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HomeMy WebLinkAboutT12N R4W SEC 10 LT 28 S2Onsite File T12N R4W Section 10 Lot 28 S2 #011-161-13 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201493 PID Number: 011-161-13 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 9 Upgrade Name DANNY LOMMEL ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ound Site Address 8621 JADE STREET ANCHORAGE, AK ❑ other Phone of Bedrooms Soil Rating Total depth original grade 907-268-7555 rNumb,r GPD/SFI Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot T1 2N R-3'0 SECTION 10 LOT 28 S2 Fill added above original gr Ft. Gravel length Ft. Township Range Section - Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station a Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100'+ TANK 0 Septic ❑ S.T.E.P. ❑ Holding [I Other Manufacturer GREER TANK Capacity 1250 Gal. Surface Water 100'+ Material HDPE 12 Number of compartments Lot Line 51+ NA Foundation 10'+Z_ LIFT STATION Manufacturer Capacity Gal. Remarks OLD TANK DECOMMISSIONED PER UPC PER CONTRACTOR Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 drainfield Tank to D3034 Installer ARCTIC TERRA Drainfieid o9034/EX]snNc CO/MTD3034 Inspector TIM ECKLUND AND ERIK WIDGER BENCH MARK (Assumed elevation) 100.00 ft Inspection1s' 12/18/2020 - Location and description nd GARAGE SLAB 3b _ 4,h _ ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's tamp oo�o0 004 Conditional Approval: Date ©� Pte.• S�DO .i.._.....s.-'.......D CE_79Gar Septic System Approv lti Date — "l ' 004 Z•r' v Note: this approval does not include well permit requirements. e �2� c��o (o)fess-10 $Aecc 84 (Rev 05/02/18) PERMIT NUMBER: RECORD DRAWING PARCEL NUMBER: OSP201493 011-166 1-30 A I B C01 35.5 47.1 MH1 37.1 48.9 STI 41.8 52.8 DBL1 42.5 53.5 DBL2 42.8 52.9 CO3 43.5 51.5 SWING TIES TAKEN FROM AS -BUILT SURVEY BY WALATKA'S - SURVEY ATTACHED GAA >S E II G "ROUP, Ltd -•-- -� ENGINEERING SALES =CONSULTING- =-- , 'ANCHORAGE, ALASKA • PHONE (907) 337.6179' WEBSITE: w.rN 9ame.cengne nng com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ALEX LOMMELL 907-268-7555 2 OF 3 LEGAL DESCRIPTION: / GARAGE D.J.G. TYPE OF WORK: I— DATE: A ° a °a• °... •° 2/22/21 W d SHE f— 100' WELL RADIUS \ U1 \ W C) Q I \ I EXISTING 4 BEDROOM HOUSE \ (• o , •4 • •a EXISTING FCO a - 4 . APPROXIMATE LOCATION OF EXISTING \ ° DRAINFIELD; WEST END PHYSICALLY EXPOSED DURING CONSTRUCTION AND CONFIRMED 5' TO WEST 87TH AVENUr TANK - SEE ATTACHED WAIVER REQUEST CO LETTER FOR DRAINFIELD TO LOT LINE. MH _..- ST1 CO DBL18,2 ZNE / W 1250 GALLON HDP GREER TANK WITH DOUBLE CLEANOUTS AFTER TANK; SINGLECLEANOUT / BEFORE TANK: FCO PRE-EXISTED THE TANK / I APPROXIMATE LOCATION OF POWER LINE - EASEMENT N WAS NOT SURVEYED IN DURING CONSTRUCTION. NEW TANK PHYSICALLY VERIFIED BY GEG DURING CONSTRUCTION TO BE 10'+ FROM POWERLINE AND/OR POWER POLE SCALE: 1"=40' GAA >S E II G "ROUP, Ltd -•-- -� ENGINEERING SALES =CONSULTING- =-- , 'ANCHORAGE, ALASKA • PHONE (907) 337.6179' WEBSITE: w.rN 9ame.cengne nng com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ALEX LOMMELL 907-268-7555 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: Tl 12N R4W SECTION 10; LOT 28 S1/2 D.J.G. TYPE OF WORK: DATE: � SEPTIC TANK RECORD DRAWINGS 2/22/21 OF il� AW m�'7:' Y 14911 s ...........;/''1 ::k............0 0 ...........1..... ....... .............. .. 1.0 10i .:'tf! Jeffrey A. Garners :'i CE -795;3 ZBr LICE SE 44"ROFESS\ #AECC884 11"ASIL1 , / PERMIT NUMBER: RECORD D RA V Y I N G PARCEL NUMBER: OSP201493 011-166 1-13 TOP OF TANK AT INTLET = 94.76 INVERT OF BUNG AT INLET = 94.12 TOP OF MANHOLE = 100.84 FINAL GRADE = 100.25 MH1 NEW 1250 GALLON H. Q. P. E. SEPTIC TANK TOP OF TANK AT OUTLET = 94.76 INVERT OF BUNG AT OUTLET = 93.94 SIS N INET IJ L ENGINEERING SALES- CONSULTING 'ANCHORAGE. ALASKA' PHONE (9071337.6179 • NEBSiTc. xvrva_aamessennneemin [nm K v [J N ... ia;� PREPARED FOR: DANNY LOMMEL LEGAL DESCRIPTION: T12N R3W SECTION 10 LOT 28 S2 TYPE OF WORK: �,_ SEPTIC TANK PROFILE PHONE NUMBER: 907-268-7555 PAGE NUMBER: 3 0 F 3 DRAWN BY: Q.J.G. DATE: 2/22/21 149, o .. . f r ............... ® J/G'Jefre A. arness w �0 B E -7953 jj °®���c�•��'2,,f �.. Z.ZoLICENSE® �4 4 PROFESS\4NP� #AECC884��®III 4p01si, / .. ARNESS ENGINEERING GROUP� Ltd Aeroceir %-Y ENGINEERING -SALES CONSULTING February 22nd, 2021 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: T1 2N R4W Section 10 Lot 28 S2 — Drainfield to lot line waiver request To whom it may concern: The subject lot is served by a private well and septic system. GEG was hired by the homeowner to obtain a COSA. During this process, it was determined that the septic tank had to be replaced. During this install, the homeowner was to install a functioning cleanout at the west end of the drainfield, in addition, he was to have the south lot line and powerline easement flagged by a professional land surveyor. These items were not completed. In short, GEG does not know the exact separation distance form the drainfield to the lot line (believed to be 5'+) or the powerline (believed to be 10'+). Attached is the record drawing for the new septic tank which shows the existing drainfield. The drainfield location is based upon information from the surveyor and the 1978 MOA record drawing. It should be noted that the exact beginning of the drainfield is unknown. Based upon our assumptions and best attempt at showing the field as accurately as possible, we are requesting that your department issue a variance allowing the drainfield to be 5 feet from the lot line. Justification for granting this waiver are as follows: This encroachment has existed for the life of the system. The lot to the south is vacant. The existing drainfield does not encroach on an adjacent field. We are unaware of any adverse impacts this waiver would have on adjacent well and/or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. in, Sincerely, P. E., M.S. * Anchorage, Alaska * Phone: (907) 337-6179' Website: www.garnessenginee(ing.com 011 Municipality ®f Anchorage ^\iS ` I �, ", s. llepartmcutt P.O. Box 196650 e 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 a Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program x x x* VARIANCE/WAIVER REVIEW x x x x Waiver#: OSV211015 PID#: 011-161-13 COSA OSC211077 Permit#: OSP201493 Legal Description: T1 2N R4W Sec 10 Lot 28 S2 Engineer: GEG Applicant: Your request for a waiver of the required 10 feet horizontal separation from the Absorption Field to the Lot Line has been approved. The approved separation distance is 5'. 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 ❑The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. Adjacent properties are not affected by this waiver. ............................................... ■ ............................. ■ 1 Waiver is Granted: X Waiver is not Granted: Date: "r"i rZ� Approved`— Name of Reviewer .................................................................... ■ ....... ■ 1 **** VARIAN C E/WAIVER REVIEW **** 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.orglonsite On -Site Wastewater Disposal System Permit Permit Number: OSP201493 Work Type: SepticTank Upgrade Tax Code Number: 01116113000 Site Legal Address: T12N R4W SEC 10 LT 28 S2 G:2324 Site Mailing Address: 8621 JADE ST, Anchorage Owner: LOMMEL DANNY D Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: rzent i� n epartment Lot Size in Sq Ft: Total Bedrooms: 1219/2020 12/912021 49252 ❑ 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 (2417). 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: Ot - / — . t --� Date: �L v Issued By: Date: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201493, Rebecca Carroll, 12/09/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201493, Rebecca Carroll, 12/09/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201493, Rebecca Carroll, 12/09/20 , f% ?' ~ MUNICIPALITY OF ANCHORAGE -- DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING ADDRESS LEGAL DESCRIPTION LOCATION ~)(o ~\ ~-~ (~-~, PHONE ~NEW ~.~-~_ ~ .~ ,~ [] UPGRADE NO. OF BEDROOMS Liq, capacity in gallons Well Absorption a DISTANDETO:I I rx ~- Z Manufacturer ~ O~O IF HOMEMADE' Insidelength ~N~I~ Manufacturer DISTANCE TO: Length of each line ~"~ No. of lines Top of tile to finish grade DISTANCE TO: Length Foundation Total length of lines Material beneath tile Depth Width -lb diameter Crib depth Building foundation Dwelling Material Width Material Nearest lot line Trench width PERMIT NO. No. of compartments Liquiddepth ~ ~ PERMIT NO. Liquid capacity in gallons PERMIT NO~ *~. ~ 0(~ t ~ inches Distance between lines ~ / I~ PERMIT NO, Depth Driller PERMIT NO. DISTANCE TO: Building foundation Sewer line Absorption area(s) Total effective absorption area Nearest lot line Distance to lot line Septic tank OTHER PIPE MATERIALS SOl L TEST RATING REMARKS 72-013 (Rev, 3~8~ - ' MUNICIPALITY OF ANCHORAGE DEPT. 825 L Street- Anchorage, Alaska 99501 ENWRONMENTAL ENG NEEm"G DW S ON JAN Telephone 264-4720 ~ _ __ DIRECTIONS: Comp]eta all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PROPERTY OWNER · pRE~PERTYRESIDENT(Ifdifferent fro ab' )' f PHONE 2. BUYER PHONE MAI LING ADDR ESS 4. REALTOR/AGENT / MAILING ADDRESS / JPHONE 5. LEGAL DESCRIPTION STREET LOC~TION / 6. TYPE OF RESIDENCE NUMBER OF BEDROOM [] One (~ Four [] Other__ ~/' SINGLE FAMILY ' [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled I [] COMMUNITY since June 1975. For wells drilled prior to that date, g~ve wel ~ PUBLIC UTILITY depth (attach log if available.) ,~t,~r~ 8. SEWAGE DISPOSAL SYSTEM ~ IND(VI DUAL/ON-SITE** **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required [] PUBLIC UTI LITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72~10(3/78) PERMIT NO. r~UN I C I F ,~L I T~' OF DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 ~L< STREET, ANCHORAGE, AK, ~501 2~4-4720 Ot~--S I TE ~JE~ PERF~ I T APPLICANT ~!.*';£~STRUCTION 2100 BLUEBERRY LOC~TION~8~I JADE S~C~ LEGAL ~/~ BL~S SlO Ti2N R4W SM / LOT SIZE ,_, / T~PE OF SOIL RBSORBTION S~STEM IS: TRENCH~ ~Rt~UFI~ MRXIMUM NUMBER OF BEDRO0~5 = 4 49500 SQUARE FEET SOIL RATING (SQ FT?BR>= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: o I:rlq 0 q,t 5 1 DEPTH= ii LEf~GTH= 25 BR~'EL DEPTH= THE LENGTH DIMENSION IS THE LENGTH <IN FEET> OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET>, THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN'THE OUTFALL PIPE AND THE BOTTOM OF THE E~CRVRTION <IN FEET). RE~--~IJ I RED SEPT I C: TA~4K S I ZE= 1~50 ~3FILLOI'-I$ PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY 8ND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TWO < 2 > I f~SPECT IONS ARE REQIJ I BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FOR A PRIVATE WELb OR 150 TO 200 FEET FROM 8 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T EXP I RES I~ECEr~BER I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE M~ICIPALITY OF ANCHORAGE. 2~ I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. APPLICANT ROBINSON CONSTRUCTION ISSUED B~ ......... DATE ....... V:<. 2 NHAWTHORNE-ENG][NEE]~NG 907-$44-4711 DEPT. OF HEALTH & ~8EP 12 lg86 RECEIVED Municipalityo Anchorage P.O. BOX 6650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES September 18, 1986 Nell Hawthorne, P.E. NHawthorne Engineering 7127 Old Seward Highway Anchroage, Alaska 99502 Subject: T12N R4W Section 10 S½ Lot 28 Dear Mr. Hawthorne: Your request for a waiver of the 100 foot separation required between the well and the septic system on the subject lot has been granted.' This requirement has been waived to 98 feet for the septic tank-to-well and leachfield-to-well separations. This waiver is valid for the existing four bedroom single family dwelling only. Sincerely, Morris Civil Engineer On-site Services SSM/ljw THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR I NSP ECTOR I NSP ECTOR DIRECTIONS: 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [~5~.~- SI NG LE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY E~,,~'~INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~I~DIVI DUAL/ON -SITE DATE INSTALLED EDPUBL'C UTILITY ~ ~ ~ Connection Verified INSTALLER [] Septic._ ~.~Tank or [] Holding Tank ~'~'.,~t" 1'~ Size: /,.,Z.;3 '~ If Tank is homemade SOILS RATING give dimensions: (:~ 4. DISTANCESwELL TO: Septic/Holding~(~ Tank Abs~io~.Area~. Sewer Line I Nearest Lot Line Absorption Area to nearest Lot Line B, COMMENTS [~'"'"APPROV ED FOR -~/-J~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) LEGAL DESCRIPTION: 2 3 4 5 6 7 8 9 10 11 12 13 14 16 17 18 19 2O SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6.650, Anchorage, Alaska 99502 276-222~ SOILS LOG -- PERCOLATION TEST SLOPE WAS GROUND WATER ENCOUNTERED? [] PERCOLATION TEST SITE PLAN IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN COMMENTS (minutes/inch) · FT AND FT 727008 (7/76) E • Municipality of Anchorage =��G `V On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I. D.011-161-13 1. GENERAL INFORMATION: Expiration Date: (O_ 4/-Z/ Complete legal description T12N R4W SECTION 10 LOT 28 S1/2 Location (site address) 8621 JADE STREET *ANCHORAG Current Property owner(s) DANNY LOMMEL Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4- 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ WaiverNariance request for: Day phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. nce: 5 � COSA Fee $ $550 Waiver Fee $ Date of Payment �' 3' 2 I Date of Payment Receipt Number i7 �o� L( i Receipt Number � ' 7 COSA # OSC211077 Waiver # 0 S l� 21 n 01 S 11 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. Name of Firm: Gamess Engineerinq Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 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 practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing 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 the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSQ SIGNATURE System #1 Approved for _�_ bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following 0, gsL��4p i 9' TH ' ...... !.t !...... ..... CE -7953_ pro f ession000 #AECC884 �G\PALITYOF ii0 T� ts/TE o rnR.qN oo �G TFR m51= By: t_�Jr 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 Nitrate Advisory Septic System Advisory Arsenic Advisory_ Well Flow Advisory Other 11 Legal Description: T12N R4W SECTION 10 LOT 28 S1/2 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1961(?) j Total depth *290+ ft j_ (2.r -z., 1 S� Cased to LINK ft j 3/,; z ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 11/19/20 Static water level at beginning of test 102.5 ft Comments *PER 1/8/79 RECORD IN MOA FILE B. TANK DATA Age of tank(s) NEW years Tank type/material SEPTIGHM Measured operating fluid level in septic tank N/A ❑ Standpipes/foundation cleanout per record drawing Date of pumping N/A D. ABSORPTION FIELD DATA Which system tested (date installed) 1978 ❑ ALL standpipes present per record drawing Total measured depth from grade 10.08+ ft (max) Measured depth to pipe invert from grade 6.08 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective VJse Parcel ID: 011-161-13 Structure served by this system Well production at time of test 5.6+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic 28.7 ug/L ❑ Arsenic less than MRL (ND) Collected by GEG Date of Sample 11/19/20 C. LIFT STATION ❑ Required maintenance com Age of lift station y Lift station materi Commen Adequacy test date 11/19/20 Results Q Pass For 4 bedrooms Fluid depth prior to test 2 in Water added 774 gal New depth 4 in Elapsed time 90 min ❑ Code -required soil cover over field Final fluid depth 2 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NO date of test) N/A Gallons introduced N/A gallons If yes, enter date Comments/Deficiencies: 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' [Z] Yes Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No *98'+ ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' R� Yes if No ft 7 Yes if No ft Manure/Animal Excreta Storage > 100' 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' 0 Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' [Z] Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' ✓❑ Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' E] 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' 0 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' 71 Yes if No ft Private Wells > 100' ❑ Yes if No *98 + ft Water Service Line > 10' Q Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S COMMENTS *WAIVER ON FILE IN MOA RECORDS (9/18/86) **SEE ATTACHED WAIVER REQUEST WITH RECORD DRAWINGS G. ENGINEER'S CERTIFICATION o OF ?"A I certify that I have determined through field inspections and review o Q Q of Municipal records that the above systems are in conformance with ;' pF MOA COSA guidelines in effect on this date. > r�'f43f 1 - 6 ffrey A. Garness, COSA Checklist yellow sheet V4�0 pro f essi000a #AECC884 Arsenic. Advisory Certificate of On -Site Systems Approval # OSC211077 Subdivision: T12N R4W Sec 10, Lot: 28 S2 A water sample revealed an arsenic concentration of 28.7 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. 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SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 (11/84) ENGINEERING FIRIVI PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATiO~N '/ As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Heaith Authority Approval shows that the on-site water supply and/or wastewater disposal system is 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 flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. /bL/~ ~" ~ ~ It -"~' ~ '~ -- ~F? -~r-. Telephone 3 ~r--~"~- ~-"7 I~ Name of Firm Address . ~/~ ~ ~ ~ ~;Z' ~ ~ ~/~ WATER WELL NOTE: This Health Authority Approval inspection merely certifies that the subject water I~ll produced 150 gallons per bedroom per day and that certified laboratory tests showed no presence of coliform bacteria in a sample of that water. Ho warantee or certification is expressed or implied concerning the long term adequacy or safety of the water supply. ON-SITE SEWAGE DISPOSAL SYSTEM NOTE: This Health Authority Approval inspection merely certifies that the subject on-site sewage disposal system accepted at least 150 gallons of water per bedroom per day as determined by methods approved by the Municipality of Anchorage Department of Health and Human Services. No warantee or certification is expressed or implied concerning the long term adequacy of the on-site sewage disposal system. Construction data reported on buried system components is from MOA files and was not verified during this inspection. DHEP APPR OVAL Approved for-'~o~-,.- ~';.9 bedrooms by~;;~'''-~=~'' ,-4~. ~"~,~ Approved ~ Disapproveo Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspectior~s or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 n 1/84) A. WELL DATA HEALTH AUTHORITY APPROV ( CHECKLIST - FEBRUARY 1984 264-4720 Well Classif~catioh ' ,~/'b//'~]'~ Ii A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ,~' Date Completed ~',~/,4'',~/,~/~//V/ Yield Total Depth ~.7~ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit: (Y/N) Separation Distahcbs fi'om Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer././--Line/.4C/CC////C'-- Cleanout/Manhole Water Sample Collected by Water Sample Test Results Depth of Grouting Pump Set At Comments ; On Adjoining Lots ; On Adjoining Lots Sanitary Seal on Casing (Y/n) Y"~'% Depression Around Wellhead (Y/N) To Nearest Public Sewer To Nearest Sewer Service Line on Lot B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) ~'~ Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: Size /.~.~"4~ .¢..,¢~ No. of Compartments Air-tight Caps (Y/N) }/~'-% Foundation Cleanout (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) To Water-Supply Well To Property Line ,,~'~/ To Water Main/Service Line Course To Building Foundation -~-/ To Disposal Field ~ '~ ' ' To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~'~"~' ?~ Width of Field .~I~'""~ · ' ' Square Feet of Absorption Area Depression over Field (Y/N) Type of System Design Length of Field Depth of Field /'O, ,'~' · Gravel Bed Thickness ~'~'-~'"' · Standpipes Present (Y/N) ~.~% Date of Lest Adequacy Test 9- Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~'~ To Building Foundation ~,~ · Lot _~v/~'/v/~ TO Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line . To Existing or Abandoned System on ; On Adjoining Lots ~'~)! ~' To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request **" I certify t ha~c./,e.~,C~z~,ed~d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~.//¢A.///~Z./~.,~.~-'/~.,t.-,,~-,~ Date ~//f 0 /,~ ~; Company _/t~,~u.,~ ~ ~ ~ ¢' -~:-~,,~ ~-, MOA No. 52 ,~ Reoeip,.o. OOi o3o Date of Payment ~" [ ~" "'- ~ ¢ -- Amount: $ ~.,~ -- 4:2--~.) Page 2 of 2 72-026 (11/84)