HomeMy WebLinkAboutCAMPBELL POINT BLK 1 LT 4Onsite File
Campbell Point
Block 1
Lot 4
#011-262-18
Municipality of Anchorage
On=Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201463 PID Number: 011-262-18
Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade
Name
Eleanor Zipay
ABSORPTION FIELD
❑E Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
8500 Heather Circle Anchorage, .AK
-73
❑ Other
Phone
Numbe r of Bedrooms
Soil Rating
Total depth from original grade
(907)242-2234
1.2 GPD/SF
10.6 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3.6 Ft.
Gravel depth beneath pipe
7.0 Ft.
Subdivision Block Lot
Campbell Point 1 4
Fill added above original grade
0.0 Ft.
Gravel length
27 Ft.
Township Range Section
Gravel width
3 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
378 Ft2
1
Ft.
Well
>100'
>1 00'
N/A
N/A
>25
TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
1,000 Gal.
Surface Water
>1
>1 00'
N/A
N/A
Material
Plastic
Number of compartments
1
Lot Line
>5'
>10'
N/A
N/A
NA.
Foundation
>1 0'
>1 0'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks
Alarm location
Electrical installed by
PIPE MATERIAL House to tank D3034 drainfield Tank to
D3034
Installer
Whitters Excavation
Drainfield D3034 C0/MTD3034
BENCH MARK (Assumed elevation) 100 ft
Inspector Luke Tidwell
Inspdection 15` 11/24/20 11/24/20
Location and description
2nd
Bottom of blue siding
3`d 4,h
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
•`••OF q♦fie♦
Conditional Approval: Date
o•�P�""
•
P" `'
•..�.�n..F.' 49th .��`...
. .... . .. .s.
'DE....
�................................................ 0
MICHAEL E. ANDERSON
I��%'•.
Septic Sys
r
Approve ht, I T�iC Date ( Z� -ZQ
No. CE-4381�e
♦♦ TF''... 12/1/20 •.••''tv�'�:
Note: this does include
'♦1,aisaeSs�o ••
approval not well permit requirements.
(Rev 05/02/18)
m
E
EN GINEEa1NG
CAMPBELL P. BLOCK 4
OSP201463 PID a 011-262-18
Oe
v 91.6 FINISH GRADE
UJ.N
91.6 ORIGINAL GRADE � Ov
NO GROUNDWATER 11/30/20
71.6
PROFILE AS -BUILT
(NO SCALE)
-M l
PERMIT # OSP201463 PID # 011-262-18
I
aI
,_.
_Q L
� B �/
O \ 1,000 GALLON SEPTIC
-y TANK w//2FMANU,VAY. -
/ 20'EASEMENT e /
I
LOT 5 /
\ EXISTING WELL
NOTE:
ABANDONED ABSORP ON PIT REMOVED COMPLETELY AND
EXCAVATED AREA BAC ILLED WITH IN SITE MATERIAL.
EXISTING SEPTIC TANK DEOMMISSIONED PER U.P.C.
ENGIN \
0 50 100
FEET
1 "=50'
A B
MH
76.6
88.5
SV
PIPES REMOVED FROM
93.0
2CO
/
95.1
EXISTING TRE( CH &
91.85
98.85
C01
91.25
ABANDONED IN PL -ACE.
MT2
89.9
110.05
CO2
LOT 3
110.55
I
EXISTING WELL_
LOT 4•
fY
-
THREE BEDROC
M HOM
aI
,_.
_Q L
� B �/
O \ 1,000 GALLON SEPTIC
-y TANK w//2FMANU,VAY. -
/ 20'EASEMENT e /
I
LOT 5 /
\ EXISTING WELL
NOTE:
ABANDONED ABSORP ON PIT REMOVED COMPLETELY AND
EXCAVATED AREA BAC ILLED WITH IN SITE MATERIAL.
EXISTING SEPTIC TANK DEOMMISSIONED PER U.P.C.
ENGIN \
0 50 100
FEET
1 "=50'
A B
MH
76.6
88.5
SV
81.75
93.0
2CO
84.1
95.1
MT1
91.85
98.85
C01
91.25
97.75
MT2
89.9
110.05
CO2
90.45
110.55
' 27' LONG x 3' WIDE x 7'
EFFECTIVE DEPTH
ABSORPTION TRENCH
: W
I
U
IC)
w
w
LEGEND
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
SOILS LOG AND PERCOLATION TEST
E N G I N E E R I H G
LEGAL DESCRIPTION: CAMPBELL POINT BI L4
PERFORMEDFOR: ELEANOR ZIPAY
DATE: 11123120 PROJECT No.:
PARCELID#: 011-262-18 TECHNICIAN: J. MILLETTE
DEPTH TEST HOLE 1
(feet)
1
2
N
5
6
7
8
9
10
11
12
13
14
15
1' OB
r�..
SM (SILTY SAND)
a.
GP (2" MINUS POORLY
GRADED GRAVEL)
PERC <1 MPI
6'�
'
READING
WAS GROUND WATER ENCOUNTERED? NO
NET TIME
(MINUTES)
DEPTH To
WATER
(INCHES)
NET DROP
(INCHES)
IF YES @ WHAT DEPTH? -
L
•
2:15
DEPTH TO WATER AFTER MONITORING: NONE
0 16 / 6 0
6 16
2
DATE OF MONITORING: 11/30/20
P
0 0 / 6 16
610
3
E
2m 35s
5
SW/SP (CLEAN COARSE SAND)
16 • r� • � � �',
17-
19-1
7
COMMENTS:
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH To
WATER
(INCHES)
NET DROP
(INCHES)
11/23
1
2:15
2m 18s
0 16 / 6 0
6 16
2
2:18
2m 33s
0 0 / 6 16
610
3
2:21
2m 35s
0 0/ 6 16
6 0
4
2:25
2m 26S
010/6-1
610
5
2:28
2m 31s
00/616
610
6
2:31
2m 32s
0 6/610
6a0
PERCOLATION RATE: <1 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 10 FT. and 11 FT.
PROJECT CLIENT:
Forge Engineering
PROJECT NAME:
Campbell Point
PROJECT NO.:
.5665-20
SAMPLE LOC.:
TH 92
NUMBER/ DEPTH:
Block 1/ Lot 1
DESCRIPTION:
Poorly -graded sand -tv/ graveI
DATE RECEIVED:
11/23/2020
TESTED BY:
JA
REVIEWFI) BY:
RJPC
100
90
80
70
60
z 50
arm 40
30
20
10
0
IIR
140
120
115
% GRAVEL 32.8
% SAND 65.0
% SILT/CLAY 2.2
% MOIST. CONTENT 7.6
USCS
USACOE FC
% PASS. 0.02 nun
% PASS. 0.002 nim
SP
N/A
N/A
N/A
UNIFORMITY COEFFICIENT (C„)
12.4
COEFFICIENT OF GRADATION (C,,
0.2
PLASTICITY INDEX
ASTM D1557 (LmCOITCCted)
N/A
N/A
ASTM D4718 (corrected)
NT/A
100
OPTIMUM MOIST. CONTENT. (corrected) N/A
3/4"
PARTICLE SIZE ANALYSIS ASTM D422 / C 13 6
U.S.SIEVEOPENING III INCHES 1 U.S.SIF.VFNUIMERS I HYDROMETER
100 10 1 0.1 0.01 0.001
GRAIN SIZE
GRAVEL SAN I
COBBLES SILT or CLAY
Coazse I Fine Coarsc Medium Fine
MOISTURE -DENSITY RELATIONSHIP ASTM D 1557
0 2 4 6 8 10 12 14 16
MOISTURE CONTENT (°/")
SIEVE ANALYSIS RESULT
SIEVE
SIZE (MM)
SIEVE
SIZE (U.S.)
TOTAL% SPECIFICATION
PASSING (M. PASSING)
N/A
DEGRADATION
152.40
6"
PLASTICITY INDEX
76.20
3"
N/A
38.10
1.5"
100
19.00
3/4"
95
12.70
I/2"
88
9.50
3/8"
81
4-75
414
67
2.00
#10
63
0.85
#20
50
0.43
440
46
0.25
#60
37
0.15
#1100
11
0.075
4200
2.2
HYDROMETER RESULT
ELAPSED DIAMEMR TOTAL%
TIt',IE(MrN) (mm) PASSING
0 _
0.5
1
2
4
8
15
30
60
250
1440
HYDRAULIC GOND.
(ASTM D2434)
N/A
DEGRADATION
(ATM T-313)
N/A
PLASTICITY INDEX
ASTM 4318
N/A
The testing services reported herein have been performed to recognized industry standards, unless otherwise noted. No other warranty is made. Should engineering
interpretation or opinion be required, NGE-TFT will provide upon written request.
11301 Olive Lane - 4nchorage, Alaska 99515 - Phone: 907-341-5934 - Fax: 907-3,14-5993 • wivw.nge-tfl.com
\
I
\
JODHPUR STREET
& m oZ 3 Fez 7
EA /HE'S
C/RC/ E
11/11/20
PO BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
October 29, 2020
MOA Development Services Dept, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Campbell Point, Block 1, Lot 4 – 8500 Heather Circle
Septic System Design
Dear On-Site Services Engineer:
The septic system on the subject lot is undocumented and is located inside the well radius. We are
submitting this permit application for the construction of a new septic system outside the well
radius and entirely on the subject property. The attached site plan identifies the location of the
home and the existing well along with the existing and proposed septic location. No conflicts exist
between this proposed system and any other well or septic system on this lot or adj acent lots.
The ground surface on the lot slopes gently to the east in the area of the proposed absorption trench.
There are no slopes greater than 25% within 50 feet downslope of the absorption trench. Drainage
arrows are shown on the site plan indicating the grade and direction of flow. Storm water drainage
will not impact this septic system. The new trench will be constructed parallel to the slope as much
as possible. The absorption trench has been designed based on existing information from adj acent
lots. A new test hole will be placed prior to construction to verify design criteria. We request a
condition to the permit requiring the test hole.
Wells on this and adj acent lots are shown. The new system will be a minimum of 100’ from all
wells and surface water, and more than 5’ away from the septic tank.
Please refer to the attached test hole log and plan and profile sheets for the septic design. If this
design is followed, there will be no adverse impacts to adj acent properties.
Sincerely,
Michael E. Anderson, PE
10/29/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201463, Rebecca Carroll, 11/06/20
2CO
1"=50'
NOTE:
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE
PROPOSED SEPTIC SYSTEM
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC
SYSTEMS.
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
CAMPBELL POINT, BLOCK 1, LOT 4
11/6/20 FEET
0 50 100
20' EASEMENT HEATHER CIRCLEJODHPUR STREETEXISTING WELL
THREE BEDROOM HOME
EXISTING WELL
DECOMMISSION EXISITNG
SEPTIC TANK PER U.P.C.
REMOVE PIPE &
ABANDON IN PLACE.
1,000 GALLON SEPTIC
TANK w/20" MANWAY.
27' LONG x 3' WIDE x 7'
EFFECTIVE DEPTH
ABSORPTION TRENCH
PROPOSED TEST HOLE
2COSVMH
CO
MT
CO
0-5%
0-5%
0-5%ABANDONED
ABSORPTION PIT.
NOTE:
THE ABANDONED ABSORPTION PIT MAY BE LOCATED AT OR NEAR
THE NEW SEPTIC SYSTEM SITE. THE PIT MUST BE REMOVED
COMPLETELY AND THE EXCAVATED AREA BACKFILLED WITH IN SITU
MATERIAL TO A MINIMUM OF 14' FROM THE NEW ABSORPTION
TRENCH.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201463, Rebecca Carroll, 11/06/20
CAMPBELL POINT, BLOCK 1, LOT 4
DESIGN FACTORS: SYSTEM REQUIREMENTS:
450 GPD PEAK FLOW
PERK RATE: 1-5 MIN/IN (NEIGHBORING LOTS)
APPLICATION RATE: 1.2 GPD/SF
7' DEEP TRENCH SYSTEM
1,000 GALLON SEPTIC TANK
TYPICAL TRENCH SECTION
(NO SCALE)
4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
3'
6"
6"
3'
7'
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
BOTTOM OF TRENCH: 10.5' BELOW GRADE
FLOW LINE ELEVATION: 3.5' BELOW GRADE
TOP OF TRENCH: 0.5' ABOVE GRADE
450 GPD / 1.2 GPD/SF / 7' DEEP / 2 SIDES = 26.78 LF TRENCH REQUIRED (27 LF SPECIFIED)
10/29/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201463, Rebecca Carroll, 11/06/20
GRr~TER ANCHORAGE AREA BOROU~,H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-251
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCA,,ON .J'/~'r.~
SEPTIC TANK:
ADDREssMAILING /~'.~,~ ~ f.~ ~. PHONE
DISTANCE FROM WELL ""7.~'
LIQUID CAPACITY /.~
MATERIAJ ~,,~'//~" ,~ ~/~"r'~- NUMBER OF
GALLONS. INSIDE LENGTH INSIDE ~DT~ DEPIH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
NEARES! LOT LINE
'-- OR W~DTH /..~
· DISTANCE FROM WELl /~t /
· TOTAL EFFECTIVE ABSORPIION AREA (WALL AREAJ
LENGTH /~/ / , DEPTH
· BUILDING FOUNDATION
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
· FOUNDATION ~
DISTANCE B~ TRENCH WIDTH '
~ LENGTH OF EACH LINE
TOTAL LENGTH
., OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE
WELL:
LOT LINE
~ ~ / ,,'/ I DISTANCE FROM . WATER ~
TYPE DEPJ'H~, BUILDING FOUNDATION. ~ SAMPLE , NEAREST
/~ /¥... NEAREST SEPTIC I SEEPAGE OTHER
SEWER LINE ~:~ '7"~ /~ /
. . TANK ~
. , SYSTEM , CESSPOOl , SOURCES
D,^GRA~ OF sYs~m , ~'~11/¢
DISTANCES:
DATE
GAAB-HD-2
·
GREATEK~ANCHORAGE AREA ~'OROUGH C:.N0.
IIEALTH DEPARTMENT
327 Eagle St. Anchorage, Alad~a 99501 279-25111 ~
NAME OF APPLICANT
RESIDENCE ADDRESS
LOCATION OF INSTAL~TION.
LEGAL DESCRIPTION, ~0 Y ~
SEEPAGE PIT ~ ,DRAIN FIELD
TO BE INSTALLED BY LICe/.~eD
APPLICATION TO INSTALL: SEPTIC TA~K
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH ~ ~- I F
~'~-Hc ~,~/~TEST RESULTS
ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
,OTHER
THIS IS TO SERVE AS
/Y/ '~ '/"~Z:~"'~77'~' . PERMIT TO INSTALL A-
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
· SEPTIC TANK SIZE
DISTANCES:
TYP~EEPAGE AREA, TYPE
DIAGRAM OF SYSTEM
Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No.~8-68 ~ffd that tl~e
above described system is in accordance with said code.
Depth
Feet
/ ~
Was Ground Wa~er Encountered2
If Yes, At.What Depth_
,
Location Sketch
s Tzme Net Time Depth To 1{20 Net Drop
~ .,
Reading
r~opased Instal~seepage Pit,, ~ Drain Field
Depth'Of Inlet
COH~ENT$: " De,tn To ~ottom O~ ~it Or Trenc~__~_~
Test Perf6r~ed B¥:~p~,~ ~
STATE OF ALASKA 31259
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING, LAND & WATER
Alaska Hydrologic Survey
WATER WELL LOG Revised 03//812016
Drilling Started: / / Completed: / / Pump Install:
City/Borough
Subdivision
Block
Lot
Property Owner Name & Address
Anchorage
CAMPBELL POINT
B1
L04
9
Well location: Latitude Longitude
Meridian S Township 012N Range 004W Section 9 , SW 1/4 of NW 1/4 of NW 1/4 of SW 1/4
BOREHOLE DATA: (from ground surface)
Drilling method:: it rotary, . able toolEjOther
Suggest T.M. Hanna's hydrogeologic classification system*
Well use:nPublic supply,ODomestic, MReinjection,nHydrofracking
https://my,ngwa.org/NC Product?id=a 185000000BYub3AAD
Commercial, Observation/Monitorin p y
g, Test/Ex lorator ,. Cooling,
Depth
From To
El Irrigation/Agriculture, []Grounding,PRecharge/Aquifer Storage,
El Heating,E]Geothermal Exploration, MOther
Fluids used:
existing well
0.0
267.0
sand and gravel, heavy, brown, little water
267.0
274.0
sand, little gravel, little water heavy blue gray
274.0
277 0
Depth of. hole: 329 ft Casing stickup: ft
Casing type: Casing thickness: inches
fine sand, heaving
277.0
288.0
Casing diameter: inches Casing depth: 329 ft
Liner type: Depth: ft Diameter: inches
Note: FULL CASE
dirty, silty, sandy gravel heaving
288.0
298.0
silt, little sand, heavy gray
298.0
318.0
sand and gravel, heavy, little water
318.0
321.0
Well intake opening type: LjOpen end,LOpen hole,i Other
Screen type: , Screen mesh size:
silty sand and gravel, heavy, layered with tight zones
321.0
327.0
Screen start: ft, Screen stop: ft, PerforatedOYes o No
Perforation description: Perf from: ft, Perf
to: ft, Perf from: ft, Perf to: ft
Gravel packedE]YesE]No Gravel start: ft , Gravel stop: ft
sand and gravel, heavy, making water
327.0
328.0
fine sand to coarse gravel, little heavy, layered with blue gray clay and gravel
328.0
329.0
Note:
Static water (from top of casing): 254 ft on / / Artesian well El
Pumping level & yield: feet after hours at 10 gpm
Method of testing:
Development method: Duration:
Recovery rate: gpm
Grout type: Volume
Depth: From ft, To ft
Include description or sketch of well location (include road names,
Final pump intake depth: ft Model:
buildings, etc.):
Pump size: hp Brand name:
Was well disinfected upon completion? i Yes ! No
Method of disinfection:
Was water quality tested?"Yes No
Water quality parameters tested:
Well driller name: .................................................... ........................
Company name: YERN.S DRILLING
..........................................................
Mailingaddress: ....................................................................................
n�n
City: State: AK Zip:
l
Phone number: ( ) -
AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a
Driller's signature:
copy of the well log be submitted to the Department of Natural
Resources within 45 days of well completion. Well logs may
Date:
be submitted using the online well log reporting system
available at:
Anchorage Municipal Code 15.55.060(1) and North Pole Ordinance 13.32.030(D) require
that a copy of this well log be submitted to the Development Services Department/City
https://dnr.alaska.gov/welts/
within 30 days of well completion.
City Permit Number:
OR email electronic well logs to
Date of Issue: / !
dnr.water. reports (d)alaska_goy
Parcel Identification Number: -
`Guide for Using the Hydrogeologic Classification System for Logging
Water Well Boreholes by Thomas M. Hanna NGWA Press
0
60
(h
157(:) 0 0?
�/os SIT " C) 0 1
WATER WELL DRILLERS LOG
Drilling Co.
VERT 'S
D-32!-LLT`G
KITER.
Depth in
feet from
Give details of formations penetrated, size of material.,
Found surface
Driller
VERNON
L. ITOWELL
274
Well owner
-ROBERT
D. ZM�z
sand, little gravel, little H2O: hea-iry blue ra
Location
Taddress
of: Towni-Ii1p;
Range, & section, if k
main road 8.500 Heather Circle, Anchorage,
De e% tzh b's ell
Size of casing-'- Depth of hole 2pq --.-Fe-etCas
2-4- 7000%
s I/�
DO NOT FIM IN
us,�-a::L3 2-�
e of well
n. or distance
2
Static * nater level 2.54 fet (Moaft)(belov) land surface. Finish of well
(check one) Open end (X Screen Perforated
Describe screen or perforations . I
Well pumping test at 10 gallons Fr7(Sj7qw(;in=ute for hours with
5 feet of dravdown from static level
Remarks bottom stable after 2 hrs.. dart bailing
Well, Log
Depth in
feet from
Give details of formations penetrated, size of material.,
Found surface
color, and hardness.
2671to
274
sand & Gravel, heavy,
brown little H2O
2741to277'
sand, little gravel, little H2O: hea-iry blue ra
2'771to288,
fine sand, heaving
288Tto
2981
dirty, silL7, sand y_gravel
-heaving
—U-81 to
3181
silt, little sand, heavy eraZ
_318,to-2211
sand & gravel, heavy,
little H2O
_321 1 to32616
silty sand & gravel,
heavylensed with t' es
X6'61'
328
sand_ & gravel, heavy,.
makin&H20
�281to
3291
fine sand to coarse
gravel, little hep=�
to
lensed with blue gray
clay and gravel. Bot t.QM g able
to
to
to
to
to
MUNICIPALITY OF
Development Services Department "
On -Site Water & Wastewater Section
Parcel I.D. 011-262-18
ANCHORAGE
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Phone: 907-343-7904
Fax: 907-343-7997
Expiration Date: -s — q - 2 0-Z
Complete legal description Campbell Point, Block 1, Lot 4
Location (site address) 8500 Heather Circle Anchorage, AK
Current property owner(s) Eleanor Zipay Day phone
Mailing address 8500 Heather Circle, Anchorage, AK 99502
Real estate agent Michelle Russell Day phone (907) 242-2234
2. TYPE OF DWELLING:
❑N Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑Q
Private Septic
0
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 $ 336. GOVT 0
Date of Payment ) 2' ��y2 0
Receipt Number ®a03 5 z3
Waiver Fee $
Date of Payment
Receipt Number
COSA # OS G20 1667 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 12/1/20
6. DSD SIGNATURE
System #1 Approved for _ bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
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By: Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: Campbell Point, Block 1, Lot 4
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 1969
Total depth 329 ft
Cased to 329 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) >18 in.
Date of flow test for COSA 10/7/20
Static water level at beginning of test 258 ft.
Comments
B. TANK DATA
Age of tank(s) `1 years
Tank type/material Septic/Plastic
Measured operating fluid level in septic tank New
❑ Standpipes/foundation cleanout per record drawing
Date of pumping New Construction - 11/24/20
D. ABSORPTION FIELD DATA Deep Trench***
Which system tested (date installed) 11/24/20
❑ ALL standpipes present per record drawing
Total measured depth from grade 10.6 ft (max)
Measured depth to pipe invert from grade 3.7 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
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 011-262-18
Structure served by this system
Well production at time of test 4.8 gpm
Water storage tank volume None gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic 5.86 ug/L ❑ Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample 11/30/20
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments: Gravity Flow System.
Adequacy test date New Construction
Results ❑ Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
***Absorption Trench constructed 11/24/20.
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
Community Sewer Manhole/Cleanout > 100'
0 Yes
if No
ft
Q Yes
if No ft
Neighboring Tank > 100' 0 Yes
if No
ft
Private Sewer/Septic Line > 25' 0 Yes
if No ft
Absorption Field on Lot > 100' 0 Yes
if No
ft
Holding Tank > 100' 0 Yes
if No ft
Neighboring Absorption Fields > 100'
Q✓ Yes if No ft
Water Main > 10'
Animal Containment > 50' 0 Yes
if No ft
0 Yes
if No
ft
Yes if No ft
Water Service Line > 10'
0✓
Yes
if No
Manure/Animal Excreta Storage > 100'
—❑✓
If septic tank is under driveway comment below
Community Sewer Main > 75' 0 Yes
if No
ft
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
Surface Water > 100'
Yes if No ft
Property Line > 5'
r✓
Yes
if No
ft
Wells on Adjacent Lots:
0
Absorption Field > 5'
Q✓
Yes
if No
ft
Private Wells > 100'
Q✓ Yes if No ft
Water Main > 10'
0
Yes
if No
ft
Community Wells > 200'
Yes if No ft
Water Service Line > 10'
0✓
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'
0✓
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
0
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
0
Yes
if No
ft
Private Wells > 100' ❑✓ Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water > 100'✓1
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION OF .6
I certify that I have determined through field inspections and review �P.•
of Municipal records that the above systems are in conformance with
MOA COSH guidelines in effect on this date. 49th 'sem
COSA Checklist yellow sheet
MICHAEL E. ANDERSON;
•. No. CE -4381 4'�Z AV
12/2/20 .•••••F���
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