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HomeMy WebLinkAboutSYLEA LT 4Onsite File MOMW Ar IS fff Pff u o I am tnev cauu 10) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201131 PID Number: 051-732-39 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: FE] New ❑ Upgrade Name Troy Davis Homes Inc ABSORPTION FIELD ❑ Deep Trench ■❑ Wide Trench ❑ Bed ❑ Mound Site Address 22960 Sheltering Spruce ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 310-2501 4 1.2 GPD/SF 4.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.0 Ft. Gravel depth beneath pipe 2.0Ft. Subdivision Block Lot Sylea 4 Fill added above original grade 1.9 Ft. Gravel length 70 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches 1 Dist. between trenches From Tank Field Tank Line 500 Ft2 Ft. Well >100' >1 00' N/A N/A >25' TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water >1 >1 00' N/A N/A Material Plastic Number of compartments 2 Lot Line >5' >10' N/A N/A NA Foundation >10' >10' N/A N/A LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank D3034Tank to D3034 drainfield Installer Alex Enterprises Drainfield D3034 CO/MTD3034 Inspector J. Mlllette BENCH MARK (Assumed elevation) 100 ft Inspection 15 12/10/0DO 12/10/,V96 Location and description dates: Top of foundation 3b 12/11/ 411 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp ~� of \l� Conditional Approval: Date ?Q' •'qcp ,�� e*; 49TM 4 ��� Septic SySte / Benjam�yr Schiller Appr w�,(— Date r �� 2- C ���sjFq• 6/30/212� pROFESS10N4� Note: this approval does not include well permit requirements.®� tnev cauu 10) SYLEA SUB, LOT 4 PERMIT # OSP201131 PID # 051-732-39 \ SyFC T LOT 21 i / (A-7- LOT 7-LT 20 ' � - / -T5'-UTILITY EASEMENT 20' ELECTRIC J/ 1 EASEMENT y ' LOT 19 70' LONG x 5' WIDE x 2' EFFECTIVE \ DEPTH ABSORPTION TRENCH r � ALTERNATE SITE: CATEGORY III LOT 18 r' 'J SYSTEM w/ 15' LONG x 5' WIDE x 2' EFFECTIVE DEPTH ABSORPTION f TRENCH APP RATE 6.0 \ r' LT 17, "` f 1,250 -GAL SEPTIC f TANK w/ 20" MANWAY LOT 1 75' ELECTRICAL TRANSMISSION LINE & DRAINA-GE EASEMENT',./ LOT 15 v/ ENGINEE PING O : 49 TM •• Benja i Schiller �'F ••. CE 2592 ••moi c�rlF June 28, 2021 �e®i� PROFE SS\�NP�'® t r � l •. r � /— W1fTER MA IN�10' FROM ! ,SEPTIC SYSTEM. EXISTING WELL I f LOT ,rt r r -r Ov 2CQ LO I/r 4 ` FGA 4•BOR44 OME ca EXISTINGIWELL A. 1 000,� ER `Jf NT j� � o/ 0�5 L_�T 4 i� l� X LOT 6 LOT PLAN AS -BUILT 1100 200 m FEET 11 A B FCO 29.8 14,1 MH 23.3 18.5 SV 21.3 21.7 2CO 20.0 25.4 C01 20.5 27.8 MT1 1 18.4 29.8 CO2 18 MT2 74.5 92.8 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEAN( FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE SYLEA SUB. LOT 4 PERMIT # OSP201131 PID # 051-732-39 I I.V OF— F— 0 99.6 FINISH GRADE 97.7 ORIGINAL GRADE 95.7-1 DRANFIELD Rocr. 1 95.7 93.7 93.7 70' GROUNDWATER @ 82.2 ON 5.28/18 \\— 79.7 PROFILE AS -BUILT (NO SCALE) sig TH Benjja i Schiller C C E 2592 J..n� 28. 2.02.1. . 0 =.- v Cb -0 3 f a o— A NW03 CD °3- SCD ?_ 3-«No�' y 0 fA t A tD m m O� j 2 m O CD to 0 1 ° A N , > —( I L1.— 1< a 3- o�j o �m vo— � ° ( �° o fs v pm S CD Q Q o Z- Z N �< CD 3 m C X a 3 CD O m O 3 a� tD 3 I AajO°�A. 0 0 1 N 't to CD A Ole Z -� Q°- 1 I �`�°tea m -o CD 1� a!� a � N � o(D IT n Qa-'oo a 3 0 I - 0 0 3— to 0 _ 1 A 0 3 -fl 0 CD O -+ to f 3 1 g-3 -r 3+ tD (D tQ -.3- I , 0- =r tD i m m -► lD CD to X 1 3 3 0 0, A 0 A 3 : m m m0 I v'omCD O Q N Q to 0 0 S •o c 0 0 Q N a 0 =. a� A o3 A c Z-< — -1 —0 Cl rn� D <Smm p Q 3 til m3+• a 3 m ? p• to ,�, .r• C 3- ?' p 3 A m mCD to -. 0 m m n o 3 D S 0 O A Q-, O_ 0 C z O� \OD C) D > U) r- U m Q Q X �o / (n --4- CA r- -g U) < .. m (D �— 68A O 0 1u Ic, 10 X-,-, -- 0 ® tO CO — 0 fl 3 0 C) ;O 0ti.�. o 0 ° 3 Ln Ln to ®w NN° Iz :3�Atr—I to m (7) % D 1 C Q is t» CD I cn 0I CDX 3m OCD 1 A S 0 O 3 CD 0 a 0 o m o� D Z Oma m • p ° Oo z y q cn z: VD m is A � : I a: II C-) cli _: _ :�lQ jig ��z :N .�Q Cnl°C w Q�O�y .N g z. -� OAl a al, m X n 0 m m m 0 0 0 \OD \ / r o cfl 68A \ / N \ r o / >mMM m Wheaton Water Well, Inc. 1190 N. Wasilla-Fish hook Road Wasilla,.AK 99654 (907)376-2041 Name: Troy Davis Homes Address: 1689 S Knik Goose Bay Rd. #400 City: Wasilla State: AK Zip Code: 99654 Well Site: Sylea Lot/Block: 4 Additional: Well Depth: 161 ft. From: To: Formation: 0 44 silt/gravel/cobble Below Ground: 159 ft. 44 60 silt/gravel Above Ground: 2 ft. 60 72 sand/wet silty Gal/Min: 12 72 94 sand/gravel/wet silty 94 140 silt/gravel Static Level: 142 ft. 140 155 wet silt/gravel 155 161 gravel/water Casing: 161ft. of 6 in. x .25 in. steel Liner Pipe: N/A Screened: N/A Perforated: N/A Grouted: Yes Depth: N/A Develop. Method: Air Use of Well: Residential Drilling Method: Rotary Misc: Other: Chlorinated to 50ppm The well was pumped 5' off the bottom with 100% draw down for 2 hours and recovered at 12. Date Drilled: 6/13/2020 Driller: Ben Mattson (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW OSP201131 Date of Issue: 06/21/2021 Parcel Identification Number: 051-732-39 Legal Description SYLEA LOT 4 Pump Installation Date: 06/10/2021 Pump Intake Depth Below Top of Well Casing: 155 Pump Manufacturer's Name: GOULDS Pump Model: 7HS07412CL Pump Size 3/4 lip Pitless Adapter Burial Depth: 15 feet Pitless Adapter Manufacturer's Name: CAMPBELL Pitless Adapter Installer: Unknown Well Disinfected Upon Completion? ✓❑ Yes ❑ No Method of Disinfection: Sterilene Comments: Pump Installer Name: Wheaton Water Well, Inc. 1190 N. Wasilla-Fishhook Road Wasilla, AK 99654 feet Property Owner Name & Address: Troy Davis Homes, Inc. 1689 Knik Goose Bay Road #400 Attention: The pump installer shall provide a pump installation log ,to the DSD within 30 days of pump installation. Development Services Department Building Safety Division _ £ $G On -Site Water & Wast'ewat'er ProgramAn 4700 Elmore Road P.O. Box 196650 d� Mark Begich Anchora s a E T Y 9 e, AK 99507 Mayor www.muni.org/onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW OSP201131 Date of Issue: 06/21/2021 Parcel Identification Number: 051-732-39 Legal Description SYLEA LOT 4 Pump Installation Date: 06/10/2021 Pump Intake Depth Below Top of Well Casing: 155 Pump Manufacturer's Name: GOULDS Pump Model: 7HS07412CL Pump Size 3/4 lip Pitless Adapter Burial Depth: 15 feet Pitless Adapter Manufacturer's Name: CAMPBELL Pitless Adapter Installer: Unknown Well Disinfected Upon Completion? ✓❑ Yes ❑ No Method of Disinfection: Sterilene Comments: Pump Installer Name: Wheaton Water Well, Inc. 1190 N. Wasilla-Fishhook Road Wasilla, AK 99654 feet Property Owner Name & Address: Troy Davis Homes, Inc. 1689 Knik Goose Bay Road #400 Attention: The pump installer shall provide a pump installation log ,to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 496650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Water & Wastewater System Permit Permit Number: OSP201131 Work Type: WellSeptic Initial'. Tax Code Number: 05173239000 Site Legal Address: SYLEA LT 4 G:1459 Site Mailing Address: 22970 SHELTERING SPRUCE AVE, Chugiak Owner: TROY DAVIS HOMES INC Design Engineer: FORGE ENGINEERING This permit is for the construction of: Q Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: a�cnt S x ` �• � n llcpartmcut 6/3/2020 6/3/2021 75236 © Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing r i ' Received By: t_ Issued By: Date: --—' �— Date-, 3 !ll MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-732-39 Property owner(s) Troy Davis Homes Day phone 310-2501 Mailina address 1689 Knik Goose Bay Rd #400, Wasilla, AK 99654 Site address NHN Sheltering Spruce Avenue Chugiak, AK Legal description (Sub'd., Block & Lot) Sylea, Lot 4 Legal description (Township, Range & Section) Lot Size 75,236 Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑X Single Family (SF) ❑X (w/wo ADU) Septic Tank 19Upgrade ElDuplex (D) r-1Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑X Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: 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: (a 15• w Waiver Fees: Date of Payment:5193IZ26 Date of Payment: Receipt Number: O 3 G 5kb Receipt Number: Permit No. 03P og 6113 Waiver No. Permit App_.:-:-: COVID-19 �.5% DISCOUNT APPLIED PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) June 3, 2020 MOA Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Subject: Sylea, Lot 4 – NHN Sheltering Spruce Avenue Septic System Design Dear On-Site Services Engineer: The owner of the subject lot intends to construct a 4-bedroom home on the property. We are submitting this permit application for the construction of a new well and septic system to serve the home. The attached site plan identifies the location of the home and the proposed well, septic system and alternate site. No conflicts exist between this proposed system and any other well or septic system on this lot or adjacent lots. The ground surface at the north end of the trench is less than 1’ higher than the south end. The absorption trench remains in the SM Layer the entire length of the trench. A slope greater than 25% is within 50’ of the north end of the trench. The trench drops only 5’ then flattens. Contours and drainage arrows are shown on the site plan indicating the grade and direction of flow. Storm water drainage will not impact this septic system. The new system will be a minimum of 100’ from all wells and surface water, 10’ from any water service and more than 5’ away from the septic tank. Please refer to the attached test hole logs and plan and profile sheets for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, P.E. 6/3/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201131, Deb Wockenfuss, 06/03/20 200100 0 FEET 1"=100' NOTE: SLOPES >25% ARE WITHIN 50' OF THE SOUTH END OF THE ABSORPTION TRENCH. THE SLOPE DROPS 5' THEN FLATTENS. NO SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND TH1 SYLEA, LOT 4 6/3/20 75' ELECTRICAL TRANSMISSION LINE & DRAINAGE EASEMENT 40' WATER EASEMENT 20' ELECTRIC EASEMENT 19.6 15' UTILITY EASEMENT S H ELT E RIN G SPR U C E AVE N U E TH2 ALTERNATE SITE: CATEGORY III SYSTEM w/15' LONG x 5' WIDE x 2' EFFECTIVE DEPTH ABSORPTION TRENCH APP. RATE 6.0. 4-BDRM HOME INSTALL 1,250-GAL SEPTIC TANK w/ 20" MANWAY. 70' LONG x 5' WIDE x 2' EFFECTIVE DEPTH ABSORPTION TRENCH (MAINTAIN MIN. 10' SEPARATION FROM PROPERTY LINE AND HOUSE FOUNDATION). FCO SV MH 2CO CO MT PROPOSED WELL EXISTING WELL NOR T H WOO D S UNI T 3, BLO C K 12CO 330330330325325LOTS SERVED BY PUBLI C WATER SYS T E M WATER MAIN >10' FROM SEPTIC SYSTEM. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201131, Deb Wockenfuss, 06/03/20 TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY 6/3/20 SYLEA, LOT 4 DESIGN FACTORS: SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW PERK RATE: 1-5 MIN/IN APPLICATION RATE: 1.2 GPD/SF 5' WIDE TRENCH SYSTEM 1,250-GALLON SEPTIC TANK 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 5' 6" 6" 1.5' 2' BOTTOM OF TRENCH: 4' BELOW GRADE FLOW LINE ELEVATION: 2' BELOW GRADE TOP OF TRENCH: 6" ABOVE GRADE 600 GPD / 1.2 GPD/SF / 5' WIDE * 0.7 RED. FACTOR = 70 LF TRENCH REQUIRED (70 LF SPECIFIED) GEOTEXTILE FABRIC 2" INSULATION Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201131, Deb Wockenfuss, 06/03/20 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST TECHNICIAN: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (feet) PROJECT No.: TEST HOLE #1 SLOPE SLOPE SITE PLAN See Site Plan DATE READING GROSS TIME (minutes) NET TIME (minutes) DEPTH to WATER NET DROP TEST HOLE PRESOAKED PRIOR TO TESTING: PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH) TEST RUN BETWEEN: FT. and FT. COMMENTS: (inches)(inches) Sylae Subdivision - Lot 19A Troy Davis Homes 02/08/18 C. Johansen Development Services Department 4700 Elmore Road Anchorage, AK 99519-6650 Municipality of Anchorage DATE OF MONITORING: WAS GROUND WATER ENCOUNTERED? DEPTH OF WATER AFTER MONITORING: IF YES @ WHAT DEPTH? No 15.5' 5/28/18 3/09 1.1 6 5 6 - none original ob silty sandfill mixed 11:20/11:26 1 2 6:22 3 4 5 6 4 8 16 " - 10 8 16 " w/ organics silty clay 6 0 16" 11:27/11:34 6:30 11:35/11:42 6:30 11:43/11:50 6:33 11:51/11:58 6:44 11:59/12:06 6:44 Professional Engineers Stamp: May 10, 2019 4 8 16 " - 10 8 16 " 6 0 16" 4 8 16 " - 10 8 16 " 6 0 16" 4 8 16 " - 10 8 16 " 6 0 16" 4 8 16 " - 10 8 16 " 6 0 16" 4 8 16 " - 10 8 16 " 6 0 16" Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201131, Deb Wockenfuss, 06/03/20 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST TECHNICIAN: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (feet) PROJECT No.: TEST HOLE #2 SLOPE SLOPE SITE PLAN See Site Plan DATE READING GROSS TIME (minutes) NET TIME (minutes) DEPTH to WATER NET DROP TEST HOLE PRESOAKED PRIOR TO TESTING: PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH) TEST RUN BETWEEN: FT. and FT. COMMENTS: (inches)(inches) Sylae Subdivision - Lot 19A Troy Davis Homes 02/08/18 C. Johansen Development Services Department 4700 Elmore Road Anchorage, AK 99519-6650 Municipality of Anchorage DATE OF MONITORING: WAS GROUND WATER ENCOUNTERED? DEPTH OF WATER AFTER MONITORING: IF YES @ WHAT DEPTH? No 15.5' 5/28/18 3/09 3.3 6 4 5 - none silty sandfill mixed 12:38/12:481 2 3 4 5 6 w/ organics silty clay 3 0 16"4 8 16" - 7 8 16" 12:49/12:59 1:00/1:10 10 1:11/1:21 1:22/1:32 1:33/1:43 peat 6" ob 3 4 16"4 8 16" - 7 12 16" 10 3 8 16"4 8 16" - 8 0 16"10 10 10 10 Professional Engineers Stamp: May 10, 2019 3 0 16"4 8 16" - 7 8 16" 3 0 16"4 8 16" - 7 8 16" 3 0 16"4 8 16" - 7 8 16" Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201131, Deb Wockenfuss, 06/03/20 M U 13 V MPGGA U T Y OF /\ Il V V lJ—Cl O RA Development Services Department r' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-732-39-000 Legal description SYLEA LT 4 Expiration Date: 11/28/2023 Site address 22960 SHELTERING SPRUCE AVE Chugiak AK 99567 Current property owner(s) SPARROW SHAYNE & JESSICA X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 8/28/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist Absorption Field Advisory Tank Age Advisory Other X Well Flow Advisory Nitrate Advisory Arsenic Advisory COSA ApprovaIjune 2022 MUMUPAUTY OF AACHO R QGE 0,1 Development Services Department �` -` Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-732-39 Complete legal description Sylea Lot 4 Location (site address) 22960 Sheltering Spruce, Chugiak, AK 99567 Current property owner(s) Shayne & Jessica SparrOW Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: X Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age 1.5yrs _ See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench a Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $_ 5_'Y� Date of Payment g1 -1z3 COSA # 12_a2_ Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 Sylea Lot 4 051-732-39 3.7+ 161 N/A 161 0.268 18+ 8/9/23 Forge Engineering 133 7/25/23 48" 7/24/23 12/11/20 5.1 3.4 N/A N/A N/A 8/9/23 1440 > 600 48 Benjamin Schiller, P.E.8/11/23 (907) 522-7773 4: ;&0 4 a aGJ• �. op o° �o:2app0; N L— 04: ZO U Lon) VA�; I y D W O) ° a ° Y N m= O °+ a c o m m °m m m o m O C O > « C t vL om n " ° ° I O w�U G jl o m a: m jl L >O O.m= o a m o c c v o m 0 m I cetc - EL j tO + O ° O ° ° ° ` cli LLL I w CC O` 0 0 m W 3 N Z mFyOTO+ TgNc?�a o x m N Z 0 m O U, c C L L T O >y� 00.Ot L O Q L m C .m c+m��`I :3 a•= c :E 0. del TW p tLncc Eccc m ° m m > ° t ° L ° N N C L H + 0. y m mococE`E t m J U:E v m N L °m a 3 c a o MUNICIPALITY OF Q Development Services Department On -Site Water & Wastewater Section Certificate of On -Site Systems Approval Parcel I.D. 051-732-39 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: 10 ^ Cj— Z / Complete legal description Sylea Sub, Lot 4 Location (Site address) 22960 Sheltering Spruce Avenue, Chugiak, AK Current property owner(s) Troy Davis Homes Day phone 310-2501 Mailing address Real estate agent 1689 Knik Goose Bay Rd #400, Wasilla, AK 99654 2. TYPE OF DWELLING: ■❑ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic ❑E 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$ ��` �7 Waiver Fee $ Date of Payment 7-1— Z 1 Date of Payment Receipt Number o3 N yQ �I% Receipt Number COSA # SSC Z i l 3 Cc>3 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 Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller Date 6/28/21 °F A4.q�ll TH 6. DSD SIGNATURE � .. .71 System #1 Approved for bedrooms/ Benjarr%V chiller System #2 Approved for bedrooms CE 12592 w Disapproved }l�lPROFESSIC0 Conditional approval for bedrooms, with the following stipulations: ll(«((f ONS yo' o�O �.� G� R Original Certificate Date: 7— q — 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 Legal Description Sylea Sub, Lot 4 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑® Well log is filed with Onsite (or attached) Date drilled 6/13/20 Total depth 161 ft Cased to 161 ft ❑® Sanitary seal is functioning correctly Fm -1 Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 6/13/20 Static water level at beginning of test 142 ft Comments B. TANK DATA Age of tank(s) <1 years Tank type/material Plastic Measured operating fluid level in septic tank N/A ❑® Standpipes/foundation cleanout per record drawing Date of pumping Installed on 12/10/20 D. ABSORPTION FIELD DATA Wide Trench Which system tested (date installed) 12/11/20 ❑Q ALL standpipes present per record drawing Total measured depth from grade 5.9 ft (max) Measured depth to pipe invert from grade 3.9 ft (min) ❑ N/A — pressurized field FE -1 Monitor tubes go to bottom of effective. If not, state depth into effective FIC Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 051-732-39 Structure served by this system Well production at time of test 12 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 6/24/21 C. T STATION ❑ Require intenance completed Age of lift station ears Lift station material Comments: dequacy test date Res FJ Pass For bedrooms Fluid depth or to test in Water added al New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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 Q Yes if No Neighboring Tank > 100' Fv-1 Yes if No ft Private Sewer/Septic Line > 25' El Yes if No Absorption Field on Lot > 100' Fv-1 Yes if No ft Holding Tank > 100' Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Yes if No 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Fv� Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 21 Yes if No ft Surface Water > 100' Property Line > 5' F,71 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' ft ft ft ft ft Yes if No ft Q Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' 21 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' ED Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' Fv-1 Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' F,71 Yes if No ft Community Wells > 200' 0 Yes if No Surface Water > 100' El Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet OF A�'-.qs� �41911 ► �r (� Benjarri 418chiller �� �Fc •. CE 12592 • �`�.�� �� ��'j��• . 6/28/21 . PROFESS QON ft ft