HomeMy WebLinkAboutFERGUSON LT 2Ferguson
Lot 2
#051- 261- 30
MUNICIPALITY OF ANCHORAGE
C DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
W'E V S4 1/'CIeSOxv
PHONE
1
w
❑ UPGRADE
MAILING ADDRESS f3 (
o x 15-;kC, T i & /V Ad
LEGAL DESCRIPTION
7' 21 F46 K Cr 0501V Sip
LOCATION
NO. OF BEDROOMS
Uy
DISTANCE TO:
Well
Absorption area
Dwelling
PERMIT NO.
EZ
w r
Manufacturer
MateLialr—
'5 /
No. of compartments n
iC
y
Liq. ca acity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
G yDISTANCE
Jaz
TO:
Well
Dwelling
PERMIT NO.
2 F
Manufacturer
Material
Liquid capacity in gallons
O
w=
DISTANCE TO:
Well
Foundation
Nearest lot liner
PERMIT NO.
J LL Z
F zw
No. of lines
Length of eafbi ine
Totallen% ! li es
"/, 7
Trench w'dt
inches
Distance between lines
G H
Top of rile to finish grafi t
Material beneath tile /
�nehes
Total effective abs prion area
W
Length
Width
Depth
PERMIT NO.
QH
as
w
Type of crib
Crib diameter
Crib depth
Total effective absorption area
y
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
10
SOIL TEST RATING `
INSTALLER
REMARKS
r
o�
APPRO ED DATTEE�� LEGAL
72-013 (Rev. 3/78) C7
TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH
MHXIMUM NUM8ER 0F BEDROOMS � 4 SOIL RHTlNG (SQ FT/RR)� 125
THE REQUIRED SIZE OF THE SOIL 1-IBS0RPTION SYSTEM JS�
��R ::11 1 11 , -0 : � ���������� Khm 1? US lot 1=1 %, 1�, T. . FV- �������� el"
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) 0F THE TRFNCH OH oRHINFIELD,
THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE
GROUND HND THE BOTT0M OF THF EXCHVHTION (IN FEET)
THERE lS N0 SET 1-1l0111 FOR TRENCHES
lHE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVB, 8ETNEEN THE OUTFHLL PIPE
HND THE 8OTTOM OF THE EXCHVHTION (IN FEET).
I[:;!! 11-o 1 IF E W`I - 1: W 7 1`00 P-1 K 551 T 21 V0= �. lv "To As �oil ��.KJ No S:
PERMIT F1PP1. I]::::H1, 4T HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURlNG THE
INSTALLHTION lNSPECTIONS OF RNY WELLS HDJHCENT TO lMI5 PROPERTY HND THE
NUMBER OF THRT THE WELL WlLL SERVE
~~� �`1,0(if < :�:*� ������IF.,: � 9 -1: 1( �) r A Ti Y I r? K F? H 171 L j T IN IfT0
BHCKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTIUN HND HPPRO;OL BY THIS
DEPHRTMENT HlLL BE SUBJECT TO PROSECUTION
07, 147 10 owl 1 1 P7 X W 707 Fy Q �S U: � I�::: V�:�: V.1 :11����
0 Et E GEO'li _CHNI CAL Et ®EVELk- 'MENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster Earl Ellis
694-2774 SOIL LOG 688-2280
Soils Et Foundations Land Development
Performed for: Name: Tel. No.
Mailing Address:
Legal Description:
Depth (feet) Soil Characteristics
0
1
2
9.
10
12
13 QF y�8�
*.° 1'01 °.
15 , •°e aq
••
16 •. ••.••.
I °•.0.•Earl P .... .��
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El
° N4 1745-E .�'-Z-'I
Ground Water Encountered: Yes No If yes, what depth �cc���;``SS1 ��
.�/
Proposed Installation: Seepage Pit Drain Field
Comments:
Performed by: Date:
�P, a, o -n dV�J GU akD
12- k �4- cn. J U � t,�, LG, O -N,
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Received by:
CASA to be released
Date:
niess otherwise requested by the engineer.
5. STATEMENT OF INSPECTION BY ENGINEER
r f
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.
t
Name of Firm Anderson -Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineers Printed Name Michael E. Anderson, P.E. Date 9/24/2016
6. DSQ SIGNATURE
System #1 Approved for l bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the
*r 49TH
Ilk
following stipulations:
s
If more than 1 septic system is on the lot:
COSA Checklist # of _
Structure served by this system
Certificate of ®n -Site Systems Approve! Checklist
Legal Description: Ferguson, Lot 2 Parcel ID: 0517261-30
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 611/79 Sanitary seal (Y/N) Y
Total depth 77 ft. Cased to 77 ft.
FROM WELL LOG
Date of test 6/1/79
Static water level
Well production
WATER SAMPLE RESULTS
30 ft.
10
Well Log (Y/N) N
Wires properly protected (Y/N) Y
Casing height (above ground) >12 in.
AT INSPECTION
9/20/16
34 ft.
10.5 g.p.m.
Coliform 0 colonies/100 mL Nitrate •817 mg/L
Arsenic ND ug/L Date of sample: 9/15/16 Collected by: 907 Water Well
B. SEPTIC/HOLDING TANK BATA
Tank Type/Material Septic/Steel. Date installed 6/22/1979
Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N)
Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN)
Date of pumping 9/26/16 pumper - JRs Pumping
Y
N
C. ABSORPTION FIELD DATA
Date installed 6/22/79 Soil rating (g.p.d./ftz or ft2/bdrm) 125 SF/BDRM System type Deep Trench
Length 75 ft. Width 3 ft. Gravel below pipe 4 ft.
Total depth 7.6 ft. Eff. absorption area 600 ftz Monitoring tube Y Depression over field N
Date of adequacy test 9/15/16 Results (Pass/Fail) Pass For 2 bedrooms
r
Fluid depth is abs3rption field before test 39 in. Water added 600 gal. New depth 48 in.
Elapsed Time: 1,440 min. Final fluid depth 39 600**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
"Pump on" level at
Datum
Size in gallons _
in. "Pump offlevel at
Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Manhole/Access (Y/N)
in. High water alarm level at
Meets alarm 8 circuit requirements?
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 > Holding tank >75
Animal containment areas >50' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5+ Property line >51
,
Water main > Q Water service line >10
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
,
Property line > 10 Building foundation > 10
Water Service line >10' Surface water >100!
Curtain drain None Noted Wells on adjacent lots >100'
Absorption fie
Surface water
d >5,
>100'
Water main >10'
Driveway, parking/vehicle storage >10'
in.
F. COMMENTS
**Septic System is at the end of its useful life. Absorption is within the last 1"
of its effective depth.
G. ENGINEER'S CERTIFICATION
1 certify that 1 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 Michael E. Anderson, P.E.
Date 9/24/2016
COSA brown sheet 10-10-12.doc
0
I, MICHAEL E. ANDERSONe: n
CE-4381
•���a
�I •........ =
Municipality of Anchorage
?P�� SL,
• - Development Services Department
Building Safety Division =.
On -Site Water and Wastewater Program
4700 Bragaw Street 5
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
Parcel I.D. 051-261-30 COSA # P I l
Expiration Date: -7-
1.
1. GENERAL INFORMATION
Complete legal description FERGUSON LOT 2
Location (site address) 20123 LAUGHLIN STREET, CHUGIAK, AK 99567
Current Property owner(s) DAVID & JANICE CROSS Day phone
Mailing address
Lending agency
Mailing address
20123 LAUGHLIN STREET, CHUGIAK, AK 99567
Day phone
Real Estate Agent ERIC DINSMORE Day pho
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
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 ARCTERRA CONSULTING, INC. Phone 868-3792
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 04/08/2011
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The
assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow
and absorption rates may change due to subsurface conditions that may not be observed from the surface,
changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the
water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long aOW
,;
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen ' �.� ....:.
encroachments deficiencies or discrepancies exist.
5. DSD SIGNATURE
Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
• „&i e%rte
ti`s : k,Jtw�►t� -�-�--
w,yTER AND ' c"
F' ,GRAM
Attachments: %;`�� • •.... •'.l�®,;�
COSA Checklist X Arsenic Advisory lT,
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: ✓° : Original Certificate Date:
(Rev. 11105) /
Municipality of Anchorage *A9
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: FERGUSON LOT 2 Parcel ID: 051-261-30
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID #
Date completed 6/1/1979 Sanitary seal (YM) Y
Total depth 77 ft. Cased to 77 ft.
FROM WELL LOG
Date of test 6/1/1979
Static water level 30 ft.
Well production 10 g.p.m.
WATER SAMPLE RESULTS:
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 24+ in.
AT INSPECTION
4/6/2011
`i#
6.15 g.p.m.
Coliform NEG colonies/100mL Nitrate 14,16 mg/L
Arsenic: t4V mgA Date of sample: 72011 Collected by: ArcTerra
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material fttic/Steel Date installed 6/22/1979 Tank size 1250 gal.
Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
High water alarm (Y/N) N Date of pumping 41541 Pumper_Rs
C. ABSORPTION FIELD DATA
Date installed 6/22/1979 Soil rating (g.p.d./ftz or fe/bdrm)125 System type Trench
Length 75 ft. Width 3 ft. Gravel below pipe 4 ft. Total depth 7.55 ft. (Measured 4/6/11)
Eff. absorption area 600 fe Monitoring tube Y
Date of adequacy test 4/6/11
Depression over field N
Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test *44.4 in. Water added 1000 gal. New depth 48 in.
Elapsed Time: 1335 min. Final fluid depth 43.8 in. Absorption rate >= 600+ 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
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 1001+
Absorption field on lot 1001+
Public sewer main 751+
Sewer /septic service line 251+
Animal containment areas 50'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 1001+
Holding tank 1001+
Manuretanimal excrete storage areas 1001+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 51+ Property line 51+ Absorption field 51+
Water main 101+ Water service line 101+ Surface water 1001+
Wells on adjacent lots 1001+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101+ Building foundation 10'+ Water main 101+
Water Service line 101+ Surface water 1001+ Driveway, parking/vehicle storage 101+
Curtain drain 501+ (None Known) Wells on adjacent lots 100'+
F. COMMENTS
*Assumed 4' effective and measured from bottom of lateral System operating in top portion of
effective depth and/or sump/MT is showing more standing fluid than what is actually occurring in
field given field layout with slope or biomat buildup in MT Field stayed in the test range for 2000 gal
pre-soak and 1000 gal test w/out backing into ST
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 KENNETH M. DUFFUS
Date 4/Os/2011
COSA Fee $490.00
Date of Payment 4—/q-0
Receipt Number Oc--5 t I C
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department
a:. a
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci. anchorage. ak.us
(907) 343-7904
Septic System Advisory
Certificate of On -Site Systems Approval # 111110
During a recent adequacy test on the septic system for Block , Lot 2 of
Ferguson subdivision, 44.4 inches of standing water was observed in the
absorption field. This indicates that approximately 93% of the absorption
area is inundated. Although this system passed the adequacy test, the
remaining life expectancy may be limited.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval
SGS Ref.# 1111291001
Client Name ArcTerra Engineering and Surveying
Printed Date/Time
04/13/2011
17:23
Project Name/# Ferguson Lot 2
Collected Date/Time
04/07/2011
12:15
Client Sample ID Ferguson Lot 2
Received Date/Time
04/07/2011
15:00
Matrix Drinking Water
Technical Director
Stephen C. Ede
PWSID 0
Sample Remarks:
Allowable Prep
Analysis
Parameter
Results
LOQ
Units
Method Container ID
Limits Date
Date
Init
Metals by ICP/MS
Arsenic
ND
5.00
ug/L
EP200.8 C
(<10) 04/08/11
04/11/11
NRB
Waters Department
Total Nitrate/Nitrite-N
4.75
0.100
mg/L
SM20 450ONO3-F B
(<10)
04/12/11
AYC
Microbiology Laboratory
E. Coli
Negative
1
100mL
SM20 9223B A
04/07/11
DLC
Total Coliform
Negative
1
100mL
SM20 9223B A
04/07/11
DLC
s
AS-BUILT _
AV G 14. L 1 N S -T- I hereby certify that I have surveyed the following described.'
property_
� $ �� s✓ c� Imo.! ,:'C.; �, � :s
5�..•��„� 20 T'fit
, � 1 Anchorage Recording Precinct, Alaska, and that the improve-
( rnents situated thereon are within the property lines and do not
overlap or-encroach on the property lying adjacent thereto, that,
`" , t no improv ments on property lyin adjacent thereto encroach
� AME
ge Atn - t on the premises In question and that there are no roadways
5'm cn sax, �v y
0, transmission e transmission lines or other, visiblq. easements on said property
M: except as indicated hereon.
d "' Dated at Eagle River, Alaska `
N6.8EM.5 this - day of A CJ U S 7` 200L
1t08ERT C. JOHNSON ,"plc,
SCALE: , Registered, land Surveyor No. -LS
Lf_ Box 77-0456, Eagle River, Alaska 99577
Phone (9,07) 694L2543