HomeMy WebLinkAboutHANSEN SAND LAKE LT 9DOnsite File
Hansen Sand Lake
PID# 012-153-37
Prior to COSA approval the well pit must be
decommissioned and brought up to current code.
COSA Checklist WELL ONLY.docx
COSA Checklist
Legal Description: HANSEN SAND LAKE LOT 9C4 Parcel ID: 012-153-36
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 UNK Total depth UNK ft
Cased to UNKNOWN ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 4/17/25
Static water level at beginning of test 39’ ft.
Well production at time of test 3.5+ gpm
Water storage tank volume None gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic 10.7 ug/L Arsenic less than MRL (ND)
Collected by Date 4/17/25
Comments Per MOA docs well drilled circa 1969. Well is on adjacent Lot 9D & is below grade in cement structure w/
manhole. A well flow was conducted & the attached 30 scale sketch shows well and sewer manholes.
B. TANK DATA – PUBLIC SEWER
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA - PUBLIC SEWER
Which system tested (date installed)
ALL standpipes present per record drawing
Total measured depth from grade ft (max)
Measured depth to pipe invert from grade 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 gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
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
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
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GRID No.
MUNICIPALITY OF ANCHORAGE —SEWER UTILITY
Name.., Address
Plat No. Subd.
Residential C7 Commerial ❑
Industr'lal
❑ No. of un -its
Acct.No
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Main Tap On Property ❑ Permit No,. Size Ty p
Drawing No. Size Main �TypeDepth at Connect.
Insulation ❑ Cleanouts Type
Connect Agent Inspector Date
Comments
Connect Location
ASSESSMENTS*
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Sewer Agreement D No. P.T.E. ❑ Roll No.
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G:~:~TER ANCHORAGE AREA BORe H
HEALTH DEPARTMENT
327 E., .E ST. ANCHORAGE, ALASKA 99501
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION -~'--~'-~ '-~----~
ADDRESS _
LEGAL DESCRiPTiON /-_,~Z-"- .~C' ~ ~Tz~
PHONE __
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE.
SEPTIC TANK:
DISTANCE FROM WELl. 2.~.---.
LIQUID CAPACITV GALLONS.
SEEPAGE SVSTEM: SEEPAGE PIT:
l-c
OUTSIDE DIAMETER
NUMBER OF
__MATERIAL O,f~,~4''I ~' ~ / COMPARTMENTS
INSIDE LENGTH INSIDE WIDTH
LIQUID
DEPTH __
~ X._5 i.5'
OR WIDTH ,
D~STANCE FROM WELL ~-- /.Z. /
E' -/~-7 /
BUILDING FOUNDATION
TOTAL EFFEC-TIVE. ABSORPTION AREA (WALL AREA) Q~'/~) C,?~J~- SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL.
NUMBER OF LINES
ABSORPTION AREA
FOUNDATION
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE
., NEAREST LOT LINE
TRENCH WIDTH
TOTAL LENGTH
. OF LINES
IN. TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE
IN. ABOVE TILE.__
WELL: TYPE ~)J~Ji--~'~-J~ DEPTH ~-~7~-~ DISTANCE FROM ' //// WATER
, , BUILDING FOUNDATION. / ~ . SAMPLE /~7'_/~) , NEAREST
LOT LINE 4 7 / NEAREST / SEPTIC f/ , . £ SEEPAGE ' OTHER
....SEWER LINE ~ TANK, D.~L~t SYSTEM ~'/~-~/~, CESSPOOL SOURCEST
DIAGRAM OF SYSTEM
DISTANCES:
/
H->~=,_5-7/
~->8=
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/
HFAITH AtJTHORITY
DATE mh W APPROVED
GREATEI _iNCHORAGE AREA . ~ROUGH Ca,eNo.
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501
279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APP,CANT~ ~ a ~ %o g~?~X MAlUNG ADDRESS :~?.~ I ~, 7~ P,0NE
RESIDENCE ADDRESS LOCATIO~ OF INSTALLATION
LEGAL DESCRIPTION Lo~ ~ C ~ ~ ~ ~.~a7 ~,~ ~,..
APPLICATION TO INSTALL: SEPTIC TANK ~)/ , SEEPAGE PIT.~ ~I~RAIN FIELD , OTHER
FINANCED THROUGH ~e L-~ TO BE INSTALLED BY ~ C
PERCOLATION TEST RESULTS. ~ ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS //"1~' ~L)C~7
AS DESCRIBED BELOW.
'76-o
· SEPTIC TANK SIZE i~.¢o
DISTANCES:
, PERMIT TO INSTALL A ~ ~,c~_
SIZE OF UNIT TO BE SERVED ~o
TYPE ff~//?~/d~-SEEPAGE AREA
DIAGRAM OF SYSTEM
Health Authority
TYPE
that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described/..~/~/~system is in acc/~dance/~-- ,,"2 with said code.