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HomeMy WebLinkAboutHULSE #1 LT 9Hulse #1 Lot 9 #050-521-30 Municipality of Anchorage On -Site Water and Wastewater Program - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191022 PID Number: 050-521-30 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: ARTHUR & APRIL HENDERSON ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 8105 MARY ESTHER DRIVE, EAGLE RIVER ❑ Other PhoneNumber of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot H U LSE #1 9 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines - Ft. SEPARATION DISTANCES Toll Septic Absorption j H.ldng7 Lift Station j Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 -- -- Ft. Well1100'+ i l NA NA NA NA TANK ® Septic ElS.T.E.P. ElHolding El Other Manufacturer ANCHORAGE TANK Capacity 1000 Gal. Surface Water 100'+ NA NA NA Material STEEL Number of compartments 2 ( Lot Line ( 5'+ 1 NA NA NA NA Foundation 10'+ NA NA NA LIFT STATION Manufacturer Capacity Gal. Curtain Drain NA NA NA NA Remarks Existing septic tank decommissioned Pump on level at in. Pump off level at in. High water alarm at in. per UPC, new deep -burial tank installed & reconnected to existing field. Pump make and model Electrical Inspections performed by Installer NORTHERN EXCAVATION PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection�s, 8/2/19 8/2/2019 Location and description dates: Zo 3rd 4`° BOTTOM OF SIDING COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL OF 4Z,4 ,4 ............ Conditional Approval: Date cC, *491H MICHAEL N. ANDERSON: No. CE 9469 9/14/1.9 Approved ` Date 16--lg-�ssto�� ING WALLS BALCONY CONCRETE PATIO BELOW as A 0 B Co Co ® C NEW 1000—GAL Co CO3CO3* D SEPTIC TANK I Lot 9 2�i EXISTING TRENCH/ SUMP 35,666 s.f. PID: 050-521-30 PERMIT OSP191022 14.9' 1, V1, 0 0 O cl-,J 3: 0 Tract 1 �q 0 0 b 0 U� -.;,-1 (1' I ITII IT` — — ----------------- — -------- - D 0 ELEKT LLC OF AZ4 00 .5 49TH* 4, Michael N. Anderson, P. E. MICHAEL N. ANDERSON' Na CE 9489 O 0 P40PESSIoO' .or MUNICIPALITY 0__F ANCHORAGE �0„ �x ,l ervices Department \ ��% Phone Wastewater Section Fax Certificate of On -Site Systems Approval Parcel I. D. 050-521-30 1. GENERAL INFORMATION Complete legal description HULSE #1 LOT 9 Expiration Date: Location (site address) 8105 MARY ESTHER DRIVE EAGLE RIVER AK 99577 Current property owner(s) ARTHUR & APRIL HENDERSON Day phone Mailing address Real estate agent 8105 MARY ESTHER DRIVE EAGLE RIVER AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Private Septic Private Well ® Holding Tank ❑ Water Storage ❑ Community ❑ Community Well ❑ Public Sewer ❑ Public Water System ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number COSA # Waiver # MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP191022 Work Type: SepticTank Upgrade Tax Code Number: 05052130000 Site Legal Address: HULSE #1 LT 9 G:0263 Site Mailing Address: 8127 MARY ESTHER DR, Eagle River Owner: ELEKT LLC Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft Total Bedrooms: ,>»ent S' DeI)ai-tnient 2/5/2019 2/5/2020 44867 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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 Received By: Date: Issued By: %�Q �tif 'R Q Date: 02 S 3 A U TV OF 1 HCHOO R GE C' 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. 050-521-30 Property owner(s) ELEKT LLC Day phone 907-854-6642 Mailing address 2191 WEST RIDGEWOOD DRIVE, WASILLA, AK 99654 Site address 8105 MARY ESTHER DRIVE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block &Lot) HULSE #1 LOT 9 Legal description (Township, Range & Section) Lot Size 44,867 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank M Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVE FOR: P Distance: certify that the above information is correct. I furthe �rtify th�t;is,r ;'n ' ordance with applicable Municipal Codes.CP ti 19 S�i:ZLY,d (S. (Sf roperty owner or authorized agent) T�w Permit/Rush Fees: / Date of Payment: .9l [l? Receipt Number:g619® Permit No. 0t) PIgl0'qa Permit App_9-1-12.doc Waiver Fees: Aq0 Date of Payment: 112%! l/9 Receipt Number: ' 3Z Waiver No. 05C l q Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 February 1, 2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New Septic Tank Permit & Conditional COSA Legal: HULSE #1 LOT 9 The owner has requested we proceed forward to obtain a septic permit to upgrade the aged septic tank on the subject lot. The proposed upgrade will serve the existing 3 - bedroom house. We are requesting a Conditional COSA with this submittal due to the icy and slope conditions at this time. There are no public safety or health risks while waiting for the install, which install will be completed by May 15, 2019. The lot and area is served by private water and this system will not impact any of the neighboring properties due to the lot layout. Please contact me if you have any questions. Sincerely, k" Michael N. Anderson, P.E. DESIGN CRITERIAi DECOMMISSION EXISTING SEPTIC TANK PER CODE, INSTALL NEW 1000—GAL SEPTIC TANK 10** FROM FOUNDATION, 5' TO FIELD & MAINTAIN OTHER REQUIRED SETBACKS TO WELLS, PROPERTY LINES,—, INSTALL DOUBLE POST—TANK CLEANOUTS, INSULATE IF <4* OF COVER, COMPACT SOILS AT CONNECTIONS & USE PROPER BEDDING IF NEEDED, Septic Design Prepared for ELEKT LLC HULSE #1 LOT 9 8105 MARY ESTHER DRIVE, Eagle River, Alaska 000, P.E. � DATE: 2/1/19 100' 0 CT, WELL IN1w In %, y BALCONY w/ CONCRETE PATIO 14.9'_ � 0 ycc'` oohBELOW .0. (9 & MAINTAIN 10' TO FOUNDATION & C! 0 5' TO FIELD. CO 0 Tract 1 ECOMM SION EXISTING 'r 0 SE IC TANK INSTALL NEW 1000 -GAL SE TICTANK ERCODE W1 D BLE PO -TANK COs. Lot 9 (n 35,666 s.f. 10' UTILITY EASEMENTS Septic Design Prepared for ELEKT LLC HULSE #1 LOT 9 8105 MARY ESTHER DRIVE, Eagle River, Alaska Michael N. Anderson, P.E. � DATE: 2/1/19 4601 NGtrone Ave. DRAWN: FWCS Anchorage, Alaska 99516 (907)727 8864/FAX: (907)345 1391 SCALE: 1 50' -dd1P:ft-'ft"k N C *.49T.. t.1flCHAEL N. ANDERSOK ' N0*7 9469 f - - ) ; 4o;zsslo �' -'w- OWNER OF LAND: Elekt LLC ADDRESS: LEGAL DESCRIPTION Hulse #1 Lot 9 DATE: 11-22-16 PERMIT NUMBER: OSP161304 DATE OF ISSUE: 11-2-16 TAX IDENTIFICATION NUMBER 05052130000 Is well located at approved permit location: ❑Yes ❑No Method of Drilling: Mair rotary ❑cable tool Depth of Well: 240' Casing Type: Steel Wall thickness .250 inches Diameter: 6 inches, depth 44 feet Liner type Static Water Level: 60 feet Recovery Rate 6 ® gpm ❑ gph Method of Testing Air Well Intake Opening Type: ❑ open end ®open hole ❑ Screened Start feet Stopped ❑ Perforations Start feet Stopped Grout Type: Bentonite Volume: 50lbs Depth: from 2 feet, to 42 feet Well Disinfected Upon Completion: ❑yes Ono Method of Disinfection: Chlorine 50 PPM Comments: MOA Surface Casine for Shallow Bedrock Bore Hole Data Depth From To 0 2 Casing Stickup 2 4 Overburden 4 14 Silt Sand & Gravel w/ Cobbles 14 109 Bedrock Gray 109 180 Bedrock Gray w/ Quartz 180 207 Bedrock Gray 207 240 Bedrock Gray w/ Quartz 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. Legal Description Hulse #1 Lot 9 Pump Installation Date: 11-6-18 Pump Intake Depth Below Top of Well Casing: 170 Pump manufacturer's Name: F&W Pump Model: 4F11P07301S Pump Size: 3/4 Pitless Adapter Burial Depth: 10 Pitless Adapter Installer: Northern Excavation Disinfected Upon Completion? ® yes ❑ no Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer: Martinson 11 Pump Installers Name: Sullivan Water Wells Property Owner Name & Address Viktor Fendich — Elekt LLC feet hp feet Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. On -Site Water System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP161304 Tax Code Number: 05052130000 Work Type: Well Initial Permit Effective Dates: November 02, 2016 Design Engineer: Subdivision: HULSE #1 Site Legal Address Owner/Address: Site Mailing Address: HULSE #1 LT 9 G:0263 to November 02, 2017 ELEKT LLC 2191 WEST RIDGEWOOD DR WASILLA AK 996540000 8127 MARY ESTHER DR, Eagle River This permit is for the construction of: N Disposal Field N Septic Tank N Holding Tank N Privy Lot Size in Sq Ft: Total Bedrooms: Y Private Well N Water Storage epartIII cnr 44867 3 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received B Issued By: MUNICIPALITY OF o Community Development Department ) Development Services Division On -Site Water & Wastewater Program ANCH®ISA GE� 3 wy ON-SITE SEWERIWELL PERMIT APPLICATION Parcel I.D. O`�'v— S2 — � O—oo 0 -343-7904 -343-7997 Property owner(s) _ k V 1 11 e Day phone _ �y 4• b C y 2 Mailing address. thjj t•fi1o"Ilan✓' J I/cupf 01? , /47� 45 Cos `/ Site address�1�1 Legal description (Sub'd., Block & Lot) I�U15LL --*-I Lo-}- q Legal description (Township, Range & Section) S vi o.1l7-3 Lot Size t-F�-i I Q, � Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial Single Family (SF) Septic Tank ❑ Upgrade ❑ (w/wo ADU) ❑ ❑ Holding Tank ❑ Renewal Duplex (D) Multiple Dwellings Privy F-1 ❑ (SF and/or D) Private Well 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) - Q1s t I "at Kl 1 k Permit/Rush Fees: 5qq — Waiver Fees: Date of Payment: toI O r b ck ?P,%te of Payment.- Receipt ayment:Receipt Number: 7CAOC>l 1 Receipt Number: Permit No. Waiver No. Permit App_9-1-12.doc R=50.00' L=36.13' App Fz3 � ROk/'�ATFOR/�ewAy 7\ � LEGEND POWER POLE W/ANCHOR ❑ MEA PEDESTAL - Q EXISTING SEPTIC PIPES PROPOSED WELL • FOUND 5/8" REBAR NOTES: 1. SEE PLAT NOTES IF APPLICABLE. 2. THIS IS A SITE PLAN ONLY. LOT 15 m PROPOSED, TWO STORY`/ FRAME W/ GARAGE 1\ tT A I• 15.0'*_ T am O LOT 0M pRF( ssss8ao �lJ Se�VO WAR= j7 = 847 W. Evergreen Ave. Palmer, Alaska 99645 �___ _ _ Phone (907)745-1110 I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: LOT 9 HULSE SUBDIVISION PLAT NO. 13-112 PALMER RECORDING DISTRICT, AND THERE ARE NO ENCROACHMENTS VISIBLE AT THE TIME OF THIS SURVEY, EXCEPT AS INDICATED. DATED THIS DAY OF 20 AT PALMER, ALASKA. IT IS THE RESPONSIBILITY OF THE OWNERS OR BUILDERS TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOTAPPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR ESTABLISHING BOUNDARY OR FENCE LINES. THIS IS NOT A LOT CORNER SURVEY. JOB NO, 16-148 CLIENT FIELD BOOK/PG(S). KALE 60 FVIn PLOTPLAN X ASBUILT MAP DRAWN raverse PC Ic� A � L,,o4 h'o �L7SA vj-e I• N1 T-2-� A-4-L�  "~ MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE MAILING ADDRESS , ,, 7 ,,,tlc LEGAL DESCRIPTION LOCATIQN a Well ~ ~t~ ~ Absorpt on area Material ~z / Manufacturer ~ ~L[ q. capac/~ ~tY in gallons ~[ IF HOMEMADE: Inside ength W dth ~_ ~ We l ~*~ ~ Foundation ~ ~ ~ ~ NO, of lines ~ Length of each Hne Total len~t~ of lines ~ ~ ~ Top of the to finish grade ~ Material beneath tile ~ ~ ~ngth Width Depth ~ ~ Cr]bdiamete~ Crib dept~ [ mSTANCE O:  Gl~s Depth Driller Material Septic tan k ~NEW [] UPGRADE NO. OF BEDROOMS PERMIT NO. No. of comp~ments Liquid depth PERMIT NO, Liquid capacity in gallons Nearest lot line Trench width ~ inches ~-~Z,~i n ch es PERMIT NO. ~ Distance between lines Total effective absorptipn area PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line PERMIT NO. Absorption area(s) OTHER PIPE MATERIALS SOl L TEST*'RATt N G / INSTALLER REMARKS APPROVED [~ATE LEGAL MUNICIPALITY OF ANCHORAGE ,. ~ : Departmenti~F Health and Environmenta~ )rotection 825 ~ Street, Anchorage, AK. ~9501 264-4720 * * * HANDWRITTEN PERMIT * * * Permit ~ ~<.QZ_~](~]) ~ON-SITE SEWER PERMIT Applicant: ~L_~/~r~/~3 ~/~¢770~ Mailing Address:~ Location: ~ J~/~Ay /~ Phone Number: Legal Description:/~ Type of Soil Absorption System Is: Trench: Drainfield: /Seepage Bed: Lot Size: /~/~Q Holding Tank: Maximum Number of Bedrooms: 3 .... Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: ' / DEPTH & LENGTH -.~,-)'~ GRAVEL DEPTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /OdO GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and ~pproval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * * I certify that: (!) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlar, c3e~ent if ~~is remodeled to include more tha~ bedr°°ms// ~A~l~c ant Dat: ~/~/~ SWP/024 (1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST [] SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 2 4 5 6 7 8 9 SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 20- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop /37/ PERCOLATION RATE / ~ (minutes/inch) TEST RUN BETWEEN ~ FT AND ~ FT Performed For "One test is worth a thousand opinions" · M~ Hs_~.e~ ___ ~)ate Performed Leaal Oescrip. tion: Lot 9 Block B&CSt~bdivision l-lulse This Form Reoorts Soils Loq yes Percolation Test 1-29 73 ne~th Feet Soil O:orburden i<~ E.xtposed r'o~dcutz Bobtom of J.~zpo~ IF Yes, At what [)enth~ L ~ Readinq Pat:: ,r-.~ · . N~}t =~me Oenth ~o H20 Percolation Rat~ ~'int~te Proposed Installation: See~¢ooe Pit 7es Drain Field De~th of Inlet Depth To Bottom Of Pit Or Trench COMMENTS: t60 square feet 6T-~-r-?~ area required per bedroom No bedrock or wa~-g~ ~--ab--~--~ feet below intended seepage Net Dron TeSt Perfnrmod Rv T .... iq M~.~ Data FROM: GREATER ANCHORAGE AREA BOROUGH ~ ~ ~ ...... CT tluA~ ~/?/~ DATE ANSWER TO: DEPARTMENT .............. ~.~/~'"/~-~-~ REQUESTED: : REQUESTED ACTION SCHEDULE FOR IMMEDIATE ACTION ~ CALL ME BEFORE YOU ANSWER FOR YOUR CONSIDERATION ~ NEED YOUR RECOMMENDATION OTHER 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 ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377 Address 4640 SHOSHONI DRIVE, ANCHORAGE, AK 99516 Engineer's Printed Name MICHAEL N. ANDERSON, PE 6. DSD SIGNATURE _f System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Date -,-,11M,2019 9, L �j'il W&a ACL N. ANDFP.SCi,JIt CE-94� Conditional approval for bedrooms, with the following stipulations: co r, PJ r" �f Flu I CVv/ildsl4 ©N -sirs E A �` n WA PROGRAM By- Original Certificate Date: 2, 2-t The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet ,^.a..5 Nitrate Advisory Arsenic Advisory" ^ t Other F001,09 rel TAT -MIN M Legal Description: HULSE #1 LOT 9 Parcel ID: 050-521-30 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 11/22/2016 Total depth 240 ft Cased to 44 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) _18 in. Date of flow test for COSA 1122/19 Static water level at beginning of test 51 ft. Comments B. TANK DATA — 8/2/2019 - 1000 -gal Age of tank(s) 0 years Tank type/material STEEL Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping Well production at time of test 4.6 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® Nc ® Coliform bacteria is Negative Nitrate ND mg/L ® Nitrate less than MRL (ND) Arsenic ND ug/L ® Arsenic less than MRL (ND) Collected by FWCS Date of Sample 1117/2019 C. LIFT STATION - NA ❑ Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA — 60'L x 5'W x 3.5'ED — 165 sf/br = 555SF Which system tested (date installed) 7/27/1983 ® ALL standpipes present per record drawing Total measured depth from grade 13.05 ft (max) Measured depth to pipe invert from grade 4.75 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective Adequacy test date 1/23/2019 Results Z Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 32 in Elapsed time 1300 min ® Code -required soil cover over field Final fluid depth 0 in ® System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced 1240 gallons Comments/Deficiencies: Using the post tank cleanout lateral elevation, it appears MT extends 4.4' below the lateral COSA Checklist yellow sheet copy 2.docx 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' If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' G. ENGINEER'S CERTIFICATION Animal Containment > 50' ® Yes if No ® Yes if No ft with MOA COSA guidelines in effect on this date. �° ° °m° ° ° ° ° ° ° ° ° ° • ° ° : n . s m MICHAEL N. ANMRSON m Manure/Animal Excreta Storage > 100' COSA Checklist yellow sheet copy 2.docx Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Wells on Adjacent Lots: Property Line > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Absorption Field > 5' ® Yes if No ft Water Main > 10' ® Yes if No ft ® Water Service Line > 10' ®Yes if No ft Community Wells > 200' Yes if No - Surface Water > 100' 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' ® Yes if No Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No 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 as p°moms„ a-000 aee mo ee oomoe of Municipal records that the above systems are in conformance +� with MOA COSA guidelines in effect on this date. �° ° °m° ° ° ° ° ° ° ° ° ° • ° ° : n . s m MICHAEL N. ANMRSON m �$�°•�f2St COSA Checklist yellow sheet copy 2.docx f � ,� ;;.�� n,l . m ° ° �•.",m ,,�.` - ft ft ft ft ft ft ft ft ft / Lot 15 � :...... S 69,49 00" goo w' ROTECr•(VE AOlUS s� WELL RETAINING WALLS 2• 6� FS ST ,to ra, BALCONY w/ �0• \ :Ilk 0 CONCRETE PATIO BELOW �a \ �o 000so�o. \ �a SEPTIC PIPES --- Lot 35,666 s. f. 4.0'x14.1' PORCH 14.9' Tract 1 0' UTILITY EASEMENTS PLOT PLAN AS BUILT X SCALE 1" = 50' GRID SW 0262 Project No. 19-028/A2 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Long & Associates, inc. (907) 522-6476 Phone (907) 522-4625 Fax Professional Land Surveyors ken0longsurvey.com o O F A Qp Jonathan0langsurvey.com d �•' 1 hereby certify that i have surveyed the following described property: LOT 9, HULSE SUBDIVISION — ADDITION No. 1 (PLAT No. 73-112) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the 4 ` k Day of ts+�i z �t�. t`"1 , at Anchorage, Alaska 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. •.'49TH '.•.�p� •. 'KENNETi-i• GY I�NG '+t 202. • �' � p© 4 BAR ••......• • goo ��®q ��'SSIONAt-�cQ AECC963