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HomeMy WebLinkAboutT15N R2W SEC 25 LT 120 Municipality of Anchorage Page ~ 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 Permit Number: ~"~"'/~ <?[¥~,~ ~'- PIDNumber: ~/~/~ ~ Name;~ ~ ~ ~/~ ~. ~p//y Wastewater System: ~New D Upgrade Address: /~IO ~~/~ ABSORPTION FIELD Phone: (~) ~/__ ~1~ .o. of B:~ooms: ~DeepTrench D Shallow Trench ~Bed ~Mound ~Other Total Depth from original grade: LEGAL DESCRIPTION so,,~i.~: /~ ~ ~P~/s,.F~. ~" Lot: / ~ B~ock:~ Subdiv~[on: Depth to pipe bo~om~from original grade: Ft. Gravel depth~beneath~ipe Ft. TownshiP:T/~ Range:~ ~ Section: ~ Fill added above original~grade: Ft. Gravel length: ~ Ft. Number of lines: Distan~ ~n lin~: WELL: ~New D Upgrade era~e~w~th: ~ Et, / Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~sT ~ Driller: Date Drill~: Static Water Level: Installer: Yield: / Pump Set¢o~a,: Ft. Casing Height/,Above~ Ground:Ft. TAN K ' ' SEPARATION DISTANCES ~s~pt~c a ,o~ding ~ S.T.E.,. TO Septic Absorption LiE Holding Public/Private Manufacturer: Capaci~in gallons: From Tank Field Station Tank Sewer L,nes ~ 1~ ~ ~/~ Number of Compa~ments: Welk /~ b~ /~ Material: ¢~ Sudace Water F/~ ~ LIFT STATION Lot ~ ~ ~ Size in gallons: Manufacturer: Line ~ ~ ' l~vel at Foundation j ~ ~ ~ ~ 'Pump on' level at: "Pump off" e : High water alarm at: Cu~ain Drain }~ ~ =ump Make & Model Electrical inspections pedormed by: Remarks: BENCH MARK ; Location and Description: ~ ~{V~/~O~ , ~ ~ ~ Assumed Elevation: ENGINEER'S SEAL Inspections pedormed by: ~5 ~. ~ Dates: 1st ~/~ ~/~ ~ ,'.-......................, 2nd / , , ~o, F~IN/ Healt~nd Hu~n Se~ices approval 'e.~... ~7o~ Reviewed and approved Date: Permit No. ;~"(~c/ <J;;~ ~-//'~ ~3-~ ~- 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 Permit No. ~"//-/ ?~/O~b 5-- Page -~ of 3 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 LegalDescription: ~7-1,.~.O,, 7-/~/,,'? ~'.14~ ~,~ ~-5~ PIDNo.: ~.~'-/,~/go~-- ( erlifie 3rilling by SULLIVAN WATER WELLS P.O. BOX 670272. CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 DEPT, OF WELL owNER OF LAND /~ yk/~,~ ADDRESS !/6~ nqa &O /q"~¢~ LEGAL D~SCRIFTION '7' .,.~' ~,3 DATE- S~ta~d:' PERMIT NUMBER STATIC LEVEL OF WATER F'F. 3a~ DRAW DOWN FT. GALS. PER HR KIND OF CASING ~O KIND OF FORMATION: From O Ft. to o'~ From')' F~om 4 F~om Fro~ ~ Ft to Ft~ From Ft. to Ft. Fr~m Ft. Io~.Ft.. From ~. Jo~ From Ft. From Ft. to Ft._ . Ft. OO~ ~O~d~ From . Ft. ,C~ ~ .~ ~e~ ~ From From From__ From From From From Ft. to From ' :' Ft. to From Ft. to-- From Ft. to From Ft. to From Ft. to From Ft. to MISCL. INFORMATION: Ft. to Ft. Ft. to__.Ft. Ft. to Ft. Fi. to Ft~ Ft. to__Ft FI. to Ft. Ft. to Ft. FI. to Ft._ Ft. to Ft. '_ Ft. to Et. , Ft · Ft,': :~' Ft. Ft._ .Ft. Ft. t~LI V LL~ AUG ! 1995 Muu;clpan[~ o1 Anchorage Dept. Health & Hurnan Services DRILLER'S NAME,~:. r ' Rick Mystrom, Mayor Mtmicipality of Ancho 'ag¢ Department of Health and Human Services 825 "L" Street P.O. Box 196550 Anchorage, Alaska 99519-6650 343-4744 July 31, 1995 Myron D & Shirley A Gavin 17350 Beaujolais Circle Eagle River, Alaska 99577 Subject: T15N R2W Section 25 Lot 120 Permit $SW940265, PID $051-316-02 The subject permit, issued July 29, 1994 by this office for a single family well and/or on-site wastewater system, has expired as of July 29, 1995. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $12D.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. ?~erely, ~ j~m~rOSS~' ~.'P~ogram Manager~J/ On-site Services enc: Copy of Permit cc: 0 & E Engineering, Inc. PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE D~PARTMENT OF HEALTH AND HUMAN S~RVICES P.O. BOX 196650, 825 "L" STREET, ROOM ANCHOP~AGE, ALASKA 99519-6650 0N-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940265 DESIGN ENGINEER:0 & E ENGINEERING, INC. OWNER NAME:GAVIN MYRON D & SHIRLEY A OWNER ADDRESS:il620 OUR ROAD ANCHORAGE, ALASKA 99516-2322 DATE ISSUED: 7/29/94 EXPIRATION DATE: 7/29/95 PARCEL ID:05131602 LEGAL DESCRIPTION: T15N R2W SEC 25 LT 120 LOT SIZE: 63162 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE FfgNICIPAL 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) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED ~ CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ENGINEER AT THE TIME OF CONSTRUCTION SHALL PERFORM ONE DITIONA , Tp DEPTH OF i5 FEET. RECEIVED ~BY: ~ DATE: Lot 120, STEVEN FLODIN P.E. PO BOX 671269 CHUGIAK, AK 99567 (907) 688-2230 Fax (907) 688-7111 SEPTIC SYSTEM DESIGN Sec 25, T15N, R2W, Seward Meridian MYRON GAVIN (OWNER) Test hole depths TH-1 13 feet 7/6/94 TH-2 13 feet No ground water encountered in either hole Analysis of soils from TH-i, 62% sand SP classification Soil Application rate of 1.2 gal/sq.ft. Area required per bedroom; 150gal / 1.2g/sf Number of Bedrooms 3 Absorption area 3 X 125 = 375 sf = 125 sf Trench size: Install perf pipe invert at 4.5 feet below original ground. Drain rock to be installed to a depth of~ feet below original ground. Trench Length = 375 sf / (2x4.5)sf/lf = 42 if Septic Tank 1000 gal. 2 compartment The installation of this well and septic system will not prevent wells of septic systems from being installed on the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. Lo-r' 4 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~/~'7~/~~'~ 4 5 6 7 8 9 10 11 13- 14- 15- 16- 17 18 19 20 COMMENTS "~ ENCOUNTERED? S iF YES, AT WHAT / ~ DEPTH? p E Oeplh to Water After ~,1/.~ - Monitoring?~f-( Date: I N / Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND '~ FT 'COO D^NCE W'THA'LSTAT.NO. N,O,P^ ,OE.,NE$,N EP,EOTON TH,SOATE. D^TE 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10- 11 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~'~ ~ " ...... '~.~'? I ~ /~O Township, Range, Section: ¢~ 2¢. T/~N/ ~, ~. 14- 15- 16- 17 18 19 2O WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Monitoring? / / / Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE__~ (minutes/inch) PERC HOLE DIAMETER ~ ~r~ M of A Unsubdivided PLA T APPRO VAL Plat a~j~roved by the ~unic/pa/ Platt/nE Author/tF AMY AVE. ]28-A ~28-B *ooo ~o~V~-2s~ SEE SAW -F AVE. ACCEPTANCE OF DEDICA T/ON '~ ~:~ boo ! q- to ~ APPROVALS DT1002493 LOT 126-A A RESUBDIVISlON OF LOT 126 OF THE BLM SMALL TRACTS SUBD. LOCATED IN SE t/4 SEC. 25, TISN, R2W, S.M. 227 Acres More Or Less 1~C FUGLESTAD 888 L$. BOX 2277 ROBERT C ,KYrENSON, ~L.S. ORT/iMUNICIPALITY OF ANCHORAGE Development Services Department �, - Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Certificate of On -Site Systems Approva Parcel I.D. 051-316-02 Expiration Date: (0-2-G 21 1. GENERAL INFORMATION Complete legal description T1 5N R2W SEC25 LT120 Location (site address) 15511 SROUFE ST, EAGLE RIVER, AK 99577 Current property owner(s) MICHELLE GAVI N Day phone 907-330-9780 Mailina address 15511 SROUFE ST. EAGLE RIVER, AK 99577 Real estate agent Raney Hardman Day phone 907-440-7257 2. TYPE OF DWELLING: FE1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well W Private Septic ❑Q Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ _6.5 Waiver Fee $ Date of Payment 7 % D� l Date of Payment Receipt Number 05q 16b Receipt Number COSA # _DSC 2 � I S. 5 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, PE Date 6/30/21 CSP TM-� s *. 49 TH TJX .* 6. DSD SIGNATURE l . �. System #1 Approved for bedrooms d� Benjarry65chiller E 1292 System #2 Approved for bedrooms ¢¢�l��s,Cs 30521 •������,.!r� Disapproved i``�'N \k Conditional approval for bedrooms, with the following stipulations: _o WAST''EVATER oz PROGKAM By: Original Certificate Date: 2 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisor Other—{ -G 5,ec to 1-Y G Legal Description: T1 5N R2W SEC 25 LT120 If more than 1 septic system on lot: COSA Checklist # 1 A. WELL DATA Fm_1 Well log is filed with Onsite (or attached) Date drilled 8/1994 Total depth 100 ft Cased to 42 ft ❑ Sanitary seal is functioning correctly ❑® Wires are properly protected Casing height (above ground) 20 in. Date of flow test for COSA 6/22/21 Static water level at beginning of test 40.4 ft. Comments B. TANK DATA Age of tank(s) 26 years Tank type/material SEPTIC/STEEL Measured operating fluid level in septic tank 51 © Standpipes/foundation cleanout per record drawing Date of pumping 5/5/21 D. ABSORPTION FIELD DATA DEEP TRENCH Which system tested (date installed) 9/10/1994 © ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 5.4 ft (min) ❑ N/A — pressurized field © Monitor tubes go to bottom of effective. If not, state depth into effective ❑® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 051-316-02 of 1 Structure served by this system Well production at time of test 2.1 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 2.73 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 6/25/21 STATION ❑ Require6 aintenance completed Age of lift station years Lift station material Comments: Adequacy test date 6/22/21 Results Q Pass For 3 bedrooms Fluid depth prior to test 14 in Water added 500 gal New depth 14 in Elapsed time `1440 min Final fluid depth 14 in Absorption rate '450 gpd Any rejuvenation treatment (past 12 months) NO If yes, enter date N/A 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' F71 Yes Community Sewer Manhole/Cleanout > 100' Q✓ Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' F✓ Yes if No ft Private Sewer/Septic Line > 25' 0✓ Yes if No ft Absorption Field on Lot > 100' F✓ Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' F/ Yes if No ft [71 Yes if No ft Yes if No ft Water Service Line > 10' F,71 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' F/ 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' F71 Yes if No ft Surface Water > 100' ®✓ Yes if No ft Property Line > 5'✓� Yes Yes if No ft Wells on Adjacent Lots: F/I Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100'✓0 Yes if No ft Water Main > 10' ✓Q Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' F,71 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' ED 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' F/I Yes if No ft Private Wells > 100' ®✓ Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that / 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. COSA Checklist yellow sheet 01Ak �� AO, CO TH 4,9 BenjarrkR--Schiller CE 12592 •6/30/21 �k�F�pROFESSI4NP www.muni.org/onsite Septic 'Tank Advisory Certificate of On -Site Systems Approval #OSC 211385 Subdivision: T15N R2W Sec 25 Lot 120 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 26 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. 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