HomeMy WebLinkAboutSUNNY ACRES BLK 4 LT 9 & 8 W2Sunny Acres
Block 4
Lot 9&8W2
#006-121-66
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP161356 PID Number: 006-121-66
Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade
Name.
William Brickwell
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ® Bed ❑ Mound
Address
8023 E 11th Court, Anchorage, AK 99502
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
0.7 GPD/SF
4 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3.5 Ft.
Gravel depth beneath pipe
1 0.5 Ft.
Subdivision Block Lot
Sunny Acres y 9 & 8 W2
Fill added above original grade
Varies -0.15' to 0.11 Ft.
Gravel length
1 43 Ft.
Township Range Section
Gravel width
20 FL
Beds: Number of Lines
4
Distance between lines
5 Fl.
SEPARATION DISTANCES
To
Septic Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank Field
Tank
Line
860 Ft'
--
-- Ft.
Well
NA
NA
NA
NA
NA
TANK ® Septic ® S T E P ❑ Holding El Other
Manufacturer
ANCHORAGE TANK
Capacity
1 1500 Gal.
Surfacewater
100'+
100'+
100'+
NA
Material
STEEL
Number of compartments
2
Lot Line
5'+
10'+
5'+
NA
NA
Foundation
51+
10'+
5'+
NA
LIFT STATION
Manufacturer
Anchorage Tank
Capacity
1500 Gal.
I
Curtain Drain
NA
*50'+
NA
NA
Remarks 'None known. Existing field decomm.
Pump on level at
44 in.
Pump off level at
42 in
High water alarm at
48 in
per code. Soils encountered at construction
permitted raising total depth to 4' with MOA
Inspection and approval.
Pump make and model
Franklin 2445040117 — 1/2HP
Electrical Inspections performed by
MOA
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
Installer Mike Anderson
_
Drainfield 3034 CO/MT 3034
Inspector ARCTERRA
BENCHMARK (Assumed elevation) 100 ft
Inspection
1" 3/10/17
Location and description
2w3/11/17
3" 3/10/17 4" 3/11/17
Garage Slab
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engin
-1116-a�
AwlOh' ALS
Conditional Approval: Date
S�
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KEV6ET H M. F'UH
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Approved Date 2-017
V ° Pyo. TO AV
—
eer's Stamp
Inspection Report_9-1-12. doc
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nA-C=8,5'
rB-C=33.0'
YA-D=15.5'
T
-B-D=33.0'
,A -F=64.0'
NEB -F=37.5'
AS—BUILT SYSTEM DETAILS/SITE PLAN Permit OSP161356
SUNNY ACRES L9 & W 1/2 L8 BLK 4 PID# 006-121-66
N89'57'10"E 74.97' (75.00' R)
x LOT 9 �/2
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$ STEP
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8023 E 11TH COURT
ANCHORAGE, AK 99502
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8023 E 11TH COURT
ANCHORAGE, AK 99502
FIELD BOOKS
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On -Site Wastewater Disposal System Permit
Permit Number: OSP161356
Tax Code Number: 00612166000
Work Type: Septic Upgrade
Permit Effective Dates: January 04, 2017 to January 04, 2018
Design Engineer: ARC TERRA CONSULTING INC
Subdivision: SUNNYACRES
Site Legal Address: SUNNY ACRES BLK 4 LT 9 & 8 W2 G:1341
Owner/Address: TETNOWSKI LINDA E
6917 CRAWFORD ST ANCHORAGE AK 995022728
Site Mailing Address: 8023 E 11TH CT, Anchorage
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank
Lot Size in Sq Ft: 10500
Total Bedrooms: 4
N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By
�lttcnr
MUNICIPALITY OF ANCHORAGE
`
Development Services Department
On -Site Water & Wastewater ProgramLILJE
"
4700 Elmore Road, PO Box 196650
Ucparnncn[
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Work Type: Septic Upgrade
Permit Effective Dates: January 04, 2017 to January 04, 2018
Design Engineer: ARC TERRA CONSULTING INC
Subdivision: SUNNYACRES
Site Legal Address: SUNNY ACRES BLK 4 LT 9 & 8 W2 G:1341
Owner/Address: TETNOWSKI LINDA E
6917 CRAWFORD ST ANCHORAGE AK 995022728
Site Mailing Address: 8023 E 11TH CT, Anchorage
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank
Lot Size in Sq Ft: 10500
Total Bedrooms: 4
N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By
MunicipaRitty of Anchorage h,
Development Services Division
On -Site Water and Wastewater Program
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV161155 COSA#: Permit#:OSP161536
PID#: 006-121-66
Legal Description: Sunny Acres Block 4 Lot 9 & 8W2
Engineer: ArcTerra
Applicant: William Brickwell
Your request for a waiver of the maximum 15 feet bed width has been approved. The approved
width is 20.0 feet. In addition, your request for a waiver of the required 5 feet horizontal
separation from the test hole to the absorption field has been approved. The approved separation
distance is 0 feet. See engineer's waiver request.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all code requirements be met or another approval
from this department.
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
...............................................................................
Waiver is Granted: X Waiver is not Granted:
Date: 0t 0 7 Approved by: hIlle4oA
Name of Reviewer
............................................................................
**** VARIANCE/WAIVER REVIEW ****
MUNICIPALITY OF
Community Development Department
Development Services Division 6
On -Site Water & Wastewater Program
/' •areTITTATM
Phone -907-343-7904
Fax 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 006-121-66
Property owner(s) WILLIAM BRICKWELL (PARTNERSHIP) Day phone
Mailing address 11425 AVION STREET, ANCHORAGE, AK 99516
6.011 M6191'SI
Site address 8023 E 11TH COURT, ANCHORAGE, AK
Legal description (Sub'd., Block & Lot) SUNNY ACRES BLOCK 4, LOT 9 & 8W2
Legal description (Township, Range & Section)
Lot Size 10500 So. Ft. Number of Bedrooms
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field Initial ❑
Single Family (SF) [
Septic Tank [kj Upgrade MDuplex
(w/wo ADU)
(D) F-1Holding
Tank F-1Renewal ❑
Multiple Dwellings ❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
_Eb w�a TD 2v ` /Teo ) ole j o be�
Distance: l�6
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of pro> jyqW�n6 r or authorized agent)
Permit/Rush Fees: k.5-
Date of Payment: t-2 12121 / (0
Receipt Number: 6o?&(J,0
Permit No. 0`JiQIW5_3(o
Permit App_9-1-12.doc
Waiver Fees: "R1
Date of Payment: Qan-Mto
Receipt Number: J 0760
Waiver No. 05yt(01155
RcTE,�
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CONSLJI,I'ING, INC,
212 E. 5l"Ave, Anchorage, AK. 99503
Office (907) 868-3791, Fax (907) 868-3793
December 19, 2016
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Upgrade Sewer Permit — Sunny Acres Block 4, Lot 9 & 8W2
The owner has requested we proceed forward to obtain a septic permit to
upgrade the septic system of the subject lot. Due to required design and subject
lot's characteristics, we are requesting a waiver to increase the width of the
proposed absorption bed from the standard 15' wide to 20' wide. The contractor
will not use heavy equipment over the absorption bed during construction.
Also, due to the lot's restraints the proposed system may encroach the existing
septic system. Therefore, any contaminated soils encountered will be removed
and replaced with MOA sand.
The general slope of this lot is flat over the septic area. On December 8, 2016 a
testhole was performed to investigate soils and groundwater. The results of this
test are attached for your review. The proposed upgrade will serve the existing 4 -
bedroom residence. We propose to install a pressurized bed. Groundwater was
encountered at 13' during excavation and at 11' at monitoring.
The property and adjacent lots are served by public water. There is no surface
water within 100' of the proposed system and there are no known curtain drains
within 50'. We do not expect there to be any adverse effect on adjacent lots by the
development of this system. If you have any questions, please contact me at 868-
3791 / FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
enneth Du s, P.E.
Attachments: On -Site Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/ Percolation Test
20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793
RCTE RR
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CO NSUI'll,ING. INC
p r 212 E. 51" Ave, Anchorage, AK. 99503
p Office (907) 868-3791, Fax (907) 868-3793
December 23, 2016
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Upgrade Sewer Permit — Sunny Acres Block 4, Lot 9 & 8W2
Due to the required design dictated by the subject lot's characteristics, we are
additionally requesting a separation waiver from testhole to the proposed
absorption bed. With the design, we have attempted to stay away as much as
possible from the existing system and due to the small lot, and area the proposed
bed will be over the testhole area. This placement will be mitigated as much as
possible with compaction of insitu soils of the testhole a ad he�ln_ __w _fhr propcxsed
bczd to prevent potential settling.
The 300 sf reserve area (10' x 30') as shown on the design is a CAT III system
with an application rate of 2 gal/day/sf. Either this or rebuilding the proposed
bed could be used as a potential reserve field.
We do not expect there to be any adverse effect on adjacent lots by the
development of this system. If you have any questions, please contact me at 868-
3791 / FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
« �,.I .Application
�.
Wastewater Absorption System Details/Site Plan
Soils Log/ Percolation Test
20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577.8736 • PH (907) 868-3791 • FAX (907) 868-3793
WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLAN
SUNNY ACRES BLOCK 4, LOT 9 & 8W2
ALLEY 50.00' N89' 57' 10'E o
MT
NEW BED
DECOMMISSION EXISTING
SEPTIC SYSTEM PER CODE
TH16-1
P `°V
MT FLAT 10"
CAT III
2GPD/SF
1.25" PVC
RE RVE
ALT. SYST.
10' X 30'
INSTALL NEW
M
RESERVE
1500 -GAL
C
130
3
STEP
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^ LOT 8
EXISTING
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a SEPTIC
50.00' N89' 57'
IO'E
EAST 11th COURT
FLAG PROPERTY LINES
Scale; 1'= 50'
AREA SERVED BY
& EASEMENTS PRIOR
PAGE 1 OF 3
PUBLIC WATER
TO C❑NSTRUCTI❑N
DESIGN DETAILS
4 BDRM X 150 GPD = 600 GPD
600 GPD/0,7 GPD PER SQ, FT. (1' SAND FOR SEPARATION) = 858 SQ.
FT
(858 / 20' W x (0,5' GRAVEL) = 43 FT. BED
USE 1 BED - 43' (L) X 20' <W) X 0.5' (ED)
Total depth of system Is 5' from original grade.
INSTALL V MOA APPROVED SAND AT 5-6' FROM GRADE PRIOR TO ADDING SEWER ROCK
ANY EXISTING SEPTIC FIELD / BIO -MATTED MATERIAL ENCOUNTERED
WILL BE REMOVED AND REPLACED WITH MOA SAND.
NO PUBLIC WELLS WITHIN 200' OF
c�
PROPOSED SYSTEM. NOTES;
NO PRIVATE WELLS WITHIN 200' OF
PROPOSED SYSTEM EXCEPT AS NOTED. 1, INSTALL 1500 GAL STEP & INSULATE TANK IF
<4' COVER.
NO SEPTIC 200' OF
PROPOSED WELLEMS EXCEPT WITHIN AS NOTED 2. INSULATE BED WITH 2' HD BURIAL FOAM IF <
3' OF FILL,
MIN. 2' FILL WITH INSULATION, )3' COVER NO
INSUL REQ.
3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE
INT❑ SEPTIC TANK.
4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO
ADJACENT
WELLS, SEPTICS EASEMENTS, PROPERTY LINES,
ETC...
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PREPARED FOR;
WILLIAM BRICKWELL
11425 AVION STREET
ANCHORAGE, AK 99516
FlELD BOOKS
BOUNDARY: BOUN[
STAMING STAKIP
AMU;LT: REJ
Acw BIE: FILE
COMPUTED:
DRAM: BMW
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DAM 12/19/"
MD. SW1341
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WASTEWATER DISP❑SAL SYSTEM DETAILS
SUNNY ACRES BLOCK 4, LOT 9 & 8W2
DECOMMISSION
SEPTIC SYSTEM
ALLEY 50.00'
EXISTING r
PER CODE
N89° 57' 10'E
0
T I -NEW BED
TH16-1
1.25" PVC
snnn' NR9°
/ MT
FLAT 10'Y
SYSTEM HOLE
CAT III
2GPD/SF
10' X 30'
RES RVE
ALT. SYST.
INSTALL NEW
12/19/16
MH 8
2.
HOLE SIZE = 3/16' = 1.00
GAL. PER HOLE @ 30
RESERVE
1500—GALCO
30 GALS (PUMP DELIVERY)/1.00 GALS✓HOLE = 30 HOLES
.
152 LF LATERAL/30 HOLES
13.0'
o
5.
STEP
3
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INSTALL FCO
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PREPARED FOR:
WILLIAM BRICKWELL
11425 AVION STREET
ANCHORAGE, AK 99516
snnn' NR9°
57' 1n'F
PRESSURIZED DISTRIBUTI❑N
SYSTEM HOLE
SPACING DESIGN
1.
RESIDUAL HEAD = 5'
12/19/16
DK. Flu=: GRID:
2.
HOLE SIZE = 3/16' = 1.00
GAL. PER HOLE @ 30
PSI
3.
30 GALS (PUMP DELIVERY)/1.00 GALS✓HOLE = 30 HOLES
4.
152 LF LATERAL/30 HOLES
= 5.0' SPACING PER
HOLE
5.
ALL HOLES SHALL HAVE CAPS INSTALLED PER MANUFACTURES SPECS.
/
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$ 1 zits/ c �' A i
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PREPARED FOR:
WILLIAM BRICKWELL
11425 AVION STREET
ANCHORAGE, AK 99516
FIELD BOOKS C pum:
BWNDAAY: BOUNDARY DRAM:
BMW
GTMING: STAKING CHECKED:
KMD
ASWILT: REJ DATE:
12/19/16
DK. Flu=: GRID:
SW1341
ACA° EIDE: FILE •10B N..:
16-254
Scalel 1'= 30'
PAGE 2 OF 3
C w
MIN. 5'.
WASTEWATER ABS❑RPTI❑N SYSTEM DESIGN DETAILS
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SUNNY ACRES BLOCK 4, LOT 9 & BW2
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FINISHED GRADE (ADD UNCLASSIFIED FILL)
SEWER ROCK
1500 GAL MIN. 1,0' SAND. FlL:T
S.T.E.P,
Lift Station
MIN. 5' I 43' BED
2.5'(typ)— \
1 1/4' PVC FROM TANK TO FIEL
1 1/4' PVC FOR MANIFOLD
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PREPARED FOR:
WILLIAM BRICKWELL
11425 AVION STREET
ANCHORAGE, AK 99516
FIELD BOOKS
BCINDARY: BOUNI
STAKING STAKIP
ASBUILT: REJ
DNC. FILE:
ACD FILE FILE
43'
COMPUTED:
DRANK:
BMW
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12/19/16
MID:
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16-254
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PAGE 3 OF 3
�RcTE�Rq F
a ARC 1 I:RR:1
coNi suL,rING, INC
212 E. 51" Ave, Anchorage, AK. 99503
Office (907) 868-3791, Fax (907) 868-3793
SOILS PERCOLATION TEST
Performed for: Bill Brickwell Date Performed: 12/08/2016
arae
e 0[' 114,
�C All
KEX ETH IUS
x 104
Projcce Sunny Acres Block 4, Lot 9 & 8W2 TEST HOLE # TH 16.1
Depth
Org/OL-ML
SP/GP/gm-sm mod dense, trace of
silt, w/ cobbles
Groundwater
14-.....'_._.` B.O.H.
15-
16-
17-
18-
19 -
HOLE PRESOAKED
20- PRIOR TO TEST
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
Was Ground water encountered? YES What depth? 13'
Depth to water after monitoring? 11' Date? 12/16/16
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
1
12/8/16
1:00
6"
-
2
1:10
10 min
6/16"
5 10/16"
3
*
1:11
-
6'
-
4
1:21
10 min
8/16"
5 8/16"
5
*
1:22
-
6"
-
6
1:32
10 min
8/16"
5 8/16"
7
*
1:33
6"
-
8
1:43
10 min
10/16"
5 6/16"
9
1:44
6
-
10
1:54
10 mill
9/16'
57/16.,
11
*
1:55
-
6"
-
12
2:05
10 min
8/16'
58/16"
*
Water
Added
Percolation Rate 1.8 (min/in) Pere Hole Diameter 6"
Test Run Between 6 feet and 7 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State
and Municipal guidelines in effect on this date.
Municipality ®f Anchorage a� �
/ Department of Health and Human Services l�lll L5
825 "L" Street
Tom Fink,
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
January 10, 1991
Linda Tetnowski
8023 East 11 Court
Anchorage, Alaska 99504
Subject: Lot 9 Block 4 Sunny Acres Subdivision
Permit #900072, PID #006-121-57
The subject permit, issued by this office for a single family
well and/or on-site wastewater system has expired as of December
31, 1990.
A new permit must be obtained from this office for a well and/or
on-site wastewater system not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this office for documentation of the installation and to close
the permit.
If a private engineer inspected the installation of the on-site
wastewater system, the original as -built inspection report
(three-part form) must be sent to this office for review,
approval and documentation. All inspection reports must be
submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $90.00 for an
on-site wastewater permit; $50.00 for a well permit; $140.00 for
a combined on-site wastewater and well permit.
If you have any questi
Since el
JohSmith, E.
Pro ram Ma ager
On-site Services
JW/ljm:200
enc: Copy of Permit
, please call this office at 343-4744.
"Kids Are Our Future"
�
DWELLING ONLY AND EXPIRES ON 12/31/7()
I CERTIFY [HAT:
1, I am familiar with the requirements for on-site sewprs and wells as SK,
forth by the Municipality of Anchorage (MOA) and the State of Alaska"
2, T will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot"
4. I understand that this permit is valid for a maximum of 4 bedrooms. l
also understand that the capacity of the total system is 4 bedrooms and
any enlargement will require an additional permit`
Signed:
�
(Owner> LTNDH I SK
issued By: DATE:
,
MUN1L]PA[IT� OF ANCHDRA9F
Department of Health & Human Services
825 L Street, Anchorage, Alaska 99501 343-41QO
ON - SITE SEPTIC TANK PERMIT
�uu �
Permit Numbers
900072 UpgradeC
Date lssued:
04/17/9O Engineer Designed
Owner Nape:
LINDA TETNOWSKI Day
Phone:
Owner Address:
8023 E. 11 CRT' 277-1776
ANCHORAGE, AK 99504
Parcel Id:
006-121~57
Lot Legal:
Subdivision: SUNNY ACRES Lot: 9 Block: 4
Section: 13 Township: 14N Range: 3W
Lot Size
7000 (sq.ft` or acres)
Max Bedrooms:
This Permit: 4 Total Capacity: 4
SEPTIC TANK: Minimum
total septic tank capacity: 1,250 gallons,
Each septic
tank must have
at least 2 compartments. Depth to top of septic
tank(s) < 4,0
feet requires
insulation over tank(s).,
INSTALL PER ENGINEERS
PLAN" NOTIFY DHH3 PRIOR TO INSPECTION.
141I11 PERMIT IS
ISSUED FOR THE EXISTING 4 BEDROOM SINGLE FAMILY
DWELLING ONLY AND EXPIRES ON 12/31/7()
I CERTIFY [HAT:
1, I am familiar with the requirements for on-site sewprs and wells as SK,
forth by the Municipality of Anchorage (MOA) and the State of Alaska"
2, T will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot"
4. I understand that this permit is valid for a maximum of 4 bedrooms. l
also understand that the capacity of the total system is 4 bedrooms and
any enlargement will require an additional permit`
Signed:
�
(Owner> LTNDH I SK
issued By: DATE:
WI S
4u
c.
v— _. __..
MA AR_ EARN wQ - THIS IIR,AW IN615,Foi�THE
Cf
67
ROFESS ONPO- tANKAONTHETI oT.A coy..ApseDAV_
RRAwt� 3V O'�OCKyER c9b-IlOoi_wirWQ,
E 1
--OUflL'
t i j
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
NAM`E—�)
JPHqNEElNEW
F,
PGRADE
MAILING
ADDRESS
LEGAL DESCR[Pzz]ON ��----
LOCATION
NO. OF BEDROOMS
Y
DISTANCE TO:
C Well(
'�' 1
Absorption area
Dwelling
PERMIT NO.
OL)
aQ
w P-
Manufacturer )
Material
No. of compartments
rn
Lie. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
JD'Z
DISTANCE TO:
Well
Dwelling
PERMIT NO.
Oz F
Manufacturer
Material
Liquid capacity in gallons
a
w=
DISTANCE TO:
Well .6—
Foundation �__
Nearest lot line
�� f
PERMIT NO.
6 �Cl --ein
� u Z
Z w
F —
No. of lines '%
�i
Len ihof ch .lint;
`j _ /t, 'j
Total length of lines
�) ��
Trench widt
�Q inches
Distance bet can lines
� F
p
Top of the to finish grade _
6
Material beneath the
,}'{ inches
Total effective dbsorption area
w
Length
WidtfT
Depth i
PERMIT NO.
QH
wa
Type of crib
Crib diameter
Crib depth
Total effective absorption area
y
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
w
DISTANCE TO:
Building foundation
Sewer line
Septictank
Absorption area(s)
OTHER
PIPE MATERI�/$
SOI L TEST RATING _
i
N
INSTALLER 0/
REMARKS
1
ROVED DATE LEGAL
72-013 (Rev. 3/78) `---�
rl t -J 04 1. ED 1, F=° t=F I_. I 'F' ky" CA F= 1=1 AA ED v" &D F' F :l ®_3 EE ((i ' 3 D
DEPARTMENT ` HEALTH AND ENVIRONMENTAL ROTECTIOf
825 40 STREET, ANCHORAGE, AK. 9160j-
264-4720
1"000-40 1 -T-E7 _n E= A 0 Fx! F=" F=, fvl r
PERMIT NO. 810200 )�
Choy&/ �iscA 4L
APPLICANT DA'V'E TETNOWSKI 8023 EAST 11TH. 337-3267
LOCATION 8023 EAST" iiTH.
LEGAL. t_ _a & W2 L r B4 SUNNY ARES LOT SIZE 8250 SQUARE FEET
TYPE OF SOIL ABSOR:P'TION SYSTEM IS: DR:AINFIELD
MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SO FT/BR)= 125
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
F=_• F== F=" "� F -F
to. 1 + L.00014(37-41== 53E3 % Fes? FA Q? E F__. FWD F0 F=° -FF A == J1.
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEE A
THE GRAVEL DEPTH IS THE MINIMUM DEPTH L �F GRAVEL. BF_ _ a__ _ _ _ .. 'IPE
AND THE BOTTOM OF THE EXCAVATION 0N FEET). A
F= F=" -r- x n_- -e F A VA F• : AL iNTS50 C3 Fl F._ L_. CA rA a„
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTICitN'; OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RES,IDEPNC:E'S THAT THE WELL WILL SERVE.
-- -- -- 'T -F -°-F CA
< -°--„_ `" FA F-"•'-' E0
FT E E &_ ®/.J l F ^: F= F_=8 -- — --
BACKFILLING OF
ANY
SYSTEM WITHOUT FINAL INSPECTION AND
APPROVAL. BY THIS
DEPARTMENT WILL
BE
SUBJECT TO PROSECUTIOPN.
MIPNIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM Is
100 FEET FOR A PRIVATE WELL OR 150 TO „`Y_00 FEET FROM A PUBLIC: WELL DEPENDING
UPON THE TYPE OF PUBLIC: WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LIPNE I- 25 FEET AND
TO A COMMUNITY SEWER: LINE IS 75 FEET. '
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE: TO INSURE PROPER IPN_,TAL.LATIOtN.
F-° F0" F-.° fwl l -T 0 .mow F=° 1 F=' E: F_=• F= C3 E - F l F3 F_. E - L , "", E3 A.
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
I UNDERSTAND THAT THE ON-SITE SEWER: SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN BEDROOMS.
_, I GNED :-.�W_!t" -_/ a �a,-r � &I_k -------------------
APPL.ICRP,PTA DAVE TETNOWSKI
ISSUED BY -1 _T=iM V4. 0
SOILS LOG
MUNIC )TY OF ANCHORAGE
'MUNICIPALITY OF ANCHORAENGEoOF HEALTH a
t DEPARTMENT OF HEALTH AND ENVIRONMENTA'N9k f&ibN',_Ci 1dl1 PERCOLATION
TEST
Pouch 8.8 W. Anehe aye. Aloka 9980Q 276232
I R 2 i MM
SOILS LOG — PERCOLATION TEST
RECcIjr.j)
PERFORMED FOR: David Tetnowski DATE PERFORMED: April 15, 1981
LEGAL DESCRIPTION: Lot 8 (W),) and Lot 9, Block 4, Sunny Acres Subdivision
Organic surface and organic silt
frozen.
1 fn4 ni
2
(SM)
3 Silt, brown to gray, frozen,
•op.C; with some fine sands and gravels
'po.'o ML
4 "� ° Sandy -gravel, brown,top frozen,
moist,slightly compact, well-
s graded, rounded gravels.
(SW -GW)
•''•�' % Silt, gray, very moist, soft to
stiff, with some fine sand.
7 ,'t ML
Gravelly -sand, brown, very
8 .o o ' moist, compact, well -graded.
9 °•0 o Silt, gray, same as layer above.
°
o•o•o ML
10—.C� Sandy -gravel, brown,
tt moist to wet, Com- NAS GROUNDWATER Yes
pact, little to no ENCOUNTEREDi
fines, rounded gravels,
t2 few cobbles and
IF VES, AT WHAT 10Zi
13 boulders. DEPTH?
(SW -GW)
14
15
16
17
18
19
20
S ` I � I -Y 5'
L I
P -
Reading
MMENNENEE
Gros
Time
Not
Time
ENNEMN
Net
Drop
ME
EMENEEZINN
EIREEMEMN
KEN=
—
S ` I � I -Y 5'
L I
P -
Reading
Date
Gros
Time
Not
Time
Depth to
water
Net
Drop
PERCOLATION
TEST RUN BETWEEN
COMMENTS Suggest over -excavation to the lower sandy -
gravel layer and backfill with a poorly graded sand.
PERFORMED BY. Howard Grey & Associates, Inc CERTIFIEOBV:
• .
Richard A. Lowman ¢
j•'s� NO. 4077.E
April 17, 1981
GRE; 'ER ANCHORAGE AREA BO'" UGH
Department of Environmental Quality
MY
3330 C Street
Anchorage, Alaska 99503
�'-j�'- `
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAM E�TOVtA+'' HSS r/1 0\ 19 Pl/ MAILING ADDRESS �O Z -3 �, %� �^� >PHONE3�3__�S/ '40
NAM
LEGAL DESCRIPTION 10 �>LJ ,9i,�,b
SEPTIC TANK:
DISTANCE NUMBER OF
FROM WELL �rJ MANUFACTURER, S%MATERIAL 5�&_Z COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY �'�-S C' GALLONS.
SEEPAGE PIT: 0/S///'_y
NUMBER OF PITS DIAMETER OR WIDTH_, LENGTH_, DEPTH .
LINING MATERIAL CRIB SIZE: DIAMETER—DEPTH— DISTANCE FROM: WELL .
TOTAL EFFECTIVE
BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE
BUILDING
FOUNDATION
CONSTRUCTION
NEAREST
LOT LINE
CESSPOOL _ OTHER SOURCES
OVED
DISTANCES:
j INSTALLED BY: Ull-VIOle
�XCyNf j1j is �1
PIPE MATERIAL:
LOT SLOPE:
REMARKS: �'_S J Ac- Jf)/aL
sU6 1`aJ i�c �xiS�i
Form No. EQ -031
NEAREST
SEWER LINE
REMA
DEPTH _
SEPTIC
TANK_
DIAGRAM OF SYSTEM
DATE
DISTANCE FROM:
SEEPAGE
SYSTEM .
`17�
ell
L \ �
�r
APPROVED '
G.A.A.B.
ura�r�rsa-r•��c�en
INSTALLATION LOCATION
LEGAL DESCRIPTION
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT. OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SOIL TEST RESULTS
IN ADDRESS �'� '1
4 synny z -a
/�/'t DRAIN FIELD
PERMIT NO
OTHER
Z
TO BE INSTALLED BY /�/ �� e�- g:�A- r'G o 4��
NOTES THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE / 17-6-0 — TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK i
FOUNDATION TO SEEPAGE PIT , DRAIN FIELD
AREA SIZE
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK .
SEEPAGE
PIT DRAIN FIELD
NEAREST
�O�TtINE.
e/fTO
SO /
N✓ELL TO SEPTIC TANK
SEEPAGE PIT
DRAIN FIELD
ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK
SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK, .
SEEPAGE
PIT DO DRAIN FIELD ,
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH RE CATIONS REGARDING INSTALLATION.
A.A.R.
OR
LICENSED DESIGNER
TYPE
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2868 AND THAT THE ABOVE
DESCRIBE SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE �� APPLICANT'S SIGNATURE � � `ti✓wtiN��
U
F NO 016
WILLIAMA EGAN, GOVERNOR
DEPT. OF ENVIRONMENTAL CONSERVATION
SOUTRCENTRAL REGIONAL OEE1Cf3380ENA11STREET
July 3, 1973. MACKAYRU1Lb1NG-ROOM850
ANCRORAGE99501
RECEIVED
Mr. Harry HartungJULpb
JUL 5 1913 p
y
Dickinson-0swald Partners GREATER gNCHORAGE AREA BOROUG
P. �. Box 326 DEPT, eF ENVIR9NMENigL gU
kOUG
Anchorage, Alaska 99501
SUBJECT: 1973 Sewer Extension --Sunny :Acres Subdivision -Alley Block 2
Dear Mr. Hartung:
The plans and specifications for this sewer extension which
consists of approximately 160 Ft. of 8 In. AC Sewer Pipe are approved
for the features with which this department is concerned.
Yours truly,
Kyle � Ch@� ry o
Regional Environmental Engineer
cc: GARB -DEQ
July 3, 1973
Harry R. Hartung
oickinsoo, Oswald & Partners
wo Coraova Street
Anchorage, Alaska J:rJ'J
Subject: Sunny Acres Subdivision, 1973 Saaer Extension
near Vir. Hartung.
Too Greater Anchorage Area borough Department of Environwental
Quality has received and reviewed the engineering plans s=-
ing too proposed seller line extensl0n. (hese plans meet with
all con:iitions with wOich this Department is concerned.
Should you have any questions regarding our review of these
plans, please contact the undersigned.
Sincerely,
Rolf Strickland, R.S.
chief Sanitarian
mld
a GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
Date Received
' G
dK 1C� Time of Inspection
` Date of Inspection �f—Q L--
REQUEST FOR APPROVAL OF
INDIVIDUAL SEINER & WATER FACILITIES
FOR
1. Approval Requested By:
Address:
2. Pronerty Owner:
3. Legal Descripti
Phone:
4. Location: �'G 2? 3 L L {G,
5. Type of Facility to be Inspected:
Number of Bedrooms:
6, Well Data: �l .
A. Type B. Depth
C. Construction /; ( c«1 v D. Bacterial Analysis
7, Sewage Disoosal System:
A. Installed _ B. Installer -)a
i
C. Septic Tank: 1. Size 2. Manufacturer
D. Seepage Pit: V 12'�%iae 2. Material
E. Disposal Field: Total Length of Lines
9. Distances:
A. Well To: Septic Tank Absorption Area , Sewer Lines
Nearest Lot Line Other Contamination
B. Foundation to Septic Tank , Ab'sorption Area
C. Absorption Area to Nearest Lot Line
Rerpiect for Approval of Ividual Sewer & water Facilities,
page Two
9. Comments:
Approved Disapproved
Approval Valid for One Year From Date Signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval to be a true
and accurate representation of the subiect sewer and water facilities located at: /
06-1220 (a)
Well ❑ Dug. 0 D
SOURCE: - ❑ .Spring ❑ C -
Dug Well orCietem Coustmctlon:
Walla ❑ Wood ❑ Concrete
Tap - ❑ '.Vood ❑ Concrete
LOCATION: ❑ E. Basement n
❑ In Yard ❑ OB
Building Sewer
DISTANCE TO: or Other Drainage Pipe—�
Tile - S..Puge.
Field---FceGPit - -
011ier Poxvble-. -
- SouiresofContaminaliov
MATERIAL: Building Sewer • - ❑.. Cast
Iron
C. Plostic feint -Material- Type
GENERAL:.Does Water Become Muddy of
Diameturof Well- _
Well Casing - - -
Material-.
Leagth-
...
Drop Pipe
..
PUMP: LOCATION:.. ❑:.In Well
' On To f
-
of Well-❑:Olh.
PURPOSE -OF EXAMINATION: Muss $
'N.WSoumoo[Supply4 (3 Yen
READiHsrRU
ON
I
REVERSE Slot
1 0I
- PUBLIC. El - SEMI-PUBLIC F1
'REF
'I
NAME
- ADDRESS
CITY
ADDRESS -
OF SOURCE
SAMPLE. COLLECTED BY
DATE COLLECTED -
- Sample Collected From 0: KUchen To,
1] OtheraW) - -
Well ❑ Dug. 0 D
SOURCE: - ❑ .Spring ❑ C -
Dug Well orCietem Coustmctlon:
Walla ❑ Wood ❑ Concrete
Tap - ❑ '.Vood ❑ Concrete
LOCATION: ❑ E. Basement n
❑ In Yard ❑ OB
Building Sewer
DISTANCE TO: or Other Drainage Pipe—�
Tile - S..Puge.
Field---FceGPit - -
011ier Poxvble-. -
- SouiresofContaminaliov
MATERIAL: Building Sewer • - ❑.. Cast
Iron
C. Plostic feint -Material- Type
GENERAL:.Does Water Become Muddy of
Diameturof Well- _
Well Casing - - -
Material-.
Leagth-
...
Drop Pipe
..
PUMP: LOCATION:.. ❑:.In Well
' On To f
-
of Well-❑:Olh.
PURPOSE -OF EXAMINATION: Muss $
'N.WSoumoo[Supply4 (3 Yen
READiHsrRU
ON
I
REVERSE Slot
1 0I
March 20 1973
Cir. John ncCauley
3023 East llth Avenue
Anchorage, Alaska 99501
Subject: Sower and Water Facilities Serving West 1/2
of Lot 3, 9, dock. , Sunny Acres Subdivision
Joar air. McCauley:
Upon ;;our requost, an inspection of the above was made
on March 2 1 , 1973. The following ?las noted; The well
is located in a pi.t twelve (12) foot deep, approximately
23 fcot Southeast of thn dwelling. Presently, standing
water exists in the ".Sit: arounC 'Lho casing and adjaccat
Pressure tank.
3N subject well would be approvad by this Department,
the casing must ba extended approxima Nly 1';. inchns above
thQ existing ground level and tho pit filled with semi -
impervious
impervious soil. Tits s£; ago system Consists of a COSSp00l
only.
For "Lit': Borough approval can •it' made,made,1;:,.t.,•:1 i dl l+JII septic
C
tank must be stubbec in betue n Ahe dwelling and the exist-
ing pit. An installation permit must he obtained from this
office before installation occurs. Duo to the season, this
Department will give temporary approval on the existing
sewage system pending the escrow of funds for the needed
improvement. Howuvev. due to the existing water in the well
pit, we can not rive the same approval to the well.
If you have any question, please contact this officer
Sincerely,
Tiro Rumfe:lt, R. S.
Sanitarian
k
Enclosure
April 30, 1973
Mr. John McCauley
9023 East 11 Street
Anchorage, Alaska 99504
Subject Water
and
aSWblock4, Sunny
Sewer
Lots3nd9Acres Subdivision
war Ar. McCauley:
on March 23, 1973, I sent a letter to you stating what must
be done to the well and the sewage system in order to get
this department's approval on the same.
On April 3o, 1973, I inspected the well and found it to be
of approved construction; therefore, all that remains for
you to do is to install a 1,250 gallon septic tank between
the dwelling and existing cesspool. An installation permit
must be obtained from thisill give temporary app department before construction
ltonn
occurs. This department w
the existing sewer system pending the escrow of funds needed
for the above installation. This installation must take
place on or before August 1, 1473.
If you have any questions, please contact me at 274-4561
Sincerely,
timothy L. Rumfelt, A.S.
Sanitarian
• Municipality of Anchorage ° PGt
On -Site Water and Wastewater Program -1
(907) 343-7904 R s .
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 006-121-66
1. GENERAL INFORMATION
Expiration Date: ,�) -24
Complete legal description SUNNY ACRES BLOCK 4 LOT 9 & 8W2
Location (site address) 8023 E 11TH COURT ANCHORAGE AK 99502
Current Property owner(s) WILLIAM & LYNETTE BRICKWELL Day phone
Mailing address
Real Estate Agent
11425 AVION STREET, ANCHORAGE, AK 99516
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class _ Well
Public Water System
Waiver/Variance request for:
Received by:
COSA to be released to the engineer,
Day phone
4
Receipt Number
TYPE OF WASTEWATER DISPOSAL:
O56
Individual
Waiver#
❑
Holding Tank
❑
❑
Community
❑
❑
Public Sewer
❑
requested by the engineer.
Date: S10? 3
COSA Fee $ Waiver Fee $
Date of Payment _/8/r� Date of Payment
Receipt Number
Receipt Number
COSA#
O56
Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
ul
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.
Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 4/28/2017
VVI I N I Nib CubA Ant NAIU IN FULL AT OR BEFORE CLOSING. Engineers Comments: This investigation was completed in compliance with
ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested.
The flow and absorption rales may change due to subsurface conditions that may not be observed from the surface, changes inland use,
local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the
system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function
satisfactory for current or future occupants or can ArcTerra guarantee that no unseen ���\
encroachments, deficiencies or discrepancies exist. �- nP A r\
DSD SIGNATURE
System #1 Approved for bedrooms.
System #2 Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms,
I�NNh�'7Ff M. D`41^'S C ,�`00
1 ,Fq,,
\VOP f85510`+1h"'
V% `�
with the following stipulations:
,;t-r)\r(':r-,
By_t��`%�-r' _ Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Onsite 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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 101 12.dm
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: SUNNY ACRES BLOCK 4 LOT 9 & 8W2 Parcel ID -006-121.66
A. WELL DATA - PUBLIC WATER
Well type
Date completed --
Total depth ft.
Date of test
Static water level
Well production
If A, B, or C provide PWSID #
Sanitary seal (Y/N) Y
Cased to ft.
FROM WELL LOG
WATER SAMPLE RESULTS:
ft.
_ g.p.m.
Coliform colonies/100 mL Nitrate mg/L
Arsenic: ug/L Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEP I STEEL
Tank size 1500 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
Date of pumping NA- NEW TANK Pumper
C. ABSORPTION FIELD DATA
Date installed 311112017 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.7
Length 43 ft. Width 20 ft.
Total depth 4.11 ft. (Measured 4rz7117) Eft. absorption area 860 ft2
Date of adequacy test NA - NEW FIELD Results (Pass/Fail)
Fluid depth in absorption field before test in. Water ad
Elapsed Time: _ min. Final fluid depth in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
ft.
�d7aYl
Collected by:
Date installed 3/1012017
Cleanouts (Y/N) Y
High water alarm (Y/N) Y
System type BED
Gravel below pipe 0.5 ft.
Monitoring tube Y Depression over field N
For -5-1 bedrooms
ed gal. New depth in.
Absorption rate >= g.p.d.
If yes, give date
D. LIFT STATION
Date installed 311012017
"Pump on" level at 44 in.
Datum BOTTOM OF TANK__
Size in gallons 1500
"Pump off" level at 42 in.
Cycles tested 2
E. SEPARATION DISTANCES - PUBLIC WATER
WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line _ _
Animal containment areas
SEPTIC/HOLDING TANK ON LOT TO:
Manhole/Access (Y/N) Y
High water alarm level at 48 — in.
Meets alarm & circuit requirements? Y --
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
Building foundation 5'+ Property line 54 Absorption field 5'+
Water main 104 Water service line 104 Surface water 1004
Wells on adjacent lots 2004
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 10'+ _ Surface water 100'+ Driveway, parkingtvehicle storage 104
Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 200'+
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 date.
Engineer's Printed Name KENNETH M. DUFFUS
Date 4128117
COSA canary sheet_2b-15.doc
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SURVEY CERTIFICATE: 1, John L. Schuller. Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance should
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
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SUNNY ACRES SUBDIVISION
LOT 9& W 1/2 LOTS BLOCK 4 PLAT P-320
SURVEY CERTIFICATE: 1, John L. Schuller. Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance should
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
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