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Home My WebLink AboutT12N R3W SEC 22 LT 9 N2 LESS N75' Onsite File T12N R3W Section 22 Lot 9 N2 Less N75 ' #015 - 141 - 27 Municipality of Anchorage 8tiff ` "' On-Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT AUG 13201 at Permit Number: OSP171316 PID Number: 015-141-27 Dwelling: ❑■ Single Family (SF) ❑ Duplex(D) ❑ Multiple (SF and/or D) Project: ❑� New ❑ Upgrade Name: Alan J. & Patricia A. Czajkowski ABSORPTION FIELD Address ❑■ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 143 Nanook Circle Anchorage, AK 99504 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 0.45 GPD/SF 6.0-7.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 2.0 Ft. 5.0 Ft. N2 LESS N75' 9 Fill added above original grade Gravel length Township Range Section 2.5-3.1 Ft. 2 x 50 Ft. 12N 3W 22 Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES 3.0 Ft. Ft. To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches Tank Field Lift Station Tank Line z10+ From 1,000 Ft 2 Ft. Well >100' >100' N/A N/A >25' TANK g Septic ❑S.T.E.P. ❑Holding 0 Other Manufacturer Capacity Surface Water >100' >100' N/A N/A Anchorage Tank 1,000 Gal. Material Number of compartments Lot Line >5' >10' N/A N/A Steel 2 NA Foundation >10' >10' N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain None Noted Gal. Remarks Pump on level at Pump off level at High water alarm at in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank D3034Tank to D3034 Installer drainfield Sanders & Sanders Drainfield D3034 CO/MT D3034 Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspection ion 15' 4/18/18 2nd 4/18/18 Location and description 3id 4/19/18 4th Garage Slab COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Air,,c�oF'Iki‘‘‘iqll Conditional Approval: Date A '1•‘Z.:' ,•Q. • •S� JelV%*: 49TH /� ••• -.*0 rA rA '. Michael E.Anderson : 00114.• 4381-E •.�`�f Appro e• t.� ��E / _ Date Q"2-1-I i1i/pep PROFESStON��► Inspection Report_9-1-12.doc T12N R3W SEC22 N2 LESS N75' LOT 9 PERMIT # OSP171316 PID # 015-141-27 It --rt---- — — — — - O'MALLEY ROAD / ' ' 1 T12N R3W SEC 22 /' \ N 1/2 OF LOT 9 LESSA 7S I \\ 100'WELL RADIUS \ 0 \ Q \ •2x50'LO x 3'WOE x . • .. ' - • ce EFFECTIY/E DEPTH ; ABSORTION TR I CHES. Cr I D• Fr n I • O TH#2 MQ1 . CO3 C04 MT2 1 / I a0 �a WELL ../ ALTERNATE SITE L}. U . . \... o �O \ w J A B cot' F L \N , , // z FCO 54.0 20.0 TH#1 • / SV1 45.3 40.5 SV2V — SV2 42.9 46.0 ?CO *s • r — — — 2C0 41.6 56.7 • • FCO CO1 40.5 86.0 FS 45.3 91.0 ` CO2 54.0 97.0 1000-GAL SEPTIC TANK CO MT1 52.1 123.9 0 MT2 62.7 131.0 - - - � CO3 52.0 123.8 � / � � 47 C04 62.1 131.0 / \ N i g / N M / / \ illiiitGE / , \ , pi 1/4, S 1/2 LOT 9 33'ROW RESERVATION i \ ��v\ LEGEND 9'0 CO-CLEANOUT *� �; vJ 2C0-DOUBLE CLEANOUT FCO-FOUNDATION CLEANOUT jai4L FS-FLOW SPLITTER VALVE 4FD-FLOW DIVERTER VALVE n '• Michael E.Anderson : 0 50 100 MT-MONITORING TUBE +Oh e,,PFDtP l• ' n NE — — — FEET SV-SEPTIC VENT k O.— 1"=50' TH-TEST HOLE T12N R3W SEC22 N2 LESS N75' LOT 9 PERMIT # OSP171316 PID # 015-141-27 O N 0 U > > 0 L.L. Cn CO N — — / 99.5 - - - I— — i95.2 ` 1 -.I.-- 94.3 94.671000 GAL 94.5 SEPTIC TANK ki �� 90.3 cl, 01- O 02 97.1 FINISH GRADE 94.6 ORIGINAL GRADE 0 92.6 92.6 DRAINFIELD ROCK 'I."— 87.6 50' 87.6 -ter 1 81.6 NO GROUNDWATER 10/02/17 TH#1 v•N N 01— 0 U� 96.7 FINISH GRADE 93.6 ORIGINAL GRADE U 92.6 -/ 92.6 DRAINFIELD ROCK ."------- 87.650, 87.6 '- ''''''''S' I 80.6 NO GROUNDWATER 10/02/17 � l .r �•• � kTH#2 bie. k 1 Michael E.Anderson 0 /" iL.' - ,- GE PROFILE AS-BUILT (NO SCALE) 4 •6, 8 ,/,,b..• `„ ,kF�D•- sNa\ r k POESSO � 0:3,10-:1 2 13 23:04 907-345- e L .4LFINL DRILL I?!G P"+GE__01!01 — Alpine Drilling & Enterprises Well Log (41 Permit Number:iiSW 171316 Date of Issue! 10-19-17 Parcel Identification Number: 015027000 Date Started:5-2471$ Date Completed: 6-1-14 is well located at approved permit location?x Yes [] No Legal Description: T12N R3W Sec 22 Lt 9 N2 less N75' Property Owner Name&Address: Czajkowski Alan&Patricia A -- Harding Homes • Borehole Data: MIA(it) Method of Drilling x aft rotary j cable tool Soil Type,Thickness& Water Strata From To -- �_.�___---- Casing type:steel - i .stick-up 0 2 I Wall TPtiolmess:2..5,0 inches silt 4 ( Diameter: ¢inches Depth:305 feet gravelly.silt Liner Type:—.___ $ Diameter:--—inches Depth- _feet sandy silt 8 32 Casing stickup above ground:2 fleet i. silt 32 38 Static water level(from ground level):271 feet sandy silt 38 53 Pumupig level:303 feet after silty gravel 53 62 2 hours pumping gpm Recovery Rate: .1,Q gpm sandy gravelly silt 62 91 jMethod of Testing: t , air silty gravel 91 121 — ----— --- -- Well Intake Openin Type: I' gravelly silt 12.1 178 x Open End 0 Open Hole 1 silt 178 218 Ll Screened Start feet Stopped - feet D Perforations Start _--feet Stopped feettravi.tly silt 21 g 229 ( _ ---�._..._ Great Type: t}entgnite i 1 s -- vokn i 2.bgi, silty water sand&gra vol 229 233 II ---Dept'' _ Start Q feet Stopped ?feet silt 233 iSS 1 ---- -- ; Pinup:Intake Depth. __ feet !. gravelly silt 255 281 Pump size_____hp Brand Name gravelly sandy silt wet 281 299 f Well Disinfected Upon Completion?z Yes[_.I No water sand&gravel 299 305 Method of Disinfection: iuri tablets Continents: WATER •M UALITY TESTING # Well Drifter: Alpine Drilling&Enterprises Conform i e7" YUBar 110496 Citrates Co1/100mL Anchorage AK 99511 L Arsenic r Lig/L • • I IF14;:.', .4 .1 -:-. [119— grli*Vilne Li ��-i f 11 04/29/2k113 2 ':04 9ST--345-a2c2 HL_PItNE LP.ILLING. PAGE e /�+1. MUNICIPALITY OF ANCHORAGE Development Services Department + •t' i . 1) Phone: 907.343-7904 On-Site Water 8, Wastewater Section Fax: 907 343.79G7 Pump Installation Log Well Drilling Permit Number: 171316 Date of Issue: 10 -19 -17 Parcel Identification Number: 015 4127000 Legal Description dock Lot Property Owner Name& Address: — • T12N R.:1A/Seo 22 Lt 3 N loss N75' I Plan.$uatri xa Czaikrr,vski Harding Horses P.Q. Box 110669 l I P,nchoratga.AK89 —. - _ . 511 -..�_—_--__ - -- _•-- — -- --- Pump Installatk m Date: Pump Intake Depth Beton Top of Well Casing: 300 feet Pump Manufacturer's Name: Gr 6.i.C1Cifi�S Pump Model: 10sQE 330_-- _--- Pump Size: 1-5.--- ._hp Pitless Adapter Burial Depth: NIA__feet Pitless Adapter NIanufactarer's Name: NSA.__,____ Pitless Adapter Installer: WA Well Disinfected Upon Completion? X Yes �n Method of Disinfection: chlcrino tablets -_--— Comments: Please save for COSA. - Pump Installer Name; _______ _.--------_. —.-- ctitupun.. Aarow Pump& Weil Service, LLC P.C). Box 110496 Mailing Address: __-_-- ____________-_ Ci AnchorageMate AK zip: Jg511 Attention: The pump tnstalicr shall prQv do e pump installation log to On-site within 30 days of pump insteilation. KAN, D 343• vtT\ J�� ""'r , l t 1] MUNICIPALITY OF ANCHORAGE r On-Site Water& Wastewater Program \`‘ S.; PO Box 196650 4700 Elmore Road y� 1 Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax (907)343-7997 ,� http://www.muni.org/onsite apartment 4 i.CH DN AGE On-Site Water & Wastewater System Permit Permit Number: OSP171316 Effective Date: 10/19/2017 Work Type: WellSeptic Initial Expiration Date: 10/19/2018 Tax Code Number: 01514127000 Site Legal Address: T12N R3W SEC 22 LT 9 N2 LESS N75' G:2636 Site Mailing Address: 10832 OUR RD, Anchorage Owner: CZAJKOWSKI ALAN J & PATRICIA A Lot Size in Sq Ft: 75794 Design Engineer: FORGE ENGINEERING Total Bedrooms: 3 This permit is for the construction of: 0 Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy 0 Private Well 0 Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 7 Received By: ' ,/ ,In-i(i,/;it in /7,0 Date: Issued By: /CeC.Q ( Date: !DAY O/7 (1.)73 `I t; ici 17,,,., 1� 04.701 -off MUNICIPALITY OF ANCHORAGE E uC1 13 21717 t C ti Community Development Department Phone: 907-343-7904 71g Development Services Division Fax: 907-343-7997 On-Site Water & Wastewater Program ON-SITE SEWER/VVELL PERMIT APPLICATION Parcel I.D. 015-141-27 Property owner(s) Alan & Patricia Czajkowski Day phone Mailing address 143 Nanook Circle, Anchorage, AK 99504 Site address 10832 Our Rd Legal description (sub'd.. Block & Lot) T12N R3W Sec 22 Lot 9 N2 Less N75' Legal description (Township. Range & Section) Lot Size 75,794 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (H all that apply) Absorption Field ❑x Initial i_1 Single Family (SF) 1 i (w/wo ADU) Septic Tank x Upgrade ❑ Duplex (D) Holding Tank ❑ Renewal Multiple Dwellings r 1 Privy ❑ (SF and/or D) Private Well ❑x Water Storage THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. 1, (Si ure • t,roperty owner or authorized agent) Permit/Rush Fees: "9-7 q Waiver Fees: Date of Payment: /0307 Date of Payment: Receipt Number: IJVICQD Receipt Number Permit No. 03 Pn"131 w Waiver No. Permit App_:-:•::_..c FORGE ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) October 11, 2017 Municipality of Anchorage Development Services Dept- On-Site Water& Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: T12N R3W Sec 22 Lot 9 N2 Less N75' Septic system design and permit application Dear On-Site Services Engineer: The owner of the above lot intends to build a 3-bedroom home on the property, so we are submitting this permit application for the construction of a new well and septic system. The attached site plan identifies the location of the home as well as the proposed well, septic location and alternate site. No conflicts exist between this proposed system and any wells, whether on this lot or adjacent lots. Drainage arrows are shown on the site plan showing the direction of flow. The drainage pattern in general will not be changed by the construction. The test holes placed on the lot indicate silty gravel with sand. No groundwater or bedrock was found down to 13'. The percolation rate was determined to be between 28-40 min/in. An application rate of 0.45 gpd/sf was used in the design of the absorption system. We are proposing to place a new 1000-gallon septic tank with two deep absorption trenches 3' wide x 50' long x 5' effective depth. The elevation of the distribution line will be 2' below the surface for a total depth of 7'. Soil will be mounded 1.5' above the trench. A minimum of 3' of fill will be placed over the absorption trench and 4' over the septic tank, or insulation with 2' of fill. The ground surface on the lot slopes moderately to the west, but there aren't slopes steeper than 25% on the lot. In general, the ground slopes at a 10-20% slope, with some flatter areas. There is a section of the lot about 60' east of the west property line that slopes at 25%, for about 30'. The septic trenches are located to the southeast of that area. The new trenches will be constructed parallel to the slope as much as possible. They will be a minimum of 100' from all wells and surface water, and more than 5' away from the septic tank. The alternate site is located more than 10' away. There are no well or septic systems that impact the locations shown. The lots to the east do not have records available, but they are greater than 100' from the well and septic areas. If the system is constructed as designed, it will have no adverse impact: • On the wells in the area or those to be constructed in the future. • On existing septic systems in the area or those to be constructed in the future. • On reserve space, either surface or subsurface, on any lots located in the area. • On drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, A.0F''� a S .rt 44E � Benjamin Schiller, PE •' f/j7i ,. '.. i it araP . :7V r• �; .. ar ,t� 40 • ,fir: % .. • ,gym 0 O'MALLEY ROAD T12N R3W SEC 22 -cif 1-- N 1/2 OF LOT 9 LESS N 7S -77., - - 1 100' WELL RADIUS 2x50' LONG x 3' WIDE, 5' EFFECTIVE PTH ABSORPTION E TRENCHES tr-1 THH#2 PROPOSED WELL /' n n cco o / I _14.6 I ISV III FCO Z ITHO# I 11 2C0 • u IMT IMT I CO CO - - — —t — ALTERNATE SITE COI 1000-G9L_W- ___T J .` CV /____I __�_ l/ / in I i \ Q X11/4, S 1/2 LOT4Q 33' ROW RESERVATION I -I I / \ \ NOTE: NO SLOPES>25%WITHIN 50'OR SURFACE WATER WITHIN _��\.. , 100'OF THE PROPOSED SEPTIC SYSTEM ArAl-' �� .'F,9 f+ NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS.LOTS • 49 TH /\ ..*v TO THE EAST HAVE NO AVAILABLE WELL INFORMATION, LEGEND BUT THEY ARE>100'FROM THE SEPTIC SYSTEM MT-MONITORING TUBE I. , FCO-FOUNDATION CLEANOUT - q . Benja� n Schiller • 9FC/ AEL 12592 .•��% + 0 50 100 TH-TEST HOLE Ir4 '••. Oct.e.20 *q, `'• --- ,,,t, M. FEET �`\\ROFEss 0- 1"=50' CO CLEANOUT �"_`4SV-FLOW SPLITTER VALVE T12N R3W SEC 22 N 12 LOT 9 LESS N 75' DESIGN FACTORS: SYSTEM REQUIREMENTS: 450 GPD PEAK FLOW 3' WIDE DEEP TRENCH SYSTEM PERK RATE: 40 MIN/IN 1000-GAL SEPTIC TANK APPLICATION RATE: 0.45 GPD/SF 450 GPD/0.45 GPD/SF/5' DEEP /2 SIDES = 100.0 LF Trench Length THEREFORE: CONSTRUCT TWO ABSORPTION TRENCHES 50' LONG x 3' WIDE x 5' EFFECTIVE DEPTH. FLOW LINE ELEVATION IN TRENCHES TO BE 2' BELOW ORIGINAL GROUND SURFACE. TOTAL DEPTH TO BE 7' BELOW EXISTING GROUND. PROVIDE 3' COVER OVER TRENCHES AND 4' COVER OVER SEPTIC TANK, OR INSULATION WITH 2' COVER. 3:1 MAX SIDE SLOPE I-111— II= (—III—III—III—III-i I-III-I I-III—III-III-I I EXISTING GROUND LEVEL -III=III=III=I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I III=III=I I I=III=III=I I I=I 1 IIII=1 1'-6" III= - IIIIII-I 1 I-I 1 I=I I I- 'I I II I I I I IITI I I I I I I I I II I II►IITII 1=I I I=I I I-I 11-7-111-7-111=1 6" _ •._:: :,.. ✓.-.r S.Mer dr +4','/;r•1.Ni ,M,•�•��I�I�I�I�I�I�I�I�I�Ir .'4VVV•• :.-.'-?-:-4111;Alio 4" PERFORATED PVC (HOLES DOWN) Y�1�1�1:1:��I��y1�1�1•:I�i • • g" aa• DRAINFIELD ROCK '4tittittIA":14-4 1:41-4': 4'TO GROUNDWATER .7- : z': '''!AA.."-14'4%1 6' TO BEDROCK OR IMPERMEABLE LAYER �- 3' TYPICAL DEEP TRENCH SECTION i (NO SCALE) *�Q:• TH '•F:S7 NOTES: %•� GRADE AREA OVER TRENCH TO DRAIN AWAY ,•, • MIN 6' SEPARATION FROM BEDROCK / Benja Schiller ' MIN 4' SEPARATION FROM GROUNDWATER ��Fg•'•, AEL12592 •.•��/� � OG 18,2017 .• , MIN 100' SEPARATION FROM NEARBY WELLS '�1F�F.,;• • sstioNP`..It...- MIN 100' SEPARATION FROM SURFACE WATER OR STREAMS MUNICIPALITY OF ANCHORAGE C�•�M,k? k DEVELOPMENT SERVICES DEPARTMENT ret "' •:9s- 0I i 4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 *.STM !.i •:17 rA / SOILS LOG AND PERCOLATION TEST % •,: ,,..�, ,,., r . Benham i Schiller Al LEGAL DESCRIPTION: T 12N R3W SEC 22 L9 N2 LESS N75' • �f�Fi�TF.,. 18,p92,.•„�a��. PERFORMED FOR: FORGE ENGINEERING 'kk PROFESS00%.1= DATE: 9-26-2017 PROJECT No.: PARCEL ID#: 015-141-27 TECHNICIAN: J. M I LLE T T E Professional Engineers Stamp: DEPTH TEST HOLE 1 (feet) 1 SLOPE SITE PLAN ' 2 :;:..AM< SAND t.lii 3 _—y ::1 Ogitti 4 = s Vii„•:t :�t "ttt�`M!�'1?� SILTY GRAVEL W/ SAND 5 ayyr,.,:ti , SEE SITE PLAN I4f 0.t”k `si 6 :t� e.��;w. 41.�N./yL'•L iri 7 . %;;xz z;, 9 $i-:e 10—Z.z'C5 ,,Z WAS GROUND WATER ENCOUNTERED? No ;,44-VAI IF YES @ WHAT DEPTH? — .4`;7 t 1, DEPTH OF WATER AFTER MONITORING: NONE 11 r2f5AVi DATE OF MONITORING: 10/2/17 12=�T. ��'.`Af ��' ��- DEPTH To 13 " `'""''''' BOH DATE READING GROSS TIME NET TIME WATER NET DROP (MINUTES) (MINUTES) (INCHES) (INCHES) 14 9/26 TEST HOLE PRESOAKED PRIOR TO TESTING: 15 I 5:10 0 16 2 5:40 30:00 0.75 0.75 S 5:41 0 17 / 5:11 30:00 0.75 0.75 18— 5 5:12 0 196 5:42 30:00 0.75 0.75 20 PERCOLATION RATE:40.0 (MIN/INCH) PERC.HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 3.5 FT. and 4.5 FT. COMMENTS: MUNICIPALITY OF ANCHORAGE _��\/\�\vo,, DEVELOPMENT SERVICES DEPARTMENT ��'.'!•"••.!9, 6 4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 'ai�*. • 1}i �c 4 014 SOILS LOG AND PERCOLATION TEST , . ,, ,,, ,,,, i Benj in Schiller . R LEGAL DESCRIPTION: TI2N R3W SEC 22 L9 N2 LESS N75' ��9k,,'• Go:".%am92 .• . ' PERFORMED FOR: FORGE ENGINEERING Ill,k PROFESSO" DATE: 9-26-2017 PROJECT No.: `~�� PARCEL ID#: 015-141-27 TECHNICIAN: J. MI LLE T T E Professional En_ineers Stam.: DEPTH TEST HOLE 2 (feet) 1 :,� »' SLOPE SITE PLAN 2 ,�v alx it 0,:vi.„,„ 5 „, d"el��.y.^','+ SILTY GRAVEL WI SAND SEE SITE PLAN w 1. 6 'ej 8 —a 0sr1•i;s�...y. *t�c..�z. a 1 O :Wi. .as WAS GROUND WATER ENCOUNTERED? NO :��ti;ML:+, IP YES(a WHAT DEPTII? I1 ��• ,t "+'1-+'44 DEPTH OF WATER AFTER MONITORING: NONE 1* .s DATEiOPMONITORING: 10/2/17 12=}ii ` "' - -/ DEPTH TO ' =?I~ GROSS TIME NET TIME NET DROP 13 "'�`"''^` BOH DATE READING WATER (MINUTES) (MINUTES) (INCHES) (INCHES) 14 9/26 TEST HOLE PRESOAKED PRIOR TO TESTING: 15 I 5:15 0 16 2 5:45 30:00 1-3/16 1-3/16 3 5:46 0 17 4 6:16 30:00 1-1/16 1-1/16 18— 5 6:17 0 19 6 6:47 30:00 I-1/16 1-1/16 20 , PERCOLATION RATE:28.3 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 3.0 FT. and 4.0 FT. COMMENTS: I< U5ingf '')L' b / 8 9 0 MUNICIPALITY OF AN RACE cgloz og £ �� n ' 4 „_ ) — - - . . ,-, iiiiqthiiii Development Services Department <�� / Phe '07-3, .-•,•O4 On-Site Water & Wastewater Section �—-� Fa ..!'a ' 4:- 997 Certificate of On-Site Systems Approval f RUSH/ Parcel I.D. 015-141-27 Expiration Date: / ( 2 (-I 1. GENERAL INFORMATION Complete legal description T12N R3W Sec 22 Lot 9 N2 Less N75' Location (site address) 10832 Our Road Anchorage, AK 99516 Current property owner(s) Alan & Patricia Czajkowski Day phone Mailing address 2440 E. Tudor Rd., Anchorage, AK 99507 Real estate agent Day phone 2. TYPE OF DWELLING: E Single Family (w/wo ADU) n Duplex Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well H Private Septic X Water Storage Holding Tank I I Community Well Community ❑ Public Water System ❑ Public Sewer n Waiver request for: Distance: (7 Received by:C Date: yfdtl, COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ I t f.L' Waiver Fee $ Date of Payment 'g/Z1112 Date of Payment Receipt Number GOa 196D Receipt Number COSA# 1 Y 1`i'Iq Waiver# fieux 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 tare)jn compliance with all applicable Municipal and State codes, ordinances, and regulations in effect;at the time of.,installation. •Name of Firm Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 203, Anchorage AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 8/20/2018 • ,''��OF A Lgs�i Al*: 49 / / 6. DSD SIGNATURE 't •`r 01- 1-41 System #1 Approved for bedrooms Michael E.Anderson . 1ik-t4381-E � "S stem #2 Approved for bedrooms F9 , •=i 'kFROFSSioP Disapproved Conditional approval for bedrooms, with the following stipulations: WATER ANG WASTEWATER PROGRAM By: Original Certificate Date: LS"Zr -f r 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 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: T12N R3W Section 22 Lot 9 N2 Less N75' Parcel ID: 015-141-27 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 6/1/18 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 305 ft. Cased to 305 ft. Casing height (above ground) '24 in. FROM WELL LOG AT INSPECTION Date of test 6/1/18 Static water level 271 ft. ft. Well production 10 g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 1 .58 mg/L Arsenic ND ug/L Date of sample: 8/10/18 Collected by: Forge Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 4/18/18 Tank size 1000 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 New Const. Pumper C. ABSORPTION FIELD DATA Date installed 4/1 8/1 8 Soil rating (g.p.d./ft2 or ft2/bdrm) .45 GPD/SF System type Deep Trench Length 2 x 50 ft. Width 3.0 ft. Gravel below pipe 5.0 ft. Total depth 6.0-7.0 ft. Eff. absorption area 1,000 ft2 Monitoring tube Y Depression over field N Date of adequacy test New COnstl. Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. N Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "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 100 On adjacent lots >100' Absorption field on lot >100 On adjacent lots >100 Public sewer main 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: Building foundation �' Property line >5' Absorption field >5' Water main Water service line >10' Surface water >100' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line Building foundation >10 Water main X10 Water Service line Surface water 100>10' Driveway, parking/vehicle storage 10 Curtain drain None Noted Wells on adjacent lots >100� F. COMMENTS G. ENGINEER'S CERTIFICATION -�..,,,,OF Ate t 4 . S,� I certify that I have determined through field inspections and ,.►,sQ;•' '• �- review of Municipal records that the above systems are in Ase •. TH _ ' •• ..��# *. 49 _ /\ •.* conformance with MOA COSA guidelines in effect on this date. '�;)••,,jjjj / Engineer's Printed Name Michael E. Anderson, P.E. 3 .. •. .>T�:� 4 / . Michael E.Anderson Date 8/20/2018 �� 9 .. ..Q. i iF°PROFESSIO ' ... ' COSA brown sheet 10-10-12.doc r I 0 I I D I o H J 0 a, ,00'SSZ M"0£,$-0.00 N 75.0' r' mz V) ® —I —ri x N) co O w ,N _ w_ Z --I X 73V 0 O m"D Vl W D n v oo m i v N X U) 0 Z m 0 z .E171z o D o D o — r o g r- 0 g0 m m -< ws w r co tigill•ila1- • —� ' b) - 0 60.1' iN Coo co - 1.3112.4 IA/ b \ err- ">••• \ �qL� w. O P / -oV v.> O p D \ m n x r-4 N o o L°°' PROTECTIVE R m cn I ADIOS ➢: - - - - 1 / \ ,00'SSZ 100,1+0.00 S avo2! ano / \ / ___1 N y z / PO \ � OD Cil C I— r- o 0 co 0o I PLOT PLAN AS BUILT X SCALE 1" = 50' GRID SW 2636 Project No. 17-281/B5 11500 Daryl Avenue. Anchorage. Alaska 99515-3049 Lang &t Associates , inc . (907) 522-6476 Phone ,�oo0opk� (907) 522-4625 Fax o F q ��4 Professional Land Surveyors kenOlangsurvey.com o . ,� jonathanOlangsurvey.com 0 S Qom.. . J .!r-d0 hereby certify that I have surveyed the following described property: O* 49TH ./\. •�7 v N 1/2 LOT 9 LESS N 75', T12N, R3W, SEWARD MERIDIAN. ALASKA D D Anchorage Recording District, Alaska. and that the improvements situated thereon are g n l7 VA within the property lines and do not encroach onto the property adjacent thereto, that Q ' KENN no improvements on the property lying adjacent thereto encroach on the surveyed Q•a. •••••.. • •• �•;•..... premises and that there are no roadways, transmission lines or other visible QQ M� o easements on said property except as indicated hereon. 0�4�p� —520D I"`�a C.,‘', Dated this the i\n1r Day of fs t;I_.•'-'C , at Anchorage. Alaska Q a �' Noe 0 a' , O\ SSioNA�`pa It is the responsibility of the owner to determine the existence of any easements, DDOOoo�" covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963