HomeMy WebLinkAboutARGYLE LT 2Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP171186 PID Number: 015-141-19
Dwelling: ❑■ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑■ New ❑ Upgrade
Name:
The Dittrich Company
ABSORPTION FIELD
❑ Deep Trench ❑■ Shallow Trench ❑ Bed ❑ Mound
Address
PO Box 90411, Anchorage, AK 99509
❑ Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
907-357-9394
1 4
1.2 GPD/SF
JTotal
9.3 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
5.3 Ft.
Gravel depth beneath pipe
4 Ft.
Subdivision Block Lot
Argyle 2
Fill added above original grade
0 Ft.
Gravel length
50 Ft.
Township Range Section
Gravel width
5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
500 Ft
1
Ft.
Well
>100'
>100'
N/A
N/A
>25'
TANK ❑■ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
11,250 Gal.
Surface Water
>100'
>100'
N/A
NIA
Material
Number of compartments
Lot Line
>5'
>10'
N/A
N/A
Steel
Two
NA
Foundation
>5'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
None
Noted
Remarks
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL House to tank D3034 Tank to
drainfield D3034
Installer
Glacier Masonry
Drainfield D3034 CO/MT 3034
Inspector MEA
BENCHMARK (Assumed elevation) 100.0 ft
Inspdection 15� 8/23/17 8/24/17
Location and description
2nd
3rd 4th
Bottom of siding.
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
�•.��,.. F A4 kit
Conditional Approval: Date
o
••
70,
49TH
r* 491H-
.................
e ...
... .i
�.�..._.�.�.:�
%.................1
r- •MICHAEL E. ANDERSON
0 CE -4381 ®
��('.r.� �y 5b 1/110
'••.......
®14%►re®a
Approved l' Date
®s®®'
Inspection Report_9-1-12.doc
PE
VA
ARGYLE LOT 2
,RMIT # OSP171186 PID # 015-141-19
I
LOT 1
50LFx5'x4'EFF
i SEPTIC TRENCH
1250 -GAL
SEPTIC TANK
I I I
I I
I I A.C. DRIVE
I I
I v i
I Ld m
WI I
Iii N
I O I
4-BDRM DOME
I
O_F
ALTERNATE SITE
I
MT1 C01 r I I
I I I •.
I II •
;V2 i TH1
I
2C
•. I I i
I Z I I
]VI 14, L� • • .
••CO2
O j N
WELL / TH#2
I i i / •• I
LOT 2
A B
LOT 3 \�
I
FCO
3.0
15.6
SV1
6.0
18.0
SV2
16.8
22.8
2CO
22.8
27.0
C01
37.2
50.1
MT1
38.1
51.0
CO2
37.2
27.6
MT2
37.8
1 27.9
\ NOTE: /
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE LEGEND
l� PROPOSED SEPTIC SYSTEM
CO - CLEANOUT
`meq TM *'0 ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS 2CO - DOUBLE CLEANOUT
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC FCO -FOUNDATION CLEAN(
`.`.�"h SYSTEMS. FS - FLOW SPLITTER VALVE
'. Michael E. Anderson : • •/ MH - MANHOLE
I �F�� .•1 CE 4381 0 50 100 MT -MONITORING TUBE
fl srF�•:;�` �,•���w FEET
1 ROFESSIONPSV - SEPTIC VENT
1 -50
TH - TEST HOLE
ARGYLE LOT 2
PERMIT # OSP171186 PID # 015-141-19
N O
LL C) CV
98.7
93.2
--------------------
93.0 92.3
92.6 1250 GAL 92.4
SEPTIC TANK
88.3
97.5 ORIGINAL AND
FINAL GRADE
92.2 92.2
88.2 50, 88.2
NOTE: MT1 HAD 6" OF DEBRIS AT THE
BOTTOM AFTER CONSTRUCTION
—81.5
= NO GROUNDWATER 7/16/17
H
�eslll
*.•STM ••*rl
I '. Michael E. Anderson
PROFILE AS -BUILT l �F•'• CE 4381 •`�%
(NO SCALE)
�t�ilF9F�PROFESS pOO'�,o��s
ow as•nIi
M -W brilling, Inc.
oP.O. Box 110389,s, Anchorage, AK 99511*
907-345-4000 * 907-345-3287 Faxis
Well Owner: Dittrich Co, LLC Use of Well: Domestic
Legal Description: Argyfe Subdivision Lot 2 Anchorage, AK
CONSTRUnI ON
Drift Method: 'Air Rotary Hole Size: 6- Hole Depth: 26"
Casing Size: 6- Cased to: 261'—, Material: —A53B Wall: —.250
Well Completion: Open —end X Screen
Screen/Perforation description: n/a
Grout Notes: 2 ) Sack(s) of Bentonite
Well Development: Air Surge
Well Disinfected: ffo-- Method:
Yield test at 20 GPM for .5 hour(s) with 100% of drawdown (DD) from static level(SWL).
Method: Air s—urge —Static Water Level (SWL): 219'
Start Date: 8/28/2017 — Completion Date: 9/1/2017
Test Pump Date: n/a Final Pump Install Date: --E/—a
MUNICIPALITY OF ANCHORAGE
-_e
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Nuinber: 05P171186 Date of Issue: - -
Parcel Identification Number. 015-141-19
Legal Description Block Lot Property Owner Name & Address:
Argyle Subdivision 2 John & Marium Claire
10841 Lipscomb Street
Pump Installation Date: 9 - 6 -2017
Pump Intake Depth Below Top of Well Casing: 252
Pump Manufacturer's Name: Grundfos
Pump Model: SQE-330
IPump Size: 1 hp
feet
Pitless Adapter Burial Depth: 10 feet
Pitless Adapter Manufacturer's Name: Martinson M -B10
Pitless Adapter Installer: Trevor Tillinghast
Well Disinfected Upon Completion? EK Yes ❑ No
Method of Disinfection: clorox bleach
Comments:
Pump Installer Name: Trevor Tillinghast
Company: M -W Drilling, Inc.
Mailing Address: PO Box 110389
City: Anchorage State: AK Zip: 99511
Attention: The pump installer shall provide a pump installation log to On-site Nvithui 30 days of pump installation.
� � N
Wa_
O
O r+7
N 'p o 1n -n C
OD Q, _
�
® < I
o m m ! -a
v n LZ -)g C
O \
D m Cp v
;o z N 4N r
r N .0k to
N 0 rn N
c V m
rn rn
Nr2Z 0rn-rZZ1
c)O; Z Oram
o 05
r Z y Z 2 a;
�) --I ® r1
O m �Nrn n��rn'o z'o
!o7 m Opa �rtZ N 4
O Z-nwmNuAf Xp=
m Q DZZ ®�r�*1r
U) Z c�0c)04 �r,o-
en O ®ZV1®®m0OX
m p '° �0NN®
Zeo�� ,? D�ocn
_ m—ir—vf7OVj--iC
cn ZZQO= zo
p m0� 08'rn ®®
m Vf®D �OZorn
2
A a -i N m
co
C
N r
0
m
rel) o
o m
V,
II
r
LIPSC®MB STREET
W
W
N 00003'10,,w 150.00'
10' ITIL. ESMT_
25' BUILDING
SETBACK LINE
� N
A A
gym`,
r
O
:V
m
35.8'
co X 35.7'
r cn
O
ZZ
c7 �
V) °
't7 °
\ .• C7
V)
p` \ N
\ g
0� \
FA \
C� \
N 00`03'30"W 150.00'
to
0
0
0
0
m
N
to
V
S 6a
a)a,••••
•%f S ���
•••
1•
P ° • `� •
All
•
s p ••°.
p • O!\ p� •
• i1
N
adv •
• •
Allf
%
s •
-.40•
• 4w
•••®
co
C
N r
0
m
rel) o
o m
V,
II
r
LIPSC®MB STREET
W
W
N 00003'10,,w 150.00'
10' ITIL. ESMT_
25' BUILDING
SETBACK LINE
� N
A A
gym`,
r
O
:V
m
35.8'
co X 35.7'
r cn
O
ZZ
c7 �
V) °
't7 °
\ .• C7
V)
p` \ N
\ g
0� \
FA \
C� \
N 00`03'30"W 150.00'
to
0
0
0
0
m
N
to
V
MUNICIPALITY OF ANCHORAGE
On-Site Water&Wastewater Program ♦° S
PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone (907)343-7904 Fax: (907)343-7997
„ t';- http//www.muni.org/onsite '�a' r
epartment
4 CHn° �t
On-Site Water & Wastewater System Permit
Permit Number: OSP171186 Effective Date: 7/25/2017
Work Type: WellSeptic Initial Expiration Date: 7/25/2018
Tax Code Number: 01514119000
Site Legal Address: ARGYLE LT 2 G:2636
Site Mailing Address: 10841 Lipscomb ST, Anchorage
Owner: DITTRICH COMPANY LLC Lot Size in Sq Ft: 44516
Design Engineer: ANDERSON ENGINEERING Total Bedrooms: 4
This permit is for the construction of:
II Disposal Field 0 Septic Tank ❑ 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
Received By: V&1 /441)(4'C Date: 1/2-6//
Issued By: Viji<t(1 A l Date: 7/2 5/2o I
MUNICIPALITY OF ANCHORAGE
„L")
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. 015-141-19
Property owner(s) The Dittrich Company, LLC Day phone
Mailing address P.O. Box 90411 Anchorage, AK 99509
Site address NHN Lipscomb Street Anchorage, AK 99516
Legal description (Sub'd., Block & Lot) Argyle, Lot 2
Legal description (Township, Range & Section)
Lot Size 44,516 Sq. Ft. Number of Bedrooms Four (4)
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field 0 Initial Single Family (SF)
(w/wo ADU)
Septic Tank Upgrade ❑ Duplex (D) ❑
Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑
Privy ❑ (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.
74-tasti E 64„,12 -)
(Signature of property owner or authorized agent)
Permit/Rush Fees: '914 Waiver Fees:
Date of Payment: -t11.3-11?" Date of Payment:
Receipt Number: �y Receipt Number:
Permit No. OS Pl 11?(o Waiver No.
Permit App_9-1-12.doc
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 677-7766 (FAX)
July 16, 2017
Municipality of Anchorage
Development Services Department
On-Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 2, Argyle Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 2, Argyle Subdivision intends to construct a new four-bedroom home
on the lot. We are therefore requesting a permit be issued for the construction of a new
well and septic system to accommodate the home. The attached Site Plan and backup
documentation identify the location and configuration of the proposed well and septic
system along with the alternate site. Also identified on the plans are the existing wells
and septic systems on surrounding lots. No conflicts exist between the proposed septic
system and well or septic systems and wells on adjacent lots. Drainage arrows are
shown on the site plan showing the grade and direction of flow on the lot. The drainage
pattern will not be changed as a result of this project.
Two test holes were recently placed on the lot in the area of the absorption trench and
alternate site. The logs indicate silty sand (SW/SM) with gravel in the zone specified for
the absorption trench. The percolation rate of the soil was determined to be 3-5
minutes per inch. No groundwater was found during the placement of the test holes
and none developed during the monitoring period. An application rate of 1 .2 gallons
per day per square foot was used in the design of the absorption system. We are
proposing to place a new 1,250-gallon septic tank and a 50' long by 5' wide by 4'
effective depth absorption trench to treat and dispose of the effluent generated in the
house. The elevation of the distribution line in the absorption trench will be 3' below the
surface and the total depth will be 7'. A minimum of 3' of fill or 2" of insulation and 2' 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 west at a
slight grade. The new trench will be constructed parallel with the contours of the slope
as much as possible in conformance with Municipal requirements. The new septic
Lot 2, Argyle Subdivision
July 16, 2017
Page Two
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.
If the system is constructed in accordance with our design the following statements
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 reserve
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 drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
'114c-d/J-
Michael E. Anderson, P.E.
Attachments
4.
4-c ftlJII *
,MICHAEL E. ANDERSON it!:,
40,0�il' No. CE-43B1
OMALLEY ROAD
wee
LOT 1
LOT 11A
No Conflicts with Well or Septic
System on this Lot.
Wl
I— I I rM'/1 l l l A.C.owe r ,
V l J
CO I
I
S)I o �
U I
o- LOT 11B
\ "( VACANT
I ~\
1.10 LOT 3
I I
LOT 2 ..•••••*��
�FOF
ARGYLE SUBDIVISION •
• ,q
_,�P.•• qs ,,`
•
44,517 SF '*
4911-1. ••7 vI
+
f ',MICHAEL E. ANDERSON
REA MAP
CE-4381
SCALE 1' = 100' 1I 'PeQ,?� i6 '� .•�,``�
LOT 2
ARGYLE SUBDIVISION
412' - __. -- 44,517 SF 412'
`-'--N 90'00'00"E 296.77'
/
/ re
FCO Alternate
W A.C. DRIVE Four Bedroom =5 s o ® Site
W0 Home TH1
IXz
41 m o
0
I- 0 w w co o
N o- —
' r z Proposed Well ^'
-57.
C113 . 5
J —1 3
L 0 n O � 0
p "' O
O O
U o `'J TH2 ® o
(/) z NOTE: 2
C , / No Areas of Excessive Slope or Surface
/
J \ Water are Within 100' of Any Part of the
New Septic System. No Wells or Wastewater
Systems on Adjacent Lots Conflict with the
\
Proposed Septic System.
I I
N 90'00'004 0 296.77'
Ciai 410'
-
44.474
LEGEND j ' \ ��
i _ 49th
MT — Monitor Tube 0• 114:41..d. A
MH — Man Hole ,
FCO — Foundation Clean Out SITE P A \ ,,;MICHAEL
E. ANDERSON ; `
TH — Test Hole ♦C • :. 'm
CO — Clean Out •♦✓�, No. CE-4381 • ti
•
FSV — Flow Splitter Valve SCALE 1' = 40' �••��,�,'•.,7-((,-i.,.•°��'V•
2C0 — Double Clean Out ♦I N,;ROFESSZzti4.
LOT 2, ARGYLE SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom Home 5' Wide Trench System
Perc. Rate: 1-5 Min./Inch 1,250 Gallon Septic Tank
Application Rate: 1.2 GPD/SF 4' Drainfield Rock
4 Bedrooms * 150 GPD/Bedroom = 600 GPD Design Flow
600 GPD/1.2 GPD/SF/5 SF (Width) *.5 (Red. Factor)= 50 LF Trench Length
THEREFORE: Construct a 50' Long x 5' Wide x 4' Effective Depth Absorption Trench.
Flow Line Elevation in Trench to be 3' Below Original Ground Surface. Total Depth to be
7' Below Existing Ground. Provide 3' Cover Over Absorption Trench and 4' Cover Over
Septic Tank.
2'6" eotextile Fabric
6" O
4" Perforated
PVC (Holes Down)
4'
Drainfield Rock
5'
I I
TYPICAL 5' WIDE TRENCH SECTION ,..•---�>,.��
(NO SCALE) � CE ...., 1111
11
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock. 49th
Minimum 4' Separation From Groundwater. o
Minimum 100'Separation From Private Wells in the Area. �� MICHAEL E ANDERSON i LC.5:
Minimum 100' Separation From Surface Water or Streams. ;1 s:, N . cE- 4
'�.... 7-rG..t.7"k.�.•
11111pa::S:: ,6..
MUNICIPALITY OF ANCHORAGE .'sir ani ,
DEVELOPMENT SERVICES DEPARTMENT r���- .•• •'••• Sit*.
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 '•,.... � ii
49th
SOILS LOG - PERCOLATION TEST ( 41z ..Ir.
-i ,'.MICHAEL E. ANDERSON•:gr
LOT 2, ARGYLE SUBDIVISION IN No. CE-4381 ti C
LEGAL DESCRIPTION: i. '....7-ii, 4 7 ,
PERFORMED FOR: JAMIE DITTRICH 94 •
DATE: 6/30/17 PROJECT No.: �1� 5 •
Professional Engineers Stamp:
PARCEL ID#: TECHNICIAN: MEA
DEPTH TEST HOLE 1
(feet)
I
OB/OG SLO` SITE PLAN
. a
- v z
4
-I — v .
5 SILTY SAND o�N SEE SITE PLAN
G . G WITH GRAVEL
1
6 .4 SW/SM
7 ' 4.
' 4.A A
8 a ..L
9 . .
G Ad.
1 0 WAS GROUND WATER ENCOUNTERED? No
IF YES @ WHAT DEPTH.'
DEPTH OF WATER AFTER MONITORING: NONE L 2%/O
11 ' DATE OF MONITORING: 7/16/17
. 4 4
12—.
GROSS TIME NET TIME DEPTH TO NET DROP
13— e• Q.. ° • DATE READING (MINUTES) (MINUTES) WATER (INCHES)
n (INCHES)
14 TEST HOLE PRESOAKED PRIOR TO TESTING:
15 c °. 7/ I 10:14 0.75"
16 BOH @ 16' 2 10:34 30 9.50" 8.75'
3 10:35 1.00"
17
4 11:05 30 9.75" 8.75"
18 5 11:06 0.75"
19 6 11:36 30 9.50" 8.75"
20
PERCOLATION RATE: 3.4 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 4.0 FT. and 5.0 FT.
COMMENTS: TEST CAVITY PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E.ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 7/16/17
MUNICIPALITY OF ANCHORAGE .ii.►►rrri4i
DEVELOPMENT SERVICES DEPARTMENT p�••P�- ..44x C+17
4700 BRAGAW STREET ANCHORAGE, AK 99519-6650
i .. 49th =*0of
SOILS LOG - PERCOLATION TEST 70 ',,,///���
T ;MICHAEL E. ANDERSEN S
LOT 2, ARGYLE SUBDIVISION *V No. CE-4391
LEGAL DESCRIPTION: •
PERFORMED FOR: JAMIE DITTRICH •�*11li �S'i' �a`~`
DATE: 6/30/17 PROJECT No.: ����m�+�
PARCEL ID#: TECHNICIAN: MEA Professional Engineers Scamp:
DEPTH TEST HOLE 2
(feet)
OB/OG SLOPE SITE PLAN
1
d
2 °
3
4
5- SILTY SAND ti o SEE SITE PLAN
• ° WITH GRAVEL z
6 :a . SW/SM
7a.
°a e
8 —..a...a •:4
9 —.-.Q. .
WAS GROUND WATER ENCOUNTERED? NO
10 .7' IF YES tri WHAT DEPTH'?
DEPTH OF WATER AFTER MONITORING: 14' L 2%
11— ' '- e DATE OF MONITORING: 7/16/17
. d
12 .' .
GROSS TIME NET TIME DEPTHATo NET DROP
13 d a 'a DATE READING (MINUTES) (MINUTES) WATER (INCHES)
(INCHES)
14 TEST HOLE PRESOAKED PRIOR TO TESTING:
15 d a 7/I I 10:20 .50"
16 BOH @ Ib' 2 10:50 30 8.75" 7.25"
3 10:51 _ .25"
17 4 11:21 30 8.50" 7.25"
18 F. 11:22 1.25"
19 6 11:52 30 8.50" 7.25"
20 -
PERCOLATION RATE: 4.1 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 4.0 FT. and 5.0 FT.
COMMENTS: TEST CAVITY PRE SOAKED PRIOR TO TEST.
TEST PERFORMED BY ANDERSON ENGINEERING. I,MICHAEL E. ANDERSON CERTIFY THAT
THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS
DATE: 7/16/17
r 1
Olt o
618910 .77 fQ
� J a.P . B`
•F � Municipality of Anchor, u -.' f �(4
On-Site Water and Wastewater Prog =a ��v 1
(907) 343-7904 MAY 1 6 2p1� i S A F E Y Y
ti
Certificate of On-Site Systems A. g al A
c'j
Zi 0>
691,9
Parcel I.D. 015-141-19 Expiration Date: (\ulq 1/ gill
1. GENERAL INFORMATION
Complete legal description Argyle Lot 2
Location (site address) 10841 Lipscomb St
Current Property owner(s) The Dittrich Company Day phone 907-357-9394
Mailing address PO Box 90411 Anchorage AK 99509
Real Estate Agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 0 Individual El
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer El
WaiverNariance request for: Distance:
Received by: Li!4h ',) /fl/-24// Date: 5/a/A S
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 1/l.&' Waiver Fee $
Date of Payment 57/1?- ti Date of Payment
Receipt Number 65M51) Receipt Number
COSA# &)Ca gf tog 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,
.,'"' J 41k, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
t for ttt- number of bedrooms and type of structure indicated herein. I further verify that based on the information
ootai, -d from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
.44 s ••; and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
Io:i :nces, and regulations in effect at the time of installation.
Name of Firm Forge Engineering Phone (907) 522-7773
Address PO Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, PE Date 5/15/18
OF At`\ t
• S
6. DSD SIGNATURE ,*:o,49 T" 0 .
JSystem #1 Approved for bedrooms � ,�
0� ..Michael E.Anderson
9F•, 43 1 E ce%
System #2 Approved for bedrooms ,111���•
`'r�
Disapproved
Conditional approval for bedrooms, with the following stipulations:
pN P,N
. FZ
•
`NPS��`NPP
p QRoGR G
�O�c s
RA�nI r
By: {9.-ibtie.0.0.. c €Q.Q Original Certificate Date: I t t <2 1) Au I
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 blue sheet r •• .. c
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Argyle Lot 2 Parcel ID: 015-141-19
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 9/01/17 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 261 ft. Cased to 261 ft. Casing height (above ground) 36 in.
FROM WELL LOG AT INSPECTION
Date of test 9/01/17
Static water level 219 ft. ft.
Well production 20 g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform N ei colonies/100 mL Nitrate ri . 3 1 mg/L
Arsenic N ug/L Date of sample: 5/14/18 Collected by: Forge Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel/Septic Date installed 8/24/17
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping Pumper New Construction
C. ABSORPTION FIELD DATA
Date installed
8/23/17 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF System type 5-Wide
Length 50 ft. Width 5 0 ft. Gravel below pipe 4.0 ft.
Total depth 9.3 ft. Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot >100' On adjacent lots >100'
Absorption field on lot >100' On adjacent lots >100'
Public sewer main >75' Public sewer manhole/cleanout >100'
Sewer/septic service line >25' Holding tank >75'
Animal containment areas >50' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
>51* >5' >5'
Building foundation Property line Absorption field
Water main >10' Water service line >10' >
Surface water
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
>10' >10 10
> '
Property line Building foundation Water main
Water Service line >10Surface water >100 Driveway, parking/vehicle storage > 0
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
*Constructed before code changed to 10'
G. ENGINEER'S CERTIFICATION
�` OF q\vi\l
I certify that I have determined through field inspections and
P::..
1, ,review of Municipal records that the above systems are in y49 TH ,p� *y
conformance with MOA COSA guidelines in effect on this date.
Michael E. Anderson, PE �74�'` eti 1it`-'�%-'
Engineer's Printed Name �� Michael E.Anderson : /
Date 5/15/18 0+ �F'• X381-E , •���%�f
+4k (4 :• tom.itcc
kk FDPROFESS\cS
COSA brown sheet 10-10-12.doc