HomeMy WebLinkAboutT12N R3W SEC 27 LT 33 Municipality of Anchorage Page I of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVlRONMFNTAL 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: ~uO o~ 0:~'5 Co PID Number: 017 o~ ~ ~
,~m~: ~ ~O~ ~O~ Wastewater System: ~New D Upgrade
Phone: ~' ~ ]No. of Bedrooms: ~ ~ Deep Trench ~ Shallow Trench D Bed D Mound D Other
Soil Rating: Total Depth fro~riginal grade;
LEGAL
DESCRIPTION
Lot: ~ ~ Block: Subdiv~ion:~ Depth to pipe bottom from original 9rode: Gravel depth heneath~ pipe
~ Section: Fill added above original g~ade: Gravel length:
WELL.: ~ New ~ Upgrade Gravelwidth: ~.5 ' Ft, Nu~beroflines:~ Distance between lines:
Classification (Private, A,B,C): Total Depth: Cased ¢o: "' Total absorption area: Pipe material:
Driller: Date Drilled: StaticWate, Level: Installer: Oateinstalled: q .
Yield: [ Pump Set at: Casing Height Above Ground:
SEPARATION DISTANCES gs.p,io o Ho,ai.g ~ S.T.S.P.
TO Septic Absorption Lie Holding ~ublic/Pevate Manufacturer: Capacity in gallons:
Well [Oo~ ~oo',~ ~ ~ ~ Material: %~-L Number of Compartments: ~
Surface
Water ~0~ ~oo% ~ --- __ LIFT STATION
Lot I I Size in gallons:~ Manufacturer:
~- , ~O~[~ ~d ~ ~ .~ ~ PumpM~de~Electricallnspectionsperformedby:
Curtain
Drain
Location and Description:
Assumed Elevation:
~ E N G I ~S SEAL
Inspections performed ~ /~2/'
Department of He, Ith and H at {t r ioe* appg,}l ',,,:.:,,,
Reviewed and approved ~/~¢~VA I ~/~ C ~M~ate: q[~/]~ .... ".,
72 013 (Rev 9/91) MOA 25 ~/
SW950230 2 2
Permit No, Page of
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
LOT 3,3, T12N RSW SEC 27
Legal DescriPtion:
01705125
PID No.:
ST1
ST2
C01
C02
C03
~-93.8'
NEW
1000 GAl
SEPTIC
TANK
/ A
ST g/.~ IPiNA
100' WE
BDRM
HOUSE
CO2
GRADE MTI
RADIUS
LOT 33
ROW RESERVli
N
1 )00 GAL
TRENCH
· 77.0' NO FOUND
, . 872r-9
ROBERT C. COWAN
CE - 8901
72-013 A (Rev. 9/91) MOA 25
STATE OF ALASKA
DEPARTMENT OF NATUlL~L RESOURCES
DIVISION OF MINING & WATER MGMT
,WATER WELL' RECORI~ ',: ," '
· LOCATION OF WI~LL
BOROUGH
LOCATION/SKETCH:
DEPTHS MEASURED
$0REHOLE DATA~
Material Type and Color
...... Dept.
oasing top nground aUrlace WELL DEPTH: DATE OF COMPLETION
Depth of holm /~/~ ft
From To
DEPTH TO STATIC WATER LEVEL;
/~. ~' ft below ~' top of c:asing
ground surface
METHOD OF DRILLING: ~,air rotary [] cable tool
[] other ,,, _
USE OF WELL: ~'!,domestic [] irrigation ~ monitor
[] public supply [] other ....
CASING STICK.UPI _~ ft. Oiam: ~ icl. tO/.~_~'t
W~LL INTAK~ OP~NIN~ TYPE: ~ o~en end ~ ~areened
~ perfotsted ~ open hole
DePt~ of openings: --~ to . tt
SCREEN TYPE: % __ Diam= in.
Slot/Mesh Size: ~ Length: .... ft
GRAVEL PACK TYPE:
Volume used: Depth to top;
GROUT TYPE, ~.~c:> ~:~'..~_
Depth: from tt
DEVELOPMENT METHOD!
Duration: ~.~?
PUMPING LEVEL AND YIELD:
ft after ...~.~__~ _ hfs pumping_ ~ __gpm
PUMP INTAKE DEPTH: ft Horsepower; ~--
WELL DISINFECTED UPON COMPLETION7 ~)('ES [] NO
CONTRACTO~R ,NFORM~;: .~ ~. REMARKS,
.~ ~& PLEASE MAIL WHITE COPY OF LOG TO:
. DNR/DIVtSlON OF MINING & WATER MGMT
Sioneture OtAUt~On 3601 C sg~ Suite 800
Anchorage, AA 99503-5936
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:SW950230
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:COCKLIN TOMMY & TAMI
OWNER ADDRESS:IS01 ATKINSON
ANCHORAGE, AK 99504
DATE ISSUED: 8/21/95
EXPIRATION DATE: 8/21/96
PARCEL ID:01705125
LEGAL DESCRIPTION:
T12N R3W SEC 27 LT 33
LOT SIZE: 108900 (SQ. FT.)
NUMBER OP BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IH 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 (iSAACS0) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343 4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
DATE:
DATE:
HEALTH AUTHORITY
APPROVALS
SEWER &WATER
INSRECTION
ENGINEERING STUDIES
ANDREPORfS
WELt INSPECTION
&FLOWTEST
ROAD DESIGN
SOJLTEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAl
INSPECTIONS
ROBERT C, COWAN, RE.
ROBERT A. SHAFER, RE.
August 7, 1995
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Lot 33, T12N, R3W, Section 27, S.M.
Request you issue a permit to drill a well and install a
septic system to serve thevthree bedroom house on the
referenced property. P~f~D
A test hole was excavated and a percolation test performed.
The approximate location of the test hole is located on the
attached site plan.
At the time of excavation no water was encountered and
after seven day ground water monitoring, the monitoring
tube was found to be dry.
This property has enough area for a future septic upgrade
which can be seen on the attached site plan.
We do not anticipate any adverse effects on neighboring
wells, septic systems or drainage patterns by the
installation of the proposed septic system.
There are no points of contamination within the proposed
well radius which can be seen on the attached site plan.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan,
RCC/gk
Enclosure
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577
Sll'E PLAN
DESIGN
0
>~o
,c)
Municipality of Anchorage
DEPARTMEN'r OF HEALTH & HUMAN SERVICES
....
825 L Street, Anchorage, Alaska 99502-0650
'
LEGAL DESCRIPTION: Township, Range, Section:
1
2
3-
4
5
6
8
9
10
11
12
13
14
15
16
17
18
19-
20~
/m L 'F .~ ,v y / c i~
fJ.O rt.
WAS GROUND WATER ,k/ O
ENCOUNTERED?
SLOPE SITE PLAN
g
IF YES, AT WHAT /4 oL
DEPTH? /¢ p
E
Monitoring7 . ~/~ "/ Dale:
Reading Date Gross Net Depth to Net
Time Time Water Drop
fr/i/~s- 3:~3 3.,~ ,, _
PERCOLATION RATE [ (m~nutes/mch) PERC HOLE DIAMETER __
TEST RUN BETWEEN ~ __ FTAND ?~' FT
////J
//
PERFORMED
By: Sg~5
ENGI
NEER
:¢~¢~.~'/%~' ~//~'7~O~fl,-,.-~- CERTIFY THAT/~HIS T,ST WAS PERFORMED IN
72-008 (Rev. 4/85)
ROBER'¥C. COWAN, RE.
ROBER'rA. SHAFER, RE.
SEWER & WA1ER
MAIN EXTENSIONS
SEWER & WATER
~NSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOWTEST
ROAD DESIGN
PERCOLATION
TEST
STRUCTURAL &
MECHANICAl
INSPECTIONS
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
REFERENCE: Lot 33, T12N, R3W, Section 27, S.M.
August 7, 1995
GENERAL:
1.
The scope of this project includes the installation of
a 1000 gallon septic tank and leachfield trench to
serve the three bedroom residence located on the
referenced property.
Construction shall be in accordance with the approved
site plan and design drawings, Municipal permit with
any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal
Regulations.
The contractor shall be responsible for obtaining any
necessary underground utility locates.
Unless specifically agreed otherwise, the property
owner shall be responsible for final grading areas
subsequently depressed from soil settling.
Contractors installing wastewater disposal systems
must be certified by the Municipal Health Department
for system installations. Owners installing their own
systems must also receive prior approval from the
Municipal Health Department.
SEPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified
septic tank manufacturer. Construction shall include
two 4" cleanouts for pumping access.
The septic tank shall be sufficiently bedded to
prevent settling or shifting of the tank.
Ail standpipes on the septic tank shall extend a
minimum of 12 inches above final grade.
17034 NORTH EAGLE RIVER LOOP . SUITE 204 . 'EAGLE RIVER, ALASKA 99577
Page Two
Lot 33, T12N, R3W,
August 7r 1995
Section 27, S.M.
Septic tanks installed with less than 4 ft. of cover shall
be insulated.
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 ft. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield.
The second cleanout shall be to clean toward the septic
tank.
Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
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 excavation become
smeared, they must be raked or scratched (ruffed--up) before
gravel (sewer rock) placement.
Once the gravel is installed, the distribution pipe is to
be installed level with the perforations faced downward.
Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
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.
Monitor tubes shall be of 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.
Page Three
Lot 33, T12N, R3W,
August 7, 1995
Section 27, S.M.
Backfill over the final gravel layer must not be less than
twenty-four (24) 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.
MINIMUM MATERIAL SPECIFICATIONS:
Any septic tank proposed for installation must be
constructed by a Municipally approved septic tank
manufacturer.
The following pipe materials are approved for use in septic
system installations in theM ' ' 'unlclpallty of Anchorage:
_Type of Pipe_
Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
Insulation shall be at least 2" thick
burial polystyrene (Dow Chemical Company
equal).
extruded direct
Styrofoam HI or
Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
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.
Ail leachfield grave]_ (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 3% passing the ~200 sieve.
When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C.
requirements.
Page Four
Lot 33, T12N, R3W,
August 7, 1995
Section 27, S.M.
INSPECTIONS:
Typically there will be a minimum of three (3) .nspectlonsi
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
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.
The second inspection must be conducted after the
placement of 'the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
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, etco Thus, the
inspecting engineer is 'to be contacted at least 24 hours prior
to the start ofconstruction.' If necessary, a pre-construction
meeting will take place on-site. The inspecting engineer will
not coordinate, direct or control in any way the contractors
activities.
The owner shall contract with the contractor to perform the work
outlined in these specifications and plans and in accordance
with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S
Engineering. S & S Engineering shall be the owner's
representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the
contractors work rests with the owner and the M.O.A.
Page Five
Lot 33, T12N, R3W,
August 7, 1995
Section 27, S.M.
S & S Engineering 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. S & S Engineering's inspecting engineer
will not be responsible for the construction means, methods,
techniques, sequence, procedures or the safety precautions
incident to this project.
CONTRACTOR/INSTALLER
•
• �-� Municipality of Anchorage °r
i E (;
On-Site Water and Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 017-051-25 Expiration Date: 12—c 01. GENERAL INFORMATION
Complete legal description _T12N R3W SEC 27 LT 33
Location (site address) _5055 NOGAARD ROAD
Current Property owner(s) _JOHN MAIN Day phone
Mailing address _SAME
Real Estate Agent Day phone
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:
Individual Well ® Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer 0
Waiver/Variance request for: Distance:
Received by: /A ._ Date: 7/0///
I
COSA to be released to the engineer,u ess otherwise requested by the engineer.
COSA Fee $ 62C, — Waiver Fee $
Date of Payment 1(1
3 1 I( Ck10Vgo Date of Payment
Receipt Number o;asf;)" .(r Receipt Number
COSA# O`g_n 11-1Waiver#
•
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.
Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE.
Engineer's Printed Name MIKE N ANDERSON, PE Date 8/28/18
may , ��;• o,
ep
•
o `� �. i.J`- ` `
er,• a cVo o/ v e
!'� N.
c s P n 0 0 0 .,
6. DSD SIGNATURE Y ;=�� P.1icH,�El. q{.;p�R;;,;, ';�
Ee•' ,J
x System #1 Approved for bedrooms ( ` '
. ••� /
System #2 Approved for bedrooms. E�`cd n: ;K,ly •
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
ON-SITE
WATER AND -_
WASE RAMR c
pROG
Y (� Original Certificate Date: q - (C9 e
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 blue sheet 10.10.12 doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system _
Certificate of On-Site Systems Approval Checklist
Legal Description: T12N R3W SEC 27 LT 33 Parcel ID:_017-051-25
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N)Y
Date completed 3/29196 Sanitary seal (Y/N)Y Wires properly protected (YIN) Y
Total depth 149 ft. Cased to 149 ft. Casing height (above ground) 12"+
FROM WELL LOG AT INSPECTION
Date of test 3.29-96 6.29-2018
Static water level 129 ft. 130 ft.
Well production 8 g.p.m. 4+ g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 2.411 Omg/L
Arsenic: ND ug/L Date of sample: 8-30.2018 Collected by: Mike Anderson
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL Date installed 9.4-95
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(Y/N)Y Depression over tank (Y/N) N High water alarm (Y/N) Y
Date of pumping 6-31-18 Pumper AROUND THE CLOCK
C. ABSORPTION FIELD DATA
Date installed 9-4-95 Soil rating (GPD/SF) 1.2 System type DEEP TRENCH
Length 37 ft. Width 2.5 ft. Gravel below pipe 6.0 ft.
Total depth 10 ft. Eff. absorption area 444 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 6.29-2018 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 38 in. Water added 500+gal. new depth 55 in.
Elapsed Time: 1440 min. Final fluid depth 41 in. Absorption rate >=_500+ g.p.d.
Any rejuvenation treatment(past 12 mo.) (YIN &type) N If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off" level at in.High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 100'+ Public sewer manhole/cleanout NA
Sewer/septic service line 50'+ Holding tank 100'+
Animal containment areas 100'+ Manure/animal excrete storage areas 100'+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'
Water main NA Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10 Water main 10
Water Service line 50'+ Surface water 100'+ Driveway, parking/vehicle storage 50'+
Curtain drain NA Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION * ' •�
49TH !,
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in �•• :MICHAEL N. Ah'DFRSCN
conformance with MOA COSA guidelines in effect on this date. raGi•. C /9#69 •' `'
sJ .
Engineer's Printed Name MIKE N. ANDERSON, PE 'QFp � •'•�,��;,;'�
Date 813112018 l``t\Nx ;N'%"-~
COSA canary sheet_2-6-15.doc
