HomeMy WebLinkAboutBURG LT 97B 051 - 172
-55
O
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program, 4700 S. Bragaw St. 'x,.,...,~
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.ci.anchorage.ak, us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: OSP101253 PID Number: 051-172-55
Name: Robert & Barbara Hoffman Wastewater System: [] New [] Upgrade
Address:
PO Box 770309, Eagle River~ AK ~9577 ABSORPTION FIELD
Phone: Number of Bedrooms:
~, [] Deep Trench [] ShallowTrench [] Bed [] Mound [] Other:
LEGAL DESCRIPTION se, Rating: Total Depth from original grade:
Block: Lot: Subdivision: 0.8 GPD/Ft2 ~ Ft,
Depth to pipe bottom from original grade: Gravel depth beneath pipe:
97B BURG 4.9 Ft. 1.1 Ft.
Township: Range: Section:
Fill added above original grade: Gravel Length:
0.8- 1.7 Ft. 1~' Ft.
Well: [] New [] Upgrade GraveJwidth: Number of lines: I Distance between lJnes:
5 Ft. 2[ 10 Ft.
Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material:
Existing Ft. Ft. 761 Ft2 D3034
Driller: Date Drilled: Static Water Level: Installer: Date Installed:
Ft. RPC 6/10/2011
Yield: I Pump Set at: I Casing Height Above Ground:
GPM[ Ft.[ Ft. TAN K
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other:
· T~ To Septic Absorption LiE Holding ~ublic/Private Manufacturer:
Capacity:
Tank Field Station Tank Sewer Line Anchorage Tank 1250 GaL
Well 100' 100'+ I00'+ NA 25'+ Material: Number of Compartments:
Steel 2
Su,faoeW~ter 100'+ 100'+ 100'+ NA ~ / LIFT STATION
Lot Line 5~'l' 7~+ 5~'1' NA~ Size: Manufacturer:
Gal.
Foundation 5~+ 10~+ 5'+ NA ~ "Pump on" level at: "Pump off" level at: in. High water alarm at:
in. in.
Curtain Drain NA * 509+ NA NA Pump Make & Model Electrical Inspections performed by:
Remarks:
· None known. Additional pert test performed at north end BENCH MARK
of field. Tank insulated. Location and Description: --
Garage Floor
Assumed Elevation:
100 Ft.
Engineer's Stamp
Inspections performed by: ArcTerra Dates: 1sT & 2ND 6/6-6/11/2011
3RD 6/13/2011
Development Se. rvices Department }Approval
Reviewed and approved by: ~_~.,..¢'~'/.~,_ ~~ Date: C;~ _/C- / t
A3-BUILT 3Y3TEM DETAILS/3ITE PLAN PerMi~ oseioie53
BURG LnT 97B PID~ 05i-i7a-55
LOT 97B
/ ~ II IEKISTIN 4-BR
-- - _ _~L HOUSE ; SCALE, l' = 50'
^-c=~,F' ~~ ' ~~ = : - ~ -:--
~B-E=68,5' ~ / IS~ c
~ ~-F=73,4' ~ ~ ~ 3H ~ _ L
~B-H=88,1' II II
~ II s~ R~c~
EagLe Rive~, AK 99577
I *~ "~ O0 ~ ~: 10-179 />e~ UL~O,
· AK. 99577
~~ FINAL GRADE
1250 GALx --;~ ~
SEPTIC ~ I~
~ ~X'l~ TRENCH 1
Performed for:
Project:
Depth
(Feet)
1-
2-
3-
4-
5-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20-
Robert Hoffman
.~,_.~.......
~.~* .." A-'"..y~
20441 Pt~ig~ B~vd., Eagle R~wr AK 99577 ~ ~~~.
Office (907) 696-6111, Fax (907) 868-3793
~ ~_ CE 71
SOILS PERCOLATION TEST
Date Performed:
Burg Lot 97B
TEST HOLE # TH 11-1
ORG/OL
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
SM/GM
B.O.H.
HOLE PRESOAKED
PRIOR TO TESTING
Was Ground water encountered? YES
Depth to water after monitoring? NA
What depth? 13'
Date? NA
Reading Date Gross Net Depth to Net
Time Time Water Drop
1 6/10/11 1:00 6"
2 1:30 30 min 2 15/16" 3 1/16"
3 * 1:31 6"
4 2:01 30min 2 15/16" 3 1/16"
5 * 2:02 - 6"
6 2:32 30 min 3" 3"
7
8
9
10
11
12
· Water Added
Percolation Rate 10 (rain/in) Pcrc Hole Diameter 6"
Test Run Between 6~ feet and 7 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State
and Municipal guidelines in effect on this date.
Permit Number:
Tax Code Number:
Work Type:
On-Site Wastewater Disposal System Permit
OSP101253
05117255000
Septic
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Upgrade
Permit Effective Dates: October 29, 2010 to October 29, 2011
Design Engineer: ARC TERRA CONSULTING INC
Subdivision: BURG
Site Legal Address:
Owner/Address:
BURG LT 97B G:1155
HOFFMAN ROBERT M & BARBARA R
PO BOX 770309 EAGLE RIVER AK 995770309
Site Mailing Address: 19939 ADRIAN AVE, Chugiak
Lot Size in Sq Ft: 50661
Total Bedrooms: 4
This permit is for the construction of:
Y Disposal Field Y Septic Tank 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.
Received
Issued By:
Date: /~'
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. muni. org/onsite
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
!~1~.~
Parcel I.D. 051-172-55
Property owner(s) ROBERT & BARBARA HOFFMAN
Mailing address PO BOX 770309, EAGLE RIVER, AK
Site address 19939 ADRIAN AVE, CHUGIAK, AK
Day phone
.Zip Code 99577
.Zip Code 99567
Legal description (Sub'd., Block & Lot) BURG LOT 97B
Legal description (Township, Range & Section)
Lot Size 50661 .Sq. Ft. Number of Bedrooms 4
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.
ARCTERRA
(Signature of property owner or authorized agent)
Permit/Rush Fees: $530.00
Date of Payment: / ~ -
Receipt Number: ~ z&'/.~" '
(Rev. 11/05)
Waiver Fees:
Date of Payment:
Receipt Number:
ARC~]~RP.A
CONSULTING, INC
20441 Ptarmigan Blvd., Eagle River, AK. 99577
Office (907) 868-3791, Fax (907) 868-3793
October 21, 2010
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
P.O. Box 196650
Anchorage, AK 99519-6650
Subject: Upgrade Sewer Permit - Burg Lot 97B
The owner has requested we proceed forward to obtain a septic permit to
upgrade the failed leachfield on the subject lot. The general slope of this lot is
fiat.
On October 14, 2010 a testhole was performed to investigate soils and
groundwater. The results of this test are attached for your review. The proposed
upgrade will serve the existing 4-bedroom house. We propose to install a 1250-
gallon septic tank with two 5'-wide shallow trenches. The existing septic tank
will be decommissioned per the UPC. Groundwater was not encountered during
excavation, but was measured at 13' during monitoring.
The property and adjacent lots are served by private water wells. There is no
surface water within 100' of the proposed system and there are no known curtain
drains within 50'. We do not expect there to be any adverse effect on adjacent lots
by the development of this system. If you have any questions, please contact me
at 868-3792/FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
Attachments: On-Site Sewer Application
Wastewater Absorption System Details/Site Plan
Soils Log/Percolation Test
Owner/Contractor Specs
20441 PTARMIGAN BLVD · EAGLE RIVER, AK 99577-8736 ° PH (907) 868-3791 · FAX (907) 868-3793
~ELL
FLAG PR[]PERTY LINES
PRIDR TD CBNSTRUCTI~ ZJl 0,''1'''' .4 ~e-~.. K
F~G / / S~ =100'
D N DETAILS PAGE 1 ~ P
/4 BDRM X 150 GPD= 600 GPD/ / /
tGO0 GPa/ 0.SGPD PER SO. FT. (~ MIN/IN/)= 750 SQ. FI/ ! \
~(750 SF / 5' W =' 150 FT X RFXO~SB (~' RACK) = 8~ TRENCH\
¥SE 2 TRENCHES - 4,q~' (L) X 5' (NV) X ~J])
l~tat depth oF s~tem is ~,5' Fr'om origin~ g~ Z ]
NO PUDLIC WELLS WITHIN E~O0' DF ToXCal. depth oF paver beL~)w disi;ribui;ion pipe is ~' ,
"5 PRIV*TE VELLS WITHIN L:~OO' DF N I~ ~~
pRnPaSED SYSTEM EXCEPT ^S NOTED. 1, INSTALL~L..~AL SEPTIC T.ANK & INSULATE TANK IF~CnVER,
NO SEPTIC SYSTEMS WITHIN 20~ DF
PRI]PI]SED WELL EXCEPT AS NOTED. 2. INSULATE TREN~ BURIAL '~3' DF FILL.
MIN. P' FILL WITH INSULATIDN, )3' CDVER ND INSUL REQ.
3. CDNTRACTDR WILL ENSURE MINIMUM 2× SLDPE INTD SEPTIC TANK,
4. CDNTRACTDR WILL ENSURE ALL SEPARATIDNS TD ADJACENT
WELLS, SEPTICS EASEMENTS, PRDPERTY LINES, ETC...
PREPARED FOR:
RDBERT ~& 3ARBARA HDFFMAN
P{] 3DX 770309
EaDLe Rivet-, AK 99577
907-G88-30GG
BEll) BOOKS
7116 '
m£cK~. KMD
SYAK~ STAKING'
~PO~sstO~D~ ~ JLS
WELL 8~ WASTEWATEiR iBISPBSAL SYSTEM DETAILS/SITE PLAN
BU~G LET 97B
FLAG PROPERTY LINES
WELL RADII & EASEMENTS
PRIOR TB CBNSTRUCTInN
NB PUBLIC WELLS WITHIN 800' DF
PROPOSED SYSTEM.
ND PRIVATE WELLS WITHIN aO0' DF
PROPOSED SYSTEM EXCEPT AS NOTED.
ND SEPTIC SYSTEMS WITHIN aO0' DF
PROPOSED WELL EXCEPT AS NOTED,
Sc(l[e:
DESIGN DETAILS PAGE 1
4 BDRM X 150 GPO = 600 GPO
600 GPO/ 0,SGPD PER SQ. FT. (8 MIN/IN.)= 750 SQ. FT
(750 SF / 5' W = 150 FT X RF 0,58 (3' ROCK) = 87' TRENCH
USE 8 TRENCHES - 44' (L) X 5' (W) X 3' (D)
Total depth oF system is 8,5' From original grade,
Total depth o~ gravel below distribution pipe is 3' .
NDTES:
1.
8.
1'= 100'
OF 2
INSTALL 1850 GAL SEPTIC TANK & INSULATE TANK IF <4' COVER.
INSULATE TRENCHES WITH 8' HD BURIAL FOAM IF < 3' OF FILL.
MIN. 8' FILL WITH INSULATION, >3' COVER NO INSUL REQ.
CONTRACTOR WILL ENSURE MINIMUM 8% SLOPE INTO SEPTIC TANK.
CONTRACTOR WILL ENSURE ALL SEPARATIONS TD ADJACENT
WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC..,
PREPARED FOR:
ROBERT & BARBARA HOFFMAN
PO BOX 770309
EcgLe River, AK 99577
907-688-3066
FIELD BOOKS co~pul~:
"OONDARY:. BOUNDARy
~i,m STAKING
m'~,~: BMW
C,ECKEm KMD
A..~ILT: JLS DATZ: 10/21/10
Dwc,. RLE: GRID: NWl 155
Ac,m nu~ FILE
~oe No.: 10--179
WASTEWATER DISPBSAL SYSTEM DETAILS
:BURG LFIT 97:B
89~7'~1" ~/ ¥ ~ ¥ ~68.~0'
FLAT
~1 O~ ~ FLAT
/ l~
~ INSTALL ~
~~ I PER UPC. ~ INSTALL NEW
50.7'
FLAG PROPERTY LINES
WELL RAI)II & EASEMENTS
PRIOR TB CONSTRUCTION
Scale: 1"= 30'
PAGE 2 DF 2
PREPARED FOR,
ROBERT & BARBARA HOFFMAN
PB BBX 770309
E6oLe River, AK 99577
907-688-3066
FIELD BOOKS COUPUTEm
OR^W: BMW
BOLIND.~. BOUNDARY
ST~N~ STAKING
~EC~: KMD
~-~LT: JLS D^~ 10/21/10
DW¢,. nLF_: ~D: NWl 155
FILE
No.: 10--179
99577
Performed for:
CONSULTING, INC
20441 Ptarmigan Blvd., Eagle River AK. 99577
Office (907) 696-6111, Fax (907) 868-3793
SOILS PERCOLATION TEST
Robert Hoffman
Date Performed: 10/14/2010
Project:
Depth
Burg Lot 97B
ORG/OL
TEST HOLE # TH 10-1
SEE ATTACHED SITE PLAN
FOR HOLE LOCATION
3-
4-
5-
7-
8-
9-
10-
11-
12-
13-
14-
15-
17-
18-
SM/GM
B.O.H.
Was Ground water encountered? NO
Depth to water after monitoring? 13'
What depth? NA
Date? 10/21/10
Reading Date Gross Net Depth to Net
Time Time Water Drop
1 10/15/10 1:00 - 6"
2 1:30 30 min 2 2/16" 3 14/16"
3 * 1:31 - 6"
4 2:01 30 min 2 3/16" 3 13/16"
5 * 2:02 - 6"
6 2:32 30 min 2 3/16" 3 13/16"
7
8
9
10
11
12
· Water Added
19-
20-
HOLE PRESOAKED
PRIOR TO TESTING
Percolation Rate 7.87
Test Run Between
(min/in) Perc Hole Diameter 6"
feet and 4 feet
I, Kenneth M. Duffus, certify that this test was performed in accordance with all State
and Municipal guidelines in effect on this date.
CONSULTING, INC
212 E. 51st Ave, Anchorage, AK. 99503
Office (907) 868-3791, Fax (907) 868-3793
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES AND MATERIAL SPECIFICATIONS
LEGAL DESCRIPTION: BURG LOT 97B
GENERAL:
1. The scope of this project includes the installation of a septic tank and/or
drainfield to serve a single-family residence on the referenced property as
delineated on the attached Municipality of Anchorage (MOA) permit and site
plan. Construction shall be in accordance with the approved site plan and
design drawings; MOA permit with any special provisions or conditions, and all
applicable State and Mtmicipal Wastewater Disposal Regulations.
2. ArcTerra Engineering & Surveying, Inc. (ArcTerra) assumes no responsibility of
the accuracy of the as-built survey provided by the owner or owner's
representative.
3. The owner or contractor is responsible to notify the engineer of any
discrepancies noted on the design plans or drawings prior to commencing work.
These discrepancies could be, but not limited to, possible encroachments, surface
water, varying soils, unplatted easements, types or use of dwellings on or
adjacent to property, nearby public wells, etc.
4. The contractor shall be responsible for locating any necessary underground
utilities, easements, property lines and surface water. The owner and/or
contractor shall ensure, if deemed appropriate, that a registered land surveyor
prior to construction flags all setbacks. The contractor shall be responsible for
verifying all pertinent separation distances and component layout.
5. Unless specifically agreed otherwise, the property owner shall be responsible for
final grading areas subsequently depressed from soil settling. On all leachfield
mound systems, the property owner shall be responsible for ensuring a
satisfactory vegetation growth over the mounded area.
6. The MOA Development Services Department On-Site Water & Wastewater
Program must certify contractors installing wastewater disposal systems.
Owners installing their own systems must also receive prior approval from said
MOA Department.
SEPTIC TANK/HOLDING TANK/LIFT STATION INSTALLATION:
1. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
2. The septic tank shall be sufficiently bedded with proper material and
compacting to prevent damaging, settling or shifting of the tank.
3. All standpipes on the septic tank shall extend a minimum of 12 inches above the
final grade.
BURG LOT 97B
October 21, 2010
Page 2 of 4
4. Septic tanks installed with less than 4 foot of cover shall be insulated. The
contractor will ensure that the fill over the tank does not exceed the burial depth
rating.
5. A foundation cleanout shall be installed one to four feet from the building
foundation. In the line between the tank and the leachfield there shall be two
adjacent cleanouts (unless an effluent pumping system exists within the septic
tank). These cleanouts shall be located on undisturbed soil not more than 10 feet
from the tank. The second cleanout, in line, shall be to clean toward the septic
tank.
6. Final grading over the septic tank shall be such that a positive slope exists away
from the septic tank.
7. All H.D.P.E. tanks shall have a vertical length of 4-inch perforated drainpipe
besides the tank extending to the bottom of the tank to above grade to monitor
ground water.
8. All tanks shall be anchored when there is not enough adequate soil cover to
resist buoyancy forces in high-groundwater areas.
9. All holding tanks and lift stations shall have an audible and visual alarm inside
the residence.
10. All lift stations shall be wired in compliance with the Uniform Electrical Code
and all MOA guidelines.
11. The contractor shall remove the old tank, or abandon it in compliance with the
Uniform Plumbing Code. The contractor is solely responsible for the
abandonment procedure.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the design. The
bottom of the excavation shall be within 2 inches of level. If the sidewalls of the
excavaction become smeared, they must be raked or scratched (roughed-up)
before gravel (sewer rock) placement.
2. Once the sewer rock is installed, the distribution pipe is installed level with the
perforations facing downward. Gravel is then to be placed over the distribution
pipe to provide a minimum of 2 inches of cover over the pipe.
3. A silt barrier must be installed between the final gravel layer and the native soil
backfill. Ensure the silt barrier covers the entire gravel surface before placing
backfill.
4. Monitoring tubes shall be four- (4) inch diameter, installed approximately in the
locations shown on the design, and extend a minimum of 12 inches above final
grade. The portion of the monitoring tube extending through the gravel shall be
perforated from the bottom of the trench to the invert of the distribution pipe.
This is equivalent to the effective depth of the gravel as noted on the design.
5. Backfill over the final gravel layer must not be less than twenty-four inches.
Insulation must be installed when the backfill depth is less than thirty-six (36)
inches. The finish grade over the trench must be mounded to prevent the
formation of a depression after settling.
6. All advanced technology waste water disposal systems (Advantex, Biocycle,
Intermittent Dosing Sand Filter, etc...) shall be constructed, installed, maintained
and monitored per manufacturer's specifications and MOA requirements.
20441 PTARMIGAN BLVD · EAGLE RIVER, AK 99577-8736 · PH (907) 868-3791 · FAX (907) 868-3793
BURG LOT 97B
October 21, 2010
Page 3 of 4
MINIMUM MATERIAL SPECIFICATIONS:
1. A MOA approved septic tank manufacturer must construct any septic tank
proposed for installation.
2. The following pipe materials are MOA approved for use in septic system
installations:
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
3. Insulation shall be at least 2' thick extruded direct burial polystyrene (Dow
Chemical Company Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder,
Fernco, or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be
installed between the final leachfield gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5'-2.5' screened gravel with less
than 3 % passing the #200 sieve. If deemed necessary, a sieve analysis should be
performed.
7. When sand is being used as a filter material its gradation specification must
conform to current MOA or ADEC requirements.
INSPECTIONS:
Typically there will be three (3) inspections required during the installation of the
wastewater disposal system. These inspections will occur as follows:
1. The first inspection must be conducted after the excavation of ditches, pits,
trenches, or beds and before the installation of any gravel. A septic tank may be
set in place, but may not be backfilled before this inspection.
2. The second inspection must be conducted after the placement of the sewer rock,
distribution lines, standpipes, and cleanouts, but before the placement of the silt
barrier, insulation, or any other backfill.
3.The final inspection is to occur upon final grading of the property.
Often there will be more than these 3 inspections required, especially with the
installation of multiple trenches, sand filters, pressurized distribution systems, etc. The
inspecting engineer is to be contacted at least 24 hours prior to the start of construction.
If necessary, a pre-construction meeting will take place on-site. The inspecting engineer
will not coordinate, direct or control in any way the contractor's activities.
The owner shall contract with the contractor to perform the work outlined in these
specifications and attached plans and in accordance with the attached MOA permit. All
materials, components, and construction practices shah comply with the MOA's and the
State of Alaska's latest ordinances, regulations, or policies regarding wells and septic
systems. The failure of the inspecting engineer to notice a material or construction non-
compliance does not relieve the contractor of his/her responsibility to correct such
deficiency. There will be no contractual arrangement existing between the contractor
20441 PTARMIGAN BLVD · EAGLE RIVER, AK 99577-8736 · PH (907) 868-3791 · FAX (907) 868-3793
BURG LOT 97B
October 21, 2010
Page 4 of 4
and ArcTerra. ArcTerra shall be the owner's representative and will inspect the work as
stated above to document the contractor's activities. Final acceptance of the contractor's
work rests with the owner and the MOA.
ArcTerra shall have no liability to the owner or to others for acts or omissions of the
contractor or any other persons performing work on this project or the failure of the
contractor to carry out the work in accordance with these construction documents.
ArcTerra's inspecting engineer will not be responsible for the construction means,
methods, and techniques, sequence, procedures or the safety precautions incident to this
project.
BY PROCEEDING FORWARD WITH THE INSTALLATION OF THE WATER
AND/OR WASTEWATER SYSTEM (S), THE PROPERTY OWNER, CONTRACTOR,
AND WELL DRILLER ACKNOWLEDGE HAVING READ AND ACCEPTED THESE
SPECIFICATIONS.
20441 PTARMIGAN BLVD · EAGLE RIVER, AK 99577-8736 · PH (907) 868-3791 ° FAX (907) 868-3793
o~ MUNICIPALITY OF ANCHORAGE O~EC
,o DEPART~ ~NT OF HEALTH & ENVIRONMENTAL PR TION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME IPHONE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION/~ '~ ~ /~Dwelling F~" PERMITNO' OF BEDROOMS ~NO,
DISTANCE TO: ~ ,,-,
~ Z Manufacturer Material No. of compartments
Liq. capacity~allons Inside leneth ~ Width
Liquid
dept~
~ ~ Material Liquid capacity in gallons
~-' DISTANCE TO: Well ~/~ Foundation ~ ~ ~/ Nearestlotlin~+ ~.~/ PERMITNO.
~ Top of tile to finish ~rade Material beneath tile
~ Total effective absomt~ area
Length 'Width Depth PERMIT NO,
~ ~ Type of crib Crib diameter /~ Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ ~' L Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
PIPE MATERIALS OTHER
SOl L TEST RATING
INSTALLER
REMARKS
3 (Rev.
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological ~ Geophysical Surveys
Drilling Permit No.
LOCATION OF WELL (Please complete either ID, lb or lc.) A.D.L. No.
I'~. I Borough Subdivision Lot Block I-'~.I I/4 qt rs. Section No. Township N r-1 Range Er-1 Meridian
_of_o,_of_
lc. DISTANCE AND DIRECT ON
2. WELL LO~ Feet Below
Surfece 4. WEL~ DEPTH: {finel) 5. DATE OF CO~PLETI~
Material Type Top Bottom /~0 ft.
8. CASING: ~ T~eeded ~'Welded
diom. in. lo__ft. Depth Sticku~ft.
9. FINISH OF WELL:
Ty~e: Dlemetet:
?
Slot/Mesh Size: Length:
Set between ft. end ft.
Backfilling ~revel peck
IO. STATIC WATER LEVEL:
~ Above or ~ Below Iond surfoce Dole
Equipment used: -.
MUNICIPAL/~ II. PUMPING LEVEL below land surface and YIELD
DEP[ ~ ANC~o ~~ ft. after hrs. pumping g.p.m.
ENvIg~.~,,;..O~ ~,. ~ ~
-'wvl~/~RL' P~OTE~r~"'~ ~ ~. ~ft' after ~hrs' pumping~g.p.m.
-"~1~ 12.GROUTING Well Grouted:
SEP ~ ,~
~ ~ Material: ~Nea, Cement 0 Other:
Length ~ Drop Pipe capacity g.p.m.
. ~ s,~-7~~ ~ C,n,r.,,.~ ~ O,he.
14, REMARKS:
16, WATER WE~L CONTRACTOR'S CERTIFICATION:
15. Woter Temperature ~.o ~ F ~ C
This~l ~es dr~led under ~y jurisdictipn end this report is true to the best of my knowledge ~nd belief;
Registered Busine~eme . Controct License Number
/' Authorized Representative ~
Form OZ-WWR (11/81) Copy Distribution: WHITE-State DGGS~ PINK-Driller, CANARY-Customer
MUNICIPALITY OF ANCHORAGE
Departmen~f Health and Environment~
825~ Street, Anchorage, AK.
264-4720
f ~ * * * HANDWRITTEN PERMIT * * *
Permit ~. ~ ~.~ WELL AND/OR ON-SITE SEWER PERMIT
Appli~: C~*& C~¢' Mailing Address:
Loc at '~n/~¢ --~/~--~ ~ / ~ / ~ Phone Number:
Legal Description:
Type of Soil Absorption System Is:
Trench: Drainfield: ~
Maximum Number of Bedrooms: ~
iProtection ~ ' ~
'
Lot Size:
Seepage Bed: Holding Tank:
Soil Rating(sq.ft/br)
The; Required Size of the Soil Absorption System Is:
DEPTH S LENGTH _ GRAVEL DEPTH
/
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(J~ TANK .SIZE = ~5~ GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance.between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 1 9 8 3 * * *
Z certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site
the residence1 is remodeled to
Signe~: ~L ~ ~.L))/.~..~i~])
Applicant
SWP/024(1/81)
sewer system may re,~uire enlargement if
include more t.~~~ed~
Issued by: t -
Date: -- -- ~
· ~'inl ciI vv/7~/- l'J ORAGED~II[TUNI /A~T~i~A~cH
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] SOILS LOG
PERCOLATION
TEST
DATE PERFORMED.~ ~ "'~ ~)
/ z,c.,)
4
7
8
9
10--
11
SLOPE
SITE PLAN
12
13
14
15
16
ENCOUNTERED? SL
O
P
IF YES, AT WHAT /O / E
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
20
PERCOLATION RATE (minutes/inch)
72-OO8 (6/79)
, ~ ~II~MUNICIPALITY Of ANCHORAG~
-~ 4' Departmen~ Health and Environment~rotection
~ .~ 825~ Street, Anchorage, AK. ~950]~,~~ _ ~
_~. ~p¢ 264-4720
- * * * HANDWRITTEN PERMIT * * *
Permit~ WELL~,1~, ~~'~'%/aRUl\uit ....Q~IT£ ~=,,-~°~'":~ PERMIT
Applicant: ~ ~ Mailing Address:
Location: Phone Number:
Legal Description: ~'~/~_~,~{~.j ._..~/~~"'~--',~ Lot Size:
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage ~ed/ _ Holding Tank:
Maximum NtLmber of Bedrooms: .__~_ y ~~ting(sq.ft/br)
The Required Size~'o~/the~'Sc~il/Absorption System
DEPTH LENGTH
GRAVEL DEPTH
Is:
WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a com~nunity sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may r~quire enlargemen~ if
the ~residence is remodeled to include more~ ~ooms
Applicant ' C'" ~_- '~' "~
Date: ~/~/~
SWP/024 (1/81)
APPLI NT FILLS OUT UPPER HA .T ONLY
Property (~wner ~'~> ~'" ':L (.:_' ', ' i ' ~ ,r~ ~.. ~ 4. ~ ._,. , ,~_~. ,,, Phone
:'"~ ' Zip Code '/"'/
Mailing:Address ~ ~ ~' ':~. ~'". , ...... ". ~ ,': .... '/"','.;: /'""/.? /'~L ;"
Buyer . ' , /.,/ /.'.':'~ ,/~'%.' .~',L. '"' ' ' -' '
Address .. ."~ . - -.~ ~ ..- '~ .--::(".~,,'-/ 1:- /,,./- ,- .:- /.-': I ) .... Zip Code './~ ''~
' -~ Phone
'" ""' ' :'" -- . '. '-' . ,- : . ~ , . ,--, .~ ,,~: ,'--.: ./' /,2,::- , "/:-//.,'// / .'
Address Zip Code
Realty Co."& Agent ,~, ,/.;,' ? ,:" Phone
Address Zip Code
Legal Description '<;;,"' ",~:' '¥': ...... "' '-" '' '-:'-' '.,~::. ~_-~'C~ /~6 ~/~/
Street Location ,>';,'/' .,.:~_/:-/..':/'/ :/' . . '., ,.. ......
Type o~ Residence
L~/Single Family
No. of Bedrooms ";1
[] Multiple Family
[] Other
Water Supply
[~'l~di~vidual ~ ~ ATTACH WELL LOG. A wetl log is required for all wells drilled since June 1975.
[] C~mmunity/ For wells drilled prior to that date, give well depth (attach log if available).
[] Public Utility'
Sewer Disposal
E~.r~lividual Year Individual Installed: .... ~
F~ Pu'blic Utility When Connected to Public Utility:
[] "Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time ' - "- ''~ '~ ~' Time ~ /'
Date Date D .
Insp~tor Insp~tor Insp~tor~~~ . Insp~t~
_.:~ ~" ~ ~~ ~.~, , "Municipa!itY,,D~t. of OrCHid:th ........
( ~ APPROVED BEDROOMS . 'CONDiTiONS OF ~entaJ
( ) D~SAPPROVED
( ) CONDITIONAL APPROVAL*
DATE ~
BY: ~
Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received
Well to Tank Septic T~k Size
72-023 (3/82)
Municipality of Anchorage
Development Services Department
Building SafetyDivision
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. munt.org/onSite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR ASINGLE FAMILY DWELLING
Pamel I.D. 051_.-1_72-55
GENERAL INFORMATION
Complete legal description BURG LOT 97B
Location (site address) . 19930 ADRIAN AVE, CI-]UGIAK,...AK.99567
COSA#
Expiration Date:
Current Property owner(s) ROBERT &.BARBARA HOGAN
Mailing address
Lending agency
Mailing address
Day phone
PO l~3X 77030~..EAGLE ~R, AK 99567
.. . Day phone
m
e
Real Estate Agent
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual Well
Individual water Storage
Community Class
Public Water System
.4
Day phone
Well
D
D
D
TYPE OF WASTEWATER DISPOSAL:
Individual On-site I~
Individual Holding Tank I-']
Community On-site r'-I
Public SeWer E]
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 sewed 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 sewed 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 20~1 ]~rARMIGAN BLVD., EAGLE RiWv'ER, AK 99577
Engineer's Printed Name KENNETIt M. DUFFUS Date 09112/2011
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 wetl 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,
AmTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
DSD SIGNATURE
~ Approved for . Z7L
Disapproved.
Conditional approval for
bedrooms.
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
bedrooms, with the following stipulations:
E~: WA'fEE AND
Arsenic Adviso~
Maintenance Agreements
Supplemental Engineers Repo~
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. munLorg/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: BURG LOT 97~
A. WELL DATA
Pamel ID:.,051_-1_72-55
Date of test
Static water level
Well production 3-5
WATER SAMPLE RESULTS:
Coliform ..bLF,,_G__colonles/100m L
Well type ~ If A, B, or C provide PWSID # ,,
Date completed ~ Sanitary seal (Y/N)
Total depth 350. ft. Cased to 82
FROM WELL LOG
42
~ g.p.m.
Well LOg (Y/N) Y
Wires properly protected (Y/N) y
Casing height (above ground) __lg..Lin.
AT INSPECTION
_ 8/30111
31 ff.
.., 2.2$ g.p.m.
Depression over field N
Results (Pass/Fail). For...._ bedrooms
Water added, gal, New depth_ _in.
g.p.d.
Nitrate _ND mg/L
Arsenic: 13.1 mgd Date of sample:,~a.~LCollected
B. SEPTICJHOLDING TANK DATA
Tank Type/Material Se?k/Steel Date installed ~ Tank size ~ gal.
Number of Compartments 2 Cleanouts (Y/N) y Foundation cleanout (Y/N) y Depression over tank (Y/N) .bi
High wateralarm (Y/N) N Date*of pumping NA-NEWTANK Pumper
C. ABSORPTION FIELD DATA ·
Date installed ~19JZIZIL Soil rating (g.p.d./ft~ or ~/bdrm) 0.8 System type_SHALLOW TRENCH
Length 134 ft. Width ~ ff. Gravel below pipe 1.1 ft, Total depth 6 ff.
Elf. absorption area Z.O/..ff2 Monitoring tube_Y
Date of adequacy test NA-NEW FIELD
Fluid depth in absorption field before test __ In.
Elapsed Time: min. Final fluid depth in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) bT. If yes, give date.-
UFT STATION
Date installed
'Pump on' level at __in.
Datum,
Size in gallons
'Pump off' level at __in.
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot.
Absorption field on lot, 100'+ .,
Public sewer main,,,?5'+ ,
Sewer/septic service line 25'+
Animal containment areas 50%
Manhole/Access (Y/N)
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots lO0'+
On adjacent lots lO0'+
Public sewer manhole/cleanout 100%
Holding tank ,,,,10o'+,
Manure/animal excrete storage areas
lOO%
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation $'+ Propertyline 5%
Water main to'+ , Water service line 10% ,
Wells on adjacent lots 't00'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundatiqn 10'+
Water Service line lO'+ Surface water 100'+
Curtain drain Sly+ (None Kno~m)
COMMENTS
Absorption field S'+
Surface water, ,,lO0'+
Water main lO%
Driveway, parking/vehicle storage ,, 10'+
Wells on adjacent lots 100'+
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
·
Engineer's Pdnted Name KENNETH M, D~$
Date 9/12/2011
COSA Fee $250.00
Date of Payment
Receipt Number
(Rev, 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Community Development Department
Development Services Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Arsenic Advisory
Certificate of On-Site Systems Approval # 111344
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
97B of Burg Subdivision. This inspection revealed an arsenic concentration
of 11.1 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.
SGS Reft# 1114163001
Client Name ArcTerra Engineering and Surveying Printed Date/Time 09/08/2011 9:48
Project Name/# Burg Lot 97B Collected Date/Time 08/30/2011 13:30
Client Sample 1D Burg Lot 97B Received Date/Time 08/30/2011 14:10
Matrix Drinking Water Technical Director Stephen C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic 11.1 * 5.00 ug/L EP200.8 C (<10) 09/02/11 09/06/11 NRB
Waters Department
Total Nitrate/Nitrite~N ND 0.100 mg/L SM20 4500NO3-F B (<10) 09/02/11 AYC
Microbiology Laboratory
E. Coli Negative 1 100mL SM20 9223B A 08/30/11 DLC
Total Coliform Negative 1 100mL SM20 9223B A 08/30/11 DLC
97B
"' '.' ', v ¥ N.,,89~57'~1" ~W x :,( x 1,,68.,9,0' x
,,~ ........ .. ,. '.4 X X 'X
· ·
·
VENTS '1.
('r'~) '~ ,,<,
LOT 97B '
.'
/
I // I. EXlSTiNC .... .i
.0 C^NI
O/H
WELL
O/H
15' T&E EASEMENT--
LINE EASEMENT
LOT
--O/H O/H
5' REMA
S89°57'52"E 168.90'
LLI
ADRIAN
AVENUE
ANCHORAGE RECORDING DISTRICT
ASBUILT OF:
BURG SUBDIVISION
LOT 97B PLAT 82-466
SURVEY CERTIFICATION: I, John L. Schuller, have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated thereon are within the property lines and no
enchroachments exist other that noted.
EXCLUSION NOTES: It is the owners responsibility to determine the
existence of any easements, covenants, or restrictions which do not
appear on the recorded subdivision plat. Under no circumstance should
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
WORK ORDER NUMBER:
1 1 -- 025
IDATE: I SCALE:
JUNE 15, 2011 I 1"=30'
ICHECKED BY~ GRID NUMBER:
IDRAWN BY:
IE-MAIL:
BOOK/PAGE:
110125
I
e= FND BRASS CAP MONUMENT
~) = FND 5/8" REBAR
1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274-4992 fax