HomeMy WebLinkAboutSANDHILL LT 10ndhill
10
#0§0-§22-12
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: .~I,~OIOLI~-H PID Number: ~_~ -~.~,'
Name:
~ET~ I o~E~T~CH WaslewaterSystem: ~ew D Upgrade
Address:
11901 ~~ P~ ~l.~b~l~ E~ ~'~ ABSORPTION FIELD
.~o.,:~ &. o7qp ~.o.of B~rooms: ~eep Trench O Shallow Trench D'Bed O Mound D Other
Total Depth from original grade:
LEGAL DESCRIPTION so,,u~u.~: O.~ ~.~,s~.~, -' t~'
Block: Subdivision: Depth to ~ipe boltom lrom original grade: Gravel depth beneath pipe
Townsh~'p: ~ J J Section: Fill added above original grade: Gravel length:
WELL: ' ~New D Upgrade Gravel width: ~ Ft. ~umbe~flines: Distance ~.n lines:
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
P~/ATF. 300 F,. I~1 FL ~O SOFt. ~Sz~
Driller: Date Drilled: ~ Static Water Level: Instafler: Dato Installed:
Yield: ~ GPM "U.. :~ n ~ ~,., TANK
SEPARATION DISTANCES ~eptic ~ Holding D S.T.E.P.
TO Septic Absorption Lift Holding ~ublic/Privale Manufacturec Capacityln gallons:
From Tank Field Slation Tank ~-.,".- 4~c~0e~- T4~<
su,~c~ ~ LIFT STATION
~oun~,,o. 77'~7, _~ ".u..o.",...,.,: .~"~;~"'~'~-,l"i'~'"'e'"'"r'"':
Cu.ainDrain P~~IElectrical lnsp~tiOns perfOrmed by: -~,
Remarks:~ ~H L~;~C~F~b ~ BENCH MARK
Location and Description:
I Assumed Elevati°n:
ENGINEER'S SEAL
Inspections performed by: g.R.~.5, Dates:ls~ r
Deparlmenl of Heallh.and Human Services approval ~... CE.J0~?
Reviewed and approved by: ~ ~ Date: ff 12~J~ ~ ~'" -'"'~'
72~13 (Rev, 9~1) MOA 25 -~': '.~ ""
Permit No. SW010424
Municipality of Anchorage
DEPARTMENT OF HEALTH AND, HUMAN
Page 2 of 2
SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744
On-Site Wastewoter Disposal System and/or Well Inspection Report
Legal Description: LOT 10, SANDHILL SUBDIVISION
PID'No.: 050-522-12
178.1'
Shed~
~/elt
SWING 'tiES
I aa.5' I ,o.2' I
I) I 7a.~' 1,3.o' I
E I,oo.~'11,z4'1
· - MONITOR 'P, JBE
~ - TEST HOLE
o - SEWER Ct. EAN OUT
-- NEW LEACH REID
· - DNERTER VALVE:
West 660.61'
ELEVATIDNS
(NDT Trl SCALE)
113P DF' ',/ELL
A~;$UMED ELIrV · 73.3'
8/12/03
01/01/1999 80:01 6882259 SULLIVAN PA6E 02/02
Certitiet ri[[ing Kog
by.
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2750
OWNER OF LAND: p~'r~'~..
LEGAL DESCRIPTION;.
DATE: ~
PERMIT NUMBER: ~ Date of Issue/O, o ~.~__O
TAX IDENTIFICATION NUMBER: O,~'O . _,.~. ~
Is well located at approved permit location? ~ U No
Method of Drilling: r~"~mtary [.3 cable tool
BORE HOLE DATA
DEPTH
IO
ATTENTION: It is the responsibility of the property owner to submil a copy of the well log to the proper authority. Municipality
of Ancl~orage: Department of Health & Human Sen/ices and/or Department of Environmental Conservation. MatSu
Department of Environmental GonservaUon,
Comrnedts:
Driller's Name
Reco~/e~ Rate:, ~ ,,gpm
Method of Testing: ,~./~'
Well Intake Openlng Type: Cl open end'~e
.~l~.r,.~; Start . f~t Stop~d . feet
~ ~top~ ~feet
~erforalions Sta~~~, -- ~0~
G~ut Type:~~ ~ t~ Volume -
Depth: from ~ .. feet, tO ~ _ f~t
Well Disinf~t~ Upon Completion? ~ O No
Depth of well:. .;~ ¢3, ~
Casing Type ~ Wall 'l~ickness 4:~5'-'O inches
Diameter 4., inches, depth_ I~/ feet
Liner Type: _~D~ -.
C~ing Stickup Above Ground:- ~ f~t
· Smt~ Water Level: . ~ . . feet
MUNICIPALITY OF ANCHORA GE
Development Sen/ices 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
Initial
Date Issued: Jun 11, 2003
Expiration Date: Jun 10, 2004
Permit Number: SW030181
Legal D esc riptio n ~.r'SANDHILL"L?~! 0 i".i
Design Engineer:. 0024 Eagle River Engineering Services
Owner Name: Peter Lorentzen
Owner Address: 11901 Business park Blvd., #108
Eagle River, AK 99577-
Parcel ID: 050-522-12
Site Address:
LotSize: 191238 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
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 dudng freezing weather
must be either:. A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Parcel I.D.
Municipality of Anchorage
Development SerViCes Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWERJVVELL PERMIT APPLICATION
FOR A SINGLE .FAMILY DWELLING
0~Ol81
Permit Number SW_..~.~~
Property owner(s) ./~e-)'f~ >
Mailing address (1) ///q.O (
Mailing address (2)
Legal description (Lot, Block & Sub'd.) ~/~,¢
Legal description (Section, Township & Range)
Lot Size /~'/I ~ '~ t3 ~' Acres/Sq. Ft.
THIS APPLICATION IS FOR:
Sewer Only ~
Sewer and Well
Sewer Upgrade []
THIS PROPERTY CONTAINS:
Hot Tub []
Swimming Pool []
Therapy Pool []
Day phone. ~'5~ z/./2 ~.5-
Zip Code
,. // .
Number of Bedrooms
Well Only []
Water Storage []
Jacuzzi
Water Softening Unit
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 Fees:. ~ q ~)~)
Receipt Number: "~0 ~
(Rev. 1N00)
Waiver Fees:
Date of Payment:
Receipt Number:
MUNICIPALITY OF ANCHORA GE
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
Renewal
Date Issued: Oct 09, 2001
Expiration Date: Oct 09, 2002
Permit Number: SW010424
Legal Description: SANDHILL LT 10
Design Engineer: 0024 Eagle River Engineering Services
Owner Name: Peter Lorentzen
Owner Address: 11901 Business park Blvd., #108
Eagle River, AK 99577-
Parcel ID: 050-522-12
Site Address:
Lot Size: 191238 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
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: ..__,.._~"~-~'
Issued By: .~
Date:
Date: //~ -' / ~ -4)/
Parcel I.D.
Municipality of Anchorage
Development Services Dep. artment
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904 '
ON-SITE SEWEPJVVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLfNG
Property owner(s)
Mailing address (1)
Mailing address (2)
Permit Number SW
Day phone
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size //, ? ~' Acres/Sq. Ft...
Zip Code '. ,.~.~.¢-.~
;;7"/x-//-,../ ',,,'C
Number of Bedrooms
THIS
$~0104Z~
APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool ·
Therapy Pool
Well Only []
Water Storage []
Jacuzzi
Water Softening Unit
I cedify that the above information is correct. I fudher cedify 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 Fees: Waiver Fees:
Date of Payment: Date of Payment:
Receipt Number: Receipt Number:
(Rev. 12/00)
MUNICIPALITY OF ANCHORAGE
Deparlment of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P,O. Box 196650, Anchorage, AK 99519-6650
(gO7) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: Oct 09, 2000
Expiration Date: Oct 09, 2001
Permit Number: SW000432
Legal Description: SANDHILLLT 10
Design Engineer: 0024 Eagle River Engineering Services
Owner Name: Peter Lorentzen
Owner Address: 11901 Business park Blvd., #108
Eagle River, AK 99577-
Parcel ID: 050-522-12
Site Address:
Lot Size: 191238 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
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 DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343..4744 ( 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: ~ Date:
Issued By: Date:
· Eagle River Engineering Services
Louis Butera, P.E.
P.O: Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
October 2, 2001
Dan Roth
On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Lot 10, Sandhill
Narrative & Permit Application
Dear Mr. Roth:
We are applying for a design change for the above referenced lot, which just had a permit renewal. The
owner wanted the leachfield in another location than alloxved by the existing test hole. A new test hole was
excavated and a similar trench system is proposed. This trench has a rock depth of 10' and located in the 2-
12' soil horizon with 1' mounded cover. There will be a Bull Run diversion valve installed with both systems
at this time.
The proposed septic upgrade/well and septic system will have veD' limited impact on adjacent properties for
the following reasons:
The surrounding lots are large and have septic systems located so as to allow sufficient room
for septic sites.
2. Immediate n~ighboring septic systems are all +30' distance.
Reserve space is adequate, due to absorption capacity and lot size, this is demonstrated on our
site plan.
4. Drainage will not be affected and is not a major consideration in our design.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
k2000\00-059B-NAR
Eagle River Engineering Services
Louis Bulera, P.E.
P.O. Box 773294 (907) 694-5195 tel
'Eagle River, AK 99577-3294 (907) 694-3297 fax
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: Lot 10, Sandhiil Estates
October 2, 2001
A. GENERAL
1. The well and septic plan are for a single family residence only.
2. The drawing and or site plan shall be a part &this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health and State
Department of Environmental Conservation requirements.
4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer.
5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet
Municipality of Anchorage, Department of Environmental Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any
adjacent multi-family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer
approval.
8. It is always recommended that a surveyor locate the nearest lot line position and the location of any
easements.
9. Any remaining open test hole excavations shall be filled.
B. SEPTIC TANK/LIFT STATION
I. Septic tank shall be 1000 gallon minimum, MOA approved tank.
C. TRENCH
1. The trench is to follow the natural land contour to maintain uniform total depth &the trench bottom.
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed 13' at any point relative to the uphill side.
4. The effluent llne within the trench shall be laid level within 0.03'.
5. The trench gravel is to be covered with typar fabric material.
6. Soil or combination &soil and extruded board insulation to a depth of 3' or equivalent is to be placed
over the leaehfield.
7. The area over the trench is to be finish graded to prevent ponding of surface water runoff.
8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any
Class "C" xvell, or 200 feet to any community xvell.
RECOMMENDED LEACHFIELD DIMENSIONS:
TOTAL DEPTH -- 12-13' GRAVEL DEPTH = 10' under pipe, 2" over pipe
TRENCH LENGTH = 38' TRENCH WIDTH = +2'
SOIL RATING = 0.6 GPD/ft2 BEDROOM CAPACITY = 3
SEPTIC TANK = 1000
Twenty-four (24) hours notice required for all inspections.
\1997~00-059spec
-15' U~;i!.i~cy Ensemen~;
+ ~ ~ ~ 15' G~V~ DRIVE~
~1 ~{~ Well and ,Septi~
~ R I ~ +100
~ z I ~,-~
~ - TEST HOLE
No development. · - MONITOR TUBE
o - SEWER CL~ OUT
+ - WELL
..... ~SEMENT
NO SURFACE WATER PROPOSED L~CH FIELD
NO KNOWN CURTAIN DRAINS ~- EXISTING L~CH FIELD
~- C~VEL DR~
W E LL/S E PT I C S IT E P LA N
_...-~'~. OF
LEGAL: LOT 10, SondHill Estotes
OW~[R: Peter Corentzen ~ .." ~'..~
~o~oo-oso~ ~[: ~/7/o~ I sclc[ ~" =~oo'~ ~.~ ........................ .........
EAGLE RIVER ENGINEERING SERVICES ~.e -tOU,S *. ~u~.~..~
P.O. Box 773294 ~,
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-3297
PERFORMED FOR:
Munh:ipallty of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" S(reet. Anchorage. Alaska 99502-0650
SOILS LOG ~-- PERCOLATION TEST
DATE PERFORMED:
LEGAL OESCRIPT ON:.,,~.~/~ .J'",,~..,~'.4.~./ .~-~".~,,~.~-j Township. Range. Section:
1
2
3
4
5
6
7
8
g
10
11
12
13
14-
15
16 """
17
19- ~
20-
COMMENTS
SLOPE
SITE PLAN
f:l: t } "'
l ll~ '
WAS GROUND WATER
ENCOUNTERED?
s
L
IF YES. AT WHAT O
DEPTH~ p
E
Reading Data {~o~ Ne; O~th to Net
Time Time Water OrEo
PERCOLATICN RArE / 7 (m.r~utes,,ncn; PERC HOLE DIAMETER.,
TEST IqUh BETWEEN ~' FT AND 7 FT
PERFORMED aY: '~'~'~'~" I~~"'~""-'~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
AGCORDANCE Wl~rl,.~ ALL STATE AND MI,JNICJPAL GL/IDE~tNES Itl EFFECT ON THIS DATE DATE.
72.008 (Re~,
Eagle River Engineering Services
Louis Butera, P.E.
P.O. Box 773294 (907) 694-5195 tel
Eagle River, AK 99577-3294 (907) 694-3297 fax
September 29, 2000
Jim Cross, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Lot 10, Sandhill
Narrative & Permit Application
Dear Mr. Cross:
The proposed septic upgrade/well and septic system will have very limited impact on adjacent properties for
the following reasons:
The surrounding lots are large and have septic systems located so as to allow sufficient room
for septic sites.
2. Immediate neighboring septic systems are all +30' distance.
o
Reserve space is adequate, due to absorption capacity and lot size, this is demonstrated on our
site plan.
4. Drainage will not be affected and is not a major consideration in our design.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
~.000\00-059NAR.DOC
i ~~0/-15' UtiUty Ec~senent
-
= ~ ~ o I I o~e~. ~ + 100'
I RIO0.O0 / (~o~,~ o~v,.oy ......
No development
~ - TEST HOLE
· - MONITOR TUBE
o - S~ER CLaN OUT
+ - WELL
NO SURFACE WATER ~EMENT
PROPOSED L~CH FIELD
NO KNOWN CURTAIN DRAINS ~- EXISTING L~CH FIELD
LEGAL: LOT 10, SondHill Esto[es
OWNER: Peter Lorentzen ~ ." ~'-~z
JOaffoo-o6owsl DATE: 9-5-00 m SCALE I =100'
(907) 694-5195 FAX: (907) 694-3297
EAGLE RIVER
ENGINEERING SERVICES
P.O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No.: 00-059
Calculated By: LB
Date: 9/29/00
Legal: Sand Hill Lot 10
Single Family 3 Bedroom Dwelling
TEST HOLE 1
Deep Trench Subsurface Wastewater Disposal Field
Water use at 150 gallons per bedroom = 450 gallons
Percolation rate = 13 minutes perinch
Wastewater application rate = 0.8 gallons per day per square foot
Required absorption area = 563 square feet
Trench width ON) = 3 feet
Graveldepth (D) = 8 feet
Required length = Required absorption area / 2 / D
Required length = 563 / 2
Required length = 35 feet
Total Excavation Depth = 11.0 feet
/ 8
00-059cal.xl$ 7:44 PM9/29/00
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street. Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
Lor¢~'-, eh
LEGAL DESCRIPTION:
1
2
3
4
5
6
7-
8-
9-
10
11
12
13
14
15
16
17
18
19
20-
WAS GROUND WATER
ENCOUNTERED?
Township. Range. Section: Itt/l/: /l/,~'~:
SLOPE SITE PLAN
"111 I.I I I
H"t-CI'"q I I I-'.-I I I
IF YES. AT WHAT
DEPTH?
,m i. WiI'A~
Grou Net Def~th to Net
Rem:ling Dltl Tim~ Tit'n~l Water' Drop
5vq k '
..~ -.Il : 'cV~.Oo ~o'oo" ~q ;h~"
PERCOLATION RATE
TEST RUN BETWEEN
/ :3 (mmule~/{m:fl) PERC HOLE DIAMETER
5' F'rANO 6 FT
PERFORMED BY: ~"- ~ · ~, ~ · I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE; DATE;
72-008 (Rev. 4/85)
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 050-522-12
1. GENERAL INFORMATION
Complete legal description
Sandhill, Lot 10
Expiration Date: / 2—' i �^ z -?--
Location
Location (site address) 24830 Hamann Rd, Eagle River
Current property owner(s) Lorentzen Alaska Community Day phone 907-227-5056
Mailing address PO Box 771315, Eagle River, AK 99577
Real estate agent
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
F-1
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 550 Waiver Fee $
Date of Payment -ZD ' 22
Receipt Number 0 n 1
COSA # 0 S C,1 0 l 2 � �
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 Crewdson Engineering LLC Phone 907-280-9493
Address PO Box 671389, Chugiak, AK 99567
Engineer's Printed Name James Crewdson Date 6/17/2022
OFA 1
6. DSD SIGNATURE .:
' :
System #1 Approved for bedrooms �aures A. Crewdson..-,
System #2 Approved for bedrooms V1527 •.•i
rii....... 4,r
p.
Disapproved 1��R`"`OONO
Conditional approval for bedrooms, with the following stipulations:
.Iml, l I"(f(ri,_
,1�-- Original Certificate Date: "-/ (6, 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 Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Checklist
Legal Description: Sandhill, Lot 10 Parcel ID: 050-522-12
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 ""'
Total depth 300 ft
Cased to 181 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 24+ in.
Date of flow test for COSA 6/17/22
Static water level at beginning of test 134 ft.
Comments *per owner
B. TANK DATA
Age of tank(s) 19 years
Tank type/material =`Pu° `°"
Measured operating fluid level in septic tank 49
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 6-22-22
D. ABSORPTION FIELD DATA
Which system tested (date installed)
❑*ALL standpipes present per record drawing
Total measured depth from grade 13.5 ft (max)
Measured depth to pipe invert from grade 3.5 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 2.1 gpm
Water storage tank volume 300* gallons
Well disinfected for coliform test? ❑ Yes ❑x No
® Coliform bacteria is Negative
Nitrate mg/L 0 Nitrate less than MRL (ND)
Arsenic ug/L ❑X Arsenic less than MRL (ND)
Collected by Crewdson Engineering
Date of Sample 8-17-2022
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 6"'x°22
Results ❑✓ Pass For 3
Fluid depth prior to test 50
Water added 460 gal
New depth 72 in
Elapsed time 180 min
❑ Code -required soil cover over field
Final fluid depth 50 in
❑ System presoaked Absorption rate 450+ gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months)
date of test) If yes, enter date
Gallons introduced gallons
Comments/Deficiencies: engineer confirmed
bedrooms
H
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'
0✓
Yes
Community Sewer Manhole/Cleanout > 100'
Q Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100' P/ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑✓ 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'
Yes if No ft
Water Main > 10'
Animal Containment > 50' ❑✓ Yes
if No ft
0✓ Yes
if No
ft
D7 Yes if No ft
Water Service Line > 10'
F-1
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway comment below
Community Sewer Main > 75' MYes
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'
0✓
Yes
if No
ft
Surface Water > 100'
Q✓ Yes if No ft
Property Line > 5'
✓0
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Q✓
Yes
if No
ft
Private Wells > 100'✓0
Yes if No ft
Water Main > 10'
✓0
Yes
if No
ft
Community Wells > 200'
D7 Yes if No ft
Water Service Line > 10'
F-1
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'
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'✓Q
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'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
V�*.
O F At�s�,l
G. ENGINEERS CERTIFICATION O'P
certify that l have determined through field inspections and review /of Municipal records that the above systems are in conformance with /A. Crewdson
MOA COSA guidelines in effect on this date.tt527.... .:.fit
COSA Checklist yellow sheet
w
cD
0
0
0
z
AI/1TCC
SURVEYORS CERTIFICATE
I hereby certify that I have surveyed the following
described property, L❑T 10, SANDHILL SU13DIVISI❑N
Anchorage Recording Precinct, Alaska, and that no encroachments
exist except as indicated. It Is the responsibility of the owner to
determine the existence of any easements, covenants, or
restrictions which do not appear on the recorded subdivision
plat. Under no circumstances should any data hereon be used for
construction of fence lines, for establishing boundary lines.
West 660.61'
EA G L E R1 VER
ENGINEERING SER VI CES
P.O. Box 773294-
10421
7329410421 VFW Drive
Eagle River, Alaska 99577
ERES Project Number: 00-059
CADD File Name: 00-059AB
24.0' 20
m
N 8.0' a
N V
6.0'
4.0' CONCRETE
FOUNDATI❑N
0
6
o �
(Xi
lU
38.0'
F❑UNDATI❑N DETAIL
NOT TO SCALE
LEGEND:
SEPTIC STANDPIPES a
WOOD DECKS
474.0' GRAVEL DRIVE
WATER WELL -6-
1
o-
ASBU/L T SURVEY
4
............9
... 9— 0
o OWNER: PETER LORENTZEN
Louis A. Butera i LEGAL. SANDHILL, LOT 10
04 's LS -9338
4�4a'0 • • aC3 SCALE: DATE: BY: SHEET: /
�Orafession°I°°o
O000000a� 1 "=100' 8/5/03 BJR 1 % f 1
a