400%
200%
100%
75%
50%
25%
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
POLLOCK HOMESTEAD BLK B LT 4
Onsite File dy a f k t� NO- r� H�,rx a tip: 0 mes ea'.. %Rev VJluet 10) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181360 PID Number: 017-112-44 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑® New ❑ Upgrade Name RICHARD HAYES ABSORPTION FIELD ❑ Deep Trench 0 Wide Trench ❑ Bed ❑ Mound Site Address El Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 0.8 GPD/SFJ 2.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 0.5 Ft. Gravel depth beneath pipe 2.0 Ft. Subdivision Block Lot POLLOCK HOMESTEAD BLK B, LOT 4 Fill added above original grade 2.0 Ft. Gravel length 80 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES 0 Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 563 Ft? 1 •a Ft. Well 100'+ too , 100'+ 50+,_ TANK ❑ Septic 9 S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'-f , 00 1001+ Gal. Material Number of compartments Lot Line _10, ( ©' J ( NA Foundation* 7 -{- I LIFT STATION Manufacturer Capacity Remarks * WIAVER REQUESTED ANCH TANK 1250 Gal. ** MOA WAIVER Alarm location GARAGE WALL Electrical installed by MOA PERMIT Installer PIPE MATERIAL House to tank 3034Tank to 3034 drainfield MIKE N ANDERSON, P.E. Drainfield 3034 CO/MT3034 Inspector MIKE N ANDERSON R.E. BENCH MARK (Assumed elevation) 96.4 ft Inspection ection 1:c 5/3/19 5/3/19 Location and description 2°d GARAGE SLAB__ 3'd 4"' . ON-SITE WATER AND WASTEWATER SECTION APPROVAL ®' � %-np �� \f�� Conditional Approval: Date �•.•° °°. 49vN I� 0 0 0 0 0 0 0. 0. A °. O.. 0 MICHAEL N. ANDERSON e'`4-- 00 Septic System___mss— r CE 9 9 Approve +—....� � Date`7���t •°���`0�� Note: this approval does not include well permit requirements. %Rev VJluet 10) Permit No. OSP181360 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: POLLOCK HOMESTEAD BLK B, LOT 4 MARK \A B Col 10 \ 15 ` CO2 10 14 TC01 15 y2 TCO2 20 12, MT1 50 74\ MT2 36 21 ( I I TCO7 INSULATION 1,250 GALLON STEEL STEP TANK SEPTIC SECTION N.T.S. PID No.: 017-112-44 \H#2 // \ I / 1250 ON STEEL 15TEP TANK MT1 / I \ I .BrN4 \ RAGE SLAB N� III A / I I I o C Cq, I . 02 / TH#1 \ 1 I' B \ DRIVEWAY NEW WELL \\ MTI SEPTIC I ASBUILT \\ \\ SALE: 1"=50' \ \ \ FMTirMT2 ®®'.®®®®® N ®�® Ij F q 2 . S ES®®®® FINI N CRA Air ,/-FILTER FABRIC @ INSULATION s yi •�^ .rH ®0 SP/CP ....................... ......... lJJ .. . ...................... MAE'... .......... .p0, : MICHAEL N. ANDERSONuOATION ®® ��� No. CTr� 9 69TEP /�,���TANK CROSS I WATER 902.5, OCT 2078 ® ES ®® 4' _ I ' I I i I / I / I ( I I TCO7 INSULATION 1,250 GALLON STEEL STEP TANK SEPTIC SECTION N.T.S. PID No.: 017-112-44 \H#2 // \ I / 1250 ON STEEL 15TEP TANK MT1 / I \ I .BrN4 \ RAGE SLAB N� III A / I I I o C Cq, I . 02 / TH#1 \ 1 I' B \ DRIVEWAY NEW WELL \\ MTI SEPTIC I ASBUILT \\ \\ SALE: 1"=50' \ \ \ FMTirMT2 ®®'.®®®®® N ®�® Ij F q 2 . S ES®®®® FINI N CRA Air ,/-FILTER FABRIC @ INSULATION s yi •�^ .rH ®0 SP/CP ....................... ......... lJJ .. . ...................... MAE'... .......... .p0, : MICHAEL N. ANDERSONuOATION ®® ��� No. CTr� 9 69TEP /�,���TANK CROSS I WATER 902.5, OCT 2078 ® ES ®® 4' ' I I i I / I / I / I i i i I ( I I TCO7 INSULATION 1,250 GALLON STEEL STEP TANK SEPTIC SECTION N.T.S. PID No.: 017-112-44 \H#2 // \ I / 1250 ON STEEL 15TEP TANK MT1 / I \ I .BrN4 \ RAGE SLAB N� III A / I I I o C Cq, I . 02 / TH#1 \ 1 I' B \ DRIVEWAY NEW WELL \\ MTI SEPTIC I ASBUILT \\ \\ SALE: 1"=50' \ \ \ FMTirMT2 ®®'.®®®®® N ®�® Ij F q 2 . S ES®®®® FINI N CRA Air ,/-FILTER FABRIC @ INSULATION s yi •�^ .rH ®0 SP/CP ....................... ......... lJJ .. . ...................... MAE'... .......... .p0, : MICHAEL N. ANDERSONuOATION ®® ��� No. CTr� 9 69TEP /�,���TANK CROSS I WATER 902.5, OCT 2078 ® ES ®® 4' Certified Drilling Log DOC CO dna ;iOBILL a. LE uusiWATER WELLS leP.O.Box 670269,Chugiak,AK 99567 688-2759 OWNER OF LAND: Kenneth(Richard) Hays ADDRESS: Bore Hole Dote LEGAL DESCRIPTION Pollock Homestead Block B Lot 4 Depth DATE: 11-2-18 From To PERMIT NUMBER: OSP181360 DATE OF ISSUE: 10-16- 0 2 Casing Stickup 18 TAX IDENTIFICATION NUMBER 0171124-4000 2 5 Fill Is well located at approved permit location:ZYes riNo 5 8 Overburden/swamp Method of Drilling: ®air rotary cable tool 8 10 Silty Sand&Gravel Depth of Well: 400' 10 22 Tight Silty Sand &Gravel w/Clay Casing Type: Steel Wall thickness 2S0 inches 22 56 Silty Sand&Gravel Diameter: 6 inches, depth 57 feet Liner type 56 57 Wet Silt&Sand w/Some Gravel Static Water Level: 7 feet 57 59 Bedrock Broken Recovery Rate 1.3 gpm gph 59 81 Bedrock Gray Method of Testing Air Well Intake Opening Type:E open end ,.open hole 81 129 Bedrock Green Screened Start feet Stopped 129 261 Bedrock Green w/Quartz n Perforations Start feet Stopped 261 304 Bedrock Green Hard Grout Type: Bentonite Volume: 50 lbs 304 331 Bedrock Gray w/Quartz Depth:from 2 feet,to 42 feet Well Disinfected Upon Completion: ®yes no 331 400 Bedrock Green Method of Disinfection: Chlorine 50 PPM Comments: -- Left casing slightly above bedrock to allow water from 56-57' zone to enter well. Made.5 GPM until silt&sand choked off flow. Reamed several times but material kept choking off. Well Yield is after Hydro-frack. WATER QUALITY TESTING Drillers Name: Cole Sullivan GtiiliorTn 00mL Nitrates N Arsenic }At � 5 ("' ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough:Department of Environmental Conservation. DOC CO tl a 1ULLIVAN WATER WELLS *-- P.O. Box 670269,Chugiak,AK 99567 688-2759 www.sullivanwaterwells.com Pump Installation Log Well Drilling Permit Number:SW OSP181360 Date of Issue 10-16-18 Parcel Identification Number: 01711244000 Legal Description Property Owner Name&Address Pollock Homestead Block B Lot 4 Kenneth"Richard"Hays Pump Installation Date: 1-23-19 Pump Intake Depth Below Top of Well Casing: 390 feet Pump manufacturer's Name: F&W Pump Model: 4F07G10301 Pump Size: 1 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Installer: Mike Anderson • Disinfected Upon Completion? ® yes E no Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer:Martinson Pump Installers Name: Sullivan Water Wells _ . Attention:The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. �N'"°""''� MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program ,: d •S,, ` PO Box 196650 4700 Elmore Road ' �u , Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 I.I ! http://www.muni.org/onsite I)u•partnicnt 4 n'CH010,°' On-Site Water & Wastewater System Permit Permit Number: OSP181360 Effective Date: 10/16/2018 Work Type: WellSeptic Initial Expiration Date: 10/16/2019 Tax Code Number: 01711244000 Site Legal Address: POLLOCK HOMESTEAD BLK B LT 4 G:3137 Site Mailing Address: 15230 Pollock DR, Anchorage Owner: HAYS KENNETH Lot Size in Sq Ft: 28528 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 3 This permit is for the construction of: 0 Disposal Field 0 Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907)343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: 1. A portion of the proposed drainfield is not within the 30 ft radius of a percolation test. Prior to construction, an additional perk test is required, as shown on the site plan, to confirm the design application rate. If the results require a design change, construction shall stop pending On-site review and approval of a change order. Please submit results with the inspection report. 2. The maximum depth for bottom of sewer rock shall not exceed 3.5 ft along entire length of drainfield. Received By: Date: / /U Issued By: :'l.6�C A eVULD-eti Date: 0 Adff2U,e Municipality of Anchorage 1� Ull Dep''rnncnt P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 e Fax (907) 343-7997 http://www.muni.orq/Onsite .-• Development Services Department On-Site Water and Wastewater Section **** VARIANCE/WAIVER REVIEW **** Waiver#: OSV181082 COSA#: Permit#: OSP181360 PID#: 017-112-44. Legal Description: Pollock Homestead Block B Lot 4 Engineer: Mike N. Anderson Applicant: Richard Hayes Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is .0 feet. In addition, your request for a waiver of the requirement to install the drainfield parallel to the slope contours has been approved. See engineer's waiver request for justifications. le {-o fL6...w,Aeb1_, r•& This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all code requirements be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: /06/20 ig Approved by: az,n,tall Name of Reviewer **** VARIANCE/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Development Services Department \. j' Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-112-44 Property owner(s) RICHARD HAYES Day phone Mailing address Site address Legal description (Sub'd., Block & Lot) POLLOCK HOMESTEAD BLK B LT 4 Legal description (Township, Range & Section) Lot Size 28,528 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (El all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank ❑ Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑ M - swellings ❑ Privy ❑ t.c) • '.: 2 �D) Private Well '�, Water Storage III 4 °Cru91018 THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: br�v.Vsti +13 o+ L t /rte,. y�� ' pa -I b 5(a `k C,oA S I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. 4/4/(1 (Signature of property owner or authorized agent) Permit/Rush Fees: ?"7`f Waiver Fees: )1 5 Date of Payment: [O /Q 1/' Date of Payment: 1011511% Receipt Number: •f ' /4064e4C. Receipt Number: * a 3101'9 Permit No. iOS Pa13teO Waiver No. OSN \Oci) G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc • MAY 15, 2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage,Alaska 99519-6650 Fax 249-7847 Re: Well and Septic Permit plus Waivers Legal: POLLOCK HOMESTEAD BLK B LT 4 To Whom it may concern: This is a request for a well and septic permit on the above referenced lot. A new test hole was excavated and found poorly graded sands and gravels(SP/GP)and water at 7.5 feet after the 7 day monitoring period. The perc rate was 4.5 minutes per inch but a slower rate will be used for longevity of the system. The secondary system will be the Advantex system. The lot slopes 2 to 3 percent toward the northwest corner of the lot, see the site plan,then flattens out to less than one percent. A drainage easement is located on the east side of the property and will be graded to keep any drainage in the easement during spring run-off. We are also requesting a lot line waiver of ZERO feet on the south property line for placement of the leach field, AND 7 FEET FROM THE TANK TO THE FOUNDATION, see the site plan. The neighbors septic is over 10 feet from the property line and our system has a shallow water table with a small area to install the leach field in. Due to the limited area we also need a waiver for the field not being parallel to the contours. As stated above the allowable area is tight and has high ground water. The surrounding properties will not be impacted by this new well and septic permit. Please call me if you have any questions. Sincerely X974 1. Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Oct. 8,2018 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Well and Septic Permit plus Waivers Legal: POLLOCK HOMESTEAD BLK B LT 4 To Whom it may concern: This is a request for a well and septic permit on the above referenced lot. A new test hole was excavated and found poorly graded sands and gravels(SP/GP)and water at 7.5 feet after the 7 day monitoring period. The perc rate was 4.5 minutes per inch but a slower rate will be used for longevity of the system. The secondary system will be the Advantex system. The lot slopes 2 to 3 percent toward the northwest corner of the lot, see the site plan,then flattens out to less than one percent. A drainage easement is located on the east side of the property and will be graded to keep any drainage in the easement during spring run-off. We are also requesting a lot line waiver of three feet on the south property line for placement of the leach field, see the site plan. The neighbors septic is over 10 feet from the property line and our system has a shallow water table with a small area to install the leach field in. Due to the limited area we also need a waiver for the field not being parallel to the contours. As stated above the allowable area is tight and has high ground water. The surrounding properties will not be impacted by this new well and septic permit. Please call me if you have any questions. Sincerely /� Michael N. Anderson, P.E. 4661 Natrona Anch,Ak 99516 Ph 727-8864 DESIGN CRITERIA: MOUND OVER (TH#1) .n• -- GRADE 3 BDRM X 150 =450 GPD0 5 .ORG FILTER FABRIC SOILS =450/0.8 = 563 GPD -0.5 � &INSULATION 563 GA/5`0.58 = 65' 1.25"0 PIPE SP/GP 3.5 (1) TRENCH 1 5.0' I SEWER ROCK 3.5' DEEP 3.0' EFFECTIVE ' 5.0' WIDE 65' LONG 12 WATER @ 7.5'OCT 2018 SEPTIC FIELD SECTION I ,1:______-------- I I � I I _1 I II I \\ I I I I \\ I II \\ X00 II - - - L — - - - - - - - - � rte ' PROPOSED , - - - - __ — — — —I DRAINAGE FIELD / 71,\\\ I \ i 'PROPERTY LINE I 1 . I 1\\ , , . I 11 I ` ' r,-,147 ._ I PROPOSED HOUSE/ L �'� '�� I I / I_'' 1- I PROPOSED WELL ‘\ I / 100'RADIUS I I >I - , ' I I I I 0 = 0 I ml a111111 CD I J Z O O al I I; _ _ _ _ — J _ _ - -- - - M • _RABBIT CREEK ROAD- — — — -- — — Septic Design Prepared for RICHARD HAYES •.• OF 44 POLLCOK HOMESTEAD, BLOCK B, LOT 4 .. ..:4** �1, *i° Anchorage, Alaska : 49 T—" /1 O 0 • • >r ,a4 • Michael N. Anderson, p.E. • DATE: 10/2/2018 W MICHAEL N. ANDERSON 4601 NATRONA AVE DRAWN: DJR •O� No. E t,4 69 �zar ANCHORAGE,ALASKA 99516 �.; . i K. :.. 4. (907) 345-3377/FAX: (907) 345-1391 SCALE: 1"=200' �4411,k1 �;; 'C`�•� I I 1 L L \ /� SEPTIC vt '\ ;\ + f �t\ I f i i y SEPTIC i 1 t \ k \ \ 1 \ I FORE T RIDGE ` 4 1 F REST�2IDGE\ \\ I I \�B`O2.LOT3// \ ' \ 1 \.., B1 CKK.LOT4 \ n-� n- • L — , . %/, , ':, ', tt1 _l_ __ __ -Hr I __ / i ! \ \\ \ 4 1 \ \ \ \ - - - ',,\—\\ — — — — - . \ \ \• SECONDARY TH \\\ \ \\ \\ ; • \REQUIRED PRIOR TO `` t INSTALLATION �� \ , \ \ \ t , \ / ‘ VACANT \ \ \ \ \ 's • 'POLLOCKHOMESTEAD-""---------, \ \ \ \ \ \ \ BLOCK B....V:17'57 1 . \ \ \ \ 1 l -� \ 2'CONTOURS TYP ,\ 1 \ ` \\ ,'� // 1 \ \ \ \._ ;\< \ TIMBERL IX#4 \ PROPERTY LINE /_ BLOCK 1.L9T 11B \ • N. \\`\ II w .CO, i \ \ 1 , PROPOSED WELL `�// H�--��` ./ �1 \ \ I \ \. 100'RADIUS /\\ ,tj • PROPOSED <' \ \ \ t 1 \ �! \ i w T \ 1250 STEP ado \•. \ /I ; \ v\ �� �\ / It 1 SEPTIC TANK . . . , \ \ -�` \i OVELL ,� \\ 1 n 1 DC,S i \' ,L --� , I!s 1 i / \\�" \ ' I / I POLLOCK HOMESTEAD . \ / \I „ \I \ 1 %0EDI. BLOCK 8,LOT 4 i' ' \\ 1 I // 'ill__ HORS I i� / \ / _ \n - • I I I j • I I :. �, I PROPERTY LINE 1 11-1#1 1 .• : i. / / I \ • TIMBERLUX#4 / r I \ BLOCK 1.LOT 11¢ I �• Lr�MT \ i. /\�' / / \ LOT LINE I \\\\ `X L ' \`� 1 • WAIVER OF 3' —� " I / / I REQUESTED I .. v SECONDARY SYSTEM --t --'1v 1 / I / k 1\\ REMOVE&REPLACE. WELL, N\ fSEPTICI --11-N\------ .. r---r\-N \�^f ice/ \ �. W �� \. i �� • �OLLO HOMEST \\ U \\ \ POLLOCK HOMESTEAD/ BI CE D K B,LOT 3 \, \\ 0 �\ \� BLOCK A,LOT 3 4, > J \ I / \\ a �\ i/ Septic Design Prepared for RICHARD HAYES 4:�.•�� OF �� POLLCOK HOMESTEAD, BLOCK B, LOT 4 • j .- ♦♦ Anchorage, Alaska • : 49 • • ,gTTHH /\ .• . • .• Michael N. Anderson, P.E. DATE: • 10/2/2018 0�x%MICHAEL N. ANDERSON; 4601 NATRONA AVE ♦� No. E 46 ANCHORAGE,ALASKA 99516 DRAWN: DJR ♦♦♦ (907) 345-3377/FAX: (907) 345-1391 SCALE: 1"=50' wVit�. \k\ ,„\*.„, 4•• Municipality of Anchorage r -NC�I�IEf 'S'SEAI)ka Development Services Department ,r�-� '~'�� i \ On-Site Water and Wastewater Section O'* ' TI.i • -,,� 4700 Elmore St. �e �9- �d P.O. Box 196650 Anchorage,AK 99519-6650 / :0/11/1411 • � � 10 www.muni.org/onsite �• •. .. . • • • •e • / (907)343-7904 �� '. MICHAEL N. AND!RSCN ; ; �- e<%,•.� CE-9469 ....,•'-‘-',.; : Soils Log - Percolation Test gt IrD •••••••• lk Performed For: ro {��.�•G�v� ��U yr �j, Date Performed: ��� Legal I- •• .• I r(� hCe ,x p �r. Township, Range, Section: -r . mss, / r( i•L 6 Slope Site Plan Depth (Feet) d ,rc. 1- 2 ('/ -71). 4r,e___ - 3- (�vt, G 4/74-c.. oK1l 4- 5- 6- 7- 8- WAS GROUND WATER 9- ENCOUNTERED? '-f r S 10- IF YES.AT WHAT DEPTH? L 0 . Depth to Water After / P 11- Monitoring? 77 c 12- Date: 70/i 4 13- ' IS CI Y4 el, 14- Reading Date Gross Time Net Time Depth to Water Net Drop 15- 01411 lawriN 1./(/ L ...,/ , 16- le �� v•�/1lo 17- IP '' Z`1//(o 18- tO it Z '419- 20 PERCOLATION RATE i.,',c (minuleshnch) PERC HOLE DIAMETER (P TEST RUN BETWEEN ( FT AND Z FT COMMENTS PERFORMED BY: AAALIL AA/LI CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Certificate of On -Site Systems Approval Parcel I.D. 017-112-44 Legal description Pollock Homestead Block B lot 4 Site address 15230 Pollock Dr Anchorage Ak Current property owner(s) Rowland Expiration Date: 1-26-2023 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Datel ® 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 X Absorption Field Advisory Nitrate Advisory _ Tank Age Advisory Arsenic Advisory _ Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department 1 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. 017-112-44 Complete legal description Pollock Homestead, Block B Lot 4 Location (site address) 15230 Pollock Drive, Anchorage, AK 99516 Current property owner(s) Mary & Kelly Rowland Day phone (907)830-8357/(907)301-4035 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑■ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 3 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑■ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 556) I Date of Payment 10//9 [ c? COSA # 0 S C 9a l S1U 0 07USOD Waiver Fee $ Date of Payment Waiver # COSA Application -June 2022 Legal Description: Pollock Homestead, Block B Lot 4 Parcel ID: 017-112-44 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 11/2/18 Total depth 400 ft Cased to 57 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 16 in. Date of flow test for COSA 10/3/22 Static water level at beginning of test 13 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 44" Date of pumping 8/2/22 A+ ❑ Required maintenance completed, if AWWTS Comments: N/A D. ABSORPTION FIELD DATA Which system tested (date installed) 5/3/19 ❑ ALL standpipes present per record drawing Total measured depth from grade - ft (max) Measured depth to pipe invert from grade 3.6/4.5 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 1,1/2,0 ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced N/A gallons N/A date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Well production at time of test .9 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date 9/28/22 C. LIFT STATION LP Required maintenance completed Age of lift station 3 years Lift station material Comments: Adequacy test date 10/3/22 Results W Pass Fluid depth prior to test 7.5/0.0 in Water added 630 gal New fluid depth $'0/2'0 in Elapsed time 1440 min Final fluid depth 7.5/0.0 in Absorption rate '450 god FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 24.0 in Effective depth used 7.5/0 in Effective depth remaining 16.5'24.0 in Comments/Deficiencies: South MT has been pulled up 0.9' or filled with debris. Elevations checked by laser measurements 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' Community Sewer Manhole/Cleanout > 100' QYes if No ft 0 Yes if No ft Neighboring Tank > 100 Q Yes if No ft Private Sewer/Septic Line > 25' � Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' M Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' FMI Yes if No ft Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' FE -]Yes if No ft rml Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 7 ft Surface Water > 100' Q Yes if No ft Tank to Property Line > 5' Fm� Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No ft Private Wells > 100' Fm� Yes if No ft Water Main > 10' ❑o Yes if No ft Community Wells > 200' W Yes if No ft Water Service Line > 10' C] Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS Waiver OSV181082 on file with municipality. 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 Forge Engineering Engineer's Printed Name Benjamin Schiller, P.E. COSA Checklist—June 2022 Prone (907) 522-7773 Date 10/17/2022 �--q o *41 Apr •�� � 419 Ri ,._. ... �� • � '—Benja�Schiller �� �� •. CE 12592 • c�� s® �> %20pR4FESSt4�t'��-®�� Municipality of Anchorage �G.:A�, Development Services Department Building Safety Division F F Y 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) # OSC22151.0 During a recent COSA on-site inspection and test of the potable water supply well on Block B, Lot 4 of Pollock Homestead subdivision, the well's productivity was determined to be .9 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is .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. MUNICIPALITY OF ANCHORAGE Development Service! i Department Phone: 907-3413-7904 On -Site Water & Wasl awater Section Fax: 907-343-7997 Lift Station/Pump Vault Owner kefl�l R=vv llw(l Street Address 15230 Phone 00!?,6' 1 P&,.l Dlesc. PID eatic Tank-, -Sludge level inc lies -Pumping, required -Pumping completed Lift statim -Pump basket cleaner -Effluent filter cleaned no -Control floats cleaner -Proper float settings confirmed no -Operation satisfactory e ng Alarm Systema -Dedicated electrical a arm circ -Audible and visual alarm inside dwelling .A1 C;1111sY Fit UPIEVICALIC a C 0 S.-.1ismetory ,Ground water intrusio -i at riser to tank connection ^Ground water intrusio'i around pipe penetrations ves(�n -Manhole lid: Functional Insulated ,Weep hole functionalyf!," nn 6� Properly Secured -All manufacturer required inspections and maintenance completedjJx no Comment= OS -411.44 Company Sig " '+e sk Date of maintenancWW440.' MUMCC PAUTY 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. 017-112-44 1. GENERAL INFORMATION Expiration Date: 12 —2,q _2_02D Complete legal description _POLLOCK HOMESTEAD BLOCK B, LOT 4 Location (site address) 15230 POLLOCK DRIVE, ANCHORAGE, AK 99516 Current property owner(s) JONATHON & KELSEY RODRIGUEZ Day phone .. Mailing address - -- 15230 POLLOCK DRIVE ANCHORAGE, AK -99516 Real estate agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: . Private Well ® Private Septic _.Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment I / 2- 2-`Zo 20 Date of Payment Receipt Number 51 ZZ 5-Z Receipt Number COSA# OSC-20 1 5 ZO 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY,_ ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 911912020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices ! methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & F41G5 . 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: BY Original Certificate Date: -/ -Z Y -20 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 Legal Description: POLLOCK HOMESTEAD BLOCK B, LOT 4 Parcel ID: 017-11244 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 11/2/2018 Total depth 400 ft Cased to 57 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 9/16/2020 Static water level at beginning of test 21 ft. Well production at time of test 1.3 gpm Comments B. TANK DATA Age of tank(s) 1 years Tank type/material STEP / STEEL Measured operating fluid level in septic tank *45" ® Standpipes/foundation cleanout per record drawing Date of pumping 9/16/2020 D. ABSORPTION FIELD DATA Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected byFWN Date of Sample 9/16/2020 C. LIFT STATION ® Required maintenance completed Age of lift station 1 years Lift station material STEEL _ Comments: *Float levels. Maint. Report Attach. Which system tested (date installed) 5/3/2019 Adequacy test date 9/16/2002 ® ALL standpipes present per record drawing Results Pass For 3 bedrooms Total measured depth from grade 4.4 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade _ft (min) Water added 500 gal ® N/A — pressurized field New depth 6 in n ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Elapsed time min ® Code -required soil cover over field w/ insulation. Final fluid depth 0 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date FV1 t:S Comments/Deficiencies: 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' ® Yes if No ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations> 10' ❑ Yes if No *7 ft Surface Water> 100' ft ft ft ft ft ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® 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' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No *0 ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *PER MOA RECORD DOCS — WAIVER. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. .. .... ......`" Curtis Huffman �� ��'`�• CE128991;0' 9�19/2Q29'c�- AW ft ilL Note: To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail security settings to determine how attachments are handled. A 201 —0 >l 1 129-0 L R Rcco,,r }ing, Dist: 301 - Anef^or age S 4,111!2019 12;2:1. MA Panes- 1 of 4 X ��t����iii��iii�����i��i�ii�i���i►�i��i����i��Ci� viii 1203-:141) Grid 137 1. 19009 1)17-1 12-44-00 ENCROACHMENT PERMIT This permits s lmvt -tcn Chugach I Iceiric A45cci;i6on, Inc„ apt A1as1 t non-profit electric cooperative, (l ertt in "C'i)ttr).aeli'}.'-vhose add loss is P. 0. Bo—,IWi..100; Anchor-,-agu A.I, Aal 9'951!) and 4r.ermeth I1ays (bcTcin "TcrMittec"), whoseaddress is 4711 Sydney Patrk Cir., Anchorage. Alaska 99516. I . 1 _uso r:ertt t hus ach is the p—antce or uscr of wi casement for the construction and narrIlllGfldtllf'.. l3i !!«: