HomeMy WebLinkAboutUPLANDS PH 2 TR 1Onsite File
Uplands Ph 2
Tr 1
PID# 050-472-93
Formerly Uplands Tr A-3, which was formerly T14N
R1W SEC 8 NE4 NW4 SW4 W2 SW4 SE4
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211247
PID Number: 050-472-93
Dwelling: X Single Family (SF)
❑ vvith ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ■❑ Upgrade
Name
SMITH PHYLLIS FAMILY
ABSORPTION FIELD
El Deep Trench❑Trench ❑Bed El Mound
Site Address
20811 Eagle River Rd
t❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
561-2227
3
GPD/SFJ
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdi,Asion
Block Lot
UPLANDS PH 2 TR 1
Fill added above original grade
Ft.l
JGravet length
Ft.
Tovrnship Range
Section
Gravel vndth
Fl.l
iBeds: Number of Lines
-
Distance between lines
- Ft.
SEPARATION DISTANCES
TO Septic
Absorption
I
Lift Station ! Holding Sewer
Total absorption area
INUmber of trenches
Dist. between trenches
From Tank
Field
Tank Line
Ft=
Ft.
Well 100'+
I
n a n a n a
TANK *1 Septic E]S.T.E.P. ❑ -folding E) Other
Manufacturer
Greer
capacity
1000 Gal.
Surface Water . 100'+�
na na i
?`Material
Plastic
Number of ccmparlments
2
Lot Line 10'+1
i
na na ! NA
'
I
LIFT STATION
Foundation 10
{
na na
Manufacturer
Capacity
Remarks Septic Tank Replacement
Gal.
Alarm location
Electrical installed by
PIPE MATERIAL House to tank D3034 Tank to D3034
drainfield
Installer
Dean
Drainfield COR,,iT D3034
Inspector NorthRlm Eng.
BENCH MARK (Assumed elevation) 100 ft
Inspection
1"' 7/23/21
2 , 7/23/21
Location and description
s
Deck
3"
elf,,
ONSITE WATER AND WASTEWATER SECTION APPROVAL++`
imp
Conditional Approval:
Date
A,`P.���
:cam -y I
:49TH,. :.* Ilk.
s*
Steve Eng
�+ CE -6256":
s
Septic istem ,�
*i;
�1 / 3 /2'
Approved rM
Date
Note: this approval does not include well permit requirements.
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Yom MUNICIPALITY OF ANCHORAGE
�On-Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
j Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 �<
t http://www.muni.org/onsite 1
-
/I lleparcIII cut
On -Site Wastewater Disposal System Permit
Permit Number: OSP211247
Work Type: SepticTank Upgrade
Tax Code Number: 05047293000
Site Legal Address: UPLANDS PH 2 TR 1 G:0057
Site Mailing Address: 20811 EAGLE RIVER RD, Eagle River
Owner: SMITH PHYLLIS FAMILY IRREVOC
Design Engineer: NORTH RIM ENGINEERING
This permit is for the construction of:
❑ Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy
Effective Date: 7/6/2021
Expiration Date: 7/6/2022
Lot Size in Sq Ft: 130747
Total Bedrooms: 3
❑ 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: Locatethe beginning of the field to confirm that the 5' separation between
�f the tankand field will be met.
Received By:
Issued By:
Date: �� f
Date: 21_
MUNICIPALITY OF
Development Services Department y
On -Site Water & Wastewater Section
Parcel I.D. 050-472-93
ON-SITE SEPTICIWELL PERMIT APPLICATION
Phone: 907-343-7904
Fax: 907-343-7997
Property owner(s) S M ITH Day phone 561- 2227
Mailing address 20811 Eagle River Rd
Site address same
Legal description (Sub'd., Block & Lot) UPLANDS Phase 2 Tract 1
Legal description (Township, Range & Section)
Lot Size 130,747 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑ Single Family (SF) 0
(w/wo AD U)
Septic Tank
0
Upgrade Q
Duplex (D) ❑
Holding Tank
❑
Renewal ❑
Multiple 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)
Permit/Rush Fees: � � � 5 Waiver Fees:
Date of Payment:SA rt/Z Date of Payment:
Receipt Number: O 6(7 0 0 Receipt Number:
P Permit No. OS a_ Q i 1 `i 7 Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
SteveEng.com Uplands Phase 2 Tract 1
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: The current 1000 gallon septic tank has failed- the seepage
trenches still function. This lot is very large with nearby drainage easement drawn on
plan sheet. No adverse impacts are expected from tank replacement. The easements are
depicted on the lot. The slope is indicated in the area of the septic system. No conflicts to
neighbor properties.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
New 2- compartment, 1000 gallon septic tank. Watertight couplings on inlet & outlet.
5 minimum between the tank and trench. 5 to property lines & 10 to house.
4 of cover or insulation is required for tank; an equivalent of 1 insulation for 1 foot
soil cover. Tank & solid pipe must be set on well compacted, stable soil.
No large rocks for tank bedding. Plastic/fiberglass tanks require special bedding per
MOA- sand or pea gravel.
4 diameter cleanouts with airtight caps are required 1 to 4 from foundation wall,
prior to any 90 degree bend in 4 inch line, in 2 nd tank compartment, and two adjacent
opposing cleanouts between the tank and the absorption field, not more than 10 from
the tank positioned to provide cleanout access towards the tank and towards the
absorption field. Manhole Riser required in 1st tank compartment.
All cleanouts must extend to at least ground level.
In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
Insulation must be placed over any pipe installed under driveways or parking areas.
Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
Sewer Service Line is minimum 2% slope.
Septic Tank to be pumped every two years or when required.
Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal)
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211247, Deb Wockenfuss, 07/06/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211247, Deb Wockenfuss, 07/06/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211247, Deb Wockenfuss, 07/06/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211247, Deb Wockenfuss, 07/06/21
TRACT 2-C
S 00001'01" E 198.07'
ALUMINUM
CAP
TRACT 1
130,747 sq. ft.
50'
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SEPTIC
CLEANOUT ^ 24 S' co �S6,
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LOG
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PAVERS
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WELL
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DRIVEWAY
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-37.0'
1"=30'
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EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE
p
RECORDED SUBDIVISION PLAT (2018-15) ARE NOT SHOWN
�S) SEPTIC
CLEANOUT
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HEREON.THIS DOCUMENT DOES NOT CONSTITUTE A
SNFD
FOLLOWING DESCRIBED PROPERTY:
THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE.
LU
TRACT 1, UPLANDS SUBDIVISION PHASE 2
HEREON BE USED FOR CONSTRUCTION OF FENCES,
TRACT 2
IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY
ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT
BOUNDARIES.
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
61.5' --�
WITHIN THE PROPERTY LINES AND NO VISIBLE
PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE
ENCROACHMENTS EXIST EXCEPTAS INDICATED.
LOCATION SURVEY STANDARDS.
THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY
0
73.7'
ALASKA.
00
c/)GRAVEL
I
VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE
I
DRIVEWAY
COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT.
f C.O.A. 122554
46.0'
Land Surveying Services 907.290.8949
JOB # 21111 NO CORNERS SET THIS DATE SCALE 1 "= 80'
SEE
BUILDING UTILITY
DETAIL POLE
�NA
�Z
20' TELE., ELEC. &
DRAINAGE EASEMENT
N 00°04'28"
W 198.10'
LOT 2
LOT 1
50'
CO
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SEPTIC
CLEANOUT ^ 24 S' co �S6,
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LOG
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a
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22 S' CONC. <
PAVERS
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WELL
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DRIVEWAY
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1"=30'
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50' ..............�
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EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE
AS -BUILT
RECORDED SUBDIVISION PLAT (2018-15) ARE NOT SHOWN
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
HEREON.THIS DOCUMENT DOES NOT CONSTITUTE A
BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES
FOLLOWING DESCRIBED PROPERTY:
THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE.
UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA
TRACT 1, UPLANDS SUBDIVISION PHASE 2
HEREON BE USED FOR CONSTRUCTION OF FENCES,
IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY
ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT
BOUNDARIES.
THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE
THIS SURVEY REPRESENTS A MORTGAGE LOCATION SURVEY
WITHIN THE PROPERTY LINES AND NO VISIBLE
PREPARED IN ACCORDANCE WITH THE ASPLS MORTGAGE
ENCROACHMENTS EXIST EXCEPTAS INDICATED.
LOCATION SURVEY STANDARDS.
THIS MORTGAGE LOCATION SURVEY SHOULD ONLY BE USED FOR A SINGLE PROPERTY
DATED THIS 24th DAY OF JUNE, 2021, AT ANCHORAGE,
TRANSACTION. RE -USE OF THIS DRAWING BY THE ORIGINAL CLIENT OR BY OTHERS, FOR
ALASKA.
ADDITIONAL USES AT A LATER DATE WITHOUT EXPRESS CONSENT OF THE SURVEYOR IS A
VIOLATION OF FEDERAL COPYRIGHT LAW. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE
LIABILITY EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES
FIXED HEIGHT LLC
COLLECTED FOR SERVICES IN PREPARATION OF THIS PRODUCT.
f C.O.A. 122554
Land Surveying Services 907.290.8949
JOB # 21111 NO CORNERS SET THIS DATE SCALE 1 "= 80'
225 W 23rd Ave., Anchorage, AK 99503 WWW. FIXEDHEIGHT COM
P.O. Box 670269 Chugiak, AK 99567
P: (907) 688-2759 F: (907) 688-2259
M
Date: 2-15-18
We have completed upgrading the existing well pit at 20811 Eagle River Road. The pressure
tank and electrical controls have been moved inside the house. The well casing was extended 2'
above final (.Trade and a pitless adapter and waterline attached. Bentonite was poured around the
pitless adapter and the pit was filled with pit run. Due to frost and encroaching utilities, the new
UF electrical line powering the purnp was run above ground until it can be buried in the spring.
I -
Regards,
Cole Sullivan
.-".."ULLIVAN
WATER WELLS
Drilling - Piling - Pumps
P.O. Box 670269 Chugiak, AK 99567
P: (907) 688-2759 F: (907) 688-2259
M
Date: 2-15-18
We have completed upgrading the existing well pit at 20811 Eagle River Road. The pressure
tank and electrical controls have been moved inside the house. The well casing was extended 2'
above final (.Trade and a pitless adapter and waterline attached. Bentonite was poured around the
pitless adapter and the pit was filled with pit run. Due to frost and encroaching utilities, the new
UF electrical line powering the purnp was run above ground until it can be buried in the spring.
I -
Regards,
Cole Sullivan
M.N.C,.AL,TV OF A.CNO.AGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME ' P O E [] NEW
MAILING ADDRESS /_
DISUSE / Well/ /-- ~ ~ Absorpt~rea Dwelling ~ . I ~ PERMJ~ ~0
Manufacturer Mat~ / No, of compartments
Liq~i~al,o ns IF H O M E~ DE: Inside length Width Liquid depth
i~_~O z 4 ~anufac~urer Material Liquid capacity in gallons
~ Foundation ~ ~
Length of eac lin Distance
te 'al bene tile
L~ngth Width ~epth f PERMIT NO,
~ ~ Type of crib 'Crib ~ameter e[ Total effective absorption area
~ DISTANc~ Well Bui~din ation Nearest lot line
~ CJass ~ ~ ~ Depth Driller Distance to lot line PERMIT NO.
~ ' :~ Sewer line Septic tank Absorption area(s)
PIPE MATERIALS
PERMIT NO.
MUN I C I~L I T~' OF AI'4C:~F=mm~E
DEPARTMENT ~HEALTH AND ENVIRONMENTAL ~TECTION
825 ~L~ STREET., 8NCHORAGE~ AK. 9950:1
264-4728
OI"-,I--S [ TE SEHEE UPGERDE PEE~I
800515 >
APPLICANT FLOYD F. SMITH
LOCAT I 0Ns,.S
TYPE OF SOIL ABSORPTION SYSTEM IS:
PO BOX 1208 ~9577
LOT SIZE
TRENCH
694-9414
48888 SQUARE FEET
MAXIMUM NUMBER OF BEDROOMS = ~
SOIL RATING
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH= ~ LE~GTH= 45 GRR~/EL DEPTH=
THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET>.
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET>.
REQIJ I RED SEPT I ¢ TANK S I ZE= 1000 GRLLO~S
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
TWO ( 2 ) INSPECT IONS ARE REQI_I I RED
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN 8 WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR R PRIVATE WELL OR 158 TO 200 FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM R PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND
TO R COMMUNITY SEWER LINE IS ?5 FEET
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERM I T E.'~CP I RES DEC:EMBER 31. 1980
I CERTIFY THAT
l: I AM F8MILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: i WILL INSTALL THE SYSTEM IN ACCORDHNCE WITH THE CODES.
3: I UNDERSTHND THHT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS.
APPLICANT FLOYD F. SMITH
V4. 0
:I;-::IPII..IH NUPIE:ER OF E:EDRC.}MS =
SOIL RATING <SQ FT,"BR)= /~"~0
'iE REOIJIREC, SIZE OF THE SOIL_ .F~BSORF'TION _.Yz. TEM IS:
.EF'TH=: ~ L E r-i,3T H=: W ~ ,3 F; fl '..-' E L [:.E F' TH .... ¢
THE LENGTH DIMENSION IS THE LENGTH <lr.,t FEET;, OF THE TRENC:H OR DRAINFIELD.
THE DEPTH OF F~ TRENCH OR PIT IS THE DIS, FRNCE E:ETWEEN THE SIJRFRCE OF THE
GROUHD RND THE BOTTOM OF THE EXC:RVRTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES
THE GRAVEL DEPTH IS THE, NZN~HLIM DEPTH OF GRAVEL BETllEEt.~ THE OUTFRLL PIPE
RHO THE BOTTOM 0F THE E~CR',/RT~ON (~N FEET).
:Et$~l_l I E:LED SEF'T I C TAr-4~:: % I ZE--' /0 O O ISAL. I__I2~[-IS
;RMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS [:,EPFtRTMENT DURING
_ _ _ · ,-I , T"
ISTALLRTION IN'qPEC:TIF~N~ OF ANY HELLS AC, JRC:ENT TO THIS FRLFER -r RNC, THE
]MBER OF RESIDENCES THAT THE HELL WILL SERVE
THE
TI.-.IC, < ':.-~ > I I'-ISPECT I ON:5 AF,:E R E [--).LI I RED
~CKFILLING AF ANY CY_-,TEM HITHOUT FIHFtL INSPECTION Rf.,tD APPROVAL BY THIS
{F'RRTMENT WILL BE SUBJECT TO PROSEC:LITIOH.
NIMUM [:,ISTRNC:E BETWEEN R NELL AND ANY ON-SITE SEHAGE DISPOSAL SYSTEM IS
FEET FOR R F'RIVFITE llELL OR 15~ TO 2E~O FEET FROM A PLIE',LIC HELL [)EPEr.l[:,IflO
-'C¢'1 T~I. CE- TYF'E OF PUBLIC: HE! L.
NIMUN DISTANCE FROtl FI F'RIVRTE HELL T0 A PRIVATE SEHER LINE IS 25 FEET AWL,
R COMMLINIT',r" SEWER LINE IS 75 FEET
]I_L LCIISS ARE REC!LiIRED AND, MLIST E;E RETURtlE[:, T0 THE DEPFIRTHENT WITHIN _TEl [',FIYS
THE NELL COf"IF'LETION.
CHEP RECfUIREMENTS MAY APPLY. %F'ECIFICATIONS AH[:, E:Fff. ISTRIJCTION DIRGRBI'IS RF:E
~'AIL~BLE TO INSURE PROPER IHSTAt_LATION.
C:ERT I F'Y' THAT
I Fir'1 FHMILIRR NITH THE REE!UIREMENTS FOR ON-si'rE SEHERS AND 14ELLS AS SE'r
)RTH B'Y' THE MUNICIPALITY OF ANE:HOPAGE
I I,~ILL INSTALL THE SYSTEM IN RCCORDFtr. ICE HITH THE COL)ES.
I UtlDERSTRN[', THAT THE ON-SITE SEWER S'T"STEM MAY REC;UIRE ENL~RRGEMEHT IF THE
:;SIDEHCE IS I~'EMO[:,ELED TO Ii'ICLU[:,E MORE THAN _~ BEDROOMS.
[] S Q.U..$ LOG~
PERCOLATION
TEST
PERFORMED FOR= /~-'~',~)¢..~ . ~ , D~E PERFp~E~D.;
/ / / / / SLOPE ~ SITE PLAN
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
2
3-
4-
5-
6
7
8
9
10
11
12
13
14.
15
16
17
18
19-
20-
COMMENTS
PERFORMED BY:
72-008 (6/79)
WAS GROUND WATER
E.COU.TERED?
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE /~ (minutes/inch}
TEST RUN BETWEEN ~' FTAND ~~'' FT
LOG OF DRILLING by A & L DRILLING COMPANY
ow-~ o~ ~uo~...jae~.,.~.tewae~t~ ........................................................
ADDRESS.-.9**L-d-**RStg~e....~U:Ve.~-...~Oa~ ..............................................
w '<"g .--SIT~**:l~gl.-e...R.:tw,e.r-i;....A:]:t8t~O: ...........................................
]fl'A TE--s'rAR~rs:D ..**~ e .b.re.a.ay**....t.96.5 ....................................................
DATR'--ENDED---*..~ ~,~11~....~ gj ~.~ .......................................................
KIND OF FORMATION:
FltOM-_..*t.? .............. FT. TO..,..26 ................ F'r..$ 8m~d...&.._g.~ave1
FROM....._~ .............. FT. TO....6.~....: ..........
FRO~.~:~5 ............. ~'r. ~0....~,~ ............... FT..~,nd.~_..~ry .........
...~!~ 80 ............... ~-tay-*'&-"g*ra~et
Fao~?.d50 ............. .Fr. TO....91 ................ FT".'~anct, wet
~r?M.....~l ............ ~r~ To....~) ............... FT"Ru~k ..........................
FROM.....89 ............. .Fr. TO...9,.I: ............... FT"$:t!t't-~----wet .........
D~TH OF WELL...t.~..~...~.~, ....................................................
STATIC LEVEL OF WATER l~....~...~...~.~. .........................
D~AW DOWN FT,....18....i('.:~.o ...................................................
GALS. IvER HIL..~0...~.i. ....................................................
KIND OF CASING....~,......~._/.~..,,,j:.rt.; ...................................... ]
· ~ '/f ':>.,...,~.]
.................. FT... ..._ w_
FROM .......................... ~o ~0 ......................... ~ ...................................
FROM .......................... FT. TO ......................... Fl' ..........................
FROM .......................... FT. TO ................. :........FT ..................................
FROM ......................... .FT. TO .......................... FT .................................
FROM .......................... IrT. TO ......................... .F~ ..................................
FROM .......................... FT. TO .......................... PT ..................................
FROM .......................... FT. TO .......................... FT .................................
DmLLER'S NAME....I'~eS...~.ull/.~att .....................................
MUNICIPALITY OF /ANCHORAGE IR
05�
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-472-93
1. GENERAL INFORMATION
Complete legal description UPLANDS PH 2 TR 1
Location (site address)
20811 Eagle River Rd
Expiration Date: I l' -(—z'(
Current property owner(s) SMITH PHYLLIS FAMILY
Mailing address
Real estate agent
2. TYPE OF DWELLING:
Fx_1 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone 561-2227
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
FX
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 6'60 Waiver Fee $
Date of Payment Date of Payment
Receipt Number C� 2 �{it 3b Receipt Number
COSA#05CZ 1 1 y 52 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 NorthRim Eng. Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date $/3/21
OF '01
Ar
6. DSD SIGNATURE
f.. . .
......
System #1 Approved for bedrooms f Steve 1n9
System #2 Approved for bedrooms ♦4y� `E-6256
Disapproved
Conditional approval for bedrooms, with the following stipulations:
OFAA,_66,_
Q
g WATER AND Wit'
R, WAST" WATER z
�1)V SEta\I`,C1t
'^- Original Certificate Date:^I`(
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
Septic System Advisory
Nitrate Advisory
Arsenic Advisory
Wall Flnw Arivicnnr nthor
Legal Description: UPLANDS PH 2 TR 1
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 2/65
Total depth 113 ft
Cased to 113 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 6/1/21
Static water level at beginning of test 85 ft.
Comments
B. TANK DATA
Age of tank(s) new years
Tank type/material e°"P
Measured operating fluid level in septic tank new
❑ Standpipes/foundation cleanout per record drawing
Date of pumping new
D. ABSORPTION FIELD DATA 9/23/80
Which system tested (date installed) same
❑ ALL standpipes present per record drawing
Total measured depth from grade 10 ft (max)
Measured depth to pipe invert from grade 5 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 050-472-93
of Structure served by this system
Well production at time of test 8+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑ N
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by NRimEng
Date of Sample 6/1/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 6/1/21
Results Q Pass For 3 bedrooms
Fluid depth prior to test 0 in
Water added 450 gal
New depth 0 in
Elapsed time 30 min
Final fluid depth 0 in
Absorption rate 450 gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
no
E SEPARATION DISTANCES
From Private Well onLot to: (Please enter distances if less than required orKcommunity well
Septic Tenk/LdtStation nnLot >�108
]Yes
Property Line >10' Yes ifNnM
Community Sewer Manhole/Cleanout 1O0'
Yes
JNo�
Absorption Field >5'
1171
MV
ifNu�
Neighboring Tank >1O0' Yes
i[Noft
Water Main >10'
Private Sewer/Septic Line >�25'R-lYes
Yes
iyNoM
Absorption Field onLot >10O' Yen
ifNo0
Water Service Line >10'
Holding Tank > 100'
21 Yes
i[Noh
Neighboring Absorption Fields > 100'
|fseptic tank inunder driveway comment below
Animal Containment >SO`
El Yes
ifNo0
R�YeS
ifNpM
Manure/Animal Excreta Storage >�1OO'
Community Sewer Main >�75* [D Yes i[NnO ��Yes i[No0
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations >�10' RYns ifNoft Surface Water >1OO' 21 Yes ifWoft
Property Line >5' �_
From Absorption Field onLot to: (Please enter distances if toss than required)
Building Foundation >1O' El Yes ifNoft
]Yes
Property Line >10' Yes ifNnM
ifNoO
Water Main >1O' Yes ifNuM
Wells nnAdjacent Lots:
Absorption Field >5'
1171
Yes
ifNoM
F. ENGINEER'S COMMENTS
Private Wells >1OO' Yen ifNoft
Water Main >10'
Yes
ifNoft
Community Wells > 200' Yes i(No8
Water Service Line >10'
Yen
ifNnM
|fseptic tank inunder driveway comment below
From Absorption Field onLot to: (Please enter distances if toss than required)
Building Foundation >1O' El Yes ifNoft
|fabsorption field iaunder driveway comment below
Property Line >10' Yes ifNnM
Wells nnAdjacent Lots:
Water Main >1O' Yes ifNuM
Private Wells >1O0' Yes ifNoft
Water Service Line >1O' Yes ifNoft
Community Wells >2OO' Yea ifNnft
Surface Water > 100' Yen if No ft
F. ENGINEER'S COMMENTS
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