HomeMy WebLinkAboutWILLIAMSON BLK 1 LT 4Williamson
Block 1
Lot 4
#015-073-09
GREA-R ANCHORAGE AREA BORT 1GH
. Department of Environmental Quality
I'if 3500 Tudor Road
Anchorage, Alaska 99507
_ INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM_
NAME MAILING ADDRESS :s/'./1 .6OX PHONE
LOCATION_ -• 9a/4 LEGAL DESCRIPTION </'� 5L /—` �T <y/�G✓�3i�a��k' ��"
SEPTIC TANK:
DISTANCE / _ NUMBER OF
FROM WELL O MANUFACTURER f/fi/,�;�F/�9/z/I MATERIAL" //��'��Z�—COMPARTMENTS—/
INSIDE LENGTH_ INSIDE WIDTH W' s-3_LIQUID DEPTH/ LIQUID CAPACITY _�J'C� GALLONS.
SEEPAGE PIT:
NUMBER OF PITS DIAMETER __—OR WIDTH L? / LENGTH—_! �/DEPTH
/DX /o,x % /.
LINING MATERIAI_o 6' 6�/��CRIB SIZE: DIAMETER __DEPTH—DISTANCE FROM: WELL
/�
/ / TOTAL EFFECTIVE
BUILDING FOUNDATION_' NEAREST LOT LINE_ W . ABSORPTION AREA (WALL AREA) SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE ✓"�/C �oajff_� CONSTRUCTION_ h? 4/ DEPTH _ � / —DISTANCE FROM:
BUILDING / / NEAREST �/' NEAREST SEPTIC , / SEEPAGE /
FOUNDATION'' LOT LINE— SEWER LINE_ ✓✓ I , TANK_A' f', SYSTEM
CESSPOOL —� I
OTHER SOURCES
APPROVED k .DISAPPROVED REMA
DISTANCES:
INSTALLED BY:
PIPE MATERIAL: ;Z
LOT SLOPE:130-�1%�`f'�
REMARKS:
Farm PW -026
DIAGRAM OF SYSTEM
CATE— APPR
mr-W.,
GREAIER ANCHORAGE AREA BOR.,UGH
DEPARTMENT OF ENVIRONMENTAL. QUALITY PERMIT NO. C
3500 TUDOR ROAD POUCH 6.650
ANCHORAGE. ALASKA 99502
TELEPHONE 279.8666
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
NAME OF APPLICANT 7T,yJ /M�A(I/LING ADDRESS G �Sl! /J' /'� PHONE
INSTALLATION LOCATION
LEGAL DESCRIPTION`/-
/ _
INSTALLATION OF: SEPTIC TANK ✓ SEEPAGE
PIT_ DRAIN FIELD OTHER -,
TYPE AND SIZE OF FACILITY TO BE SERVED -J ��v/C
FINANCED THROUGH - �- TO BE INSTALLED BY
SOIL TEST RESULTS z=�'� / NOTEIlTHIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE TYPE ����-�L'f� SEEPAGE AREA SIZE
MINIMUM DISTANCES, REQUIREMENTS/
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT 1�2 v DRAIN FIELD
SEPTIC TANK TO SEEPAGE PllWALL
SEPTIC TANK-. SEEPAGE PIT �y DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO S17PTIC TANK v L SEEPAGE PIT
DRAIN FIELD -- ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK
DRAIN FIELD _
SEEPAGE PIT
SEPTIC TANK,------I�1e SEEPAGE PIT �) DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC 'TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE. CAPS,
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION,
G
HEALTH AUTHORITY
OR
LICENSED DESIGNER
%7X
TYPE _
SYSTEM
1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2868 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ,
DATE.17 / /�� APPLICANT'S SIGNATURE
APPLI( N'T FILLS OUT UPPER HK ONLY
Property Owner /79r G f, ! !� <)- ' p % r bri6 .a 1 )lig 'c' nIV- .
7'J -e. .. i
Phone
Mail Ing Address `" ,• ,� Zip Code 99' O 7
y����aU�
-7S 2-r
—
y�
Buyer �))l�LYRa
Address ki-' Zip Code _
r r 1 1
Lending Institution /` 7 �y /T ' `- L f F' - L "� f Phone
C2 Y! -'
V
Address r3� C� - r/ Zip Code, -
Really Co. & Agent. Phone
L GlLt7`G'rL j'.%j Sl egr,JiLY�Lr
Address/ /�-%�.rJ!%r• Zip Code
Legal Descrlptbn �O !/ J;�loc ��. (A)-11 S 0
Street Location f-�j (=-n S yl—L�
of Residence
Type,
❑ Single Family -r;, /�
No. Bedrooms GC � �Q
Multiple Family of p
❑ Other
Water Supply
� t1 "�""""'
❑ Individual
ATTACH WELL LOG. A well log Is required for all wells drllled since June 1975.
Community
For wells drllled prior to that date, give well depth (attach log if available).
fj Public Utility
Sewer Disposal
,V Individual Year Individual Installed: -Z
❑ Public Utility When Connected to Public Utility: _
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE: INITIATED.
Time
Time
Time
Time
Date
Date
Date
Dat7e
Inspector
Inspector
Inspector
Inspector
Field Notes: �E_/.t \
�„Erc. /!'��p'iC E9 � 1r� ('70 ,C���
MUNICIPALITY OF ANCHORAGE
i_ ,. �.f Com'” _ .. � r) l ".
� t1 "�""""'
ENVIF a -L /." '-:o F rI
RECEIVED
( APPROVED BEDROOMS CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL PPR�OOVALL''/
DATE
BY:
Soils Rating
e Sewer Installed Well To Absorption Area
Well Log Received/ for .t;u w
JAS- 1!,
q' 2 Well to Tank 0,
Septic Tank Slze %O
72 023 131011
r -
ALASKA CnUIROn OTAL COnTROL ONUS, InC.
13ngineering 6 Enuironmental Studies
IAUNICIPALIIY 01= ANCHORAGE
-_7 C.- ,.-.....
ENVI:':! 1 I
ALASKA TITLE GUARANTEE
8050 OLD SEWARD HIGHWAY
ANCHORAGE AK 99502
SELLER — MICHAEL HOWARD
SUBDIVISION—WILLIAMSONS
9/29/82
BUYER—
BLOCK-1 LOT -4
ADEQUACY TEST FOR SEWER SYSTEM
THE 'TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN AREA OF 802 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 900 GALLONS OF WATER PER DAY.
TIME SURGE CAPACITY OF THE SYSTEM IS 100 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
6 BEDROOM HOME.
SEPTIC 'TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 2770
THIS 6 BEDROOM HOUSE.
92
1'
9R tS�...........r ..
4Y C. Raid, Jr...: 11,
No. 2251Ea,
IS ADEQUATE FOR
1220 West 25th Auenue 4 Anchorage, Alaska 99503 • 907) 276-1361
WELL WAIVER
ON-SITE SEPTIC PLAN
REVIEW
DUPLEX
WILLIAMSON SUBDIVISION
LOT 4 BLOCK 1
prepared by
OHI Consulting Engineers
2820 DeArmoun Road
P.O. Box 111349
Anchorage, Alaska 99511-1349
(907) 345-1385
September 1, 1994
06!09700 11:01 VAX 9072697650 ULC Dn&Ry' 0002
WAL i ER J. HAcKEL. GOVERNOR
DEPT. OF ENVIHONMENT,ti1, CONSERVATION
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3.470
ANCHORAGE, ALASKA 99515
September 14, 1994
Mr. Dee High, P.E.
DHI Consufting Engineers
P.O. Box 111349
Anchorage, AK 99511-1349
(907) 349-7755
RE: Lot 4 Block 1 Williamson Subdivision - 5231 E. 98th Avenue; On -Site Wastewater
Disposal System and Horizontal Well Waiver Separation Distance Plan Review.
ADEC project nos. 9521 -WW -244-079, 9521 -WV -244.012
Dear Mr. High:
This letter is in response to the materials received in this office September 1, 1994,
requesting a waiver from the required separation distance between an existing Gass "C'
public well and a proposed replacement on-site wastewater disposal system. The
Department has reviewed the submitted materials which included a cover letter,
completed checklist for waiver of separation distances, soil percolation logs, site
diagrams, engineered plans and calculations for the on-site wastewater disposal system
and surrounding area well and soil logs. Based upon this review it appears that there
are two waivers from the required horizontal separation distance for a Gass 'C public
well, one for the septic tank and the other for the proposed absorption trench.
Horizontal Well Waiver SepaM ton Distance-
From
ist a
From the information provided in the submittal, the reduced horizontal separation
distances from the required 150 feet to 101 feet between the well and absorption trench,
and 84 feet between the well and septic tank does not appear to present a significant
contamination source or threat. The satisfactory results obtained from the recent water
analysis for total collform bacteria and nitrate indicate that the present well is not being
impacted by the reduced separation distances which currently exist between the well and
a failed cn-site septic system
Wastewater Dlsposat System:
Based upon the intended use of the dwelling (six bedroom duplex) and your assumption
of the subsurface soil conditions as detailed in the submitted data, it appears that the
�116/09/00 L1:02 r.0 90728078.10
Mr. Dee High, P.E.
DEC DIM" Q003
2 September 14, 1994
proposed on-site wastewater disposal system (deep absorption trench) is adequately
sized (750 square feet). Therefore, subject to the following requirements, the construction
plans are approved for -the concerns of this Department, in accordance with State
Wastewater Disposal Regulations (18 AAC 72).
The Installation of the wastewater disposal system will need to be monitored by a
professional engineer (P.E.).
2. Complete as -built drawings of wastewater disposal system will need to be
submitted to this office under the stamp of a P.E. The drawings will need
to verify soils, water table, and impermeable strata separation.
3. Monitoring tubes will need to be installed at the ends of each trench. This
change can be verified on the requested as -built drawings.
This approval does not imply the granting of additional authorizations nor does it obligate
any federal, state, or local regulatory body to grant required authorizations.
Thank you for your cooperation with this Department, if there are any questions regarding
the above please do not hesitate to call.
Sincerely,
A1211�e__
Michael Lu. E.I.T.
Environmental Engineer
MLU/cf
��/�UHMPAUTY OF\ H C E ORAOE
Development Services Department `'7 Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 015-073-09-000
Expiration Date:
Legal description WILLIAMSON BLK 1 LT 4
Site address 5231 E 98TH AVE Anchorage AK 99507
Current property owner(s) WHEELES IAN
11/21/2023
X The On-site system(s) is/are approved for 6 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories: System has a 51 year old handmade concrete tank.
Absorption field was rejuvenated on July 16, 2023 using Hydrogen Peroxide.
Original Certificate Date: 8/21/2023
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval June 2022
MUNICIPALITY OF ANCHORAGE
e . -..I
Development Services Department Phone: 907-34377904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 015-073-09
Complete legal description WILLIAMSON BLOCK 1 LOT 4
Location (site address) 5231 E 98TH AVE ANCHORAGE, AK 99507
Current property owner(s) IAN WHEELES Day phone
2. ON-SITE SYSTEMS SIZED FOR 6 BEDROOMS
3. TYPE OF WATER SUPPLY: ❑ Private Well ® Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑ Plastic ® Concrete ❑ Fiberglass
Age 51 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested:
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ Waiver Fee $
Date of Payment
COSA # S Z Iy
Date of Payment
Waiver #
COSA Application.doc
COSA Checklist.docx
COSA Checklist
Legal Description: WILLIAMSON BLOCK 1, LOT 4 Parcel ID: 015-073-09
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled CIRCA 1972 Total depth 135* ft
Cased to 40+* ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 24+ in.
Date of flow test for COSA 5/9/2023
Static water level at beginning of test 83 ft.
Well production at time of test 2.5+ gpm
Water storage tank volume NA gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 5/9/23
Comments *Per MOA file & ND / clean water analysis results.
B. TANK DATA
Measured operating fluid level in septic tank *54”
Date of pumping 8/16/2023
Required maintenance completed, if AWWTS
Comments: *Per tank fluid levels, bottom of tank & post
tank cleanout invert elevations.
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA (Upper / Lower Trenches)
Which system tested (date installed) 9/29/1994
ALL standpipes present per record drawing
Total measured depth from grade 10.2 / 8.3 ft (max)
Measured depth to pipe invert from grade 2.4 / 2.9 ft
(min) N/A – pressurized field.
Per record drawings, field is insulated. (ADEC)
Monitor tubes go to bottom of effective.
If not, state depth into effective 5.5’ Lower Trench
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) Y
If yes, enter date 7/16/23
Adequacy test date 8/17/2023
Results Pass
Fluid depth prior to test 40 / 50 in
Water added 1000 / 500 gal (1500 Gal Total)
New fluid depth 69 / 67 in (Rose to Lower Lateral)
Elapsed time 1440 min
Final fluid depth 49 / 47 in
Absorption rate 900 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 84 in
Effective depth used 49 / 65 in (Final fluid + Any missing)
Effective depth remaining 35 / 19 in
Comments/Deficiencies: Rescind OSP231180. Field was treated with 4 drums of hydrogen peroxide. Approximate total
measured depths from existing grade. ED per elevation measured shots & appears approximately 1.5’ (18”) ED is missing
in the lower trench.
COSA Checklist.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No *84 ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
*Previous issued well waiver. See MOA file.
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 8/18/2023
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
8/18/23
15'
EA`.
MORTGAGE SURVEY X SCALE 1" 330' GRID SW 2437 Project No. 23-197/A1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates, inc. (907) 522-6476 Phone 0000Oppp
(907) 522-4625 Fax oo ()F A CpO�
Professional Land Surveyors kenolongsurvey.com o
Y _......
jonathanOlangsurvey.com OvP' .• �S4o0
I hereby certify that I have surveyed the following described property: O�Lj:
LOT 4, BLOCK 1, WILLIAMSON SUBDIVISION (Plat No. 70-38) o* : 49TH
Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a
representation of the conditions that were found on the date the survey was performed.
This survey does not constitute a boundary survey and Is subject to any Inaccuracies Q
that a subsequent boundary survey may disclose. The Information contained hereon shall V coA••. KENNfEfH .LAN o�
not be used to establish any fence, structure, or other Improvements.
��P�'••.LS-520 •�O
Dated this the ' Day of M 2U2j at Anchorage, Alaska 44O�.RaS3�oNA1 �ooO
It Is the responsibility of the owner to determine the existence of any easements, wppp�c
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
Parcel I.D. 015-073-09
Municipality of Anchora€
On -Site Water and Wastewater Program
(907)343-7904
/1 8 9 70
llQZ-9 AON 8
o <
3141SS�
r
Certificate of On -Site Systems Approval
Expiration Date: _
1. GENERAL INFORMATION
Complete legal description Williamson, Block 1, Lot 4
Location (site address)
5231 E. 98th Avenue Anchorage, AK 99507
Current Property owner(s) Jeffrey Heys & Penny Bauder Day phone _
Mailing address
Real Estate Agent
5231 E. 98th Avenue Anchorage, AK 99507
Chris Swires
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings. (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Six
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Fx-1
Individual
n
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for: - - Distance:
Received by: Date:
cT'
COSA to be released to the enginderlunless otherwise requested by the engineer.
COSA Fee $ O CI t r 9wh
Date of Payment o�
Receipt Number
COSA#—)a05�J�
Waiver Fee $
Date of Payment
Receipt Number
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 theon-sit€ 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 Anderson Engineering Phone
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SI NATURE
System #1 Approved for n bedrooms
System #2 Approved for _ bedrooms
Disapproved
522-7773
Conditional approval for bedrooms, with the following stipulations:
By: Ud Original Certificate Date: 1 e2 ` 6 " f 2 -
The unici ity A orage Development Services Division (DSD) issues Certficates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional dvil 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 blue sheet - , c
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: Williamson, Block 1, Lot 4
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 1972 Sanitary seal (Y/N) Y
Total depth 135 ft. Cased to >40 ft
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS
ft.
9pm-
Parcel ID: 015-073-09
Well Log (YIN) N
Wires properly protected (YIN) Y
Casing height (above ground) >18 in.
AT INSPECTION
11/27/12
40 ft
4.25 g.p.m.
Coliform 0 colonies/100 mL Nitrate N/D mg/L
Arsenic N/D ug/L Date of sample: 9/18/12 Collected by: MEA
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Concrete
Tank size 2,770 gal. Number of Compartments
Date installed 9/11/72
Cleanouts(Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 12/4/2012 Pumper Around the Clock Pumping
C. ABSORPTION FIELD DATA
Date installed 9/29/94 Soil rating (g.p.d.lft2 or ft2lbdrm) 1.2 GPD System type Deep Trench
Length 56.1 ft. Width 3 ft. Gravel below pipe 7 ft.
Total depth 9 ft. Eff. absorption area 785 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 11 /20/12 Results (Pass/Fail) Pass For 6 bedrooms
Fluid depth in absorption field before test 60/32 in. Water added 900 gal. New depth 79/48 in.
Elapsed Time: 1,440 min. Final fluid depth 60/32 in. Absorption rate >= 900 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed _
"Pump on" level at
Datum
in.
Size in gallons
Manhole/Access (Y/N)
"Pump off"level at
in. High water alarm level at
Cycles tested
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot
84'**
> 100'
Absorption field on lot
N/A
Public sewer main
Sewer /septic service line
>25'
>50'
Animal containment areas
SEPTIC/HOLDING TANK ON
LOT TO:
>5'
On adjacent lots
On adjacent lots
>100'
>100'
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excrete storage areas >100'
Building foundation Property line >5
Water main >10' Water service line >10'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10, Building foundation >10'
Water Service line >10' _ Surface water >100'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
See Well Waiver.
G. ENGINEER'S CERTIFICATION
I certify that l 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 Michael E. Anderson, P.E.
Date 12/5/2012
COSA brown sheet -1 0-10-1 2.doc
Absorption Feld >51
Surface water >100'
Water main
>10'
Driveway, parking/vehiclestorage >10'
in.
DISfURBED
LAWN AREA"
AN
`
�
5231 E. 98TH
PARKING Y\RE4 u° ^
| \
| ~
�NOTES
I.ADJUST GRADE TO DRAiN IF SETTLED
OVER TRENCHES, ABANDONED PIT OR
`
SEPTIC TANK. REMOVE LARGE ROCKS
8cDEBRIS, |FANY.
2.M|NYM4L2`COVER OVER PIPES AND
TANK SHOULD NOT BE DECREASED.
DONOT DISTURB PIPES, INSULATION,
FABRIC OR CLEANDUTD^ DO NOT DISTURB
EXISTING TREES &c SHRUBS.
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DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
October 21, 1994
Mrs. Laurie Kozisek
DHI Consulting Engineers
P.O. Box 111349
Anchorage, AK 99511-1349
(907) 349-7755
RE: Lot 4 Block 1 Williamson Subdivision - 5231 E. 98th Avenue; On -Site Wastewater
Disposal System and Horizontal Well Waiver Separation Distance Plan Review,
ADEC project nos. 9521 -WW -244-079, 9521 -WV -244-012
Dear Mrs. Kozisek:
This letter is in response to the materials received in this office October 19 & 21, 1994,
requesting final operation approval for a replacement on-site wastewater disposal system.
The Department has reviewed the submitted materials which included an engineered as -
built of the wastewater disposal system and a completed Certification of Construction for
Domestic Wastewater Systems. Based upon this review it appears that the system was
constructed substantially in accordance with the previously approved plans. Therefore,
approval to operate the constructed wastewater disposal system (soil absorption trench)
is granted in accordance with State Wastewater Disposal Regulations (18 AAC 72).
Attached is an Approval of On -Site Residential Water and Sewer Systems verifying
this Department's approval of the wastewater disposal system.
Thank you for your cooperation with this Department, If there are any questions regarding
the above please do not hesitate to call.
Sincerely,
Michael Lu, E.I.T.
Environmental Engineer
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1.
State of Alaska
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
P.O. Box O, Juneau, Alaska 99811-1800
CERTIFICATION OF CONSTRUCTION
FOR
DOMESTIC WASTEWATER SYSTEMS
CrT 17
Instructions:
1. Within �10 days after the constnlction, installation, or modification of a project is completed, the owner, the contractor(s)
responsible for constructing the project, and a registered engineer responsible for construction inspection, complete and sign
this form declaring that the project was constructed in accordance with the most recent Department -approved plans, or in
accordance with the attached as -built drawings.
2. If a project is being completed in phased construction, a map shall be attached showing that portion of the project being
declared completed on the date stated in the Owner's Section. Completion of each phase of a project must be declared as
it is completed. Additional Certification of Construction forms are available from any Department of Environmental
Conservation office.
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Pieate type orprint, except for sigrtafnre.
SECTION A Owner's Section
Name and brief description of project Lot 4 Block 1 Williamson Subdivision Modification of existing
on-site septic system serving a duplex.
9521 - WW -244-079 and
Jay & Kathy Rowe ADEC Project No. 9521 - WV -244-012
Name of owner J
Address 5231 E 98th. Street Apt A
Anchorage, Alaska 99516 Date Project Completed 09/29/94 *
City Stale Zip
* Topsoil and seeding will be installed by June 30, 1995
I certify that I am the owner of the above -referenced project. I further certify that this project was constructed in accordance with
the latest plans submitted to and approved by the Alaska Department of Environmental Conservation (ADEC), or in accordance with
the attached as -built drawings. I understand that I may be required to take remedial measures to correct any construction which was
completed without prior ADEC approval, which departs from the approved plans, and which is found to be inconsistent with the
applicable requirements of ADEC wastewater disposal regulations (I8 AAC 72).
t"u rev(6/90) Page 1 of 2
SECTION B Coutractoes Section
I certify that I (or an individual under my direct supervision) have conducted an inspection of the project referenced in Section A,
or portions of the project which I had the responsibility for construdiog, and that to the best of my knowledge and information, the
project, or those portions, was or were constructed in accordance with the latest plans submitted to and approved by the Alaska
Department of Environmental Conservation, or in accordance with the attached as -built drawings.
For multiple contractors, if applicable:
or
Typed or Panted Name of Contractor Signature of Contractor (please sign in ink) Date
•••s•sssss•s•••.•s••s•♦ss•s••s•ssasuss•asass••••••sa•ssassars•sass•.••♦s♦sss••r•ssassss•••••ssssarwwssa••••••s•
SECTION C Englueees Section
I certify that I (or an individual under my direct supervision) have conducted an inspection of the above referenced project, and that
to the best of my knowledge and information, the project was constructed in accordance with: (check one of the following)
❑ the latest plans submitted to and approved by the Alaska Department of Environmental Conservation
or
® in accordance with the attached as -built drawings.
Responsible for Construction Inspection Professional Engineer
(please sign in ink) Registration Number
Laurie M. Kozisek
Typed or Printed Name of Professional Engineer
IM13 m(6/90) I Page 2 of 2
DS