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HomeMy WebLinkAboutT15N R1W SEC 8 LT 117T15N R1W Sec. 8 Lot 117 #051-151-12 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221114 Work Type: Septic Upgrade Tax Code Number: 05115112000 Site Legal Address: T15N R1 W SEC 8 LT 117 G:1257 Site Mailing Address: 21223 JAYHAWK DR, Chugiak Owner: EBY ERIC K & KIRSTEN E Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date �i r� n s I)epartnient 5/19/2022 5/19/2023 Lot Size in Sq Ft: 108900 Total Bedrooms: ,8' y ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (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 co 1 �x e,n c� bcoi� Are VNC G se C_Cls�> 1 S �* �--C' e -o' -b + OTfY-°O'Sl+ Received By: Date: Issued By: fes' ` �2�r'�-Q1� Date: l 01? 4 MUNICIPALITY OF I IPALIT ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-151-12 Property owner(s) ERIC EBY Day phone 907-529-4385 Mailing address 21223 JAYHAWK DRIVE *CHUGIAK, AK 99567 Site address Legal description (Sub'd., Block & Lot) T15N R1 W SECTION 8 LOT 117 Legal description (Township, Range '&-Section) Lot Size Sq. Ft. Number of Bedrooms 8-" L( APPLICATION IS FOR: (® all that apply) Absorption Field Q Septic Tank I] Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade x❑ Renewal ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) (w/wo AD U) Duplex (D) Multiple Dwellings (SF and/or D) Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. ) ZJhr n z s S (Signature of property owner or a P C -/—i agent) Permit/Rush Fees: _0595 Waiver Fees: Date of Payment: 5' —% (1 _ Z Date of Payment: Receipt Number: ()Z2P) 7G Receipt Number: Permit No. OSP Waiver No. GMevelopment Services\Building Safety\On Site Water and Wastewater\FormsUient Forms\Permit Application.doc /D0 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221114, Rebecca Carroll, 05/19/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221114, Rebecca Carroll, 05/19/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221114, Rebecca Carroll, 05/19/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221114, Rebecca Carroll, 05/19/22 MUNICIPALITY OF ANCHORAGE 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. 051-151-12 Legal description T1 5N R1 W Sec 8, lot117 Site address 21223 Jayhawk Dr Chugiak AK Current property owner(s) Eric Eby Expiration Date: 3-14-2023 The On-site system(s) is/are approved for bedrooms X Conditional approval for 4 bedrooms, with the following stipulations: Comments or advisories: Field to be extended in spring of 2023 By: Original Certificate Date:_t Z 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 UH- MWALITY OF A CH0RAG Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-151-12 Complete legal description T1 5N, R1 W, SECTION 8; LOT 117 Location (site address) 21223 JAYHAWK DRIVE *CHUGIAK, AK 99567 Current property owners) ERIC & KRISTEN EBY Day phone 907-529-4385 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: X 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: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑■ Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑ 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 $ d--90 + 019La 76 Date of Payment COSA # Waiver Fee $ Date of Payment Waiver # COSA AppUca6on_June 2022 Legal Description: T15N, R1 W, SECTION 8; LOT 117 Parcel ID: 051-151-12 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1974 M Total depth *76.0+ ft Cased to LINK. ft ❑ Sanitary seal is functioning correctly Well production at time of test 3.2 + qpm Water storage tank volume **400 gallons Well disinfected for coliform test? ❑ Yes IN No ❑ Coliform bacteria is Negative ❑ Wires are properly protected Nitrate 2.07 mg/L ❑ Nitrate less than MRL (ND) Casing height (above ground) 18+ in. Arsenic ug/L ❑ Arsenic less than MRL (ND) Date of flow test for COSA 11/18/2022 Collected by GARNESS ENGINEERING Static water level at beginning of test 73.2 ft. Date 11/18/2022 44 Comments *PER GEG FLOW TEST. **2 - 200 GALLON GREER PLASTIC STORAGE TANKS ***PUMP 561 GALLONS OVER 167 MINUTES. STORAGE TANK LEVELS UNCHANGED (50" & 49.5"). LEVEL IN CASING DROPPED 2.8 FEET B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 11/18-28/22 ❑ ALL standpipes present per record drawing Total measured depth from grade 3.8 ft (max) Measured depth to pipe invert from grade 2.8 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ 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) If yes, enter date C. LIFT STATION ❑ Required maintenance completed Age of lift station NEW years Lift station material PLASTIC Comments: Adequacy test date NEW Results ❑ Pass Fluid depth prior to test NEW in Water added NEW gal New fluid depth NEW in Elapsed time NEW min Final fluid depth NEW in Absorption rate *450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used NEW in Effective depth remaining 6 in Comments/Deficiencies: *TRENCHES WILL BE EXTENDED BY 15' EACH IN SPRING OF 2023 TO BE SIZED FOR 4 -BEDROOMS. COSA Checklist June 2022 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' 0 Yes if No Community Sewer Manhole/Cleanout > 100' QYes if No ft E Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' [E Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ■❑Yes if No ft ❑i Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' nn Yes if No ft [�] 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' 0 Yes if No ft Surface Water > 100' © Yes if No ft Tank to Property Line > 5' ❑o Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑N Yes if No ft Private Wells > 100' ❑E Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS PLEASE ISSUE CONDITIONAL COSA . NEW TRENCHES WILL BE EXTENDED IN SPRING OF 2023. TO BE SIZED FOR 4 -BEDROOMS. 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 Gamess Engineering Group, LTD. (GEG) Phone Engineer's Printed Name Jeffrey A. Garness Date _ In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not 3uarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the personiparty that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 907-337-6179 o OF.gCU 4 ,o.�F-.-•........ X40 Jef eV, r , A. 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L cu J LU 4J v- vi ma 3 oa En �' 00 vcu vi 1,' L2 2 p Baa) 0a)�a) :ti V L Q > cn�v Y CL °Xc °)Emmami i i ^ > 'S U a) �a)c Qw �Ev a v i> v a) < lD L c0 "mcn2°Oo a � c� N =COo+' Q 0) T a) O Op N C T L C O C 'V O L ` l�I Ln >- ai Ln p p v m v a) E o v 1 m m ate- a`) 4 - Ln 3 u Z C O u) p -p O C) n CL a) h Q o i ,n C) a) m a1) I- 0 .5 N m Q _J _ :3 LL io m S' �- .0 :E Q O O O O O O CL y 2 m to Co � w ° m G • �% N c N 2 N a) m tf cli Q o O �2 �; �v)o �NNCL O: 43) LU (v O 0) 0 m Off' O p Lt - v NCL E = O L 0 E - ®<W �V i) C7 CV ri v •®� � GARNESS ENGINEERING GROUP, Ltd Jr ENGINEERING -- SALES =CONSULTING December 13, 2022 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Revisions to Septic System Upgrade Design and Conditional COSA for T15N R1W Section 8 Lot 117 Attention Deb Wockenfuss: A septic permit was issued on 5/19/2022 for a 3 -bedroom house (OSP221114). A 3 -bedroom sized drainfield was installed on 11/18-28/2022. The house actually has 4 -bedrooms, so additional square footage must be added to the newly installed drainfields. Attached is a revised design drawing which shows the location of the newly installed STEP tank and drainfields; and also shows the location of the additional trench length that will be added to the drainfields in the spring of 2023. The new STEP tank is adequately sized for a 4-bedrrom residence. We have shown the approximate limits of the test hole on the revised design. The east end of the drainfields will be slightly outside the 30 -foot radius of the test hole. Approximately 90% of the drainfields are within the 30 -foot radius of the test hole excavation limits. We request the permit be revised for 4 -bedrooms. The house sale is set to close on December 15th. We request a conditional COSA be issued or the property on the condition that additional square footage be added to the newly installed drainfields in the spring of 2023. We do not anticipate any adverse effects with operating a 4 - bedroom residence on the newly installed septic for approximately a 6 -month period. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. , Sincerely, E., M. S. %4k 3/Z7_... 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com Ecklund, Timothy J From: Sonja Blewett <Sonja@garnessengineering.com> Sent: Wednesday, December 14, 2022 10:27 AM To: Ecklund, Timothy J; Wockenfuss, Deborah M. Subject: RE: 21223 Jayhawk drive Hello, following up on status of this one? Do you think this one will be issued today? Thanks Sonja From: Sonja Blewett Sent: Tuesday, December 13, 2022 1:33 PM To: 'Ecklund, Timothy J' <timothy.ecklund@anchorageak.gov>; 'Wockenfuss, Deborah M.' <deborah.wockenfuss@anchorageak.gov> Subject: FW: 21223 Jayhawk drive Hi Tim, here is email below from ARM Septic on scope of work and it being under $2,000. Thanks! Sonja From: ARM Septic Services LLC <ARMServicesAK@outlool<.com> Sent: Tuesday, December 13, 2022 1:31 PM To: Sonja Blewett <Sonia@garnessengineering.com> Subject: Re: 21223 Jayhawk drive Yes it's going to be under 2000 Sent from my iPhone On Dec 13, 2022, at 1:30 PM, Sonja Blewett <sonia@garnessengineering.com> wrote: Thank you. Just to confirm, Its under $2,000? Sonja From: ARM Septic Services, LLC <armservicesak@outlook.com> Sent: Tuesday, December 13, 2022 1:29 PM To: Sonja Blewett <Sonia@garnessengineering.com> Subject: 21223 Jayhawk drive To whom it may concern: ARM Septic Services, LLC is returning in the spring/early summer(2023) to 21223 Jayhawk drive to extend the leech fields 15 linear feet per field, per the engineers direction, to meet the requirements of a 4 bedroom septic system. 1 Scale 1" = 50' a C 2 Legend: Frontier Surveys, LLC Project No: 22-187 Ordered By: ARM Septic Services LOT 92-8 — _ N890 59.17wW 329.82 Lo `l AN M i I• I N �\ CCVV r 130.3 716.5 � 6 I 1 �p� \ � M 2 CAR\A CD ay . GARAGE 1 I i X53 \ I � W 'z Lu k mol timl a ! Fj M I q I —J------------ 50' R-O_W. RESERVE _. $ BK. 230 PG. 40 c CC] Culvert n LE, Elec. Pedestal 14) Septic EDGE OF PAVEMENT N89° 59'27"W 329.99 I Sign ® Wood Deck —x-- Fence Tel. Pedestal Telephone Pole --Overhead Utility l;;I Septic Clean Out `y) Water Well is Sign Date: 04/11/2022 Plat: 83-503 1 Grid: 1257 166.7 123.3 104.2 Lot 117 Sec 8 T15N R9 W Seward Meridian 108,900 Sq. Ft. +/- 21223 Jayhawk Drive 2 Story Woad Frame House with 2 Detached Garages ri JAYHA WK DRIVE NOTE: BEARINGS & DISTANCES FROM BLM SURVEY APPROVED MA Y 31, 1917 DO NOT MATHEMATICALLY CLOSE BEARINGS & DISTANCE SHOWN ON THIS PLAT WERE DERIVED FROM PLAT # 83-503. General Notes: 1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws. a 25 50 100 2- Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey - 3. All meas urementslsetbacks are to the vi sualla pparent building footprint- Scale In Feet 4. All dimensions to property lines are pluslminus 0-1ft- .1001- *r::49-TH ... ... �'. Pierre M . Sir ler. `j • . No. L.S: - 9812 . • i ■� ��QF� • . 04111/202Z. • •��� O�fs5 bPi AV PROFESSIONAL SEAL This survey complies with the ASPLS Mortgage Loration Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may reveal- It is the responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for construction or for establishing a beundary or fence fine. As -Built Survey of: Lot 117, Sec 8, T15N, R1W, Seward Meridian I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or under my direct supervision on April 8th, 2022. Frontier Surveys, LLC I FRONTIER 650 W. 58th Ave. Suite E Anchorage, Alaska 99518 Lft SiLwveys- 907.460.1686 - info@frontiersurveys.com www.frontiersurveys.com GRE '"'ER ANCHORAGE! AREA BOr'"'UGH Department of Environmental (;~uality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORI' ON-SITE JEWAGF ,DISPOSA!. SYSTEM SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER INSIDE WIDTH__ X NUMBER OF MAT E R iA L&~4CI~I'6 ~l ,,,~.~_ CO M pA RT M ENTS I -- LIQUID DEPTH__ _LIQUID CAPACITY /0~)(~ GALLONS, SEEPAGE PIT: ~b~o '70' ~ ~¥{o ~A'~-"~ O~:'~, NUMBER OF PITS ]--. DIAMETER --~.¢~! OR WIDTH !~'~,, LENGTH~-, DEPTH LINING MATERIAL ~.bY¢xg-e.~ CRIB SIZE: DIAMETER.~' DEPTH _ DISTANCE FROM: BUILDING FOUNDATION NEAREST LOT LINE .. ADDITIONAL ABSORPTION WELL J2 ' _. TOTAL. EFFECTIVE ABSORPTION AREA (WALL. AREA) ~"~ _S(~. FT, WELL.: ~'-~) BUILDING NEAREST NEAREST FOUNDATION ~ LOT LINE SEWER LINE CESSPOOl OTHER SGURCES ~ APPROVED _ DISAPPROVED REMARKS~ DEPTH_ SEPTIC -rANK DISTANCE FROM: SEEPAGE / SYSTEM 17-'(~ DISTANCES:. INSTA LED BY:. PIPE MATERIAL:- REMARKS: Form No. EQ~031 DIAGRAM OF SYSTEM GRI=_.,'ATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "O"STREET ANCHORAGE, ALASKA 99503 TELEPHONE 27.1-4561 SEWAGE DISPOSAl. SYSTEM -- APPLICATION AND PERMIT PERMIT NO.. INSTALLATION LOCATION IN STALLAT[ON OF: SEPTIC TANK // S BEPAGE PIT ~// , DRAIN FIELD. FINANCED THROUGH TO BE ]NSTALLEO BY t-.~ /~ ' COMPLEflON DATE ANTICIPATED ,, OTHER. NOTE~ THIS PERMIT 15 NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. FOUNDATION TO SEEPAGE Pit ~ / , DRAIN FIELD SEPTIC 'rank TO SEEPAGE PIT WALL /~-~ / SEPTIC TANK SEEPAGE PIT ~'~ / . _ , DRAIN Field WeLITO SEPTIC Tank ~~ '/ , SeePAge PIT_ /~ SEEPAGE ALSO CONSIDER AREA WELLS. AREA SIZE WATER MAIN TO SEPTIC TANK SEEPAGE PIT BACKFILL TYPE I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, 28-68 AND TNAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE, ~./~[, ~ ~ • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval l e,, T5, S v� Parcel 1. D. 051- (5- 12, Expiration Date: -7-11-14 1. GENERAL INFORMATION Complete legal description Lot 117, Section 8, T1 5N, R1 W, S.M. Location (site address) 21223 Jayhawk Drive, Chugiak, Alaska 99567 Current Property owner(s) Bruce & Theresa Bartley Day phone (907) 688-3657 Mailing address 21223 Jayhawk Drive, Chugiak, Alaska 99567 Real Estate Agent Ed Erickson @ Keller Williams Day phone (907) 227-5275 2. TYPE OF DWELLING: Fx] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) WaiverNariance request Received by: :! - ' - -- Date: COSA to be released to L 4ginear, unle s=otherwise requested by the engineer. COSA Fee $_ Date of Payment Receipt Number COSA# Waiver Fee $ Date of Payment Receipt Number Waiver # 3 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request Received by: :! - ' - -- Date: COSA to be released to L 4ginear, unle s=otherwise requested by the engineer. COSA Fee $_ Date of Payment Receipt Number COSA# 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 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 Pinard Engineering Phone (907) 357-3647 Address PO Box 871347, Wasilla, Alaska 99687 Engineer's Printed Name Paul E. Pinard, P.E. 6. DSDSIG ATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Date 4/10/14 bedrooms, with the following stipulations: By: Original Certificate Date:_) — The M icip ofnc� a 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 S - � 0 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: Lot 117, Section 8, T1 5N, R1 W, S. M. A. WELL DATA Well type Pvt If A, B, or C provide PWSID # Date completed 1974 ? Sanitary seal (Y/N) Y Total depth 150 ft. Cased to ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 0.918 mg/L Arsenic ND ug/L Date of sample: 2/21/13 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Conrete Block Tank size 1000 gal. Number of Compartments Parcel Well Log (YIN) N Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 2/23 & 2/24/13 58.2 ft. g.p.m. 0.33 Collected by: Pinard Engineering Date installed August 1974 Cleanouts(Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 5/3/13 Pumper JRs Pumping C. ABSORPTION FIELD DATA Date installed 8/74 Soil ratio Pit & Drain Line g (g.p.d.lftz or ftZ/bdrm) System type Length Pit - 15 ft Width Pit -12 ft. Gravel below pipe 4 ft. Total depth 7.3 ft. Eff. absorption area 300 fh Monitoring tube Y Depression over field N Date of adequacy test 2/23-24/13 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 25 in. Water added 470 gal. New depth 26 in. Elapsed Time: 1410 min. Final fluid depth 26 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Known If yes, give date D. LIFT STATION Date installed NA "Pump on" level at Datum Size in gallons _ "Pump off' level at Cycles tested _ E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 1001+ Public sewer main NA Sewer /septic service line 25' + Animal containment areas 50' + Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100' + On adjacent lots 100' + Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas 100' + SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ 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 Known Wells on adjacent lots 100' + Absorption field 5' + Surface water 100' + Water main 10'+ Driveway, parking/vehicle storage 10' + F. COMMENTS Since ST was homebuilt, MOA staff requested a leakage test. One was conduced while the in. owner was out of town. There was no drop in the liquid level in 18.5 hours. G. ENGINEER'S CERTIFICATION L" ! certify that / have determined through field inspections and 2 ' 4 review of Municipal records that the above systems are in @ a 3 conformance with MOA COSA guidelines in effect on this date. X r . — tia�ot0400e eae 6ypp„r d Pi l E. Pinard, Engineer's Printed Name Pau , P.E. v�' �'�u I A O 0 Date 5/30/13 �•J. ^.. ems. ra��”-O GJetJ �P�u�: . COSA brown sheet 10-10-12.doc Municipality of Anchorage R r Development Services Department Building Safety Division s On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 132132 During a recent COSA on-site inspection and test of the potable water supply well on Block , Lot 117 of T15N R1W Section 8 subdivision, the well's productivity was determined to be 0.33 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 Certificate of On - Site Systems Approval. LOCATION: Lot 117, Section 8, T15N, R1W, S.M. DRILLER: M & W Drilling DATE WELL COMPLETED: Circa 1974 WELL DEPTH: 150' STATIC WATER LEVEL (top of casing): 9.2' PINARD ENGINEERING P.O. Box 871347 Wasilla, AK 99687 (907) 357-ENGR (3647) WELL FLOW TEST JOB NUMBER: 13-033 DATE OF TEST: 2123 - 24113 FIELD STAFF: PJ Pinard 1�1 Time Elapsed Time (Minutes) Static Water Level Flow Rate m Cumulative Gallons Pumped Remarks 4:35 PM - 58.2' 4.0 - Start Test - Meter 560620 4:50 15 84.9' 4.0 60 560680 5:05 30 102.3' 4.0 120 560740 5:20 45 118.0' 3.3 180 560800 5:35 60 138.1' 2.7 230 560850 5:50 75 138.2' - 270 Stop Flow - 560890 2/24/13 3:05 15 62.0' 3.3 - Resume Flow - 560900 3:20 30 85.9' 3.3 320 560950 3:35 45 100.4' 3.3 370 561000 3:50 60 117.3' 3.3 420 561050 4:05 75 130.5' - 470 Stop Test - 561100 EEJ I-1— RECOVERY 5:15 70 111.5' All well protection features are adequate. Average Flow Rate: 0.33 gpm Comments: DURING THIS TEST, THIS WATER SUPPLY WELL WAS CAPABLE OF h... �? PRODUCING 4.0 GPM FOR LIMITED PERIODS. THIS TEST DOES NOT Reviewed by: Paul Pinard'�rl NOT CONSTITUTE A WARRANTY OR GUARANTEE THAT THE WATER SUPPLY SYSTEM WILL CONTINUE TO FUNCTION AND PRODUCE AT THIS RATE. Date: 2128113 PINARD ENGINEERING P.O. Box 871347 C Wasilla, AK 99687 (907) 357-ENGR (3647) ADEQUACY TEST LOCATION: Lot 117, Section 8, T15N, R1W, S.M. APPLICANT: Bruce & Theresa Bartley 21223 Jayhawk Drive Chugiak, Alaska 99567 SEPTIC TANK TYPE/SIZE: Homemade (concrete & steel)/1000 Gallons, per MOA Records ABSORPTION SYSTEM: Seepage Pit & Shallow Drain Line, per MOA Records DAILY FLOW: 3 BEDROOMS x 150 GAL/BR = 450 Gallons TEST DATA JOB NUMBER: 13-033 DATE OF TEST: 2/23 - 24/13 FIELD STAFF: PJ Pinard NUMBER OF BEDROOMS: 3 SCUM: 0.0' SLUDGE: Minimal NEEDS TO BE PUMPED: Yes No XX CURRENTLY IN USE: Yes XX No Time Flow Rate Volume Cumulative Volume Septic Tank Septic Tank Soil Absorption System Comments pM (GPM) (GALS) (GALS) Liquid Level A Level Monitor Tube 1 * A SAS Level Monitor Tube 2* A SAS Level 4:35 4.0 - - 5.2' - 2.1' - Start Flow -Meter 560620 4:50 4.0 60 60 5.3' 0.1' 2.2' 0.1' 560680 5:05 4.0 60 120 5.3' 0.0' 2.2' 0.0' 560740 5:20 3.0 60 180 5.3' 0.0' 2.2' 0.0' 560800 5:50 - 90 270 5.3' 0.0' 2.2' 0.0' Stop Flow 560890 2/24 3:05 3.3 - 270 5.2' - 2.1' - Resume Flow - 560900 3:35 3.3 100 370 5.3' 0.1' 2.2' 0.1' 561000 4:05 - 100 470 5.3' 0.0' 2.2' 0.0' Stop Test- 561100 RECOVERY Date *ALL MEASUREMENTS IN FT. TEST: PASSED XXX FAILED COMMENTS: This system was found to be operating satisfactorily. There was 2.1' of measurable liquid in the SAS MT prior to beginning the test. With the addition of470 gallons to the system (the design daily flow), the level rose only 0.1, leaving almost half of the ED of the SAS still available. A recovery measurement showed satisfactory absorption. Reviewed by: Paul Pinard Date: 2128113