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Home My WebLink AboutT15N R1W SEC 5 LT 103 N2 ,~GREt 'RI ANCHORAGE AREA B0R Department of Environment Quality 3500 Tudor Road Anchorage, Alaska 99507 ~GI'I INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION LEGAL DESCRIPTION ~ SEPTIC TANK: DISTANCE EROM WELL /_~ INSIDE LENGTH / / ~c~ NUMBER OF / I /' ' INSIDE WID~H~ _~/~//'~ LIQUID DEPTH LIQUID CAPACITY/'~ALLONS. TILE DRAIN FIELD= / i / TOTAL LENGTH / DISTANCE FROM WELL /~¢ FOUNDA'rION NEAREST LOT LINE ,/~ OF LINES NUMBER OF LINES ~ ~ DISTANCE BETWEEN LINES ~--/~ TRENCH WIDTH~IN. TOTAL EFFECTIVE ABSORPTION AREA ~ S~.~ FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OFTILETO FINtSH GRADE~ . MATERIAL BENEATH TI~E IN. ABOVE TILE~' IN, WELL: TYPE CONSTRUCTION .... DEPTH DISTANCE FROM: / / BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION__ LOT LINE ~.'~"' SEWER LINE TANK /~.'~/, SYSTEM CESSPOOL APPROVED OTFIER SOURCES DISAPPROVED DISTANCES: INSTALLED SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: REMARKS Form PW-O2? DATE~Z~ DIAGRAM OF SYSTEM APPROVED~ G.A.A,B, NAME OF APPLICANT GREATEr: ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. DISPOSAtL SYSTEM -- APPLICATION AND PI:RMIT ' SEWAGE INSTALLATION LOCATION INSTALLATION Of: SePTiC TANk ~ ! SEEPAGE PIT- ~/~ , DRAIN fieLD TYPE AND SIZE OF FACILITY TO SOiL TEST RESULTS//~/~'~_~f , OTHER FOUNDATION TO SEEPAGE PiT ~/'2/ , DRaiN FIELD ~ / ~/ DRA,N FIELO ~~/2/ SEPTIC TANK ---,.)__, SeePAge PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK /~'~) / , SEEPAGE PIT DRAIN FIELD /~-~/ ALSO CONSIDER AREA WELLS, WATER MAiN TO SEPTIC TANK /~ / . SEEPAGE Pit DRAIN FIELD SEPTIC TANK, --~/ SEEPAGe PIT /~J ~ i DRAIN FIELD TO RIVER, LAKE. STREAM. CAST IRON INTO AND OUT O~ SEPTIC TANK AND INTO CRIB CROSSING GAP OF ~XCAVATION 5 FEET INTO UND]~TURBED SOIL, F~TTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL TO bo H F~EGULATIONS REGARDING INSTALLATION. AREA SIZE TYPE I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DE$CRI B ED ~YSTEM I$ I N ACCORDANCE WITH SAID C~DE'E~/~/ ~.'*~ ~ I *~f A ~~~ DAT ~ '/~ APPLICANT'S SIGNATURE FORM NO, EQ-016 --/00', 0 &' E EA .ENT CO. /VEERING ~ DEVELOi Box:90, Davis St., Eagle River, Alaska 99577 694-2774 or 333-5240 Russell Oyster 694 2774 Civil Engineering Soils ~ Foundations I erfo~ ~e,J 'For Legal Descri?t~on; Greu~lwater Encountered; Depth feet Earl Ellis 333-524O Surveying Land Development Classification iirea Calcu] a tion II .,% ) .............. ~:~/: ~.0 58 9 4 4 ~ 9 z~'78 I~ECIUESTEO BY ..~ ~="' M U 11 C I PA T OF Development Services Department '1 q On -Site Water & Wastewater Section Parcel I. D. 051-082-11 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description T15N R1W SEC 5 LOT 103 N2 Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: (Q -2-7 ^Z'( Location (site address) 21313 OLD PIONEER DRIVE, CHUGIAK, AK 99567 Current property owner(s) MARTHA L. CONLAN Mailing address Real estate agent PO BOX 671514, 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: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ "� S 0 Date of Payment7Z,2A j Receipt Number :3 12115 COSA# O SC � 11 S&-7 Waiver Fee $ Date of Payment Receipt Number 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 7/7/2021 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 for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWrS 6. DSD SIGNATURE %C System #1 Approved for J System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms v .r- A��lil� • ' . Curtis uffman H 67% CE 128991 ,•��`� a 1\�� PROFESS10t_��~� bedrooms, with the following stipulations: WATER AND Wit' J� WAST_-VVATER oz 1 010. \� JjJJ� ��r SER\J `,1\ bw '� l/ Original Certificate Date: (� Z 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 Legal Description: T15N R1W SEC 5 LOT 103 N2 Parcel ID: 051-082-11 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA ® Well log is filed with Onsite (or attached) Water storage tank volume NA gallons Date drilled 10/1990 Well disinfected for coliform test? ❑ Yes ® No Total depth 139.5 ft ® Coliform bacteria is Negative Cased to 139.5 ft Nitrate mg/L ® Nitrate less than MRL (ND) ® Sanitary seal is functioning correctly Arsenic 9.2 ug/L ❑ Arsenic less than MRL (ND) ® Wires are properly protected FWES Casing height (above ground) 18+ in. Collected by Date of flow test for COSA 6/30/2021 Static water level at beginning of test 10 ft. Date of Sample 6/30/2021 Well production at time of test 4+ gpm Comments WELL CAPABLE OF HIGHER PRODUCTION — APPEARS RESTRAINED BY PLUMBING AT SPIGOT. B. TANK DATA Age of_tank(s) __9___ years _ Tank type/material STEP / STEEL Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping 6/30/2021 D. ABSORPTION FIELD DATA Which system tested (date installed) 7/20/2012 ® ALL standpipes present per record drawing Total measured depth from grade 6 ft (max) Measured depth to pipe invert from grade ft (min) ® N/A — pressurized field ® Monitor tubes go to bottom of effective. If not state C. LIFT STATION -- ® Required maintenance completed - Age of lift station 9 years Lift station material STEEL Comments: *FLOAT LEVELS Adequacy test date 6/30/21 Results Z Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 1 in depth into effective Elapsed time <5 min ®Code -required soil cover over field 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) If yes, enter date Gallons introduced gallons F° Comments/Deficiencies: . 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' ® Yes if No Community Sewer Manhole/Cleanout > 100' Surface Water > 100' ® 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 ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' —® Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ft Yes if No ft Building Foundation > 10' ®Yes if No ft if absorption field is under driveway comment below Manure/Animal Excreta Storage > 100' ® Yes if No Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft From Septic/Holding 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 _ 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 G. ENGINEER'S CERTIFICATION 1 certify that 1 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. 'AM, 11011 .... .......... • �.• Curtis Huffman Fc • CE 128991 •4`4 ,,� �l�c� • . 7/9/21 , . • AMP, l F�pROFESSIONP MUNICIPALITY OF ANCHORAGE ek-)pmcml r, , r, c s Ll c n e, I n F Snoti- Tank: Uft staliork- -Purillc-, ba8ket clearled,ac 1 110 C.,,c�n-Irc-4 floats; cleanec-d Lif-: Sta'ili(-,in.`!�--,Ljt-r,r-.,, Vzull Maintenance Log S,�rc-�4 Ad io ail nt til 11 e ir F; ma�l r.,O'n m So Nam, Svs,em: no n n and alarr-r.., iri�-�de @rnj r -J- (!,:, Ell Manhole i s e= r lnnez�q!or--i + 10 r c, u ri c' n t r s cr, n @ riser to k c ' .,GroL.,-,,d 'vvaler iritr-,slcm airound pl-lipepenelra*ions ves c-, h c f ncl i:-,) n a I n 441,-Jnholc lid: [=p,t lio-n a I ( v p: s j n c, [nsulaled -y n c Prop eiy SecuT�ed c—,; n o Other -A'l i,.,,Larufp-cturer required lln8pect.-fcm8 and mantemince c.,ampieted L ,� v e �.) 0.n 63141— Cormmcnts: Qualffieci Maintenance Provider: Compa nv , —",-I --- ic, - --n- -., mattv ! D,-ift-, of rnalritenanc D,, REQUEST FOR APPROV~,L OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS~ Complete all parts on page 1. Inconlplete requests wil~ not be processed. Please allow ten 10 days for processing, ~UNICIPALITY OF ANCHO"AGE DEPARTMENT OF HEALTH & ENV RONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 2. BUYER MAILING ADDRESS 3. ~.ENDING INSTITUTION MAILING'ADDRESS 4. REAL¥~OR/~[GENT MAILING ADDRESS B. I. BOA[. DESCfllPT[ON ;TREET LOCATIO~ ' t . 6, TYPB OF RESlDBNCE 8INGLE FAMILY MULTIPLE FAMILY 7. WATER SUPPLY .~ INDIVIDUAL* [] ~UBLIC UTI LITY SEWAGE DISPOSAL SYSTEM **If individual/on-site, give installation date ' ~ if system is over two (2) years old an adequacy test is required INDIVI DUAL/ON-SITE** PUBLIC UTILITY ~ by this Department, NOTE: THE INSPECTION FEE MUST AqCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, HONE PHONE PHONE PHONE PHONE NUMBER OF BEDROOMS · [] One [] Four [] Other [] Two [] Five .,~ Three [] Six * ATTACH WELL LOG, A well Icg is requ'ired for all wells drilled ~JD.~e~Ju~nA ~1_9.7.~, .For wells drilled prior to that date, give well depth (attach Icg if available,) 1. PROPERTY OWNER ,=1"~ a ~' .7:>. MA, L,N DDRESS ?.6, 5-o75A PROPERTY RESIDENT ('if different from above) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] oTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTA LED []PUBLIC UTILITY ~_ / Connection Verified INSTALLER []Septic Tank or []HoldingTank ~'~ ~ Size; /~:)~(0 If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFAC~.~ ~r TOTAL ABSORPTION AREA MATERIAL n~A Sewer Nearest Lot Line 4, DISTANCES Septic/Holdi rea Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS ~APPROVED FO~'~ BEDROOMS ~,~'~ONDITIONAL APPROVAL (letter must accompany certifieatel [] DISAPPROVED 72-010 (Rev. 3/78)