HomeMy WebLinkAboutT12N R3W SEC 23 SW4SE4NW4SE4 PTN PARCEL 8A
' Municipality of Anchorage Page i 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
Name: ~ Wastewater System: ~ New ~ Upgrade
Address:
~,~8,~-~'~-~ A~o~.~, h~ ~,~ ABSORPTION FIELD
Phone: ,~ . ~J'~ ~No. of Bedrooms~ ~ Deep Trench ~ShallowTrench ~Bed ~Mound ~Other
LEGAL DESCRIPTION so]~.~],~: ~''~ GPD/Sq. Ft. Total Depth from ~i~al grade:
Township: I Range: I Section: Fill added above original grade~ Gravel length:
WELL: ~r~,~ New Q Upgrade Grave, widm: ~ ; Number~flines: lDis[ancebetweenlines:
Classification (Private, A,B,C): Total Depth: ~ Total absorption area: Pipe material:
Driller: ~ed: StaticWater Levek Instal]er: Date installed:
SEPARATION DISTANCES ~'Se.~ ~ Holding ~ S.T.E.P.
TO Septic Absorption Lift Holding =ublic/Privat~ Manufacturer: Capacity in gallons:
From Tank Field Station Taok Sewer'Lines ~ ~&~ ~ ~[~ ~00
~ ~ Material: Number of Compadments:
Water ~OI+ ~oo+ - _ ~ LIFT STATION
Foundation ~ .]~ ~ ~l~ -- -- -- "Pa mp:o." level ~~[ at: I High water alarm at:
Cu~ain Pu~de[ I Electrica[Inspections pedormed by:
Remarks: 'TR~cv k~r~ ~c~J) BENCH MARK
Location and Description:
Department of Heal~ and ~uman Se~ices approval '~' ~; ~, ~,~,.~,~ .,.,.~...::,.:.:; ,~:;~,.,,, "~'~ ~ .-
72-013 (Rev. 9/91) MOA 25
Permit No.
SW960259 2 2
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
SW4, SE4, NW4, $E4, T12N, RSW, SEC. 25
Legal Description:
015-231-15
PID No.:
GRADt
CO1
COg
MT
B
39.5'
40.5'
87.5'
95.5' NEW TRENI
97.0' /
103.5'
SEP lC TANK
80.1'
m#2&
SITE
N
CO1 & C02
MT1 &
NO FOUND
69.3'
ST1 ST2
ROBERT C,
72-O13 A (Rev. 9/91) MOA 25
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM
PERMIT NUMBER:SW960239
DESIGN ENGINEER:S & S ENGINEERING
OWiNER NAME:COUGHLAN VIRGINIA N
OWNER ADDRESS:il950 COUGHLAN WAY
ANCHORAGE, ALASKA 99516
PAGE 1 OF 1
(UPGRADE) PERMIT ~2/- ~
DATE ISSUED: 8/08/96
EXPIRATION DATE: 8/08/97
PARCEL ID:01523113
LEGAL DESCRIPTION:
T12N R3W SEC 23 SW4SE4AUN4SE4 PTN
LOT SIZE: 78705 (SQ. FT.)
NUMBER OF BEDROOMS: ~ THIS PERMIT:
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80) .
3. THE 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:
RECEIVED BY: ///'~ DATE:
ROBERTC. COWAN, RE.
ROBERTA. SHAFER, RE.
CIVIL ENGINEERS
(907) 694-2979
July 24, 1996 FAX(907)694-1211
SEWER&WATER
INSPECTION
ENGINEER]NGSTUOIES
AND REPORTS
WELL INSPECTION
& FLOWTEST
ROAD OESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: Virginia Coughlan Tract SE 1/4,
Request you issue a permit to upgrade the
serving the existing two bedroom house on
property.
Sec. 231T12N, R3W
septic system
the referenced
Test holes were excavated and percolation tests performed
in the areas of the proposed upgrade. The approximate
location of the test holes is located on the attached site
plan.
encountered and
it was found to
At the time of excavation water was not
after seven days ground water monitoring,
be dry.
Attached is the proposed upgrade design.
We do not anticipate any adverse effects on neighboring
wells, septic systems or drainage patterns by the
installation of the proposed septic system.
The proposed 1000 gallon septic tank is to be placed
outside the well protective radius. Attached is a site
plan which depicts the location of the proposed tank.
If you require additional information, please contact us.
Sincerely,
Robert C. Cowan,
EncloSure
ON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER. ALASKA 99577
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
Township, Range, Section:
1
2
3-
4-
5-
7
8
9-
10-
11
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
TEs~-
SLOPE
WAS GROUND WATER
ENCOUNTERED?
L
IF YES, AT WHAT ~ O
DEPTH? p
Depth to Water After
Monitoring?
E
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
711,/o(, G', 17 -- -t 'Is,,,
PERCOLATION RATE .
TEST RUN BETWEEN .
(minutes/inch) PERC HOLE DIAMETER __
PERFORMED BY: ........... L J~'2..~./~ ,~_ ~"1~/'~,..--- CERTIFY THA~ THiS TEST WAS PERFORMED IN
ACCORDANCE WIT~Xe~F~L GUIDELINES IN EFFECT ON THIS DATE. DATE: ? / ~ / ~j G
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
Township, Range, Section:
1
2
3-
4-
5
6-
7
8
g,
10 ,
11
13-
14-
15-
16-
17-
18-
19-
20-
h'lL
2, ~.,'l,,tv¢ L
WAS GROUND WATER D~ V
ENCOUNTERED?
S
L
IF YES, AT WHAT ~ O
DEPTH? P
E
Depth to Water After _
Monitorin6? OP.-¥ .
SLOPE SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
7/f,/'l ~, / G;¥~' - ~ ~-/,t ,, -
G'.~ ~'/~ -
PERCOLATION RATE ! 3,JJ~ (minutes/inch). PERC HOLE DIAMETER
TEST RUN BETWEEN '7 FT AND ~' FT
COMMENTS
PERFORMED B,: : -~!"?"~ , CERT,~¥ T,^, T,,$ TEST WAS "EBFOR'ED 'N
e,.~ ~agm ~lver C~p Road No. ~.,: .....
ACCORDANCE WITH ~g~b~GU~DELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
ROBERTC. COWAN, RE.
ROBERT A. SHAFER, RE.
SEWER&WATER
MAIN EXTENSIONS
SEWER&WATER
INSPECTION
ENGINEERING STUOIES
AND REPORTS
WELL INSPECTION
& FLOWTEST
ROAD DESIGN
SOILTEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
EFERENCE:
~ENERAL:
1.
3e
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
Virginia Coughlan Tract SE 1/4, Sec. 231T12N~R3W
July 24, 1996
The scope of this project includes the installation of
a 1000 gallon septic tank and a leachfield trench to
serve the proposed two bedroom residence located on
the referenced property. The existing cesspool is to
be abandoned in place.
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.
~EPTIC TANK INSTALLATION:
A septic tank is to be constructed by a certified
septic tank manufacturer. Construction shall include
two 4" cleanouts for pumping access.
e
The septic tank shall be sufficiently bedded to
prevent settling or shifting of the tank.
3. 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
Virginia Coughlan Tract SE 1/4, Sec.
'July 24, 1996
23~T12N%R3W
6e
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
' d
tank). These cleanouts shall be located on undlsturbe
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:
1. Excavate the proposed trench to the dimensions shown on the
design. The bottom of the excavation shall be within 2
inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed-up) before
gravel (sewer rock) placement.
2. 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.
3. A silt barrier must be installed between the final gravel
layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
4. 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
Virginia Coughlan Tract SE 1/4, Sec.
July 24,
5e
23,T12N~R3W
1996
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 aawer 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 the Municipality of Anchorage:
Type of PiRie
Perforated Solid
e
0
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 leachfle-d
gravel layer and the native soil backfill.
Ail leachfield gravel (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
Virginia Coughlan Tract SE 1/4, Sec.
July 24, 1996
231T12N~R3W
INSPECTION$~
Typically there will be a minimum of three (3) inspections
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.
2e
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, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre-construction
meeting will take place on-site. The inspecting engineer will
not coordinate, direct or control in any way the 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
Virginia Coughlan Tract SE
July 24, 1996
1/4, Sec. 23~T12N;R3W
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
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 015-231-13
1. GENERAL INFORMATION:
Expiration Date: 3-,-,7 2-d2-(
Complete legal description T12N R3W SECTION 23 SW4SE4NW4SE4 PTN PARCEL 8A
Location (site address) 11950 Coughlin Way *Anchorage 99516
Current Property owner(s) Barbara Kelly Day phone 619-890-1851
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
1 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
1
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
X
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver/Variance request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 660 CO V I O Waiver Fee $
Date of Payment
Receipt Number
Date of Payment
Receipt Number
COSA # 0_':�L2U 16,6.E Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: t'Z /I z o
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 datels 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
system/s; 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.
6. DSD om= SIGNATURE
System #1 Approved for ( bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the
K__
?�iTY(op CC884
ATERA
. rE
WASTE "?AA0 rn�^ ^
ttlpu�a�AA4 R
x`1(0
Original Certificate Date:—L-2 2 2 -ZO
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 Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other c—Ta,. - A0(vf4t`ury
COSA Checklist
Legal Description: T12N, R3W, SECTION 23, SW4SE4NW4SE4, PTN PARCEL 8A parcel ID: 015-231-13
If more than 1 septic system on lot: COSA Checklist # of,
Structure served by this system
A. WELL DATA
Y 7
OR Well log is filed with Onsite (or attached)
Well production at time of test 6+ gpm
Date drilled &&59(7)�r,
Water storage tank volume NIA gallons
Total depth * 72(?) ft
Well disinfected for coliform test? ❑ Yes ❑ No
Cased to UNKNOWN ft
01 Coliform bacteria is Negative
❑ Sanitary seal is functioning correctlysNitrate
0.970 m /L E] Nitrate less than MRL (ND)
❑ Wires are properly protected
ci ��a ,i
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Casing height above round 12+ in.
9 9 ( ground)
s u\(
Collected by GEG, LTD. & AWPS
Date of flow test for COSA ""8/20
j
Date of Sample "113120 ,v,srzos 1112312°
Static water level at beginning of test 21.1
ft.
Comments *See attached well log r� pp
;� �z,F ; �, Wr�LL Lo 6 Fvq—I—J 19(1-o Pe
ox
B. TANK DATA
Age of tank(s) 24 years
Tank type/material UPTICISTEE
Measured operating fluid level in septic tank 49
❑ Standpipes/foundation cleanout per record drawing
Date of pumping 11/30/20
D. ABSORPTION FIELD DATA SHALLOW TRENCH
Which system tested (date installed) 9114196
0 ALL standpipes present per record drawing
Total measured depth from grade *4.33 ft (max)
Measured depth to pipe invert from grade 3.6 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
G. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments: N/A
Adequacy test date 1107/20
Results P- Pass For _
Fluid depth prior to test 0
Water added 517 gal
New depth 3 in
Elapsed time 135 min
ON Code -required soil cover over field
Final fluid depth 0 in
❑ System presoaked Absorption rate 150+ gpd
_ bedrooms
in
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE
date of test) N/A
Gallons introduced "`2042 gallons If yes, enter date
Com meets/Deficiencies: 'Ar MT "WEST MT APPROXIMATELY 1 INCH SHORT "'PRE-SOAKED ON 1106/2° ""SYSTEM SIZED FOR 3 BEDROOMS
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 1001
Community Sewer Manhole/Cleanout > 100'
[✓ Yes
if No ft
V Yes if No
if
ft
Neighboring Tank > 100' [�✓ Yes
if No ft
Private �
Line > 25' [�]✓ Yes
if No
ft
Absorption Field on Lot > 100' []✓ Yes
if No ft
Holding Tank > 100' � Yes if
Neighboring Absorption Fields > 100'
No
ft
� Yes
if No ft
Animal Containment > 50' ✓Yes if No
—
ft
Community Sewer Main > 75' [✓ Yes
if Na ft
Manure/Animal Excreta Storage > 100'
❑✓ Yes if No
ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' (-✓ Yes
if No ft
Surface Water > 100 ' Yes if
Property Line > 5' ✓1 Yes
if No ft
— No
Wells on Adjacent Lots:
ft
Absorption Field > 5' ❑ Yes
if No Unk ft
Private Wells > 100'
_ [✓� Yes if No
ft
Water Main > 10' Yes
if No ft
Community Wells > 200' f7l Yes if No
ft
Water Service Line > 10' Q Yes
if No ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' 0 Yes
if No ft
If absorption field is under driveway comment below
Property Line > 10' Yes
if No ft
Wells on Adjacent Lots:
Water Main > 10'✓1 Yes
if No ft
Private Wells > 100'[]✓ Yes if No
,
Water Service Line > 10' ® Yes
if No ft
Community Wells > 200'[]✓ Yes if No
rt
Surface Water > 100' FV1 Yes
if No ft
F. ENGINEER'S COMMENTS
From where the sewer line exits the house. GEG did not verify separation to interior sewer lines.
G. ENGINEER'S CERTIFICATION
l certify that I have determined through field inspections and review
or Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
OF
01TH
�0
.Jetr� y A. 'Gorness 'p.
CE -7953 G
s� tit l -n
4� \.,�
f essioo`—'
#AECCB$4
DEVELOPMENT SERVICES DEPARTMENT
On -Site Water and Wastewater Section
uni.org/onsite
Septic 'Tank Advisory
Certificate of On -Site Systems Approval #OSC 201666
Subdivision: T12NR3W Sec 23 SW4SE4NW4SE4PTN8A
907-343-7904
Fax: 343-7997
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 24 years old. Typical replacement costs range from $8,000 to $11,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of what the metal of a 20 year old steel tank MAY look like.
; Ma�lmg Address P O Box 196650: Anchorage, Alaska 99519 6650 *www muni org
STATE OF ALASKA 143
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING, LAND & WATER
Alaska Hydrologic Survey
WATER WELL LOG Revised 08/13/2016
Drilling Started: 1 I completed: b / s / -1 b0 Fump Insialr. I /
City/Borough
Subdivision
Block
Lot
Property Owner Name & Address
Anchorage
AUDUBON HILLS
VIRGINIAN CQ U G H LAN ,
Well location: Latitude Longitude
Meridian S Township 012N Range 003W Section 23 , SW 1/4 of SE 1/4 of NW 1/4 of SE 1/4
BOREHOLE DATA: (from ground surface)
Drilling method: it rotary, able tool,QOther
Suggest T.M. Hanna's hydrogeologic classification system'
Well use:OPublic supply, ❑Domestic, QReinjection,OHydrofracking
littps:lliny.ngwa.org/NC Product?id=a 185000000BYub3AAD
❑C ommercial,-Observation/Monitoring,QTest/Exploratory,Cooling,
❑irrigation/Agriculture,OGrounding,E]Recharge/Aquifer Storage,
❑ Heating, [:]Geothermal Exploration,lOther
Fluids used:
Depth
From To
brown clay
0.0 18.0
clay and gravel
8.0 60.0
Depth of hole: 72 ft Casing stickup: ft
Casing type: Casing thickness: inches
heaving sand and water
60.0 72.0
Casing diameter: inches Casing depth: ft
Liner type: Depth: ft Diameter: inches
Note:
Well intake opening type: Open end, Open hole, ` Other
Screen type; , Screen mesh size:
Screen start: ft, Screen stop: ft, Perforated[ -]Yes 0 No
Perforation description: Perf from: ft, Perf
to: ft, Perf from: ft, Perf to: ft
Gravel packedQYes ❑No Gravel start: ft , Gravel stop: ft
Note:
Static water (from top of casing): ft on_/ / Artesian well
Pumping level & yield: feet after hours at gpm
Method of testing:
Development method: Duration:
Recovery rate: gpm
Grout type: Volume
Depth: From ft, To it
Include description or sketch of well location (include road names,
buildings, etc.):
Final pump intake depth: ft Model:
Pump size: hp Brand name:
Was well disinfected upon completion? U Yes D No
Method of disinfection:
Was water quality tested?❑Yes F�No
Water quality parameters tested:
Welldriller name: ..................................................................................
Company name: MCINROY DRILLING
Mailingaddress: ....................................................................................
T
City: State: AK Zip:
Phone number: ( )
AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a
copy of the well log be submitted to the Department of Natural
Driller's signature:
Resources within 45 days of well completion. Well logs may
be submitted using the online well log reporting system
available at:
Date: / I
Anchorage Municipal Code 15.55.060(1) and North Pole Ordinance 13.32.030(D) require
that a copy of this well log be submitted to the Development Services Department/City
https://dnr.alaska.gov/welts/
within 30 days of well completion.
OR email electronic well logs to
City Permit Number:
Date of Issue: ! /
dnr.water.reports (a)alaska.gov
Parcel Identification Number:
Water Well Boreholes by Thomas M. Hanna NGWA Press
-Q Virgina (Norstroi.)
urilling .72 foot of 6" hole ,,10.00 per foot total v 720.00
.p�Gi.o o�.2SC-s''C�fi-U`l •- •' : � j i -
y / 4
+•n ` y..t'iw McInroy
Log of well for Virgins. Norstrom
0 to 8 feet nrown clay
8 to 60 feet Olay and gravel
60 to 72 meet heaving nand ;nater
Pumped at the rate of 7 gallon per minute from a
¢5
depth of 45 foot water cleared up good. cell
cased with heavy six inch pf steel pipe.
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