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HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 1 LT 5COnsite File t2w a" 45 w9' i 01 Aftk am AIV Ar i61 J Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191512 PID Number: 017-061-37 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex.(D) ❑ Two Single Family Project x New F-1Upgrade Name L1MAN1 FLAMUR ABSORPTION FIELD Site Address 9 Deep Trench ❑ Wide Tren h ❑ Bed ❑ Mound 5856 KALGIN DR, Anchorage ❑ Other Phone Number of Bedrooms Soil Rating Total d pth from original grade 4 0.6 GPD/SF 9 Ft LEGAL DESCRIPTION Depth to pipe invert from original grade lave] depth beneath pipe Subdivision Block Lot 2.0 MOUNTAIN PARK ESTATES BLK 1 LT 5C Ft Ft. Fill added above original grade G avel length Township Range Section V+ Ft. I E 4, Ft. Gravel width Beds: Number of L nes Distance between lines SEPARATION DISTANCES 2.0 Ft. Ft. To Septic Absorption Holding I Sewer Total absorption area Number of trenche Dist. between trenches -rom Tank Field Lift Station Tank Line 1 Q08 Ftp Ft. Well 1001+ 1 001+ 5Or�, TANK 9Septic ElS.T.E.P. ElHoldi El Other Manufacturer Gal acity Surface Water 1001+ 100,+ GREER TANK 1re 50 Gal. Material Nur iber of compartments Lot Line 10,+1 101+ NA PLASTIC 2 Foundation 10,+ 10,+ LIFT STATION Manufacturer Ca city Remarks rm location installed by Installer PIPE MATERIAL House to tank 30 4 Tank to 8034 MIKE N ANDERSON, P.E, drainfield Drainfield 30 CO/MT 3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 1 1.2 ft Inspe tion 1s' 9/5/20 2 a 9/5/20 Location and description 3'" 41° GARAGE SLAB ON-SITE WATER AND WASTEWATER SECTION APPROVAL I =ngineer's Stamp Conditional Approval: Date Septic System Approved >1 Date3-2-q-2-1 Note: this approval does not include well permit requirements. av 05/02/18) 7, 9TH ow.... • ......... .. . . !.� .... • • .. ............. . �•n : M CHAEL N. ANDLRXN � ` =y ��~�lrS�s�?-oma Permit No. OSP191512 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: MOUNTAIN PARK EST. BLK 1, LOT 5C MAR A _ B C C01 // \ / 9 --2 TC01 18 22 TCO2 22 25 CO2 WELL, `7 22 25 CO3 I / 22 25 C04 20 30 C05 55 50 MT1 20 30 MT 1 55 1 50 PID No.: 017-061-37 �< BENCH, GARAGE SLAB MT20005/ DRyd6WAY �,X /® 1 // \ / kH#5 ! \ THirt4 i� ®02. /j Ttb2 WELL, `7 C I / — 2 LAST C S"C TANKS v \ \ i TI la�p4— 1 / /, 1 � ASBUILT/ 'xy vv SCALE: V'450' \\ (TGo2 GG GRADE i1.0 ORD ®Ar ! _ 98.2 49TH •: ®® _5 1.250.. GALLON 41 9A 58 G41of •• PLASnc TANK '/ II 44 5 O ;MICHAEL N. ANDERSON,_iA, . o. CE 9460® \� 3-3-21 •. ORY, SEPT 2020 ®® 1 .......... �.. SEPTIC SECTION ®®® � lP\ ®®® N.T.S. •✓ ® DOC CO dba BILL 8& COLE ULLIVAN WATER WELLS P.O. Box 670269, Chugiak, AK 99567 688-2759 OWNER OF LAND: Flamur Limani ADDRESS: 5856 Kalgin Drive — Anchorage, AK 99516 Bore Hole Data LEGAL DESCRIPTION Mountain Park Est Block 1 L5C DATE: 9-17-20 Depth From To PERMIT OSP191512 DATE OF ISSUE: 11/18/19 NUMBER: TAX IDENTIFICATION 01706137000 NUMBER Is well located at approved permit location: ®Yes ❑No Method of Drilling: ®air rotary cable tool Depth of Well: 295' Casing Type: Steel Wall thickness _250 inches Diameter: 6 inches, depth 289 feet Liner type Static Water Level: 220 feet Recovery Rate 7 ® gpm F] gph Method of Testing Air Well Intake Opening Type: ® open end Flopen 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 0 no Method of Disinfection: Chlorine 50 PPM Comments: 0 2 Casing Stickup 2 4 Overburden 4 59 Silty Sand & Gravel 59 144 Silty Sand & Gravel w/ Clay Tight 144 190 Clay & Gravel w/ Cobbles Tight 190 278 Hardpan & Clay 278 295 Tight Sand & Gravel Water WATER QUALITY TESTING CoMbrm COU100mL Nitrates L Arsenic /L h 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. P- DOC CO dba Bt!! & CDLE ;%, ULLIVAN WATER WELLS P.O. Box 670269, Chugiak, AK 99567 6BB-2759 www.suilivanwaterwells.com Pump Isallai®n Log Well Drilling Permit Number: SW OSP191512 Date of Issue 11-18-19 Parcel Identification Number: 01706137000 Legal Description Mountain Park Est Block 1 L5C Pump Installation Date: 9-24-20 Pump Intake Depth Below Top of Well Casing: 270 Pump manufacturer's Name: F&W Pump Model: 4F10G10301 Pump Size: 1 Pitless Adapter Burial Depth: 10 Pitless Adapter Installer: Red Dog Disinfected Upon Completion? ® yes ❑ no Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer: Martinson 11 Pump Installers Name: Sullivan Water Wells Property Owner Name & Address Flamur Limani 5856 Kalgin Drive Anchorage, AK 99516 feet hp feet Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Water & Wastewater System Permit Permit Number: OSP191512 Work Type: WellSeptic Renewal Effective Date Expiration Date: Tax Code Number: 01706137000 Site Legal Address: MOUNTAIN PARK ESTATES BLK 1 LT 5C G:2938 Site Mailing Address: 5856 KALGIN DR, Anchorage Owner: LIMANI FLAMUR Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: '1l1��Vnt G r, 1)epat—tI1 ent 11/18/2019 11/17/2020 Lot Size in Sq Ft: 20800 Total Bedrooms: 4 Q Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ 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 I2�13/1 lek' J eC1c�A i'0V1S1(),� Qui o\,8�,'A-ior\cj PU-CA04-\on �C&+ 15 C'�,,) cV 'C t d nocontCJ-1-� o� c-(`�� � 01 1 lP� Cir-c�t1{ Co n� r m 'f P I csti a � lI dj e�� PI'aoe Su�on��f reA�Q. ��� J4` Lv_yed{ ' IU 017-s `k a �/_0VJ �1% s�vP �e��' ,n� _�'d CIOZ • SeP pit-ClN e n 0.S i+ eo 6L - S(ZPe'- —frn c -r/1f)Z0Z'V Received By: Date: Issued By: 1 Date: Municipality 4'q e X 3'T ait ' L P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section t1 • I, t Sr n VARIANCE/WAIVER REVIEW * * x * Waiver#: OSV191099 COSA#: Permit#:OSP191512 PID#: 017-061-37 Legal Description: Mountain Park Estates Block 1 Lot 5C Engineer: Mike N. Anderson Applicant: Flamur Limani Your request for a waiver of the requirement that the absorption field be installed parallel to the contour lines of the slope has been approved. See engineer's waiver request and profile drawing for justifications. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all code requirements be met or another approval from this department. 1 Waiver is Granted: X Waiver is not Granted: 4 JLLGDate: I a 13 Approved by:12 %'{/C(n Name of Reviewer M1.1111 1 11 IN if 1 VARIAN C E/WAIVER REVIEW **** MUNICIPALITY CSF ANCHORAGE I Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-061-37 Property owner(s) FLAMUR LIMANI Mailing address 964 SHAKESPEARE CIRCLE, ANCH AK Site address SAME Day phone Legal description (Sub'd., Block & Lot) MOUNTAIN PARK ESTATES BLK 1 LT 5C Legal description (Township, Range & Section) Lot Size 20,800 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: all that apply) Absorption Field 0 Initial 0 Single Family (SF) 0 Septic Tank El Upgrade ( w/wo ADU) Holding Tank Renewal F] Duplex (D) El Multiple Dwellings Privy (SF and/or D) Private Well EI Water Storage THIS APPLICATION INCLUD(EnnS((A WAIVER REQUEST FOR: Ty -e-\'1 C.k 1A)A eco- .pJ. A 4 S 6o'p_ Distance: 1 41 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: A eJ Fees: Date of Payment: - (2dixg Date of Payment: Receipt Number: U10- I&Ga Receipt Number: 1 ti's Permit No. 15S P16 171110 bear No. cs GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc IZ 311C1 2e - 2L1 b3. Cc$ 1 Dec. 13, 2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New Septic and well Permit, Change Order & Waiver Legal: MOUNTAIN PARK ESTATES BLK 1 LT 5C To Whom it may concern: This is a request for a changer order on the septic and well permit for the above referenced lot. The location of the system has been altered due to the moving of the house therefore we are requesting a change order and waiver, please see the attached submittal. Nothing has changed due to soils or ground water. A new test hole will be completed prior to installation to verify the soils. The waiver is required for the system which is not parallel to the contours. This change order andwiaver 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. 4661 Natrona Anch, Ak 99516 Ph 727-8864 RUSH,) Nov. 15, 2018 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New Septic and well Permit, renewal Legal: MOUNTAIN PARK ESTATES BLK 1 LT 5C To Whom it may concern: f This is a request for a septic and well permit on the above ref enced lot. A two test holes (by Garness) were excavated and found silty gravels for the entire depth. Th perc rate was found be 12 minutes therefore a simple deep trench was designed with an effective depth of feet. No water was measured in the test hole during or after the excavation. The slope around the site is flat with no cut banks within 100 feet. All of the neighboring septic will be surveyed prior >- of the well. 456 > t" 9 This system will not impact any of the Please call me if you have any Sincerely * v4 Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 ct<<$ltq 0 L -0(eI -37 o23a_ Cv it(07 s p ja15j2- jo NppueA1160 suaM ME-Dc,. to the lot layout. DESIGN CRITERIA: 4 BDRM X 150 = 600 GPD SOILS = 600/0.6 = 100 GPD 1000 GA/6 = 83' (1) TRENCH 8.0'DEEP 6.0'EFFECTIVE 2.0'WDE 83'LONG GARNESS GARNESS(TH#l) (TH#z) oRG 1.0 GM oRG 1.0 GM oRG 1.0 GM ,AP|PE W2 \1, A)\"li'*='-\\.- / too'nnDrus ),^..X--:j--'\\ ,/..w v jl iLr -// r\ LGi \ ------------lll-- \ -NAKNEK LANE-+lll '-t'' I dl()I LtllJIo,o-tzlql I -71 rril tl tp L.r'itltttl.rlrnf.mllC/)l 12llml t€1lol rall<ttmtl'l I I I Ilr \ttFl rEl IR\ lfitt=l lO ,Et<lm \' I l ,1 \_-DEllYouN ti9t9:- - t{ \ {\ rF-- PROPOSED HOUSE --\/ F*- / .^\lt\1-i;! .-'-1 I I I l I I I I I I Septic Design Prepored for FLAMUR LIMANI MOUNTAIN PARK ESTATES, BLOCK 1, Anchorage, Alaska MICHATL N. ANDERMichael N. Andelson, P.E. 4601 NATRONAAVE ANCHORAGE, ALASI(A 995 1 6 (eo7l 7 27 -886a / FAX: (907) 345-1 391 DATE: 9l7l2A2A DRAWN: DJR SCALE: 1"=200' BLACK6. LOTT ---\'_*_--*_l \-l*-//f / PROPOSED WELL & 1OO'RADIUS / : LOCATION TO BE DONE BY SURVEYOR PROPOSED 1 I PLAsrc sEPrc ,250 GALLON TANKW120' RISER I-\-\J \/L/.-/-SEPTTC\ l )'\-\ L\--I.' \I II I Id 1, I 5 I 9/ rltoury/ntn pnRr esretes ./ BLOCK 4, LOT 5 @we* MOUNTAIN PARK ESTATES BLOCKl, LOT4 .-///a// /\* \/V\ ADDITIOML TEST HOLE DONE, SEE TH#3 PROPOSED RESERVE FIELD, 5X24X1' EFF. APPLICATION RATE OF 5 GPD/SF, CAT III SYSTEM IV \\ l--l\ MOUNTAIN s_.$F No. CE 9469 h:eiffi$S Septic Design Prepored for FLAMUR LIMANI PARK ESTATES, BLOCK 1, Anchorage, Alaska DATE: 91712020 DRA\A/N: DJR SCALE: 1"=50' Michael N. Anderson, P.E. 4601 NATRONAAVE ANCHORACE, ALASKA 99s 1 6 PO7l727-s864l FAX: (907) 345-1391 Co+ z PROPERTY LINE BOTTOM OF TEST HOLE #4 PROFILE OF PROPOSED DMINAGE FIELD 6X83' ELEVATION VIEW BOfiOM OF TEST HOLE #2 MOUNTAIN PARK ESTATES Septic Design Prepored for FLAMUR LIMANI MOUNTAIN PARK ESTATES, BLOCK 1, LOT 5C Anchorage, Alaska fm Michael N. Anderson, P.E. 4601 NATRONAAVE ANCI-|ORAGE, At-Ast(A 99s 1 6 (ean 727-8864 { Ft+}k (gon 34s-139t DATE: 91712020 DRAWN: DJR SCALE: 1"=30' I I J MOUNTAIN PARK ESTATES BLOCK 6 LOT 10 j(NO CONCERN) J I MOUNTAIN \PARK ESTATES / J BLOCK 1, LOT 5A_ I J CSEPT1C I MOUNTAIN PARK ESTATES BLOCK 6, LOT 9 MOUNTAIN PARK ESTATES BLOCK 1, LOT 5B Cs—EP11C MOUNTAIN PARK \ ESTATES \ BLOCK 6, LOT 5 \ I ( AP)' SE) \ \ MOUNTAIN PARK ` Apsox \ \ / j ESTATES BLOCK 6, LOT MOUNTAIN PARI( ESTATES LOCK 6, LOT 8 MOUNTAIN PARK ESTATE5 SEPTIC \ BLOCK 6, LOT 7 ARtD ARES #TH#2 TH$1 MOUNTAIN PARK ESTATES BLOCK 1. LOT 4 CVACAM..D MOUNTAIN PARK ESTATES BLOCK 6. LOT 3 NO CONCERN) J 3 UNTA•iN PARK iJ E5T4LOCK A LOT\5 / RO MATE)— MOUNTAIN PARK ESTATES BLOCK 4, LOT 6ya-' I • (NO CONCERN) I MOUNTAIN PARK MOUNTAIN PARK ESTATES ATESBLOCK 4. LOT 7 BLOCKK. 4, LOT 4 // I I (NO CONCERN) SSW I 1 c I I I 1 101 4=7oF 4 GARNESS ENGINEERING GROUP, Ltd. -9. 4 CONSULTANTS 8. GENERAL CONTRACTORS •.•......... 01 E TUDOR RO/•0. SWE 101 • ANC"OWC ).K 00307 • PHMZ (WW37-6170 • W (9M3sa-u4a • rvF.asrrF: .. PREPARED FOR: PHONE NUMBER: PAGE NUMBER: GEORGE JETT 440-1114 1 OF 1 +7Q6 .J f G rness LEGAL DESCRIPTION: DRAWN BY: Qhs E— 3 MOUNTAIN PARK ESTATES SUBDIVISION; LOT 5C, BLOCK 1 J.N.T. TYPE OF WORK: DATE: V©pr—es 01\0\ essi01\0\ Q SITE PLAN 5/11/2007 IJLJV 1 1 MOUNTAIN PARK MOUNTAIN PARK ESTATES { I ESTATES BLOCK 4, LOT 3 { BLOCK 4, LOT 8 NO CONCERN) i y (NO CONCERN) 101 4=7oF 4 GARNESS ENGINEERING GROUP, Ltd. -9. 4 CONSULTANTS 8. GENERAL CONTRACTORS •.•......... 01 E TUDOR RO/•0. SWE 101 • ANC"OWC ).K 00307 • PHMZ (WW37-6170 • W (9M3sa-u4a • rvF.asrrF: .. PREPARED FOR: PHONE NUMBER: PAGE NUMBER: GEORGE JETT 440-1114 1 OF 1 +7Q6 .J f G rness LEGAL DESCRIPTION: DRAWN BY: Qhs E— 3 MOUNTAIN PARK ESTATES SUBDIVISION; LOT 5C, BLOCK 1 J.N.T. TYPE OF WORK: DATE: V©pr—es 01\0\ essi01\0\ Q SITE PLAN 5/11/2007 Ulm GARNESS ENGINEERING GROUP, ]Ltd. CONSULTANTS & GENERAL CONTRACTORS 01 TUR ROM, SUR 101 • ANCHORAGE. MC. 00507 - PHONE 9D 7-6170 • FAX: 1907)338-3246 • VAMStiE: 0amuergM,e+rtn0.eom E DO SOIL LOG — PERCOLATION TEST ,.,. - LEGAL, DESCRIPTION: MOUNTAIN PARK ESTATES, LOT 5C, BLOCK 1,-p- s. J y A. orness. E-7953 4 ` j PERFORMED FOR, GEORGE JErf DATE: 25 2007 9., @r., q' AtiQDEPTHr feet) - ORGANICS Qpp( pp14o44a TEST HOLE #1 1 2 aGW :=--zz: ORG 3 ;; :f:f GP ML GM CL 4 GC OL N SW MH 5 °+ as SP CH SM off SEE ATTACHED 6 SC SITE PLAN 7 9 10 11 12 13 14 15 16 17 18 DEPTH TO GROUNDWATER DATE SEEPS ® 3'- 5' 4/25/2007 15.5 5/4/2007 2:05 6" DATE READING CLOCK TIME NET TIME MINUTES) WATER LEVEL READING NET DROP INCHES) 5/9/2007 1 2:05 6" 2 2:35 30 2 1 /2" 3 1/2' 3 2:35 6" 4 3:05 30 2 1/2" 3 1/2' 5 3:05. 6" 6 3:35 30 2 1/2" 3 1/2' 19 PERCOLATION RATE 8.5 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 1.0 FT. AND 2.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: Z YES NO SOILS LOGGED BY: CALEB GALL PERCOLATION TEST PERFORMED BY: BENNY MAUS COMMENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PE FORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: C/1 0- GARNESS ENGINEERING GROUP, Ltd_ cowauoxwro& GENERAL CONTRACTORS t~' FS -01L LOG - PERCOLATION TEST FoA oFgrmpTn w MOUNTAIN PARK ESTATES. LOT 5 BLOCK 1. PERFORMED FOR:_ YErTHkTeex) ORGANICS GEORGE JETT SM usamns DATE READINr G CLOCK TIME NET TIME MINUTES) WATER LEVEL READING NET DROP INCHES) mum 11111111 IV"", DEPTH TO DATEGROUNDWATER 16' 5/4/2007 19 PERCOLATION RATE(MIN./INCH) PERC' HOLE DIA. O (INCHES) TEST RUN BETWEEN iFT. AND 2FT. 20 AFOUR HOUR PRESOAK WAS PERFORMED: Z YES MNO SOILS LOGGED BY: CALEB GALL PERCOLATION TEST PERFORMED BY: COMMENTS: PERFORMED BY QEQ Ltd | JEFFREYA.CARNES3 CERTIFY THAT THIS WA8RDANCE DATE READINrG CLOCK TIME NET TIME MINUTES) WATER LEVEL READING NET DROP INCHES) 19 PERCOLATION RATE(MIN./INCH) PERC' HOLE DIA. O (INCHES) TEST RUN BETWEEN iFT. AND 2FT. 20 AFOUR HOUR PRESOAK WAS PERFORMED: Z YES MNO SOILS LOGGED BY: CALEB GALL PERCOLATION TEST PERFORMED BY: COMMENTS: PERFORMED BY QEQ Ltd | JEFFREYA.CARNES3 CERTIFY THAT THIS WA8RDANCE Carroll, Rebecca M. From: Tobish, Thede G. Sent: Friday, September 7, 2018 4:02 PM To: Odell, Shawn M.; Carroll, Rebecca M. Subject: RE: Permit OSP181216 Follow Up Flag: Follow up Flag Status: Flagged The parcel contains no wetlands—it is not subject to wetland regulations and the soils are non -wetland gravels. Thede From: Odell, Shawn M. Sent: Friday, September 7, 2018 4:00 PM To: Tobish, Thede G. <thede.tobish@anchorageak.gov>; Carroll, Rebecca M.<rebecca.carroll@anchorageal<.gov> Subject: Permit OSP181216 Thede, could you send an e-mail regarding there are no wetlands to on-site Mountain Park Estates Blk 1 Lt 5C 1 MUNICIPALITY OF ANCHORAG Development Services Department On -Site Water & Wastewater Section Parcel I.D. 017-061-37 1 Certificate of On -Site Systems Approval Expiration Dater GENERAL INFORMATION Complete legal description MOUNTAIN PARK ESTATES BLK 1 LT Location (site address) 6866 KALGIN DR, ANCH AK Current property owner(s) FEKRI ISMAI Mailing address SAME Real estate agent 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone �R uSC't- hone: 907-343-7904 Fax: 907-343-7997 LI -2 ©2 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER iSPOSAL: Private Well El 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 $ $120 Date of Payment Receipt Number COSA # OSC211120 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, l verify th on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this on-site water supply and/or wastewater disposal system is (are) safe, functional and ad bedrooms and type of structure indicated herein. I further verify that based on the infor Municipality of Anchorage files and from my investigation and inspection, the on-site water disposal system is (are) in compliance with all applicable Municipal and State codes, ordii effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify tl Name of Firm MIKE N ANDERSON, P.E. Phone 72' Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. 6. DSD SIGNATURE System #1 Approved for 4 System #2 Approved for Disapproved Conditional approval for my investigation, based plication, shows that the luate for the number of ation obtained from the .tpply and/or wastewater nces, and regulations in information submitted. Date 3-16-p1 e l• • 4 bedrooms i,• bedrooms bedrooms, with the following stipulatil dT, l F 'a CE - 9469 el((((((f(( �N�' ? r I Y Ijt- , I(/1 N-sp-E VV o INA' UjC_�_ AND rn J� P r T L '0 Gk AM o 8 CXiL Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approv I (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.a Municipality of Anchorage is not responsible for errors or omissions in the professional engineers 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 BLK 1 LT 5C If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 9/11/20 Total depth 205 ft Cased to 280 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24"+ in. Date of flow test for COSA new Static water level at beginning of test 220 ft. Comments B. TANK DATA Age of tank(s) new years Tank type/material plastic Measured operating fluid level in septic tank new ❑ Standpipes/foundation cleanout per record drawing Date of pumping new D. ABSORPTION FIELD DATA new system 2020 Which system tested (date installed) 915/20 ❑ ALL standpipes present per record drawing Total measured depth from grade 9 ft (max) Measured depth to pipe invert from grade 3 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 yellow sheet Parcel ID: 017-061-37 Structure served by this system Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 1.98 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 1121/2' C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date new Results 0 Pass For 4 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) 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' [D Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Absorption Field on Lot > 100' El Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' 7✓ Yes if No ft Community Sewer Main > 75' C]✓, Yes if No ft Community Sewer Manhole/Cl anout > 100' Yes Q Yes if No ft Private Sewer/Septic Line > 26M/ Yes if No ft Holding Tank > 100' FV -1 Yes if No ft Animal Containment > 50' Yes if No ft Manure/Animal Excreta Storag > 100' ft Private Wells > 100' R] 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' Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' Water Main > 10' Yes if No ft Community Wells > 200' Water Service Line > 10' Q Yes if No ft If septic tank is under drivewaN From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Q Yes if No ft If absorption field is under d Property Line > 10' [✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Water Service Line > 10'✓Q Yes if No ft Community Wells > 200' Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that l 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 yellow sheet []✓ Yes if No ft ❑✓ Yes if No ft Q Yes if No ft ent below comment below Yes if No ft Yes if No ft Lot 4 NOTE: DUE TO SNOW & ICE COVER, THE LOCATION OF THE ASPHALT DRIVEWAY IS APPROXIMATE. PLOT PLAN AS BUILT _x_ SCALE 1 _=40__ GRID _ SW 2938Project No. ___ 18_076/85 ---- 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates inc. (907) 522-6476 Phone (907) 522-4625 Fax o©�� F q°0 Professional Land Surveyors ken®langsurvey.com v .. ,9 �0 jonathan®langsurvey.com 1 hereby certify that I have surveyed the following described property: 49TH*0� LOT 5—C, BLOCK 1, MOUNTAIN PARK ESTATES SUBDIVISION (PLAT No. P-501) Q .. ............. Anchorage Recording District, Alaska, and that the improvements situated thereon are """""" G 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 �'� ' KEtJNEIIi ...LAN. ....� premises and that there are no roadways, transmission lines or other visible �, r o G easements on said property except as indicated hereon. Dated this the f3� _ Day of t�atJi r 4€:;„4----- l..k �'Fp .LS -5202.• gJp� _ =_--__ , _—____, at Anchorage, Alaska oR fop a4� OF-ESSIONAG �a It is the responsibility of the owner to determine the existence of any easements, °Opppoa�' covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963