HomeMy WebLinkAboutT15N R2W SEC 25 LT 90
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
I ~ ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE [] NEW
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
~ I Absorption area 'Dwelling PERMIT NO.
~ Manufacturer , Material ~%~.~ Uo. of compartments
~ ~ ~ Liq. capacity in gallons Inside length Width Liquid depth
~ J ~ ~O IF HOMEMADE: ~ ~
DISTANCE TO: Well Dwelling PERMIT NO.
Manufacturer Material .~ Liquid capacity in gallons
~D DISTANCE TO: Well /~ ,~ Foundation Nearest lot line/O ,~ PERMIT NO.~
No, of lines j Length of each line Total length of lines Trench width ~ Distance between lines
~ Top of tile to finlsh grade ~.~ ~*~¢~ ~ ¢ ~
~ /~[~ i Material beneath tile Total effective absorption area
Length Width Depth PERMIT NO,
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ Class Depth Driller Distance to Jot Jine PERMIT NO,
~ foundation Sewer line Septic tank Absorption area(s)
Building
DISTANCE
TO:
OTHER
PiPE MATERIALS
APPROVED ~ -' ~h t~O~A~ ~ LEGAL
L. EFi- Fi T
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
8~5L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOl LS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
SLOPE
1
2
4
5
6
7
8 -¢4,.~(
9 I
10
11 WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
. DEPTH?
14-
15-
16
17
18
19
2O
PERFORMED BY:
DATE PERFORMED:
SITE PLAN
Reading Date Gross Net Depth to Net
Time Time Water Drop
I~N RATE (minutes/inch)
i FT
72-008 (6/79)
TEST RUN BETWEEN
'~ : , ..... CERTIFIED BY: ~:;~'~'(
Eagle R(ver, At( 99j~7
694-519~;
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of GeoJogicol 81 Geophysicol Surveys
Drilling Permit No.
LOCATION OF WELL (PleDGe complete either re, lb or lc.) A.D.L. No.
.'~chorag, Uo3, Go~ 90 _of_or_of_ 25 15 sE] 2 w~
~Jo~sTA.CS AND DIRECTION FROM ROAD INTERGECTIONS 5. OWNER OF WELL: Char~es
J A~dress: ~[~i 1697 Blue o~ce
cl~ ~r~y ! 3 ~ A~get ~ ~.,ted ~ Bored
F~avel EGO 12 1~ ~ Irriaatlon ~ Re0harge ~ CommerJeal
shale ~ ~h L~yers ~f bro~ 28 67 8. CASING: ~ Threaded ~ Welded
g~e~ns~ona ~' 2~0 ~ 2~~ Slot/Mesh Size: ~'~. Length:
Backfilling Grovel pack
"VVl~og~ HEAL~,T' ~G~ Equipment used:
16. WATER WELL CONTRACTOR'S CERTIFICATION: ~J~';~:? ~:~ f~,C'[
Re~lered BuMness Name ~,~/~ , ~ C~nlracf Lice~s.: Number
ANCHORAGE AREA BOR }GH
Department of Environment Quality
3500 Tudor Road
Anchorage, Alaska 99507
INSPECTION REPORT ON-SITE SEWAGE'DISPOSAL SYSTEM
NAME '~/?~ ¢ D
LOCATION
MAILING ADDRESS~'~Oy ~t¢~ ~)j~ ~).'¢~ PHONE
LEGAL DESCRIPTION -~'r ~' ~-/~ ~/ ~- ~/ ~/d~ ~:~
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
MANUFACTURERfI~t~;~? /~/A{~'$ MATERIAL ~'~::~'~ ~;~
INSIDE WIDTH LIQUID DEPTH.
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY/~'~-~ GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL
TOTAL LENGTH
FOUNDATION ~/: NEAREST LOT LINE J~'~' OF LINES
NUMBER OF LINES ~ DISTANCE BETWEEN LINES TRENCH WIDTH ~' IN. TOTAL EFFECTIVE
ABSORPTION AREA ~ SQ. FT. LENGTH OF EACH LINE g/~ ~/~X -~O[
DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE .~f ( MATERIAL BENEATH TILE /;~ IN. ABOVE TILE ~' IN.
WELL:
TYPE
BUILDING
FOUNDATION
CESSPOOL
APPROVED
CONSTRUCTION _
NEAREST
LOT LINE__
OTHER SOURCES
DISAPPROVED
NEAREST
SEWER LINE
DEPTH
SEPTIC ~ SEEPAGE
TANK ~g SYSTEM
REMARKS
DISTANCE FROM:
DISTANCES:
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAL:
Flex/>'p.
LOT SLOPE:
Form PW*027
DIAGRAM OF SYSTEM
G.A.A.B.
-[~:~E:ATE:R ANCHORAGE: AREA BOROUGH
SEWAGE ~ISPOSAL SYSTEM ~ APPLICATION AND PERMIT
PERMIT NO,
INSTALLATION LOCATION
INSTALLATION
~JNANCEDTYPE AND S]ZETHROuGHOF FACILITY TO ~E ~ ~~~: - ~
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
FOUNDATION TO SEEPAGE Pit Z~
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK , SEEPAGE PIT
, SEEPAGE PIT ./~
· SEEPAGE Pit
iO0/
SEPTIC TANK, ., SEEPAGE PIT DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CR'OSSJNG GAP OF
EXCAVATION 5 FEET INTO UND]STUREJED SOil.
4 INCH D]AMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit
FITTED WITH AIRTIGHT REMOVABLE CAPS.
BOROUGH REGU TIONS REGARDING INSTALLAT]ON.
TYPE
I CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
Russell Oyster
694-2774
Civil Engineering
Soils ~- Foundations
0 E~ E ENGINEERING E~ DEVELOPMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 333-5240
SOIL LOG
Earl Ellis
333-5240
Surveying
Land Development
Performed for:
Legal Description:
Depth (feet)
0
1
2
3
4
5
6
7
8
9
10
ll
flame: ~'~,,~-- Q~,~'/ Q:b~,~--~x~f-7' Tel. No.
Mailing Address: ~,-~, ~ C4[ ~G~ ~'~, ~
Soil Characteristics
12
Ground Water Encountered: Yes N~
Proposed Installation: Seepage Pit
CommentS: ~/~ ~ qA~ J~
If yes, what depth
Drain Field
MUNICIPALITY OF ANCHORAGE
Development Services Department `� Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 051-283-13
Certificate of On -Site Systems Approval
Expiration Date: 5__- Z-2 - 2702 Z-
1. GENERAL INFORMATION
Complete legal description T1 5N R2W SEC 25 LT 90
Location (site address) 15739 Chris Ct
Current property owner(s) RUNGE DENISE Day phone 907-255-0101
Mailing address
- _. _ . _-_ -- .-- _ -- ..
Real estate agent TNS Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Q
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ Jr� Waiver Fee $
Date of Payment Date of Payment
Receipt Number Receipt Number
COSA # 0 3 C 0 3, Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm NorthRim Eng. Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Date 2/10/22
V 1.0'% 2
Conditional approval for bedrooms, with the following stipulations:
ON
Siff
WATER AND
WASTf_V'ATER z
l
...Ilk\�1
ill/JJr J� ZY
gY Original Certificate Date: 2
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 engineers work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory —�-- Other
COSA coech,t blue Shue!
•
Legal Description: T15N R2W SEC 25 LT 90
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled /31/85
Total depth 253 ft
Cased to 20* ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 2/8/22
Static water level at beginning of test 52 ft.
Comments * Into bedrock
B. TANK DATA
Age of tank(s) 45 years
Tank type/material Fbgls
Measured operating fluid level in septic tank 46
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 9/13/21
D. ABSORPTION FIELD DATA 4/27/85
Which system tested (date installed) same
❑ ALL standpipes present per record drawing
Total measured depth from grade 7.5 ft (max)
Measured depth to pipe invert from grade 5 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
OR Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 051-283-13
Structure served by this system
Well production at time of test 0.5 gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by NRimEng
Date of Sample 2/8/22
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 2/8/22
Results Q✓ Pass For 4 bedrooms
Fluid depth prior to test 8 in
Water added 600 gal
New depth 20 in
Elapsed time 60 min
Final fluid depth 8 in
Absorption rate 600 gpd
Any rejuvenation treatment (past 12 months) no
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'
0
Yes
Community Sewer Manhole/Cleanout > 100'
0 Yes
if No
ft
0 Yes
if No ft
Neighboring Tank > 100' 21 Yes
if No
ft
Private Sewer/Septic Line > 25' Yes
if No ft
Absorption Field on Lot > 100' 21 Yes
if No
ft
Holding Tank > 100' Yes
if No ft
Neighboring Absorption Fields > 100'
0 Yes if No ft
Water Main > 10'
Animal Containment > 50* 0 Yes
if No ft
[E] Yes
if No
ft
Yes if No ft
Water Service Line > 10'
0
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main > 75' E] Yes
if No
ft
R Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
0
Yes
if No
ft
Surface Water> 100'
0 Yes if No ft
Property Line > 5'
0
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
0
Yes
if No
ft
Private Wells > 100'
0 Yes if No ft
Water Main > 10'
ft
Yes
it No
ft
Community Wells > 200,
Yes if No ft
Water Service Line > 10'
0
Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
0
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
0
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Yes
if No
ft
Private Wells > 100' Yes if No ft
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water > 100'
Rl
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
/ 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
-4- ��q
Ar,A,,'
stew
Eng — . w'k
'.,
CE -62W
110*/ 2 if
Municipality of Anchorage
® Development Services Department
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
Nater Well Advisory
Certificate of On -Site Systems Approval (COSA) 4 OSC221063
During a recent COSA on-site inspection and test of the potable -water
supply well on T15N R2W Sec 25 Lot 90, the well's productivity was
determined to be .5 gallons per minute. The minimum well productivity
required by this Department (AMC 15.55) for a 4 -bedroom residence is .41
gallons per. minute. Although the subject well currently exceeds this
minimum requirement, all parties concerned are advised that the production
capacity of the well may fluctuate. Restriction of non-critical water uses
such as washing cars and watering lawns and gardens may be required.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot. block, subdivision, section, tow?hip, range)
Location (adCress or directions)
(b) Applicant Name ~-~"~, "'/¢J J~ '¢~'"x~--"Telephone: Home ~¢',~'o~-~'~''-~-~ Business
Applicant Address ~ ~ .,,~ ,~.,( / ,5' ~ ) Z~/~, ~- ~ ~, cc__ ~?,~ ,Y---'~,£ ,~.
(c) Applicant is (check one): Lending Institution/J~ Owner/builder []; Buyer []; Other [] (explain);
~/" ~'/
(d)
Lending
Institution
Address ~ ~ ¢,4~.-=. ~_. ,
(e) Real Estate Company and Agent./~/~
Address
Telephone
Mail the H,~A to the following address:
(f)
TYPE OF RESIDENCE
Singie-Family~}~ Multi-Family []
Number of Bedrooms --~
Other
3. WATER SUPPLY
"~lndividual Well~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite [~ Public [] Community [-]' Holding Tank [-I
Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72 025 (11/84)
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and ~
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information Obi
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supp
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations irt elh~(4 ¢:m
the date of this inspection~,~f-
Name of Firm E/~LJ: HIVEFI ENGINEERING SERVII~E~ Telephone
Address EAGLE RIVER, AK -09577
Date P. 0. BeX 773294
694-5195
Engineer's Seal
Approved for ~bedrooms by
Approved Disapproved Conditional /%
Terms of Conditionai Approval The e×isting well ±s only adequate for (I) bedroom, A new
well must be drilled and must produce a minimum sustained
yield of 0. 104 gallons per minute per bedroom. Funds to
be escrowed to ass~ure work is completed no later than
30 June 85.
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph $ above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Descrip. tion: ~--~'
~ 0
MUNICIPALITy OF ANCHORAGE
DEPT. OF HEALr~ &
I."NYtRONMENTAL PROT£C~IoN
RE.CEI EP
WELL DATA
Well Classification ~:::)~'~ ~/'~ ~-~ Ii A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) )1~ Date Completed /~'..,,~ ('~"~ ~..."') Yield
Total Depth /~/o .,.,.,.,.,.,.,.,.,,~ Cased to ~¢'~ '/- Depth of Grouting '/w~
Static Water Level ~,o"
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N) .~'
Separation Distances from Well:
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
C~)mments
),~,~ ;'//
; On Adjoining Lots /¢¢
'/~'¢' ~; On Adjoining Lots /'~'~
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot -
; Date ~////
SEPTIC/HOLDING TANK DATA
Date Installed ~¢¢- /¢'?'F
Standpipes (Y/N) r1/
Depression over Tank (Y/N)
Size
Air-tight Caps (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line J ~
To Water Main/Service Line /~
Course
No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped
; for ~/,4
Temporary Holding Tank Permit (Y/N)
To Building Foundation ' ~'~'~'~'~'~'~'~'~'~-'~ /
To Disposal Field ~'o v--
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /~'
Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well /~"~'
To Building Foundation ,,~
Lot ~ ~
To Water Main/Service Line ,"~-~ c-
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
.Y
To Property Line /¢ -~'
To Existing or Abandoned System on
; On Adjoining Lots '3,¢
To Cutbank (if present)
Comments
LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed Date
Company MOA No.
Receipt No. _
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
Engineer's Seal
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Time Time Ti~ Time
Date Date Mete Date
Insp~tor Inspirer Inspirer Insp~tor
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Soils R'ting D*te ~wer installed Weg To Absorption Area ~ $ Well Log Received
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