HomeMy WebLinkAboutUS SURVEY 3201 LT 13 T10N R1W SEC 9US Survey
3201
T1ON R1W
Sec. 9
Lot 13
#090 - 021 - 22
4700 Elmore
Permit Number:
Community
On-Site
St. • P.O. Box 196650 Anchorage,
ON-SITE
0 SP 12 ( Otto
Municipality
Development
Water and
AK 99519-6650
WASTEWATER
PID Number:
of Anchorage
Department
Wastewater Program
• http://www.muni.org/onsite
INSPECTION REPORT
D9' 0 -02( -7,Z
Page / of 2--
• (907) 343-7904
❑ New F Upgrade
Name:
(� ory ISQ (tilt)
ABSORPTION FIELD
Trench
4( Per/114
Address
5 41 (0 5 to hC)(Yr Or
faDeep Trench ■ Shallow
❑ Bed • Mound
❑ Other
Phone
Number of Bedrooms
3
Soil Rating Ck,. L Total depth from original grade
t GPD/SF 7r 5 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
1, 0 Ft.
Gravel depth beneath pipe
61r S Ft.
fpr Bioek- Lot
U 5 5 (.(Y v eevl 3 2.- 0 l (,
Fill added above original grade
2., 0 Ft.
Gravel length p
0
5 Ft.
Township J Range Section
,D
7/D r./ rc.. i tA) S C C. 9
Gravel width
Z, 0 FL
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
From
Septic
Tank
Absorption
Field
Lift Station
Holding
Tank
Sewer
Line
Total absorption area
3 Ft'
Number of trenches
(
Dist. between trenches
Ft.
Well
kti v71-
/ De f-
��
111
iv4
/
S v
TANK 7$('Septic 0 S.T.E.P.
Holding
Other
■
■
Manufacer
Atur
/lour r C1 '}-4✓I (-e.
Caacity
('Z S. Gal.
Surface Water
/oo'k
(0/ .�
NA
Material
Sd-�e
Number of copmpartments
7�
Lot Line
50Cf
SO`f
Foundation
z di.
L d r
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
),O
Remarks Jn
f� k Cra4kta
Pump on level at
Pump off level at
in.
High water alarm at
in.
Pump make a, • odel
Electrical Inspections performed by
Installer / h
(�^) �C1 �06on P. t= r
PIPE MATERIAL House to tank
Drainfield
Tank to
-5074 d as eld 7u3'(
3039 CO/MT -3 in
Inspector Ni I h c_ iqd ri 4 �,, Pr
BENCH MARK (Assumed elevation) /
�o ft
Inspection,
dates:
Z:
1' 5 Z/!'L O� 2n° s/y� Z Y,
t
i0
Location and description p
prop DY 63 o44 rdri'ir
3" 4th
COMMUNITY
Conditional Approval:
DEVELOPMENT DEPARTMENT APPROVAL
Date
Er-°a4r`
_® t
"•" �' ,
r� gc�i(§
i v�t MICHAEL
t�'S• CEE9
9�°p>
$p QFESSibk
Stan e
OF ; 4r ' a.
� e .�
N. ANDEFSc, J A''
69
���
r''i`�4
Approve!
y,
i' Date d�.':
v (
,o a.,_
Permit No OSP121056
Page 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744
On—Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: US SURVEY 3201 LOT 13 T1ON R1W SEC 9
of 2
PID No • 090-021-22
1
/ / i
'•\
/ / \
/ / •
•
/ /
/ /
i /
�' 7 100' EXISTING WELL RADIUS
/ 1
I I
BENCH, TOP OF GAS METER
F
B
• COI
N TG01%
N ���\ CSI CO3. C@2 ��\
N -�� t L,C05
\\ /
MARK
A
8
bRND.
ELEV,N
PIPE
ELEV.
CO
2
42
98
9$.6
14
53
98
92.
TCO
15
53
97
•
T6�02
0
53
97
CO2.,58
96
92
CO3
5
58
96
92
C04 \
3
94
90.6
MT
\36
60
94
N005
65
6' .
4
90.6
•
N
N
FFCO C011TC01
1 {
1.250 GALLON
STEEL TANK
/
13/(/
68a
8
C05
SEPTIC SECTION
N.T.S.
0
/
/
90
+20
/
/
y/ /
1
/
/
7/ / I
/ / (
V
/ 11
/
/
/ /
AS6/U LT /
SCA: 1"=50' /
/
91.8 ORIOINIL
9RC
SM/CN
77.E. BOH. 10_
`
�� OF ** '••
♦♦‹P
:co•..:
,tr%.17 *0
49 H /\ .•
• •
•
i•
%
• cK MICHAEL N. ANDERSON is
is
•1:s... No Q4.6 9 / II
iC ,.':,ESS\•' ,,,�♦ ♦
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: 05P121056
Tax Code Number: 09002122000
Work Type: Septic Upgrade
Permit Effective Dates: April 30, 2012 to April 30, 2013
Design Engineer: ANDERSON CONSTRUCTION & ENG'G
Subdivision: US SURVEY 3201
Site Legal Address: US SURVEY 3201 LT 13 T10N R1W SEC 9 G:4660
Owner/Address: BAILLIO YVONNE K & GARY L JR
5865 COBBLER DR ANCHORAGE AK 995021896
Site Mailing Address:
Lot Size in Sq Ft: 108900
Total Bedrooms: 3
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must 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 must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
mA
Date: `7`7C4z
Date: V/30/Z_
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
Mayor Dan Sullivan
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Phone: 907-343-7904
Fax: 907-343-7997
Parcel I.D. 0 9O — p y/ --2-2--
Property
-2'ZProperty owner(s) 6 (Norm 42>a t < t, o Day phone
Mailing address 5` & S C, 4t 6(.etr Of 4 4504 ---
Site address
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section) USS 3 o 1 L-1
Lot Size /0 v v O'1 -Sq. Ft. Number of Bedrooms 3
THIS APPLICATION IS FOR:
( all that apply)
Absorption Field [�
Septic Tank
Holding Tank ❑
Privy ❑
Private Well ❑
Water Storage ❑
THIS APPLICATION IS AN:
Initial ❑
Upgrade
Renewal ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: S 30 Waiver Fees:
Date of Payment: 1-44070.-- Date of Payment:
Receipt Number: k5ISeDI CL* ac, Receipt Number:
Permit No. OSe i a \ CC Waiver No.
G:1Building\On SitelForms\Client Forms\Permit App_010411.doc (Rev. 1/11)
Michael N. Anderson, P.E.
Civil/Structural Engineering & Construction
4661 Natrona Avenue
Anchorage, Alaska 99516
Phone 345-3377
Fax 345-1391
April 30, 2012
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: US SURVEY 3201, LOT 13, T10N, R1 W, SEC 9, Septic system upgrade revisions
To Whom it may concern:
This is a request for a new 3 bedroom septic system permit. A test hole was excavated at the southwest
corner and found silty -sandy gravels, SM/GM for the entire 14 foot depth. No water was observed during
the excavation or after the 7 day monitoring period. The perc rate was measured at 12 minutes per inch,
however a slower rate will be used for longevity. The old system is in a flat area which I don't like, so it will
be decommissioned in-place. I have experience in this area and don't like the area due to possible spring
flooding.
The owner has stated that the house is a 3 bedroom unit and I have inspected the house and it is a 3 bedroom
residence. Therefore the alternate site for the 4 bedroom system is not required. The new 3 bedroom trench
length will be 58 feet long with 6.5 feet of effective depth. The old trench will be decommissioned as stated
on the drawings.
The lot topography consists of a set of benches with the house on the upper bench area and the old system
on the bottom bench. The elevation difference is about 11-15 feet between benches. The slope between is
20 to 25 percent. We are trying to keep the system uphill from the very flat lower bench were the old system
is located to avoid any spring runoff or potential ponding areas. There no cut banks greater than 25% or
open water with 200 feet of the new proposed system.
The neighboring lots are mostly large 2.5 acre plus parcels and they will not be impacted by this new 3
bedroom system. The slope is flat as you enter the lot, then gradually slopes down about 10 -20 percent to
the west-northwest with no cut banks greater than 25% or open water with 200 feet.
Please call me if you have any questions.
Michael N. Anderson, P.E.
DESIGN CRITERIA:
3 BDRM X 150 = 450 GPD
SOILS = 450/0.6 = 750 GPD
750 GA/13 = 58'
(1) TRENCH
8.0' DEEP
6.5' EFFECTIVE
2.0' WIDE
58' LONG
•
EXISTMr DRAIN FIELD
TO BE
DECOMMISSIONED
EXISTING TANK TO
BE PUMPED &
CRUSHED
N \
\\
N
N/
MIN. 3' OF COVER OR 2' W/2" INSULATION TYP.
MOUND OVER
GRADE
FILTER FABRIC
4"0 PIPE
SEPTIC FIELD SECTION
PROPERTY UNE
EXISTING WELL
RADIUS
.9'
EXISTING
D'NEWAY
EXIS11NG HOUSE
// N \ N
/ / •
Septic Design Prepared for
GARY & YVONNE BAILLIO
US SURVEY 3201, LOT 13, TION, R1W, SECTION 9
Indian, Alaska
Michael N. Anderson, P.E
4661 NATRONA AVE.
ANCHORAGE, ALASKA 99516
345-3377 / FAX: 345-1391
DATE:
DRAWN:
SCALE:
4/5/2012
DJR
1"=100'
e 071%
14
•49M.
f4zA
-
$Av.MICHAEL N. ANDERSON
. No. Cy 94
PIRCFFi Gt.
X
N
PROPERTY LINE
EXISTING DRAIN
TO BE DECOMMISIONED
APPROX.
LOCATION OF
SLOPE
BREAK
EXISTING SEPTIC TANK
TO BE CRUSHED &
ABANDONED
FC01\
/
/
PROPOSED 1,000
GALLON SEPTIC
TANK
PROPERTY UNE
N
N
N
N
N
1
MT
EXISTING WELL
100' RADIUS
h
PROPOSED DRAINFIELD
Septic Design Prepared for
GARY & YVONNE BAILLIO
US SURVEY 3201, LOT 13, T1ON, R1W, SECTION 9
Indian, Alaska
Michael N. Anderson, P.E
4661 NATRONA AVE.
ANCHORAGE, ALASKA 99516
345-3377 / FAX: 345-1391
DATE:
DRAWN:
SCALE:
4/5/2012
DJR
1"=30'
i`:' 49 % z} V•
•
i /`f'!� i
■
4•
VA MICHAEL N. ANDERSON
1� No. 9 G6. 9
Performed For: C 09
Legal Description: tA'S Sur vcl 32 o
Tip At, K)
scz4
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.ci.anchoracie.ak.us
(907) 343-7904
Soils Log - Percolation Test
'pat ilia
1-
2-
3-
4-
5-
6-
7-
8-
9-
10-
11-
12-
13-
1
Depth
(Feet)--_
4t `fa e'?trMrc
1" 4UM
41 fit
Elm/SNI
15-
16-
17-
18-
19-
20 -
COMMENTS
fvSfoy,r .F
/Id (t-
Slope
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT DEPTH?
Depth to Water After
Monitoring?
100.,• • MICHAEL N. ANDERSON ems;
Date Perfo med
Township, Range, Section:
,40
0
AIp#1Cd E
Date: 40#07i
Site Plan
S
-ete_
a
Vl t
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
i/b/Z
S.'ao,e.„
30r.t,n
(9 f/
2,s/.
60 r /
f //
6"2s//
r.
0
Z, r"
?
l9"
Z,S.ry
PERCOLATION RATE
TEST RUN BETWEEN
LA4it. SIVwrtt pmrc
I045 air 4t 14.
(minutes/inch) PERC HOLE DIAMETER
'Z.-- FT AND 3 FT
rr
PERFORMED BY:
CERTIFY THAT THIS TESTJVAS/
nl fI r�a�1,
rc, '
PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: � (Z
MUNICIPALITY OF ANCHORAGE
HerNh and Environmental Prote'-'`}_on
Fourth Floor West
825 L. Street
Anchorage, Alaska 99501
279-2511, x 224, 225
II'JSPECTION REPORT ON-SITE SEWAGE DISPOSAL. SYSTEM
NAME 1 �. MAILING ADDRESS 9_ &Y'� Ars6 (3 els() 'PHONE ��'3
: LOCATION I�-C 1n' t EGAL DESCRIPTION Cdr la k,/ a ) (04/ e 2.
- OVA 2 -
SEPTIC
SEPTIC TANS:
DISTANCE
FRQM WELL/ do I MAN
UFACTURER MATERIAL
INIDE LENGTH INSIDE WIDTH___.
NUMBER OF
COMPARTMENTS_. 2T..
LIQUID DEPTH LIQUID CAPACITY iCCIC3GALLONS.
TILE DRAIN'FIELD;
TOTAL LENGTH ��
DISTANCE FROM WELL 41" FOUNDATION NEAREST LOT LINE OF LINE
(' ((
# hof L4nes DISTANCE BETWEENLINESTRENCH WIDTH"' IN TOTAL EFFECTIVE
ABSORPTION AREA (Do / 50 FT LENGTH OF EACH LINE '
DEPTH OF FILTER i z. r
' DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE -+ IN ABOVE TILE IN
SEEPAGE PIT:
DIAMETER OR WIDTH_ I ENGTH__., DEPTH
Lo cj Crib Rings Crib Size:
DIAMETER _____DEPTH_ DISTANCE FROM: WELL _._
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA)
BUILDING FOUNDATION NEAREST LOT LINE
0
,Well,
",Class: Depth: _
Well Distance To: Lot Line _
(Bldg Sewe L'ne:
Pipe Materials: �3c3f
# of Bedrooms:
Installer:
,Remarks:
SQ FT
•-.. .
HER; N0
-DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
' 825 // ANCHORAGE! HK. 99~`l
� ������
l
S u } /l ��\
HPFLICA@T GARY BHILLIO
LOCATION BIRD CREEK
LEGAL L1] R10 T10N R2E
TYPE OF SOIL HBS0RBTION SYSTEM IS: TRENCH
URXIMUM`NUM6ER OF BEDROOMS =
THE REQUIRED SI7E DF THE SOIL ABSORPTION SYSTEM
���r-m-1E7-1Es!
LOT SIZE
1089@
/IC]\ ^ 4/lt
/W-YAIn
�
°]-J4D2�,-..,
SOU9RE FEET
SOIL RATING (SQ FT/BP)- 185
!NE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHIHFIEL).
THE DEPTH H TRENCH OR PIT IS THE DISTANCE. BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF !HE EXCAVATION (IN FEET).
THERE TS N0 SET WIDTH FUR )RNCHES. .
• THE GRAVE_ DEPTH IS /HE MI@IMUM DEPT1 OF GRAVEL JETHEEN |HE nUTFHLL PIPE
HND THE POTTOM OF THE EXCAVATION (IN FEEL).
IR: FE. !FT,:-..'.'.�.:21 FE: '' ' - ir FA Pmq ��2.7.:�
�K-���C)1E:-11 CHIN)! -
PACKAGE PLANT MAY BE INSTH|LFD AT THE PERMITTEE/S OPTION SUBJECT TO THE
,F0U-0WIN[�•CONDITT0HS-
i' EITHER H CLHSS ! OR II NSF HPPROVLD PLHN| MAY BE INSTALLED.
2. H CONTINUOUS MHINTENHNCF AGREEMENT IS REQUIRED. IF H MAINTENANCE
HGREFMENT }H NO! KftF| C|}RREN\ YOU MHY BF REQUIRED TO ENLARGE THE SOIL
ADSORPTION SYSTEM HM/OR YOU MAY BE sU8JECI /0 PROSECUTION.
_____
___ ���C-.)! > ft,,,IP.E;F-"El.C.:'1- Li JE���i�
BACKFILLING OF ANY SYSTEM WITHOUT FRNHL INSPECTION AND APPROVAL AY !HIs
DEPARTMENT WILL BF SUnJECT TO PROSECUTION.
MINIMUM DISTHNCE BETWEEN H WEJ AND ANY ON-SITE SEWAGE DISPOSAL.
108 FEE| FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL
OTHER REQUIREMENTS MAY HPP!'Y. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS
AVAILABLE TO INSURE PROPER INSTRLLHTION.
IS
HRE
CERTIFY THAT
1: I GM FAMILIAR Wl/H THE REQUIREMENTS FOR ON-STTF sEWEks AND WELLS AS SET
FORTH BY ;HE MuhICIFSLITY OF HNC-h1OR�IGIE.
2: I WILL INSTALL_ THE SYSTEM IN ACCORDANCE WITH THE CODES.
]� I
UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE FNLHRGEMFNT THE
RESIDFNCF IS PEMODELED TO INCLUDE MORE THAN ] BEDROOMS.
SIGNED:
�n�| GARY
�';
�-� ��'°^�`�ee��f��� °-'' -- -
i1 IO « '
��
/�~�)
DATE __// _/_`__-'/_
D"tment of Health anti Environme i'roieetion'
`' t H f�1 o" R,,.. 1 p. K' .,1
IS Q_ �0��-1 W7 1�C�5r_ �-
Anchorage, Alaska 99507
27 G_7T 'Ls-(
- I'EROI,A'CION'f1:5.1
Performed for 6a.vy (-104 40' )ate Performet:1
Legal Description: i'3 }S fob T r_ lot z t
This form reports: Soils log Percolation • tes t -ye"-
Depth
Feet
1 " Ode(71-Nle
2 -.
-- Y _t
If yes, at what depth?
Reading
Date
Gross Time
ilet Time
Depth to Water
t
- -- -
Wet Urop
Percolation rate/ _ minute.
• Proposed ins tal1atton; Seepage Pit Field
Depth of Inlet Depth
_ t lottom of pit or trench _ _
COI ltlENTS;
f'elfonned tly ied By: )ate,..:4v7(ff77
EQ 040 (0/74)
61; uo
LLO
4LA__A„‘„ H4
°
nuri c z rirft CIF= REIC.WE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 E. TUDOR RD., ANCHORAGE, AK. 99507
276-2221
WEEL_L_ RiEFEFZP1I71-
PERMIT Na ( 76129 )
APPLICANT poRy BAILLIQ P 0 BOX 456 - ANCH 653-8462
LOCATION BIRD CREEK
LEGAL L13 SEC 10 T10N R2E LOT SIZE 108900 SQUARE FEET
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION.
SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER
INSTALLATION.
IPEFRMIt VelLIE> rIDIR ONla teEFIFR FIROM ISSU�
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
• , Y
`
SIGNED* Aii )L/,,/j.i/-,`
APPLICANT GARY 8I
' �^l ~}/'
,~� //�'f _DATE /=' ��` /' /��
ISSUED B\/ �l/�� v�y`'�,� .'• x ��~�_/. ~^
5a/1A\/n^,ii
7/7(o , 04- &^0-tec (Ay) ^~� - 3)Cur u cC(
�-
/3,�}�/� (��.k (�f-�(�Y)B��..
«rv«
64.4 -fa
WATER WELL LOG
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH, &
ENVIRONMENTAL PROTECTION
FOSS DRILLING JUN 2
1336 Ingra Street _
Anchorage, Alaska 99501 •pC �/
WELL OWNER S o�/ L r y13Lta ull is D USE OF WELL / i [ h Y E
D
LOCATION Li5 . l 51,..NV� 301 1 5J Jt.oh lDi 1401" 4.3, '6ULordi /1,r, t
SIZE OF CASING ''DEPTH OF HOLE 90 FT. CASED TO 9/D FT.
YIELD c O GAL.PER.MIN. WITH 8
STATIC WATER LEVEL
FEET OF DRAWDOWN.
REMARKS
DATE COMPLETED c5, J 76 PUMP TO BE SET AT
S KR tit"
Oto .Sa• 741 d' l7reividJ tGra>y
aCto p.2 S Sand dV Grc.Vel arty
toSD n/4 y £ra✓ga/ rP.y
ato, ,
to_
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1,11cL4 w- Weer
,— MUNICIPALITY OF ANCHOR/AP
DEPARTS, _Al OF HEALTH AND ENVIRONME. AL PROTECTION
825 L Street, AnchoraaP. Alaska 99501
264-4720 itt, Li) Eil id'
Date Received: January 26, 1978
#1: Time anytime, a.m. #2: Time #3: Time
Date 1-31-78 Tuesday Date Date
Insp Pratt Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
1. Lending Institution Request: Alaska Teamster's Federal Credit Union
Mailing Address: 1200 Airport Heights Road #430 Phone276-8180
2. Property Owner: Gary L./Yvonne K. Baillio Phone: 653-8462
Mailing Address: Post Office Box 456 99510
3. Legal Description: T10N R1W Section 9 Lot 13
4: Single Family Residence: (x) Number of Bedrooms: Two
Multiple Family Residence: ( ) Number of Bedrooms:
5. Well System: Individual Well (x) Community/Public System ( )
Permit #
Depth of Well Well Log on Fife -(v )
Construction Bacterial Analysis
6. Sewage Disposal System: On-site System (x) Public Utility ( )
Permit # Installed 1977 Installer
Septic Tank Size 1,000 gallons Manufacturer Sunset Plastic
Absorption Area 1,204 sq.' Soils Rate Material
7. Distances: Well to Septic Tank to Absorption Area
to Sewer Line
to Nearest Lot Line
Nearest Lot line Absorption Area
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: T1ON R1W Section 9 Lot 13
Comments:
Affadavit Attached:
Approved:
Disapproved:
Letter Attached: ( )
Da Jt Th
Date:
Department Worksheet:
661-096 =z0 Z.91 Od0
C C ZIA' /-9�
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�• '-�� Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 090-021-22 Expiration Date:
1. GENERAL INFORMATION:
Complete legal description US SURVEY 3201, LOT 13 - T10N, R1W, SECTION 9
Location (site address) 153 Ray Halla Lane *Indian
Current Property owner(s) Charles & Angela Hunt Day phone 748-9882
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: 3
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for.
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 550 Waiver Fee $
Date of Payment (o/ I5 1 bo'a 2 Date of Payment
Receipt Number Da (' 9 �C Receipt Number
COSA # OS C oZ ), I _� 9 � Waiver #
0LJ
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 Engineering 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 �',vl }i ��»,•
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational Irfe of all wells `i
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 u ': �} `•) ' '` y
workmanship), and the water usage of the family utilizing the systems. 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 ?%t• • • • `• • • ... • • • • • •... • •
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 '!� �. CE- Cj
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 `�'h;'e•ry •�
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right=ss1�^"=
whatsoever.
#AECC884
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
,- --- ' —tom Original Certificate Date: Co - 2 (- 7Z,
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
Septic System Advisory
Well Flow Advisory
`UTY(pF��6�, �
Nitrate Advisory `` 'n_
Arsenic Advisory OAi_ S� y0
Other CATER TF
�AST=�� rn=^
�o-o pR�GgM R
Legal Description: US SURVEY 3201, LOT 13 - T1 ON, R1 W, SECTION 9
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
ON Well log is filed with Onsite (or attached)
Date drilled 5/5/76
Total depth 90 ft
Cased to 90 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 6/6/22
Static water level at beginning of test 74.0 ft
Comments
B. TANK DATA
Age of tank(s) 10 years
Tank type/material "
Measured operating fluid level in septic tank 50"
❑ Standpipes/foundation cleanout per record drawing
Date of pumping I II (� —
I
D. ABSORPTION FIELD DATA TRENCH
Parcel ID: 090-021-22
Structure served by this system
Well production at time of test 6+ gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
NitrateQ,'10k "'mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by GEG, LTD.
Date of Sample 6/3/22
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Which system tested (date installed) 5/2/12
Adequacy test date 6/6/22
❑ ALL standpipes present per record drawing
Results ❑✓ Pass For 3 bedrooms
Total measured depth from grade 9.83 ft (max)
Fluid depth prior to test 61 in
Measured depth to pipe invert from grade `2.33 ft (min)
Water added 548 gal
❑ N/A – pressurized field
70
❑ Monitor tubes go to bottom of effective. If not, state
New depth in
depth into effective 6.0 - 6.41'
Elapsed time 240 min
p
❑ Code -required soil cover over field
Final fluid depth 67 in
❑ System presoaked
Absorption rate 450+ and
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) YES
date of test)
introduced N/A gallons
9/14121Gallons
If yes, enter date
Comments/Deficiencies: THENCH CLEAN -OUTS APEAR TO BE ABOUT 5' OUT OF LEVEL SEE ATTCHED EMAIL INDICATING NO FREEZING ISSUES.
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'
❑ Yes
if No
Community Sewer Manhole/Cleanout > 100'
P1 Yes
if No
ft
Q Yes
if No ft
Neighboring Tank > 100' R Yes
if No
ft
Private Sewer/Septic Line > 25' M Yes
if No ft
Absorption Field on Lot > 100' M Yes
if No
ft
Holding Tank > 100' [D Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' Q Yes
if No ft
[� Yes
if No
ft
ft
If septic tank is under driveway comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Yes
if No
ft
P1 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No
*5+ ft
Surface Water > 100'
Yes if No ft
Property Line > 5'
Q✓ Yes
if No
ft
Wells on Adjacent Lots:
Yes
Absorption Field > 5'
P1 Yes
if No
ft
Private Wells > 100'
Q Yes if No ft
Water Main > 10'
0 Yes
if No
ft
Community Wells > 200'
Q Yes if No ft
Water Service Line > 10'
[7✓. 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'
P1 Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Yes
if No
ft
Private Wells > 100' El Yes if No ft
Water Service Line > 10'
Q Yes
if No
ft
Community Wells > 200' 0 Yes if No ft
Surface Water > 100'✓Q
Yes
if No
ft
F. ENGINEER'S COMMENTS
*MET CODE AT TIME OF INSTALLATION - 4' FROM ST -I TO EDGE OF
BOTTOM OF DECK STEPS.
DRAINFIELD IS�APPROACHING THE END OF IT'S USEFUL LIFE
1-11=F- U7 q9
G. ENGINEER'S CERTIFICATION o� OF
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with p
MOA COSA guidelines in effect on this date. T
... 4 .� .. .........
COSA Checklist yellow sheet
QQ .J f y G mess,
u40ed pro f essio�°moo
#AECC884
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Erik Widger
From: Angela Hunt <angelahunt76@gmail.com>
Sent: Tuesday, June 14, 2022 3:46 PM
To: Erik Widger
Subject: Septic system freezing
Hi Erik,
I am writing in response to your question regarding past issues with the septic system freezing. The septic
system was installed immediately before we moved into the house in 2012 and we have never experienced
any freezing.
Please let me know if you have any other questions.
Best,
Angela Hunt
MCA,aald-4' Painpiny Service
7500 Beluga Circle
Anchorage, Alaska 995__
(907) 338-4476 • (907) 830-1421 907) 830-19111
Invoice # 1 6 1 1 9
Date:
Contact
Description Price per unit
Amount
Septic tank pumped
Sludge in tank
NWBio-mat
Leach treatment
in leach
Af -.r 1p -m-1 4" 1-7k
10% interest will be charged monthly on unpaid bills until paid.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
® 4700 Elmore Street
D.O. Box 196650
S Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. ORO —024 - 22.
1.
GENERAL INFORMATION
Complete legal description Lk S sc, rv-ry 'S2 0 (
COSA# G 5C tait4-13
Expiration Date: g f yf 1a2
r/o J.i / t12, i kD, t
Location (site address)
Current Property owner(s) G vrvl IR o t 1. (, 0
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
Day phone
Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
3
TYPE OF WASTEWATER DISPOSAL:
VI Individual On-site .
❑ Individual Holding Tank ❑
0 Community On-site ❑
0 Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site 'Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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 frorithe 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 cedes,
ordinances, and regulations in effect at the time of installation.
Name of Firm /`fit[cc.ALL/ rvfcn P E,
Address ' (fo Erik( Awe -
Engineer's Printed Name M,keA1Jtn teYtsl 9, Date
tE OF,., .j 11
1P. 1
Phone 7 2 7 -
5. DSD SIGNATURE
t✓ Approved for r bedrooms.
Disapproved.
x'49`
v t MICHAEL N. ANDERSON : e
g < -il,-. CE -9 9 •
t
s •vet
Conditional approval for bedrooms, with the following stipulations:
;Iscitt f
zzinN-SITE
WATER AND
PROGRAM .5$
/lJlls I1G\\`��
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrite Advisory ✓
t/ Air /Ede
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
(Rev 11105)
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Cul -
Legal Description: HS tette 3
tv'et1 2-o( T/V74, l2(W 4rz9 Parcel ID: Cr? 0 - 021 -Z, Z---
A.
,A. WELL DATA
Well type 91. wa Le-- If A, B, or C provide PWSID # / Well Log (Y/N) Y
Date completed 5154 Co Sanitary seal (Y/N) Y Wires properly protected (YM) Y
Total depth 90 ft. Cased to T 0 ft. Casing height (above ground) / g in.
FROM WELL LOG AT INSPECTION
Date of test SA (9-L 5747 2—
Static water level 77- ft. 73 ft.
Well production Z0 g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform
Arsenic:
colonies/100 mL Nitrate 5 2 -mg/L Collected by: Mt e MAK brit -04
ug/L date of sample: h'/ 3/ t -
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material S -er ( Date installed 5/2-A 2 -
Tank size 1'2- V gal. Number of Compartments "1-- Cleanouts (Y/N) Y
Foundation cleanout (YIN) ? Depression over tank (Y/N) 7t High water alarm (YM)
Date of pumping 7.( -MA) Pumper
C. ABSORPTION FIELD DATA dR� �e five
Date installed 5/2A Soil rating (g.p.d./ft2 or ft2/bdrm) -.Or System type ID,rr,p t tiro &
Length S'9 ft. Width L. 0 ft. Gravel below pipe &1C ft.
Total depth 7 Sft. Eff. absorption area 7S`( ft2 Monitoring tube Y Depression over fieldI
Date of adequacy test 11 tiA0 Results (Pass/Fail) / For 3 bedrooms
Fluid depth in absorption field before test / in. Water added /gal. New depth /In.
Elapsed Time: / min. Final fluid depth lin. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons ccess (Y/N)
"Pump on" level at in. P evel at in. High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot /0 D' 1 -
Absorption
Absorption field on lot 1 v D 'IL
Public sewer main _ _ h/ 4.
On adjacent lots
/too
On adjacent lots / 00'
pr.•a kc-
P43:btie sewer manhole/cleanout
Sewer /septic service line SO '4- Holding tank N
SJ '1L
Animal containment areas 101 1- Manure/animal excrete storage areas /t2e ' 4 -
SEPARATION DISTANCES FROM SEPTIC/H8t T41G TANK ON LOT TO:
Building foundation 2-Q 4-
t4
Water main
Property line SO
Absorption Feld /00'71 -
Water
0D'tL
Water service line S 0 Surface water / v a '4 --
Wells on adjacent lots /op 1-4
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 5-01+ Building foundation z Of f Water main N /4 c
Water Service line 50 14- Surface water / 00' f Driveway, parking/vehicle storage Z o r 4 -
Curtain drain um kr/Irk n r� Wt
pfo ells on adjacent lots /On
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I 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.
Engineer's Printed Name /` At parr %&(An £et I un
Date 51V/
OF A(fq‘\l
:less?,
.p-Itri 49TH
. . Rs,_i
COSAFee $ 400
Date of Payment
Receipt Number
(Rev. 4110)
514/12
15 a3g0
•y '!
to
1..: MICHAct'W:. 'ARSONa�®
�t c1'27..3....*. 57,.9/ 9 Scoff ;
t 1 @,p p"0f ET S' • •,,,\..s._
.`.s
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Community Development Department
Development Services Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC121143
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Lot 13 of USS
3201 subdivision. This inspection revealed a nitrate concentration of 5.27
milligrams per liter (mg/L) was reported for the property's well water
sample. 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.
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