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Home My WebLink AboutT12N R3W SEC 33 LT 233Onsite File f3 3 t Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT rmit Number.- OSP191430 PID Number: 018-322-11 Page 1 of 2 ling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: A New ❑ Upgrade Name MOON ABSORPTION FIELD Deep Trench Q Wide Trenc p ❑ Bed ❑ Mound Site Address 2910 East 154th ❑ Other Phone Number of Bedrooms Soil Rating Total d th from original grade 5 1.2 GPD/SF 3.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 1.0 Ft. Gr Ivel depth beneath pipe 25 Subdivision Block Lot T12N,R3W,SEC 33, LOT 233 Ft. Fill added above original grade Gr ivel length Township Range Section 2'+ Ft. $ ' Ft. Gravel width 5.0 Ft. Beds: Number of Li es Distance between lines SEPARATION DISTANCES Ft. To Septic p Absorption � Lift Station Holding Sewer Total absorption area Number of trenche Dist. between trenches From Tank Field I Tank Line 625 Ft2 Ft. Well 100'+ 100'+ 100'+ 50�+ TANK N Septic 0 S.T.E.P. 0 Holdin 0 Other Manufacturer GREER TANK Cap 1 5Q0 icity Gal. Surface water 100'+ 100'+ 100'+ Material NurrYer of compartments Lot Line 101+ *51+ 10'+ NA PLASTIC 2 Foundation 10'+ LIFT STATION Manufacturer Cap city Remarks *WAIVER REQUESTED GREER TANK 1C00 Gal. Alarm location INTERIOR PANEL Elec MI tical installed by DA PERMIT Installer PIPE MATERIAL House to tank 30 4 Tank to 3034 drainfield MIKE N ANDERSON, P.E. Drainfield 3034 COIMT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 1 G 6.5 ft Inspection v, 7/21/19 2� 7122/19 Location and description 3f1 4th GARAGE SLAB ON-SITE WATER AND WASTEWATER SECTION APPROVALn ineer's stamp ��w a w e�c o ;" . @� Conditional Approval: Date •~t_ "' ` 00, ,,-:.• Septic SystemV�!,r� Approved W Date .� 3-- �'�;�;>' 3/�]?� '•�\ .� Note: this approval does not include well permit requirements.';`9 'Rav Mlr)9N Al Permit No. OSP191430 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: T12N R3W SEC 33 LT 233 PID No.: 018-322-11 i MARK /A B C D C01 CO2 / 25 35 27 8 \ 1 CO3 C04 27 19 27 20 \ 1 \ \ \\�WELL \\ TC01 TCO2 25 21 22 25 i \ TC04 MT1 16 330 90 75 \ \ I \ MT2 62 90 I \ BEf CFS,\GARAGE SLAB �� \ \ DRIVEWAY T1 TH#2 — — — — \\ C \ r \ \ I TC03 TC01 \ \\ # \ TH � � \ \ M 0 .0 03 I TC04 TC C04 I I I I I \ \ (2) PLASTIC �EPTIC TANKS �I 4" x 4' WIDE INSULATION UNDE� DRIVEWAY I I I i I I I I I I SCALE: 1 "=50' I C01 CO2 COS C04 TC01 0 TCO2 MT1 MT2 2 a7TC�04 OI • CLl ��®® SUTATION FlNISH GRADE •• 0 (.-, ` °•• vJ • ®®®� s. ,,—FILTER FABRIC k INSULATION .0 ORG ® 49TH . 9a 1,500 GALLON -24-1 PLASTIC 1,000 'u"E" POLt GALLON 9 99 GM PLASTIC •• TANK 9.4 TANK •••••••••••••••••••• ••••• •• •••• •• :•MICHAEL N. ANDERSON: 89 WATER 90, OCT 2079 No. CE 9469 ArAr ® .3-3-21ARP ®®®�® SEPTIC SECTION N.T.S. /�.- ry.••�•'�•� ® \' ®®®� �'ESS ®® Municipality of Anchorage Development Services Department On-site Water and Wastewater section 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.or -q/onsite (907) 343-7904 h1["HAEL' N, ANDERSON 4i 'CE 6P 94 Soils Log - Percolation Test 0 Performed For: Date Performed: Legal Description: (Iasn6j 5 -or, -33 —Township, Range, Section: L " - 2 3 1- 2- 3- 4- 5- 6- 7- 10- 11, 12- 13- 14- 15- 16- 17- 18- 19- 20 - COMMENTS 00 A V C, CP y tv (3090"'. Site '�-A WAS GROUND WATER ENCOUNTERED? Date Gross Time Net Time IF YES, AT WHAT DEPTH? L Depth to Water After 0 P Monitoring? L9 E Date: '71-4? I Reading Date Gross Time Net Time Dept to Water Net Drop 1.11U- I luill MM I 1= 7 -- (MlnuteShnch) PERC HOLE DIAMETEI _ � TEST RUN SET EEN FT AND FT PERFORMED BY: /m K_)A' - I CERTIFY T,AT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THlS DATE. DATE: Z7 / 'L( Feb. 23, 2021 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Lot line waiver Legal: TI 2N R3 W SEC 33 LT 233 To Whom it may concern: This is a request for a lot line waiver of 5 feet from the septic trench to the west property line, see the site plan. The granting of this waiver will not impact any of the neighboring properties due to very large lot sizes. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage /1 o ✓� L.)C��fCtl7GllC � P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 a (907) 343-7904 a Fax (907) 343-7997 http:/Iwww.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * x x x VARIANCE/WAIVER REVIEW x* x x Waiver#: OSV211014 COSA OSC211066 Permit#:OSP191430 PID#: 018-322-11 Legal Description: T1 2N R3W Sec.33 lot 233 Engineer: Mike Anderson Applicant: Your request for a waiver of the required 10 feet horizontal separation from the Absorption field to the lot line has been approved. The approved separation distance is 5'. This waiver approval applies to the Existing only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department ❑The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. Y, Adjacent properties are not affected by this waiver. ............................................... ■ t t .. t .................... t ... ■ Waiver is Granted.- X Waiver is not Granted: Date: Z� Approved Na e of Reviewer **** VARIANCE/WAIVER REVIEW **** f - STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING, LAND & WATER Alaska Hydrologic Survey v y� 9r~fNi Oi Ma JPP WATER WELL LOG Revised 08/18/2016 Drilling Started: 2 A /20 Completed: 2 A /20 Pump Install: 11 /07 /2020 City/Borough Subdivision Block Lot Property Owner Name & Address C. Moon 2910 East 154th Ave. Anchorage MOA 233 Well location: Latitude Longitude Meridian Seward Township 12N Range 3W Section 33 1/4 of 1/4 of 1/4 of 1/4 BOREHOLE DATA: (from ground surface) Drilling method: Wir rotary, aable tool,DOther Suggest T.M. Hanna's hydrogeologic classification system* httos://my.ngwa.org/NC Prod uct?id=a185000000BYub3AAD Well use:OPublic supply,QDomestic, OReinjection,OHydrofracking El commercial, DObservation/Monitoring, OTest/Exploratory,OCooling, El Irrigation/Agriculture,E]Grounding,❑Recharge/Aquifer Storage, El Heating, ElGeothermal Exploration,DOther Fluids used: none Depth From To Casing Stick Up 0 2 Overburden 2 4 Depth of hole: 4Z ft Casing stickup: Z ft Casing type: Steel Casing thickness: .250 inches Casing diameter: 6 inches Casing depth: 42 ft Liner type: Depth: ft Diameter: inches Note: Silt & Gravel 4 14 Clay with Gravel 14 22 Wet Sand and Gravel 22 40 Coarse Gravel with Water 40 42 Well intake opening type: ■ Open end,!—Open hole,DOther Screen type: , Screen mesh size: Screen start: ft, Screen stop: ft, PerforatedE]YesO■ No Perforation description: Perf from: ft, Perf to: ft, Perf from: ft, Perf to: ft Gravel packedOYes NNo Gravel start: ft, Gravel stop: ft N ote: Static water (from top of casing): 18 ft on2 A /20 Artesian well Pumping level & yield: feet after hours at gpm Method of testing: Development method:Air Lift Duration: 1 hour Recovery rate: 20 gpm Grout type: Bentonite Volume 2 Bags Depth: From 0 ft, To 20 ft Include description or sketch of well location (include road names, buildings, etc.): Final pump intake depth: 30 ft Model: 1 OSQE07-208 Pump size: .5 hp Brand name: Grundfos Was well disinfected upon completion?IMI Yes Lj No Method of disinfection: Chlorine Tabs I WATER QUALITY TESTING Coliform �/ e Nitrates Col/100mL ArS$niC�{ mg/L �_ ug/L ' Was water quality tested?I es QNo Water quality parameters tested: Well driller name: �Urlr)r!y naY......................................................... Company name: H.eftv..Dr.i.1.1lnq... Iric............................................... Mailing address: P..O..BOX..1.1.2.1.3.0................................................ ath 11 . Z , z NT city: Anchorage State: AK zip: 99511 Phone number: (907 ) 345 -0593 AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a copy of the well log be submitted to the Department of Natural Driller's signature: Resources within 45 days of well completion. Well logs may be submitted using the online well log reporting system available at: Date: 02 /04 /2020 Anchorage Municipal Code 15.55.060(1) and North Pole Ordinance 13.32.030(D) require that a copy of this well log be submitted to the Development Services Department/City https://dnr.alaska.gov/welts/ within 30 days of well completion. OR email electronic well logs to City Permit Number: OSP191430 Date of Issue: dnr.water.reports(c alaska.cLov Parcel Identification Number: `Guide for Using the Hydrogeologic Classification System for Logging Water Well Boreholes by Thomas M. Hanna NGWA Press Development Services Department Building Safety Division On -Site Water & Wastewater Program , 4700 Elmore Road ' P.O. Box 196650 Mark Begich Anchorage, AK 99507 s a F E T Y Mayor www.muni.org/onsite (907) 343-7904 Pump Installation L® Well Drilling Permit Number: SWOSP1914,14 Date of Issue: Parcel Identification Number: Legal Description T1 2N R3W SEC33 LT233 G:3134 Property Owner Name & Address: Moon Pump Installation Date: 11-07-20 Pump Intake Depth Below Top of Well Casing:30 feet Pump Manufacturer's Name: Grundfos Pump Model:1 OSQE07-200 Pump Size.5 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Manufacturer's Name: B 1 Ox Pitless Adapter Installer: Anderson Well Disinfected Upon Completion? ® Yes ❑ No Method of Disinfection: Chlorine Tabs Comments: Pump Installer Name: Johnny Kay Hefty Drilling, Inc. Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. avZZT2n�+ 2zOma00S <OyA�^y2m a m m o= Y r 2 Cam?z�yp �nZ�rO�mm� O�Z�^AC�O Z�YpOaZm =OanpromA ABY D' �l`n0 Y `m�y aaca vs OZ =OA VC, ?cav=', na1i� 2 -rop tnOm O A jAr%O Cm2 Zy�cl m-�-2ia �ao2 O V m z p y T Y U Z m o> Omnv] O O y m n pUm mrtTi3< a ,yn z�zo m =R'2 n0 2 �< x pm-i<D OIm D x S H z n n r n Q y �Ln MLA r U �t y c m om H mADmp3 �o U �AA«m m n0u N O7 m C_ Q Q " .o> H T.TI p zm w m -G V t Gm m m 33' RIGHT OF WAY RESERVED IN PA ------------------------- mmz nzz rN+D9zv�p w p-+ -I nDi D p p V 7 H N m Ln H Ln 7-1 z + -+ H H z m D O D H A o D i <-An w < S H m -i H V] O 'v m Ln m ID 0 to -am r 2 r m m A �V � Ln --1 0 Cu ,U Z N mm 7c nz? m �nnOr �I p (31 Dmz D n m o �02 �GlcO � mHS � a�C < Di un z= m v C) x w tam z � y �Ln r r U �t y c m �o ti M N O7 m C_ -i --------------.------------ Q 33' RIGHT OF WAY RESERVED IN PA ------------------------- w y Z C � T S U �t v\ �o ti m r I 33' RIGHT OF 6l AV RESERVED IN PATENT ----------------------- 40/, BRgTs<q� skYs SOB „H, ±,,Y, MUNICIPALITY OF ANCHORAGE ,rter,t On-Site Water&Wastewater Program N0 .S• \ PO Box 196650 4700 Elmore Road �• Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 r” http://www.muni.org/onsite \ ' / Department RkCMOA^°. On-Site Water & Wastewater System Permit Permit Number: OSP191430 Effective Date: 11/18/2019 Work Type: WellSeptic Initial Expiration Date: 11/17/2020 Tax Code Number: 01832211000 Site Legal Address: T12N R3W SEC 33 LT 233 G:3134 Site Mailing Address: 2910 E 154TH AVE, Anchorage Owner: MOON COURTNEY & JESSE Lot Size in Sq Ft: 108900 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 5 This permit is for the construction of: Ei Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: The entire subsurface disposal field and/or alternate is not within a 30 foot radius of a percolation test. The Engineer needs to do an additional percolation test prior to the construction of the septic field. 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: I141/C Date: X14 if r ' Issued By: /1ek?) • Date: / U MUNICIPALITY OF ANCHORAGE Development Services CDepartment ;" Phone: 907-343-7904 On-Site Water & Wastewater Section -//: Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 018-322-11 Property owner(s) CLIFF ELLINGSON Day phone 360-8329 Mailing address 5033 CAPE SEVILLE DR ANCH AK Site address Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T12N R3W SEC 33 LT 233 Lot Size 108900 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field 0 Initial Ei Single Family (SF) D (w/wo ADU) Septic Tank E Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ D) Private Well ❑ 6 9,v Resiip � Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: SEP 2 4 2019 << Dist.. b f168L9 "n I certify that the above information is correct. I further certify that this is in akar ance with applicable Municipal Codes. MIAAN- (Signature of property owner or authorized agent) Permit/Rush Fees: gae) Waiver Fees: Date of Payment: `UR(1/0 Date of Payment: Receipt Number: °Vet810 Receipt Number: Permit No. 05 091(13() Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Sept. 23,2019 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 Legal: T12N R3W SEC 33 LT 233 To Whom it may concern: This is a request for a septic and well permit on the above referenced. A test hole was excavated and found the same material top to bottom, SP with water at 10 feet during excavation and after the 7 day monitoring period. The proposed system is a 5-wide by 80 feet long with two 1,000 gallon tanks and a lift pump in the second tank. This new system will not impact any of the neighboring properties due to the large lot size and good soils. The creek located on the east side has been shown plus the 100'off-set. The slope is less than 1 percent to the southwest, see the site plan. Sincerely /m4_ Michael N. Anderson. 1'.1.. 4661 Natrona Anch, Ak 99516 Ph 727-8864 . I DESIGN CRITERIA: MOUND OVER (TH#1) o r GRADE in 5 BDRM X 150 = 750 GPD SOILS = 750/1.2 = 625 GPD 10 .ORG -1 0 i= im._— FILTER FABRIC 625 GA/5*0.64 = 80' -3.5 1.25"0 PIPE W/ SP 1/4"HOLES @ 48" (1)TRENCH I• 5.0' I SEWER ROCK 3.5' DEEP 2.5' EFFECTIVE 5.0'WIDE 80' LONG -11 WATER @10'MAY 2019 SEPTIC FIELD SECTION 1 1 />-\\-----\\. `. — — , ` �\ I 'i � \\ OLD SEWARD r SI 1 r I �E�v �I, HIGHWAY , v I \ / \ / i ' \ 1 1 \ - 1 s_LS`` i T W 1 r i 0 r \ \IP,GPs`41 co .. ro IN..P 1 1 _ 1 J _- L 1 PROPERTY LINE J/ \in . 1 \l'1°-\‘ Ik ' P 074 NS \ -- / 1 kr---,-, o vPG .-_ �,___ .. i ' .. 7:. = I / .1\01F: \_.),< _,9 ,o \e7POTth5?-6474 .111 -1N\ —1- 1 Septic Design Prepared for isivisSiiiiiii CLIFF ELLINGSON �•�P� •9.F'•/14/1444 . T12N, R3W, SECTION 33, LOT 233TH NJ, iA Anchorage, Alaska 49 • i i Michael N. Anderson, P.E. DATE: 9/19/2019 �P•:•MICHAEL •N. ANDERSON/pm 4601 NATRONA AVE st ��Ak� ' No. CE 9469 ,„ AV DRAWN: DJR ref( •° •i ANCHORAGE,ALASKA 99516 �j C••+' \ , •4 (907) 727-8864/FAX: (907) 345-1391 SCALE: 1"=200' 44k. SS\':444 �l ��--\ / T12 ,R3 PROPERTY LINE \1/41 1 SECTION 3,L I zos 4 1 t- / 1 1 •\\ / I I I •\ 1 \ \\ // 1 \ \ \ \7\\ / 1 \ \ 1 / \\ \\ \ 33'Km / \ / \\ \\ \\ EASEMENT • t -- \ \1 I/ ® \ •\ / \1 \\\ \\� PROPOSED �`� , 1 \ \ i WELL 100' I I\ / \\ I I RADIUS \ \ / \ \-rscp. \\\ TEST HOLES NOT - I, \\ t<`� SECONDARY TEST' USED DUE TO \ , V I HOLE REQUIRED WELL LOCATION / / \ //\\ PRIOR TO ` • \\ !// \ 2'CONTOURS TYP. PROPOSED \ INSTALLATION "\\\ HOUSE x // \\ STREAM HIGH • MT \ • ---- _- roe, Off• A \\ I. WATER MARK < 1' N /\/ \\\\ \s_u#1 IN M2 Xvvv • vvvv A v� I AO z' I vvvv .v\v 1 I 1 Z TCO TCO 1 i No I ��\�• •\\ \ �e I�� e • 1 No 0 11 \\\\ \�•� TWO 1000 GALLON \ ~v \ ,\ I PLASTIC TANKS W/LIFT N \`\``_\\\\y"\\\\� I STATION SEPTIC TANK 1 --,•<\\\ •. MT • �P 1 \ 1 \ v o\0 Q<1 \ ALL SLOPES THIS AREA • / co\O t \\ \ FLAT WITH NO CUT I \\ \ BANKS OR SLOPES>25% 1 PROPOSED SITE — \WITHIN 50'OF THE \\\ \\SKS 'c' K \ t-^ — 'TNCFtE, 20' T12N,R3W \ \\ / SECTION 33.LOT 233\\ \ • /n / -I- AV S ev.m.tif Ep4eh.eryt. - - I I ,\ / I 1 \ 'IT evvx � . T1,ZIQ.R3W 1 \ SECJION 33.LOT 239 \ \\ \ // I \ \ / \ \ Septic Design Prepared for CLIFF ELLINGSON �.•�P-_••OF 44'114. . T12N, R3W, SECTION 33, LOT 233 a T • H �� i1 Anchorage, Alaska S • : 49— • • Michael N. Anderson, P.E. DATE: 9/19/2019 O :.MICHAEL N. ANDERSON; _: 4601 NATRONA AVE DRAWN: DJR • ••A • N;' 9469 • �: '�l • ANCHORAGE,ALASKA 99516, r....,4.••�... -.C.9 47 (907) 727-8864/FAX: (907) 345-1391 SCALE: 1"=50' •�,1 �;' �4 Municipality of Anchorage -NE`'S, C�AL) • .�. ,-t L?, �.,, Development Services Department 0,,,,,v.,... • .• °•Sr v a On-Site Water and Wastewater Sectionso�j° �•� r ��- o •jc. -•.e` 4700 Elmore St. r 'k • 49TH •.• ' �1 P O. Box 196650 Anchorage,AK 99519-6650 ••...... .. .. :'P' di ... '� WWW.muni.orq/onsite •F4 \ (907)343-7904 e'er ..•• • ........... • r` .�. MICHAEL N. ANDERSON ;r4t Pl ri s.•. CE-9469 .•.&,' Soils Log - Percolation Test I /e, '•.. _•-,,,s,...,......' � % Performed For G• + Date Performed:i\ ` i ittil, �. �� t n Sun \ `� �.�` Legal Description: /l (,to 4- Z- -5 Township, Range, Section: Slope Site Plan Depth (Feet) 1-_ - eSCA 2- 1P 3- Li't� P la rl 4- 5- P 6- 7- 8- WAS GROUND WATER 9- ENCOUNTERED? NI"f S S 10- IF YES,AT WHAT DEPTH? /('I L O Depth to Water After / P 11-� , I?:.dp rN. Monitoring? /t' E 12- Date 47L,ll 13- 14- Reading Date Gross Time Net Time Depth to Water Net Drop 15- 7)41/14 /V Mrti V S 16- Z ( /` 5// 17- ,1) I / t 5.. /t 18- 4./0 (, /� Sit � a SI' 19- 20- Gid v 9// PERCOLATION RATE 1 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN .� FT AND '3, FT COMMENTS Auf rL-riLArnat_ 4\0 tff( 't PERFORMED BY: ,NAR I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ZWil MUNICIPALITY OF ANCHORAG L\ t Development Services Department On -Site Water & Wastewater Section Parcel I.D. 018-322-11 1 Certificate of On -Site Systems Approval hone: 907-343-7904 Fax: 907-343-7997 Expiration Date: & - � -2- Current Z GENERAL INFORMATION Complete legal description T1 2N R3W SEC 33 LT 233 Location (site address) 2910 EAST 154TH, ANCH AK Current property owner(s) COURTNEY MOON Mailing address SAME Real estate agent 2. TYPE OF DWELLING: (� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: Private Well 0 Water Storage [] Community Well ❑ Public Water System ❑ Waiver request for:_ hcu 4 Q" V-Q_r 6 , i Day phone Day phone TYPE OF WASTEWATER Private Septic Q Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $-12-0 Date of Payment 0 LCe y Io0 Receipt Number _ Z%26/ z I COSA# 0Sf 21 0&6 Dista Waiver Fee $ Date of Payment 3.A/ I bo 2 Receipt Number 0O `A 8 Waiver # 0 S V Q 1.l 0 1 L; )ISPOSAL: Q 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify thE t my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this a plication, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adE quate for the number of bedrooms and type of structure indicated herein. I further verify that based on the inforr iation obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site waterupply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordin nces, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify th information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727 8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 2-15-21 1 � et "I f1 6. DSD SIGNATURE `�`�•� r/ ••��•-• `-J System #1 Approved for 5 bedrooms r -r �, r�icH EL N. AtJDERSCiJ•'�' System #2 Approved for bedrooms f. =. • J ,'•\ ;%s Disapproved nr Conditional approval for bedrooms, with the following stipulatio s: IPAL�Ty��,�` a 171, tnti Original Certificate Date: 3 3 — Z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approv (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. T e 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: T12N, R3W, SEC 33, LOT 233 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 214120 Total depth 42 ft Cased to 42 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 18 ft. Comments B. TANK DATA Age of tank(s) NEW years Tank type/material * Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping *(2) PLASTIC TANKS, 1500 & 1000 D. ABSORPTION FIELD DATA NEW SYSTEM Which system tested (date installed) NEW ❑ ALL standpipes present per record drawing Total measured depth from grade 5.2/5.5 ft (max) Measured depth to pipe invert from grade ft (min) Al NIA —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 0 gallons Com ments/Deficiencies: CASA Checklist yellow sheet ParceOD: 018-322-11 Structure served by this system Well production at time of test Water storage tank volume 0 Well disinfected for coliform tE ❑ Coliform bacteria is Negati Nitrate 0.674 mg/L ❑ Nitr Arsenic ug/L ❑ Ars Collected by MNA Date of Sample 11/24/21 gallons ❑ Yes ❑ No less than MRL (ND) is less than MRL (ND) C. LIFT STATION ❑ Required maintenance comr eted Age of lift station NEW years Lift station material PLASTIC i Comments: Adequacy test date NEW Results ❑✓ Pass For 5 Fluid depth prior to test 0 Water added NEW gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment If yes, enter date bedrooms 12 months) 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' Community Sewer Manhole/CI ✓0 Yes Neighboring Tank > 100' ❑✓ Yes Absorption Field on Lot > 100' ❑✓ Yes Neighboring Absorption Fields > 100' 0 Yes Community Sewer Main > 75' [D Yes if No ft if No ft Private Sewer/Septic Line > if No ft Holding Tank > 100' Animal Containment > 50' if No ft Manure/Animal Excreta Stor 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 Yes if No ft I Wells on Adjacent Lots: Absorption Field > 5' ✓0 Yes if No ft Private Wells > 100' Water Main > 10'✓❑ 0 Yes if No ft Community Wells > 200' Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway, 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 d Property Line ? 10' ❑Yes if No ft if No ft Wells on Adjacent Lots.- ots:Water WaterMain > 10'✓❑ ,..,..... hAS�FR5�49 .{ s Yes if No ft Private Wells > 100' Water Service Line > 10' 0 Yes if No ft Community Wells > 200' Surface Water? 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 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 anout > 100' ❑✓ Yes if No ft ❑✓ Yes if No ft ✓❑ Yes if No ft ❑✓ Yes if No ft > 100' ✓❑ Yes if No ft M Yes if No ft ❑✓ Yes if No ft ❑✓ Yes if No ft ment below comment below Yes if No ft Yes if No ft d.. M!C?1f;t ,..,..... hAS�FR5�49 .{ s 4r yC�}A/CJ