HomeMy WebLinkAboutMG LT 3AMG
Lot 3A
#051-045-01
Municipality of Anchorage Page 1 of 3
Development Services Department
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 9951926650
www.ci.anchorage.ak.us (907) 345.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SW060004
PID Number. 051-045-01
MD Construction Inc.
Wastewater System: New
AOeaee
10200 Hillside Drive Anchorage, AK 99516
ABSORPTION FIELD
346.3174
Three
5' Wide Trench
LEGAL DESCRIPTION
sal Ra v
1.2
Tar Dep n ham agrwl9ade
6.5
GPDX?
Ft.
111 A La
own to PNe hmlram koro a" prsos
Growl dwm O PPe
3A
MG
2.5 FL
4 FL
T.IWW Ramps,
si a
FY amoed www agnw qr Y
Gravel Ue Vh
2.3 Ft.
40 Ft.
Well: New
Gravel wwn.
5
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1
awwK. hw.ewrrre
Ft.
FL
cWeM1ohm (Pnvwe, A 0. cL
Taw D.MCa.eO
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olal a PKm was
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Private
62
F1. 62 FL
400 Fe
ASTM 3034 PVC
0~
Due DNW
$MIK Wear Level
Sullivan Water Wells
316106
17 FL
Sanders and Sanders
2123106
.'w°
20
PWVsaw
1
c...o AhowGram
2
TANK
GPM
Ft.
Ft
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
From
Septic
Tank
Absorption
Field
Litt
Station
Holding
Tank
2utilictPinnite
sew Line
Anchorage Tank
1000
wea
>100'
>100'
NIA
WA
>25'
Stweel
Two (2)
saraaww.
>100'
>100'
NIA
NIA
LIFT STATION — NONE ON LOT
Lau*
>5'
>10'
NIA
NIA
Gr
Faselwm
>5'
>10'
NIA
NIA
in
h
In.
cMt ib
None
Noted
PurrvM M°
I Ziii YrPeaKme Peiamwf by
Rw"'r"
BENCH MARK
Back Deck Southwest Comer
100.0 FL
Engineees Stamp
�a
OF 444♦
:4'P\t;-
♦i
Inspections performed by: A. Harala
Dates: 1 2123106
, ♦♦
.Ay9.tn
2nd 2123106
Department of Health and Human Services approval
1 4'Ci-AEL C A'.^.ERS0% tyrs
♦
/
fl 6
♦ 1 O CE -Ater
N
♦♦♦4 ➢�o`�„ o,L���:
Reviewed and approved by:
Date: !Z
j9«
(Re 1(10))
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519.5655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. SWD600D4
PID No. 051-045-01
a
U x r
U H x U
PROFILE AS -BUILT -
Scale: t' • 19
FROM JMD-CONSTRUCTION FAX NO. : 9077463159 Jul. 21 2006 07:12AM P2
Catitfrb riCrfrrg �g
_by
SULLIVAN WATER
CO. d0a
P.O. BOX 670272, CHUGIAK, ALASKA 99567 -TELEPHONE 683-2759
OWNEROF.LAND: 11140 Cc•JS I _
ADDRESS:
LEGAL DESCRIPTION: /y G
DATE: 3 A x
PERMIT NUMBER: ° c Date of IsSueZ • 6 -1225
TAX IDENTIFICATION NUMBER: 4>57.0f -S'_ 8/
Is well located at approved permit location? � O No
Method of Drilling: v rotary U cable tool
Depth of well: /;�
Casing Type STCtc- Wall Thickness 'EPS D Inches
Diameter G 1* Inches. depth 6d- feet
Liner Type: ,fOI* .le
Casing Stickup Above Ground: feet.
Static Water Levet: feet
Recover Rate: A 0 gpm
Method of Testing: A2
Well Intake Opening Type: 4 <n end O open hole
U Screened: Startfeet Stopped feet
0Perforations Start _ C f�vSStopped feet
Grout Type: 13�-uTa^'.T� Volume 100465
Depth: from t% feet, to -2 O feet
Well Disinfected Upon Completion? (@�<es O No
Method of Disinfection: CNA.4�',+Ia 5J &41
Comments:
C'q-r ' p
0 043<0
Driller's Name
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.
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water d Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: Jan 06, 2006
Expiration Date: Jan 06, 2007
Permit Number: SWO60004 Parcel ID: 051-045-01
Legal Description: MG SUBDIVISION LOT 3A
Design Engineer: 0014 Anderson Engineering Site Address: NHN MAYTAG STREET
Owner Name: JMD CONSTRUCTION, INC Lot Size: 98435 SO. FT.
Owner Address: 10200 HILLSIDE DRIVE Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE. AK 99516 -
This permit is for the construction of.
❑✓ Disposal Field [D Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage
All construction must be In accordance with:
1. The attached approved design.
2. All requirements specked 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Date:
Issued By'� Date:
Municipality of Anchorage
Development Services Department �•'��
Building Safety Division �.^A On -Site Water and Wastewater Program n/ y , CT ,
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWERIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. D51- 0q5 01 Permit Number SW
Property owner(s) JMD Construction, Inc. Day phone 346.3174
Mailing address (1)10200 Hillside Drive Anchorage, AK 99516
Mailing address (2) tN tJ Maytag Street Zip Code
Legal description (Lot, Block & Sub'd.) _Lot 3A. M.G. Subdivision
Legal description (Section, Township & Range)
Lot Size %t%Acre /S .Ft
THIS APPLICATION IS FOR:
Number of Bedrooms Three (3)
Sewer Only ❑ Well Only ❑
Sewer and Well ® Water Storage ❑
Sewer Upgrade ❑
Y 91;91119:7341;7 9 itt &991.1: i if-IN&I
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: OgiP -Si c n5 -4%-c4. Waiver Fees:
Date of Payment�I�1 P & Date of Payment:
Receipt Number. 576)q #,L_ Receipt Number.
(Rev. 12/00)
ri
MEMO.
DATE: 2/13/2006
TO: Joe Goodall
WITH: MoA/On-Site Water and Wastewater
FROM: Mike Anderson
SUBJECT: Lot 3A, MG Subdivision
Well and Septic Permit No. SW060004
Absorption Trench Location Change
The test hole location shown on the Site Plan submitted with the original permit
application was scaled from a drawing furnished by the developer and completed by
S&S Engineering during the subdivision process. The actual location of the test hole in
the field was different than the location scaled from the drawing. We have therefore
moved the proposed absorption trench to the actual location of the test hole. We also
completed a test hole adjacent to the S&S test hole to verify the soil conditions. We
found similar to identical conditions as noted on their log.
Attached is a revised site plan showing the new location of the absorption trench along
with the actual location of the test hole. A test hole was also completed near the
location of the original absorption trench site with similar results as the S&S test hole.
We hereby request the permit be revised to allow the new location of the well and
absorption trench.
Please let me know if you have further questions.
W -A-1= FEE:- //
j' A4,o PAYMENT DATE: z A v -
RECEIPT #: I (;�ZJ
December 30, 2005
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 3A, M. G. Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of the subject property intends to construct a new three-bedroom home on
the lot. We are therefore requesting a permit be issued for the construction of a new
well and septic system to serve the home. No conflicts exist with adjacent septic
systems or wells and the proposed septic system and well on this lot. The attached
Site Plan and backup documentation identify the location and configuration of the
proposed well, septic system and alternate site. The current drainage pattern is
identified on the Site Plan. The drainage pattern will be maintained after development
of this lot is complete.
Test holes were recently placed on the lot during the subdivision phase by S&S
Engineering. These holes indicated clean sand with some gravel and silt(SM) in the
area of the absorption trench and alternate site. The accepting soils were tested and
found to have a percolation rate of between 1 and 5 minutes per inch in the accepting
soils. Groundwater was not encountered during the original test hole placement, but
was noted at 11' below the surface on May 18, 2005. Our design includes the
placement of a new 1,000 -gallon septic tank along with a 38' long by 5' wide by 4'
effective depth absorption trench to collect and treat the sewage generated in the
house. The bottom of the trench will be 6.5' below the surface. The distribution pipe
will be 2.5' below the surface. A minimum of 3' of cover will be placed atop the trench
and a minimum of 4' of cover will be placed atop the new septic tank.
The ground surface on the lot slopes at varying grades toward the west near the
absorption trench as shown on the Site Plan. The absorption trench will be constructed
parallel with the slope of the ground surface as much as possible in conformance with
Lot 3A, M.G. Subdivision
December 30, 2005
Page Two
Municipal requirements. The new septic system will be constructed a minimum of 100'
from the well on this and on the adjacent lots. It will also be constructed a minimum of
100' from any surface water in the area.
If the system is constructed in accordance with our design the following statements
apply:
1. The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
OF
.49th _ •:
:•••
MICHAEL E. ANDERSON ' �•
No. CE -(4381
LOT 3, M.G.
SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Three Bedroom House 5' Wide Trench System
Perc. Rate: 3.85 Min./Inch 1,000 Gallon Septic Tank
Application Rate: 1.2 GPD/SF 4' Drainfield Rock
3 Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate) = 375 SF Absorption Area
375 SF/5 LF (Width)* .5 (Red. Factor) = 37.5 LF Trench Length
THEREFORE: Construct a New 38' Long x 5' Wide x 4' Effective Depth Absorption Trench
Flow Line Elevation in Trench to be 2.5' Below Original Ground Surface. Total Depth to be
6.5' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over
Absorption Trench.
Natural
Backfill
2'0"
Geotextile
Fabric
6" 4" Perforated
PVC (Holes Down)
4'0" 1 I , I— Drainfield Rock
5'
TYPICAL 5' WIDE TRENCH SECTION ••..o
(NO SCALE) •�P�� OF.......,
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock. e' 49th
jo.Minimum 4' Separation From Groundwater. 1,�.
o...... ..
Minimum 100' Separation From Wells in the Area. 00AL MICHAEL E. ANDERSON
Minimum 100' Separation From Surface Water or Streams: 0#6';', No. CE4381
S�S••1,o p�bFESS x�P.®�®•
I-
2-.
3-
4-
5-
6-
7-
8-
.9-
10-
12-
13-
14-
15-
16-
17-
18-
19-
20-
Depth
=2-
3-
4-
5-
6-
7-
s-
9-
10-
12-
13-
14-
15-
16-
17-
18-
19-
20-
Performed For:
gal Description: M. G., Lot 3A Township,
�� • Slope •
'�`.e�+ti �em,�000 pua�en�a
�
C t_ �
Munic,lpality of Anchorage M (RG.I'fSEER'%SEALg`
Development Services. Department^r ora ^ee e�e. aoma <�Aes
Building Safety Division.
�qpp po5oobseaee eoeoaooaeeooa�jl
On Site Water and Wastewater.P[ogram S`_ qi+};i HAEL 9, ANDE;z-,.z?= 1-1
4700 South 6ragaw St. � oa e ,ti 0
P.O. Box 196650 Anchorage, AK 99519-6650 �V. - ay��/te �qa�
www.ci.anchoraoe ak us
(907) 343-7904i�
Soils Log- - Perco.la.tion Test
Date Performed: 2/13/06
ng11 e, Section:
Depth
(Feet) r
'' So,Nt•� ��IS
NJ
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT DEPTH? t
Depth to Water After 0
Monitoring? E
E
Date:
Site Plan
Reading Date Gross Time Net Time Depth to Water Net Qrop
P;:Prn1 ATInM All
Same Soil. CF%Td[Tf3�
COMMENTS 'AI%JN FT AND FT
as S&S Tes Ho e. es Die tor.Vertribation.
PERFORMED BY: I CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES I -EFFECT ON THIS DATE. DATE:
Performed For:
Legal Description:
Municipality of Anchorage
Development Services. Department
Building Safety Division .
On -Site Water and Wastewater—Program.
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
w_ ww.ci.anchoraae ak us
(907)343-7904
Soils tog - Percolation Test
I
M. G., Lot 3A Township,
7-
8-
9-
10-
11-
12-
13-
14-
1
16-
17-
18-
19-
20-
1 rif
+� C (F-NRINEER SE,L'j., ;
.. ..moon..
to" E5
NUCHA.EL C. A11DEP3G,-4
-.CE
4381
PROFESSk
Date Performed: 2/13/06
Section: -7-
Site
Site Plan
Aq.
WAS GROUND WATER
(Z/
(`� /
ENCOUNTERED?
2-
3-
IF YES, AT WHAT DEPTH? L
LAA
4-
5-
Depth to Water After .0.
Monitoring?
6
7-
8-
9-
10-
11-
12-
13-
14-
1
16-
17-
18-
19-
20-
1 rif
+� C (F-NRINEER SE,L'j., ;
.. ..moon..
to" E5
NUCHA.EL C. A11DEP3G,-4
-.CE
4381
PROFESSk
Date Performed: 2/13/06
Section: -7-
Site
Site Plan
Aq.
WAS GROUND WATER
(Z/
(`� /
ENCOUNTERED?
IF YES, AT WHAT DEPTH? L
mw e— G6
Depth to Water After .0.
Monitoring?
.5
E
E
Date:
-0-
V.0-
PFRrnl AT1n1J MAT.
................ rcr,(MULL UTAMETER
TEST RUN BETWEEN FT 'AND FT
COMMENTS Test Hole for Verification Pur ores.
ame on a ions as es, o e.
PERFORMED BY: =` I CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
_.ic, c.a, aVVV XX -VV VAA VV, 444 OOJV JV 1llnu"Lffi
DEC -29-2005 10:51 5&S ENGINEERING
Municipality of Anchorage
Uevelopment Services Department
Building Safety Minion
On -Site Water and Wastawater program
4700 South 8ragaw St.
P.O. Box 196650 Anchorage, AK 99519.6650
Www,munl,or@lcnsito
(907) 343-7904
Soils Log - percolation fest
Performed For:% IG F_j—'t Ec �Rk—' A-�D l
Legit DoacriptPon: I—oT
bepth
�•..i '
6-
7-
12-
13.
-7-12-13- ' G:
14-
20-1
L9
4-
20 -
SP4-
SM 4_I jE'�i AVi5C WAS GROUND WATER
I %NCQUNTERED7 (`✓
��y t^t�s" ^,hay s
IF S, AT WHAT DEPTH7 L
tt?�uulx n�GT' e• etrthtoWaterAfter o
rs, �2�VzcG. L-Ct�S&. v
MardloHnp? ( 6
Date:
1 �! 4--l4`�-(�7��
FO fq
((f►424> Pr-ty)
L9 UU4
907 694 1211 P.03/04
.............i'��.
<�.. v E
71, f/
RCI3ERT C, COWAN��
G► CE - 8801 S!M ,
Date Performed: % t O
Site Plan
Reading Dole
Gross Time
Net Time
Depth to Water
Net Drop
3-0
PERCOLATIOt4 RATE 'moi tp`, (minuteVtnch) PRRC HOLE DIAMETER W'
TESTRUNBEIWEEN r FT AND 14, $ 1 FT
COMMENTS_(`+!: l S ' :50t45 �� 5T' /4nV .
^
PERFORMED 9Y: � —CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL G11LINES IN EFFECT ON THIS DATE. DATE:
Municipality of Anchorage •
On-Site Water and Wastewater Program•
,t _ (907) 343-7904
5 A r C T Y
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-045-01 Expiration Date: ? 2 �l 7
1. GENERAL INFORMATION
Complete legal description MG Lot 3A
Location (site address) 22097 Maytag St
Current Property owner(s) JD Mechem Day phone 222-8827
Mailing address Same
Real Estate Agent Cindy Wilson Day phone 244-1930
2. TYPE OF DWELLING: <°6� 8 9 �0
® Single Family (w/wo ADU) � � , �
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex) APR 1
X26'.1
ti
�6 h
3. NUMBER OF BEDROOMS: 3 << oc 6 8 I
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class C Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Received by: "'`" Date: OW/7
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ `$ 5v-(0 Date:
Date of Payment ``G M? Date of Payment
Receipt Number aol.i q 36 Receipt Number
COSA# 165a/9 // 2 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm NorthRim Engineering Phone 694-7028
Address PO Box 770724. Eagle River
Engineer's Printed Name Steve Eng Date $(4&14Dp
OF /)
otrA�� 'O�rrs�..r��' ;ckA
i � IL
* �
6. DSD SIGNATURE ' .
System #1 Approved for bedrooms. : v�. a
,Q NC�r S16YBr1 + a
System #2 Approved for bedrooms. � P 625 � ..s•
rc iy
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
pt*1-St
AND
��,
Wp,-TER z
c12- VNASTt��`TEF.
�:
PROGRA"
lin" '-CG
/
By: Original Certificate Date: L( "
The Municipality of Anchorage Devlopment 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 blue sheet 9.1.12.doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of Ora-site Systems ;pprov ll Checklist
Legal Description: /fl LOT 3,4 Parcel I D:C5/--O'/S-Q/
A. WELL DATA [�
Well type I— If A, B, or C provide PWSID# Well Log (Y/N) �f
Date completed 3/C/O Sanitary seal (YIN) l Wires properly protected (Y/N)
Total depth 4.--2 ft. Cased to g-Z-ft. Casing height (above ground) ZU in.
FROM WELL LOG AT INSPECTION
Date of test 3 1676 /7P 7
Static water level / 7 ft. 21 ft.
Well production 2-d g.p.m. &"71-' g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate I, mg/L
Arsenic /fib ug/L Date of sample: //jf/f7 Collected by: /\1i i ,..
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SE? 7C7 S77 2_ Date installed 2/23/06
Tank size /GQo gal. Number of Compartments Z Cleanouts (YIN)
Foundation cleanout (YIN)y Depression over tank (Y/N) // High water alarm (YIN)
Date of pumping 7- (4,(-167 Pumper AVM
C. ABSORPTION FIELD DATA
Date installed 2/23/6K Soil rating g.p.d./ft2 r ft2/bdrm) l System type.) rreRc.-4
Length II O ft. Width 5" ft. Gravel below pipe ft.
Total depth `,-(aft. Eff. absorption area i/CC ft2 Monitoringtube �/ Depression over field /vft
Date of adequacy test ii/y/ 7 Results (Pass/Fail) /- ( For, bedrooms
Fluid depth in absorption field before test 6 in. Water added 475 gal. New depth /Z-- in.
Elapsed Time: �-3 0 min. Final fluid depth C in. Absorption rate >= g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N & type) l� If yes, give date
D. LIFT STATION NA
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off" level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot /DQ rf- On adjacent lots / O `f-
Absorption field on lot /Q Q On adjacent lots /Od "'"
Public sewer main / 2a .4' Public sewer manhole/cleanout A90 +'
l
Sewer/septic service line 2 S 'r Holding tank /PO It
i
Animal containment areas .5.0 f- Manure/animal excrete storage areas 100 'r'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 4— Property line pr, -F Absorption field � -�-
Water main la r� Water service line /0 'f Surface water /O0 "1—
Wells
tWells on adjacent lots /5c "1
ABSORPTION FIELD ON LOT TO:
Property line `6 "14 Building foundation /d PI" Water main /G'"f"
Water Service line /O t Surface water /Q 4 f- Driveway, parking/vehicle storage /d ('r
Curtain drain Wells on adjacent lots /001--t-f- •
F. COMMENTS
G. ENGINEER'S CERTIFICATION "+ OF
I 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. '--
Engineer's Printed Name 5-rev iI 6
t ' ; slaver' V,. -..g Aso;
�% PE 825 J�
Date 4//t P/(7
'
COSA yellow sheet 2-6-15.doc
Municipality,of Anchorage
b••• ••r
-• Development Services Department
Building Safety Division
On-SRe Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-0650
www.muni.org/onsite
(907)343-7904
Parcel I.D.
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
051-045-01
1. GENERAL INFORMATION
Complete legal description Lot 3A, M.G. Subdivision
Location (site address)
22097 Maytag Street
Current Property owner(s) JMD Construction
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
COSA#
Expiration Date: ' . t7 IG
10200 Hillside Drive Anchorage, AK 99516
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well❑
Individual Water Storage ❑
Community Class Well ._ ... __❑
Public Water System ❑
Three (3)
Day phone 346-3174
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
R1
Individual Holding Tank
❑
-Community On-site -
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system Is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Finn Anderson Engineering
Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date 7121n006
. Y• 1
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S. DSD SIGNATURE �iyStw°uc> c —M
-NO- No CE -4391r
✓ Approved for _ bedrooms. �i:@�,� �."3a-y,E•'�
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
01
By- I- � Original Certificate Date:_
(RW JIM
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Brno 196650
Anchorage, AK 99519-650
www.muni.orglonake
(907) 3437904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: tot 3A, M G Subdivision Parcel ID: 051-045-01
A. WELL DATA
Wen type Private
If A, B, or C provide PWSID # _ Well Log (YIN) Y
Sanitary seal (Y/N) Y Wires property protected (Y/N) Y
Total depth 62 It. Cased to 82 ft -
FROM WELL LOG
Date of test 316 2006
Static water level 17 R
Well production 20 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate N/D mg/L
Anionic: N/D mgA Date of sample: 7/17/06
B, sEPTICIHOLDING TANK DATA
Tank Type/Material Seydc/Steal
Tank size 1.000 gal. Number of Compartments 2
Casing height (above ground) 24 in.
AT INSPECTION
;N
9.p -m.
Other bacteria 0 colonies/100 mL
Collected by: J. Anderson
Date installed
Cleanouts (Y/N)
Foundation deanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping New Construction Pumper
C. ABSORPTION FIELD DATA
Date installed 2/23!2006 Soil rating (g.p.d./e or Nl/bdnn)1.2 GPO/SF System type 6 Wide Trench
Length 40 ft Width 5 ft. Gravel below pipe 4 It.
Total depth 9-10 ft. ELT. absorption area -10-0ft' Monitoring tube Y Depression over field N
Date of adequacy test New Conal. Results (PassJFail) For _ bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
– uvenatan tneamrent (past 12 mol (Y/N 8 type)-- yes. 9 date
D. LIFT STATION
Date Installed Ske in gallons
'Pump on' level at _, in.
E. SEPARATION DISTANCES
Manhole/Access (y"
Pump ofr level at _ in. High water alarm level at in.
des tested Mesta slamh & ai it requimmenta?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station an lot >100'
Absorption field on lot >IW
Public sewer main WA
Sewer h:eptic service line >26
On adjacent lots >iw
On adjacent lots >100'
Public sewer menhowdeanout NIA
Holding tank WA
Antmal containment areas None Manure/antral excrete storage areas Nana
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation >S Property line >6 Absorption field >10'
Water main >1g' Water service line >1V Surface water >1W
Wells on adjacent tots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property tine >10 Building foundation >70' Water main >10'
Water Service tine >10 Surface water >100 ply, PuWakietkie xWege >28
Curtain drain None Noted Wells onAQ 0 ,
adjacent krta aaas►
F. COMMENTS:
G. ENGINEER'S CERTIFICATION.�OpP,�� '9C.9
I cs'* that I have determined through field kopectibno and 1('da
review of Munt4W retaords that Me above systems ere in � 49th r
owdbrmance with MOA COSH guidelines in elfed on Mh date.
mom
Engineer's Printed Name Michael E. Anderson, P.E. ali�� n
�. ti tla CE -4=
Date T/311M
COSH Fee S 5� Waiver Fee $ _
Date of Payment (3l /0 6 Data of Payment
Receipt Number ig ?414D Receipt Number,
MAYTAG STREET
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