HomeMy WebLinkAboutWARD LT 6Ward
Lot 6
#011-122-85
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507 Page of
www.cl.anchorage.ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SW060307
PID Number. 011-122-85
M� Sharon Graytrdx
Wastewater System: ❑ New ❑ Upgrade
AO>,M•.
1327W. 27th Avenue, Suite 100 Anchorage, AK 99503
ABSORPTION FIELD
Poor,. 229.3048
5
O D@*P Trrrm O Sw Tw d Dew O Man• O o1w
LEGAL DESCRIPTION
Scmi a
1.0
Tar o.w mvno 1t W109
GpoFe
Ft,
9rx Loc 6 SICM1wwat
Ward
DWM M PAF• m Ran OWW W
w
10 aPm Cuw•m pw:
4 Ft.
7 Ft
T••nr.pR"
s.rart
fa aa.• mn onp,Ml p•w-
GrM lrgm:
2-3 Ft.
54 FI.
Well: ❑ New
❑ Upgrade
Gr„.I,wam:
ra Cg lomat:
1
Dwwro •rwwlMw:
I
5 Ft.
n
Cw.Mrnaoor, (ftv b, A & C):
T•W DOM.
G.•• W:
Trr raapmn MM
Pp• MMIFMI
AWWU
Ft.
n
756 Fe
ASTM D3034 PVC
Dnar
D• a Drwal.
st•uc Vmw U .
•IMrwr
0.w w .
Ft
Poor Boy Construction
5125-30.2007
roma:
Pero SMa
C•Mrp twpnAoow Cw•wla
TANK
GPM
rt
n
SEPARATION DISTANCES
0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
Septic
Absorption
LM
Holding
utxrlPrnnca
'
From
Tank
Field
Staeon
Tank
Stover Une
Anchorage Tank
11.500 Gr.
M•WW
ro aConwmrw.
vwr
N/A
NIA
N/A
NIA
NIA
Steel
TWO
s,e•nwr.r
>100'
>100'
WA
N/A
LIFT STATION
LN un•
>5'
>IV
N/A
N/A
cr
'PMro an M.M r
'Poop •T M.. x
My, w•wr rrm •t
Fw•q•uml
>s
>10'
N/A
NIA„
cuunt>•M
None
Noted
Pura Mae • M••M
EW Inp•mww Pvnxnw q
RMrIMIw'
BENCH MARK
tonwn ra D•ecrve n .
Garage Slab
100.00 FL
F
Inspections performed by: A. Harala
Oates: 19 5/25107
���� OF A �1
z"° 5/26ro7
��p,.•
Development Services Department Approval
49M
*
Conditional Approval
Date:
/ : E ANDOt50N:
>A MICHAEL
� '' � CE 4381 • `'•
.r
Reviewed and approved by: JaMMI&FAA1
Date:
ROFES
pM am)
it
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904
Permit Number. SWO60307
PENNY ROSE
CIRCLE A1'11�15' GAS EASMDrr
LOT 7
A
si 10.7 saw
S2 19W 545'
5 59 T 47
C4 112.1- 727
Sit.
M7 105.5' 69.9'
LOT 5
M1
TM� \ S \.)S1
Five Bedroom
Home
Page 2 of 3
PID No. 011-122-85
I
b.a.mtl
LOT 6
/
/ I
\
6oo
I
4 a � � p 11 f 0' Uillitt EASE]IENi
49th S 89'52'00' W 118.56'
%% Nocr�;y PLAN AS—BUILT
•h_ �•^•»[Y.��61._.• SCALE 1' = 40'
LOT 7
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage. AK. 99519-6655 - 343-7904
Onsite Wastewater Disposal System or Well Inspection Report
Permit Number. SWO60307
PID No. 011-122-85
M
98.6
96.0
rr..n.a Gna.
Ed•6na Glade -
Geot xtile Fabric
Drainfield Rock
91.95k \
85.0
76.9 54 (Trench Length)
No Groundwater
PROFILE AS -BUILT -
No Scale
92.0
MUNICIPALITY OF ANCHORAGE
Development Services Department
Onsite Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Permit Number: SWO60307
Legal Description: WARD LOT 6
Design Engineer: 0014 ANDERSON ENGINEERING
Owner Name: SHARON GRATRIX
Owner Address: 1327 WEST 27TH AVENUE
ANCHORAGE. AK 99503 -
I�'�z
/[A I T'51
63916,
Date Issued: Sep 21, 2006
Expiration Date: Sep 21, 2007
Parcel ID: 011-122-85
Site Address: NHN PENNY ROSE CIRCLE
Lot Size: 45681 SQ. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit Is for the construction of:
R Disposal Field Q Septic Tank Holding Tank ❑ Privy Private Well El 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.
5. The following special provisions.
THE ENGINEER IS TO CONFIRM THAT THE WATER LINES 10' AWAY. -:t
Received By.
Issued By:
r�Pjl L+ AL
al } U — ------I Date:
O
Date:
Municipality of Anchorage
Development Services Department
~ : Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www.muni.org/onsite
(907) 343-7904
Parcel I.D.
ON-SITE SEWERMIELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
nil -122-85
Property ovmer(s) Sharon Gratrix Day phone
99503
Mailing address 1327 West 27th Avenue Anchorage, AK Zip Code
Site address Penny Rose Circle Anchorage, AK Zip Code .
Legal description (Sub'd., Block & Lot) Lot 6, N
Legal description (Township, Range & Section)
Lot Size 45,681 Sq. Ft.
THIS APPLICATION IS FOR (® all that apply):
Absorption Field F-1
Septic Tank 2
Holding Tank ❑
Privy ❑
Private Well ❑
Water Storage ❑
Number of Bedrooms Five
THIS APPLICATION IS AN:
Initial
I]
Upgrade
❑
Renewal
❑
certify that the above information is correct. I further certify that this application is being lade for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: f LKLo Waiver Fees:
Date of Payment: 81 &fD to (aL�� Date of Payment:
Receipt Number. 95*1 Receipt Number.
(Rev. 11105)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
MEMORANDUM
DATE: September 19, 2006
TO: Deb Wockenfuss
FROM: Mike Anderson, P.E.
SUBJECT: Lot 6, Ward Subdivision
Septic System Construction Permit
We have revised the septic system design for Lot 6, Ward Subdivision for an
application rate of 1.0 Gallons per Square Foot per Day which resulted in a trench 54'
long x 3' wide x 7' effective depth. The attached site plan and back up documentation
have been changed to reflect the modification. A note has also been added Ito the
plans requiring an inspection of the water service line to verify a minimum separation of
10' from the new absorption trench.
The side yard drainage easement is provided to allow access of surface runoff from the
cul-de-sac to the settlement pond/absorption area at the back of the lot. It tallows
access to the area for cleaning and maintenance. It also allows area for overland flow
of runoff should it ever develop. The porosity of the soil in the area is such than no
surface water accumulates in the easement. None has been noted since the
development of the subdivision. Surface water has been seen in the pond area at the
back of the lot, but the new septic system is more than 100' from this water.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
September 14, 2006
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 6, Ward Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 6, Ward Subdivision intends to construct a new five -bedroom (home
on the lot. We are therefore requesting a permit be issued for the construction of a new
septic system to accommodate the home. The subdivision is currently served by the
AWWU water system. The attached Site Plan and backup documentation identify the
location and configuration of the proposed septic system along with the alternate site.
Also identified on the plans are the existing water service on the lot and those on
surrounding lots. This is a new subdivision and the second lot to be developed. No
conflicts exist between the proposed septic system and wells or septic systems on
adjacent lots. Contour lines are shown indicating the surface slope of the property in
the area of the new septic system.
Two test holes were placed on the lot in the area of the absorption trench and alternate
site. Additional tests were placed on the lot during the subdivision phase and all
indicated a poor to well graded sand (SW/SP) material with some sand. The
percolation rate of the soil was determined to be less than 1 minute per inch. No
groundwater was found during the placement of the test holes, and was not noted
during the monitoring period. An application rate of 1.0 gallons per day per square foot
was used in the design of the absorption system. We are proposing to placeia new
1,500 -gallon septic tank and a 54' long by 3' wide by 7' effective depth absorption
trench to treat and dispose of the effluent generated in the house. The elevatiori of the
distribution line in the absorption trench will be 4' below the surface and the total depth
will be 10'. A minimum of 3' of fill will be placed over the absorption trench and 4' over
the septic tank.
The ground surface on the lot in the area of the septic system slopes to the
Lot 6, Ward Subdivision
September 14, 2006
Page Two
The new trench will be constructed parallel with the slope as much as possible in
conformance with Municipal requirements. The new septic system will be constructed a
minimum of 100' from all wells and any surface water and 10' the proposed and existing
water services in the area. I
If the system is constructed in accordance with our design the following
apply:
1. The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on d
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
'-r �1fi i
'! 49;h !\ 4
V C`IAE. E ANDERSON
4 NO. CE -4381
Hanks Subdivision
�1
I
I
I
I
150' I
I I
10' T&E Esmt—
0' Utility Esmt
Ratclifflp Subdivision
3
1 2
AREA PLAN
SCALE V = 100'
Im
4
M
VACANT
us
Lot 6
45,681 g
sq.ft. N
c
__
...............
�•441
�'�
•
49th•�`
VACANT
I
I
A :,MICHAEL E. ANDERSON
N
o
I
4
�
w
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c
Lot 1
4
;}
10
r'
40,168 o
i=
o
sq.ft.
N
Lot 2
jC
m
40,262
� x
sq.ft.
1�
S00'1,3 36'E
IZ7
49.97'
IM
114.01'
134.00'
Id
1
249.83'n
PENWf
1.
--� S89'51'10'W 329.76'—'n
---CIRCLE
ROSE
I0
249.69'
113.95
134.00_
00' 13'36'E C2
I•
50.03'
15'
Gas Esmt
I
I
1
I
10' T&E Esmt
Drainagc�
`P.
oR
Esmt
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uo
0
R
rn
fid.
Lot 9 w
u
Lot 8
u
g
Lot 7
j
ri
40,155 °�
N
40,250
oo
w
42,134
sq.ft.
"
sq.ft.
nAi
sq.ft.
I
I
I
I
150' I
I I
10' T&E Esmt—
0' Utility Esmt
Ratclifflp Subdivision
3
1 2
AREA PLAN
SCALE V = 100'
Im
4
M
VACANT
us
Lot 6
45,681 g
sq.ft. N
c
__
...............
�•441
�'�
•
49th•�`
...............
...s..._,
A :,MICHAEL E. ANDERSON
PENNY
ROSE
CIRCLE
►�'
WARD SUBDIVISION
LOT 6
45.681 S.F.
\\ 54' Long 3' Wide
x 7-
Neet a Depth
\\ TH3
\ ® Absorption rench
4' Insulation Over
\ \
Line Under Pavement
\\\ Alternate Site TH
s�6•
\\\ AC Pavement
1, 00 Callon
Septic Tank
+�
Five
I
\
Bedroom
\
\\
Home
I
\
I
\
I
a a
NOTE: Water Service Line Placement
• Must be Inspected to Verity
10' Separation From Absorption Trenches. \\�
gj �o
I o
\i.
I
Drainage
Easemen
g 49t�0`—Uti qty Easenseni
;MICHAEL r ANDERSON
..... SITE PLAN -
0,,111 %
LAN0,111 % SCALE V = 40'
LOT 6, WARD SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Five Bedroom Home Deep Trench System
Pero. Rate: <1 Min./inch 1,500 Gallon Septic Tank
Application Rate: 1.0 GPD/SF 7' Drainfield Rock
5 Bedrooms X 150 GPD/1.0 GPD/SF (Application Rate) = 750 SF Absorption Area
750 SF/14 SF/LF = 53.6 LF Trench Length
THEREFORE: Construct a 54' Long x 3' Wide x 7' Effective Depth Aborption Trench at the
Location Shown. Flow Line Elevation in Trench to be 4' Below Original Ground Surface. Total Depth
to be 11' Below Existing Ground. Provide 3' of Cover Over Trench and 4' Over Tank or Provide
2" of Insulation and 2' of Cover. Maintain 10' Separation From Water Services in the Area.
Natural
Backfill
3'6"
Geotextile
Fabric
6" 4" Perforated
PVC (Holes Down)
Drainfield Rock
3'
'ICAL DEEP TR
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock-
Minimum
edrockMinimum 4' Separation From Groundwater.
Minimum 100' Separation From Private Wells in the Area.
Minimum 1 00'Separation From Surface Water or Streams.
Minimum 10' Separation From Water Service Line.
IDF
«" ".E;e--....C4 �iaei
Municipality of Anchorage r,`•iENCiNEEF%A� 1 1;+0
Development Services Department 1�'* $91H �r a; ';* �j
BUEding Safety Of0sion „ J ' ��.... •.,�f
• �d On•SIIe Water and Wastewater Program r �i ��
47DO South Bragaw SL V ••••,••'•••• ...............0
P.O. Box 196650 Anchorage, AK 99519.6650 d' �.
ngrw.d.enchoraae ek-rn �iy •. CE- 43
(907)343-7904 + B'frt'-.9-I-t.aff. '�• ,`'•
I. �g'rfo ...j••;;:. p;•.
Soils Log - Percolation Test
Performed For. , . Slim rl.,j 6 nA •r&(x Date Perfonn4d:�111 f [f (e
Legal Description: .�v r (,�+ W/t1tri 'steer b,' . Tom.sNfp, Range, Sectlon: .
Slope Sue Plan
Depth .
(Feet)
o
/ N N
O ' '
f I O
WAS GROUND WATER -�
' ENCOUNTERED?
10 s r
' ffYES, AT WHAT DEPTH? s
11-
Depth to W" After Monitorinal E I .
12- Date:
13-
14- ' Reading Data Gross Time. Net Time Depth to Water I Net Drop
15-
16-
17
20-
PERCOLATION RATE 0*1"Aft" PERC HOLE DW.LETER (i ^
TESTRUNSETWEEN S FT -AND 6e FT I .
COMMENTS_ /KS 1410,1111 j 1441-�/FNGiI, l t.Vs�%�_1:�crn�4—, sem. _A. 1_ _
PERFORMED BY: � t :CERTIFY THAT THIS TESTI WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND. MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: I '
i
a OF �C
Municipality of Anchorage •. � �'�7ENG'IF�EIErrs`$If,• -
Development Services Department
• •tir DMsiDn
On•SfleWaleriSafety
ndWaitnvalerP 4911JiS- O4
Program p.. ....... yf"•;"".�
4700 South Brapew SL ��.r1 �
P.O. Box 196650 Anchorage, AK 99519650 .,y •....
Www. el anchorage •M us A :lAIp1AEL E. ANCEREON � ,' 0 .
(907) 343-7904 CE- 31
Soils Log - Percolation Test
� f'
PepROFESII�
domiedFor. 5f A(LwJ G��al 2l :"..-•.. 1,
K Dale PeAotm'ed:
Legal Desalptlon: T (p��js-r ? sV�i b TownshFj, Range, Section:
SE—f'T"f—I She Plan
I o
�U r7f�
W
0
WASGROUNDWATER
' ENCOUNTERED)
7 YES, AT WHAT DEPTH?s _ O
Depth to West Attar ••��
MgnnorMp7 ryy ytf E
Dale.
Reading
. Date 'Gross Time.
Net Time
Depth to Water
Net Drop
9-il cc z: io
•
i'
!
9.7s'
s
27 zl
9. S, I
2231
'-to
7- .14?
bay I
yl s,.
PERCOLATION RATE < IIa+w.A+ee PERC HOLE DIAMETER
TEST RUN BETWEEN 'S F7 FANO(� FT
COMMENTS -
PERFORMED BY: • t CERTIFY THAT THIS TEST WAS
• PERFORMED IN Af;CORDANCE WITH ALL STATE AND. MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT/BUILDING SAFETY DIVISION
ON-SITE WATER AND WASTEWATER PROGRAM
4700 SOUTH BRAGAW ANCHORAGE, AK 99519
PROJECT #: SOILS LOG - PERCOLATION TEST
PERFORMED FOR: LanTech.Inc. DATE P
LEGAL DESCRIPTION:
2
3
4
5
6
7
„L
8
9
10
12 '.� .
14-
15-
16-
17
4 15 16 17
18 '
TEST HOLE # 11 SLOPE
OG
OL --
Brown and Orange
SM/SP/SW
Sloughing Sidewalls
-S% Silt
BOH 19'
- 0,
u7 491,11
WAS GROUNDWATER
ENCOUNTERED? NO
S
NET
TIME
L
IF YES, WHAT DEPTH?
0
DEPTH OF WATER None
P
AFTER MONITORING:
E
DATE: 2/28/2005
10:27
SITE PLAN
Ar
See Site Plan
See Site Plan
2/16/05
READING DATE
GROSS
TIME
NET
TIME
DEPTH TO
WATER
NET
DROP
Start 2/17
10:17
6.88-
1
10:27
10
Dr
.10 -
Recharge
10:28
6.88-
2
10:38
10
Dr
.10'
Recharge
10:39
6.88-
3
10:49
10
Dry,
.1
I
I
I
PERC RATE: -1 MIN./INCH PERC. HOLE DIAMETER:
TEST RUN BETWEEN--2.3—FT. AND 4.5 FT,
COMMENTS: Test Hole Pre Soaked Prior to Percolation Test.
TEST PERFORMED BY: AH I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: I 2/28/2005
_ I
I
I
2
3
4
5
6
7
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT/BUILDING SAFETY DIVISIC
ON-SITE WATER AND WASTEWATER PROGRAM
4700 SOUTH BRAGAW ANCHORAGE, AK 99519
PROJECT #: SOILS LOG - PERCOLATION TEST
PERFORMED FOR: LanTech. Inc. DATE
LEGAL DESCRIPTION: Lot 6 Johnston Subdivision I
TEST HOLE # 12
's
OL
Brown and Orange
SM/SP/SW
Sloughing Sidewalls
.5% Sitt
WAS GROUNDWATER
ENCOUNTERED? NO S
L
IF YES, WHAT DEPTH? 0
DEPTH OF WATER None P
AFTER MONITORING: E
DATE: 2/28/2005
{' 49th ••�}
Mous L AWDMs
17 .a,,i
1$ BOH 18'
COMMENTS: Test
2/17/05
• READING DATE
GROSS
TIME
NET
TIME
DEPTH TO
•WATER
NET
DROP
Start 2/18
10:52
6.88- .
1
11:02
10
Dr
.10 -
Recharge
11:03
6.88-
2
11:13
10
Dr
.10 -
Recharge
11:14
6.88'
3
11:24
10
Dry
.1
I
I
"
I
PERC RATE: =1 MIN./INCH PERC. HOLE
TEST RLN BETWEEN 4.0 FT. AND 5.0 T.
TEST PERFORMED BY: AH I, MICHAEL . ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: I 2/28/2005
UNICI AL.ITY 'OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section �__... F - -
Fax: 907 343 7997
Parcel 1. D. 011-122-85
Certificate of On -Site Systems Approval
Expiration Date: 2 - 2!; —2-0 Z(
1. GENERAL INFORMATION
Complete legal description WARD LT 6
Location (site address) 6966 PENNY ROSE CIR ANCH, AK
Current property owner(s)
Mailing address
Real estate agent
SHARON GRATRIX
W."I TA W
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY:
Private Well10
Water Storage
❑
Community Well
❑.
Public Water System
❑
Day phone
Day phone
TYPE O
G ep ';�8g
P �
Q din
orf}�ny ZQa
C4 ublic Sev co
TER DISPOSAL:
Waiver request for: 6' `.,Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 560 Waiver Fee $
Date of Payment 31 Llla��o �v Date of Payment
Receipt Number rX If -9 Receipt Number
COSA # (J"S("9610?�A 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 MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE ANCH AK
Engineer's Printed Name MIKE N ANDERSON, P.E. Date 3-4-20
�tf> a a o° a c° o � �•, �l 1
6. DSD SIGNATURE
5�,° o 0000`o 0 000° 00000^'' f/�
System #1 Approved for bedrooms >
S'? o MICHAEL N. ANDERSON
System #2 Approved for bedrooms ` ",`.` ��° CE - 94
Disapproved t °
Conditional approval for bedrooms, with the following stipulation:
S Q I C, J r s v C>!—"
By: �'`"- Original Certificate Date:
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
COSA Checklist
Legal Description: WARD LT 6
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth ft
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Comments
B. TANK DATA
Age of tank(s) 13 years
Tank type/material steel
Measured operating fluid level in septic tank 48
FO -1 Standpipes/foundation cleanout per record drawing
Date of pumping 2/25/20
D. ABSORPTION FIELD DATA
Which system tested (date installed) 5/25/07
V ALL standpipes present per record drawing
Total measured depth from grade 13.2 ft (max)
Measured depth to pipe invert from grade 6.2 ft (min)
❑ N/A — pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective
Parcel ID: 011-122-85
Structure served by this system
Well production at time of test 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 _
Date of Sample
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 2/25/20
Results ❑✓ Pass For 5 bedrooms
Fluid depth prior to test 36 in
Water added 750+ gal
New depth 42 in
Elapsed time 1440 min
• Code -required soil cover over field Final fluid depth 36 in
❑o System presoaked Absorption rate 750+ 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:
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'
❑ Yes
if No
ft
❑ Yes
if No ft
Neighboring Tank > 100' ❑ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No ft
Absorption Field on Lot > 100' ❑ 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
❑ Yes
if No
ft
✓❑ Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main > 75' ❑ Yes
if No
ft
❑ 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'
0 Yes if No ft
Property Line > 5'
❑✓
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'
0
Yes
if No
ft
Community Wells > 200'
✓❑ Yes if No ft
Water Service Line > 10'
❑✓
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'
✓❑
Yes
if No
ft
Private Wells > 100' Q Yes if No ft
Water Service Line > 10'
Q
Yes
if No
ft
Community Wells > 200' 0 Yes if No ft
Surface Water > 100'✓❑
Yes
if No
ft
F. ENGINEER'S COMMENTS
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
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