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HomeMy WebLinkAboutT12N R3W SEC 21 LT 32AOnsite File ~GR, 'TEE ANCHORAGE AREA BO' ~UGH ~.~ ' Department of Environmental Quality ' ~ 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: N E ~b0~'¢~K'~7 DISTA C~,~' ,),.. -~ FROM WELL ~ MANUFACTURER INSIDE LENGTH INSIDE WIDTH NUMBER OF ¢~ MAT E R IALgl~ ¢¢//~'L/3 ~ / COMPARTMENTS ~ /¢00 LIQUID DEPTH LIQUID CAPACITY GALLONS. SEEPAGE P,T: NUMBER OF PITS / DIAMETER OR WIDTH LINING MATERIA SIZE: DIAMETER__ ADDITIONAL ABSORPTION LENGTH DEPTH L~ DEPTH DISTANCE FROM: WELL)L]°~--¢-~ . ABSORPTION AREA (WALL AREA ~ S(~. FT. / WELL: TYPE CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION_ LOT LINE SEWER LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM D ISTANC ES: DIAGRAM OF SYSTEM Form No. EQ-031 I GREATE~R ANCHORAGE AREA BOR~,0GH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE~ ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO.. MAILING ADDRESS PHONE INSTALLATION Of: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED P~NANCED THROUGH SOIL TEST RESULTS SEEPAGE PIT-- ~~DRAIN FIELD TOSE'NSTALLEDS OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL. TESI' COMPLETION DATE ANTICIPATED / ~ ''~ '-2 FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK-- ~ TO RIVER, LAKE. STREAM. fOUNDATiON TO SEEPAGE Pit. ~ , DRAin FIELD /~-~ SEPTIC TANK TO SEEPAGE Pit WALL J~ TO NEAREST LOT LINE. Drain FIELD /~J~ / , ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK //Q / SEEPAGE PIT /'~ DRAIN field /Q SEPTIC TANK, ~'~/ , SEEPAGE PIt /~)/ , DRAIN FIELD ~ GRAVEL baCKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE FORM NO. E(~-016 ALASKA ENVIRONMENTAL CONTROL SERVICE~--,.INC. 1200 West 33rd Avenue. ,uite B ANCHORAGE. ALASKA 99503 (907) 561-5040 SHEET NO. OF DATE M-W DRILLING, Inc. O. Box 4-1728 · 2811 Dawson A C 907~279-I741 ANCHORAGE, ALASKA. 99509 DRILLING LOG Well Owner Mec~s . Use of Well Dom Location (address of: Township, Range, Section, ff ]mov~n; or distance main road L52A, Sec 21, T. lZq, R$.W Size of casing 6 Depth of Hole Static water level 162 ft. (~ Screen ( ); Perforated ( Describe screen or perforation Well pumping test at ~0 gallons per (li~iKi~) of drawdown from static level. 200 feet Cased to 198 , feet (below) land surface. Finish of well (check one) open end ( X ). N OhO (minute) for 1 hours with 100% Date of completion 21 July 75 WELL LOG Depth in feet from ground surface Give detni]~ of formations penetrated, size of material, color and hardness Gravel Fill 0 .TO. 1 i TO 3 5 TO l_~ 15 TO '19 19 TO 24 TO 85 85 TO_ 140 '140 .TO 164 164 .TO , 175 !75 TO 184 184 TO 200 .TO .TO .TO .TO Surface Organies Sandy Gravel S~nd Cobble Gravel Clayey Gravel · ~/JL 2 :. ,,.c,e;, '"'-;FED Small Cobble Grav~l: clayey to silty sand matrix Cemented Gravel: occai~ioual.boulders Olay A/A with few small gravel ~eamn 1--CUSTO]~L2t MUNICIPALITY OF ANCHORAGE Development Services Department -f 4 p p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-273-35-000 Expiration Date: 12/18/2023 Legal description T1 2N R3W SEC 21 LT 32A Site address 4143 E 112TH AVE Anchorage AK 99516 Current property owner(s) HERBEN DAVID W & MARIE C XThe On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 9/18/2023 Tdhis 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 Tank Age Advisory Arsenic. Advisory Other COSA ApprovaLJune 2022 �1.1�U1 HMPAUTY OF AHCHORQOE Development Services DepartmentPhone: 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. 015-273-35 Complete legal description T12N R3W Section 21 Lot 32A Location (site address) 4143 E 112th Avenue, Anchorage, AK 99516 Current property owner(s) David & Marie Herben Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: Al 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: Q Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: 0 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 16 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed N 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 $ 5 iJ J Waiver Fee $ Date of Payment Date of Payment COSA # 0,5C 2 3 133 Waiver # COSA Application—June 2022 Legal Description: T1 2N R3W Section 21 Lot 32A Parcel ID: 015-273-35 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 7121173 Total depth 200 ft Cased to 198 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 8/22/23 Static water level at beginning of test 154 ft Comments B. TANK DATA Measured operating fluid level in septic tank 4811 Date of pumping 9/1/23 One Stop Pumping ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 9/12/06 ❑ ALL standpipes present per record drawing Total measured depth from grade 7.7 ft (max) Measured depth to pipe invert from grade 2.6 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ 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 1304 gallons 8/22/23 date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Comments/D COSA Checklist June 2022 Well production at time of test 6.7 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes FOR Nc ❑ Coliform bacteria is Negative Nitrate 1.60 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date 8/15/23 C. LIFT STATION L --r ired maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 8/22/23 Results ❑ Pass Fluid depth prior to test 0 in Water added 1228 gal New fluid depth 11 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate ' 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 63.6 in Effective depth used 0 in Effective depth remaining 63.6 in 5.3'x 41'x 2' field dimensions x 0.4 void space x 7.5 gal/ft3 = 1303.8 gal 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' F0_1 Yes if No ft Fol Yes if No ft Neighboring Tank > 100' n Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No ft Q Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Q 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' 0 Yes if No ft Surface Water > 100' ® Yes if No ft Tank to Property Line > 5' no Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' n Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' E Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS 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 Forge Engineering Engineer's Printed Name COSA Checklist June 2022 Benjamin Schiller, P.E. Phone (907) 522-7773 Date 8/24/23 49 TH Benjar chiller CE 12592 • .�U�`��® tos/ac/e A UUM -•PTS 'MCtl NL 1 'tZ »s 1 C 'KLI -1z 1, YL[ l�rmrs�o-a\�"1'Rs woY or --- - - - - - --- N I it SII Q Nin m -------------- _I y ------------ aR�,w,P�L, - } I � N J � Oa wo z o N Q I I N N I I I I I W o N W m .> 0 W N ZN w Ij Wf— a3 N> U ¢O w0 f�1 m z W O^ QaQ OOWZ N N �zN I N ' I I I mw UZW zN }UW }W > J m CL 8Z2 O z -N� I I I 5' H O CL zz N oo��i �: Nm } m a ow < z NF 3w =Vag w �¢ z F z� OQ ~VIQN U z pN 2w O= Z N O N � W o z 8, Q O U m W ¢ } z = � W W K- WO U J =QZ y w z.=! 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W o N W m Z 0 W 2 wz r` I I 1 - IO- W G N I O I a3 I _ U ¢O w0 f�1 m z W m VF QaQ N N �zN a o ' I � I UZW U W O }UW }W > J m M>O _ a 8Z2 O z -N� I I I 5' H O W� a = x I -�” it SII Nin m -------------- _I y ------------ aR�,w,P�L, - � � - `- Z I I 1' 1 : I I cO i I 1': .. .. L--- I a ri Z I I 1 - IO- W G N I O I II O of II O O I _ I.: O= f�1 m z W I a I 1 I I 3 1 i M I , ' I � I 1N3N3Sv3 .unun ,OL (b) JJOS O96'£4 8Z2 I ( I I I I I I I I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES · DIV, S,ON O. ENV, RONMENTALSERV'OES 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 Descriptioq (include lot, block, subdivision, section, township, range) ,eot''~ ~'.%4;. j""{.~-Yz,~) /73¢-.~_~z~ ~ / Location (afld(ess or direptions) (b). Propedy Owner ~¢1/~ :~.-Z¢~¢ Telephone: Home ~" F~ (c) Lending nstitution Mailing Address' ':., (d) Real Estate Company and Agent Business Address Telephone (e) Telephone Mail the HAA to the followin(~ address: or: Check here i~, if hold for pick up. List contact person and day phone number below. L; ' TYPE OF RESIDENCE Single-Family~' Number of Bedrooms WATER SUPPLY Individual Well'S' Community [] Public [] Note: If 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 I of 2 72-025 fRev 8/86~ Fronl '~JON~ $,JaaU!~UD leUO!SSa~oJd eq~ u! suo!ss!uJo Jo s~o~e ~o,t elq!suodseJ lou s! elbejoLlou¥ ,to ,~],!ledp!unR aM.L 'panss! s! el. eoWpa9 e aJojeq etep eZ~leUe Jo suo!],oedsu! ionpuo3 lou op SHHQ ,to s@e,~oldW3 'sl. ueuJe~inba~ ale,s pue le~apa~ u!elJe3/~,tsBes ol ~epJo u! suoBnl!lsu! 8u!puel J!eL.li pUB seuJoq Jo sJaseLpJnd ol ,~sepnoo e se sit,Ii seop SHHG eq/'e>tsew ,to alelS eqt u! peJels!lbeJ ~aeuCbue leUO!SSe,toJd luepuedepu! ue ~q e^oqe ~] qde~Se~ed u! ua^Cb suo!lelueseJde~ eql uodn /~lUO peseq se~.eowpeo leAoJdd¥ /~lpoqln¥ LWeeH sanss! (SHHG) se3!^JaS uewnH pub LllleeH ,to lUeLU~edaC] @aeJoLpu¥ JO /~l!ledp!unv~ eq/ NOli~¥O le^oJddv leUOB!puoo ,to suJJe/ leUO?4puoo pe^oJddesiC] pe^o~dd¥ Jo,t peAoJdd'¢ 'IVAOHdd~ SHHCl euoqdala/ WELL DATA MUNICIPALITY OP ~NC~CIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICF~I~II~Ilq~AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 JUL 1 5 1987 284-4?20 Legal Description: RECEIVED Well Classification Well Log Present~)N) Total Depth Static Water Level ~ /,EO, Casing Height Above Ground Electrical Wiring in ConduitON) ~'~'"'~--/~(c/f/f'¢/¢~' If A, B, C, D.E.C. Approved (Y/N) Date Completed ~¢~/- ¢.~ Yield Cased to Depth of Grouting Pump Set At Sanitary Seal on Casin~__~'4) Depression Around Wellhead (Y//N)~ Separation Distances from Well: To Septic/Holding Tank on Lot (~r/X TO Nearest Edge of Absorption Field on Lot /°) /O/ ; On Adjoining Lots To Nearest Public Sewer Line /J//4~ To Nearest Public Sewer Cleanout/Manhole /¢//~ To Nearest Sewer Service Line on Lot Water Sample Collected by -/~-~':¢ ./~L. ~¢.~,Z_~.~'/ ; Date Water Sample Test Results B. SEPTIC/HOLDING TANK DATA Date Installed ~" ~'~':~ Size /0~'~ No. of Compartments standpipes ~N) _r 'Ai r-tig ht Ca ps~_.~"~q ) Foundation Cleanout (Yc~N.? Depression over Tank (Y~) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ,tJ/~ ;for / Holding Tank High-Water Alarm (Y/N) xC///-}' Temporary Holding Tank Permit Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property L?ne To Water Main)serVice Line d¢c'~'/'~J~.~7~ tt~ To Building Foundation To Disposal Field Course To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed '~'.' LZ ,' 75 Width of Field /2--'"~/.,,~ / ,/ Square Feet of Absorption Area Depression over Field (Y/~)~')) Results of Last Adequacy""Test / Separation Distance from Absorption Field: / ~t.~/o / 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 Depth of Field Gravel Bed Thickness Standpipes PresentbN) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots '_:~o / To Cutbank (if present) £ 1~ 7'- LIFT STATION '~ ,~/L Dimensions Size in Gallons ~"'""'"'~..~ Manhole/Access (Y/N) "Pump On" Level at '~_~.~.~p Ov:"n ~ ~t High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments P~.~.~_~.g Adequacy Test, Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ~),~ ch.¢c;ked,/erified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~__---~f ~4,.~/~- Date Company /"~:¢ ~' MOA No. E)>? Receipt No. Date of Payment Amount: $ Page 2 of 2 ALASKA el OlROIqm F1TAL COFITROL SE!Ru C S, ~n§i~¢erin§ $ ~nui~onmen1~l $1udies InC. Munic[ps].ity of Ancnorege Departmenil of Hea]i'h & Human Services 825 L S'~reet Anchorage, Alaska 0050~ Re: Lot 32 A, T32N, **'"' o=.-:-. . The :~ui2ject lot contains a 3 bedroom honse served wi2h a p~;ivate well and on-site sewer system. The sewer s~stem, installed July 2, J973, was oi'i~:inaJly instt~iled ~o~' a 2 bedroom house. TL cons.isis of ~ 6 fool deep iolf crib w~th ~ totaJ, area of 324 aquane feet.. The soil ?sting Js 125 sqare feet per. bedroom. fh:ft~ crib was overbuJ!t for 2 bedrooms ).,u~: is shy 5i square feet, or [4%, fan a 3 bedroom home. The septic tank is !,000 saiion capacit.~. 0n 6/25/87, alt ad,e%ro, acy tesh was perfo~'med on [he crib. Ah the si:arb .',)f hhe Les1-, '[he cr]N was probed a_..?~d fou.qd to be 8.2 feet total depth from the surface wit. h 3.6 feet of slza_qd!ng wa'~er in the crib. 667 gallons of wa'~er was introduced into the crib v,;imh a (acm] rise of 0.49 feet. After 80 minutes, ~00 ga.ilons had beex~ ab,'.:orbed. ~,~, -',~ ....... - for a 3 bedPoo.q~ home, 3 bedz'oom '.size ~,,zould require t~.~l ext. t'e~i~e~ sinai] addJtiol~. 8ince~-eiy, Alan C. Wien };nSfJ :4eer J no~ Tech!~ ici alt ~-/Jp ?OVOQ !)¥; 1200 I~¢st 33rd J~ucnu¢, $ui1¢ [~ · ~nchora§¢, Alaska 99503 .[907} 561-5040