HomeMy WebLinkAboutOUR MOUNTAIN BLK 1 LT 1Our Mountain
Block 1
Lot 1
051-111-39
Municipality of Anchorage Page 1 of_3 1(
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: SW980046 PID Number. 05111139
Name: MM&M Contracting
Wastewater System: New ❑ Upgrade
Address:
ABSORPTION FIELD
Phone: 688-1236
No'ABreeema.
D Deep Trench VS allow Trench. D Bed D Mound D Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade: r
% O
.4o GPD . Fl.
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
1 1. Our Mountain
3 Ft.
FL
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
'75'
1. Ft.
Ft.
WELL:L�New ❑Upgrade
Gravel width:
Number, of lines:
I
Distance between lines:
•
5 Ft.
/ Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
_7%9
Pipe material: .4,57M D-3034
Private
320 FL
68 Ft.
sD.Ft.
x`910
Driller.
Sullivan
Date Drilled:
4/7/98
static Water Level:
180
Installer. w4 M
Date installed:
4&1-23 'Jb
Ft.
GpNTZV, /NG
Yield: - 20
Pump Set at:Height
Casing Above Ground:
TANK
GPM
FL
2 Ft.
SEPARATION DISTANCES
NSleptic OHOlding ElS.T.E.P.
To
Septic
Lift
Holding
rivate
Man��u{ff,,a�c�t��u��re��r.. }',y
1`ANK
Capacity in gallons:
IOpa
From
Tank
StaTwn
Tank
Sewer Linm
/'r'tr .
-NA'
ICompertments:
welt
1ST/
I'%/i�1��MaNum
water
150'
rF.Wfld
1J/A
t41A
> 150'
LIFT STATIONSize
3L)
9 A
N/A
I8.5'
in gallons:
Manufacturer.Loe
"Pump on" level at
"Pum level at
High water alarm at:
Foundation
IZ 5,N/A
V P
Curtain
,1 n
Pump MakehM
Electrical Inspections performed by.
Drain
Remarks: t�tivc r- Toro 1011civ ;r
BENCH MARK
/0;1511 L1�
Location and Description: -
Assumed Elevation:
/OA• O
Ft
ENGINEER'S SEAL
1n f`
Y C it 0
�nn e
e
/a{
° ° V
I- 1P
Dates:ls
by: & Z $
D
Inspections performed ;'•,�
Z3�7
y
2nd
Cvk44dk?°e°°,`,s'
rr
Department of Health and Human Services approval
r `° 4t41tAJ1, A�tJ , d
���`t7`ii'F
Reviewed and approved by. Date:17-199
72-013 (Rey, 9191) MOA 25
Page 2 of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
$� u;LEGEND
0 �• b� ,`O� SP1 Septic Pump, compartment 1
SP2 1.2
C Clean Out
- MT Monitor Tube .l
i
Permit No. _Sw980046 Page 3 of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: LT 1, BLK 1, our Mountain Riibd. PID No.: 05111119
Cl
9 3 el 982 g2 ✓ rC3
9.70
9483
�94$ 1,000 gal 85 °° 9355.
943 septic 5 °'d°,°• absorption
nk
89II2 trench
e5' W
129L45'94135 bends
�}
136
�M-T1
/ C4
93i o np`�6o
e septic
.q P
`nB�.e oo eOOo
895,
275 _
960
ex fabric w/ 2" insulation
EE rock e^ TH#
759-
ELEVATION AS -BLT
1" = 10"
LEGEND
SP1 Septic Pump, compartment 1
SP2 u u u 2
C Clean Out
MT Monitor Tube
— SI
767
'\5 MT2
960Y /
t935a
0 o0oao
e °
89-4r
FROM MMM CONTRACTING PHONE NO. : 6881238. Dec. 01 1998 02:02PM P1
MT
by
Doc co, *a
§ULLI VAN WATER WELLS
P.D. BOX 070272, CHUOIAK, ALASKA 09567 • T90PHONE 688.2759
OWNER OF LAND AV Al _ 1BORE H(
t n�i
ADDRESS - -P
LEGAL DESCRIPTION / 0 T / ...&e
ntj T&AJ
PERMIT NUMBERIMAL Date of Iasue„�(-- i - 91i
TAX INDENTIFICATION NUMBER
to wall located at approved permit location? 43"`!r',(7 No
Method of Drilling:tr rotary Q cable tool
Depth of Well: '? _ t P�' J_._
Casing Type .S'7t' C4 Wall Thickness inches
Diameter N inches, depths _feet
Liner Type: It�1.J
Casing Stickup Above Ground: feet
Static Water Level (from ground level): 1 T is feet
Pumping Ievel;�!set after firs. pumping __gpm
Recover Rate:. 010 PM
Method of Teating: 1
Well Intake Opening Type: O Open End Opdplan Hole
n Screened; Startfeet Stopped feet
L7 Perforations Start �.__ e-4 Stopped feet
Grout Type: _Volume
Depth: fromfeet, to
" feet
Pump Intake Depth: feet
Pump Size
Brand Name
Wall Disinfected Upon Completion? bVrCs O No
Method of Dleinfectlon:C#d % (r WE M e.&!'1
ommenW -7 9 e
t904,- dA et (aa y
DATA
ousA 1344 En .l
Q n1� 6(QdJ1:c Ctrl i�1f/x
16 0 /Jit C V 4,f 06Z^0%-1 V(4.OR Y
[ ,rr4 rw 4� NA�i
k 64,aAc c &K&a 6&KAd
00 0"
MA
Munici party J, —. no, B90
Dept Health & Human servIces
Driller's Name -4
to the
er
ATTENTIONItis the Departmentoof Healtof the h & Human property
Services and/oowner to bDepartmit a copy
ofof IhEnviroll mental Conrservattiiom Ma Su gaccuglty
of Anchorage:
Department of Environmental Conservation,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW980046
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:
OWNER ADDRESS:MM&M CONTRACTING
PO BOX 670495 CHUGIAK, AK 99567
PARCEL ID:05111139
LEGAL DESCRIPTION:
OUR MOUNTAIN BLK 1 LT 1
LOT SIZE: 44992 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1,\' 01�
PAGE 1 OF 1
DATE ISSUED: 4/01/98
EXPIRATION DATE: 4/01/99
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 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
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:
RECEIVED BY: 14t4it L I
ISSUED BY:
DATE: "I[ v(e-'Nh
DATE: q. l ' y8
May 30, 1997
Municipality of Anchorage
Department of Heath & Human Services
825 L Street
Anchorage, AK 99502-0650
Subject: Lot 1, Block 11 Our Mountain Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer:
We hereby apply for, a permit to construct a new well and septic system on
Lot 1, Block 1, Our Mountain Subdivision. 'The attached Site Plan and
backup documentation identify the size and location of the new absorption
bed to be constructed on the lot. It. also shows the proposed location of
the new well along with the 100' protective radius.
A testhole performed in the area of the new absorption trench revealed
silty gravel with a percolation rate of 24 minutes per inch. A total of 750
square feet of absorptive area will be required to serve the new three
bedroom home. We are proposing to place _a single 75.' Jong lateral 5' wide
with 4' of gravel beneath the _.distribution pipe. The distribution pipe w i 1
be placed 2.5' below the existing'.. ground surface: Our 'investigation
revealed no groundwater in Testhole'No. 1L but water at 11.26-in T.esthole
No. 2. The. absorption trench is designed for groundwater at this level.
No conflicts exist between the proposed location of the new septic system
and the protective radii of the 'adjacent wells. `The surface of the lot
slopes from southeast to northwest 'at grades varying from :6% to 10%. The
surface of the ground in the ;area of the absorption trench is fairly flat.
If the system is constructed as` designed the following statements can be
made:
1. The system, if constructed .:,as designed', wjll have noadverse impact.
on the wells in the area or those to be constructed in 'thoue
.
.TYUI-ANCHOBAU
ENORONfOENTAI SFRVICES; tIIVISIUN
MAR 19 1998.
FUllmn
.... .......
LOT 1, BLOCK 1,
OUR MOUNTAIN SUBDIVISION
L2
Go
'ot
L15
t
OF ljj�
6� 49TH*
r� ...... ; �lii ..r:.�
6�tr ,MICHAEL E.ANDERSON
: Um
4301-E C7"o
4
IK 2,
�-
a
Iry SYSt�r�
�n+Z ar
AREA MAAP� iPALIYYOFANCHORAGE
„,'�, "N i AI. SERVICES DIVISIRN
I I SCALE 1" = 100'
I MAR 1 y 1998
LOT 1, BLOCK 1, OUR MOUNTAIN
SUBDIVISION
DESIGN FACTORS:
Three Bedroom Home
Pere. Rate: 24 Min./Inch
Application Rate: .6 GPD/SF
SYSTEM REQUIREMENTS:
5' Wide Trench System
1,000 Gallon Septic Tank
4' Drainfleld Rock
3 Bedrooms X 150 GPD / .6 GPD/SF = 750 SF of Absorption Area
750 SF/5 LF (Width) X .5 (Red. Factor) = 75 LF Length. of Trench
Therefore: Construct a 5' Wide Absorption Trench With One Lateral 75'
In Length. Distribution Pipe in Trench Placed at 2.5' Below the Original
Ground Surface. Mound Over Trench a Minimum of 1'.
V\ll/
z
� �a ECir•6'XT' 1 LE
/* PVL
i
TYPICAL 5' WIDE TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away. $$�.���
Maintain 4 Vertical Separation From Ground Water.
Minimum 3' Cover Over Trench or Direct Bury Insulation.
MuniAnchorage
' DEPARTMENT OFF HEALTH
H 8 HUMAN SERVICES
925 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: MMPI CONTRACTING DATE
LEGAL DESCRIPTION: A•.1 . 151. p� I ri'14 SI bTownship, Range, section:
00
1
1617I T"'
18
WAS GROUND WATER . r
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Bko
MMd
waa AIw
Monimrlll0--) S Imo.
(dp7 � Ont
,9
20 PERCOLATION RATE ZT I u
(mmuuwineh) PERC HOLE DIAMETER
TEST RUN BETWEE7t� 3 �7i FT AND FT
COMMENTS ✓, / WRra /6raS0A.'E AO �-
�i OMICHAEL .............
NDERSrk e
11
PERFORMED BY.- """7 1 yyl."t" �' "�L"'- CERTIFY THAT TF/}IS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: h
72.(= (Rev, 4/85) -
,r Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: MMM CONTRACTING E
I DAT
LEGAL DESCRIPTION:LI,t>I' �Lry` 1_ I I ISI 6/b Township, Range, Section:
1
-'T/cusr
OL—
M
9-/
10
11
12
13
"
J O/
14
13 ohlr
16
17
18 /_
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH? 7
DnMtoW8WAkff 17 ��
tAotumrit>p? Due
1,0
"�(fNra7 ivft"5E!�-1
` v
d"k 1'L'..it3�l:�.c
f�=
20 ,- y „
PERCOLATION RATE �Z_ (mmutewinch) PERC HOLE DIAMETER
TESTRUN /BETWEEN f FTAND FT -
COMMENTS �'� aA V/ J4j w,eJ d/I°-
7 f i
PERFORMED BY: �/� - i (-� �'���`�tjERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE
72008 (Rev. 4/85)
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 1, BLOCK 1, OUR MOUNTAIN SUBDIVISION
GENERAL:
1. The scope of
this project
includes furnishing
and installing
a new 1,000
gallon septic tank. Work also
includes the
construction
of a new 5'
wide absorption trench a total of
75' in length
with 4'
of drainfield rock
beneath the
distribution
piping. The
distribution piping is
to be placed
at 2.5' below
the existing
ground surface.
2. Construction shall be in accordance with the approved site
plan, design drawings, Municipal Permit with any special
provisions or conditions, and all applicable State and
Municipal Wastewater Disposal Regulations.
3. The Contractor shall be
responsible
for
obtaining all
underground utility locates
and for the
layout
of the septic
system and verification of
the location
of all
lot lines.
4. Unless specifically agreed otherwise, the contractor shall
be responsible for final grading areas subsequently
depressed from soil settling. Property owner shall be
responsible for revegetation of affected areas unless
specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must
be certified by the Municipal Department of Health and
Human Services for system installations. Owners installing
their own systems must receive prior approval from D.H.H.S.
before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,000 gallon septic tank must be procured from an
approved source and installed at the location shown on the
Site Plan.
MUNICIPALITY OP ANCUGHAo!i
cNVIFIOI?!,gi:r�1TN. senvlc'i I)11/IS! P,I
MAR 19 1998
nF
Lot 1, Block 1, Our Mountain Subdivision
May 30, 1997
Page Two
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts
for pumping access.
3. The septic tank shall be sufficiently bedded to prevent
settling or shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of
12 inches above final grade.
5. Tanks installed without 4' of cover shall have`a minimum of
2" of direct burial insulation.
6. A foundation cleanout shall be installed one to four feet
from the building foundation. Two cleanouts are required
between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive
slope exists away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown
on the design. The bottom of the trench shall be within 2"
of level.
2. Distribution piping
must
be placed
level with perforations
down atop a level
bed of
drainfield
rock. Rock should then
be placed over the
pipe
to provide
a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between
the drainfield rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the
locations shown on the design. The portion below ground
must be perforated.
MUNICIPALITY OF ANCflORIIGU
CNVIRO70MEN'fAI. SERVICES OIVISION
MAR 19 1998
Lot 1, Block 1, Our Mountain Subdivision
May 30, 1997
Page Three
5. Contractor shall verify the septic tank and drainfield are a
minimum 100' away from any private water wells in the
area, 150' from a Class "C" Well or 200' from any community
well.
6. Direct bury insulation must be placed over the distribution
system if less than 3' of backfill depth is available. Finish
grade over the trench must be mounded to prevent
settlement or depressions.
7. Grade area surrounding the absorption trenches to drain
away.
8. A minimum 2' of accepting soil is required below the
drainfield rock for a 5' wide trench. Contractor shall verify
this condition prior to placement of the rock. All pockets of
unacceptable materials must be removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a Municipally approved
septic tank manufacturer.
2. The following pipe materials are approved for use in septic
system installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C.
(perforated and solid), ASTM F810 or H.D.P.E. (perforated,
but not solid) and ASTM D2662 or A.B.S. (perforated and
solid).
3. Insulation shall be at least 2" thick extruded direct burial
polystyrene (Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
MUNICIPALITY OF ANCHOHAW
ENVIRONMENTAL SERVICES DIVISION
MAR 19 1998
Lot 1, Block 1, Our Mountain Subdivision
May 30, 1997
Page Four
5. A permeable geotextile fabric (Typar, Mirafi or equal) must
be installed between the final drain rock layer and the
native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than
3% passing the #200 sieve.
INSPECTIONS:
A minimum of two inspections are required` by Municipal
Ordinance. These inspections must be conducted under the
supervision of a professional engineer registered in the State
of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation
of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement
of the geotextile fabric, gravel, distribution piping,
standpipes, cleanouts and insulation. No backfill should be in
place at the time of inspection.
Contractor shall provide a copy of all field survey layout and
construction notes for use in preparing the certified as -built
of the completed system.
MUNICIPALI'T'Y % ANCHHHAU
ENVIAON.MENUL SEOVICFS OPII£il;Jpd
MAR 19 1998
5' WIDE '
88' LONG-- L Il r 12
NU SEPTIC W1TH1N\
200' Of WELL
A
r
flE1J1
q 8'
D WELL
/ 100' SETBACK LOT 11
I
AIR UNIIEVELOPED�
IDO' ETBAC "" �' �•
FCO
.� PROPOSED 1250 GAL
L OPE D S,1.E.P. TANI( y`' % TH % %
PROPOSED TRENCH (PRESSURIZED!
NOTE, USE 1 1/4• PIPE
14OLE AT
STRUCTURES,
NO WELLS WITHIN Do HOLES SHOWN ON
- --- _-._-- 200' OF SEPTIC i i /ACCD DUV WAROAN AS -BUIL]
% IT IS THE -RI
�J� ~ TO VERIFY E.
10' MINDISTANCES, j
CONSTRUC110
I. nr 9
SEPTIC AREA
N. l 77 62or1 T F(
L.
Parcel I.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
051-111-39
1. GENERAL INFORMATION
COSA# OCI 0NJC
Expiration Date:
Complete legal description Our Mountain, Block 1, Lot 1
Location (site address) 24515 Whaley Avenue
Current Property owner(s) Adam Howell Day phone 688-7700
Mailing address 24515 Whaley Avenue, Chugiak AK
Lending agency Day phone
Mailing address
Real Estate Agent Laura Hamilton Day phone 696-0357
Mailing Address RE/MAX of Eagle River
Unless otherwise requested, COSA will be held by DSD for pickup
AT
2. NUMBER OF BEDROOMS:
3
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Q
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. 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 infornjation
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 NorthRim Engineering Phone 694-7028
Address P.O. Box 770724
Engineer's Printed Name Steve Eng Date 5/26/09
5. DSD SIGNATURE
l/ Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
WASTEWAt trc
e. PRUUrwiv"
MT
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: &Z 6)", Original Certificate Date:
(Ray. 17A5)
i
Municipality of Anchorage a'
• �; Development Services Department '
Building Safety Division '
On -Site Water & Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: M., mo,..+M.. CInrL , I n , Parcel ID:--osi-un-39
A. WELL DATA
Well type'_P If A, B, or C provide PWSID # _ Well Log (Y/N) Y
Date completed _4/7/98 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y
Total depth 32o ft. Cased to bs ft. Casing height (above ground) 29 in.
FROM WELL LOG AT INSPECTION
Date of test wni98 5/11/11
Static water level ,an ft.
Well production 20 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate0.27Mg/L
Arsenic: 0.747g/L date of sample: 5/14/09
B. SEPTICIHOLDING TANK DATA
Tank Type/Material septic/steel
Tank size 10o6 gal. Number of Compartments 2
185.6 ft.
5.5 g.p.m.
Other bacteria 0 colonies/100 mL
Collected by: NorthRin Eng.
Date installed 4/23/98
Cleanouts (YM) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 1/30/09 Pumper JR's
C. ABSORPTION FIELD DATA
Date installed 4/23/98 Soil rating (g.p.d.KO or fe/bdrm) 0'6 System type
Trench
Length 75 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth _e'Sft. Eff. absorption area 750ft= Monitoring tube Y Depression over field N
Date of adequacy test 5/11/09 Results (Pass/Fail) Pass Fora bedrooms
Fluid depth in absorption field before test 0 in. Water added 450 gal. New deptt in.
Elapsed Time: omin. Final fluid depth o in. Absorption rate >= aso 9 p d
Any rejuvenation treatment (past 12 mo.) (YIN & type)
unk
If yes, give date
D. LIFT STATION
Date installed
'Pump on" level a _ in.
Datum
E. SEPARATION DISTANCES
Size in gallons Manhole/Access (YIN)/�t�_
'Pump off" level a _ in. High water alar el aeG t in.
Cycles tes Meets alamf & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot /00 ''t" On adjacent lots /a O 1 -f"
Absorption field on lot 1196 +` On adjacent lots /4'90 "e'
Publicsewer main Public sewer manhole/cleanout
Sewer /septic service line 2 S 't Holding tank
Per
Animal containment areas Manure/animal excrete storage areas 1470 1f
6/3/pQ
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation rt Property line /L1 lt Absorption fields-ffl -�r
Water main /,4 Water service line /p t Surface water /OD 'f
Wells on adjacent lots OG 'e -
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
i
Property line /0 r Building foundation 4eQ 'I Water main NlA
Water Service line /D i f Surface water 14il 'f- Driveway, parking/vehicle storage,
Curtain drain MA114 Wells on adjacent lots /DO
F. COMMENTS
w�- . 4-4, �.
G. ENGINEER'S CERTIFICATION .s �� OF A 1 �f y
1 certify that I have determined through field Inspections and? �+;• ':� +d
review of Municipal records that the above systems are in v • 4�7_`•� ':
d .............
conformance with MOA COSA guidelines in effect on this date.
r
Engineer's Printed Name S T F✓E 6nf 4, -,: Steve - PIP
Date �lo���Q dpi f:, tE EY56 .• yaw
COSA Fee $ CNO
Date of Payment 2 7
Receipt Number 03535C
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
ANALYTICA
GROUP
Northrim Eng
Attn: Steve Eng
17237 Bear Paw Circle
Eagle River, AK 99577
907-694-7028
Fax: 907-694-7026
Client Sample ID:
24515 Whaley
Sampling Location:
24515 Whaley
Client Project:
Nonhrim Eng
Sample Matrix:
Aqueous
COC #:
Steve
PWS#:
Residual Chlorine:
Comments:
Lab#: A0905156-0IA
SP-Analytica, Inc. -Anchorage
4307 Arctic Blvd.
Anchorage, AK 99503
Phone: 907.258-2155
Fax: 907-258-6634
Report Date:
5/22/2009
Receipt Date:
5/14/2009
Sample Date:
5/14/2009
Sample Time:
9:00:00AM
Collected By:
Steve
Flag Definitions:
MRL = Method Reporting Limit
MCL= Maximum Contaminant Limit
B = Present also in Method Blank
11= Exceeds Regulatory Limit
M = Matrix Interference
J = Estimated Value
D = Lost to Dilution
•• = RL higher than MCL: target not detected
TNC = Too Numerous to Count - result rejected
CF = Confluent Growth - result rejected
TCNG = Turbid Culture No Growth - rejected
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
92228 (Aqueous) - TCbyAtembFilt: Enumerat Test was conducted by: Analytica - Anchorage
Bacteria, Other <MRL CFU/l00mL 1.0 5/15/20095/152009CW
Total Colifomt <MRL CFU/l00mL 1.0 1 5/152009 5/152009 CW
Lab#: A0905156-0IB
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
4500-NO3E (Aqueous) - Nitrate+Nitrite pres Test was conducted by: Analytica - Anchorage
Nitrate -Nitrite as Nitrogen 0.278 mg(L 0.10 10 5222009 5222009 JQ
Lab#: A0905156-0IC
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
200.8200.8 (Aqueous) - Family Well Water I Test was conduo
Arsenic 0.747 ug/L 0.15 10 200.8
Page 3 of 3
by: Analytica - Thornton
5222009 5222009 GY
Parcell.D.
q lZ-7/o4,
Municipality of Anchorage
"
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program ,,, ,T
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
051-111-39
1. GENERAL INFORMATION
COSA Otc,D1g1
Expiration Date: 7 - -27-06
Complete legal description Tnt i i Tilprlr 1 • nu r mountnin CnbdiW rIon
Location (site address) 24515 Whaley Ave. Chugiak, AK
Current Propertyowner(s) Emily S Jack Jones Day phone 250-7602
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
PO Box 670954 Chupiak,99567
Day phone
Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
3
TYPE OF WASTEWATER DISPOSAL:
{� Individual On-site 10
❑ Individual Holding Tank ❑
❑ Community On-site ❑
❑ Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work.
4. 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 Onsite 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.
NameofFirm S IS S Engineerinp Phone -694-7.979
Address 17034 N. Eagle River Loop ate 204 Eagle River, AK 99577
Engineer's Printed Name Robert C. Conan, P E Date fob
OF,-, X
R08ERT C. COWAN
5."DSU 51UNAI URE -- ak'gL%reQa.)-beolof Z'`Q,
RrAxrfC;In.. apPSD "
Approved for 3 bedrooms. tl:l;l'• :i";;�N^ �:
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other_
By: V7�?��✓ —r�'� 1.+!% Original Certificate Date: 'L,22- D C
(Ray. 11A5)
Municipality of Anchorage •°,
• Development Services Department
Building Safety Division °
On -Site Water & Wastewater Program ' • "
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsde
(907) 343-7904
CERTIFICATE �OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: t, -T (•j `JLn Our N0C,,t 1x) 5/b Parcel ID: DS 1 39
A. WELL DATA
Well typerLlygTt If A, B, or C provide PWS�I/D� # = Well Logi)_
Date completed .q.L/9$ Sanitary seal�l) ` ES Wires properly protected�l) kk'S
� n
Total depth 2 ft. Cased to ft. Casing height (above ground) j J F in.
FROM WELL LOG AT INSPECTION
Date of test t4b h6 3/6 0 6
Static water level /F� r9C91 464LXtIL tb5 , ft
S e
Well production 020.0 y.p.m. 9.P.m.
WATER SAMPLE RESULTS:
Coliform __�?_colonies/100 mL Nitrate Q mg/L Other bacteria O colonies/100 mL
Arsenic: D mgA Date of sample: 2 e1 o6 Collected by: SRS '10Kee !V4v
B. SEPTICIHOLDING TANK DATA ----
Tank Type/Material 5t-YfIG S%i✓EL Date installed
Tank size 10 0 gal. Number of Compartments 2 Cleanout (�J) �%F4
Foundation cleanout(�H) _*b Depression over tank ((1a N0 QI� High water alarm (Y La
Date of pumping 2 Pumper '?vrv%Pi"4
C. ABSORPTION FIELD DATA
Date installed dzz ti/9g Soil rating (g.p.d.W or ft2Abdrm) 0. (o System type gV(W(.0 J TYLrAX14
Length —ft• - Width 5eO ft. Gravel below pipe Ne b ft.
qZ *Z1[i
Total depth UO l ft. Eft. absorption areaft2 Monito�ring�tube_ Depression over field
Q
Date of adequacy test �Q6 Resu aiq "r ' For _5_ bedrooms
u
Fluid depth in absorption field before test IQ in. Water added gal. New depth6 in.
Elapsed Time: 9W min. Final fluid depth _Q_ in. Absorption rate >= q5o+- g•P•d•
Any rejuvenation treatment (past 12 mo.) (Y& type) tud If yes, give date =
D. LIFT STATION N';4
Date installed Size in gallons
'Pump on" level at —in. 'Pump off" lev —
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankflift station on tot too 14 -
Absorption field on lot _ (00 r /
High water alarm level at
Meets alarm & circuit requirements?
On adjacent tots
1 co 14 -
On adjacent lots I o0
Public sewer main N A Public sewer manhole/cleanout OA -
Sewer
A -
Sewer /septic service line WwLe - oRS f Holding lank tis 4
Animal containment areas SD !4 Manure/animal excrete storage areas /60 i
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 // Properly line S r4 Absorption field S r�
Water main NA Water service line 10 / Surface water 100 /'I"
Wells on adjacent lots r e Co -I
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line /0 'It Building foundation /0 /4' Water main ION
r
Water Service line /0 } Surface water loo /*
Driveway, parking/vehicle storage
Curtain drain wcw'17 K,vcuulm Wells on adjacent lots Axy /-/
F. 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 data.
Engineer's Printed Name R d /34-"L C, Cc, JV',
Date � I a i r/o C
COSA Fee $ /C w-- J/ l/ t�014Z Waiver Fee $
Date of Payment - 06 Date of Payment
Receipt Number / Receipt Number
(Rev. 11M5)
tF , CC ;aaol .r .Aa;
in.
Fes.."
r
Y:
- ws-l�•� i Gle-' /
`to'tJ*,�i7y'
�•�, ��i'i'?-M to e'. •..
' -
• •
.1�rsr�rnrrnt•
I hereby certify that I have surveyed the fullowing
a
described property: L O r l , - e le c k. I , ' '
4 6 Cl
1 �•-r
rc v •" ,
Io T/ThJ RIt✓,fM� -�—
•��
any
'
Anchorage Recording Precinct, Alaska, and that the pro-
'A/
`to'tJ*,�i7y'
�•�, ��i'i'?-M to e'. •..
' -
• •
.1�rsr�rnrrnt•
I hereby certify that I have surveyed the fullowing
described property: L O r l , - e le c k. I , ' '
4 6 Cl
Io T/ThJ RIt✓,fM� -�—
Anchorage Recording Precinct, Alaska, and that the pro-
'A/
posed improvements, as planned thereon by the builder,
w+ OF
G
will be within the property lines and will not overlap
„�, •4 .... ,y . n _
: .• ^?
f-^. •'+
or encroach on the property lying adjacent thereto, that
thereto
�•'��•�
r
°''�:�' -••� ��
no improvements on property lving adjacent
encroach on the premises m question and that there are
' 1 a
no roadways, transmission lines or other visible ease-
s,�
-
ments on said property except as indicated. hereon.
• tJ %� lei :-Vr_
«
� I(7s,thems�oncihiity
NOTE
of tht$uildefto
Dated at Eagle River, Alaska
V
Robert C J� ir. ��n � ;,�
l No. ESO's .. �� fie the
tomes u Z lfiesp�Ror�
this ; }ter- day of �
�sl ��dti•. , ` +'.i ta!p
4.'1 �••,,.«„ ,• -� �W
rnnsGdR exi_
ROBERT C. JOHNSON
SCALE: Registered Land Surveyor No. 880 -LS
/p ss. \\;_ -
��L��f'!Z.:
- ..
r
I^ o rp 'Box 456, Eagle River, Alaska
-.
.. �`:`►...
_ -
Phone 894-2543 .
SCS Rct#
1060666001
Client Name
S & S Engineering
Project Name/H
LI BI Our Mountain SD
Client Sample ID
LI 111 Our Mountain SD
Matrix
Drinking Water
PN SID
Sample Remarks:
All Dates/rimes are Alaska Standard Time
Printed Date?ime
02/17/2006 14:52
Collected Date rime
02/09/2006 12:13
Received Daterrime
02/09/2006 16:28
Technical Director
Stephen C. Ede
Metals by ICP/MS
Arsenic ND 5-00
Microbiology Laboratory
Total Coliform 0
ug/l, EP200.8 C (<-10) 02/13/06 02/15/06 TK
col/100mL SM209222B A (<-I) 02/09/06 TLF
Allowable
Prep
Analysis
Parameter
Results
PQL
Units
Method
Container ID
Limits
Date
Date Init
Nitratc•N
ND
0.100.
mg/L
EPA 353.2
D
(<-10)
02/10/06 JC
Metals by ICP/MS
Arsenic ND 5-00
Microbiology Laboratory
Total Coliform 0
ug/l, EP200.8 C (<-10) 02/13/06 02/15/06 TK
col/100mL SM209222B A (<-I) 02/09/06 TLF
