HomeMy WebLinkAboutBRANDT LT 2Onsite File
Brandt
Lot 2
#015-142-99
(Rev 05/02118)
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201135
. PID Number: 015-142-99
Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: 0 New ❑ Upgrade
Name
MGJ
ABSORPTION FIELD
F Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
11440 TOTEM RD
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4
1.2 GPD/SF
8.5 Ft,
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3.5 Ft.
Gravel depth beneath pipe
5 Ft.
Subdivision Block Lot
BRANDT LT 2
Fill added above original grade
0 Ft.
Gravel length
50' Ft.
Township Range
Section
Gravel width
2.0 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
5500 Ft2
1 •0
Ft.
Well
100'-1-
100'+
501+
TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
GREER TANK 1250 Gal.
Surface Water
100, +
100,+
I
Material
PLASTIC
Number of compartments
2 .
Lot Line
10'+
10'+
NA
Foundation
10'+
10'+
I
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks
Alarm location
Electrical installed by
PIPE MATERIAL House to tank 3034 dTank torainfield 3034
Installer
MIKE N ANDERSON, P.E.
Drainfield 3034 Co/MT3034
Inspector MIKE N ANDERSON, P.E.
BENCH MARK (Assumed elevation) 103.55 ft
Inspection1st 7/25/20 7/25/20
2nd
Location and description
ection
WEST GARAGE MAN DOOR SIL
3`d 41h
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
gne�r4q�(amp
Gam„ i 4f
Conditional Approval:
Date
fr a • . ch -, 1
��:_ �'-o • J �'; ?,
..�
,'h•
�� •;
Septic S
Approved t� �'
Date 2'Z�r
-------- — _
�� .�• ��r ;
q . D ♦ .s
l �.� rw
Note: this approval does not
include well permit requirements.
:x� -�
(Rev 05/02118)
Permit No. OSP201135
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: BRANDT LT 2 PID No.: 015-142-99
MARK
A
B
C01
10
15
CO2
10
21
TC01
18
28
TCO2
27
31
CO3
29
35
054
30
38
0
50
48
MT1
44
62
C06
45
63
MT2 _
_ 49
47
BENCH, GARAGE LAB _
l
C06MTy / / DRIVEWAY
CO TC,01 01
TH#4i ®II CO3 X02
\ u MT2
NEW
W 1
I
NEW 1250 GALLON PLASTIC TANK
1
\ ASBUIL
\ SCALE: W
N.T.S.
1
I
I
I
I
� I
/
OF
OG 401�
)RG AW
Ar
Ar '' 4 9 0..®Hp /gym •' ®S
SM/AAL •�••J /L ....� ....
DRY. DEC 2019
:.MICHAEL N. ANDERSON:
jw
No. CE 9469
%'-.,12-21-20�0®�ESS\®®®
�V1TAU us
+®
® DOC CO dba
�[!! 8c COLE
;40-k-, LLIVAN WATER WELLS
r—___P.O. Box 670269, Chugiak, AK 99567 688-2759
OWNER OF LAND: MGJ
ADDRESS:
LEGAL DESCRIPTION Brandt Lot 2
DATE: 7-13-20
PERMIT NUMBER: OSP201135 DATE OF ISSUE: 7/7/20
TAX IDENTIFICATION NUMBER 01514299000
Is well located at approved permit location: ®Yes ❑No
Method of Drilling: ®air rotary cable tool
Depth of Well: 145'
Casing Type: Steel Wall thickness .250 inches
Diameter: 6 inches, depth 145 feet
Liner type
Static Water Level: 112 feet
Recovery Rate 20 ® gpm 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 ❑ no
Method of Disinfection: Chlorine 50 PPM
Comments:
Bore Hole
Data
Depth
From
To
0
2
Casing Stickup
2
4
Overburden
4
28
Silty Sand & Gravel
28
69
Silty Sand & Gravel w/ Clay
69
111
Silty Sand & Gravel
111
129
Silty Sand & Gravel w/ Clay &
Cobbles
129
145
Sand & Gravel w/ Cobbles
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.
Well Drilling Permit Number: SW OSP201135 Date of Issue 7-7-20
Parcel Identification Number: 01514299000
Legal Description
Brandt Lot 2
Pump Installation Date: 11-17-20
Pump Intake Depth Below Top of Well Casing: 130
Pump manufacturer's Name: F&W
Pump Model: 4F11P07301S
Pump Size: 3/4
Pitless Adapter Burial Depth: 10
Pitless Adapter Installer: Mike Anderson
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
M G1
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: OSP201135 Effective Date:
Work Type: WellSeptic Initial Expiration Date
Tax Code Number: 01514299000
Site Legal Address: BRANDT LT 2 G:2637
Site Mailing Address: 11440 TOTEM RD, Anchorage
Owner: BRANDT LAWRENCE D 50% &
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
0
Uel>artmerit
7/7/2020
7/7/2021
Lot Size in Sq Ft: 87173
Total Bedrooms: 4
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
Date:
Date: 7 7 202-0
MUNICIPALITY OF ANCHORAGE
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. 015-142-99
Property owner(s) LARRY BRANDT
Mailing address TOTEM RD, ANCH AK
Site address SAME
Day phone
Legal description (Sub'd., Block & Lot) BRANDT SUBD. LT 2
Legal description (Township, Range & Section)
Lot Size 87,173 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
[7�
Initial 0
Single Family (SF)
0
(w/wo ADU)
Septic Tank
ElUpgrade
1-1Duplex
(D)
ElHolding
Tank
ElRenewal
❑
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
7
Water Storage
❑
THIS APPLICATION INCLUDES
A 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)
u
Permit/Rush Fees: -Far, 1&1,5+111 Waiver Fees:
Date of Payment: J� I��1 �6 Z -11Date of Payment:
Receipt Number: o013'11 Receipt Number:
Permit No. Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
COVID-19
2570 DISCOUNT APPIIFn
June 30, 2020
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: New septic & well permit
Legal: BRANDT SUBD. LT 2
To Whom it may concern:
This is a request for a septic and well permit on the above referenced lot. Four test holes were done
by Garness Engineering for the new subdivision and we have used data for soil logs 3 & 4. A
simple deep trench has been designed for the simple gravity flow system. A new 1250 gallon
plastic tank has been specified with the 20 inch riser. The slope has been shown, see the attached
site plan. This new septic and well permit will not impact any of the neighbors or encroach on any
wells, septic or open water issues.
Sincerely
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201135, Rebecca Carroll, 07/07/20
SEPTIC FIELD SECTION
DESIGN CRITERIA:
5.0' EFFECTIVE
4 BDRM X 150 = 600 GPD
SOILS = 600/1.2 = 500 GPD
500 GA/5 = 50'
2.0' WIDE
50' LONG
(1) TRENCH
11.0' DEEP
18.5
(TH#4)
5.5
ORG 1.0'2.0'
-11.0
-6.0
MOUND OVER
FILTER FABRIC
SEWER ROCK
3,3(
GRADE
1"=200'
PROPERTY LINE
PROPOSED SEPTIC
-E 112TH AVE--TOTEM ROAD-PROPOSED WELL
100' RADIUS
SCALE:
DJR DRAWN:
DATE:
BRANDT, LOT 2
Anchorage, Alaska
MGJ
6/24/2020
6/9/2020-GAMACHE DRIVE0-E 112TH AVE-
(TH#3)
2.5
SM/ML
ORG
17.5
SM/ML
SEPTIC
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201135, Rebecca Carroll, 07/07/20
PROPOSED
DRAINAGE FIELD
1"=50'
PROPOSED
RESERVE FIELD
NEW 1250 GALLON
PLASTIC SEPTIC TANK
PROPERTY LINE
PROPOSED WELL
100' RADIUS
DRIVE
W
A
Y
DAVID RING
LOT 2B
-TOTEM ROAD-SCALE:
DJR DRAWN:
DATE:
BRANDT, LOT 2
Anchorage, Alaska
MGJ
6/24/2020
6/9/2020
PROPERTY LINE
BRANDT
LOT 1
EKVALL
TRACT B-1
T12N R3W SECTION 22
LOT 46 10' POWER & TELEPHONE EASEMENTCOCO
COCO20" RIS
E
R
DCO
MT
CO
1' CONTOURS TYP.
10' UTILITY EASEMENT
10' UTILITY EASEMENT
TEST HOLES 3&4
BY GARNESS, SEE
MOA SUBDIVISION
FILE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201135, Rebecca Carroll, 07/07/20
❑ I
TOPO CONTOUR LINES TESTHOLELOCATIONAREAPPROXIMATE; THEY
WERE NOT SUREYED IN BUT ARE BASED UPON
DAVID RING; LOT,
OT ARE 5' AND APPROXIMATE FLAGGING OF THE LOT LINES IN THE FIELD
EPTIC ►
AR�
VID RING; LOT
1
\ T.H. T.+.#1 ►
01
--
SEPTIC
150 EET RESERVEAREA V
80 EE � ` ►
lL O LO TO TH EAST PROPOSED BRANC
E ECOME "LOTOTING LOT �O. OES OT NCRO HON SUBDIVISION; LOT 2 /►
o no een r
I T}2M R3W SECTIObkf2; LOT 46 I
TRACT B-1
LOT 1
GARNESS ENGINEERING
GROUP, Ltd
ENGINEERING,, SALES �CONSULTING,
�� - als ��.I.�
3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 - PHONE (907) 337-6178 • FAX (907) 338-3246-VEBSffE: www.ganmssergmemBg.com
PREPARED FOR:
PHONE NUMBER:
PAGE NUMBER:
LARRY BRANDT
907-351-7957
1 OF 2
PROJECT/LEGAL DESCRIPTION:
DRAWN BY:
T12N R3W SECTION 22 LOT 43A
D.J.G.
TYPE OF WORK:
DATE:
� SEPTIC SYSTEM DESIGN UPGRADE
112/2019
GARNESS ENGINEERING GROUP, Ltd
_ll � —
3701E TUDOR ROAD. SUITE 101 • ANCHORAGE. AK RB5n7 • P.1-1-11
LEGAL DESCRIPTION:
PERFORMED FOR:
DEPTH
(feet)
1 ORG
2-
3-
4 34
5-
6
7-
8
9—
M L ML
10
11
12
13
14-
15
16
17 iml
B.O.H.
18
SOIL LOG - PERCOLATION TEST
Tl 2N R3W SECTION 22 LOT 43A
LARRY BRANDT
DATE: 12/13/2019
TEST HOLE #1
s �
II�III!11
%//%
/.�
NNE
•
�fiffl[ll
7/N�
•
DEPTH TO DATE
GROUNDWATER
DRY 12/13/2019
DRY 12/30/2019
SITE
t"= 170'
DATE READING CLOCK I NET TIME WATER LEVEL NET DROP
TIME (MINUTES) READING (INCHES)
A PERCOLATION TEST COULD NOT BE PERFORMED DUE TO RUNOFF AND/OR WEEPING
FROM THE ORGANIC LAYER INTO THE PERCOLATION BENCHES - SOILS APPEARED
PERMEABLE AND A PERCOLATION TEST COULD BE ATTEMPTED AT A LATER DATE
19 PERCOLATION RATE (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN FT. AND FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES NO
SOILS LOGGED BY: DAVID GARNESS PERCOLATION TEST PERFORMED BY: N/A
COMMENTS: PERCOLATION READINGS ARE WITHIN 1/160F INCH.
PERFORMED BY GEG, Ltd. 1, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFOR ED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: Z l
_,-�..-�..�. �.., �. �������� ..�wrrvrw.ac,nne>avr-rnvrve(wi)a:fieiiy-hHJ[lYU/)J]8-3296'VYEBSITE: W.YN.gamessen$�eelpig.Com
SOIL LOG - PERCOLATION TEST
LEGAL DESCRIPTION: Tl 2N R3W SECTION 22 LOT 43A
PERFORMED FOR:
DEPTHI,---
(feet) [ZZ=j
E
i
e
9
10
11
12
13
14
15
16
17
18
LARRY BRANDT
TEST HOLE #21
DATE: 12/13/2019
SOIL CLASSIFICATIONS
•-
WEEP AT 3'
Wit
I11111111ML
1611111GM%//%CL
GCNNl1
•
:'
IIIIIIIIIMH
'
%//%CH
•
%��.. sc
all
DEPTH TO DATE
GROUNDWATER
DRY 12/13/2019
5`
l
N
SCALE:
I' =100'
DATEI.
READING CLOCK NET TIME WATER LEVEL NET DROP
TIME (MINUTES) READING (INCHES)
A PERCOLATION TEST COULD NOT BE PERFORMED DUE TO RUNOFF AND/OR WEEPING
FROM THE ORGANIC LAYER INTO THE PERCOLATION BENCHES - SOILS APPEARED
PERMEABLE AND A PERCOLATION TEST COULD BE ATTEMPTED AT A LATER DATE
19 PERCOLATION RATE (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
B.O.H. TEST RUN BETWEEN FT. AND FT,
20 A FOUR HOUR PRESOAK WAS PERFORMED:
❑ YES NO
SOILS LOGGED BY: DAVID GARNESS PERCOLATION TEST PERFORMED BY: N/A
COMMENTS: PERCOLATION READINGS ARE WITHIN 1116 OF INCH; TESTHOLE WAS BACKFILLED AND NO LONGER VIABLE FOR GROUNDWATER MONITORING
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERF RM D IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: G
SOIL LOG - PERCOLATION TEST
LEGAL DESCRIPTION: TI 2N R3W SECTION 22 LOT 43A
PERFORMED FOR: LARRY BRANDT DATE: 12/20/2019
DEPTH
(feet)
1
CLOCK
TIME
ORG TEST HOLE #3
SOIL CLASSIFICATIONS
WATER LEVEL
READING
NET DROP
(INCHES)
2
11:50
-
LOAM
-
2
12:20
GW ORG
3
6"
3
s, :,,�l*i= GP ML
-
6"
-
GM CL
a
30
0"
GC OL
5
12:50
-
SW LLLI I I I I MH
5
6
1:20
':►'•: SP CH
0"
6"
7
SM ,' OH
6
6"
-
SC
7
8
9 SM TO ML
10
11
12
13
14
15
16
17
B.O.H.
18
DEPTH TO DATE
GROUNDWATER
DRY 12/20/2019
DRY 12/30/2019
1 EE�]
SITE
1" = 100'
DATE READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
12/20/2019 1
11:50
-
6"
-
2
12:20
30
0"
6"
3
12:20
-
6"
-
4
12:50
30
0"
6"
5
12:50
-
6"
-
6
1:20
30
0"
6"
7
1:20
-
6"
-
6
1:50
30
0"
6"
19 PERCOLATION RATE <5 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 4.5 FT. AND 5.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: JODY MAUS
COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH. RECOMMEND SOIL APPLICATION RATE OF 0.8 GPD/FT2
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PEFf- ORIVIED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 3141
GARNESS ENGINEERING GROUP, Ltd
1 E I V,
ENG NE R N ULTING
ISOIL LOG - PERCOLATION TEST
LEGAL DESCRIPTION: Tl 2N R3W SECTION 22 LOT 43A
PERFORMED FOR: LARRY BRANDT DATE: 12/20/2019
DEPTH
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)_
(feet)
11:51
-
ITI= I= AA I
LTEST HOLE j
-
2
12:21
30
oll
6"
3
12:21
-
SOIL CLASSIFICATIONS
2—
Z
Z:�
30
oll
6"
5
12:51
-
4� - - � -,
G W
6
ORG
3 —
oll
6"
ORGANICS, STUMP,
1:21
GP
6"
ML
6
1:51
30
DEBRIS - AREA DISTURBED
M I I W I
G M
C L
4
G C
OL
SW
MH
5 —
ORGANICS/LOAM
SP
CH
Z:zz:::
SM
OH
6---j
SC
7
8
9
10
11
12
13
14
15
16
17
18
SM TO ML
DEPTH TO DATE
GROUNDWATER
DRY 12/20/2019
DRY 12/30/2019
ON
A
N
SCALE:
i IT
DATE READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)_
12/20/2019 1
11:51
-
6"
-
2
12:21
30
oll
6"
3
12:21
-
6"
-
4
12:51
30
oll
6"
5
12:51
-
6"
-
6
1:21
30
oll
6"
7
1:21
-
6"
-
6
1:51
30
oll
6"
19 — PERCOLATION RATE <5 (MIN./INCH) PERC. HOLE DIA, 6 (INCHES)
TEST RUN BETWEEN 6.5 FT. AND 7.5 FT,
20 — A FOUR HOUR PRESOAK WAS PERFORMED: Fj YES NO
SOILS LOGGED BY:— JODY MAUS PERCOLATION TEST PERFORMED BY: JODY MAUS
COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH. RECOMMEND SOIL APPLICATION RATE OF 0,8 GPD/FT-
PERFORMED BY GEG, Ltd. 1, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PE70R�ED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
MUNICIPALITY OF ANCHORAGE'/,"
cv H
C ORAE �® �
4 '
Development Services Department j` Phone: 907-343-7904
Ori -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-142-99
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Expiration Date: 3 —a- z >Zo`m
BRANDT LT 2
11440 TOTEM RD, ANCH AK
Current property owner(s)
Mailing address
Real estate agent
MGJ
��
2. TYPE OF DWELLING:
Fx7l Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
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.
COSH Fee $ 90 (COVID -19) Waiver Fee $
Date of Payment � a 0 a Date of Payment
Receipt Number 021 3 9 Receipt Number
COSA # OSC201684 Waiver #
S. 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. l 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 MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE ANCH AK
Engineer's Printed Name
MIKE N ANDERSON, P.E.
6. DSD SIGNATURE
System #1 Approved for 4 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
Date 12-15-20
rF •i.
MICHAEL N. ANOLFZ��C`j
CE 94
kkQ
with the following stipulationnnh��►'°'
OF 1.461
i�
m:=
J23—Zc�
Original Certificate Date:_?!
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 biue shoot
Legal Description: BRANDT LT 2
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 7/13/20
Total depth 145 ft
Cased to 145 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 112 ft
Comments
B. TANK DATA
Age of tank(s) 2020 years
Tank type/material *
Measured operating fluid level in septic tank NEW
❑ Standpipes/foundation cleanout per record drawing
Date of pumping * new plastic tank w/ 20" riser
D. ABSORPTION FIELD DATA NEW SYSTEM
Which system tested (date installed) 7/25/20
❑ ALL standpipes present per record drawing
Total measured depth from grade 8.5 ft (max)
Measured depth to pipe invert from grade 3.5 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
FOR 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
Comments/Deficiencies:
COSA Checklist yellow sheet
Structure served by this
Well production at time of test,
Water storage tank volume 0
Well disinfected for coliform to
❑ Coliform bacteria is Negati�
Nitrate 0.531 mg/L ❑ Nitr
Arsenic ug/L ❑ Ars
Collected by MNA
Date of Sample 1214120
C. LIFT STATION
❑ Required maintenance c
Age of lift station ye
Lift station material
Comments:
Adequacy test date NEW
Results [✓ Pass For 4
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
ID: 015-42-99
5+
gallons
? ❑ Yes IN No
less than MRL (ND)
is less than MRL (ND)
feted
_ bedrooms
in
t 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 Manho
Private Sewer/Septic Line > 2!
Holding Tank > 100'
Animal Containment 2 50'
Manure/Animal Excreta Storac
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
0
Yes
if No ft
Neighboring Tank > 100'
Q
Yes
if No ft
Absorption Field on Lot > 100'
El
Yes
if No ft
Neighboring Absorption Fields
> 100'
Yes
if No
Q
Yes
if No ft
Community Sewer Main > 75'
Q✓
Yes
if No ft
Private Sewer/Septic Line > 2!
Holding Tank > 100'
Animal Containment 2 50'
Manure/Animal Excreta Storac
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
Q
Yes
if No
ft
Surface Water > 100'
Property Line > 5'
[✓
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
ED
Yes
if No
ft
Private Wells > 100'
Water Main > 10'
Q
Yes
if No
ft
Community Wells > 200'
Water Service Line > 10'
R-1
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'
Q
Yes
if No
ft
If absorption field is under d
Property Line > 10'
Q
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
121
Yes
if No
ft
Private Wells > 100'
Water Service Line > 10'
ED
Yes
if No
ft
Community Wells > 200'
Surface Water > 100'
Q
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that I 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
eanout > 100'
Q Yes
if No ft
i' Q✓ Yes
if No ft
Q✓ Yes
if No ft
0 Yes
if No ft
> 100'
0 Yes if No ft
0 Yes if No ft
Q✓ Yes if No ft
Q✓ Yes if No ft
comment below
comment below
0 Yes if No ft
Yes if No ft
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