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Home My WebLink AboutSIEFKER #3 LT 7Def ker #3 Lot 70 #015-281-37 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page I of 'L www.cLanchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: �uw/cp 0 1 PID Number: Name Rofiarf S¢n�e� Wastewater System: ❑ New ® Upgrade Aeneas. P. o. 00 it 6VYOa� Fe%v-4ankr 99708 ABSORPTION FIELD Pndu �/ ` 14 m d Benad.s: I urs - 60 1 Q 3 IRDaao rw o SnallO Trench O Bae 0 Mand a 0"w LEGAL DESCRIPTION SOI Rating 1.7 TOM Depnft= or9ulppde. GPDIFft 10. Ft. Blodk LotPp. / aelche,- $upeLmf_J wn. �+ Trst ec7� 46 /r2 DepUl p ndtdn hard ,cul 3 S Ft. a� Geta CeP nOa wd.91 �Fl 7d 0,P: Range. sedan: FaaddedaCo..l.g"Wade Gravel L.rWN 0. S Ft. 3 L Fl. Well: E ❑ Upgrade wST ❑ New GravN w,dn. ^ Nuna.rdl.re. Dnlraa enwsan Inas FI FI Cpsvncauon lPmins.A B. C): Tdal D.pm: Cased b' TdY.o.dpron raa Ppe MdarW F �ld herF Ft. FL �,/ l �� FIs 0— O v Ncm DrOw Dale Dnw.. Sola WMer La "AW Data antallb. Ft. :+" r' 1019 ioc Yu Pump SM N. ca.,np Hag"Aow. Gourd TANK GPM FL Ft SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Litt Holding lubllePrivate •d"•' aP.ulY From Tank Field Station Tank Sewer Line kn cA &Lri6ze ?"p74 10CV" wall 106 jig, > MaIxW / NVrip.r of campan .. s ~K. water !CC r > too' - - LIFT STATION Let Llrw 13 r 19, — _ WI Found~ 2 f t 3 Y r — Perp err rw n 'Pump olr I.vH n. Wpn wstar alga M. n F N. CU n Dra rl _ — Puny Moxa a Moeal Etectmal er.p.oaon. partdm.d M. R.maAa Pro v ow nem rJec.cle.! AP BENCH MARK Locatan.a Da.apaan. I Tn fctIt 3 - 667C-oom re lLrc r -r/tw, g o/-)lo.r o/ e -o -nem /-r,;„ 0 -1 nrfr�i q-bealrVem top -=a/ N,awa Wv~. o,ne� < /lac. /UorOFL Psr oval 02rolper6ea.La4o/no�! t�adP, Engineers Stamp Inspections performed by: Tanch S✓c Dates: 1"_101910&- 2nd 10 /9 /off � � OF Azo, p Development Services Department Approval 1,�; ••"......•.g,"�` Conditional Approval Date: yL 49TH ...........::......... 1 THEODORE F. ALOORE�j V Revii 06 6r iwed and approved by: • �. V Date: - 0 - C ,V-0-- CE -3589 p` A 4ajyi •.fir+/D6� dad' PERMIT NO: SW060315 PAGE 2OF2 PID NO: 015-281-37 �OF.A(`�h6 SWING TIES:f;' ? •'• + �0 vfr FROM: COR. "A" COR. "B' a.:..................:... ef FDN. C.O. "C" 11 29.$ : S.T. C.O. "D" 24' 36' THEOOOPE F. )ADORE �{.' ••, CE - 339 "� N S.T. C.O."E" 29.5' 39' 4. DBL. C.O."F"33' 41'`�'�JE>»••;. `E'y TR. M.T. "G" 67' 66' TR. C.O. "H" 67' 65.5' NEW 1000 -GALLON SEPTIC TANK — NEW 32 -FOOT LONG SOIL ABS. TRENCH - w. 6.9' EFF. GRAVEL T.H. ; DRIVE "G.. ---------------------------------------E TBM T SOIL COVER 100' PLAN VIEW SCALE: 1" = 30' 4' SOIL COVER „ „ ELEV. 86.1' PROFILE VIEW NOT TO SCALE BOTTOM T.H. #1 ELEV. 77.8' M.T. DRY TRACT 7D SIEFKER SID #3 IN 11000 -GALLON 93.4V. SEPTIC TANK rI ) IL ql MUNICIPALITY OF ANCHORAGE _Si Development Services Department On -Silo Water 6 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 \ ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sep 26, 2006 Expiration Date: Sep 26, 2007 Permit Number: SWO60315 Parcel ID: 015-281-37 Legal Description: SIEFKER #3 LT 7D Design Engineer: 0019 FLATTOP TECHNICAL SERVICES Site Address: 012240 JEROME ST Owner Name: ROBERT SENNER Lot Size: 49546 SO. FT. Owner Address: PO BOX 84400 Total Bedrooms: 4 Permit Bedrooms: 4 FAIRBANKS , TX 99708-0000 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank E] Holding Tank ❑ Privy E] Private Well ❑ Water Storage All construction must 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 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 By: Date: 9 X26 /O6' Issued By: Lk /41 An,,/, ,� Date: C1 zr 06 Municipality of Anchorage Development Services Department Building Safety Division • a� i On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. too S - 2 81 — 3 7 Propertyowner(s) Rub rf _(enefl. Day phone y5*X'-6e410 Mailing address P -o• Vox &40y&&. F�s-S ah N4 h -k Zip Code 9974',5 Site address 12 2-y0 'Te -d~ S'� Zip Code Legal description (Sub'd, Block & Lot) ir�cF 7 0, S'#'sF k.— W-3 S i -n Legal description (Township, Section & Range) Lot Size 4c�.,54(P Sq. Ft. THIS APPLICATION IS FOR (®all that apply) Absorption Field M Septic Tank 10 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 'y THIS APPLICATION IS AN: Initial ❑ Upgrade 10 Renewal ❑ I 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. ,Z (Signature of property owner or authorized agent) Permit/Rush Fees: Y 60 -`2 Waiver Fees: Date of Payment: 9 y "// 2.0a if Date of Payment: Receipt Number: Receipt Number: (Rev. 11105) i-: FLATTOP TEG HNICAL SERVIOrl 4,;,,,::M CIVIL S ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION d ANALYSIS TED MOORE, P.E. 14530 ECHO CANYON ROAD PHJFAX: (907)345-1355 ANCHORAGE, AK 99516 E -Mail: tgmoore@gci.net September 14, 2006 M.O.A. DSD P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a permit to upgrade the wastewater disposal facilities on Tract 7D of Siefker #3 S/D. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the soil log, the native material between 2 and 19.5 feet below ground level is a fine silty sand with a measured perc rate of 2 minutes per inch. Using the soil application rate of 1.2 gpd/sq. ft. specified in the wastewater ordinance, this 4 -bedroom residence requires a total absorption area of (4 x 150)/1.2 = 500 square feet. The proposed 40 -foot long trench design with 7 feet of effective gravel has a total absorption area of 560 square feet. The topography of the lot in the area of proposed construction slopes gently down towards the south and west at approximately 6%. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space -surface and subsurface, or on drainage. A site for a similarly configured replacement system is shown on the site plan. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, 1�wte o. Ted Moore, P.E. TRACT782 TRACT 8B d R 100' r ----------------------------------------------- {- INSTALL NEW 1250 -GALLON SEPTIC TANK n - TRACT8C I I I I I I I I I i I I I I I I I I I 1 p��:.n�•�: �� `.• �' TRACT 7D, SIEFKER SID 83 ,y . j. Jw m '; SEPTIC SYSTEM UPGRADE , 49 *0 SITE PLAN "/ '" FLATTOP TECHNICAL SERVICES 1INCH =5C FEET / p :� THEODORE F. MOORE !� 14530 EC110 CANYON ROAD DRAWN BY TFM �: CE -3589 ; �cAr ANCIIORAGE, ALASKA 99516 SEPTEMBER, 2006 � w pr HRS ��%I , % ,`\'a;►e8s1D �` NOTE: THIS IS NOT A SURVEYED PLAT. �� ALL LOCATIONS SHOWN ARE APPROXIMATE. C.O. CONSTRUCT NEW 40 -FOOT LONG INSTALL NEW SOIL ABSORPTION TRENCH W. 1250 -GALLON 7.0' EFF. GRAVEL UNDER DIST. PIPE SEPTIC TANK 4" DIA. 4" DIA. F-810 PERF. PIPE--\ D-3034 NEW4"DIA. FROM NEW F 40 D-3034 DN. C.O./ M.T. DBI C.O. PLAN VIEW SCALE: 1" = 10' MONITOR TUBE CLEANOUT MOUND BACKFILL 6" CROSS—SECTION "A" - "Alo SCALE: I" = 5' ORIGINAL GROUND FABRIC OF AtRt /—FILTER c G, , 11 4- DIA. F-810 PERF. PIPE f4 7.5 7 1/2"- 2 1/2"SEWER GRAVEL ......... . ....... THEODORE F. MOORE %f CE -3569 Ir Ar BOTTOM OF EXCAVATION CROSS—SECTION "A" - "Alo SCALE: I" = 5' i TEST HOLE # 1 FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION:_ Tract7D,.Siefker.SID#3 DATE PERFORMED: September 5, 2006 PERFORMED FOR: Wendy Rousalis 8 Robert Senner _ _-- DEPTH (feet) 1- 2- 3- 4- 5- 6- 7- 8 - 3- 4- 5- 67-8 9' 10-- 11 - 12 011- 12 1 13 14- 15- 16- 117- 18- 19- 20 415- 1617- 18- 19 20 COMMENTS: ML Fine sandy silt fill material Pt. SM Reddish sandy loam SM Fine silty sand Dry, uniform consistency Cakey near bottom of test hole B.H. e is ,�- • �, ,,, (_t .� �.. � s i . •'. /J C J�r ...`..�:F :7,Q • i'..0 )CRc F. ADORE j 1•T Cc -3529 { ••.�(06•� x'04 ��.•� tee+ SITE PLAN_____ TRACT 7D SIEFKER SID #3 N f ----- �-7 Depth to Groundwater Date No Grouridwater —, -9/5/06-- Moriitortube dry.—+9112M Date Reading Clods Net Time Percometer Time (minutes) Reading Net Drop (inches) — —t -- 9/5 _ —]2" Presoak 2712 - 12" Resoak_ _ 271/2 —rt— —2-:01-:50 -- -23 Add water 8 start #1 water _ 3/8 —1-----_ 2:06:50 _5 _—_;_19 3/8 07 20 T 4 ---_-_- _Add _2 _-�_ 233/8 #2 2:12:20_5-19 5/8._ * 2;12:50 - _ _ 23 318 — —2:17:50_ 5 _ 19 3r4 -33/4- 1 _ 3 5/8 -Add water #3 PERCOLATION RATE -2— (minutesfinch) PERC HOLE DIAMETER 6" TEST RUN BETWEEN -6.5 — FT AND_-7,0_Ff PERFORMED BY FLATTOP TECHNICAL SERVICES. 1�� i •atv —CE RTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 9 / / y / OC rFYattop 7ecfinicafSemices 14530 Echo Can yon RP9Anchomge, AX99516 None (907) 34S -135S Tract 71), Sielker S/D #3 12240 Jerome Street Wastewater disposal system upgrade Specifications 1.0 General: 1.1 The scope of the project consists of abandoning an existing log crib seepage pit and installation of a new 1250 -gallon septic tank that discharges into a new 40 -foot long soil absorption trench containing a total of 7.5 feet of sewer gravel. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform to Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 Unless agreed otherwise, the contractor shall be responsible for any tree clearing and grubbing necessary to complete the project. Prior to the start of excavation, the contractor shall cut down and remove the branches of all trees larger than 6 inches in diameter and neatly stack these trees outside the construction area. 1.5 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.6 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The existing log crib seepage pit which shall not be retained in service must be properly abandoned by thoroughly pumping, removing the top and backfilling with soil. 2.2 The new 1250 -gallon, 2 compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4"' per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A cleanout shall be installed I - 4 feet from the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating a 40 -foot long trench to a depth of 11.0 feet. The long axis of the excavation shall parallel an existing contour 3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. 3.3 A total of 7.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 7.0 feet above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum of 3 feet of soil cover is to be placed over the filter fabric. 3.6 The top surface of the cover material shall be raised a minimum of 6 inches higher than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 4.0 Inspections: 4.1 A total of4 engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to backfill. This inspection maybe incorporated with any of the above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. Parcel I.D. 015-281-37 Municipality of Anchorage a On -Site Water and Wastewater Program (907)343-7904 skrerr Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Siefker #3, Lot 7D Location (site address) 12240 Jerome St. 99516 Current Property owner(s) M W Lewis Mailing address Real Estate Agent 12240 Jerome St. 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Expiration Date: 7 ZG Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual Fxl Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: L41,1, Date: x 416 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ �iQ D Date of Payment g1/Z�/13 _Cho Receipt Number 061 Dq G COSA# Li L I -� It3CA Waiver Fee $ Date of Payment Receipt Number Waiver .# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 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 Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE f/ System #1 Approved for 3 bedrooms System #2 Approved for _ bedrooms Disapproved Phone (907)272-8218 Date 4/15/13 Conditional approval for bedrooms, with the following stipulations: By:/ Original Certificate Date: Z6 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 blue sheatf 1, c If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system i Certificate of On -Site Systems Approval Checklist Legal Description: Slefker #3, Lot 7D A. WELL DATA Well type Private If A, B, or C provide PWSID # _ Before 2006 � " I c1 �lv Date completed Sanitary seal (Y/N) Y Total depth %f�*ft. 33—+ Cased to UNK ft. "'�j�j FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 0.193 mg/L Arsenic 0.540 ug/L Date of sample: 4/10/13 B. SEPTIC/HOLDING TANK DATA Parcel ID: 015-281-37 Well Log (Y/N) N Wires properly protected (YIN) Y Casing height (above ground) 24 in. AT INSPECTION 4/12/13 33 ft 3.7 Collected by: PES Tank Type/Material Septic/Steel Date installed 10/9/06 Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping C 1 0/ I a Pumper )� S c A C S RA nri ,..n e,- V C. ABSORPTION FIELD DATA Date installed 10/9/06 Soil rating (g.p.d.W or ftz/bdrm) 1.2 GPD/SF System type Deep Trench Length 32 ft. Width 2.5 ft. Gravel below pipe 6.9 ft. Total depth 10.4 ft. Eff. absorption area 441 ftz Monitoring tube Y Depression over field N Date of adequacy test 4/12/13 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 510 gal. New depth 33 in. Elapsed Time: 190 min. Final fluid depth 0 in. Absorption rate >= 450+ g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date IFT STATION Date installedaze lec7 lions "Pump on" level at in. "Pump off" level at Datum Cycles tested _ E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Manhole/Access (YIN) er alarm level at in. Meets alarm & circuit On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOTTO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I 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. Engineer's Printed Name Steven R. Pannone Date 4/15/13 COSA brown sheet 10-10.12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage11 0+ Municipality 8f Anchorage -..\J Development Services Department � °< Building Safety Division Onsite Water and Wastewater Program , A ; r 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL-. FOR A SINGLE FAMILY DWELLING N Parcel I.D. O!S - Z61 - 3 7 COSA # Expiration Date: w - .2 1 -_b_7 1. GENERAL INFORMATION Complete legal description 01, 7 op S re Fkrr C/o -93? Location(s ite address) f2 -z -'YO Tero�we SF. Current Property owners) Wte PIX Reuralcr k'401rtrt StOA« Day phone (9 0-7) ' rx- -6o to Mailing address Lending agency Mailing address Real Estate Agent Mailing Address P o, Box i9y yoo Farr Laekr _ Ak 9f ft7o6 Al'arke, W-4 Day phone Bill B,wllle, Dynan„c Pfo4. Day phone 3'Y6 -l916 3N1 �C"Sf *4AcAor o� hot 946033111 Unless otherwise requested, COSA will be held by DSD for pickup. Pl eaxc cot I ! J3,11 S &when Cot!} ;.jr r`ea cey !oma /�, e k- l- 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Individual On-site 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. DSO also Issues COSAs upon request to homeowners. Certificates of Onsite 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 Firm F/af-lOi 7-ie,4n:eaF/ S..e.c, Phone S yr- 13Ss- Address_/NS30 &C40 faAyo+ !i/, i4nc40moa? A -k 95+5/6 Engineer's Printed Name ',o Afe down F. Ma ore Date _ /'Y 1 -+ca --c4, 2-0'407 5. DSD SIGNATURE _(/ Approved for _3 bedrooms. Disapproved.• I . I 1 TIK=1 F. MOORE Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other_ BY v/� !� Original Certificate Date: 3 - %L _ 0-7 (Rev. HAs( Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: � r r o c f 7D S'r a Fk er S /0 VO3 ParcelID: Orf' - z 6 t- 3 T A. WELL DATA Well type X1[4' Date completed JQ 6IC If A, B, or C provide PWSID # Sanitary seal (Y/N) Total depth 71 t ft. Cased to 7 3 * I. FROM WELL LOG Date of test . Static water level Well production ft. 9.p -m. WATER SAMPLE RESULTS: . , i Coliform _colonies/100 mL Nitrate o.2vt mg/L Arsenic: < 5- ppb date of sample: Y / t 6107 B. SEPTIC/HOLDING TANK DATA Tank TypelMaterial SeAfrc. /SFei/ Tank size 14#400 gal. Number of Compartments 2 Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION Io/to/off 31 ft. g.p.m. Other bacteria _(_colonies/100 mL Collected by: Pho f/� Teob $ ✓e Date installed to / 9 / oti Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) _fit High water alarm (YIN) N -A . Date of pumping N. A. L MtwA Pumper N. A. _— C. ABSORPTION FIELD DATA Date installedlot Od Soil rating (g.p.d.lft2 or its/bdrm) I. System type T�t*c4 06% Length 3 2 ft. Width 2.S ft. Gravel below pipe 6.9 ft. Total depth W. IV ft. Eff. absorption area 1111 fe Monitoring tube i Depression over field N Date of adequacy test IJ. A. ( N cw) Results (Pass/Fail) P For 3 bedrooms Fluid depth in absorption field before test 4 in. Water added Q gal. New depth_ in. Elapsed Time: 11_ min. Final fluid depth Q in. Absorption rate >= '/S6 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date P. A. D. LIFT STATION N• A. Date installed 'Pump on' level at _ in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off" level at _ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot. 16d' Absorption field on lot ! 1 9 r Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots > 1000 On adjacent lots > 100 in. Public sewer main N• A. Public sewer manhole/cleanout N.q, Sewer /septic service line 2t' Holding tank V. 4 - Animal containment areas M. A. Manure/animal excrete storage areas N• A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 21' Property line 13 Absorption field >< Water main N• A, Water service line 7 ra' Surface water _ > 1001 Wells on adjacent lots > 1CV SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 19, Building foundation 3 W Water main N• A_ Water Service line fO' Surface water > 100' Driveway, parking/vehicle storage 1 so' Curtain drain None Spin Wells on adjacent lots > I tav F. COMMENTS G. ENGINEER'S CERTIFICATION I 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. Engineer's Printed Name Tei to choex F. f efcp + COSA Fee $ O 212- . f Date of Payment' Receipt Number (Rev. 11105) , Waivdr Fee $ Date of Payment Receipt Number S+�..... _a n;2c;—..........�, !CC 3589 .{ [% 49 o ,A• r^ ? •ST p0 11gg1 v A = FA C 0 0 ❑ C4 M �o i !llM1��n� 11gg1 v N ❑°❑7127°W 165.051 II ------------------- �• ❑ a 0 0 ❑ m E� SCS ReE# 1070833002 All Dates/Times are Alaska Standard Time Client Name Flattop Technical Srv. Printed Date?ime 03/15/2007 16:24 Project Name/p Flattop Tech Collected Date/rime 02/28/2007 15:00 Client Sample ID L 7 Siefker SID N3 Received Date/time 02/28/2007 15:57 Matrix Drinking Rater Technical Director Stephen C. Ede PN SID 0 Sample Remarks: Parameter Results PQL Metals by ICP/MS Arsenic ND 5.00 Waters Department Total Nitmtc/Nitritc-N 0.241 0.100 Microbiology Laboratory Total Coliform 100. No Coli Allowable Prep Analysis Units Method ContainerhD Limits Date Date Init ug/L EP200.8 C (<10) 03/07/07 0309107 TK mg/L EPA 353.2 D (<10) 02,2&07 1DS coUl00mL SM2092220 A (<i) 02,2&07 DPT