HomeMy WebLinkAboutOSMOND OLSEN LT 1A0
mond OI
Lot lA
#012-242-38
Municipality of Anchorage
® a.� Development Services Department
Building Safety Division
On -Site Water & Wastewater Program, 4700 Bragaw St. _
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: OSP101031 PID Number: 012-212-38
Name`
GEORGE ROONEY
Wastewater System: ❑ New ® Upgrade
Y
Address:
7617 JEWEL LAKE ROAD * ANCHORAGE, AK * 99502
ABSORPTION FIELD
Phone: No. of Bedrooms:
(907) 240-7382 I^ Lf
❑ Deep Trench ® Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION ,8mui /;7'e' -Soil
Rating: 1 O
Total Depth from original grade:
Jo (fa✓r1C
GPD/Sq. Ft.
6.0 MAX Ft.
Block: Lot: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
— 1A OSMOND OLSEN
2.0 Ft.
4.0 Ft.
Township: Range: Section:
Fill added above original grade:
Grovel length:
SEE DWG. Ft.
(2 @ 30) 60 TOTAL FL
WELL: ® New El Upgrade
Grovel width:
5
Number of lines:
2
Distance between lines:
15+
Ft.
Ft
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material:
A
376 Ft
376 Ft
600 So. Ft.
D 3034/F-810/SCH 40
Driller.
SULLIVAN WATER WELLS
Dote Drilled:
8/19/2010
Static Water Level:
75
Installer:
A+ HOME SERVICES
Date installed:
7/20-21/2010
Ft
Yield:
5
Pump Set At:
Casing Height Above Ground:
2 +
TAN
GPM
Ft
FL
SEPARATION DISTANCES
❑ Septic ❑ Holding ®S.T.E.P. ❑ Other
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer.
ANCHORAGE TANK
Capacity in gallons:
1500
From
Tank
Field
Station
Tank
Sewer Lines
Well
100'+
*90'+
100'+
—
25'+
Material:
STEEL
Number of compartments:
2
Surface Water
100'+
100'+
100'+
—
—
LIFT STATION
Lot Line
5'+
**1'+
5'+
—
—
Size in gallons:
1500
Manufacturer.
ORENCO
'Pump on' level at:
`Pump off' level at:
High water alarm at-
tFoundation
Foundation
5'+
10'+
5'+
—
—
42"
42"
46"
Curtain Drain
NONE KNOWN
Pump Make & Model:
Electrical Inspections performed by:
20-13SI-05—HHF
M.O.A.
Remarks:
BENCH MARK
Location and Description:
*WAIVER OSX101002. **WAIVER #OSP101042.
BOTTOM OF TRIM, NE CORNER OF HOUSE
OLD TANK WAS ABANDONED PER UPC.
DOUBLE C/O BEFORE TANK APPROVED BY MOA
Assumed Elevation: 100.00
IN LIEU OF A F.C.O.
Ft.
Inspections performed by: GEG, Ltd. Dates: 1st 7/20/2010Qo6Ooof,
ENGINEER'S SEAL
Op
2nd 7/21/2010
0� OF A' �Q
��••'
�S`d��
3rd
oo /
Development Services Department Approval �0
g'TH
Conditional approval: Date:
A
• T • • • • • • • •Q
Jef,r�GarnesS
d0
9s CE -7953 .•' ce�
��peap o\F'�
�ofesston o0
�D�O�oo��
Reviewed and approved by. IIMM441'��w11h114Date: 3 I
��
(Rev. 4/06)
AS BUILT DRAWING
OSP101031 - 012-242-38
STRAWBERRY ROAD
A B C
~ ~ ~ DBL1 36.13: 23.46 31.28 --
DB~ 37.13 24,17 31.89
NEW 1500 GALLON / ST1 38.16 26.77 33.41
S.T.E.P. TANK~ ST2 43.01 32.32 40.09
-- ALTERNATE SITE / MH 44.21 34.06 41.83
~ 7 MT1 26.73 25.49 34.24
~ ~ // ~ ~,.~o ~o.~ ~.~
~ -- ~MT3 ~UH ~ MT4 38.03 53.93 62.01
-- -~ DB
~ HOUSE ~ ~ '
~~ABANDONED WELL
GARNESS
PREPPED FOR: ......
A
GEORGE R00NEY .-:
LEGAL DESCRIPTION:
AS-BUILT DRAWING OF NEW SEPTIC SYSTEM / / u
(Rev 01105)
PERMIT, NUMBER: AS BUILT DRAWING PARCELID NUMBER:
OSP1010,51 - 012-242-,58
fFINAL GRADE = 96.77-97.3
ST1 / ST2 MH
TOP OF TANK --~ r~ / ~ ~ /--- TOP OF TANK
AT INLET = 89,43 -- AT OUTLET = 89.44
NEW 1500 LO
/ I I ANCHORAGE TANK I
INVERT OF BUNG -~ I I 10 GAUGE DEEP BURIAL
AT INLET 8882 // STEP TANK
[SOUTH TRENCHI
[NORTH TRENCH]
ORIGINAL
= 96.,33 FABRIC
MT FINAL GRADE = MT
97.0-97.15 ORIGINAL
GRADE =
96.33
FINAL GRADE =
97.17-97.37
ATION
FABRIC
4.05' INVERT OF
PIPE =
94.38
TRENCH =
90.33
T
4.05'
10'-I.
INVERT OF
PIPE =
94.38
Of
TRENCH =
90.33
PRESSURIZED LINES ARE 1.25" PVC WlTH I
1/4" HOLES SPACED 2' ON CENTER. (1.3
HOLES PER LATERAL. 26 HOLES TOTAL.)
· ~ RELATIVE ELEVATION OF BO1TOM
OF TESTHOLE = 84.33 (DRY)
A Ga ess
DRAWN BY CE 7
PROFILE AS-BUILT OF NEW SEPTIC SYSTEM 8/19/2010
(Rev. 01/05)
GARNESS ENGINEERING GROUP,
CONSULTANTS & GENERAL CONTRACTORS
Ltd.
August 24, 2010
Municipality of Anchorage
Development Service Department
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907) 343-7904
Ref: Proposed Waiver Amendment for Osmond Olsen S/D; Lot lA,
To whom it may concern:
Prior to the construction of a new well, a waiver (OSX101002) was issued for this property. The waived
distance was to be 94 feet from the new well to the new drainfield. The well was drilled by Sullivan
Water Wells on 8/19/2010. GEG, Ltd. located the well for the as-built drawings. The well was found to
be as close as 92.2' from the edge of the well to the edge of the drainfield. We are requesting that you
waive the distance from the well to the drainfield to 90 feet.
We are unaware of ~v adverse impacts this installation would have on adjacent wells or septic systems.
If you have any queStiOns, please contact us at 337-6179. Thank you for your assistance.
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com
154
Well Log
Parcel Identification Number:
Is well located at approved permit location?
Section: Town:
Permit Number: OSP 101031 Date of Issue 5/2s/zo10
Date Started: 8117/20'10 Date Completed: 8/19/2010
Property Description OSMOND OLSEN Lot lA Block NONE
Property. Owner Name & Address: GEORGE ROONEY
PO BOX 100572 ANCHORAGE AK 99510
Bore ole'Oat : " Oept Method o}0rilling I ii akro l-' cable
Soil Type, Thickness & Water Strata From To Casing type:
Casing Stickup
Sand
Clay
Silt & Sand
Clay & Silt
Clay Sand Gravel W/Silt
Clay W/Gravel
Clay
Clay Sand Gravel
Water Sample Results:
Arsenic:
Nilzates
Total Coliform Bacteria
Other bacteria:
Attention:
0122423 SO oo
iX .:Yes .~_..No
Range:
0 3 Wall thickness 0,2s inches
Diameter 6 inches Total: 37t5 feet
3 6*t ................
Liner type:
61 126
Diameter inches Depth: feet
~26 t7~ Casing stick-up above ground: $ feet
175 22O Static Water Level(from top of casing) 7s feet
220 224 Pumping Level: feet after
224 327 .... I hours pumping ....... gpm
Recovery Rate s gpm
327 368
Method of Test/ag: Air
368 376
Well Intake Opening Type
~ Open End ["] Open Hole
[~ Screened Start .__ feet Stopped ..... feet
Perforations Start feet Stopped feet
GroutType: Bentonite dry granular Volume: ~0
Depth ~A Start o feet Stopped aa,
Pump Intake Depth: feet
Pump size: HP brand name
Welt disinfected upon Completion? ~ Yes i__~ No
Method of disinfection CI-tLORINE 50 PPM
Commen~s: 20 GPM VERY SILTY WATER ~ 220'-224'. WATER
AT THIS ZONE WOULD NOT CLEAN UP.
ug/] Well Driller:
Cole Sullivan
mg/[ Sullivan Water Wells
colonies/100mL P.o. Box 67o272
........ Chug/ak, AK 99567
col/l OOmL (9o71688-2zS9
The property owner shall provide this log to DSD (onsite) and DNR within 30 days of completion,
Pounds
feet
69Zg 999 Z06
SlleM JeleM UeA!llnS
10/13/2010 03:30
M~r~
Pump Installation Log
D~te of Tuque: __
PAGE
0
· '~"~ ". 'g" ,- ~
83/83
~e~--~--D escripdeu
O~w~-nd Ot%~-~ Lo+ ~A
Puml~ ~ust~iler .Name:
:L0/20/2010 23; 49 9.072~30742 A~PS, INC, PA~E ~2/~2
To Whom ltiMay Concern:
Begiming ~u~st 30, 20t0, AnchOrage Well & Pump Service s~ed the process of deco~[ssmning ~e
well at Osm6nd Olsen. Subdihsion Lot lA for George Kooney. The,process that took place began with
pulling ~e ~ump, pip~ ~d wire ou[ of fhe well. ~e wellhead was excavated ~y the cruet. ~en the casing ~"~
was .cut off~ 6 feet below grade ~d chlorinated at tBe well, A~er mixing, a bentonite ~d Portland ' ~r~.
cemea~, slur~.was then poured into the top of the well casing slowly to prevent bridging until filled to ~e .~ ..
top. Once. the well ~ filled with ~, slu~e~tonite mixture, A~chorage Well & Pum~ Se~ice welded '
on the caP'a~d backfill was completed b'y ~e owner at the location. If you have any ather questions about
the pmcess'0f decommissionlng the Wells at Osmond Olsen Su~vision Lot 1A~ please feel ~ce to coatac~
our office. ~
Jim Rid~a~
A~chorage Well & Pump Sewi~
330 E 76"4ve.
.Anchorage, AK 99518
(907) 243z0740.
:~'~,
07/2672010 08~
APLUS
~9~ 4~90 TO:86~6T70
Inspection Report
Municipality of Anchorage, Building Safety Division
4700 Elmore Road
INFO & HE-LP [907) 343421 ~
INsPECTiON; VOICE {@07) 343-8'300 ' FAX (907)?J,9-7777 ' www.muni.org
Name ods electric
Company
ACtdress-7617 JEWEL LAKE RD
Grid $W2226
Subdlvl¢on OSMOND OLSEN LOT 1A gl( n/a TR n/e
WOrK Description @optic ligt st~tlon
PAGE
Permit # 104224
bepeeflon Date p.3.Ju[-2010 AM
Phone 272.4591
Insp. ps,brined/prepaid 0 / 0
~ermlt l'echnlciltrt DAY, JINNY R.
Comments of Directions c~ll to meet
inspection Type Bec¢c¢:Retr0
Comments (for inspoctor use only)
y ' ~ ( ..... , ~ ,~-~'
Inspector
Permit Number: OSP101031
Tax Code Number: 01224238000
Work Type: WellSeptic
Permit Effective Dates: May 28, 2010
On-Site Water & Wastewater System
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Upgrade
to May 28, 2011
Design Engineer: GARNESS ENGINEERING GROUP LTD
Subdivision: OSMOND OLSEN
Site Legal Address: OSMOND OLSEN LT 1^ G:2226
Owner/Address: ROONEY GEORGE
PO BOX 100572 ANCHORAGE AK 995100572
Permit
Site Mailing Address: 7617 JEWEL LAKE RD, Anchorage
Lot Size in Sq Ft: 16662
Total Bedrooms: 4
This permit is for the construction of:
Y Disposal Field Y SepticTank N Holding Tank N Privy Y Private Well N Water Storage
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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions: Permit includes waiver OSP101042 allowing the drainfield to be within 1 foot
of the property line.
Received Date:
Issued By: Date:
~ .... ip lity ~'¢'~
· ~'~"~ Munic a of Anchorage
:( "~' ~ :~','~' P.O. Box 196650 · 4700 Elmore Road
~~' Anchorape, Alaska 99519-6650 · (907) 343-7904 · Fax (907) 343-7997 ·
DeFa,' tment
http:llm.muni.orqlOnsite
Development Services Department
On-Site Water and Wastewater Proqram
**** VARIANCE/WAIVER REVIEW ****
WR#: OSX101002 HA#: Permi¢: OSP101031
PID#: 012-242-38
Legal Description: Osmond Olsen, Lot lA
Engineer: GEG
Applicant: Georfle Rooney
Your request for a waiver of the required 1 O0 feet horizontal separation from the absorption field
to the private well has been approved. The approved separation distance isq~r~D ~.~'
This waiver approval applies to the existing absorption field to private well separation only. Any
future upgrade to the on-site wastewater disposal system will require all separation distances be
met or another approval from this department.
Waiver is Granted: X Waiver is not Granted:
Rec#: 077897 Amount: $1,050.00 Date Paid: 81412010
**** VARIANCE/WAIVER REVIEW ****
Wc,:v~ r: 05? I~ I ~ q2
Municipality of Anchorage
Development Services Department
Building Safety Division
On-SEe Water & Wastewater Program
4700 Bragaw SL
P.O. Box 196650
Anchorage. AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERHIT APPLICATION
FOR ,b. SINGLE FAHILY DWELLING
Parcel I.D. 012-242-38
Property owner(s) ~;EORGE ROONEY
Day phone 240-7382
Mailing address
Site address
7617 JEWEL LAKE ROAD * ANCHORAGE. AK
Zip Code 99502
Legal description (Sub'd, Block&Lot) OSMOND OLSEN S/D: LOT lA
Legal description (Township, Section & Range)
Lot Size Sq. Ft. Number of Bedrooms
4
THIS APPLICATION IS FOR ( ~;~all that apply):
Absorption Field
Septic Tank
Holding Tank
Pdvy
Pdvate Well []
Water Storage []
THIS APPLICATION IS AN:
[] Initial []
[] Upgrade []
Renewal []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
PermitJRush Fees: ~~ L~
Date of Payment: '.-~'//¢///O
Receipt Number:. '--7 '7 -7. ~ I ~.
Waiver Fees: C~ 0 0
Date of Payment: '-~'"/~":)'/! 0
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS ~,=~,~:u!.~,~.~ ...........
May 6, 2010
Municipality of Anchorage
Development Service Department
On-Site Water & Wastewater Program
4700 Eimore Road,
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907) 343-7904
Ref.' Proposed Septic Upgrade for Osmond Olsen S/D; Lot lA,
To whom it may concern:
The existing four bedroom house is served by a private well and septic system. The septic system is in a state of
failure and needs to be upgraded. We are proposing to install a new 1500 gallon S.T.E.P. tank and a dual 5-wide
trench type drainfield. One test hole was excavated on the property. The drainfield will be designed around the 30
foot radius of'this test hole. Comments regarding the design are summarized as follows:
1. SOIl,S: Sen the attached logs which shows the soil classifications, groundwater monitoring, and the percolation
test results. NOTE: The soil surrounding the drainfield was classified ns SW (well graded sand) and the percolation
rate was less than one minute per inch. This would ordinarily require the installation of a sand filter;, however, we
believe the insitu sandy soils will act as a sand filter, negating the need for a constructed sand filter.
2. DRAINFIELD DESIGN: Sen attached design drawing for drainfield specifications.
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system.
4. TOPOGRAPIIY: As can be seen on the attached design drawing, the average topography in thc area of thc
drainficld is relatively fiat. In short, there are no slope concerns.
5. WELL SITE: The current well encroaches on thc area intended for thc proposed septic system. We arc
proposing to abandon this well and relocate the well site to maintain 100 foot separation from thc well to thc new
septic system. Sec attached design drawing for specified well site.
6. LOT LINE WAIVER: Due to site constraints, we are requesting a one foot waiver from thc dsainfields to the
lot line. We are unaware of any adverse impacta this would have on any surrounding wells or septic systems.
We arc unaware of any/~dverse impacts this installation would have on adjacent wells or septic systems. If you have
any questions, please/oltact us at 337.6179. Thank you for your assistance.
tel) ,
NOT~: Attached is a site plan drawing, a design drawing, one sail log. which are all part of the design package for
this septic system. (Contact G.£. G. Ltd. for 7page construction specification letter.)
3701 E. Tudor Road, Suite I 01 * Anchorage, AK 99507-1259
Ph: (907} 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com
PROPOSED
SEPTIC
UPGRADE ~
~ STRAWBERRY ROAD
BR[N~WOOD / % J
~ ~ v-- .. ~ OSUONO \
OLStN \ I
13 000 ~ 18 \ STRAWBERRY
\ / BLOCK 2. / \ ~ PATCH LOT 't
/ 0 \ (PROPOSED)
I
BRr'NTWOOOBLOCKLoT, !2' LLJ "" ~'~ / /// \ i
BRD,4TWOOD LLII ~ I
BLOCK 2. ~: t t. OT 2
LOT ~0 Ld \ I r I
"~ \ / I I
\ / I I
\ OSUOND / ~ 5~,AW~£R RY
OLS£N / I PATCH LOT 2
\ LOT 3 /
BR£NI~OOO /
BLOCK 2. ", /
-- I
I
~ BR£NTWOOD I
I BLOCK 2.
I OLSt'N I
~OT · I I
~ I.~ S £: ~ I
ir'mo'
OSMOND
OLS;.
LOT 5 I
_~ ~o~~,[~o~,o~ ' ~ ...... 'fl"/'-":~'1"":':':~ 1
GEORGE ROONEY 20 7582 I 1 OF2 ~ ,~, '~'f/;~.~ -'
SITE PLAN '*/' ~'/' ~'
NUMBER OF BEDROOMS: 4
GALLONS PER DAY (CPO): 600
PERCOLATION RAT~/S: <1
PROPOSED APPUCATION RAT~: 1.0
DRAINFIELD DESIGN:
lENGTH: (2 ~ 30) 60' TOTAL
1' LOT UNE
WAN[R
REQUESTED
NOTE: THE CONTRACTOR
SHALL HAVE THE NORTH &
WEST LOT LINES, AND ALL
WELL RADII FLAGGED BY A
REGISTERED LAND SURVEYOR
PRIOR TO CONSTRUCTION.
PROPOSED DRAINFIELDS ARE
PRESSURIZED. UNES ARE TO
BE 1.25' PVC. LATERAL LINES
ARE TO BE 24' LONG. WITH
1/4" DIAMETER HOLES
SPACED 2' ON CENTER (15
HOLES PER LATERAL LINE. 26
HOLES TOTAL.)
STRAWBERRY ROAD
PROPOSEO
MT
EXISTING CRIB TO BE A~ANONDEO PER CODE
- PROPOSED 1500 GALLON
S.T.E.P. TANK J
__ /~-ALTERNAT~ SIT~ ~ REQUIRE
BEDROOM
~o EXI511N~ WELL 'TO
I BE DECOMIS~ION[D
/ / PROI~OSED NEY/
/
,/ PROPOSED I00' WELL
/
GARNESS ENGINEERING GROUP, Ltd.
. ? '- .... -? CONSULTANTS & GENERAL CONTRACTORS ~¢--. ....
PREPARED FOR: IPHONE NUMBER: PAGE NUMBER:
GEORGE ROONEY 240-7582 2 OF 2
OSMOND OLSEN LOT lA D^T£ A.J.G.
SEPTIC DESIGN 5/6/1
0
.~ ~.. I ..: .................I1~ :'"'1'
ISOIL LOG - PERCO~TION TESml ~[.~,tl./~.~ ........... .~
DEPTH m
(~eet) ~ ORe,CS ~TEST HOLE ~1I
-- I In ATIN [ ..........................
~ GW ~ OEO STRAWBERRY ROAD
' SP CH / -~ x I
SW-S~ SC ~ I
GROUNDWATER DATE t t
D~ 5/4/2010 ~
11 DATE READING CLOCK NET TINE WATER LEVEL NET DROP
TIME (MINUTES) READING (INCHES)
12 5/5/2010 1 9:30 - 12- -
2 9:52 2 O" 12"
15 5 9:52 - 6' -
4 9:35 1 O'
14 5 9:55 - 6' -
6 9:34 1 O" 6'
15 7 9:54 - 6' -
8 9:55 1 O" 6'
16
17
1 PERCOLATION RA~E <1 (HIN./INCH) PERC. H~E DIA. 6 (INCHES)
TEST RUN BETWEEN 4.0 FT. ~D 5.0 FT.
20 ~ A FOUR HOUR PRESOAK WAS PERFORMED: ~ YES ~ NO
SOILS LOGGED BY: ROB ~MPBELL PERC~ATION TEST PERFORHED BY: ~DREW
COMMENTS:
PERFORMED BY GEG, Ltd. I, JEFFR~ ~ GARNESS, CERTI~ T~T THIS WAS. PERFORMED IN ACCORDANCE
WITH ~L STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF FIEALTLI & ENVIRONMENTAl. PROTECTION
ENVIRONMENTAl.. ENGINEERING DIVISION
825 LStreet-Anchorage, Alaska 99501 Telephone 2644720
ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELL INSPECTION REPORT
L_OCATION
DISTANCE TO:
TAbsorption erea
Manufacturer
Liq. cal IF HOMEMADE: -- Inside length
DISTANCE TO: Well Dwelling
Manufacturer
DISTANCE TO: Well
No, of lines "~th of each
Top of tile to finish grade
ESundai. ion
line 'Potat length of lines
Material beneath tilo
Nearest lot line
h.. O. OF BEDROOMS ?
Dwelling PE--~MI"~- NO.~'~ -~,
Material ,¢~-.. ~ ~No, of compart¢~nts
Width Liquid depth
PERMIT NO.
Material Liquid capacity in gallons
PERMIT NO,
Trench width Distance between lines
roches
Total effective absorption area
inches
Length Width Depth PERMIT NO,
Type of crib Crib diameter Crib depth Total effective absorption area
' Well Building foundation Nearest lot line
DISTANCE TO:
Class Depth Driller Distance to lot line PERMIT NO.
DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PiPE MATERIALS
SOl L ']-EST RATING
INSTALLER
ATe
REMARKS
APPROVED
DATE
LEGAL
"� aL
• -� Municipality of Anchorage °`
On -Site Water and Wastewater Program
(907) 343-7904 E ,
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 012-242-38
1. GENERAL INFORMATION
Complete legal description Osmond Olsen Lot 1A
Expiration Date: 01-1(,-26
Location (site address) 7617 Jewel Lake Rd. Anchorage. AK
Current Property owner(s) _George Rooney Day phone
Mailing address
Real Estate Agent
P.O. Box 100572 Anchorage, AK 99510-0572
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
WaiverNariance request for:
Received by:
4
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual
Holding Tank
❑
Community
❑
Public Sewer
❑
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 6—S-0 Waiver Fee $
Date of Payment &- 13- 2 Z
Receipt Number 02.3 3C
COSA # 0SC 2 21 2,f0
Date of Payment
Receipt Number
Waiver #
Distance:
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 :ARCTERRA CONSULTING,. INC.- Phone 696-6111
Address 20441_PTARMIGAN BLVD_, EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUSDate
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future �� �►\ Nk
occupants or can ArcTerra guarantee that no unseen A► C)PI A \
encroachments, deficiencies or discrepancies exist.
6. DSD SIGNATURE
System #1 Approved for L( bedrooms. arc «nnzr'f �
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System #2 Approved for bedrooms. 1 fV.
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Disapproved.
Conditional approval for bedrooms, with the following stipulations:
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Original Certificate Date:` zZ_
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 Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10-10-12 doc
Legal Description: Osmond OIsen Lot lA
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 8/17/2010
Total depth 376 ft
Cased to 376 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 34 in.
Date of flow test for COSA 5/25/22
Static water level at beginning of test 80 ft.
Comments
B. TANK DATA
Age of tank(s) 12 years
Tank type/material STEP/Steel
Measured operating fluid level in septic tank 42
10 Standpipes/foundation cleanout per record drawing
Date of pumping 10/5/21
D. ABSORPTION FIELD DATA
Which system tested (date installed) 7/21/10
ALL standpipes present per record drawing
Total measured depth from grade 6.7 ft (max)
Measured depth to pipe invert from grade ft (min)
NIA — 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 gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 012-242-38
Structure served by this system
Well production at time of test 4.8 gprn
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes 0 No
Coliform bacteria is Negative
Nitrate mg/L M Nitrate less than MRL (ND)
Arsenic 5.99 ug/L ❑ Arsenic less than MRL (ND)
Collected by Areterra Consulting
Date of Sample 5/25/22
C. LIFT STATION
11 Required maintenance completed
Age of lift station 12 years
Lift station material Steel
Comments:
Adequacy test date 6/18/22
Results Z Pass For 4 bedrooms
Fluid depth prior to test 0 in
Water added 600 gal
New depth 0 in
Elapsed time 30 min
Final fluid depth 0 in
Absorption rate 600+ gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
® Yes if No ft
Wells on Adjacent Lots:
Septic Tank/Lift Station on Lot > 100'
® Yes if No ft
Private Wells > 100' ® Yes if No ft
Community Sewer Manhole/Cleanout > 100'
® Yes if No ft
® Yes
if No
ft
® Yes
if No
ft
_ _Neighboring Tank > 100' _ _ _® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
ft
Absorption Field on Lot > 100' ❑ Yes
if No
90X ft
Holding Tank > 100' ® Yes
if No
ft
Neighboring Absorption Fields > 100'
Animal Containment > 50' ® Yes
if No
ft
® Yes
if No
ft
Manure/Animal Excreta Storage> 100'
Community Sewer Main > 75' Yes
if No
ft
® Yes
if No
ft
From SepticlHoiding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft
Property Line > 5'
® Yes if No ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes if No ft
Private Wells > 100' ® Yes if No ft
Water Main > 10'
® Yes if No ft
Community Wells > 200' ® Yes if No ft
Water Service Line > 10'
® 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'
❑ Yes
if No 1**
ft Wells on Adjacent Lots:
Water Main > 10'
Yes
if No
ft Private Wells > 100' ® Yes if No ft
Water Service Line > 10'
Yes
if No
ft Community Wells > 200' ® Yes if No ft
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
*Waiver#OSX101002 Granted for 94' on 6/1/10 then edited to 90' on 2/4/11 r*Waiver#OSP101042
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and review
of Municipal records that the above systems are in conformance with 493H
MOA COSA guidelines in effect on this date. a'".
CE
COSA Checklist yellow sheet
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MUNICIPALITY OF ANCHORAGE
Development Department Phone, 9-07-343-7904
On -Site W t r & Wastiaw,,jtor Secti,,on � v Fax- 907-343-7997
1A Station/Pump Vaitit
Lj
Ovmer Street Address-Sqr f
pttc Teak,
-Slu r e level inch s -Pumping: rc uir r rji;rrg completed �
Lift station:
-Purnp basket cleaned ii -Effluent filter cleaned
•t onlr l floats cleaned .,. � -Proper fl t s tti t s c nfirmed �� n
-Operafion s test ctcar
Alarm Sir
-Dedicated electrical alarrt"r U rccr.rit 110 -Audnt e andvisual alarms insidc dvvrellirig yes r
•Altura system rat�ra tisfactor not salisfactor
Manhole Riser
-Ground water intrusion at riser to tank connection re's Xno
• mend water intrusion around p4pe pen tr'ationssir;-Weep frog functional s no
-Manhole lid-, Fwicttonal
Insulated ,. Properly Secured nq
Ptler
.141 manufacturer required inspections area maintenancecomWeted F � �r
Comments:
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!qualified Maintenance Provider,
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Technician
Company
Signature
of maintenance
�.w ..�.
Date
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