HomeMy WebLinkAboutT15N R1W SEC 18 LT 161 Onsite File
T15N R1W
Section 18
Lot 161
#051 - 232 - 07
Municipality of Anchorage
On-Site Water and Wastewater Program • (907)343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181399 PID Number: 051-232-07
Dwelling: El Single Family (SF) ❑ Duplex(D) ❑ Multiple (SF and/or D) Project: ❑ New ❑� Upgrade
Name:
Thelma Dubyak ABSORPTION FIELD
Address ❑ Deep Trench El Shallow Trench ❑ Bed ❑ Mound
7451 Tangle Court, Anchorage AK 99504 ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
(907) 242-3762 4 GPD/SF Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot Ft. Ft.
161 Fill added above original grade Gravel length
15 N Township 1a W s Section Ft. Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES Ft. Ft.
ToSeptic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Tank Line Ft2 Ft.
Well >100' N/A N/A N/A >25' TANK l Septic ❑S.T.E.P. ❑Holding ❑Other
Manufacturer Capacity
Surface Water >100' N/A N/A N/A Anchorage Tank 1250 Gal.
Material Number of compartments
Lot Line >10' N/A N/A N/A Steel 2
NA LIFT STATION
Foundation >10' N/A N/A N/A Manufacturer Capacity
Curtain Drain None Noted Gal.
Pump on level at Pump off level at High water alarm at
Remarks Insulation was not used in this project
in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank Exist. Tank to D3034
Installer drainfield
Denali Excavating Drainfield Existing CO/MT D3034
Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft
Inspection 1=, 11/26/18 nd Location and description
dates: 2
3r0 4th Bottom of lower log.
Engineer's Stamp
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Conditional Approval: Date .�' ' `tplk,
i*5P TM 79*rl
Benja chiller��.."' •, cE 12592 \(A/
'— ,, 9 /--1-- •Vi=/
Approve Date ( (-2-C(—( il'FeP----- 10N*�+
��\\\tom'~
Inspection Report_9-1-12.doc
T15N R1 W SEC18 L161
PERMIT # OSP181399 PID # 051-232-07
4;"' /
/
LOT 144 // ALASKA RAILROAD RIGHT-OF-WAY // / BEVERLY DRIVE
--
/ - —
\.
/ 33'BLM RIGHT-OF-WAY
_________
/ RESERVATION(PER PATENT) ,— '
/ -
— _ / 15'T&E EASEMENT
/ / -- -
/ /
/ /
/
/
/ N A B /.
/ / �_ ,, _
/ �_ SV1 63.6 43.0
SV2 68.3 47.8
OPOP DECOMMISSIONED WELL - 2C0 70.1 47.7
�P"
QST coo
Q
.. / 'Q 4-BDRM CABIN _I \
..,
LOT 161 SHED
/ NEW 1,250 GALLON O
/ SEPTIC TANK EXISTING SEPTIC TANK
SVEXISTING
DECOMMISSIONED PER
SV21 MOA CODE. LOT B
2C0 SHED EXISTING WELL LINE
EXISTING ABSORPTION TRENCH
/ TO REMAIN IN SERVICE.
EXISTING WELr RADIUS
�+ .\\' NOTE: LEGEND
.%ei•••• sili ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN.NO CONFLICTS WITH CO-CLEANOUT
j*'.t. 7H• �;• .,9 WELLS OR SEPTIC SYSTEMS. 2C0-DOUBLE CLEANOUT
# FCO-FOUNDATION CLEANOUT
g;•:.
` /0 . FD-FLOW DIVERTER VALVE
• 0 50 100 MH-MANHOLE
Ben n Schiller /
� •
0 4, .. CE 12592 i/ mi — — — FEET MT-MONITORING TUBE
(lN. . .�18 -, = SV-SEPTIC VENT
1��� s`��� illfitbE
OIN[[RING 1" 50' TH-TEST HOLE
T15N R1W SEC18 L161
PERMIT # OSP181399 PID # 051-232-07
/Ol N0
LL (n (I) CV
— — f— 99.4 — — —
—
/- 94.5
n ,v
93.9 -71 1250 GAL 93.7
SEPTIC TANK
V
• � — 89.6
j*'49Th ,i *l
0
Ben a n Schiller '
GE PROFILE AS-BUILT Q4,; ��E2?59z --
.�o.�...,�� (NO SCALE) \�xA\POOFESS I
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT i 907-343-7904
On-Site Water and Wastewater Section Fax:343-7997
www.muni.org/onsite
Well Decommissioning Log
Legal Address:
Subdivision Block Lot
T R { \' Section `s Lott
On-site Water&Wastewater Section certified contractor performing the well decommissioning:
Name: :74nY' Signature: %ice G (k-:
Company:
l G y7t ii .ir'.
Well decommissioning date (` 7 Method of decommissioning:AMC 15.55.060L1 a.0 b.❑ c.
Location:Use the space below to provide a drawing of the property showing the following items:
• North arrow •
• Decommissioned well location
• Location of other water wells on the property
• Two separate swing-tie distances for each well shown on the drawing
Note:The swing-tie distances shall be measured from either permanent structures or the properly corners.
. .
•
•
•
•
•
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;rte
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'
G'\Developrnent Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Well Decommisioning form.doc
9'0 7 WiPi- I t ALL
RESIDENTIAL&COMMERCIAL WATER AND WELL SERVICES
24HR EMERGENCY SERVICES AVAILABLE
FREE ESTIMATES
907-230-7$6S'
In regards to the property at 18906 Beverly Ave Chugiak AK,99567 the well data is as follows:
Total Depth 51'
Static Water Level 38'
With a flow rate of 4.5 Gallons per Minute
If you have any question please feel free to call John at 907-230-1868.
Thanks,
John Netherton
, ""', MUNICIPALITY OF ANCHORAGE
/ On-Site Water&Wastewater Program :S
a ,�,,', PO Box 196650 4700 Elmore Road ',
°. Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,_
q
http://www.muni.org/onsite
I)cI,artnicnt
On-Site Wastewater Disposal System Permit
Permit Number: OSP181399 Effective Date: 11/20/2018
Work Type: SepticTank Upgrade Expiration Date: 11/20/2019
Tax Code Number: 05123207000
Site Legal Address: T15N R1W SEC 18 LT 161 G:1054
Site Mailing Address: 18906 BEVERLY AVE, Chugiak
Owner: DUBYAK THELMA JEAN Lot Size in Sq Ft: 110642
Design Engineer: FORGE ENGINEERING Total Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field Q Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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: The water service line from the well to the house shall be located at time of construction to
confirm a minimum 10 ft separation from the new tank. The water service line location shall be shown on the
record drawing.
Received By: . /L 12/ Date: /1
Issued By: ' / ' / (,mac l Date: 11„Mr& I
MUNICIPALITY OF ANCHOR A 8 97741,
Community Development Department °-'h8 44d-7'
Development Services Division Fax: 907-343-7ti
On-Site Water & Wastewater Program h�
ON-SITE SEWER/WELL PERMIT APPLICATION oI 6 8 L
Parcel I.D. 051-232-07
Property owner(s) Thelma Dubyak Day phone
Mailing address 7451 Tangle Court, Anchorage AK 99504
Site address 18906 Beverly Avenue, Anchorage, AK
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section) T15N R1W Section 18 Lot 161
Lot Size 110,642 Sq. Ft. Number of Bedrooms Four (4)
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(Ei all that apply)
Absorption Field ❑ Initial ❑ Single Family (SF) 0
(w/wo ADU)
Septic Tank IXI Upgrade n Duplex (D)
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy I (SF and/or D)
Private Well
Water Storage
THIS APPLICATION INCLUDES A VARIANCE /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 of property owner or authorized agent)
Permit/Rush Fees: ;2A S• 00 Waiver Fees:
Date of Payment: t (l s j l g Date of Payment:
Receipt Number: Receipt Number:
Permit No. oS P tb k1 c 1 Waiver No.
Permit App_ -: ::.,c
T15N R1W S18 L161
S' LOT 144 // ALASKA RAILROAD RIGHT-O!)NAP /'� BEVERLY DRIVE
i.
/ 33'BLM RIGHT-OF-WA / \\
//// RESERVATION(PER PATENIT) / ..
/— -y/ / / \ 15'T&E EASEMENT
/ // \ //
I
O
Q0 y / I EXISTING WELL •• , 1 '
/
coskr< / LePT 161 i �/
I
NOTE: '�o° / \\
4-BDRM CABINI
/
DECOMMISSION EXISTI SEPTIC TANK \\ HE / . '. I
PER MOA CODE. LOCK' E WATER PLACE NEW't2 0 GALLON ,
/ •..
i •ti
I
SERVICE LINE FRO WELL PRIOR TO SEPTIC TANKli. .
CONSTRUCTION AD VERIFY A MINIMUM ...`EXIS' NG 1,250 t•LLO
10'SEPARATI916 FROM NEW SEPTIC TANK. IN SEP IC TANK. \ LOT B
/ I SHED \
/ EXISTING ABSORPTION TRENCH _ .. \
TO REMAIN IN SERVICE. --- • ---.. \
/ \ \
\
/ \
40�����iiiii� NOTE: LEGEND
••�Y"->"Z • • NO SLOPES>25%WITHIN 50'OR SURFACE WATER WITHIN 100'OF THE PROPOSED SEPTIC SYSTEM CO-CLEANOUT
,% 2C0-DOUBLE CLEANOUT
4 ° 49th _ 1 ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH FCO-FOUNDATION CLEANOUT
` i Zna..,-i WELLS OR SEPTIC SYSTEMS. FD-FLOW DIVERTER VALVE
oc: :MICHAEL E. ANDERSON & r MH-MANHOLE
.j��JNo. ce-4ae� � 0 50 100
40.1:0,., 1.20-18 cEN m m EN FEET MT MONITORING TUBE
f�0.� ;5;;�4i•�• *RPGE
1"=50' TH-TESTI HOLE T
NNW
GE
ENGINEERING
PO BOX 240773
ANCHOR AGR,AK 99524
522-7773 677-7766(FAX)
November 2. 2018
Municipality of Anchorage
Development Services Dept-On-Site Water& Wastewater Program
4700 Elmore Rd
Anchorage,AK 99507
Subject: TI5N Rl W Section 18 Lot 161 — 18906 Beverly Avenue
Septic System Design and Permit Application
Dear On-Site Services Engineer:
The septic tank on the subject lot is leaking and must be replaced prior to the issuance of a COSA
for the property. The attached site plan identifies the location of the home and the existing well
and septic system. No conflicts exist between this proposed system and any other well or septic
system,whether on this lot or adjacent lots.
The new septic tank will be placed a minimum of 5' from all deck or stairway foundation supports
and all lot lines. The existing septic tank will decomissioned in accordance with Municipal Code.
The 100' protective radius for the existing well on the lot is shown. The placement of the new
septic tank will not encroach into surrounding protective well radii. Please refer to the attached
plan sheet for the septic design. If this design is followed, there will be no adverse impacts to
adjacent properties.
Sincerely,
*• 49TH / *+4
Michael E. Anderson,PE Ag d
/ 114-1-etta412----?
5 . Michael E.Anderson :
Ttsr'•. 11318 . • 4,..�'
�Ikt.�PROFESSIONP4r
~'i~..,. m ~ MUNICIPALITY OF ANCHORAGE
lq O,~j ~,~ i 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 /~/~ P, NE - '~IEW
~ Manufacturer ff~' e ~/ __ ~a '~~-~ - No. of~,partmonts ~
~ ~ O IF HOMEMADE:
~ DISTANCE TO: Well Build ng foundation Nearest lot dne
~~¢~S1~ ~ ~ ~ Depth ~ Dri~l.r D~stance to lot Uno PERMITNO.
~ DISTANCE TQ: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
INSTALLER -~
PERMIT NO~
IqPPLICFtNT JOFIN C. PECK PO BOM, ±56E, ER
L. OCRTI ON E,'E?,/ERL',r' DR
L. EGRL 'f'±SNRiW S:1.8 LOT ±6± LOT SIZE
688-;240C~
:Z±E~642 S6)I.JARE F'EET
T'T'PE OF SOIL FIBSORPTION SYSTEM IS: TRENCH
MRXIMUbl NUMBER OF' BEDROOMS = 4
SOIL RRTING (SQ F'T,."BR)= :1.25
THE F..E..UIRE[ .... I~E OF THE :,OIL. HBSORPTION ..,~..,TEM I:,.
['-," E F=" T' I-~ == .¢-':.:: I__ E ~"'4 (Fi 'T' [-I =: ¢'~-"; :~: (~ F~ R %"' E L~ ~.) EC F" T !-4: '-",'-' .4-
TFIE LENGTH DIMENSION IS TFIE LENGTH (IN FEET> OF THE TRENCFI OR DRRINFIELD.
THE DEPTH OF R TRENC:N OR PIT IS THE DISI'RNCE BETHEEN THE SURFRCE OF' THE']
GR. OUND RND THE BOTTOM OF THE EXCR'v'RTION (IN FEET).
"['HERE IS NO SET HIDTH FOR TRENCHES.
THE GRR',,,'EL DEPTH IS THE MINIMUM DEPTH OF GRR'v'EL BETHEEN THE OUTFRLL PIPE;
RND'THE BOTTOM OF THE EXCRVRTION (IN FEET).
PERMIT RF'PLICFtNT HRS THE RESPONSIBILIT'-r' "FO INFORM THIS DEPRRTMENT .[:,tJRING THE
INSTRLLRTION INc;PECTIONS OF' RN¥ HELLS RDJRCENT TO THIS PROPERT'¢ FIND THE
NUMBER OF RESIDENCES THRI" THE WELL HILL SERVE.
8F~CKFIL. LING OF' F~N"? S"r'STEM WITHOUT FINRL INSPECTION FtND FIF"PRO'v'RL B"F THIS
[:'EPRRTMENT WILL. BE SUBJECT TO PROSECUTION.
MINIMUM [:,ISTF]NCE BETWEEN R WELL. RND RN'¢ ON-SITE SEHRGE DISPOSRL SYSTEM IS
100 FEET FOR FI PRIVRTE HELL OR t5C1 TO ;2E~ FEET FROM FI F'UBLIC WEL. L DEPENDING
UPON THE T'¢PE OF F'UBLIC HELL
MINIMUM DISTFtNCE FROM R PRIVFITE WELL TO FI PRIVRTE SEWER LINE IS ;25 FEET RND
TO R COMMUNIT"r' SEWER LINE IS '?5 FEET.
WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEF'RRTMENT WITHIN 5:(.4
OF THE WELL. COMPL. ETION.
OTHER REQLJIREMENTC; MFI'¢ RPPL"r'. SPECIF'ICFITIONS FIND CONSTRUCTION DIFIGRRMS RRE
RVF:IlLRBLE 'TO INSURE PROF'ER INSTlUlLLRTION.
P'E~;i:I".I ][ 'T' E 2:-.,:P I RES.. E)ECE:r'IBEF~:
I C:ER"FIF"r' THRT
1: I BM FRMILII::tR 14ITH TFIE REQUIREMENTS FOR ON-SITE SEWERS RND 1.4ELLS RS SET
F'ORTH BY THE MUNICIF:'RLI]"'¢ OF RNC["IORRGE.
2: I WILL INSTFILL THE S"r'STEM IN RCCORDRNCE WITH ']"HE CODES.
:J~: I IJNDEERSTFIN[:, THRT THE ON-SITE SEWER S'-?STEM MR"r' RE6!UIRE ENL. RRGEMEN]' IF THE
RES:[DENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS.
S I GNED '. .....................................................................
FtPPL I C'F:INT ..I'0HN C. PECK
U
',,,'4, 0
C:, E i--'" 'T' I'-!~-:: ~_3 L_~ENt3 TH= K~ ~]F~FtVEL tC)EP '1'!--I =
O & E ENG..~IEERING & DEVELOI-,dENT CO.
Box 90, Davis St,, Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-2774
Performed for:
Name:
SOIL LOG
Mailing Address: ~;)' O, //~Ox; 41'~ /
Legal Description: / O 7~
Earl Ellis
688-2280
Tel. No.
Depth (feet)
Soil Characteristics
0
1
2__
3__
5__
6__
7__
9__
l'fL ~/CT '77f~ 5o~.
10__
'" iGOTTO/Cl 0 Y t~IT-
Oomme~t$~
Performed by:
PLOT PLAN
PERC. TEST
WATER
DEPTH OF HELL
DRAW DOWN FT.
GALS, PER HR
KIND OF CASING
From ' FI.
Fro~ ~ ~ Ft.
DRILLER'S NA ~E.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-472O
Application Date 3/7/86
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 161 T15N R1W Sec.18
Location (address or directions)
Applicant NameJ-ohn Peck
Applicant Address _ PC',B 1_~66 ~
(b) Telephone: Home 688-2400 Business
Ea[le River: AK 99577
(c) Applicant is (check one): Lending Institution []; Owner/builder[~:; Buyer []; Other [] (explain);
(d) Lending Institution City Mort[age Telephone _f~94-3~03
Address ¢,enl:erfie]d l')r,"ive~ EaEle River Alaska
(e) Real Estate Company a~d Agent
Address
Telephone
(f) MailtheHAAtothefollowingaddress:
pJckuD by Cng4n¢¢~
TYPE OF RESIDENCE
Single-Family [] Multi-Family []
Number of Bedrooms 4
Other
WATER SUPPLY
Individual Well [~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status,
4. SEWAGE DISPOSAL
Onsite ~ Public~mmunity [] Holding Tank []
community~f system,~ must have written confirmation from the State Department of Environmental Conservation
Note:
If
attesting to the legality and status.
72-0~5 (11/84)
Page 1 of 2
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ', ' ·"
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the omsite 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 files 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.
Name of Firm
Address
Date
EAGLE RIVER ENGINEERING SERVICES
EAGLE RIVER, AK 99577
P. O. ~OX 773294
694-5195
Telephone
DHEP APPROVAL ~'~
Approved for ~ bedrooms by ~
Approved /~ DisapproveJ
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 inspections 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 (11/64)
MUNICIPALITY OF ANCHORAGE (MOLl
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4726
Legal Description:
DEI~', OF HEALTH
ENVIRONMENTAl- pROTECTION
101986_
RECEIVED
WELL DATA
Well Classification /0'~/
Well Log Present (Y/N)
Total Depth ~'~ ~' / Cased to
Static Water Level "~7 ' ¢"-,~'
Casing Heigl~t Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot /~-6 '
To Nearest Public Sewer Line
Cleanout/Manhole /Z/'/.~
tf A, B. C. D.E.C. Approved (Y/N)
Date Completed 4~'//~ c~,/¢.~ Yield
Depth of Grouting
Pump Set At /~o
Sanitary Seal on Casing (Y/N) ~"
Depression Around Wellhead IY/N)
: On Adjoining Lots ¢-1 ¢ ~ '
: On Aajoining Lots '-/~
To Nearest Public Sewer
To Nearest Sewer Serwce Line on LOt '~'¢'~
Water Sample Collected by ~'q~E- /8,¢;.~ ,E',~',~ee .... y :Date
Water Sample Test Results S~ ~-/~ t~ ~ ~o ,~ ~ ~/, '~,~ ~' ~,~^ ~,~
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) /~','/~f
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line ~/¢'
To Water Main/Service Line
Size /.-)~-,) G~/, No. of Compartments
Air-tight Caps (Y/N) ,../ Foundation Cleanout fY/N~
Date Last Pumped J-~ ,,,~
N/,4 : for --
Temporary Holding Tank Permit IY/N)
To Building Foundation 30 / ~,
To Disposal Field -~/~ /
To Stream. Pond. Lake, or Major Drainage
: Course ,~'~¢,,~ e
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
S0its Rating in Absorption Strata
Date Installed
Width of Field
Sq Jare Feet of Absorotion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot "'"'~ "~/c°
To Water Main/Service Line ~/o '
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area. or Vehicle Storage Area
Type of System Design ~'
Length of Field /~ D
Depth of Field ~' Z
Gravel Bed Thickness /~'~ '"
Standpipes Present (Y/N)
Date of Last Adequacy Test ~/~/'~
To Property Line ,-~,~--
To Existing or Abandoned System on
; On Adjoining Lots '~?~"
To Cutbank (if present)
Comments
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 that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed j-,~~ ~ Date '?//?./
Company ~'~-,/~',~,~', MOA No. ~'7-
Receipt No '~'"'1 ~-'~'~ ~ ~
Date of Payment ~ -~L5
Amoum: $ G,...~.--~ o~
Page 2 of 2
72-026 (11/84}
HZ~O~
Time s
Date
Inspector~¥C.c '~ I n a Pect o~,L~'~ InspectS' '
Comments
~~ Conditional Approval
Date Sewer Installed ~ Permit No, Septic Tank Size
//~ ~/ Holding Tank Stze
Soils Rating Well To Absorption Area Well Log Received
Weft to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
.. ,
Propert~ Owner ~ ~ ~ ~ ~ ~ ~hone
Buyer
Realty Co. & Agent /V/A ,, Phone
Address ·
~ Single Family
D Multiple Family No. of Bedrooms
D Other
Wat~ ~ly
~lndlvldual
A~ACH WELL LOG. A well log Is required for all wells drilled since June
~ Community 1975, For wells drilled prior to that date give well depth (attach og f
~ Public Utillt~ avallab
Sew~posal ~~7)~
~ Individual
~ Holding Tank
NOTE: THE INSPECTION FEE MUST, ACCOMPANY EACH REQUEST BEFORE'PROCESSING CAN BE INITIATED,
RuhSti
MUNICIPALITY OF ANCHORAGE EPEfrms
*
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On-Site Systems Approval
Parcel I.D. 051-232-07 Expiration Date:
1. GENERAL INFORMATION
Complete legal description T15N R1W Sec 18 Lot 161
Location (site address) 18906 Beverly Ave
Current property owner(s) Thelma Jean Dubyak Day phone
Mailing address 7451 Tangle Court, Anchorage, AK 99504
Real estate agent Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
n Duplex
Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well Private Septic
Water Storage ❑ Holding Tank ❑
Community Well Community ❑
Public Water System [ Public Sewer [
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 3U.6O Waiver Fee $
Date of Payment1 1 101i'�I$ Date of Payment
Receipt Number C)/ ,O1ID Receipt Number
COSA# 35C1%141 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.
Name of Firm Forge Engineering Phone 907-522-7773
Address PO Box 240773, Anchorage, AK 99524
Engineer's Printed Name Benjamin Schiller, PE Date 11/26/18
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6. DSD SIGNATURE /1% 7.c.,?..",..4 6
System #1 Approved for L. bedrooms / . Ben)ankr S hiller .
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System #2 Approved for bedrooms f -47.��o p11/26/18.•fav ,i
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Disapproved!\Zi`,"_�,
Conditional approval for bedrooms, with the following stipulations:
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By \ L`�- ,--___ (_,4Original Certificate Date: / (^7-q -1
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: T15N R1W S18 Lot 161 Parcel ID:051-232-07
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y*
Date completed 822 82 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 54* ft. Cased to 49* ft. Casing height(above ground) 36 in.
FROM WELL LOG AT INSPECTION
Date of test 8/22/82* July 2018
Static water level 37 ft. 38 ft.
Well production 2+ g.p.m. 4.5 g.p.m.
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate ND mg/L
Arsenic ND ug/L Date of sample: 8/30/18 Collected by: 907 Water Well Services
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 1 1/26/18
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N
Date of pumping Pumper New Tank
C. ABSORPTION FIELD DATA
Date installed
11/01/81 Soil rating (g.p.d./ft2 or ft2/bdrm) 125 sF/BDRnn System type Shallow Trench
Length 68 ft. Width 6 ft. Gravel below pipe 3.33 ft
Total depth 8 ft. Eff. absorption area 692 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 8/13/18 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 13** in. Water added 600 gal. New depth 17 in.
Elapsed Time: 1440 min. Final fluid depth 13 in. Absorption rate >= 600 g p d
Any rejuvenation treatment(past 12 mo.)(Y/N &type) None If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off'level at in. High water alarm level at in.
Datum Cycles tested Meets alarm &circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100 On adjacent lots 100
Absorption field on lot 100 On adjacent lots 100
Public sewer main >75' Public sewer manhole/cleanout >100'
Sewer/septic service line >25' Holding tank 100'
Animal containment areas >50' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
>10'Building foundation Property line >5 Absorption field >5
Water main >10' Water service line >10' Surface water >100'
Wells on adjacent lots 100
ABSORPTION FIELD ON LOT TO:
Property line Building foundation >10 Water main >10
Water Service line Surface water >100>10' Driveway, parking/vehicle storage >10
Curtain drain None Noted Wells on adjacent lots >100�
F. COMMENTS
*Well info taken from 1986 COSA. COSA also mentions a well log, but none can be found on record.
**The initial 13 inches in the trench was wet silty mud.
G. ENGINEER'S CERTIFICATION ��-qt,-%.\\\‘
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I certify that I have determined through field inspections and i '10)4
review of Municipal records that the above systems are in gbP •• `, :t.9 ��
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conformance with MOA COSA guidelines in effect on this date. 0*:.49•TM i. • * r
Benjamin Schiller, PE
Engineer's Printed Name % j"`
Date
11/26/18 Benjan,n5chiller••• re
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COSA brown sheet 10-10-12.doc
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Lot 144 /' // ALASKA RAILROAD RIGHT-OF-WAY // BEVERLY DRIVE `
1 / WEST 4.407 Chains (RECORD)/290. ' (COMPUTE) _
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/ 33' 3LM RIGHT-OF-WAY
/ / RESERVATION (PER PATENT) /
/ / 15' T&E EASEMENT
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PLOT PLANAS BUILT X SCALE 1' = 50' GRID NW 1054 Project No. 18-471/A3
& Associates,S o c i a t e S, inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang
(907) 522-6478 Phone
(907) 522-4625 Fax OF � THE WESTERLY BOUNDARY IS DESCRIBED AS THE CENTERl1NE OF THE
Professional Land Surveyors kenOlangsurvey.eomff' A ALASKA RAILROAD. THE LOCATION SHOWN HEREON IS APPROXIMATE AND WAS
jonathonOlangsurvey.com ,09.,,,C ''. • •• '''.11/4011) NOT SURVEYED FOR THIS PROJECT.
I hereby certify that I have surveyed the following described property: (6(..1.:`'.' ,.4.-- •'��
Lot 161, SECTION 18, T15N, RIW, SEWARD MERIDIAN, ALASKA 49TH �� '•. * THE ALASKA RAILROAD RIGHT-OF-WAY TI OF-WAY IS HEREON FEET ON BOTH SIDES OF THE
Anchorage Recording District, Alaska, and that the improvements situated thereon are / 17 EXISTING TRACKS. THE LOCATION SHOWN IS APPROXIMATE.
within the property lines and do not encroach onto the property adjacent thereto, that 4
no Improvements on the property lying adjacent thereto encroach on the surveyed KENNETH••t.•,•••
premises and that there ore no roadways, transmission lines or other visible �,
easements on said property except as Indicated hereon. QV 1lf(g
Dated this the Day of tJO11,1,"65.0- , _ , at Anchorage, Alaska ti '•G. 992202
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It Is the responsibility of the owner to determine the existence of any easements.
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covenants, or restrictions which do not appear on the recorded subdivision plot. AECC963