HomeMy WebLinkAboutBUSHNELL LT 2Bushnell
Lot 2
#090-021-60
Municipality of Anchorage Page 1 of 3
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
Permit Number: SW000391 PID Number: 090-021-60
Name: CHIP AND TERA LAVALLEE
Wastewater System: ■ New ❑ Upgrade
Address:
704 SUNSET DR 99501
ABSORPTION FIELD
Phone:
(907) 272-6086
No. of Bedrooms:
2
❑ Deep Trench ■Shallow Trench 13 Bed D Mound 13 Other
DESCRIPTION
Sall Iiat ng:
1.2
Tafel Depth from original grade:
(MAX.)
GPD/Sq. FG
.0 Ft.
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
2 BUSHNELL
4.42 (MAX.) FL
2.58 (AVG.) Ft.
Township:
Range:
Section:
Fill added above original grade:
Grovel length:
—
—
—
N/A Ft.
32 It
WELL:
Gravel width:
Number of Ni
Distance between IInes;
—
New [-1Upgrade5
pt,
1
F.
Claeegiwllan (Private, A,e,C):
Total Depth:
Cooled To:
Total abeoroon ave:
Pipe material:
PRIVATE
112 Ft
112 Ft.
255 SQ. Ft
D 3034/ F-810
Driller
Date Drilled:
Static Water Level:
Inateller.
Data metalled:
HEFTY
10/2/00
90
CONRAD CONTRACTING
10/10/00 — 10/14/00
a
Yield:
Pump Set At.
Dosing Height Above Graand:
TANK
14 GpM
Ft
1.5'+ It
SEPARATION
DISTANCES
■ Septic ❑ Holding 0 S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Pdvots
Manufaetunr.
ANCHORAGE TANK
Capacity in gallons:
1000
From
Tank
Field
Station
Tank
sewer unee
Well
100'+
100'+
—
—
z5'+
Materiel:
STEEL
Number of comportments:
2
SurfaWater tie
100'+
100'+
-
-
-
LIFT STATION
Wat
LotShe
5'+
10'+
—
—
—
In gallons:
Manufacturer.
Line
'Pump on' level at Pump =High
water alarm at:
Foundation
5'+
10'+
—
—
—
_eeeej
CurtainPump
Make I: Eloctrfcal Inspections performed by:
Drain
NONE KNOWN
BENCH MARK
Remarks: TEST WAS DEEPENED TO 13+ FEET. SAME SOIL
Location and Drarlption:
PROFILE AS TH 1. NO GROUNDWATER.
TOP OF PILE ON NORTHEAST CORNER OF
HOUSE.
Assumed Davatbn:
100.00
Ft.
ENGa1PE we
p060f
o OF
%
-
AWWC, INC.
Inspections performed by: Dates: 1st 10/10/2000
...J; .....
2nd 10/10/2000
3rd 10/14/2000
0• a A.ess;'•.�
Department of Health an H man Services approval
00044 '' ., 7953
5 0-1
,.
v�
0
��a"40
Reviewed and approved by: Date:
fesslo
�0000����
72—Di3 Rev. 9/91) MDA 25
PERMITNUMBER: AS -BUILT DRAWING PARCEL ID NUMBER:
SWO
SW000391 090-021-60
ST1
38.27
34.79
ST2
44.32
40.06
DBL7
46.43
42.44
D3L2
47.45
43.47
MTI
56.24
53.46
MT2
83.48
80.30
CO3
84.65
8032
\ \ \ F4ti
\ \ FP
\ �o• \ \ x'90
TEST HOLE EXCAVATED 13' \ \
DURING CONSTRUCTION. SAME
SOIL PROFILE AS IN THj1. ";'•.'
NO GROUNDWATER.ALTERNATE SITE.
'• i! ;
DRN'D MAY i _ \
NEED TO BE
REROUTED.
1
ALASKA NVATER & AVAST : m'ATL'R K.D.W.
Ste'
CONSULTANTS. INC.
6901 DEBARK ROAD. SUTF PB • ANCHORAGE. AK 9950.' PNONF. 907)537-6179 • FA% 01)556-3746 1 w 40'
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
CHIP AND TERA LAVALLEE (907) 272-6086 2 OF 3
LEGAL DESCRIPTION:
BUSHNELL SUBDIVISION; LOT 2
TYPE OF WORK:
AS—BUILT OF SEPTIC SYSTEM UPGRADE
DRAINFIELD
LOT 18
U.S. SURVEY 3201
,
't
�
/ /
�
•''
iii y
NITTHjt
�. 5,...
DBL2
DBL7
C///ppp...
NEW 1000 GALLON
,�, �:,'• A
SEPTIC TANK
NEW TWO '
\
BEDROOM
\
HOUSE I
NEWS•',•
WELL \ I
110. \ I
/
1
ALASKA NVATER & AVAST : m'ATL'R K.D.W.
Ste'
CONSULTANTS. INC.
6901 DEBARK ROAD. SUTF PB • ANCHORAGE. AK 9950.' PNONF. 907)537-6179 • FA% 01)556-3746 1 w 40'
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
CHIP AND TERA LAVALLEE (907) 272-6086 2 OF 3
LEGAL DESCRIPTION:
BUSHNELL SUBDIVISION; LOT 2
TYPE OF WORK:
AS—BUILT OF SEPTIC SYSTEM UPGRADE
DRAINFIELD
LOT 18
U.S. SURVEY 3201
PERMffNUMBER: AS-BUILT DRAWING PARCEL ID NUMBER:
SWO
SW000391 090-021-60
for Of f"-
Af PLEf - 9535
WV uGf PIPE -
Af PLEf - 95.48
511
CM - 96.0+
5f2
MW 1000 6AI,I.ON
5M1C TMK
mom OF MCN
- 90M ( AVG.)
ALASKA «'ATER & WASTKR'ATIM
CONSULTANTS, INC.
6901 DF9A ROAD, SOW 79 • ANCNORAGE. M 99504' PNONF. 907)357-0179 • PAX 07)56-374
PREPARED FOR: PHONE NUMBER:
CHIP AND TERA LAVALLEE (907) 272-6086
LEGAL DESCRIPTION:
BUSHNELL SUBDIVISION; LOT 2
TYPE OF WORK:
AS -BUILT PROFILE OF SEPTIC SYSTEM UPGRADE
7. W02
for Of f"
Af OUILEf - 95.95
- MJ rOPPre
Af OUfl.Ef - 95.19
FINN. awA - 96.15+
WVEI2f OF PIPE
-92.92
10/20/20
AWN BY:
K.D.W.
ALE:
1--40'
CE NUMBER:
30F3
D
�
A. Gamess�
-7953 :79
OCT -19-2000 1551 LR)ALLEE & SONS, INC. P.01
MU
HEFTY DRIWNO i i E / V��� V wA'cn wcLA ALASKA
3540 AKULA DRIVE =J STATE N URAL!A
• ANCHORAGE• AK 995 u . DEPARTMENT OF NATURAL RESOURES
ARCH) RAGA45E. 93 •,1 �G Division Of Geological S GRODhy/IDDI Survvrs
mow•
.ere
LOCATION OP WELL (Il see4 40-0,1614 alto$, 16. 1% 0,r 14.1
M 40raub I SYodWleloR I Lot 716c1
Drilling Poem"N4. OQ�
A.O.L.
1► '/cave. Drilling
le. DISTANCE AND DIRECTION FROM ROAD INTCAICCTIONS S. OWNER y� �ILL �,—•
( inn, °`
S �,n../C / /•� I L A/al6r.: / U j. �Uc/n,et_Ft,J/t
Street Address RN Area of Wall Lasalle, VL1 U��. Qk—gq 0 •. •.
I„t btew
i. WELL LOG
A. WELL DEPTHS (Ilnel) 0. OATC M EOMgLCT10N
d e.loeo
Material Type Too 0114- /�' LOT - d- 00 e
t a. O cable lees 9101eu,T 0 Delva■ Q out
nqL. OVA G 0Avo, Qd,fl64r❑Sero! ❑DIAIrt
• T.USE:USI Domestic. ❑ hello Ilo►•b Q IP40011T
e t C�. !0 litigation 0A6449r14 [3Commerical
tad Well Q Others
e. CAS NO, O Thronged Welded
Ue-.1A. 1a�� /1. Depth Weight _lot./ It.
oleo, In. to�ft. Dealt 311ctuP It.
S, FINISH 01 WCLLS
Type: ! A LC--OIOwdM
Qlel/Meek Bizet L ollNi
Bel ►ebbe. if. and /l.
R4011111ng Gravel Sect
10. STATIC WATER LEVCI YQ /0-
0 Above or Q Below land. surface
E4alPmaot paid:
It. PUMPING LEVEL below load suttee• and YIELD
It. alar ��bs. Pem0,lna-9.p.m.
atlu bre. RwPloe �1•P•w.
IZ.GROUTING Wall 4r40164t.'MY;* 0 we
11.14,141: Q Neel aemonl O Olo$el a,
IS, PUMP, (It available) NP
Le+11b of Drop pipe 11. eesee111 e.►.w.
0 SYIm, C3dal O Cenlrilleel 0 Otbu
It a4maaee,
q j
la. WATCN WELL. CONTRACTOR'S CERTIPICATIONI 1l. W, 141 Ya -0,v---
�.
ThIII ,^ ►ee ^rlllad.rn4e• my lorledletlee and Ibis report Is bee 16 IM but o1 q 6.6.10,140 aid bare,{
aea:.e :
Signed t
Unt•d R tir.je Nam,
A.
Cenlrect LICep44 Retailer
Part, OR•WWa til/ellI•
�•�-Cse/ DiWUetbe: WNIT[•a1,40GRl, PINN•Odiby CANMY•Cee14-U
] P U a
2Q U
TOTAL P.01
Na.
Te+atbgN�
Rupe C�
11eel1A• t
�•I�d�d�
a(]
W❑
le. DISTANCE AND DIRECTION FROM ROAD INTCAICCTIONS S. OWNER y� �ILL �,—•
( inn, °`
S �,n../C / /•� I L A/al6r.: / U j. �Uc/n,et_Ft,J/t
Street Address RN Area of Wall Lasalle, VL1 U��. Qk—gq 0 •. •.
I„t btew
i. WELL LOG
A. WELL DEPTHS (Ilnel) 0. OATC M EOMgLCT10N
d e.loeo
Material Type Too 0114- /�' LOT - d- 00 e
t a. O cable lees 9101eu,T 0 Delva■ Q out
nqL. OVA G 0Avo, Qd,fl64r❑Sero! ❑DIAIrt
• T.USE:USI Domestic. ❑ hello Ilo►•b Q IP40011T
e t C�. !0 litigation 0A6449r14 [3Commerical
tad Well Q Others
e. CAS NO, O Thronged Welded
Ue-.1A. 1a�� /1. Depth Weight _lot./ It.
oleo, In. to�ft. Dealt 311ctuP It.
S, FINISH 01 WCLLS
Type: ! A LC--OIOwdM
Qlel/Meek Bizet L ollNi
Bel ►ebbe. if. and /l.
R4011111ng Gravel Sect
10. STATIC WATER LEVCI YQ /0-
0 Above or Q Below land. surface
E4alPmaot paid:
It. PUMPING LEVEL below load suttee• and YIELD
It. alar ��bs. Pem0,lna-9.p.m.
atlu bre. RwPloe �1•P•w.
IZ.GROUTING Wall 4r40164t.'MY;* 0 we
11.14,141: Q Neel aemonl O Olo$el a,
IS, PUMP, (It available) NP
Le+11b of Drop pipe 11. eesee111 e.►.w.
0 SYIm, C3dal O Cenlrilleel 0 Otbu
It a4maaee,
q j
la. WATCN WELL. CONTRACTOR'S CERTIPICATIONI 1l. W, 141 Ya -0,v---
�.
ThIII ,^ ►ee ^rlllad.rn4e• my lorledletlee and Ibis report Is bee 16 IM but o1 q 6.6.10,140 aid bare,{
aea:.e :
Signed t
Unt•d R tir.je Nam,
A.
Cenlrect LICep44 Retailer
Part, OR•WWa til/ellI•
�•�-Cse/ DiWUetbe: WNIT[•a1,40GRl, PINN•Odiby CANMY•Cee14-U
] P U a
2Q U
TOTAL P.01
�0
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
h' '_
/a/io aoCJ/d,�3�r'
/D 1/6
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Permit Number: SW000391
Date Issued: Sep 22, 2000
Expiration Date: Sep 22, 2001
Parcel ID: 090-021-60
Legal Description: BUSHNELL LT 2
Design Engineer: 0041 AK Water & Wastewater Consultant Site Address:
Owner Name: Chip & Tera Lavallee Lot Size: 49025 SO. FT.
Owner Address: 704 Sunset Dr. Total Bedrooms: 2 Permit Bedrooms: 2
Anchorage . AK 99501 -
This permit is for the construction of:
0 Disposal Field Q✓ Septic Tank Holding Tank Ej Privy Q✓ Private Well El Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-4744 (24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: -1Z —�'r
Date: q-22-00
ALASKA WATER F& WASTEWATER
CONSULTANTS, INC. -
September 8, 2000
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Well and Septic Design for Bushnell Subdivision; Lot 2
To whom it may concern:
The proposed 2 bedroom house will be served by a private well and septic system. One test hole
was excavated on the property. The proposed septic system will be designed within this 30 foot
radius. We are proposing that a 1000 gallon septic tank and a five foot wide drainfield be
installed. Comments regarding the proposed design are summarized as follows:
1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring,
and the percolation test results. It is our opinion that due to the overall appearance of the soils, an
application rate of 1.2 gallons/day/fl2 should be used. The insitu soils should act as a sand filter.
2. TRENCH DESIGN:
a. Percolation Rate: <1 minutes/inch
b. Allowable Application Rate: 1.2 gallons/day/fl2
c. Number of Bedrooms: 2
d. Design Flow: 300 gallons per day
e. Minimum Absorption Area: 250 fl2
f. Total Depth: 6 feet (max.)
g. Effective Depth: 3 feet
h. Width: 5 feet
i. Reduction Factor: 0.58
i. Minimum Length: 30 feet long
j Effective absorption area = 258 fl2
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
6901 Debarr Road, Suite 213 * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
4. TOPOGRAPIIY: The proposed septic area is generally flat; in short, there are no slope
concerns.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179, or 244-9612. Thank you for
your assistance.
.E., M.S.
NOTE: Attached is a site plan drawing, a design drawing, one soil log, and a 7 page
constniction specification letter which are all part of the design package for this septic system.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Far: (907) 338-3246 * Website: ak«,Nvc.com
LOT 16
/ U.S. SURVEY 3201
ARE!3 ♦\` `\♦ `♦/
I �` ♦` (WELL 100'+--�-
i y ♦ \
• % ♦'` --- / ALTERNATE •♦ ` LOT 15
SITE ♦ ♦ U.S. SURVEY 3201
THII
I y ��- ♦ , \ `�
�♦ I ` ♦ ;' ^- • ASEPTIC ►a(! ♦♦\\\ \♦♦♦
1 AR! ♦♦
j ♦ ♦ PROPOSED SEPTIC SYSTEM. SEE �� `♦
DESIGN PACE 2 OF 2 FOR DETAILS. 1 \`
ol
/ ` ` .. ♦ I / LOT 18
/ PROPbgED ` ♦�{ PROPOSED U.S. SURVEY 3201 j ♦`
LOT 32
U.S. SURVEY 3201
I
S/D
ALASKA NATER & NASTK«7ATKR
CONSULTANTS, INC.
aom .v:vevv engin V tTE fe �GE. " 99504 • MORE (907)537-8179 • F" (907"]8-324
K.D.W.
1" = 100'
PREPARED FOR PHONE NUMBER: rwL NVMOLn:
CHIP AND TERA LAVALLEE (907) 272-6086 1 1 OF 2
BUSHNELL SUBDIVISION; LOT 2
SITE PLAN FOR PROPOSED WELL LOCATION AND SEPTIC SYSTEM
A. Camess;
E-7953 ♦F.�
4 -
\ \ °0`yF
\ \ \ 'p-
110-
PROPOSED
0•�
\ /o \
PROPOSED DRAINFlELD. EXCAVATE \ � \
A TRENCH THAT IS 8 FEET DEEP, \
BY 3 FEET WIDE. BY 30 FEET - \
LANG. ADD 3 FEET OF CLEAN. \
WASHED SEWER DRAINROCK.
INSTALL DOUBLE
CLEANOUTS
'ED 1000
EPTIC TANK
/1
PROPOSED
WELL
yn
/ / PRESERVE RESEE SITE
/ /// MAY REQUIRE
// / MODIFlCAT)ON
TH/1 TO DRIVEWAY
- INSTALL
FOUNDATION
CLEANOUT
LAT 18
U.S. SURVEY 3201
DRAWN BY:
tAI.ASRA IVATI;R S WASTEWATER
K.D.W.
SCALE
CONSULTANTS.INC.
•• c 40�
....... . ......
••.....
6901 OFRARR ROAD. SLITE 2R • ANCHORAGE. AX 99506' PHONE 907),137!179' FAX 907)33"266
a ..
QQ
......
REPARED FOR: PHONE NUMBER:
PAGE NUMBER:
CHIP AND TERA LAVALLES (907) 272-6086
2 OF 2
efr A.
QO �� •, 7953
ess?
��
EGAL DESCRIPTION: -
BUSHNELL SUBDIVISION: LOT 2°
,. •
�4v�Qdp"relllO��a��
YPE OF WORK:
DESIGN OF PROPOSED WELL LOCATION AND SEPTIC SYSTEM
040000��
ALASKA WATER & WASTEWATER CONSULTANTS, INC. ob�0000
Or �O^S�000
NET TIME
6901 OEBARR ROAD. SUITE 2B • ANCHORAGE. AK. 99504
PHONE (907) 337-8179 ° FAX (907) 338-3248 P
8/25/00
SOIL LOG
- PERCOLATION TEST Opk ,
..•• •. . ' . .. .......
�0
LEGAL
BUSHNELL S/D• LOT 2
DESCRIPTION: 0
PERFORMED FOR: CHIP AND TERA LAVALLEE•••••••••••�
r .A. Gam ess:
DATE
PERFORMED: 8/25/2000
—7953
Q \FO
TEST HOLE #1 44p"
(feet)
ORGANICS
Prof a clod"
o0. .v ,
sniL CLASSIFICATIONS \ \
0 0°; d
SITE PLAN \ \
GORG \ \
W I' = 100'
puo_.y.
GM CL \\ \\
4
Qo°. d
GC OL — f \
SW MH,�\
5
..,., ; SP CH
sm-
' : OH Q
e°°c4 y
SM
'OTH
8
SW GW
/
Sc �Z 1
" 1Y
7
e oa•
DEPTH TO
ROUNDWATER DATE \\ I
8—
o°oa`�=
DRY 8/25/2000 j\
o •....
°o°: �''
DRY 9/3/2000 \\
10
boo.-
it
0° o'
a
DATE READING TIME (MINUTES) READING (INCHES)
12
° oy.;
s.D.I
13
14—
15
16
17
18
19
PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 8 (INCHES)
20
TEST RUN BETWEEN 8.5 FT. AND 7.0 FT.
COMMENTS:
PERFORMED BY ALASKA WATER do WASTEWATER. I, JEFFREY A. GARNESS, CERTIFY THAT THIS
WAS PERFO M D IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON
DATE: Sf 03
CLOCK
NET TIME
WATER LEVEL NET DROP
8/25/00
P��EO
P`'
R0�0
Pe50
kus*
MUNICIPALITY OF ANCHORAGE
Development Services Department _ f Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Parcel I.D. 090-021-60
Certificate of On -Site Systems Approval
Expiration Date:
1. GENERAL INFORMATION
Complete legal description BUSHNELL LT 2
Location (site address) 324 POWERLINE RD, Anch AK
Current property owner(s)
Mailing address
Real estate agent
GREGORY LAWTON
PO BOX 8615 Indian AK
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 2
4. TYPE OF WATER SUPPLY:
Private Well
Water Storage
Community Well
Public Water System
Waiver request for:
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
0
Private Septic;
0
❑
Holding Tank!
❑
❑
Community
❑
❑
Public Sewer i�
❑
Received by: Date
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ q 8 o / 610 0 6a
Date of Payment to Za/;0 s'6
Receipt Number 6025-67
COSA # ()S G ac)1=9
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
COVID-l9
257o DISCOUNT APPLIED
Distance:
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. Date 5-31-20
6. DSD SIGNATURE
System #1 Approved for 2
System #2 Approved for
Disapproved
Conditional approval for
OF
49T ys°
rj
bedrooms • MICHAEL' N. ANDERSON , %
f''
bedrooms �,�;•,• CE 99 •,�
� aFj p�( , 1
bedrooms, with the following stipulations:
J
J.
a<<���/�
��1111))1 )1111111
By: � Original Certificate Date: tp'— r20
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 y�
0 t
COSA Checklist blue sheet
COSA Checklist
Legal Description: BUSHNELL LT 2 Parcel ID: 090-021-60
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 'oianwo
Total depth 112 ft
Cased to 112 ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 5/27/20
Static water level at beginning of test 90 ft.
Comments
B. TANK DATA
Age of tank(s) 20 years
Tank type/material 5"j'GSf
Measured operating fluid level in septic tank 48
Al Standpipes/foundation cleanout per record drawing
Date of pumping MAY 27
D. ABSORPTION FIELD DATA SHALLOW TRENCH
Which system tested (date installed) 1011012000
® ALL standpipes present per record drawing
Total measured depth from grade 7.1 ft (max)
Measured depth to pipe invert from grade 4.5 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 0 gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Well production at time of test 5+ gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 0.778 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by MNA
Date of Sample 5/27120
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 5/27/20
Results ❑✓ Pass For 2 bedrooms
Fluid depth prior to test 15 in
Water added 300+ gal
New depth 20 in
Elapsed time 1440 min
Final fluid depth 14 in
Absorption rate 300+ 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'
❑✓
Yes
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
ft
❑ Yes
if No ft
Neighboring Tank > 100' ❑ 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' ❑ Yes
if No ft
Neighboring Absorption Fields > 100'
✓❑ Yes if No ft
Water Main > 10'
Animal Containment > 50' ❑ Yes
if No ft
❑ Yes
if No
ft
✓❑ Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
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'
❑✓
Yes
if No
ft
Surface Water > 100'
❑✓ Yes if No ft
Property Line > 5'
✓❑
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
if No
Yes
if No
ft
Private Wells > 100'
✓❑ Yes if No ft
Water Main > 10'
❑✓
Yes
if No
ft
Community Wells > 200'
✓❑ Yes if No ft
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'
❑Q
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'✓❑
Yes
if No
ft
Private Wells > 100' P✓ Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
ft
Community Wells > 200' ❑✓ Yes if No ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l 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.
COSA Checklist yellow sheet
r F',
r
MICHAEL N. ANDERSON `yam
CE -9 69
k RoPESSiu�`, ��
DEVELOPMENT SERVICES DEPARTMENT
On -Site Water and Wastewater Section
g„
www.muni.org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval #OSCosc201222
Subdivision: Bushnell Lot 2
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 20 years old. Typical replacement costs range from $8,000 to $11,000.
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of what the metal of a 20 year old steel tank MAY look like.
r
} Mailing Address PO Box 196650 *Anchorage Alaska 99519 6650* www muni org 7
Ecklund, Timothy J
From:
Walters, Michael S.
Sent:
Tuesday, June 9, 2020 8:51 AM
To:
Ecklund, Timothy J
Subject:
RE: Bushnell Lot 2
Right of Way notes the well is in the 50' BLM Reserve and has no objections at this time.
Mike
From: Ecklund, Timothy <timothy.ecklund@anchorageak.gov>
Sent: Tuesday, June 9, 2020 8:42 AM
To: Walters, Michael S. <michael.walters@anchorageak.gov>
Subject: Bushnell Lot 2
Mike,
Could you confirm that ROW has no objection to a well on the subject property being located just inside a BLM Reserve.
See attached
Thanks Tim
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-\ Municipality of Anchorage ,
1 Development Services Department':`
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING t�t
Parcel I.D. �.D9�'Qa �— /r0 COSA # Do � -t�
Expiration Date: J — l l —.!az
1. GENERAL INFORMATION
Complete legal description 5sl,nell Lei 7 -
Location
Location (site address)
Current Property owner(s) Clnarkes L Ay4 Illee Day phone 1053--105,9
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
JCC 5 8 (3oX 85ro6 (;;n\ 0-rce1L `i95YD
Unless otherwise requested, COSA will be held by DSD for pickup.
Day phone
Day phone
2. NUMBER OF BEDROOMS:
a
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
IE
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm $Pu1ZKLANb c1 yf/_R1A/rr
Address 20.3 W. ISK SVje. Z03AAnc�x14c'I AK 94501
Engineer's Printed Name _ Lys Spsir�an�
5. DSD SIGNATURE
Approved for 2
Disapproved.
Conditional approval for
bedrooms.
Phone 2-4 q - 39 t u
Date fo is o•a
OF
P� .. .... �(1
tAAS P SFURFLA
.\o
1 ���E551Cit� E.
bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By:- O/�1�, !�� Original Certificate Date: '7-40,
(Rev. 11,OS)
Municipality of Anchorage ••,
• '� Development Services Department
Building Safety Division `
On -Site Water & Wastewater Program "
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: B Isl��e1) Lo{ 2 ParcellD: 094- 021- 6fl
A. WELL DATA
Well type PriJ Ac If A. B, or C provide PWSID # = Well Log (Y/N) Yes
Date completed _14m00 Sanitary seal (Y/N) -Y!r6 Wires properly protected (YIN) `/es
Total depth11_ft. Cased to Ita ft. Casing height (above ground) 2/o in.
FROM WELL LOG AT INSPECTION
Date of test _L01-4 20o0 513t zoo
Static water level 90 ft. 1Z ft.
Well production ly 9 P•m• G. g.p.m.
WATER SAMPLE RESULTS:
Coliform Ii colonies/100 mL Nitrate 0.5(o mg/L
Arsenic: N_ ug/L dale of sample: 531 o}
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Arsc. ,oras lark' S}�1
Tank size lao gal. Number of Compartments 2
Foundation cleanout (YIN) y Depression over tank (Y/N) N
Other bacteria 91_colonies/100 mL
Coltected by: L c rs }d a� l
Dale installed lol/%ztoo
Cleanouts (YIN)
7<
High water alarm (Y/N) /%/
Date of pumping '3/o' Pumper A4 Flon SefJiOe�
C. ABSORPTION FIELD DATA
Date installed to co 2000 Soil ratingg.p.d./ft orfelbdrm) 42- System type 5W1o,,) T�enc%
Length 3a ft. Width 5 ft. Gravel below pipe 2./o ft.
Total depth _5 ft. Eff. absorption area 255 ftZ Monitoring tube Y Depression over field W
Date of adequacy test 5 3/ oI Results (Pass/Fail) as
For a bedrooms
Fluid depth in absorption Neal before test 5 in. Water added 50o gal. New depth 15 in.
Elapsed Time: 0 min. Final fluid depth ,�_ in. Absorption rate >= 500 g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) &&Arte know^ If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
'Pump on' lev _ in. 'Pump off level _ in. High water alarm lev in.
Dat Cycl led Meets alWrg circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot too'+ On adjacent lots
Absorption field on lot 100+ On adjacent lots
1Oo'+
I0o'+
Public sewer main ,VIA Public sewer manhole/cleanout N
Sewer /septic service line 50 t Holding tank .NIA
Animal containment areas 54- Manurelanimal excrete storage areas JOD +
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 1+ Property line 10+ Absorption field S t r
Water main /� A Water service line 25 t Surface water 100,+
Wells on adjacent lots 100'4 -
SEPARATION
00+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line I0+ Building foundation 10 i Water main L/A
Water Service line 25 1+ Surface water 100 + Driveway, parkinglvehicle storage Z
Curtain drain None 065.r4e. Wells on adjacent lots I DD A-
F.
F. COMMENTS
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.
Engineer's Printed Name Lac'S SAut'f isol
Date 15 D+
COSA Fee $ T�
Date of Payment 6h 9
Receipt Number. `>'to &&
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
00F.A4.
rq
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15"0
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\ ��\ �p0>• Povs •CC 0S.
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LOT 1
01
4 \
•m LOT 2
voce twa
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/ted
LOT 18
US SURVEY NO.3201
NOTE: 1)IIcarings and distances are as plat No. 85-302, Anchorage recording district.
5ENTEC
Surveying • Engineering
2525 Gambell Street, Suite 200, Anchorage, Alaska 99503
Tele: (907) 5634835 Far (907) 563.3817
AS BUILT OF: LEGAL DESCRUMON
Lot 2,
Bushnell Subdivision,
07-4666
2•'49TM*
MICHAEUS.. HORNE.: S i
v,'•, No. LS -5;18`
i
...
1 40%rfS lPtN� -W1 �\\W���
tducted a physical nrvey of this property as shown
this drawing and that the improvements situated
reon aro within the property lines and no
soachments exist other than noted.
CLUSION NOTES: It is the owners tesponsibilsry
to determine the existence of any easements, covenant
or restrictions which do not appear on the recorded
subdivision plat NOTE: Under no circumstances
should any data hereon be used for the construction or