HomeMy WebLinkAboutT15N R1W SEC 18 LT 95BT15N R1W
Sec 18
Lot 95B
#051-172-14
Certified Drilling Log
DOC CO dba
liiLLi1YAEN WATER WELLS
lleP.O, Box 670269, Chugiak, AK 99567 688-2759
OWNER OF LAND: Kaylene Johnson-Sullivan Bore Hole Data
ADDRESS: PO Box 771054 Eagle River AK 99577 Depth
LEGAL DESCRIPTION T15NR1WSEC18LT95B From TO
DATE: 8/25/17 TO 12 Casing stickup
PERMIT NUMBER: OSP171231 DATE OF ISSUE: 8/17/17
TAX IDENTIFICATION NUMBER 05117214000 2 f 5 Overburden
5 23 Silt sand &gravel
Is well located at approved permit location: Yes nNo
Method of Drilling: Nair rotary Ecable tool 23 26 Silty sand wet
Depth of Well: 140 26 54 Tight sand gravel w/cobbles
Casing Type: Steel Wall thickness .250 inches 54 75 Sandstone
Diameter: 6 inches, depth 64 feet
75 96 Sandstone conglomerate saturated
Liner type none ____ ___ __ _
Static Water Level: 28 feet 96 114 Hard shale
Recovery Rate 6 ® gpm n gph 114 125 Sandstone
Method of Testing air
125 140 Sandstone conglomerate
Well Intake Opening Type: ❑ open end ®open hole
El Screened Start feet Stopped
U Perforations Start feet Stopped
Grout Type: Casing Seal Volume: 100Ibs
Depth:from 2 feet,to 20+ feet
Well Disinfected Upon Completion: Nyes n no
Method of Disinfection: Chlorine 50 PPM
Comments:
WATER QUALITY TESTING
CoNkxm N c, Co1/100mL
Nitrates o ..mg/L
Arsenic S. Lig& --
1)5/ii t lbi4 11 Drillers Name: Bill Sullivan
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority.
Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation,
MatSu Borough: Department of Environmental Conservation.
DOC co dal
1!mnuij.1IIAEN,« WATER WELLS
P.O. Box 670269, Chugiak, AK 99567 688-2759
www.sullivanwaterwells.com
Pump Installation Log
Well Drilling Permit Number: SW 0SP171231 Date of Issue 8/17/17
Parcel Identification Number: 05117214000
Legal Description Property Owner Name & Address
T15NR1WSEC18LT95B Kaylene Johnson-Sullivan
Pump Installation Date: 9/1/17
Pump Intake Depth Below Top of Well Casing: 96 feet
Pump manufacturer's Name: Meyers
Pump Model: Rustler
Pump Size: 3/4 hp hp
Pitless Adapter Burial Depth: 10 feet
Pitless Adapter Installer: Sullivan Water Wells
Disinfected Upon Completion? ® yes ❑ no
Method of Disinfection: Chlorine 50 PPM
Comments: Pitless Manufacturer: Martinson
Pump Installers Name: Sullivan Water Wells
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
On-Site Water & Wastewater Program
4700 Elmore St. ■ P.O. Box 196650 i Anchorage, AK 99507-6650■vvww..rnu.ni.org/Q-rt to • (907) 343-7904
Well Decommissioning Log
egal Address: }m __ zwL_e ,� r
subdivision Block Lot• _
15N R 1W Section 18 Lot 95B
1n-site Water&Wastewater Program certified contractor performing the well decommiss' ing:
Jame: Bill Sullivan Signature A'1.,./R,4<-----...„
:ompany: Sullivan Water Wells
veil decommissioning date: 9/1/17 Method of decommissioning: AMC 15:55.060L1 a. ❑ b. E c. 2/
ocation: Use the space below to provide a drawing of the property showing the following items;
• North Arrow
• Decommissioned well,
• Other water wells on the property,
• Two separate swing-tie distances for each well shown in the drawing,
rote:The swing-tie distances shall be measured from either permanent structures of property corners.
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,N`G O MUNICIPALITY OF ANCHORAGE
On-Site Water& Wastewater Program
.a"', PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone: (907)343-7904 Fax (907)343-7997 ,fir r,
"` httpl/www.muni.orglonsite r
itarinivni
ANC H OH"'
On-Site Water System Permit
Permit Number: OSP171231 Effective Date: 8/17/2017
Work Type: Well Upgrade Expiration Date: 8/17/2018
Tax Code Number: 05117214000
Site Legal Address: T15N R1W SEC 18 LT 95B G:1155
Site Mailing Address: 19735 ADRIAN AVE, Chugiak
Owner: JOHNSON-SULLIVAN KAYLENE & Lot Size in Sq Ft: 38264
Design Engineer: Total Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Ei Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
To close out this permit please provide the following:
1)Well log
2) Pump install log
3)Water sample results
4)Well decommissioning log for existing well
Received By: ` 416. Date: 7
Issued By: � Date: 3/17720 -1
i`B`' U 1,N tlCll PALL/ Il Il OF NCI 1O ?•: AGE
6 1 C), 147")
Community Development Department ^ �iP' { Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. `/5-;)A /c.J Src i�og5 43 05'1 ' R"a),
Property owner(s)0/40444i'-5- L 54..+,-c-'-) ") Day phone gO ~do',3EV
Mailing address lace 43 o A 7' ?VT)-ref 1,444i- Z '& -
Site address 1' 7/S- 4,dic. /4"J E
Legal description (Sub'd., Block & Lot) / j c P ) /141u' (IC i8 4-or qs.
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑ Initial ❑ Single Family (SF)
(w/wo ADU)
Septic Tank ❑ Upgrade
Holding Tank ❑ Renewal Duplex (D) ❑
❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well E
Water Storage E
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
s
Permit/Rush Fees: Z. 1 r..� Waiver Fees:
Date of Payment: 44 C ,17 Date of Payment:
Receipt Number: 215334 Receipt Number:
Permit No. Ora f f1 l 23 I Waiver No.
Permit App_9-1-12.doc
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ASBUILT SEWARID & ASSOCIATES LAND SURVEYING 694-0824
I HEREBY CERTIFY THAT I HAVE SURVEYED THEE`
FOLLOWING DESCRIBED PROPERTY, J �o +70F A 'it
AND THAT NO ENCRO ENCROACHMENTS EXIST EXCEPT AS ,ritT:•' '-.:f•
INDICATED. IT IS THE RESPONSIBILITY OF THE '' "f .'• H
OWNER TO DETERMINE THF. EXISTENCE OF ANY GRID: w
EASEMENTS, COVENANTS, OR RESTRICTIONS • j�/ �'
WHICH DO NOT APPEAR ON THE RECORDED SUBDI- mea uwwd N
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: f • r �Ar
ANY DATA HEREON BE USED FOR CONSTRUCTION ,./.5"2:-.1"...? 4I,%,-• '.rr
OF FENCE LINES, OR FOR ESTABLISHING BOUND- DRAMs ;It k t\-35:.
ARY LINES. ha,a,...•.
Inspection Report_1-1-12.doc
Municipality of Anchorage
Community Development Department Page 1 of 3
On-Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE
WASTEWATER INSPECTION REPORT
Permit Number: OSP171158
PID Number: 051-172-14 ❑ New ❑✓ Upgrade
Name:
CHARLES & KAYLENE SULLIVAN
ABSORPTION FIELD
❑✓ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
19715 ADRIAN AVE
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
3
1.2 GPD/SF
11.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
5.0 Ft.
Gravel depth beneath pipe
6.0 Ft.
Subdivision
Block Lot
95B
Fill added above original grade
0 Ft.
Gravel length
32 Ft.
Township Range Section
T15N
R1 W S18
Gravel width
2.5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
384 Ftz
1
Ft.
Well
100+
100+
N/A
N/A
25+
TANK p Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1000Gal.
Surface Water
100+
100+
N/A
N/A
Material
Number of compartments
Lot Line
23.2
20.8
N/A
N/A
STEEL
2
NA
Foundation
9.3
29.1
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
50+
50.
N/A
N/A
Gal.
Remarks
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
Installer
PIPE MATERIAL House to tank 3034Tank to 3034
drainfield
HOMEOWNER
Drainfield 3034 CO/MT 3034
Inspector Pannone Engineering Services
BENCH MARK (Assumed elevation) 100ft
Inspection st
dates: 1 18JUL17
2"' 19JUL17
Location and description
3`' 20JUL17
4'h
House Trim near foundation cleanout
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
_��•\ 11v
A�'451��
Conditional Approval:
Date
��G_
�� � �iteven f�. FSannorae
Approved VuLttu
�Q Date $l1 b %
�j,�ftFES51011'--i
Inspection Report_1-1-12.doc
DESIGN PARAMETERS
PRIMARY SEPTIC SYSTEM
NO. BEDROOM: 3(450 gpd)
TANK SIZE: 1000g
PERC RATE: 3.5 MPI
SOIL RATING: 1.2 GPD/SF
AREA RQD: 375 SF
SYS. TYPE: DEEP TRENCH 6.0'ED
MIN LENGTH: 31.3 LF
USE:
32.OLFx2.5'Wx6.0' E.D., 11.0' TD
TOTAL AREA: 384 SF y�A
_1� /
w w —WATER LINE/
ABBREVIATIONS
WELL RADIUS
TH
TEST HOLE
6.7
(P)
PROPOSED
— ss ss —NEW SEPTIC
(E)
EXISTING
19.2
CO
CLEAN OUT NO.
21.6
MT
MONITOR TUBE NO.
A B
TYP
TYPICAL
�a
50'
ABANDONED TANK PER MOA CODE. VERIFIED 11.9
ORIENTATION OF ABSORPTION FIELD,
MAINTAINED REQUIRED DISTANCE FROM
EXISTING FIELD. ENSURED 10' SEPARATION 21 9 o
FROM WATER SERVICE LINE MAINTAINED o INSTALLED ABSORPTION FIELDP
e 32LFx2.5'Wx6.0'E.D., 11.0'T.D.
W/ COs & MTs AT END
3BR
SFD A
-0 J
\ % I
95B o I w
i 153.8 m
o 17 6,4
� Q
INSTALLED 1000G SEPTIC TANK(P
WITH FC BEFORE AND DCO AFTER, ENSURE 10' 1 m
SEPARATION FROM WATER SERVICE LINE MAINTAINED 20 MEA EASEMENT
I I —----—— --------
3' P tent ROW Reserve
� —_� --_—_ --_--—-- WELL E
ADRIAN Ave
Z
wo
01 Z Z Z
o I56
1U U U m()
1000g
SEPTIC
TANK (N)
NOTES:
RECORD DRAWING
DRAWN I JRL
SITE PLAN
PROFILE
SCALE:1"=10'
FILTER FABRIC
-DRAIN ROCK 6" ABOVE PIPE INV
—4" 0 DRAIN PIPE
M-
w
m
10
�o
0z
� U
Manac+
+ a rooso�
7 �� &• ` V
s �
92 9
msa
°
32.0 I u
PANNONE ENG SVC, LLC
P.O. BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
T15N R1 W S18 L95B
SITE: 19715 ADRIAN AVE
CHARLES & KAYLENE SULLIVAN
PO BOX 771054
EAGLE RIVER, AK 99577
u
+e
+a rw rnau+o.•rzx
Date
07/21/2017
FC
18.5
6.7
T1
20.7
12.2
T2
25.5
19.2
DCO2
27.2
21.6
MT1
63.1
1
61.0
C01
64.0
61.9
�a
50'
ABANDONED TANK PER MOA CODE. VERIFIED 11.9
ORIENTATION OF ABSORPTION FIELD,
MAINTAINED REQUIRED DISTANCE FROM
EXISTING FIELD. ENSURED 10' SEPARATION 21 9 o
FROM WATER SERVICE LINE MAINTAINED o INSTALLED ABSORPTION FIELDP
e 32LFx2.5'Wx6.0'E.D., 11.0'T.D.
W/ COs & MTs AT END
3BR
SFD A
-0 J
\ % I
95B o I w
i 153.8 m
o 17 6,4
� Q
INSTALLED 1000G SEPTIC TANK(P
WITH FC BEFORE AND DCO AFTER, ENSURE 10' 1 m
SEPARATION FROM WATER SERVICE LINE MAINTAINED 20 MEA EASEMENT
I I —----—— --------
3' P tent ROW Reserve
� —_� --_—_ --_--—-- WELL E
ADRIAN Ave
Z
wo
01 Z Z Z
o I56
1U U U m()
1000g
SEPTIC
TANK (N)
NOTES:
RECORD DRAWING
DRAWN I JRL
SITE PLAN
PROFILE
SCALE:1"=10'
FILTER FABRIC
-DRAIN ROCK 6" ABOVE PIPE INV
—4" 0 DRAIN PIPE
M-
w
m
10
�o
0z
� U
Manac+
+ a rooso�
7 �� &• ` V
s �
92 9
msa
°
32.0 I u
PANNONE ENG SVC, LLC
P.O. BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
T15N R1 W S18 L95B
SITE: 19715 ADRIAN AVE
CHARLES & KAYLENE SULLIVAN
PO BOX 771054
EAGLE RIVER, AK 99577
u
+e
+a rw rnau+o.•rzx
Date
07/21/2017
��•'
Scale
1 " = 50'
P.I.D. NO
....... .. . .....
�w �I�. �POnn011e V: 08/08/20y7
CE 8149
13E
051-172-14
PERMIT NO.
OSP171158
Sheet
�'. ...•:,��
/�pl�"
2 OF 3
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
August 8, 2017
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 S. Bragaw Street
P O Box 196650
Anchorage, Alaska 99519-6650
Subject: T15N, R1W, Sec 18, Lot 95B
Absorption Field Construction Waiver Request
Ladies and Gentlemen:
We request a waiver to the requirement that there be a cleanout on each end of the absorption field.
Currently there is one with a monitoring tube at that far end of the field. Due to the close proximity of the
post tank double cleanout to the beginning of the field, in conjunction with there being no bends in the
drain line from the tank to the field the need to include a near end cleanout would be redundant.
Granting this waiver is not likely to affect the health and safety of this lot or the surrounding lots now or in
the future.
If you have any questions or concerns, please contact me at 907.272.8218.
Sincerely,
.... A 4t#
• `9
t
Steven R. Pannone
Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
111 Il
Municipality of Anchorage
ME
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997
http://www.muni.org/Onsite
_
Development Services Division
On -Site Water and Wastewater Program
Waiver#: COSA#: Permit#: OSP171158
PID#: 051-172-14
Legal Description: T15N RIVV Section 18 Lot 95B
Engineer: Pannone Engineering Services
Applicant: Charles & Kaylene Sullivan
Your request for a waiver of the requirement to provide a cleanout at the near end of the trench
has been approved. See engineer's letter for waiver request and justification.
This waiver approval applies to the existing absorption field only. Any future upgrade to the on-
site wastewater disposal system will require all code requirements be met or another approval
from this department.
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
.. H . @ @ .. @ @ @ . ■ @ ... H .. H .. @ H H .. H .. f
Waiver is Granted: X Waiver is not Granted:
t _
IA
j
Date: / UfJO Approved by gL,EaI r'`C�(;i'.�..
` Name of Reviewer
..... IN @ @ . H ... @ .. @ . ! ... @ . @ @ . @ ... t
hSEll 111 1 111IR-11
�,`"ALf MUNICIPALITY OF ANCHORAGE
Iii
� .. o ,t\111(On-Site Water& Wastewater Program 5PO Box 196650 4700 Elmore RoadAnchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 -
http://www.muni.org/onsite cpartmean t
,hCNORpGE
On-Site Wastewater Disposal System Permit
Permit Number: OSP171158 Effective Date: 7/11/2017
Work Type: Septic Upgrade Expiration Date: 7/11/2018
Tax Code Number: 05117214000
Site Legal Address: T15N R1W SEC 18 LT 95B G:1155
Site Mailing Address: 19715 ADRIAN AVE, Chugiak
Owner: JOHNSON-SULLIVAN KAYLENE & Lot Size in Sq Ft: 38264
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3
This permit is for the construction of:
CEJ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions:
To close out this permit, submittal of the following are required:
1) Inspection report and record drawings.
2)Water sample results for well installed in 2008.
3) Decommissioning log for original well (required to be decommissioned under permit SW080086).
4) Updated as-built survey (required to close out building permit R11-1656).
Al
Received By: ` pp. ;:, / Date:
Issued By: �QX1 ki.. COOL.--Le�' Date: 1201
MUNICIPALITY OF ANCHORAGE
Community Development Department T , Ph �9
Development Services Division �—' -�
On-Site Water& Wastewater Program71 1111 I
AIM
ON-SITE SEWER/WELL PERMIT APPLICATIO4.40:0
Parcel I.D. 051-172-14 '� $ .L°'1`
Property owner(s) CHARLES & KAYLENE SULLIVAN Day phone
Mailing address PO BOX 771054, EAGLE RIVER, AK 99577
Site address 19715 ADRIAN AVE
Legal description (Sub'd., Block & Lot) T15N R1W S18 L95B
Legal description (Township, Range & Section)
Lot Size 38,264 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(El all that apply)
Absorption Field ❑x Initial ❑ Single Family (SF) ❑x
(w/wo ADU)
Septic Tank Upgrade 0 Duplex (D) ❑
Holding Tank ❑ Renewal U Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 7 Ll Waiver Fees:
Date of Payment: (a '73--11 Date of Payment:
Receipt Number: OSS Receipt Number:
Permit No. D�P1�1 11ygu Waiver No.
Permit App_ - :_ c
Pannone Engineering Services ac
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
July 5, 2017
Subject: T15N R1W 518 L95B
Septic System Permit Request
Design Narrative
This is a design narrative for a permit to install an upgrade septic system to be issued for this property. The
proposed system will serve an existing three bedroom (3) house. Currently the lot and all surrounding lots
are developed. A new 1000-gallon tank, absorption field will be installed. There are no wells within 100'
of the proposed septic system.
1. Soils. One test hole was conducted in the area by PES in June of 2017. Bedrock was not encountered in
those test holes. Ground water was not encountered to a depth of 17 feet in June of 2017. Based on
the results of the percolation tests and overall soils appearance; an application rate of 1.2
gallons/day/square was used for a conventional wastewater system in the area of the test hole.
2. Soil Absorption System Design.
a. See Sheet 1 of the design package.
3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field.
The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage
ditches.
4. Topography: The existing topography on the lot generally slopes from north to south, with a slope
of approximately 0%to 1% in the area of the drain field. There are no steep slopes within 50' of the
proposed drain field. The proposed drain field will maintain 50' separation all steep slopes.
5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that
the review is complete and that there are no further comments is received from MoA On-Site Department,
the note will be removed and "Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of this or the surrounding lots.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
*y
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lt' 1 **
t d
/ TRUE NORTH or, �CALE : 1'1.31:1'
* I
/ 93A
A\ EXISTING UNDOCUMENTED SEPTIC SYSTEM
ABANDON TANK PER MOA CODE. VERIFY —33.2
ORIENTATION OF ABSORPTION FIELD, MAINTAIN
REQUIRED DISTANCE FROM EXISTING FIELD.
ENSURE 10' SEPARATION FROM WATER SERVICE— ' —
LINE MAINTAINED f ° INSTALL ABSORPTION FIELD(P)
1 fl- W/ cos &31.6 l' • 32LFx2.5 Wx6.0'E.D., 11.0'T.D.
MTs AT ENDS
3BR = r41111111.P" I C
N. • SFD
if ia 4\
95B a
m
INSTALL 1000G SEPTIC TANK P 157.0 114.4
WITH FC BEFORE AND DCO AFTER, ENSURE 10'
SEPARATION FROM WATER SERVICE LINE MAINTAINED Q
7 7 I >.o
CL
M
W ..
•
. _ . _ .
______
, ,
/ / ADRIAN Ave _
DESIGN PARAMETERS \
7
PRIMARY SEPTIC SYSTEMIP
NO. BEDROOM: 3(450 gpd) M _________ _
TANK SIZE: 1000g M
PERC RATE: 3.5 MPI \
SOIL RATING: 1.2 GPD/SF ABBREVIATIONS '
AREA RQD: 375 SF 17
SYS. TYPE: DEEP TRENCH 6.0'ED w w — WA LINE / TH TEST HOLE
MIN LENGTH: 31.3 LF WELL ADIUS (P) PROPOSED
USE: —ss —ss — NEW SEPTIC CO CLEAN G OUT NO.
32.OLFx2.5'Wx6.0' E.D., 11.0' TD CO CLEAN
TOTAL AREA: 384 SF MT MONITOR TUBE NO.
/ 1 TYP TYPICAL
NOTES: PANNONE ENG SVC, LLC Dote
FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, A 99510 P+(rG � : 9,0_ 06/21/2017
PHONE (907) 272-8218 FAX (907) 272-8211 _ (V..* 1, Scale
*.4 dt •* 1" = 50'
T15N R1W S18 L95B ; ••• ' • l• P.I.D. NO
-171--172-14
SITE: 19715 ADRIAN AVE � "$3ewn It Ponno a PERMIT NO.
DRAWN JRL CHARLES & KAYLENE SULLIVAN REtE 81149 0SP171158 r
SITE PLAN PO BOX 771054 / o:•••.• • Sheet
EAGLE RIVER, AK 99577 '' t OF 3
TEST HOLE 1 SOILS LOG — PERCOLATION TEST
SLOPE SITE PLAN
OR TOPSOIL
1
Brown Silty
2 SM/GM SAND & li
GRAVEL
3
OR TOPSOIL
4
5
6 /1 o
X TEST i
7 HOLE tr
8 GM SM Brown Silty SBDR
/SAND &
9 GRAVEL ter
10 95B , of
11 of
12
13 --
SLOPE
1a WAS GROUND WATER
ENCOUNTERED? N
15 TH 1
IF YES, AT WHAT
16 DEPTH? —NA—' x
17 DEPTH TO WATER AFTER
BOH MONITORING? — DRY —
DATE PERFORMED: 13JUN17 DATE: 20JUN2017
NO GROUNDWATER
CLOCK WATER RATE SOIL TEST RESULTS/ANALYSIS
READING DATE TIME NET TIME LEVEL NET DROP (MPI) • PERCOLATION RATE 3.5(min/inch)
READING (Hydrologic Soils Group: HSG A)
1 13JUN17 1105 5.900" • PERC HOLE DIAMETER 6"
2 1115 10 MIN 9.067" 3.167" 3.2 • TEST RUN BETWEEN 6 FT AND 7 FT.
3 1116 s,gp0" • TEST RUN FOR OVER AN HOUR, LAST
THREE READINGS PROVIDED.
4 1126 10 MIN 8.832" 2.932" 3.4
5 1127 5.900"
6 1137 10 MIN 8.724" 2.824" 3.5
7 1138 5.900"
8 1148 10 MIN 8.690" 2.790" 3.5
COMMENTS:Test hole excavated by the homeowner.
PERFORMED BY:Joseph Lawendowski. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE
AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
NOTES: PANNONE ENG SVC, LLC ,AI I Date
FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, A 99510 P4. 114 06/21/201,
PHONE (907) 272-8218 FAX (907) 272-8211 VI.•.• 1, Scale
*i`. . t_ j' . * NTS
T15N R1 W S18 L95B ' • •• �• •• P.I.D. NO
SITE: 19715 ADRIAN AVE172 14
DRAWN JRL ••Old II• "�n � 'PERMIT NO.
CHARLES & KAYLENE SULLIVAN4�7. :4::,
vrt•. RE7 5 . OSP171158
PO BOX 771054 ;••.., o` Sheet
SOILS LOGS EAGLE RIVER, AK 99577 `llaT
i 20F3
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON-SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55.
2. SCOPE OF WORK: INSTALL NEW 1000g SEPTIC TANK, AND SOIL ABSORPTION SYSTEM.
3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 17 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL
TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 17 FEET BELOW
EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY.
4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC
LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED
SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK.
5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED.
6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES.
7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING
AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER.
8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE
CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN.
9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED-LINE AS-BUILT DRAWINGS TO THE
ENGINEER. THE RED-LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND
TANK ELEVATIONS.
10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION,
TOP OF PIPE WITH CLEAN-OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING.
11. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE
PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER
(OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN DEFECTS BY THE
CONTRACTOR.
12. THE CONTRACTOR SHALL SIGN THE FOLLOWING:
I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE
ORDERS, AND THAT THE AS-BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS
CONSTRUCTED.
CONTRACTOR:
BY: . TITLE:
DATE:
NOTES: PANNONE ENG SVC, LLCDote
FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 4• 06/21/201/
PHONE (907) 272-8218 FAX (907) 272-8211 'P'' '•. Scale
* 40rd. ,.1 •._* NTS
T15N R1W S18 L95B P.I.D. No
SITE: 19715 ADRIAN AVE � ri it ie' 051-172-14
�evetW^"6
PERMIT N0.
DRAWN JRL CHARLES & KAYLENE SULLIVAN ,'•••RE 7ao48z• OSP171158
DESIGN NOTES Po Box 771054 1;;;• •• Sheet
EAGLE RIVER, AK 99577 3 OF 3
I
A real estate property owner (Owner) may install their own septic system.
111111 lillyp 1111lig I I q lig I � I � I �! I I ��� I I I I I! 1111;!
717,77'sul 7j -71F771 1#777177 tridi Turrialai 7 oFuTUMUT-71pleff,
single-family or duplex home if the homeowner satisfies and agrees to the following
requirements.
The property owner and excavation equipment operator may perform work on no more than
one owner installed pTlect in a. 12 -month period.
As owner of (legal description) .7_L:Ln� Z L 4A�, 5,-t /,�_ 4ol'f, /.3 1 agree the
following items are true and accurate.
1. My experience installing septic systems is as follows.
2. The name of the excavation equipment operator is. S14
3. There will not be compensation for installation services rendered.
4. 1 will be actively involved with the septic system installation at all times. yY
5. The name of the inspecting engineer is j xW �,4P6 Aj6.
i,. I agree to discuss the following items with the inspecting engineer:
a. Permit design criteria and specifications,
b. Inspection requirements set forth in AMC 15.65.150.
c. 2 -hour minimum advance notice given to the On-site Water & Wastewater
Program for all required municipal inspections.
7. 1 agree any changes I make to the items listed above will require a new approval before
performing work.
8. 1 agree to have the project -specific On-site Wastewater Disposal System Permit available
at the construction site for the duration of all related work.
Owner's printed name:
Owner's signature: Date:
Septic System Owner Installer Agreement—FeI52015.doc
Permit Number: OSPl11139
Tax Code Number: 05117214000
Work Type: Septic
Permit Effective Dates: July 13, 2011
On-Site Wastewater Disposal System
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 EImore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Upgrade
to July 12, 2012
Design Engineer: GARNESS ENGINEERING GROUP LTD
Subdivision: T15N R1W SEC 18
Site Legal Address: T15N R1W SEC 18 LT 95B G:1155
Owner/Address: VICKARYOUS AMBER & DAVID
PO BOX 191044 ANCHORAGE AK 995191044
Permit
D (; ]) a r I: Ill e Il t~
Site Mailing Address: 19715 ADRIAN AVE, Chugiak
Lot Size in Sq Ft: 38264
Total Bedrooms: 3
This permit is for the construction of:
Y Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions: The Final Inspection Report for this permit will not be approved until permit
SW080086 has been finalized.
Received By: ~/~~--,-; ,~* -- Date:
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services
On-Site Water & Wastewater Program
Phone: 907-343-7904
Fax: 907- 343-7997
Mayor Dan Sullivan
On-Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. 0,~ i - iq~- I~
Property owner(s) C/O STEVE WAKELAND
Mailing address 19715 ADRIAN AENUE * CHUGIAK, AK
Day phone 850-9246
Site address 19715 ADRIAN AENUE * CHUGIAK, AK
Legal description (Sub'd, Block & Lot ) LOT 95B
Legal description (Township, Section & Range) T15N, RlW, SEC'
Lot Size ~.., ~- ~ LI Sq. Ft. Number of Bedrooms
THIS APPLICATION IS FOR:
( [] all that apply)
Absorption Field []
Septic Tank []
Holding Tank []
Privy []
Private Well []
Water Storage []
THIS APPLICATION IS AN:
Initial []
Upgrade []
Renewal []
THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR:
N/A
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
Permit No.
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
(Rev. 01/11)
GARNESS ENGINEERING GROUE Ltd.
CONSULTANTS & GENERAL CONTRACTORS
June 29, 2011
Municipality of Anchorage
Development Service Department
On-Site Water & Wastewater Program
4700 Elmore Rd.
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907) 343-7904
Ref: Proposed Septic Upgrade for T15N, RIW, SEC 18, LOT 95-B
To whom it may concern:
The subject property has a mobile home on it that is served by an undocumented septic system and a
private well. The homeowner is proposing to build a 3 bedroom home. After completion of the home,
they plan to remove the trailer from the property. We are proposing that the undocumented septic system
be abandoned, and that a new 1000 gallon septic tank and 5-wide trench type drainfield be installed. Two
test holes were excavated on the property. The drainfield will be designed around the 30 foot radii of
these test holes. Comments regarding the design are summarized as follows:
1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the
percolation test results.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system.
4. TOPOGRAPI-IY: As can be seen on the attached design drawing the topography around the
drainfield is relatively flat. In short, there are no slope concerns.
We are unaware o~any adverse impacts this installation would have on adjacent wells or septic systems.
If you have any q~stions, please contact us at 337-6179. Thank you for your assistance.
/Sincei~ly, I'"
U.S.
NOTE: Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design package for
this septic system. (Contact G.E.G. Ltd. for 7page construction specification letter.)
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
~ '/ !
/ ~ /
/ / /
/ / / / LhgT 69, T15N, R1W, SECTION 18
/ / / \ \ ,..-~°~'
/ ~ / \
/ / / \
// / \
----j-c_-
/ / I I
/ '~ / ~ I
z
/ / / LOT 95A, T15N, RIW, SECTION 18
, /
/
,/' // ~ ~X,ST,N~ ~.T,C S~ST~.~ 0~. W~. <
% . / ~ TO BE
/ %% / ~BILE HOME . TO BE REMOVED.~ % ABANDONED%
~ P~SED 5 BEDROOM HOUSE~ ~%
/ LOT 95A T15N R1W SECTION 18 ~ ~ ~ f' ~%
/ ~ ~ ~ ,,~ ~ .....
J ~ · TH~I~ ~TH~2 ~,
, ~ ~--~ / ,/ " ADRIAN AVENUe. -/ / x
Xx/ % / / X / /
,~ x, II _~ x i /
/ x~ //~ I / ~
~ ~ ~ ] / { ~ .... RADIUS
~~~ I ~ N
/
/~ ~~~ N /
LOT ~O,A, T~SN, R~W, SEC=ION ~ / x /
/ I I ~~
s ~ LOT 100, T15N, RIW, SECTION 18
LOT 101B, T15N, RIW, SECTION 18[ ~~ %0%
SCALE:
PREPARED FOR: I PHONE NUMBER: I PAGE NUMBER:
C/O STEVE WAKELAND 830-9246 1 OF 2 ~ * ¢ '' I ¢ Y' '--
T15N, RlW, SECTION 18, LOT 95B J.L.M.
S~TE PL*. ~0~ PROPOSED SEPTIC UPO~,DE 6/29/20~
I
DESIGN CRITERIA: ALT. DRAINFIELD DESIGN CRITERIA: NOTE: THE CONTRACTOR
NUMBER OF BEDROOMS: .3 (USING CAT III ADVANCED WASTEWATER SYSTEM) SHALL HAVE THE SOUTH &
GALLONS PER DAY (GPD): 4-50 GPD NUMBER OF BEDROOMS: .3 WEST LOT LINES, THE
PERCOLATION RATE/S: 7.5 & 8.57 GALLONS PER DAY (GPD): 450 GPD UTILITY EASEMENT AND ALL
PROPOSED APPLICATION RATE: 0.8 PERCOLATION RATE/S: 7.5 & 8.57 WELL RADII FLAGGED BY A
MINIMUM DRAINFIELD SD.FT.: 56.3 ALLOWABLE APPLICATION RATE: 5.0 REGISTERED LAND SURVEYOR
MINIMUM DRAINFIELD SD.FT.: 90
DRAINFIELD DESIGN: PRIOR TO CONSTRUCTION.
MAXIMUM DEPTH: 9 FEET ALT. DRAINFIELD DESIGN:
WIDTH: 5 FEET MAXIMUM DEPTH: 9 FEET
LENGTH: 57 FEET WIDTH: 5 FEET
M.O.A. APPROVED SAND FILTER: N/A LENGTH: 12 FEET
EFFECTIVE: 4 FEET EFFECTIVE: 4- FEET
REDUCTION FACTOR: 0.5 REDUCTION FACTOR: 0.5
ACTUAL SQ.FT.: 570 ACTUAL SQ.FT.: 120
GEG, Ltd. HAS A 7 PAGE SPECIFICATION
LETTER THAT PERTAINS TO THIS DESIGN. OLD WELL TO BE ABANDONED Z
TO OBTAIN A COPY OF THE LETTER LOT 9.3A, T15N, RlW, SECTION 18 COMPLETELY PER MOA ORDINANCE.----,
CONTACT GEG. BY PROCEEDING FORWARD \
WITH THIS INSTALLATION THE ENGINEER .......................... \ -J
WELL DRILLER CONTRACTOR AND '~ ~_^~..~ u,.~uv~.um~.r_u\ ,,,
' SEPTIC TANK & DRAINFIELD TO
PROPERTY OWNER AGREE THAT THEY / RI:' nl:'C~MMl':::~lnN~'n pl:'R Upc: \
HAVE READ THESE SPECIFICATIONS AND / ..............
AGREE TO ACCEPT THE TERMS AND / \
COND,T,ONS OUTLINED. /\
~ PROPOSED ./
\ 1000 GALLON ~ ~
VEPTiC TANK /--INSTALL FCO ___ ,~ - ~ ~ o []_
X ( 3 BEDROOM /
~ / HOUSE J
~ / l ~ ' MOBILE HOME
."~/ ~ (TO BE REMOVED AFTER /
~.~ ol ~ ~ HOME IS COMPLETED) /
ALT - - '-'/~--"-~ -- --INSTALL ,..'
DRA NF ELD~ DBL. CO'S / ~ ~,' ' ",
-- I'': ~: I
/-, l r ./ '-<oo.
--- ~ ~r.":'~} I"" ~'~ "~ I, ''~' '. '
--- ~ - ,~[ "' ~ F' "'/.~ '%.4 , -': "~
~'~'-~'/' "~ MT ~.~,/0 ! '. · ,/~¢.'3 Z .. I, '~1~ ...... ·
r- ......... -~ ...... 71 '" ' ~ "-~'/ /~"*'7'"~,.... '"~ ' ¢ .;
CC),~ CO ~ '~ ~., :/' '' '',
- - :-7- - - - .... -
--4-' :-~, F-- -
TH#1 / TH#2 I .... :,t /. :'~/ ,
,..': ,~.:, ,'.: :':. ,I
,~ -- ~ -- ~ -- ~ -- ~ -- ~.:-~-.~ -- -~, __ -~ ~ ..~/,-- --,~- ~ -~ ---./.-- -- ,~: '.-f~, -
,".~'~ / ,'": .-',' /'.- :-i'~ , i '-'.'~
- -~ '- -- -- --~---~ -- ...... ~-.'+- -- -,~- --/.~..'.~ -- ' r~.-- ....
PROPOSED / ~'~ . ~.:; ..~ u-/ /:. "./ ', L20' ESMT. PER MEA ,J."."'.
DRAINFIELD-/ ~ ~:' .'.'! /~.:~i :'/ I
I -" ~ / .'.- .'.'
NOTE: SHALLOW DITCHLINE ALONG ADRIAN AVE. NO CONCERNS \
SCALE:
GARNESS ENGINEERING GROUP, Ltd
CONSULTANTS & GENERAL CONTRAGTORS ,~
PREPARED FOR: IPHONE NUMBER: PAGE NUMBER 4~,-'-~t~.//~.-.'
STEVE WAKELAND [ 850-9246 2 OF 2 ~ ~-~
, ,
1
DRAWN BY
LEGAL DESCRIPTION: : \ ~/0 ~i '"
T15N, RIW, SEC 18, LOT 95B J.L.M. '~[~'~,.~.~.,.,,~lt~17~.~."g,g~!.¢~,,~/
TYPE OF WORK: DATe: REVISED
PROPOSED SEPTIC UPGRADE 7/12/2011 ~,,~,~.~N~.~
(Rev. 01/05)
GARNESS ENGINEERING GROUP, iLtd.
CONSULTANTS & GENERAL CONTRACTORS
5701 F- TUDOR ROAD~ SUffE 101 * ANCHORAGE, AK, 99507 * PHONE: (907)537-6179 * FAX: (907)558-5246 * WEBSO'F~ garnessenglneerlng.com
ISOIL LOG - PERCOLATION TESTI
LEGAL DESCRIPTION: T15N, RlW, SEC 18, LOT 95B
PERFORMED FOR: STEVE WAKELAND
DATE: 6/15/11
ORGANICS
TEST HOLE #1
SOIL CLASSIFICATIONS
GM TO SM
SOILS LOGGED BY:
gW ~ ORG
GP ML
GM CL
GC OL
SW MH
SP CH
SM OH
SC
DEPTH TO
GROUNDWATER DATE
DRY 6/15/11
DRY 6/15/11
~-~ ~/'~ h ~
SCALE:
1" = 100'
SEE ATTACHED
SITE PLAN
DATE READING CLOCK NET TIME WATER LEVEL NET DROP
TIME (MINUTES) READING (INCHES)
6/15/11 1 1:40 - 6.00- -
2 2:10 50 2.00" 4.00"
3 2:10 - 6.00" -
4 2:40 50 2.00" 4.00"
5 2:40 - 6.00" -
6 3:10 30 2.00" 4.00"
PERCOLATION RATE 7.5 (NIN./INCH) PERC. HOLE DIA. 6
TEST F~UN BETWEEN 5 FT. AND 6 FT.
A FOUR HOUR PRESOAK WAS PERFORHED: [] YES [] NO
JODY MAUS PERCOLATION TEST PERFORNED BY: JODY MAUS
(INCHES
CONNENTS:
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: (~ ~//11
ORGANICS
DEPTH ~
TEST HOLE ~2
SOIL C~SSIFICATIONS
' OM CL
GC OL
SW MH
~SP EH
SEE ATTACHED
sc SITE PLAN
DEPTH TO
GROUNDWATER DATE
GM TO SM
10
1~ DATE READING CLOCK NET TINE WATER LEVEL NET DROP
TINE (MINUTES) READING (iNCHES)
2 2:11 50 2.50" 5.50"
4 2:41 50 2.50" 3.50"
6 5:11 50 2.50" 3.50"
15
16
17
18
PERCOLATION RATE 8.57 (N]N./~NCH) PERC. HOLE DIA. 6 (INCHES)
19
TEST RUN BETWEEN 5 FT. AND 6 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ~ YES ~ NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED 9Y: JODY MAUS
CONHENTS:
PERFORMED BY OEO, Ltd. I, dEFFREY A. GARNESS, CERTI~ THAT THIS WAS?ER~ORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
DEPTH TO
GROUNDWATER DATE
DRY 6/15/11
DRY 6/1 5/1 1
FROM : PANNONE ENG SVC PHONE NO. : 9872728211 May. 29 2009 03:54PM P2
[7z--- (Y
ttrtlt din 'Log
by
coc co. eft
SULLIVAN WATER WELLS
P.Q. BOX 670272, CHUGIAK, ALASKA. 98567 *TELEPHONE SM -2759
OVV IER OF LAND: �� 1
AGJRESS: L q -C qq
LEGA(. DESCRIPTI ON.
GAPE:
PERM ' NUMBER: �Ef kte cf fssu l:v, - -
TAX IDENTFICA'TION NUMBER:
Is well located at approved permit location? Pes ❑ No
Method of Drilling: air rotary �l cable toot
DspiF: of wall: 70 _—•— —_--
Casitig 1Npe w'all "Noknes5 inehe
Diameter._ -L-------- inches. depth
UnerType:
Casing Stickup Above GGr�roo� una: feet
Static %'Vater Level: -� G feet
Recover Rate:
t�
Ue-hod of Testing:
wbij Intake Opening Type: Ct open end �.apen hole
:a Screened; Start feet Slopped feet
O Perforations .Start . feei Slopped FEet
Grout Types
Depth: from � feet, to fest
Well Disinfected LlDon Comp. tion?)Z%s 7 No
Method of Olslnfection: - ��l�tiy+ „�b Olvf--
Comments;
BORE ;OLE DA7A
Drifleft Narne c e- �� Xu
ATFEN-nON: It Is the respons iIbility of the property owner to submit a ropy of the +,veil tog to the proper aulthoflty. Municipallty
of Amborage: Department of Health & Human Services and/or DApertment of Envlron�tental Conservation. MatSu borough:
Delrarfmtnt of Envirccimental Consetvat art,
�e
Development Services Department
Building Safety Division
: ' On -Site Water & Wastewater Program
A� ll
4700 Elmore Street
P.O. Box 196650
Mark 8egich Anchorage, AK 99519-6650
Mayor www.muni.org/onsite
(907) 343-7904
InstallationPump
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number: 051-172-14
Legal Description
TI5NRTW Sec. 18, Lot 95B
Pump Installation Date: 9-4-2008
Pump Intake Depth Below Top of Well Casing: 102` feet
Pump Manufacturer's Name: Meyers
Pump Model: 2N05-08
Pump Size 1/2 hp
Pitless Adapter Burial Depth: 10 feet
Pitless Adapter Manufacturer's Name: Campbell B-10
Pitless Adapter Installer: Not Aarow Pump
Well Disinfected Upon Completion? ® Yes ❑ No
Method of Disinfection: Recirc
Comments:
S F1 E T Y
Replacement Only: YES NO
Property Owner Name & Address:
Dave & Amber Vickaryous
Pump Installer Name: Aarow Pump & Well Service LLC
907-346-9355
Anchorage, AK 99516
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Municipality of Anchorage
Community Development Department
On -Site Water & Wastewater Program
47OOElmore St. nP.(J.Box 19685OinAnchorage, AK99SO7-G65Oae/?Yq*,0uni`org/omsite m(9O7)343-79O4
Legal Address: 19715 Adrian Lane
Subdivision Block Lot
On-site Water & Wastewater Program certified contractor performing the well decom
Name: Bill Sullivan
Company:
Signature
s
Well decommissioning date: 5/10/17 Method ofdecommissioning: AMCI5:5S.06OLI a. [] b. 0 c.
Location: Use the space below to provide a drawing of the property showing the following items
°
North Arrow '
°
Decommissioned well,
~
Other water wells onthe property,
°
Two separate swing -tie distances for each well shown i^thedmudo§,
Note: The swinA�>edistances shaUhemeasured �mmebherpennanentstructures ofproperty corners.
69
C4 L
16. 1 *x24.1 COAAAAGE
LOT 95-8
�
A9 25* RW UTILITY EASEMEW
WELL
Pao CTIVE WELL
WE lus
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastowator Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Upgrade
Date Issued: Jun 19, 2008
Expiration Date: Jun 19, 2009
Permit Number: SW080086
Legal Description: T15N R1W SEC 18 LOT 95B
Design Engineer: 0062 PANNONE ENGINEERING SERVI(
Owner Name: AMBER VICKARYOUS
Owner Address: PO BOX 196530
ANCHORAGE, AK 99519-
Parcel ID: 051-172-14
Site Address: 19715 ADRIAN DRIVE
Lot Size: 38264 SQ. FT.
Total Bedrooms: 2 Permit Bedrooms: 2
This permit is for the consb'uction of:
[] Disposal Field [] 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 DSD at least 2 hours pdor to each inspection. Provide notification by coiling
(907) 343-7904 ( 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 dosed on the same day.
B. Covered, sealed, and heated lo prevent freezing.
5. The following special provisions.
A. PROVIDE DOCUMENTATION THAT THE EXISTING WELL WAS DECOMISSlONED IN ACCORDANCE WITH
THE CODE.
Parcel I.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www.munLorg/onsite
(907) 343-7904
ON-SITE SEWER,/VVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Property owner(s) Amber Vickawous
Mailing addressP..O. Box 196530, Anchoraqe, Ak
Site address J~J5 ~'3¢,0 ~ ~/d ~"'~ ~.
Legal description (Sub'd., Block & Lot) Let 95R
Legal description (Township, Range & Section) T15N R1W $18
Lot Size 38,264 Sq. Ft. Number of Bedrooms 2
Day phone
Zip Code 99519
Zip Code .99577
THIS APPLICATION IS FOR ([~ all that apply):
Absorption Field []
Septic Tank []
Holding Tank []
Privy []
Private Well []
Water Storage []
THIS APPLICATION IS AN:
Initial []
Upgrade []
Renewal []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
Pannone Engineering Services, LLC
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment:
Receipt Number:
(Rev. 11,'05}
Waiver Fees:
Date cf Payment:
Receipt Number:
l~annone Engineering ~ervices,
Consulting Eng/neers
June 9, 2008
P.O. Box 102954
Anchorage, Alaska, 99510
(907} 272-8211 Fax
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
4700 S. Bragaw Street
Anchorage, Alaska 99519
Subject:
T15N RIW S18, Lot 95B
Well Replacement Permit Request
Ladies and Gentlemen:
I am writing to request that a permit to install a new well be issued for this lot. The proposed systems will serve an existing two-
bedroom house. Currently the lot is developed. The existing septic system was designed and installed for a four-bedroom small
multi-family (two houses) and appears to be operating adequately for four bedrooms. The two-bedroom trailer was removed
earlier this year. The existing well was probed and found to be 33 feet deep. Also the existing 1,000 gallon septic tank is located
approximately 90 feet from the existing well. The proposed well will be located in the south east corner of the lot. The
surrounding lots are served by private water systems and septic systems, which are over 100 feet from the private water system..
1. Surface Water: There is no surface water within 100 feet of the proposed system.
2. Topography: Lot 95B slopes to the south at approximately one to five percent based on existing contour information.
The proposed installation will not affect the future development of the surrounding or existing lots. There are no septic systems
within 100 feet of the proposed well location. If you have any questions or concerns, please Contact me at 272-8218.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Attachments:
Page 1 of 1
/' 93A :
1lA ..ps, ,~ JSTT~cG
-EXlST'G %,
SEPTIC ..
;f-PROPC~E~'\ WELL/
'~'~ EXlST'G,:WELL
/ -EXlST'G
/ SEPTIC
-EXIST'G /
SEPTIC
96B?IsT'G
961
NOTES: J~-NON~. ]~T~ .q~ f T ~ ~ - 'Date
PANNONE ..... ...
~SUED FOR ............ P.O. BOX 102954 ANCHORAGE, A~ 9~
....... ~,.~..u~.,u~ PHONE (907) 272-8218 FAX (907) 272-8211
o~,,/~ F*."~- ~ ~*'~ ,'=,oo'
.... {'~~ P.I,D, NO
T15N, RlW, S18, Lot 95B ~~ 351-172-14
Amber V~ckaryous
PLAN Anchorage, AK 99519 ~I,~'. "~ *h -
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LOT g$-C
EXIST'D lO00g
SEPTIC TANK-
N89°57'40'W 283.50
'/ EXIST°G WELL
'/ ABANDON PER CODE-
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E~ST'¢ 2 BR
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EXIST'G UNDOCUMENTED
DRAIN
N89°57*40'W ~,283.50
ADRIAN AVENUE \
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NOTES:
iSSUED FOR CONSTRUCTION
s/u/os
PLAN
/
PROPOSED
/ ~ /
/ /
/ /
/ /
/
\
CE 8149
PANNONE ENG SVC, ;3C
P.O. BOX 102954 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
T15N, R1W, S18, Lot 95B
Amber Vickaryous
P.O. Box 196530
Anchorage, AK 99519
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On-Site Water and Wastewater Program a JUV. ' '1'`'
'` (907) 343-7904 "�'$`�i`�"
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Certificate of On-Site Systems Approval c>II °` 6 e G9��
Parcel I.D. 051-172-14 Expiration Date: a Q 17
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•
1. . GENERAL INFORMATION �--
Complete legal description T15N R1 W Sec 18 Lot 95B
Location (site address) 19715 Adrian Ave.
Current Property owner(s) Charles Kaylene Sullivan Day phone
Mailing address PO Box 771054 Eagle River, AK 99577
Real Estate Agent Day phone
2. TYPE OF DWELLING:
O Single Family (wlwo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family andfor Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Weil C Individual 0
Individual Water Storage E Holding Tank ❑
• Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑ '
WaiverNariance request for: Distance:
.-.-.......-. ._ Received'b :' -.: t . _L: )i ! j.._a.j ---- ---------Date:-'1OI) ?-..., . - ... .. .._. .------•---•
COSA to be released to the engineer, unless otherwise reques ea by the engineer.
COSA Fee $ 0-(o g Waiver Fee $
Date of Payment / 1 31 1 11 Date of Payment
Receipt Number d$ (OG Receipt Number
COSA# 05Q'Il PD?"C;1 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 7of. On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater
disposal systeri s_•(al•e) 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.
In conducting;an adequacy test, I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guideline's`end regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system.The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 7/31/2017
eco.-
•-c*.-,-
6. DSD SIGNATURE • "2
System#1 Approved for t� bedrooms I, •SIeven R. Pannone •
CE-814G ...- -.1
System#2 Approved for bedrooms $��`�i�,,
•Pim
Disapproved �� `, OFFESS\W"`•
Conditional approval for bedrooms, with the following stipulations:
. r 1-W�y\,\
�� v� .
9} �l-SIC
c .
ERAND
pROGRMA
c.
_...._.._._......_......_ c.
By; -P.. �';�,e� ��� t,X- - . ..-.-- Ori inal-Certifica
te.Date: F---/-o- _G2.0_11_7 .... ._ _-_
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 . X
Well Flow Advisory Other
COSA blue sheer r ,
If more than 1 septic system is on the lot:
COSA Checklist # ' of '
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: T15N R1W Sec 18 Lot 95B Parcel ID: 051-172-14
A. WELL DATA
Well type
Private If A, B, or C provide PWSID# _ Well Log (YIN) Y
Date completed 8/25/2017 Sanitary seal (YIN ) Y Wires properly protected (Y/N) Y
Total depth 140 ft. Cased to 64 ft. Casing height (above ground) 24 in.
FROM WELL LOG AT INSPECTION
Date of test 8/25/2017 NEW
Static water level 28 ft. 28 ft.
Well production 6 g.p.m. 6 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate ND mg/L
Arsenic 8.80 ug/L Date of sample: 9/5&11/17 Collected by: Sullivan's
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/SteelDate installed 7/20/2017
Tank size 1 000 galNumber of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A
Date of pumping NEW Pumper N/A
C. ABSORPTION FIELD DATA
Date installed 7/20/2017 Soil rating (g.p.d./ft2 or ft2lbdrm) 1.2 GPD/SF System type Deep Trench
Length 32 ft. Width 2.5 ft. Gravel below pipe 6 ft.
Total depth 1 1 ft. Eff. absorption area 384 ft2 Monitoring tube Y Depression over field N
Date of adequacy test NEW Results (Pass/Fail) N/A For bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo ) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 1 0+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION +.iblizo`�~`t
I certify that I have determined through field inspections and g'� •r• -vrk
review of Municipal records that the above systems are in fir, •.* i
conformance with MOA COSA guidelines in effect on this date. •• •• 9_
Steven Pannone 7 • •••• /
Engineer's Printed Name � • •eleven k. onnone •
Date 9/20/2017 0� 4�•• CE-8149•
COSA canary sheet_2-6-15.doc
Certified Drilling Log
DOC CO dba
UL
,
WATER WELLS
BILLLI8c GOLVANE1
►
P.O. Box 670269, Chugiak,AK 99567 688-2759
OWNER OF LAND: Kaylene Johnson-Sullivan Bore Hole Data
ADDRESS: PO Box 771054 Eagle River AK 99577 Depth
LEGAL DESCRIPTION T15NR1WSEC18LT95B From To
DATE: 8/25/17 0 2 Casing stickup
PERMIT NUMBER: OSP171231 DATE OF ISSUE: 8/17/17 2 5 Overburden
TAX IDENTIFICATION NUMBER 05117214000
Is well located at approved permit location: ®Yes nNo 5 23 Silt sand &gravel
Method of Drilling: Nair rotary ❑cable tool 23 26 Silty sand wet
Depth of Well: 140 26 54 Tight sand gravel w/cobbles
Casing Type: Steel Wall thickness ,250 inches 54 75 Sandstone
Diameter: 6 inches, depth 64 feet
75 96 Sandstone conglomerate saturated
Liner type none
Static Water Level: 28 feet 96 114 Hard shale
Recovery Rate 6 gpm ❑ gph 114 125 Sandstone
Method of Testing air 125 140 Sandstone conglomerate
Well Intake Opening Type: ❑open end ®open hole -
❑ Screened Start feet Stopped
❑ Perforations Start feet Stopped
Grout Type: Casing Seal Volume: 1001bs
Depth:from 2 feet,to 20+ feet
Well Disinfected Upon Completion: Zyes ❑no
Method of Disinfection: Chlorine 50 PPM
Comments:
WATER QUALITY TESTING
Coilform tstpj Cou100mL
Nitrates t41) mg/L
Arsenic S. ii, . q 11 Drillers Name: Bill Sullivan
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority.
Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation.
MatSu Borough:Department of Environmental Conservation.
Parcel I.D. 051-172-14
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Expiration Date: l�OV
1. GENERAL INFORMATION
Complete legal description T1 5N R1 W Sec 18 Lot 95B
Location (site address) 19715 Adrian Ave.
Current Property owner(s) Charles & Kaylene Sullivan Dahone
Mailing address
Real Estate Agent
*0 Box 771054 Eagle River, AK 99577
2. TYPE OF DWELLING:
� Single Family (w/wo ADU)
❑ Duplex
F-1 Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOHS: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
I -XI
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for: Distance:
Received b jW Date:
COSA to be released to the engineer, unless otherwise requesw by the engineer.
As certified by my seal affixed hereto and as of the validation date shown below, 1 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 systemJs .(ate) 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.
In conducting,,an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guideling"s %nd regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
Date 7/31/2017
6. DSD SIGNATURE
System #1 Approved for bedrooms Seven R.'E�annorie
•, CE -8149
System #2 Approved for bedrooms
Disapproved ?0 ESSO
Conditional approval for bedrooms, with the following stipulations:
D�;R,p,Nt
By: PuLzILia _ W Original_ Certificate Date: 6 /2 / 7
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
COSA blue sheet_r c
Ifmore than iseptic systemhsonthe lot
COSAChecNimt#o�__
Structure served bythis system 1____
Certificate of On -Site Systems Approval Checklist"
T1�0l�1VV����1Ak�����
Legal Description: ' '~' ^ ' ^ ' ` ^ ~~ '~ ^~^ ~~~~
4^WELL DATA
Well [r�'v�t�
type Private IfA`B.orCprovide PVV80#
Date completed 6C8/2008 Sanitary seal (Y/N)y
_
Total depth 120 ft, Cased to 62ft.
Date of test
Static water le5Ove|
Well �
production '^2.5
WATER SAMPLE RESULTS:
ft.
mm
NEGCoColiformm NEGoo|onieo/1O0 mL NitrateNDng/L
Arsenic 106 ug/L Date of sample: 7/21/2017
B. SNGTA0KDATA
��(�nf'r/��t8(�|
T�kTyp�Ma�h�� r^'�� '
Tank size 1000 gai Number ofCompartments 2~_
Foundation cleanout (YYN)Y
Date ofpumping . NEW
Depression over tank (YN- Pumper YN) ..
N/A
051-172-14Paroa |
Well Loo (YYN)Y
Wires properly protected (Y/N)Y
Casing height (above ground) 24
AT INSPECTION
uc �
ColePES
by:
Date installed 7/2DC2017
High water alarm KN/AYN)
�0
C. ABSORPTION FIELD DATA
Date installed 7/20/2017 Soil rating (g.pd. /ft2 or ft2 /bdrm)1.2 GPD/SF System type Deep Trench
^'
�� ��
Length ~ ft. Width 2.5 ft. Gravel below pipe G ft.
/ 384\/ N
Total deo;�'�. E�.absorption area K8nnitohngtube _'___ Depression over �e|d`",__
�VV
�
Date ofedequaoytest '`^-`` Remu|tn(Paoa/Fai|)N/A.,,..__ For bedrooms
Fluid depth inabsorption field before test in. Water added gal. New depth______in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g -pd-
�
Any juvenatkon�eabnant(past 12moj0ON&type) '` Ifyes, give date
C\LIFT STATION
Date installed___
"Pump on" level ct
Datum
_ Size ingallons __
in. "Pump off' |eve| at
— Cycles tested
E. SEPARATION DISTANCES
WELL ONLOT TO:
'--
I
f
Manho�A\coeaa�YN)
High water alarm level at in.
K4oe��
alarm mquimman�?______
Septic Wh
otsnftnha�k���
station
� On adjacent lots '~~ 100f
Absorption�10Of �|don|ot '~^ [)nadjacent lots '"" 1OOf
Public sewer main 75+ Public sewer manhole/cleanout 100f
�
Sewer /septic �f 1OOfoservima|ine ^-~ Holding tank '~~
Animal containment areas 50f Manure/animal excrete storage areas 100f
SEPTIC/HOLDING TANK OMLOT TO:
Building foundation 5+on Property5f|ine'^-`____
Water main ' " 10 f VVa�/rmen/ice line 10f
Wells onadjacent lots 100f
ABSORPTION FIELD {}NLOT TO:
Property10f |ine '~ Building foundation 10f
Water Service line 10f Surf1O0f
�oewmbar '~�
Cud�0�
Curtain ~" Wells onadjacent lots 100f
F. COMMENTS
G. ENGINEER'S CERTIFICATION
/cedify that/have determined through field inspections and
review of Municipal records that the above nyoh*nno are in
conformance with MOA C(]3Aguidelines /neffect nnthis date.
Engineer's Printed Name Steven Pannone
Date 7/31/2017
C0Sacanary 000*Lz-6-1u.dun
Absorption field 5f
Surface water 10Of
Water1Of
men '~
Driveway, parking/vehicle storage
10f
^^^
Municipality of Anchorage
Development Services Department
Building Safety Division
MVI/
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
w,,Nvv.muni.or(Y/onsite
:n
(907) 3 343 3-7904
Certificate of On -Site Systems Approval 4 OSC171329
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted. on the well water supply on T15N R1
Section 18 Lot 9513. This inspection revealed an arsenic concentration of
10.6 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. information 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.
Carroll, Rebecca M.
From:
McGee, Lynn M.
Sent:
Thursday, August 10, 2017 10:24 AM
To:
Carroll, Rebecca M.
Cc:
Right of Way Requests
Subject:
Encroachment Permit for water well at 19715 Adrian Avenue, Lot 95B.
Rebecca:
ROW has all the letters of non -objection and fees paid, We will be issuing the ROW Permit when the
permit is typed up and signed by the current owner. It will be done 8-14 or 15, 2017.
Lynn McGee
Senior Plan Reviewer
Right of Way Section
mcgeelm@muni.org
343-8226
343-8250 (fax)
3,
6�1
21�
e9