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Home My WebLink AboutELMORE #1 BLK 4 LT 4 Elmore #1 Block 4 Lot 4 #018-171-39 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT ermit Number: OSP231G22 P(D Number: 018=171`-39 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: Q New ❑ Upgrade Name HULTQUIST HOMES ABSORPTION FIELD 0 Deep Trench ❑ Wide Trench ❑ :Bed ❑ Mound Site Address 4201 SHOSHONI AVE, ANCH AK ❑ Other Phone Raticu} To2al.degth.irap�origiraalgsadre 3ber.of.Bedw=sJDepth 2 GPD/SF 8 Ft. LEGAL DESCRIPTION to pipe invert from original grade Ft. Gravel depth beneath pipe 5Ft. Subdivision Block Lot ELMORE # 1 BLK 4 LT 4 added above original grade 1 Gravel lehgth Township Range Section Ft. 38 Ft. Gravel width 2.0 1380 Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding l Sewer Total' absorption area Number of trenches ist .between trenches From Tank Field Tank Line Ft? 1 Ft. Well 100'+ 100'+ 50'+ TANK p Septic ❑ S.T.E.P. ❑ Holding ® Other Manufacturer ' Capacity Surface Water 1001+ 1001+ f ANCH TANK/GREER 1000 Gal. Material Number of, compartments Lot Line 10'+ 10'+ NA PLASTIC 2 Foundation *5'+J 10'+ ( LIFT STATION Manufacturer Capacity Remarks * OUTSIDE FOOTING BEARING Gal. Alarm location Electrical installed by fistaUer PIPE MATERIAL House to tank 3034 dTank to 3034 M KE N ANDERSON, P.E. Drainfield 3034 CO/MT 3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) ft Ins dot ectiosn 1s, 6/4/23 2nd 6/3/23 Location and description 10:1,13 ` ' MIUA 3'a 4m TOP OF MANHOLE �e,- ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engin ers Stamp Conditional Approval: Date —�- •'' �'' ' :�' ' A 9 T- t1; .r fl•.•..... ►.I. ............ ', : MICHAEL, N. ANLAP.SCN ;; = Septic Syste ApprovedDate zli z3 .- C - 9469 �� 17 ••fJ�ea/ Note: this approval d not include well permit requirements. Permit No. OSP231022 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ELMORE #1, BLK 4 LT 4 PID No.: 018-171-39 ® 1 11 WELL I 1 i \/ I A/WELL � v MARK \ A B C01 4\ 27 TC01 15 \ 18 TCO2 21 18 CO2 25 21 _C05 35� C04 16 C05 43 25 ® WELL \\ TCO2 \\-- _C05 \ ----'� 01 / C04 \ A,---- �- 7 — — — — — — — I I I WELL 1 7.5 TC01 1.000 GALLON PLASTIC TANK I \ ASBUILT I SCALE: 1 "=50' I WELL I I 1 SEP11C Man N.T.S. rRLTER FABRIC 91 64 W 24" "HIGH"WOOD D CK f PILE SUPPORT V1000 GALLON STIC TANK RESERVE APPLICATIONOF 3GPD/SF 20'X2'X5� EFF. TRENCH BENCH, TOP OF GP GM/GP NO WATER ® 84 MARCH. 2023 MICHAEL N. ANDERSON. ' No. CE 9469 .416 �J �'�O'��'•.......•.•••'�• MUNICIPALITY OF ANCHORAGE 1 ti -W Development Services Department Phone: 907-343-7904 On -Site Water &Wastewater Section Fax: 907-343-7997 Well Log Permit Number: # osp231022 Date of Issue: 3-3-23 Parcel Identification Number: Date Started: 3-17-23 Date Completed: 3-17-23 Is well located at approved permit location? Yes ❑■ No ❑ Legal Description: Elomore #1 BLK4 LT4 G:3036 Property Owner Name & Address: Hulquist Homes Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From To casing stick up 0 2 2 4 overburden silt & gravel 4 30 moist silt & gravel 30 43 silt & gravel 43 79 boulder 79 81 silt & gravel 81 97 coarse gravel w/ H2O 97 100 LAT: 61.092773 LON: -149.790423 Water Sample Results: Arsenic: Nitrates: Total Coliform Bacteria: ug/L mg/L colonies/100mL Method of Drilling ❑■ air rotary ❑ cable tool Casing type: steel Wall Thickness: •250 inches Diameter: 6 inches Depth: 100 feet Liner Type: Diameter: inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): 77 feet Pumping level: feet after hours pumping gpm Recovery Rate: 15 gpm Method of Testing: airlift Well Intake Opening Type: E] Open End ❑ Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: Bentonite Volume: 2 bags Depth: 20' Start 0 feet Stopped 20 feet Well Disinfected Upon Completion? Yes No Method of Disinfection: tabs Comments: 0 ❑ Well Driller: Johnny Kay Company: Hefty Drilling, Inc. Mailing Address: po box 112130 Anch. AK Attention: The well driller shall provide a well log to the On-site Water and Wastewater Section within 30 days of completion. Development Services Department Building Safety Division G� eG On -Site Water & Wastewater Program 4700 Elmore Road z. . z P.O. Box 196650 Mark Begich Anchorage, AK 99507 s n E T Y Mayor www.muni.org/onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: [ 6 a Z, Date of Issue: Parcel Identification Number: Legal DescriptionProperty Owner Name & Address: � `{ A^[ GLvih� f�0"Tt5 ��c, � to a/, 4 Pump Installation Date: 8-1-25 Pump Intake Depth Below Top of Well Casing: 6i 0 feet IPump Manufacturer's Name: C rLAnd d, 4 Pump Model: /0 Pump Size hp Pitless Adapter Burial Depth: feet IPitless Adapter Manufacturer's Name: COM611 6- to Pitless Adapter Installer: N � 2/ ),-\ Well Disinfected Upon Completion? Yes ❑ No Method of Disinfection: Q I "CCC � ,to I Comments: I Pump Installer Name: Johnny Kay Hefty Drilling, Inc. Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. 1 " =30' CA 0 SH OSH ON I AVE S 89.46'30" W 133.08' ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: ELMORE SUBDIVISION ADD Nol LOT 4 BLOCK 4 PLAT P -635A SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoul( any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE: E—MAIL• AUG 7, 2023 1 "=30' schullerOak.net 23-011 DRAWN BY: CHECKED BY GRID NUMBER: BOOK AGE JLS SW3036 230256 WAY 0 0 • v N 0 M 00 J 30' ►�ASM14 S F �\ L 0 �� N / �.• 49TH r / ............... ......... .� �- VA �Q ................ ........... I -.JOHN L. SCHULLER.• 0 / = , / J01- LS -10408 �� "` ' j . ew,, • �� / ~1831 Talkeetna Street Anchorage, Alaska 99508 o fe o� �. ,�, (907) 227-1455 office � l sslo=�� (907) 274-4992 fax \\�. 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: OSP231022 Work Type: WellSeptic Initial Tax Code Number: 01817139000 Site Legal Address: ELMORE #1 BLK 4 LT 4 G:3036 Site Mailing Address: Owner: ANDERSON MICHAEL N & SHERI L Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: �t�lcnr ,� r• a ^U �' llCl)81'CITICIIC Lot Size in Sq Ft: Total Bedrooms: 3/3/2023 3/2/2024 23783 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 Received By: l S VIF_-.O -f -0 t'No r Issued By: Date: Date: 3 3 2 3 MUHMP UTY Of ° HCHO RAE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section --- Fax: 907-343-7997 ON-SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 018-171-39 Property owner(s) HULTQUIST HOMES Day phone Mailing address 12570 Old Seward Hwy Suite 204 Anchorage, Alaska 99515 Site address NEW BUILD NO SITE ADDRESS, CORNER OF SHOSHONI AND BUFFALO, Legal description (Sub'd., Block & Lot) ELMORE #1, BLK 4 LT 4 Legal description (Township, Range & Section) Lot Size 23,783 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Fx_1 Initial 0 Single Family (SF) 0 (w/wo ADU) Septic Tank [K]Upgrade F-1Duplex (D) ❑ Holding Tank F-1Renewal F-1Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well 0 Water Storage ❑ THIS APPLICATION INCLUDES A 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: mo Date of Payment: oil , L— / gUa3 Receipt Number: o 27 / 9 / Permit No. 0 SP �Z_? 16 A' Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Feb. 28, 2023 Municipalities of Anchorage On-Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: Septic and well permit Legal: ELMORE #1, BLK 4, LOT 4 To whom it may concern: This is a request for a well and septic permit on the above referenced lot. A single test hole was excavated to 16 feet. No water observed during excavation or after the 7-day monitoring period. The measured perc rate was 3 minutes per inch. The soil log consisted of poorly graded gravel (GP) in the top 9 feet then changed to a silty gravel (GM) from 9 feet to the bottom of the hole at 16 feet. A simple deep trench has been designed for the proposed 3-bedroom house. The slope in the area is about 5 percent running to the SW corner of the lot. No cut-banks or steep slopes exist within 100 feet of the site. This well and septic design will not impact any of the surrounding neighbors, see the attached site plan. Sincerely was Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231022, Curtis Townsend, 03/03/23 1"=100' PROPERTY LINE PURPOSED NEW WELL W/ 100' RADIUS SCALE: DJRDRAWN: DATE: ELMORE #1 BLK 4, LT 4 Anchorage, Alaska HULTQUIST HOMES 2/28/2023 WELL 10' UTILITY EASEMENT DESIGN CRITERIA: 5' EFFECTIVE 3 BDRM X 150 = 450 GPD SOILS = 450 GPD/1.2GPD/SF = 375 SF 2.0' WIDE 38' LONG (1) DEEP TRENCH 7.0' DEEP 375 SF/5*2= 37.5' USE 38' SEPTIC FIELD SECTION 16 (TH#1) 1.0 GP ORG 1.5'2.0' -7.0 -2.0 MOUND OVER FILTER FABRIC SEWER ROCK 3,3( GRADE 9.0 GM/GP WELL WELLWELL WELL WELL SHOSHONI DR BUFFALOEAST 142ND Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231022, Curtis Townsend, 03/03/23 1"=50' PROPERTY LINE SCALE: DJRDRAWN: DATE: ELMORE #1 BLK 4, LT 4 Anchorage, Alaska HULTQUIST HOMES 2/28/2023 PROPOSED NEW WELL MT CO TH#1 FCO TCOSLOPE 2%-5%WELL WELL 10' UTILITY EASEMENT DCO TCO CO Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231022, Curtis Townsend, 03/03/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231022, Curtis Townsend, 03/03/23 MUNICIPALITY OF ANCHORAGE 0 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. 018-171-39 Legal description ELMORE #1 BLK 4 LT 4 Site address 4940 SHOSHONI AVE Current property owner(s) HULTQUIST HOMES INC Expiration Date: 12/20/2023 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: By: bedrooms, with the following stipulations: Original Certificate Date: 9/20/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovMjune 2022 KMT�Wi, WIVKO� M - Development Services Department On -Site Water & Wastewater Section ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 018-171-39 Complete legal description ELMORE # 1 BLK 4 LT 4 Location (site address) SHOSHONI AVE, ANCH AK Current property owner(s) HULTQUIST HOMES 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: 0 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 Q 13 A's Date of Payment COSA # �� G �� ) 2 _`7� Waiver # COSA Application -June 2022 COSA Checklist Legal Description: ELMORE # 1 BLK 4 LT 4 Parcel ID: 015-171-39 If more than. 4 well. andlor septic system on lot, provide separate checklist.. Structure served by this system A. WELL DATA N Well log is filed with Onsite (or attached) Date drilled 3/17/23 Total depth 100 ft Cased to 100 ft ® Sanitary seal is functioning correctly ❑� Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA NEW Static water level at beginning of test 77 ft. Comments B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) NEW N ALL standpipes present per record drawing Total measured depth from grade 9 ft (max) Measured depth to pipe invert from grade 4 ft (min). ❑ N/A —pressurized field. ❑ Per record drawings, field is insulated. Q 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 Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test 5+ gpm Water storage tank volume NONE gallons Well disinfected for coliform test? ❑ Yes ❑ No ® Colfform bacteria is Negative Nitrate 2.29 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/LArsenic less than MRL (ND) Collected by HEFTY DRILLING Date 8/2/23 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date NEW Results QPass 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 drawing*) 60 in Effective depth used 0 in Effective depth remaining 60 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' FYes if No _ ft Neighboring Tank > 100' Rn Yes if No ft Absorption Field on Lot > 100' E Yes if No _ ft Community Sewer Manhole/Cleanout > 100' Yes if No _ It Private Sewer/Septic Line > 25' Q Yes if No ft Holding Tank > 100' Yes if No _ ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No _ ft 0 Yes if No —ft Manure/Animal Excreta Storage > 10b' Community Sewer Main > 75' Yes if No _ ft �]i 'Yes if No _ ft ❑ N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' 7 Yes if No *5 ft Yes ifNo_ft R Yes if No _ ft Yes if No _ ft Surface Water > 100' Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' OYes ifNo_ft CEYes ifNo_ft Q Yes if No _ It Water Service Line > 10' El Yes if No _ ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS * TANK IS OUTSIDE FOOTING BEARING AREA G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply, with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm MI 14_t� Am L e v-,SuN P&% Phone 727-8864 Engineer's Printed Name Giww.C! Date T1412 or ..� a MICHAEL N AND[RSCN• CE -9469 f•;:,�;: COSA Checklist June 2022