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Home My WebLink AboutBUSHNELL LT 2Bushnell Lot 2 #090-021-60 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage Page 1 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: SW000391 PID Number: 090-021-60 Name: CHIP AND TERA LAVALLEE Wastewater System: ■ New ❑ Upgrade Address: 704 SUNSET DR 99501 ABSORPTION FIELD Phone: (907) 272-6086 No. of Bedrooms: 2 ❑ Deep Trench ■Shallow Trench 13 Bed D Mound 13 Other DESCRIPTION Sall Iiat ng: 1.2 Tafel Depth from original grade: (MAX.) GPD/Sq. FG .0 Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 2 BUSHNELL 4.42 (MAX.) FL 2.58 (AVG.) Ft. Township: Range: Section: Fill added above original grade: Grovel length: — — — N/A Ft. 32 It WELL: Gravel width: Number of Ni Distance between IInes; — New [-1Upgrade5 pt, 1 F. Claeegiwllan (Private, A,e,C): Total Depth: Cooled To: Total abeoroon ave: Pipe material: PRIVATE 112 Ft 112 Ft. 255 SQ. Ft D 3034/ F-810 Driller Date Drilled: Static Water Level: Inateller. Data metalled: HEFTY 10/2/00 90 CONRAD CONTRACTING 10/10/00 — 10/14/00 a Yield: Pump Set At. Dosing Height Above Graand: TANK 14 GpM Ft 1.5'+ It SEPARATION DISTANCES ■ Septic ❑ Holding 0 S.T.E.P. To Septic Absorption Lift Holding Public/Pdvots Manufaetunr. ANCHORAGE TANK Capacity in gallons: 1000 From Tank Field Station Tank sewer unee Well 100'+ 100'+ — — z5'+ Materiel: STEEL Number of comportments: 2 SurfaWater tie 100'+ 100'+ - - - LIFT STATION Wat LotShe 5'+ 10'+ — — — In gallons: Manufacturer. Line 'Pump on' level at Pump =High water alarm at: Foundation 5'+ 10'+ — — — _eeeej CurtainPump Make I: Eloctrfcal Inspections performed by: Drain NONE KNOWN BENCH MARK Remarks: TEST WAS DEEPENED TO 13+ FEET. SAME SOIL Location and Drarlption: PROFILE AS TH 1. NO GROUNDWATER. TOP OF PILE ON NORTHEAST CORNER OF HOUSE. Assumed Davatbn: 100.00 Ft. ENGa1PE we p060f o OF % - AWWC, INC. Inspections performed by: Dates: 1st 10/10/2000 ...J; ..... 2nd 10/10/2000 3rd 10/14/2000 0• a A.ess;'•.� Department of Health an H man Services approval 00044 '' ., 7953 5 0-1 ,. v� 0 ��a"40 Reviewed and approved by: Date: fesslo �0000�� 72—Di3 Rev. 9/91) MDA 25 PERMITNUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: SWO SW000391 090-021-60 ST1 38.27 34.79 ST2 44.32 40.06 DBL7 46.43 42.44 D3L2 47.45 43.47 MTI 56.24 53.46 MT2 83.48 80.30 CO3 84.65 8032 \ \ \ F4ti \ \ FP \ �o• \ \ x'90 TEST HOLE EXCAVATED 13' \ \ DURING CONSTRUCTION. SAME SOIL PROFILE AS IN THj1. ";'•.' NO GROUNDWATER.ALTERNATE SITE. '• i! ; DRN'D MAY i _ \ NEED TO BE REROUTED. 1 ALASKA NVATER & AVAST : m'ATL'R K.D.W. Ste' CONSULTANTS. INC. 6901 DEBARK ROAD. SUTF PB • ANCHORAGE. AK 9950.' PNONF. 907)537-6179 • FA% 01)556-3746 1 w 40' PREPARED FOR: PHONE NUMBER: PAGE NUMBER: CHIP AND TERA LAVALLEE (907) 272-6086 2 OF 3 LEGAL DESCRIPTION: BUSHNELL SUBDIVISION; LOT 2 TYPE OF WORK: AS—BUILT OF SEPTIC SYSTEM UPGRADE DRAINFIELD LOT 18 U.S. SURVEY 3201 , 't � / / � •'' iii y NITTHjt �. 5,... DBL2 DBL7 C///ppp... NEW 1000 GALLON ,�, �:,'• A SEPTIC TANK NEW TWO ' \ BEDROOM \ HOUSE I NEWS•',• WELL \ I 110. \ I / 1 ALASKA NVATER & AVAST : m'ATL'R K.D.W. Ste' CONSULTANTS. INC. 6901 DEBARK ROAD. SUTF PB • ANCHORAGE. AK 9950.' PNONF. 907)537-6179 • FA% 01)556-3746 1 w 40' PREPARED FOR: PHONE NUMBER: PAGE NUMBER: CHIP AND TERA LAVALLEE (907) 272-6086 2 OF 3 LEGAL DESCRIPTION: BUSHNELL SUBDIVISION; LOT 2 TYPE OF WORK: AS—BUILT OF SEPTIC SYSTEM UPGRADE DRAINFIELD LOT 18 U.S. SURVEY 3201 PERMffNUMBER: AS-BUILT DRAWING PARCEL ID NUMBER: SWO SW000391 090-021-60 for Of f"- Af PLEf - 9535 WV uGf PIPE - Af PLEf - 95.48 511 CM - 96.0+ 5f2 MW 1000 6AI,I.ON 5M1C TMK mom OF MCN - 90M ( AVG.) ALASKA «'ATER & WASTKR'ATIM CONSULTANTS, INC. 6901 DF9A ROAD, SOW 79 • ANCNORAGE. M 99504' PNONF. 907)357-0179 • PAX 07)56-374 PREPARED FOR: PHONE NUMBER: CHIP AND TERA LAVALLEE (907) 272-6086 LEGAL DESCRIPTION: BUSHNELL SUBDIVISION; LOT 2 TYPE OF WORK: AS -BUILT PROFILE OF SEPTIC SYSTEM UPGRADE 7. W02 for Of f" Af OUILEf - 95.95 - MJ rOPPre Af OUfl.Ef - 95.19 FINN. awA - 96.15+ WVEI2f OF PIPE -92.92 10/20/20 AWN BY: K.D.W. ALE: 1--40' CE NUMBER: 30F3 D � A. Gamess� -7953 :79 OCT -19-2000 1551 LR)ALLEE & SONS, INC. P.01 MU HEFTY DRIWNO i i E / V�� V wA'cn wcLA ALASKA 3540 AKULA DRIVE =J STATE N URAL!A • ANCHORAGE• AK 995 u . DEPARTMENT OF NATURAL RESOURES ARCH) RAGA45E. 93 •,1 �G Division Of Geological S GRODhy/IDDI Survvrs mow• .ere LOCATION OP WELL (Il see4 40-0,1614 alto$, 16. 1% 0,r 14.1 M 40raub I SYodWleloR I Lot 716c1 Drilling Poem"N4. OQ� A.O.L. 1► '/cave. Drilling le. DISTANCE AND DIRECTION FROM ROAD INTCAICCTIONS S. OWNER y� �ILL �,—• ( inn, °` S �,n../C / /•� I L A/al6r.: / U j. �Uc/n,et_Ft,J/t Street Address RN Area of Wall Lasalle, VL1 U��. Qk—gq 0 •. •. I„t btew i. WELL LOG A. WELL DEPTHS (Ilnel) 0. OATC M EOMgLCT10N d e.loeo Material Type Too 0114- /�' LOT - d- 00 e t a. O cable lees 9101eu,T 0 Delva■ Q out nqL. OVA G 0Avo, Qd,fl64r❑Sero! ❑DIAIrt • T.USE:USI Domestic. ❑ hello Ilo►•b Q IP40011T e t C�. !0 litigation 0A6449r14 [3Commerical tad Well Q Others e. CAS NO, O Thronged Welded Ue-.1A. 1a�� /1. Depth Weight _lot./ It. oleo, In. to�ft. Dealt 311ctuP It. S, FINISH 01 WCLLS Type: ! A LC--OIOwdM Qlel/Meek Bizet L ollNi Bel ►ebbe. if. and /l. R4011111ng Gravel Sect 10. STATIC WATER LEVCI YQ /0- 0 Above or Q Below land. surface E4alPmaot paid: It. PUMPING LEVEL below load suttee• and YIELD It. alar ��bs. Pem0,lna-9.p.m. atlu bre. RwPloe �1•P•w. IZ.GROUTING Wall 4r40164t.'MY;* 0 we 11.14,141: Q Neel aemonl O Olo$el a, IS, PUMP, (It available) NP Le+11b of Drop pipe 11. eesee111 e.►.w. 0 SYIm, C3dal O Cenlrilleel 0 Otbu It a4maaee, q j la. WATCN WELL. CONTRACTOR'S CERTIPICATIONI 1l. W, 141 Ya -0,v--- �. ThIII ,^ ►ee ^rlllad.rn4e• my lorledletlee and Ibis report Is bee 16 IM but o1 q 6.6.10,140 aid bare,{ aea:.e : Signed t Unt•d R tir.je Nam, A. Cenlrect LICep44 Retailer Part, OR•WWa til/ellI• �•�-Cse/ DiWUetbe: WNIT[•a1,40GRl, PINN•Odiby CANMY•Cee14-U ] P U a 2Q U TOTAL P.01 Na. Te+atbgN� Rupe C� 11eel1A• t �•I�d�d� a(] W❑ le. DISTANCE AND DIRECTION FROM ROAD INTCAICCTIONS S. OWNER y� �ILL �,—• ( inn, °` S �,n../C / /•� I L A/al6r.: / U j. �Uc/n,et_Ft,J/t Street Address RN Area of Wall Lasalle, VL1 U��. Qk—gq 0 •. •. I„t btew i. WELL LOG A. WELL DEPTHS (Ilnel) 0. OATC M EOMgLCT10N d e.loeo Material Type Too 0114- /�' LOT - d- 00 e t a. O cable lees 9101eu,T 0 Delva■ Q out nqL. OVA G 0Avo, Qd,fl64r❑Sero! ❑DIAIrt • T.USE:USI Domestic. ❑ hello Ilo►•b Q IP40011T e t C�. !0 litigation 0A6449r14 [3Commerical tad Well Q Others e. CAS NO, O Thronged Welded Ue-.1A. 1a�� /1. Depth Weight _lot./ It. oleo, In. to�ft. Dealt 311ctuP It. S, FINISH 01 WCLLS Type: ! A LC--OIOwdM Qlel/Meek Bizet L ollNi Bel ►ebbe. if. and /l. R4011111ng Gravel Sect 10. STATIC WATER LEVCI YQ /0- 0 Above or Q Below land. surface E4alPmaot paid: It. PUMPING LEVEL below load suttee• and YIELD It. alar ��bs. Pem0,lna-9.p.m. atlu bre. RwPloe �1•P•w. IZ.GROUTING Wall 4r40164t.'MY;* 0 we 11.14,141: Q Neel aemonl O Olo$el a, IS, PUMP, (It available) NP Le+11b of Drop pipe 11. eesee111 e.►.w. 0 SYIm, C3dal O Cenlrilleel 0 Otbu It a4maaee, q j la. WATCN WELL. CONTRACTOR'S CERTIPICATIONI 1l. W, 141 Ya -0,v--- �. ThIII ,^ ►ee ^rlllad.rn4e• my lorledletlee and Ibis report Is bee 16 IM but o1 q 6.6.10,140 aid bare,{ aea:.e : Signed t Unt•d R tir.je Nam, A. Cenlrect LICep44 Retailer Part, OR•WWa til/ellI• �•�-Cse/ DiWUetbe: WNIT[•a1,40GRl, PINN•Odiby CANMY•Cee14-U ] P U a 2Q U TOTAL P.01 �0 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 h' '_ /a/io aoCJ/d,�3�r' /D 1/6 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW000391 Date Issued: Sep 22, 2000 Expiration Date: Sep 22, 2001 Parcel ID: 090-021-60 Legal Description: BUSHNELL LT 2 Design Engineer: 0041 AK Water & Wastewater Consultant Site Address: Owner Name: Chip & Tera Lavallee Lot Size: 49025 SO. FT. Owner Address: 704 Sunset Dr. Total Bedrooms: 2 Permit Bedrooms: 2 Anchorage . AK 99501 - This permit is for the construction of: 0 Disposal Field Q✓ Septic Tank Holding Tank Ej Privy Q✓ Private Well El 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. Received By: Issued By: Date: -1Z —�'r Date: q-22-00 ALASKA WATER F& WASTEWATER CONSULTANTS, INC. - September 8, 2000 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 and Septic Design for Bushnell Subdivision; Lot 2 To whom it may concern: The proposed 2 bedroom house will be served by a private well and septic system. One test hole was excavated on the property. The proposed septic system will be designed within this 30 foot radius. We are proposing that a 1000 gallon septic tank and a five foot wide drainfield be installed. Comments regarding the proposed design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, an application rate of 1.2 gallons/day/fl2 should be used. The insitu soils should act as a sand filter. 2. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch b. Allowable Application Rate: 1.2 gallons/day/fl2 c. Number of Bedrooms: 2 d. Design Flow: 300 gallons per day e. Minimum Absorption Area: 250 fl2 f. Total Depth: 6 feet (max.) g. Effective Depth: 3 feet h. Width: 5 feet i. Reduction Factor: 0.58 i. Minimum Length: 30 feet long j Effective absorption area = 258 fl2 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 6901 Debarr Road, Suite 213 * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com 4. TOPOGRAPIIY: The proposed septic area is generally flat; in short, there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179, or 244-9612. Thank you for your assistance. .E., M.S. NOTE: Attached is a site plan drawing, a design drawing, one soil log, and a 7 page constniction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Far: (907) 338-3246 * Website: ak«,Nvc.com LOT 16 / U.S. SURVEY 3201 ARE!3 ♦\` `\♦ `♦/ I �` ♦` (WELL 100'+--�- i y ♦ \ • % ♦'` --- / ALTERNATE •♦ ` LOT 15 SITE ♦ ♦ U.S. SURVEY 3201 THII I y ��- ♦ , \ `� �♦ I ` ♦ ;' ^- • ASEPTIC ►a(! ♦♦\\\ \♦♦♦ 1 AR! ♦♦ j ♦ ♦ PROPOSED SEPTIC SYSTEM. SEE �� `♦ DESIGN PACE 2 OF 2 FOR DETAILS. 1 \` ol / ` ` .. ♦ I / LOT 18 / PROPbgED ` ♦�{ PROPOSED U.S. SURVEY 3201 j ♦` LOT 32 U.S. SURVEY 3201 I S/D ALASKA NATER & NASTK«7ATKR CONSULTANTS, INC. aom .v:vevv engin V tTE fe �GE. " 99504 • MORE (907)537-8179 • F" (907"]8-324 K.D.W. 1" = 100' PREPARED FOR PHONE NUMBER: rwL NVMOLn: CHIP AND TERA LAVALLEE (907) 272-6086 1 1 OF 2 BUSHNELL SUBDIVISION; LOT 2 SITE PLAN FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM A. Camess; E-7953 ♦F.� 4 - \ \ °0`yF \ \ \ 'p- 110- PROPOSED 0•� \ /o \ PROPOSED DRAINFlELD. EXCAVATE \ � \ A TRENCH THAT IS 8 FEET DEEP, \ BY 3 FEET WIDE. BY 30 FEET - \ LANG. ADD 3 FEET OF CLEAN. \ WASHED SEWER DRAINROCK. INSTALL DOUBLE CLEANOUTS 'ED 1000 EPTIC TANK /1 PROPOSED WELL yn / / PRESERVE RESEE SITE / /// MAY REQUIRE // / MODIFlCAT)ON TH/1 TO DRIVEWAY - INSTALL FOUNDATION CLEANOUT LAT 18 U.S. SURVEY 3201 DRAWN BY: tAI.ASRA IVATI;R S WASTEWATER K.D.W. SCALE CONSULTANTS.INC. •• c 40� ....... . ...... ••..... 6901 OFRARR ROAD. SLITE 2R • ANCHORAGE. AX 99506' PHONE 907),137!179' FAX 907)33"266 a .. QQ ...... REPARED FOR: PHONE NUMBER: PAGE NUMBER: CHIP AND TERA LAVALLES (907) 272-6086 2 OF 2 efr A. QO �� •, 7953 ess? �� EGAL DESCRIPTION: - BUSHNELL SUBDIVISION: LOT 2° ,. • �4v�Qdp"relllO��a�� YPE OF WORK: DESIGN OF PROPOSED WELL LOCATION AND SEPTIC SYSTEM 040000�� ALASKA WATER & WASTEWATER CONSULTANTS, INC. ob�0000 Or �O^S�000 NET TIME 6901 OEBARR ROAD. SUITE 2B • ANCHORAGE. AK. 99504 PHONE (907) 337-8179 ° FAX (907) 338-3248 P 8/25/00 SOIL LOG - PERCOLATION TEST Opk , ..•• •. . ' . .. ....... �0 LEGAL BUSHNELL S/D• LOT 2 DESCRIPTION: 0 PERFORMED FOR: CHIP AND TERA LAVALLEE•••••••••••� r .A. Gam ess: DATE PERFORMED: 8/25/2000 —7953 Q \FO TEST HOLE #1 44p" (feet) ORGANICS Prof a clod" o0. .v , sniL CLASSIFICATIONS \ \ 0 0°; d SITE PLAN \ \ GORG \ \ W I' = 100' puo_.y. GM CL \\ \\ 4 Qo°. d GC OL — f \ SW MH,�\ 5 ..,., ; SP CH sm- ' : OH Q e°°c4 y SM 'OTH 8 SW GW / Sc �Z 1 " 1Y 7 e oa• DEPTH TO ROUNDWATER DATE \\ I 8— o°oa`�= DRY 8/25/2000 j\ o •.... °o°: �'' DRY 9/3/2000 \\ 10 boo.- it 0° o' a DATE READING TIME (MINUTES) READING (INCHES) 12 ° oy.; s.D.I 13 14— 15 16 17 18 19 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 8 (INCHES) 20 TEST RUN BETWEEN 8.5 FT. AND 7.0 FT. COMMENTS: PERFORMED BY ALASKA WATER do WASTEWATER. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFO M D IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE: Sf 03 CLOCK NET TIME WATER LEVEL NET DROP 8/25/00 P��EO P`' R0�0 Pe50 kus* MUNICIPALITY OF ANCHORAGE Development Services Department _ f Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 090-021-60 Certificate of On -Site Systems Approval Expiration Date: 1. GENERAL INFORMATION Complete legal description BUSHNELL LT 2 Location (site address) 324 POWERLINE RD, Anch AK Current property owner(s) Mailing address Real estate agent GREGORY LAWTON PO BOX 8615 Indian AK 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 4. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System Waiver request for: Day phone Day phone TYPE OF WASTEWATER DISPOSAL: 0 Private Septic; 0 ❑ Holding Tank! ❑ ❑ Community ❑ ❑ Public Sewer i� ❑ Received by: Date COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ q 8 o / 610 0 6a Date of Payment to Za/;0 s'6 Receipt Number 6025-67 COSA # ()S G ac)1=9 Waiver Fee $ Date of Payment Receipt Number Waiver # COVID-l9 257o DISCOUNT APPLIED Distance: 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 5-31-20 6. DSD SIGNATURE System #1 Approved for 2 System #2 Approved for Disapproved Conditional approval for OF 49T ys° rj bedrooms • MICHAEL' N. ANDERSON , % f'' bedrooms �,�;•,• CE 99 •,� � aFj p�( , 1 bedrooms, with the following stipulations: J J. a<<��/� ��1111))1 )1111111 By: � Original Certificate Date: tp'— r20 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other y� 0 t COSA Checklist blue sheet COSA Checklist Legal Description: BUSHNELL LT 2 Parcel ID: 090-021-60 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 'oianwo Total depth 112 ft Cased to 112 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 5/27/20 Static water level at beginning of test 90 ft. Comments B. TANK DATA Age of tank(s) 20 years Tank type/material 5"j'GSf Measured operating fluid level in septic tank 48 Al Standpipes/foundation cleanout per record drawing Date of pumping MAY 27 D. ABSORPTION FIELD DATA SHALLOW TRENCH Which system tested (date installed) 1011012000 ® ALL standpipes present per record drawing Total measured depth from grade 7.1 ft (max) Measured depth to pipe invert from grade 4.5 ft (min) ❑ N/A —pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 0 gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 5+ gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 0.778 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 5/27120 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 5/27/20 Results ❑✓ Pass For 2 bedrooms Fluid depth prior to test 15 in Water added 300+ gal New depth 20 in Elapsed time 1440 min Final fluid depth 14 in Absorption rate 300+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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 Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' ✓❑ Yes if No ft Water Main > 10' Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft ✓❑ Yes if No ft Water Service Line > 10' ❑✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' ❑ Yes if No ft ❑ 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' ✓❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' if No Yes if No ft Private Wells > 100' ✓❑ Yes if No ft Water Main > 10' ❑✓ Yes if No ft Community Wells > 200' ✓❑ 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' Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑Q Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓❑ Yes if No ft Private Wells > 100' P✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet r F', r MICHAEL N. ANDERSON `yam CE -9 69 k RoPESSiu�`, �� DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section g„ www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSCosc201222 Subdivision: Bushnell Lot 2 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 20 years old. Typical replacement costs range from $8,000 to $11,000. 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 20 year old steel tank MAY look like. r } Mailing Address PO Box 196650 *Anchorage Alaska 99519 6650* www muni org 7 Ecklund, Timothy J From: Walters, Michael S. Sent: Tuesday, June 9, 2020 8:51 AM To: Ecklund, Timothy J Subject: RE: Bushnell Lot 2 Right of Way notes the well is in the 50' BLM Reserve and has no objections at this time. Mike From: Ecklund, Timothy <timothy.ecklund@anchorageak.gov> Sent: Tuesday, June 9, 2020 8:42 AM To: Walters, Michael S. <michael.walters@anchorageak.gov> Subject: Bushnell Lot 2 Mike, Could you confirm that ROW has no objection to a well on the subject property being located just inside a BLM Reserve. See attached Thanks Tim N 0 O , 09 ! 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L 3 ,LO,OZ.6-V S w PPOZI IIjUIMPS w -\ Municipality of Anchorage , 1 Development Services Department':` Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING t�t Parcel I.D. �.D9�'Qa �— /r0 COSA # Do � -t� Expiration Date: J — l l —.!az 1. GENERAL INFORMATION Complete legal description 5sl,nell Lei 7 - Location Location (site address) Current Property owner(s) Clnarkes L Ay4 Illee Day phone 1053--105,9 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address JCC 5 8 (3oX 85ro6 (;;n\ 0-rce1L `i95YD Unless otherwise requested, COSA will be held by DSD for pickup. Day phone Day phone 2. NUMBER OF BEDROOMS: a 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site IE Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 $Pu1ZKLANb c1 yf/_R1A/rr Address 20.3 W. ISK SVje. Z03AAnc�x14c'I AK 94501 Engineer's Printed Name _ Lys Spsir�an� 5. DSD SIGNATURE Approved for 2 Disapproved. Conditional approval for bedrooms. Phone 2-4 q - 39 t u Date fo is o•a OF P� .. .... �(1 tAAS P SFURFLA .\o 1 ��E551Cit� E. bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By:- O/�1�, !�� Original Certificate Date: '7-40, (Rev. 11,OS) Municipality of Anchorage ••, • '� Development Services Department Building Safety Division ` On -Site Water & Wastewater Program " 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: B Isl��e1) Lo{ 2 ParcellD: 094- 021- 6fl A. WELL DATA Well type PriJ Ac If A. B, or C provide PWSID # = Well Log (Y/N) Yes Date completed _14m00 Sanitary seal (Y/N) -Y!r6 Wires properly protected (YIN) `/es Total depth11_ft. Cased to Ita ft. Casing height (above ground) 2/o in. FROM WELL LOG AT INSPECTION Date of test _L01-4 20o0 513t zoo Static water level 90 ft. 1Z ft. Well production ly 9 P•m• G. g.p.m. WATER SAMPLE RESULTS: Coliform Ii colonies/100 mL Nitrate 0.5(o mg/L Arsenic: N_ ug/L dale of sample: 531 o} B. SEPTIC/HOLDING TANK DATA Tank Type/Material Arsc. ,oras lark' S}�1 Tank size lao gal. Number of Compartments 2 Foundation cleanout (YIN) y Depression over tank (Y/N) N Other bacteria 91_colonies/100 mL Coltected by: L c rs }d a� l Dale installed lol/%ztoo Cleanouts (YIN) 7< High water alarm (Y/N) /%/ Date of pumping '3/o' Pumper A4 Flon SefJiOe� C. ABSORPTION FIELD DATA Date installed to co 2000 Soil ratingg.p.d./ft orfelbdrm) 42- System type 5W1o,,) T�enc% Length 3a ft. Width 5 ft. Gravel below pipe 2./o ft. Total depth _5 ft. Eff. absorption area 255 ftZ Monitoring tube Y Depression over field W Date of adequacy test 5 3/ oI Results (Pass/Fail) as For a bedrooms Fluid depth in absorption Neal before test 5 in. Water added 50o gal. New depth 15 in. Elapsed Time: 0 min. Final fluid depth ,�_ in. Absorption rate >= 500 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) &&Arte know^ If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) 'Pump on' lev _ in. 'Pump off level _ in. High water alarm lev in. Dat Cycl led Meets alWrg circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot too'+ On adjacent lots Absorption field on lot 100+ On adjacent lots 1Oo'+ I0o'+ Public sewer main ,VIA Public sewer manhole/cleanout N Sewer /septic service line 50 t Holding tank .NIA Animal containment areas 54- Manurelanimal excrete storage areas JOD + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 1+ Property line 10+ Absorption field S t r Water main /� A Water service line 25 t Surface water 100,+ Wells on adjacent lots 100'4 - SEPARATION 00+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I0+ Building foundation 10 i Water main L/A Water Service line 25 1+ Surface water 100 + Driveway, parkinglvehicle storage Z Curtain drain None 065.r4e. Wells on adjacent lots I DD A- F. F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Lac'S SAut'f isol Date 15 D+ COSA Fee $ T� Date of Payment 6h 9 Receipt Number. `>'to && (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number 00F.A4. rq L, ;S E• Sf ;;3G,\�,l % 15"0 f5r \ ��\ �p0>• Povs •CC 0S. O0\40, LOT 1 01 4 \ •m LOT 2 voce twa Isr 0.1" t s.ry / eLo'ro0 /s /ted LOT 18 US SURVEY NO.3201 NOTE: 1)IIcarings and distances are as plat No. 85-302, Anchorage recording district. 5ENTEC Surveying • Engineering 2525 Gambell Street, Suite 200, Anchorage, Alaska 99503 Tele: (907) 5634835 Far (907) 563.3817 AS BUILT OF: LEGAL DESCRUMON Lot 2, Bushnell Subdivision, 07-4666 2•'49TM* MICHAEUS.. HORNE.: S i v,'•, No. LS -5;18` i ... 1 40%rfS lPtN� -W1 �\\W�� tducted a physical nrvey of this property as shown this drawing and that the improvements situated reon aro within the property lines and no soachments exist other than noted. CLUSION NOTES: It is the owners tesponsibilsry to determine the existence of any easements, covenant or restrictions which do not appear on the recorded subdivision plat NOTE: Under no circumstances should any data hereon be used for the construction or