HomeMy WebLinkAboutT15N R1W SEC 30 LT 72 E2Certified Drilling Log
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,mn ►LLIV AE WATER WELLS
At OP
P.O. Box 670269, Chugiak, AK 99567 688-2759
OWNER OF LAND: Northern Utilities Services LLC
ADDRESS: 19133 Darvy Rd. Eagle River, AK 99577
Bore Hole
Data
Depth
From
To
LEGAL DESCRIPTION T15N R1 W SEC 30 LT 72 E2
DATE: 2/3/25
0
2
PERMIT NUMBER: OSP251021 DATE OF ISSUE: 1/29/25
TAX IDENTIFICATION NUMBER 05130212000
Is well located at approved permit location: ®Yes [—]No
Method of Drilling: ®air rotary ncable tool
Depth of Well: 62'
Casing Type: Steel wall thickness .250 inches
Diameter: 6 inches, depth 62 feet
Liner type
Static Water Level: 18 feet
Recovery Rate 20 ® gpm n gph
Method of Testing Air
Well Intake Opening Type: ® open end ❑open hole
❑ Screened Start feet Stopped
❑ Perforations Start feet Stopped
Grout Type: Bentonite Volume: 50 Lbs.
Depth: from 2 feet, to 42 feet
Well Disinfected Upon Completion: ®yes Ono
Method of Disinfection: Chlorine 50 PPM
Comments:
2
4
4
20
20
30
30
44
44
61
Casing Stickup
Overburden
Silty sand and gravel
Gravel, silt, water
Gravel, sand, water
Sand and gravel, water
Drillers Name: Cole Sullivan
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority.
Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation.
Matsu Borough: Department of Environmental Conservation.
Pump Installation Log
Well Drilling Permit Number: OSP251021 Date of Issue: 01 2925 -
Parcel Identification Number: 05130212
Legal Description Block Lot Property Owner Name & Address:
APSLEY DANIEL R & JESSICA V
T15N R1 W SEC 30 72 E2 173 KING AVE
FT LEAVENWORTH, KS 66027 1206
I Pump Installation Date: 2
- 20 - 2025
IPump Intake Depth Below Top of Well Casing: 42
feet
IPump Manufacturer's Name: PD WATER SYSTEMS pump
Model: 4PWP07GH 05C162P
Pump Size: .50 hp
IPitless Adapter Burial Depth: 12
Pitless Adapter Manufacturer's Name:
feet
CAMPBELL 1
WATER QUALITY TESTING
Coliform _ COI/100mL
Mtrates _!..2:Y__ mg/L
Arsenic ____e ug/L
Pitless Adapter Installer:
Northern Utility Services F C3
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: PELLETS
I Comments:
Well Drilling was completed by Sulivan Water Wells on 2/3/25.
IPump Installer Name: Ben Matlock
ICompany: Northern Utility Services
Mailing Address: 6600 Wes Way
City: ANCHORAGE state: AK Zip: 99518
Attention: The pump installer shall provide a pump installation log to On -site within 30 days of pump installation.
OPINA uN SE V #CES PAR-ri 'j-i4 `', f J ti S. 1
i'6 i J � .If1 31 907- 43-790�:
On -.site Water and I astemrater Section Fax: 343'797
Www.ik9L.ni.crg a"9nsit'__
Well Decommissioning Log
Legal Address: 19133 Darby Rd. Eagle River
Subdivision Block Lot
T 15N R 1W Section 30 LOt 72E2
On -site Water & Wastewater Section certified contractor performing the well decommissioning:
Name:
Ben Matlock Signature:
Company:
Northern Utility Services
Well decommissioning date 2/20/25 Method of decommissioning: AMC 15.55.060L1 a. ❑ b. ❑ c. Q
Location: Use the space below to provide a
drdW1ir)`W`$ they dpe the following item 7
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STORY
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6
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I,ITILITY PI: SERVE
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Lot 72
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DECONIMISSIC'NEDWELL R
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IFIFRVI
N 89'51 `00"'fir 165.50'
DARBY ROAD
v:\ueveiopment ServiceMbuuding Satety\on Site Water and Wastewater\Forms\Client Forms\Well Decommisioning form.doc
Drilling Permit No,
LOCATION OF WELL' (Pleoae complete either la, lb or lc.)- , A.D.L. No. `~
I Io,J Borougyh Subdivis ion lyol Block Ib. 1/4 qin- ecllon No. Tawnaht Ran ♦ Merl dlonT—�
n °
Ant l2j 366 (15 N E� Seward
I SO Wig
Fl-�!DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS OWNER OF WELL: 5
8Lt`A 0� ?2 Evr4>\¢ E24
a, gl e River, Ak . 9957
• Address:
Street Addraps and Area of Watt Locallon Iq�C Uwv� VgvCS, �vGa�pr A
¢. WE`4V
L,DEPTi1: ifinal) 5. Rq?E OF Cty�LETIO#5
l F �J l,t i V ..
g O Ccblo tool XaRofary 0 0rivan Q Dug
' D Auger Q Jeffed ❑ Bored 0 Other:
7 USM.TNem/sfio O Public Supply Industry
0 Irrigation Q Recharge Q Comm♦rlcal
1
Q Test Wall 0 Other:
A. C(41NG: 0 Threaded X Welded
di am. 6 in. to40 ff. Depth weight 1.7 h.
diem. ^min, to ft. Depth Stickup It.
9. FINISH OF WELL:
TYPO: — Diameter:
Slol/Mosh Slsr: Length:
Sot botween fl. and fl.
Backfilling Gravel path
2. WELL LOG Feet Ba low
SUI I*c0
Material Type Top Bottom
Stick-up 0 2
!
Loam
4 gravel ..
Sandy gravel -- 18 35
ecu a.n, waer -
I
t
i
� c
I
'O. STATIC WATER LEVEL: ft. %
7at0
Above or 0 5elow land surface
Equipmen! used:
JI. PUMPING,LEVEt. below land surface and YIELD
It. offer hrs, pumping g.p.m.
I!. offer hrs. pumping _`g.p.m.
12.GROUTING Wall Grouisq: D Ysa O No
Material: 0 Neat Cemont 0 Ofhsr:
13, PJMP: (it avoilobi^) HP
Length of .Drop Pip* N, capacity
0 Suttm. O Je! 0 Canlrifical Q Other
14. RENARIr$�oduction of 20 GP11
16. 'NATER WELL CVNTRACTOR'S CERTIFICATION: --'— '--'-
15. Wa!ar Tornpeta lure' °
This call was drilled under my jurisdicli0n and this report is Irct to th.q nasi of my knowledge and belief;
_ "Maenuson Drilline, Ae 53t35_ _
Rogist♦red Business Nom. Contract license tturnber
Address: P a0 . Box 770504 Eagle River, Ak . 99,577
S. gnee Dale: C?Ct . ?_ 9, 1
Authorfrad Reprs'sental,lvo
Forr. [`iz V:WR (if .} C.py D+str+0uti3n: W141TE-Strte C3GS. ';h'K':�ril:c:, t::+.•:4�i T'•Cuirom.r
O F 0 C
P.O. Box 670269 Chugiak, AK 99567
P: (907) 688-2759 F: (907) 688-2259
Northern Utility Services
19133 Darby Road
Eagle River, AK 99577
Camera Inspection Report
Resting Static: 10'
Pitless: 12'
Holes: 16.7', 35.6', 39'
Pump: 43'
Yield: 9GPM
Date: 1-28-25
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
hftp://www.muni.org/onsite
On -Site Water System Permit
Permit Number: OSP251021
Work Type: Well Upgrade
Tax Code Number: 05130212000
Site Legal Address: T15N R1 W SEC 30 LT 72 E2 G:0654
Site Mailing Address: 19133 DARBY RD, Eagle River
Owner: APSLEY DANIEL R & JESSICA V
Design Engineer: NORTHERN UTILITY SERVICES, LLC^
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
,went
s.
t)(tlYarrIl7P,tlf
1 /29/2025
1 /29/2026
54450
❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ Water Storage
All construction shall 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: To close out this water well permit the owner is to submit:
• well log
• pump log
• water quality results
• water well decommission log
Received By: i f �h FU Date:
Issued By: Date: �'_
3
MUNICIPALITY OF ANCHORAGE
Adw�fthl
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section
ON -SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 05130212000
Property owner(s) APSLEY DANIEL R & JESSICA V
Mailing address 19133 Darby Road
Site address 19133 Darby Road
Legal description T15N R1W SEC 30 LT 72 E2
Number of Bedrooms 3
Engineering Firm Northern Utility Services
Building Permit Number
Day phone 719-502-6195
Not Applicable Al
APPLICATION IS FOR:
APPLICATION IS AN:
(Z all that apply)
Absorption Field
El
Initial ❑
Septic Tank
❑
Upgrade
Holding Tank
❑
Renewal El
Privy
❑
Well
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Permit/Rush Fees: -7, -z- 5—
Date of Payment: Z -2- Ci 42
Permit No. (),5 f Z5_1 ( )'7—
Waiver Fees:
Date of Payment:
Waiver No.
Distance:
THIS WELL IS TO BE SITED, DRILLED AND
BLOOM COUNTY INSTALLED AND THE EXISTING WELL IS TO BE
DECOMISSIONED IN ACCORDANCE WITH ALL
7� Lot 2 ( Lot 1 APPLICABLE STANDARDS AND PROVISIONS
�% 1 I OF AMC CHAPTERS 15.55 AND 15.65.
TREE FORT w/ DECK O%z GLWI'
S 89'50'30"E 165.57'
PLAYHOUSE
c �3 T (, SEPTIC CV SEPTIC
PIPES �' PIPES-,
1Ci:nft�'i MANHOLES � Z ( 0,.,mIVnusalmska.ctlnn,
.� • oECK 64.7' ( ao7) 2A0 -7 0 7,5
0 LGI / —
40.3'
N L T S; D C / 1 STORY
n RESIDENCE TO
ow / WALKOUT, I 50' ROADWAY &
.ONEU :' BSMT. UTILITY RESERVE
40.3'
b=K
54,5!-'.""." ^77.3'
/ 16.3'X12.2' SHED
z
/ O
o Lot
' W1 of Lot`/ 72
NEW WELL O
W 3 FT. OFFSET EAST O
W O OF EXISTING I I O I
OIJ EXISTING WELL
(TO BE DECOMISSIONED)
Ej of poi' 72
\ 54,627 S.F.
j-WELL /
50' ROADWAY &
UTILITY RESERVE a
i'
— — — — — --N 49:5i=80 165.50' —
DARBY ROAD o
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to I
-----------------------------
0 10 25 50 100
low =sow
UL' NUN: UM
DRAWN: OM �E.�F' A�gsr,l
CHECKED: 19133 DARBY RD.N (OR r e.. tv
*. •��'.
DATE: 1 /29 2025 E R N j +:. 49 TH
REV./DATE: '
Qn". i.:...
NEW WELL UTILITY SERVICES On mill.,
D1 P.O. Box 233368 Anchorage, AK 99523 �1k`\\\\"
d I Tel: (907) 222-4084 Infoid-nusalaska.com
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
Municipality of Anchorage
On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211146 PID Number: 051-302-12
Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade
Name
REICH
ABSORPTION FIELD
Wide Trench Q Bed El Mound
[:1 Deep Trench
Site Address
9133 Darby Rd
t❑
er
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
8507974849
3
0.8 GPDISF
5 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Gravel depth beneath pipe
4.2 Ft.
0.8 Ft.
Subdivision Block Lot
T1 5N R1 W SEC 30 LT 72 E2
Fill added above original grade
0 Ft.l
(Gravel length
53.5 Ft.
Township Range Section
Gravel vridth
13.5 Ft,l
Beds: Number of Lines
3
Distance between lines
4 Ft.
SEPARATION DISTANCES
To Septic
From Tank
Absorption Holding ' Sewer
Field Lift Station Tank Line
Total absorption area
722 Ft-
Number of trenches
1
Dist, between trenches
- Ft.
Well 100'+
100'+ na na ria
TANK ❑Septic F] S.T,E.P. [IHcicing ❑ Other
Manufacturer
Capacity
Surface beater 100'+
100'+ na n a
Greer
1250 Gal,
Material
Number of compartments
Lot Line10'+
j 10'+ na na NA
Plastic
2
Foundation 1 0'+
+ 1 0'+ na na
LIFT STATION
Manufacturer
Capacity
Remarks
Greer
250 Gat,
Alarm location
Electrical installed by
House
Installer
J R's
PIPE MATERIAL House tb tank D3034Tank to D3034
drainrield
Drainfield D3034 C01MT D3034
inspector NorthRim Eng.
BENCH MARK (Assumed elevation) 100 ft
Inspeectiosn 1.7 5127121 211:15/28/21
3"d 41.1
Locationdateand description
Deck
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineers Stamp
Conditional Approval: Date
+OF A( 444
='ry�i
* :49TH *ft
♦♦�± Steve z s ?tea
� 4 6'/3%21+
Septic System r -
Approved Date
Note: this approval does not include well permit requirements.
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61
MT3
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22
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33
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No Neighbor Conflicts
Darby Road
NORTHRIM
T15N R1W SECTION 30
1// 50'
ENGINEERING
SteveEng.comRECORD
LOT 72 EAST 2
PO Box 770724
Eagle River, Alaska 99577
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MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP211146
o S'
Department
Effective Date: 5/18/2021
Work Type: Septic Upgrade Expiration Date: 5/18/2022
Tax Code Number: 05130212000
Site Legal Address: T1 5N R1 SEC 30 LT 72 E2 G:0654
Site Mailing Address: 19133 DARBY RD, Eagle River
Owner: REICH MATTHEW J & ROBIN M
Design Engineer: NORTH RIM ENGINEERING
This permit is for the construction of:
Q Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy
Lot Size in Sq Ft: 54450
Total Bedrooms: 3
❑ Private Well ❑ Water Storage
All construction shall 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By:
Date:_5
Issued By: `e.:(`,oD,. Date:
MUNICIPALITY OF ANCHORAGE
Development Services Department f '; ' Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-302-12
Property owner(s) REICH
Mailing address 19133 Darby Rd
Site address same
Day phone 8507974849
Legal description (Sub'd., Block & Lot) T1 5N R1 W SEC 30 LT 72 E2
Legal description (Township, Range & Section)
Lot Size 54,450 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
(® all that apply)
Absorption Field 0
Septic Tank El
Holding Tank ❑
Privy
❑
Private Well
❑
Water Storage
❑
APPLICATION IS AN: TYPE OF DWELLING:
Initial ❑ Single Family (SF) 0
Upgrade
(w/wo AD U)
�
Duplex (D) El EllMultiple Dwellings ❑
(SF and/or D)
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature o-Tproperty owner or authorized agent)
Permit/Rush Fees:���
Date of Payment: ,�3/z 1
Receipt Number: 0 272 y D
Permit No. OS P21 I ( y 6
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
SteveEng.com
Steve Eng, PE, PH
907-694-7028
SteveEngPE@gmail.com
Date: 5/12/21 Number of Pages:
To: MOA On-Site Services
Subject: T15N R1W Section 30 Lot 72 E 2
Septic System Failure
The subject septic system has failed- a new STEP will replace the old one. The existing seepage
bed will be rebuilt due to no available space. The original test hole monitor tube is present and dry.
Please issue a permit so the septic system can be replaced. Please review as soon as possible. This
is a large lot with no nearby neighbor conflicts. Elevations below the house are flat; above the
house is indicated.
If there is need for additional information or clarification please give me a call.
Thanks-Steve
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211146, Rebecca Carroll, 05/18/21
� TH IRM
FE,ZINEERING SteveEng.com
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211146, Rebecca Carroll, 05/18/21
T15N Rl W Sec 30 L72 E2
SPECIFICATIONS & DESIGN GUIDELINES
Wastewater System Sizing: This is an existing 3 -bedroom, single family home. Due to
limited area, the only space available is the current septic site- it will be rebuilt. A STEP
tank/bed is currently in use- tank will be decommissioned per UPC and new STEP tank
w/ bed installed. Neighbor lots are served by septic systems and public/private wells;
there are no conflicts. The topography slopes from north to south as depicted in drawing.
Previous soil tests reveal GM, the monitor tube is still in place & dry. An application rate
of 0.8 GPD/FTZ could be used, since this is a bed. Bed Width = 562.5 FT2/13.5' = 42'
bed. An oversized bed will be used, matching the existing footprint, 50'x 13.5' bed, 0.5'
effective depth. 5' total depth. Previous bed drain -rock & surrounding soil to be
excavated. Leveling the bed with MOA -approved sand.
Specification Requirements: All components and work must comply with the
Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water
Regulations and Wastewater Regulations.
• New 1250 Gallon STEP tank. MOA -Approved.
• 5' minimum between the tank and bed. 10' minimum to property line from bed.
• 4' of cover and insulation is required for force main; 2" Minimum thickness for
insulation.
• Tank & solid pipe must be set on well compacted, stable soil.
• 4 inch diameter cleanouts with airtight caps are required 1 ' to 4' from foundation
wall, prior to any 90 degree bend in 4 inch line.
• All cleanouts must extend to at least ground level.
• In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron.
• Bed to be placed level, minimum of 4' to groundwater, 6' to bedrock.
• Drain rock to be 1/2" to 2 1/2" screened. Drain rock to be distributed uniformly.
• Force main to be 1.25" Schedule 40 PVC or equal.
• Distribution pipe to be 1.25" Schedule 40 PVC w/ 1/8" orifice @ 30" on -center.
• Silt barrier (filter fabric) to be installed above the drain rock.
• Smeared bed must be raked or scarified before drain rock placement.
• The finish grade must be mounded to promote drainage away from trench.
• Insulation must be placed over any pipe installed under driveways or parking areas.
• Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789,
ABS ASTM D2661,
• Sewer Service Line is minimum 2% slope.
• Septic Tank to be pumped every two years or when required.
• Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal)
49TH
Steve Eng
CE -6256
SSG&1?1
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211146, Rebecca Carroll, 05/18/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211146, Rebecca Carroll, 05/18/21
Municipality of Anchorage
Development Services Department
Building Barely DMsion
On -Site Water and Wastewaler Program
4700 South Bragaw SI.
P.O. Box 196850 Anchorage, AK 995196650
stww.munlmrglonsito
1907)043.790r
Soils Log - Percolation Test
I
Petlormed For: i1 OF y �� t7Ee.: ; TI5N ; J21 KJ Date Pala
Legal Description: lgahl f — MaL Township, Range, Secllon:
Depth
1
19-
20 -
COMMENTS
— M44V[—S
-4m
WAS GROUND WATER
vyzT--� ENCOUNTERED?
SIF YES,ATN1iAT DEPTH? L
ZT4Vtk) TO t`oTr D.pnmwsllrAMr 0
-1b J621Fy NO Monitoring?P� '
15&t) D.t« 23 �E
t
Silo Plan
rcm,u.nr.urarwrG 1mwhN��d.I
TESTRUNBETWEEN t FT •
y'v
FERC HOLE DIAMETER
FT
PERFORMED BY: , S Lh 1i�+ee� RTI THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL ATE ANO MUNI y ELINES EFFECT ON THIS DATE. DATE:
P1 fl,WE
,
rcm,u.nr.urarwrG 1mwhN��d.I
TESTRUNBETWEEN t FT •
y'v
FERC HOLE DIAMETER
FT
PERFORMED BY: , S Lh 1i�+ee� RTI THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL ATE ANO MUNI y ELINES EFFECT ON THIS DATE. DATE:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, TeJephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
B.,.e DISTANCES
.~/"/";//~ "'"' ~ ~ )/~ ~ ~ SEPTIC ABSORPTION
Addre~ TANK FIELD WELL
LEGAL OE~CRI~IlON COT LINE ~-
Lot I Block p Subdivision
~ ¢ ~ ~/~ FOUNDATION
Township, Range, Section
AS-BUILT DIAGRAM (Bhow location of well, septic system, propeAy lines, foundation,
~/~ ~/~ ~ ~ driveway, water bodies, etc.)
TANKS
~ SEPTIC ~/~,~' ~ HOLDING
Manufacturer Capacity in gallo~s
TYPE OF SYSTEM ,_ ./~_
~TRENCH ~ BED ~ W. DRAIN ~OTHER
Depth ,o pipe bottom Bom / TotaL depth Bom oPgina, grade / ~'/~
original grade ~ FT ~,J' FT ~'~t,
~ FT ~ /~ ~ ~,
~ S~FT ~- ~ ~ FT
~ /J'~ SQFI ~ ~ ~. ~/~
Installer ~ g ~ Date Instal,ed
WELLS
~ PRIVATE ~,~r/~r ~ OTHER (Identify1
FT
FT
REMARKS:
~// ~/~ /-~ ~ ~ ~ ~ ~/' Inspections Pedormed by:
I ~~ cediiy Iha, this inspe.i0n was pedormed acc0rdinD
72-013 (3/85)
PERFORMED FOR:
LEGAL DESCRIPTION:
4-
5-
6-
7
8-
9-
10-
11
13-
14-
15-
16-
177
19
20-
COMMENTS
I~ SOILS LOG
MUNICIPALITY OF ANCtHOP..a~E
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PR~OTECTION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~ PERCOLATION
825 L, Street, Anchorage, Alaska 99501 264-4720 'JUL1 0 i~SgTM
SO,LS LOG-.ERCO'AT,ON TEST RECEIVED
~..¢/'~'~ ~.~j'.~,z' -- ,~$~'~-~ DATE PERFORMED: ~R/a~5
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
S
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERFORMED BY:
72-008 (6/79)
Eagle Rivor Engin~dno Services
p, ~3 I~v ??3297
Eagle River, AK 99577
6g~5195
CERTIFIED BY:
,,DATE:
Owr~cm
W:[L.I.]EAN H, I :1 l I F']~ ,~D
19],:53 DARBY ROAD
.~HLJu:~ J: ~..~,.. ~ AK ~ '?~. ~ 7
Day F'lnone:
f..~ ? .,~ ~,8 7 1
P a r' c: e 1 :I: cl: 0 5 1 --:]:..";02'.- 1
L.o'L l...ega.l.: Subc!:i. visic~n: - Lot: '7~:~ Bl~cl-.'.: E :1./~
S~c:tion~ ::50 'T'o~n~h~p~ J. DN
Lot Size Dzl. 4DO (sc:I. Et,, or ac:res)
Max t~edroc~ms~ Th:i,~ Permit: 3 'r'c:)taI Cap~c:~ty~
cal::ia[::ity~ :1.,000 ga:l.].c)ns. !Eac:h septic
):)ept, h to:, tc~p of sep'L:i.c tank (s) < 4,,0
II'~lF!]t:i:l'~l D,:I-i.H,,S:, F:'F,']:OR Tf) 1ST & 2ND ]:!xlSPE~['Y'f']:DIqS BY E:NG]iNEE:R~
AFTt~:R I]I:::'F:' :t: CIE HOUF/I~i~ CAI.,.L 343-'-4681 AND I,.E~:AVlE A I"IIESSAEiIE~
CONS'I'I'~UCT I:::'ER E~I'qGINEIEI'tS DESIGN,,
F!'.liS PIE[RIIIT EXI::'IRIES :t.;2/:5:1./EI':? AND VALID F:OR A S]:IqGLIE F:'AMILY HOME.
]]F:' i:.')ED :I;S INSTAI_..IJED ZN 131.4 A ;Et F:'00]' SAND F;' ]: L'I"E:I::;: W]:L.L,.
]: E;Iii:FCI'II:::'Y 't"I"IA'i',~
I'C)P'I:.H []y th~z' !flun:icit::iality o{ Al"lc:hcipage (Iff(IA) ~r'icJ 'Lhe State c:)[
2.,, I will :insta.l. 1 i'.!ie syst'.em in ac:copdarlce with all MI]A c:od~]s and
arid J,n c:clmpliaric:e wi'Eh the desJ. gn cr.J.'Leria o{' 'Lh:i.s perm:it..
:i~;~ :t: ~*~:i.].:l. adlnere to:) aJ.]. M[)A and State (::ri Alaska r~':,cluiremerd'.s t(::n· i:.h('.,) se'h back
d i. sta. ncE)s~ [ru:)m any ~:,x :Lst lng we]. ]. ~, v~ast, ewateP d:ispc:~sal ~;~ystem c:P pub l
sE~werage system on th:J.s (::~1' any adjacent ch', near'by ].oi:,.
· q..,]: understar]d 'Lh,;~i:. i:.his pePmit is valid f'or' a max:i, mum c:l~' :]; bedr'ooms.
also understand that the c:apac:ity (::~{ the i:.ota! system :i.s 3 bedrc~(::)ms arid
~i']y el'i].aPgi.:ame[ii:. ~:L]L:[ p~2(;jilJ, r'e an addJ.'LJ, l:/!la:L pE'Ph]J.t,,
(Ownem) 1.1,, 'T II,,,.L.~
~.~ .......................... ~ ................... ...................................................
/
NEIGH
WELL
+100'
ND WELLS +100'
D 89
J
50' 30~E 165,50
~DECK "
,GAR.'/H[ USE /
lO0'
APPRDX, WELL
LDC, +tO0'
APPRBX, CLASS
C WELL LDC.
+150'
C
RIGHT DF WAY
EXIST]NB LEACH F]ELD
NEfF LEACH FIELD
CLEANDUT - o
SCALE, l" = 40'
IWELL AND SEPTIC SITE PLaN
LEGAL: T15N, RiW SEC 30, LBT 78B
DWNER: TILLFDRD
CBNTRACTDR: RASHUSSDN
EAGLE RIVER ENGINEERING
PB BX 773E94'
EAGLE RIVER, AK, 99577
694-5195
SERVICES
Louis A. Butera : ~
c~-~7~
REVISION ~1 06/86/89
+
NEIGH
V/ELL
+100'
NO WELLS +100'
]3 89 50' 30"E 165,50
DECK
GAR,/H[IUSE'
1oo'
1Si
~ APPROX, WELL
LOC, +100'
APPROX. CLASS
C ~ELL LOC,
+i50'
WELL AND SEPTI'C STTE PLAN
RIGHT DF WAY
EXISTING LEACH FIELD ::::::::
NEW LEACH F[E[_D :;:;:::,
CLEANOUT - ·
SCALD i' = 40'
LEGAL~ T15N, Rig/ SEC 30, LOT 72B
Og/NER, TILLFORD
CONTRACTOR: RASMUSSON
EAGLE RIVER ENGINEERING SERVICES
PD BX 773894'
EAGLE RIVER, AK, 99577
694-5195
SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: LOT 728, T15N RlW Sec. 30
GENERAL
1. The well and septic plan are for a
2. The drawing and or site plan shall
3. All materials and workmanship shall
Health and State Department
requirements.
single family residence only.
be a part of this specification.
meet the Anchorage Department of
of Environmental Conservation
4. All soil tests are advisory to the design and are to be verified or
modified fn the field by the engfineer.
5. All excavations and depths are advisory and are to be verified or
modified in the fleld by the contractor to meet Municipality of
Anchorage, Department of Environmental Conservation requirements.
6. It is the responsibility of the owner to obtain all necessary permits
or easements and to locate any adjacent multi-family wells.
?. The excavation ls 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 ]fine
posJtion and the location o¢ any easements.
BED
1. The bed is to follow the natural '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. The total depth of the bed excavation is not to exceed 5' at any
point.
4. The sewer line is to replace the existing sewer line that leads to
the existing pit.
5. ]'he bed gravel frs to be covered with typar fabrfc material.
6. Soil or combination of soil and extruded board insulation to a depth
of 4' or equivalent is to be placed over the leachfield.
7. The area ever the bed is to be fJnlsh graded to prevent ponding of
surface water munoff.
8. The septic tank and leaohffeld must not be closer than 100' to any
existing private well, 150' to any Class "C" well, or 200 feet to any
community well.
RECOMMENDED LEACHFIELD DIMENSIONS
TOTAL DEPTH 5' GRAVEL DEPTtt = 6" BED LENGTH = 50' BED WIDTH=' 13.5'
Soil Rating = 150
Bedroom Capacity = 3
Septic Tank Size = 1250 INCLUDING LIFT STATION.
Absorbtion Area = 6?5
1' SAND FILTER REQUIRED UNDER BED GRAVEL.
LIFT STATION REQUIRED.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:
DATE PERFORMED:
LEGAL DESCRIPTION: ~p1/- 7~-,- ~::~ ~-J~'/ /'-~/~'~'~ J'~; ~
SLOPE SITE PLAN
1
2
3 ,~/ ,?.C ~
4
5
6
7
9
10
WAS GROUND WATER
1 1 ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
13-
14-
15-
16-
17-
18-
19-,
2O -:
$
Y~S L
0
P
E
~.;--z /
i I
FERFORMED EY
MUNICIPALITY OF ANCHORAGE
VN05%A
Development Services Department= Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 051-302-12
Certificate of On -Site Systems Approval
Expiration Date: 7- t/ --Z/
1. GENERAL INFORMATION
Complete legal description T1 5N R1 W SEC 30 LT 72 E2
Location (site address) 19133 Darby Rd
Current property owner(s) REICH
Mailing address
Real estate agent
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone 8507974849
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
0
Private Septic
Z
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 $2.904 165',
Waiver Fee $
Date of Payment '�20
Date of Payment
Receipt Number 6 Z
Receipt Number
COSA # 05G2 113 (`j S
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 NorthRim Eng. Phone 694-7028
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng Date 5/12/21
-.Ar
q1
6. DSD SIGNATURE * ; 49-r *�♦f
System #1 Approved for bedrooms
System #2 Approved for bedrooms f♦ c Steve Eng i
Disapproved I` cE-625612122
Conditional approval for bedrooms, with the following siipula`tlons:
N -SITE
WAT€o G
rip—rrr,z
WAST-- TATE
r_MJ�o AAM
�lJ�/JcNrSE V1GE5o `\\�
By: Original Certificate Date: 'Z
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSH) 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 vrork.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
.. 1AI-It 1-1_....A J..d--_.. naL__ -. ...
Legal Description:
T1 5N R1 W SEC 30 LT 72 E2
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled unk
Total depth unk ft
Cased to 40'+ ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 4/28/21
Static water level at beginning of test 24.5 ft.
Comments
I W1ri1Zt:45T_%r_1
Age of tank(s) new years
Tank type/material STEPPistc
Measured operating fluid level in septic tank new
❑ Standpipes/foundation cleanout per record drawing
Date of pumping new
D. ABSORPTION FIELD DATA New
Which system tested (date installed) same
❑ ALL standpipes present per record drawing
Total measured depth from grade 5 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
depth into effective
Parcel ID: 051-302-12
of Structure served by this system
Well production at time of test 5+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 3.7 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by NRimEng
Date of Sample 5119/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material PIStC
Comments: New Greer STEP
Adequacy test date new
Results R Pass For 3
Fluid depth prior to test 0
Water added gal
New depth in
Elapsed time min
bedrooms
is
❑ Code -required soil cover over field Final fluid depth in
❑ System presoaked Absorption rate gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies: New septic
COSA Checklist yellow sheet
E SEPARATION DISTANCES
From Private Well onLot to: (Please enter distances if less than required cxifcommuniiyvwa|
Septic TonhiLUfStation onLot >1OU
�jYeo
JN$M
Community Sewer Manhole/Cleanout > 100'
r�Yeu
JNuM
r7lYeo
F�lYes
if No
Neighboring Tank >1O8' 21 Yes
ifNoM
Yen
Private Sewer/Septic Line 25,[-1lYes
if No
Absorption Field VnLot >1OQ' E] Yes
ifNo8
Yes
Holding Tank >1O8' Yes
if No
Neighboring Absorption Fields > 100'
Yes
|fNoft
Animal Containment �5U' Yes
if No
Yoa
|[Nn0
Manure/Animal Excreta, Storage 1OO'
Community Sewer Main >�75' Yeo
i[NoM
f-,/�Yes
if No
From Septic/Holding Tank unLot to: (Please enter distances if less than required)
Building Foundations >10' Yes ifNoM Surface Water >10I
M
R/ Yes if No ft
_
Property Line > 5^
�jYeo
JN$M
ifNO0
Wells onAdjacent Lots:
Absorption Field >5'
r7lYeo
ifNuM
Yeo
Private Wells >1DO' Yes if No.
Water Main >1O'
Yen
ifNoft
Community Wells >2D0' Yes if No.
Water Service Line >10'
Yes
ifNnft
Surface VVator>�1U0'
|fseptic tank isunder driveway comment below
From Absorption Field onLot to: (Please enter distances ifless than required)
Building Foundation >10' Yea ifNoft |fabsorption field iounder driveway comment below
Property Line >10'
2]
Yes
ifNO0
Wells 0nAdjacent Lots:
Water Main > 10'
Yeo
JNoD
Private Wells �>1OU'
Water Service Line >1n'
Yes
ifNoM
Community Wells >2OO'
Surface VVator>�1U0'
Yes
|fNoft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
/certify that / have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MCACOSA guidelinesineffect onthis date.
M
M
2] Yes ifNoft
El Yes if No ft
