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Municipality of Anchorage 1d
On-Site Water and Wastewater Program• (907)343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181179 PID Number: 014-172-11
Dwelling: El Single Family(SF) 0 Duplex(D) ❑ Multiple(SF and/or D) Project: ❑ New ■❑ Upgrade
Name: ABSORPTION FIELD
Sherman Reynolds
Address ❑ Deep Trench 0 Shallow Trench ❑ Bed 0 Mound
2848 Lore Rd. Anchorage, AK 99507 0 Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
317-3617 3 1.2 GPD/SF 11.6 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 7.6 Ft. 4.0 Ft.
14 W2 Fill added above original grade Gravel length
Township Range Section 0 Ft. 38 Ft.
12N 3W 9 Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 5.0 Ft. Ft.
To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Tank Line 380 Ft2 1 Ft.
Well >100' >100' N/A N/A >25' TANK 0 Septic 0 S.T.E.P. 0 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.
Pump on level at Pump off level at High water alarm at
Remarks
in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank Exist. Tank to D3034
Installer drainfield
PCN Drainfield D3034 CO/MT D3034
Inspector J. Millette BENCH MARK (Assumed elevation)100 ft
Inspeectio 1I 7/23/18 2"° 7/24/18 Location and description
a3'd 7/24/18 4th Garage Slab.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp��```\,\
.4.1-1'"G OFA �kk
Conditional Approval: Date i�Q' •gS,�i4
. 49 /\ •.* pl
#11
Z.ami
Michael E.Anderson
�p��� auctrU
���PF�� 381E •'s.-- /Approved . '�JI I�' CCA Date (01/18 �l F9F°PROF o��'`.�
�l‘‘‘,N,-%.- -%.16.---
Inspection
ES ��
Inspection Report_9-1-12.doc
Iv ) ' GE
ENGINEERING
PO BOX 240773
ANCHORAGE,AK 99524
522-7773 677-7766(FAX)
August 13,2018
MOA Development Services Dept, On-Site Water&Wastewater Program
4700 Elmore Rd
Anchorage,AK 99507
Subject: T12N R3W SEC9 L14 W2—Separation to groundwater
Dear On-Site Services Engineer:
The design of this system included a test hole showing no groundwater or impermeable soil layer
down to 15' and a profile that was 9'to the bottom of the trench.However,during the construction,
the elevation to the existing septic pipe coming out of the home was lower than expected. The
bottom of the trench ended up 2.6' lower than design. This left a separation of 3.4' to the bottom
of the test hole.
In this neighborhood,there is no evidence of shallow groundwater,bedrock,or clay. Test holes on
neighboring lots all show sand to the bottom with no groundwater:
T12N R3W SEC 9 Lot 15 W2 17' deep No groundwater
T12N R3W SEC 9 Lot 15 E2 16' deep No groundwater
T12N R3W SEC4 Lot 59 W2 20' deep No groundwater
In addition,the well log for the property to the southeast(Nadine Lot 20A 1)shows sand and gravel
down to 32'. We request approval for this system based on these historical test hole records.
Sincerely,
4°F• :qs,�i 1+�
Benjamin Schiller, PE Ave' . ..1; ':9
*:49TMvigF
_ A . ..
r+. Benja 7 chiller
4414.'4
°.CE1132/51982• . ;
L. „*` ..r
o�ss �
// // // // // // // // // // // // // // // // // // // // // // // // // // //
CL
ALTERNATE SITE
100500
FEET
1"=50'
EXISTING WELL
NOTE:
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE
PROPOSED SEPTIC SYSTEM
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC
SYSTEMS.
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
LORE ROAD
PERMIT # OSP181179 PID # 014-172-11
T12N R3W SEC9 L14 W2
A B
SV1 73.3
SV2 76.7
A
B
2CO 78.1
CO1 80.8
MT1 80.3
CO2 62.9
40.1
46.4
49.4
53.9
56.4
70.0
IRRIGATION WELL
GATE
3-BD
R
M
H
O
M
E
THA
THB
1000-GALLON
SEPTIC TANK
38' LONG x 3' WIDE x 5'
EFFECTIVE DEPTH
ABSORPTION TRENCH
EXISTING
ABSORPTION
TRENCH
EXISTING ABSORPTION
TRENCH ABANDONED IN
PLACE
CO2
CO1 MT
2CO
EXISTING WELL
1
0%
1
0%
1
0%
EXISTING SEPTIC TANK
DECOMMISSIONED IN
PLACE IN ACCORDANCE
WITH MOA CODE
FCO
SV1
SV2
Aug 08, 2018
T12N R3W SECS L14 W2
PERMIT # OSP181179 PID # 014-172-11
O <vO
U
LL (n (o CV
- - 100.8 — — —
— — /— 92.9
v E
94.5 J `� 91.8
92.3 1000 GAL 92.1
SEPTIC TANK
J '''' '"•— 87.9
�
2 99.0 ORIGINAL/FINISH GRADE UU
A�,.`3.(Y;.4 -aggSieh Li4 •5^a-,ra-:.. 1f. T�i� t• $� i»v� vu.w.
_
91.4 >t�ayS �,24ya43".FJ•,.l jE•v?^c.srf.4.6> Y.•ri4•, d'1ay�e
' Q � EY
91.4
Lt...
;".1; ' Z�rKx-4' � :jyS � Yi'�x }� .;� �it�+ , ' y � y.. vSL
' � �V2w:.. C^r'P7'�w , 7`tihc : yy+ Y. Hffr.CuwK. � `_ i,. .
I — 87.4 38' 87.4 —
84.0
NO GROUNDWATER 6/09/18
H
i Ft
*:49TH 1\ •*+r
PROFILE AS-BUILT �70.. Benja ' chiller i
•) CE 12592 •\•`�/
*fGE 4.. Aug 08.2078 .• �
(NO SCALE) ��l`\\\""�4�
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
P0Box 1866s 470OElmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
PermitNumber OSP181179
Work Type: Septic Upgrade
TonCode@unnber 01417211000
Site Legal Address: T12NR3VVSEC 9 L 14W2 G:2234
Site Mailing Address: 280OLORE RD, Anchorage
Owner: REYNOLDS SHERMANSURVIVOR'S
Design Engineer: FORGE ENGINEERING
This permit isfor the construction of:
Effective Date
Lot Size in Scl Ft:
Total Bedrooms:
7/11/2018
7/11/2019
103338
2 Disposal Field 2 Septic Tank [] Holding Tank
[] Privy [� Private Well [] Water Storage
All construction shall beinaccordance 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
VVastovvabar 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 15.85.Provide notification bycalling (907)343-7QQ4(24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall beeither:
a. Opened and Closed onthe same day, or
b. Covered, sealed, and heated to prevent freezing
Received By:
Issued By:
3
~
/
/ / / -��.
l�r �uuV|��� -L� ,� �� /< �// V*� K ���� / ( -7 / ��
^~' --- V -- � - ^ ~vv � - -- ~ .
Date: X /
Date: /
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 3148-9'
On-Site Water & Wastewater Program (\:b 041,41 f
ON-SITE SEWER/WELL PERMIT APPLICATION z
JUL 0 5 2018
Parcel I.D. 014-172-11-000 w
Property owner(s) Sherman Reynolds Day phone �� 6 L 9 c�
Mailing address 2848 Lore Rd. Anchorage, AK 99507
Site address QUO Lore S`aa
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section) T12N R3W SECTION 9 LOT 14, W2
Lot Size 103,338 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field Ix1 Initial n Single Family (SF) H
(w/wo ADU)
Septic Tank Upgrade Duplex (D)
Holding Tank ❑ Renewal 1 1
Multiple Dwellings
Privy U (SF and/or D)
Private Well ❑
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.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5coeiI•vo Waiver Fees:
Date of Payment: 1 I ( Lt Date of Payment:
Receipt Number:, 01S�,2-�0 Receipt Number:
Permit No. 05 Tpig�1i 9 Waiver No.
Permit App_ • ::.,c
1, 4 ' GE
ENGINEERING
PO BOX 240773
ANCHORAGE,AK 99524
522-7773 677-7766(FAX)
July 9,2018
Municipality of Anchorage
Development Services Dept-On-Site Water&Wastewater Program
4700 Elmore Rd
Anchorage,AK 99507
Subject: T12N R3W SECTION 9 LOT 14 W2—2800 Lore Rd.
Septic System Design and Permit Application
Dear On-Site Services Engineer:
The owner of the above lot intends to sell the property in the future and would like to upgrade to
a new 3-bedroom septic system. We are submitting this design and permit application for the
construction of a new septic system. The attached site plan identifies the location of the home
and the existing well, proposed septic location and alternate site and the existing septic location.
No conflicts exist between the proposed system and any other wells or septic systems either on
this or adjacent lots.
The ground surface of the proposed septic location on the lot is relatively flat. There are no
slopes greater than 25% within 50 feet down slope of either the primary or alternate site. Storm
water drainage will not impact this septic system. The new trench will be constructed parallel to
the slope as much as possible.
Wells on this and adjacent lots are shown. The new system 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 12' away.
Please refer to the attached test hole log, soils lab analysis, plan and profile sheets for the septic
design. If this design is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
�O",F A‘\qSi�
Michael E. Anderson,PE 1E•49 TH •,k
•• Michael E.Anderson
r 9F•• 4381-E
9 41: 7/9/18 •,cv ••
T12N R3W SEC9 L14 W2
LORE ROAD // N
_ /
i � '‹N .
\ ` , � � // EXISTIN �W` L � ��`\
„I . .
W2 L,,OT 14 II
EXISTING WELL i } \ •• 0 •
I j. \ •_ I
)//'
... . . .
..
:. . /
/ /
/ / ilk
� :.j . /0
� , 0
/ o7," .5, .......
f / - - - -
/ ,,�
\-- 4 FCO
.it i I-GALLON
N DECO MISSION /S "TIC TANK
XISTI G SEPTIC TRACT A
!WACO_9 RDANCE WITH
MOA Cti• . — — ' -� 11
EXI ING •
,TH
ABSORPTION y •
TRE CH •1 i CO ,o, • — — — /
/ ,TH' :�' �.!' EXISTING /
ABSORPTION
/
G.•' / TRENCH
'�o . o \ LOT 16
38'L*NG x3'WIDE xS �••• ��
EFF TIVE DEPTH \o / \
ABSORPTION TRENCH / IRRIGATION WELL \
/ \ LOT 15
\ - -
I LOT 14
I — —
r I .
\ / LOT13
�4 ' GE \ /
NOTE: \ / — —
•`����"%k NO SLOPES>25%WITHIN 50'OR SURFACE WATER WITHIN 100'OF THE LEGEND
/�07 .OF4‘.4k11, PROPOSED SEPTIC SYSTEM CO CLEANOUT
j*'49 j� *9 ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS 2CO-DOUBLE CLEANOUT
•• ••• •••• •• -.(1,1_,, PROPERTY ARE SHOWN.NO CONFLICTS WITH WELLS OR SEPTIC FCO-FOUNDATION CLEANOUT
7y� SYSTEMS. MT-MONITORING TUBE
SV-SEPTIC VENT
FA •. Michael E.Anderson . 00 0 im
50 Ell 100
0OAF;•• 4831-E *(`Qi 0 FEET TH-TEST HOLE
IItFgF�ROFEOSSIO�,� . �-
��‘\\Nve"' 1 —50'
T12N R3W SECTION 9 LOT 14, W2
DESIGN FACTORS: SYSTEM REQUIREMENTS:
450 GPD PEAK FLOW 3' WIDE DEEP TRENCH SYSTEM
PERK RATE: 2.9 MIN/IN 1000-GAL SEPTIC TANK
APPLICATION RATE: 1.2 GPD/SF
450 GPD / 1.2 GPD/SF / 5' DEEP /2 SIDES = 37.5 LF TRENCH REQUIRED (38 LF SPECIFIED)
BOTTOM OF TRENCH: 8' BELOW GRADE
FLOW LINE ELEVATION: 3' BELOW GRADE
TOP OF TRENCH: 6" ABOVE GRADE
6"
_ =III=III-III=III=III= -
T III--III-III-III-I 11-I I I
1=1 11=1 Hal EI 11-I 11-1
III-III-III-III-I I 1=1 I
1111111-11111111111IIIIIIIL 111111
2'-6' 1=1 I -1 I 1=1 I1=11I-111=-1
111-111-III-111-111=111
1=111=111=111-111=1 I 1=-1
111=1 11=111-1 I =1111 I I
61,
4" PERFORATED PVC (HOLES DOWN)
�'."9'9;9;9;9;9;9;9 9;9;0'- DRAINFIELD ROCK
•;9;9;9;9;9;9;9;9P9 .; . 9.
9999�::::::::::::::::::::::;:•
9999 :::
:::::::::;:;9999 100::::::::.
:::;:;:;:;:;:::::::::;:::::;,
9:9;9; ::::::::::;9:9:9:9.
9:9:9:9:::::.:::9:.:::::::::.
.0,;10:10:10:10;110:9:10:10.
3'
GE
I n4iN EEPING
TYPICAL DEEP TRENCH SECTION -`�'`F
.'4c9 ,
t
(NO SCALE) i��Q•
4� !F,9�+
49TM
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY %Zy
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' # '. Michael E.Anderson
WITH 2" OF INSULATION fr<.jsl�., 78�oElE�• Age•
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER 1k, ��PgO....0HP�
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY \�N 1%-�`
yam`N.N.\\‘
MUNICIPALITY OF ANCHORAGE �`,�oFA.. A., k
DEVELOPMENT SERVICES DEPARTMENT *S TM �\Ft.:.,A
4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 ��� )`y-L- ���„„/,
SOILS LOG AND PERCOLATION TEST % •. Michael E.Anderson/
TO 1'F••lk , 4831-E 1.-S-.-/.24.. %
LEGAL DESCRIPTION: TI2N R3W SECS L 14 W2 kk e°PROFESSioo`-��
PERFORMED FOR: SHERMAN REYNOLDS ����x\�*~
DATE: 6/01/18 PROJECT No.: Professional Engineers Stamp.
PARCEL ID#: 014-172-I I TECHNICIAN: J. MILLETTE / N. SHAFER
DEPTH TEST HOLE A
(feet)
1 1r.LL U 1' OB SLOPE SITE PLAN
2 „ ��
3 :.10.
4h�
. 1 >; ;
5 _y • NZ SEE SITE PLAN
7 —" -.1c4:4',1';.'i SAND
`8 SP/SW
9
1 0 3. ., WAS GROUND WATER ENCOUNTERED? NO
it ° IF YES a WHAT DEPTI I? -
;� DEPTH OF WATER AFTER MONITORING: NONE
11 �,.� X< F^ DATE OF MONITORING: 6/09/18
"g 4kyi
12 /
A`9�y�`C
DEPTH TO
} "�WDATE READING GROSS TIME NET TIME WATER NET DROP
13 (MINUTES) (MINUTES) (INCHES) (INCHES)
14—W.:;0.,, 6/01 TEST HOLE PRESOAKED PRIOR TO TESTING:
15 ,'j��" .`' 1 11:33/11:43 10 4/816 4 1s
16 2 11:44/11:54 10 4/lis 314
16
3 11:56/12:06 10 4/71s 3 s
17 4 12:08/12:18 10 4/716 316
18 5 12:20/12:30 10 4/716 31s
19 6 12:32/12:42 10 4 1 716 316
20
PERCOLATION RATE: 2.9 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 1 FT. and 2 FT.
COMMENTS:
MUNICIPALITY OF ANCHORAGE OFA ��l�l
DEVELOPMENT SERVICES DEPARTMENT :1114:4* �••
4700 ELMORE ROAD ANCHORAGE, AK 99519-6650 *•t�49 !� *9
7.�k . ., '''S
SOILS LOG AND PERCOLATION TEST �/ •. Michael E.Anderson
�t+11�14.- Yg1 p'1.13(�r�
LEGAL DESCRIPTION: 1 I 2N R3W SEC9 L14 W2 iFDPROFESS'\ONa
PERFORMED FOR: SHERMAN REYNOLDS `���‘\\%`
DATE: 6/01/18 PROJECT NO.: Professional Engineers Stamp:
PARCEL ID#: 014-172-11 TECHNICIAN: N. SHAFER
DEPTH THB
(feet)
1 SLOPE SITE PLAN
2 SP/SW
3
4
5 SEE SITE PLAN
6
7
8
9
10 WAS GROUND WATER ENCOUNTERED? NO
IF YES @ WHAT DEPTH? -
11 DEPTH OF WATER AFTER MONITORING:
DATE OF MONITORING:
12
GROSS TIME NET TIME DEPTH TO NET DROP
13 DATE READING (MINUTES) (MINUTES) ' WATER (INCHES)
(INCHES)
14 6/01 TEST HOLE PRESOAKED PRIOR TO TESTING:
15 1 12:58/13:08 10 4/81-s° 412
16 2 13:09/13:19 10 4/716 3 14
16
3 13:20/13:30 10 4/7 1 3 s
17
4 13:31/13:41 10 4/716311
1s
18 5 13:42/13:52 10 4/716 31
6
19 6 13:534/14:03 10 4/71s 3 a-
20 20 -
PERCOLATION RATE: 2.9 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 1 FT. and 2 FT.
COMMENTS: PERCOLATION TES I ONLY. NO MONI FOR TUBE SE 1. SAME SOIL AS I HA.
Hea and Environmental ])rorer
Fourlh Floor Wost
825 L Street
Anchorage, A]aska 9950]
279-2511, x 224, 225
TII.E DRAIN FIELD:
[)IS]ANC[ I ROM W I ./~/~ //F IO(If4i)AllO;q r,l. AiTt SI
1RI [~l(~t ,,'/l()fH~ !rq¢- TOIAL LI'[I[CIIV~
Log Crib .... ii ~ ll(J s
I01,:t t_l i ECIIVf
Well~ /~ Depth: - ' , ·
I
We].! Distance,To: Lot LJ.n~---
Bldg: ~ewer Line: ....
I"II':IX .L t"1i,,,11"1 htlJl 1[,. LN Cfi: BI~I)t~'.I:)CIi"I'i~; =
I::1 I:'P:ICI-::iFII::}iI::: I::'l...l:':li",! I HFI'.r' I~:E: :1: I",tS I FILL.Ii:I) Iq I i ,LI[:~ F'E:I',:.'H I il [::~L{ '" ~:~, OPI ]: CII",I '.E;I...IEiL.] I'_"Zl::: '1' '11/:1 IFII!E
F i.::[i..LCLkl ).. iqIJ~ COI',ID ]: I ] Oiqti::;:
:L [~.J: IHICI"~: I':1 I.::LF:I?~;?:i!; i (::114'. ]: ]: I",1('};I': HI::'[,'B'.(3',/L~:D PLIdI",IJ P'IP:IM I.~:E :[N~71'FII_I._[:[I:::,.
;::L F:I Cl::ll'.,I i :[ j'..ll...ll::tij:~; I"IFI :[ I",t I I::NFII'.,IC:F£ FII:~iI,?.E:[EI',IE:I'.~ [ :1: ~:i; I-,?.[~L:~I.J :[ I;:'.1.~_:1). ]: F I::1 I"IFI I I",1'1 [}:I",IFII",tC:[(
FIl.::if,:tEJ-::i"lt::]",ll :!.'?; i",t()1 I-([:!:1:::'1 C:Llla~.I~[".I",II './OIJ I"lFlk' E[I~: N:L-):i.!I...III:<I~:D
FIBSCII-,?.F'I ]:O1",1 '.E;"r":~;]l'~:l'l FII",ID,-/CII:'?. YOU P'IB"P I}J;E SLIEkJL:':L.:I 'ICI
q-l-I _,HI_
L(~
DA'~J~RECEIV ED
INSPECTION APPOINTMENTS ~-(' '~ L.I,.~ I ~
TIME TIME TIME
~-ATE -, DATE DATE
NSPECTO~x iNSPECTOR NSPECTOR
MUNICIPALITY OF ANCHORAGE ~UN~CIPALI~ OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH &
825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION
( ENVIRONMENTAL SANITATION DIVISION OCT 2 g 1979
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1, Incomplete req,ests wild not he processed, Please allow ten (10) davs for processing,
~ PROPERTY OWNER . PHONE
MAILING ADDRESS
PROPERTY RESIDENT(If different fmmabeve~ ~ ~ ~HONE
2, BUYER PHONE
7~.
~/E~
3
MAILING ADDRESS
3~ENDING INSTITUTION PHONE
~AILIN6 ADORESS
4. REALTOR/AGENT PHONE
~AILING ADDRESS
"~--~EGA L DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS
[~ [] One [] Four
SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [~' Three [] Six
[] Other
7. WATER SUPPLY
~ INDIVIDUAL~ ~' ATTACH WELL. LOG. A well log is reouired for all wells drilled
~ COMMUNITY smce ~lune 1975. For wells drilled prior to that date, give well
~ PUBLIC UTI LITY depth (attach mg if available.)
8. SEWAGE DISPO,~iAL SYSTEM
~[~* INDIVIDUAL/ON-SITE'" \C)~'~.'~ YEAR ON-SITE SYSTEM WAS INSTA_LED.
[] PUBLIC UTI LITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQtJEST BEFORE PROCI-'SSING CAN BE INITIATE[).
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [~ OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] I NDIVI DUAL/ON-SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[~Septic Tank or [] Holding Tank
Size: ~'~(~ ~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to near0st Lot Line
5. COMMENTS
[] APPROVED FOR BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
~L~-.~DISAPP ROVED
72-010 (Rev. 6/79)
POUCII 61i50
ANCliO?AGE, Al AS<A99502
· ,9 · .71 I
October 24, 1979
' Marlow L. Skinner
2800 ]Lore Road
Anchorage, Alaska 99507
Subject: T12N R3W Section 9 W% Lot 14
Approval for your individual sewer and waker
can not be granted until the following items
compleked:
facilities
have been
(1) The top of the well casing sealed with a sanitary
sea]_ so that it is water tight.
(2) The water analysis report be delivered to this
office from Chem Lab, 5633 B Street, for our
review.
(3) The cleanout to the septic
above ground level.
tan]< needs to be raised
Please notify this department for a re-inspection when the
noted descrepancies. If there are any further questions,
contact this offioe at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: Alaska First Mortgage Corporation
207 East Northern Lights Boulevard
99503
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
Environmental Health Division
CASE REVIEW WORKSllEET
CASE NUMBER: DATE RECEIVED: ~ ,~, COMMENTS DUE BY:
8-8668 August 5, 1987 '-~"-:~[V August 28, 1987
SUBDIVISION OR PROJECT TITLE:
Lot 1 Tannie Subdivision '0 i ,~V' 3
( } PUBLIC WATER AVAILABLE ( ) PUBLIC SEWER AVAILABLE
( ) COMMUNITY WATER AVAILABLE
71-014 (Rev. 5183)
PRELIMINARY PI.~.T APPLICATION OFFICE USE
Munlcipldlty of Anchorage REC'D BY
DEPARTMENT OF COMMUNITY PLANNING
P.O. Box 6650 VER~V OWN
Anchorage, Alaska 99502-0650
A. Please fill in the information requested below, Print one letter or number per block. Do not write in the shaded blocks.
1. Vacation Code
0. Case Number (iF KNOWN)
2. New abbreviated legal description {T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOTS 34).
3. Existing abbreviated legal description (T12N R2W SEC 2 LOT 45 OR SHORT SUB BLK 3 LOT 34) full legal on back
page.
4. Petitioner's Name (Last- First)
5. Petitioner's Representative
Address 2221 E. Northern Lights Blvd. Address 4040 "B" Street
City Anchoraqe State AK 99508 City Anchoraqe State AK 99503
Phone No. 276--1451 Bill Me Phone No. 562-2000 Bdl Me
6. Petition Area 7, Proposed 8. t:xisting 9. Traffic 10. Grid Number 11. Zone
Number Number Analysis Zone
Acreage Lots Lots
12. Fee $
B
Date: July 31, 1987
350.00 13. Community Council Abbott [z3op
I hereby certify that (I am) (I have been authorized to act for) the owner of the property described above and that I desire to
subdwide it m conformance with Chapter 21 el the Anchorage Mumcipal Code of Ordinances. I understand that payment
of the basra subdivision tee ~s nonrelundable and ~s to cover the costs assocmted w~th processing this application, that ~t
does not assure approval of the subdiws*on, I also understand that additional fees may be assessed if the Mumclpality s
costs to process this application exceed the basra lee. I further understand that assigned hearing dates are tentative and
may be have to postponed by Plan nmg Staff, Platting Board, Plan ning Commission, or the Assembly due to administrative
reasons.
Signature
'Agents must provide written proof or authorization.
C. Please check or fill in the following:
1. Comprehensive Plan -- Land Use Classification
× Residential
Commercial
Parks/Open Space
Transportation Related
2. Comprehensive Plan -- Land Use Intensity
Special Study
3. Environmental Factors (if any): N/A
a. Wetland
1. Developable
2. Conservation
3. Preservation
Marginal Land
Commercial/industrial
Public Lands/Institutions
Dwelling Units per Acre
Alpine/Slope Affected
b. Avalanche
c. Floodplain
d. Seismic Zone (Harding/Lawson)
D. Please indicate below if any of these events have occurred in the last three years on the property.
Rezonmg Case Number.
Subdiwsion Case Number
Conditional Use Case Number
Zoning Variance Case Number
Enforcement Action For
Building/Land Use Permit For
Army Corp of Engineers Permit
E. Legal descr~pbon for advertising.
N. 200' of W. 1/2 of Lot 14 of Section 9, T. 12 N., R. 3 W., S.M., AK
Alpine/Slope Affected
Industrial
Special Study
F. Checklist Waiver
X 30 Copies of Plat
X Reduced Copy of Plat (8'/2 x 11)
~ Cerhficate to Plat
X Fee
× Topo Map 3 Copies
X Soils Report 4 Copies
X Aerial Photo
X Housing Stock Map
~ Zoning Map
Water:
Sewer:
Private Wells Community Well Public Utility
Private Septic Community Sys. Public Utility
Ge,nt Sem n,
'Per your verbal',request we augered two
· on July' 21, 1987, ' :.The put. pose of th:e.'testho!~s ]was to identify
the '.soil and. to dete~m.ine if- groundwst~r,'was,~present in ,order, to
obtain a Municipal Septic. System installation P~rmit ~ ' '
The attached pr?pe~'ty .s~rvey, performed by ~all~ Hild0nen~ RLS,~
Shews the location of the testh~tes in: relation'-~O the:-residence
and the existing well and septic tank~..The soil l~gs are shown on:
the standard form used by the Municipal Health )epartment.
Both testholes were augered to a total depth of~ 1[,5 feet, and
showed identical soil conditions ~ poorly gmad~d ~sand.with a
pe~:colation rate faster than 5 min/inch. According tO Municipal
practice, sieve, analyses were performed on representative samples
from both testholes. The gradation · of the sand meets .th~
requirements of the Municipal Code. No ground wat(~ ~as. observed.
during the drilling of the testholes, nor was any observed :seve~:
days later, on July 28, 1987.
For septic system design purposes a soil rating of ].25 can be
assigned to the sand, and a septic system absorption trench 40
feet long, 10 feet deep.aDd with 5 feet of washed rock can be
installed to serve fhe present three'bedroom residence. This
system can be lnst. a~led para-l,lel w~th the proposed south lotl~n
of the parcel. This :will locate the trench' ll2:f~et distant from
t e well. For laTtin u~ oses a second alternate loc~tion~
h . .P - gP, P
be shown parallel tO~, a~d t~n ~feat away from the '.firl~t one.~
:" locat ion is~ also mor~,'than ~Li00/f~et ~awa?-~Om the( Wel.~b'. ' '
' The MunJcip~i ~standards ~f0k/on-s~te waste', water~dispoSa1
also stipulates, that minimum are, aS,'<:' a~ available for t~'
ins~a [iai ion:. 'of s~ptiC ~yst~ms, / F~r;~exi'Sting p~a'[t~d !0ts ~thls
-"minimum ar~a is.3000.: sq~l~re femt~ foF-..~, three-bedroom hot, se and
soil wi~ h a ra~i~ 6f 125~'~ For ~ ~r)pos~d,'- subd~vSsi)n lot' ~he
required~ area;, is., .10;000 square fe~' ~TO. meet~ any of th~9
· ~,,~m:e~[~ '~ the~ ~es~ht 'well mUs~',:be:-r~oc'at:~d' . towards
.-north · 91~opert~ l~ne, ,. The p~oposed~lo(,9~%~cent to, th~
· driveway wi] 1 ~satis'fy th~se requi~emen s ~% ~,~-' -~ '
Home ,~avings &. Loans . ' ~ ~ ~l~,:~l~ t~ .......
F. ASEM~:NT$ O? RECORD, O'i'HER I'HAN
THOSE SHOWh ON THE RECORDED
PLAT, ARE I'.lO'r SHOWN HiRtiON.
Al Built No Corfllrl Sit Thil Data
qc~r/~ Zoo'or ,ae~ ~z
Municipality of Anchorage
DEPARTMENT OF HFALTH & FtUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SO LS -- . RCOL T O. tEST
LEGAu ~escm~T,ON:~ ~ ~ ~ L~ ~ I ~ N~//~ Townsh,p, Range, Sec o .
' ' SITE PLAN
SLOPE
1
2
3
4
5
6
7
8
9
10
11
12
13-
14-
15-
16
17
18
19
2O
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT G
DEPTH? P
E
Oeplh ID Water Aller,~,
N
'0
Monitoring?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE /~'--~ -- (m,nutes,,nch) PERC HOLE DIAMETER
TEST RUN BETWEEN ' / __ FT AND /l~.....'~ FT
COMMENTS
ACCORDANCE WITH ALL STATE AND MUNICIPAL. GUIDELINES IN EFFECT ON THIS
72-008 [Rev. 4/85)
PERPORMED FOR:.
LEGAL DESCRIPTION:
MuRIcipallty of Anchorage
DEPARTMFNT OF HFALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION 'TEST
~OkJN ~ __ DATE PERI
Township, Range, Section:
COMMENTS
SLOPE
ENCOUNTERED?
S
iF YES, AT WHAT ~)
DEPTH? p
E
gepth Io Water Afterk I ~
Monitoring? I~(V
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE /~'~' tm,nutes/*nch) PERC HOLE DIAMETER __
TEST RUN SETWEEN / FTAND 18,~" FT ~//5
72-008 (Rev, 4/85)
UNIFIED SYSTEM ASTM D-248/
7/21/87
N200 El/2
SAMPLE IDENTITY LOT 14 SEC 9 TH#I
PASSING #200 SIEVE: 8.20%
PASSING # 40 SIEVE: 66.10%
PASSING # 10 SIEVE: 87,70%
PASSING # 4 SIEVE: 91.00%
PASSING 1/2 IN SIEVE: 95.80%
PASSING 3/4 IN SIEVE: 97.10%
PASSING 1 INCH SIEVE: 100.00%
PASSING 2 INCH SIEVE: 100.00%
PASSING 3 INCH SIEVE: 100,00%
RETAINED: 57.90%
RETAINED: 21.60%
RETAINED: 3.30%
RETAINED: 4.80%
RETAINED: 1.30%
RETAINED: 2.90%
RETAINED: 0.00%
RETAINED: 0.00%
RETAINED: 0.00%
DiO IS 0.08 MM.
D30 IS 0.2O MM.
D60 IS 0.35 MM.
THE LIQUID LIMIT IS UNKNOWN
THE PLASTIC LIMIT IS UNKNOWN
THE PLASTICITY INDEX IS UNKNOWN
CU = 4.38
CC = 1.429
THE SOILS ARE COARSE GRAINED
SANDY SOILS
BORDERLINE SOILS
THE SOILS ARE POORLY GRADED SAND.(SP)
ALASKA ~[1UIRO[lmg[1TAL COI1TROL 5~RUIC~$, I[1C
, /
Comment8
Reported to
Approved by.
$1Z£ OF OP[NINGIN I~H[S I NUMBER ~ MESH ~R INCH U.S. ~ANDARO
~ ~ '~ k-~ ~ --~ O
~0 ~ ~ ~ I0
~ ~- :'X ~ , .o~
[
UNIFIED SYSTEM ASTM ~,2487
LOI 223B
SAMPLE IDENTITY 18 FEET DEEP
PASSING #200 SIEVE: 2.30% RETAINED: 67.80%
PASSING # 40 SIEVE: 70.10% RETAINED: 22.90%
PASSING # lo SIEVE: 93.00% RETAINED: 1,50%
PASSING # 4 SIEVE: 94.50% RETAINED: 2,60%
PASSING 1/2 IN SIEVE: 97.10% RETAINED: 2,20%
PASSING 3/4 iN SIEVE: ,99.30% RETAINED: 0.70%
PASSING I INCH SIEVE: 100.00% RETAINED: 0.00%
PASSING 2 1NC[{ SIEVE: 100.O0% RETAINED: 0,00%
PASSING 3 INCH SIEVE: 100.00% RETAINED: 0.00%
D10 IS 0.14 MM.
D30 IS 0,24 MM.
D6O IS 0.38 MM.
THE LIQUID LIMIT IS UNKNOWN
THE PLASTIC LIMIT IS UNKNOWN
THE PLASTICITY INDEX 1S UNKNOWN
CU = 2.71
CC = 1.083
THE SOILS ARE COARSE GRAINED
SANDY SOILS
THE SOILS ARE POORLY GRADED SAND.(SP)
ALASKA E[1UIRO[lmdlTAL CONTROL SE~UICE$, lie
Legal Description._
Sample Depth-- /~/
O
D ~ ~_
Commenfs
Reported to
,lotted--____.?"/~ ~/S Checked by_~_____~pro~d b~,
SIEVE ANALY e~ S
SIZE OF OI~.NING iN INCHES I NUMBER OF MESH PER INCH U.S. STANDARD
-- , il' I I~t ~o
-'
GRAIN SIZE IN MtLLIM[TE~
L
CONSULTING
ENGINEER
TELEPHONE 1907) 279-3916
HOME SAVINGS AND LOANS
1001 E. BENSON BLVD.
ANCHORAGE, ALASKA 99508
attn. Tannie Dunne
JULY 29, 1987
INVOICE
FOR PROFESSIONAL SERVICES RENDERED
SOIL IDENTIFICATION AND TESTING
N200', W1/2, LOT 14, SEC 9, T12N, R3W
$ 620.00
THANK YOU
Terms: Net 30 days from posted date.
past due accounts. ( 12% annually )
1% service charge on
all
uni¢ipality of Anchorage
MEMORANDUM
DATE: September 4, 1987
TO: Gus Andress, P.E., Manager THRU:
On-site Services/Water Quality
FROM: Susan E. Oswalt, On-site Service~~O.
SUBJECT: ~8668: Tannie Subdivis-i~n~,
Recently I wrote a review for Community Planning on Tannie
Subdivision. The subdivision consisted of only one lot, which
was approximately 33,000 square feet in area. A copy of my review
is attached, indicating the lot size failed to conform to AMC
15.65.145A. Either the lot size needed to be increased to 40,000
square feet or public sewer needed to be extended to it. I was
totally unaware until the letter from Mr. La Pierre reached me,
that Robby had made a verbal committment on this case.
Robert W. Robinson
On-site Services
The justification for allowing this plat to proceed, according to
Jerry Weaver, was that the ownership of the land was already in two
names, and they had in fact been considered as separate parcels by the
owners. State law prohibits sale of aliquot parts; however, I am
uncertain as to the date the sale occurred. Notwithstanding this, as
I read AMC ].5.65, land not currently platted is subject to all
ordinance requirements.
Subsequently, Jerry Weaver approved the plat, subject to "resolving
on-site septic and well with the Department of Health and Human
Services".
It is my feeling that this plat approval violates AMC 15.65.145A.
Person.~ally, I do not wish to be the person signing the final plat.
This is a rather embarrassing issue perhaps, but the department has
made a committment it may not be possible to keep. I would like
to request that we pursue a legal opinion on this situation,
preferrably from Don Edwards or Julie Garfield, before we sign the
final plat.
SEO/ljw ~5
SHORT PLAT
SUM~4ARY OF ACTION
August 31, 1987
S-8668 TANNIE SUBDIVISION
The plat was approved subject to:
Resolving utility easements.
Dedicating 25 feet of ROW on the east boundary.
Placing a note on the plat stating access to Lot 1 will
be limited to 'the dedication on the east boundary at
the time Lore Road is constructed to collector
standards.
Resolving street names and designations with Public
Works.
Showing a 10 foot vegetative buffer easement along Lore
Road.
Resolving on-site septic and well with the Department
of Health and Human Services.
Platting Authority
[)OWL
Hr. 3erry Neaver
Platting Officer
Hunicipality of Amchorage
P.O. Box 196650
Anchorage, Alaska 99519
4040 "B" Street Anchorage, A}aska 99503-5999
Telephone (907) 562-2000
August 21, 1987
w. o
· I~IAALITy,OFD£P?~ OF ANCHo~A~
I:NVIRoNMENLqI~qL~&
~uTE~TiON
RECEIVED
Case No. 5-8668
Iannie Subdivision, Lot 1 Abbreviated Plat
Department o¢ Health & Human Services Comments
Dear 3arty:
As you may be aware, the Department of Health and Human
Services (DHHS) has recommended denial of this plat because
of the code requirements definieg minimum lot size for an
on-site system.
We have discussed this plat with Robbie Robieson on several
occasions. Hr. Robinson has agreed to consider the proposed
lot as having been "historically utilized as a subdivided
lot" and not object to the plat on that basis.
Please also note that percolation test, ground water monitor-
ing and septic system redesign documents were submitted in
support of the subdivision application. We expect that plat
approve], will be subject to construction of a new on-site
system and well. We intend to coordinate the eecessary
permits and construction prior to submitting the plat.
Hr. Robinson has further agreed to discuss this case with you
should you have any questions, Please inform me as soon as
possible iff you Feel that any oF the above may jeopardize the
plat approval.
Thank you for your assistance in this matter.
Very trsly yours,
DOWL ENGINEERS
Curtis LaPierre, ASLA
Project Manager
CL:kk
cc:..-Robbie Robinson, DItHS /
Susan Oswalt~ DHHS
MUNICIPALITY OF ANCHORAGE
ft''•'a 3.` T
Development Services DepartmentPhone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 014-172-93 Expiration Date: 2-0
1. GENERAL INFORMATION
Complete legal description Bush Lot A
Location (site address) 2800 Lore Road
Current property owner(s) Day phone
Sherman Reynolds Survivors Trust& Peggie Reynolds Decedents Trust (907) 317-3617
Mailing address
Real estate agent
2848 Lore Road, Anchorage, AK 99507
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Private Septic
0
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 $ Jy Waiver Fee $
Date of Payment y "��e — Z% Date of Payment
Receipt Number. 0Z,? Receipt Number
COSA # 05c2 I r k -7 7 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 Forge Engineering Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller Date 4/15/21
..0' coP n l9
6. DSD SIGNATURE ...........
System #1 Approved for bedrooms �r :�BenjamLniSchiller
System #2 Approved for bedrooms fl��sCE 12592
Disapproved ll`i pROFESS10Na�
Conditional approval for bedrooms, with the following stipulations:
llllci(i((((
Q
ON-SITE m'
WATER AND
I , AI E Roz
PROGRAM
O _=
„- 1\c"Pppp5
By: h.., Original Certificate Date: 2 d 2
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
Septic System Advisory
Well Flow Advisory
COSA Checklist blue sheet
X Nitrate Advisory
Arsenic Advisory
Other
Legal Description:
Bush Sub, Lot A
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 9177*
Total depth 134* ft
Cased to 134* ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 12 in.
Date of flow test for COSA 4/5/21
Parcel ID: 014-172-93
of Structure served by this system
Well production at time of test 6 gpm
r
Water storage tank volume,Nh' gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 0.758 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample 4/2/21
Static water level at beginning of test 57.5 ft
Comments *No well log available. Data taken from handwritten notes in file/2018 COSA.
IFe\,11II'll IT-A�d
Age of tank(s) 3 years
Tank type/material Septic/Steel
Measured operating fluid level in septic tank 48
❑O- Standpipes/foundation cleanout per record drawing
Date of pumping 4/15/21 Isaacs Pumping
D. ABSORPTION FIELD DATA Shallow Trench
Which system tested (date installed) 7/24/18
FM_1 ALL standpipes present per record drawing
Total measured depth from grade 11.5 ft (max)
Measured depth to pipe invert from grade 7.8 ft (min)
❑ N/A — pressurized field
Al Monitor tubes go to bottom of effective. If not, state
depth into effective 3.7
❑ 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 yellow sheet
C. LIFT STATION
uired maintenance completed
Age of lift sta years
Lift station material
Comments:
Adequacy test date 4/5/21
Results ❑✓ Pass For 3 bedrooms
Fluid depth prior to test 10 in
Water added 528 gal
New depth 10 in
Elapsed time 1440 min
Final fluid depth 10 in
Absorption rate "fDu and
Any rejuvenation treatment (past 12 months)
If yes, enter date
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'
0
Yes
Community Sewer Manhole/Cleanout > 100'
7 Yes
if No
ft
Yes
if No ft
Neighboring Tank > 100' Fv� Yes
if No
ft
Private Sewer/Septic Line > 25' Yes
if No ft
Absorption Field on Lot > 100' Fv� Yes
if No
ft
Holding Tank > 100' Fv� Yes
if No ft
Neighboring Absorption Fields > 100'
Yes
if No
Animal Containment > 50' Fv� Yes
if No ft
F-1 Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' E] Yes
if No
ft
0 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' El Yes if No ft Surface Water > 100' Q Yes if No ft
Property Line > 5'
0
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Fl
Yes
if No
ft
Private Wells > 100' 0 Yes if No.
Water Main > 10'
0
Yes
if No
ft
Community Wells > 200' F-71 Yes if No
Water Service Line > 10'
0
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' 21 Yes if No ft If absorption field is under driveway comment below
Property Line > 10' Fv-J Yes if No ft Wells on Adjacent Lots:
Water Main > 10' 0 Yes if No ft Private Wells > 100' Q Yes if No
Water Service Line > 10' Fv� Yes if No ft Community Wells > 200' Yes if No
Surface Water > 100' Rl Yes if No ft
F. ENGINEER'S COMMENTS
®F
G. ENGINEER'S CERTIFICATION 'i",�,�Q
� Co
1 certify that 1 have determined through field inspections and review TH '
of Municipal records that the above systems are in conformance with
MOA COSAguidelines in effect on this date.,-` . ,
.l.. .
Benjakrrv5chiller
�F� •, CE 12592 • �`i�`®'�
4/15/21
PR0f E SS10Nt` --�—
COSA Checklist yellow sheet
ft
ft
ft
ft
MUNICIPALITY OF ANCHORAGE
Development Services Department 4_ Phone: 907-343-7904
On Site Water & Wastewater Section '- Fax: 907-343-7997
Certificate of On-Site Systems Approval a
Parcel I.D. 014-172-93 Expiration Date: ("-- 2Z—(
1. GENERAL INFORMATION
Complete legal description Bush Lot 2
Location (site address) 2800 Lore Rd
Current property owner(s) Sherman Reynolds Day phone 317-3617
Mailing address 2848 Lore Rd, Anchorage, AK 99507
Real estate agent Day phone
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well Q Private Septic
Water Storage ❑ Holding Tank ❑
Community Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Waiver request for: Distance:
Received by: 1-eptj a .t I Date:
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment Date of Payment
Receipt Number Receipt Number
COSA# 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 Forge Engineering Phone 907-522-7773
Address PO Box 240773, Anchorage, AK 99524
Engineer's Printed Name Benjamin Schiller, PE Date 10/22/18
G. OF 164��k��
momCo..
4gTH j' •9 ¢4
6. DSD SIGNATURE %' "`• ;,�- F
,1.• 1 = '._,,._
3
System #1 Approved for 3 bedrooms d, .'lBenja�n•Schiller •
System #2 Approved for bedrooms �1ir92Fci• • 10/225 8 . Age
System
Disapproved �to,
kw'FRROFESS1W�
Conditional approval for bedrooms, with the following stipulations:
o
vIt
::AA:TW
N-SITETERANDEWATER z:
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Original Certificate Date: �(2 —22-(
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: Bush Lot 2 Parcel ID:014-172-93
A. WELL DATA
PrivateN*
Well type If A, B, or C provide PWSID# Well Log (Y/N)
Date completed Unknown Sanitary seal (YIN) Y Wires properly protected (Y/N) Y
Total depth 134 ft Cased to 134 ft Casing height(above ground) 12 in.
FROM WELL LOG AT INSPECTION
Date of test *Unknown 10/15/18
Static water level 42 ft. 59 ft.
Well production 10+ g.p.m. 6.5 g.p.m.
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate 0.68 mg/L
Arsenic NDug/L Date of sample: 10/10/18 Collected by: Forge Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 7/24/1 8
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(YIN) Y Depression over tank (YIN) N High water alarm (Y/N) N
Date of pumping Pumper New construction
C. ABSORPTION FIELD DATA
7/24/181.2GPD/SF Deep trench
Date installed Soil rating (g.p.d./ft2 or ft /bdrm) System type
Length 38 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 11 .6 ft. Eff. absorption area 380 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New 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 Size in gallons Manhole/Access (YIN)
"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:
>100'
Septic tank/lift station on lot
On adjacent lots �
100'
Absorption field on lot On adjacent lots
100'
>7Public sewer main 5 Public sewer manhole/cleanout 100'
Sewer/septic service line >25' Holding tank >100'
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 1�' Surface water 100'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10'
Building foundation >10' Water main X10'
>10'
Water Service line Surface water X100 Driveway, parking/vehicle storage
10'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
*Handwritten notes in the file regarding well log.
G. ENGINEER'S CERTIFICATION ������®®
e OF Q (9e
/ certify that I have determined through field inspections and '9 ��°
review of Municipal records that the above systems are in C-o •
•'�
conformance with MOA COSA guidelines in effect on this date. Alf
49 m )' ..•
Engineer's Printed Name Benjamin Schiller, PE , •c--c---9; • • • • c �(
Date 10/22/18 , •
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Benjam.�n:Schiller . /
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_ REVISED per Mat N° ss
\ " x- w I RECERTIFIED 8-08-18
AS-BUILT NO CORNERS SET THIS DA
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I IereoyceoyroanhavepelfocoedaNatgageet
Lot 21 Lot 20 \ Lot 19 I Lot 18 Lot 17/ Lot 16 I a the ralowIng destined poverty: LOTS A&A
BUSH SUBDIVISION
MOOSE RIDGE SUBD.(Plat No.84-256) Anchorage Recording David.Alaska and that the
Improvements situated thereon are within the prop
and do nd overlap or encroach on the property I5N
adjacent thereto.that no umprovements on the pros
edlacent thereto encroach an the premises In dues
that there are no roadways.transmission Ones of a
visible easements on sad property except as Inde
hereon.
Dated al Anchorage.Alaska
EASEMENTS OF RECORD.OTHER THAN this 30th day of JUNE .201
THOSE SHOWN ON THE RECORDED FRED WALATKA A ASSC
PLAT ARE NOT SHOWN HEREON FB 17-7. pg 8-11Engineers and Surveyors
UNLESS OTHERWISE NOTED. BE am-tee-rasa