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HomeMy WebLinkAboutMADDUX PARK LT 5271V Page -- of 2 Municipality of Anchorage T DEPARTMENH AND HUMAN SERVICES T OF HEAL ENVIRONMENTAL SERVIC9 S DI 10 sSTelephone: 343-474 Alaska 9951 s Anchorage, inspection Report P.O. Box 196650 Disposal System and/or Well Inspl � � 25 l -�b5 O "-Site Wastewater Disp PID Number: Svj g b24`�' '14 Upgrade Wastewater System11 : ❑ New Permit Number: G Name: Address: ABSORPTION FIELD P.Lri ❑ Mound ❑ Other _ ro Z ❑ Bed Qp >Deep ❑ Shallow Trench anal rase: phone_ � � 4— b�X. � I � o No of Bedrooms: Trench Depth from original I A• Total Dep I O• Soil Rating: _P a �+ DESCRIPTION . w GPD�S Ft Gravel depth beneath pipe E G AL Original grade:: -7 A, F L D Depth to pipe bytto? from ang 9 Ft. Lot: Subs �vision: y I • 3 .� th. 5- Block: �p.QvuX rade: Gravel ! I Fill added above ori� i 19 Ft. Distance between line Township: Section: O Number of lines: Range: I ---I Gravel width: / ,}. Ft. WELL_ upgrade >-S Pipe material: F l l New Total absorption area: D3o34- I Classif i Total Depth: Cased To: I SQ. Ft. �y t cation1.5C) I to Date installed' f �� (Private, A,B,C) 15n Ft. � S� Ft. C- a Driller: DPID filled: Static water Level: Installer: A g�l f qa 05 Ft. wpO TANK yield_ _ j�Rlt,LIN� CasingHeightAboveGround: Set at: Z Holding Ft. ❑ S.T.E.P. Pump `5Q Ft. Q GPM AN C c � Septic gallons: I ST C Capacity in SEPARATION D Public/Private Manufacturer: _ 125b Litt Holding N� ^�- artments: Absorption Sewer Lines Number of Comp Frern To Septic Station Tank Tank field / Material: GT�� w�e, t- l�l.- lovt�" N'a N A 25'' LIFT STATION 1 �/V ate e '���. I �1k ` ! Size in gallons: Manufacturer: LOB I Pump off" level at: High water alarm � � fk 2 �^ ,pump on"level at: ctions performed by: c1a*iorl 5 �- �s - Pum Modei Electrical Inspe Cur-taIn NIP N A N A Qa tes rt l BENCH MARK F:1 e T-n ��c �. (ZOLA u� tr, ;VA-7 Location and Description: Ta � of Co a arEcS: _ Assumed Elevv ti n� D guy tom—' 0`�►� / IL�N� D A S ENGINE'S SEA y4�VS xu Nil, a.,,�znt��ecU,' Of AL 191 /^1G Dates2nd `N �g JAltAESP.W►Wl� VDections performed b Y tq),%o No•9608 f 1F . s •. ,. C.E. alt and H an Services approval ,t���������' department of He f Date: �� R-ied and approved by: PERMff NUMBER: AS BUILT DRAWING PARCEL ID NUMBER: SW:980244 018-251-05 FlwL am NSi fm co Mf 97.90± FINK.6m PLl" PAW OWAK am 10.0,90+' 98M - 96.91 5� 9f2 Ar o-"rf - 97.77 IN511.ATION for' of f)" %011UT - 97,68 �r ' NSW 125O CA&LON NdYCitf GF PPC NJVEl2f GP BIIJ� 94B9(iW) 17.E 5�KCf" AiOl11LbT-96." t--- - ---- - - ����� EAST 144th AVENUE 87,49 Ci1Y) A B FC01 2.0 — FCO2 2.3 ST1 6.8 24.5 ST2 15.4 30.6 DBL1 17.7 32.6 DBL2 18.6 33.4 TH#246_ MT2 ---- FS C01 i _XING BDRM HOUSE I i FS 38.6 53.0 / /( C01 21.9 / 7Qi7• � ~\ MTt 20.4 ` R,q4 � NEW ELL CO2 73.9 81.4 / MT2 70.3 78.3 + / WELL 100' WERADIUS L 100' WELL WEL1 ALASKA WATER AND. WASTEWATER CONSULTANTS, INC. 7320 E. CHESTER HEIGHTS CIRCLE, ANCHORAGE, AK 99504 PHONE: (907) 337-6179/FAX: (907) 338-3246 _.GAL DESCRIPTION: MADDUX PARK SUBDIVISION, LOT 5 OF ul—,K: AS -BUILT OF SEPTIC SYSTEM UPGRADE :_PARED FOR: PHONE NUMBER: JOE BLAUSTEIN 745-8761 6'E: DF?A4'!N LAY: SCALE: PAGE; S/1 1 /98 A.C.G. 1 = 40` 2 OF 2 7H t' D812� DBL1 pq -- FCO1 IVORY OF At 49 � •�,� 0 NYIIVY... ....... '-,DAMES P. WILLIAMS- a NO. 9608 op el. • C.E. 44d Ar o f e s stogy°v 04Qoao�" 3 7 8 6, F . u i LOCATION OF WEL( STATE. OF ALASKA OEPA# IN "tT"OF NATURAL RESOURCES it 'OF M,01N G & WATER M IltT Nf A WELL RECORD QOfitlUON ij MO.$ N Lor 6L - SECTION 11OWK0777 11P pZi� a a NOR mEmowk T d r N 1-1 E r1s F7W LOCATIOWSKETCH: . . . . . . . . . . . WELL OWNER; Cl I,-Sm" 0- DEPTHS MEASURED FROM:C] casioa top O,grourd surioce. WELL DEPTH: DATE OF COMPLETiON 1$1 Depth of hole; ft Oepth of casm4; ft BOREHOLE DATA, Depth Material Type and Color From To (A AD • 0 1XI DEPTH TO STATIC WATER LEVEL: ft below :#E top of casing ❑ qwui-id swiarij Ante: METHOD OF DRILLING0C', air rotary r7caul? (txo ❑ other r USE OF WELL .J dcmastic C3 irrigation 0 morkof public suo,l ;,y Z other CASING STICX�WP; ft. Diam. ft Casing type: il�� m INTAKE OPENING TYPE;>e Cpel end sueer�iv, V4971WELL Cl perforated 7open We Depths of ooerungs: to Ir 011 SCREEN TYPE- Slot/Mesh Size: Length: GRAVEL PACK TYPE: Volumt V34d; Depthto top. 1P4 GROUT TYPE - depth: from f r to DEVELOPMWT METHOD! Duration. SEP PumF4NG LEVEL Aril?,. YIELD; it aftes, hrs pumping -Z- 'D Dept. Fieal ul Services PUMP INTAKE D# ft Horsepower., WELL DISINFAC '�VP(m COMPLETION? 7,01 YEi—Tiiu tip., CONTRACTOR INFO RM I Fri are BuillneSS NOMA PLfrz^. WHITE COPY OF LOG TO. DiA: 'OF MINNG & WATER 00MV 571§ftture of Auffid-n-z—aa-Me—sptdisentaW, ;mm 316,01 C St. Suit* goo ANC" AGE AK 90603-S936 Phone (9071289-8639, Fox (9071601-1 UA Wood tmd Sons�Contra ng Early View Dr. Anchorage, AK 99504 (907) 4-10-1813 Fax (907) 338-1303 1 ((A 61 �. w e l l 0-� J J &�� GIvLAV WIA lux 11 0 LA 1 j V6/2-&A r aOl� ad U1 ty of knchora( 1�7 Department of"health and Humart, Se-virl-r1c" 82-5 Siree' B ro x 9 6 4E c, 343-4744 Jeffery A. Garness, P.E. Alaska Water & Wastewater consultants, Inc. 7320 East Chester Heights Circle Anchorage, Alaska 99504 Re: Water Well Decommission For Lot 5 Maddux Park Subdivision, P. I. N. 018-251-05 Permit Number SW980244 Dear Mr. Garness: This office approves the procedure as described in a letter written by Jason Wood and discussed by yourself and me on August 11, 1998 of permanently decommissioning the existing water well on the subject lot. The decommissioning as described to me was cutting the casing off 10 feet below ground level and filling the well in with native soil with a high silt content and compacted within the casing. While this method does not follow the letter of the Anchorage Municipal Code 15.55, the intent of the code has been met. In the future when anyone decommissions a water well permanently the procedure must be in accordance with AMC 15.55. If there are any questions of the above please call me at 343-4761. Sincerely, b' ' x `'� Daniel J. Roth Civil Engineer On -Site Services Program cc: Jason Wood Joe Blaustein z uj to oo 1jo F'O b. 0 is P At a a —0 M CD It VIA Ot -C> Ui to r4 40 in uj 0-2 RL is by 6V"P?,l MS000 N '0., INNUSIV3 2JVOd .01 ---------------------------------------- GIs I Ou Munice ality of Anchorage Departi-nerit of Heait'h and Human Services m, 825 "L" Street Rick Mystro Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 http://wwe c_y(horaqe-ak.us July 16, 199S Jeffrey Garness, P.E. Alaska Water and Wastewater Services 7320 East Chester Circle Anchorage, AK 99504 Subject: Waiver Request for Maddux Park-, Lot 5 *\Y a I ver Request #NV1_1,9S0037, PID #01 S 25105 Permit --'SW980.244 Dear Mr. Garness: Your request for a waiver of the required 10 foot horizortal separation from the on -site wastewater disposal system to a propet-,y'lline has been approved. The approved separation distanc-, is 21.0 feet. This wai-%;cY a­pz=val a1 plies to file on -Site waste -Rater dispo d system to P, Z� property line separatio-n. only. An,,., ftituc lnp2rade To the on -sit e was-,e,,- ' *ater disposal a�! se,,�aration distances be met or anoer th sys"M W-1 i�q apprc-,al from this depar,ment. M lei' con—mis or qpl.icstions regarding this ,va'�7e.l If there -1.r-_ any --ft'.IJ i please call our office at Sincerely, Donna a C. C i -v' 11 E n g. i r Can -Site -IYVLtCr Qualitv Program MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -site Services Section Waiver Review Worksheet WR# lA1 �ig0037PID# �-Z-LJ I -fS HA# Permit Date Received: Legal Description: Engineer: A�x iie_ fi ceu 732c' Applicant: 11De_i>� 2 \�� Waiver Requested: \ +D t1,10i-Y`\ Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other. Points: Waiver is Granted: tik\ Waiver is NOT Granted: List Conditions or Reasons for above: Date : V �.� l ke �G! Rec # : C) 3 -7 7C Amount: $ By: Name of Reviewer 0 -7 Date Paid: Alaska Water & Wastewater 7320 East Chester Heights Circle — Anchorage — Alaska 99504 (907) 337-6179 — Fax (907) 338-3246 Consulting Engineers May 21, 1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Well Relocation and Septic Upgrade Design for Lot 5, Maddux Park Subdivision To whom it may concern: The existing 4 bedroom house is served by a private septic system and a private well. The existing well is to be permanently abandoned per M.O.A. requirements and a new well is proposed to be drilled in the southeast corner of this property. The existing undocumented septic system which consists of a septic tank and a unknown sized drainfield, which is surcharged. The existing septic tank and drainfield is to be abandoned completely. We request a permit to install a proposed deep trench with a 1250 gallon septic tank (see attached design). Also, we request you issue a 2 foot lot line waiver from the north property line to the new trench. The objective of placing the trench so close to the lot line is to maximize the separation distance from the old drainfield. Comments regarding the proposed upgrade design are summarized as follows: 1. SOILS: Attached is a soils log (Test hole #2) which shows the soil profile, and the percolation tests result. The soils below the organics are a SM/ML mixture with a few SP pockets to a depth of 6 feet. At 6 feet the soils transition to a SM/GM, which is a silty sand to silty sandy gravel, to a depth of 16 feet (bottom of test hole). No groundwater was encountered during the excavation of the test hole. Two soil percolation tests were performed, one at 4.0 to 4.5 feet, which perked at 20 minutes/inch, and one at 7.0 to 7.5 feet, which perked at 15 minutes/inch. 2. TRENCH DESIGN: a. Percolation Rate: 20 minutes/inch b. Allowable Application Rate: 0.6 gallons/day/ft2 c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 1000 ft2 f. Total Depth: 10 feet (max.) MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 C' P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON -SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW980244 Legal Description: MADDUX PARK LT 5 Design Engineer: Alaska Water & Wastewater Services Owner Name: Joseph Blaustein Owner Address: HC049130 Palmer , AK 99645-0000 Date Issued: Jul 16, 1998 Expiration Date: Jul 16, 1999 Parcel ID: 018-251-05 Site Address: 002610 144TH AVE E Lot Size: 13489 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [?] Disposal Field F✓ Septic Tank Holding Tank Privy All construction must be in accordance with: 1. The attached approved design. Private Well ❑ Water Storage 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 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. Make note of the well abandonment procedure in the As -Built package Received By: L.L'�� {��iL��''t.�J� '� Date: Issued By: ` J �� (� N4?Ni Date: r' 1 b ' 76 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services e LLy On -Site Services Program 825 L Street, Room 502 {� Y P.O. Box 196650, Anchorage, AK 99519-6650 ll 9 (907) 343-4744 ON -SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT: fir ,Ly( -S_et Upgrade Date Issued: Jul 16, 1998 Expiration Date: Jul 16, 1999 Permit Number: SW980244 Legal Description: MADDUX PARK LT 5 Design Engineer: 41 Owner Name: Joseph Blaustein Owner Address: HC049130 Palmer , AK 99645-0000 Parcel ID: 018-251-05 Site Address: 002610 144TH AVE E Lot Size: 13489 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: F Disposal Field F Septic Tank Holding Tank ❑ Privy Private Well 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 (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. Make note of the well abandonment procedure in the As -Built package Received By: Issued By: / ,, 414Ae. C i 55 Vr C) i+lq bWli 55io�v�- Date: -' 3 1 4( 8. epr„T-jp�d Date: c 78 t e? c; nA C vur'ec'A-S 4via4 o wt ►5s io vl g h i. j. Effective Depth: 7 feet of drainrock Width: 3 feet Minimum Length: 72 feet Effective absorption area = 1008 ft2 (>1000 ft2 OK) 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: Starting at the west side of the driveway, there is approximately a 1% to 3% slope which tapers out at the base of the retaining wall. This lot is generally flat and there are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. Sincerely, / I f %% Jeffrey j'G ess, P.E., M.S. la iCD ApFfAm Inc E. 14,AVENUE ,---- ATHf I Q / TO IcTING 4 DRM 1 Q 0- 1 N I �o \ I /I \ 10 -- I I O - ` LAJ 6 � -- � I ---------------------------------1 -------------------------------, i I1 ' ALASKA WATER & WASTEWATER MADDUX PARK SUBDIVISION; LOT 5, OF WORK: SITE PLAN PARED FOR: PHONE NUMBER: JOE BLAUSTEIN (907)745-8761 5/21/98 J.L.M. I 1= 100' I 1 OF 2 I r / / / / / 602 APPM3L LW. F aZillu%,gym TT Gar S.- 7953 e`t t. 1 VO�°r 0 f essto���ov 100, wELL RADIUS / EAST 144th AVENUE \ (APPROXIMATE LOCATION) PROPOSED UPGRADE DRAINFIELD , I FEET DEEP BY 2.5 FEET WIDE aw BY 72 FEET LONG WITH 7 FEET &o / OF SEWER DRAINROCK. a� —RETAINING WALL \ 1 / TH#2 a \ rY�- _ I C----------------- MT 0 I TH#1 I / - - _ - EXISTING 1 EXI NG L (4bOCUMETTTED DRAINFIEL.D gDRM (TO BE COMPLETELY ABANDONED) _ 4 HOUSE r w INSTALL CL CO w I / WEL c -PROPOSED 1250 GALLON w SEPTIC TANK I / EXISTING SEPTIC TANK A \ \ /A� (TO BE COMPLETELY ABANDONED) \ R�GOGTIO�y 1 \ POP OSED WELL \ \ 1 D0' WELL RADIUS ' IVORY DRIVE WE[ I 1DO' WELL RADIUS ` E / � I I E PRIOR TOCONSTRUCTION, THE CONTRACTOR SPONSIBLE FOR HAVING THE NORTH AND SOUTHWEST ERTY LINE FLAGGED BY A REGISTERED LAND SURVEYOR. PREPARED BY: ALASKA 'WATER & WASTEWATER � ........... LEGAL DESCRIPTION: , MADDUX PARK SUBDIVISION; LOT 5, ' 7 4) TYPE OF WORK: DESIGN OF WELL RELOCATION AND SEPTIC SYSTEM UPGRADE ao/j. PREPARED FOR: PHONE NUMBER: W n •''• f CE 7 53Go all •D JOE BLAUSTEIN (907)745-8761 ����� ryf DATE: DRAWN BY: SCALE: PAGE: �1QOred P • •' Q� 5 2 �ofeSsi° 21 98 J.L.M. 1 = 302 OF 2 pp n >' % ppp'oo©O`er ALASKA WATER & WASTEWATER 7320 E. CHESTER HTS. CIRCLE • ANCHORAGE, AK. 99504 PHONE (907) 337-6179 + FAX (907) 338-3246 SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: MADDUX PARK SUBDIVISION; LOT 5, PERFORMED FOR: JOE BLAUSTEIN DATE PERFORMED: 5/14/98 DEPTH TEST HOLE #2 (feet) j FILL (SM) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 GANICS SP POCKETS SOIL CLASSIFICATIONS _ ORG _— ML I CL OL MH / CH OH GW GP GM GC SW SP SM SC I= I ---- SM/GM SILTY SAND TO TY SANDY GRAVEL ).H. DEPTH TO GROUNDWATER DATE DRY 5/14/98 SITE PLAN 649 r - 100' „� LOC. E. 144th AVENUE \ i ppS � T1{� ��EDEU DESIGN),, 1 , {/ / THO EX151►NG \ ousCnNG UNDTUMENT D l i M wmm Tmlk- I I AiNk I� f i ♦ / 1 I � �•f �� I DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 5/14/98 - PERK EENCH 11 / 4.0'-4.5' — - -- 1---4:32 6" 4 1/2" 2 -- 5:02 30 MIN. 1 1/2" -- 3 5:02 6" — _ 4 _ 5:30 28 MIN. 4 1/2" 1 1/2" 5/14/98 - PERK EENCH 12 / 7.0'-7.5' 1 4:31 6" - - 2 5:01 30 MIN. 4" -- 2" - 3 -- 5:01 6„ — 4 5:31 30 MIN. 4" 2" 19- PERCOLATION RATE 20/15 (MIN./INCH) PERC. HOLE DIA. 20 TEST RUN BETWEEN (#1)4.0-4.5 FT. AND (#2)7.0-7.5 FT. COMMENTS: BOTH PERC HOLES WERE PRESOAKED FOR 4 HOURS PRIOR TO TEST. 6" (INCHES) I PERFOMED BY ALASKA WATER & WASTEWATER I, , CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ALASKA WATER & WASTEWATER 7320 E. CHESTER HTS_ CIRCLE + ANCHORAGE, AK. 99504 PHONE (907) 337-6179 * FAX (907) 338-3246 SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: MADDUX PARK SUBDIVISION; LOT 5, PERFORMED FOR: JOE BLAUSTEIN DATE PERFORMED: 5/14/98 DEPTH a ;-- TEST HOLE 1 (feet) p FILL (SM) 1 2- 3- 4- 5- 6 7 8 9 10 11 12 13 14= 15 16 17� 18 ORGANICS SM/SP WITH EFFLUENT BLACK SLUDGE AND LIQUID B.O.H. EVIDENCE OF OLD SOIL CLASSIFICATIONS _ ORG —ML /j ! CL OL -----1: MH CH i ' %' OH GW GP GM GC SW SP SIM SC f __ ` no°o Do I — DEPTH TO GROUNDWATER DATE N/A 5/14/98 e' SITE PLAN 02 E. 144th AVENUE TH/' ROrOE OEU PGRADGAI Ei �I //T►+iE_ _ 005n I � DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) - N/A _ — 19 PERCOLATION RATE - 20 TEST RUN BETWEEN - COMMENTS: EXCAVATED INTO OLD UNDOCUMENTED SYSTEM. Jv PERFOMED BY ALASKA WATER &WASTEWATER I, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND ` MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: / $ iJ (MIN./INCH) PERC. HOLE DIA. 6" (INCHES) FT. AND — FT. i/ 1 Parcel I.D. 018-251-05 1 17 a,tAit G 201G Municipahty,!'W\ Anchor. On -Site Water anal stewater Progr (907) 34 04 C� �N 1 6 8 Certificate of On -Site Systems Approval GENERAL. INFORMATION Complete legal description Maddux Park, Lot 5 Location (site address) 2610 E 144th Ave. Expiration Date: l� Current Property owner(s) Suzanne & Edward L.Ohr Mailing address Real Estate Agent 2610 E 144th Ave. 2. TYPE OF DWELLING: P Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual F Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee Waiver Fee $ Date of Payment Date of Payment Receipt Number %� iE B �� Receipt Number COSA# 05L;� f b Waiver # If more than 1 septic system is on the lot: COSA Checklist # 1 of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: MaddUX Park, Lot 5 A. WELL DATA r I Well type Private If A, B, or C provide PWSID # Date completed Sanitary seal Y/N Y ry ( ) Total depth 150 ft. Cased to 150 ft. FROM WELL LOG Date of test 9/8/1998 Static water level 65 Well production 12 WATER SAMPLE RESULTS: Coliform Neg colonies/10 Arsenic 5.02 ug/L ft. Parcel ID: 018-251-05 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 3/8/2016 97 g.p.m. 5.9 mL Nitrate 0.109 mg/L Date of sample: 3/8/2016 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Number of Compartments 2 Collected by: ft. g.p.m. PES Date installed 8/5/1998 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y !! Depression over tank (Y/N) N / High water alarm (Y/N) N Date of pumping 3b'//aft CV Pumper 60—a 4), C. ABSORPTION FIELD -DATA Date installed 8/5/1998 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 GPD/SF System type Deep Trench Length 75 ft. Width 2.5 ft. Gravel below pipe 7.4 Total depth 12.3 ft. Eff. absorption area 1 1 10 ft2 Monitoring tube Y Depression over field N 3/8/2016 Pass 4 ft. Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test 41 in. Elapsed Time: 1440 min. Final fluid depth 41 Water added 643 gal. New depth 55 in. in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date Municipality of Anchorage GE O A f Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # OSC 161080 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 5 of Maddux Subdivision. This inspection revealed an arsenic concentration of 5.02 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Infonnation on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. EAST 144th AVENUE � CrJ W I EXISTING 'tq rs , HOUSE 1�1 � QN f WELL 62,09 N90" 00' 00"E UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING, REPRODUCTION MAY CAUSE ERRORS IN SCALE. _ I,tT SURLY SURVEY TYPff —_ b . SYMBOLS t FOIZATit?N AS• -BUILT LJ FINAL STRUCTURE AS -BUILT , ry SET REk3Af 7 DRAINAGE �- f ASPHALT ❑ PLAN .. , ... SC [tIT 5I G FOUND RESAR 8._..p... e.. WOOD FENCE i� CONCRETE 9 ASSUMED ELEV, }I � -F METAL FENCE IC I WOOD DECK AS-PLOOC- COMET.RS As—s�€Lr ... No eeazr+i_€IC �`r -JILGRAPHY IONTOPAS- ��c��rlFlcancua .as—�ul.r ... �a cc�z>aesis >z:r EcEA PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF TIME BUILDER OR OWNER, PRIOR TO ONLY TI-iOSE IMPROVEMENTS ABOVE GROUND AND vISIBLE WILL BE, CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW HE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH 00 NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL OISTAiNCES ARE RECORD UNLESS OTHERWISE;: NOTED. SURVEY CERTIFICATION � •�1 Prepared by I�oDerL E. Johns, Jr. SX Assoc. PLOT PLAIN (� Land Surveyors am+arc.rel-446l+6wh.s ' 6thaa................Professional Urrs tat dra+rtr and haee#s, aqd tkgE i rr #+ + � 1700 Brink Driye. do wI t my nRRw -- m 0, to as r a afl sl s yaw and Ia OR a«c wa my zw0.106" and ala&fku , atl dwwwoas ha. tt a V - p.E , t ANCHORAGE. A.LASKA 9850A Scale- It _ �ryI � 3SJ Ret, Lot S.F`, Rec. Plat File No. aa,. and cOf-t + . H' ; Y ���$3 FOUNDATION AS --BUILT RaOa t . s„ Nooy awtly-that I aawt pw^t +d to Ae—Wit —r of Ow fixotdatiom tab tat M gat a* I #•###r.+ # .. :r,.x. • I""-n a !t "!s ru., -' a # ##.#.# # f,##,f # a Dole Surve & � 03/22/16 Drawn b � REJ Crocked b . aR , ai' w sk . and hft—akko as oa—, :kr AM, r` .. fry 4 vt ROBERT E. ,JOHNS JR o. � Date Drawn: �30���1 � Grad. 30 4 W.O. � �-�33 FINAL STRUCTURE As—ecnLT �' a, 121-5 4, LegaDescription:I. Rbwt F- sam' 'V., b**6s r t ttems� Wa IV a ......Lot 5 ' ssMand tatnwh—on b—.fd a6M.m.4MYCt .6n #aQ..'aS .1ifo>,i.a. fill f4ailcwln SAJ L1 J!1 '', MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section CIM P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 018-251-05 HAA # 0 WS 0 q _ID 1. GENERAL INFORMATION Complete legal description Lot 5; Maddox Park Subdivision Location (site address or directions) 9 It Property0kner Plaustei n Day phone 74 r)_876 1 AWaiiii'ing Address HC04 Box 9130 Palmer, AK 99645 Lending agency Day phone Mailing address Agent'- Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on -site XX Holding tank Community on -site Public sewer NOTE: if community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-M (Rev. 1/91) Front MOA #21 Municipality of Anchorage A&V DEPARTMENT OF HEALTH & HUMAN SERVE 1 �, �lIAL'"'� Environmental Services Division AP^'T^i. SERV1(-Pz 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: A4,012UX ��%/L , �o7 � Parcel I.D.: A. WELL DATA Well type 1u AFt Fz If A, B, or C, attach ADEC letter. ADEC water system number Log present (�'/N) Total depth Sanitary seal (YyN) Date of test Static water level Well production Date completed 8^1 -w Cased to ( SU , YES FROM WELL LOG bs� I_ `IT Casing height (above ground) C- Wires properly protected &/N) YFS AT INSPECTION 6A — IUEw wfF_c"_ g.p.m. WATER SAMPLE RESULTS: (\1 Coliform (K Nitratey+\� Other bacteria 0 Date of sample: It -.)- _9 C3 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed `( - 4'51(3 Tank size 1A50 Number of Compartments Cleanouts &N) , � Foundation cleanout ( )N) bg(-6- �1v Depression (Y(1�1 _L L' — High water alarm (Y, 0)w Date of Pumping w Pumper V / ci. C. ABSORPTION FIELD DATA Date installed `� - 8 S%8 Soil rating./(g.p.d./ft2 r ft2/bdrm) V 6 System type b—=&P 11�C t4 oa , Length Q� Width S Gravel thickness below pipe Total depth Effective absorption area n1,,��� 0 SF Monitoring Tube present (t(Y�1) �2- Depression over field (Y/© Nd Date of adequacy test U Results (Pass/Fail) i\-)IA- For bedrooms �/ A Immediate) after /� ( ) d UTA Fluid depth in absorption field before test (in.); y gal. water added in. Fluid depth " 177 (ins) Minutes later: NIA Absorption rate = �,' /J' g.p.d. Peroxide treatment (past 12 months) (Y�To IJ/Aa If yes, give date fjIn" 72-026 (Rev. 3/96)" F1 i o rt cni, c- r E i e c. t. r i c. -7 14 1,5 3 Y;--11 6 STATE OF ALASKA WAO "w, V'OF NATURAL RES 4;OF` M;N LOCATION OF WELL, 11 WELL ASCOR0 rsEcTlow ME�No, i 0 N F w LOCATIONISKETCH: WELL OVWOER; j r) DEPTHS MEASURED FROM:Mcasir,4 top El,ground surface. WELL DEPTH; DATE OF CQMPLFTI06 0000 of hole, Et 'Q-, 0', BOREHOLE DATA; Depth Depth of ft Material Type and Color Frorn To DEPTH TO STATIC WATER LVAL, *111 410-1k ft lift )c tOP Of C23419 Date: METHOD OF DRILLING.,ax rotary other USE OF WELL-.>rj Qlcmeatic C3 irrigation :,j moro-w 11� fro, 19' 0 public svp�iy other 17 F, STICXUP; ft Diam� f i., KQ, }` WELL INTAKE OPENING TYPE open end Perlorelecl ED Open hole A�l Depths Of 000r?mgs; to SCREEN TYPE- Diam, j Siot/Mesh Siz GRAVEL PACK TYPE: Volume used:.. Dep1h to top; LINF GROUT TYPE: Depth; from it to t —i,- 77 U V 7 7 7 -47 —i MELOPMI&XMIETHOD: "Al — Dept. H�,a'lth Hur ort Serenv es PUMPING LgVEJ ANQ YIELD. it after hru pumping t PUMP INTAKE DIS •yp-.i CONTRACTOR INFORMATION. 1 REMARKS. ered Sualnen Name PL c;r WHITE COPY OF LOG TO - a An, t e', ef - 40A— .,OF mwwa & WATgR Mimi 4 utnorlZea ReSOrdsentity" 301 C St, suits goo ANC"RAGE AK 90603-6936 Phecis (9071269-6633, Fox (9071602-1 "4 APPLIC NT FILLS OUT UPPER HAI ONLY Property Owner l ,: ' �1 r Phone / Mailing Address t : f� .- - ` % Zip Code'' Buyer f = f Address Zip Code Lending Institution f "'�. y. ,? Phone Address f-/.!''%ram .. "'•y _. Zip Code = Realty Co. & Agent Phone �J r _ Address ' Zip Code —" Legal Description Street Location Type of Residence ,* Single Family ,./ El Multiple Family No. of Bedrooms ❑ Other Water Supply �9, Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal [: Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ,(t l� t �^ (p (� fl'j- A—Q-� ( ) CONDITIONAL APPROVAL' r DATE r o _ `7- BY: i Soils Rating Date Sewer Installed Well To Absorption Area Ov Well Log Received N j SJ Well to Tank 3 '> Septic Tank Size 72 023 (31U) W e-"� �ti4 p91CN0AAtit aFFd �L T GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received - `Ey Time of Inspection Date of Inspection 5/J REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR � '-,- A ///, :2 i,, r ::: - y�i- / Approval requested by: Mailing Address: �lX �!>,�% ��U9 Phone: Property Owner: �,/�/>>L Phone: Mailing Address: Legal Description: Location: ,�/�/1✓�"�G°�-��/ ,/�ccCf� ��v — �' ffiuc� Type of facility to be inspected of bedrooms A. Type Construction Sewage Disposal System: B. Depth D. Bacterial Analysis A. Installed �/�✓�X /�lvS 6. Installer �:'Gf'/✓'�!'�.�'��C��.9i/.�' C. Septic Tank: 1. Size 2. Manufacturer ,,�'W. ��%✓� f � �<<� D. Seepage Pit 1. Absorption Area E. Disposal Field: Total length of lines A. Well to: 2. Material Septic tank Absorption area Sewer Lines/-/' Nearest 1 of 1 i ne %D t , Other contami nation j��i�'c'/G✓<<`/��� B. Foundation to septic tank J''',-- , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Re,-,..2st for Approval of Individual _ aer & Water Facilities Legal Description Comments ApprovedDisapproved Date Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM d �/�-,�.e-�vT• G mod.-�,..� %J'��7---%-, s�z��y. I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED i Date EQ-034 (1/74) KA pCNO[AG( A1 A� G 3 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 C Street, Anchorage, Alaska 99503 274-4561 Date Received 2 ' — -7 T Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Approval requested by: YS Mailing Address: S/4�7 �(�5�' 7 Ph on Property Owner: Sim --e- Phone: Mailing Address: 3. Legal Description: L G� Alq 6 � � S 4. Location: 5. Type of facility to be inspected- � It, _ No. of bedrooms 6. Well Data: fJ ( _ J A. Type ) 1 /l��' �G��l �� B. Depth r. C. Construction (J,� D. Bacterial Analysis 7. Sewage Disposal System: 7P' A. Installed B. Instaille C. Septic Tank: 1. Size , J� 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material ��,�_ r E. Disposal Field: Total length of lines d 8. Distances: A. Well to: Septic tank Absorption area �� Sewer Lines Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line i = EQ-034 (1174) Page 1 of two pages