HomeMy WebLinkAboutGROH LT 1Onsite File
LOT 1
PID# 015-521-12
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Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: 015-521-12
PID Number: OSP261184
Dwelling: F* Single Family (SF)
F-1 with ADU El Duplex (D) M Two Single Family Project: M New FM Upgrade
Name
Crown Point Inc
ABSORPTION FIELD
[:1 Deep Trench Al Wide Trench F-1 Bed R Mound
Site Address
10960 Totem Rd
El Other
Phone
(907) 727-5259
Number of Bedrooms
13
Soil Rating
Total depth from original grade
4.0 GPD/SFI
5.6 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3.6 Ft.
Gravel depth beneath pipe
2.0 Ft.
Subdivision
Groh
Block Lot
1
Fill added above original grade
0.0 Ft,
Gravel length
20.0 Ft.
Township Range Section
Gravel width
5.0 Ft.
Beds: Number of Lines
N/A
Distance between lines
N/A Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
142 Ft2
1
N/A Ft.
Well
>50'
>50'
N/A
N/A
>25
TANK 0 Septic 0 S.T.E.P. 171 Holding M Other
Manufacturer
Anchorage Tank
Capacity
1500 Gal.
Surface Water
>50'
>50'
N/A
N/A
Material
Plastic
Number of compartments
2
Lot Line
>5'
>10'
N
N/A
NA
Foundation
>10'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Orenco
Capacity
I nteg rated Gal.
Remarks AWWTS system
Alarm location
Between deck and FCO
Electrical installed by
Frontier Electric
PIPE MATERIAL House to tank D3034 drainfieldTankto D3034
Installer
BTH
Drainfield D3034 CO/MT D3034
Inspector Justin Earls
BENCH MARK (Assumed elevation) 100 ft
Inspection 1-7/8/26
7/8/26
Location and description
dates:
nd
2
Rear Sliding Door Threshold
aro 7/9/26
4,,7/9/26
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
F Ak"AA
Conditional Approval:
Date
TH
Benianny c ihill er
Septic System
Approved7/23/2026`%`°
5f
t
Date 7/23/2026
CE 12592 ..'J,$ ,W
N-
,F*V). -7/20126 * *
4
klk�, PROFESSO
Note: this approval does not include well permit requirements.
tKev ut)/uz/i z3)
Benjamin Schiller
CE 12592R
E
GISTEREDPROFE S S I O N A L E N GINEER
1"=20'
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
TH#1
PERMIT # OSP261184 PID # 015-521-12
GROH, LOT 1
A B
MH 21.8
POD 23.5
CO3 27.0
A
B
CO1 30.9
MT1 33.4
CO2 48.9
MT2 46.6
26.8
28.8
23.2
20.8
21.2
16.4
13.7FEET
0 20 40
PLAN AS-BUILT
7/20/26
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3-BDRM HOME
MT2
MT1
20' LONG x 5' WIDE, 2' EFFECTIVE
DEPTH ABSORPTION TRENCH
NEW 1500-GAL
ADVANTEX FAP SEPTIC
TANK
EXISTING WELL w/ 50'
RADIUS (TYP)
525
520
515
VACANT
CO2
CO1
CO3
WELL >50' OUTSIDE VIEWPORT
MH
POD
BM LOCATION
ALARM
LOCATION
PROFILE AS-BUILT
(NO SCALE)
93.7
88.7
94.6
98.0
FC
O
MH
PERMIT # OSP261184 PID # 015-521-12
GROH, LOT 1
CO
Benjamin Schiller
CE 12592
R
E
GISTEREDPROFE S S I O N A L E N GINEER
1500 GAL ADVANTEX
FAP TANK
AX-20
FILTER
POD
7/20/26
98.0 ORIGINAL & FINISH GRADE
20'
DRAINFIELD ROCK
MT
TH
#
1
NO GROUNDWATER 6/15/26
94.4
CO CO
82.0
92.4
MT
94.4
92.4
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As-Built
Feet
0 30 60
Permit Number:OSP261184
Tax Code Number:01552112000
Work Type:Septic Upgrade
Effective Date:
Design Engineer:
Site Legal Address:GROH LT 1 G:2637
Owner:CROWN POINTE INC
Site Mailing Address:10960 TOTEM RD, Anchorage
Lot Size in Sq Ft:11199
Total Bedrooms:3
This permit is for the construction of:
Disposal Field Septic Tank Holding Tank Privy
Non-Public
Water 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. Coodinate with On-Site staff regarding preferred method.
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
7/2/2026
7/2/2027
FORGE ENGINEERING
Special Provisions: Title was transferred without a COSA. A COSA will be required when
closing this permit.
Expiration Date:
þ þ ¨¨¨¨
Issued To:
Issued By:
Date:
Date:
7/2/2026
7/2/2026
FORGE ENGINEERING
Isatou B Njie
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
��1
Development Services Department j Phone: 907-343-7904
On -Site Water & Wastewater Section
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I. D. 015-521-12
Property owner(s) Crown Point Inc
Mailing address PO BOX 112313, AnChora
Day phone _
e, AK 99511
Site address ' - - y -niv L j.{6 P 1-6 E
Legal description Groh, Lot 1
Number of Bedrooms 3
Engineering Firm Forge Engineering
Building Permit Number
Permit/Rush Fees: T 0
Date of Payment: -3 0/) o
Permit No. C) S L L
May 2025
Not Applicable ❑■
Initial
❑
Disposal Field
❑x
Septic Tank
0
Holding Tank
❑
Privy
❑
Well
❑
Water Storage
❑
Permit/Rush Fees: T 0
Date of Payment: -3 0/) o
Permit No. C) S L L
May 2025
Not Applicable ❑■
Initial
❑
Upgrade
Fx_1
Renewal
❑
Waiver Fees:
Date of Payment:
Waiver No.
Distance:
June 23, 2026
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Groh, Lot 1 – 10960 Totem Rd
Septic system design
Dear On-Site Services Engineer:
The owner of the above lot owns a 3-bedroom home on the property. The existing septic system
serving the home has reached the end of its useful life, so we are submitting this permit application
for the construction of a new septic system. The attached site plan identifies the location of the
home as well as the proposed septic location. No conflicts exist between this proposed system and
any other well or septic system, whether on this lot or adjacent lots.
The ground surface on the lot has a mild slope >10% from the east to the west across the entire lot.
There are no slopes greater than 25% within 50 feet downslope of the proposed system. Contours
are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not
impact this septic system. The new trench will be constructed parallel to the slope as much as
possible.
Wells on this and adjacent lots are shown. The new system will be a minimum of 50’ from all
wells and surface water, and more than 5’ away from the septic tank. Please refer to the attached
test hole log, plan and profile pages for the septic design. If this design is followed, there will be
no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP261184, Isatou Njie, 07/02/26
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
1"=20'
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
TH#1
GROH, LOT 1
FEET
0 20 40
SEPTIC PLAN
6/23/26
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3-BDRM HOME
MT
MT
DECOMMISSION EXISTING LOG
CRIB. LOCATE, PUMP AND
BACKFILL PER UPC
20' LONG x 5' WIDE, 2' EFFECTIVE
DEPTH ABSORPTION TRENCH
DECOMMISSION
EXISTING CONCRETE
TANK AND REPLACE
WITH NEW 1500-GAL
ADVANTEX FAP SEPTIC
TANK
DECOMMISSION EXISTING CONC
CRIB. LOCATE, PUMP AND
BACKFILL PER UPC
EXISTING WELL w/ 50'
RADIUS (TYP)
10.0
10.0
525
520
515
VACANT
CO
CO
CO
WELL >50' OUTSIDE VIEWPORT
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP261184, Isatou Njie, 07/02/26
GROH, LOT 1
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
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
DESIGN FACTORS:SYSTEM REQUIREMENTS:
450 GPD PEAK FLOW
PERK RATE: 22.8 MIN/IN
APPLICATION RATE: 4.0 GPD/SF
5' WIDE TRENCH SYSTEM
1500-GAL ADVANTEX FAP SEPTIC TANK
BOTTOM OF TRENCH: 5.5' BELOW GRADE (10.0' MAX)
FLOW LINE ELEVATION: 3.5' BELOW GRADE
450 GPD / 4.0 GPD/SF / 5' WIDE * 0.70 RED FACTOR [2.0 DEEP] = 15.8 LF TRENCH REQUIRED
(20.0 LF SPECIFIED)
6/23/26
2'
5'
6"
3'
6"
4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
GEOTEXTILE FABRIC
PROVIDE ADDITIONAL FILL TO
ACCOUNT FOR SETTLEMENT
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP261184, Isatou Njie, 07/02/26
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE: PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
DEPTH
(feet)
TEST HOLE 1
DATE READING NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERCOLATION RATE: (MIN/INCH)
(inches)(inches)
DATE OF MONITORING
DEPTH TO WATER AFTER MONITORING
22.8
6/8/26 1
2
3
SM-SC (CLAYEY SILTY SAND)
Professional Engineers Stamp:
GROH, LOT 1
6/8/26 015-521-12
CROWN POINT
4 0
16
OB
30
Benjamin Schiller
CE 12592REGISTEREDPROFESSION A L E N GINEER
PERC TEST LOCATION
TECHNICIAN: JUSTIN EARLS
6 8
16
NONE
6/15/26
COMMENTS:
SITE PLAN
2 8
16
USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED UNLESS OTHERWISE NOTED.
6/23/26
MOISTURE NOTED AT TIME OF DIGGING?NO
SM (FINE SILTY SAND)
SM (FINE SAND)
4 0
1630
4 0
1630
5 6
16
5 5
16
1 6
16
1 5
16
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP261184, Isatou Njie, 07/02/26
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this Day of T� ( n/ of 20� C-, by and between
, herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (A
described as Z --r, $- / crct-- C /,:,
located at (legal description)
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
e
k Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
e4t4 It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
e
_ Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page 1 of 3
&4 IV- Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS maybe
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
6414 Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
14 Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
aN_ Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018)
Page 2 of 3
OWNER:
By: (signature) Date:
K�3 Get�� (print name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
7/2 /Li
The foregoing instrument was acknowledged before me this "day of ,
209(,, by 1JlAQ i� �Q floe o('�
NOTARY PUBLIC FOR ALASKA°,, Official sear
' State of Alaska
My Commission expires: Notary Public
Nadia Maldonado
Can nssan 12Wr,UN CWNAW V*K0TRel1o2➢
MUNICIPALITY:
By: `
(signature) Date:�-/'Z12-o ZJ—
s<-L (print name)
Title:
(rev. 05/18/2018) Page 3 of 3
TO
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As-Built
Feet
0 30 60
Gr TER ANCHORAGE AREA BORO' H
DF. PAFITNIENT OF ENVIRONMENTAL QUALIqlY
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
iNSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC 'rANK:
DmTANCE fROM WELL__ .~
LIQUID CAPACITY_
_.GALLONS.
MATERIAL ('~/~' ~/~Z = '~"'~z' NUMBER OF
COMPARTMENTS
'-'~/~'/''~3~'~ LIQUID
INSIDE LENGTH INSIDE WIDTH. DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT: /~/"~"'~"~
NUMBER OF PITS .... / ODTSIDE DIAMETER_ ~ OR WIDTEI
LINING MATERIAL_L//~/LZ'/~'~'~';¢ ~'~"/K/ DISTANCE FROM WELt
NEAREST LOT L,NE ~ ~'
TOTAL EEFECTIVE ABSORPTION AREA (WALL AREA)
__, LENGTH ''¢''~) , DEPTH ~'
BUILDING FOUNDATION ~'~'')~ ,
SQ, FT.
TILE DRAIN FIELD:
TOTAL LENGTH
OF LINES
DISTANCE FROM WELL____ FOUNDATION , NEAREST LO! LINE
w,,,,,_
ABSORPTION AREA~ SQ. Ff. LENGTH OF EACH LI :~ ~"
DEPTH OF EILTER MATERIAL BENEATH TILE.
DEPTH: TOP OF fILE TO FINISH GRADE
IN. ABOVE TILE
/ DISTANCE FROM /./¢~ / WATER
WELL: TYPE/.~¢~,,~// DEPTH ,//,~ , BU LD NG FOUNDATION _'"'~'_ _._ SAMPLE _~/~:'~/u¢~ , NEAREST
NEAREST SEPTIC -' SEEPAGE ~- OTHER- ·
LOT LINE ,/(') "/O ,,~'/ , SEWER LINE .... , TANK "~' , SYSTEM ~/~' , CESSPOOL. ~" . SOURCES.
DIAGRAM OF SYSTEM
DISTANCES: J
DATE
GRP&TER ANCHORAGE AREA BOROUCH
HEAl. TH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE FROM WELt ~"1~ !
LIQUID CAPACliY / '~" '~)
GALLONS.
MATERIAL u/~f~i~ ~/"J~- ]'~ NUMBER OF /
COMPARTMENTS
LIQUID
INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS__
LINING MATERIAL
NEAREST LOT LINE
~/ __OUISIDE DIAMETER
,~t I TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
OR WIDTH
DISTANCE FROM WELL
/S"/ X 2~' X' G/
, LENGTH , DEPTH 6
BUILDING FOUNDATION ~/~'"'~!
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELL ~-¢~AIION , NEAR~gI--'L"~C'EiNI:. OF LINES
ABSORPTION AREA SQ. Ff. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE____
WELL: TYPE. ¢-,~J~///~'~ DEPTH f/,r~'/ DISTANCE FROM
· BUILDING FOUNDATION,
LOT LINE /~}~' SEwERNEARESfLINE '/,, ~'~'~ SEPTIC ~-.& ~' SEEPAGE
, , TANK , SYSTEM
WAFER
SAMPLE
CESSPOOL
, NEAREST
OTHER
, SOURCES
DISTANCES:
DATE
DIAGRAM/i~ ~_ OF~...S~,.EM
'Dj 'rz'
t
APPROVED ~-' '~
HEALTH AUIHORIIY
GREATEK ANCHORAGE AREA
HEALTH DEPARrI'MENT
327 Eagle St. Anchorage, Alaska 99501
.)ROUGH CaseN0. ~-
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
''--J /~.~;'(b,'/~'.~' ~-'1~ LOCATION OF ,NSTALLATION~.~~ J .- ..... ~) ~]~"
RESIDENCE ADDRESS ~;~/~,/ . c~ .- _ ~
.LEGAl. DESCRIPTION ~" ~ ]:/.( .~ ~,.(~/,~,~ ~?.-- ~:.'-~ ~ ~:~b,~.,
APPLICATION TO INSTALL: SEPTIC TANK ~.- ,SEEPAGE PIT ~- ,DRAIN FIELD ~ ,OTHER
TOSERVETHE FOLLOWING FACILITY. ~' (S,~ /,Z~,'-~
FINANCED THROUGH ~. ~ ~ ,~,~ /r~f~)BE INSTALLED BY~
PERCOLATION TEST RESULTS~ $~ ~"A~/~¢~
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS";~,.' .~,Z....~-,,~-;-~-,,--:, , PERMIT TO INSTALL A .5¢~~A1- 5,..~,:._.;~ /,~.~r ~
AS DESCRIBED BELOW. SIZE OF UNLT~r.T~O~B~E. SERVED LT~ /~<~ W,.'~_~ /~/.,-~_e
SEPTIC TANK SIZE ~ ,~-C~ 'TYPE'~?~A-'~---~ACG EDIAGRAM AREAoF SYSTEM~ ~"~9~ ~tTY Z A~l¢'~ ("ff ~
Health Authority
'):-"D:/-::~ o¢- 0'~/~ 7-b ~, 0'7z Ze,.~
I certify that I am familiar with the reqUkements of Greater Anchorage Area Borough Ordh]ance No, 28-68 and that the
above described system is in accordance with said code.
/
DATE__ ~ APPLICANTS SIGNATURE d. (': :; .,.. '~ '/ .....
CREATER ANCHORAGE AP. FA BOROUGH
HEALTH DEPAkTHEI~IT
327 EAGLE STREET
ANCHORAGE~ AI,A[-tKA 99501
CASE
Perfommed For -" '"- ~ ' /' t' Date Performed ,~d 5 /-)~-~ /~'~?
Legal Description: Lot / Block Surm~v~sion
This Form Repopts at So~ls Log ........ ~ ............. JePcoJ. atlo~ lest
De pt h
Feet Soil Charac tepisti ¢.:s
~,171 '/cI,' C-¢ //*" ,'~c"~C'
~ltlg
Was Ground Water Encountered?
If Yes,~..~* ~':~'a~ Depth
Readin~ I
[~of)sed Ins.'al)_a:xon: Seepage Pit
G~'oss Time
Net Time
Location Sketch
Net Drop :
Drain Field
DePth Of Inlee ~ ............. '
. --~ - :~L~_dd ~Z2_L(d/2~. Depth ]o Bottom Of
. /; ,~~~,.~ '. , .,~ e -
Test
Pemfomm~d
Data CePtified By' , ~ '
'1
MUNICIPALITY OF ANCHORAGE
Development Services Department
Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Certificate of On -Site Systems Approval
Parcel ID 015 -521-12
Legal description GROH LT 1
Site address 10960 TOTEM RD
OSC261265
Expiration Date: 7/8/2027
Current property owner(s) CROWN POINTE INC
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
No comments
By: Isatou B Njie
Original Certificate Date:
7/23/2026_
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 Service 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 submittal.
ATTACHMENTS:
COSA Checklist X
Absorption Field Advisory
Tank Age Advisory
Other
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory - X
MUNICIPALITY OF
Development Services Department
On -Site Water & Wastewater Section --
ANCHORAGE
Phone: 907-343-7904
Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 015-521-12
Complete legal description Groh, Lot 1
Location (site address) 10960 Totem Rd
Current property owner(s) Crown Point Inc
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
Day phone (907) 727-5259
3. TYPE OF WATER SUPPLY:❑ Private Well serving # 1 dwelling units
❑ Other Non-public well as regulated by MOA ❑ Water Storage
❑ Community Well or Public
4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass
Age NEW - See advisory if steel or fiberglass older than 20 years
6. ABSORPTION FIELD: ❑■ AWWTS ❑ Bed ❑ Deep Trench ❑■ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
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 $ 73 (� " Waiver Fee $
Date of Payment I a2A I go 1(o Date of Payment
COSA # S C -Z b / 2 C . Waiver #
COSA Applicalion_Apr2025.doc
COSA Checklist_May2025.docx
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. DISPOSAL 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_May2025.docx
E. SEPARATION DISTANCES
From Well on Lot to:(Please enter distances if less than required)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’Yes if No ft
Disposal Field on Lot > 100’Yes if No ft
Neighboring Disposal Fields > 100’
Yes if No ft
Sewer Line/Main > 100’ Yes if No ft
Sewer Manhole/Cleanout > 100’
Yes if No ft
Sewer Service/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 Disposal Field(s) on Lot to:(Please enter distances if less than required)
Tank to Foundation > 10’Yes if No ft
Field to Foundation > 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/Service Line > 10’Yes if No ft
Surface Water > 100’Yes if No ft
Wells on Adjacent Lots:
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
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907-343-7904
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
Arsenic Advisory
Certificate of On-Site Systems Approval # OSC261265
Subdivision: GROH , Block: , Lot: 1
A water sample revealed an arsenic concentration of 7.54 micrograms per liter
(ug/L). 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.