HomeMy WebLinkAboutWAGNER LT 1Onsite File
Wagner
Lot 1
PID# 017-092-88
Formerly Wagner Tr 2
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page I of 3
OWSITE WASTEWATER INSPECTION REPORT
Permit Number: OSP151054 PID Number. 017-092-33
Dwelling: M Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: M New ❑ Upgrade
Name:
Erik Hjelm
ABSORPTION FIELD
M Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
`Mess
14910 Wildien Drive Anchorage, AK 99516
171 other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
947-1110
1 4
.45 GPD/SF
12.2 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
4.2 Ft
Gravel depth beneath pipe
8.0 Ft
Subdivision - Block Lot
Wagner Tract 2
Fill added above original grade Ft.
0-1
Gravel length
84 Ft.
Township Range Section
Gravel width
3 Ft
Beds: Number of tines
Distance between lines
I Ft
EPARA71ON DISTANCES
TO
Septic
Absorption
LIR Station
Holding
SewerTotal
absorption area
Number of trenches
Dist between trenches
I
From
Tank
Feld
Tank
Line
1,3W& Fe
TWO
>1t/—&V Ft.
Well
>100'
>100'
>100'
>75'
>25'
TANK NSeptic ❑S.T.E.P. Holding r_] Other
Manufacturer
Anchorage Tank
Capacity
1 1,250 Gal.
Surface Water
>100'
>100'
NA
NA
Material
Number of compartments
Lot Line
>5'
>10'
NA
NANA
Steel
Two
Foundation
>5'
>10'
NA
NA
ILIFT STATION
Manufacturer
capacity
curtain Drain
None
Noted
Gel.
Remarks Slope fronting absorption trench
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
flattened to <25% for 50'.
Punip make and model
Electrical Inspections performed by
Installer
PIPE MATERIAL House to tank D3034 d amfield D3034
Red Dog Excavating
Draintiela F810 corMT
Inspector W. Roberts
BENCH MARK (Assumed elevation)100.0 it
l"sp1� 5/8/15 5/11/15
Location and description
2-
dates:3m
0
House Lower Level Finished Floor.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
♦s��h►�gL
JF41
Conditional Approval: Date
'PN
`tifQ�i
�.�49thLA•�
�. .p. WHAE.xE. ANxxxx. ..
MICHAEL E. ANDERSON
No. CE -4381 ��2=
Appr6gd Date 2 -LZ-
'+�; ;�••
Inspection Report 9-1-12.doc
Permit Number: OSP151064
49th
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
TRACT 1
S 89'57'18'E 367.14'
MICHAEL E. ANDERSON
0' UTILITY EASEMENT
UNSUBDIVIDED
Garage
TRACT 2
WAGNER
101,331 s.f.
Advantex Treatment
System with 20' Long x
3' Wide x 8' Effective
Depth Absorption Trench.
2 GPD/SF Application
Rate.
Page 2 of 3
PID No.: 017-092-33
B
RIGHT OF WAY EASEMENT
PLAN AS BUILT
SCALE 1' = 50'
LEGENn
Mr — Monitor Tube
FOO — Foundation Clean Out
TH — Test Hole
CO — Clean Out
FSV — now Splitter Valve
GRAVELW
I—
QAIVEWAY;.
v
. .
m
z
m
<j
Z/"
rn
r
t C4
v
a
CB
Hz
N
MICHAEL E. ANDERSON
0' UTILITY EASEMENT
UNSUBDIVIDED
Garage
TRACT 2
WAGNER
101,331 s.f.
Advantex Treatment
System with 20' Long x
3' Wide x 8' Effective
Depth Absorption Trench.
2 GPD/SF Application
Rate.
Page 2 of 3
PID No.: 017-092-33
B
RIGHT OF WAY EASEMENT
PLAN AS BUILT
SCALE 1' = 50'
LEGENn
Mr — Monitor Tube
FOO — Foundation Clean Out
TH — Test Hole
CO — Clean Out
FSV — now Splitter Valve
Page 3 of 3
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number: OSP151054 PID No. 017-092-33
Co / N UU y
1,250 Gallon
Septic Tank
p 99.2 98.0
N V
p 99.6 n
95.4 11 Drainfield Rods 95.4
87.4
81.0 43' (Trench Length)
No Groundwater �J
WEST TRENCH
99.3
98.0
Finished Greco
96.3 4II Drainfield Rods
87.3
81.0 43' (Trench Length)
No Groundwater j
EAST TRENCH
PROFILE AS -BUILT
No Scale
p 99.4 n
February 18, 2016
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Tract 2, Wagner Subdivision
Waiver Request
Absorption Trench Sidewall to Absorption Trench Sidewall
Dear Onsite Services Engineer:
The new absorption trenches constructed on the subject lot were placed less than 16'
apart because of problems controlling the alignment during excavation. The sidewall at
the south end of the westerly trench is only 14.3' from the sidewall of the easterly trench.
It then transitions to 16' at 17' to the north. Only a short segment of the trench is less
than 16'. We therefore request a waiver be issued allowing the trenches to remain in their
existing locations. The effluent in the trenches will be absorbed downward into the
accepting soils and very little migration in an easterly or westerly direction is anticipated.
Sincerely,
y4'z_.J' 'f� a'l'
Michael E. Anderson, P.E.
ii ••'• 49th (�V •••••••'-%}
MICHAEL E. ANDERSON
NO. CE -4381 ,
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road; PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP151054
Tax Code Number: 01709233000
Work Type: Septic Initial
Permit Effective Dates: April 02, 2015 to April 01, 2016
Design Engineer: ANDERSON ENGINEERING
Subdivision: WAGNER
Site Legal Address: WAGNER TR 2 G:3038
Owner/Address: HJELM ERIK
14910 WILDIEN DRIVE ANCHORAGE AK 995163967
Site Mailing Address: 14551 GOLDEN VIEW DR, Anchorage
This permit is for the construction of:
Lot Size in Sq Ft: 101335
Total Bedrooms: 4
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued %
Municipality of A
P.O. Box 196650 0 4700
Anchorage Alaska: 99519-6650 • (907) 343-79
chorage went s
0.epai
Imore Road4• Fax (907) 343-7997 `tment
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907=343-7904
Development Services Division Fax: 907-343-79911 TAL
On -Site Water & Wastewater Program
vik 2 2015
ON-SITE SEWERIWELL PERMIT APPLICATION
Parcel I.D. 017-092-33
Property owner(s) Eric Hjelm Day phone 947-1110
Mailing address 14910 Wildien Drive Anchorage, AK 99516
Site address 14551 Golden View Drive Anchorage, AK 99516
Legal description (Sub'd., Block & Lot) Wagner, Tract -4a
Legal description (Township, Range & Section)
Lot Size 101,335 Sq. Ft. Number of Bedrooms Four
APPLICATION IS FOR:
(® all that apply)
Absorption Field
Septic Tank
19
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
IN
APPLICATION IS AN: TYPE OF DWELLING:
Initial Single Family (SF) Q
(w/wo ADU)
Upgrade ❑ Duplex (D) ❑
Renewal ❑ Multiple Dwellings ❑
(SF and/or D)
Absorption Trench to Slope
-Tv�.rnf'i 4rrTrLt�i
�-dertifv that the above information is corr
M
I further certify that this is in
(Signature of property owner or authorized agent)
Dis tance: 35738'
ty,
3
cordance with
Permit/Rush Fees: '569- Waiver Fees: A/S `
Date of Payment:S� f / $ Date of Payment: 31a q/ 17
Receipt Number:
Permit No. tis P/IT/(1151
Permit App_":. :_'.,:c_
Receipt Number:
Waiver No. OSV 16-1009-
Permit
u (UU%
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX
March 23, 2015
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 Elmore Road
Anchorage, AK 99519-6650
Subject: Tract 2, Wagner Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Tract 2, Wagner Subdivision intends to construct a new four-bedroom
home on the lot. We are therefore requesting a permit be issued for the construction of
a new septic system to accommodate the home. A well is currently in place on the lot.
The attached Site Plan and backup documentation identify the location and
configuration of the existing well and proposed septic system along with the alternate
site. Also identified on the plans are the existing wells in the area and septic systems
on surrounding lots. No conflicts exist between the proposed septic system and well or
septic systems and wells on adjacent lots. Drainage arrows and ground surface
contours are shown on the site plan showing the grade and direction of flow on the lot.
The drainage pattern will not be changed as a result of this project.
The test holes placed on the lot in the area of the absorption trenches and alternate site
indicate silty sand with gravel (SM/GM). The percolation rate of the soil at the existing
test hole was determined to be 30-40 minutes per inch. No groundwater was found
during the placement of the test holes and none was noted during the monitoring
period. An application rate of .45 gallons per day per square foot was used in the
design of the absorption system. We are proposing to place a new 1,250 -gallon septic
tank and 2-42' long by 3' wide by 8' effective depth absorption trenches to treat and
dispose of the effluent generated in the house. The elevation of the distribution line in
the absorption trench will be 3' below the surface and the total depth will be 11'. A flow
splitter valve will be placed to insure even flow to each trench. A minimum of 3' of fill or
2" of insulation and 2' of fill will be placed over the absorption trench and 4' over the
septic tank.
The ground surface on the lot in the area of the septic system slopes to the west at a
shallow grade with some cross sloping from the east. The new trenches will be
constructed parallel with the contours of the slope as much as possible in conformance
Tract 2, Wagner Subdivision
March 23, 2015
Page Two
with Municipal requirements. The new septic system will be constructed a minimum of
100' from all wells and any surface water and 10' the proposed and existing water
services 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.
Sinc/erely,, ar Q
Michael E. Anderson, P.E.
Attachments
MICHAEL E. ANDERSON
No. CE -4381
- TOP OF
............ .
1 FOU
197 4A'
5/8"x30" REBAR
LEGEND
MT — Monitor Tube
FCO — Foundation Clean Out
TH — Test Hole
CO — Clean Out
FSV — Flow Splitter Valve
Contour Interval — 2' : tL
UNSUBDIVIDED
SITE PLAN
SCALE 1' = 50'
0
0
CA
0
t'?
N
V
p
0
0
PARCEL 18
49th
•
MICHAEL E. ANDERSON
No, CE -438811 ti
TRACT 2, WAGNER SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS
Four Bedroom Home Deep Trench System
Perc. Rate: 31-60 Min./Inch 1,250 Gallon Septic Tank
Application Rate: .45 GPD/SF 8' Drainfield Rock
4 Bedrooms X 150 GPD/.45 GPD/SF (Application Rate) = 1,333.3 SF Absorption Area
1,333.3 SF/16SF/LF = 83.3 LF Trench Length
THEREFORE: Construct 2-42' Long x 3' Wide x 8' Effective Depth Absorption Trench at the Location
Shown. Flow Line Elevation in Trenches to be 3' Below Original Ground Surface. Total Depth to be
11' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption
Trench. Maintain 100' Separation from Wells in the Area.
Natural
Backfill
Geotextile
Fabric
6" O 4" Perforated
PVC (Holes Down)
M
3'
Drainfield Rock
TYPICAL 5' WIDE TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Wells in the Area.
Minimum 100' Separation From Surface Water or Streams.
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: WAGNER TR -2
PERFORMEDFOR: ERIC HELM/MAX MEDEMA
DATE: 7/15/I4 PROJECT No.:
PARCEL ID#: TECHNICIAN: JB
DEPTH TEST HOLE 1
(feet)
1 OB/OG
2
3
4
5 SM/GM
6
7
8
9
SLOPE
WAS GROUND WATER ENCOUNTERED? No
10 IFYES@ WHATDEPTH?
DEPTH OF WATER AFTER MONITORING: NONE
L I DATE OF MONITORING: $/1/2014
14-
15-
16-
17--
4151617 BOH @ IT
18
49th
E. ANDERSON
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH To
WATER
(INCHES)
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
7/15
1
1:20
3.125
2
1:50
30
4.00"
,875"
3
1:51
3.25"
4
2:21
30
4.00"
.75't
5
2:22
3.125'
6
2:52
30
3.875"
.75"
PERCOLATION RATE:: 40 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 4.5 FT. and 5.5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 3/20/15
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
�• 49th , !V
SOILS LOG - PERCOLATION TEST
E. ANDERSON
LEGAL DESCRIPTION: WAGNER TR -2
PERFORMED FOR: MAX MEDEMA
DATE: 7/15/14 PROJECT No.:
PARCEL ID#: TECHNICIAN: JB
DEPTH TEST HOLE 2
(feet)
1111111111111 OB/OG
2
3
4
5
6 SM/GM
7
8
9
10
11
1
17 BOH @ 17'
18
19
SLOPE
WAS GROUND WATER ENCOUNTERED?
No
IF YES @ WH
DATE
DEPTH OF WATER AFTER MOM
GROSS TIME
(MINUTES)
DATE OF MO
DEPTH (INCHES) To
WATER
AT DEPTH? O
TORING: NONE
NITORING: 8/1/14
-
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH (INCHES) To
WATER
NET DROP
(INCHES)
TEST HOLE PRESOAKED PRIOR TO TESTING:
7/15
1
1:25
5.25^
2
1:55
30
4.25^
1.0011
3
1:56
5.00°
4
2:26
30
4.125"
.875"
5
2:27
5.25"
6
2:57
30
4.375"
.87511
PERCOLATION RATE:34.3 (MIN/INCH) PERC. HOLE DIA. 9 (INCHES)
TEST RUN BETWEEN: 4 FT. and 5 FT.
COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 3/20/15
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 FAX
March 23, 2015
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Tract 2, Wagner Subdivision
Absorption Trench to Slaorth
Wi
Dear Onsite Services Engineer:
The ground surface slopes on Trdivision exceed 25% toward the
west property line. The proposedstem is approximately 38' from a
break in grade greater than 25%.he alternate site is 35' from the
same break in grade. We are therefore applying for a waiver allowing placement of the
absorption trench at this location.
The imaginary 25% slope when extended downward from 2' above the distribution line
does not daylight. We therefore recommend the waiver be issued allowing the trench
system and alternate site to be placed at the location shown on the Site Plan.
Sincerely,
" a-.,
Michael E. Anderson, P.E.
L43
MICHAEL E. ANDERSON
No. CE -4381
745'
740'
735'
730'
725'
37'
720'
715'
Exist)
Grou
d
710'
25%
25%
705'
700'
0 5' 10' 15' 20' 25' 30' 35' 40' 45' 50' 55' 60' 65 75 80' 85' 90' 95' ..AS..��1 , 115'
AV
or T
WAGNER SUBDIVISION i ... ..........
TRACT 2 00 MICHAEL E. ANDERSON %,��
-4381
SLOPE ASSESSMENT
SLOPE
,,1�fti\a�aav�''•
MUNICIPALITY OF ANCHORAGE
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. 01 7-092- S16
Expiration Date: 7- 1 ,zoz 2-
1. GENERAL INFORMATION
Complete legal description Wagner L_ca- _I
Location (Site address) 14551 Golden View Drive, Anchorage, AK 99516
Current property owner(s) Erik Helm Day phone (907)947-1110
Mailing address
Real estate agent
14551 Golden View Drive, Anchorage, AK 99516
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑■
Private Septic
Q
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 $ -6-5 () I Waiver Fee $ _
Date of Payment 3/21 l A0 a s Date of Payment
Receipt Number 0 C) � b Receipt Number
COSA # SSG 22 g 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 Forge Engineering (M.J.) Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller, P.E. Date 3/28/2022
A��`�l
', �t
TH
6. DSD SIGNATURE % ,• • ::
JJ 1 �S-
System #1 Approved for 4' bedrooms Ir Benjamjrt�5chiller
System #2 Approved for bedrooms ��F��st •. CE 12o 2 . •'������/
Disapproved 11 ROFESSI
Conditional approval for bedrooms, with the following stipulations:
`\1�\�,( OF AkCy
By: Original Certificate Date: - Zr��
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
a� W
Q)OGh
TS
By: Original Certificate Date: - Zr��
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist
Legal Description: Wagner Lot 1 Parcel ID: 017-092-33
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled Unknown
Total depth '75* ft
Cased to >40* ft
0 Sanitary seal is functioning correctly
9 Wires are properly protected
Casing height (above ground) >18 in.
Date of flow test for COSA 2/22/2022
Static water level at beginning of test 41.6 ft
Comments *Measurements taken from 2016 COSA
B. TANK DATA
Age of tank(s) 6 years
Tank type/material Septic/Steel
Measured operating fluid level in septic tank 49
0 Standpipes/foundation cleanout per record drawing
Date of pumping 3/21/22 Isaac's Pumping Service
D. ABSORPTION FIELD DATA Deep Trench
Which system tested (date installed) 5/8/2015
Q ALL standpipes present per record drawing
Total measured depth from grade 3.2/4.9 ft (max)
2/13.2
Measured depth to pipe invert from grade 11.ft (min)
❑ N/A — pressurized field
FC Monitor tubes go to bottom of effective. If not, state
depth into effective
Well production at time of test 1.0 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑ No
9 Coliform bacteria is Negative
Nitrate 0.277 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑® Arsenic less than MRL (ND)
Collected by Forge Engineering
Date of Sample 3/15/2022
STATION
❑ Requl aintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 2/22/2022
Results ZPass For 4 bedrooms
Fluid depth prior to test 18/21" in
Water added 750 gal
New depth 28/29" in
Elapsed time 1440 min
11/9*
9 Code -required soil cover over field
Final fluid depth in
Absorption rate >600 d
Q System presoaked p 9p
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months)
date of test)
Gallons introduced 2000 gallons If yes, enter date
Comments/Deficiencies: "Fluid measurements post presoak. Measurements listed for West/East trench.
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
E✓
Yes
Community Sewer Manhole/Cleanout > 100'
ft
f✓
Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100'
Q
Yes
if No
ft
Private Sewer/Septic Line > 25' Q✓ Yes
if No ft
Absorption Field on Lot > 100'
Q
Yes
if No
ft
Holding Tank > 100' Yes
if No ft
Neighboring Absorption Fields
> 100'
if No
ft
Animal Containment > 50' Yes
if No ft
Q
Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75'
Q✓
Yes
if No
ft
0✓ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter
distances if less than required)
Building Foundations > 10'
R
Yes
if No
ft
Surface Water > 100' M Yes
if No ft
Property Line > 5'
Q
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
M✓
Yes
if No
ft
Private Wells > 100' Yes
if No ft
Water Main > 10' ...
✓I
Yes
if No
ft
Community Wells > 200' Q✓ Yes
if No ft
Water Service Line > 10'
Q
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'
E✓
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
Q
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'✓Q
Yes
if No
ft
Private Wells > 100' 0 Yes if No ft
Water Service Line > 10'
Q✓
Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water > 100'✓❑
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
/ certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
TWO.
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® MIl>tnicipaRIltr of Anchorage
On -Site Water and Wastewater Program 2
(907)343-7904
Certificate of ®n -Site Systems Approval
Parcel I.D. 017-092-33 Expiration Date:
B. GENERAL INFORMATION
Complete legal description Wagner, Tract 2
Location (site address) 14551 Golden View Drive Anchorage, AK 99516
Current Property owner(s) Erik Hjelm Day phone 947-1110
Mailing address 14910 Wildien Drive Anchorage, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
M Single Family (wlwo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: i
ur
4. TYPE of WATER SUPPLY:
TYPE of WASTEWATER DISPOSAL:
Individual Well
0
Individual
X
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
M
WaiverAlariance request
Recelved by: 1 ZL / 1,; M //)/1Q/ Date: a a,Zlk
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ (01.9 D /
Date of Payment
Receipt Number C)5-7 t `7 (55)
COSA# 05CG /0;-[
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
S. STATEMENT Or 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 Anderson Engineering
Address P.O. Sox 240773 Anchorage, AIL 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SIGNATURE
T System #1 Approved for --14- bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
Phone 522-7773
Date 1/28/2015
ao ,.•-
.vY
49th
,11CHAEL E.
bedrooms, with the following stipulations:
Original Certificate Date:
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory L!051 Other
COSA blue sheet t ... c
If more than 1 septic system is on the lot:
COSA Checklist #
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: Wagner, Tract 2 Parcel ID: 017-092-33
A. WELL DATA
Well type Private if A, B, or C provide PWSID # _
Date completed Unknown Sanitary seal (Y/N) Y
Total depth '75 ft. Cased to >40 ft.
FROM WELL LOG
Date of test
Static water level ft.
Well production 9—
P.M-WATER SAMPLE RESULTS:
Coliform --i—colonies/1 00 mL Nitrate .688 mg1L
ND 1!12/16
Arsenic ug/L Date of sample:
B. SEPTIC/HOLDING TANK DATA,
Tank Type/Material Septict$teel
Tank size 1,250 gal. Number of Compartmentsa.,
Foundation cleanout (YIN) Y Depression over tank (Y/N) N
Date of pumping New. Const. Pumper
Well Log (Y/N) N
Wires property protected (Y/N) Y
Casing height (above ground) >18 in.
AT INSPECTION
11/12/15`
43.3 ft.
9—
P.m-
Collected by Anderson Engineering
Date installed 5/8/2015
Cleanouis (YIN) Y
_ High water alarm (Y/N) N
C. ABSORPTION FIELD DATA
Date installed 5/8-11/15Soil rating (g.p.d.M2 or fe/bdmt) .45 GPD/SF System type peep TrefiCtt
Length 2 9 42' ft. Width 3 ft. Gravel below pipe 8. ft.
Totai depth 1'2- ft. Eff: absorption area 1,344 f Monitoring tube Y Depression field, N
Date 61,adquaeystiy4a1/yU11St. Results.(Pass/Faii)-�^ For bedrooms
Fluid depth in absorption fleld;before test in. Water added ' gal. New depth in.
Elapsed Time: mih. Final fluid depth in Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type)
If yes, give date
r-
D. LIFT STATION
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 requiremerns?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tanklIft station on lot
>100'
Absorption field on lot
>100'
Public sewer main
>75'
Sewer /septic service line
>25`
Animal containment areas
>59.
SEPTICIHOLDING TANK ON LOT TO:
Building foundation >5'
Property line >5'
On adjacent lots >100'
On adjacent lots >100'
Public sewer manhole/cleanout >100'
Holding tank >75'
Manurelanimal excrete storage areas >100'
+
Absorption field >5
Water main >10' Water service line >10' Surface water >100'
Weiss on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
+ >10 >10
Property line >10 Building foundation Water main
>100
Water service fine > 10 Surface water Driveway; `parkinglvehlde storage > 10
None Noted >100' .
Curtain drain Wells on adjacent lots ,
;1. -CM brown sheet 10-16-12.doc
Municipality of Anchorage
Development Services Department P '
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Water Well Advisory
Certificate of On -Site Systems Approval (COSA) # osc161021
During a recent COSA on-site inspection and test of the potable water
supply well on Block , Lot Track 2 of Wagner subdivision, the well's
productivity was determined to be 0.8 gallons per minute. The minimum
well productivity required by this Department (AMC 15.55) for a 4 -bedroom
residence is 0.58 gallons per minute. Although the subject well currently
exceeds this minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction of non-critical
water uses such as washing cars and watering lawns and gardens may be
required.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
10/02/2015 23:69 907-345-0202 ALPINE DRILLING PAGE 01/01
Development Services Department
Building Safety Division �• b`
b On -Site Water A Wastewater Program
4700 Elmore Road q
P.O. Box 196650
MarkEegich Anchorage, AK 99507
Mayor www mVri oro/o fi
(907')343-7904
Pump Installation Log
Well Drilling Permit Number: SW j+a Date of Issue; Iia
Parcel Identification Number:__
Legal Description Property Owner Name &Address:
Wagmr Tract 2 Erik riialm
14551 Goiden View Dr.
Anchorage, AK 995i8
Pump Installation Date: 19.2016 — —
Pump Intake Depth Below Top of Well Casing: 76 feet
Pump Manufacturer's Name: cmr;iae
Pump Model: 7wS05
Pump Siff .s hp
Pities Adapter Burial Depth: 14 feet
Pitless Adapter Manufacturer's Name; MaMneon
Pitless Adapter Installer: fila
Well Disinfected upon ComplMioD? ® Yes ❑ No
Method of Disinfection'-
Comments:
isinfection:
Comments:
Pump Installer Name: Aurow Pump & We115e"ira, LLC
P.O. Box 110496
Anohnmge, AK 99511-4496
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
M