HomeMy WebLinkAboutELMORE #2 BLK 8 LT 9Onsite File
#018-172-42
(Nev uwuu-i u/
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201084
PID Number: 018-172-42
Dwelling: ❑ Single Family (SF) ❑ with ADU
❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade
Name
MARK & KERI ROCHON
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
4801 E 145TH AVE
❑ other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block
Lot
ELMORE #2 BLK 8 LT 9
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range
Section
Gravel width
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 I
Tank
Line
FP
Ft.
Well j 100'+
I
50r.�'
J
TANK El Septic ®S.T.E.P. El Holding El Other
Manufacturer Capacity
ANCH TANK 1000 Gal.
Surface water � 100'+
Material
PLASTIC
Number of compartments
2
Lot Line 110'+
i
'
NA
Foundation 1 10'+
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks VC'ed n1,,gi(,�,Ad _��ev- 00C
Alarm location
Electrical installed by
PIPE MATERIAL House to tank 3034 Tank to
drainfield 3034
Installer
MIKE N ANDERSON, P.E.
Draintield CO/MT3034
Inspector MIKE N ANDERSON, P.E.
BENCH MARK (Assumed elevation) 100 ft
Inspectionm 5/8/20
Location and description
2nd
DECK
3rd 4"'
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
�
Ome Al���`
° • °
Conditional Approval:
Date
1 ° ° ' ° i� ��
o ° 49TH ��� •°• �,�
(fee. •o•o aes •oo• s• osY
:
• o •e a • • e e•• e o 0 o e e ,�
6� • MICHAEL N. ANDERSON
Septic System w "4�>••
Approve.... _ �" �,,.� (._ /J�
r".
r
Date 2.cl 2 C)
s3 e
CE 94 9
Note: this approval does not include well permit requirements.®o�RFES_t0`
(Nev uwuu-i u/
Permit No. OSP201084 Page 2 of 2
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: ELMORE #2 BLK 8 LT 9 PID No.: 018-172-42
MARK / A B
/
C01 13 33
CO2 / 14 35
/
02 i 16 39
03 17 40 1
SEPTIC \ /
/
I WELL
-
I
\ BENCH, CORNER OF DECK
I
/
NEW 1000 GALLON PLASTIC TANK
/ TIC
\
pq
02
DRNEWAY
I \
I
1
a WELL
I
(
\ ASBUILT/
\\ SCALE: 50'
`
TCS, Co COJ
TCO2
OF
0®
4®
® 49 Li
9 .1 1.000
GALLON 4
PLASTIC
TANK
•..... ••®
O
B
m°;MICHAEL. N. ANDERSON;`®
9i
No.
®® CE 9469
®®••'•'...�...•�
SEPTIC SECTION
®®�®till }SSS\®®®®®®
N.T.S.
April 29, 2020
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: New Septic tank permit
Legal: ELMORE #2 BLK 10 LT 9
To Whom it may concern:
This is a request for a septic tank permit on the above referenced lot. A new 1000 gallon plastic tank will be
installed and this tank replacement will not impact any of the neighbors.
Sincerely
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201084, Rebecca Carroll, 05/01/20
f'~"'~ MUNICIPALITY OF ANCHORAGE ~
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
MAILING ADDRESS
PTION
P.ONE ~[Tj ~NEW
L~Cf C]_$ [] UPG.ADE
LOCATION NO. OF BEDROOMS
DISTANCE TO:
Manufacturer
Liq. ca~o~O~itv i IF HOMEMADE: J Inside length Width Liquid depth
DISTANCE TO: Weg I Dwelling PERMIT NO.
Manufacturer [ Material Liquid capacity in gallons
Material beneath tile
Depth
inches
PERMIT NO.
Type of crib Crib diameter Crib depth Total ef fecti~ absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
~lass Depth Driller O~stance to lot line PERMIT NO.
DISTANCE '1'O: Building foundation Sewer line Septic tank Absorption area(s)
flon area
OTHER
PiPE MATERIALS
SOIL TEST RATING
"EMAR s'NSTALLE"A '"Fo
DATE
72-013 (Rev. 3/78)
LEGAL
I~lELL FiND
PERMIT NO. < 82104~ >
APPLICANT
LOCATION
LEGAL
MUNICIPALITY
DEPARTMENT ~ HEALTH AND ENVIRONMENTAL . .~OTECTION
825 'L' STREET, ANCHORAGE,
264-4~20
ON--S I TE SE[qER PERM I T
TOM WESTERHOF
L~ BB ELMORE #2
SPA BOX L146 ~9507 ~4~-5~67
LOT SIZE 9~99~9 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD
MAXIMUM NUMBER OF BEDROOMS
SOIL RATING (SQ FT?BR)= 125
THE REQUIRED SIZE OF THE SOIL ABSORPTIO~ SYSTEM IS:
DEPTH= 4 LE~Gth= ~ GRAVEL DEPTH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINfIEL[~.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET>.
THE TRENCH WIDTH IS 5. 000 FEET.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET>.
REQU I RED fi:EPT I C TI~NK $ I ::'E= :1.000 GFILLON$
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS Of ANY WELLS ADJACENT TO THIS PROPERTY AND'THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
t~O (2> I r~SPECTIOr~S FIRE REQUIRED
BACKFILLING Of ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BV THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURMED TO THE DEPARTMENT WITHIN ~0 DAYS
Of THE WELL COMPLETION.
OTHER REQUIREMENTS MRV APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERM I t EXP T RES DECEMBER ~-~ :L982
I CERTIFY THAT
l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY Of ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
~ovember ?, 1977
Susan Dabelsteen
Star acute AB ox 478-C
Anchorage, Alaska 99502
Subject= Lot 9 Block 8 Elmore Su~division A~dition %2
According to the R & M Consultants soils test dated February
7, 1977, it will be possible to install a shallow drainfiel~
system on the above lot providing the ground contour a11o~s
for the septic tank outlet to be no lower than three(3)
vertical feat from the top of the ground. The specifications
of this ahallowdrainfield with twelve(12) inches of approved
gravel backfill for a two(2) bedroom dwelling is=
(1)
Drainfield that is throe(3) feet wide and four(4) feat
deep with twelve(12) inches of gravel backfill will
require a seventy(70) linear feet of trench.
(2)
Drainfield that is four(4} feet wi~e and four(4) feet
deep with twelve(12) inches of gravel backfill will
require fifty-seven(57) Einear feet of trench.
A parm/t from this department is required before any on-site
sewer system, is installed. Please bring this letter with
you when you obtain this permit.
If there ara any further questions, please contact this
office at 264-4720.
Sincerely,
Cory Willis,
Sanitarian
February 8, 1977
R & M NO. 751107
· Mr. William S. Elmore
SRABox 479
Anchorage, Alaska 99507
Test lIole and Soil Log Report for Sanitary System
Lot 9, Block 8, Elmore subdivision, Addition #2, Anchorage, Alaska
Dear Mr. Elmore:
We are submitting herewith the test boring ~esults and our comments
regarding soil conditions encountered at the subject site. £his in.-
vestigation was performed in accordance with your request of February 3,
1977 and those procedures outlined in a.letter dated July 15, 1977
by Hr. Rolf Strickland of the Municipality of Anchorage, Department
of Environmental Quality.
A single test hole was put down within ~e subject site area for the
.purpose of d~fining general subsurface soil conditions for the proposed
sanitary system. Excavation was accomplished with an auger type
drilling rig and the test hole was extended to a total depth of
19 feet below ground surface. The final log prepared for the test
hole has been included in Drawing A-01.
Groundwater_was encountered in the test hole while drilling at a depth
of 8 feet.~ j)
We appreciate being given this opportunity to be of service to you.
Should you have any questions with regard to the above, please do not
hesitate to contact us.
Very truly yours,
R & M CONSULTA}~TS, INC.
James $~. ]~ooney
Vice President
WR/ e
xc: Municipality of Anchorage
LOT9
25
~, 40'~'~-~
2.12~
8~
~I-1
2-7-77
0.0'
ORGA~IIC SILTY S~21D . ,:
SILTY SAND (S:[) ; ' .'-
~0
~50~
S~D W/T~CE SILT (SP) .
Occaslonal. Cobbles, ~'Zet
........ 7.0~
SAND W/SO)~E SILT AND
SO:~E GRAVEL (S~! to ~.)
Very Wet, Brown
Test llole locations are approxinate
and have not been located by survey
me thod s.
SILTY sram Wso:~"
CRAWL (~.)
. Wet
Boulder at 19' " ..... "'
19.0'(.' TD .-
This log represents subsurface soil'.':'::'
conditions within Lot 9, Block 8 ' :"' .~' {
Elmore Subdivision, Addition ~.2 '' '
Anchoraqe, Alaska
VN, V~Z
t~NSULTANTS. INC.
SA~IITAR'I SE~'~ER TEST }[OLE
%/ILLI;~'I S. EL?lORE
A}IC}IO.~AGE, AIAS.~A
7 1107
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 I.D. 018-172-42
1. GENERAL INFORMATION
Complete legal description
Location (site address) _
Current property owner(s)
Mailing address
Real estate agent
Expiration Date: 21 - 2-0
ELMORE #2 BLK 8 LT 9
MARK & KERI ROCHON
Day
4801 E 145TH AVE, ANCH AK
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
El
Private Septic
El
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 $ ��o J ! G - Waiver Fee $
Date of Payment l I2 0 Date of Payment
Receipt Number 0 Z I aQQ Receipt Number
COSA # () 5 C a0 l i q 5 Waiver #
COVID-19
25% DISCOUNT APPLIED
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 MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE ANCH AK
Engineer's Printed Name MIKE N ANDERSON, P.E. Date 5-15-20
F yr:
49TH -. •° s: ,,
6. DSD SIGNATURE ;�°,.,.;,,,.,..�. o...........°�Ft
.. P
System #1 Approved for 3 bedrooms X • • • • • •':; ;_ �;y:+ ......
^ • • • °
i ..0 - MICHAEL N. ANDERSON
System #2 Approved for bedrooms ��`<,;,• Cr -94 9 .,•`:
Disapproved t�'�D •`f!?;►.��Z `�,��.,,
lk PRQfESSIVI
Conditional approval for bedrooms, with the following stipulatiN30Q,o�.�
--(- ---- V��"
r
�l 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 engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist
Legal Description: ELMORE #2 BLK 8 LT 9
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 4/2/83
Total depth 101 ft
Cased to 99.5 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 26"+ in.
Date of flow test for COSA 4/22/20
Static water level at beginning of test 56 ft.
Comments
B. TANK DATA
Age of tank(s) NEW years
Tank type/material SEP72C,Pv S:
Measured operating fluid level in septic tank NEW
❑ Standpipes/foundation cleanout per record drawing
Date of pumping NEW
D. ABSORPTION FIELD DATA SHALLOW 5 -wide
Which system tested (date installed) 10/28/82
❑ ALL standpipes present per record drawing
Total measured depth from grade 4.0 ft (max)
Measured depth to pipe invert from grade 3.0 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 0 gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 018-172-42
Structure served by this system
Well production at time of test 4.1+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 0.29 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by MNA
Date of Sample 4/22/20
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 4122/20
Results Q Pass For 3 bedrooms
Fluid depth prior to test 4 in
Water added 500+ gal
New depth 6 in
Elapsed time 1440 min
Final fluid depth 4 in
Absorption rate 450 gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
M
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'
Q Yes
if No
ft .
M Yes
if No ft
Neighboring Tank> 100' Q✓ Yes
if No
ft
Private Sewer/Septic Line > 25' M Yes
if No ft
Absorption Field on Lot > 100' Yes
if No
ft
Holding Tank > 100' Yes
if No ft
Neighboring Absorption Fields > 100'
Q Yes if No ft
Water Main > 10'
Animal Containment > 50' Yes
if No ft
✓� Yes
if No
ft
Yes if No ft
Water Service Line > 10'
P/l
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main > 75' FV -1 Yes
if No
ft
21 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'
✓1
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
M✓
Yes
if No
ft
Private Wells > 100'
Q Yes if No ft
Water Main > 10'
0
Yes
if No
ft
Community Wells > 200'✓Q
Yes if No ft
Water Service Line > 10'
P/l
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'
U Yes if No ft
Water Service Line > 10'
F�
Yes
if No
ft
Community Wells > 200'
0✓ Yes if No ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that l 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.
COSA Checklist yellow sheet
�^y
f�°#e4YT,j .�'�r' °.5.ii'
iie.?41 r i",
�• e e oee�'Ri.� .. '�:e�ea eoe esao o v t'ff'
MICHAEL N. ANDERSON , p�
CE - Q469 , L,Yy�
Lot 3 / Lot 4
N 89'56'17"E 212.00'
AT
Lot 5
-----
�----
Lot 9-----
40,280 s.f. 10' UTILITY EASEMENTS
I
WELL
IRpS.
RPp1v5
?
9.8'x10.2' SHED
�Io
0
0
1
CHAIN-LINK FENCE
3.5DECK /
0
v
Lot 1 O 0
2.1'x9.8 CANT �_ 1
0
I LOt
7
5.5'
M
RETAINING WALL
80.4'
02o:z'x1�.1'
2 STORY
(
o
o
SHED
RESIDENCE m
O
80.4'
SEPTIC PIPE
MANHOLE
DECK
SEPTIC PIPES
3 " j
CANTS '
0
t1)
Ln
>.
o 61,
N 89' 6' 17"W 212.00'
0
E. 1445th AVENUE
PLOT PLAN ___ AS BUILT _X_ SCALE _ 1=_= 50__ GRID SSW 3036. Project No. �_0_-21 �_R1_____
,�
11500 • Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & A S S o c i a t e S, i n C. (907) 522-6476 Phone �400v0o�
(907) 522-4625 Fax o0 0
Professional Land S u ry e ors ken®iangsurvey.com (:)F
q �p
y jonothan®longsurvey.com �vP '' .100
I hereby certify that I have surveyed the following described property.-
LOT
roperty:LOT 9, BLOCK 8, ELMORE SUBDIVISION — SECOND ADDITION (PLAT 69-96)
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property lines and .do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other' visible
easements on said property except as indicated hereon.
Dated this the �� �° g
Day of ___�•l�_1 ________, , at Anchors e, Alaska
It Is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
�* 49TH
KENN H G. LANA o
d4FAFo' •.LS -5202.•' gJpG
�Q�nROFessIONA� `�' v�
AECC963
G l
4.)• DA 0
r+) fitiggkift
• � Municipality of Anchorag `G
On-Site Water and Wastewater Program 2 Ali.Z 1 � `"`f K '
(907) 343-7904 a�6
‘2j
j () < <
.>
Certificate of On-Site Systems Approva `` 01 6 S
Parcel I.D. 018-172-42 Expiration Date: jfri '1 17
1. GENERAL INFORMATION
Complete legal description Elmore No. 2, Block 8, Lot 9
Location (site address) 4801 E. 145th Avenue
Current Property owner(s) James & Sandra Hoglund Day phone 345-6209
Mailing address 4801 E. 145th Avenue Anchorage, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
El Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Three
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 0 Individual 0
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: V pl onzeli r pdpe Date: Wi 7/17
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ ��(v I' Waiver Fee $
Date of Payment Tl l t l ii Date of Payment
Receipt Number o121C Receipt Number
COSA# OC. fl 1 511 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 antl type 01 structure Indicated here\n. ve0y t ai utSSd
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 Anderson Engineering Phone 522-7773
Address 1399 West 34th Avenue No. 203 Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller, P.E. Date 8/W,11- ,4� txq
waw '`
re= •,' •rJ e.
a `-•
; , <fr
6. DSD SIGNATURE 0--• •••,
Nija .1
System #1 Approved for bedrooms �061 0. r 12::WI, 1,.?
System #2 Approved for bedrooms voir.94);°•Y1,1* 1.3 •
Disapproved t'
Conditional approval for bedrooms, with the following stipulations:
_c '3 (9
A-Velkoje S 2 -
•
VVIicz7 V
,
�,r
it j1r�
Sr !.; _
v I
By: liter Original Certificate Date: 7H 7 _C 7
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 blue sheet f - .
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Elmore No. 2, Block 8, Lot 9 Parcel ID. 018-172-42
A. WELL DATA
Well type Private If A. B, or C provide PWSID # Well Log (YIN) Y
Date completed 4/2/83 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y
Total depth 101 ft Cased to 99.5 ft Casing height (above ground) 28 in
FROM WELL LOG AT INSPECTION
Date of test 4/2/83 7/21/17
Static water level 55 ft 58.6 ft
Well production 20 g.p.m 4.0 g.p.m
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 0.296 mg/L
Arsenic
ND D ug/L Date of sample 7/20/17 Collected by: Anderson Eng
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 10/28/82
Tank size 1 '000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 8-1 -17 Pumper Northland Pumping
C. ABSORPTION FIELD DATA
Date installed 10/28/82 Soil rating (g.p.d./ft2 or ft2/bdrm) 125 sF/BDRM System type 5' Wide
Length 68 ft. Width 5 ft. Gravel below pipe 1 ft.
Total depth 4 ft. Eff. absorption area 391 ft2 Monitoring tube Depression over field N
Date of adequacy test 7/21/17 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test_0'5 in. Water added 452 gal. New depth 6 in.
Elapsed Time 1 ,440 min. Final fluid depth 1 '5* in. Absorption rate >= 450 g.p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
*Septic system remained in use by occupants during this 24-hour period, introducing
additional effluent into the trench. Additionally, the first 50 gallons caused the water to rise
to 2". Calculations indicate that the trench absorbed more than 450 gallons.
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level atin. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm &circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot >1001 On adjacent lots >100'
Absorption field on lot >100' On adjacent lots 100'
Public sewer main >75' Public sewer manhole/cleanout >100'
Sewer/septic service line >25' Holding tank >75'
Animal containment areas >50' Manure/animal excrete storage areas 100'
SEPTIC/HOLDING TANK ON LOT TO:
>5' >5' >5'
Building foundation Property line Absorption field
Water main
>10'10 Water service line >10'10 Surface water >100'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
10' 10'
Property line > Building foundation > Water main 10' >
100'
Water Service line > Surface water10' > Driveway, parking/vehicle storage >
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
The septic tank is more than 35 years old and may be nearing the end of its
useful life.
G. ENGINEER'S CERTIFICATION o iohirs�►4 y
40 e. orI certify that I have determined through field inspections and a.`Q.•' •'•q�+0
review of Municipal records that the above systems are in at el. 'i 1#d
conformance with MOA COSA guidelines in effect on this date. ;* 49 rH s -.720
g Benjamin Schiller, P.E. r
Engineer's Printed Name ,-•..• v
Date 7/27/2017 $ • /T" / Seti:+er:
If CE- d
COSA brown sheet 10-10-12.doc
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Lot 3 Lot 4 Lot 5
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N 89'56'17"E 212.00' \
_ _ _ , _ _
I10' UTILITY EASEMENTS
Lot 9 WELL I
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RETAINING WALL 2 , m
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E. 145th AVENUE
PLOT PLAN _ AS BUILT X SCALE 1" = 50' GRID SW 3036 Project No. 17-255/A1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates , inc .
(907) 522-6476 Phone Q4��Opp�
(907) 522-4625 Fax Q
Professional Land Surveyors kenOlangsurvey.com , .'''7_, F �4
jonathanOlangsurvey.cam �
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I hereby certify that I have surveyed the following described property:
Go,71, ��'\ OQ
LOT 9, BLOCK 8, ELMORE SUBDIVISION — SECOND ADDITION (PLAT 69-96) p * 49TH 1\ ,-Y*Q4
Anchorage Recording District, Alaska, and that the improvements situated thereon are 0 ...) V
VA
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed .. K.ENNETHAG. LAN(1�: 0
premises and that there are no roadways, transmission lines or other visible ��c^� oO
easements on said property except as Indicated hereon, V s: t h.t i n .''41
04 ,per-...LS-5202.•'' �J �
Dated this the Day of -%-'cci t 1i" , , at Anchorage, Alaska Q4q�4� 510NAL�a�
It 1s the responsibility of the owner to determine the existence of any easements, ��44o�a=
covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963
APPLF'-'NT FILLS OUT UPPER HA~'''~ ONLY
Lending Insli~tion ~/ D ~ ~?~ ~ Phone
Address Zip
Address Zip
Type of Resl~nce
Water Supply
Sewer Disposal
~ Holding Tank
NOTE: THE INSPECTION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
~)r r~TT
(~) APPROVED S~.OOMS '~ON~mONSO~
( ) CONDIT~NAL ~ROVAL'
BY: ' ~ ~
Soils Rating Date ~wer
