HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 2 LT 3Onsite File
D 2 .
E
Municipality of Anchorage
On-Site Water and Wastewater Program - (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181258 PID Number: 017-061-03
Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ® New ❑ Upgrade
Name:
BRIAN AHO
ABSORPTION FIELD - EXISTING
®Deep Trench El Shallow Trench EJ Bed ❑Mound
Address
5840 DE ARMOUN RD., ANCHORAGE
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
1.0 GPD/SF
9 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3 Ft.
Gravel depth beneath pipe
6 Ft.
Subdivision Block Lot
MOUNTAIN PARK ESTATES 2 3
Fill added above original grade
VARIES 0.84 — 0.85 Ft.
Gravel length
38 Ft.
Township Range Section
Gravel width
3 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
456 Ft'
Ft.
Well
100'+
100'+
NA
NA
NA
TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
ANCHORAGE TANK
Capacity
1000 Gal.
Surface water
1001+
1001+
NA
NA
Material
STEEL
Number of compartments
2
Lot Line
5'+
10'+
NA
NA
NA
Foundation
10'+
10'+
NA
NA
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
NA
*NA
NA
NA
Remarks
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
*None known.
Pump make and model
Electrical Inspections performed by
Installer NORTHERN EXCAVATION
PIPE MATERIAL House to tank 3034 d airfield 3034
Drainfield 3034 CO/MT 3034
Inspector FWCS / MNA
BENCH MARK (Assumed elevation) 100 ft
Inspection 15 8/20/18 2nd 8/20/18
Location and description
3rd 8/21/18 4" 7/16/19
BOTTOM OF SIDING
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
a:1%-`ft0k
0
® OF 4, 1
Conditional Approval: Date
MICHAEL N. ANDERSON: [�
Gj No. CE 9469
�
�---�1�U� _l�J
7/26/19...-' 6
..........
Approve l Date
® Onssio0", .w
IJPUIIVI1 rV PUI I_�-I-IL.000
MOUNTAIN PARK ESTATES 132, L3
11,9'
24.3'
Lot 2
ow
A -C=21.4'
B -C=15.4' FCO
A -D=25.5'
B -D=11.9'
B -E=17.4'
G -E=51.7'
B -F=35.7'
G -F=22.3'
N
C.1
PID: 017-061-03
PERMIT: OSP181258
LD SV.
0.6'000-GAL
TANK
3DV. 2GPD/SF a;
RRESERVE
0'L x 6'ED
12.0'G TH18-1 rn
Lot 4
O
0
O
CO t
F
Lot 3
TH#1 2015 36,991 s.f.
m
SCALE: V _
•CO GO CO CO CO CO /-MT
5_45 98.49 97.57 FINAL GRADE 97.56 96.7:
i INSULATION0,0
t 0 ORC
FILTER FABRIC
95.03
4.28 3.72 95.73 SP/SM
1.000 -GALLON SEWER ROCK
STEEL TANK
ORIGINAL GRADE
THy1 2015
DRY 5/29/15
SEPTIC SECTION 19' BOH
77.72)
SCALE: NTS
PREPARED FOR: SUPPORTOSERVICES:
BRIAN AHO � OF AZ l
MOUNTAIN PARK ESTATES B2, L3
5840 DeARMOUN RD., ANCHORAGE, AK 99516 * 491H 9*
Michael N. Anderson, P.E. DATE: 7/26/2019 -p MICHAEL N. ANDERSON
No. CE 9469
Af
Ancho age nAloska 99516 a Ave.
DRAWN: FWCS$0 7/26/19�,�
(907)727 8864/FAX: (907)345 1391 SCALE: 1" = 30' p�FESS10Ty��
Michael N. Anderson, P.E.
Civil/Structural Engineering and Construction
4661 Natrona Ave. Anchorage, Alaska 99516
Phone 345-3377 Fax 345-1391
SOILS LOG -PERCOLATION TEST
LEGAL DESCRIPTION: MOUNTAIN PARK EST. B2 L3
DEPTH
Reading
FEET
OG SOILS
Net
Drop
=, ORG/OL
2
6"
3
4.
6"
5
6
6"
7
SP/SM - fines
8
9
6"
10
11
6"
12
13
14
1
16
BOH
17
19
20
OF
*:4 9 TH
* *.0
MICHAEL N. ANDERSON.'
No. CE 9469 w
s
8/28/ 13. � • •' �$
ssto�
PERFORMED FOR: BRIAN AHO
TESTHOLE # 18-1 DATE PERFORMED: 8/17/18
GROUND WATER ENCOUNTERED: NO
IF YES, AT WHAT DEPTH: NA
DEPTH TO WATER AT MONITORING: DRY
DATE: 8/28/18
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
USE 2GPD/SF W/ ADVANCED SYSTEM FOR
RESERVE SITE 20'L X 2'W X6'ED.
Reading
Date Gross Net
Time Time
Depth to
Water
Net
Drop
8/18/18 10 min
6"
2 12/16"
"
6"
2 11/16"
"
6"
2 11/16"
6"
2 11/16"
"
6"
2 12/16"
"
6"
2 12/16"
PERCOLATION RATE 4 (MIN / INCH)
TEST RUN BEWTWEEN 4 & 5 FT
PERC HOLE DIAMETER 6"
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16 H
PERFORMED BY: FWCS /NINA - I MIKE N. ANDERSON CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT
ON THIS DATE. DATE: 8/28/18
Certified Drilling Log
DOC CO dba
®BILL 8& COLE
®�►ULLIVAN W
P.O. Box 670269, Chugiak, AK 99567 688-2759
OWNER OF LAND: Brian Aho
ADDRESS:
Bore Hole
Data
Depth
From
To
LEGAL DESCRIPTION Mountain Park Estates Block 2 Lot 3
DATE: 8-22-18
0
2
PERMIT NUMBER: OSP181258 DATE OF ISSUE: 8-16-18
TAX IDENTIFICATION NUMBER 01706103000
Is well located at approved permit location: ®Yes ❑No
Method of Drilling: Mair rotary ❑cable tool
Depth of Well: 315'
Casing Type: Steel Wall thickness .250 inches
Diameter: 6 inches, depth 315 feet
Liner type
Static Water Level: 274' feet
Recovery Rate 8 ® gpm ❑ gph
Method of Testing Air
Well Intake Opening Type: ® open end ❑open hole
❑ Screened Start feet Stopped
❑ Perforations Start feet Stopped
Grout Type: Bentonite Volume: 50 lbs
Depth: from 2 feet, to 42 feet
Well Disinfected Upon Completion: ❑yes ❑ no
Method of Disinfection: Chlorine 50 PPM
Comments:
2
4
4
82
82
84
84
87
87
204
204
215
215
219
219
269
269
271
271
291
291
301
301
315
Casing Stickup
Overburden
Silty Sand & Gravel
Sand
Boulder
Silty Sand & Gravel
Damp Silt w/ Gravel
Silt w/ Gravel Sand Dirty Water
Clay & Gravel w/ Silt
Silt & Sand Water
Silt & Sand w/ some Gravel
Tight Sand & Gravel
Sand & Gravel Water
Drillers Name: Cole Sullivan
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority.
Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation.
Matsu Borough: Department of Environmental Conservation.
www.sullivanwaterwells.com
Pump Installation Log
Well Drilling Permit Number: SW OSP181258 Date of Issue 8-16-18
Parcel Identification Number: 01706103000
Legal Description
Mountain Park Estates Block 2 Lot 3
Property Owner Name & Address
Brian Aho
Pump Installation Date: 8-28-18
Pump Intake Depth Below Top of Well Casing: 290
feet
Pump manufacturer's Name: F&W
Pump Model: 4F05A07301
Pump Size: 3/4
hp
Pitless Adapter Burial Depth: 10
feet
Pitless Adapter Installer: Northern Excavation
Disinfected Upon Completion? yes no
Method of Disinfection: Chlorine 50 PPM
Comments: Pitless Manufacturer: Martinson
Pump Installers Name: Sullivan Water Wells
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
4
N0PAlITYOe MUNICIPALITY OF ANCHORAGE
On-Site Water&Wastewater Program S.�
PO Box 196650 4700 Elmore Road
r.
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,�
Y 'qzhttp://www.muni.org/onsite
. 4f u
I)ciahrtmunt
4heNOPp6E
On-Site Water & Wastewater System Permit
Permit Number: OSP181258 Effective Date: 8/16/2018
Work Type: WellSeptic Initial Expiration Date: 8/16/2019
Tax Code Number: 01706103000
Site Legal Address: MOuNTA I N PARK ESTKTE S &LK L L✓J 3
Site Mailing Address:
Owner: AHO BRIAN Lot Size in Sq Ft:
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 3
This permit is for the construction of:
El Disposal Field 0 Septic Tank ❑ Holding Tank 0 Privy El 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
ISpecial Provisions:
The Engineer needs to do an additional test hole prior to the construction of the septic field. Construction may
proceed at your own risk before the 7 day water monitoring is complete. Please submit stamped and signed
results with the As-built Inspection Report. If the results require a design change, construction of the system will
stop pending On-Site review and approval.
Received By: Date:
Issued By: h,--97./ Date: v /' /3
Municipality ®f Anchorage '"�
! .
-"� P.O. Box 196650 ® 4700 Elmore Road
Anchorage. Alaska 99519-6650 ® (907) 343-7904 0 Fax (907) 343-7997
http://www.muni.orq/Onsite
Development Services Division
On-Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSC181061 COSA#: Permit#: OSP181258
PID#: 017-061-03
Legal Description: Mountain Park Estates B2 L3
Engineer: Mike N. Anderson
Applicant: Brian Aho
Your request for a waiver of the required 50 feet horizontal separation from the absorption field
to the excessive slope has been approved. The approved separation distance is 35.0 feet.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
Waiver is Granted: X Waiver is not Granted:
Date: OM Approved by: i`_ / .. ./
Narne of Reviewe
**** VARIANCE/WAIVER REVIEW ****
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 017-061-03
Property owner(s) BRIAN AHO 907-602-3858
Day phone
Mailing address
1630 EASTRIDGE DR. #303, ANCHORAGE, AK 99501
Site address 5840 DE ARMOUN ROAD, ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) MOUNTAIN PARK ESTATES BLOCK 2, LOT 3
Legal description (Township, Range & Section)
Lot Size 36,850 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field > Initial Single Family (SF)
(w/wo ADU)
Septic Tank > Upgrade
Duplex (D) ❑
Holding Tank U Renewal ❑ Multiple Dwellings ❑
Privy _ (SF and/or D)
Private Well R-
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
------) -
(Signatur.2f_pryrty owner or authorized agent)
Permit/Rush Fees: ql 7'• a' Waiver Fees:
Date of Payment: '/q/l8 Date of Payment:
Receipt Number: eL 16 1,9-- Receipt Number:
Permit No. DSPtc I Waiver No.
Permit App_9-1-1 2.doc
Michael N. Anderson, P.E.
Civil/Structural Engineering and Construction
4661 Natrona Ave. Anchorage, Alaska 99516
Phone 345-3377
Fax 345-1391
August 13, 2018
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: New Well & Septic Permit& Slope Waiver
Legal: MOUNTAIN PARK ESTATES BLOCK 2, LOT 3
To whom it may concern:
This is a request for a 35' waiver to slope with a new well and septic permit on the above referenced lot to
serve the proposed 3-bedroom house. Test holes were excavated and found clean for the entire depth. A
conservative application rate of 1.0 gpd/sf was used in lieu of 1.2 gpd/sf. A simple deep trench was
designed with an effective depth of 6 feet. No water was measured in the test hole during or after the
excavation. The slope at the proposed trench is location is 10-15% and 35' from the top of the 45% slope
as shown on the design.
Based on the subject and adjacent lots soils data,the alternate site will be located at the location noted on
the design for a testhole to be performed prior construction. It is anticipated that based on these area soils
a conventional system will act as the alternate site—otherwise an advanced wastewater system will be the
reserve. The lot and area is served by private water and this septic system and well will not impact any of
the neighboring properties due to the lot layout.
Please call me if you have any questions.
Sincerely,
Michael N. Anderson, P.E.
Phone 907-727-8864 'VW 8
cel 1013
215-'
o1 069163000
DESIGN CRITERIA: OUND OVER
TH#1 1,0' 41.111LRADE
3 BDRM X 150 = 450 GPD _10,• DRG
SOILS = 450/1.0 = 450 GPD ILTER FABRIC
450 GA/12 = 38' _3, _•� •'0 PIPE
SEWER ROCK
(1) TRENCH
9' DEEP SP/srn
6.0' EFFECTIVE _9
2.0' WIDE -19.0' --0-1 z,
38' LONG
SEPTIC FIELD SECTION
DEARMOU'
rillirs ,:4444,:lir. .4
mill
1,1%46.,0
.......„..
. i v ',our
1 I%
Or ')
4 .pUPf!rr
ftmodm
Septic Design Prepared for AW671&'�‘
BRIAN AHO �� of A4J t
MOUNTAIN PARK ESTATES B2, L3 �� 1— 171
+
5840 De Armoun Road Anchorage, Alaska / * l * /
Michael N. Anderson, P.E.
1QCHAEL N. ANDERSON.
DATE: 8/8/2018 1�� No. I H9 /
4601 Natrone Ave. DRAWN: First Water Con. Srv.
Anchorage, Alaska 99516 1„ ,,,, e444'/
9 ssioK i
(907)727 8864/FAX: (907)345 1391 SCALE: 1” = 100' �`_7110:41.P.
I— 0 i
PROPOSED
WELL LOC. o
WELL LOC.
TH#2 1:•• \
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12. .1......
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ns
icy"
ROOF OVERHANG 111
go Amt.m co '
0
FoR RESERVE
6.0 I
WELL LOC. i.4 x �
. . �. + . of
M 3_BR HOUSE o CO In
N) 1 .0' .r 12.•' i c0
w
•s o- .TPROPOSED Lot 4
Lot 2 16.4 ��.'J,_— ._co s o SANK ,,.3
10' TO FOUN• J'
iO 5' TO DECK 1- o EXISTING
o SUPPORTS % TH#1 p SEPTIC
o '\ PROPOSED FIELD 4
v) \04,...
OLP t
\It
ABANDI) D . • . • . . . • •
SEP �$ . . ••
•o
K
EXISTING . •.05� K
SEPTIC • .COQ
•
•
•
Lot 3
36,991 s.f. 30' UTILITY EASEMENT
Septic Design Prepared for _�OF ‘\
BRIAN AHO <S ) •
MOUNTAIN PARK ESTATES 82, L3 d 491 �c * ,
5840 De Armoun Road Anchorage, Alaska �/o FA
Michael N. Anderson, P.E.
MICHAEL N. ANDERSON.
DATE: 8/8/2018 `, Na gi
4601 Natrone Ave. �4
e Alaska 99516 DRAWN: First Water Con. Srv. 1 � / e'/
Anchorage, ssto��
(907)727 8864/FAX: (907)345 1391 SCALE: 1" = 40' \�`�
'Municipality of Anchorage y +4tINEER sE•pky,f_��a
/ 1r
/� Development Services Department " :�
On-Site Water and Wastewater Section ei : 49T T N •-.4-
• e
0 4700 Elmore St. r •
0,
P.O. Box 196650 Anchorage,AK 99519-6650
N► ' www.muni.orq/onsite r r
/ /.,•• MICHAEL/,'. ;y.N. ANDERSON :;� r4
ej(907)343-79049p( w
Soils Log - Percolation Test ll PR FSctp',`N-=
D
Performed For: (3i,„.4 (0 Date Performed: 5 L /5
Legal Description: rAU;Art h1,, Pr,'(ti s 4 f,v , Township,Range.Section:
6 z_ ,...0 2 S'ope Site Plan
Depth
(Feet).
U• JA . -
2- . fit {)( 0 0
3-
4 I
5
p7470 . . .
7-
8- Iry 0 S
WAS GROUND WATER D
9-
S o n ENCOUNTERED? 1 v
S
10- V1/41/
�// IF YES AT WHAT DEPTH? L
Depth to Water After OP
11 Monitoring? E
4, 4 tvreve„,
12- Dale 0 Vi<
13-
14- Reading /Date Gross Time Net Time Depth to Water Net Drop
15- '5.-/7 7 //S-. /t7m,n yI 5 ii
16- l0 't 5-//
17- C0 't 5::
20
1a L" S
19--�____ 1/'
' ,771v41
PERCOLATION RATE Z, (nnutes,inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 4' FT AND 5- FT
COMMENTS
PERFORMED BY: 1 1N..1{` I CERTIFY THAT THIS TEST/WAS
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: i51/4(
MUNICIPALITY OF ANCHORAGE
And
Development Services Department
On -Site Water & Wastewater Section
Certificate of On -Site Systems Approval
Parcel I.D. 017-061-03
1. GENERAL INFORMATION
Phone: 907-343-7904
Fax: 907-343-7997
Expiration Date: , / _ T —1
Complete legal description MOUNTAIN PARK ESTATES BLOCK 2, LOT 3
Location (site address) 5840 DE ARMOUN ROAD, ANCHORAGE, AK 99516
Current property owner(s) JAMIESON BARNES Day phone
Mailing address 1630 EASTRIDGE DRIVE #303, ANCHORAGE, AK 99501
Real estate agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well ®
Private Septic
Water Storage ❑
Holding Tank
❑
Community Well ❑
Community
❑
Public Water System ❑
Public Sewer
❑
Waiver request for:
Distance:
Received by:
Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $J
Waiver Fee $
Date of Payment 112-9 10
Date of Payment
Receipt Number
Receipt Number
'
COSA # 0 AJC l ql 0(4�-i/
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377
Address 4661 NATRONA DRIVE, ANCHORAGE, AK 99516
Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 7/26/2019
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. 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, any estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by Fwr.s and Anderson Construction & Engineering.
6. DSD SIGNATURE
System #1 Approved for -1— bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
.-4�'k
Air :. ..F. AL
/ '4 •/
I� MICHAEL N. ANDERSON:' a
No. CE 9489 w j
1 .7/26/1.9• •' '
\ AW
FESS1010
bedrooms, with the following stipul�ftgfflFff,,,
�ii�, SERVIC�s_�.•��
1111)11,11
By. Original Certificate Date: 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
Legal Description: MOUNTAIN PARK ESTATES BLOCK 2 LOT 3 Parcel ID: 017-061-03
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
® Well log is filed with Onsite (or attached)
Date drilled 8/22/2018
Total depth 315 ft
Cased to 315 ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSH 8/22/18 — NEW WELL
Static water level at beginning of test 274 ft.
Well production at time of test 8 gpm. WELL LOG
Comments
B. TANK DATA — 8/21/1018 - NEW 1000 -GAL
Age of tank(s) 0 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank
® Standpipes/foundation cleanout per record drawing
Date of pumping NA — NEW TANK
Structure served by this system
Water storage tank volume_ gallons
Well disinfected for coliform test? ❑ Yes ® Nc
® Coliform bacteria is Negative
Nitrate 2.12 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
Collected by
WES
Date of Sample 7/16/2019
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA — 38'L x 3'W x 6'ED —1.0 GPD/SF = 456 SF
Which system tested (date installed) NA — NEW FIELD
® ALL standpipes present per record drawing
Total measured depth from grade 9_8 ft (max)
Measured depth to pipe invert from grade 3.8 ft (min)
® N/A — pressurized field
® Monitor tubes go to bottom of effective. If not, state
depth into effective
® Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist copy 5.docx
Adequacy test date NA — NEW FIELD
Results ❑ Pass For 3 bedrooms
Fluid depth prior to test — in
Water added _ gal
New depth _ in
Elapsed time min
Final fluid depth _ in
Absorption rate gpd
Any rejuvenation treatment (past 12 months) N
If yes, enter date
FWr,
MA
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
® Yes
if No
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No ft
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No ft
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ® Yes
if No ft
® Yes
if No
ft
ft
If septic tank is under driveway comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
® Yes
if No
ft
Surface Water > 100'
® Yes if No ft
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
Private Wells > 100' ® Yes if No —ft
Absorption Field > 5'
® Yes
if No
ft
Private Wells >100'
® Yes if No ft
Water Main > 10'
® Yes
if No
ft
Community Wells > 200'
® Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
® Yes
if No ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No _ ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No ft
Private Wells > 100' ® Yes if No —ft
Water Service Line > 10'
® Yes
if No ft
Community Wells > 200' ® Yes if No ft
Surface Water > 100'
® Yes
if No ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and review
of Municipal records that the above systems are in conformance
with MOA COSA guidelines in effect on this date.
COSA Checklist copy 5.docx
OF 1,1111,
......... ��
'4.9 Tx
MICHAEL N. ANDERSON.
No. CE 9469104
W
7/26/19 0�
DEARMOUN ROAD
" o
p \ IJ
/110.2 \
N 86.22'26'E 3' �'---------
/ ._.--._-----
WELL
I 100 PROT TiVE RAIDUS
N }
v ? .
\ 12.3'x16.3' SHED '.
P., .
p
5.4'x9.3' PORCH
16.5IR
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n 2 STORY
\ o
n � RESIDENCE 1 n
n ,. 12.0' ; 1 52.8'
1z.o• _ Lot 4
W G17,4'0
Lot 2
PIPES
8.1'x12.0' BALCONY
w/ DECK BELOW
Lot 3
36,991 s.f.
30' UTILITY EASEMENT
Unsubdivded
PLOT PLAN AS BUILT X SCALE 1: —=4C' GRID SW 2938 Project No. 18-372/65
Associates,
Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone o
� o(907) 522-4625 Fax 4`�Professional Land Surveyors kenOlangsurvy.com
jonafhanOlangsurvoy.comopp..p..�..eC4 Q
Q�
44
S 0
I hereby certify that I have surveyed the following described property: G'�0��'�4�
LOT 3, BLOCK 2, MOUNTAIN PARK ESTATES (PLAT No. P-461) 49T --
H
-------- ••.. dp
Anchorage Recording District, Alaska, and that the Improvements situated ihorson are V,'•'-----
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 KEN ETH lA s
premises and that there are no roadways, transmission lines or other visible rc ry o G
easements on sold property except as Indicated hereon. Q�O4 Pte'?`5-5�0�.-'-•J�AOO
Dated this the 2 A'. , Day of ITuw 'Lo l°1 of Anchorage, Alaska e a No v
SSIONA-
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
