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Home My WebLink AboutT15N R1W SEC 8 LT 45Onsite File T15N R1W Section 8 Lot 45 #051-093-02 , .,,,,. MUNICIPALITY OF ANCHORAGE /~", DE 'ITMENT OF HEALTH AND HUMAN SER ~S ~ .. "- -. Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT .a.,o DISTANCES ~:~,,/?~ ~ r ~ ~ TO SEPTIC ABSORPTION WELL A~,~FROM ~ TANK FIELD TANKS ~ SEPTIC ~ HOLDING / TYPE OF SYSTEM RENCH ~ BED ~ W. DRAIN ~ OTHER I FT ~. ~ ' FT WELLS ~,~,~ ~ PRIVATE ~ OTHER (Identify) FT~ FT REMARKS: Municipal and Slate guidelines In elle~ on ~[1 dale: ~ "*~ Health Depadmenl Approwh ~ ~ 72-013 (~,'85) MUNICIi- ALITY OF ANCHuRAGE , DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION. G25 L STREET, ANCHORAGE, AK ~9501 ~'~4-4720 ON--SITE SEWER ~, WELL PERMIT PERMIT NO: 850545 ~'~ DATE ISSUED: 08/27/85 AF'PLICAN~: ADDRESS: CONTACT F'HONE: CHARLES S. BARR P.O. BOX 541 EAGLE RIVER, AK 99577 99577 LEGAL DESCRIP: SUBDIVISION: BLM LOT: 45 SECTION: 8 TOWNSHIP: 15N RANGE: 1W LOT SIZE:· 2.5A (SQ.FT. OR ACRES) MAX BEDROOMS: 4 Listed below are the options available to you system. in designing your Choose the option that best fits your site. BLOCK: NA septic TRENClt DEPTH TO PIPE BOTTOM (FT.) 4.0 GRAVEL DEPTH (FT.)~ 5.5 TOTAL DEPTH (FT.) . 9.5 GRAVEL WIDTH (FT.) GRAVEL LENGTH (FT.) 51.0 GRAVEL VOLUME '(CU. YDS.) 17.5 TANK SIZE (GALS) 1,250.0 SOIL RATING (SQ.FT./BR) '85 BED W. DRAIN 4.0 4.0 0.5. 5.5 4.5 7.5 16.0 5.0 ~2.0 57.0 1~.0 27.5 1~250.0 ** 1~250.0 ** 85 85 - ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certify that: i. I am familiar with the requirements 2. for on-site sewers and wells as set ~orth by the Municipality o~ Anchorage (MOA) and the State of Alaska. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. I will adhere to all MOA and State o~ Alaski requirements for the set back distances from any existing well, wastewater disposal system or,public s~werage system on this or any adjacent or nearby lot. 4. I understand that this'permit is valid fop a maximum of 4 bedrooms and any enlargement will ~equire an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT. AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL I~SPECTION REPORT~ AND (5) THE ELECTRICAL WO~HUST BE DONE BY~A LICENSED ELECTRICIAN.~ APPLICANT: . BARR PERFORMED FOR: ~"'~'~ ¢~ ¢.~t' DESCRIPTiON:~ ~'t ~ ~ ~ LEGAL 1 2 3 m SOILS LOG MUNICIPALITY OF ANCHORAGE [] PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST . -- ~ SLOPE SITE P LA~'- ~ 8 10 12 13 14. ~5- 16- 17- 18- 19- 20- WASGROUNDWATER ENCOUNTERED? IF YES. AT ~HAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERC_ _~T..~ :O;~ RATE ~" TEST RUN BETWEEN FT AND FT COMMENTS PERFORMED BY: 72-008 {6/79) :"P. O. BeX 773294 ,-~a~e P~v~', AK 99577 694-5195 CERTIFIED BY: COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume 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 Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: T15N R1W SECTION 8 LOT 45 051-093-02 1.5 UNKNOWN None 8.65 18 FORGE ENGINEERING 5/22/19 31 11/2/20 4 SEPTIC/STEEL 49" 11/4/20 - Alaska Quality Septic Septic System is gravity flow. Absorption Bed 4/20/16 5/22/19 3 7.2 0 6.6 450 0 0 0 >450 None 1968 ✔ COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to:(Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’Yes if No ft Absorption Field on Lot > 100’Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’Yes if No ft Holding Tank > 100’Yes if No ft Animal Containment > 50’Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to:(Please enter distances if less than required) Building Foundations > 10’Yes if No ft Property Line > 5’Yes if No ft Absorption Field > 5’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to:(Please enter distances if less than required) Building Foundation > 10’Yes if No ft Property Line > 10’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft F. ENGINEER’S COMMENTS G. ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 11/20/20 ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ EPOWS MUNICIPALITY OF ANCHORAGE Development Services Department ` Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 051-093-02 _Expiration Date: Z 1. GENERAL INFORMATION Complete legal description T15N R1W SECTION 8 LOT 45 Location (site address) 20334 J-K Lane, Chugiak, AK Current property owner(s) Marvin & Cheryl Kroener Day phone 907-854-6932 Mailing address P.O. Box 670426, Chugiak, AK 99567 Real estate agent John Wilson Day phone 907-748-3787 2. TYPE OF DWELLING: Single Family (w/wo ADU) Duplex Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Ix I Private Septic x Water Storage ❑ Holding Tank Community Well n Community n 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 $ 5/11) //9 Waiver Fee $ Date of Payment 'i Date of Payment Receipt Number O8?4 ID Receipt Number COSA# d 5C/9 la;43 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 Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 6/6/19 Hi �' �y11�i�y::J♦♦ 491 !%tel ••�♦�f 6. DSD SIGNATURE • n•"' r •- •• `, �........ • fr; System #1 Approved for 3 bedrooms :MICHAEL E ANDERSON: 1= ♦ •. ♦ -. •y No. CE-4381 i= System #2 Approved for bedrooms ♦i fF sisns •�°eco + a Disapproved •h�PRCFTS;11 ��•�• Conditional approval for bedrooms, with the following stipulations: ll(((((((((o k 1441 7-4.. ,8 1rS. "'1ST114/0 s- "% LiA414f = 47;6/fCcs -)))/1))1111)111�• Original Certificate Date: Ip 2-C-9 -/ 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 Checklist blue sheet COSA Checklist Legal Description: T15N R1W SEC 8 LOT 45 Parcel ID: 051-093-02 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA ❑Well log is filed with Onsite (or attached) Well production at time of test 1.5 gpm Date drilled Unknown Water storage tank volume NA gallons Total depth ft Well disinfected for coliform test? El Yes ❑■ No Cased to ft ❑■ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate mg/L ❑ Nitrate less than MRL(ND) ❑■ Wires are properly protected Arsenic 8.45 ug/L ❑ Arsenic less than MRL (ND) Casing height (above ground) 22 in. Collected by Forge Engineering Date of flow test for COSA 5/22/19 Date of Sample 5/31/19 Static water level at beginning of test 31 ft. Comments No Well Log is available. B. TANK DATA C. LIFT STATION Age of tank(s) 3 years ❑ Required maintenance completed Tank type/material Steel Age of lift station years Measured operating fluid level in septic tank 49 Lift station material ❑� Standpipes/foundation cleanout per record drawing Comments: NA Date of pumping 6/10/2019 D. ABSORPTION FIELD DATA Absorption Bed Which system tested (date installed) 4/20/16 Adequacy test date 5/22/19 ❑■ ALL standpipes present per record drawing Results ❑✓ Pass For 3 bedrooms Total measured depth from grade 7.2 ft(max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 6.6 ft(min) Water added 450 gal El N/A—pressurized field New depth 0 in ■❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 0 min depth into effective ❑■ Code-required soil cover over field Final fluid depth 0 in ❑ Absorption rate 450+ gpd System presoaked (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) None date of test) Gallons introduced 1968 gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100' ✓❑Yes if No ft E Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' ✓0 Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Animal Containment> 50' ✓� Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft —❑✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 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' El Yes if No ft Community Wells >200' 0 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' ✓0 Yes if No ft Private Wells > 100' 0✓ Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells >200' ElYes if No ft Surface Water> 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION soloisl�ii4 �••.'PE.Q. 44.�4.• I certify that I have determined through field inspections and review i'< of Municipal records that the above systems are in conformance with 4 ��' { y MOA COSH guidelines in effect on this date. ' 49th /� ...*��, �' MICHAEL E. ANDERSON ��= • ku II •0VI % No. CE-4381 ;..Za ��F,%..•... ..06/06/19 (c.;--i COSA Checklist yellow sheet �.et)%...... �"•