HomeMy WebLinkAboutJASMINE LT 8Onsite File
Jasmine
Lot 8
#051-221-18
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP221322 PID Number: 051-211-18
Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑■ New ❑ Upgrade
Name
Troy Davis Homes
ABSORPTION FIELD
❑� Deep Trench El Wide Trench [:1 Bed El Mound
Site Address
22920 Parks Creek Cir
El Other
Phone
(907)357-9394
Number of Bedrooms
Three (3)
Soil Rating
0.8
Total depth from original grade
14.0
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
7.1 FJ
Gravel depth beneath pipe
6.9 Ft.
Subdivision Block Lot
Jasmine 8
Fill added above original grade
-3.2
Gravel length
42
Township Range Section
Ft.
Ft.
Gravel width
3.0 Ft.
Beds: Number of Lines
n/a
Distance between lines
n/a Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
756 Ft2
1
n/a Ft.
Well
>100'
>1 00'
N/A
N/A
>25
TANK F!] Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Infiltrator
Capacity
1530 Gal.
Surface Water
>1 00'
> 100'
N/A
N/A
Material
Plastic
Number of compartments
2
Lot Line
>5'
>10'
N/A
N/A
NA
Foundation
>1 0'
>10'
N/A
N/A
ILIFT
STATION
Manufacturer
Capacity
Remarks
Gal.
Alarm location
Electrical installed by
Installer
PIPE MATERIAL House to tank D3034 Tank to D3034
drainfield
Precision Excavation
Drainfield D3034 CO/MTD3034
Inspector B. Schiller
BENCH MARK (Assumed elevation) 100 ft
Inspection ection 15` 1/24/23 2�d 1/25/23
Location and description
31" 1/26/23 4'h
Top of foundation @ Garage
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
F AJ
Conditional Approval: Date
��Q'�.• •'giQ��i
ll
Je
.
Septic SySte
Approved t
% �•• Benjam,,Ochiller • -
�¢ �' • CE 12592 • `�
�'sl�•
Date
• 4/10/23 '�c,��
,��� pR4fESS1�N��
ot . this approval does not include well permit requirem nts.
tDe ncin�i� o
ALTERNATE SITE
MAINTAIN 14' SEPARATION
Benjamin Schiller
CE 12592R
E
GISTEREDPROFE S S I O N A L E N GINEER
1"=50'
NEW 42' LONG x 3' WIDE, 7' EFFECTIVE
DEPTH ABSORPTION TRENCH
1530-GAL SEPTIC TANK
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
PT - PERC TEST
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
MT1
TH#1
PERMIT # OSP221322 PID # 051-211-18
JASMINE SUB, LOT 8
A B
FCO 21.9
MH 23.0
SV1 14.5
A
B
C
C
-
-
-
2CO 16.4
CO1 19.7
MT1 22.8
-
31.3
28.9
CO2 58.6 20.3
5.9
13.9
19.0
21.2
-
-
-
FEET
0 50 100
FCO
PARKS CREEK CIRCLE
3-BDRM HOME
15' T&E EASEMENT
40' ACCESS, NATURAL GAS,
TELECOMMUNICATION &
ELECTRIC EASEMENT
TH#2
NEW WELL
700
690
680
670
710
NO WELL OR SEPTIC ON THIS LOT
NO WELL OR SEPTIC
ON THIS LOT
MT2
CONFIRMATION PERC TEST
CO1
CO2PT#3
2CO
4/7/23
PLAN AS-BUILT MT2 54.5 16.8-
PROFILE AS-BUILT
(NO SCALE)
98.5
94.6
101.8
MH
SV
101.5 FINISH GRADE
42'
DRAINFIELD ROCK
MT
1
TH
#
1
NO GROUNDWATER 11/22/22
90.7
97.6
CO
1
CO
2
84.7
90.7
97.6
104.7 ORIGINAL GRADE MT
2
2C
O
98.3
1530 GAL PLASTIC
SEPTIC TANK
Benjamin Schiller
CE 12592
R
E
GISTEREDPROFES S I O N A L E N GINEER
4/10/23
PERMIT # OSP221322 PID # 051-211-18
JASMINE SUB, LOT 8
FC
O
99.1
INSULATION
Name:
r
,ell Site:
ditional:
ll Depth:
Below Ground:
Above Ground:
Gal/Min:
Static Level:
Casing:
Liner Pipe:
Screened:
Perforated:
Grouted:
Depth:
Develop. Method:
Use of Well:
Drilling Method:
Misc:
Wheaton Water Well, Inc.
1190 N. Wasilla-Fishhook Road
Wasilla, AK 99654
(907)376-2041
Troy Davis Homes
1689 S. Knik Rd. #400
Wasilla State: AK
Jasmine
22920 Parks Creek Cir, Chugiak
505 ft.
From:
32;
503 ft.
32
33
2 ft.
33
42
0.25
48
48
56
24 ft. 56
82
82
126
42ft. of 6 in. x .25in. steel 126
360
360
390
N/A 390
465
465
488
N/A 488
496
496
505
N/A
Yes
Air
Residential
Rota ry
Zip Code: 99654
Lot/Block: L8
Formation:
Sand & Gravel
Silt/Sand/Cobble
Silt
Hard Grey Rock
Soft Rock Dark Grey
Med Grey Rock
Soft Grey Rock
Med Grey Rock
Soft Grey Rock
Med Tan Rock
Soft Dark Grey Rock
Hard Tan Rock
Med Grey Rock
FRACTURED AT:
195
325
455
Other: Chlorinated
The well was pumped 5 off the bottom with 100% draw down for 2 hours and recovered at 0.25gpm .
Date Drilled: 1.20.23 Driller: Benjamin Mattson
Development Services Department i # Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: 221322 Date of Issue: 08.11 _22
Parcel Identification Number: 051 _211 _ 18
Legal Description Block Lot Property Owner Name & Address:
Jasmine 8 Troy Davis Homes, Inc.
22920 Parks Creek Cir. Chugiak 1689 Knik Goose Bay Rd #400
Wasilla, AK 99654
Pump Installation Date: 02 -22 -2023
Pump Intake Depth Below Top of Well Casing. 453 feet
Pump Manufacturer's Name: Meyers
Pump Model: 1 H P 5 G P M
Pump Size: 1 hp
Pitless Adapter Burial Depth: 12 feet
Pitless Adapter Manufacturer's Name: Campbell
Pitless Adapter Installer: U n known
Well Disinfected Upon Completion? ❑ Yes ❑ No
Method of Disinfection: Sterilene
Comments:
Pump Installer Name:
Company: Wheaton Water Well, Inc.
Mailing Address: 1190 N Wasilla Fishhook Rd
City: Wasilla State: AK Zip: 99654
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
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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 Water & Wastewater System Permit
Permit Number: OSP221322
Work Type: WellSeptic Initial
Tax Code Number: 05121118000
Site Legal Address: JASMINE LT 8 G:1059
Site Mailing Address:
Owner: TROY DAVIS
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
't»cnt S
U
Department
8/11/2022
8/11/2023
42209
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Q 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
P -M w
C o I De,,,yn .�-7ovcd ani c,�Iyed. 11/30/2z
Prov: A Gori (e,+e fiert hole- r`5 tv he done 1 n 1 -he Iota-I-►o� s�roc�n o�1
A e /Plan Viea). — P f l'C'r fa cenfrao"hbn .
Veronica Pope
GE 2022.08.11
Received By: °°' 15:24:34 -08'00'
&I Issued By:
Date:
Date:
3
a
MUHMPAUTY 01F AHCHORAGE
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.0,51 214-1-0 0-651-2-21-1g
Property owner(s) Troy Davis Homes Day phone 907-357-9394
Mailing address 1689 S. Knik-Goose Bay Rd #400, Wasilla, AK 99654
Site address NHN Parks Creek Cir
Legal description (Sub'd., Block & Lot) (Jasmine Sub, L8)
Legal description (Township, Range & Section)
Lot Size 846,219 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
0
Initial Ex]
Single Family (SF) 0
ADU)
Septic Tank
RX
Upgrade El(w/wo
(D) ❑
Holding Tank
❑
RenewalDuplex
❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
0
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:./312
Date of Payment:
Receipt Number:
Permit No. 05PO2 1322
Permit App__- : .-.,:c
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
August 10, 2022
E E R I N G
Minicipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE CONIPUANC
OSP221322, Cab Wbckenfuss, 08/11)
PO BOX 240773
ANCHORAGE, AK 99524
522-7773
677-7766 (FAX)
FORGECIVIL.COM
MOA Development Services, On -Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: 007 Sub, Tract C (Jasmine Sub, Lot 8) — NHN Parks Creek Cir
Septic system design
Dear On -Site Services Engineer:
The owner of the above lot intends to build a 3 -bedroom home on the property, so we are
submitting this permit application for the construction of a new well and septic system. The
attached site plan identifies the location of the home as well as the proposed well, septic location
and alternate site. No conflicts exist between this proposed system and any other well or septic
system, whether on this lot or adjacent lots.
The ground surface on the lot slopes moderately toward the road. There are some small areas with
slopes greater than 25% within 50 feet downslope of either the primary or alternate site, but the
design meets steep slope provisions. Contours are shown on the site plan showing the grade and
direction of flow. Storinwater drainage will not impact this septic system. The new trench will be
constructed parallel to the slope as much as possible.
Wells on this and adjacent lots are shown. The new system will be a minimum of 100' from all
wells and surface water, and more than 5' away from the septic tank. The alternate site is located
more than 16' away.
Please refer to the attached test hole logs, soils lab analysis, plan and profile pages for the septic
design. If this design is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
:z
Benjamin Schiller, PE
WELL OR SEPTIC -ON TH
JASMINE SUB, LOT 8
/1250 -GAL
'ANK MIN 1i
2x 21` LONG x 3'
MAINTAIN 14',
"PARkS CREEK -CIRCLE
I15' T&E EASEMENT N
/'�_PROP_OSED WELL f
W/ 100' RADIUS
RPTIQN TRENCHES-\
:TI'ON AND 10' FROM
D PROPERTY LINES
PROPOSEDTEST HOLE
ALTERNATE SITE
MAINTAIN 14' SEPARATION
_..
173ACT r
40' ACCESS, NATURAL GAS,
f.
NO WELL OR SEPTIC TELECOMMUNICATION �
---ON THIS. LOT ELECTRIC EASEMENT
NOTE:
NO SLOPES >46% WITHIN 100'. SLOPES > 25% ARE WITHIN 50', BUT
DESIGN MEETS STEEP SLOPE PROVISIONS. NO SURFACE WATER
WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM
A
t
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
• • • • S PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC
SYSTEMS.
• �® 0 50 100
?�ME kM M FEET
'w 111=50'
GIN EE RING
�nfa
LOT 9
NO WELL OR SEPTIC
ON THIS LOT
LEGEND
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
�
Y
E -
DESIGN FACTORS:
450 GPD PEAK FLOW
PERK RATE: 6.7 MIN/IN
APPLICATION RATE: 0.8 GPD/SF
SYSTEM REQUIREMENTS:
DEEP TRENCH SYSTEM
1250 -GAL SEPTIC TANK
450 GPD / 0.8 GPD/SF / TDEEP / 2 SIDES = 40.2 LF TRENCH REQUIRED (42 LF SPECIFIED)
BOTTOM OF TRENCH: 14' BELOW GRADE (MAX)
FLOW LINE ELEVATION: TBELOW GRADE (MAX)
TOP OF TRENCH: 6" ABOVE GRADE
(MAX 7.0') --/
r�l
ILE FABRIC
RATED PVC
DWN)
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
.......... ..........
Benja ' Schiller
CE 12592
2022
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
DEPTH
(feet)
PERC TEST #3
DATE READING START TIME NET TIME(minutes)
DEPTH toWATER NET DROP
PERCOLATION RATE: (MIN/INCH)
(inches)(inches)
DATE OF MONITORING
WAS WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING
IF YES @ WHAT DEPTH?
0.1
1/24/23 1
2
3
SAND (SM)
Professional Engineers Stamp:
No
Jasmine Sub - Lot 8
1/24/23 051-211-18
Troy Davis Homes
1:491
2
3
5 0
16
1:51
1:52
0:29
Benjamin Schiller
CE 12592
R
E
GISTEREDPROFE S S I O N A L E N GINEER
1/10/24
PERC TEST LOCATION
TECHNICIAN:B. SCHILLER
11 0
16
-
-
-
COMMENTS:
6" DIAMETER TEST HOLE PRESOAKED PRIOR TO TESTING
SITE PLAN
6 0
16
USCS SOIL CLASSIFICATION WAS VISUALLY DETERMINED
0:44
0:49
4
5
6
1:54
1:56
1:57
0:48
0:49
0:43
5 0
16 11 0
16 6 0
16
5 0
16 11 0
16 6 0
16
5 0
16 11 0
16 6 0
16
5 0
16 11 0
16 6 0
16
5 0
16 11 0
16 6 0
16
UNABLE TO PERK LAYER DEEPER THAN 8' FOR SAFETY
SOIL LAYER CONFIRMED IN TRENCH TO BE THE SAME AS IN TH #1
DEPTH
(feet)
1-
2
3
4
5
6
7
8
9
1
11
12
13
14
15
16
17
18
19
2
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 ELMORE ROAD ANCHORAGE, AK 99519-6650
I SOILS LOG AND PERCOLATION TEST
LEGAL DESCRIPTION: JASMINE SUBDIVISION - LOT 8
PERFORMED FOR: TROY DAVIS
DATE: 02/02/18 PROJECT No.:
PARCEL ID#: TECHNICIAN: C. JOHANSEN
TEST HOLE # 1
•:
N ' •
• 4 •
• SILTY SAND
W/ SOME GRAVEL (SP -SM)
SLOPE
Stamp:
SITE PLAN
SEE SITE PLAN
` .. TH DEEPENED TO 20' ON 11/8/22
COMMENTS: --
DATE
READING
WAS GROUND WATER ENCOUNTERED?
NO
DEPTH To
WATER
(INCE-IES)
NET DROP
(INCHES)
2/06
IF YES n WHAT DEPTH?
-
L
12:30
•
•
0
DEPTH OF WATER AFTER MONITORING:
NONE
0
1:00
30
4X
DATE OF MONITORING:
5/29/18
P
1:01
•
0
4
1:31
30
4)/2
412
11/22/22
E
1:32
` .. TH DEEPENED TO 20' ON 11/8/22
COMMENTS: --
DATE
READING
GROSS TIME
(MINUTES)
NET TIME
(MINUTES)
DEPTH To
WATER
(INCE-IES)
NET DROP
(INCHES)
2/06
TEST HOLE PRESOAKED PRIOR TO TESTING:
1
12:30
0
2
1:00
30
4X
4%4
3
1:01
0
4
1:31
30
4)/2
412
5
1:32
0
6
2:02
30
4/2
4/2
PERCOLATION RATE: 6.7 (MINANCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 4 FT. and 5 FT.
MUNICIPALITY OF ANCHORAGE w+ water
DEVELOPMENT SERVICES DEPARTMENT l cAN
4700 ELMORE ROAD ANCHORAGE, AK 99519-6650—
�., ....... .. ..�
SOILS LOG AND PERCOLATION TEST
'.`Benjarr'r Schiller
LEGAL DESCRIPTION: JASMINE SUBDIVISION — LOT 8 ``'�F4?��2'�`����-�-�r��
a,l �+°ROFESSI�Na -�
PERFORMED FOR: TROY DAVIS
DATE: 02/02/18 PROJECT No.: Professional Engineers Stamp:
PARCEL ID#: TECHNICIAN: C. JOHANSEN
DEPTH TEST HOLE #2
(feet)
1 OB SLOPE SITE PLAN
2
3
4
5 yi. �1` !� SEE SITE PLAN
% SILTY SAND i
6 W/ SOME GRAVEL (SP -SM)
7 S`
8 '
9
10 WAS GROUND WATER ENCOUNTERED? NO
•.: IF YES @ WHAT DEPTH? - L
I 1 - DEPTH OF WATER AFTER MONITORING: NONE 0
�;~�:• .:; DATE OF MONITORING: 5/29/18 P
12'
;. .........
.fir..:'..
13
14
s:
15
16
17
18
19
20F-7
PERCOLATION RATE: 0.4 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN: 4 FT. and 5 FT.
COMMENTS: -
GROSS TIME NET TIME DEPTH To NET DROP
DATE READING (MINUTES) (MINUTES) WATER (INCHES)
(INCHES)
2/06 TEST HOLE PRESOAKED PRIOR TO TESTING:
I 11:41/11:43 2:09 0 / 6 6
2 11:44/11:4 6
2:10
0/ 6
6
3
11:47/11:49
2:09
0 / 6
6
4
11:50/11:52
2:08
0 / 6
6
5
11:53/11:57
2:08
0 / 6
6
6
11:58/12:00
2:08
0 / 6
6
MUMCPALI TY OF ' HCM0 (23 ;�
i I�cr
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-211-18-000
Expiration Date: 7/27/2024
Legal description JASMINE LT 8
Site address 22920 PARKS CREEK CIR Chugiak AK 99567
Current property owner(s) WOODS JARED
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for
Comments or advisories:
bedrooms, with the following stipulations:
Original Certificate Date: 1/11/2024
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 X Well Flow Advisory X
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval_June 2022
MUNICIPALITY OF ANCHORAGE
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. 051-211-18
Complete legal description Jasmine Lot 8
Location (site address) 22920 Parks Creek Circle, Chugiak, AK 99567
Current property owners) Troy Davis Homes, Inc.
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
Day phone (907) 357-9394
3. TYPE OF WATER SUPPLY: ■❑ 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: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel X Plastic ❑ Concrete ❑ Fiberglass
Age < l yr - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑■ Deep Trench ❑ 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 Waiver Fee $
Date of Payment J /,(/z q Date of Payment
COSA # O S 2 1-1 10 1 Waiver #
COSA Application—June 2022
COSA Checklist_June 2022
COSA Checklist
Legal Description: Parcel ID:
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
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.
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
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes go to bottom of effective.
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
Benjamin Schiller, P.E.
(907) 522-7773
Well Nater Advisory
Certificate of On -Site Systems Approval # OSC241001
Subdivision: Jasmine, Block: , Lot: S
This well's productivity was determined to be .25 gallons per minute. The minimum
well productivity required under (AMC 15.55) for a 3 -bedroom residence is .31
gallons per minute or 150 gallons per day per bedroom. Although the well
production does not meet this requirement, water storage has been provided to
meet minimum code requirements.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
`Mailing Address P h0 Boxr196650 *Anchorage, Alaska 995196650 *www muni org
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