HomeMy WebLinkAboutDRAKE BLK 2 LT 5DOnsite File
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I Municipality of Anchorage OCT 0
Community Development Department 92018 Page 1 of 3
On-Site Water&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: OSP181252 PID Number. 017461-14
0 New •Upgrade
Name:
MONTE BUDAHL LIVING TRUST ABSORPTION FIELD
Address: ® Deep Trench 0 Shallow Trench 0 Bed 0 Mound
3341 MERGANSER AVE*ANCHORAGE,AK 99516 0 Other
Phone: No.of Bedrooms: soil Rating. Total Depth front original grade:
(907) 345-9915 3 0.8
GPasv.FL 9.5 MAX Ft.
Depth to pipe invert from original grade: Gravel depth beneath pipe:
LEGAL DESCRIPTION
SEE DWG. FL 6.0 Ft.
Subdivision: Block: Lot: Fil added above original grade: Gravel length:
DRAKE 2 5D SEE DWG. Ft 50
Ft.
I ownshlp: - Range: - Section: - Gravelwidth: Beds Number of lines: Distance between lines:
2.5 - -
Ft. Ft.
SEPARATION DISTANCES Total absorption area ,Iumber of trenches: Dist.between trenches:
To Septic Absorption Lift Holding Public/Pnvate 600 1 -
From Tank Field Station Tank Sewer Lines SQ.FL FL
/
Well 100'+ 100'+ - - 25'+ TANK • Septic 0 S.T.E.P. ❑Holding 0 Other
Manufacturer: Capacity
Surface Water 100'+ 100'+ - ANCHORAGE TANK 1500
Gal.
Material: Number of compartments:
Lot Line 5'+ *3'+ - N/A
STEEL 2
Foundation 10'+ 10'+ _ -
LIFT STATION •SECOND COMPARTMENT OF STEP TANK
Curtain Drain _ NONE KNOWN - Manufacturer. Capacity:
ANCHORAGE TANK 1 *500 Gal.
Remarks:PER CONTRACTOR THE OLD TANK WAS DECOMMISSIONED PER UPC. 'Pump on"level at Pump off'level at High water alarm at
BOTTOM OF EXCAVATION OF TRENCH WAS INSPECTED BY MOA ONSITE 44 40 I 46
EMPLOYEE TIM ECKLUND ON 9/6/2018*OSV181057;DRAINFIELD INSULATED Pump Make 8 Model: Electrical Inspections performed by
*500 MOA
4'WIDE 4"THICK UNDER DRIVEWAY PER CONTRACTOR.
PIPE MATERIAL
House to tank EXISTING/D3034 Tank to D1785
drainfield
Installer
WILCO EXCAVATION Drainfield D3034 CO/MT D3034
Inspector GEG, Ltd. BENCH MARK (Assumed elevation)
Inspection
100.00 Ft.
Dates: 1st 9/6/2018 2nd 9/6/2018 Location and Description:
3rd 9/7/2018 4th 9/7/2018 BOTTOM OF TRIM AT SE CORNER OF HOUSE
ENGINEER'S SEAL
Community Development Department Approval „,,.oQoo 0
Conditional approval: Date: os.�A0o
• D
v
fil
%4 Dry E— • e�O
— - ticPO
Approved: `' Date: 2-�-1� ��4•zap ���k3•1 I c:N -�oG
6 6r n LICENSE 0 �ofessi000'
l� #AECC884 O�OODO�
Inspection Report_1-1-12.doc
PL•r2MIT NUMBER: PARCEL ID NUMBER:
OSP181252 RECORD DRAWING 017-461-14
I
1
ST1 37.2 26.3 23.4 / ......_
/ \ 1
ST2 42.0 34.5 31.2 / \
N.
MH 43.6 36.7 33.2 DRAKE,BLOCK 2,LOT 5A \
—
MT1 51.2 37.9 32.7 N 1 N
MT2 74.7 43.0 35.1 VACANT
CO1 52.5 40.8 35.7 \ \\ 1 SCALE:
CO2 76.9 44.9 37.4 \ \ 1
\ 1"=40'
7 / \ N DRAKE;BLOCK 2,LOT 5D \
\ \ \
/ \ \ \ 1
\
\ I — 10'UTILITY EASEMENT`I 1 I
DRAI4E;BLOCK 2,LOT 5C I 1 I
I_
Fl
(� 1 NEW STEP TANK IS
\ APPROXIMATELY 0 FEET FROM L I
I 1 \ EDGE OF GRAVEL DRIVEWAY. 1 I`
S
I — I / I J
I I
\ \J5
l'i' < 4q0(/ \\ op�0) / �� GARAGE •w'= / Z
/ (.. � 1 _
Tt
EXISTING FCO 0
\\\ IIIIIIII� . /�/
/� \ I_ ^ _ '
1 -7L-/_- I A
--
/ EXISTING
/ HOME EXISTING SEWER LINE
/ I- / •
\N. / __� I EXISTING1DRAINFIELD
- --`\ // , DECK I''-- Cs•:
�� - — y' I
C;PTIC
CO I
. . 01 I
•L.
NEW 1500 GALLON STEP TANK;
10'MAX BURIAL DEPTH
NEW DRAINFIELD;INSULATED 4'WIDE UNDER 1
DRIVEWAY WITH 4"OF HIGH DENSITY INSULATION I
MERGANSER AVE. I
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GARNESS ENGINEERING GROUP, Ltd ,i i`:`• • _ •�':'��.
'
GENGINEERING.SALES CONSULTING •
3701 E TUDOR ROAD.SUITE 101•ANCHORAGE.AK 99507•PHONE(907)3376179•FAX(907)338-3246•WEBSITE www.gamessenpneenng corn •
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: -fire ..Ga •me.s '4�i iii
0'
MONTE BUDAHL LIVING TRUST 907-345-9115 2 OF 3 • c
LEGAL DESCRIPTION: •. a QCt -71'9 �"
DRAWN BY: . O.•• l�l•D l �!` 1
DRAKE; BLOCK 2, LOT 5D D.J.G. • � � P•�� (`� •
TYPE OF WORK: DATE:
LICENSE.* 1111111111%1110'.'
t ESS,"".4
SEPTIC SYSTEM SITE PLAN RECORD DRAWINGS 9/18/2018 #AECC884 ��1111%' ' ' ' j
PERMIT NUMBER: PARCEL ID NUMBER:
OSP181252 RECORD DRAWING 017-461-14
•
FINAL GRADE=99.37-99.47
TOP OF TANK ST1 ST2 NH
AT INLET=92.12 _ ' TOP OF TANK
AT OUTLET=92.16
\,..........._
/1
NEW 1500 GALLON
INVERT OF BUNG S.T.E.P. TANK RATED FOR 10'
AT INLET=91.50 BURIAL DEPTH
PER CONTRACTOR
TOP OF TANK,BOTTOM OF TRENCH AND TOP OF
DRAINFIELD INSPECTED BY MOA ONSITE EMPLOYEE TIM
ECKLUND WITH THE MOA ONSITE DEPARTMENT
MT CO FINAL GRADE=98.48-98.70
ORIGINAL GRADE @ HIGHEST POINT=99.52 INSULATION(4'WIDE,4"THICK UNDER DRIVEWAY)
FILTER FABRIC
. ",!. I
44.1.P.. .....:.:,:,-
.::0"
SEE DESIGN NARRATIVE N,, ti �
REGARDING SEPARATION N, ice•.
DISTANCE TO GROUNDWATER N. - INVERT OF PIPE=96.02
6.0 FEET ,fti.
NI 1
.i N i.
i1.
'` BOTTOM OF TRENCH=90.02
............40401.1.1 • .. ............. .... :c\4.4.
GARNESS ENGINEERING GROUP, Ltd (fl£ENGINEERING •SALFS .CONSLLLTING 4
3701 E TUDOR ROAD.SUITE 101•ANCHORAGE.AK 99507•PHONE(907)0074.79•FAX(907)006-3216•WEBSITE:www.ga,msssentreenAg.Com 03� • + ••,� •r ee
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0'k Jerey ..Game ..:�W
MONTE BUDAHL LIVING TRUST 907-345-9115 3 OF 3 0 0" ! : �"
1t% EC 779 r
LEGAL DESCRIPTION: DRAWN BY:
DRAKE; BLOCK 2, LOT 5D D.J.G. /
TYPE OF WORK: DATE: LICENSE* p"OFESS l ,4•
SEPTIC TANK AND TRENCH PROFILE 10/15/2018 #AECC684 ,ki••aus*. I
YlMOOFENCE EAS' ICC.06
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SHANE A.HOLT `�
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MERGANSER AVENUE Ya�1�040'` "`g
ii / AS BUILT SURVEY 1"=20'
' `f' 0 NO CORNERS SET THIS DATE
./M
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
THE INEOUNTIOE HEREON IS FOR THE USE OF LEECING INSTITUTIONS SPECIFICALLY TO ACM ANY 15
STRUCTURES ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
O•FLICTS EETMEEN EEISTING ND PLATTED LOT LINES MD/OR EASEMENTS;ME
WY TO se USED FON NOSTITONIAG AromORF sTWCTURES. TEMWEEMENIS,OR FENCELINES. VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
EASERF+TS O RECORD,OTMA THIN THOSE APPEARING CM THE RECORD PLAT,ME NOT SHHIMN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
IEE (UNLESS OIUTEO) EXIST OTHER THAN NOTED.
NOTE:
INFERCELINES NMT MAY MPEMR ON MIS DMMINO ME NOT TO IF USED 10 DETEp91F
PWPPRTT LINES OR POSITION AD)ITIOAL INYROVEMENTS. DATED AT ANCHORAGE,ALASKA THIS I Iv DAY OF
ANY PAWNS 9O4.HEREON NMT RE APPROREPMTE OM TO RECESSIVE SRN ANO/0R ICE. Gr IP,,, , 2019
HOLT LAND SURVEYING
9309 GROVER DRIVE
ANCHORAGEAK 99607
11910,E•1E9-42.194-77 907-346.6610
i
,N,C,PAL/r►Oo MUNICIPALITY OF ANCHORAGE Oen('
On-Site Water&Wastewater Program 1� �;
'/� � �� PO Box 196650 4700 Elmore Road � �;
111
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
'—‘111911141)(1).11 IllIcl:
`` �* httpa/www.muni.org/onsite
ANCHOR P'E
On-Site Wastewater Disposal System Permit
Permit Number: OSP181252 Effective Date: 8/10/2018
Work Type: Septic Upgrade Expiration Date: 8/10/2019
Tax Code Number: 01746114000
Site Legal Address: DRAKE BLK 2 LT 5D G:2834
Site Mailing Address: 3341 MERGANSER AVE, Anchorage
Owner: BUDAHL MONTE G LIVING TRUST Lot Size in Sq Ft: 17822
Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3
This permit is for the construction of:
0 Disposal Field Cl Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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
i
Received By: %� ✓-) Date: 2 / ID / I8
Issued By: CS:MA Date: VI b 1 F'
Municipality of Anchorage 4?�
in•,,:.r rrrr•,r
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 0 Fax (907) 343-7997 •
http://www.muni.orq/Onsite
Development Services Department
On-Site Water and Wastewater Section
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV181057 COSA#: Permit#: OSP181252 •
PID#: 017-461-14
Legal Description: Drake Block 2 Lot 5D
Engineer: Garness Engineering Group
Applicant: Monte &Tamara Budahl
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 3.0 feet.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
Waiver is Granted: X Waiver is not Granted:
Date: ?/9 l 8 Approved by: RJi .íc \�
/ Name of Reviewer
**** VARIAN C E/WAIVER REVIEW ****
X5 7 8 9 10
ti MINit
r,
MUNICIPALITY OF ANCHORA
aUG072018
Community Development Department \ - Phone: • ' •e
Development Services Fax: 907- ' ' :'7
On-Site Water & Wastewater Program
Mayor Dan Sullivan
On-Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. 017-461-14
Property owner(s) MONTE &TAMARA BUDAHL Day phone 907-345-9115
Mailing address 3341 MERGANSER AVENUE`ANCHORAGE,AK 99516
Site address 3341 MERGANSER AVENUE *ANCHORAGE.AK 99516
Legal description (Sub'd, Block& Lot) DRAKE: BLOCK 2, LOT 5D
Legal description (Township. Section & Range)
Lot Size Sq.Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING:
(Zan that apply) Initial ❑ Single Family (SF)
Absorption Field ® (w/wo ADU)
Septic Tank ® Upgrade Duplex (D) ❑
Renewal ❑
Holding Tank ❑ Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE!WAIVER REQUEST FOR:
DRAINFIELD TO LOT LINEDistance: 3 FEET
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 6(4 Waiver Fees: 2/5
Date of Payment: 2 /21 i' Date of Payment: 812111
Receipt Number: 66 85- Receipt Number: Ci6 Y516
Q '
Permit No.
d aP �Q� ' Waiver No. OS V 101 d 5
(Rev.01/11)
gcs
GARNESS ENGINEERING GROUP, Ltd Adv‘inced re,t
ENGINEERING SALES CONSULTING Dealer
August 3, 2018
Municipality of Anchorage
Development Service Department
On-Site Water &Wastewater Program
4700 Elmore Road
Anchorage. AK 99507
Ref: Proposed Septic System Upgrade for Drake; Block 2, Lot 5D
To whom it may concern:
The existing 3-bedroom house is served by a private well and septic system. The drainfield is in a state of
failure and needs to be upgraded. We are proposing to install a new 1500-gallon STEP tank, and deep
trench type drainfield. We are proposing to utilize the existing testhole information from 1991 by Ted
Moore, P.E. Comments regarding the design are summarized as follows:
1. SOILS: See attached 1991 Testhole #2 in MOA records performed by Ted Moore, PE which shows
the soil classification, percolation test and groundwater monitoring data. As can be seen on the site plan,
the proposed drainfield location is outside the 30-foot radius for both testholes. The drainfield is located
between Testhole #1 and Testhole #2 and we are proposing an application rating that is the more
conservative of the two. In short, we feel it is reasonable to assume that the soil profile will be consistent
throughout the drainfield.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE WATERS: There are no surface water concerns.
4. TOPOGRAPHY: The topography adjacent to the proposed trench are flat. See attached 40 scale
drawing and the MOA ARC Gis mapping.
5. WAIVER: The proposed drainfield is approximately 5 feet from the lot line. We are requesting that your
department issue a variance from the required separation distance of 10 feet from lot line to drainfield
down to 3 feet. The proposed drainfield will not be encroaching on an adjacent septic system.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems.
If you have any ques ons, please contact us at 337-6179. Thank you for your assistance.
sincere ,
I '
Jeffrey •. r :ss, P. ., M.S.
Presid=
3701 East Tudor Road. Suite 101 *Anchorage.Alaska 99507-1259
Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com
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ROBERT BORN; I
LOT 3B
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DRAKE;BLOCK
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/ DRAKE LOCK l�RAKfDBh a DI• DT 50 11% I F-
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/ 4 1 \ I I w CLASS"A"WELL THAT
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RADIUS 1 � j I w DOES NOT ENCHROACH
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GARNESS ENGINEERING GROUP, Ltd *'• '' ' •
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FNGINFFRINC'SAI FS G CONSUI TING
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3701 E.TUDOR ROAD,SUITE 101•ANCHORAGE.AK 99507•PHONE(907)337-6179'FAX(907)338.3246'WEBSITE:www.gBmessengineering.com - •• ,
PREPARED FOR: PHONE NUMBER: 'PAGE NUMBER: ♦(� 3 i'' A. Ga ess •.•W=
MONTE&TAMARA BUDAHL 907-345-9115 1 OF 2 O j.,,, C • , c•41^ I.
PROJECT/LEGAL DESCRIPTION: DRAWN BY: I, . •Ca 6 `�••••�,` •
Mir .
DRAKE; BLOCK 2, LOT 5D D.J.G. ..FD•'.p•�'��OFF - '''
TYPE OF WORK: DATE: LICENSE ,4.1 E�` 4•
SEPTIC SYSTEM DESIGN UPGRADE 8/6/2018 #AECC884 �����
•
DESIGN CRITERIA: GEG.Ltd.HAS A 8 PAGE SPECIFICATION )iii...... NOTE:THE CONTRACTOR SHALL HAVE THE SOUTH
NUMBER OF BEDROOMS:3 LETTER THAT PERTAINS TO THIS DESIGN.TO S — AND EAST LOT LINE,ALL PERTINENT WELL RADII AND
GALLONS PER DAY(GPD):450 GPD OBTAIN A COPY OF THE LETTER CONTACT %I' SURFACE WATER SETBACKS FLAGGED BY A
GEG.BY PROCEEDING FORWARD WITH THIS REGISTERED LAND SURVEYOR PRIOR TO
PERCOLATION RATE/S:'2.1 8'7 MIN/INCHINSTALLATION,THE ENGINEER,WELL DRILLER, CONSTRUCTION
PROPOSED APPLICATION RATE:0.8 GPD/BEDROOM CONTRACTOR AND PROPERTY OWNER AGREE . I I
MINIMUM DRAINFIELD SQ.FT.:562.5 FT' THAT THEY HAVE READ THESE
'PER TH BY TED MOORE,PE IN MOA RECORDS SPECIFICATIONS AND AGREE TO ACCEPT THE GARAGE HAS WATER,BUT DOES NOT HAVE
DRAINFIELD DESIGN: Il TERMS AND CONDITIONS OUTLINED. SEWER PER CONVERSATIONS WITH OWNER
MAXIMUM DEPTH:9.5 FEET (TAMARA BUDAHL)ONSITE ON 8/1/208
WIDTH:2.5 FEET
LENGTH:50 FEET DRAKE;BLOCK 2,LOT 5A \
EFFECTIVE:6 FEET VACANT \
ACTUAL SQ.FT:600 FTS \\
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DRAKE;BLOCK 2,LOT 5C \ \ 1 I
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/ T 4.- _ �- �/ SEPTIC T NK;INSTALL DOUBLE
/ i___ - -J CLEANOUT BEFORE SEPTIC
APPROXIMATE LOCATION OF / EXISTING
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T.H.#2 BY TED MOORE,P.E. APPROXIMATE LOCATION OF T.H.#1 PER
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' •-•INFIELD PER PIPE LOCATIONS ON AS-BUILT
L. SURVEY AND MOA RECORDS;EXISTING
PROPOSED DRAINFIELD;DRAINFIELD TO BE C� DRAINFIELD IS TO REMAIN IN PLACE OR FUtURE
INULATED 4'WIDE 4"THICK UNDER DRIVEWAY USE THROUGH ON/OFF BALL VALVNSIDE THE
SCALE: LIFT STATION
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1"=40' MERGANSER AVE. EXISTING SEPTIC TANK TO BE DECO MISSIONED PER PC
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3701 E.TUDOR ROAD,SUITE 101•ANCHORAGE,AK 99507'PHONE(907)337-6179'FAX(907)338-3246'WEBSITE:www.ganeosengieering.com •••• ,••••
'PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 fn% ' ' - ess W
DRAKE; BLOCK 2, LOT 5D 907-345-9115 2 OF 2 ♦�J,%I C? •••. ' :
PROJECT/LEGAL DESCRIPTION: DRAWN BY: 0♦ • , op, .•
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SEPTIC SYSTEM DESIGN UPGRADE D.J.G. ♦e••,, • (`''�p�. 4.
TYPE OF WORK: DATE: LICENSE.40 PROFESS
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SEPTIC SYSTEM DESIGN UPGRADE 8/9/2018 LICENSE
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Municipality of Anchorage Page __of_
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: .~ x~°t 'z'/'"i"~ln ~ PID Number: t_~['"~ - Lt~ ~- ~ ~
Name:/~.. Wastewater System: u New ~Upgrade
Ad~es~: - /
~ ~ ~ / ~~dr~s~/~ ~ ABSORPTION FIELD
LEGAL DESCRIPTION Soil Rating:. Total Depth from original grade:
Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel dept~ beneath pipe
Township: I Range: I Section: Fill added above original grade: Gravel length', ~
/- ~ Ft. ~ ~ Ft.
WELL: ~New ~ Upg rede Gravel width:~ Ft. Number/of lines: i~Distance between lines:Ft.
Classification (Private. A.B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~
0~ ~ ~3 Ft. ~0 Ft. ~ SQ. Ft. ~/O
Y ~--~/ ~~Date~ritle~ Static Water Level: ~' Ft. Installer:~~~ Date-installed:
Yield: ~ Pump Set at: ' ~Casing Height Above Ground:
/~ ~p", ~ g "~. I /2 "~ ~ TANK
SEPARATION DISTANCES ~eptic ~ Holding ~ S.T.E.P.
To Septic Absorption Lift Holding Public/Private Manufactu~r: Capacity in gallons:
From Tank Field Station Tank Sewer Lines~ ~ i~ ~0~ 0
Surface
w~ /00 '~ /~'
~ LIFT~ ~STATION
LineL°t /~ I /~ , Size in gallons: Manufa~/~~
~/~~
Foundation ~ ,+ ~ ,~ "Pump on' level at:~le~el at: High water alarm at:
Drain ~ 0 ~ ~ ~ I ~, ~ Pu Electrical Inspections performed by:
~ ~ ,~ BENCH MARK
Remarks: ~ ~ ~ ~
Location and Descriptio~
/ w ~ Assu~ Elevation:
EN,~US~,~AL
Inspections performed by: ~o~4 ~ ~,.r ~ ~.~, ~: ~st ~-~ ~ ~~
bgle River, Mask. ~S~ ~ 2nd '~g~, - ~ ~~~'~'~~::'
Department of He~d Hula ces ,~ ..... ~. -. ~.~...
Reviewed and approv Date , /
72-013 (Rev. 9/91) MOA 25
IOOo FBME EAST 100 06
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-' Q000Opp�
EAST 70.02 ' ,41.c(''.'OF A�gS,�4
il
vQ4-o
Op TH
g
a.
�, /
...
OQ
O.. SHANE k HOLT.• oQ • �
hs LS-6914 .' ,641g/4goMERGANSER AVENUE 00000do0
TE
INFORMATION HEREON IS FOR THE USE OF LENDING II6TITUTIOILS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEN EXISTING STJCTU1ES AND PLATTED LOT LINES AND/OR EASEMENTS;AND IS
NOSURVEY T TO BE USED FOR POSSITIO DCG ADDITIONAL STRUCTURES,DENKIVE1BEC
R5.OR FELINES. AS 13UI LT SURVEY 1" = 30'
EASOENTS OF RECORD,OTHER THAN THOSE APPEARING ON THE RECORD PLAT.ARE OCT SHOW NO COMERS SET THIS ROTE
HEREON(UNLESS INDICATED)
NOTE: FENCELINES THAT PAY APPEAR CM TIQS(RAYING IRE NOT TO BE USED TO DETENBE
PROPERTY LINES OR POSITION ADDITIONAL IIIPROVBdTS.
ANY PAVING SHOWN HEREON NAY BE APPROXIMATE OIE TO EXCESSIVE SNOW AW/OR ICE. I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 5 D. BLOCK 2. DRAKE SUB.
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE,ALASKA THIS 25 TM DAY OF
ULv , 2018
HOLT LAND SURVEYING
9309 GROVER DRIVE
ANCHORAGE,AK 99507
13980.FB 189-42 907-345-5513
Permit No
~W~30063 Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: DRAKE SUBDIVISION, BLOCK 2, LOT 5D
PID No.: 01746114-
SCALE
CO1
NEW
1000 GAL
SEPTIC TANK
1"=10'
C02
FINAL ORADP~x C t
98.1'
· §2.1' NO WATER FOUND
I
I
I
I
I
.,,~J,-lO' UTIL, ESMT.
NEW
COl
NEW
C02 88,5' 55.,5'
C03 34.5' 59'
C04 34.5' 59'
C05 37' 59'I
MT 37' 40.§'
~06. 1.55' I 34.5'l
)00 GAL
TANK
100' WELL RADIUS
WELL'
SCALE 1" = 40'
BDRM
EN
iEAL ';,''
72-013 A (Rev. 9/91) MOA 25
IWell Owner I
Joseph L, Pollard
I I
Well Log
Alaska Now-Well/Vern's Driilling
12241 Avlon
Anchorage, Alaska 99516
(907) ~45-44,7
Location 01' Well
I Borough Subdivision
Anchorage Drake
Lot
PERMIT ~ $W930063 .
Block N Range E Merdian
21Sectt°n N°l T°wnship S, W
Well Log Ft, Below Surface
~leterlal Type Top Bottom
brn silty till 0 35
hard pan/cobbles 35 60
brn hard pan/lenses of gravel/H20 60 69
sandy gravel, H20 15 gpm 69 73
Well Depth (fit) Date of Completion
I 7~1 14/27/931
Drilling Method Use
I rotary J Id°mesuc '1
Casing Type
Jwelded J
Diameter (in,) Depth (FL.)
It° I
Finish of Well
Type Diameter
Static Water Level
Level (ft.) Date
137' J J 5/7/93J
Weight (Ibs/ft)
Pumping Level
Below T of C (fl,)After (hrs)
I I I
Pumping (g,p,m)
I
Setting (ft)
6rouUng
YesJ~J Material
Pump
H,P, Capacity
I I
Remarks
Jset
Type
Jsubmersible
bottom of pump @ 63' from Lop of casing
This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief.
Authortze~d Representative
Ve~n/~Nowell~ ,~,/~,~/____~_.~~/~ -
I
Date
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW920025 DATE ISSUED: 3/06/92
DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES EXPIRATION DATE: 3/06/93
OWNER NAME:POLLARD JOSEPH L
OWNER ADDRESS:8628 HARLEQUIN DRIVE
ANCHORAGE, ALASKA 99516
PARCEL ID:01746114 /
I l ��
LEGAL DESCRIPTION: DRAKE BLK 2 LT 5D
LOT SIZE: 17822 (SQ. FT.) 6v
C�l S
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 "3 0 V
THIS PERMIT IS FOR THE CONTRUCTION OF. Ljq
v
DISPOSAL FIELD / WELL SYSTEM v
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN. 116
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
1. VERIFY CONSISTENCY OF SOILS THROUGHOUT LENGTH OF
TRENCHES.
2. TOTAL DEPTH OF SYSTEM MAY NOT EXCEED 9.5 FEET UNLESS
ENGINEER VERIFIES NO BEDROCK TO 17.5 FEET. IF NOT
VERIFIED, ADJUST\DE,SIGN(�ACCORDINGLY.
RECEIVED BY:
DATE:
v
ISSUED BY:("�� DATE: 3
CIVIL & ENVIRONMENTAL ENGINEERING * ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345-1355 February 26, 1992
ANCHORAGE, ALAS KA 99516
M.O.A. DHHS
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sirs:
The purpose of this letter is to provide the required design narrative in support of our application for a
permit to construct wastewater disposal facilities on Lot 5D, Block 2, Drake S/D, located at'3341
Merganser Avenue. Soils logs, perc test results, a site plan, design drawings and specifications are
enclosed for your review.
The proposed system will be constructed in the vicinity of test hole # 1. As can be seen from the soil
log, the native material between 3 and 11.5 feet is a fine, slightly silty sand with a measured pert rate of
2.1 minutes per inch. The underlying material is not impermeable. Using a soil application rate of 1.0
glxt/sq, ft. which is slightly more conservative than that specified in the wastewater ordinance, this 3
bedroom residence requires a total absorption area of 450 square feet. The proposed 57' trench with 4 feet
of sewer gravel beneath the distribution pipe has a total absorption area of 456 square feet. The slightly
larger designated replacement system is based on a soil application rate of 0.8 glxl/sq, ft.
The topography of the lot is generally level in the area of the proposed construction. There are no
wells or septic systems other than those shown on the site plan within 200 feet of the proposed system.
The proposed project will have no impact on present or future water supply and wastewater disposal
'systems serving adjacent properties, nor will it have any impact on reserved space/surface and subsurface,
or on drainage. '
Please give me a call at 345-1355 if you have any questions on this submittal.
Sincerely,
Ted Moore, P.E.
Flattop Techn~al Serv~es
14530 Echo Street, Anchorage, AK99516
Phone (907) 345-1355
Lot 5D, Block 2, Drake S/D
3341 Merganser Avenue
Wastewater disposal system installation
~;s ~t,x- Specifications
1.0 General:
1.1 The scope of the project consists of installation of a 1000 g',dlon septic tank followed by a 57'
long soil absorption trench containing 4.5' of sewer gravel between 7.0 and 11.5' below ground level.
1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor
deviations from these drawings may be allowed or required by the engineer conducting the inspections.
All construction procedures and material specifications shall conform with Municipal and State
requirements.
1.3 All sepm'ation distances shall be in conformance with Municipal requirements, unless specifically
waived.
1.4 The contractor shall be responsible to obtain any necessary utility locates, and to work around any
buried utilities.
1.5 The property owner shall be responsible for determining the location of property lines.
2.0 Septic Tank:
2.1 The 1000 gallon septic tank shall be Municipally approved with two compartments, and shall be
set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a
4" cleanout. The tank shall not be buried under the location of the proposed driveway.
2.2 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The
waste line from the residence to the septic tank shall be of cast iron and shall exit the daylight basement at
the minimum feasible depth and shall have a slope of 1/4"' per foot. The portion of the line passing under
t e proposed driveway shall be insulated w~th 2 of rigid, burial type msulaUon. The waste line between
the tank and the ~sofl absorption system shall drop at least 2 inches and shall have a minimum slope of 1/8"
per foot. A cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall
be installed within 5 feet downstream of the septic tank.
2.3 The contractor shall trace the existing waste line leaving the building and shall properly abandon
and backfill any on-site wastewater disposal facilities.
3.0 Soil absorption system:
3.1 The soil absorption system shall be constructed by excavating a 57' long trench to a depth of
11.5' below ground level in the vicinity of test hole #1. The bottom of the excavation shall be level. Any
compacted or smeared surfaces shall be raked to allow proper infiltration. During construction, the
inspecting engineer shall verify the continuity of soils throughout the entire trench, and if different soils are
encountered shall modify the design accordingly.
3.2 The soil absorption trench shall be no closer than 10 feet from any property line or from the
future foundation of the proposed garage.
3.3 A total of 4.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with
the perforated distribution pipes laid level such that the pipe inverts are no less than 4.0 feet above the
bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing
the #200 sieve.
3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on
the design drawings. The portion of the monitor tube extending through the sewer gravel shall be
perforated.
3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel before backfill
with unclassified soil. The top surface of the cover material shall be raised a minimum of 12 inches higher
than the surrounding terrain to allow for subsequent settlement, and shall be graded to smooth contours.
Fill slopes shall be no steeper than 3:1.
3.6 The owner shall be responsible for placement of topsoil and reseeding over the construction area.
4.0 Inspections:
4.1 A total of 4 engineering inspections will be required during the course of the project: (1) initial
stakeout with the contractor to establish the location of the system and to discuss the plans, specifications
and construction procedures, (2) after the native material has been excavated to expose the infiltrative
surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3)
after the sewer gravel is in place and the disg'ibution pipes have been laid and connected up to the septic
tank, but prior to placement of insulation or filter fabric, and (4) after final backfill and grading is
complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to
backfill. This inspection may be incorporated with any of the above inspections.
4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in
advance to ensure the availability of the engineer.
-.J
...!
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I ' '= 16~ t-O"
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Sg_.¢TlOl¥
I" --- 5'~-0'
Flattop Technical Services
14530 Echo Street
Anchorage, Alaska 9951 e.
LoT 5"~ gl. lC '~, DI~A (<~ $/D
h/A_gTE bu'AT~R P
PI. AN ~ F_.RO..g.g-..qEcT'toN
O u-~ N. E Y: .'r'.F'.t~.
PERFORMED FOR:
Flattop Technical Services
14530 Echo Street
Anchoraqe, Alaska 9951R
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anch~orage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
Dr, cane H.~l o' er'zo,~
DATE PERFORMED:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
iff-
~r~A/~.~= Township, Range, Section:
1"1 I.. d-r~y
Den. re
~ecc~e£
$~o(~#r co.
COMMENTS
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
S
L
IF YES, AT WHAT iOeq.~ 0
DEPTH? ~
II/,,r/fl
Depth to Waler Alter
Monitoring? Date:
Gross Net Depth to Net .
Reading Date Drop (.,~r~)
I0 / ~ Time Time ~'Ft}n); Water
12" PreScott II: I~ ~7 %
~ It: q~: Jo 83
PERCOLATION RATE ~' ! (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~'- ..~ FTAND 7,~:~ FT
PERFORMED BY: F{¢I~/~ T¢c/~ Cf/C , ~"-~-~ ~ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WiTH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
PERFORMED FOR:
Flattop Technical Services
14530 Echo Street
.~/nchoracm, .Alc~ska 99516
Municrpality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION:
?~-
1
2
3 5
4
5
7
8
9
10
11
12
13
15
16
17
18
19
20
COMMENTS ~1 ~
P/~A/'~T°wnship, Range,Secti°n: _~ec ~8, 'T'I?-/V/ SLOPE SITE P(AN
~e,.~ot~l, .~,~? loc,,,,
WAS GROUND WATER
ENCOUNTERED? N ,
S
L
IF YES, ATWHAT t0cf.~, O
DEPTH? ~
Depth to Water Aller M, 1] ~C~t
Monitoring? Dale: II /5' i'll
Gross Net Depth to Net
Reading Date Drop ~'~)
PERCOLAIlON F~A'IE _ 7 (m,nutes/mch) PERG HOLE DIAMETER
IESi' RUN BETWEEN _'7.,C'/ _ b'l AND 7'~' FT
PERFORMEDBY: ~(a~ ~C~ ~UC ' ~' ~ CER3IFYTHA~THISTESTWASPERFORMEDIN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES tN EFFECT ON THIS DATE. DATE: J/ /.7 /~/
72'008 (Rev. 4/85)
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. 017-461-14-000
Expiration Date:
Legal description DRAKE BLK 2 LT 5D
Site address 3341 MERGANSER AVE Anchorage AK 99516
Current property owner(s) BUDAHL MONTE G LIVING TRUST
9/9/2023
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
Original Certificate Date: 6/9/2023
'This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory x
Tank Age Advisory Arsenic Advisory
Other
COSA Approval_June 2022
U MCI PALITY OF ANCHORAGE
Development Services Department P P Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 017-461-14
Complete legal description DRAKE; BLOCK 2, LOT 5D
Location (site address) 3341 MERGANSER *ANCHORAGE, AK
Current property owner(s) TAMMY BUDAHL Day phone 1-214-457-2820
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: R Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age -5 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: ❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ .55-0 Waiver Fee $
Date of Payment 5/23
COSA # 0_5 C_ 231156
Date of Payment
Waiver #
COSA Applica6on_Juna 2022
ndv)
(3
COSA Checklist
Legal Description: DRAKE; BLOCK 2, LOT 5D Parcel ID: 017-461-14
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system
cl
A. WELL DATA
Well log is file with Onsite (or attached)
Well production at time of test 4.8+ gpm
Date drilled &7i°f`99"3 Total depth 73 ft
Water storage tank volume N/A gallons
Cased to 70 ft
Well disinfected for coliform test? ❑ Yes No
X Sanitary seal is functioning correctly
❑rColiform bacteria is Negative
❑■ Wires are properly protected
Nitrate:; -)-'9 mg/L ❑ Nitrate less than MRL (ND)
Casing height (above ground) 12+ in.
Arsenic ug/L Arsenic less than MRL (ND)
Date of flow test for COSA 5/10/2023
Collected by GEG
Static water level at beginning of test 35 ft.
Date 5/5/2023
Comments WELL WIRES ARE IN CONDUIT, HOWEVER, CONDUIT IS DAMAGED (SEE ATTACHED PHOTO)
ra
B. TANK DATA
Measured operating fluid level in septic tank 47.75
Date of pumping
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 9/2018
OR ALL standpipes present per record drawing
Total measured depth from grade 8.6 ft (max)
r Measured depth to pipe invert from grade 2.45 ft (min)
? ❑ N/A - pressurized field.
0
❑ Per record drawings, field is insulated.
X Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced " gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
YC. I?.IFT STATION
Required maintenance completed
Age of lift station -5 years
Lift station material STEEL
Comments:
Adequacy test date 5/10/2023
Results Q Pass
Fluid depth prior to test 35.25 in
Water added 606 gal
New fluid depth 48.5 in
Elapsed time 120 min
Final fluid depth 44.25 in
Absorption rate 450+ gpd
FIELD STATUS - POST RECOVERY
Effective depth (per record drawings) 72 in
Effective depth used 44.25 in
Effective depth remaining 27.75 in
Comments/Deficiencies: PIPES IN 1993 TRENCH ARE PRESENT BUT MT AND NORTH C/O ARE NOT SHOWN ON
FEB 2019 SURVEY. SEE JULY 2018 SURVEY FOR 1993 TRENCH PIPE LOCATIONS. 1993 TRENCH DRY UPON ARRIVAL AND REMIANED DRY THROUGHOUT TEST
COSA Checklist—June 2022
°� t [2,2
� b a ?, i L lgD C��Z)
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
M Yes if No ft 0 Yes if No ft
Neighboring Tank > 100' n Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft
Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' [C Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft
R Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ME Yes if No ft QYes if No ft
❑ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10' [_M� Yes if No ft Surface Water > 100' ❑■ Yes if No
Tank to Property Line > 5'
Field to Property Line > 10'
Water Main > 10'
Water Service Line > 10'
F. ENGINEER'S COMMENTS
*WR#OSV181057
❑i Yes if No ft
❑ Yes if No *31+ ft
Q Yes if No ft
Q Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100' 0 Yes if No
Community Wells > 200' Q Yes if No
If tank or field is under driveway comment below
TRENCH IS LOCATED UNDER DRIVEWAY - SEE RECORD DRAWING IN MOA RECORDS
ft
ft
ft
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Gayness Engineering Group, LTD. (GEG) Phone 907-337-6179
Engineer's Printed Name Jeffrey A. Garness Date �_b, e
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in
accordance with the guidelines and regulations established by the Municipality of Anchorage and industry
practices. The reported results describe the condition of the system/s on the date/s of the evaluation.
Separation distances were measured to readily identifiable features. Hidden defects or encroachments may
exist that were not identified during the evaluation. The operational life of all wells and septic systems depend
upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate
during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing
the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not
guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding
the future performance of the well or septic system. GEG makes no representation whether an alternative well
or septic system can be installed on the property in the event either of the current systems fail to perform
adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG
to perform the evaluation. Reliance upon the information provided in this report by any other person or party
(including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever.
COSA Checklist—June 2022
*, 4 TH � y*
v� - er- y H. uamess:
CE 795
)Z�-
LICENSE �d Pro t e s sionoQcs
#AECC884 ��OODO00
M
MUNICIPALITY OF ANCHORAGE
Development Service!; Department Phone: 907-3�i,,3-7904
On -Site Water & Wasi iBwater Section Fax: 907-343-7997
Lift Station/Pump Vault
Maintenance Log
AA 0 1
Owne Street Addressy;q Ave.
P h o rk&Zat
2 -3Legal Desc. PID
_--
,SepticTank:
-Sludge level _� inches -Pumping: required -Pumping completed 4e5_._._j-L
o
Lift statim:
-Pump basket cleaner P_ no -Effluent filter cleaned e��o
-Control floats cleaner -Proper float settings confirmed 0-M
-Operation satisfactory t
Alarm System;
-Dedicated electrical a arm circuit /Me -W --no -Audible and visual alarm inside dwelling no
-Alarm system operatic }n -satisfa ois tory
Manhole Rise
-Ground water intrusio'i at riser to tank connect on
-Ground water intrusio i around pipe penetrations es 0 -Weep hole functional w- ,
e_
-Manhole lid: Functicinal Insulated Properly Secured tiaLTD10
Othgr
-All manufacturer requi red inspections and maintenance completed &M
Comments:
.... W.OnK. I'V_Q.....GAS'....451W. 0.1.6 ............................... .....................
""J,
................................... _ ......................................................................................................
................................... .......................................... I .......... ................ .................
.......... ......................... . ........................................................... ........... - ...... .......... ......
Maintenance ErQvidevi
Technician 44%M n -
Date of maintenanceG/1,�-20-;)-73
11
Company , "
0_ej Kc "_J'c_e__S-_
Signature OW�
1 - —
�rens: P. 0. Box 196650 * Anchoraqe, Alaska 99519-6650 ' www.muni.org
■
vcQ�` 50
.7m
aT r� ♦ - h
77 M7 .�{�•
lb
s �r-
Completion Notes:
Job Total $240.00
PRE WORK SIGNATURE POST WORK SIGNATURE
Signed By: Signed By:
CUSTOMER MESSAGE i Invoice Total: $240.00
We now accept payment online for pumping jobs at
Deposits $0.00
WWW.APLUSAK.COM
Payments $0.00
Please just type in amount on invoice and we will mark ITotal Due: $240.00
as paid once payment is processed. Thank you!
* We are not responsible for any damage to driveways,
walkways, and or pavement due to soft ground, poor
installation, or slick/icy conditions.
Invoice
"'SA FUL'olS�
A+ HOME SERVICES
DATE
05/1212023
907-345-1890
INVOICE#
3703
TERMS
Due Upon Receipt
7400 Old Hillside Way
DUE DATE
05112/2023
Anchorage, AK 99516
(907) 345-1890
info@apiusak.com
BILL TO
SERVICE LOCATION
Monte Budahl
j
Monte Budahl
3341 Merganser Avenu
3341 Merganser Avenu
Anchorage AK 99516
Anchorage AK 99516
(907) 312-3344
(907) 312-3344
JOB# DATE POIREF#
DESCRIPTION
1J019746196 05/12/2023
1500 gallons, 2 standpipes, 40ft to the right side of the house,
i
i
15 ft from driveway
Completion Notes:
Job Total $240.00
PRE WORK SIGNATURE POST WORK SIGNATURE
Signed By: Signed By:
CUSTOMER MESSAGE i Invoice Total: $240.00
We now accept payment online for pumping jobs at
Deposits $0.00
WWW.APLUSAK.COM
Payments $0.00
Please just type in amount on invoice and we will mark ITotal Due: $240.00
as paid once payment is processed. Thank you!
* We are not responsible for any damage to driveways,
walkways, and or pavement due to soft ground, poor
installation, or slick/icy conditions.
cKo+R�e�
ANCHORAGE WELL & PUMP SERVICE, INC.
7640 KING STREET
ANCHORAGE, AK 99518
PH. 907-243-0740
Bill To:
Monte & Tammy Budahl
3341 Merganser Ave
Anchorage, AK 99516
Invoice
Invoice #: 20234867
Ship To:
Monte & Tammy Budahl
3341 Merganser Ave
Anchorage, AK 99516
SALESPERSON
YOUR NO.
SHIP VIA
COL
PPD
SHIP DATE
TERMS
DATE
PG.
TYLER S RIDGWAY
35899
Net 30
5/23/2023
1
TY.
ITEM NO.
DESCRIPTION
PRICE
DISC %
EXTENDED
PRICE
TX.
1
Service Call
CAMERA WELL - HIGH NITRATES
1
Field Service
5119/23 - Camera well and record results.
$400.00
$400.00
RESULTS: Found no sign of casing
breakage or intrusion above the static
water level.
0.5
ST5-Tyler
Service Tech
0.5
ST1-Dave
Service Tech
SALE AMT.
$400.00FREIGHT
We appreciate your business. Thank you!
$0.00
SALES TAX
$0.00
TOTAL AMT.
$400.00
PAID TODAY
$0.00
BALANCE DUE
$400.00
I
I
a
l"titrate Advisory
Certificate of On -Site Systems Approval # OSC231156
Subdivision: Drake, Block: 2, Lot: 5D
A water sample revealed a nitrate concentration of 21.9 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/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. Since nitrates are known to slowly increase, we recommend
you monitor the water,_ quality._ Please see the attached..'.'Nitrate Fact Sheet for -
important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Mailing Address P D' Box 196650 *Anchorage, Alaska 99519 6650 *www muni org
r
or'dtrections
'investigatic~'*'Of: ~his Heal~
and/or w~tewater dispo~i s s~'~is ~fe,~f~i~nal And'ad~uate ~rthe number of, b~rooms
and ~pe of stmctur~ndi~t~
the Municipali~ of Anchorage files and from my inves~ation and insp~tion, t~e on~itewater
supply an~or w~tewat~'r' disp6~1: system is in.complian?e Wi~,~ all Municipal and Satecodes,..
? Engin~fs signature
':.:..~;=.:'~: .,:7: ;; '~=L'~'_"./,:',7,', '". '7;'.;7~. ..... "':;;";:.,"':'~::;:;:.". ':' :,.~. 'Z: ..= '
upon
;~f'Al~kii;;~'oHH~
a certificateis issUed; ,The Munic
3U
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744
Legal Description:
Health Authority Approval Checklist
/-~c-5/~ Z- / Z);' ~, ~e -~/~7 Parcel I.D.:
o/7- ?
A. WELL DATA
Well type~o
Log present
Total depth
If A, B, or c, attach ADEC letter. ADEC water system number
Date completed e~_ 2. 7- ~ ~
!
Cased to 7 0 / Casing height (above ground)
S,'mitary seal (Y/N) ~/
Wires properly protected (Y/N) ~
Date of test
Static water level
Well production
FROM WELL LOG
AT INSPECTION
27
g.p.m.
g.p.m.
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate
Collected by:
Other bacteria ~ '
.5' 0-~ ~ .c ~,,5'" ~e,--,'., .~
B. SEPTIC/HOLDING TANK DATA
Date installed 5/-,~ O - 9.3 Tank size ~ aa a,..q., g Number of Compartments
Foundation cleanout (Y/N) ~/ Depression (Y/N)
"'~ " ,,4 ,'-
Date of PuniPingi.ff¢/2."..9.£ ~":... Pumper
ABS~R~PT. ION ~LD DATA.
Dat¢!~{~s[,afied~ z~, -~'O ~ ~ ~ Soil rating ~or ~Z~d~)
., Width ~ -: ~ Gravel t~c~ess below pipe
Effectiv~:abso~tion~ea q&g Monitoring Tube present(~
Date of adequa~ test' ff ~ /" ~ ~-- Results (Pass,ail)
Cleanouts (Y/N) /
High water alarm (Y/N)
Fluid depth in absorption field before test (in.); ~ ;" Immediately afterd/~/gal, water added (in.):
Fluid depth Minutes later: "<??~"~¢~i~.~:!~¢'~iS§'6~fion rate = ~7/f- O -/- g.p.d.
Peroxide treatment (past 12 months) (Y~ A/ If yes, give date /v//54
System type /7' e~,-, ~ ,~/
f rr
Total depth 1~ '6'
Depression over field (Y/(9~ /t/
For bedrooms
~ Size in gallo!ls~~~
Manhole/Access (Y/N) ~~I~~* __ "Pump ofF' level at*
High water alarm leveijlt~~ *Datum ~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot /~ 0 /.~
; On adjacent lots
Absorption field on lot / 0 0 "~ ; On adjacent lots
Public sewer main
Public sewer manhole/cleanout
Sewer/septic service line /V./~d
Lift station
SEPARATION DISTANCES FROM SEPTIC~ TANK ON LOT TO:
Foundation / O /'~' Property line / 6~ '''~ Absorption field
Water main/service line ~ ~/-q-
· . Surface water/drainage /OO q/- Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation /d "-,~ Water main/service line
Surface water /~ ~ / /-
Curtain drain
Driveway, parking/vehicle storage area
Wells on adjacent lots / ~
F. ENGINEER'S CERTIFICATION
I certify that I have determined thrufield inspections and review of Municipal
in conformance wit~~_ g~l~on this date.signature
Engineer's Name
Date
HAA Fee $ x~
Date of Payment
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
ms are
.....
Waiver Fee $ t~
Date of Payment
Receipt Number