HomeMy WebLinkAboutSST BLK 2 LT 1Onsite File
SST
Block 2
Lot 1
#015-082-18
/q 7e A
Municipality of Anchorage Page of 3
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
Permit Number: S w93 0.36? PID Number: O t S•0 8 2l(
Name: Oe 11 I -)or+, e✓
Wastewater System: 63 New ❑ Upgrade
Address:
&6Z2 +/lerrlvf Circle Ao+cA 94rlK
ABSORPTION FIELD
Phone:
3 �s _Z35 -S
No. of Bedrooms:
U Deep Trench ❑Shallow Trench O Bed ❑Mound ❑Other
LEGAL DESCRIPTION
Soil Rating:
Q.
Total Depth from original grade:
/ H r
GPD/Sq. . Ft.
Lot: Block: Subdivision:
I Z SS r
Depth to pipe bottom from original grade:
'
Gravel depth beneath pipe _
6 Ft.
Ft.
Township:
12. i t
Range:
3 fti 1
Section:
Fill added above o. iginal grade:
I
Gravel length:
y
r s- Ft.
Ft.
WELL: ®New ❑Upgrade
Gravel width: _
2-S
Number of lines:
Distance between lines:
Ft.
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:-
Pipe material: F-810 Peri,
r i veA ke
28O Ft.
199 Ft.
752 SO. Ft.
p-3o3V Non- of
Driller:
/44the
Date Drilled:
13
Static Water Level:
Installer:
6etl 1-,6mev
Date installed:
?A1
Io,S Ft.
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM
— Ft.
2 Fl.
SEPARATION DISTANCES
XSeptic ❑ Holding ❑ S.T.E.P.
- To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
Tank
Capacity in gallons:
/000
From
Tank
Field
Station
Tank
Sewer Lines
Am Chon 2
Well
1y0'
IyS
—
^
13ol
Material:
-5
Number of Compartments:
2
Surfac
Water
>100
> too
—
—
>roo'
LIFT STATION Nr A.
Lot
r
SO
,
—
`IS'
Size in gallons:
Manufacturer:
Line
t(o
Foundation
C� t
Z I
_
"Pump on" level at.
"Pump off' level at:
High water alarm at:
Curtain
Pump Make & ModelElectrical
Inspections performed by:
Drain
Remarks: s ,-em +&r/Lr/(eW Qer �2*rz->&,eo
BENCH MARK
er/riif leSf he h _-i' z Geu o �•
Location and Description: �+
Ciof foM aJ Sio%i1
20 eon J)o 4edrock
of hoafe ecrntr A"
e4 re at a_ '{{i •
Assumed 1(9U.nO
ENGINEER'S SEAL
F�V'�., OAe�p0A1 iN
Inspections performed by: _ElaHOn 'recti Svc Dates: 1st 31z o41•�1%
TIff
2nd 312-5-19
. ..........<-0Y.
........
Department of Heal d H cervices a r val 0
pp
'THEODORE F. S.Av^ORE ,o
�; c `:35S9.�Cy�
Reviewed and approved by /
Date:
-., atncv. ora trnuHq '-. w, -
Permit No. SW 9303(02 Page 2 of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 ® Anchorage, Alaska 99519-6650 A Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: LOTS BLK 2 i SST PID No.: 01508218____
Permit No. SW `I3O3 62
Page 3 of 3
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343 -474 -
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: LOT 1 . ?)Lk 2 SST PID No.- 0150 $218
�m
�i(Z-9/9N
« S E OF ALASKA
DEPARTMEN..jF NATURAL RESOURCES
DIVISION OF WATER
WATER WELL RECORD
LOCATION OF WELL
BOROUGH
SUBDIVISION
LOT
BLOCK
SECTION O.TRS
SECTION
TOWNSHIP
❑N
RANGE
❑E
MERIDIAN
%
❑S
❑W
LOCATION/SKETCH:
WELL OWNER:
RECElVED .M;R 2 9
DEPTHS MEASURED FROM:❑casing top ❑ground surface
WELL DEPTH: DATE OF COMPLETION
Depth of hole: C9_ do ft
Depth of casing: t
BOREHOLE DATA: Depth
Material Type and Color. From To
v
, ,n
O
�
DEPTHLSTATIC WATER LEVEL:
% [ ft below top ❑ surface
L l �/
of casing ground
Date: 3 ! /
r. D
1-3-
� -2
`—�
r
METHOD OF DRILLING: air rotary ❑ cable tool
11other
USE OF WELL: 9. domestic ❑ irrigation C1monitor
-�
11 public supply E3other
J..
CASING STICK-UP: 4t:'Diam: 0 in. to t?'71ft
Casing type: in. to`_L22_ft
WELL INTAKE OPENING TYPE: ❑ open end _ ❑ screened
❑ perforated 0 open hole
Depths of openings: to ft
C/ 7
SCREEN TYPE: Diam: in.
Slot/Mesh Size: Length: ft
GRAVEL PACK TYPE:
Volume used: Depth to top:
GROUT TYPE: Volume:
Depth: from ft to ft
'gyp
DEVELOPMENT METHOD:
1 r
Duration: -tet-1
PUMPING LEVEL AND YIELD:
�Sy ft after / hrs pumping gpm
JUL 51994
PUMP INTAKE DEPTH: ft Horsepower:
Municipality of Anc 10ra
WELL DISINFECTED UPON COMPLETION? 13,YES ❑ NO
Dept. Health & Human
CONTRACTOR INFORMATION:
REMARKS:
PLEASE MAIL WHITE COPY OF LOG TO:
`I DNR/DIVISION OF WATER
Date PO BOX 772116
EAGLE RIVER AK 99577-2116
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE n b nom)
DEPARTMENT OF HEALTH AND HUMAN SERVICES S p m
P.U. BOX 196650, 825 "L" STREET, ROOM 502 q
ANCHORAGE, ALASKA 99519-6650 S-_'gtl- 1jj
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
.PERMIT NUMBER:SW930362 DATE ISSUED: 9/14/93
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES EXPIRATION DATE: 9/14/94
OWNER NAME:KIM YOUNG H
OWNER ADDRESS:8320 EXETER DR.
ANCHORAGE, AK 99507
PARCEL ID:01508218
LEGAL DESCRIPTION: SST BLK 2 LT 1
LOT SIZE: 40510 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
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 343-4744 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
AN ADDITIONAL TEST HOLE SHALL BE DUG AT THE TIME OF
CONSTRUCTION TO VERIFY THAT BEDROCK IS AT A DEPTH OF GREATER
THAN 20 FT. (TEST HOLE SHALL BE DUG TO 20 FT.)
�� `
RECEIVED BY: '` DATE:
ISSUED BY:
DATE: �! I
CIVIL & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSTS
THEODORE F. MOORE, P.E. September 2, 1993 14530 ECHO ST.
PH: (907) 345-1355 ANCHORAGE, ALASKA 99516
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The purpose of this letter is to provide the required design narrative in support of our application for a
permit to construct water supply and wastewater disposal facilities on Lot 1, Block 2, SST S/D, located on
East 99th Avenue. Soils logs, perc test results, a site plan, design drawings and specifications are
enclosed for your review.
The proposed wastewater disposal system will be constructed between test holes #1 and #2. As can
be seen from the soil log for test hole #1, the native material between 5.5 and 18 feet below ground level is
a gravely silty sand with a measured perc ate of 27 minutes per inch. Using the soil application rate of
0.6 gpd/sq. ft. specified in the wastew er ordinance, this proposed 3 bedroom residence requires a total
absorption area of (3 x 150)/0.6 = 7 square feet. The proposed 47' long trench with 8 feet of sewer
gravel beneath the horizontal distribution pipe has a total absorption area of 752 square feet.
Proximity to bedrock is not a concern on this lot, and there was no indication of tighter soils
immediately beneath the bottom of the test hole. The soils testing and groundwater monitoring were done
in the spring of the year. In consideration of these facts, we felt it was appropriate to design the system
with the bottom of the trench at 14' below the original ground surface. This allows the most efficient
trench configuration.
The topography in the vicinity of the proposed construction slopes down to the north and west at
approximately 5%.
The proposed project will have no impact on present or future water supply and wastewater disposal
systems serving adjacent properties, nor will it have any impact on reserved space/surface and subsurface,
or on drainage.
Please give me a call at 345-1355 if you have any questions on this submittal.
Sincerely,
Ted Moore, P.E.
I
I
I
I
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I
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I HOUSE
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I
EXISTING WELL
I �
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20 0 20 40 60 80 100
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9TH
FEET
LOT 1, BLOC
4
WELL AND SE
.........•.......•....,..
J
SITE I
o.••• ••iii-. iss+e,.ev
THEODORE. f. 4AOORE°,• �.
FLATTOP TECHNICAL SE]
FPOI
'
REPLACEMENT
T.H.—
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TRENCH SITE
�#2
T.H.
\
#1
—
ol
'
al
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/
°O
47' LONG SOIL
�'oo'
I
ABSORPTION TRENCH
3 BDPM
w
E//
HOU
OZ
1000 GALLON
I
SEPTIC TANK
I
PROPOSED_
FLI
WELL
I
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1
_—L------
--�-- EAST 99th AVENUE_
20 0 20 40 60 80 100
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9TH
FEET
LOT 1, BLOC
4
WELL AND SE
.........•.......•....,..
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SITE I
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THEODORE. f. 4AOORE°,• �.
FLATTOP TECHNICAL SE]
g °,• CE - 3589 �+
Q��M'✓`°•.00e.°°°+
14530 ECHO STREET
��
ANCHORAGE, ALASKA 9;
C.O.
in
N
47LONG SOIL
ABSORPTION TRENCI
W. 8' SEWER GRAVEL
BELOW DIST. PIPE
In
6
in
C6
"All
M.T 47'
i
"All
El
PLAN VIEW
1 „ = 10 1-011 0'-0„
i
i
5
SECTION "A - All
1 11 = 51-0"
FINAL GRADE
ORIGINAL GROUND
BACKFILL
CLEANOUT
FILTER FABRIC
HORIZ. DIST PIPE (F-810)
MONITOR TUBE
PERF PORTION THRU
SEWER GRAVEL
SEWER GRAVEL
(8.0' BELOW DIST PIPE)
ASTM F-810
ASTM D-3034
1000 GALLON
SEPTIC TANK
O
FROM
RESIDENCE
C At�'��
fi 9!•i9Y0 YOf..•fef ••Y/ �\�e•6 Gha
!/CQ',
�� pY•e•• ••.•s. ••••••.N R9
e THEODORE P. MOORE_ve PC
CE -3539 Ar
Flattop 7echnicafServices
14530 Echo Street, Anchorage, AK99516
Phone (90 7) 345-1355
Lot 1, Block 2, SST S/D
9541 Homestead Trail
Wastewater disposal system installation
Specifications
1.0 General:
1.1 The scope of the project consists of installation of a 1000 gallon septic tank followed by a 47 foot
long soil absorption trench with a total of 8.5 feet of sewer gravel.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations from these drawings may be allowed or required by the engineer conducting the inspections.
All construction procedures and material specifications shall conform with Municipal and State
requirements. All separation distances shall be in conformance with Municipal requirements, unless
specifically waived.
1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any
buried utilities.
1.4 The contractor shall provide adequate cover material and rough grading over all system
components to ensure that proper drainage is achieved after settlement and that there are no residual
depressions. Insofar as possible the contractor shall minimize damage to trees.
1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after
the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction.
2.0 Septic Tank:
2.1 The 1000 gallon, two compartment septic tank shall be. set level on undisturbed soil. Each
compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried
less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation.
2.2 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The
waste line from the residence to the septic tank shall have a minimum slope of 1/4"' per foot, and the waste
line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A
cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be installed
within 5 feet downstream of the septic tank.
3.0 Soil absorption system:
3.1 The soil absorption system shall be constructed by excavating a 47 foot long trench to a depth of
14' below the original ground level.
3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to
allow proper infiltration.
3.3 A total of 8.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with
the perforated distribution pipes laid level such that the pipe inverts are no less than 8.0 above the bottom
of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the
#200 sieve.
3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on
the design drawings. The portion of the monitor tube extending through the sewer gravel shall be
perforated.
3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel before
backfill. The top surface of the cover material shall be raised a minimum of 12 inches higher than the
surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours. Fill
slopes shall be no steeper than 3:1.
3.8 Unless specifically agreed otherwise, the homeowner shall beresponsiblefor finish grading,
placement of topsoil and seeding the disturbed areas after the backfill material has stabilized.
4.0 Inspections:
4.1 A total of 4 engineering inspections will be required during the course of the project: (1) initial
stakeout with the contractor to establish the location of the system and to discuss the plans, specifications
and construction procedures, (2) after the native material has been excavated to expose the infiltrative .
surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3)
after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic
tank, but prior to placement of filter fabric, and (4) after final backfill and grading is complete. The septic
tank requires one inspection after it is set level and the piping connected, but prior to backfill. This
inspection may be incorporated with any of the above inspections.
4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensure the availability of the engineer.
IaitOp Technical Services
. s 4
14530 Echo Street
Depth to
Water
•
Anchorage, Alaska 99516
Municipality of Anchorage�.........
II: : 30
0���
e
...1'...•...y
DEPARTMENT OF HEALTH & HUMAN SERVICES
• THeoOos:e P. alooala
825 "L" Street, Anchorage, Alaska 99502-0650
y,`•,• CE - 3539 Ill ,%
"�'••......•••
SOILS LOG — PERCOLATION TEST
22 S/
moi•
+ 4hr'�
A�
TEST J�OL r # 1
12:3930
P:
iiaakm4
PERFORMED FOR: BRIAN d- C INDy ZE"ONG
DATE PERFORMED, S/21/9.3
LEGAL DESCRIPTION:LOT I. 13LK 2 SST- S
DEPTH P>~
1
LSM Silty S•un"t/ /.aam
2 Rev( -=�> cz,ay
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
SP gravelly scmo(
(damP)
NL Cray Sro
1 Township, Range, Section: <
S1'7 G-rauelly s�lEysand(
Sonne col.bley J- fctrgG
� oulc(ed
SLOPE
14 T12N R
SITE PLAN
WAS GROUND WATER
ENCOUNTERED? _No
hrc roe G(rC V S
�1t1 \/ IF YES, AT WHAT L
DEPTH? P
O'% E
Oeplll to Water Aller
Monitoring? M_y Dale: 5-126/93
13oHoln of A o I e
Reading Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
z" P ES0 k 5 21
II: : 30
21 %z
STAR
12:z :00
23 1
I :39:00
IS
22 S/
s/
+u O
12:3930
23 V
12-.54 : 30
15
22 3/
1/2
+ N o
12'5S!30
23 •s/
1:10:30
15
23
S'/g
+920
I : 11 30
23 V&
1'•26:30
I5
23
Yz
20 L .
PERCOLATION RATE z(minutes/inch) PERC HOLE Of 8
TEST RUN BETWEEN '7.6- FT AND $ FT
COMMENTS Ned-ertetf _S"(4c el r [uar%t� GQrrprjel fI-encA cons>Li-e.e e/2'un
S r ze f ren els
PERFORMED BY: E-zATTOP TECH S VCS _ I -�� /i r./r�,C_ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON I"HIS DATE. DATE: r`f a �� -7 ( (9 93
72-008 (Rev. 4/85)
3=lattop Technical Services
14530 Echo Street Lie
Alaska 99516 �••••••••••••••••••••••:,•
Anchorage,
Municipality o1 Anchorage . �..... ... ...�:...;;;;
DEPARTMENT OF HEALTH & HUMAN SERVICES ;.0'• THEODOIzE F. A100RE
3539. •. - .` rt
825 "L" Street, Anchorage, Alaska 99502-0650 '� 1�14 CE : �
SOILS LOG — PERCOLATION TEST'`'p •r�n�tt'1���Qu��
Tesf Ffn fe # 2 41I _'..,ft
PERFORMED FOR: BRIAN A- CINDY L80NG DATE PERFORMED: S12I1 �I3
LEGAL DESCRIPTION:
DEPTH P,f
1
St1
2
SST S/L> Township, Range, Section: SE(
Sr try S4/1 dy fo a M
3 SP (rrave(ly Sante
4 N 1 6Lray S`r 4
�
1 �
7 Srt C�Mvefly S�l�y San�f
8 (Srrnrletr 10 my eri4f
enco<cn!-erect in T. H. #.2)
9-
SLOPE SITE PLAN -
10- WAS GROUND WATER
ENCOUNTERED? N
11 S
IF YES, AT WHAT OL s
12 DEPTH? P
O% E
13 Depth to Water Alter
Monitoring? M. r dry gale:-5�2-9197
14
15
16
17
18
19
20
Reading Date Gross Net Depth to Net
Time Time Water Drop
I I PERCOLATION RATE (minules/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
COMMENTS _ Sr'7 ma{-eriCC ht T-1-1`EII 'r Y lT _yc//nlf ao- 4v yia f{rl et
_ _ _
f3&-ho9 on 2r'c%J_ � Sizefrcnc%�.e..___�_.6�J� /"
PERFORMED BY: FLATTOP "'�gcH S` V—C� I _�//� 9nz'e,1 CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Municipality of Anchorage a
On -Site Water and Wastewater Program _.
(907) 343-7904 ,FET Y
Certificate of On -Site Systems Approval
Parcel I. D.015-082-18
1. GENERAL INFORMATION:
Expiration Date:0-111
3 2 0 91 2
Complete legal description SST; BLOCK 2, LOT 1
Location (site address) 6931 EAST 99TH AVENUE *ANCHORGE AK
Current Property owner(s) PATTY GALLEGO Day phone 229-5719
Mailing address
Real Estate Agent COURTNEY GRANT Day phone 830-6852
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:�-
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for: Distance:
m
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 5 O
Date of Payment a 0 2
Receipt Number Q 18106
COSA # o SCa a 10 3 0
Waiver Fee $
Date of Payment
Receipt Number
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,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: If
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
systemis; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. DS4 SIGNATURE
,/ System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
y�—�.sres�
'E—%95:5 •'• ,�`�
�Ofc,s �iOP c�
#AECC884
ON_S1TE
��R ANp r
with the followil stipuW161 ("$_V,,ATER o
AAs
J
By: Original Certificate Date:3 aD�a
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_
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Other !" t t";so, X
COSA Checklist
Legal Description: SST; BLOCK 2, LOT 1
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
X Well log is filed with Onsite (or attached)
Date drilled 3125194
Total depth 280 It
Cased to 199 ft
ns Sanitary seal is functioning correctly
nN Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 1/17/22
Parcel ID: 015-082-18
Structure served by this system
Well production at time of test Z 4.8 =---gpm
Water storage tank volume gallons
Well disinfected for coliform test? El Yes No
11�
El Coliform bacteria is Negative
Nitrate mg/L E]I�W�Itrate less than MRL (ND)
Arsenic ug/L U4rsenic less than MRL (ND)
Collected by GEG
Date of Sample 1/17/22
Static water level at beginning of test 76.2 ft.
Comments *NOTE: LEGAL DESCRIPTION OF WELL LOT IN MOA RECORDS
INCORRECTLY STATES "HOMESTEAD" SUBDIVISION
B. TANK DATA
Age of tank(s) 27 years
Tank type/material �p"�
Measured operating fluid level in septic tank 48"
W Standpipes/foundation cleanout per record drawing
Date of pumping 5/4/21
D. ABSORPTION FIELD DATA
C. LIFT STATION
FI Required maintenance com
Age of lift station ars
Lift station mate
CommeaW .
Which system tested (date installed) 311994
Adequacy test date 1/17/22
ON ALL standpipes present per record drawing
Results F-1 Pass For 3 bedrooms
Total measured depth from grade 15.7 ft (max)
Fluid depth prior to test 43 in
Measured depth to pipe invert from grade 7.25 ft (min)
Water added 615 gal
M N/A – pressurized field
New depth 57 in
❑ Monitor tubes go to bottom of effective. If not, state
Elapsed time 120 min
depth into effective 7.83
Code -required soil cover over field
Final fluid depth 51 in
❑System presoaked
Absorption rate 450+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) NO
date of test) =2
Gallons introduced N/A _gallons
—9
If yes, enter date N/A
Comments/Deficiencies:
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
❑ Yes
if No
Community Sewer Manhole/Cleanout > 100'
Q Yes
if No
ft
Q Yes
if No ft
Neighboring Tank > 100' Yes
if No
ft
Private Sewer/Septic Line > 25'E] Yes
if No ft
Absorption Field on Lot > 100' Yes
if No
ft
Holding Tank > 100' 21 Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' El Yes
if No ft
�✓ Yes
if No
ft
ft
If septic tank is under driveway comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' P1 Yes
if No
ft
0✓ Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No
ft
Surface Water> 100'
Yes if No ft
Property Line > 5'
Q Yes
if No
ft
Wells on Adjacent Lots:
Wells on Adjacent Lots:
Absorption Field > 5'
Yes
if No
ft
Private Wells > 100'
Yes if No ft
Water Main > 10'
Q Yes
if No
ft
Community Wells > 200'
Q Yes if No ft
Water Service Line > 10'
❑✓ Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
0
Yes
if No **
ft
If absorption field is under driveway comment below
Property Line > 10'
[D
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
✓l
Yes
if No
ft
Private Wells > 100' 0 Yes if No ft
Water Service Line > 10'
P✓
Yes
if No
ft
Community Wells > 200' 2✓ Yes if No ft
Surface Water > 100'
✓0
Yes
if No
ft
F. ENGINEER'S COMMENTS
*5'+ CODE AT TIME OF INSTALLATION **DRAINFIELD IS NOT UNDER DECK
SUPPORT• •
G. ENGINEER'S CERTIFICATION ,� OF
v`>� .• ,�5��
l certify that l have determined through field inspections and review
of Municipal records that the above systems are in conformance with p
MOA COSA guidelines in effect on this date. :. 4 4-U4 . • . • • • • . • • .
COSA Checklist yellow sheet
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MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904
On‐Site Water and Wastewater Section Fax: 343‐7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org
Septic Tank Advisory
Certificate of On‐Site Systems Approval # OSC221030
Subdivision: SST Block:2, Lot: 1
The septic tank for this property is 27 years old. The average life for a steel septic
tank is 20 years.
This advisory must be attached to all copies of the subject Certificate of On‐Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
PLAT NO, 77-152
�soti*T* SUt""I' DIVISION
LOT 1 BLOCK 2
Z,51 0 S.F.
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�'¢deessiona ►
via i**
`—`UILDING DE rAIL
B`VCERTIFY THAT I HAVE SURVEYED THE
GASTALDILAND
PROPERTY DEPICTED ABOVE AND THAT NO
ENCROACHMENTS EXIST EXCEPT AS
SURVEYINGI LLC
rr IS THE RESPONSIBILny OF THEOWNER TO
x # D R
JEFF A.
DETERMINE THE EXISTENCE OF ANYASEMENTS-
�20001 E. DOWLING RD.v SUITE 01
COVENANTS OR RESTRICTIONS WHICH DO NOT
ANCHORAGE, ALASKA w9507
wi1Gr
y t► Alr x *r` RECORDEDSUBDIVISION PLAT,
PHONE 248-5454
--l'UNDER
NO CIRCUMSTANCES ANYDATA
GRID
DATE
HEREON BE USED FOR CON UCTION OR FOR
,�
/2017 11
;: ! E
ANCHORAGE RECORDING DI ICT, ALAS KA
JOB
NOTE 'NO CORNERS SET TH I S DATE•
F
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`—`UILDING DE rAIL
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # n UZ) - OR Q - I'
0; -f
a5 0 III �.M
1. GENERAL INFORMATION
Complete legal description l o t 1, 6 /0c k 2 SS T S /D
Location (site address or directions) EasF 99 411 4e
Property owner Gell 1{vma< Day phone l ys' 2 3, S -
Mailing address ! 562 Z Gut/ie mof Cercle� /3nchorxc5vQf Ak 99S /6�
Lending agency Nor awls t t l or f9aAP Day phone 2 7 6 - Y ZSO
Mailing address 2SSd pe/),n/;p Su.fc /,Y% AAchorc ' f)l<' 89503
Agent r,lonP Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
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 f
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.
72-025 (Rev. 1/91) Front MOA #21
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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm Ft a >!h ie Te.chn r', -a f Seryl r<r Phone 3 13,27 -
Address
3,2
AddressRNs 3� macho S/, f cho�cr�e, /9k 916'�
Engineer's signatureDate Su IX fj l9 9 y
.• A
Aop 91H �* ♦ h
`1 f
rs
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�•f.•H••♦••••/1•••••H�•J dv�
d e THEODORE F. MOORE ; nA
CE - 3589 •")
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6. DHHS SIGNATURE
X Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
By: Date 7- 2 2
1UTIC
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025(Rev.1/81) Back MOAN21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: `v¢ ►i r3lock- 24 SST S/D Parcel I.D.
A. Well Data
Well type Pr'va k If A, B, or C, attach ADEC letter. ADEC water system number N. A
Log present (Y/N) i Date completed 312S-19'1 Driller Al me Drrlhe
Total depth 280' Cased to 199 Casing height 2'
Sanitary seal (Y/N) Y Wires properly protected (Y/N)
FROM WELL LOG
Date of test 3 / ?15-19 y
Static water level / Os '
Well flow 7 g•p•m•
Pump levels —
SEPARATION DISTANCES FROM WELL TO:
AT INSPECTION
Septic/holding tank on lot
1 `/ G'
Z
rn
_
n
lid
1'�S''
; On adjacent lots
> ►OG '
Ess
� O
T
Fle4L% Fec.4
Svc
Z
in Gi
o
X
Septic/holding tank on lot
1 `/ G'
; On adjacent lots
7 I GG '
Other bacteria
O cc,/ // G G ,7) -L
Absorption field on lot
1'�S''
; On adjacent lots
> ►OG '
Public sewer main > too Public sewer manhole/cleanout > (GG'
Sewer service line � I oo' Petroleum tank non
WATER SAMPLE RESULTS:
Coliform None
rV or1�
Nitrate
< O• / m /.f!
Other bacteria
O cc,/ // G G ,7) -L
Date of sample:
(/ /3/9,y
. 6/ �9 /9 y
Collected by:
Fle4L% Fec.4
Svc
B. SEPTIC/HOLDING TANK DATA
Date installed 3 / 2S / 9 y Tank size / 000 aed Compartments
2
Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) /`/
High water alarm (Y/N) N.A. Alarm tested (Y/N) N. A.
Date of pumping Al. A. ( he w) Pumper 1V, A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 1 NO' On adjacent lots *-> 100" Foundation
To property line SO' Absorption field 2Y, Water main/service line > roo'
Surface water/drainage > too
72•026(3/93)•Front CONTINUED ON BACK PAGE
C. LIFT STATION (N, A)
Date installed Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
"Pump off" Level at
Cycles tested
Surface water
Date installed 3 / ZS /9 y Soil rating (GPD/Ft2) 01 6 System type Tree c h
Length y7 ' Width 2,s' Gravel thickness 19.0 Total depth Py'
Total absorption area 752 Cleanout present (Y/N) Y Depression over field (Y/N) IV
Date of adequacy test N' A. C n.e w�) Results (pass/fail) N• R. for Bedrooms
Water level in absorption field before test N • A. After test ��• �.
Peroxide treatment (past 12 months) (Y/N) N If yes, give date N• A,
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot t iS , On adjacent lots > too, Property line 60'
To building foundation /2' To existing or abandoned system on lot Nine
On adjacent lots > 3 o Cutbank None Water main/service line > 670
'
Surface water > too' Driveway, parking/vehicle storage area > .Sri'
Curtain drain tyone seen
E. ENGINEER'S CERTIFICATION
l certify that l have checked, verified, or conformed to all MOA and NAA
Signature lir m�
Engineer's Name -Th eoem'are F, r-1o0r-e
Date J u I{ f, /99y
of this inspection.
P�� • So- •�S�'• T'#-
M!!!!♦PPP ♦!!P••. P♦♦°c55"
�•, CE - 3.589
Ian! �•�}}.,, befv°•P 8.S
HAA Fee $ 3a0 � Waiver Fee $ _
c� G
Date of Payment ,% —/� / \� Date of Payment
Receipt Number s- ( y J Receipt Number.
72-026 (3/93)' Back
SINCE 1908
CT&E Ref.#
Client Sample ID
Matrix
Client Name
Ordered By
Project Name
Proj ect#
PWSID
Commercial Testing & Engineering Co.
Environmental Laboratory Services ri�oois®ei�oi®irieiiiiii®®®i'sreie®ir
LABORATORY ANALYSIS REPORT
94.2913-1
Ll BLK2 SST S/D FRONT HOSEBIB
WATER
FLATTOP TECHNICAL SRV
UA
WORK Order
79412
Printed Date
06/17/94 @ 11:37 hrs.
Collected Date
06/13/94 @ 13:30 hrs.
Received Date
06/13/94 @16:45 hrs.
Technical Director
STEPHEN C. EDE
Released BSL
Sample Remarks: ROUTINE SAMPLE COLLECTED BY: T.F. MOORE.
QC Allowable Ext. Anal
Parameter Results Qual Units Method Limits Date Date .Init
– -- – ------ ------------- --------------
Nitrate-N 0.10 U mg/L EPA 353.2/300.0 10 06/15/94 DJS
* See Special Instructions Above UA= Unavailable
** See Sample Remarks Above NA=Not Analyzed
U=Undetected, Reported value is the practical quantification limit. LT=Less Than
D =Secondary dilution. GT= Greater "Ihan
5633 B Street, Anchorage, AK 99518-1600 — Tel: (907) 562-2343 Fax: (907) 561-5301
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