
5
'
46
.
2
'
210.5'
195.3'
96.8'
DI
R
T
D
R
I
V
E
W
A
Y
LOT 119
LOT 146B
PLAT #78-169
LOT 146A
PLAT #78-169
LOT 1
LOT 2
BEVERLY HEIGHTS
SUBDIVISION
PLAT #70-342
LOT 3 LOT 147A
PLAT #83-220
HIDDEN HILL COURT
PLANTER (TYP.)
LOT 120
LOT 137
N90° 00' 00"W 328.88' (R)
N89° 35' 45"W 330.96' (M)
N89° 58' 39"E 327.98' (R)
(BLM SURVEY)
(PLAT #78-169)
(THIS SURVEY)
N0
0
°
0
3
'
0
0
"
W
3
2
9
.
9
3
'
(
R
)
N0
0
°
0
3
'
0
0
"
W
3
2
9
.
9
0
'
(
R
)
N90° 00' 00"E 328.88' (R)
N0
0
°
0
3
'
0
0
"
W
2
9
6
.
3
2
'
(
M
)
N89° 42' 56"W 329.91' (M)
(B
A
S
I
S
O
F
B
E
A
R
I
N
G
)
N0
0
°
0
3
'
5
9
"
W
2
9
6
.
5
1
'
(
M
)
S
S
SCSSS
S
16.4
'
1
8
.
3
'
5.2'
6
.
0
'
29.8
'
1
2
.
3
'
8.2'
1
6
.
3
'
16.4
'
2
0
.
4
'
8.0'
2
1
.
7
'
1
4
.
4
'
6.0'
8
.
3
'
10.3
'
S
H
E
D
CHICKEN COOP
GREENHOUSE
PREPARED BY:
FRONTIER SURVEYS, LLC
650 W. 58th AVE. SUITE E, ANCHORAGE, AK 99518
907-460-1686
DRAWN BY:
CHECKED BY:
DATE:
SCALE:GRID: NW1054
1.Excepting for gross negligence, the liability for this survey shall not
exceed the cost of preparing this survey. Dimensions to property lines
are plus/minus 0.1ft.
2.This document is created by Frontier Surveys for the purpose of an
as-built survey for Emily Selix (Robert Meyer III), only.
General Notes DisclaimerLegend
1. 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.
RS 1" = 50ft
07/16/2024 24-152BH
Scale 1" = 50'
AN AS-BUILT SURVEY OF
LOT 136
T15N R1W SEC18
19016 HIDDEN HILL COURT
CONTAINING: 108,900 Sq. Ft. +/- (RECORD)
RECORD PLAT: N/A
R
E
GISTEREDPROFESSIO N A L L A N D S URVEYORRachel N. Shoemake
No. L.S. - 14646
Aug 08, 2024
DRAWING ID:
Gas Meter
Electric Meter
G
E
Septic
Water Well
S
W
Wood Deck
Telephone Pole
Overhead Utility
Concrete
Fence[
Found Rebar
Found Monument
Found Alum. Cap
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
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP241148
Work Type: SepticTank Upgrade
Tax Code Number: 05123202000
Site Legal Address: T15N R1 W SEC 18 LT 136 G:1054
Site Mailing Address: 19016 HIDDEN HILL CT, Chugiak
Owner: MEYERS ROBERT M III
Design Engineer: C&M ENGINEERING SERVICES
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
�11tt n r
f,
Ucparetnf:�nc
7/1 /2024
7/1 /2025
108900
❑ Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy ❑ 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: The 1993 septic permit (SW930302) is to be closed out along with this tank permit.
Received By: A °v\ Date:
Issued By: Date: r 'Zo 27
ON -SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 05123202000
Property owner(s) MEYERS ROBERT M III Day phone
Mailing address
Site address 19016 HIDDEN HILL CT
Legal description (Sub'd., Block & Lot) T1 5N R1 W SEC 18
Legal description (Township, Range & Section)
Lot Size 108,900 Sq. Ft. Number of Bedrooms 3
LT 136
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(Z all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF)
(w/wo ADU)
Septic Tank
Upgrade
Duplex (D) ❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings ❑
Privy
EJ
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
NONE
Distance: NA
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
C&M ENGINEERING
(Signature of property owner or authorized agent)
Permit/Rush Fees: 1Z Z �_ Waiver Fees:
Date of Payment: f Y Date of Payment:
Receipt Number:
Permit No. () S i
Receipt Number:
Waiver No.
G:\Development Services\Building Safety\On Site Water and WastewaterTorms\Client Forms\Permit Application.doc
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 136
Dear Reviewer,
The above referenced property is currently served by an older septic system with a leaking tank that
needs to be replaced. The owner is seeking COSA after the tank is replaced. The existing septic system
was installed in 1994 and was inspected by S&S engineering. A letter on file indicates that the system
was inspected, but the report was not submitted due to insufficient cover. Sufficient fill has since been
placed over the field. We will document the leachfield during the tank installation and will submit a record
drawing.
Our review of available documentation and field investigation show that this project will not adversely
impact any nearby Wells, Wastewater disposal systems, replacement disposal sites, or drainage flowing
onto and off of the subject property.
As shown on the plan, the tank will be greater than 10’ from the house foundation.
The tank will be of MOA approved construction.
The tank must be covered with a minimum of 2” moa approved insulation and 3’ of cover or a minimum of
4’ of cover without insulation.
The repair must be performed by a moa certified installer in accordance with MOA requirements, Or by a
qualified homeowner. If groundwater is encountered during excavation of the tank hole, an alternate tank
type may be required.
Repair of the proposed system will not negatively impact adjacent lots.
Upon completion of the installation, a record drawing will be submitted showing the location of the new
tank, leach field, well, and other applicable features.
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
6/18/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241148, Curtis Townsend, 07/01/24
CHARLES G BALZARINI
CE-13854REG
IST EREDPROFE S S I O N A L E N GINEER
6/18/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241148, Curtis Townsend, 07/01/24
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Septic System Owner -installer Agreement
The On -site Water and Wastewater Section (On -site) may issue an approval for a homeowner
to perform work on an on -site wastewater disposal system to serve that individuars owner -
occupied, single4amily or duplex home if the homeowner meets and agrees to the following
requirements:
1. The property owner and excavation equipment operator may perform work on no more
than one owner -installation project in a 12-month period.
2- Owner's projected active involvement with the installation:
"A7-, S�Tp-1 I -1ZA g CD r."o Q--�o 0 41i-
elk
3. The name of the excavation equipment operator. �,'e,► k hA Meese P-4
4. 1 agree that there will be no monetary compensation for installation services rendered.
5. The name of the inspecting engineer. CIA "L-e 4 13 AI- Z 4 R,',J "
6. 1 agree to discuss the following items with the inspecting engineer.
a. Permit design criteria and specifications.
b. Inspection requirements set forth in AMC 15.65.070.
c. Advance notice given to the On -site Water & Wastewater Section for all required
municipal inspections (AMC 15.65.070A).
7. 1 agree to have the project -specific On -site Wastewater Disposal System Permit available
at the construction site for the duration of all related work.
8. 1 agree that if the system is an advanced wastewater treatment system (AWWTS), I will
obtain additional installation instructions and approval from the equipment distributor.
' AAr5
As owner of (legal description) T Wt J 91 W - :Sc< J :3
I agree that the information above is true and accurate.
Owner's printed name: go 6Iet2T- M mle-!:{10 25
1
Owner's signature: Date: Zz/ AR 4
I I , Mailing Address: P. Q. Box'196650 * Anchorage, Alaska 99519.6650 * www.rnuni.org
ROBERT C. COWAN, RE.
ROBERTA. SHAFER, RE.
SEWER & WATER
MAIN EXTENSIONS
SONER & WATER
INSPECTION
ROAO DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
Date:
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
RECEIVED
9 1996
Municipality of Anohorage
Dept, Health & Human 8ervloea
The septic inspections for the re~erenc~d property, w~re
performed on ~.~ ~q and ~.~ . Prlor to submlttlng
the On-site Wastewater Disposal System and/or Well Inspection
Report we are waiting for the ~e~3A~- do~ to be
completed. O9~~C~.
If we may be of further service please contact us.
Sincerely,
17034 NORTH EAGLE RIVER LOOP SUITE 204 EAGLE RIVER, ALASKA99577
Rick Mystrom,
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "U' Street
P.O, Box 196650 Anchorage, Alaska 99519-6650
343-4744
November 15, 1994
Mr. Colburn Jones
136 Lounsbury Road
Ridgefield, CT 06877
Subject: T15N, R1W, Sec 18, Lt 136
Permit #SW930302, Parcel ID #051-232-02
Dear Mr. Jones:
The subject permit, issued August 16, 1993 by this office for a single family well and/or on-site
wastewater system, has expired as of August 16, 1994.
A new permit must be obtained from this office for a well 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 the on-site wastewater system has been completed and 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 consu'uction completion.
When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00
for a well permit and $440.00 for a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
Program Manager
On-Site Services
JC/kb
cc: Robert C. Cowan, P.E.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE
1 OF
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930302
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:JONES COLBURN D & ROBERTA L
OWNER ADDRESS:136 LOUNSBURY RD.
RIDGEFIELD, CT 06877
DATE ISSUED: 8/16/93
EXPIRATION DATE: 8/16/94
PARCEL ID:05123202
LEGAL DESCRIPTION: T15N R1W SEC 18 LT 136
1
LOT SIZE: 108900 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
DATE:
DATE:
ROBERT SHAFER, P E
ROGER SHAFER, P E
August 7, 1993
CIVIL ENGINEERS
(907) 694-2979
FAX 694 1211
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERfNG STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
Anchorage, AK 99519-6650
REFERENCE: Lot 136, Section 18, T15N, R1W, SM, AK
We request you issue a Dermit to drill a well and install a
seDtic system to serve the proposed three bedroom house on
the referenced property.
A test hole was excavated and a percolation test performed on
the referenced property. The approximate location of the
test hole is located on the attached site plan. The
monitoring tubes within the holes have been checked and found
to be dry.
This property has enough area for a future septic upgrade,
which can be seen on the attached site plan. We do not
anticipate any adverse effects on neighboring properties by
the installation of the proposed septic system.
If you have any questions, or require additional information
for yo~__~e~ew, please contact us.
PERCOLATION
TEST
A. Shafer, P.E.
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON 81TE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
'lsu
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:~7 /J.~/7/-~//~./~,/'~,.~-,~ ownship, Range, Section:
SLOPE
2
5
7
8
9
10
SeO!AJeS ueu. Inl-I ~,~ qll[-~al..t ~d~Ci
£66L £ L 9fl¥
11
13-
14-
15
16
17
18
19,
20-
SITE PLAN
IF YES, AT WHAT
DEPTH?
Depth Io Wat..~...A~'~,~, J
Monitoring? _~ Date
Reading Date Gross Net Depth to Net
Time Time Water Drop
.... :o -
:o~' ~ ,% ,/)_1~1~.
.'3a ~ ?" IlL
PERCOLATION RATE ~:~ (minutesnnch) PERC HOLE DIAMETER
~ TEST RUN BETWEEN, Z~-~T AND Z~ FT
17034 Eagle River Loop EoadNo 9n~
PERFO R ME'aI~¥~ [~'; .... A;'~'~- '',~'Z '--'' ~~ CERTIFY THAT THiS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL ST ATE ANO M~NIClPAL GUIOE~ECT ON THiS DATE, DATE:
~ ~ ~.ev 4~ ~
ALASKA LAND DEVELOPMENT SERVICES
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR; ~7-~j'/
SITE PLAN
PERCOLATION RATE (minutes/inch)
TEST RUN flETWEEN -- FT AND FT
~.~ I~'~./.-'...I ~',H rl-o.~ s~.,~' ~
ALASKA LAND DEVELOPMEiVT SERVICES
Eng~eem . Sur,,e>'om - Planners
SOILS LOG -- PERCOLATION TEST
6
20-
OATE PERFORMED:__ /(~? ~-
MUNICIPALITY OF ANCHORAGE
Development Services Department% Phone: 907-34.3-7904
On -Site Water & Wastewater Section �� ' Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-232-02
Legal description T15N R1 W SEC 18 LT 136
Site address 19016 HIDDEN HILL CT
Current property owner(s) MEYERS ROBERT M III
Expiration Date:
6/12/2025
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
By: G�
Original Certificate Date: 8/9/2024
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory X
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA ApprovMjune 2022
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 05123202000
Complete legal description T1 5N R1 W SEC 18 L136
Location (site address) 19016 Hidden Hill Court
Current property owner(s) Meyers
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: FM -1 Private Well R Private Well serving 2 dwelling units
R Private Well serving 3+ dwelling units R Community Well or Public
F-1 Water Storage
4. TYPE OF WASTEWATER DISPOSAL: RE Private Septic R Private Septic serving 2 dwelling units
El Holding Tank n Community Septic or Public Sewer
5. SEPTIC TANK: [-] Steel X Plastic Fj Concrete [_J Fiberglass
Age 0 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: 0 AWWTS E] Bed E] Deep Trench FN� Wide Trench 171 Seepage Pit
Waiver request for: Distance:
Expedited review requested: 11I
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ 53a)
Date of Payment A-
COSA # -S C_ 'z_
Waiver Fee $
Date of Payment
Waiver #
COSA Application—June 2022
COSA Checklist_June 2022
COSA Checklist
Legal Description: Parcel ID:
If more than 1 well and/or septic system on lot, provide separate checklist. 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
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
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.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
COSA Checklist_June 2022
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
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
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to 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
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F.ENGINEER’S COMMENTS
G.CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Phone
Engineer’s Printed Name Date
C&M ENGINEERING
CHARLES BALZARINI, PE 8/1/24
r-VIUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT Aie"
907-343-7904
On -Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Well Water Advisory
Certificate of On -Site Systems Approval # OSC241204
Subdivision: T15N R1W Sec 18 . Block: , Lot: 136
This well's productivity was determined to be .5 gallons per minute. The minimum
well productivity required under (AMC 15.55) for a 3 -bedroom residence is .31
gallons per minute or 150 gallons per day per bedroom. Although the well
production does not meet this requirement, water storage has been provided to
meet minimum code requirements.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.