HomeMy WebLinkAboutBENSLERS ESTATES LT 1Benslers Est.
Lot 1
#015-521-21
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 2
www ci.anchorage ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: two PID Number:
Nan,*
71m
Wastewater System: ❑ New ❑ Upgrade
•�� II ouv 6 dreA Raaf #,%c4oaoq95
ABSORPTION FIELD
Pn la~ d eNrooms
Y 6 —! o �/
a D..p T(rwn D TrrrA D Beit o M]U W I_
LEGAL DESCRIPTION
So Rating
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SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other:
To
Septic
Absorption
Lit
Holding
ubhrJPnvate
Maroifwaw
wacar
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Sewer Line
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Inspections performed by: _Ffaf'fon Tic!, Sr c Dates: 1' S'118109
Engineer's Stamp
2"W
Development Services Department Approval
;+�;.••••••l�"r:
Conditional Approval Date:
•....•....M..S '
yI'..•.....
it
d /L/ t
�
yt• .,� :. NiOGOR: F �� R11 d A
CE-3599
Reviewed and approved by:��stti Date:'1?��T`
�.`jtid1�y
IR�aoel
,.t 6'
PERMIT NO: SW090060 CL PAGE 2 OF 2
-------------------------------------------------------------------------------------
PID NO: 015-521-21
NEW 1250 -GALLON
GREER SEPTIC TANK
EXISTING SOIL
SWING TIES: "
E" •., ABS. TRENCH
FROM: COR. "A" COR. "B" DBL.
TO: C.O.
S.T. C.O. "D" 18' U.
S.T. C.O. "E" 25' 3T LOT 1
DBL. C.O. "F" 27' 38' 4 BDRM ""�
TBM', DRIVE; BENSLERS
HOUSE
ESTATES
WELL
R=100'
w
PLAN VIEW
SCALE: 1" = 30' � ♦����`,`,
lI� 4 DI
'�E••� F •� •.1� 1
.......
`♦ • 7NE000RE F.IIOOgE i /
CE -3589 1�%
1,\:hh as
3+ FEET SOIL COVER No MnrG n 6 ' O'� fo✓e f
-2" RIGID INSULATION Qe� T /%wra
�/r�✓ .s/sv�o9
INV—/ 1250 -GALLON
94.5 11111rEPTIC TANK INV.
94.3•
PROFILE VIEW
NOT TO SCALE
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SWO90060
Legal Description: BENSLER ESTATES LOT 1
Design Engineer: 0019 FLATTOP TECHNICAL SERVICES
Owner Name: JIM BENSLER
Owner Address: 11,000 BIRCH ROAD
ANCHORAGE. A 99516-
Date Issued: May 18, 2009
Expiration Date: May 18, 2010
ParcelID: 015-521-21
Site Address: 11,000 BIRCH ROAD
Lot Size: 0 SO. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ 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. N1a"i�
Issued By: /Z
Date:
Date: T/
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, Alaska 99507
www.muni.org/onsite
(907) 343-7904
ON-SITE SEWERIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0/5--5,21— ? 1
Property owner(s) 7t#" f3 tot lei' Day phone 7 Y x-10 It '?
Mailing address 111000 f3 tre4 T2 c -e of Zip Code 9 9s-1/.
Site address 1I Zip Code
Legal description (Sub'd., Block & Lot) 40f 1, 13e,%f der/ 6f'rANi
Legal description (Township, Range & Section)
Lot Size Sq. Ft.
THIS APPLICATION IS FOR (® all that apply):
Absorption Field
❑
Septic Tank
IXC
Holding Tank
❑
Privy
❑
Private Well ❑
Water Storage ❑
Number of Bedrooms !,
THIS APPLICATION IS AN:
Initial
❑
Upgrade
IXC
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.
__
(Signature of property owner or authorized agent)
Permit/RushFees: 3-30 `= Waiver Fees:
Date of Payment: Sy fyJ dog Date of Payment:
Receipt Number: 0 CS 16 G Receipt Number.
(Rev. 11/05)
mac_•. ori • _
FLATTOP TECHNICAL SERVICES .
CIVIL & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION d ANALYSIS
TED MOORE, P.E. 14530 ECHO CANYON ROAD
PHJFAX: (907)345-1355 ANCHORAGE, AK 99516
E -Mail: tgmoorefgcl.net May 14, 2009
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 replace an old septic tank on Lot 1 of Benslers Estates, located at 11000 Birch Road. A
site plan and specifications are enclosed for your review.
Your DSD On -Site files have the information for the two lots of Benslers S/D reversed. This lot
(the more northerly one) has the 4 -bedroom system shown on the enclosed copy of the inspection report.
It appears that this report was originally identified correctly as Lot 1, but the legal description on the
inspection report was subsequently, incorrectly, changed to Lot 2. A visual inspection of the two
properties makes the discrepancy obvious. Hopefully you will be able to correct this misfiling.
An expedited review and approval would be appreciated so that the tank can be replaced as soon
as possible. This tank replacement will also bring it into compliance with the required 100 -foot
separation distance from the well. Please give me a call at 345-1355 when the permit has been
approved.
Sincerely,
Ted Moore, P.E.
LOT 3
CABIN
BY THE
CREEK
SID #2
No da+y
LOT 1
HIGGINS
ESTATES
NO SEPTIC
WITHIN
100' OF
WELL
LOT 3, CABIN BY THE CREEK S/D
�F
HOUSE �♦ •'
SEPTIC AREA e
o
i
I
i_
L S
- -f ---�44k-wlt 4"Al�N04-IYUIYg--------------
------------.F'
l--------
OT 1
' BENSLERS
ESTATES
Scar.{r•4 � w�dl �4ri
fireneh,�fes✓
\-
R=100'
EXISTING r,
50 -GALLON SEPTIC TANK ;
INSTALL NEW 1250 -GALLON ;
SEPTIC TANK IN SAME HOLE
BUT 2+ FEET NORTHEAST
RETAIN EXISTING
_._.
DRIVE; SOIL ABS. TRENCH
WELL ;
LOT 2
BENSLERS 4 R = 100
ESTATES FROM WELL
HOUSE
SERTIC " ® !
SYSTEM
,
4A#w`vAv4\
:q� �1
% �L• . . .
* .-49 it,
........................
=y % THEODORE F.900RE
CE - 3589 1 �cA
LOT 1, BENSLERS ESTATES
SEPTIC TANK REPLACEMENT
SITE PLAN
FLATTOP TECHNICAL SERVICES
14530 ECI10 CANYON ROAD
ANCI IORAGF ALASKA 99516
1 INCH = 50 FEET
DRAWN BY TFM
MAY, 2009
NOTE: THIS IS NOT A SURVEYED PLAT.
ALL LOCATIONS SHOWN ARE APPROXIMATE.
lF attop 7ecfenicaCSemkri
14530 Echo Canyon Rpg.Ancfrosage,.AX 99516
ti'fow (907)345-1355
Lot 1, Benslers Estates
11000 Birch Road
Septic Tank Replacement
Specifications
1.0 General:
1.1 The scope of the project consists of abandoning a 1250 -gallon steel septic tank and replacing
it with a new approved 1250 -gallon steel septic tank in almost the same location, as shown on the site
plan.
1.2 Construction shall be as depicted on the approved site plan. 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.
1.3 The installer shall be responsible to obtain any necessary utility locates, and to work around
any buried utilities.
1.4 The installer shall provide adequate cover material and rough grading over the tank to ensure
that proper drainage is achieved after settlement and that there are no residual depressions.
1.5 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 1250 -gallon steel septic tank must be properly abandoned per code..
2.2 The new 1250 -gallon steel, 2 compartment septic tank shall be Municipally approved and
shall be set level on undisturbed soil. The tank shall be installed in the same hole as the existing tank,
except than it shall be shifted approximately 2 feet towards the northeast to ensure that it is clear of the
100 -foot protective radius around the well. 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 rigid insulation plus 2 feet of soil cover.
2.3 The existing line from the residence shall be properly connected into the tank on
compacted soil. A double cleanout shall be installed in the discharge line within 5 feet of the tank prior
to the point of connection with the existing soil absorption trench.
3.0 Inspections:
3.1 A total of 3 engineering inspections will be required during the course of the project: (1)
initial discussion with the contractor to finalize the location of the tank and construction procedures, (2)
after the tank is set level and piping connected but prior to backfill, and (3) after rough backfill and
grading is complete. The installer shall coordinate the timing of the inspections with the engineer
sufficiently far in advance to ensure the availability of the engineer.
72-013 (Rev.3/78)
MUNICIPALITY OF ANCHORAGE
;1/ 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 PHONE L, NEW
❑UPGRADE
—1-t-�
MAILING ADDRESS
See
LEGAL DESCRIPTION
LOCATION a NO. OF BEDR00
a
Wellr
Absorption are r
Uwelhng
PERMIT NO
O Y
DISTANCE TO:
vi J
Z
X'570
O
Manufacturer
Mater
No. of eompartmnpts
ss2
Q
W t..
rn
LL
Liq, capacity in gallons IF HOMEMADE:
inside length
_
Width
Liquid depth
Y
DIST
Dwelling
PERMIT NO.
_10Z
S? H
Manufacturer Material
Liquid capacity In gallons
O
W
DISTANCE T0:
Well=
/ /�
Foundation 7S Nearest lot line74_
7
PERMIT NO. F'/005_6'.
J W Z
No. of Imes
Length of each line[� 7
Total length of lines Trench width Is-
Distance between lines p
N
F Z w
7 9
y _G Inches
/Y-
Ton of file, to hnish
Material beneath tile
Total effectivegbigr n arp�
oH
gratle . ./1
I
L
�y
Length
Ymtlth
Depth
PERMIT NO.
W
Q 1-
Type of crib
Crib diameter
Cnb Mh Total effective ahsnrptwn area
wd
_
DISTANCE TO:
Well
w
Building f.—a",4 n Neam
Depth
Driller Distance to lof 1
PERMI O.
JClas
S/
�O
W
i
DISTANCE TO:
Building foundation
Sewer line Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS AA '' n D
SOIL TEST RATING
/
t
a0
INSTALLER
REMARKS
� q /�
L '
T y•y
I
16
�w
I
APPROVED DATE LEGAL
72-013 (Rev.3/78)
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH fvvA 1
MAXIMUM NUMBER OF BEDROOMS 4 SOIL RATING (SO FT/BR)- 150
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH— 1LO L_EtJdTH® m50 C3rZ',nVEL F3•EPTH— 'ss
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
REC;lU I AEC} 'SEPT I G TF r4t.' !E31=— 12Z50 OnL_ LOFVS
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
--- TWO <.2> FIRE FZ EGIU I FIEF?
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY 014 -SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERMIT E}4P I RES F?EGEMOER 31, 1 SE1
I CERTIFY THAT
1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR OH -SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: 1 14ILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDR00 S. SPT, N wrTh S�,/ T.sl %
SIGNED:__�'��'.-v.�c.. �•-•,a.( --r�1st...�/
-------------- ----�--------- G.o. _ 7
APPLICANT JIM BENSLER
TL, ; 4S i.coVa"
ISSUED BYL'=C�t A— / L /' /c ��"� of
----DATE---—��-------
V4. 0
50
MUM I G IrAL_ I TY OF= nr4GH1=1r�-n 3E
11 RI
DEPARTMENT
HEALTH AND ENVIRONMENTAL OTECTION
Ih��u.
825 'L'
STREET, ANCHORAGE, AY.. 99501
x rr o a•
264-4720
gyp'
WELL FiN[>
ON—SITE SE14ER PERM
I T.1,,` Lo_1�6-qI
PERMIT
NO. < 810056 )
APPLICANT
JIM BENSLER
r SRA BX 1655 A ANCH 07
LOCATION
BIRCH RD,
LEGAL
BENSLER ESTATES LT.
1/T12NR314See-XIL LOT SIZE 54000
SQUARE FEET
NE;y,FiyNejrNc/1 ta%
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH fvvA 1
MAXIMUM NUMBER OF BEDROOMS 4 SOIL RATING (SO FT/BR)- 150
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEPTH— 1LO L_EtJdTH® m50 C3rZ',nVEL F3•EPTH— 'ss
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
REC;lU I AEC} 'SEPT I G TF r4t.' !E31=— 12Z50 OnL_ LOFVS
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
--- TWO <.2> FIRE FZ EGIU I FIEF?
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY 014 -SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PERMIT E}4P I RES F?EGEMOER 31, 1 SE1
I CERTIFY THAT
1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR OH -SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: 1 14ILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDR00 S. SPT, N wrTh S�,/ T.sl %
SIGNED:__�'��'.-v.�c.. �•-•,a.( --r�1st...�/
-------------- ----�--------- G.o. _ 7
APPLICANT JIM BENSLER
TL, ; 4S i.coVa"
ISSUED BYL'=C�t A— / L /' /c ��"� of
----DATE---—��-------
V4. 0
t
1
PERFORMED
LEGAL DE�SCR
llFff
1 n,`•
4
2-
3-
4-
5 345
6-
7 7
8
10-
11
12-
13-.
14
15
16
17
16
19
20
COMM
n
0 SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION fk PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 89501 2644720
SOILS LOG — PERCOLATION TEST
POSED 6EA>S4B¢S £STa
O'RCAKUt cs
C,0.,KucLL%/ 51L.T
O
(sip)
•150 eb"/
We\rw
DATE PERF RMEO: 1 Zd
T-aj4 Ra w su1
WAS GROUND WATER S
ENCOUNTERED] L
O
P
OF A( 4e o E
�.••••.,._ 4 nI1r.F YES, AT WHAT
�T
Ralphiljoke
s✓, :� NO. 1995E
,�\ILpROFES$101
SITE PLAN
ale
e in
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
qh0 le,
b
—
''
n
�-
PERCOLATION RATE (minutes/inch)
C1
TEST RUN BETWEEN. FT AND 2 FT
PERFORMED BY: xL CERTIFIED BY: _��✓ _DATE
Wei I L®g
1 �1
For......-itl.... 'cAuS,9:rZ �;UILDEI', • 1,. 1
....................................................................................................
Location..7`�y�'�Gc? ��T�T�S C.aT 9 '
.................... .................
Datecompleted.......`I." Z." .................................................. ... ........................
Depthof well........... S.................................................................................
Sizeof casing..........�..,f�...................................................................................
Distance to water..*,F ....SU.....................................i7 c�C�'lo........................................
Distance to water while pumping ......... �.�q�'..q .......................................... rate
of .............. 900 .......................... gallons per hour.
I Formation
I from
I to
5:4VAy
/3 S�
He
..................................................................
Driller
.0
DELTA DRILLING COMPANY
SRA BOXZ794 8
ANCHORAGE. ALASKA 99507
34-C- 44-70
• t
INSPECTION APPOINTMENTS
DATE RECEIVED
TIME TIME
TIME
DATE DATE
/-'f
6. TYPE OF RESIDENCE
DATE
INSPECTOR INSPECTOR
C'
INSPECTOFj�
MUNICIPALITY OF ANCHORAGE
\
UNICIPALIIy OF ANC
DEPT. OF HEALTH &
\ DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTE17Y1TJNINMENTAL
1 925 L Street - Anchorage, Alaska 99501
PROTECTION
ENVIRONMENTAL SANITATION DIVISION
\
JUL 17 1981
Telephone 2644720
R C E I V E D
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER ES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing,
I. PROPERTY OWNER
><
�l Yp is pr1/1/G S. 6 P.tS Ae 1'—
PHONE
MAILING ADDRESS
— 01
S,eA A),</GSsA
YEAR ON-SITE SYSTEM WAS INSTALLED.
PROPERTY ESIDEN T III dillerent lrom above)
PHONE
2. BUY R
72.010M. 91701
Su ...a -
H N
MAILING ADDRESS
3. LENDING INSTITUTION
�.trf s> «���s�d F�t��
PHONE
�a -9yy
MAILING ADO -SS
3500 1 .ele,
4. REALTOR/AGENT
—YL(_
PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
Lt, / eks/rr
STREET LOCATION
//
6. TYPE OF RESIDENCE
NUMBER OF,8EDR00MS
SINGLE FAMILY
❑ One A Four ❑ Other
❑ MULTIPLE FAMILY
❑ Two ❑ Five
❑ Three ❑ Six
7. WATER SUPPLY
INDIVIDUAL'
' ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
& SEWAGE DISPOSAL SYSTEM
g INDIVIDUAL/ON-SITE"
YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLICUTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72.010M. 91701
1
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLICUTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON-SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATEINSTALLED
G— 11—
INSTALLER �^
�p
❑SepticTankor [::]HoldingTank
Size: trl-.= 1f Tank is homemade
give dimensions:
SOILS RATING
/ S�
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
4. DISTANCES
WELL T0:
MATERIAL
SePGc/Holding Tenk Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
L►� APPROVED FOR 44— -BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
_3
BY
72010 (Rev. 6/79)
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
Parcel I.D. .5-21 - 2r COSA# Qq QILJZ
Expiration Date:
1. GENERAL INFORMATION
Complete legal description 1'0 f 'tr R ens its"yt f�Gi
Location (site address) II F 000 Q ►re -A Roe -o(
Current Property owner(s) T► #.• 9 e'ry 1'¢ r Day phone 3 Y6- IPY 7
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
11 000 6►r'cS POad, neh&n;oA Ak 99516
Day phone
Terry 4:cye -
Re
MAx
Day phone
2YG -?667
�► o W. 3 6
'►" AW
tp jej&_
h^car ej2ye
Sw
[TT
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. .5-21 - 2r COSA# Qq QILJZ
Expiration Date:
1. GENERAL INFORMATION
Complete legal description 1'0 f 'tr R ens its"yt f�Gi
Location (site address) II F 000 Q ►re -A Roe -o(
Current Property owner(s) T► #.• 9 e'ry 1'¢ r Day phone 3 Y6- IPY 7
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
11 000 6►r'cS POad, neh&n;oA Ak 99516
Day phone
Terry 4:cye -
Re
MAx
Day phone
2YG -?667
�► o W. 3 6
'►" AW
tp jej&_
h^car ej2ye
hoc 99 So,?
Unless otherwise requested, COSA will be held by DSD for pickup. p l ecve ec[ l f .Tim ►3cM 11i
3yG-fOY3 cuh<n CGSA re
2. NUMBER OF BEbROOMS: �_ hlso cat►" 7C.#-r62�110,1?4&000 49 ZVO-3667
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
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 Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below. I verify that my Investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm _Flufian 7-ec4 w ece/ Service.- Phone 3r/S'- r3 S -t -
Address /YS 3o L -e4, 62'-X&„ Route(. A„c!, t}cr 99S/�
Engineer's Printed Name Th e&elo )=. r'-roo.w Date _ S—/ 21 / 2-ew9
S. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for
tF. .. .............
9 •............. !
'. TKOCOR: F. ALooRe
f.. �� h.'••
CE -35S9
C,�;.ki
......y~i q.
bedrooms, with the following stipulations:
_ % WASTEWATER
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date:
i
(Rev 11105)
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: 1-o f_l,.0 6,*n-cl«r gr An kr/ Parcel ID: 015'-5'7-1—V
A. WELL DATA
Well type(w f If A, B, or C provide PWSID #
Date completed/EI Sanitary seal (Y/N) Y
Total depth l 3 e n. Cased to 13 ft.
FROM WELL LOG
Date of test 'q/7- /45f
Static water level 68 ft.
Well production 16 9 P•m•
WATER SAMPLE RESULTS:
Coliform '�_colonies/100 mL Nitrate I. SC mg/L
Arsenic: <� uglL date of sample: `I / 17 /09
B. SEPTIC/HOLDING TANK DATA
Tank Type/Matedai Stn tr•L c
Tank size 1?- gal. Number of Compartments
Well Log (YIN) Y
Wires properly protected (Y/N) Y
Casing height (above ground)/ A in.
AT INSPECTION
Y /17 /09
7 Y n.
8. 8 + g.p.m.
Other bacteria 6colonies/100 mL
Collected by: Flog Nab Tic6r S u'c
Date installed S-1119(09
Cleanouts (Y/N) `r
Foundation cleanout (Y/N) = Depression over tank (YIN) N High water alarm (Y/N) 1✓•
Date of pumping N. A t4tw) Pumper
C. ABSORPTION FIELD DATA
Date installed/17 / Soil rating (g.p.d./ft? or fte/bdrm) r3'03� System type 7•rdAt!,
Length 1[9 ft. Width 3 ft. Gravel below pipe 7 ft.
Total depth 12. ft. Eff. absorption area gW_jQe Monitoring tube Y s Depression over field
Date of adequacy test Y/ -7/09 Results(Pass/Fail) Ferl For A_bedrooms
.i
Fluid depth in absorption field before test 2 d6 in. Water addeds30 gal.', New depth "S.
Elapsed Time:l�_min. Final fluid depth in. Absorption rate >= 66D g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) t Jon [ 1,cn o If yes, give date N • �•
D. LIFT STATION V. A.
Date installed Size in gallons
'Pump on' level at_ in. 'Pump off level at _, in.
Datum
E. SEPARATION DISTANCES
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot I cy,
Absorption field on lot fig,
Public sewer main N• A.
Sewer /septic service line > 291'
Manhole/Access (Y/N)
High water alarm level at
Meets alarm 8 circuit requirements?
On adjacent lots �> (epee r
On adjacent lots rao
Public sewer manholetcleanout M- A.
Holding tank N• A.
Animal containment areas P. A`• Manure/animal excrete storage areas Al. A.
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 16' Property line 9'0' Absorption field !> s'
Water main N• A. Water service line '�> ra' Surface water > roo •
Wells on adjacent lots > /00'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
in.
Property line qs-, Building foundation 30' Water main N• A.
Water Service line > to • Surface water �* IOo t Driveway, parking/vehicle storage /S"
Curtain drain _Mont Seen Wells on adjacent lots ,F too,
F. COMMENTS Doecemenir {vr 1-44f 1 t Z tlitne Fnwd..er hn i(y S G.,,/=,/,0„i
in /414n1c.f1c,/ On—t•f-! �ilt/
G. ENGINEER'S CERTIFICATION r �, i1 �y'•4,
I certify that I have determined through field inspections and '' ' .R d'� • '•.'` 1,
TF7 ;may S'?9 f:
review of Municipal records that the above systems are in r w
conformance with MOA COSAguidelines Ineffect onthis date. li3,y-ri•�••••_••• 3••-=
Engineer's Printed Name Tivac�t�r[ /= rcuore`� a •••....�.. yr
1 . TF(E:,�pRE F. ")CkE
Date Mc.Lr 21 2009 C�iiV
A
COSA Fee $ `i961 =`
Date of Payment /22-/0
Receipt Number oSy G
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
SCS ReLN
1091510001
ug/L
CP200.8
Client Name
Flattop Technical Srv.
Printed Dateffime
05/042009 16:48
Project Name/H
LI 1lenslcrs SID
Collected Date/Time
04/172009 12:45
Client Sample ID
LI Benslers SID
Received Datef(ime
04/172009 13:20
Matrix
Drinking Water
Technical Director
Stephen C. Me
P3,*'SID
0
Sample Remarks:
Allowable Prep Analysis
Parameter Results KNI Units Method Container ID Limits Date Date Init
metals by ICP/MS
Arsenic
Waters Department
Total Nitratc/Nitrile-N
Microbiology Laboratory
Colony Count
Total Coliform
Fecal Coliform
ND
5.00
ug/L
CP200.8
C
(<10)
0424109 05/01/09
NRB
1.65
0.100
mg(L
SM204500NO3-F
11
(<10)
0423/09
JD7.
0 coU100mL
SM20922211
A
(<200)
04/17/09
DLC
0 coV100ml.
SM209222D
A
(<I)
04/17/09
DLC
0 col/100mL
SM20922211
A
(<1)
04/17/09
DLC
FIWD
cecK
FIA �}
100 111
r
WATER
WELL
IV UTILITY EASEMENT
OA
2aroRr
N\'1pp FRAME
IgUSE
iP UTILITY EASEMENT
E
— — — — — — — — —
SEWER
STAND PIPES
GRAVELp AY
64
S 89-56- 6 E
279.63'
LOT
LOT
46,137 S.F.
1316
id UTILITY EASEMENT
01= At• • ,1
i'L:1:.... e
e , . MATT T. CROW �:.t w
ASBUILT CERTIFICATION
1 HEREBY CERTIFY THAT 1 HAVE SURVEYED THE FOLLOWING PROPERTY, LOT 1
BENSLERS ESTATES SUBDIVISION, AND THAT NO ENCROACHMENTS EXIST,
EXCEPT AS NOTED.
EXCLUSIONS
IT IS THE RESPONSIBILITY OF THE OWNER OR BUILDER TO DETERMINE THE EXISTENCE
OF ANY EASEMENTS, COVENENTS,OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED PLAT.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR ESTABLISHING
BOUNDARY OR FENCE LINES.
MATT CROW, LS 11597
ASBUILT SURVEYOF
DRAWN DATE SCALE SHEET LOT
BY 5109108 1 R=40' 1 OF 1 BENSLERS ESTATES SUBDIVISION
M. C. LOCATED W
NEfp. SE114. NE 114. NE 114 SEC. 22. T12N. R2W SEWARD MERIDIAN, ALASKA
ALASKA CONSTRUCTION SURVEYS, LLC I FOR
4141 B STREET, SUITE 203 JIM BENSLER
ANCHORAGE, ALASKA 99503