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HomeMy WebLinkAboutT12N R3W SEC 22 LT 8 N180'K, t' x. ,.�� � �N . '�...,�r � ,.,. Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON -SITE WASTEWATER INSPECTION REPORT Permit Number:.OSP241384 PID Number: 015-521 -01 Dwelling: Z Single Family (SF) n with ADU n Duplex (D) El Two Single Family Project: n New 0 Upgrade Name RUSSEL & KAREN MABRY ABSORPTION FIELD Z Deep Trench [:1 Wide Trench n Bed n Mound Site Address 10833 OUR ROAD, ANCHORAGE El Other Phone Numberof Bedrooms Soil Rating Total depth from original grade 3 0.6 GPD/SFI(Field elevated 2'- see note) 8 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2 Ft. Gravel depth beneath pipe 6 Ft. Subdivision Block Lot Fill added above original grade VARIES 1.3'— 1.8 Ft. Gravel length 63 Ft. Township Range Section T12N R3W 22 Gravel width 2Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 756 Ft2 1 NA Ft. Well 100'+ **80'+ 25'+ TANK Z Septic 0 S.T.E.P. [:1 Holding [I Other Manufacturer GREER Capacity 1500 Gal. Surface Water 100'+ 100'+ Material HDPE Number of compartments 2 Lot Line 5,+ 10'+ NA Foundation *8.5'+ 10'+ LIFT STATION Manufacturer ORENCO Capacity 1500Gal. Remarks Deep -burial Tank. Field insulated. *Outside soil bearing prism. **To adjacent undocumented crib. Alarm location INSIDE GARAGE Electrical installed by BRICKWELL Tank o PIPE MATERIAL House to tank 3034 drainfietld 3034 Installer MICHAEL N ANDERSON, PE Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspdates: ection 1st 12/20/2024 12120/24 Location and description 2 3rd 1/6/25 4 1h 1/20/25 12 ND MH - STEP MANHOLE ON -SITE WATER AND WASTEWATER SECTION APPROVAL 4 •Conditional Approval: Date low ..... . .. . ......... 'A Septic System Approved ' ` " " " " " " i " Curtis Huffman - Date CE 128991 ;0, Fe�.1 /22/202;. - - - �io , '°wOF E SS1QA� Note: this approval does not include well permit requirements. (Rev 05/02/18) PID:015-521-01 PERMIT:OSP241384 FIRST WATER CONSULTING T12N R3W SEC 22 LOT 8 N180' FIRST WATER CONSULTING T12N R3W SEC 22 LOT 8 N180' DEEP-BURIAL HDPE STEP TANK TO FOUNDATION O'MALLEY ROAD I Ng0000,on" F ?9, 7 -on I ou 0 0 o 00 ry Q 0 0 ry 0 �I o 0 0 0 z w N N I N 0 0 0 0 z 33 I CRIB • CRIB i ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: BLM LOT 8, NORTH 180' T12N R3W Sec22 S.M. ALASKA SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoull any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. 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. WORK ORDER NUMBER: DATE. SCALE: E—MAIL: JAN 17, 2025 1 "=50' schullerak®gmailxom 25-001 DRAWN BY: CHECKED BY GRID NUMBER: BOOK/PAGE: JLS SW2637 250101 0 = FND I" IRON PIPE OO = FND 5/8" REBAR .44 is ag_'w I V. !INNN ®0 F 4 Nu AW ,0' TH .......... ...... ... .... ?A •.JOBN L. SCHULLER.• 0 `� ••: LS-10408®� • i Ar 0 o fes slo nab AdMW .Adw � P� SUR V PL L A NIj 0 sG�� ti 1pp, �.� 1. Cn 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / FirstWaterAK@gmail.com January 28, 2025 Municipalities of Anchorage (MOA) On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: T12N R3W SEC 22 LOT 8 N180’ – 10833 OUR ROAD, ANCHORAGE Based on searches at the MOA & DEC, site investigations, recent survey, discussions with the adjacent property owner – we are requesting amendment of the previously MOA issued waiver #WR88-036 From the referenced lot’s private well to the undocumented apparent septic crib / pit located on T12N R3W SEC 22 LOT 8 M280’ at 10845 Our Road, Anchorage. The MOA record documents show that this crib pipe was noted at 95.5’ on the as-built survey from 1988. There is another collapsed, defunct and depressed absorption crib area noted on the attached document. The undocumented absorption or crib area in use is currently barricaded / blanketed by sawhorses draped by a grey tarp and is approximately 91’+ from the referenced well as shown. We are therefore requesting the current wavier of 95.5’ be amended to 85’ from the private well on Lot 8 N180’ to this crib located on Lot 8 M280’. The existing well has been in use for several decades without any known issues or adverse impacts to the lot, adjacent lots or aquifer. The insitu sandy-silty soils shown in the well log extend to approximately 176’ deep with a static water level of 131’ create a contained and barricaded seal from the wellhead to the aquifer. The recently, attached nitrate level results show very low levels at 0.371 mg/L. There appears to be no adverse effects of the lot or surrounding lots with regards to the location of this private well and we once again request the MOA to issue the waiver per the justifications stated. Sincerely, Curtis Huffman, P.E. PID:015-521-01N 180' LOT 8 WELL TO UNDOCUMENTED CRIB ON M280' LOT 8 FIRST WATER CONSULTING T12N R3W SEC 22 LOT 8 N180' NU - Municipality of Anchorage A"� P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV251004 P I D#: 015-521-01 COSA#:OSC251019 Permit#: Legal Description: T12N RM SEC 22 LT 8 N180' Engineer: First Water Consulting Your request for a waiver of the required 100 feet horizontal separation from the absorption field to the private well has been approved. The approved separation distance is 85.0 feet. This waiver approval applies to the existing 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: n Date: � ? � �2 �� Approved by: V Name of Reviewer **** VARIAN C E/WAIVE R REVIEW **** MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241384 Work Type: Septic Upgrade Tax Code Number: 01552101000 Site Legal Address: T12N R3W SEC 22 LT 8 N180' G:2637 Site Mailing Address: 10833 OUR RD, Anchorage Owner: MABRY RUSSEL B & KAREN L Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: :19 IVI)artntetzt 1�2 z/ 2�o 2 11 /19/2025 53404 ✓❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 Received By: i .'5 Date: _ Issued By: Date: `� 3 p�jpl Development Services Department ❑Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-521-01 Property owner(s) MABRY RUSSEL B & KAREN L Day phone Mailing address 5000 O'MALLEY ROAD, ANCHORAGE, ALASKA 99507 Site address 10833 OUR ROAD, ANCHORAGE, ALASKA 99507 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T1 2N R3W SEC 22 LOT 8 N1 80' Lot Size 53,404 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field Initial r_1 Single Family (SF) FX1 (w/wo ADU) Septic Tank Upgrade El Duplex D (D) Holding Tank EJ Renewal D Multiple Dwellings D Privy 0 (SF and/or D) Private Well EJ Water Storage R THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (,gigh-a1-O.r.'e,bf.property owner or authorized agent) 7. Permit/Rush Fees Date of Payment Receipt Number: Permit No. Waiver Fees: Date of Payment: Receipt Number: Waiver No. GAIDevelopment Services\Building Safety\On Site Water and WastewaterTorms\Client Fonns\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / FirstWaterAK@gmail.com ! !! November 20, 2024 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: T12N R3W SEC 22 LOT 8 N180’ – (10833 OUR ROAD, ANCH.) The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install one deep trench and 1 500-gallon deep-burial HDPE STEP tank to serve the existing 3-bedroom residence. The design is based on the recent test hole conducted on November 8, 2024. No groundwater was observed at test hole excavation or monitoring. The slopes are flat at the proposed upgrade location. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241384, Curtis Townsend, 11/22/24 FIRST WATER CONSULTING T12N R3W SEC 22 LOT 8 N180' DESIGN CALCS: NO WELLS FOUND WITHIN 100' OF PROPOSED SEPTIC SYSTEM. NO MOA RECORDS NO MOA RECORDS Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241384, Curtis Townsend, 11/22/24 FIRST WATER CONSULTING DESIGN DETAILS: T12N R3W SEC 22 LOT 8 N180' Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241384, Curtis Townsend, 11/22/24 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 FirstWaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: T12N R3W SEC22 L8 N180’ – 10833 OUR ROAD ON O’MALLEY PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 11/15/2024 DEPTH FEET OG SOILS 1 ORG/OL/FILL 2 3 4 5 6 7 8 GM 9 10 11 12 13 14 15 16 17 BOH 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 11/09/24 30 min 6” 2 4/16” 30 min 6” 2 3/16” 30 min 6” 2 3/16” PERCOLATION RATE 13.7 (MIN / INCH) TEST RUN BEWTWEEN 5 & 6 FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 11/15/2024 TESTHOLE # 24-1 DATE PERFORMED: 11/8/2024 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: RUSSEL & KAREN MABRY 11/15/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241384, Curtis Townsend, 11/22/24 O'M ALLEY ROAD 1 T' . 4 N 90a00'00"E 297.00' 0 0 0 ©0 c� cr_ Q Izz 0 0 af 0 �I a a 0 0 0 z LiJ N j N I N 0 0 O z 33 I ANCHORAGE RECORDING DISTRICT, ALASKA AS. -BUILT OF: NORTH 180' BLM LOT 8 T12N R3W Sec22 S.M. ALit.SKA SUItiVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property tis shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than. noted. Under no circumstance shoul4 any information on this drawing be used for construction of fences, stru�,tures, improvements, or for {,,stablishing boundary lines. EX(�LUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do r1ot appear on the recorded subdivision plat. WORK ORDER NUMBER: DAZE: SCALE: E—MAIL NOV 6, 2024 1 "=50' schullerakOgmail.Gom 24--108 DRAWN BY. CHECKED BY GRID NUMBER: BOOK,, A�GEi JLS SW2637 240337 0 = FNI) I " IRON PIPE * = FND 5/8" REBAR .�► oil AMW 0 �� D ''W Ice,491H- .7 / L / ..............................� ••.J HN L. SCHULLER.� 0 % = s, LS--).0408 w �'� - •� R �r • . ' ' •� - ' • C 831 Talkeetna Sti,•eet 'C",,6 AW Anchorage, Alaska 99508 o fe a� \-_~."'' (907) 227--1455 office ss.ari •�. :`I.�,`q�"� (907) 274--4992 fax MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name Address ? oo3 /f Ord ??.,%? Township. Range. Section TANKS '~. SE PTIC/z..//~ 7~'' Material [] HOLDING Capacity in gallons No. of Compa~lments / TYPE OF SYSTEM ~[,TRENCH [] BED [] W. DRAIN [] OTHER Depth to pipe bottom from Total depth from original grade original grade 3,~ FT .// Fill added above original grade~, ~"'~ FT Gravel depth beneath pipe '~' ~ Gravel length Gravel width Total absorption area Distance bet wee~l lir~es Number of lines Pipe material / soa~/ SO FT Date Installed WELLS '~PRIVATE [] OTHER ¢ldentifv) Classification (A,B,C) Total Depth FT Cased [o Installer Date Inslalled: ET DISTANCES WELL LOT LINE FOUNDATION SEPTIC TANK ~),t~ ~- /~'¥ ADSORPTION WELL FIELO AS-BUILT DIAGRAM (Show location of well. septic system, property lines, foundation. driveway, water bodies, etc.) cedily that Ibis inspe~ion was pedermed according to all Municipal and Stale guidelin~ in ellecl on this dale: 72-013 (3/85) · M IJ N I C I P A I_ I T Y 0 F' A . , H 0 R A G E Department oF Healt. h .*., Human 825 L. c).~ .,~ .... ~-, e¢.C, Ancherage, Alaska 9950~ 0 N - S I T E S IF. W E R P E R M I T F'ermi'L Number: 8~3()1,?.9 Date Issued~ :7/2.':/88 Upgrade Engineer Designed Owner Acldr e. ss: Par. cel Id: Lot L. egal: AI_L. I ANtE BANK P.O. BOX 99003 ANC'H[]RAGE, AK 99509-90():3 015- 141-"6~: Subdivision: fflE]-EB & BOUND8 L.ot: N180' ~8 BlO'~k~ ~Section: 2R Towe~h~p: 54000 (sq. Ft.. or acres) This Per'mit: 3 To'Lal Capacity: 3 Day F:'hone: &]]58-789() · E:.PllC TANK: Minimum total septic tank capacity: 1,000 c]allons. Each septic tank mus-;t, have at ].east,:'".' .... compa, ptments:,, Depth to top o~' ~e..._~. requiPes insulation oveP t. ank (s) INFORM D.H.H.S,, PFI]:OR TO :LST & 2ND INSPECTIONS BY ENGINEER. AF'I"ER OFFICE HOURS, CALL 343-4681 AND LEAVE A MESSAGE. CONSTRUCT PER ENGINEERS ATTACHED AF)PROVED DESIGN. 'I"FIIS PERMIT EXF'IRES 12~./:31/88.. THIS F'IERMIT V¢~LID FOR A SINGLE FAMILY RESIDENCE ONLY. I F I CERTIF:'Y ]"HAT: 1,, I am familiar wit. h 'Il. he pequirements for on-.site sewers and wells as set Forth by the Municipality of Anchorage (MOA) and the State eF A].aska. 2. I ~ill :i. nst. a].l t. he syst. em in accordance with all MOA codes and Peguiations, and in compliance with t. he design c:r'iteria of this per. mit. 3,. I will adher'e to all MOA and State o¢ Alaska requirementr~ Fop t. he ~e't:. back distances Fpom any existing well, wastewaten disposal syst. em or public sewemage system en thie or any adjac:ent er nearby lot, 4. I unders't, ar~d that this permi'L is valid ~'or a maximum oF 3 bedrooms,, a].~se understand that the capacity c)~ the tot. al syet. em i[~ 3 bedroems and any enla,'~7-rL wi ],}~ an additional permit,, Tom Fink, Mayor unicipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 July 28, 1988 Leroy C. Reid, P.E. Alaska Environmental Control Services, Inc. 1200 West 33 Avenue, Suite B Anchorage, Alaska 99503 Subject: Waiver Request for T12N R3W Section 22 N180' Waiver Request ~WR88-03~, Permit #880129 Lot 8 Dear Mr. Reid: Your request for waiver of the required 100 foot separation of a septic system to a private well has been approved. The approved separation distance is 95.5 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, aniel J. Roth Civil Engineer On-site Services DJR/ljw#6 ALASKA nuIRonm I TAL CONTROL S RUIC S, ~nqineerinq ~- ~auironmenlnl $ludies inc. July 12, 1988 Municipality of Auchorage Department of ttealth & Human Service 825 L Street Anchorage, AK. 99503 Attn: Dan Roth Re: N 180' Lot 8, T12N, RSW, Section 22 The subject lot w~ll be apgrading its sewer system (See attached design) with a Health Authority Application fo]lowing. The well on this lot is 95.5 feet from the neighbor sewer standpipe to the seuth. This sewer system was iastalled approximately 1964 and is undocumented. Type and size is unknown. The subject well was drilled 8/15/77 and is 176 feet deep and cased to 163 feet. Water samples taken 6/17/88 are satisfactory. The well is slightly downs]ope from the standpipe. A well flow test has not yet been done. The well log shows static level at 131 feet, We feel that this distance does not pose a threat of coutamination to the well. We request that you .~rant a waiver of 95.5 feet from well to neighbor sewer sys tern. If you have any questions, please call. Sincerely, Alan C. Wien Engineering Technician 1200 [Uesl 33r~ Auenue. Suile ~ .Anchoro(~e, Aloskn 99503.(907) 561-5040 PERFORMED FOR: Munlmpality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICI~ 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Township, Range, Section: 7- 8- 9= 13- 14- 15- 16- 17- 18- 19- 20- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? SLOPE SITE PLAN Depth to Water ADer MenDerinD? p/L'/ Dale: Gross Net Depth to Net Heading Date Time Time Water Drop v. ( ~lvf- d4 ( ,b?- ,fb ,/3 >. ) /lY~- I~ ) ' ,6~-, ~6 , I~ COMMENTS ~'~ 2"~'/~- ,/,~" 'T~ PERFORMED SV: //-' ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON :i-HIS DATE. DATE: PERCOLATION RATE ~O,~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~' ~. FT AND ? FT ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue. Suite El ANCHORAGE. ALASKA 99503 (907) 561-5040 CALCULATED BY /~r ~/~/t/~ DATF I I I ( I i I I I I I I I I i ! 0 O0 0 0° U H ~MUNICIPALITY OF ANCHORAG~x~ Hca ch and Environmental Prote ion Fourth Floor West 825 L Street Anchorage, Alaska 99501 279-2511, x 224, 225 SEPTIC TANK: DISTANCE FROM WELL_. INSIDE LENGTH MANUFACTU RE R _~~L''- INSIDE WIDTH MATERIAL _ LIQUID DEPTH _ _ NUMBER OF COMPARTMENTS LIQUID CAPACITY . GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL ~ of Lines ABSORPTION AREA FOUNDATION __ DISTANCE BETWEEN LINES SQ. FT. LENGTH OF EACH LINE DEPTIh TOP OF TILE TO FINISII GRADE_ TOTAL LENGTH ~'7 NEAREST LOT LINE __OF LINE TRENCH WIDTHS/FIN. ' TOTAL EFFECTIVE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE SEEPAGE PIT: Log Crib Rings BUILDING FOUNDATION_ Db",METER . _ OR WIDTH --, LENGTH--, DEPTH Crib Size: DIAMETER___DEPTH'_ DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE . ABSORPTION AREA (WALL AREA) SQ. FT. Well Class: Depth: Well Distance To: Lot Line Bldg: Sewer Line: __ Pipe Materials: # of Bedrooms: Installer: Remarks: DATE~--/~'h'h A~ROVEO PE~T NO. RPPLICFINT LOCBTION LEGRL DEF'RRTMENT HERLTH FIN[:, Eh'-'IRON"IENTRI_ ~:CFI"ECTION '- 825 '"L'"' STREET., FINCHORRGE, BK. E,~... H Z GHT O~R R [:h.-" Cr" M~ L. L E "r' POR LB SEC 22 Ti2N R]:W LOT SIZE 54089 SQURRE FEET 'T'¢PE OF SOIL_ RBSORBTION SYSTEM IS: TREt',ICH f'IFIXIMIJM NUMBER OF BEDROOMS = 2: SOIL RFI]'ING (Si.7.! FT2BR)= ]:00 THE RE(;!UIRE[:, SIZE OF "rile SOIL. RBSORPTtON S'gSTEM IS: iEi:. E F'-]- ~-~=-= ~_~ L_ E ~'-.~ ~3 T F-~ = 57" ~]~ F-: ,R "..-" EZ IL [:.EF"TH;= :L:: THE LENG]"H DIMENSION IS THE LENGTH (I~4 FEET) OF THE TRENCH OR [.',RRtNP~'IELD. THE DEPTH OF' FI TRENCH OR PIT IS THE DISTFINCE BET~4EEN THE SURFRC'E OF THE GROUND FIND THE BOTTOM OF THE E',:.:',CFIVRTION (IN FEET). THERE IS NO SErf. 1.4I[:,TH FOR TRENCHES. THE GRR',,,'EL DEPTH IS THE MINIMUM DEPTH OF GRR',,,'EL BETWEEN THE OUTPFILL PIPE FIND THE BOTTOM OF THE E,'-".;CFI',/RTION (IN FEET). F' ~'~ C: IK f~ ,3 EE F' L. R ['-,~ ]" F--C'.E .fZ-~ El ][ ~-;-': E [:, / EITHER FI CLFISS I OR II NSF FIPPROVED PLRNT btF. l'.r' BE tNSTFILLED. Fi CONTINUOIJS MFiINTENFINCE RGREEMENT I~ REQUIRE[:,. IF FI MFIINTENFINCE FiGREEf,IENT I'.E; NOT KEPT CURRENT '¢OU MFI'¢ BE REQUIRE[:, TO ENI...FiRGE 'THE SOIl. FIBSORPTION S'gSTEM FIND,.'OR "r'OU MFI"r' BE SUBJECT TO PROSECUTION. 81=IC'KFIL. LING OF RNY S"¢STEM 1.4ITHOIJT FINFIL INSPECTION FINL':, RPPROVFIL B"r' THIS [:,EPFIR-f'MENT WILL BE SUB.'fECT TO PROSECUTION. MINIMUM DISTRHCE BETWEEN R WELL AND RNY ON-SITE SEWFIGE DISPOSRL. SYSTEM IS aL00 FEET FOR R F'RIVBTE WELL OR 200 FEET FOR R PUBLIC WELL WELL LOGS FIRE REQUIRED RND MUST BE RETLIRNED ]'0 THE DEPRRTMENT WITHIN ];0 DR'CS OF' THE WELL CBMF'LETION. SF'ECIFICFI'TIBNS I=IND CONSTRUCTION DIRGRFIMS RRE RVRIL. RBL. E TO INSURE PROPER I NS-FFILI_FIT I ON. t CERTIF'¢ THRT aL: I F4M FFiHILtRR WITH THE REQUIREMENTS FOR ON-SITE :E, EWERS FIN[:, 1.4EL..L_S FIS SET FORTH B'9 THE MUNIBIPFILIT'¢ BF FINCHBRRGE. ;-]:: I' WILL INSrf'FILL THE S'gSTEM IN RCCORDFINCE WITH THE CODES. 2:: I UNDERSTRNC, rf'HFIT THE OH-SITE SEWER S"r'STEM MFIV REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMO[[:'ELED TO INCLUDE MORE THFIN ]: BE[:'ROOMS. tl- S- 6- 7- '--Xl 0 - 11 lZ- D/'"~lrtment of Health and Environmet I Protection Anchorago, Alaska 09507 ,,-;tmm~l~Wl.~ l IU,;II()I,ATIi)N 'I'I,;ST I'crformed For _eqal escri Th{s form repor~6fi-~Jb6 De') t h Was groNlld water ellCOUFlterod? L vz I ___/]/.0_ ........If yes, at w,~at dt!3th? Readinq ess Time Net Ti.lc ?.~?U[.__to W,9.ter- Percolation rate L{',~ ~:nnut~ ~,Prot)osed installat{oil-: S~epage Pit Drain I'ield YIELL CONSTRUCTION LOD USDS no, ~elt Iocstion: (eddress& )eggl description) ~~ Location sketch or rm~a*ks Static hater level //~f ft. <above, ~.~'~ land surface. Date Finisb el well: ( ~-- screen, perforated, open-hole, other) Describe inferrers and size: Well yield tested by (pumping, bailing, aiF) at /~ 8al/min. fo( ~ hours with /~ / ft. of dra.down from static level. DRILLER'S NATERiAL LOG Depth below land surface in feet __.to --to. to, Qive description of strata penetrated (size of materiel, color, hardness of drilling, and water content) ,z, / £ Sheet Date: Well Information: Ttl.'Depth ~''~Z~L' Depth of Casing "7/-'/''~ Scree~ From To Cesing Size ~ /'' .Screen Dlam Remarks Pump Information: Pump On: WATERWELL - TEST PUMP REPORT Intake DepthL~ ,~ Dump Size //,~-... ,~ Air Line Depth Static Water Level /,.~ ~ AY. Dlecharge '~,'~-- .GPM, Max Drawdown Time .,_.~--~)"~:' ~"~. Date ~_~[~u~Pump Off: ~-~,~"~ Time /~,~, Date WATER PIEZO. FLOW REMARKS TIME WATER PIEZO- FLOW REMARKS TIME LEVEL TUBE GPM .EVEL TUBE GPM ./ 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 OSC251019 Parcel ID 015-521-01 Expiration Date: t u v Legal description T12N R3W SEC 22 LT 8 N180' Site address 10833 OUR RD Current property owner(s) MABRY RUSSEL B & KAREN L X The On -site system(s) is/are approved for 3 bedrooms 0 Conditional approval for bedrooms, with the following stipulations: Comments or conditions: Original Certificate Date: 1 /29/2025 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 Service 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 submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-521-01 Complete legal description T12N R3W SEC 22 LOT 8 N180' Location (site address) 10833 OUR ROAD ANCHORAGE, ALASKA 99507 Current property owner(s) RUSSEL & KAREN MABRY Day phone 2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: Z Private Well F] Private Well serving 2 dwelling units R Private Well serving 3+ dwelling units R Community Well or Public F-1 Water Storage 4. TYPE OF WASTEWATER DISPOSAL: Z Private Septic 0 Private Septic serving 2 dwelling units R Holding Tank R Community Septic or Public Sewer 5. SEPTIC TANK: El Steel Z Plastic R Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: F-1 AWWTS 0 Bed Z Deep Trench R Wide Trench El Seepage Pit Waiver request for: To well to undocumented adiacent crib — see attached Distance: Expedited review requested: R 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 $ ��C) Date of Payment COSA # 05C, 267 /0 1 19 Waiver Fee $ 11 g 0 Date of Payment Waiver# 0 5 \/ i 100 L. COSA Application.doc COSA Checklist Legal Description: T12N R3W SEC 22 LOT 8 N180' Parcel ID: 015-521-01 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 8/11/1977 Total depth 176 ft Cased to 163 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 10/24/24 Static water level at beginning of test 130 ft. Comments B. TANK DATA Measured operating fluid level in septic tank NA Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: Which system tested (date installed) NEW ® ALL standpipes present per record drawing Total measured depth from grade 9_8 ft (max) Measured depth to pipe invert from grade NA ft (min) ® N/A — pressurized field. ® Per record drawings, field is insulated. ® Monitor tubes (MT) go to bottom of effective. (ED) 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) N If yes, enter date Well production at time of test 2.6+ gpm Water storage tank volume None gallons Well disinfected for coliform test? ❑ Yes ® Nc ® Coliform bacteria is Negative Nitrate 0.371 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Fri Collected by Date 10/24/2024 C. LIFT STATION ❑ Required maintenance completed Age of lift station 0 years Lift station material HDPE Comments: Adequacy test date NA - NEW SEPTIC Results ❑ Pass Fluid depth prior to test in Water added gal New fluid depth _ in Elapsed time _ min Final fluid depth in Absorption rate gpd FIELD STATUS — POST RECOVERY - NEW Effective depth (per record drawings) 72 in Effective depth used 0 in Effective depth (ED) remaining 72 in Comments/Deficiencies: Approximate total measured depths from existing grade. COSA Checklist.docx 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' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Holding Tank > 100' ® Yes if No ft KI ft Neighboring Absorption Fields > 100' Animal Containment> 50' ® Yes if No ft ❑ Yes if No *85+ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes 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' ❑ Yes if No **8.5+ ft Surface Water > 100' ® Yes if No ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS ® Yes if No ft ® Yes if No ft ® Yes if No ft ® Yes if No ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' ® Yes if No ft ® Yes if No ft If tank or field is under driveway comment below *See attached amended Waiver WR#88-036 submittal request. **See attached docs — outside soil bearing prism, 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 FIRST WATER CONSULTING Phone 907-350-9566 Engineer's Printed Name CURTIS HUFFMAN PE Date 1/28/2025 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well 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, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & F1'l S TH ` Curtis Huffman CE 128991 1/28/25 «'+ COSA Checklist.docx MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ~ ' ' Business (b)" Property,Owner/{z~/"'~:~z~' J~,,'~r/J,~- Telephone: Home (~) . Le, nding Institution ,. : Mailing Address', Telephone (d) Real Estate Cq[npany and Agent Addres§. ,'-'; Telephone (e) Mail the HAA to the followin(] address: or: Check here~, if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single-Family'~ Number of Bedrooms WATER SUPPLY Individual Well~ Community [] Public [] Note: tf community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite'~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/861 Front .ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functionaJ 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address /¢Z~ Date DHHS APPROVAL Approved for ~bedrooms by Approved ~/~'~.~__ Disapproved Terms of Conditional Approval Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a dertificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72 025 fRev 8/861 Back tCUNICIpALtTY OF ANCHOR/NI~NICIPALITY OF ANCHORAGE (MOA) EHVIP. OHMENIAL sERVICES DI"CI~IIJTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 WELL DATA 2 9 1988 RECEIVED Well Classification Well Log PresentGN) Total Depth ~ /?O! Casedto~c' /,~¢i Static Water LeveJ ~ /'3~' · 264-4720 Legal Description: Casing Height Above Ground Electrical Wiring in Conduit~N) Separation Distances from Well: To Septic/Holding Tank on Lot ~/~//~*' If A, B, C, D.E.C. Approved (Y/N) Date Completed '¢~-/"¢~ ?¢' Yield "~ ¢'~"' ~/~ Depth of Grouting "'J'//¢ PumpSetAt ~ /~'/ Sanitary Seal, on Casing~N) Depression Around Wellhead (Y~ /¢¢ t,"r ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot _ //~" ; On Adjoining Lots To Nearest. Public Sewer Line ///"~ To Nearest Public Sewer Cleanout/Manhole '¢///¢ To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments "~ Date Installed StandpipesON) Depression over Tank (Y ~(..~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line ' :TO Waten~ain/Service Line SEPTIC/HOLDING TANK DATA Size ' /~ No. of Compadments ~¢¢ ~ ~/~¢ Air-tight Caps~N) Foundation Cleanout (Y~ Date Last Pu,mped ~'*/~ ~ /~ ~/~ ;for ~/~ Temporaw Holdin~ Tank ~ermit (Y/~) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage 72-02601/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y~). Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well //,~ / To Building Foundation ~"~'~' Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments' Type of System Design Length of Field ~-'"-~D.-- Depth of Field // Gravel Bed Thickness '~, ~ Standpipes Presen~)q) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions d Manhole/AccessiON) "Pump Off" Level at Ventt~f4) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I.,~/~he~d~,~e~f. ie~d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed g.,¢_..¢.;_._~... ~..4.j~...~-~ Date ,~'~"'~"~' Company ,'~'~ MOA No, Receipt No.. ¢~F¢/'~) Date of Payment Amount: Page 2 of 2 72-026 (11184) ~ ~" ~ , Date Rece ~1: Time ~ - - Da~e 11-23-77 Wednesday Date //~ pg Date Insp Buchholz Insp~~~~o Insp Meet Buck here - REQUEST POR APPROVAL OF INDIVIDUAl, SEWER AND WATER ~ACILITtES Lending Institution Request: Alaska Mutual Savi__n_gs Bank Mailing Address: 601 West 5th Avenue 99501 Phone: 274-3561 349-3494 2 o Property Owner: Mailing Address: Buck Hight Phone: Star Route A Box 1586C 99507 3. Legal Description: T12N R3W Section 22 Lot 8 Single Family Residence: (x) Number of Bedrooms: Three Multiple Family Residence: ( ) Number of Bedrooms: Well System: Permit ~ 7~ 7A Dep'hh of Well Construction ___~ Individual Well (x) Community/Public System ( ) 167' Well Log on- File Bacterial Analysis Sewage Disposal System: On-site System (~ Public utility ( ) Permit # _2_?~ 7~_~--- Installed. __1~923___ Znstailer ~ ~ Septic Tank Size ~ ~ Manufacturer __~~ Distances: Well to Septic Tank __1'~0 to Sewer Line Nearesh Lot line to Absorption Area qO ~ Absorption Area to Nearest Lot Line , A/j