HomeMy WebLinkAboutCARIBOU LT 1�N,ax
No.
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· . Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~vq~o:(,'S PID Number: o~-o
Name: ~/~/~'~'~' /4,/(~/~r~ WastewaterSystem:~ New D Upgrade
/~ ~. C~ Zo~ " ..ABSORPTION FIELD
~ ~/v~I ~ ~9~77 No. ol ms: ~ Deep Trench ~ShallowTrench ~Bed ~Mound DOther
WELL: ~ New D Upgrade e~.~widm: Num~rof lin~:
SEPARATION DISTANCES ~p.c ~ Holding D 8.T.E.P.
Weir /~ /~ ~ ~ ~1+ Matedal~ Num~r°f~mpa~ments:
Sudace
Line
Foundation
Cu"ainDrain ~0~ ~O~ ~mp"keaM~ IEl~td.ltns~tmons..o~.~
Remarks: P~0,~O~P Zo ~ / BENCH MARK
. 2n~ ~-~-~V ' '
Depadment of Health and Human Seduces approv
~eviewed and approved by: Date: [-2g g~
72-013 (Rev. 9/91) MOA 25
Permit No. ~wc~'~3~;6~ Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P,O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: W1/2.NE1/4.NE1/4 SE 1/4,SEC.6~T14N,R1W,S.M. PID No.:05052102
c0193 9' C02 95.3'
.
A B
FCO 20.§ 24,0
COl 22.(~ 25.0
C02 28.(3 20.0
C03 28? 44.0
C04 40.~ 53.0
C05 52.C 41.0
C06 3l.(l 15.0
},lTl 40.{3 51.5
YT2 32.C 1"/.5
0
LINSULATION ~
87.8'-
100' 'WELL RADIUS
l"sa~L~ '= 80' . I SITE PLAN
RECEIVED
MunicipalitY oi An¢liorage
Dept. Health & Human
. e ifie) Dr lli g og
SULLIVAN WATER WELLS
P.O. BOX $70272, CHUGIAK, ALASKA 9956/' · TELEPHONE 688.2759
.- I
ADDR~S I~O~ C~I~H~¢O F.E ~ STATICLEVELOFWATERFr.
LEGALD~CRI~ION~ ;~ ~E{ ~{,~ ~ ~ ~l~ ~
DATE- Sta.ed 0~ Ended ~¢ 3 GAU. PER HR W~ O
PE~IT HUMBER KI~D OF CASING ~ ~) ~
KIND OF FORMATION:
From ~) Ft. to-~.~Ft, c4 ~',-.~C ~ ~"; C Ad~O From Ft. to_~FI.
From ~, FI. to ~ Ft. OO~ ~j ~ From~ Ft. to__FL
'
r,m ,3 ~ ~t. to ~ ) ~t., C~';' ' ~,~ '~'- F,om Ft.
From ~ / ~, ~ ~ i ~ ~
Ft. toh,~ Ft.,~~ ~'-~ ~ .,,/~ C .( From FI. to Ft.
From Ft. to__Fi, From ~
From Ft. to Ft. From ~.Ft.'lo~Ft.
From Ft. to Ft. From Ft. lo Ft.
From ELto FI. RECEIVED Flrom ELto FI.
From Ft. to Ft. dUN 6 i,~,~. From Ft. to FI.
From FI to Ft-- From Ft. to FI.
· ~ ~umc~pahty oI,~ncnorage
From __ FI. Io I~..pt. Health & Human Se~lces From FC Io.~.Ft.
From ~ Fl. to Ft. From Ft. to Ft.
From Ft. to Ft. From Ft. to Ft
MISCL INFORMATION:
DRILLER'S NAME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L' STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930363
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:WRIGHT LARRY
OWNER ADDRESS: 0503210200088
DATE ISSUED: 9/14/93
EXPIRATION DATE: 9/14/94
1
PARCEL ID:05032102
LEGAL DESCRIPTION: T14N R1W SEC 6 W2NE4NE4SE4
LOT SIZE: 217800 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. T}IE 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 DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: -A, %-~3.
DATE.'
DATE:
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
September 13, 1993
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
SEWER & WATER
INSPECT~CN
Municipality of Anchorage
DEPARTMENT OF HEALTH AND ~ SERVICES
825 L Street
Anchorage, AK 99519-6650
RECEIVED
SEP 1 4 1993
k, lunic~palitY et Anc~_orage
Dept. Health & Human .~en;ices
REFERENCE:
W 1/2, NE 1/4, NE 1/4, SE 1/4,
SECTION 6, T14N, R1W, SM, AK
Proposed Caribou Subdivision
we request you re-issue permit #SW930195 to drill a well and
install a septic system to serve the proposed four bedroom
house on the referenced property.
The existing permit was issued on 7/1/93 for a three bedroom
home. The owner now wishes to install a system large enough
for a four bedroom home.
This property has enough area for a future septic upgrade,
which can be seen on the attached revised site plan. We do
not anticipate any adverse effects on neighboring properties
by the installation of the proposed septic system.
If you have~ questions, or require additional information
f.or ~ev~, please contact us.
rt A. Shafer, P.E.
RAS/LSU/lsu
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
I ........... %~uoolvlclo~
DRAWN L. S. ULSHER J ' R.A.S. I DATF"6/24/93 J S"T'1 OF,
DESIGN CRITERIA: REVISION 9/11/9.3
4 BDRM = 600 GPD STRUCTURES, EASEMENTS, OR ENCROACHMENTS
SOILS = 1.2 GPD/SQ. FT. SHOWN ON THIS SITE PLAN ARE AS SHOWN ON
450/1.2 = 500 SQ. FT. REQ'D AN AS-BUILT SURVEY DRAWN BY:
FLEMING SURVEYING SERVICES
DEEP TRENCH: ~T IS THE RESPONSIBtLTIY OF THE CONTRACTOR~,~
10' DEEP TO VERIFY EASEMENTS. REQUIRED SEPARATION
6'
EFFECTIVE
42' LONG
CONTRACTOR IS REQUIRED TO
OBTAII UTILITY LOCATES
PRIOI ANY EXCAVATION
WOR
DISTANCES, AND PROPERTY LINES PRIOR TO
CONSTRUCTION.
100' WELl, RADIUS
PROP.
DRTVE
PROPOSED
~0BDRM
VAcanT 2
/
co
-- GAL SEPTIC TANK
co uT
TRENCHES
EDGE OF ROAm
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 #L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930195
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:WRIGHT LARRY
OWNER ADDRESS: 0503210200088
DATE ISSUED: 7/01/93
EXPIRATION DATE: 7/01/94
PARCEL ID:0503~102
LEGAL DESCRIP T14N R1W SEC 6 W2NE4NE4SE4
LOT SIZE: 217800 !. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR
DISPOSAL FIELD /SEPTI'
ALL CONSTRUCTION MUST
CONTRUCTION OF:
TANK / WELL SYSTEM
IN ACCORDANCE WITH:
1. THE ATTACHED
2. ALL REQUIREMENTS SPE(
15.55 AND 15.65 AND
REGULATIONS (18AAC72)
3. THE ENGINEER MUST NOT
PRIOR TO EACH INSPECTION
CALLING 343-4329 OR
4. FROM OCTOBER 15 TO APRIL
ABSORPTION SYSTEM UNDER
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE
B. COVERED, SEALED AND HEATED
5. THE FOLLOWING SPECIAL PROVISI~
DESIGN.
FlED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
STATE OF ALASKA WASTEWATER DISPOSAL
DRINKING WATER REGULATIONS (18AAC80).
AT LEAST 2 HOURS
PROVIDE NOTIFICATION BY
AFTER BUSINESS HOURS
SUBSURFACE SOIL
DURING FREEZING
DAY
PREVENT FREEZING
SPECIAL PROVISIONS:
RECEIVED BY:
ISS,ED /
DATE:
DATE:
ROBERT SHAFER. P.E.
ROGER SHAFER. P.E,
June 20, 1993
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
S;TE PtANS
SOILTEST
PERCOtATIOfl
TEST
4unicipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Street
Anchorage, AK 99519-6650
REFERENCE:
W ~/2, NE 1/4, NE 1/4, SE 1/4,
SECTION 6, T14N, RIW, SM, AK
Proposed Caribou Subdivision
~e request you issue a permit to drill a well and install a
septic system to serve the proposed three bedroom house on
bhe referenced propez-ty.
the attached site plan shows the development of the East 1/2
~f the North 1/2 of the reference property. A preliminary
'plat will be submitted in the near future to subdivide the
referenced property into three lots. The site plan shows the
development of Lot 1 of these three lots.
A test hole was excavated and a percolation test performed.
The approximate location of the test hole is located on the
attached site plan. The monitoring tube within the test hole
has been checked and found to be dry.
This property has enough area for a future septic upgrade,
which can be seen on the attached site plan. We do not
anticipate any adverse effects on neighboring properties by
the installation of the proposed septic system.
If you have any questions, or require additional information
for your review, please contact us.
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER. ALASKA 99577
LEGAL E: 1 2 H 1/_2 W 1 2 NE: I/4 NE: I 4, 1/4, SEC 6, TI4N, R1W,
DRAWN ........... (~,D .......
DESIGN CRITERIA:
BDRId = 450 GPD
,~OI/S -- 1.2 GPD/SQ. F'T.
450/1.2 = 375 SQ. FT. REO'D
DE,EP TRENCH: ~d ~'~ {~''''
10 DEEP ~" ' V
6' EFFECTIVE ' J't''':'~
OF 1
CONTRACTOR IS REQUIRED TO
OBTAIN UTILITY LOCATES
PRIOR TO ANY EXCAVATION
WORK.
100' ltELL I~.DIU$
PROP. ~"EI2~'
DRIV]3
PROPOSE£
3 .BDP, M
~us~ ~
1000 GAL $[PTIC TAI~
TRENCH
/
EDGE OF
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
PE NCE E 1/2, N 1/2, W 1/2, 1/4, 1/4, SE 1/4,
SECTION 6, T14N, RIW, SM, AK
GENERAL
1.
me
Se
The scope of this project includes the installation of a
1000 gallon septic tank and a leachfleld trench to serve
the proposed three bedroom residence on the referenced
property.
Construction shall be in accordance with the approved
site plan and design drawings; Municipal permit with any
special provisions or conditions; and all applicable
State and Municipal Wastewater Disposal Regulations.
The contractor shall be responsible for obtaining any
necessary underground utility locates.
Unless specifically agreed otherwise, the property owner
shall be responsible for final grading areas subsequently
depressed from soil settling. On all leachfield mound
systems, the property owner shall be responsible for
ensuring a satisfactory vegetation growth over the
mounded area.
Contractors installing wastewater disposal systems must
be certified by the Municipal Health Department for
system installations. Owners installing their own
systems must also receive prior approval from the
Municipal Health Department.
SEPTIC TANK INST~T.T.RTIONz
me
A septic tank is to be constructed by a certified septic
tank manufacturer. Construction shall include two 4"
cleanouts for pumping access.
me
The septic tank shall be sufficiently bedded to prevent
settling or shifting of the tank.
All standpipes on the septic tank shall extend a minimum
of 12 inches above final grade.
4. Septic tanks installed with less than 4 ft. of cover
shall be insulated.
Page Two
E 1/2, N 1/2, W 1/2, NE 1/4, NE 1/4, SE 1/4,
SECTION 6, T14N, RIW, SM, AK
June 20, 1993
A foundation cleanout shall be installed one to four feet
from the building foundation. In the line between the
tank and the leachfleld there shall be two adjacent
cleanouts (unless an effluent pumping system exists
within the septic tank). These cleanouts shall be
located on undisturbed soil not more than 10 ft. from the
tank. The first cleanout, in line, shall be to clean
toward the leachfield. The second cleanout shall be to
clean toward the septic tank.
Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INST~?.?.qTION~
Excavate the proposed trench to the dimensions shown on
the design. The bottom of the excavation shall be within
2 inches of level. If the sidewalls of the excavation
become smeared, they must be raked or scratched (ruffed-
up) before gravel (sewer rock) placement.
e
Once the gravel is installed, the distribution pipe is to
be installed level with the perforations faced downward.
Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
A silt barrier must be installed between the final gravel
layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
Monitor
· tubes sh~ll be of four (4) ~nch diameter and
lnstalled approximately in the locations shown on the
design. The portion of the monitoring tube extending
through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This
is equivalent to the effective depth of the gravel as
noted on the design.
Backfill over the final gravel layer must not be less
than twenty-four (24) inches. Insulation must be
installed when the backfill depth is less than thirty-six
(36) inches. The finish grade over the trench must be
mounded to prevent the formation of a depression after
settling.
Page Three
~ z/2, ~ 1/2, . 1/2, ~E 1/4, ~ 1/~, SE 1/~,
SECTION 6, T14N, R1W, SM, AK
June 20, 1993
MINIMUM MATERIAL SPECIFICATIONS=
Any septic tank
constructed by a
manufacturer.
proposed for installation must be
Municipally approved septic tank
The following pipe materials
septic system installations
Anchorage:
are approved for use in
in the Municipality of
Type of Pipe
Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
A permeable nontoxic silt barrier (Typar 3401, Mirafi
140N, or equal) must be installed between the final
leachfield gravel layer and the native sol1 backfill.
All leachfield gravel (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 3% passing the %200 sieve.
7. When sand is being used as a filter material, it's
gradation specifications must conform toAMC 15.65.060D.
Page Four
E 1/2, N 1/2, W 1/2, NE 1/4, NE 1/4,
SECTION 6, T14N, RXW, SM, AK
June 20, 1993
SE 1/4,
INSPECTIONS:
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and
before the installation of any gravel. A septic
tank may be set in place, but may not be backfilled
before this inspection.
The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
o
The final inspection is to occur upon final grading
of the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre-
construction meeting will take place on-site.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street, Anchorage, Alaska 99~2~650
SOILS LOG -- PERCOLATION TEST
LEGA, DESCRIPTtON:~'/~/ ~' //~"/~'~'2~'~'h'P~,~ge'Sect'On
--~ c~y
3~
5
4' /f e
7'
8
wAS GROUND WATER
E NCOUNTERED~
11 IF YES, AT WHAT
DEPTH?
12
13
14-
15
17'
18-
19
20 PERCOLATION RAIE + , {m,nutes/inch) PERC HOLE DIAMETER
~EST"UN"ETW~EN ~NO .___.C~--_ F~ //__ .'.
DAT£
NOTES: Em
provided by cl
building 9~od
Elevations bas
~'~...
PLAT NO.
MWNUPAUTY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 050-321-76
Certificate of On -Site Systems Approval
Expiration Date: 2 S -2DZZ
1. GENERAL INFORMATION
Complete legal description CARIBOU LT 1
Location (site address) 19840 Kirk Avenue Eagle River AK 99577
Current property owner(s) VANDEGRIFF CODY & JESSICA Day phone
Mailing address 19840 Kirk Avenue Eagle River AK 99577
Real estate agent Day phone
2. TYPE OF DWELLING:
Ej Single Family (w<o A:D:U:):)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well 0 Private Septic 0
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 $ 5 5 () Waiver Fee $
Date of Payment P- 0 8' a 0z Date of Payment
Receipt Number 0 `i 3 61 Receipt Number,
COSA # QS C cZ 1 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 Eklutna Engineering, LLC Phone 907.406.1058
Address 19162 Mountain Rd Chugiak AK 99567
Engineer's Printed Name Curtis Townsend,
6. DSD SIGNATURE
PE Date41r o"
*i
•' 49 TH♦�/
10 0-
0...... ........................ r
System #1 Approved for bedrooms �. :CURTIS TOWNSEND
i No. CE 11904
System #2 Approved for bedrooms �1��' �t Iz �\�•
Disapproved
Conditional approval for bedrooms, with the following stipulations:
((t
OFI: /-
ON
yo
?ER AND m
Original Certificate Date: 12-- Z
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
Well Flow Advisory
COSA Checklist blue sheet
Nitrate Advisory
Arsenic Advisory`
Other �(�ist�✓�/
COSA Checklist
Legal Description: Caribou lot 1 Parcel ID: 050-321-76
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 8/93
Total depth L20 ft
Cased to 120 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) > 16 in.
Date of flow test for COSA 1111112021
Static water level at beginning of test 52 ft.
Comments
B. TANK DATA
Age of tank(s) 27 years
Tank type/material septic S-tOO(
Measured operating fluid level in septic tank
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 11/9/2021
D. ABSORPTION FIELD DATA
Which system tested (date installed) 1994
IN ALL standpipes present per record drawing
Total measured depth from grade 122117.' ft (max)
Measured depth to pipe invert from grade 6.7/5.2 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
Well production at time of test 6.4 gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑ No
OR Coliform bacteria is Negative
Nitrate 3.43 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Curtis Townsend
Date of Sample 1111412021
C. LIFT STATION
❑ Required maintenance co
Age of lift station
Lift station material-- "�
Commen
Adequacy test date W11r.1021
Results F71 Pass For 4 bedrooms
Fluid depth prior to test 40/0 in
Water added 600 gal
New depth 62/35 in
Elapsed time 1440 min
❑ Code -required soil cover over field
Final fluid depth 40/0 in
❑ System presoaked Absorption rate >600 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no
date of test)
Gallons introduced 3263 gallons If yes, enter date
Comments/Deficiencies: MT1/MT2
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'
❑✓
Yes
Community Sewer Manhole/Cleanout > 100'
f7v Yes
if No
ft
® Yes
if No ft
Neighboring Tank > 100' ✓v Yes
if No
ft
Private Sewer/Septic Line > 25' M Yes
if No ft
Absorption Field on Lot > 100' [Z] Yes
if No
ft
Holding Tank > 100' Z Yes
if No ft
Neighboring Absorption Fields > 100'
Yes if No ft
Water Main > 10'
Animal Containment > 50' Yes
if No ft
F,71 Yes
if No
ft
i
Water Service Line > 10'
✓V
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway comment below
Community Sewer Main ? 75' MV 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'
❑✓
Yes
if No
ft
Surface Water> 100'
Q✓ Yes if No ft
Property Line > 5'✓i
l
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
[]✓
Yes
if No
ft
Private Wells > 100'
Yes if No ft
Water Main > 10'
El
Yes
if No
ft
Community Wells > 200'
0 Yes if No ft
Water Service Line > 10'
✓V
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'
El
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'
[Z]
Yes
if No
ft
Private Wells ? 100'
U Yes if No ft
Water Service Line > 10'
C]✓
Yes
if No
ft
Community Wells > 200'
P/1 Yes if No ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
shorter trench is taking most of the water
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.
COSA Checklist yellow sheet
Septic Tank Advisory
Certificate of On -Site Systems Approval #OSC 211703
Subdivision: Caribou Lot 1
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 27 years old. Typical replacement costs range from $9,000 to $12,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of what the metal of a 20 -year-old steel tank MAY look like.
Mallmg Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org
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Municipality of Anchorage
On-Site Water and Wastewater Program
(907) 343-7904 s r T
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-321-76 Expiration Date: ( I-22-(g.
1. GENERAL INFORMATION
Complete legal description _CARIBOU LT 1
Location (site address) _19840 KIRK AVE, EAGLE RIVER AK
Current Property owner(s) _LARRY WRIGHT Day phone
Mailing address _33389 DILLARD RD, EUGENE, OR 97405
Real Estate Agent Day phone
�6S67897
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2. TYPE OF DWELLING: '
® Single Family (w/wo ADU) Q A(i
❑ Duplex Q �' 2 1018
❑ Multiple Dwellings (Single Family and/or Duplex) c
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3. NUMBER OF BEDROOMS: 4 d 9 5 n
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4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: ./ A, Date: i 2? ! ,
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee S41-(°d Waiver Fee $
Date of Payment 5/2i J I'S Date of Payment
Receipt Numberc� ,,`` Receipt Number
COSA# OS c'1 v 14"2-0 Waiver#
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5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE.
Engineer's Printed Name MIKE N ANDERSON, PE Date 8/18/18
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6. DSD SIGNATURE t4 ,••MICHAEL N. ANDERSON
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System #1 Approved for y CE 94 9 ��:�
bedrooms. r'°••y ?, /V,
System #2 Approved for bedrooms. , iS, 4'�
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
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ON-SITE
WATER AND "'
WAST EWATER -
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PROGRAM \l.
Original Certificate Date:22
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 -7-0 ZON,i
COSA blue sheet 10.10.12.doc 6
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system _
Certificate of On-Site Systems Approval Checklist
Legal Description: CARIBOU LT 1 Parcel ID: 050-321-76
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y
Date completed 8-93 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y
Total depth 120 ft. Cased to 120 ft. Casing height (above ground) 16"+
FROM WELL LOG AT INSPECTION
Date of test 8-93 8-8-18
Static water level 70 ft. 77 ft.
Well production 12.0 g.p.m. 4.5+ g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 3.30 mg/L
Arsenic: ND ug/L Date of sample: 8.8-18 Collected by: Mike Anderson
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL Date installed 5.16-23-94
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N)Y
Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 8-8-18 Pumper QUALITY PUMPING
C. ABSORPTION FIELD DATA—
Date installed 5.16.23-94 Soil rating (GPD/SF) 1.2 System type DEEP TRENCH
Length * 30/13 ft. Width 3.0 ft. Gravel below pipe 6.5&5.5 ft.
Total depth 11 &12.5 ft. Eff. absorption area 546_ft2 Monitoring tube Y Depression over field N
Date of adequacy test 2-19-2018 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 8/12 in. Water added 600+gal. new depth 21/57 in.
Elapsed Time: 1350 min. Final fluid depth 9/25 in. Absorption rate >=_600_g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes. give date
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 requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank 100'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10 Water main 100'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+(None Known) Wells on adjacent lots 100'+
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F. COMMENTS ..*-17\Pg�. OF Al.Qs >!t
*SMALLER TRENCH IS TAKING MOST OF THE FLOW. r y'•
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G. ENGINEER'S CERTIFICATION •
/ • MICHAEL N. ANDERSON : e
I certify that l have determined through field inspections and '. C�E� •4 9./ :��
review of Municipal records that the above systems are in +i1��' `- ?�f�/�J.••• ��r
conformance with MOA COSA guidelines in effect on this date. �lFe p��Fes`=t�•'''' •t ',.:''
Engineer's Printed Name MIKE N. ANDERSON. PE
Date 8/1812018
COSA canary sheet_2-6-15.doc
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT ( s ,f Ii. 907-343-7904
On-Site Water and Wastewater Section `� Fax: 343-7997
www.muni.org/onsite
Septic Tank Advisory
Certificate of On-Site Systems Approval # 0SC181420
Subdivision: Caribou, Lot: 1
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 24 years old. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On-Site Systems
Approval.
This is an example of what the metal of a 20 year old steel tank MAY look like.
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Mailing Address: P.O. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org
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ASBUILT SEWARD & ASSOCIATES LAND SURVEYING 694-082q
I HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCALE ,,SO, .,� �`�`�`��a�
FOLLOWING DESCRIBED PROPERTY: _ / �� of AL
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AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 65..r. ;'` ''t`-;�• ' '�'
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INDICATED. IT IS THE RESPONSIBILITY OF THE v',J': • 7.2_1;i://e.,
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: ”" '
EASEMENTS, COVENANTS., OR RESTRICTIONS /./A-/ZSS- 9 Rte,
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- ---- . Duane Merk Seward : ~sS
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FS' 5',c)4.,...) i.S-5 13. .::s�
ANY DATA HEREON BE USED FOR CONSTRUCTION /yy Z 7 t�� 4 1c3�
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OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN: 'tik °'' siotaa`\.'tom"
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