HomeMy WebLinkAboutGOLDEN VIEW HEIGHTS LT L-2Onsite File
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Inspection Report_1-1-12tdde
Municipality of Anchorage
Community Development Department Page 1 of 3
On-Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 - http:/Iwww.muni.org/onsite • (907) 343-7904
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP141115
PID Number: 020-043-16 ❑✓ New ❑ Upgrade
Name:
John Erik Andersen
ABSORPTION FIELD
❑ Deep Trench ❑✓ Shallow Trench ❑ Bed ❑ Mound
Address
7405 Grand Oaks Drive Crestwood,
KY 40014
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
727-5259
4
1.2GPD/SF
7 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3 Ft.
Gravel depth beneath pipe
4Ft.
Subdivision
Block Lot
Golden View Heights
L-2
Fill added above original grade
.5-1 Ft.
Gravel length
50 Ft.
Township Range Section
Gravel width
5Ft.
Beds: Number of Lines
Distance between lines
I Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
500 Fiz
One
I Ft.
well
>100'
>100'
N/A
N/A
>25'
TANK ❑O Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1,250Ga1.
Surface Water
>100'
>100'
N/A
N/A
Material
Number of compartments
Lot Line
>5'
>10'
N/A
N/A
Steel
Two
NA
Foundation
>5'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
None
Noted
Gal.
Remarks
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
-
Pump make and model
Electrical Inspections performed by
Installer
PIPE MATERIAL House to tank D3034 drainfieldTank to
D3034
Northern Excavation
Drainfield F810 CO/MT D3034
Inspector MEA
BENCH MARK (Assumed elevation) 100.0ft
Inspection„
5/20/14
d 5/20/14
Location and description
dates:
T4 5/21/14
2
4'”
Garage Slab.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
::�wiftwi
®1
Conditional Approval:
dw,
Date
�!`P;.•' ,
j4�•9 TH
.... ....
'.
....... ..................
® -MICHAEL E. ANDERSON
CE-4381
Approved
>� f, Date//-7-14
Inspection Report_1-1-12tdde
Municipality of Anchorage Page 2 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 — 343-7904
Permit Number. OSP141115
Z
v
Vl
O
Z
0
v
m
PID No. 020-043-1
Lcrcun
M1 — Monitor Tube
FCO — Foundation Clean Out
TH — Test Hole
Cl — Clean Out
PLAN AS BUILT
SCALE 1" = 50'
sees
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number: OSP141115 PID No. 020-043-16
98.2
U fq W U U
Orlgtnal &
Finished
Grace
1,250 Gallon
Septic Tank
493.7 93.5
g U
96.7 98.0
Finished Gee
Original G=nd
Geotudle FaWc
93.2 Drainfield Rode 93,2
89.2 89.2
50' (Total Effective Trench Length) 80.0
No Groundwater
10/31/12
As
49th f
...................
PROFILE AS-BUILT10
M1CHA433RSGN 1Z
N0. CEA-4381
No Scale +♦♦ pA. 2� r jlP��4.�a0
02/07/2014 20:25 507-345-8202 ALPINE DRILLING PAGE 01/01
Alpine Drilling & Enterprises
Well Log
Permit Number: #SW 141995 Date of Iwsue: T Parcel Ideutitication Number: 2004316000
Date Started: E20-14 Date Completed: 5-21-14 is well located at approved permit location? x Yes ❑ No
Legal Description: Golden View Heights Lot L2
Property Owner Name By Address: Anderson John Erik
7405 Grand Oaks Drive
Crestwood Kv 40014
Borehole Data:
Soil Type, Thickness 3t Water Strata
Depth (,it)
From To
Method of Drillingair rot
x ❑cable tool
_--ary
Casing ty=pe: steel
Stick -IV
U
2
Wall Thickness: .250 inches
Organles & sill
gravelly silt
2
3
3
21
Diameter: 5 inches Depth; 97 feet
Liner TI ,pe:
Diameter: _,,, inches Depth: feet
sandy silt
21
35
Casing stickup above ground: 2 feet
Static water level (from ground level): 45 feet
gravelly silt 35 %3
silty sandy 1120
73
74
Pumping level: 116 feet after
gravelly silt
silty water sand & gra4,el
74
65
8j
87
2 hours pumping 4 gpm
Recovery Rate: 4 gpm
Method of Testing: air li ..
gravelly silt
67
91Well
Intake Opening Tv pe
bedrock
91
126
❑ Open End Open Hole
❑ Screened Start T._.,_ feet Stopped ` feet
x Perforations Start E6 feet Stopped 89 feet
Grout Type: bentaniie granules Volume: 1 has
e t ; Stan U flet S=ed 7 feet
Pump: Intake Depth , feet
Pump size --_ hp Brand Name
Well Disinfected Upon Completion? x Yea ® No
Method of Disinfection: chi rine to dem
Comments:
Well Driller: Alpine Drilling & Entetprises
PO Bos 110496
Anchorage AK 99511
aw
`" t7n-Site Wafter & Wastewater Program
4700 Elmore Road
P,O. lox 196650
MarkBegieh Anchorage, AK 99507'' £ "'
Mayor www.muni,oro/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW 141115 Date of Issue: 5119/14
Parcel Identification Number: 2004316000
Legal Description
Golden view Heights Lot L2
Property Owner Name & Address:
Anderson John Erik / Houghton Construction
7405 Grand Oaks Drive
Crestwood KY 40014
Pump Installation Date., 9/26/14
Pump Intake Depth Below Top of Well Casing: 120
feet
Pump Manufacturer's Name: Goulds
Pump Model: 7SBO5422C
Pump Size v2 hp
Pitless Adapter Burial Depth: N/A feet
Pitless Adapter Manufacturer's Name: NIA
Pitless Adapter Installer: NIA
Well Disinfected Upon Completion? J❑ Yes No
Method of Disinfection:
Comments
Please save for your engineer.
Pump Installer Natne: Aarow Pump & well service, LLC
This is needed for your COSA,
P.O. Box 110496
Anchorage, AK 99511-0496
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
On -Site Water & Wastewater System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP141115
Tax Code Number: 02004316000
Work Type: WellSeptic Initial
Permit Effective Dates: May 19, 2014 to May 19, 2015
Design Engineer: ANDERSON ENGINEERING
Subdivision: GOLDEN VIEW HEIGHTS
Site Legal Address: GOLDEN VIEW HEIGHTS LT L-2 G:3238
Owner/Address: ANDERSEN JOHN ERIK
7405 GRAND OAKS DR CRESTWOOD KY 400149688
Site Mailing Address: 15701 WIND SONG DR, Anchorage Lot Size in Sq Ft:
Total Bedrooms:
This permit is for the construction of:
5;zo/y 2 01"
47049
Y Disposal Field Y Septic Tank N Holding Tank N Privy Y 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 By:
6/111"r
d
Issued By: !i„v Date: S/q
MUNICIPALITY OF ANCHORAGE
A 1
® �t
Community Development Department P e: 907-343-7904
Development Services Division ax: 907,-3432714
On -Site Water & Wastewater Program MNT 1
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 020-043-16
Property owner(s) John E. Andersen Day phone 727-5259
Mailing address 7405 Grand Oaks Drive Crestwood, KY 40014
Site address 156701 Wind Song Drive Anchorage, AK 99516
Legal description (Sub'd., Block & Lot) Golden View Heights, Lot L-2
Legal description (Township, Range & Section)
Lot Size 47,049
Sq. Ft.
Number of Bedrooms Four (4)
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
0
Initial F-1
Single Family (SF)
(w/wo ADU)
Septic Tank
0
Upgrade E]Duplex
(D)
Holding Tank
E]Renewal
E]
Multiple Dwellings
Privy
❑
(SF and/or D)
Private Well
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Dis tance:
I certify that the above information is correct. .I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number: l'i�U�?i/�
Permit No.
Permit App_9-1-12.doc
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
El
1
May 10, 2014
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot L-2, Golden View Heights Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot L-2, Golden View Heights Subdivision intends to construct a new four-
bedroom home on the lot. We are therefore requesting a permit be issued for the
construction of a new well and septic system to accommodate the home. The attached
Site Plan and backup documentation identify the location and configuration of the
proposed well and septic system along with the alternate site. Also identified on the
plans are the existing wells and septic systems on surrounding lots. No conflicts exist
between the proposed septic system and well or septic systems and wells on adjacent
lots. Drainage arrows are shown on the site plan showing the grade and direction of
flow on the lot. The drainage pattern will not be changed as a result of this project.
The test holes placed on the lot in the area of the absorption trench and alternate site
indicate silty gravel (GM/GP) with sand in the zone specified for the absorption trench.
The percolation rate of the soil was determined to be 1-5 minutes per inch. No
groundwater was found during the placement of the test holes and none developed
during the monitoring period. An application rate of 1.2 gallons per day per square foot
was used in the design of the absorption system. We are proposing to place a new
1,250 -gallon septic tank and a 50' long by 5' wide by 4' effective depth absorption
trench to treat and dispose of the effluent generated in the house. The elevation of the
distribution line in the absorption trench will be 3' below the surface and the total depth
will be 7'. A minimum of 3' of fill or 2" of insulation and 2' of fill will be placed over the
absorption trench and 4' over the septic tank.
The ground surface on the lot in the area of the septic system slopes to the northwest.
The new trench will be constructed parallel with the contours of the slope as much as
possible in conformance with Municipal requirements. The new septic system will be
Lot L-2, Golden View Heights
May 10, 2014
Page Two
constructed a minimum of 100' from all wells and any surface water and 10' the
proposed and existing water services in the area.
If the system is constructed in accordance with our design the following statements
apply:
1. The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
—
Sincerely,
-
Michael E. Anderson, P.E.
Attachments
4CS \
Lot L-1 Exiwe®
AREA MAP
SCALE 1' = 100'
LOT L2
GOLDEN VIEW HEIGHTS
Lof L-3
-FOUND 5/8" RMB (ttPICX) Lot L-2
sx 47,049 s.f.
50' Longg z 5' Wide
z 4' Eflective Depth _
\ 5x Absorption Trench
_
----707 ELECTRICAL. EASEMENT
SS N(erna(e /
Ste
iH2
rHt /
/ 5x
/ co
MT a518 '`('1,250 Gallon
_ co as6.8 Septic funk
864.7
7 865.0
I Prosed
e
1 30 L.F. 18" CMP I
\ I
\ 30.00'
NOTE:
No Areas of Excessive Slope or
Surface Water are Within 100' of Any
Part of the New Septic System.
855.5 I JlFou�r yBm room
5%
A - TOP OF 5/8- REBA
852.50 — —
F-17
I
1 �
10' T&E EASEMENTS
------------
- - � SITE PLAN
SCALE 1' = 50'
Lot L-1
L
►3=33
LEGEND
MT - Monitor Tube
FCO - Foundation Clean Out
TH - Test Hole
CO - Clean Out
2CO - Double Clean Out
LOT L-2, GOLDEN VIEW HEIGHTS SUBDIVISION.
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Four Bedroom Home 5' Wide Trench System
Perc. Rate: 1-5 Min./Inch 1,250 Gallon Septic Tank
Application Rate: 1.2 GPD/SF 4' Drainfleld Rock
4 Bedrooms * 150 GPD/Bedroom = 600 SF Ab tion Area
600 SF/1.2 GPD/SF/5 SF (Width) *.5 (Red. Factor= 50 LF Trench Length
THEREFORE: Construct a 50' Long x 5' Wide x 4' Effective Depth Absorption Trench.
Flow Line Elevation in Trench to be 3' Below Original Ground Surface. Total Depth to be
7' Below Existing Ground. Provide 3' Cover Over Absorption Trench and 4' Cover Over
Septic Tank.
2'6" 1 1 1 /Geote)tile Fabric
Al
4" Perforated
PVC (Holes Down)
Drainfield Rock
4'
Coarse Sand (See Specification)
5'
TYPICAL 5' WIDE TRENCH SECTION •••..�,
(NO SCALE) ���P�E.�•
.Tc,.
NOTE: Grade Area Over Trench to Drain Away. :;'
Minimum 6' Separation From Bedrock.Q, ;; 49th
Minimum 4' Separation From Groundwater. 0*
Minimum 100' Separation From Private Wells in the Area. iAMACH WE;. MDER ON
Minimum 100' Separation From Surface Water or Streams. ���!� :: No. ce asei
E
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
DEPTH
(feet)
1-
2-
3 -
4 -
6-
7-
8-
9-
10-
11
12-
13-
14-
15-
16-
17-
18 -
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: GOLDEN VIEW HEIGHTS, LOT L-2
PERFORMED FOR: JOHN ANDERSEN
DATE: 10/24/12 PROJECT No.:
PARCEL ID#: TECHNICIAN: A. HARALA
TEST HOLE 1
OB/OG
:a I SILTY GRAVEL
° WITH SAND
a GM/GP
SLOPE
MICHAEL E. ANDERSON
No. CE -4381
SITE PLAN
SEE SITE PLAN
k
i.
a
WAS GROUND WATER ENCOUNTERED? NO
IF YES @ WHAT DEPTH?
DEPTH OF WATER AFTER MONITORING: NONE O 5-10%
DATE OF MONITORING: 10/31/2012 p
a IC -
0
n
a
°
BOH @ 16'
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH TO
WATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
10/2
1
1:32/1:42
10
1.25"/8.37"
7,12°
2
1:43/1:53
10
1.37/8.62"
7,251
3
1:54/2:04
10
1.25°18:37"
7.12"
4
2:05/2:15
10
1.00"/8.25,,
7.25'
5
2:16/2:26
10
1.25"/8.37"
7.12"
6
2:27/2:37
10
1.00='/8.1r2"
PERCOLATION RATE: 1.4 (MIN/INCH) PERC. HOLE DIA. 611 (INCHES)
TEST RUN BETWEEN: 3.5 FT. and 4.5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
T)ATF• 10/31/12
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
DEPTH
(feet)
1-
2
3
4
5
6
7
9
10-
11
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: GOLDEN VIEW HEIGHTS, LOT L-2
PERFORMED FOR: JOHN ANDERSEN
DATE: 10/24/12 PROJECT No.:
PARCEL ID#: TECHNICIAN: A. HARALA
TEST HOLE 2
OB/OG
a SILTY GRAVEL
G WITH SAND
d. GM/GP
DRY
d
a
15 —moi BOH @ 15'
16
17
SLOPE
N
IR
Z. ..
49th
MICHAEL E. ANDERSON
SITE PLAN
SEE SITE PLAN
t
WAS GROUND WATER ENCOUNTERED? NO
IF YES @ WHAT DEPTH?
DEPTH OF WATER AFTER MONITORING: NONE 0 5-10%
10/
DATE OF MONITORING: 31/2012 p
DATE
a
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
12
NET DROP
(INCHES)
0
TEST HOLE PRESOAKED PRIOR TO TESTING:
13
1
1
5:14
7.3819
a
2
14
4
16.25"
8,8711
15 —moi BOH @ 15'
16
17
SLOPE
N
IR
Z. ..
49th
MICHAEL E. ANDERSON
SITE PLAN
SEE SITE PLAN
t
WAS GROUND WATER ENCOUNTERED? NO
IF YES @ WHAT DEPTH?
DEPTH OF WATER AFTER MONITORING: NONE 0 5-10%
10/
DATE OF MONITORING: 31/2012 p
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH To
WATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
10/2
1
5:14
7.3819
2
5:44
30
16.25"
8,8711
3
5:45
7.251t
4
6:15
30
16.06"
8.81"
5
6:16
7.50"
6
6:46
30
16.31"
8.81"
PERCOLATION RATE: 3.4 (MINANCH) PERC. HOLE DIA._ �(INCHES)
TEST RUN BETWEEN: 3.5 FT. and 4.5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
nATR• 10/31/12
MUNICIPALITY OF ANCHORAGE
Development Services Department ;'� Phone: 907-343-7904
On -Site Water & Wastewater Section y' Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 020-043-16
Legal description GOLDEN VIEW HEIGHTS LT L-2
Site address 15701 WIND SONG DR Anchorage AK
Current property owner(s) ANDERSEN
Expiration Date:
5/6/2025
X The On -site system(s) is/are approved for 4 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: 6/13/2024
This Certificate of On -Site Systems Approval (COSA) is intended. to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA ApprovaLJune 2022
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 020-043-16
Complete legal description GOLDEN VIEW HEIGHTS LT L-2
Location (site address)
15701 WINDSONG DR
Current property owner(s)
2. ON -SITE SYSTEMS SIZED FOR 4 BEDROOMS
Day phone
3. TYPE OF WATER SUPPLY: X-1 Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: n Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: Ifl Steel _ Plastic ❑ Concrete ❑ Fiberglass
Age 10 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 1 Deep Trench M Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On -site staff
to verify the accuracy of the information provided.
COSA Fee $ 5-0 Waiver Fee $
Date of Payment Jt' r�, % Date of Payment
COSA # () S f P . Waiver #
COSA Application_June 2022
COSA Checklist
Legal Description: GOLDEN VIEW HEIGHTS LOT L-2
Parcel ID: 020-043-16
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system
A. WELL DATA
X Well log is filed with Onsite (or attached)
Date drilled 5/21/14 Total depth 126 ft
Cased to 97 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 20 in.
Date of flow test for COSA 6/6/24
Static water level at beginning of test 44 ft.
Comments
B. TANK DATA
Measured operating fluid level in septic tank 48
Date of pumping 6/6/24
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 5/20/14
0 ALL standpipes present per record drawing
Total measured depth from grade 8 ft (max)
Measured depth to pipe invert from grade 4 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
❑ Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
COSA Checklist June 2022
Well production at time of test 4+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes❑ No
❑fi Coliform bacteria is Negative
Nitrate 0.233 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L A Arsenic less than MRL (ND)
Collected by MNA
Date 5/6/24
C. LIFT STATION
❑ Required maintenance completed
Age of lift station _ years
Lift station material
Comments:
Adequacy test date 516124
Results Q Pass
Fluid depth prior to test 13 in
Water added 600+ gal
New fluid depth 20 in
Elapsed time 1440 min
Final fluid depth 13 in
Absorption rate 600+ gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 48 in
Effective depth used 13 in
Effective depth remaining 35 in
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
Q Yes if No _ ft �i Yes if No _ It
Neighboring Tank > 100' ❑i Yes if No _ ft
Absorption Field on Lot > 100' R1 Yes if No _ ft
Private Sewer/Septic Line > 25' Q Yes if No ft
Holding Tank > 100' QYes if No _ ft
Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No _ ft
❑i Yes if No _ ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Yes f No _ ft Q Yes if No _ ft
❑ N/A— Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
Tank to Property Line > 5'
Field to Property Line > 10'
Water Main > 10'
Water Service Line > 10'
F. ENGINEER'S COMMENTS
gYes
ifNoft
0 Yes
if No _ ft
OYes
ifNo_ft
QYes
ifNo_ft
2Yes
ifNo_ft
Surface Water > 100'
Wells on Adjacent Lots:
Private Wells > 100'
Community Wells > 200'
Yes if No _ ft
E Yes if No _ ft
0 Yes if No _ ft
If tank or field is under driveway comment below
G. CERTIFICATION & 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, indicates that the on -site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm /miltk+e- /1'LdCIPA ov/ IPCi.
Engineer's Printed Name Saw C�
COSA Checklist June 2022
Phone 727-8864
Date (A/11(2I
Ai
i(✓)�Y: iF
a• F • • R.�:• •,�i
Y�
J • MICHAEL N. ANDERSCN
��r•, CEO.94b9 ".i
• Municipality of Anchorage °
On -Site Water and Wastewater Program <
(907)343-7904 saFE,
Certificate of On -Site Systems Approval
Parcel I.D. 020-043-16 Expiration Date: a ' /�
1. GENERAL INFORMATION
Complete legal description Golden View Heights, Lot L-2
Location (site address) 15701 Wind Song Drive Anchorage, AK 99516
Current Property owner(s) John Erik Andersen
Mailing address
Real Estate Agent
Day phone
7405 Grand Oaks Drive Crestwood, KY 40014
2. TYPE OF DWELLING:
7 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Four
4. TYPE OF WATER SUPPLY:
Individual Well
Fx�
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Waiver/Variance request
Received by:
Day phone
� RPF7POM 11
s
JC
Individual
0
Holding Tank
❑
Community
❑
Public Sewer
❑
COSA to be relea6ed"to the eeimeer, uWs otherwise requested by the engineer.
COSA Fee $ (o.q' W
Date of Payment 1011 Ig C�
Receipt Number onf3 l
COSA# oe?ctq 1510
Date: 1/ 1
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SIGNATURE
System #1 Approved for _± bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
Phone 522-7773
Date 10/28/2014
OF, 4
• 49TH
� �.MICHA�IF�,CvAWD€RSON : � �
® J : CE -4387
0rEssi`)
with the following stipulations:
By: %/. % Original Certificate Date: — 7r
ILI
The M rnicipa ofchorage 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 r _, c
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: Golden View Heights, Lot L-2
A. WELL DATA
Well type Private
Datecompleted 5/21/14
Total depth 126 ft.
Date of test
Static water level
Well production
If A, B, or C provide PWSID #
Sanitary seal (YIN) Y
Cased to 97 ft.
FROM WELL LOG
5/21/14
45 n
4 g.p.m.
Parcel 1D: 020-043-16
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >l 8 in.
r_TJ91►6'l:JxeyIrePl
HSI
g.p.m.
WATER SAMPLE RESULTS:
Coliform '' 0 colonies/100 mL NitrateCJ 195 mg/L
Arsenic � ug/L Dateofsample: 10/28/14 Collected by: Anderson Engrg.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 5/20/14
Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N
Date of pumping New Const. Pumper
C. ABSORPTION FIELD DATA
Date installed 5/20/14
Length 50 ft.
Total depth 8 ft. Eff. absorption area 500 fe
N COIIS t
2 GPD/SF
Soil rating (g.p.d./ftz or ft2/bdrm) 1.System type 5' Wide
Width 5 ft. Gravel below pipe 4 ft.
Monitoring tube Y Depression over field N
Date of adequacy test eW ' 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.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum _
Size in gallons
in. "Pump off" level at
E. SEPARATION DISTANCES
WELL ON LOT TO:
Cycles tested
Septic tank/lift station on lot >100'
Absorption field on lot >1 00'
Public sewer main N/A
Sewer /septic service line >25'
Animal containment areas >50'
SEPTIC/HOLDING TANK ON LOT TO:
>5'
>5
Building foundation Property line
Water main >10, Water service line >10'
Wells on adjacent lots > 100'
ABSORPTION FIELD ON LOT TO:
Propertyline >10' Building foundation >10'
Water Service line >10' Surfacewater >100'
Curtain drain None Noted Wells on adjacent lots >100'
Manhole/Access (Y/N)
in. High water alarm level
Meets alarm & circuit requirements?
On adjacent lots >1 00'
On adjacent lots >1 00'
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excrete storage areas >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that t 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 Michael E. Anderson, P.E.
Date 10/28/14
COSA brown sheet_10-10-12.doc
Absorption field >5'
Surface water >100'
Water main
N/A
Driveway, parking/vehicle storage > 10'
V*
�HAEL E. ANDERSON : A
CE -4381
PROFFSS10Na :4*
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in.
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PLOT PLAN
I
I
LOT L-3
N 89'57'36"E 190.25'
LOT L-2
47,049 s.f.
z
I
PIPES
1'x8.2' CANT
2.0'x28.2' CANT
2.0'x18.2' DECK
\ \-1.4'x3.3' CANT
i.O'x12\�' CANT
0'x10.0' SCANT
r
R=700, 10' T&E
PROTECTIVE RADIUS
S 89'58'25'W 190.
LOT 6K/
I — —
AS BUILT X SCALE i" = 40' GRID SW 3238 Project No. 14-020
Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049
(907) 522-6476 Phone ooF p
Registered Land Surveyors (907) 522-4625 Fax O q o=�/ pp
ken9langsurvey.com / jonathan®langsurvey.com �o `� ..........I
I hereby certify that I have surveyed the following described property: Q�
LOT L-2, GOLDEN VIEW HEIGHTS SUBDIVISION (PLAT 97-73) QQo 4.9TH 9*
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 Q
no improvements on the property lying adjacent thereto encroach on the surveyed�
0 _
0.... o
premises and that there are no roadways, transmission lines or other visible DA . KENNETH G. LANG x
easements on said property except as indicated hereon. Q
s
G
Dated this the Day of at Anchorage, Alaska OQ1'PFa '••LS -5202.••• yJpO
440pRorFSS10NAL �Qc
It is the responsibility of the owner to determine the existence of any easements, ppp�01ooa
covenants, or restrictions which do not appear on the recorded subdivision plat.
C
DECK
COV7."
'VJp
WA
I
PIPES
1'x8.2' CANT
2.0'x28.2' CANT
2.0'x18.2' DECK
\ \-1.4'x3.3' CANT
i.O'x12\�' CANT
0'x10.0' SCANT
r
R=700, 10' T&E
PROTECTIVE RADIUS
S 89'58'25'W 190.
LOT 6K/
I — —
AS BUILT X SCALE i" = 40' GRID SW 3238 Project No. 14-020
Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049
(907) 522-6476 Phone ooF p
Registered Land Surveyors (907) 522-4625 Fax O q o=�/ pp
ken9langsurvey.com / jonathan®langsurvey.com �o `� ..........I
I hereby certify that I have surveyed the following described property: Q�
LOT L-2, GOLDEN VIEW HEIGHTS SUBDIVISION (PLAT 97-73) QQo 4.9TH 9*
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 Q
no improvements on the property lying adjacent thereto encroach on the surveyed�
0 _
0.... o
premises and that there are no roadways, transmission lines or other visible DA . KENNETH G. LANG x
easements on said property except as indicated hereon. Q
s
G
Dated this the Day of at Anchorage, Alaska OQ1'PFa '••LS -5202.••• yJpO
440pRorFSS10NAL �Qc
It is the responsibility of the owner to determine the existence of any easements, ppp�01ooa
covenants, or restrictions which do not appear on the recorded subdivision plat.
I I
I
I LOT L-3 F- �
30.0, N 89'57'36'E 190.25'
LOT L-2
47,049 s.f.
n
0o
I
SEP ric PIPES
2.0'x8.2' CANT
Z Z 2.0'x28.2' CANT N
�/� oR 70.8' 3p? a 12.0'xl8.2' DECK I 0
OD
0o
Z / COVERED DECK N 81.4' m I LOT L-1
V J/ N N
�' DRIVEWAY r
/v I V
1.4'x3.3' CANT I �'
.0'x 1 �' CANT
r*1 2 O'x10.0' j�ANT
I \
o�
WELL I
R= 100, 10' TdcE EASEMENTS
PROTECTIVE
RaDlus The locailo I of Le siructure(s)as
—Ozon6 t IjS rid drawing
as -bunt) c res � Title 21,
S 89158'25-W 190 25'
I I LOT 6K
PLOT PLAN AS BUILT X SCALE 1' — 40' GRID SW 3238 Project No. 14-020
Lan & Associates, inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049
g(907) 522-6476 Phone
Registered Land Surveyors (907) 522-4625 Fax F / 4
kenOlang*urvey.com / jonothanOlongsurvey.com .`�. O
I hereby certify that I have surveyed the following described property:
LOT L-2, GOLDEN VIEW HEIGHTS SUBDIVISION (PUT 97-73) : 491H �*
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 .
premiss* and that there are no roadways, transmisslon lines or other visible O KENNETN G. f/gO
easements on sold property except as Indicated hereon. 00N....11� � OQQ
' :. • • .. •. S-520
Dated this the (y`� Day of w it �- l ,+ ; of Anchorage, Alaska Q� eaA ,. 05d0
v
�4p °q-sSIOHN. o
It Is the responsibility of the owner to determine the existence of any easements, 0�4�oodQ
covenants, or restrictions which do not appear on the recorded subdivision plat.