HomeMy WebLinkAboutT15N R1W SEC 5 LT 71Onsite File
T15N R1W Sec 5
Lot 71
#051-081-11
Municipality of Anchorage
On -Site Water and Wastewater Section 1 (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP201237 PID Number: 051-081-11
Dwelling: M Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: New
❑Upgrade
Name
JONES ABSORPTION FIELD
Site Address
21888 BIRCH CREEK DR, CHUGIAK AK N Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Phone ❑ Other
:�����Number of Bedrooms Soil Rating Total depth from original grade
0.6 GPD/SF 5
Ft.
LEGAL DESCRIPTION IDepth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 1.0
T15N R1 W SEC 5 LOT 71 Ft. 4 Ft.
Fill added above original grade Gravel length
Township Range Section
Remarks
location
Electrical installed by
Gal.
Installer PIPE MATERIAL House to tank 3034 draintield Tank to
MIKE N ANDERSON, P.E. 3034
_
Drainrield 3034 CO/MT 3034
Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 112.5 ff
Inspdection ates: 1� 11/22/21 2nd 11/23/21 Location and description
3rd 4t" TOP OF TANK MH
ON-SITE WATER AND WASTEWATER SECTION APPROVAL I Engi�QPs,, amp
itional Approval:
Date
Septic System
Approved
Date
Note: this approval does not include well permit requirements.
w 05/02/18)
•ems'' � � _ .,..._�,
f`I^
/� \� 1 1 • 9
,;4 49TH
70 MICHAEL .V, AhZ% k..c_ ` F
CE -9
V142
44
2 +
Ft.
78 Ft.
SEPARATION DISTANCES
Gravel width
2.0
Beds: Number of Lines
Distance between lines
To
From
Septic
Tank
Absorption
Field
Lift Station
Holding
Ft.
Sewer Total absorption area
Ft.
Number of trenches
Dist. between trenches
Tank
Line Ft2
1248
2
Well
100
1001+
50'+ TANK ❑i Septic ❑ S.T.E.P.
❑ Holding ❑ Other
Manufacturer
Capacity
Surface Water
1001+
100,E
GREER/ EXISTING
1500
Material
Gal.
Number of compartments
:�_i
Lot Line
10'+
10'+
I
NA PLASTIC
2/1
Foundation
*10r+
101+
LIFT STATION
Remarks
location
Electrical installed by
Gal.
Installer PIPE MATERIAL House to tank 3034 draintield Tank to
MIKE N ANDERSON, P.E. 3034
_
Drainrield 3034 CO/MT 3034
Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 112.5 ff
Inspdection ates: 1� 11/22/21 2nd 11/23/21 Location and description
3rd 4t" TOP OF TANK MH
ON-SITE WATER AND WASTEWATER SECTION APPROVAL I Engi�QPs,, amp
itional Approval:
Date
Septic System
Approved
Date
Note: this approval does not include well permit requirements.
w 05/02/18)
•ems'' � � _ .,..._�,
f`I^
/� \� 1 1 • 9
,;4 49TH
70 MICHAEL .V, AhZ% k..c_ ` F
CE -9
V142
44
Permit No. OSP201237 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: T15N R1 W SEC 5 LOT 71
PID No.: 051-081-11
MARK
A
B
c
c01
85
90
c —
CO2
45
—
TC01
38
30
TCO2
36
27
i
CO3
36
27
C04
36
27
i
C05
70
55 80
C06
74 45
C07
70 47
C08
84 80
MT1
75 46
/
MT2
85 81
I
C01 HOUSE
1
CO
COT, C05 � TC01
100' WELL RADIU4
t] TQ02 CO2
\\�
111 11 ® CO3
4
I/ B
BENCH, TOP OF MH\\
11
�� 11 A
�—
--I----
/ 11 �
1
C 11 ® // I
/ x
T42-
ASBUILT
SCALE: 1"=50'
CO1
CO2 7CO2 CO3 0O4
C06.B
�7� OF
•••�'• �,
FTCOI
CO5.7
MTIh2
\ 1f®®
P
.��
®
\
1.0
OR
® 49 TH
FILTER FABRIC
•,
1
NEW 1,500 GALLON
PLASTIC TANK
sc.m aooc
. ... .. . . .. .
107j?_\ ;MICHAEL N. ANDERSON;®
2'
•No. CE 9469
3-22-22
®®�®®®
SEM
WATER 0 91
MAY 2020
\G'vg&
Municipality of Anchorage
Date
Development Services Department
On -Site Water
• • • • `
and Wastewater Section
,� �. • "
A {
e 4700 Elmore St.
P.O. Box 196650 Anchorage, AK 99519-6650
.-' C7.
•?
*..,LH 1,
www.muni.org/onsite
(907) 343-7904
.,, 4' 9 a•
° .
40
MICHAEL N Ah;;,, .. • •r
f r ,? • .,, aaC..v �,
cE-�
Soils Log - Percolation Test �`�;:,,. 69
Performed For: — K C JUc rti e S Date Performed $ L7 Pp ^ •r -• •,; .` ,
Legal Description: 1Pj l , P•/t (�v }. � ( Township, Range, Section:
QIT_H-2 1_
Cgs e
1-
2-
3 e;;-Cp If-
4-
5- y
7-
8 -
9_
Date
WAS GROUND WATER
Net Time
Depth to Water
ENCOUNTERED? `i C
1{) _
//
rt (rt `ti (
S
IF YES, AT WHAT DEPTH? to, L
11-
Depth to Water After O
Monitoring? e
12-
Q rr
4F'd &j V" , Date: t t Z t
13-
14-
15-
16-
17-
18-
19-
20-
Site Plan
Reading
Date
Gross Time
Net Time
Depth to Water
Net
//
rt (rt `ti (
SAR,
Drop
Q rr
lip
tp If
{ L.
AFt?t`n! eTlnnDort=
�i
•••••��••• �•r ICM, rtULt U"Mt I tH tj
TEST RUN BETWEEN Z-- FT AND FT
COMMENTS A- t A- %/ U(
PERFORMED BY: t. (N A , i CERTIFY THAT THIS TEST W S
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
I 50' BLM I 50' BLM I
I ROW RESERVE I ROW RESERVE 1
LOT 77 I
I
I I I
I I
MEM SR
I SR
I S
I I
FS
R
�f A
50' BLM W
ROW RESERVE
1
I
I I
I
I I
87.8'!
I
LOT 76A I
Im
I
pp i. ... .
A It J E63
R , Y. i2 a :NFyii ti ErF `---S t$ :,�..•:. 5 .
I I
I o
I m I
I O
Z
LOT 75B I I
JOANN SUBD.
(PLAT 84-442) �
5050' BLM
(PLAT 84-442) ROW RESERVE
170.2'
LOT 70
SDO'06'00"E 329.80' (R)
25' SIDE SETBACK
OSR
OSR
e
SR
®R
OS
0
OSR
DECK ROOF
I I
C. 0. I L
I
1
I
I
I
I
-I
I
I
- - + - N00'06'00"W 329.- (R) - - - - -
LOT 60
LEGEND EXCLUSION NOTES:
BUILDING IT IS THE OWNER'S RESPONSIBILITY TO DETERMINE THE EXISTENCE OF ANY
---------- ROOF OVERHANG (2' TYPICAL) EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE
RECORDED SUBDIVISION PLAT.
DRIVEWAY
x FENCE NOTES:
- - PROPERTY LINE 1. UNDERGROUND UTILITIES HAVE NOT BEEN LOCATED OR SURVEYED. UTILITY
ADJACENT PROPERTY LINE LOCATIONS TO BE FIELD VERIFIED.
BUILDING SETBACK 2. NO CORNERS SET THIS SURVEY.
CULVERT 3. LOCATED WITHIN MUNICIPALITY OF ANCHORAGE GRID NW1457.
C.D.
❑D CLEANOUT SURVEY CERTIFICATION:
EMm ELECTRIC METER
RODNEY P. KINNEY ASSOCIATES. INC. HAS CONDUCTED A PHYSICAL SURVEY
OSR SEPTIC RISER OF THIS PROPERTY AS SHOWN ON THIS DRAWING AND THAT THE
IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND
WELL NO ENCROACHMENTS EXIST OTHER THAN NOTED.
ABBREVIATIONS _
BLM BUREAU OF LAND MANAGEMENT — O ,Q\\�L\\
E EASTING/EAST '+,�7J
EL. ELEVATION /���� ' ' • , �' 1�
N NORTHING/NORTH 49TH
(R) RECORD PER BLM DEPENDANT
RESURVEY AND SUBDIVISION OF"""' """""""""""'II
/SECTIONS DATED MAY 13, 1955
S SOUTH ............
ROW RIGHT-OF-WAY �j. Clark E. Kinney o
W WEST 1 �s LS 11 60 �//
LIS-711
aAx"11-ofessjoji'l
te/
II
-----n-}----------------------------------
II I -
II GRAVEL DR! VEI4AY
I I
I I
u— — — — — — — — — — — — — — — — -
x I0
�o
I
m�
m
---------------------------L----------
I
LOT 72 I LOT 59
I
I
I
I
I
I
I
I
I
I
-------------�
A N
mea
ZE: m
A
0
fa
MOD
3
A
---------------I
I
I
I
I
I
i
1
GRAPHIC SCALE I
I
30 0 15 30 60 120
( IN FEET )
1 inch = 60 It
I
TRACT B
` �-
RPKA
RodneYPlinneyAssociate%inc.
KNIK VIEW SUBD.
LOT 71
SECTION 5, T15N, R1 W, S.M.
ANCHORAGE RECORDING DISTRICT
(PLAT 99-47)
DESIGNED BY: -
SHEET NO.
1
DRAWN BY: CCR
lo;
APPROVED BY: CEK
ONE STORY WOOD
DATE: AUGUST 18, 2021
I
�`
FRAME BUILDING
18.0' 2
L`°
ts.o'e •. e.t 6_t'
2.D'
2
LOT 71
– z
SECTION 5,
I
I
I
T15N, R 1 W, S. M.
CONCRETE
I
I
I
12.5' SECONDARY FRONT
SETBACK
I
L--------
------------------
- - - - -
0
f n
�
WELL N
n
A
mm
rn r
m�
m
I
1
I
I
I
I
-I
I
I
- - + - N00'06'00"W 329.- (R) - - - - -
LOT 60
LEGEND EXCLUSION NOTES:
BUILDING IT IS THE OWNER'S RESPONSIBILITY TO DETERMINE THE EXISTENCE OF ANY
---------- ROOF OVERHANG (2' TYPICAL) EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE
RECORDED SUBDIVISION PLAT.
DRIVEWAY
x FENCE NOTES:
- - PROPERTY LINE 1. UNDERGROUND UTILITIES HAVE NOT BEEN LOCATED OR SURVEYED. UTILITY
ADJACENT PROPERTY LINE LOCATIONS TO BE FIELD VERIFIED.
BUILDING SETBACK 2. NO CORNERS SET THIS SURVEY.
CULVERT 3. LOCATED WITHIN MUNICIPALITY OF ANCHORAGE GRID NW1457.
C.D.
❑D CLEANOUT SURVEY CERTIFICATION:
EMm ELECTRIC METER
RODNEY P. KINNEY ASSOCIATES. INC. HAS CONDUCTED A PHYSICAL SURVEY
OSR SEPTIC RISER OF THIS PROPERTY AS SHOWN ON THIS DRAWING AND THAT THE
IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND
WELL NO ENCROACHMENTS EXIST OTHER THAN NOTED.
ABBREVIATIONS _
BLM BUREAU OF LAND MANAGEMENT — O ,Q\\�L\\
E EASTING/EAST '+,�7J
EL. ELEVATION /���� ' ' • , �' 1�
N NORTHING/NORTH 49TH
(R) RECORD PER BLM DEPENDANT
RESURVEY AND SUBDIVISION OF"""' """""""""""'II
/SECTIONS DATED MAY 13, 1955
S SOUTH ............
ROW RIGHT-OF-WAY �j. Clark E. Kinney o
W WEST 1 �s LS 11 60 �//
LIS-711
aAx"11-ofessjoji'l
te/
II
-----n-}----------------------------------
II I -
II GRAVEL DR! VEI4AY
I I
I I
u— — — — — — — — — — — — — — — — -
x I0
�o
I
m�
m
---------------------------L----------
I
LOT 72 I LOT 59
I
I
I
I
I
I
I
I
I
I
-------------�
A N
mea
ZE: m
A
0
fa
MOD
3
A
---------------I
I
I
I
I
I
i
1
GRAPHIC SCALE I
I
30 0 15 30 60 120
( IN FEET )
1 inch = 60 It
I
TRACT B
` �-
RPKA
RodneYPlinneyAssociate%inc.
KNIK VIEW SUBD.
LOT 71
SECTION 5, T15N, R1 W, S.M.
ANCHORAGE RECORDING DISTRICT
(PLAT 99-47)
DESIGNED BY: -
SHEET NO.
1
DRAWN BY: CCR
APPROVED BY: CEK
DATE: AUGUST 18, 2021
SCALE: 1'=60'
_ BIRCH CREEK
\ \
LOT 4
BLOCK 4
REV. DATE DESCRIPTION DY
` �-
RPKA
RodneYPlinneyAssociate%inc.
KALEB AND KATIE JONES
20505 LEPRECHAUN DR.
CHUGIAK, AK 99567
LOT 71
SECTION 5, T15N, R1 W, S.M.
ANCHORAGE RECORDING DISTRICT
AS—BUILT
DESIGNED BY: -
SHEET NO.
1
DRAWN BY: CCR
APPROVED BY: CEK
DATE: AUGUST 18, 2021
SCALE: 1'=60'
CCCCCI1118 ECCICEECC■ ICCCI149f
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://w .muni.org/onsite
On -Site Water & Wastewater System Permit
Permit Number: OSP201237
Work Type: WellSeptic Initial
Tax Code Number: 05108111000
Site Legal Address: T15N R1 W SEC 5 LT 71 G:1457
Site Mailing Address: 21888 BIRCH CREEK DR, Chugiak
Owner: JONES KALEB KIMBER &
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date:
I,�cnt
�o� 3,�
n
spar invent µ
Lot Size in Sq Ft:
Total Bedrooms:
8/31/2020
8/31/2021
108900
0 Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy 0 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: The entire subsurface disposal field and alternate is not within a 30 foot radius of a
s percolation test. The Engineer needs to do an additional percolation test prior to the construction of the septic
a' field. Please submit stamped and signed results with the As -built Inspection Report. If the results require a
design change, construction of the system will stop pending On -Site review and approval.
Received By: 41
Issued By. _Vj(' 9 C
Date:
Date. � 31 vZO, 0
MUNICIPALITY OF 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. 051-081-11
Property owner(s) KALEB JONESDay phone g✓�q -69 y y
Mailing address 20505 LEPRECHAUN DR, CHUGIAK AK
Site address SAME 2 1055 9 ,'rc li C ce k D r
Le al descri tion (Buba Block & Lot) T15N R1 W SEC 5 LT 71
g p ,
Legal description (Township, Range & Section)
Lot Size 108900 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
0
Initial ❑
Single Family (SF)
0
(w/wo ADU)
Septic Tank
0
Upgrade F-1Duplex
(D)
❑
Holding Tank
ElRenewal
ElMultiple
Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
0
Water Storage
❑
THIS APPLICATION INCLUDES
A 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: $61 S GGU10- IC
Date of Payment: W
hO
Receipt Number: 010059
Permit No. OsP2yIZ77
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
August 12, 2020
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: New well and septic permit
Legal: T15N R1W SEC 5 LT 71
To Whom it may concern:
This is a request for a well and septic permit on the above referenced lot. A test hole was completed and
found silty sand (SM) for the full 14 foot depth with water observed at 12 feet. After the 7 day monitoring
period the water was measured at 9 feet. The perc rate was measured at 22 minutes per inch. A simple
narrow trench has been designed with 4 feet of effective depth. A new 1500 gallon plastic tank will also be
installed with a 20 inch riser. The secondary test hole has been shown on the site which will be done before
the system is installed. This new system will not impact any of the neighbors or encroach on any wells,
septic or open water issues. The owners phone number is 854-6944.
Sincerely
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201237, Rebecca Carroll, 08/31/20
SEPTIC FIELD SECTION
DESIGN CRITERIA:
4.0' EFFECTIVE
5 BDRM X 150 = 750 GPD
SOILS = 750/0.6 = 1250 GPD
1250 GA/8 = 156'
2.0' WIDE
(2) 78' LONG
(2) TRENCHES
5.0' DEEP
14
(TH#1)
1.0
SM
ORG 3.0'2.0'
-5.0
-1.0
MOUND OVER
FILTER FABRIC
SEWER ROCK
3,3(
GRADE
-TORKELSON CIR--KNIK VISTA STREET-SCALE:
DJRDRAWN:
DATE:
T12N, R1W, SECTION 5, LOT 71
Chugiak, Alaska
KALEB & KATIE JONES
7/14/2020BIRCH CREEKDRIVEPE
T
E
R
S
CREEK100.0'PROPERTY LINE
PROPERTY LINE
SEPTIC
WELL
WELL
PROPOSED
WELL
H2O @ 9' May 2020
INSULATION &
1"=200'
VACANT
VACANT
BLM EASEMENT
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201237, Rebecca Carroll, 08/31/20
PROPOSED
DRAINAGE FIELD
PROPOSED 1500
GALLON PLASTIC
SEPTIC TANK WITH 20"
RISER
1"=50'
TH#1
PROPOSED
SECONDARY
SYSTEM, 5X50, 2'
EFF, APPLICATION
RATE OF 4 GPD/SF
PROPERTY LINE
PROPOSED
HOUSE
PROPOSED WELL
100' RADIUS
DRIVE
W
A
Y
SCALE:
DJRDRAWN:
DATE:
T12N, R1W, SECTION 5, LOT 71
Chugiak, Alaska
KALEB & KATIE JONES
7/14/2020
PROPERTY LINE
T12N, R1W, SECTION 5
LOT 71
T12N, R1W, SECTION 5
LOT 76A
T12N, R1W, SECTION 5
LOT 60
T12N, R1W, SECTION 5LOT 70T12N, R1W, SECTION 5LOT 72SECONDARY TEST
HOLE REQUIRED
PRIOR TO
INSTALLATION
CO
CO
COCO
DCO
TCO TCO
DCO
FCO
MT
MT
SLOPES WERE MEASURED IN THE
FIELD AT 4:1 (12-14 DEGREES), NO
EXCESSIVE SLOPE WITHIN 100' OF THE
SITE, THIS DOES NOT MATCH THE PLOT
PLAN
4:
1
S
L
O
P
E
SMALL DRAINAGE
STREAM
4:
1
S
L
O
P
E
4:
1
S
L
O
P
E
50' BLM
EASEMENT
SPLITTER VALVE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201237, Rebecca Carroll, 08/31/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201237, Rebecca Carroll, 08/31/20
MUNICIPALITY OF ANCHORAGE
Development Services Department j Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 051-081-11
Certificate of On -Site Systems Approval
Expiration Date: b - Z q — 17-
1.
z
1. GENERAL INFORMATION
Complete legal description T1 5N R1 W SEC 5 LT 71
Location (site address) 21888 BIRCH CREEK DR, CHUGIAK AK
Current property owner(s) KALEB JONES Day phone
Mailing address
20505 LEPRECHAUN DRIVE, CHUGIAK AK
Real estate agent Day phone
2. TYPE OF DWELLING:
Fx] Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
5
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Private Septic
F]
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 $ 7-5 Waiver Fee $
Date of Payment ��� 2- Date of Payment
Receipt Number Otl270 Receipt Number,
COSA # 6S'C2,1% 0 0 5 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 MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE ANCH AK
Engineer's Printed Name MIKE N ANDERSON, P.E.
6. DSD SIGNATURE
System #1 Approved for 5
System #2.Approved for _
Disapproved
bedrooms
bedrooms
Date 1-10-22
.gyp a J 1" 4 :f i
*o 49TH
• � • ••
19►fCHAEIN. fiANDLPP Ipj
Cc -
an .v
V&
Conditional approval for oeurooms, with the totlowing stipulation
llll(t((((ff�/�
ON-SITE
AND
r- k, t T
Cl
tion.
m -
By: f M,/--� Original Certificate Date: �-2Z
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: T15N R1 W SEC 5 LT 71
If more than 1 septic system on tot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 9/3/20
Total depth 104 ft
Cased to 104 ft
❑ Sanitary seal is functioning correctly
On Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA new
Static water level at beginning of test 30 ft.
Comments
B. TANK DATA
Age of tank(s) NEW years
Tank type/material ""
Measured operating fluid level in septic tank NEW
❑ Standpipes/foundation cleanout per record drawing
Date of pumping NEW
D. ABSORPTION FIELD DATA
Which system tested (date installed) 1!22/2'
❑ ALL standpipes present per record drawing
Total measured depth from grade 8 ft (max)
Measured depth to pipe invert from grade 4 ft (min)
❑ NIA — pressurized field
HE Monitor tubes go to bottom of effective. If not, state
depth into effective
Parcel ID: 051-081-11
Structure served by this system
Well production at time of test 5+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes ❑ No
ON Coliform bacteria is Negative
Nitrate 5.82 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by MNA
Date of Sample
1/18/22
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date new
Results [D Pass For 5 bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
❑ Code -required soil cover over field Final fluid depth in
❑ System presoaked Absorption rate gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) _
date of test)
Gallons introduced 0 gallons If yes, enter date
Comments/Deficiencies:
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
21
Septic Tank/Lift Station on Lot > 100'
if No
ft
Community Sewer Manhole/Cleanout > 100'
Q Yes
if No
ft
[]✓ Yes
if No ft
Neighboring Tank > 100' Q Yes
if No
ft
Private Sewer/Septic Line > 25'El Yes
if No ft
Absorption Field on Lot > 100' Q Yes
if No
ft
Holding Tank > 100' n Yes
if No ft
Neighboring Absorption Fields > 100'
CD
ft
if septic tank is under driveway comment below
Animal Containment > 50' Z Yes
if No ft
Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Yes
if No
ft
� Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' Q Yes if No ft Surface Water > 100'[]✓ Yes if No ft
Property Line > 5
21
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Q
Yes
if No
ft
Private Wells > 100' Q Yes if No ft
Water Main > 10'
- Q
Yes
if No
ft
Community Wells > 200' Q Yes if No ft
Water Service Line > 10'✓Q
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'
21
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
Q
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Yes
if No
ft
Private Wells > 100' [v] Yes if No ft
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200' ❑✓ Yes if No ft
Surface Water > 100'✓Q
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through held inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
�i•� MICHAEL N.
�,'. C -94.69
COSA Checklist yellow sheet
DEVELOPMENT SERVICES DEPARTMENT
On -Site Water and Wastewater Section
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC 221005
Subdivision: T15N R1W Sec 5 Lot 71
907-343-7904
Fax: 343-7997
A water sample revealed a nitrate concentration of 5.82 milligrams per liter (mg/Q.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
Mailing Address P `O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address P 'Q Box 196650;* Anchorage, Alaska 99519 6650 * www muni org
i
OWNER OF LAND: Kaleb )ones
ADDRESS: 21888 Birch Creek Drive Chugiak, AK 99567
LEGAL DESCRIPTION T15N R1W Sec 5 Lot 71
DATE: 9-3-20
Bore Hole Data
Depth
From To
0
2
PERMIT NUMBER: OSP201237 DATE OF ISSUE: 8-31-20
TAX IDENTIFICATION NUMBER 05108111000
Is well located at approved permit location: ®Yes F—]No
Method of Drilling: ®air rotary ❑cable tool
Depth of Well: 104'
Casing Type: Steel Wall thickness ,250 inches
Diameter: 6 inches, depth 104 feet
Liner type
2
10
10
48
48
62
62
75
75
97
97
104
Static Water Level: 30 feet
Recovery Rate 25 I gpm ❑ gph
Method of Testing Air
Well Intake Opening Type: ® open end ❑open hole
❑ Screened Start feet Stopped
❑ Perforations Start feet Stopped
Grout Type: Bentonite Volume: 50lbs
Depth: from 2 feet, to 42 feet
Well Disinfected Upon Completion: ®yes ❑ no
Method of Disinfection: Chlorine 50 PPM
Comments:
Casing Stickup
Overburden/Peat
Tight Silty Sand & Gravel
Tight Silty Sand & Gravel. w/ Clay
Tight Silty Sand & Gravel
Clay & Gravel
Silty Sand & Gravel
Drillers Name: Cole Sullivan
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.
9/7/21, 12:06 PM
kaleb Birch creek pump log.bmp � o D I o2
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ot
elopment Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: Date of Issue:
Parcel Identification Number:
Legal Descrip 'on Block Lot' Proverty,Ow�Name & Address:
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51--C-5
Pump Installation Date: — C4 -_3 200
Pump Intake Depth Below Top of Well Casing: 7,5 feet
Pump Manufacturer's Name: (� /r✓� C O�
Pump Model: 11052f-_-15 -3 3G
Pump Size: / • 5 hp
Pitless Adapter Burial Depth: ��� feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
Well Disinfected Upon Completion? [ffiYes ❑ No
Method of Disinfection: G//:�,,-:__ TE,�
Comments:
Pump Installer Name:
Company:O%
Mailing Address:
City: State: Zip:
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Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
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