HomeMy WebLinkAboutT12N R3W SEC 22 LT 14 PTN S2 & W30'Onsite File
#015-141-09
· ' Municipality of Anchorage Page / of '~
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: .~ W ~ C~0~-7 PIDNumber: O~3--lql
Name~c~'¢,~e ~O~ ~ Wastewater System: ~New D Upgrade
~o o'~/~x ~d, ~¢4 ¢9~/ ABSORPTION FIELD
NO. of Bedrooms:
Phone: ~ ~ - /O ~ ~ ~ ~ Deep Trench ~ Shallow Trench ~ Bed D Mound ~ Other
LEGAL DESCRIPTION so, Rating: Totat Depth from original grade:
Lot ~ I/~~0 ~ / ¢ Block: Subdiv~ion: Depth to pipe bottom~,from~original grade: Ft Gravel depth beneath~, ] pipe Ft.
Township: [Range: I section: Fill added above origin. I grade: Gravel length:
Number of lines; J Distance between
WELL: ~ New ~ Upgrade Gravel width: ~ '~ Ft JI -- Ft.
Classification (Private. A.B,C): Total Depth: Cased TO: Total absorption area: Pipe material; ~ _~ / ~
Driller: ~'~ P~lh%3 Date~/~/~)Drilled: StaticWater Leve[:~ ~Ft. Installer:~¢ Date installed:~/ /~/ ~¢
Yield: Pump Set at:~ Casing Height Above Ground:
TANK
SEPARATION DISTANCES ~ Septic a Holding ~ S.T.E.P.
To Septic Absorption LiQ Holding Public/Private Manufacturer: Cap~city in gaJloRs:
From Tank Field Station Tank Sewer Lines ~C~Of~¢ ¢ T~ ~ [ ~ 0 ~
Material: Number of Compa~ments:
Surface
Water > ~OO' > ~ .... LIFT STATION ~. ~.
Lot Size in gallons:J Manufacturer:
Foundation
Cudain _ _ Pump Make & Model ~ Electrical Inspections pedormed by:
Drain
Remarks: BENCH MARK
Location and Description:
J Assumed Elevation:
ENGINEER'S SEAL
Inspections performed by: F(¢ ~¢ %¢~4 ~c Dates: 1st ff//ffgYq ~.., .....
Depa~ment of Health and Human Se~ices approval ::::{;. ~, c~:-~5~9
72-013 (Rev. 9/91) MOA 25
PERMIT NO: SW990057
PID NO: 015-141-09
SWING TIES:
FROM: COR, "A" COR. "B'
TO:
TR. C.O. "D" 40.5' 49'
TR. M.T. "E" 42.5' 50'
TR. C.O. "F" 81' 64'
DBL. C.O. "G" 67' 40'
S.T.C.O. "H" 64.5' 35'
S.T.C.O. 'T' 62' 29'
WELL
TBM
1000 GALLON 'T'
SEPTIC TANK
PAGE 2 OF 2
PLAN VIEW
SCALE: t" = 30'
SITE FOR SIM.
./.~-- REPL, TRENCH
40' LONG SOIL ABS. TRENCH
W. 5.1' GVL. BELOW PIPE
DRIG. GROUND ELEV.
LONG SOIL ABS. TRENCH
5.1' GRAVEL BELOW PIPE
BOTTOM TRENCH ELEV. 82.C
T.H. #2 BOTTOM M.T.
i~ELEV. 75.5 DRY 6/16/99
PROFILE VIEW
NOT TO SCALE
92.1
1000 GALLON
INV.
SEPTIC TANK
92.4
S 112, LOT 14, SEC 22, TI2N, R3W, S.M.
SEPTIC SYSTEM INSTALLATION
AS-BUILT INSPECTION REPORT
FLATTOP TECHNICAL SERVICES
14530 ECHO STREET
ANCHORAOE, ALASKA 99516
SCALE:AS NOTED
DRAWN BY TFM
SEPTEMBER, 1999
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Sfreet, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON.SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Apr 13, 1999
Expiration Date: Apr 12, 2000
Permit Number: SW990057
Legal Description: T12N R3W SEC 22 LT 14 PTN S2 & W30'
Design Engineer: 0019 Flattop Technical Services
Owner Name: Eugene & Dolores Roguszka
Owner Address: 4320 O'Malley Road
Anchorage, AK 99516-
ParcellD: 015-141-09
Site Address: 004400 OMALLEY RD
Lot Size: 97350 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chaptem 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
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October '15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
With the issuance of this wastewater disposal system permit, the exploratory well permit #SW990035 can now be
considered a regular well permit.
If there are any questions about this permit, please call the On-site program at 343-4744.
Received By:/. ('/
:F TTOP TE CHNICA : . SERYICES! ,.
CIVIL & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. J. 4530 ECHO ST.
PH: (907) 345-1355 ANCHORAGE, ALASKA 99516
April 5, 1999
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The purpose of this letter is to provide the required design narrative in support of our application for
a permit to construct wastewater disposal facilities on the South ½ of Government Lot 14, Section 22,.
T12N, R3W, S.M. I understand that a well drilling permit has recently been issued for this lot. Soils
logs, perc test results, a site plan, design drawings and specifications are enclosed for your review. The
property owner, Eugene Roguszka, needs the septic permit as soon as possible so that he can file for Iris
building permit.
The proposed system will be constructed in the vicinity of test hole #2. As can be seen from the soil
log, the native material below 2 feet is a gravelly sand with a measured perc rate of less than one minute
per inch. Despite the rapid measured perc rate, no additional sand filter should be required, because the
in-situ native sand will fulfill the role ora sand filter. Using the soil application rate of 1.2 gpd/~q, ft.
specified in the wastewater ordinance for soils with perc rates faster than 5 minutes per inch, this 3-
bedroom residence requires a total absorption area of(3 x 150)/1.2 = 375 square feet. The proposed 40
foot long trench design with 5 feet of effective gravel depth has a total absorption area of 400 square
feet.
The topography of the lot in the area of the proposed septic system construction slopes down
towards the southeast at 5 - 10%.
The proposed project will have no significant impact on present or future water supply and
wastewater disposal systems serving adjacent properties, nor will it have any significant impact on
reserved space-surface and subsurface, or on drainage.
Please give me a call at 345-1355 if you have any questions on this submittal.
Sincerely,
Ted Moore, P.E.
OIMALLEY ROAD
Q- TAYLOR S/D
LLI
LOT 15, SECTION 22, /
~ TRACT "C"
,' / WELL
6o/0 ~'~ ~T.H. ' REPLACEMENT TRENCH
0' NO SOIl ABS. IRENCH
.'/ W. §.§' GV/BETW. 2' & 7.§' B.G.L.
SEPTIC $oU'rH ~12, LOT '14,
SYSTEM SEC. 22, T'12~, R3VV, $.M.
COT ~8 (VACANT) kOT 1~ (V^C^NT)
~ .o°" ° * '~' ,/'",~Z ~ PROPOSED SEPTIC SYSTEM
DRAWN BY TFM
~ , %Th~OOO~ F. ~OOR~ &' Aq, 14530 ECHO STREET
~",~;.?o,. C1~-3589 ,.,~,.~ ANCHORAGE, ALASKA 99516 MARCH, 1999
. , ~:~,~;~.:- ' ~g/r~ ' ALL LOCATIONS SHOWN ARE APPROXIMATE.
4" DIA. D-3034 WASTE LINE FROM HOUSE
1000 GALLON
SEPTIC TANK
-- DOUBLE C.O.
/ 4" DIA. F-810 PERF PIPE
/
'~ 40' LONG SOIL ABSORPTION TRENCH
WITH 5' GRAVEL BELOW DIST. PIPE
BETWEEN 2.5' & 7.5' B,G.L
PLAN VIEW
SCALE: 1" = 10' - 0"
3
1
cLEANouT
-- MONITOR TUBE
MOUND BACKFILL 12"
~AL GROUND
FILTER FABRIC
F-810 PERF. PIPE
- 2 1/2" SEWER GRAVEL
BOTTOM OF
EXCAVATION
SECTION "A" - "A"
SCALE: 1" = 5' - 0"
S 1/2, LOT 14, SEC. 22, T12N, R3W, S.M.
SEPTIC SYSTEM DESIGN
PLAN AND CROSS-SECTION
FLATTOP TECHNICAL SERVICES
14530 ECHO STREET
ANCHORAGE, AK, 99516
SCALE: AS SHOWN
DRAWN BY: TFM
MARCH, I999
Flattop Technical Services
14530 Echo Street, Anchorage, AK 99516
Phone (907) 345-1355
South ½ of Lot 14, Section 22, T12N, R3W, S.M.
O'Malley Road
Wastewater disposal system installation
Specifications
1.0 General:
1.1 The scope ofthe project consists ofinstalling a 1000 gallon septic tank followed by a 40 foot
long soil absorption trench containing a total of 5.5 feet of sewer gravel.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations from these drawings may be allowed or required by the engineer conducting the inspections.
All construction procedures and material specifications shall conform to Municipal and State
requirements. All separation distances shall be in conformance with Municipal requirements, unless
specifically waived.
1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around
any buried utilities.
1.4 The contractor shall provide adequate cover material and rough grading over all system
components to ensure that proper drainage is achieved after settlement and that there are no residual
depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas.
1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading
after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the
construction.
2.0 Septic Tank:
2.1 The new 1000 gallon, 2 compartment septic tank shall be Municipally approved and shall be set
level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a
4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial
type, rigid insulation.
2.2 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The
waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the
waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot.
A cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be
installed within 5 feet downstrean~ of the septic tank.
3.0 Soil absorption system:
3. I The soil absorption system shall be constructed by excavating a 40 foot long trench to a depth of
7.5 feet below ground level, with the long axis parallel to the natural contour of the land.
3.2 The bottom of the excavation shall be level. Because the native material at the site is a clean
gravelly sand, there is a good chance that the sidewalls of the trench will tend to slough in as the trench
is being excavated. This will probably mean that significantly more sewer gravel will be needed to fill
the excavation than in a typical trench.
3.3 A total of 5.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with
the perforated distribution pipes laid level such that the pipe inverts are no less than 5.0 feet above the
bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing
the #200 sieve.
3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on
the design drawings. The portion of the monitor tube extending through the sewer gravel shall be
perforated.
3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel before
backfilling with 3 feet of sandy material from the excavation.
3.6 The top surface of the cover material shall be raised 12 inches higher than the original grade,
and shall be graded to smooth contours. Fill slopes shall be no steeper than 3: I.
3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have
the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and
seed to promote rapid revegetation of all areas disturbed by the construction.
4.0 Inspections:
4.1 A minimum of 4 engineering inspections will be required during the course of the project: (1)
initial stakeout with the contractor to establish the location of the system and to discuss the plans,
specifications and construction procedures, (2) after the native material has been excavated to expose the
infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test
information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected
up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and
grading is complete. The septic tm~k requires one inspection after it is set level and the piping
connected, but prior to backfill. This inspection may be incorporated with any of the above inspections.
4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensure the availability of the engineer.
TEST HOLE
LEGAL DESCRIPTION:
DATEPERFORMED:
PERFORMED FOR:
DEPTH
(fee~
11-
12-
13-
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
South 1/2, Gov't. Lot 14, Section 22, T12N, R3W, S.M.
March 29, 1999
Eugene Roguszka
Pt.
SM Yellowish sandyloam (frozen)
SW/GW Clean gravelly sand
Dry, unstable sidewalls
Many cobbles to 5" diameter
SLOPE
Depth to Groundwater Date
No ~roundwater 3/29/99
Monitor tube dry 4/5/99
SITE PLAN
TRACT"C" OF N 1/2, LOT 14
~7
S 112, LOI ~4, $1:G 22
'1'12~, RSW, S.M.
Date Reading Clock Net Time Percometer Net Drop
Time (minutes) Reading (inches)
3/29 5 gallon presoak 11:00:30 24 1/2
Perc hole dry 11:01:15 0.75 17.25 7.25
PERCOLATION RATE <<1 (minutes/inch) PERC HOLE DIAMETER 6
TEST RUN BE'FWEEN 3.0 FTAND 3.5 FT
COMMENTS: During perc test the water depth never reached 12 inches as 5 gallons was added at 4 gpm, and all the water was completely
absorbed in 45 seconds. No sand filter needed because the native material is predominantly sand.
PERFORMED BY FLATTOPTECHNICALSERVICES. i ,'~,~-.-~ ~ CERTIFYTHATTHISTESTWASPERFORMEDIN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
ITEST HOLE
LEGAL DESCRIPTION:
DATE PERFORMED:
PERFORMED FOR:
DEPTH
(feet)
1
3
4
5-
6
7-
FLATTOP TECHNICAL SERVICES
14530 ECHO ST.
ANCHORAGE, ALASKA 99516
SOILS LOG -- PERCOLATION TEST
South 1/2, Gov't. Lot 14, Section 22, T12N, R3W, S.M.
March 29, 1999
Eugene Roquszka
Pt.
SLOPE
SM Yellowish sandy loam (frozen)
SW Clean, somewhat gravelly sand
Dry, sidewalls unstable
Less gravel and cobbles than in T.H. #1
LOT 15
TRACT "C" OF N 1/2, LOT 14
S 1/2, LOT 14, SEC 22
T12N, R3W, S.M.
Depth to Groundwater Date
No qroundwater 3~29~99
Monitor tube dry 4/5/99
Clock Net Time Percometer Net Drop
Date Reading Time (minutes) Reading (inches)
3/29 5 gallon presoak 11:59:40 25 1/4
Perc hole dry 12:00:20 0.67 17 1/4 8
PERCOLATION RATE <<1 (minutes/inch) PERC HOLE DIAMETER 6
TEST RUN BETWEEN 4.0 FTAND 4.5 FT
COMMENTS: This sand material is so clean that 5 gallons of water poured into the perc hole at 4 gpm never reached a depth of 12 inches,
and all the water was completely absorbed after 40 seconds. No sand fitter needed because the native material is sand.
PERFORMEDSY FLA3-1'OPTECHNICALSERVICES. I ::~,.~,~ ~ CERTIFYTHATTHISTESTWASPERFORMEDIN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
M-W DRILLING, Inc.
P.O, Box 110378 · 10330 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
PERMIT # SW99035
DRILLING LOG
~ell Owner
~o~tion (address of'. Township, Range, Section, if known; or distance main roBcl
T,,'~qTM 14; ~('q~T(']N' ~.. rPl~; I?qW; .qM: A4~ ~IMAT,T,~V
ANCHORAGE, ALASKA
Size of casing 6" Depth of Hole 2 8 2 feet Cased to 2 8 0.5 feet
Static water level 2 3 0 ft. (~i~ ~low) land surface, Finish of well (check one)
Screen ( ); Perforated ( y )..
Describe screen or perforation N~ A~:
Well pumping test at 1.5 ga~,~,'~s 13~' (~; of drawdown from static l~vel,
open end ( X );
(minute) for 1 hours with 100%
ft.
Date of completion 05 APRIL, 1 9,99 ,
Depth in feet from
ground surface
WELL LOG
Give d~lls of formations penetrated, size of material, color and hardness
0 TO 2
2 TO 6
6 TO 45
45 TO 56
56 TO 115
115 TO 121
121 TO. 140
140 TO 143
143 TO. 148
148_TO 217
8~1 BROWN
GPLAVI~II,: SILTY
O~: SILTY. CLAYEY
; SI~'~R~TM ;,~,' , ,~--
CLAY: SILTY, GRAVELLY
'GRAVEL: SILTY
COARSE GRAVEL: SILTY, SANDY~ WET
223 ,TO. 229
GRAVEL: SILTY, CLAYEY
229 TO 260
· GRAVEL: SILTY
260 TO 263
COARSE GRAVEL: $ILTY~ WET
263 TO 282
GRAVEL: SILTY~ SLIGHTLY CLAYEY~ WATERREARING
L--CUSTOMER
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WATER SUPPLY PERMIT
Initial
Date issued: Mar 18, 1999
Expiration Date: Mar 17, 2000
Permit Number: SW990035
Legal Description: T12N R3W SEC 22 LT 14 PTN S2 & W30'
Design Engineer: 0000 None Required
Owner Name: Eugene & Dolores Roguszka
Owner Address: 4320 O'Malley Road
Anchorage, AK 99516-
Parcel ID: 015-141-09
Site Address: 004400 OMALLEY RD
Lot Size: 97350 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] SepticTank [] Holding Tank [] Privy
[] Private Well [] Water Storage
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
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special previsions.
This permit is for an exploratory well only.
If water production is determined to be satisfactory the well must be temporarily decomissioned as per AMC
15.55.01~0.J until a permitted wastewater disposal system is constructed.
If the water production is found to be insufficient the well must be permanantly decomissioned as per AMC
15.55.060.J.
A well log must be turned into the Department within 60 days of drilling in addition to a statement regarding the
decomissioning of the well (ie. permanant, temporary) including intended acitons for wastewater disposal.
Date:
O!
,' OAD
LOT 9URVEY OE:RTIFIOATION
I he~ e~/cert,fy that I hove ~ur ~eyed ,he ~ s~n ~ ~ri~
in ~1~ ~ th~ ~e are ~ r~a~, utili~ li~s ~ ~her vlsiUe
Prepered I~:
R. £. BUTTON
Reg/ster~d £ond Surveyor
519 · Eighth Ave. AncborogetAIoska 99501
/floc
LEGEND
I~ = Brass col:~oed ~ recovered
o -' iron p~pe ond/o~ rebor recovered
o : 2x2 h~b~ rock recovered
· = ~/8"x~O"rebor ~.-,t this survey
~w~$T ~ F~ OF T~ Al ~ OF LOT I~ ~
~nchoroge Recording District, Alaska
LOT SURVEY CERTIFICATION
~oo,e /"~100'
~ef. 2656 F'e' N°'~D-43
· ¢ % R. L BL, non ."' "'?
LEGEND
Br~ or Aluminum ceded me~me~t rjcovered
0 I~ Cpa ancot rear recovered
2x~ hub ~teek recovared
J 5/8'x ~' rebar se~ this surv~
Prepared by; ~. £. 8UFFON
Registered l. and Surveyor
(907)2Y9- ~ZO0 519 W. Eighth Ave. Anc~a~ ~/oeko 9~501
0',4 ,A/ / E'7"
~OAD
~OT /~ ?
,350'
LOT
4°43
I 330'
Lot /,~ , Block
3~'C. 2~, ~/~/k/o,/~. 3 Wo, S.A~.~ ALA.S/~A
Anchorage Recording District, Aloska
LOT SURVEY CERTIFICATION
.~ LOT/4
LEGEND
o Iron pipe ond/or reb~r recovered
~ 2 x~ hub ~ rock recovered
2636
Property of:z--
//0
~ 6o
V•f ;��
Development Services Department `
On -Site Water &Wastewater Section -
Certificate of On -Site Systems Approval
Parcel I.D. 015-141-09
1. GENERAL INFORMATION
Complete legal description
f7plyl-Ils
Phone: 907-343-7904
Fax: 907-343-7997
Expiration Date: 0,� D
T12N R3W SEC 22 LT 14 PTN S2 & W30'
Location (site address) 4400 O'Malley Road Anchorage, AK
Current property owner(s) Eugene RogusZka Day phone 508-864-4591
Mailing address 4400 O'Malley Road, Anchorage, AK 99507
Real estate agent
Mary Cox
2. TYPE OF DWELLING:
Fx] Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
907-440-9820
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Fx�
Private Septic
FE
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ dssU — ` Waiver Fee $
Date of Payment i ' LO\ r Date of Payment
Receipt Number q `i ('0 Receipt Number
COSA# ne;>c-\Ak15 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. 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 11/7/19
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
By: ju Original Certificate Date: 1 1
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
Septic System Advisory
Well Flow Advisory
COSA Checklist blue sheet
Nitrate Advisory
Arsenic Advisory
Other Tan x
COSA Checklist yellow sheet
COSA Checklist
Legal Description: Parcel ID:
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test?Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date of Sample
Comments __________________________________________________________________________________
B. TANK DATA
Age of tank(s) years
Tank type/material
Measured operating fluid level in septic tank
Standpipes/foundation cleanout per record drawing
Date of pumping
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA ______________________
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective
Code-required soil cover over field
System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Adequacy test date
Results Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
Comments/Deficiencies:
T12N R3W SEC 22 LT 14 PTN S2 & W 30' 015-141-09
6
4/5/99 0
282
280.5
4.17
>18 FORGE ENGINEERING
11/5/19
227
10/10/19
20
SEPTIC/STEEL
47"
11/11/19 - A Plus Home Services
DEEP TRENCH
6/16/99 11/5/19
3
8.6 0
3.5 850
0
154
0
450+
✔
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.
11/12/19
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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
Septic Tank Advisory
Certificate of On-Site Systems Approval # OSC191531
Subdivision: T12N R3W Section 22, Lot: 14 PTN S2 & W30'
The septic tank for this property is 20 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
100' WELL RADIUSOHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU OHU
N90° 00' 00"E 1318.68 REC.
N90° 00' 00"E 329.67 REC.BASIS OF BEARINGSN00° 06' 00"W 585.00 REC.S00° 06' 00"E 330.78 CALCULATEDBY LINE EXTENSION INTERSECTN00° 06' 00"W 585.00 REC.S89° 51' 29"W 299.71 CALC.
N89° 56' 42"W 330.64 MEAS.
N90° 00' 00"W 329.67 REC.S00° 12' 58"E 583.60 MEAS.S89° 45' 41"E 329.46 MEAS.S00° 18' 27"E 254.90 CALC.N00° 03' 00"W 255.00 REC.N89° 57' 00"W 300.00 REC.;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;SSSSSSWETOHU OHU OHU
N00° 06' 00"W 584.65 MEAS.16.0
31.940.54.56.9
4.51
1
.
32.67
.
3 32.12.015.111.2
15.2
2.114.010.7
16.3
14.0LOT 15LOT 13LOT 13DOCUMENT NO. 2016-048540-0ANCHORAGE RECORDING DISCTRICTDOCUMENT NO. 2015-022402-0
ANCHORAGE RECORDING DISCTRICT
TAYLOR SUBDIVISIONPLAT #74-37LOT 14, SECTION 22TRACT 12 NORTH, RANGE 3WEST S 2' & W 30116,426 Sq. Ft. +/-4400 O'Malley Road1 Story Wood Frame HouseWith Attached 2 Car Garage25.8
47.3204.6
LOT 19
S89° 56' 42"E 30.00 CALC.
1
3
.
8 30.3PAVED DRIVEWAY℄ O'MALLEY ROAD SSSPREPARED BY:FRONTIER SURVEYS, LLC650 W. 58th AVE. SUITE E, ANCHORAGE, AK 99518907-460-1686DRAWN BY: CHECKED BY: DATE: SCALE:DRAWING ID: SHEET 1 of 11. Excepting for gross negligence, the liability for this survey shall notexceed the cost of preparing this survey. Dimensions to property linesare plus/minus 0.1ft.2. This document is created by Frontier Surveys for the purpose of a plotplan for Mary Cox, only.3. This document is based on U.S. BLM Dependent Resurvey andSubdivision of Sec. 22 Dated: 2/14/1952.4. All lot corners have been located and marked.General Notes DisclaimerLegend1. This survey complies with the ASPLS Mortgage Location Standards. The survey represents visibleimprovements and conditions at the time of the survey. This document does not constitute a boundarysurvey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is theresponsibility of the Owner to determine the existence of any easements, covenants, or restrictionwhich do no appear on the record plat. Under no circumstances should this document be used forconstruction or for establishing a boundary or fence line.S
T
A
TEOFALASKA49THROYEVR
U
SDNALLANOISSEFORPDERETSIGERFrederic W. WagnerNO. LS-9946KC & FW 1" = 50ft11/20/201919-462SS11/20/2019Scale 1" = 50'AN AS-BUILT OFLOT 14, SECTION 22TRACT 12 NORTH, RANGE 3 WEST S 2' & W 30'ANCHORAGE RECORDING DISTRICT, THIRD JUDICIAL DISTRICTSTATE OF ALASKA4400 O'MALLEY ROAD ANCHORAGE, AKCONTAINING: 116,426 Sq. Ft. or 2.67 ACRES +/- (CACLCULATED)RECORD PLAT: U.S. BLM DEPENDENT RESURVEY AND SUBDIVISION OF SEC. 22 DATED: 2/14/1952ETEElectric MeterElec. PedestalTel. PedestalWellFound Alum. CapFound RebarSepticUtility PoleSignFound PipeLight PoleGas PumpsSW75'R.O.W.CULVERT
EDGE OF PAVEMENT