HomeMy WebLinkAboutT15N R1W SEC 9 LT 90TI5N RIVV
tion 9
Lot 90
· //'051 - 104-47
Municipality of Anchorage Page i o!__
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wast.water Disposal System and/or Well Inspection Report
Permit Number: SW940235 PIDNumber: 051-104-47
Nam~uskoski, Daniel & Sallie Wastewater System: ~New [] Upgrade
Address:
P. O. BOX 143467, Anchorage,9~.14 ABSORPTION FIELD
Phone: No. of BTrooms: I~Deep Trench [] Shallow Trench [] Bed E3 Mound [] Other
Soil Rating; Total Depth from original grade:
LEGAL DESCRIPTION 1.2 GPD/Sq. Ff. 9. 0'
Lot: Block: Subdivision: ]epth to pipe bottom from original grade: Gravel depth beneath pipe
90 4,0' Ft., 5,0' Ft.
To.~:~ ~h~p: Ra~ Section: Sec, 9 Fill added~above original grade: Ft. Gravel4Qrlength:0r Ft.
Gravel width: Number of lines: Distance between lines:
WELL: [;~.New [] Upgrade 4.0 i Ft. i --- Ft.
Classification (Private, A,B,C): Total Depth: Cased To; Total absorption area: Pipe material:
Private ] R0 Ft. 8Q' JO"Ft. 400 SQ. Ft Solid D3034i F810
Driller: Date Drilled: Static Water Level: Installer: Date installed: ps r f,
Sullivan 7/94 38 Ft. M M & M Contracting8-4-94
Yield:0 · 58 GPM Pump Set at:unk Ft. Casin~ Height Ab0ve Gr0und:Ft. TANK
SEPARATION DISTANCES E~Septic [] Holding E] S.T.E.P.
TO Septic Absorption Lift Holding ~ublic/Prlvate M nufa turer: Capac~.Y0t~)g~llons:
From Tank Field Station Tank SewerLines ~p_~. Tank
Material: Number of Compartments:
We~l' 120 ' 136 ' ...... Steel 2
Su,,oe -- ~ LIFT STATION
Water kl00' +100, ....
Line Fl00 I +50" ......
"Pump
Remarks: BENCH MARK
TQD of foundation. NW corner
10 0.0 Ft,,
ENGINEER'S SEAL
~ Dates:let ~-3-94
Department of Health.at~ Hum~n..S~rvi'ces approval
Reviewed and approved b Date: ~
72-013 (Rev. 9/91) MOA 25
WATER
BLM
AND WASTE~,/ATER ABSORPTION SYSTEM
LB] 90 (NW 1/4 S9 T15N RIW)
hJ
Q
~ENT ROW RESERVE
WELL O ~~~?
i1~3'
30,4'
PREPARED FOR~
M M ~ M CONTRACTING
PO ]}OX 670485
CHUGIAK, AK~ 99567
KN]3 ENGINEERING
20441 PTARMISAN BLVD
EAGLE RIVER, AK, 99577
694 2359
WAS EWATER A]}SBRPTISN SYSI-EH
]}L~ LOT 90 (NW 1/4 S9 T15N
40 LF TRENCH
ALL SOLID PIPING D3034, ALL LATERALS F810.
1000 GALLON SEPTIC TANK FROM ANCHORAGE TANK USED,
PREPARED FUR:
H H ?, H CUNTRACT[NG
P~ ~BX 610485
CHUGIAK~ AK, 99567
KND ENGINEERING
~0441 PTARMIGAN BLVD
EAGLE RIVER, Al<, 99577
694 2359
DATE: 8-4-94 DRAWING
NO~mSO~U~ tAS BUILT
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW940235
DESIGN ENGINEER:KND ENGINEERING
OWNER NAME:RUSKOSKI DANIEL & SALLIE
OWNER ADDRESS:P.O. BOX 143467
ANCHORAGE, ALASKA 99514
DATE ISSUED: 7/13/94
EXPIRATION DATE: 7/13/95
PARCEL ID:05110447
LEGAL DESCRIPTION: T15N R1W SEC 9 LT 90
LOT SIZE: 108900 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOURS)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY: ~t~~
ISSUED BY: ~- -.
' /
DATE:
DATE:
7-/3
~[D ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)694-2359~FAX (907)696-8111
On-Site Services
DHHS
825 L Street
Anchorage, AK 99501
Dear Sirs:
MUNICIPALI1Y OF ANCHORA(~E
ENVIRONMENTAl. SERVICES DIVISION
, !.JN 2 7 1994
RECEIVED
June 24, 1994
REF: Lot 90 NW 1/4, Sec 9, T15N, R1W
Attached is our request for an on-site well and sewer permit for the above lot.
As shown on the site plan, there are no conflicts with existing on-site well or sewer systems or
with potential reserve areas.
This lot is generally flat in both directions. There is adequate area on the east and south portion
of the lot to install both an original and a replacement system. This is in addition tot he
proposed replacement area located west of the proposed site. The natural slope will provide
positive drainage away from the proposed installation site. There is no surface water within
100 feet of any portion of the proposed installation.
We performed a soil test on this property to a depth of 15'. The soils were consistent below the
first 1.5' and provided excellent adsorption. The design we are submitting is based on the
percolation rate of approximately 3 minutes/inch and was run between 4'-5'. The length of the
proposed trench is 27' as identified on drawing 94-S2-0608.
Thank you for your consideration of this request. If there are any questions, please call me at
696-6111 or leave a message at 694-2359.
Sincerely,
KND Engineering
Attachments:
On-Site Sewer Application
Wastewater Absorption System Details
Site Plan
Soils Log/Percolation Test
A N ~2E
L[] ]'
b,/ASTES/ATER A]}SBRPTI[3N ,3YSTEM
90 (NW 174 .39 T15N
6O
61
UNDEVELBPED
67
50'BLM PATENT RBW RESERVE
50'~LM PATENT RBW RESERVE
ANK
W
· WELL
88
WELL
92
LBT SIZB
LESS: L~T PERIMETER
WELL RADII, HOUSE
FBBYPRINT, RBW RESERVE
TOTAL AREA AVAILABLE
FOR SEPTIC SYSTEM
108~900SF
54,100 SF
54,800SF
PREPARED FBR:
M M ~ M CBNTRACTING
PB ]}BX 670485
CHUGIAK, AK, 99567
KN]3 ENGINEERING
20441 PTARMIGAN SLY]3
EAGLE RIVER, AK, 99577
694 2259
SCALE, l' = 100' 194-S1- 0608
WASTEWATEF~ A]DSBRPTIBN SYSTEM
SLM LOT 90 (NW 174 S9 TiGN RIW)
38 LF TRENCH
..... l' 6' MINIMUM FROM BOTTOM BF TEST HOLE
T[DTAL DEPTH ElF SYSTEM %0'
DESIGN CRITERIA
SOILS RATING 1.2 GPD/SF
3 BEDROOM HOUSE - 3 x i50 GPD/BEDR[DBN = 450 GPO
450 GPO + 12 GPD/SF = 375 SF ADSI]RPTIBN AREA
375 SF + (a)(5'$) 38 LF TRENCH (MINIMUM)
2" ND INSULATION REQUIRED OVER TRENCH IF < 4' GROUND COVER
2' HD INSULATION OVER TANK IF < 4' COVER
INSTALL 1000 GAL STEEL SEPTIC TANK
PREPARED FBR~
M M g< M CBNTRAC¥IN5
PI3 ]}OX 678485
CHUGIAK, AK¢ 99567
KND ENGINEERING
20441 PTARMIGAN 3LVD
EAGLE RIVER, AK~ 99577
694-2359
DATE: 7 8 94
NOT lO SCALE
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: MM&M Contracting / I~N~ FnglnP~r~!g OA1
LEGAL DESCRIPTION: Lot 90 NW 1/4 S9T15NR1W Township, Range, Section:
Organic
Loam
Sandy Gravel,
Trace of silt
5
6 erc Hole
lev
7
8
9
10
11
12
13
14
15 Water at time
of digging
16- 'Sand, fine
17
18
19 -
20 -
SLOPE
SITE PLAN
LevE
WASGROUND WATER
ENCOUNTERED? Yes
IF YES. AT WHAT
DEPTH? T 5 '
Depth to Water Alte','
Monitoring? 15' Date: 6/l 3/94
.f
LE /e
Gross Net Depth to Net
Reading Date Time Time Water Drop
O 6/4/94 13:30 4" _
1 13:35 5 rain 5 11/16" 1 11/16"
2 13:40 5 rain 7 5/16" 1 5/8"
3 13:45 5 min '5"-611'/15 1 11/16"
4 13:48 3 min 7 11/16" l"
5 13:52 4 min 9 1/16" 1 3/8"
* Watt r added
22 min 7 3/8"
PERCOLATION RATE .
TEST RUN BETWEEN
3 (m~nutes/~nch) PERC HOLE DIAMETER
5 FT AND -- 6 FT
11
COMMENTS H01e pre,naked print fn f:sting
~.nno+ DL'ffus
PERFORMED BY: [~AI ./KM~ ~ ........ h m. CERTIFY THAT THiS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: -- 6/4/93
72-008 (Rev. 4/851
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES.
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY OWELLING
Parcel I.D. # 051-104-47 HAA#
INF RM -I0O AT"
1.
GENERAL
Completeiegaldescription Lot 90, Se'c. 9, T15N, R1W
Locatrd'6 ~tfe-ad,,dress or directions)
P~°perty Ow.~er
Mailing address
Lending agency
Mailing address"
.~niel & Sallie Ruskoski
Day phone
Day phone
Agent
Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water~
xx
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Individual on-site
Holding tank
Community on-site
Public sewer
XX
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system. ~','~<'.. , .. ~ ~ .
?2.,025(Rev, I/91) Fronl MOA#21
WATER WELL ADVISORY,
During a recent Health Authority Approval on-site inspection and
tes~ of the__potab~e wgter supply well on Lot ~ Block '~
of O~C' ~- I /5~'/~/FV Subdivision, the well's productivity
was determined to be ~3~ gallons per minute. The minimum well
productivity required by this department (AMC 15.55) for
a ,~ bedroom residence is~,~/ gallons per minute.
Although the subject welt currently exceeds this minimum
requirement, all part'ies concerned are advised that the
production capacity of the well may fluctuate. Restriction of
noncritical water uses such as washing cars and Watering lawns
and gardens may be required.
This advisory must be attached to all copies of t'he subject
Health Authority Approval.
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:. Lot
A. Well Data
Well type Private
Log present (Y/N)
90, Sec. 9, T15N, R1W parcel I.D. 051-104-47
If A, B, or C, attach ADEC letter. ADEC water system number
Y Date completed 7/94 Driller Sullivan
Total depth 18 0 ' Cased to
Sanitary seal (Y/N) Y
Date of test
Static water level $ 8 '
Well flow 0.58
Pump level1 unkn
FROM WELL LOG
7/94
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 12 0 '
Absorption field on lot 1 ~ 6 '
Public sewer main NA
Sewer service line + ? 5 '
WATER SAMPLE RESULTS:
Coliform ,~ Nitrate
Date of sample: 8- 2 4- 9 4
B, SEPTIC/HOLDING TANK DATA
80' 10"
Wires properly protected (Y/N)
AT INSPECTION
Casing height 24"
Y
.g.p.m.
MUNICIPAU r¥ OF ANCHOI~GE
ENVIRONMENTAl. SERVICES DIVISION
; On adjacent lots +100 '
; On adjacent lots + 100 '
Public sewer manhole/cleanout NA
Petroleum tank + 10 0 '
$~P 1 6 1994
g.p.m.
RECEIVED
Other bacteria
KND
Collected by:
Date Tank size 10 0 0 Compartments 2
High
Date:of pumping
Well(s) on lot 120 '
TO property line +100 '
Sudace water/drainage
72-026 (3/93)' Front
Foundation cleanout (Y/N) ¥ Depression (Y/N)
Alarm tested (Y/N)
,stem Pumper
SEPTIC/HOLDING TANK TO:
On adjacent lots + l00 '
Absorption field 9 '
+100'
Foundation 11.5 '
Water main/service line +25 '
CONTINUED ON BACK PAGE
P.O, BOX 6?02?2, CHUGIAK~
Wi Li, S
DATE- Started , , E.ded "~/'~'~ .........
-!
PERMIT NUMBER
GALS, PER HR
KIND OIr ('AGING
KIND OD FORMATION:
From- (~ _Ft.
From....,:~! Ft.
From .Z~.
Fi'om, /~ ,Fl.
From ~ Ft.
From /] ()~Ft.
From __Fl 1o~ FI.
Fro~ , FI, to. - FI ............
From .... Ft, lo ........... Ft._ ..... ,, ,,
rrom Ft, to.. Ft., .........
From.~ FI, 1o,_. Ft.
From Fl. to . ...~Ft ...... ..,, .......
From FI,.{o ..... FI.__ .. , ,
From , Fi, to ..... ~.. Ft,_, ,
From Fl. loFt, .
From_ ~Ft, to .... FI
From Ft. to. .-.Ft
From ,, Ft. to ..... Fi .....
From Ft. to.~F1 .....
~rom ..... 'Ft. to ........ ,FI,- ..
From--Ft, to . __Ft,._~
From ........~-.-Ft. to.~- Fl, . ~
From,,. Ft, lo~, Ft .......
Fmm ~Ft, to --Ft
From _Ft, to_ .~Ft.__
From~ , ,Ft. to ~Ft
From____FI, to _~.FI.__
MISCL, INFORMATION:
C4s,, g
From__ ,Fr
From~.~FI, to
From__,Ft, lo , ,Ft. __ ..........
From~__~Ft. to ....... F!
NORTHERN TESTING LABORATORIES INC.
3330 INDUSTRIAL AVENUE
2505 FAIRBANKS STREET
FAIRBANKS, ALASKA 99701
ANCHORAGE, ALASKA 99503
!
(907) 456-3116 · FAX 456 3125
(907) 277-8378 · FAX 274 9645
KND Engineering
20441 Ptarmagm Blvd
Eagle River AK 99577
Report Date: 08/31/94
Date Arrived: 08/24/94
Date Sampled: 08/24/94
Time Sampled: 7:00
Collected By:
Attn:
Our Lab #:
Location/Project:
Your Sample ID:
Sample Matrix:
Comments:
Lab
Number Method
A133376
Lot 90 N W Sec 9
Water
Parameter
Units
* Definitions *
B = Below Regulatory Min.
H = Above Regulatory Max.
E = Estimated Value
M = Matrix Interference
D = Lost to Dilution
MDL = Method Detection Limit
Date Date
Result * MDL Prepared Analyzed
A133376 EPA 353.3 Nitrate-N mg/1 <MDL 0.10 08/26/94
Repo---rted By: A~ony J. Lange
Chemistry Supervisor
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVSNU8 FAIRBANKS, ALASKA 99701 (907) 456 3116, FAX 456-3125
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277 8378 · FAX 274-9645
DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA
KND Engineering
20441 Ptarmigan Blvd
Eagle River, AK 99577
Public Water System I.D.#
Date Received:
Date Analyzed:
Date Reported:
Next Sample Due:
08/24/94 Time Received:
08/25/94 Time Analyzed: 15:00
08/31/94 Time Reported: 12:17
Comments:
S =
U =
POS =
ND =
Collected by: kmd TNTC =
Sample Type: CG =
Routine HSM =
Method of Analysis:
Fermentation Tube MPN
SA =
Old =
Comments: R =
NT
Satisfactory
Unsatisfactory
Positive Test Result
None Detected
Too Numerous To Count (>200 Colonies)
Confluent Growth
Heavy Sediment Masking, Results May
Not Be Reliable
Sample Age >30 Hours But <48 Hours,
Results May Not Be Reliable
Sample Age >48 Hours, Too Old For
Analysis
Resample Required
No Test
* # Colonies/100 ml
** # Colonies/mi
Sample Sample Total* Fecal* Other* HPC**
Location Date Time Lab# Coliform Coliform Bacteria Result Comments
1 Well Head 08/23/94 19:00 A85259 ND ND ND NT S
Envi~nmental Analyst
C. LIFT STATION NA
Date installed
Size in gallons
Vent (Y/N) "Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LiFT STATION TO:
Weft on lot On adjacent lots
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
Surface water
D. ABSORPTION FIELD DATA
Date installed 8- 4 - 94
Length 40 ~ Width
Total absotption area 400 SF
Date of adequacy test NA
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/Ft2) 1.2
Gravel thickness
Cleanout present (Y/N) ¥
Results (pass/fail)
5!
Systemtype Deep trench
Total depth 9 '
Depression over field (Y/N) N
for Bedrooms
After test
if yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 13 6 '
To building foundation 2 8 '
On adjacent lots + 10 0 '
Surface water + 10 0 '
On adjacent lots + 10 0 ' Property line + 5 0 '
To existing or abandoned system on lot NA
Cutbank + 10 0 ' Water main/service line + 2 5 '
Driveway, parking/vehicle storage area + 5 0 '
Curtain drain + 100 '
E. ENGINEER'S CERTIFICATION
I ce~'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect or~
Signature
Engineer's Name KND Enqineerlnq, Ken Duffus, P.E.
Date
HM Fee $
Date of Payment
Receipt Number
72-026 (3/93)' Back
Waiver Fee $
Date of Payment
Receipt Number
STATEMENT OF INSPECTION BY ENGINEER
As ~ertified by my' seal affixed hereto and as of the validation date shown below, I verity that my
investigation of this Health Authority Approval application 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 verity 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 KND ~.nsr±neer±n.~~ Ken Du£fus, P.~.. Phone 694-2359
Address 20441 P%armi(3an B]vd.. Ra(31a ~var. A]a.~ka 99,577
Engin~fs signature /~ Date ~
6. DHHS SIGNATURE
~-'"-' Approved for ~ bedroomsl '
__ Disapproved.
__ Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtssy to purchasers of homes
and their lending Institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
'raspons b e for errors or om ssions n the profess ona[~ eng neer's wOrk '? ~ ~, .: ~r ' ]~ :.~ . [
72-025(Rev, I/gl) Beck MOA#21 ,,
r,147 s
•
•_ -� . Municipality of Anchorage
On-Site Water and Wastewater Program
(907)343-7904 ,, E TY
Certificate of On-Site Systems Approval
Parcel I.D. 051-104-47 Expiration Date: 1_2`.(T_
1. GENERAL INFORMATION
Complete legal description T15N R1VV Sec. 9 Lot 90
Location (site address) 20525 Upper Bowery Ln. Chugiak, AK 99567
Current Property owner(s) Donna Newkirk Day phone
Mailing address P.O. Box 670293 Chugiak, AK 99567
Real Estate Agent Day phone
2. TYPE OF DWELLING:
0 Single Family(w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Q Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received b . ‘11117Date: /P/2//
ir
COSA to be released to the e :neer.unless otherwise requested by the engineer.
COSA Fee $ f2 to Waiver Fee $
Date of Payment q/Pa 1 t g Date of Payment
Receipt N umber 0557 6/6 Receipt Number
COSA# 65(.12 iUq 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 onsite 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.
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test.
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 745-8200
• Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R Pannone Date 9/19/2018
P111- • k_ . *r �� 4
y ¢o � sf,"*: a ! /\ .*
/
6. DSD SIGNATURE :: '�� ,•
System#1 Approved for bedrooms ••leveri�2.•Fannone •
System#2 Approved for bedrooms ��} 4 • CE-8149
!�` • .�
Disapproved e R,qi
Conditional approval for bedrooms,with the following stipulations:
-0 Q�.\ °1- l�y0
.
'Py .
----, - 014-S1TE 'h
\NATER P`NO
o WASTEWATER
pKOGRA� -
o moo•
.
••p:�FMr sER��•
:y: ,�-J�! i Original Certificate Date: 7 *^(
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 blue sheet_f '- ..
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: T15N R1VV Sec. 9 Lot 90 Parcel ID:051-104-47
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log(YIN) Y
Date completed 7/94 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y
Total depth 180 ft. Cased to 80 10 ft. Casing height(above ground) 24 in.
FROM WELL LOG AT INSPECTION
Date of test 7/94 9/7/2018
Static water level 38 ft. 54.1 ft.
Well production 0.58 g.p.m1.3
g.p.m.
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate 0.169 mg/L
Arsenic ND ug/L Date of sample: 9/10/2018 Collected by: PES
•
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel • Date installed 8/4/94
Tank size 1 000 gal. Number of Compartments 2 Cleanouts(YIN) Y
Foundation cleanout(Y/N) Y Depression over lank(Y/N) N High water alarm(YIN) N/A
Date of pumping C11051Ie) Pumper i\\GSC.C\ C,\Qc\\\-q f� rlC--/ L.L.C.
C. ABSORPTION FIELD DATA
Date installed 8/4/94 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 g.p•d/sf System type Deep Trench
Length 40 ft. Width 4 ft. Gravel below pipe 5 ft.
Total depth 9ft. Eff. absorption area 400 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 2/28/18 Results(Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 450 gale New depth 34 in.
Elapsed Time: 720 min. Final fluid depth 0 in. Absorption rate >= 450+ g p d
Any rejuvenation treatment(past 12 mo.)(Y/N & type) Non Known 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 +
11
Absorption field on lot 100 + On adjacent lots 100 +
Public sewer main 751+ Public sewer manhole/cleanout 100 +
Sewer/septic service line 251+ Holding tank 100 +
Animal containment areas 501+ Manure/animal excrete storage areas 1001+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 101+ Property line 101+ Absorption field 101+
Water main 25�+ Water service line 25'+ Surface water 1001+
Wells on adjacent lots 100 +
ABSORPTION FIELD ON LOT TO:
11
Property line 10 + Building foundation 10 + Water main 10 +
Water Service line 25 + Surface water 100'+ Driveway,parking/vehicle storage 101+
11
Curtain drain 50 + Wells on adjacent lots 100 +
F. COMMENTS
House approximately 500 gallon water bladder in crawl space.
Well is drilled in bedrock - well production may vary with shifting rocks.
.,-tee,keee
G. ENGINEER'S CERTIFICATION ��OF A4 k'1
I certify that I have determined through field inspections and ,d�''`�'• 4� •���
review of Municipal records that the above systems are in :;1,*: .• )ir '..*fP
conformance with MOA COSA guidelines in effect on this date. 0 ZV
Engineer's Printed Name Steven Pannone i •':S1veri IR...Pannone:
Air
9/19/2018 r}NI
�• CE-8149 ��
Date _
1oeaad�
, --COSA canary sheet_2-6-15.doc
Sent By: RE/MAX OF EAGLE RIVER, INC. ; 9076960214; Aug-13-02 11 :16AM; Page 2/2
\ •
•
•
•
•
• ;if!. .'......::::.-... ..
•
,�•'� . .eth
` ms. .. •
�.a.
r• ies • ,0\
`-,
•
• ...ri. ,...
•
'^':::: •• • .•-• . .
b
r a _ `r• _. ,� _ u . , / W` �P. , ..0P.--1.r�"- •• . -- . .
. 6 c - - i Y . ---o • ?x_44, ``' . ,-' +• - . ` ;. .
i a ` 3: .. a' : ' . .•...s . .S y`p .'& ASSOCIATES LE1ND SURVEYING b 94-0 8 2g
HEREBY CERTIFY.:-THAT I HAVE SURVEYED:THE' • 'E;,, ..�•
=OLLOWING DESCRIBED PROPERTY ' • 1-7A: t OF R�"
�a.�'-gas ... 'Tls .Pir4%...r:� =`. '.DAT.EI:":_:: ... .. _ R
IND THAT NO ENCIQACHMENTS..EX[SrT EXCEPT AS: ,r`h. ,•'. •K1 R. '-'-‘x—'ti
NDICATED. IT IS•..THE RESPONSIBILITY OF:THE::..' •��lz :.,<';';'.
)INER TO DETERMINE THE EXISTENCE..OF 'ANY':"`:. GRtb.........'.. "
.ASEMENTS, COVENANTS, OR:'.RESTRICTIONS•. •..•erir t • i d
'HiCH DO NOT APPEAR•ON•THE.RECORDS)& m.:-.•:. ' �• Veen- Mull` Sewt'0
'ISION PLAT. UNDER'NO CIRCUMSTANCES-.SHOULD'R 'F& • • •. t.s-sv a � :r
►NY DATA HEREON4E FOR''CONSTRUCTI.O 9J-"'—� t c,J�,r
>F' FENCE LINES, .OR FOR ESTABLISHING BOEJND•-,:. ' •DRAWN'. • . -...c),
• • 1...p.. r
MY LINES. —r.....,......."•
08/13/2002 TUE 11:00 [TX/RX NO 6226] Z002
Parcel I.D. 051.104-47
1.
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
NAA # /~-~;;2. ~) ~.~ ~)
Expiration Date: //-
GENERAL INFORMATION
Complete legal description T15N, E1W, Sec, 9, Lot 90
Location (site address or directions) 20525 Upper Bowery Lane, Chuglak, AK 99567
C~rrent Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Daniel & Sallie Ruskoskl
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER O1~ BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
Day phone 688.1247
Day phor~e
Day phone
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding lank []
[] Community On-site · []
[] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional
civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners, Certificates of Health
Authority Approval are valid for 90 days from the date of issue for properties served by a pdvate 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, I verity that my
investigation, based on procedures outlined in the Health Authority 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 verity 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 KND ENGINEERING. INC. Phone (907) 696.611t
Address 20441 Ptarmigan Blvd.. Eaqle River, AK 99577
Engineer's Printed Name Kenneth M, Duffus Date 07103102
,,,'
5. DSD SIG~
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with ~e following stipulations:
Additional Comments
Attachments:
HAA Checklist
Septic System Advisory
Well Flew Advisory
X
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
(Rev. 01,~2)
legal Descflption:
A. WEII DATA
Well type odvatq~
Date completed 711094
To~l del~ II~Q fi.
Municipality of Anchorage
Development Services Department
Building Safety DMslon
On-Site Water & Wastewater Program
4700 South Bmgaw St.
P.O. Box 106650 Anchorage, AK 99519-6650
www.ci.anchorage.ek.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Tt~N. RtW Sec. 0. L~ 90
If A, B, or C provide PWSID #
Sanltap/seal (Y/N) L
FROM WELL LOG
Date of test 711994
Static water level 33
Well production 0.08
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi.
Arsenic: NA rog JI.
Parcel ID: 051-t04-47
.0
Well Log (Y/N) Y
Wires pmpedy protected (Y/N) y
Casing height (above ground) 2'
AT INSPECTION
T/1t02
78 fl.
0.39 g.p.m.
Nl~ate (~,:27,7 mgJI.Other bacteria O colonies/100 mi.
Date of sample: 07/01/02 Collected by: KND En~tineertna
SEPTICAIOLDING TANK DATA
Tank Type/Matert~l se~c/~tsel Date installed 8/4/94
Number of Compartments 2 Cleanouts (Y/N) ~
Tank size 1000 gal.
Foundation deanout (Y/N) Y_.Depression over tank (Y/N) LHIgh water alarm (YIN) N
Date of pumping ?/11~2 Pumper JRs
ABSORPTION FIELD DATA
Date installed 8/4/94 ~oll rating (g.p.dJ~ or It~/bdrm) t.2
Length ~ lt. Width I} It. Gravel below pipe ~
Total depth L It- Eft. absorption area 4Q~ ~ Monitoring tube ~._
Date of adequacy test 7/1/02
Results (Pass/Fall) Pass
System type De~e Trench
Fluid depth in absorption field before test t?.5 In.
Elapsed Time: 1~11) min. Final fluid depth 1/In.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
Water added 450 gal. New depth 25 in.
Abeorpflon rate >= 450 g.p.d.
N If yes. give date
Depression over field N
For ~._ bedrooms
O. UFT STATION
Data installed HA
'Pump on' level at in.
Datum
E. SEPARATION DISTANCES
Property line 10'*
Water Service line
Curtain drain 50'+
F. COMMENTS.
S~e in gallons Manhole/Access (Y/N)
'Pump off level et __ in. High water alarm level at
Cycles tested Meets alarm & circuit requirements?.
On adjacent lots t00'*
On adjacent lots t00'*
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot t00'+
Pubflc sewer main
Sewer/septic service line
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line ~'+
Water main 10'+ Water service line tO'+
Wells on adjacent lets 1QQ'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
t0'+ Surface water t00'+
Wells on adjacent lots 100'+
t00'+
Absorption field 5"+
Surface water t00'*
Water main t0'+
Driveway, paddng/~mhlcle stmage
Water system consists of a 1.000 gallon storaoe bladder in crawlsuace. Per visual interior Insoecflon--bladeer aopeam Io be in
G. ENGINEER'S CERTIFICATION
I cern'fy mat / have detarm/ned through field/nspect/ons end ~ "[4~[tl ~k .:~.~.,~
rev/ew of Mun/c/pal records that the above systems are in
conformance ~ MOA HAA gulde//nes /n effecf on this date.
Engineer's Printed Name Kenneth M, Duffus
Data 07/03/02
HAA Fee $375.00
Date of Payment 07103/02
Receipt Number ~3,~(;'~
Waiver Fee $
Data of Payment
Receipt Number
Municipality of Anchorag6
Development Services Department
Building Safety Division
On-Site Water and Wastexvater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
ww~v.ci.anchorage.ak.us
(907) 343-7904
Water Well Advisory
Health Authority Approval # 020301
During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Block , Lot of T15N, R1W,
Section 9, Lot 90 subdivision, the well's productivity was determined to be
0.39 gallons per minute. The minimum well productivity required by this
Department (AMC 15.55) for a 3-bedroom residence is 0.31 gallons per
minute. Although the subject well currently exceeds this minimum
requirement, all parties concerned are advised that the production capacity of
the well may fluctuate. Restriction of non-critical water uses such as
washing cars and watering lawns and gardens may be required.
This advisory must be attached to all copies of the subject Health Authority
Approval.
FAX ~10. : ~07 688 ~247 Jul. 0~ ~ O~:O1PM
O' Oi 30' ~!
.~SEPT]C VENTS Typ.
50'DL't4PAILNI ,~rlw RESERVE
'~' N O' Ol' W 330,13
UPPER BEI~/ERY
I ANF
'~tK CT&E Envlmnmental~wlceslnc.
CT&E Ret.#
Client Hame
Project l~ame/#
Client Sample ID
~atrix
Ordered By
PWSID
Sample Remarks:
1023948001
KND Engineering
TI YN RIW Sec 9, Lt 90 Hose Bib
TISN RIW Sec 9, Lt 90 Hose Bib
Drinking Water
All Date~Tim. are Alaska Standard Time
Printed Date/rime 07/03/2002 13:45
Cnllected Daterl'ime 07/01/2002 15:00
Ia 2 51 :4°
l~icrobiolo~¥ Laboratory
Total Coliform
Results
PQL
Unfts Me,od
Allowable P~ep Analysis
Ltmi~ Dale Date
0.227 0.200 mg/L EPA 300.0 (<10) 07/01/02
col/lOOmL SMI8 9222B
Inlt
JLTF
(<1) 07/01/02 KAP
L_
200 W. Pot~er Drive
Drinking Water Analysis Report for Total Coliform Bacteria aneho..~.,aK 99518-1605
Tel; (907) 562-2343
RE~ID INSTRUCTIONS oN REvERSE SIDE BEFORE ¢OLL£CTING S.4MP£E Fax: (907) 561-5301
MUST BE COMPLETED BY WATER SUPPLIER
umcWA Er svsTm m# IIIIIII
~ PRIVATE WATER SYSTEM
$ttld l~t~ult~ D Stnd involct
~1 SendResult~
Send In~,~ict
SAMPLE DATE:
.Month
SAMPLE TYPE:
O Repeat Sample (for routine sample
with lab ref. no. )
13 Special Purpose
-g't~d ~.tltl ,~¢ q t tot 9~
Day Year
Treated Waler
Untreated Water
Time Collected
Collected By
TO BE COMPLETED BY LABORATORY
alysls ahowa this Water SAMPLE to be:
' Satisfactory . .. ·
0 Unsatisfactory
t~ Sampto over 30 houm old: results may
be unreliable .
n Sample too long in transit; sample ~hould
not be over~g~ours old at examination
to indicate reliable results. Please
. new sample via =p~cial ~clSvcn'y mail
Date Received
Analytical Method: '~l~embrane Filter
~.n MMO-MUG
· Number ofcolonie~'100 mi.
Lab Ref. No. Result* ' Aaa vat
Sent to A.D.ILC. Aoch Fbk$ Jun
Client notified of unsatisfactory results:
Ph*n:~ -. S9o~e with
BACTERIOLOGICAL WATER ANALYSIS RECORD '
E. ¢~1~ --
-- Colonies/lO0 mi
BGB COLIFIRM
Comments:
MMO-MUG R~ult: Total C~llform
Membrane Filter: Direct Count
Verification: LTB
Fecal Coliform Confirmation
Final Membrane Filter Results
Coliform/100 mt
Fazed
Foxed
f~'"~ ~ Member ot tho $05 Group I$oni~tt% C:&o&rala de Su~illnnce)
· RONMENTAL ;ACIUTIES.. IN ALASKA, .....CALIFORNIA,~. FLORIDA. iLUNOIS, MARYLANO, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA