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HomeMy WebLinkAboutT15N R1W SEC 19 LT 37T15N R1W Sec 19 Lot 37 #051 - 241 - 29 CO co 0 —� O m E- 66'6ZE M:,00,66a00N ( I W ♦� ly V� Q ®k,co rn U h.l w %0.J E„ Ym v o UO c V� • �' F.. N •• `"� r�. �wp �pl6. : '= •'�o �S' ' • E v E tam a N m a m 6 E �VQVn �a ` g m ¢H W a m m ' ��• g�s��"' :�V�O aur ° E r a s 1-3 O c w c +s Z t N Q y0-. ✓,X� - °$WAC O o LLIE ;5 $ m w kEm i'a5>°1oE ky zi: � I w m CO co 0 —� O m E- 66'6ZE M:,00,66a00N ( I W W I m w c +s Z y0-. O o m ky zi: � I m W 'x '064 r I oze t— m rl- 00N � ',`jlki' � :' "�.�i�:i� '•':.',��i: `fit✓ � � CO � :(S" 'P Q 8 E00 Ci• fD C :f:iaJ: COcsz z v, O V 'g �.. a .;, .... a a m ik c, I H w ,tf% rt 2 p I �Nollvnaasaa :r;sY I avow M9.09 W W F j;r S 0 W= o Wr om 68'8ZE M,:OO MON LD N 3 0 M ( z=co CO w0 m F— I F- {—Lu 2W6n co 0 ram Municipality of Anchorage Community Development Department On -Site Water & Wastewater Program 4700 Elmore St. a P.O. Box 196550 ■ Anchorage, AK 99507-6550 a wvv 8.i p%r onsite ■ (907} 343-7904 Legal Address: IM -IL hj nnj, kt-2. 6- - Subdivision Block Lot T �!, n _ R UD SectioLot 3- On-site water & wastewater Program certified contractor performing the well decommrffifig`:__ rr Name: (O a Signature - r/��,; Company: Su IJ VO_0 i �l S - Well decommissioning date: r(LqLli Method of decommissioning: AMC 15:55.060L1 a. ❑ b. ❑ c. Location: Use the space below, to provide a drawing of the property showing the following items; • North Arrow • Decommissioned well, • Other water wells on the property, • Two separate swing -tie distances for each well shown in the drawing, Note: The swing -tie distances shall be measured from either permanent structures of property corners. 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 Na~.e DISTANCES ~=:~ I'-'~ '7/~ ~ ~ T~-'~ FROM~ SEPTIC ABSORPTION Addre~ ' TANK FIELD WELL Phone[s) [~ermit NO. No. of Be~Jroom$ WELL ~ - ~ ~0~ ~ LOT LINE I ~ LEGAL DESCRIPTION Township, Range, Sec~n AS*BUILT OIAGRAM (Show'cation of well, septic sys~m,'pro~e~y lin~s, foundation, ~'~ ' ~'~ ~K~" ~ driveway, water bodies, etc.) A IN ~SEPTIC ~ HOLDING Manufacturer Capacity in gallons Material No. of Compartments ~ TRENCH ED ~ W. DRAIN ~ OTHER ~ ~ Dep,h 'O pipe bottom from Total depth from odgina, grade ~ ~ ~ original grade ~ FT ~,~ FI Fill added above original grade Grsvel depth beneath pipe ~ ~ FT ~,~ FT ~ ~FT ~ FT ~'~ Total absorption area ~Q~T Dista~ce between lines ~ FT ~ ~C~ Number of hnes ~oil rating Pipe m~tedal ' WELLS ~RIVATE ~ OTHER (Identify} ~~ Cmassiflcati°nn~)(A'B'C) ~ Tota) Depth FT Cased to FT ~ ,~ ~ J e o. R ~Na. GJH~RINGie ....... ced~ Ihat Ih~ inspe~ion was pedormed according tb al:l/''''' 72-013 (3/85) M U N I C I P A L i T Y 0 F A N C H 0 R A [~ E Depaptment of Health & Human Sepvices 825 L StPeet, Anchor~age:~ Alaska 99501 343~4720 Per'm:i,'L Numbel': Da'Le Issued~ 0 N '-- S I T E S E W E R P E R M 04/'2-5/89 EngineeP De~ :i. gned Owr'~e.~ Name: Owner. Adc!r' ess: GL. ADY~S DIXSON I::'. 0. BOX 770535 EAGLE R ]: VER .,. Al< 99577 Day F'h oil ~ 11 688'-"2 ]. :i'"' ~i!l F'ar eel Id: 05 ~.--~4 1''l' .'.?, 9 Lc!t I..e. ga:l.: Subd:~vision: ..... Lot: W:I./2 L37 Blc~ck: SeClL:ilon: 19 'll'ownshJlpll 15N Range: Max BedPooms: '['hi.~ P~r'mit: 3 Total Dapaci'Ly: ,..~[.,.[ [ ,I.l,, TANK:. M:i. nimum :.c~L:: 1 ~e:: 'L lc:, Lar:k c. apa"" ....~'~,,".. 'Lank. must h.'ave a'L least 2 cc~mpamLmen'l:s:, Depth ]]qF:OF?M D.H,,H.S. F'RIOR ll'l]) 1S'I' & 21xlD INSPECTIOIq.C3 BY ENGINEE~R, IF CONSTRUCT PER [~:NGINEERS ATTACHED AF:'PROVISD DESIGIxl. 'l'H]:~] F'ERMIT EXF:'IRES ~.;~/:][::1./89 AND V ~] [ .Ii .[ ]~) Fll}R ff-~ SII'4GL.E FAMII..Y HOME:, PRE)VIDE: ONE ADDZI'~ONAL SOIL. B LOG Nt'FH AS-BUILT 'FO VERIFY CONSIS"I'ENCY OF:' SO ]:LS I N BED. I :[. 4. Issued By: CER]"iFY 'THAT: for'L[] by thE.) ML~FIicipa].~.ty Of Ant:borage (IqOA) and the State of Alaska, I i~J.Z]. :i. nstal], the s'/E-$t(am in accoPdarH::e ~:i.'Lh ail. MOA cc~c:les and I ~,c[1], adhepe to all MO~ al'~cl State of A].aska i-~eqL~ir'(~li~en'l:,s lop the s~::eL bac:k r .=/::,,..,=,rtl (3FI th"" c3f' 4Al"ly iAd.jac:~r'Yl'. OP I"l(~.})apby 1(:3'~. ][ L~rlclePs'Land 'Lhat ti _~, p(~pmi'l:, is valid [(:)~' a "" ' al. sc:) under'stared 'Lhat the c:al:)ac'.i, ty o~' the 'Lo'Lal system i~s 3 bedpocHm~ and any enlargement wi].l ~'equi~'e an addit.~.ona], per'mi'E, .... ..._ ....... ................... ..... ...... 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 DISTANCES ~ L-.~/~'C::;~',J'~--~ '[~::)1 .~/'- ~ r''''~ ,~ SEPTIC ABSORPTION WELL Address / TANK FIELD Lot ~loc Subdiv~si I AS-BUILT DIAGRAM (Show Iocanon of well, septic system, properly lines, foundation, ~ . ~. ~ driveway, war er bodies, etc.) ~SEPTIC ~ HOLDING Manui~cturer CapaciL, in gallons ~ ~ ~,~ I Material NO. of Com.a.~ents ~ ~ )' ~'~ TYPE OF SYSTEM . . ~ . ~TRENCH D ~ W. DRAIN ~OTHER ~>~ ~ ~ ~ I ~ FT ~ Fi ~ ~r~ ,H~ Total absorption area ~ SQ FT ~ FT " ~ ~ ~ ~ Number oflines~ ~ [ Soilranng, ~ SOFT Pipemateria,~ ~ ~ ~ F --' ~ WELLS ~VATE ~ OTHER fldentifv) ~' DEFT. ~r HEALTH & Scale: ~,~, ENGINEEfl'SSEAL ENVI~0~MENTAL P~QTE~TION MAYo 5. :, S & S ENGINEERING .:,.~ ' ' M u nj cip~ ~fn~l~ ~t ~at~ ~1 ~ 7n?a ~1~ g~v~r i ~ ~.~ ~.~=,.~ ~ ~a~his/~/~in~e~i°n was pedormed according lo all 72~013 (3/85) ,u:'a? r' rn i t J'4L[mb a~ P ,~ (]wriep Name: GL.ADY'S D]:XSON Clwnep Am_h-~.~ .... P. [). BOX ' TM '=: = EAGLE RIk ~:.R~ Al-.:: 9957'7 Day I:~h<~r'ie ~ 6 Jt.l'-,= ,L,..,8 Papcel :Id: 05 :L-24 ].'-29 Lot Legal: Subdivision: Lot.: E1/2 L37 Sec:1'..i.I;)l~: 19 "Fo~ns, hip~ 15N Rar'~ge: 1W I...i~'L ii, axe 2. ua (!~Cl,. {"L. E)P Max Bedr. oc:.ms~ 'This I:::'ei"mi'L: 2 Total Capac:ity: SEF::']'!C "I'ANK: Min:Lmum 'Lot. al sapt:i.c: t. arH.:: - ,::t- ac ,. Ly. r: :~ (~ ;~:~ :L ll::)f]i$,, ~:~ac::h sr~pti.:::: ........ ~ o.nt:a t,l~ ,,.ii Lk:.,.pu~' t.o 'Lop c;¢~ ~:-.a,p'L:i.E tarlk(~]) < 4.0 :rhlF[iRM D.H.H.S., PRIOR 'TO :I. ST & 3ix!l:) ZNSF:IEC'FIONS BY E:NGINIEER~ :IF AF'TE:R C)F:'FICE HOURS CAI,.,,L. 343.-468:I. ANO I.,.[~AVE a MESSAGE:. CONSTFi:L.K:71" F'IER E:NGINEERS AT'I"A(}HED AF:'PROVE:D DISSIGN. 'T'HZS F'!ERMIT EXPIRES 12/3:L/89 AND VALID FOR A SII',IGL..E FAI"III,.,Y 1.4C)IdE. ONE ADI) I'f'I ONAL. SO ILS L, OG MUST BE SUBM:I:T'I'IED W:I:'I"H AS-I:.;L.I.LI._.'I' TO VERIFY SOIL.. COIqS:[S-I'ENCY ']'HRCR.li3HOUT BED, ,5i~ i g n e d: ( E]bIr t ~.-9 P ) ! CER"FIFY THA'T': _1.. I a¢¥1 fam:Ll:Lar' ~9:[th t.J]Ei, r,e(::jt.tiPa, fJliz.~n'~..s fclp cin.-..z;:[t[~ BeW(~P~ al'id we .[. ]. !;;; a!~ ~;e'~.. fop'Lb by the Mur)icipalit. y of Anchi]page~ (HOA) and the State of 3. :i: will :i.r'lst. al]. the syst. em in ai::cc)r'i:lar'~ce ai'Lh all MOA codas and r'agu.Lat, ic~n¢,~ and in c:clmplJ, anl]e wi'Lb the design critepia of Cl"tis pepmit,, ~,, I will a(::lher'e 'l'..~ all MOA and St, a'ke of Alaska paqLtii"~Zeilli:ant. E¢ fOP the set back dist. ar~c:es fpc)rr~ any existing ~ell~ t, ga~st, et~at, ep di!ksposal system oP public: ~oewer'age sy!gcLa~m or'l t. his cw any adjac:ent c:)p neaJ. by lot.. z[.. '.[ t.tlgC:JE, P!~tand '[.hat '[.J'qJ.~s permi'L is valid for' a maximum of ~?. bedr'c,r.)ms. :[ a:[5[i~c:) Ltr]cJar'st. and t. hat. t, ha c:aJ:laa:J.t..'~ Of t.h(~ tcl'Lal sys{aal ~.S ~ b6ec:JPcli:)ills5 arid any er~:l, aJ'gemer~t t,,~:L].:l, r'equire an addi'Liona'.L per'mit,, ........................ ~ .............. ~...-~~ .................................................................................. GL.AOY'S L~IXSON Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 L Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: DATE Township, Range, Section: ~/~E ~ r SLOPE 5 6 7 8 9 I0- 11 WASGROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth t° W?er After ~=~ t ~/~/~ 13 - Iflanitoring? -- Date: 14- 15- 16- 17- 18- 19- Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE [,~"/ (mlnute~ch) PERC HOLE DIAMETER i ~ TEST RUN BETWEEN ~ ~ PERFORMED BY: ~~ CERTIFY THAT THIS TEST WAS PERFORMED IN ' ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI~ECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) 6446 -HU-. G79ATER ANCHORAGE AREA BORO-2H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME / rIII I1-- fi LOCATION Ill, OK b SEPTIC TANK: / DISTANCE FROM WELL 8' -5/ ,•< SI A 1: MAILING/" ADDRESS /iC7x 2 ) /O LEGAL DESCRIPTION f '4--1 i A, ` LIQUID CAPACITY F� F14,/ A.4. MATERIAL l) e t^ I e tor dye- '- PHONE t 4? -27 t' GALLONS. INSIDE LENGTH NUMBER OF COMPARTMENTS t y-.4%4/4 ?����.%4% 4 fes. INSIDE WIDTH 1 LIQUID DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE l OUTSIDE DIAMETER E''. 1 -�.-..� TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) OR WIDTH ..; LENGTH Y7 a DISTANCE FROM WELL .J; "` /C <; / DEPTH C 3 BUILDING FOUNDATION SO FT a '/ TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF. LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE FOUNDATION NEAREST LOT LINE DISTANCE BETWEEN LINES SQ FT LENGTH OF EACH LINE DEPTH OF FILTER -MATERIAL BENEATH TILE TOTAL LENGTH OF LINES TRENCH WIDTH IN TOTAL EFFECTIVE IN ABOVE TILE WELL: LOT LINE TYPE /1( 1 DEPTH DISTANCE FROM T /.. WATER , BUILDING FOUNDATION " SAMPLE /1/0 NEAREST NEAREST - _ -' SEPTIC , SEWER LINE `a ,TANK fr r SEEPAGE'/ .fs- • s/ SYSTEM � ,- CESSPOOL OTHER SOURCES DISTANCES: DIAGRAM OF SYSTEM DATE APPROVED HEALTH AUIHORHY G&AB-HD-2 GREATS u ANCHORAGE AREA ,-OROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 Case No 53 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT ,c eF: NAME OF APPLICANT /U%QiA/CE DiKson% MAILING ADDRESS & i 5 70 RESIDENCE ADDRESS LOCATION OF INSTALLATION 3 ✓ ' idd./ zor 07 PHONE NO SS' LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK �^ /,��ee , SEEPAGE PITTl , DRAIN FIELD , OTHER tJ,.-0n nt./ TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH < <> TO BE INSTALLED BY -PERCOLATION TEST RESULTS %Y/4 ANTICIPATED DATE OF COMPL TION jJ // 7 fa 9' BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS 4/244-17-71), PERMIT TO INSTALL A AS DESCRIBED BELOW. SEPTIC TANK SIZE C''rt; �? DISTANCEr✓ 2JAtetog0a,ta -720 SIZE OF UNIT TO B TYPE SERVED 5- AL. 0fri) SEEPAGE AREA .P 8'8' Q TYPE lel DIAGRAM OF SYSTEM 7 c�- er 1 ealth Authority I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. r 4- 4,2_enci DATE APPLICANTS SIGNATURE 4A'/i/��v�/>�� ®Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 5 A a E T.Y Certificate of On -Site Systems Approval Parcel I.D. 051-241-29 1. GENERAL INFORMATION: Complete legal description T15N, R1W, SECTION 19, LOT 37 Expiration Date: Location (site address) 19212 KLONDIKE STREET CHUGIAK AK 99567 Current Property owner(s) ANDREW FERGUSON Day phone 907-229-8133 Mailing address Real Estate Agent 19212 KLONDIKE SSTREET, CHUGIAK, AK 99567 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 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 ❑ WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 55D Date of Payment l �. t rvjrg Receipt Number o7?)1567 COSA # 05C tq/534 Date: Waiver Fee $ _ Date of Payment Receipt Number, Waiver # 949 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: Gayness 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 74 1. t 1 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the 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 SIGNATURE System #1 Approved for -3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, #AECC884 t0F (( 4, ON-SITE: g WAT` 11_1� AND m 1 m WASTEVATER o with the foil* it j stroagcons"ky By: Original Certificate Date: 12--) 0 ^1 i 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 Adufsary , Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10-10-12.doc M1!1 e Legal Description: T1 5N, R1 W, SECTION 19; LOT 37 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled *UNK Total depth *52 ft Cased to **30 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected *** Casing height (above ground) 12 in. Date of flow test for COSA 11/6/19 Parcel ID: 051-241-29 Structure served by this system 1 Well production at time of test 5.4 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 0.883 mg/L ❑ Nitrate less than MRL (ND) Arsenic 10.9 ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 11/25/19 Static water level at beginning of test NKft. 'WELL POSSIBLY DRILLED IN 1965 PER 2007 COSA. INFORMATION ON WELL SHOWN ON 1969 INSPECTION REPORT. **PER PREVIOUS 2007 COSA. "'ABOVE BASEMENT CONCRETE SLAB. WELL LOCATED IN CONCRETE BUNKER OFF BASEMENT. DRAIN HOLE INSTALLED SO UPPER SLAB DRAINS TO LOWER BASEMENT CONCRETE SLAB WHICH HAS A FLOOR DRAIN (SEE PHOTOS). --UNABLE TO REMOVE WELL HEAD DUE TO PIPING CONFIGURATION. 3,145 GALLONS WAS PUMPED FROM WELL IN 577 MINUTES. 2ND WELL ON PROPERTY WAS DECOMMISSIONED BY SULLIVAN WATER WELLS ON 11/4/2019 (SEE ATTACHED LOG) B. TANK DATA Age of tank(s) 50+ years Tank t e/material FORTANK HOI type/material SERVING HOUSE Measured operating fluid level in septic tank 48.5" C. LIFT STATION NOTE: DISCUSSED WITH TIM EKLUND ON 12/4/2019 ABOUT wired maintenance completed 50+ YEAR OLD CONCRETE Age TANKS. HE STATED THAT of lift Age of lift sta years INSPECTIONS OF BAFFLES NOT REQUIRED, BUT AN Lift station material ADVISORY LETTER WILL MOST LIKLEY BE ISSUED. ❑ Standpipes/foundation cleanout per record drawing Comments: Date of pumping 10/21/2019 (FOR BOTH TANKS) NOTE: THERE ARE 2 SEPTIC TANKS AND 2 DRAINFIELDS ON PROPERTY. THE SEPTIC SYSTEM FOR AN OLD MOBILE HOME (REMOVED) HAS NOT BEEN IN USE FOR 10+ YEARS PER OWNER AND TANK HAS BEEN RECENTLY PUMPED, SO LIQUILD LEVEL COULD NOT BE DETERMINED. SEPTIC TANK FOR HOUSE ONLY HAS 45" OF COVER AND SEPTIC TANK FOR OLD MOBILE HOME ONLY HAS 17" OF COVER. NO FREEZING ISSUES PER OWNER (SEE ATTACHED STATEMENT). FOUNDATION CLEANOUT IN BASEMENT (SEE PHOTOS). D. ABSORPTION FIELD DATA TED (FOR HOUSE) IBED (FOR OLD TRAILER) Which system tested (date installed) '4/29/89 ❑ ALL standpipes present per record drawing Total measured depth from"3.8/3.5 .grade ft (max) Measured depth to pipe invert from grade "3.2/3.0 ft (min) ❑ N/A — pressurized field ** OR Monitor tubes go to bottom of effective. If not, state depth into effective Adequacy test date 11/6/19 Results ❑✓ Pass For 3 / 3 bedrooms Fluid depth prior to test 0/0 in Water added 622/523 gal New depth 0 / 0 in Elapsed time 0 / 0 min ❑ Code -required soil cover over field Final fluid depth 0 / 0 in FIR System presoaked Absorption rate 450/450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced "`2100- gallons If yes, enter date Comments/Deficiencies: `NEW DRAINFIELDS WERE INSTALLED FOR THE EXISTING HOUSE AND OLD TRAILER (REMOVED). "ELEVATIONS WERE PERFROMED DURING SEPTIC ADEQUACY TEST. FOUND FUNCTIONAL MONORTING TUBE IN EACH DRAINFIELD THAT WAS 6" LOWER IN ELEVATION THAN THE DISTRIBUTION LINE. 2ND MT IN EACH DRAINFIELD WAS AT OR NEAR THE SAME ELEVATION AS THE INVERTS OF THE DISTRIBUTION LINE. THESE MTS APPEARED TO HAVE DIRT IN THEM. IT IS UNKNOWN IF BEDS ARE INSULATED. DRAINFIELDS MAY BE SHY ON COVER. NO FREEZING ISSUE PER OWNER (SEE ATTACHED STATEMENT). "'PRESOAK ONLY ADDED TO DRAINFIELD THAT SERVED OLD TRAILER (REMOVED). 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 > 100'Community ❑ Yes *50'+ Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25'[E Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ❑✓ Yes if No ft 0 Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5+ ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' El Yes if No ft Private Wells > 100'✓❑ ** Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200'❑ Yes if No ft Water Service Line > 10' El 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' ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft ** Private Wells > 100' Q Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' El Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *MET SEPARATION DISTANCE AT TIME OF INSTALLATION. **WITH CAVEAT - NOT ABLE TO PHYSICALLY LOCATE WELL ON LOT 36 (EAST OF THIS PROPERTY) DUE TO LOTS OF STORAGE ITEMS, DILAPIDATED STRUCTURES, DEBRIS, ETC., ON PROPERTY, FENCED & GATED YARD, AND ALSO POTENTAIL AGGRESSSIVE DOG ON PROPERTY. G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with p* 4 , �* MOA COSA guidelines in effect on this date. :. .. .. • ........ • .. Q.. QO fr A. Garness• NN C) �44�Prt2� C' eF�°oO COSA Checklist yellow sheet 40 a Pr o f e s soon°oma #AECC884 Arsenic Advisory Certificate of On -Site Systems Approval # OSC191584 Subdivision: T15N R1W Sec.19, Lot 37 A water sample revealed an arsenic concentration of 10.9 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. z H�~�; � � � F� Mailing Andress P q Bbx��9665tl * Ahchor��gey�Alaska 93�a19 665���wu+�w.mum�org <�� � �, � _,� �,a,,,...�:.�a�"a'�,w.ax".�...fi..�,�..�,..��„ ..�',rr.:�:�*�� a,.m�,�. �.�'�M..`x"-,�i^�'.,1%?£��..�;��;n.''`� ,�.�s-...3:,.,...a�vs ,erF �...n�;`'exr��'',�.t'�Sa�a,.0r+,�_%,�.s�.�.?�.r�,n,o-�..:"✓Naaf�-'�.«'', �.+,w3,.,� ,�',`mx.��� �� �r�:s Parcel I.D. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 051- X11- 2i COSA# (9'�OYi'Iq Expiration Date: / 1— 2 0 - 07 1. GENERAL INFORMATION Complete legal description Lot 37; Section 19; T15N; R1 W, S.M. Location (site address) 19212 Klondike Street Current Property owner(s) Ruth McPhorren Day phone 2724585 Mailing address 3200 Purdue St.- Anchorage, Ak. 99508 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site 0 ❑ Individual Holding Tank 0 ❑ Community On-site 0 ❑ Public Sewer 0 The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat 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 s IS engineering Address 15861 S. Birchwood 14). Rd. - Chuglak, Ak. 99567 Engineer's Printed Name Roberti# C. CowM,... Phone 694.2979 Date ;'i[I f f', Ir ..keres,.r 5. DSD SIGNATURE ! 73 ROBERT C. COWAN f 4 ,'• C.. - 8801 f ``•",� i. Approved for 3 bedrooms. NI, e,:" . '.. — Disapproved. tal1\., _i3•1. Conditional approval for bedrooms, with the following stipulations: tttttturrrrr,;, `;: ON-SITE WATER AND 4:;:•71:69:1n) WASTEWA l� • • PROGRAM Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other (Rev11g5) Original Certificate Date: 2 — - Q — 07 Municipality of Anchorage Development Services Department Building Safety Division OnSite'Water & Wastewater Program 4700 Bragaw Street P.O. Box 196850 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE/SYSTEMS APPROVAL APPROVAL CHECKLIST Legal Description: 14.1 ST�itz iv OF LT 376 moi. / /p; ! 6 7i&) Ferret ID: 0 ,.6— 1 -2. y i- a A WEU. DAT Well type. eAuA1 E Date co,pplleted Total dept viK Date of test Static water level Well production If A, B, or C provide PWSID # = Well Log ((Yinj-•-J�A) �/ Sanitary seat) � es Wires Properly protecte44) l Cased to .910 -f' ft.' Casing height (above grow e) in. WELL woo-WELTC OHO" FROM WEU. LOG AT INSPECTION 14) ibo sE»+rac y. WATER SAMPLE RESULTS: Conform 0 colonies/100 mL Nitrate R• 3mg/L ,.. Arsenic: _ mglI Date of sample: WZIO1 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SE-Frnc.1 crnEU Tank size lob gal. Number of Compartment j Foundation deanoth 5 Depression over tank (1® ft. g.p.m. Date of pumping C. A4SORPTION FIELD/DATA Date installed S/3/P4 Soll rating (g.p.dJfta it. Width Total depth jarft. Eff. absorption area r`Gs fi Date of adequacy test %/as/D Resin Fluid depth in absorption field before test fp in. )� Elapsed Time:lig min. Final fluid depth HIM Any rejuvenation treatment (past 12 mo.) (Ye type) - atm W t yen I-sviI'' 1/0 I+1614 t r*Frt tali., est !6' i 5tor &O*' 0f150abs ` metkett xgcart OP oC- sNowiAX (A) cots a4ft. Pumper t t Length 3$ r S.2 g.p.m. r toot Other bacteria o colonies/1OOmL_._.__ Collected by: Ss- SCuNge Date installed id /!(0169 Cteanoutr(° q /PS High water alarm (Ye) d')d 0 System type e ---& -b ft. Gravel below pipe 0. 5 ft. Monitoring tube _ja, Depression over field A.im ail) For ?7 bedrooms Water addedSLO gal. New depth /tin in. Absorption rate >= 41Gro+ g.p.d. Ai 6 If yes, give date D. LIFT STATION 401 - Date installed Size in gallons - •- Man Pump on' level at _ in. Pump off' I High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES _ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot SC + Absorption field on lot / On adjacent lots On adjacent Tots fit + Public sewer main A.j I f3 Public sewer manhole/cleanout it)//3 5 + Holding tank 41; Sewer /septic service line Animal containment areas so '+ Manure/animal excrete storage areas po �l SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 /+ Property line 5 -f / Absorption field S '/' Water main it)'f}Water service line (O /1- Surface water f OC'O f -i - Wells on adjacent lots DO SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 '- Building foundation to +- Water main /l) l Water Service line /O'+ Surface water (CO 'f' Driveway, paddng/vehide storage IO 14 Curtain drain VOLT" 1CAn.1t) Wells on adjacent lots ((a© 14- F. F. COMMENTS • G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Rd h tit; C _ Co N9e' $//7/07 Date COSA Fee $ Date of Payment t / m i /07 Receipt Number O c i 6& tt (Rev. 11/05) '130. ev Waiver Fee $ Date of Payment Receipt Number HEALTHAUTHORn APPROVALS SEWER &WATER MAN D(TENSIONS SEWERS WATER INSPECTION ENGINEERINGS; UOiES P11OREPORTS WELL INSPECTION {FLAM TEST SITE PIANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL S MECHANICAL NSPECIIONS ON SITE WASIEWAI ER OSP06AL SWT EM DESIGN Augeat 20, 2007 ROBERT C. COWAN CML ENGINEERING MUNICIPALITY OF ANCIIORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 37; Section 19; T15N; R1W 19212 Klondike St. PH: 907-694-2979 FAX: 907-694-1211 This letter is to inform you that the structure on the east side of the property labeled as a mobile home on the as -built survey is a storage trailer. It is not hooked up to the septic or water lines. If you require additional information, please contact us. hafer, P.E. 15861 S. Birchwood Loop Road - Chugiak, Alaska 99567 z op szt_sx.....45.....i....‘..v, : t- /Q:Cfi:o/ j JJ u s" 'N% /� '� •r mo i 66"6Z£ M.,00,61e00N �I1l; \•\: 1 ( 0 w m w 0 z 0 J 13 NOLLYAN3SBM avow MEI As 6812£ Mw00,0Ze00N 0 J M 0 J