HomeMy WebLinkAboutHOKAMA HEIGHTS LT 1Onsite File
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Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191267 PID Number: 017-341-08
Dwelling: Single Family(SF) Duplex (D) Multiple (SF and/or D) Project: New Upgrade
Name:
BRENDA & RANDY NOLIN ABSORPTION FIELD - EXISTING
Address Deep Trench Shallow Trench Bed Mound
5301 DE ARMOUN ROAD, ANCHORAGE Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
3 GPD/SF Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot Ft. Ft.
HOKAMA 1 Fill added above original grade Gravel length
Township Range Section Ft. Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES Ft. Ft.
To Septic Absorption I Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Lift Station Tank Line Ft2 -- -- Ft.
Well 100'+ NA NA NA NA TANK Septic S.T.E.P. Holding Other
Manufacturer Capacity
Surface water 100'+ NA NA NA GREER 1250 Gal.
Material Number of compartments
Lot Line 5'+ NA NA NA HDPE 2
NA
Foundation 10'+ NA NA NA LIFT STATION
Manufacturer Capacity
Gal.
Curtain Drain NA NA NA NA
Pump on level at Pump off level at High water alarm at
Remarks Existing septic tank decommissioned
per code., in. in. in.
Pump make and model Electrical Inspections performed by
Tank to
PIPE MATERIAL House to tank 3034d a nfeld 3034
Installer MIKE N. ANDERSON
Drainfield CO/MT 3034
Inspector FWCS / MNA BENCH MARK (Assumed elevation) 101.7 ft
Inspection 1•; 9/3/19
2nd 9/3/2019 Location and description
da
3`° 41" BOTTOM OF SIDING
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL 4110. F \��
AP-. )
Conditional Approval: Date l<4':.. •. '`f'
*49THi\ * �
� 'MICHAEL N. ANDERSON:
Allf
, Gj No. CE 9469 /
9/6/19 • $
v
Approved / Date q/ / , ,Essio14.'i'
�9 �.11‘.:46:
/
Inspection Report_9-1-12.doc
MT
•
A -C=17.2'
B -C=24.1'
A -D=20.8'
B -D=28.1'
PID: 017-341-08
PERMIT: OSP191267
SEPTIC SECTION
SCALE: NTS
PREPARED FOR: SUPPORT$SERVICES: ' ► OF \\
BRENDA & RANDY NOLIN �� 444�
HOKAMA HEIGHTS LOT 1 w �' T / �� 4 9 IT.
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5301 DEARMOUN RD., ANCHORAGE, AK 99516
Michael N. Anderson P.E.
� DATE: 9/6/2019 MICHAEL N. ANDERSON /
No. CE 9469
4661 Natrona Ave. DRAWN: FWCS 11 9/6/19cs�
Anchorage, Alaska 99516 \ 1'ijpSS10�A1 w
(907)727 8864/FAX: (907)345 1391 SCALE: 1" = 30' �`_'�
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MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4740 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http-J/www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP191267
Work Type: SepticTank Upgrade
Tax Code Number: 01734108000
Site Legal Address: HOKAMA HEIGHTS LT 1 G:2937
Site Mailing Address: 5301 DE ARMOUN RD, Anchorage
Owner: NOLIN BRENDA S 50% &
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
7/26/2019
7/2512020
72529
❑ Disposal Field C1 Septic Tank ❑ Holding Tank ❑ Privy ❑ 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
Received By:
Issued By: � [ J
''CA ("4'Vt'W'
Date: I
Date:
3
IE� P4A70V\,/,,S
MUNICIPALITY OF ANCHORAGE
Afte
Development Services Department�; Phone: 907-343-7904
On -Site Water & Wastewater Section Fax. 907-343-7997
ON-SITE SEPTICMELL PERMIT APPLICATION
Parcel I.D. 017-341-08
Property owner(s) ERIC & JENNIFER MAXON Day phone 9074404601
Mailina address 9031 NOBLE CIRCLE, ANCHORAGE, AK 99502
Site address 5301 DEARMOUN ROAD, ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) HOKAMA HEIGHTS LOT 1
Legal description (Township, Range & Section)
Lot Size 72,529 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF)
(w/wo AD U)
Septic Tank
®
Upgrade ®
Duplex (D) ❑
Holding Tank
ElRenewal
❑
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.
FWCS - Brent Western
(Signature of property owner or authorized agent)
Permit/Rush Fees: ,2';5 -
Date of Payment: W .2g/ !q
Receipt Number: odogI o
Permit No. 05PIQ /0%_'
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc
Michael N. Anderson, P.E.
Civil/Structural Engineering and Construction
4661 Natrona Ave. Anchorage, Alaska 99516
Phone 345 -3377 / Fax 345 -1391
Support Services
Brent M. Western
907-440-4601
July 17, 2019
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: HOKAMA HEIGHTS LOT 1
To whom it may concern:
The owner has requested we proceed forward to obtain a septic permit to upgrade the
aged septic tank on the subject lot. The proposed upgrade will serve the existing 3-
bedroom house.
The lot and area is served by a private water and will not impact any of the neighboring
properties due to the lot layout. Please contact Brent M. Western or me if you have any
questions.
Sincerely,
Michael N. Anderson, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191267, Rebecca Carroll, 07/26/19
Michael N. Anderson, P.E.
BRENDA & RANDY NOLIN
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191267, Rebecca Carroll, 07/26/19
~--~ MUNICIPALITY OF ANCHORAGE ~'~
DEPARTIvlENT 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 PHONE / '~NEW
MAI LING ADDR ES~'
LEGAL DESCRIPTION
J.-.JoKA~A HEIGHTg _~OBD. CoT I ; T~ZN;f?3gJ.
LOCATION NO. Of §EDROOM~(~
Absorption area Dwelling O '~ PERMIT NO.
D,STANCETO: JW ,, ioo./ 7,0' 8,
~ ~ ManuCacturer ~ ~ ~ Material ~ N°' of compartments
Liqj c~t~n gallons IF HOMEMADE: Inside length ~ Width ~n Liquid depth
~ ~ DISTANCE TO: Well , D~lling PERMIT NO.
0 ~ ~ Manufacturer~ Material kiquid ca~acitg in ~allons
~oarost lot line ~_,~ ~ ¢~MIT ~0.
~ ~oll / Foundation
~ ~ DISTANCE TO: I Od '+----
~ ~ ~ ~o. of linos I ~en~th of ea~n~ Total len~t~es~ Tronch~i~d~ ~
~ TopoftiJotofinishgrade 4, O' Materialbeneathtilezi~S'' ~" e~ 'O'
~ Length Width Depth P~NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorp~
~ Well Building foundation Nearest lot line
m DISTANCE TO:
~ Class Depth Driller A /~ Distance to lot line PERMIT NO,
/t/~
~ Building foundation Sewer li~ ' Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST RATING
iNSTALLER
APP~%X:'"' ]'~3-;~"-- ~/ .~{¢--/DATE LEGAL
F'ER.M I T NO.
RF'PL I CRNT
P. CL BOX 4-?±7 RNCH. RLRSKR 5¢-]"~-72~-]7
LOC:RTION 'R ~ 999999
LEGRL Tt2N R]:W SE'E: 27 .~'/~1 /ILO'lC z(Z '/,L./. xD]LOT_ I~-E SQ_IRRE FEET
TYF'E OF SOIL RBSORF'TiOt'.,I SYSTEM IS: TF..EI'~L.H
,~ "-~ ' '-" F' _(SI;! '')'
~IH,-:ItlLII" ...... HUME:ER OF EEDRDZMS = (]: SOIL RHFiN', FT,-E,F....7 2]:':.E'~
THE REQUIRED SIZE OF THE SOIL RE:SORPTION SYSTEM IS:
THE LENGTH DIMEN'=;ION IS THE LENGTH (~N FEET) OF THE TF..EN_.H OR E:,RR~NF~ELD.
' i~ I S
THE DEPTH OF R T~ENJH OR PiT THE [:,ISTRNCE BETWEEN THE SURFRCE OF THE
]R~ NJ, RND THE BnTTAM OF THE E,..,~MYMTION (IN FEET).
THER. E I'-:, NO SET W I[:,TH FOR TRENCHES.
THE GRRVEL DEPTH ~S THE MINIMUM DEF'TH OF P~"'",,'~'J~.n, ~ BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE E,d_.HvNTIJN (IN FEET).
F-:E ¢:-:! Li T F~: El:. "'_-~;EF"T :[ C: -f"RI'-.iE::] ~ ]; ZE= ::L C-,L---', L'--""
PERMIT RF'F'LICRNT HRS ]"FIE RESPONSIBILITY TI] INFORM THIS [:,EF'RRTMENT D_IF.'ING THE
'- - - 'I '"" "' 1'"' '1 "" -
IN:,THLLHTILN tN_-,FE_.TILN=, OF RNY WELLS RDJRCENT TO THI~ PROPERTY RND THE
NLIMBER OF RESTDENCES THRT THE WELL HILL SERVE.
0 i'-.~ .=. F~-": E L----,. L" Z ~..." E--Z ir-:.
BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPEC:TION RND RF'F'ROVRL BY THIS
DEF'RRTMENT WILL BE SUE:JECT Ti3 PROSEC:UTION.
MINIMUM DISTRNCE BETWEEN R HELL RND RNY ON-SITE SEWRGE DISPO'=;RL SYSTEM IS
±CIEI FEET FOR R PRIVRTE HELL OR ±5Ct TO 2C1E~ FEET FROM R PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM [:,ISTRNCE FROM R PRtVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
HELL LOGS RRE REQUiR. E[:, RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 2.:E~ [:,RYS
OF THE WELL COMPLETION.
OTHER REI_-]UIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONS]"RUCTION [:,IFtGRRMS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
I CERTIFY THRT
:L: i RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: t WiLL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
~: i UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF' THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS.
......................
RPPLICRNT FRED GLOVER
t .... UEu ...... DRTE V4.0
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
5
6
7
8
9
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
F"I EL GLOVg
DATE PERFORMED;
PERCOLATION
TEST
o
i
10
11
12
13
.... ~--'-,,14
./ 16
~8
COMMENTS
C, Reid,
No~ 2251-E
~,' ~.
'ROUND WATER S
RED? ~/~, L
0
P
E
AT WHAT
Gross Net Depth to Net
Reading Date Time Time/~[. i ~ Water I~',T Drop
PERCOLATION RATE~ inch)
TEST RUN BETWEEN ~
PERFORMED
72:ooa t6/7g~
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological a SeophysicDI Surveys
Oritiing Permit No.
either lb lc.) A. D:L. No.
',a.'LIBorough Subdivision Lot Block I-~.1 '/4qlrs. Section No. TownshiPNO Range Er--] Meridian
Anch 1 _o~_of__o~-- s~
i lc. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS ~. OWNER OF WELL:
Fred Glover
Hokama Heights Sub. Address'.
Street Address and Area of Well Location
2. WELL LOG Feet Below 4. WELL DEPTH: (final) 5. DATE OF COMPLETION
Bm.cee 270 ,t. 12 - 3 - 8~
Material Type Top Bottom
gravel 0 25 6. ~ Ceb~e fool ~ofary ~ DHven ~ Dug
silty till 25 60 ~ ~ua.~~ dotted ~ Bored ~ Other:
cemented cobbles ~. 5 ~n. to 265'-.
_cemented gravel 225 250 ~. ~,,,s, o~ w~:
bedrock shelf 230 242 ~,.:open ~ole o~.,,~ 5"
cemented silt & gravel 242 260 Slot/Mesh Size: Length:
cemented gravel - H20 260 263 s~t ~.,...
Well producing 4~ gpm ~ow o~ ~ ~,o~ ,~.~ ,ur~ac~ oot,
ft. after ~hrs. pumpin$ 4~ g.p.m.
12.~ROUTING Well Grouted: ~ Ves ~No
Material: ~ Neat Oement ~ Other:
tS. PUMP: (if ovallabie) HP
14. REMARKS:
[5. Water Temperature ~ ~ F ~ C
Registered Business Name Contract License Number
N~,~: SRA Box 1560 Anchorage, Alaska 99507
Author~ed Representalive
Form O~-WWR (11/81) Copy Distribution; WHiTE-State DGGS, PINK T Driller, CANARY-Customer
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological a Geophysical Surveys
Drilling Permit No.
LOCATION OF WELL (Please complete either la, lb or lc.) A.D.L. No.
anch 1 _of_of--of -- sr-I wE3
Ic.JlDISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 5, OWNER OF WELL:
Fred Glover
Hokama Hights ~-'~.~ Address;
Street Address and Area of Well Location
2. WELL LOG Feet Below 4. WELL DEPTH: (final) 5. DATE OF COMPLETION
S.r,oae 236 ". 7 - - 8.3
M at erta I Type Top Bottom
gravel 0 25
~ ~ ty t~ 1] 25 60 ~ Auger ~ defied ~ Bored ~ Other:
h~d p~H ~0 ~ ~8 7. use~ Domestic ~ Public Supply ~ Industry
BouZde~ ~0~~-~04~ ~ ~rr~aat~on ~ ~echarge ~Commedcal
H 152~ ~ Te.t Well ~ Other:
h~d gr~y ~lt ~ ~ve~L ~ ~8 2~5 dJam ~n to ~ f~ De t~ We ght lbs./ft.
o~nt~, oob~ uiom, 4 in. to ft. Depth Sticaup~t.
cemented gravel 2~5 230
~lot/Mes~ SSze: Length:
~NV~ N~N~AL [u~ ..... IO. STATIC WATER LEVEL: /~ ft. / /
· ~ ~ t~ ~ Above or ~ Below land surface
ft. after ~hrs. pumping.~g.p.m.
I~.GROUTING Well Grouted: ~ Yes ~No
Materiel: ~ Neat Cement ~ Other: _
Length of Drop Pipe ft. copacity ~g.p,m.
[~. REMARKS:
Perfora2ed
15, Water Temperature ~o ~ F ~ C
This we[I w~s drilled under my jurisdiction and this report is lrue to the best of my knowledge and belief;
Registered Business Name Contract License Number
Authorized Representative
Form OZ-WWR (11/81) Copy Distribution; WHITE-State DGG$~ PiNK-Driller~ CANARY"Customer
EpL/7M-5
MUNICIPALITY OF ANCHORAGE
r,
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. 017-341-08
1. GENERAL INFORMATION
Complete legal description HOKAMA HEIGHTS LOT 1
Expiration Date:
47
Location (site address) 5301 DEARMOUN ANCHORAGE AK 99516
Current property owner(s) BRENDA & RANDY NOLIN Day phone
Mailing address
Real estate agent
9031 NOBLE CIRCLE ANCHORAGE AK 99502
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic,
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community ,
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ SGJ_
Date of Payment � I iq `i /q
Receipt Number a('05?lob
COSA# a6C_19133
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377
Address 4661 NATRONA AVENUE, ANCHORAGE, AK 99516
Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 8/16/2019
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by Fw'fS and Anderson Construction & Engineering.
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
'Air OF AZ4
* 9 H
�
/ 4die/
MICHAEL N. ANDERSON:
No. CE 9469 j
\ ')?OF'ESSIO-o�
bedrooms, with the following stipulations:
By: Original Certificate- Date: 9 /
The Municipality of Anchorage evelopment 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.
COSA Checklist
Septic System Advisory
Well Flow Advisory
COSA Checklist blue sheet
X Nitrate Advisory
Arsenic Advisory
Other
Cie Checklist
Legal Description: HOKAMA HEIGHTS LOT 1 Parcel ID: 017-341-08
If more than 1 septic system on lot: COSA Checklist # _of
A. WELL DATA
® Well log is filed with Onsite (or attached)
Date drilled 12/8/1983
Total depth 270 ft
Cased to 183 ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 6/20/2019
Static water level at beginning of test 236 ft.
Well production at time of test 1.0 qpm
Comments
B. TANK DATA — NEW TANK
Age of tank(s) 0 years
Tank type/material SEPTIC / HDPE
Measured operating fluid level in septic tank
® Standpipes/foundation cleanout per record drawing
Date of pumping NA — NEW TANK
Structure served by this system _
Water storage tank volume NA gallons
Well disinfected for coliform test? ❑ Yes ® Nc
® Coliform bacteria is Negative
Nitrate mg/L ® Nitrate less than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
NES
Collected by �>
Date of Sample 6/20/2019
C. LIFT STATION - NA
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA — 40'L x 3.5'W x 10'ED — 230 SF/BR = 800 SF
Which system tested (date installed) 7/15/1983
® *ALL standpipes present per record drawing
Total measured depth from grade 12.4 ft (max)
Measured depth to pipe invert from grade 4_3 ft (min)
❑ N/A — pressurized field
® Monitor tubes go to bottom of effective. If not, state
depth into effective 8.1*
Adequacy test date 6/20/19
Results 0 Pass For 3 bedrooms
**Fluid depth prior to test 24 in
Water added 730 gal
**New depth 60 in
Elapsed time 1320 min
® Code -required soil cover over field **Final fluid depth 24 in
❑ System presoaked Absorption rate 450+ gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies: *Per second post tank CO and MT elevations. **Fluid levels include missing 1.9' ED. F
COSA Checklist copy.docx
E. SEPARATION DISTANCES — Per MOA record docs & observations 5117/19.
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No ft
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No ft
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No ft
Neighboring Absorption Fields > 100'
Animal Containment > 50' ® Yes
if No ft
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ® Yes if No ft Wells on Adjacent Lots:
Property Line > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft
Absorption Field > 5' ® Yes if No ft
Water Main > 10' ® Yes if No ft
®
Water Service Line > 10' ®Yes if No ft Community Wells > 200' Yes if No ft
If septic tank is under driveway comment below
Surface Water > 100' ® Yes , if No ft
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below
Property Line > 10' ® Yes if No -ft Wells on Adjacent Lots:
Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No _ ft
Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft
Surface Water > 100' ® Yes if No ft
F. ENGINEER'S COMMENTS -
G. ENGINEER'S CERTIFICATION
I certify that l 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 copy.docx
AW
OF
.49 Tx *�
..MICHAEL N. ANDERSON..
No. CE 9489
4/6/19.. • •' IeAAW
nsslvs�
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
ParcelI.D. O1'~-3H1-08 COSA# ¢' otoll¢,7
'1. GENERAL INFORMATION-
Complete legal;description` '.~o~zmz~ ¥1¢!.~{,5 Lo4 t
ko~tion(site.address) 5301 D~ Ac.m~.rl ~o~! A,c~or¢,)e) A~ ~51G
Curr~ntPropedy owner(s) ~)e~ ~o~ Day phone 336- 5i2V
Mailing aOdress
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Add.tess
unless Otherwise reqUeSted, COSA will be held by DSD for pickup.
N0'MBER OF' BEDROG~s:
TYPE oF WATER sUPPLY:
Individual Well
Individual Water Storage
Community Class ~ Well
Public Water System
TYPE OF WAsTEWATER DISPOSAL:
Individual On-site · J~
Individual Holding Tank []
Community On-site []
Public SeWer []
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site 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 On-Site System's 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. (Cedificates 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 theprofessional 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 ..,q~¢.~,\~,~
Address. &03 ~, i~'q'.Ave,
Engineer's Printed Name
DSD SIGNATURE
L/'"" Approved for
Disapproved..
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well .Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By:
Original Certificate Date:
{Rev. 11105)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore 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:
A. WELL DATA
Well type
· ~o~c..~. ~,~,½~, Lo~' ~ ParcellD:
J
IfA, B, or C provide PWSID # --
Well Log (Y/N)
Date completed i';I- ~- tq$~ Sanitary seal (Y/N)
Total depth ~"-IO ft. Cased to I~).~ ft.
FROM WELL LOG
Date of test
Static water level ~ ~JI ft.
Well production ~, 5 g.p.m.
ot -3,tt-oS
Y
Wires properly protected (Y/N) ~'
casing height (above ground) [~ ~' in.
AT INSPECTION
1a0 ft.
[. O g.p.m.
WATER SAMPLE RESULTS:
Coliform ~ colonies/100mL Nitrate N'D mg/L
'Arsenic: [0~ ug/L~ date of sample:
B, SEPTIC/HOLDING TANK DATA
Tank Type/Material ~C'ee¢ /
Tank size ~000 gal. Number of.Compartments 7_
Foundation ¢leanout (WN,) ~ Depression over tank (Y/N) ~
'Date ofpumping. ~/7-"IIZ°tO Pumper ,A4
c. ABSORPTION FIELD DATA
Date in{;talled. "7-1151Fi~ Soil rating (g.p.d./ft~ or~).~
Length ' ~0 'ft. '~ Width 3.5 ft.
Total depth I~,~fi. Eft. absorption area ~00 ft~ Monitoring tube __
Date of adequacy test 7. 20~O Results (Pass/Fail) .
Fluid depth in absorption field before test ._~ in. Water added ~50 gal.
Elapsed Time: _/~ min. Final fluid depth _/~_.__ in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) Nc)
Other bacteria ..~'coloniesllO0 m L
Collected by: L~,5
Date installed ~JlS/
Cleanouts (Y/N)
/V~ High water alarm (Y/N)
System type Deeo T~ncJn
I
Gravel below pipe. lC)
"~ Depression over field /V'
Absorption rate >:
If yes, give date
ft.
For 'Z~ bedrooms
Newdepth ~ in.
z~cJO g.p.d.
D. EIFT .STATION
Date installed Size in gallons ,..
"Pump on" leYe~ at "Pump off' level at.~ in.
/
Datum / Cycles
tested
E, SEPARATION DISTANCES
Manhole/Access (Y/N) ~
High water alarm level at
Meets alarm & circuit requirements?
~ SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot.. l C~~'1'
'Public sewer main
Sewer/septic service line
Animal containment areas
On adjacent lots'lOct+
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~' ~+ Property line
Water main /V'/A Water service line
· Wells on adjacent lots ~C~
Absorption field
Surface water iCC
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line lot+ Building foundation JO
· Water Service line ID 4- Surface water
Curtain drain ~ 4- Wells on adjacent lois I OD -t-
F. COMMENTS
Water main /V/A,
Driveway, parking/vehicle storage
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 L A iz.s ~p~ ~ ~i
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
~E ~R~YOE TAKE~ EE~IBIU~ ~0~ ~ INI~AL ~ANSAC~ON ONLY AND ASSUME~ F~ANCIAL LIAS]M~ ONLY ~OR ~g COST OF ~E
~S~D DISTANCES PREVA[ O~ S~ALING. REPRODUC~ON MAY CAUSE EERORS IN SCALE,
m~ SURVEY TYPE S~BOLS
~UNbA~C~EE~a-~m~AS-~ILT ~ $~T ~EBA~ ~ ~ DRAINAGE ~ ASPHALT
PLOT P~N , , , AS-BUrLT, . . LOT ~R~Y.. , ~APHY ~ ~OD ~NCE
~ AS-EUlET... NO CO~ERS ~ ~ R - T... N~E~S~? ~ ASSUMED ELEV. ~ ~AL FENCE ~
PLOT PLANS ~ LOT SURVEYS NOTE:
(T I~ ~ ~$PON$1~IL.I~ O~ ~E ~UILDER OR O~ER, PRIOR TO ONLY ~OSE IMPRO~MEN~ ABO~ GROUND AND
CONS~uC~ON. TO ~EI~Y PRO~O~ED BUILDING GRADE; RELA~ ~HO~. ~N~. ~LS. ~EP~C CLE~NQU~, ~DEWALK$. DRI~WAY~,
TO ~NISHED GRADE AND U~LITY CONNEC~ON~ AND TO 0~RMIN[ E~C,, A~ ~HO~ IN ~EIR APPROXIMA~ ~OCA~ION, ONLY. SNOW
~E EXIS~NCE OF ANY EASEMENT~, CO~NANT~ O~ RE~rC~ON$ MAY PRE~NT SOME IMPRO~MEN~ ~ROM BEINQ SEEN AND LOCA~D.
~I~_~. DO NOT APPEAR ON THE RECORDED SUBDI~ION ~AT. ALL DI~TANC~ A~ R~CO~D UN~E~ O~HER~
SURLY CERTIFICA~ON _~a~m. Prep0red by
nF Robert E Johns, Jr. & Assoc.
~UNDA~ON AS-BUILT ~.. t 1 Rec, Lei ~,F.
hM p~ m ~Nu~t ~y .f th. / DO{e
............ SGS
SGS ReL# 1104354001
Client Name Spurkland Engineering Printed Date/Time 08/26/2010 13:55
Project Name/# Hokama Heights LI Collected Date/Time 08/23/2010 11:45
Client Sample ID Hokama Heights L1 Received Date/Time 08/23/2010 12:00
Matrix Drinking Water Technical Director Stephen C. Erie
Sample Remarks:
4500NO3 - Total Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to the LCS for accuracy requirements.
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Waters Department
TotalNitrate/Nitrite-N ND 0.100 mg/L SM20 4500NO3-F B (<10) 08/23/10 AYC
Microbiology Laboratory
E. Coil Negative 1 100mL SM20 9223B A 08/23/10 SDP
Total Coliform Negative 1 100mL SM20 9223B A 08/23/10 SDP
SGS ReL# 1100360001
Client Name Spurkland Engineering Printed Date/Time 02/12/2010 10:28
Project Name/# Ho Kama Heights L1 Collected Date/Time 02/02/2010 11:30
Client Sample ID Ho Kama Heights LI Received Date/Time 02/02/2010 11:55
Matrix Drinking Water Technical Director Stel~hen C. Ede
Saml~le Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic 5.09 5.00 ug/L EP200.8 C (<10) 02/03/10 02/09/10 NRB
Waters Department
Total Nitrate/Nitrite-N 0.100 U 0.100 mg/L SM20 4500NO3-F B (< 10) 02/03/I 0 RJT
Microbiology Laboratory
Colony Count 0 col/100mL SM20 9222B A (<200) 02/02/10 SDP
Total Coliform 0 col/100mL SM20 9222B A (<1) 02/02/10 SDP
Fecal Coliform 0 col/100mL SM20 9222B A (<I) 02/02/10 SDP
APPLI¢ 'NT FILLS OUT UPPER HA[ ' !!ONLY
P'ropert~'O~ne~ ~\.,,~% ~ ~'~ ,~(~)\~.,9~/~.,,~ Phone
Ma~HngAddres~ ~7'~,~Q~ ~.\~0;(-(,..~?~. C.). ~\~. ~:~-) Zip Code~.~'~__~
Address Zip Code
Lending institution ~'~r..2~.,~_.~~ X~,.._~.,,j,~.~,~j~. k./~ ~\~.jx~3~.,...,. Phone
Realty Co, & Agent Phone
Address Zip Code
Street Location -- ~-'~'"~ ~. %~-~j~..%\ ~.
Type of Residence
ingle Family
ultiple Family No. of Bedrooms
[] Other
V~r Supply
~lndividual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
[] 'Community For wells drilled prior to that date. give well depth (attach log if available).
[] Public Utility
'~nr Disposal
dividual Year Individual Installed: t
ublic Utility When Connected to Public Utility:
[] Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
ITime ~ r \~t,-..~. ) -~._.~ ) ~"- '¥'"-'"-/Time/ ~ '~ ...... Time~ ~'-~ ....... ~ Time '
Date Date Date Date
Insp~tor Insp~tor Insp~tor Insp~tor
FJeJd Notes: O¢ C' ~'
~EPT, OF HEALTH &
C E ~~-- ~ lC~~ ~ ENVIRONM:NTAL PROTECTION,
RECEi E
) APPROVED BEDROOMS *CONDITIONS OF APPROVAL
( ) DISAPPROVED ~
( ) CONDITIO~L APPROVA~
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
~-- (~ ~ WelltoTank Septic T~k Size ~ O O ~
Novemoer 22, 1983
Tim M. ~rown
5610 Silvera~o Way, A-6
Anchora~[~e, AK 99502
Subject: Lot l, Block 0, Ho~ama Heights Subdivision
Approval ~or the individual sewer and water facilities cannot
be granted until the ~ollowin9 items have been completed:
~
Awell log submitted to t~is o~ice ~or o%~r ~lies
review.
o T~e top o~ the well casin~j shoutG be sealed so that it is
~//-water tight.
~ Exposed electrical wir~s to t~%e well head are in violation
~/~of ~t~e ~unicipality o~ ~mc~ora~e codes and must ~ encased
in conduit.
~~. ~ The water ~acilities were not turned ?n a~_~i'~ ~ime O~
-/~~ scheduled inspection. Please call thls o~lce zor anotn~
. ~ ~ppointment.
V~0.~tease notify this ~partment ~or a reznspectzot~ when
..... ~ ~ ted I~ there are any
/~ noted discrepancies have been correc · ~ ·
further questions, please call t~is o~ice at 264-4720.
Sincerely,
CW48/ej/gl
Cory Willis,
Acting Sewer & Water
Pro~] r a~% Ma ~a~j)e r