HomeMy WebLinkAboutT15N R1W SEC 8 LT 124Onsite File
T15N R1W
Section 8
Lot 124
#051-154-07
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: SW �7��39 PID Number: os��syo7
Name: le
Wastewater System: ❑ New 'Upgrade
Address:
Z123/i T ltrw�' pr �+� i�� /�il� 99l'�i
ABSORPTION FIELD
Phone:
No. of Bedrooms:
3
❑Deep Trench ❑Shallow Trench XBed ❑Mound ❑Other
LEGAL DESCRIPTION
Soil Rating:
D
Total Depth fromor/i�inalgra de:
y,O ��i�/L•O �'Ck
GPD/Sq. Ft.
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
��.�
�• insii
Ft.
� � Ft.
Township:
%lS�
Range:
Section:
Fill added above original grade:
(. O
Gravel IeVh:
1/7
Ft.
Ft.
//
WELL: Fit= ❑ New OUpgrade
Gravel width:
1S,31
Number of lines:
Distance between lines:
y.s-
P14HS --e,41 5%T<- Svd-S.
Ft.
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
6Y5-
Pipe material: lFg7te,
11A 3--'13�1
DRi✓Arr=
Ft.
Ft.
SO. Ft.
�ccrL� C
Driller:
Date Drilled:
Static Water Level:
Installer: pp— 0609
Date installed:
Ft.
%'✓a
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
Septic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
HL�iJ. /rje,, k
�p40
Well
1 7-s-
138
"�
// 4
! / ^
/V f�
Material:
TE-E_SurfacL
Number of Compartments:
�-
+iso
LIFT STATION
Water
Lot
O
qZ3J 2
I
�O i
Size in gallons:
Manufacturer:
Line
Foundation
l/
'
/t/,�
"Pump on" level at:
"Pump of " evei a'
High water alarm at:
curtain
���
�
}
Pump Make el
I Electrical Inspections performed by:
Drain
Remarks: ,2 ,/PEC fi ro��!i�• s��
BENCH MARK
Location and Description:
Assumed Elevation:
/ O!�; 40
Ft-
ENGINEER'S SEAL
/
.low �
..�` OF A�►t
• �%
Inspections performed b : F� E s 6- 23-577
p p y Dates: 1 st
•cb a• 6V
* %
2nd 6- 2s ��
49Ili
. "f...,s...«.«.«..........
Department of Health and Human Services approval
Loufs A.Butera ;
% d
Reviewed and approved by: Date: F`-( anal
tc CE -6736 0I
+'�}•• •�.•• 1
72-013 (Rev. 9/91) MOA 25 vV �`�wy��srCk
of 2
Permit No. SW970139 Page 2
Municipelity of Anchoroge
DEPARTME-"NT OF HEALTH AND HUMAN SERVICES
FNVlRONMI=NTAL SERVICES DIVISION
P.O. Box 196650 · Anchorege, Alasko 99519-6650 Telephone: 345-4744.
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: Lot 124 T15N R1W ,Sec 8
PID No.: 05115407
N Bgd57'0" E
329.90
~ TEST HOLE /
1000
--- ~,~SC~E~T LWL
SEPTIC TANk
TH 1
® /°o.
,X4.3'
A C -- 24.7' FILTE~ 5AND
B C - 4g,.2' LAYE¢~
A-D -- 72.1'
~ ~ C = 70.5'
ABANDONED
z u 5EPTIC
3 ~ TAN~
ABANDONED
SEPTIC
AREA
EXISTING
WELL TO BE
ABANOONED
NOTE:
EX[SlING HOUSE IN PI~OCE55
OF BEING I~EI'iOVEI)
329.90
S 89d57'0' W
WELL
LOCATION
SCALE
7/1/98
1" = 60'
89.5
�rrttffirb DAttn I'
1
by '.-�VIECEIVED
DOC Co, dba
SULLIVAN WATER WELLS JUN 2 4 1998
P.O. BOX 670272, CHUGIAK, ALASKA 99567 * TELEPHONE 688-2U9MUl'l:0ipality of Anchorage
ept, Health & Human Services
OWNER OF LAND DEPTH OF WELL
ADDRESS CO
IlY
LEGAL DESCRIPTIO
DATE - Started Ended
PERMIT NUMBER 44
KIND OF FORMATION:
STATIC LEVEL OF WATER FT.
bRAW DOWN FT.
GALS. PER HR
KIND OF CASING
From
Ft. to
Ft. to
_—Ft
Ft. to
i J I C From
Ft. to
Ft.
From
From
Ft. to
Ft.
Ft.
Froi-n
—Ft. to
Ft.
From
Ft. to
0
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
S' From
—Ft. to
Ft.,
From
Ft. to
Ft.
Y From Ft. to
Ft.
From
Ft. to
Ft.
"4xi, __r;�04,lj From
Ft. to
Ft.
From--.-
Ft. toL.L�
Ft.
From
Ft. to
Ft.
'–Ft.
From
L
Ft. to
i
Ft.
i "j From
to
Ft.
'I
4
%.JFrom
Ft.
Ft.,
From
Ft. to
,
Ft.
to
From
5--i
Ft. to`,
"2,'
Ft.
J4-:jU'.1c,11Z .V,�LJ-r'9 From
Ft. to
Ft.
From---!
Ft. to
'2
F t.
From
—Ft. to
Ft.
From
Ft. to
_,Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
MISCL. INFORMATION:
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. toFt
DRILLER'S NAME
PAGE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALAS[CA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYETEM PEP, MIT
PERMIT NUMBER:SW970139
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:BISSELL CLIFFORD V & JANE ANN
OWNER ADDRESS:21234 JAYHAWK DR
CHUGIAK, ALASKA 99567
DATE ISSUED: 6/17/97
EXPIRATION DATE:
PARCEL ID:05115407
LEGAL DESCRIPTION:
T15N R1W SEC 8 LT 124
LOT SIZE: 108900 (SQ. FT.)
NUMBER OF BRDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAl, FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
THE ATTACHED APPROVED DESIGN.
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).
THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SANE DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
THE FOLLOWING SPECIAL PROVISIONS.
1 OF
6/17/98
SPECIAL PROVISIONS:
[ ECEIVED BY:
DATE:
[ agle I iver
P.O. Box 773294
Eagle River, AK ))577-3294
Engineering
Louis Butera, P.E.
ervice s
(907) 694-5195 tel
(907) 694-3297 fax
May 23, 1997
Jim Cross, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
BLMlot 124 T15nRlw Sec 8
Narrative & Permit Application
Dear Mr. Cross:
The proposed well and septic system will have very limited impact on adjacent properties for the
following reasons:
1. The surrounding lots are large, allowing sufficient room for septic sites.
2. Immediate neighboring septic systems are all +30' distance.
3. Reserve space is adequate, due to absm!otion capacity.
4. Drainage will not be affected and is not a major consideration in our design.
If you have any questions please call our office at 694-5195.
Sincerely,
Louis Butera, P.E.
/
\1997\97-030-NAR.DOC
~ 'rHt .5eP'nc. TANK
~Q ~-,- , i ~ ' /~" P~OP
J AR~ .- WELL TO
A~AN DON
NOTE:
~ISTING HOUSE TO 5~ ~EHOVEO
S 89d57'0' ~
/ ~ TEST HOLE
J MONITOR ~BE
a S~ER C~NOUT
~ ~. - WELL
NO SURFACE WATER ~- ~SEMENT ;~:'..~
. NO KNOWN CURTAIN DRAINS ~--~ PROPOSED ~CHFIELD
.... ,,~ ..... ~- ~I~ING L~CHFELO
OWNER: BISSEL ';:' -
CONTRACTOR:::.NfA .. · . . ~ ~.''
JOB~ 97-050 IDATE: 5/29/97 I SCALE 1" =.6~ ~~~""~
..
~ P.O. Box 773294
~ EAGLE RIVER, AX 99577 '*;% "" .... '" ~
~ ~ (907) 694-.5~95 FAX: (907) 694-3297
EAGLE RIVER
ENGINEERING SERVICES
P,O. Box 773294
Eagle River, Alaska 99577
(907) 694-5195
ERES Project No,: 97-030
Calculated By: LB
Date: 5/21/97
Legal: BLM LOT 124 TI5N R1W SEC 8
Single Family 3 Bedroom Dwelling
TEST HOLE1
Bed Subsurface Wastewater Disposal Field
Water' use at 150 gallons per bedroom = 450 gallons
Percolation rate = 0.3 minutes per inch
Wastewater application rate = 0.7 gallons per day per square foot
Required absorption area = 643 square feet
Bed width(W)= 15 feet
Gravel depth (D) = 0.5 feet
Required length = Required absorption area / Bed width
Required length = 643 / 15
Required length = 43 feet
Total Excavation Depth = 1.5 feet
2' APPROVED FILTER SAND LAYER
REQUIRED BELOW SEPTIC ROCK
SINGLE FAMILY ON-SITE WORKSHEET
ERRS PROJECT NUMBER: 97-030 CALCULATED BY:
LEGAL DESCRIPTION: BLM LOT 124 T15N RIW SEC 8
NUMBER OF BEDROOMS:
WATER USE PER BEDROOM:
PERCOLATION RATE:
DEPTH TO GROUNDWATER:
DEPTH TO IMPERMEABLE LAYER:
ANTICIPATED DEPTH OF COVER:
MOUND OR BED SYSTEM
WASTEWATER APPLICATION RATE:
ABSORPTION AREA REQUIREMENT:
MINIMUM BED LENGTH
12 FEET WIDE BED
15 FEET WIDE BED
TRENCH SYSTEM
WASTEWATER APPLICATION RATE:
ABSORPTION AREA REQUIREMENT;
SHALLOW TRENCH OPTIONS
5 FEET WIDE TRENCH
LB
3
150 GALLONS
0.3 MINUTES PER INCH
6 FEET
10 FEET USABLE SOIL STRATA
1 FEET TOTAL USABLE DEPTH:
USABLE SOIL STRATA DEPTH:
0.7 GAL/SQ.FT
643 SQ.FT
2
1
54 FEET
43 FEET
N/A GAL/SQ.FT
#VALUE! SQ.FT
DEEP TRENCH OPTIONS
3 FEET WIDE TRENCH
EFFECTIVE REQUIRED TRENCH EFFECTIVE REQUIRED TRENCH
DEPTH (FT) ENGTH (FT) DEPTH (FT) ENGTH (FT)
1 #VALUE! 4 NA
2 NA 4.5 NA
2.5 NA 5 NA
3 NA 5.5 NA
3.5 NA 6 NA
4 NA 7 NA
8 NA
9 NA
DESIGN SPECIFICS
FIELD SYSTEM:
GRAVEL DF' PTH:
TRENCH OR BED WIDTH:
LENGTH:
TOTAL
EXCAVATION
DEPTH:
B (B=BED, S=SHALLOW TRENCH & D=DEEP TRENCH)
0.5 FEET
15 FEEl'
43 FEET
1.5 FEET
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
525 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG .-- PFRCOLATION TEST
PERFORMED F 0 R: __,~/~')"~_//'
LEGAL DESCRIPTION:
I,?.. y
Township, Range, Section:
1
2
3
4
5
6
7
8
9-
10-
11
12
13
1,4
15
16
17
18
19
20-
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED? /V~
IF YES, AT WHAT /
DEPTH?
Depth to Water Alter
i'donitoriflg? ~ Date:
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE L~'~ [m,nutes/,nch) PERC HOLE DIAMETER (~ '/
TEST RUN I~ETWEEN ~:-.-- FT AND ~ F'r
I ' ~'~"~ ~'~ ~'~'"~'~'~'"'""~ ~'~ CERTIFY THAT THIS TEST WAS PERFORMED IN
PERFORMED BY:
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE:
E gle River Engineering
Louis Butera, P.I~.
P.O. Box 773294
Eagl~ River, AK 99577-3294
ervices
(907) 694-5195 tel
(907) 694-3297 f,,×
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: BLM lot 124 T15N RIW Sec 8
5/23/97
A. GENERAL
1. The well & septic phm is for a single family residence ooly.
2. The drawing and or site plan shall be a part of this specification.
3. All materials and workmanship shall meet the Anchorage Department of Health reqairements.
4. All soil tests are advisory to tile design and are to be verified or modified in the field by the engineer.
5. All excavations and depths are advism3' aod are to be verified in the field by the contractor to meet
Municipality of Anchorage requirements.
6. It is the respoosibility of the owner to obtain all necessary permits or easements and to locate any
adjaceot multi-family wells.
7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer
approval.
8. It is always recommended that a surveyor locate the nearest lot line position and the location of any
easements.
9. Any remaioiog open test hole excavations shall be filled.
B..SEPTIC TANK
1. The septic tank shall be a minimum of 1000 gallons and shall be of approved MOA design.
C. BED
1. The bed is to follow the natnral land contour to maintain uniform total depth of the bed bottom.
2. The bottom of the bed shall be level, plus or minus 1.5".
3. A 2' filter sand layer shall be required at a total depth of 4'. Material shall be an ADEC approved
filter saod.
4. The total depth of the gravel layer is oot to exceed 0.5' at any poiot.
5. The effiuent liue is to be 3034 PVC fi'om the taok to the bed, and FSI0 perforated pipe within the
bed.
6. The bed gravel is to be covered with typar fabric material.
7. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed
over tile bed. Mounded side slopes not to exceed 3:1.
8. The septic tank and leachfield must not be closer than 100' to aoy existiog private well, 150' to any
Class "C" well, or 200 feet to any commuoity well.
RECOMMENDED LEACHFIELD DIMENSIONS:
BENCHMARK - 100.00 ASSUMED DATUM at flagged uail in tree
BOTTOM OF 2' FILTER SAND LAYER = 4' BELOW GRADE
BOTTOM OF GRAVEL LAYER = 2' BELOW GRADE'
SAND FILTER THICKNESS -- 2' of ADEC approved material
GRAVEL THICKNESS = 6" under pipe, 2" over pipe
BED LENGTH -- 43' BED WIDTH = 15'
SOIL RATING = 0.7 GPD/ft5 BEDROOM CAPACITY = 3
SEPTIC TANK = 1000 gallon
Twenty-fonr (24) hours notice required for all inspections.
\1997\Bed-sa-l.doc
MUNICIPALITY OF ANCHORAGE
Development Services Department �`'
p P �- =- Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-154-07
1. GENERAL INFORMATION
Complete legal description T15N R1W SEC 8 LOT 124
Expiration Date: 3 ^2I - 20 Z Z
Location (site address) 21234 JAYHAWK DRIVE, CHUGIAK AK 99567
Current property owner(s)
Mailing address
Real estate agent
LIFFORD V. BISSEL
PO BOX 670033, CHUGIAK, AK 99567
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
Day phone
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ Waiver Fee $
Date of Payment f 5 ZO2 1 Date of Payment
Receipt Number 715 15 7 Receipt Number
COSA # 0SC 2 11 '7 1 '7 Waiver #
Distance:
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 FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name _CURTIS HUFFMAN, PE Date 12/15/2021
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. 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 in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. 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, any estimate of how long a system will function satisfactory ��Q: •' • . • �)
for current or future occupants or guarantee that no unseen encroachments, deficiencies or rg• '.9 `r
discrepancies exist can be given by First Water Consulting & % *: TH
Fwrs �. .. .......�
6. DSD SIGNATURE"
��'•. "" '...."
• • Curtis Huffman
System #1 Approved for bedrooms CE 128991 -,�����
4_•12/15121-�f
System #2 Approved for bedrooms �1,F�'°ROFESSIONP 4
Disapproved
Conditional approval for bedrooms, with the following stipulbin
�t�d
WA pg"TR Z�
v''ATE o
Original Certificate Date:
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 Adviso y
Well Flow Advisory Other _S�+tfa
le
K
Legal Description: T15N R1W SEC 8 LOT 124 Parcel ID: 051-154-07
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
® Well log is filed with Onsite (or attached)
Date drilled 6/1997
Total depth 120 ft
Cased to 72 ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 12/7/2021
Static water level at beginning of test 28 ft.
Comments
B. TANK DATA
Age of tank(s) 24 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 49"
® Standpipes/foundation cleanout per record drawing
Date of pumping 12/6/2021
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6/23/1997
❑ ALL standpipes present per record drawing
Total measured depth from grade *3_9 ft (max)
Measured depth to pipe invert from grade *3_3 ft (min)
❑ N/A — pressurized field
® Monitor tubes go to bottom of effective. If not, state
depth into effective
of — Structure served by this system _
Well production at time of test 2+ gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? ❑ Yes ® No
® Coliform bacteria is Negative
Nitrate 1.96 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
NES
Collected by '
Date of Sample 12/8/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station — years
Lift station material
Comments: SEE MOA TANK ADVISORY
Adequacy test date 12/7/2021
Results 2 Pass For 3 bedrooms
Fluid depth prior to test 0 in
Water added 600 gal
New depth 4 in
Elapsed time 1330 min
® Code -required soil cover over field W/ INSULATION Final fluid depth 0 in
® System presoaked Absorption rate 450 gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N
date of test) —
Gallons introduced 2000 gallons If yes, enter date
Comments/Deficiencies: *AT MT & CO. ELEVATION SHOTS TAKEN SHOW 0.79-1.23' ED BELOW LATERAL. F-
Surveyor missed pipes under snow - all pipes located per MOA record IR.
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'
El Yes if No ft
Wells on Adjacent Lots:
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
Surface Water > 100'
® Yes
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
Community Sewer Main > 75' ®Yes
if No
ft
Manure/Animal Excreta Storage > 100'
® Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ® Yes if No ft Surface Water > 100'
P rt L'
ft
ft
ft
ft
111
® Yes if No ft
rope y ine > 5
El Yes if No ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes if No ft
Private Wells > 100' ® Yes if No
Water Main > 10'
® Yes if No ft
Community Wells > 200' ® Yes if No
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
_ 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
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
ORIGINAL WELL DECOMMISSIONED BY COLE SULLIVAN DECEMBER 2021.
G. ENGINEER'S CERTIFICATION
l certify that l 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.
ft
ft
Septic Tank Advisory
Certificate of On -Site Systems Approval #OSC211717
Subdivision: T15N R1W Sec 8 lot 124
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 24 years old. Typical replacement costs range from $9,000 to $12,000
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.
100
Cn
U7
Oo O W
r7 M >
N' z
O Li!
ct� a U
t1)
00
Oo
Z0
z
a
X
w
V)
w
X
3i
0=
0
V)
BASIS OF BEARING
N89°57'00"E 329.72' (329.93' R) _
JAYHAWK DRIVE
50' R.O.W. RESERVE
HCP
RAMP
• ®� r GRAVEL
SEPTIC• w Z W w D/W
VENT a r C a
(tYp) O o
-Z to
t O
RO r
a.o
ab
SHED
LOT 124
N89`55'12"E 329.69'
(N89°56'30"E 329.97' R)
ANCHORAGE RECORDING DISTRICT, ALASKA
AS -BUILT OF:
BLM LOT 124
T15N R1W SEC8 S.M. BLM PLAT MAY 13, 1955
SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchroachments exist other than noted. Under no circumstance should
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
DEC 14, 2021 1"=50' 1 schulleer6uk.net
21-169 eoacirAM
JLS N W1257 220108
SHED
8:0'
0
0
SHED
= FND MONUMENT
® = FND 5/8" REBAR
OF 4
i " % J�p
1,HN L. SCHULLER;
LS -10408
fessiono� Low
M
ry
to 0
M 0
U O
n P
r -
O
00
z0
z
O L NDSa4l�g
�}
R
0C�
1831 Taikeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274-4992 fax
Municipality of Anchorage
Community Development Department
On -Site Water & Wastewater Program
4700 Elmore St. ® P.O. Box 196650 w Anchorage, AK 99507-6650 m www.rnuni,orgZonsite m (9071343-7904
Legal Address:
Subdivision -j Block Lot
T_ R i (, Section Lot Ig L�
On-site Water & Wastewater Program certified contractor performing the well decommissi7nin :
Name:, , i
i I `1 Signature A AGb(-6U11 ) r
Company:f<<t+i
Well decommissioning date: o! r Method of decommissioning: AMC 15:55.0601-1 a. ❑ b. ❑ c. i
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.
----- -- __ :�O,yi1u LJ 1, Tarr