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Home My WebLink AboutBRUIN PARK FIRST ADDITION BLK 5 LT 19GAAB-HD- I GRI::~TER ANCHORAGE AREA BOROI'GH HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION SEPTIC TANK: DISTANCE FROM WELL MAlUNG~ /7~'~'-- ~ ADDRESS PHONE LEGAL DESCRIPTION ~L/~ LIQUID CAPACITY 7(~) J MATERIAL GALLONS. NUMBER OF COMPARTMENTS ~ ,,~.~'~>/,,"~/~:::~r.~ /~'~J:;~ ~'~'~" LIQUID INSIDE LENGTH INSIDE WIDTH DEPTH__ SEEPAGE SYSTEM: SEEPAGE PiT: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE OUTSIDE DIAMETER OR WIDTH ~J~,'~L~/ DISTANCE FROM WELL ~"~'~ / TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) BUILDING FOUNDATION SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELi FOUNDATION. NUMBER OF LINES DISTANCE BETWEEN LINES ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE SQ. FT. LENGTH OF EACH LINE NEAREST LOT LINE TRENCH WIDTH TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE DEPTH OF FILTER MATERIAL BENEATH TIL.E IN. ABOVE TILE WELL: TYPE ~¢, lie c-'J DEPTH LOT LINE ~ / NEAREST /7 / SEPTIC SEWER LINE , TANK DISTANCE FROM , BUILDING FOUNDATION. 7~) ," SEEPAGE , SYSTEM WATER .SAMPLE CESSPOOL , NEAREST OTHER , SOURCES DISTANCES: I b---)e = 1o4' ~ ..-> a - DATE DIAGRAM OF SYSTEM )0 I / APPROVED ~ AUTHORITY -~' - ................... Location of Installa~ion ..... Residence AddresSLegal Description ~/~ ~ ~: ~ "~:~- ........ Financed Through .... ... To be Installed Percolation Test Re.u~t,~ ......... Anticipated BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT This is to serve as - ,,, , .... , permit to install a --- ....~as described below, Size of unit to be served S~ptic tank size Type____.Seepage Area .. ~, _~ Type___ Health Author'{ty ~ I certify that I am familiar 'with the requi~men~s of Greater Anchorage A~ea Borough Ordinance No, 28-68 and that the above described system is in accordance with said code, APPLI(r NT FILLS OUT UPPER HAL ONLY Lending Institution Phone Address Zip Code Realty Co. & A~nt Phone Address ~8~ Zip Code Street Locati~ ~/Y/~'Z Type of Resl~nce ~ Single Family ~ Multiple Family No. of Bedroo~ ~ Other Water Supply ~ Individual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal ~ Individual Year Indiv~ual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Tirne ~]...~ i~ ~ Time ,nsp~tor I::,Or Insp~tor ,nsp~,o:: Field Note~ ~ - . ~Jt ~ ~ ~-'~- - ~ .... ~/ ~~ //C~~ -- ~ ~~ MUNICIPALI~ OF ANCHORAOE C ' RECEIVED ( [ ) APPROVED BEDROOMS ~b~ [ ~0 ~)~ 'CONDITIONS OF APPROVAL ( ) DISAP~OVED Soil~ ~afin~ Da~e ~wer Inslalled Well To ~orption Area ~ Well Lo~ ~eceived ~--~ Well to Tank ~n Septic ,~k Size 72.023 (3/82) ALASKA B, iUIROIlmE FITAL COFITROL Sel dlCe$, IFIC. APRIL 7 1983 RICH ANSITE SRA BOX 1780 A ANCHORAGE AK 99507 SELLER - RICH ANSITE BUYER- SUBDIVIS ION-BRUIN PARK BLOCK-5 LOT-19 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN AREA OF 240 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 150 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 222 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 1 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF THIS 1 BEDROOM HOUSE. 900 IS ADEQUATE FOR 1200 LUest 33rd Auenue, Suite ~ * Anchoroqe. Alosko 99503 · (907) 276-1361 Parcel I.D. 016-111-27 Certificate of On -Site Systems Approval Expiration Date: l 3 'D zo Z `? Legal description BRUIN PARKFIRST ADDITION BLK 5 LT 19 Site address 11340 WILLENE DR Anchorage AK Current property owner(s) CUSACK X The On -site system(s) is/are approved for 2 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Original Certificate Date: 11 /30/2023 This 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 Approval_June 2022 MUMCIPAUTY OF Development Services Department On -Site Water & Wastewater Section ANCH AGE Phone: 907-343-790 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application I. GENERAL INFORMATION Parcel I.D. 016-111-27 Complete legal description BRUIN PARK #1; BLOCK 5, LOT 19 Location (site address) 11340 WILLENE DRIVE, ANCHORAGE, AK Current property owner(s) JASON CUSACK 2. ON -SITE SYSTEMS SIZED FOR 2 BEDROOMS Day phone 907-947-1492 3. TYPE OF WATER SUPPLY: 0 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: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank 0 Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age NSA - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ 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 $ ?—'250 Waiver Fee $ Date of Payment ( Z �j �% Z� Date of Payment I COSA # 0 cj ,23 �-{ 7 Waiver # COSA ApplicaHon_June 2022 I -A COSA Checklist Legal Description: BRUIN PARK #1; BLOCK 5, LOT 19 Parcel ID: 016-111-27 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 2+ gpm Date drilled UNK. Total depth *100 ft Water storage tank volume NIA gallons Cased to *50+ ft Well disinfected for coliform test? ❑ Yes ® Nc R Sanitary seal is functioning correctly oliform bacteria is Negative ❑Q Wires are properly protected Nitrate 0. N01 mg/L ❑ Nitrate less than MRL (ND) Casing height (above ground) 12+ in. Arsenic ug/L ❑ Arsenic less than MRL (ND) Date of flow test for COSA 11/15/2023 Collected by GEG, LTD. Static water level at beginning of test 49.5 ft. Date 11/15/2023 Comments *PER AAROW PUMP & WELL SERVICE 2/15/2013 INVOICE (ON FILE AT MOA). K DATA fluid level in Date of pumping ❑ Required enance comple AWWTS FIELD DATA Which em tested (date installed) ❑ ALL standp present per record drawing Total measured depth m grade ft (max) Measured depth to pipe inve m grade ft (min) ❑ NIA —pressurized field. ❑ Per record drawings, field is insula ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used fo ore than 30 days prior to date of test) Gallons introduced _gallon date Any rejuvenation treatment 12 months) NIA If yes, enter date COSA Checklist June 2022 STATION ❑ Require Age of lift station Lift station maW Adequacy test date Results ❑ Pass Fluid depth prior to test Water added aal New fluid depth in Elapsed ti min Fin id depth in com tion rate gpd STATUS — POST RECOVERY depth (per record drawings) in Effective de used in Effective depth re ing in Qk ed12t/z3 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' NSA Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft F!] Yes if No Neighboring Tank > 100' no Yes if No ft Private Sewer/Septic Line > 25' ❑■ Yes if No Absorption Field on Lot > 100' ❑ Yes if No NSA ft Holding Tank > 100' 0 Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' ❑■ Yes if No ❑o Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑■ Yes if No ft ❑■ Yes if No ❑ N/A — Served by Community Well (not on lot) or Public Water Tank and Absorption Field(s) on Lot to: (Please enter distances if less than Building Foundations -J Yes if No ft Surface Water > 100' Tank to Property Line > 5' ❑ Yes I _ ft W djacent Lots: Field to Property Line > 10' ❑Yes if Wells > 100' Water Main > 10' Yes if No—:: ft Community Wells 5, Line > 10' ❑ Yes if No ft If tank or field is under driveway F. ENGINEER'S COMMENTS *WELL UNDER DECK WITH ACCESS HATCH. ft ft ft ft ft U Yes if No ft ❑ Yes if No ft ❑ Yes if No ft 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 Gamess Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness Date 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 oQoo00 practices. The reported results describe the condition of the system/s on the date/s of the evaluation. �o�o �4 4 Separation distances were measured to readily identifiable features. Hidden defects or encroachments may o Q exist that were not identified during the evaluation. The operational life of all wells and septic systems depend o . • S Q upon a variety of variables, including but not limited to soil conditions, groundwater levels that may fluctuate P during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing �* 49 T �* 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 I � the future performance of the well or septic system. GEG makes no representation whether an alternative well . .... . .............. I .... or septic system can be installed on the property in the event either of the current systems fail to perform Q J fr --G-or ss:• adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG QO to perform the evaluation. Reliance upon the information provided in this report by any other person or party s tj 795 coG (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 4Q� ed a • • • LICENSE RX_rofess10_ o COSA Checklist June 2022 uAECCW )OD FENCE WOOD FENCE /1 J�� ; �� oUSE P E FP DECK WELL? FOUND YPCS4617-E2.00" FROM COMPUTED POSITION LOT 18 NOTE GRAVE1 DRIIIDVAYkIAYCAICROACHIVTOI.OTISA=RDIVC 7-OPRIOR SURVEY- T7'ECURREIVTICE�ISNOWCOAIDIT.',OtiSDO NOTALL ANYENCROACHMENT TO BE CONFIRMED g_ �zz 5'- 0 F A P..-'49 THW ai % SHANE A. HOLT oN A LS-6914 p fessionO NOTE. SOUNDARYAND CORNERS CF TH,S LOTARE COMPL17ED HOLDING THE E4ST,50UAD4,RYOFSRUlA1 PARKSUR (fAKEO7jSp"M_:DUE TO NUMEROUS FOUND CORNERS NOT )VA TCeNG THE FECOFD PLAT DA T4, SAID CORNEPS FOUND ARE SH61111V A*RE0 Ai JV,?fLA PON TO COMPUTED TED 300,"VDARY FOUND YFC S 55 15'E 2 54' FROM COMPUTED POS17ION THE INFORMATION HEREON I s FOR THE USE OF LENDING ZRSTITUT70NS SPECIFICALLY TO SHOW ANY CONFLICTS - iNG ST IT RE_ AN HE 'SEMEN ON LICTS BETWEEN EXIST� , MU U Es D PLATTED LOT LINES S AN DIOR EA TS; AND FS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES E SE N E a A A 'IF' TSHOFNRHCOR OR A% LEG.L,ENTITY, THFR THAN THOSE APPEARING ON THE RECORD PLAT 0" ARE No T S ON ERE " I U NL_ S S I D CATED) N p = R NOTE: FENCELI ED THAT MAY APPEAR ON THIS DRAWING ARE NOT 70 BE USED TO DETERMNE PROPERTY LINES OR POSITION ADD171ONAl INPROVEgENTS. ANY PAWING SHOWN HEREON GREGN RAY BE A;PROX I MATE DUE TO EXCESSIVE SNOW AND/OR ICE. ONLY VISIBLE IMPROVEMENTS ARE SHOWN "HEREON LOT 20 WOOD FENCE FOUND YPC S 54 51'E2 46' FROM COMPUTED POSITION AS-BUIL TSURVEY f 11 = 301 NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT 1 HAVE PERFORMED A SURVEY OF THE FOLLOWIM, DESCRIBED PROPERTY LOT19 3tOCK5 3RUINPARKNO 11 PLA TP - 580) W04ORAGE RECORDIM DISTRICT, ALASKA, AM TKAT THE VISIBLE IMPROVEFENTS SITUATED THEREON ARE WITHIN THE PROPERTY LIKES AeC) NO VISIBLE EtXROACHMENTS EXIST OTHER 1HAIN WTED. DATED AT ANOWAGE,ALASKA THIS 16 TH DAY OF NOVEMBER, 2023 W5MTYD4TA aVTH5L'RAW%61SPREPA,?k0A0R THF0;""0FfiW0RDChlY H3a0rLRAONVDERSUD5'71F�WE VG AWCCPNhC; CRUMTAWTIEDATAfiEjFDN6PRO&STEDtWDERCOPYR16H7LAW 9GAG&95 75976 aF5-50 ANCHORAK R97 1 22.3-&.15 AAROW PUMP & WER SEROCE, LLC P.O. Box 110496 Anchorage, AK 99511 Office: (907) 346-9355 o Fax (907) 345-0202 Eagle River: (907) 622-9335 N2 I 1. CUSTOMER JOB SITE -- ------- -- - --- - -------- ----- ------ . . . .... --- ------ ---- .------ L -J L INVOICE DATE WELL DEPTH S L CHLORINATED PUMP DEPTH SALESPERSON QUANTITY DESCRIPTION''PRICE AMOUNT -7' &,-,5 7, --- - - ------------- - - --- ---- ----------- ------------- ...... ... . - ?; . .. .. ..... LABOR HOURS RATE AMOUNT TOTAL MATERIAL X TOTAL LABOR "ZI WORK ORDERED BY DATE COMP. TOTAL LABOR PAY THIS AMOUNT i I SIGNATURE (I Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work is not paid for in 90 days I agree to allow Aarow Pump & Well Service, L.L.C. the right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for equipment.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS.