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HomeMy WebLinkAboutT15N R1W SEC 9 LT 96AOnsite File T15N R1W SEC 9 Lot 96A PID# 051-104-58 Formerly Lt 96 GRFATER ANCHORAGE AREA BOROuj(-­ti HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME_ iii MAILING l'y yL' �r�f✓�/�C� PHONE �,7fj, ,%/ ,�C ADDRESS LOCATION /�/� %��'��1��a -`�ZZ_�LEGAL DESCRIPTION SEPTIC TANK: G,�jVC--I, _...r.._ NUMBER OF / DISTANCE FROM WELL �/)L' MATERIAL �-� COMPARTMENTS yy DEPTH LIQUID G L7 LIQUID CAPACITY GALLONS. INSIDE LENGTH � INSIDE WIDTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL '__� '� NEAREST LOT LINE zo TILE DRAIN FIELD: DISTANCE FROM W NUMBER OF JIKIES ABSORPTION AREA / 1 OUTSIDE DIAMETER OR WIDTH /--;? LENGTH , DEPTH .DISTANCE FROM WELL ,BUILDING FOUNDATION_sem TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)- SQ. FT. TOP OF TILE TO FINISH GRADE FOUNDATION , NEAREST LOT LIN DISTANCE'RETWEEN LINES SQ. FT. UNGTH OF EACH TRENCH W TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE DEPTH OF FILTER MATERIAL BENEATH TILE: IN. ABOVE TILE _ / DISTANCE FROM , WATER WELL: DEPTH /��r/1 TYPE DEPTH BUILDING FOUNDATIONSAMPLE—/��� NEAREST NEAREST SEPTIC SEEPAGE OTHER LOT LINE ,/l' SEWER LINE , TANK ��'4-' �, SYSTEM Z,'�S�2 CESSPOOL ✓ SOURCES L� DISTANCES: DIAGRAM OF SYSTEM DATE HEALTH AUTHORITY GAAB-H: URll:el-1171. R � Clll1011 AGIE AIRIjA T DRGU(Cvffff Case No HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 ,n alb SE V9AOE DISPOSAL SYSTEPA - APPLICATION a PERRAITr NAME OF APPLICANT/_11&FIe< 1}(i'k /'1 %� MAILING ADDRESS Th t %.,/ �' PHONE NQ.0Y 26 RESIDENCE ADDRESS_ lf�(f/CL% ��%�� f-�%` LOCATION OF INSTALLATION_ LEGAL DESCRIPTION' --1 2 APPLICATION TO INSTALL: SEPTIC TANK SEEPAGE PIT v , DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FACILITY_ FINANCED THROUGH TO TO BE.I•NSTALLED BYi— PERrT,� I Tenni TFcT RESULTS ANTICIPATED DATE OF COMPLETIONGL- BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT -2 Z-// 0 THIS IS TO SERVE AS AXE f/%%%hie C%1� >< PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVEDC SEPTIC TANK SIZE CTL' TYPE iLNLICll"LSEEPAGE AREA"��Yl�ic'i TYPE i DIAGRAM OF SYSTEM Q 64 L,p DISTANCES�0)I) %e HEALTH AUTHORITY OR LICENSED DESIGNER P 9N I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and th the above described sys m is in accordance with said code. / DATE GS S iC3 APPLICANTS SIGNATURE C1.i CJ %e HEALTH AUTHORITY OR LICENSED DESIGNER P 9N I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and th the above described sys m is in accordance with said code. / DATE GS S iC3 APPLICANTS SIGNATURE Depth Feet 'ZREA'I'ER ANCHORAOE AREA BOROUGH HEALTH DE?ARTb!EI'IT CASE ANCHORAGE~ ALASKA 99501 Legal Description: Lot Block Sub(hv~s~on ~pcolat 1 on This Form Reports a: So~ls Log Soil Characteristics Location Sketch / ~ i ) , I i Reading P~:te qross Time Net Time Depth To 1t20 Net Drop P~<mosed Instsllac~on: Seepage Pit ~'/ Drain COMAEN.S. Test Performed Dora Certified Date Develo ment Services Department p p ment �- Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-104-58 1. GENERAL INFORMATION Expiration Date: 7r 12 -Z(/ 2Z Complete legal description T15 N R1 W SEC 9 Lot 96A Location (site address) 22186 Birchwood Lp, Chugiak, AK 99567 Current property owner(s) Mailing address Real estate agent Patricia Lamoreaux & Joy Pennington Day phone PO Box 670224, Chugiak, AK 99567 Carmi Gubser 2. TYPE OF DWELLING: ❑M Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone (907)830-3228 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Q Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distan Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 53-0 Date of Payment 3 /ZQ ZZ Receipt Number 0 ! '17 COSA # C`� S% Z2/ (1 Date: Waiver Fee $ 11'8'0 I I Date of Payment q I 3 Receipt Number U Waiver# 0sV � a 9 �a 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 --Forge Engineering-- - - (MJ.) Phone --(907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 3/28/22 :4� 1 TH 6. DSD SIGNATURE ... 3 � System #1 Approved for bedrooms /� �.. Benjamlq.5chiller System_#2 Approved. for bedrooms }F��� •. 3/28/2z2 .• vim`` �_., . DisapprovedCilli RO SSI Conditional approval for bedrooms, with the following stipulations: \`llll((((((ffrrr/I WN-SiT�� N m AST[.-� , D m irr J�-o M o By: Original Certificate Date: 2-_2(9 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other Legal Description: COSA Checklist T1 5N R1 W SEC 9 L96A If more than 1 septic system on lot: COSA Checklist # of Parcel ID: 051-104-58 Structure served by this system A. WELL DATA ■❑ Well log is filed with Onsite (or attached) Well production at time of test 3.2 gpm Date dulled 7/3/1-958 Water storage tank volume gallons Total depth 140 ft Well disinfected for coliform test? ❑ Yes ❑E No Cased to unknown ft ■❑ Sanitary seal is functioning correctly ❑E Wires are properly protected Casing height (above ground) +24 in. Date of flow test for COSA 12/20/22 Static water level at beginning of test 90.6 ft. Comments B. TANK DATA Age of tank(s) 52 years Tank type/material Septic/Concrete Measured operating fluid level in septic tank 51 0 Standpipes/foundation cleanout per record drawing Date of pumping 1/5/22 JR's Septic D. ABSORPTION FIELD DATA Seepage Pit Which system tested (date installed) 8/17/1970 Q ALL standpipes present per record drawing Total measured depth from grade 13.5 ft (max) Measured depth to pipe invert from grade n/a* ft (min) ❑ N/A — pressurized field R Monitor tubes go to bottom of effective. If not, state depth into effective ❑■ Coliform bacteria is Negative Nitrate 7.72 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 3/23/2022 STATION ❑ Require intenance completed Age of lift station ears Lift station material Comments: Adequacy test date 2/16/22 Results Q Pass For 3 bedrooms Fluid depth prior to test 33 in Water added 778 gal New depth 45 in Elapsed time 1440 min ❑ Code -required soil cover over field Final fluid depth 38 in ❑ System presoaked Absorption rate '450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: 'No cleanouts in installed system. Pipes are for septic tank and crib. COSA Checklist yellow sheet 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' >50* Community Sewer Manhole/Cleanout > 100' Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' 0✓ Yes if No ft Private Sewer/Septic Line > 25' 0✓ Yes if No ft Absorption Field on Lot > 100' 99'5* p _ ❑Yes if No 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 —0✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0✓ 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' 0✓ Yes if No ft _. Water Main > 10' _ _✓❑ Yes_ if No . _ ft Comm�.rnity Wells > 200' ✓0 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' 0Yes 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' 0✓ Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' 0✓ Yes if No ft Surface Water > 100' 0✓ Yes if No ft F. ENGINEER'S COMMENTS *Field measurements differ from survey due to signficant slope. Tank separation met code at the time of installation. G. ENGINEER'S CERTIFICATION \ if: At,q�1�� i certify that 1 have determined through field inspections and review ro ' of Municipal records that the above systems are in conformance with *."49 71i • ,//•* MOA COSAguidelines in effect on this date. .. . .... ...... . Benjamochiller / �F'��• CE 12592 \ r •3/28/22 4 COSA Checklist yellow sheet t�l��pROFESSIONP ffib� MUNMP1-,W T Y OF A, HCHORAGOE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC 221117 Subdivision: T15N R1W Sec 9 lot 96A 907-343-7904 Fax: 343-7997 A water sample revealed -a nitrate concentration of 7.72 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Municipality of Anchorage �r S _ Department P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV221117 COSA#:OSC221022 Permit#: PID#: 051-104-58 Legal Description: T15N R1W Section 9 Lot 96A Engineer: Forge Engineering Applicant: Patricia Lamoreaux & Joy Pennington Your request for a waiver of the required 100 feet horizontal separation from the absorption field to the private well has been approved. The approved separation distance is 96.0 feet. See engineer's waiver request for justifications. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................... ■ ............................. ■ 1 Waiver is Granted: X Waiver is not Granted: Date: Q, Approved by: t"J NA. Name of Reviewer **** VARIAN C E/WAIVER REVIEW **** April 11, 2022 UTE E E R I N G PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677.7766 (FAX) FORGECIVIL.COM MOA Development Services, On -Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: T15N R1 SEC 9 L96A - 22186 Birchwood Lp Well waiver request Dear On -Site Services Engineer: - A septic permit for this lot was issued on April 14, 1970, specifying the code -required minimum separation distances from the well to the septic tank (50') and seepage pit (100'). An inspection report for the installation was submitted and approved on August 17, with a sketch showing a measurement of 100' to the seepage pit. However, the significant downhill slopes on the property affect the horizontal measurement. While the physical measurement seems to match the record drawing, the new as -built survey shows the strict horizontal distance to be slightly over 96' from the well to the seepage pit standpipe. We have taken a water sample from the well and found nitrates under 10 mg/L with no bacterial contamination. The location of the well is uphill from the septic system, so there is no possibility that effluent could overflow the system and run toward the well. In addition, this system has existed for over 50 years with no adverse effects. Based on this information, we hereby request a waiver be issued for the 96' separation between the well and seepage pit. Sincerely, Benjamin Schiller, PE Drilling Started STATE OF ALASKA 81796 DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING, LAND & WATER Alaska Hydrologic Survey WATER WELL LOG Revised 08/18/2016 Completed: / / Pump Install City/Borough Subdivision Block Lot Property Owner Name & Address i_n_L a_m o r_e K Eklutna T15N R1 W SEC 9 6A _AI_v a_u x ,_A Well location: Latitude 61.40501 Longitude -149.46968 Meridian S Township 015N Range 001W Section 09 , SE 1/4 of SW 1/4 of SE 1/4 of NW 1/4 BOREHOLE DATA: (from ground surface) Drilling method: it rotary, ELPable too]00ther Suggest T.M. Hanna's hydrogeologic classification system* https:/Imv.ngwa.org/NC Product?id=a185000000BYub3AAD Well use:OPublic supply,ODomestic,E]Reinjection,OHydrofracking © Commercial, ElObservation/Monitoring, OTest/Exploratory,E]Cooling, ®Irrigation/Agriculture,©Grounding,ORecharge/Aquifer Storage, QHeating,®Geothermal Exploration,®Other Fluids used: Depth From To Gravel 0.0 169.0 Brown clay 69.0 185.0 Clay and gravel 85.0 105.0 Depth of hole: 140 ft Casing stickup: ft Casing type: Black pipe Casing thickness: inches Casing diameter: 6 inches Casing depth: ft Liner type: Depth: ft Diameter: inches Note: Hardpan 105.0 107.0 Gravel and clay with a little water 107.0 118.0 Very fine sand - bears water 118.0 131.0 Clay and gravel 131.0 136.0 Well intake opening type: Open end,l Open hole,[10ther Screen type: , Screen mesh size: Screen start: ft, Screen stop: ft, PerforatedDYesE No Perforation description: Perf from: ft, Perf to: ft, Perf from: ft, Perf to: ft Gravel packed0Yes 0 No Gravel start: _ft, Gravel stop: ft Hardpan 136.0 139.0 Water sand 139.0 140.0 Note: Static water (from top of casing): 95 ft on / / Artesian well Pumping level & yield: 4 feet after 6 hours at 10 gpm Method of testing: Development method: Duration: Recovery rate: 10 gpm Grout type: Volume Depth: From ft, To ft Include description or sketch of well location (include road names, buildings, etc.): Final pump intake depth: ft Model: Pump size: hp Brand name: Was well disinfected upon completion?Lj Yes U No Method of disinfection: Was water quality tested?Wes F]No Water quality parameters tested: Welldriller name: .................................................................................. Company name: .PENN JERSEY-MCINROY DRILLING INC Mailingaddress: .................................................................................... Ngth City: State: AK Zip: Phone number: ( ) - Driller's signature: AS 41.08.020(b)(4) and AAC 11 AAC 93.140(a) require that a copy of the well log be submitted to the Department of Natural Resources within 45 days of well completion. Well logs may be submitted using the online well log reporting system available at: https:Hdnr.alaska.gov/welts/ Date: Anchorage Municipal Code 15.55.060(1) and North Pole Ordinance 13.32.030(D) require that a copy of this well log be submitted to the Development Services Department/City within 30 days of well completion. OR email electronic well logs to City Permit Number: Date of Issue: dnr.water. reports (Q7alaska.goy Parcel Identification Number: Illy UIV I Iyuluyc—Viw �Idb uuwauun oysiem wr Logging Water Well Boreholes by Thomas M. 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