HomeMy WebLinkAboutTUXEDNI PARK BLK 2 LT 5Onsite File
Tuxedni Park
Block 2
Lot 5
#041-022-22
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191227 PID Number: 041-022-22
Dwelling: F91 Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑t Upgrade
Name:
Donald & Elizabeth Carter
ABSORPTION FIELD
❑ Deep Trench 9 Shallow Trench ❑ Bed ❑ Mound
Address
6700 Haida Circle Anchorage, AK 99507
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
345-4371
4
1.2 GPD/SF
2.4/3.3 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
1.9/2.8 Ft.
Gravel depth beneath pipe
0.5/0.5 Ft.
Subdivision Block Lot
Tuxedni Park 2 5
Fill added above original grade
2.1 / 1.3 Ft.
Gravel length
2 @ 50 Ft.
Township Range Section
Gravel width
5.0/5-0 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
500 Ft z
2
>6 Ft.
Well
>100'
>100'
N/A
N/A
>25'
TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Greer
Capacity
11,250 Gal.
Surface Water
>100'
>100'
N/A
N/A
Material
Number of compartments
Lot Line
>5'
>10'
N/A
N/A
Plastic
2
NA
Foundation
>10'
>10'
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
None
Noted
Gal.
Remarks Tank Serial # 1719
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Tank is insulated.
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL House to tank D3034 Tank
drainfield D3034
Installer
Denali Excavating
Drainfield D3034 CO/MT 3034
Inspector J. Millette
BENCH MARK (Assumed elevation) 100 ft
Inspeection 15' 7/10/19 7/10/19
Location and description
2nd
3`° 4th
Bottom of siding
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
OF
"""
���� q�.q
Conditional Approval: Date
a®� °yc°°°'+•"`
•t...
,• e
X . 49 th = 9�
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"�esununu��es�............ aoame
® MICHAEL E. ANDERSON
r�,Uvdp
�c
� % •. No. CE-4381 _ AV
% �o..�. 10/14/19 ,�+•°���Air
4�e®�s'Ft1 .................
Approved Date c2 �y �D��
n� _4e
16
inspecuon Keporr_ai i-iz.aoc
7657607557457
6
0
755
EXISTING WELL PROTECTED
BY 3" STEAL BALLARDS
100500
FEET
1"=50'
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
PERMIT # OSP191227 PID # 041-022-22
TUXEDNI PARK, BLOCK 2 LOT 5
A B
2CO1 10.8
MH 23.4
SV 27.9
A
B
C
C
25.0
MT1 26.5
2CO2 30.2
CO1 48.5
MT2 50.2
54.9
54.7
52.3
55.1
53.5
54.4ATELIER DRIVE8/13/19
HAID
A
CI
R
CL
E
10' UTILITY
EASEMENTS4-BDRM HOME2-50' LONG x 5' WIDE
x 0.5' EFFECTIVE
DEPTH ABSORPTION
TRENCHES
NEW 1,250 GALLON
SEPTIC TANK w/20"
MANWAY.
CO2
CO1
CO4
CO3 2CO2
2CO1
MH
SV
THA
ALTERNATE SITE:
CATEGORY III SYSTEM w/
20' LONG x 5' WIDE x NO
EFF. DEPTH ABSORPTION
TRENCH. APP. RATE 6
GPD/SF.
PLAN AS-BUILT
MT5
MT3
MT4
FSMT2
MT1
MT3 93.4
CO2 92.9
CO3 55.1
MT4 53.7
MT5 94.4
CO4 95.7
100.6
101.0
48.2
48.8
97.0
97.7
100' WELL RADIUS
PROFILE AS-BUILT
(NO SCALE)
92.4
87.4
93.3
97.1
93.3 FINISH GRADE
50'
DRAINFIELD ROCKMTMH SV2CO1250 GAL PLASTIC
SEPTIC TANK
TH-AGROUNDWATER @ 83.7 5/28/19
88.8
89.3 COCO79.2
88.8
89.3
92.25
91.2 ORIGINAL GRADE
PERMIT # OSP191227 PID # 041-022-22
TUXEDNI PARK B2 L5
10/14/19MTEAST TRENCHFCO
93.3 FINISH GRADE
50'
DRAINFIELD ROCKMT
88.7
89.2 COCO88.7
89.2
92.0 ORIGINAL GRADE MTWEST TRENCH
TH-A2" INSULATION
GROUNDWATER @ 84.5 5/28/19
80.0 MT
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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: OSP191227
Work Type: Septic Upgrade
Tax "Code Number: 04102222000
Site Legal Address: -Fc�IXe�v�' Park £31k 2- Lf 5
Site Mailing Address:
Owner: CARTER DONALD L 50% &
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms
�n,tnt
c�
t.)4llil rtill ant
6/24/2019'
6/23/2020.
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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.
Special Provisions: Prior to Inspection Report approval, the well casing is to be protected.
3
Received By: Dater
Issued By: Date: 24 114
_
E CO) 09Ads
MUNICIPALITY OF ANCHORAGE
Community Development Department = Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 041-022-22
Property owner(s) Donald & Elizabeth Carter
Mailing address 6700 Haida Circle Anchorage, AK 99507
Site address Same
Day phone 3Y.L 1-13 7l
Legal description (Sub'd., Block & Lot) Tuxedni Park, Block 2, Lot 5
Legal description (Township, Range & Section)
Lot Size 86789 Sq. Ft. Number of Bedrooms )
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑X
Initial ❑
Single Family (SF) ❑X
Septic Tank
❑X
Upgrade ❑x
(w/wo ADU)
Holding Tank
❑
Renewal ElDuplex
(D) El
Privy
❑
Multiple Dwellings ❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION
INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 5 -l5 -
Waiver Fees:
Date of Payment: to//Q 1Q Date of Payment:
Receipt Number: �1 07X� lb Receipt Number:
Permit No. r J5pl q Waiver No.
Permit App_.;- : ....,c
June 18, 2019
MOA Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Tuxedni Park, Block 2, Lot 5 – 6700 Haida Street
Septic System Design
Dear On-Site Services Engineer:
The existing septic system on the subject lot has failed and a new system must be placed to serve
the four-bedroom home. The existing septic tank will be decommissioned in accordance with
Municipal Code. We are submitting this permit application to construct the new septic system.
The attached site plan identifies the location of the home and the existing well and septic systems
along with the proposed septic location. No conflicts exist between this proposed system and any
other well or septic system on this lot or adjacent lots.
The ground surface on the lot is virtually flat in the area of the proposed absorption system.
There are no slopes greater than 25% within 50 feet downslope of the primary site. Topographic
contours are shown on the site plan indicating the grade and direction of flow. Stormwater
drainage will not impact this septic system. The new trenches will be constructed parallel to the
slope as much as possible.
Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all
wells and surface water, and more than 5’ away from the septic tank.
Please refer to the attached test hole log, and plan and profile sheets for the septic design. If this
design is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Michael E. Anderson, PE
6-18-19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191227, Deb Wockenfuss, 06/24/19
7657607557457
6
0
755
EXISTING WELL
10050 0
FEET
1"=50'
EXISTING
1,250
GALLON
SEPTIC
TANK. DISPOSE
PER
MOA
CODE.
NOTE:
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE
PROPOSED SEPTIC SYSTEM
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC
SYSTEMS.
CO
-
CLEANOUT
2CO
-
DOUBLE
CLEANOUT
FCO
-
FOUNDATION
CLEANOUT
FS
-
FLOW
SPLITTER
VALVE
MH
-
MANHOLE
MT
-
MONITORING
TUBE
SV
-
SEPTIC
VENT
TH
-
TEST
HOLE
LEGEND
MT
TUXEDNI PARK, BLOCK 2 LOT B
ATELIER DRIVE6/21/19
HAID
A
CIR
C
L
E
10'
UTILITY
EASEMENTS4-BDRM HOMEEXISTING
ABSORPTION
TRENCH. REMOVE
ABOVE
GROUND
PIPE
AND
ABANDON
IN
PLACE.
2-50' LONG x 5' WIDE x .5'
EFFECTIVE DEPTH ABSORPTION
TRENCHES - 6' APART.
1,250 GALLON SEPTIC
TANK w/20" MANWAY.
MT
CO
CO
CO
CO
FS
2CO
2CO
MHSV
NOTE:
MINIMUM 6' SEPARATION FROM
OLD ABSORPTION TRENCH TO
NEW ABSORPTION TRENCHES.THAALTERNATE SITE: CATEGORY III
SYSTEM w/20' LONG x 5' WIDE x NO
EFF. DEPTH ABSORPTION TRENCH.
APP. RATE 6 GPD/SF.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191227, Deb Wockenfuss, 06/24/19
TUXEDNI, BLOCK 2, LOT 5
DESIGN FACTORS: SYSTEM REQUIREMENTS:
600 GPD PEAK FLOW
PERK RATE: <1 MIN/IN
APPLICATION RATE: 1.2 GPD/SF
5' WIDE ABSORPTION TRENCH SYSTEM
1,250-GAL SEPTIC TANK
TYPICAL TRENCH SECTION
(NO SCALE)
4" PERFORATED PVC (HOLES DOWN)
DRAINFIELD ROCK
5'
1'
2'
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
BOTTOM OF TRENCH: 3' BELOW GRADE
FLOW LINE ELEVATION: 2.5 BELOW GRADE
TOP OF TRENCH: 1' ABOVE GRADE
600 GPD / 1.2 GPD/SF /5' WIDE * 1.0 RED. FACTOR = 100 LF TRENCH REQUIRED (100 LF SPECIFIED)
6/18/19
6"
6"
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191227, Deb Wockenfuss, 06/24/19
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE:
PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
TECHNICIAN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DEPTH
(feet)
PROJECT No.:
TEST HOLE A
SLOPE
SLOPE
SITE PLAN
See Site Plan
DATE READING GROSS TIME
(minutes)
NET TIME
(minutes)
DEPTH to
WATER NET DROP
TEST HOLE PRESOAKED PRIOR TO TESTING:
PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH)
TEST RUN BETWEEN: FT. and FT.
COMMENTS:
(inches)(inches)
TUXEDNI PARK B2 LB
5/21/19
J. Millette
DATE OF MONITORING:
WAS GROUND WATER ENCOUNTERED?
DEPTH OF WATER AFTER MONITORING:
IF YES @ WHAT DEPTH?
YES
9'
7.5'
0.03 6
5 6
041-022-22
DONALD CARTER
5/30
1
2
3
4
5
6
<0:01 6" / 12" 6"10:31
1' OB
FINE SAND, COARSER WITH DEPTH
5/30/19
Professional Engineers Stamp:
6/18/19
<0:01 6" / 12" 6"10:30
<0:01 6" / 12" 6"10:33
<0:01 6" / 12" 6"10:34
<0:10 6" / 12" 6"10:35
<0:01 6" / 12" 6"10:36
BOH
SP
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191227, Deb Wockenfuss, 06/24/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191227, Deb Wockenfuss, 06/24/19
D
M
r
rs■iSIR 0amMFAV»Lwdi KIM i.-1
Lot 1
Lot 4
TILITY EASEMENTS
PLOT PLAN AS BUILT X SCALE 1" = 40' GRID _ SW 2042 Project No. 19-243 R1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049~
Lang & Associates, inc. (907) 522-6476 Phone 000�OpoO
Professional Land Surveyors kenOors keno 5lan92-46survey5 Faxcom F ..A
� .
jonathanOlangsurvey.com SOP s QO
I hereby certify that I have surveyed the following described property:
LOT 5, BLOCK 2, TUXEDNI PARK SUBDIVISION (PLAT No. 67-103)
Anchorage Recording District, Alaska, and that the improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
Dated this the Day of at Anchorage, Alaska
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
49TH
?� KENNETH G. LANG o
�4p,Fo ..Ls -5202.• ' CJ
O
,o Ngo
�Q���FfSSIONAL �o
AECC963
MUNICIPALITY OF ANCHORAGE (' ~
" DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILING ADDRESS
LOCATION NO. OF BEDROOM~
DISTANCE TO: I Wel~/~l'j/''' Absorption area/~ · D~lling~l ~/~[~ PERMIT NO. ~ ~
Manufacturer Materi~/ No. of compartments ~
Li~ ~?~&gallons IF HOME.DE: Inside lengt~ _
DISTANCE TO: ~Well Dwe ng PERMIT NO,
Manufacturer Material Liquid capacity in gallons
Length of e~ch line ~ ~ inches
N°'°fline' ~grade ~O' ~ Trench width
Total effecti~ absorption are~ ~
Length W~dth Depth PERMIT NO.
Type of crib Crib diameter Crib depth Total eff~ti~ absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
Cla~ ~ ~ Depth Driller Distance to lot line PERMIT NO.
Absorpt on area(s)
DISTANCE TO: Building foundation Sewer line Septic tank
OTHER
PIPE MATERIALS
SOIL TEST RATING -/ O ,/,/,/,/,/,/,/,/,/~~
REMAR.s'NSTAL'ERg / .-- tO
DATE LEGAL
N
]"11_11'-.I T L- T F'RL T T'7' ~-~F RI'-,IL-H CIF:R,-~E
/ ,_.,, DEPRRTHENT/'~, HERLTH RND ENVIRONr'IENTRL/'r~.C~TECT, ION
, 'o , .o~ · STREET, RNCHORRGE., RK.
./ .. .~ · 264-4720
PERM'IT NO. ,. 82A486 ) - -- -- "-r'~)~-v
· RF'F'LICRNT CRHDY CAF:Al,lAY ' SRA BOX I~,jF 9:~;,0--'
LEGRL L5 B2 TUXE[:,NI PRRK LOT _,I/L~222~2 SQLIRRE FEET
TYPE OF ""~
=,LIL RE:SORPTION SYSTEH tS: DRRINFIELD
MRXIHUH.,NUHE:ER OF BEDROEmhlS = 3. .. SOIL RRTING (SQ FT/BR)= 125
THE R~QUIF:ED SIZE OF THE 'SOIL RESORPTION SYSTEH IS: -
THE LENGTH DIHENSIoN IS THE LENGTH (IN FEET) OF THE TREHCH OR DRRINFIELD.
,THE DEPTH OF R TRENCH OR PIT IS THE [:,ISTRNCE BETHEEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
THE. , TF:F,I'-4CH !.4 I DTH T S 5. 8~'Z_'~C'ZI FEET.
· THE GRRVEL DEPTH IS THE'HINIMUM DEPTH OF. GRR'¢EL BETHEEN THE 'OUTFRLL PIPE
RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
PERHIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORf'I THIS DEF'~RTr,IENT DURING THE
INSTRLLRTIOH INSPECTIONS OF RNY HELLS RD.TRCENT TO THIS PROPERTY RND THE
NUMBER OF RESIDENCES THRT THE HELL HILL SERVE.
TI...I~-, ,; 2 --', T I'-,ISF'ECT T ~--~t-.l'_--~ RF:E · F:E~_--!LI 'r RE[:,
BH~KFILLING OF RN'.r' S'.r'STEN HITHOUT FINRL INSPECTION RNr> RPPROVRL BY THIS
DEF'RRTMENT HILL BE SUBJECT TO PROSECUTION.
HINIHUH DISTRNCE 'BETHEEN R HELL RND RNY ON-SITE SEI4RGE DiSPOSRL SYSTEM IS
'100 FEET FOR R PRIVRTE HELL OR 150 TO 2~36~ FEET FROM R PUBLIC HELL DEPENDING-
L?ON THE TYPE OF PUBLIC HELL.
HINIMUM DISTRNCE FROM R PRIVRCE HELL TO A PRIVRTE SEHER LINE I~ 25 FEET RND
TO ~ COHHUHITY ~EHER LINE IS 7~ FEET.
HELL LOGS RRE REQUIRED RND' MUST BE RETLIRNED TO THE DEPRRTHENT HITHIN 38.'DRYS
OF THE HELL COMPLETION.
OTHER REQUIREMENTS HRY RF'PLY. ]SPECIFICRTIONS RND CONSTRUCTION DIR~RRf,1S RRE
RVRILRE:LE TO IN~URE FROF'ER INSTRLLRTIOIT.
F'EF:I'.ll T .F:-~F- I RES B. ECEblE:EF: 2;2. 2982
I CERTIFY THRT '"." ';"
· : ~ Rf,1FRf,IILIRR HITH THE REQUIREHENTS FOR 'ON-SITE SEHERS RND HELLS ~S,~bT'_.
· FORTH BY THE r'IUNICIPRLITY OF'RNCHORRGE. '
2: I NILL INSTRLL THE S'¢STEH IN RCCORE:,RNCE I4ITH THE CODES.
3: I UNDERSTRND'THRT THE'ON-SITE SEHER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO IN,CLUDE MORE THRN 3: BEDROOMS.
V4. 0
! ~.rtF~' mai .:..'ii
m F~qTH S'/ 'r~ I,~J/Ii~JtFu~[P/ J~ ,~k]~ .... 7-? .';
'- ~. [ HEM. ~ r~_ ~'~ tN 7~:~:~'~p:~ t4[~ ~ ~. . .'.,:'..~ .
· ~;.~,~i~ ~,~ ~o ~o/~,~..,.~ ,.,~ ~: ~o,~,~. .~.:~.,',~
· -~,,~,-~:~~:4 ~~ ......... , ...... '
· . "... ~~,.~m__~'~o~' o~,~w~ : . . ~::?:.~.:
.. ' . - ., ~...:' ~ ~..-/ ~ ~. ·
'. · ~" ', ' ~- ' '~ t "' Zl ' /,~ - :"::,-
' ' '' " ,.~ ~ /. 'I
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRON~AU'PROTECTION
825 L. Strut, Anchorage, Alaska 99501 2~720,
~,,,~,
SOILS LOG - PEROOLATION TEST
SOILS LOG
PERCOLATION
TEST
RECEIVED
DATE PERFORMED:
LEGAL DESCRIPTION: I ~T
SLOPE
SITE PLAN
12-
13-
,2,oc ~
WAS GROUND WATER
ENCOUNTERED?
IF YES. AT WHAT
DEPTH?
Sa.///
Reading Date Gross Net Depth to Net
Time Time Water Drop
l~oTTo ~ OF
20-
COMMENTS
PERFORMED BY:
PERCOLATION RATE I~.~ C M~elU/~L,} {minutes/inch)
TEST RUN__BETWEEN FT AND F~ ~
~. ~i,...~.....~ ~ERT, F,ED.~: 'r:, ~ DATE: ~'/,,,/,,..
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG- PERCOLATION TEST
~ SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
DATEPERFORMED:
SLOPE
SITE PLAN
%
.,, COMM ENTail
[:PERFOaU"D
. .Date ~ 'Gr~s~ ;, Net Depth to
,~. ,'_ . .. ....
..3
Drop
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL R£SOURES
Division of GeologiccI a Geophysical Surveys
LOCATION OF WELL (Please complete either I0, lb or lc.)
Tuxedni 5 !-u'-uf-u'-I
I'~.IOISTANcE ANO DIRECTION FROM ROAO INTERSECTIONS
Drilling Permit No.
A.D.L. No.
$ection
Nu.I TownlhIpS[-~N~'-] Range w~jED Meridian
$. OWNER OF WELL: Joe Castaway
Addrlll:
Street Address end Area of Wall Locution
2. WELL LOG Feet Below
Surface
Muterial Type Top Bottom
sandy silty gravel O 25
b~ova% silty till w/gravel 25 50
heavy silty sand w/gravel dirty 50 65
~enses silty hard till w/water 65 80
sandy gravel H20 80 87
tAUNICIFALli¥ L,r , ,~OhCRACE
p---r t~': I J," ' "7, '-I r,
ENVlg .i ¢_3..A. ~ ,O [. D:,I
JUL 2 '[ 19hZ
RbCEIVED
16. WATER WELL CONTRACTOR'S CERTIFICATION'.
I
4. WELL DEPTH: (finul) J 5. DATE OF COMPLETION
87 '" '1 6 - 30 -
6. ~Cable fool ~Rotory []Drlvun []Dug
I-IA.g.r [] J.,t.d !-I 80,.d [] O,h.r:
7.USZ: [~a Oome,tlc [] Public Supply ["] Induetry
Fl Irrigation 1"1 Rechorgo [] Commerlcal
[] Tilt Well [] Other:
diam. ~ in. to__ ft. Dopth Weight__
Ibe./ft.
ft.
diam. In. to.__ ft. Depth Stlckup
9. FINISH OF WELL:
Type: Diameter:
Slot/Me Ih Silt: Length:
Set between ft. and
Bock filling Grovel pock
I0. STATIC WATER LEVEL: ft.
fl.
/ /
Duse
[] Above or [] Below land lurface
Equipment used:
II.PUMPING LEVEL below land surface and YIELD
ft. utter ~hrl. pumplng__g.p.m.
--fl' ofler hre. pumping g.p.m.
12.GROUTING Well aroused: [] Yea [] No
Malarial: [] NOD! Cement [] Other:
IS. PUMP: (If available) HP
Lungfh u! Drop Pipe fl. cupoclly g.p.m.
E) Subm. I--I "' [] C,n,,,co, [] O,h.,
14..EMA.~8** ~0 ~m
~O[~ dep[h o~ c~si:g 8~~
s~cl level ~0~
15. Wetlr Temperature o ~ F . ~ C
This well was drilled under my Jurisdiction and this report Is true lathe beet of my knowledge and belief;
Vern's Drilling &Ent. ~ ~
Add,.,.: SRA Box 1560 Anchorage, Alaska 99507
Form OZ'WWR (11/81) Copy Distribution: WHITE-State DGGS~ PiNK-Driller. CANARY'Customer
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section - Fax: 907-343-7997
Parcel I.D. 041-022-22
Certificate of On -Site Systems Approval
Expiration Date: -VIf oC v
1. GENERAL INFORMATION
Complete legal description TUXedni.Park, Block 2, Lot 5
Location (site address) 6700 Haida Circle Anchorage, AK 99507
Current property owner(s) Donald & Elizabeth Carter Day phone 345-4371
Mailing address 6700 Haida Circle Anchorage, AK 99507
Real estate agent June Constantine Day phone 727-5863
2. TYPE OF DWELLING:
[E] Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family
and/or
Duplex)
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
E
Private Septic
0
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for:
Distance:
Received by:
Date:
COSA to be released to the engineer, unless otherwise requested by the
engineer. i
COSA Fee
Waiver Fee $
Date of Payment /Zzg o2 fJ
Date of Payment
Receipt Number
Receipt Number
COSA #
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. I acknowledge that On -Site staff may visit the site:to verify the information submitted.
Name of Firm Forge Engineering Phone 907-522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SIGNATURE ' J
JSystem #1 Approved for —( bedrooms
System #2 Approved for bedrooms
Disapproved
Date 1/28/2020
Conditional approval for bedrooms, with the following stipulations:
Rrrrfro
By: 44e4 aV7,e_ff Original Certificate Date:
i
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: Tuxedni Park, Block 2, Lot 5
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 6/30/82
Total depth 87 ft
Cased to 81 ft
OR Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) '18 in.
Date of flow test for COSA 7/22/19
Static water level at beginning of test 17
Comments
B. TANK DATA
Age of tank(s) <1 years
Tank type/material Septic/Plastic
ft.
Measured operating fluid level in septic tank New
❑ Standpipes/foundation cleanout per record drawing
Date of pumping New Construction - 7/10/19
D. ABSORPTION FIELD DATA 5' Wide Trench
Which system tested (date installed) 7/10/19
❑ ALL standpipes present per record drawing
Total measured depth from grade 4.5/4.6 ft (max)
Measured depth to pipe invert from grade 4/4.1 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
Septic System installed 7/10/19.
COSA Checklist yellow sheet
Parcel ID: 041-022-22
Structure served by this system
Well production at time of test 8 gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑ Nc
❑ Coliform bacteria is Negative
Nitrate 1.79 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by FORGE ENGINEERING
Date of Sample 01/24/20
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date New Construction
Results [] Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
0✓
Yes
Community Sewer Manhole/Cleanout > 100'
M Yes
if No
ft
[z] Yes
if No ft
Neighboring Tank > 100' 21 Yes
if No
ft
Private Sewer/Septic Line > 25' 0 Yes
if No ft
Absorption Field on Lot > 100' R� Yes
if No
ft
Holding Tank > 100' ❑✓ Yes
if No ft
Neighboring Absorption Fields > 100'
Yes if No ft
Water Main > 10'
Animal Containment > 50' [✓ Yes
if No ft
0 Yes
if No
ft
Yes if No ft
Water Service Line > 10'
M✓
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main > 75' R Yes
if No
ft
0 Yes
if No ft
From Septic/Holding Tank 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
Property Line > 5'
F71
Yes
if No
ft
Wells on Adjacent Lots:
No. CE -4381
°�°f
Absorption Field > 5'
R-1
Yes
if No
ft
Private Wells > 100'✓❑
Yes if No ft
Water Main > 10'
Q
Yes
if No
ft
Community Wells > 200'✓❑
Yes if No ft
Water Service Line > 10'
M✓
Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
0
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
0
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'✓Q
No. CE -4381
°�°f
Yes
if No
ft
Private Wells > 100' Q Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
ft
Community Wells > 200' Q Yes if No ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
OF �t�
.........
1 certify that 1 have determined through field inspections and review
��;.>°'` ''•• S
�•'"a ®°
of Municipal records that the above systems are in confonnance with
g
��
MOA COSA guidelines in effect on this date.`
l -° �g ti
a.aaea mvaa .+mava�
auu �uaoanaaanaaaameaaanaaaeoaaaa°aa. v�e�ata
0. fi MICHAEL E. ANDERSON
No. CE -4381
°�°f
Q° 1/29/20
aP�
COSA Checklist y ellow sheet
����'••..""a"'..._
'OROFES-,\C �
MUNICIPALITY OF ANCHORAGE ~..
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name CAHg~'V ¢~t1~ ~/./~ Telephone: Home ,,~'~3,-~,~' ~q Business
Applicant Address
(c) Applicant is (check one): Lending Institution I-I; Owner/builder,~; Buyer []; Other [] (explain);
(d) Lending Institution
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
Telephone
TYPE OF RESIDENCE
Single-Family,~ Multi-Family
Number of Bedrooms
Other
WATER SUPPLY
Individual Well ~1~ Community [] Public [] '
Note: If community well ~ystem, must have written confirmation from the State Department of Environ mental Conservatior~
attesting to the legality and status.
SEWAGE DISPOSAL . · '
OnSit Public[] commt~nity[] Holding Tank[] : . '
· Note: if community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality end status.
Page 1 'of 2 ?2-025 {11/84)
E~IGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA I*A AND INFORMATION ~' '
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the 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 verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
NameofFirm T~o~:l,C~f ~,j,J~J~,.,l~ ~)J:? Telephone ~79- ~/~
Address ~ ~ ~ l~
Engineer's Seal
Approved for ~ e,~,., bedrooms by Date
Approved ~ Disapproved
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
' 72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
WELL DATA
Well Classification
Well Log Present (Y/N) ,)/'
Total Depth ~ 7 Cased
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~ · 3C~ · F~. Yield ~0 ~,.~
Depth of Grouting f,,'
Pump Set At ~:~ o 7-'/'o ~-f
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N) N
To Nearest Edge of Absorption Field on Lot ~ ! ~
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
; On Adjoining Lots
; On Adjoining Lots
N'O~ ~" To Nearest Public Sewer
1'40~Lr-- To Nearest Sewer Service Line on Lot
:Date
B. SEPTIC/HOLDING TANK DATA
Date Installed 7. ,2,0. g ~
Standpipes (WN) "T'u~'o
Depression over Tank (Y/N)
'Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) --"-
Separation Distances from Septic/Holding Tank:
Size / ~Z. ~, O No. of Compartments. '7' U~ O
Air-tight Caps (Y/N) '7" Foundation cleanout (Y/N) ~.~------~
I~ Date Last Pumped Il !~ L ~:~r''~
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
Comments
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
Page I of 2
To Stream, Pond, Lake, or Major Drainage
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed 7' .~..c~
· . · ',, Width of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation ~ ~-~
Lot /'V o
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design u~,/~,,~ '7-~N c/fi-
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test o
To Property Line
To E~(isting or Abandoned System on
; On Adjoining Lots
To Cutbank (if present) N O
NON~
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request
I certify that I have checked, verifie~, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed
Company /. ~'/~ u ~'~--~~'-,~j'/ MOA No.
Receipt No. ~"~)"~
Date of Payment
Amount: $ ~'~"?~ Engineer's Seal
Page 2 of 2
72-026 (11/84)
CONSULTING ENGINEER
~.03 W. 15Ih AVE "C" SUITE 203
ANCHORAGE. ALASKA 99501
TELEPHONE: (907) 279-39'16
SEPTIC
SYSTEM
ADEQUACY
TEST
LEGAL:
LOCATION:
OWNER:
RESIDENCE:
WATER SYSTEM:
SEPTIC SYSTEM:
LOT 5, BLOCK 2, TUXEDNI PARK
6700 HAIDA CIRCLE ,',.
JOE CARAWAY ~...~.~.
ON SITE WELL
FROM MUNICIPAL RECORDS:
TANK: GREER, STEEL, TWO COMP.
1200 GAL.
ABSORPTION SYSTEM: WIDE TRENCH
ABSORPTION AREA: 429 SQ. FT.
SOIL RATING: 125
INSTALLATION DATE: JULY 1982
DATE OF PUMPING: JANUARY 13, 1986
DATE OF TEST:
JANUARY 10, 1986
TEST PROCEDURE: SYSTEM WAS INSPECTED. TANK HAS 2.5 FEET OF
COVER. LIQUID DEPTH 48 INCHES. TOTAL DEPTH OF
DRAINFIELD IS 40 INCHES, MOMITORING TUBE IS 22 INCHES ABOVE
GROUND. THERE WAS 3 'INCHES OF WATER IN THE FIELD.
WATER WAS ADDED TO THE SYSTEM AT A STEADY RATE OF 6 GALLONS PER
MINUTE. WATER LEVELS IN TANK AND FIELD WERE MONITORED UNTILL 450
GALLONS OF WATER HAD BEEN ADDED. THE WATER LEVEL DID NOT RISE IN
TANK. THE WATER LEVEL IN THE FIELD ROSE 6.5 INCHES. WITHIN 23
MINUTES AFTER THE TEST WATER LEVEL IN FIELD HAD GONE DOWN 2
INCHES. 'THIS INDICATES THAT THE FIELD'S ABSORPTION RATE IS ON THE
ORDER OF 3 GALLONS PER MINUTE.
TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF
THE MUNICIPALITY OF ANCHORAGE.
The operational life of all septic systems depends on the local
soil conditions, groundwater 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 septic system. We can therefore not give any estimate of
how long the system will continue to meet the operational requi-
rements of the Municipality and State.
RESIDENTIAL
WELL
~""%~203 W. 1Sth AVE "C" SUITE 203
ANCHORAGE. ALASKA 99501
TELEPHONE: (907) 279-3916
INSPECTION
LEGAL:
LOT 5, BLOCK 2, TUXEDNI PARK
LOCATION:
6700 HAIDA CIRCLE
OWNER:
JOE CARAWAY
TYPE OF WELL:
SINGLE FAMILY
WELL LOG AVAILABLE:
INSTALLATION REQUIREMENTS
WELL YIELD FROM WELL LOG:
PUMP YIELD:
YES
MET: NO. WIRES NOT IN CONDIUT,
SANITARY SEAL **
30 GALLONS PER MINUTE
MORE THAN 6 GALLONS PER MINUTE
NO
DATE OF INSPECTION:
TEST PROCEDURE:
TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA
JANUARY 10, 1986. TEST WAS NEGATIVE.
JANUARY 10, 1985
WELL WAS PUMPED AT A CONSTANT RATE OF 6
GALLONS PER MINUTE WHILE THE DRAWDOWN WAS
MONITORED WITH AN ACOUSTIC PROBE. THE WELL
WAS PUMPED TILL THE DRAWDOWN STABILIZED.
STATIC LEVEL WAS FOUND TO BE LESS THAN 25
FEET. AFTER 70 MINUTES OF PUMPING THE WATER
LEVEL WAS 34 FEET.
ON
TEST RESULT .'
'. '
· -..'%-. .......
· .''Y".' A
~...~....)-.~.. ?~'~
JUN. 2~. I971 .~.:~
~,~.~'..
THIS WELL MEETS THE REQUIREMENTS OF THE
MUNICIPALITY OF ANCHORAGE.
.The Municipal requirement for well flow is
150 gallons of water per bedroom per 24
hours.This well surpasses this requirement.
The assessment of the condition of this well
applies only to the conditions as of this
date. The flow rate of the well may change
due to subsurface conditions that may not be
observed from the surface, and changes in
land use and other factors that may impact
the conditions of the aquifer feeding the
well.
** Sanitary seal and conduit installed on Jan. 17
.~PPLI(;'~I. T FILLS OUT UPPER HA['-!ONLY
Buyer
· Address
Address
Realty Co. & Agent
Address
Legal Description
Street Locatlc~
Type o f ~,~si~nce
I~ngle Family
[] Multiple Family
[] Other
Water Sfl,~afy
[]v.l~divldual
[] Community
[] Public Utility
Sew~r
I~dividual
[] Public Utility
C] Holding Tank
No. of Bedrooms
('",'vc
Zip Code
Zip Code
Zip Code
Zip Code
Phone
qS.c'/O
Phone
ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975.
For wells drilled prior to that date, give well depth (attach log if available).
Year Individual Inslalled: "~ ( ,t,, ~ ~ ~ ]~:'//' ~,.~ '-.
When Connecled lo Public Utility: '~'~.
?
/
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Date
Inspector
Field Notes:
(.....~) APPROVED BEDROOMS
( . ) DISAPPROVED
( ) CON DITIO N AL_APPROV~A L°
Time Time Time
Date Date Date
Inspector Inspector Inspector/.~
~IUNICIPALITY OF ANCHORAGE
DEPT. OF HEALIH &
ENVIRONMr'NTAL PROi'i:CIION
JUL 1 5 It383
RECEIVED
· 'CONDITIONS OF APPROVAL
if monies are escrowed t~ have.fill brought in
to cover .the depression over the septic tank.
This will need to be reinspected by this office.
Soils Rating
Date Sewer Installed
IWell To Absorption Area
Well to Tank
Well Log Received
Sel~lic Ta~k Size
DATE:
TO:
· ~c~pal~ty of ~
Anchor-age
FROM:
SUBJECT:
9"1-010 (4/76)