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HomeMy WebLinkAboutBROWNS RESUB LT 37(PLAT P-498) LT 5 T13N R3W SEC 22 Onsite File BROWNS RESUB LT 37(PLAT P - 498) Lot 5 #006 - 324 - 10 OWNER OF LAND: ADDRESS: LEGAL DESCRIPTION DATE: 4-20-20 PERMIT NUMBER: OSP191324 DATE OF ISSUE: 11-18- 19 TAX IDENTIFICATION NUMBER 00632410000 Is well located at approved permit location: NYes 0No Method of Drilling: ®air rotary ❑cable tool Depth of Well: 82 Casing Type: Steel Wall thickness .250 inches Diameter: 6 inches, depth 82 feet Liner type Static Water Level: 22 feet Recovery Rate 30 --❑ gpm _� gph Method of Testing Air Well Intake Opening Type: 0 open end open hole ❑ Screened Start feet Stopped ❑ Perforations Start feet Stopped Grout Type: Bentonite Volume: 3 batch Depth: from 2 feet, to 20 feet Well Disinfected Upon Completion: Eryes no Method of Disinfection: Chlorine 50 PPM Certified Drilling Log DOC CO dba BILL 2& COLE ULLIVAN WATERh WELLS P.O. Box 670269, Chugiak, AK 99567 888-2759 MGJ Browns Resub Lot 37 Comments: 20' of 10" surface casing installed. After 6" drilling was completed, annular space was pressure grouted from bottom up and 10" casing removed. Bore Hole Data Depth From To 0 2 2 4 4 16 16 20 20 27 27 47 47 58 58 77 77 84 Casing Stickup Overburden Silty Sand & Gravel Sand Wet Silty Sand & Gravel Hardpan Sand & Silt Water Hardpan Sand & Gravel Water Drillers Name: Cole Sullivan ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu Borough: Department of Environmental Conservation. R- DOC CO dba BILL a DOGE P.O.Ole _lot ULLIVAN WATER WELLS 0; Box 670269, Chugiak, AK 99567 688-2759 www.suilivanwaterwells.com Pump Installation Log Well Drilling Permit Number: SW OSP191324 Date of Issue 11-18-19 Parcel Identification Number: 00632410000 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. N,, ""rY MUNICIPALITY OF ANCHORAGE ` .__.moo On-Site Water&Wastewater Program . °. 111 C^it 5(,, ,ice PO Box �196650 4700 Elmore Road , n �' Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax (907)343-7997 n ,t 1,ft httpa/www.muni.org/onsite cpartinent 4NcHoRk '• On-Site Water System Permit Permit Number: OSP191324 Effective Date: 11/18/2019 Work Type: Well Initial Expiration Date: 11/17/2020 Tax Code Number: 00632410000 Site Legal Address: BROWNS RESUB LT 37(PLAT P-498) LT 5 T13N R3W SEC 22 G:1537 Site Mailing Address: 5027 E 25TH CT, DUPL, Anchorage Owner: BDMG VENTURES Lot Size in Sq Ft: 8040 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 6 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy El Private Well 0 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 Special Provisions: See the special well construction requirements on the plan view sheet. • Received By: Date: ///iii « y Issued By: 4/ `ileDate: /(/ c 0 0 icy ality of Anchorage Department P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program VARIANCE/WAIVER REVIEW 4)1174-11 6�svlq loco Waiver#:—Gi4-969 COSA#: Permit#:OSP191324 PID#: 006-324-10 Legal Description: BROWNS RESUB LT 37(PLAT P-498) LT 5 T13N RM SEC 22 Engineer: Mike N. Anderson Your request for a waiver of the required 100 feet horizontal separation from the public sewer manhole/cleanout and public sewer line to the private well has been approved. The approved separation distance is 60 feet. Any future upgrade to the public sewer system will require all separation distances be met or another approval from this department. ................................................■.............................t Waiver is Granted: X Waiver is not Granted: Date: Approved by: .Name of Reviewer ............................................................. ................ I **** VARIAN C E/WAIVER REVIEW **** ' - MUNICIPALITY OF ANCHORAGE Development Services Department 1�. �, Phone: 907-343-7904 On-Site Water & Wastewater Section \— Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 006-324-10 Property owner(s) MGJ Building Group Inc Day phone Mailing address Site address Legal description (Sub'd., Block & Lot) BROWNS RESUB (PLAT P-498) LT 5 Legal description (Township, Range & Section) _ I, Lot Size 8,040 Sq. Ft. Number of Bedrooms 6 APPLICATION IS FOR: APPLICATION IS AN: I P,, 9II DW LLI !:_: (®all that apply) ?'. Absorption Field ❑ Initial El ! Single Fami y (S' El ,/iii, ADU ti Septic Tank ❑ Upgrade CI Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well 0 Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: & te•/( +'0 4 tvw C., 0 „ Distance: 7R / I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: , V.:6- Waiver Fees: /(16 Date of Payment: waci /'9 Date of Payment: ?/aQ119 Receipt Number: 0 2(10t.g6 Receipt Number: it ' ..ti 64925 Permit No. a SPIg i.3a Waiver No. 05(I/4IOCQO G:1Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc • Oct 9, 2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage,Alaska 99519-6650 Fax 249-7847 Re: New well permit and waivers Legal: BROWNS RESUB (PLAT P-498) LT 5 To Whom it may concern: This is a request for a well permit and waiver of 60'to the south AWWU manhole plus the sewer line and 65'to the east AWWU cleanout. The lot has AWWU sewer service on three sides of the lot. Attached is a site plan showing the AWWU manhole in the NE corner, a service clean-out on the east property line and another AWWU manhole just 60 feet south of the proposed well. The distance to the AWWU south manhole is 60 feet from the proposed new well therefore we are requesting a waiver of 60 feet which is about half way between the manhole on the south and the cleanout on the east. Justification for this waiver is the two existing wells located on the lot directly to the west has been performing well for the past 25 years with no violations or contamination issues and both well logs show good confining layers of clay and silt, see attached. Also all of the existing ground slopes away from the new proposed well site, see site plan. A weld-on pitless will be install to prevent and contaminates from reaching the water table also. The granting of this waiver will not impact any of the neighboring properties. Sincerely ' 4— Michael N. Anderson,P.E. 4661 Natrona Anch,Ak 99516 Ph 727-8864 I II II II II II 10'UTILITY&5' I I AWWU II EASEMENTS' II _ _ _ _ _ _ _ _ _ J I I - - - - - - - - - - - - - - J LL — , I— 7.'_ _ — — _ -` — — III `I AWWU MANHOLE EXISTING 100' • . �T II I I AWWU SEWER / WELL RADIUS �.--�� �•� IIT I I AWWU CLEAN // I I ��� Mi/ %//I II `tel I OUT PIPE I I // II I ` / \ / / I I I ING I r� I I cx I JPROPOSED PROPERTY LINEHOUS' � I Io AWWU SEWER WELL W/60' 5 LINETO AWWU MANHOLE& ELL 66� A \` w CLEAOUT, BENTONITE �® 1N J AROUND CASING TO 40'MIN. (:,.) ''ii I Ov.e.r d list l wri e'Cu�iS/n s cn® ski, I 4�t r•kN•e .41wlI ,u1 {`. ° 'I r' II I I / wL—m in / / - - �- - — o- f — — — — ,\ \\ �// EAST 25TH COURT�— ` / / // / I ` ` .- / , / . / �\ \ // / AWWU SEWER -_____ .' LINE AWWU MANHOLE CONDO ASSOCIATION PRIVATE WATER SYSTEM Septic Design Prepared for MGJ CONTRACTING •�*** OF g4'44, BROWNS RESUB (PLAT P-498) LT 5 ;��' .i. _ Anchorage, Alaska ; " ''t 49TH %\ ; 2 •� iiiii, ■ • Michael N. Anderson, P.E. DATE: 10/8/2019 � II . :;MICHAEL N. ANDERSON. 4601 NATRONA AVE DRAWN: DJR .j'J' No. E 469 =� ANCHORAGE,ALASKA 99516 v�♦< ••••'�/jf�f . °' '� (907) 727-8864/FAX: (907) 345-1391 SCALE: 1"=50' .4. I I sa mem I 8 I I SEWER SERVICES DATA(DESIGN) © SEWER SERVICES DATA(AS-BUILT) I I I I• I I %111181 1/14,41452i 1 W I W 911 lea SWIll .x 0 w 1'W r W 0w•44 ![7107 ro m SOjE Mfg 11301191 ro CO SO( -.1 __ ._ J I 1 t 2 1042336 1710 10623 244/1 17910 I t 7 70.2196 1105 9107 714 17910 _� ' I 3 t 1 elm 1e021 7921 15129 3 e 4 724707 905e679 2l.I 7 m1 lely _-'. -_ East 7.tb Avenue : !t c I Ia1» Tl.0 274 ,6121 s k c 7t.9do0 ea» :1.ir 719 1e121 L_____ 0•"'0. I I 7 t 0 12•115170 190.04 714 10101 7 t 6 72,93 00 0611 1923 211 10103 -INT/' • 9 t 10 ,7.1700 ._4 .70 76( 17174 9 t 4 12.5200 70.4 17.77 201 1X)4 .- r... ----- ` .�/ j - `' -- \ • 11 k 17 11.1112 175. 73.00 201 1X31 II t 17 11.0.77 7501 7107 7.01 17631 • - 13 k 11 11171.17 1 . 7500 7.04 171.79 11 t 14 14.7212 7420 7507 7.01 171.» � 15 t 16• 1016110 Inn 114 Int) 13 t 16 81.6701 72.77 7507 7205 17377 I !i!. \ - ``. I I! ' i I 17 t 11 10.50. 17737 400 750 17142 ,7 e 4 14.10.0 »S7 Qo7 7.01 17342 \ •m 1 7 6 10 k 20 08 174.14 400 \211 173e1 19 t 30 11.11.00 74.14 4177 701 17504 12 f W. - ,�R n _ ff fI 71 k 77 N/A 17101 11.13 7d., 11127 71 1 77 77.92.62 7661 W10' 701 17724 I/ 1' I t. "p. I + / ' � I i V ( 7! 11 01.10 17021 Ap 7.01 'q7.V 21 k 27 12.0981 7626 7640 701 17717 .9 G' I NOIR( 17117-00 1X.73 77.» 671 179 OW ICIRf !2.17.09 7673 7207 1509 10093 el 9 ^ 70 6. 6 - •\.° 8' ,• •5't l8'.. ° II 1 (1)6x181 Al C00(Op ' ( \y i B 100. g 3\§'\G 4 73\y I [2)05091%u 51[W AHE 6.11601 WI 0.70 Fm. o \ `- n. _ �u 11 2� ►1 m I 1 " / I • .. vim_ i y/ �o ! 111 .Y II a W / •/ ( �I I i 1 ) 1 I I Foy t\$ 1 •WI 7 '4 S s igh27/18M I e � �� "t3 • ! ! ' :, • - - IW itsi- ae j P. WIN\`\' it 5 i • F • I -it 'D t i I G I o. i ' %� �; .A I X (� Hatcher 190 L10. i •i € ` e! r01I. t/ lin 1111 Q ' �= yD i i !I eo l i i • , • ,; �. � 1111 4 A " .. ' I.' '14175 -i. ay7 I MI d • 100 8,,, ■ W19 .. g I f I • a-!015111 1182• .04+173 (X1%110401- I 1 I d04 0.'•Q I t I F. . ley 3o/ x01757 . • 19000. .'-. \1 �1 I'S I 573°017."7. • i I �- F 77 , t� �" ll i A 5 I x11e!W■ 1 S m1(ax11soo+allKro �` comic 117us7 �i ! I eov-16607 I • // 11111 . 2222... y.- 9100 10100 /f ,,.[o 171W 13100 8459'70••04 207.33 LF •• d \ 1.1759 / I 1 SEWER SERVICEPROFILE!7Ij- i5'cl ` -- 5r.`. 2 -sou:22.2 :IS 150 - - - - I EgAv1.149.0 c W East 26U �-"Avenue � VERT 1 -5 ____L___.- 'S AMI i .._ CO I I I MOM MCC CLEMOUI MS GRAPHIC SCALES O`r;,B" 1 2' MEN SEWER SERVICE PLAN I �y ICPPLNf" SCN.E 1•.30' i I 5 0I 5 101 FE e:...ce. et16� 1,•'.!"111 - �� P2 ao 0 30 6°n t 1I- . r I I I 1 �� �/ W Oil 15 s71� SC/AL 1•-30' '111115 7� e•ev a-!o �, RECORD DRAWING StovE;w +/ so 0 50 100 FT !a 1 - IxrawAlwl 042..[0*V.- P 750I �A • .0 7Xwlxlelat 1snlXen.2711.190 _ t[f1ep) MI = = Irti . `y =MOOR Li1_ TYPICAL SEWER SERVICE DETAIL SCALE: 1•=s0• . ' 9 SHEET 6 LESS DWI l n° I lCONSMEITOLI 1.10014.• myna P009001 ,4111_1_8' .8 SHEET NOTE n•1 x• rzSEW 1'".t. 10611 I. 701(0 TO 311111 1.1-I 70010115.8141500*11 WES SII IS A REDUCED PRINT RE�CEDACCOR(INCAS (,e; .t...1 li,,•_;6'. I e1«c9 erwFa/f!0) 0,",0 SEWER KEY Mur AWWU PERMIT NUMBER SCALE:1'407 PS02-150 SEE SHEET 14NLI0m N10ADYT C ITE[aD s wsm INGOTS 3 OF 4 NOTE O a PROPOSED RI'SUDOIV.SON Iw11ElI 4 COME • a TO 4 OF TNS PARCEL 01T0 LATS IRA &see CONSTRUCT MN A.5(TYPE A) STA K•411.70-tr•E L. Z WT1TE WTENlS:a TTS[ R O A a Po Quo a s 4�' •- 1335, 'O =OE A!N[• •• t WTERNL As.42CM n T. CONSTRUCT MOWS(TYPE A) -- _F_ 11 v L1: :sie.oma I, e iv CONTRACTOR sA 100•NEU,COwCT To VSA STA II•S2.q L-------_ J— ---t....7,4.-- - - 0. _'_ S 1 RRDMltD KIM TK .�•� rATnVV pENSTT �'l "—q—"' -3►GN lE inT.1 4!D I1 7i ROOMYAIEAUI_COMPACTED PALMER COURT "' � � •-- ------------- • i cLb ----- mu'A. __. -------EO --- F — ^ A!R!N TO RIM YAEMRY DENSITY � _.,T -- —_4Q7TT ill D us.EA I - t 6ETST 70 I .1. s $ NOTE' THE CONTRACTOR SHALL NE110Vt AND DISPOSE M1 — O I u 4 i STA IST12.7$ ' N4Y.1 i�*t••-r•,L• O 8 ;( ALL ORGANO NATURAL *51055 NOWV•T •I I r 1 L. 1 ' .-A C.O. ...soh TYPICAL TRENCH DETAIL (IMPROVED R.O.W.) _ w a ' n ;i;/�NwIR T!^Itlt , %{ Sse NO N T.S. r r" 0 N r-i1 w `n11 0; I O "nta NtgRle tp ggi m c i (i iEP(I -- l IMSTALI a•♦r`�l; ':i;a ;;'y .i/i• ----- �_- : PS a '. Z g (SEE NOT S• enI L1 ryTR'I WA-6 .I t r A 20 ,, is ; :; , LEfi T"t xl T • .o,,,,, unc,MAICiwl%..':i.'^:;', ID --_a _—___ < x -5114 .0 c �kryiNA P_PASU 1 , 1 w n XPS.••• ^Q. Is• J i Z:'/,.' :.a L/s 1.--0.71=-1_ -_ - •.yrs,• I ••t .I _T SLOPEAS MUNRO• X44��., �'•;1.' ,'w CCs 1 ° m _] I I .`T+1}^"_Llq- •..• (]? •n CON1R1CfO11 d,, s';;•.II;;•'%• ;„, " Iy = a1 .i� ; 1:._�}_ ,_ °I•,: ( ��.- _ NE G� �''� 1_ -"ice fit. L s 1� lggfo,•',!,1„;,„, + . I a INSTALL C.O.A-2 =• . T �E}Fy5 r MOreTNO 3x1101 PIE ••.. . E�-*00500 H*TCRUL CCAPACIe0 y STA 0.71.505 30 O� 4 I t 1; 1 N{ ; tJC•.v, V =11.6•4tp•..w•b TO 11%10.01R1Y DENSITH A1• 1 NI f J 0 Lam._ A 1•l..4 33' 33' .1.7." 3x. : ,• • 5750 g saw$ - 1150$ IRK 104 %1 TYPICAL TRENCH DETAIL (EASEMENT) I'__'____ .........,r_.:___ L`------- -----_______ 5ATSN GLACIER I tr STREET _ _ ens rem n I. _ :I I 4 O i 1 s+iZ w 30 atm 30• IMS! 5075 1 f r --EimEl_amm NEffini-- • =.. g - - _ leIM -- • rmail m.___._. =lilmm - _ @ -- _w1 =Vi.E ._ Ill 1....w _ _ _ _ _. _ ___ . I__. 1P11 1 4_PIM= _ I >� _ .'g. '.� p_' -•_00 I :_s9 _-�-� I , E i ..1 1 i a I f _-, i�ir_A :gym il I- .i iffl.-- --minft-7:::-....1E1== 2. ' -al 77411211 M . t M - >— • •'' - 1-w-- _ 7 --.1:1 (UCEICR011NID 10E2TT� I - v jai ; t-�- 1.)..h_(...".:. '; - C CAUTI N w rte: ... -• -'... - 1_ �+ ) I MIRI I*3.DDI NY' -C - III - , ..._...�.._ _.. I •• i I I 1 T.��_.LFII'O - s.-' / I/K,�" .._ _.. . i T - 1 I. _ .. I I ,wise l �.�: .0 0 — _ ���' 3 's--ee.,," •_ - EEiNY 56608 04A -r —1 1 I • 11^ S.E..! A SAP/ 11..+63(8 T®... N.,100. s 109/ ..__.. V I 4 III i _ t - I I I I t I— i j mom_ s � _. -. - =i 1. i : � _ 1 -, . 2 111:ESE2-'1EN�� _ tSlElrl�o lee I INC�;; R1�;1 L I -- B I 1 i i - .._0 •'•., '- I -,, .... ,_._ =zSF . -•-N.:C. ,= ,-:. °,-' , ,•r: I ! S7 - i - I _ -0400,- �`11+00 1 11700 15.00 -20I00 z1+03' MUNICIGRAPHICt�_L- - � 7SC+4LE °N, 4_..r,,-_, . ANCHORAGE R SECT "N'1YsA as ItV ANCHORAGE WATER a ANCI N ILO 0006 SN TANI 11400.11011 IC SEA b. LOCATION I W TP no No.I LOUDON 0111.. DCO. au AI "*rt g. HA IMT COOLSTAAM . A !EE 04EET 201• rip RD rA CIE YN SNLDT 2 0/• ITb RA NN _ �1 I 1 .__- __—. S us algr t 9f 4 eaLH G•A•Y! SEL POET2 OF : I►ES1 le' ~ . r - --- �, .E N;°, BROWN'S LLD NO lig, r, - - - - _ .- _ _ _.. 1 e �1 SHEET 2 OE+ MAI _ _ Ra1 N.Y CN Mu _ ,_ :' �r£J}y J�.sc -_ __ --- -- I -. .-1. ....-- wi—rd11,• PAR SD_ - '•/T p M^ A1N1�� HORr N'DAn (o1101D0 34 ISTOUCDON NECOR5 REVIS,O iT._......__.._ _.. 1 VERTICAL DATUM VERTICAL DATUM /LAN CHICK ENGINEERS - AL -SCA1E•Lt,... ACCT.110 11111••203-1000 JR V5 G 9 < • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 006-324-10 Expiration Date: I 7-L-1 o_ 1. GENERAL INFORMATION: Complete legal description Browns Resub, Lot 37 (P-498), Lot 5, T12N R3W Sec 22 Location (site address) 5025 E. 2511 Court *Anchorage AK 99504 Current Property owner(s) MGJ Building Group Day phone 907-887-4412 Mailing address Real Estate Agent 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) M Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 6 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well M Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer M WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 210 CC) V1 Date of Payment SA' A0 Receipt Number 00 0_5 G COSA# DSiL 2oiL{�1.5 R vsh ; 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. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systemis on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or '+� ::.. • ! ��',j, encroachments may exist that were not identified during the evaluation. The operational life of all wells h •; ; and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of. the well or septic stem. GEG makes no representation whether an alternative well or septicsystem P Y P P r:. ; can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to CF.] �'(l, •. kj2`� .I•� �f� �` perform the evaluation. Reliance upon the information provided in this report b an other person or P P P P Y Y P �,, a, " " party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. *AECC884 6. DSD 1GNATURE System #1 Approved for 6 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: By: �l�l/�-� Original Certificate Date: g Z The Municipality of Anetforage 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 l/ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: Browns Resub, Lot 37 (P-498), Lot 5, T12N, R3W, Sec22 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Date drilled 4/20/20 Total depth 84 ft Cased to 82 ft ❑■ Sanitary seal is functioning correctly Q Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA New Static water level at beginning of test 22 ft. Comments *30 GPM per well log B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank ❑■ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (ma Measured depth to pipe invert from grade ft (min) ❑ N/A —pressurized field ❑Monitor tubes go to bottom of ective. If not, state depth into effective ❑ Code -required soil er over field ❑ System preso ed (Required if ant for greater than 30 days prior to date of to introduced gallons 'Deficiencies: Awwu sewer COSA Checklist yellow sheet Parcel ID: 006-324-10 Structure served by this system Well production at time of test *New gpm Water storage tank volume NSA gallons Well disinfected for coliform test? ❑ Yes 0 No ❑■ Coliform bacteria is Negative Nitrate mg/L ❑■ Nitrate less than MRL (ND) Arsenic ug/L ❑■ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 8/12/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station year Lift station material Comments: Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date iy� 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' N/A Community Sewer Manhole/Cleanout > 100' Yes if No *— 60 ft F1 Yes if No ft [D ❑ Yes if No Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No N/A ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' if No Animal Containment > 50' El Yes if No ft M Yes if No ft if No ft tic tank is under driveway comment below * 60 Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' El Yes if No ft n 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' ❑ Yes i ft Property Line > 5' ❑ Yes if No ft on Adjacent Lots: if No ft Absorption Field > 5' ❑Yes if No ft rivate Wells > 10 ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft lWells ommu ells > 200' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft tic tank is under driveway comment below From Absorption Field on Lot to: (Please enter dist Building Foundation > 10' ❑ Yes o ft Property Line > 10' es if No ft Water Main > 10' ❑ Yes if No ft Water Serv' ine > 10' ❑ Yes if No ft ace Water > 100' ❑ Yes if No ft if less than required) If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft F. ENGINEER'S COMMENTS *WR#OSV® r, of lo(,o *62.3' from center of closest c/o MH to center of well AWWU Sewer ooboo OD G. ENGINEER'S CERTIFICATION o 5�4 1 certify that 1 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. . . 4 0 �................... .......... � f ey A. Ga ness.- Q COSA Checklist yellow sheet of essionoo� #AECC884 D��Oood6 s I BFB r> /R. WEST 60.00 10' UTUTY EASEMENTAlf --- - - - - - -------_----_____--`:i 5' SEWER EASEMENT _ � ^ j w�"o,,a0 ti E i mas0.,� 110 f01,.r"DIUPLEX 6 C:amx .-� p,380 ocwaam'' r /Upw�p� STORY D FRAME o I 4)�.��aQo o 0�nmati f I q a'aap as 0. O 6 5 6 i a I ! O 0 4) � om I so ,,., a v k0'0 ' o oU° v m y a� :V5 0000 w } O a ° 28.0 I u Q c~n q q �r I ( O oo�a �� i P f Q, A co ar ai • s» y.!2 o WELL I ° e 1 U u> co t a� o am &. �a I I z f m w gip" na+aa j C7 rrI f I r z cc o 41:;: C ti � p 1_60.00 ,I o 00 ► �, v c C) a E. 25TH o w`` +"g � COURT �,�cd EAST v_O � r~ q d i� Jd