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HomeMy WebLinkAboutT12N R3W SEC 26 W2 NE4 NW4 NE4 NE4Onsite File T12N R3W Section 26 W2 NE4 NW4 NE4 NE4 #017-432-35 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201498 PID Number: 017-432-35 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name /el'�YYlO Ili®r7 s HELENAQMANE GG_ ABSORPTION FIELD Site Address I ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound 7100 HUFFMAN RD, ANCH AK El Other 3 0.8 GPD/SF $ LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 2 Ft 6 T12N R3W SEC 26 W2 NE4 NW4 NE4 NE4 Fill added above original grade Gravel length Township Range Section 1.5 Ft. 47 Gravel width Beds: Number of Lines I Distance between SEPARATION DISTANCES 2 Ft T From Septic Tank Absorption Field lift Station Holding Tank Sewer Line Total absorption area 864 FP Numbei Well100'+ 100'.+. 50r+ TANK D Septic EJ S.T.EP Manufacturer GREER TANK :Surface Water Water 100'+ 10 NA Material PLASTIC Lot Line 10'+ 101+ Foundation 10'+ 101+ LIFT STATION Manufacturer Remarks lines :hes Dist. between trenches Ft. ding Q Other -apacity 1000 Gal. Vumber of compartments 2 'apacity location Electrical installed by Installer PIPE MATERIAL House to tank 3034 d aintieid 3034 MIKE N ANDERSON, P.E. Drainfield 3034 co/MT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 103.2 R Inspection dates: v, 9/20/21 2-w9/21/21 description Location and 3 I ¢,h CORNER OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL .� OF �onditionalApproval: Date "'��:•'• •oar-`;, :r497f1 . ........... • MICHAEL N. ANDERSEN : `z` Septic System 7CE - 94 4 �a Approve=Date &� r ° , t 2 jj3 (. • ° - : y Note: this approval does not include well permit requirements. (Rev Permit No. OSP201498 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 26 W2 NE4 NW4 NE4 NE4 MARK A B FCO 55 18 TC01 57 20 TCO2 62 23 C01 42 32 CO2 43 33 CO3 35 46 C04 52 34 MT 53 35 ECOM-W€ 23 27 I / I / I BENCH, 1/ I i -00H021,VEWAY' CoCo �l M3=BEDROOM RESERGE FIELD I � / WELL I / 1 1 / I WELL \\ ASBUILT SCALE: PID No.: 017-432-35 iTTO OF SIDING i i NEW 1000 GALLON PLASTIC TANK DECOMMISSIONED WELL / PER MOA SUBMITTAL WELL CUT-OFF & SEPTIC BURIED 1 DRY JULY 2021 F AW 49TH :MICHAEL N. ANDERSON: •. No. CE 9469 .: ®%' 2-13-21 .•.•• o o® Municipality of Anchorage K ��i E ,t?s� j Development Services Department ' tib;• • ° • • • • • ° On -Site Water and Wastewater Section 4700 Elmore St. a f� 40TH R� P.O. Box 196650 Anchorage, AK 99519-6650 wWW.muni.orq/On51te (907) 343-7904 �� • • , ..... ° . - MICHAEL N. fii:�,LF(SC:� ,°`• 16 Soils Log - Percolation Test u Performed Fo y or: P Date Performed Legal Description: 'T- J'Z �.J W t, 2 Township, Range, Section: - Dept 1 - GrT jSr D tC� t,a61 (Feet) 1-1 co�• 2- 3- 4- 1 15- 6- 7- P-cr, ,PI Cz1-rf 8- 9- WAS GROUND WATER Gross Time Net Time 3Drn,� ENCOUNTERED? j D 10- s IF YES, AT WHAT DEPTH? L 11- Depth to Water After P . J1 Monitoring? v E 12- // Date: I,rt 13- 14- 1 f3v do V, 16- 17- 18- 19- 20 - COMMENTS A --t L Reading Date Gross Time Net Time 3Drn,� Depth to Water co It IO � Net Drop ?j" 3n DFArnnrnu n . J1 - • t� ^^�,=a„� I-LKU HUGE DIAMETER 4-/1 TEST RUN BETWEEN ^ FT AND ] tI�LFT PERFORMED BY: _ /l4 AIA I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: MUNICIPALITY OF ANCHORAGA Development Services Depal rtment Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Well Log Permit Number: # 201498 Date of Issue: 2-22-21 Parcel Identification Number: I - - Date Started: 3-1-21 Date iCompleted: 3-3-21 Is well located at approved permit location? Yes R No [__j SEC - Legal Description: T12N R3W SEC 26 W2 NE4 NW4 NE4 NE4 G:2839 Property Owner Name & Address: –RQbale®- ge-fell- IV_%Lft4ndos .1100 Huffman Rd. Anchorage, AK Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From TO Method of Drilling nM❑ air rotary F] cable tool Casing type: steel Wall Thickness: -250 inches Diameter: _!Jnches Depth: 47 .—feet Liner Type: Diameter: —inches Depth: feet Casing stickup above ground: -?_feet stick up 0 2 overburden 2 3 silt & gravel (dry) 3 47 bedrock 47 300 Static water level (from ground level): _31 feet Pumping level: --- — -- —feet after hours pumping Recovery Rate: i--gpm Method of Testing: airlift Well Intake Opening Type: n Open End Q Open Hole ❑ Screened Start ---feet Stopped feet ❑ Perforations Start feet Stopped feet bentonite volume: 2bass Grout Typ'e._ Depth: 20' Start 2—feet Stopped _?O feet Well Disinfected Upon Completion? Yes No Method ofDisinfection: tabs Comments: Well Driller: Johnny Kay Company: Hefty Drilling, Inc. Mailing Address: P.O. Box 112130 Anch, AK99511 Water Sample Results: Arsenic: U&L Nitrates: _(\I mg/L Total Coliform Bacteria colonies/100mL Attention: The well driller shall provide a well log to the 0n -site Water and Wastewater Section within 30 days of completion. Well Drilling Permit Num Development Services Department Building Safety Division On -Site Water A Wastewater Program 4700 Elmore Road ° P.O. Box 196650 =. z 4 G: Anchorage, AK 99507 s A E r Y wwwauni.org/onsite (907) 343-7904 Pump Installation Log r: SW� i3�q Date of Issue: .,,�A-62j Parcel Identification Number: Legal Description i Property Owner Name & Address: NC 1V1`L. ( Ci2x, '-, q ge re_n iea m o n of o ,.s Pump Installation Date:21 Pump Intake Depth Below Top of Well Casing: 0 feet Pump Manufacturer's Name: 'Iy4z' .'�- Pump Model: 'C-3 C' Pump Size hp PitIess Adapter Burial Depth: i J feet Pitless Adapter Manufacturer's Name: C.1_1W1%_41 /6 Pitless Adapter Installer: Well Disinfected Upon Completion? [] Yes [] No Method of Disinfection: Vt1 � I I , Comments: Pump Installer Name: Johnny Kay Hefty Drilling, Inc. Attention. The pump installer shall provide a pump installation log to the DSA within 30 days of pump installation. DEVELOPMENT SERVICES DEPARTMENT" a On -Site Water and Wastewater Section f www.muni.org/onsite ` Leg a(Address: Well DecommtSSlontn Subdivision T12N R3W SEC 26 W2 NE4 NW4 NE4 NE4 Block Lot T R Section Lot On-site Water & Wastewater Section certified contractor performing the well decommissioning: Name: MIKE ANDERSON, P.E. Company: SAME Well decommissioning date 9/20921 907-343-7904 Fax: 343-7997 Signature: dFd, • �A Method of decommissioning: AMC 15.55.060L1 a. ❑ b. ❑ C, ❑ Location: Use the space below to provide a drawing of the property showing the following items: • North arrow • Decommissioned well location • Location of other water wells on the property • Two separate swing -tie distances for each well shown on the drawing Note: The swing -tie distances shall be measured from either permanent structures or the property comers. G:\Development Servicesl& lding SafetylOn Site Water and WastewateriFormstClient Formslwell Decommisioning ROC±R DQE DRIVE v��222 �� f9/. .w\\rr, \/ƒ l2k2 \a/2(®`7 6Wt k��k � G-1 / \ \j gym\ « �/- ems@ §\ ® \y/ �\+ 7 %\\ \ f � v��222 �� f9/. .w\\rr, \/ƒ \3/ � G-1 / \ \j gym\ « �/- ems@ §\ ® \y/ �\+ 7 %\\ \ f a e $ , m z ~ /§§ % ® _e] LM v��222 �� 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 httpIlww .muni.org/onsite On -Site Water & Wastewater System Permit Permit Number: OSP201498 Work Type: WellSeptic Upgrade Tax Code Number: 01743235000 Site Legal Address: T12N R3W SEC 26 W2 NE4 NW4 NE4 NE4 G:2839 Site Mailing Address: 7100 HUFFMAN RD, Anchorage Owner* ROHALEY DONALD L & Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 2/22/2021 4 54360 0 Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy 0 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 Special Provisions: 1) A portion of the proposed field is outside the 30 ft radius of the percolation test. An additional perk test shall be done at time of construction to verify application rate.. If results require a design change, construction shall stop pending Onsite approval of a change order. Please submit results with the inspection report. 2) A 3 -bedroom reserve field shall be shown on the record drawing and shall be located so that the entire length is within the 30 ft radius of percolation tests. 3) Existing well is to be decommissioned due to proximity to septic system and high nitrates. Decommissioning log shall be submitted to close out this permit. Com Received By: Date: ZZ f Issued By: �AA� �Q31 t�� X�O a �� I Date: MUNICIPALITY OF Ae Development Services DepartmentQ . F On -Site Water & Wastewater Section Parcel I.D. 017-432-35 ON-SITE SEPTICIWELL PERMIT APPLICATION Property owner(s) Helen Ramondos Mailing address 7100 HUFFMAN RD, ANCH, AK Site address SAME Day phone Legal description (Sub'd., Block & Lot) T1 2N R3W SEC 26 W2 NE4 NW4 NE4 NE4 Legal description (Township, Range & Section) Lot Size 54,360 Sq. Ft. Number of Bedrooms 3 Phone: 907-343-7904 Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field X❑ Initial ❑ Single Family (SF) 0 (w/wo AD U) Septic Tank 0 Upgrade Q Duplex (D) ElHolding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well 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) X225 Permit/Rush Fees: $168.75 COVID-19 ) W 37085 (COVID-1 ( aiver Fees: 4' Date of Payment: �- ` "Z �Date of Payment: 0 Receipt Number: 00q,'19 % of 3166 Receipt Number: 1 C,60 Permit No. OSP201498 Waiver No. OSV261087� GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit AA:(plication. doc Sept. 7, 2021 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic tank & well permit CHANGE ORDER REQUEST Legal: T12N R3W SEC 26 W2 NE4 NW4 NE4 NE4 To Whom it may concern: This is a request for a change order for the septic system and well permit on the above referenced lot. The system has no septic tank therefore a new 1000 gallon plastic tank has been installed, see the site plan. A new well is also installed, see the attached site plan. We are requesting a change order to add a new septic field for a 3 bedroom field. The test hole showed silty gravel (GM) for the entire depth of 14 feet. The perc was 8 minutes inch with no water during or after the 7 day monitoring period. This new field will not impact any of the neighbors or encroach on any wells, septic or open water issues. Sincerely /7;' ' Michael N. Anderson, P.E. 4661 Natrona Ave. Anch, Ak 99516 Ph 727-8864 Feb. 7, 2021 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic tank & well permit Legal: T12N R3W SEC 26 W2 NE4 NW4 NE4 NE4 To Whom it may concern: This is a request for a septic tank and well permit on the above referenced lot. The system has no septic tank therefore a new 1000 gallon plastic tank is proposed, see the site plan. A new well is also proposed due to very high nitrates, see the attached water test. This tank replacement and water well 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 Ave. Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201498, Rebecca Carroll, 02/22/21 DESIGN CRITERIA:MOUND OVER (TH#1) u, GRADE 3 BDRM X 150 = 450 GPD 0HORG FILTER FABRIC SOILS = 450/0.8 = 562 GPD 1' & INSULATION 562 GA/10 = 56' 4"0 PIPE GM -2.0 (1) TRENCH -7.0 I I `SEWER ROCK T DEEP 5' EFFECTIVE 2.0 2.0' WIDE 14 56' LONG TRENCH NO WATER JULY 2021 -UPPER HUFFMAN RD- I I � 1` EXISTING LOG CRIB REMOVED AND \\ PLACED W/ SAND i / WEL�� / r \ r \ I SEPTIC \ 1 SEPTIC FIELD SECTION PROPERTY LINE I ®vm ---i— I I EXISTING 1 rl \\ BEDROOM p \ HOUSE / Lr I 1 %! PROPOSED NEW -- WELL W/ 100' RADIUS /I--- \ -\ SEPTIC �\ Septic Design Prepared for HELEN RAMONDOS T12N R3W SEC 26 W2 NE4 NW4 NE4 NE4 • �cae Anderson, • • DATE: 4601 NATRONA AVE DRAWN: ANCHORAGE, ALASKA 99516 (907) 727-8864 / FAX: (907) 345-1391 SCALE: 4 SEPTIC\ 1 EXISTING WELL TO BE DECOMMISSIONED ®®®®WRITA%OF ® �P••• AV ®�.,. AV ® �[: 4 IH IF 0 9/9/2021 0 � MICHAEL N. ANDERSON: ® No. CE 9469'•,,:Ar DJR ®®8-30-21'� 1"=100' Municipality of Anchorage Development Services Department On -Site Water and Wastewater Section 4700 Elmore St. P.Q. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Soils Log - Percolation Test 11 `��F'•� '�'�° D Performed For: • n K �. 5 Date Performed: d Legal Description: _7` L-) -7r—e- Z tQ Township, Range, Section: l NZ `I N Q144 Irl (� �{ N C 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20 - COMMENTS �7 IA4 �vve-��- WAS GROUND WATER Date ENCOUNTERED? I Q 49TH '•, ;� P IF YES, AT WHAT DEPTH? L j . . :..Vo..0 ........... MICHAEL N. ANDERSON C�c Date: ; Soils Log - Percolation Test 11 `��F'•� '�'�° D Performed For: • n K �. 5 Date Performed: d Legal Description: _7` L-) -7r—e- Z tQ Township, Range, Section: l NZ `I N Q144 Irl (� �{ N C 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20 - COMMENTS �7 IA4 �vve-��- WAS GROUND WATER Date ENCOUNTERED? I Q Depth to Water S IF YES, AT WHAT DEPTH? L Depth to Water After Monitoring? r�/ yJ a E Date: �Z f Site Plan C/ Reading Date Gross Time Net Time Depth to Water Net Drop C/ f rt ,-,# 3 rcrcwu+� ��n rvli c (minuteslinch) PERC HOLE DIAMETER f� TEST RUN BETWEEN `SFT AND FT PERFORMED BY: N 't I CERTIFY THAT THIS TES W S PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 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U z U- `1 O r � Q O C C) U 4) L L z U)U) U ^ Ll 'a] v ) L E� O Z a) > L () O C) 0 c/1 .+ u Z Y J O C? CN Q C`7 O LL Z CD J a o W a) 'Z i V [L V- V— F— I L- 0 O Q co E t cn cn a) W (A 0 U O J �1w O 1.6 W m MI w O LL0 W N W VI W z O N C O C a) N C a) U a) m 0 tu d ❑ J a a Cl) w W 2H LL LU CL H M U_ U) 7 O a- 0 O a) >, N C O) O O E a) O U ❑ a) a) Cl) cn c m 73 > 0 c I..L a)❑ U M a) U) C N (A L D.. O ❑ a) J a > cn ca O a a ❑ ❑ �N�/ w W H U) LL LU a H Iq N U C (B U 0 0 U) a) D a) L a) -r.1kliI4 a) O Ar V a) N N) *i > O O L. MQ O = O U +r :E r+ E L O (D W r c 0 m N V i o M () c Q �L m .0 T a) a) U - (D E \:J Q) a) Q Cl) 0 a) � U) cu Q" U a) � CO O U Q U O a) � a) ~ _a c � O o ❑ ui � ElU � U 0 N ,C V- C ❑ La) cu a) a a) o 0 O U N = O t06 ElU _,r_ m L ❑ ❑ U O c CL U >, Q O ❑ cu o Cf) ❑ O W Y Z o a U L- a U M w (L m LU Q Q ui to N U C (B U 0 0 U) a) D a) L a) -r.1kliI4 a) O Ar V a) N N) *i > O O L. MQ O = O U +r :E r+ E L O (D W r c 0 m N V i o M () c Q �L m .0 T a) a) U - (D E \:J Q) a) Q Cl) 0 8/27/24 9/6/24 (A+) N/A Benjamin Schiller, P.E. (907) 522-7773 Oct. 25, 2022 Municipalities of Anchorage On-Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: Septic system connection Legal: T12N R3W SEC 26 W2 NE4 NW4NE4 NE4 To whom it may concern: This letter is in reference to the new proposed 2-bedroom home to be built by the owner which will connect into the existing 3-bedroom septic system. Spinell Homes Inc. has provided a plot plan showing where the new house will be located and it appears that they have enough elevation to connect to the existing 1000 gallon septic tank located in the front yard of the original house. From the plot plan the elevation of the garage slab is 930 which will be field verified during excavation for a min. slope of 2 percent. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 AsBuilt 6/1/23 Feet 0 40 80 Received Date/Time 12/08/2020 15:44 12/08/2020 13:30Collected Date/Time 1206587001 Matrix SGS Ref.# Client Sample ID 7100 Huffman Client Name Project Name/# Printed Date/Time 12/21/2020 16:20Mike N. Anderson, P.E. Technical Director Stephen C. Ede 7100 Huffman Drinking Water Sample Remarks: Parameter Results LOQ Units Method Allowable Limits Prep Date Analysis Date InitContainer ID Metals by ICP/MS DMM12/18/20EP200.8ug/LArsenic 12/10/20ND5.00 (<10)B Waters Department EWW12/18/20SM21 4500NO3-Fmg/LTotal Nitrate/Nitrite-N 15.8 2.00 (<10)*C Microbiology Laboratory A.L12/09/20SM21 9223B100mLE. Coli Negative 1 A A.L12/09/20SM21 9223B100mLTotal Coliform Negative 1 A Page 2 of 5 I ,al z rn vs, 01, UIVS!JaDIODED N 00 03' 53' W 330.01 > �c n Z 0 4T. Z > -'C z -4 40; SO O/V vs, 01, UIVS!JaDIODED N 00 03' 53' W 330.01 I umm z co cn co :;a C) C) m > m 7F0 - z A :I - c TI z I �c n Z 0 4T. I umm z co cn co :;a C) C) m > m 7F0 - z A :I - c TI z I MUNICIPALITY OF ANCHORAGE K I Development Services Department 1 Phone: 907-343-7904 On -Site Water & Wastewater Section _ Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-432-35 1. GENERAL INFORMATION Expiration Date: Complete legal description T12N R3W SEC 26 W2 NE4 NW4 NE4 NE4 Location (site address) 7100 HUFFMAN RD ANCH, AK Current property owner(s) DON & WASSILISSIA ROHALEY Day phone Mailing address SAME Real estate agent 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 E Private Septic E 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 $ �gov + � 16 s- IeU SH Waiver Fee $ Date of Payment %/1/6121 Date of Payment Receipt Number 01C,7-753' Receipt Number COSA # O S C M I (v7 I Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 11-12-21 6. DSD SIGNATURE System #1 Approved for 3 System #2 Approved for _ Disapproved Conditional approval for T H ,/oae..• •• a e. o •. a., . .s.eoe ee .......... bedrooms N; /AICHAtl Ft�CERSCrd ; :• bedrooms _ _�=-' C-_9 9 bedrooms, with the following stip ulatioux. "~� IT Y Oj- A44, -i �y WATER Amin m=_ G WAST" v 'ATER z � `�S Original Certificate Date: 12-- TheMunicipality 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 engineers 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 26 W2 NE4 NW4 NE4 NE4 Parcel ID: 017-432-35 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA IN Well log is filed with Onsite (or attached) Date drilled 313121 Total depth 300 ft Cased to 47 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA t1130/21 Static water level at beginning of test 31 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 new Well production at time of test 2+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L On Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 11/30121 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA NEW Which system tested (date installed) 2021 Adequacy test date NEW AN ALL standpipes present per record drawing Results MV Pass For 3 bedrooms Total measured depth from grade 9.5 ft (max) Fluid depth prior to test in Measured depth to pipe invert from grade 3.5 ft (min) Water added gal ❑ N/A — pressurized field nm monitor Monitor tubes go to bottom of effective. If not, state depth in depth into effective s Ela ped time min ❑ Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 0 gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Yes if No Septic Tank/Lift Station on Lot > 100' If absorption field is under driveway comment below Property Line > 10' Community Sewer Manhole/Cleanout > 100' if No E✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' [✓ Yes if No ft Absorption Field on Lot > 100' [✓J Yes if No ft Holding Tank > 100' Q✓ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' [✓ Yes if No ft F✓ Yes if No ft Community Sewer Main > 75' Cp Yes if No ft Manure/Animal Excreta Storage > 100' �]✓ Yes if No ft 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' Q✓ Yes if No ft Property Line > 5' Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' P/1 Yes if No ft Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 21 Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet w .� 49TH' �. • ;. e e f- � alb . • ..... a o c' s tAICHan N. CE -9+ 9