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HomeMy WebLinkAboutSIEFKER #2 LT A-5C Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231304 PID Number: 015-272-54 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New M Upgrade Name MCGILLIVRAY FAMILY TRUST ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ound Site Address 11520 JEROME STREET *ANCHORAGE, AK El Other Phone Number of Bedrooms Soil Rating Total depth original grade 907-350-1237 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SIEFKER #2; LOT A-51C Fill added above original gr Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100,+ TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Z1001125'+ Manufacturer GREER TANK Capacity 1500 Gal. Surface Water 100'+ Material Number of compartments Lot Line 51+ 00FNA HDPE 12 Foundation LIFT STATION Manufacturer Capacity 110,+ Remarks PER CONTRACTOR OLD TANK DECOMMISSIONED PER UPC Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 A+ HOME SERVICES Drainfield D3034/EXISTING CO/MTD3034 Inspector GEG BENCH MARK (Assumed elevation) 97.31 ft Inspdecct Sn 19I 9/25/2023 2nd - Location and description 3'd _ 4'" _ TOP OF MH ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp o0600p4 Conditional Approval: Date oo�P ,oma*c� 4- � T� .. .... ...........� d I-. T .................� Septic System 0� ff y` Gar ess: Q � -•, CE95 �p Approved Date �;�3/20��—� Note: this approval does not include well permit requirements. r #AECC884 D0000 �r�ov uaivu 10/ PERMIT NUMBER: RECORD DRAWING W I N O PARCEL NUMBER: OSP231304 015-277 2-54 10' UTILITY EASEMENT PIPE LOCATION ARE SHOWN PER DBL1 37.9 52.7 DBL2 39.4 53.3 MH 42.0 54.9 STI 46.7 57.6 DBL3 48.0 58.5 DBL4 49.5 59.5 PIPE LOCATION ARE SHOWN PER .DWG FILE PROVIDED BY SURVEYOR (.PDF IS ATTACHED). SWING TIES WERE DERIVED IN AUTOCAD.--- O GARAGE + •.:; ;; '. TENT SIEFKER #2; LOT A -5B • NEW 1500 GALLON GREER TANK 4�. •: ?•'., `- "' ` r- t'( 1976 TRENCH; NEW CO AND MT +' : '..a „ ~ _•; INSTALLED AT NW END OF TRENCH f:' DBL3&4 EXISTING ~.•.`� �' . �'•: O H1 HOUSE STI DBL1&2 i• —"BOOTLEGGED"SYSTEM \ \ DOCUMENTED IN 2023 \ 100' WELL RADIUS — I SCALE: 1"=40' 10' UTILITY EASEMENT 9 Ltd ENGINEERING -SALES, CONSULTING 3701E. TUDOR ROAD, SUITE 101 "ANCHORAGE, AK 99507 * PHONE (907) 3373179' FAX (907) 338-3246' WEBSITE: w gars ,ngineer.ng.co PREPARED FOR: PHONE NUMBER: PAGE NUMBER: MCGILLIVRAY FAMILY TRUST 907-350-1237 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: SIEFKER #2; LOT A -5C D.J.G. TYPE OF WORK: DATE: SEPTIC TANK RECORD DRAWINGS 9/29/2023 OF F I\` .. .... R ................ eyA Game S••:'� A 1 C -7953 ' �_�AV LICENSE ���2 AV N*�5�� � ••• #AECC884 PERMIT NUMBER: PARCEL ID NUMBER: OSP231304 RECORD DRAWING 015-272-54 TOP OF MANHOLE = 97.61 FINAL GRADE = 97.00-97-31 MH1 ST1 TOP OF TANK AT INTLET = 93.12 TOP OF TANK AT OUTLET = 93.12 INVERT OF BUNG AT INLET = 92.42 INVERT OF BUNG AT OUTLET = 92.25 NEW 1500 GALLON GREER TANK • PER CONTRACTOR TANK IS IN:OLD LATED • PER CONTRACTOR BOTH THE STEEL AND CONCRETE TANK RE ABANDONED PER UPC • PER CONTRACTOR OLD SEEPAGE PIT WAS DECOMMISSIONED PER UPC VA ��•�� O ..`'• - 711♦ Aw •. GARNESS ENGINEERING GROUP, Ltd = %.....6...1•.4 .. ........................% ENGINEERING SALES CONSULTING _ 3701E. TUDOR ROAD SUITE 10" ANCHORAGE, AK 99507 -PHONE (907) 337-6179 -FAX (907) 338-3246 'WEBSITE:xvnvgamessengneenng— ^ �.......... ...... PREPARED FOR: PHONE NUMBER: PAGE NUMBER: �n e rey A. G � mess VAw MCGILLIVRAY FAMILY TRUST 907-350-1237 3 OF 3 0, C) ' CF"79 3 LEGAL DESCRIPTION: DRAWN BY: \ �•••'���� SIEFKER #2; LOT A-5C D.J.G. LICENSE �pROFESS1����' TYPE OF WORK: DATE: SEPTIC TANK PROFILE 10/2/2023 #AECC884 4FA►�\\�� • EIMP fl - 00 *9 I.. Oro fl - Lot A-6 N89059'12"E 297.01 10' Utility Easement rage Greenhouse cp Tent 24.1 —0.8 Jan Shed Septic vent (typ) Manhole � Chimney 1.0 —0 E well 0 ii Ramp 26.( Z 2.5 OH Shed Wood fence MIJ 0 E 0 CY) o C) 0 I Z Concrete ret. wall (typ) i E 1IJJ cu lO LOT A -51C 33 7301 i -J W W Cl) W 2I ry W 3 10Utility Easement 33 N89058'30"E 297.37 CY) co CY) M _6J KLA17 ROAD RECERTIFIED 9-27-2�) /-) AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASKS Standards of the following described property: LOT A -5Q, SIEFKER SUBID. No. 2 Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 27th —day of September, 1976. FRED WALATKA & ASSOCIATES, L.L.C. Engineers and Surveyors 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. OF • A4 I AW A, 49th 000 00 s. 00 00 00 izabeth L. Walatka 8036 - LS SCALE: 1"= 50' AW xvt� EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED 11 Fb 23-1, pg 30-32 PLAT ARE NOT SHOWN HEREON Recert 6-15-79, 8-27-86, 7-11-23 BE UNLESS OTHERWISE NOTED. Fb 76-2, pg 35 I hereby certify that I have performed a Mortgagee's inspection in accordance with ASKS Standards of the following described property: LOT A -5Q, SIEFKER SUBID. No. 2 Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 27th —day of September, 1976. FRED WALATKA & ASSOCIATES, L.L.C. Engineers and Surveyors 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231304 Work Type: Septic Upgrade Tax Code Number: 01527254000 Site Legal Address: SIEFKER #2 LT A -5C G:2635 Site Mailing Address: 11520 JEROME ST, Anchorage Owner: MCGILLIVRAY FAMILY TRUST Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date Expiration Date: �»cnt �0 U � Department Lot Size in Sq Ft: Total Bedrooms: 9/18/2023 9/17/2024 88262 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: C Date: Issued By: � Date: �� Z 3 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION N Parcel I.D. 015-272-y y Property owner(s) THOMAS MCGILLIVRAY Mailing address 11520 JEROME STREET *ANCHORAGE, AK Day phone 907-350-1237 Site address 11520 JEROME STREET *ANCHORAGE, AK Legal description (Sub'd., Block & Lot) SIEFKER #2; LOT A -5C Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field © Initial ❑ Single Family (SF) El Septic Tank Upgrade x❑ (w/wo ADU) Holding Tank El Renewal❑ (D) ElRenewal Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: DRAINFIELD TO DRAINFIELD Distance: 3 FEET 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: _ y Date of Payment: 5 2 02- Receipt Number: Permit No. Si' 1 3 U Waiver Fees: Date of Payment: Receipt Number: Waiver No..0_5V 1310119 GADevelopment Services\Building Safety\On Site Water and Wastewatefforms\Client FormsWermit Application.doc Ali Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231304, Curtis Townsend, 09/18/23 11 clld'7_ Municipality ®f Anchorage _:,..tt� s n 11, =rv, J_ P.O. Box 196650 ® 4700 Elmore Road Anchorage. Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV231049 Permit#:OSP231304 PID#: 015-272-54 Legal Description: SIEFKER #2 LT A -5C Engineer: Jeff Garness Your request for a waiver of the required 10 feet horizontal separation between the 1976 trench and the undocumented trench has been approved. The approved separation distance is 3 feet. This waiver approval applies to the existing absorption fields. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................... 0 E R N a E ............ 0 N a a K E E N 0 0 a n. 1 Waiver is Granted: X Waiver is not Granted: Date: / QO2 Approved by: Name of Reviewer ................................................ 0 N a a X N ................. 0. 0 0... 1 **** VARIANCE/WAIVER REVIEW **** Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231304, Curtis Townsend, 09/18/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231304, Curtis Townsend, 09/18/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231304, Curtis Townsend, 09/18/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231304, Curtis Townsend, 09/18/23 Lot A -5B 1-0 1 OR 0 24.1 Lot A-6 8189059'12"E 297.01 — — 10' Utility Easement — — — — N Sent Storage Shed 0 cd 1.0 m Septic vent (typ) CCo y 2 Chimney ° ° d'° Ramp Shed 2.5 OH Wood fence r. crGreenhouse V cree ret. wall (typ) 158.6-- PSP,�att Well 4 LOT A -5C I Ic °3 E N lW C) M co o C) O r 33 7301 H W W C/) W 2 01W ------ ---- ---------i 10' Utility Easement 33 N89058'30"E 297.37 M M (r7 M KLATT ROAD RECERTIFIED 7-11-23 _ AS -BUILT NO CORNERS SET THIS DATE UNLESS OTHERWISE NOTED. Fb 76-2, pg 35 BE 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. ""NNN N w I v. OF I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards the following A �� . » • • • • Cq� t� of described property: LOT A -5C SIEFKER SUBD. No. 2 » AM • °49th » •.�� Anchorage Recording Precinct, Alaska, and that the rr • improvements situated thereon are within the property lines �r and do not overlap or encroach on the property lying . , adjacent thereto, that no improvements on the property lying >! o . lizabeth L. Walatka .° oo adjacent thereto encroach on the premises in question and s° ,.r ' that there are no roadways, transmission lines or other . • . Z .s �` visible easements on said property except as indicated SCALE: V=50' �F� »`• �o ssioNt+ti y► hereon. Dated at Anchorage, Alaska this 27th day of September, 1976. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED g4 Fb 23-1, pg 34-32 / ".. FRED WALATKA 8 ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON Recert 6-15-79 8-27-86 Engineers and Surveyors UNLESS OTHERWISE NOTED. Fb 76-2, pg 35 BE 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. GRE ,.iR ANCHORAGE AREA BOR,. Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION/REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION () 4F~ ~--~Z-~/¢'/~ LEGAL DESC RIPT,O. SEPTIC TANK: DISTANCE FROM W E L L ~4'~,~/~z '7~?AN U FACT U RER INSIDE LENGTH INSIDE WIDTH__ _? (~'~//'~ X_)uC¢~,e.~,' NUMBER OF MATERIAL __ COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY GALLONS. DISTANCE FROM WELL FOUNDATION ~__NEAREST LOT LINE ¢;~ ~') / TOTAL LENGTH / OF LINES ~ / NUMBER OF LINES ~L__ DISTANCE BETWEEN LINES .TRENCH WIDTH,~'~J. IN. ABSORPTION AREA ~ SQ. FT. LENGTH OF EACH LINE __ DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE TOTAL EFFECTIVE IN. ABOVE TILE IN. WELL: TYPE BUILDING FOUNDATION CESSPOOL APPROVED .CONSTRUCTION__ __ NEAREST LOT LINE __ , OTHER SOURCES DISAPPROVE[D--. NEAREST SEWER LINE _REMARKS DEPTH SEPTIC SEEPAGE , TANK __, SYSTEM DISTANCE FROM: DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM Form EQ-032 GRE:, !R ANCHORAGE AREA BO, JGH -~':~-~- SEWAG' DISPOSAL SYSTEM --, APPLICATION AND PERMIT TYPE ANDSIZE OP FACILITY TO BE SERVED 5 SOIL TEST,ReSULTS __ / '7{~ NOTE~ THIS PERMIT IS NOT VALID WITHOUT SOle TEST COMPLETION DATE ANTICIPATED ~U~'P~~ ~/~ ~ / FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OE'~ENViRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, SEPTIC TANK SIZE TYPE 'SEEPAGE AREA SIZE TYPE ~-~.~' ~'"{~;~- MINIMUM DISTANCES, REC/UIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE Pit SEPTIC TANK tO SEEPAGE PIT WALL SEPTIC TANK ,SEEPAGE Pit TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FI ELD~ SEPTIC TANK, SEEPAGE Pit , DRAIN FIELD , DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS, SEEPAGE PIT , DRAIN FIELD CAST IRON rNTO AND OUT OF SEPTIC TANK AND INTO CRIBCROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL, 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANI~:AND SEEPAGE Pit FITTED WITN AIRTIGHT REMOVASLE CAPS. GRAVE:I. BA(~J~FILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION, I CER'rIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA r~OROUGH ORDINANCE NO. 28-6B AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. .~ --~ -- APPLICANT'S SIGNATURE ~ EQ-016(3-75) T.H. 1 8/2/76 0! Klatt Road Sandy Silt w/some Organic Material Sand w/some gravel & TR Cobbles SP Sandy Gravel w/TR Cobbles GP 14' T.D. This log represents subsurface soil conditions within Lot A-5 Sieker Subdivision Sec 21 T12N R3W PI&M CON~ilJLTANTS~ INC. R.P Fortin GRID: Anchorage, Alaska PROd. NO 656263-A DWG. NO. MUNICIPALll'Y OF DEP'[, OF HEAL[II & ENVIRONMENTAL PROlt!CI ION WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological A Geophysical Surveys LOCATION OF WELL ]~.] Borough .An ch ]~C~J DISTANCE AND DIRECTION (Pleuse complete either Io, lb or lc.) Subdivision Drilling Permit No. 860196 A.D.L. No, Lot Block I/4qtrs. Section No. Township N[~] Renge EEl Merldlon L-of-o'-o'- so ~OM ROAD INTERSECTIONS ~,. OWNER OF WELL: Add~e,s: Tom McGillivray Well Location pe Top Bottom 0 Irri~otlon 0 Rechorg~ 0 Commerlcal 8. CASING: ~ Threaded ~ Welded ~1_ 1~7 138 di.m. 5 In. 'O 180 ". Ooplh Weight Ibs,/ft. ~_a~l~ 138 I 46 ~. FINISH OF WELL: Type:~pO~ ~l~ Dlome/er: sJ. lt-lenses 146 165__ s,o,/~o,, s,,.: g..~t.: tel & silt s~t ~,.~. ~ravel It20 ]75 180 145' IO. STATIC WATER LEVEL: ft, / / gp~l ~ Above or ~elow land surface Dote Equipment used: II. PUMPING L[VEL below land surface and YI~D O~ {O~G~ ft. oder hrs. pumping 1 g.p.m. _~u ~. oF H~L~~A~- ?~n~ ft. a.~ hrs. pu~pin~ ~...m. 14. REMARKS: CERTIFICATION: [5. Waler Temperoture ~o ~ F ~ C W jurisdiclion ond this report is hue lo the besl of my knowledge and belief; Name Contract License Number Copy Distribution; WHITE-StoLe DGGS~ PlNK-Dri]ler~ CANARY-CustOmer 2. WELL LOG Materiel Type sandy-gravely hard pan cobbles ..... h a~r~jb.~b~r n__ with .lenses gray brn sloppy of cemented blue brn hard -bill 15 plus 16. WATER WELL. CON'~RACTOR'S This well wes drilled under .Al a~ka_ No ~v7 We ]_~l_/ ..... Regisl~rod Business Ii!2'./) I... S'tl::;~Elii]', AI',.IC)I'IOI::d.~GI}i; ,, Al'=:] 9'-/u.'zC) 2 6z1'-'4'i 2() I.... l!!i] E')A I.... I..OT S I Ztii!i: I..,.OT: ASC RANGlii:] ',: 3W f'c,f'l:.l"~ I:)y 'i'.l'"~f.'.~ Mur"~:i.c:::i.l::ial:i. ty of' Arlchc!r'alLle (MOA) arid the State of' A].aska,, :[ ~x~:i:l.:l.:i. ns'i:.a].l tl'"~e:, ~i~ys'/:.em :i.n accc~r, danc:(:..:, t,,~:i, tl~t all I"l(]A c::c)d(:~)s and arid :i.n c:(::)ml::,]ianc:¢:a ~,~:i.'l'..l'l ti't(.:..:, des:i.~?p'i c:r-:i, ter':i.a i~f' th:i.s i::ler'm:i.'/'.,, :f: ~.,,~:i.].]. adh(.::,r'(.:,-~ '~'.(::) ,'.:il.1. MOA and State c:)f~ A]a. ska r.(.:.~qu:Ll"(.:.':,ment~i t'(::)t' 'i'.l"le~) s(.:::,t back (::j :j. s.l.. an c es I i, (:]m ali y (:~:,x i st :i rig ,~.)~.~ ]. 1 ,, ,,-~as'~..e~u~d:. [.:'.)[' (;:1 :i. sp c)sa ]. ~ys'l'..em (::)[' j::) uJ::~ :J. i c ............... :t..,.... AI"F"I...!.CZ:AI',II ~ '1 IIOI"IA'.:~i F'fl:: GJ.I....I...IVI':d.~' MUNICIPALITY OF ANCHORAGE Development Services Departments Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 015-272-54 Certificate of On -Site Systems Approval Expiration Date: 3 2o �— y Legal description SIEFKER #2 LT A -5C site address 11520 JEROME ST Anchorage AK Current property owner(s) MCGILLIVRAY FAMILY TRUST XThe On-site system(s) is/are approved for 3 bedrooms Conditional approval'for bedrooms, with the following stipulations: Comments or advisories: M Original Certificate Date: 10/3/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovMjune 2022 MUMUPAUTY OF ANCHORAGE Development Services Department x_ -P P P Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application ? 1. GENERAINFORMATIONf , L Parcel I.D. 015-272-54 Complete legal description SIEFKER #2; LOT A -5C Location (site address) 11520 JEROME STREET *ANCHORAGE, AK Current property owner(s) MCGILLIVRAY FAMILY TRUST Day phone 907-350-1237 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑® 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: ❑Q Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑® Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑IE 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 $ D KO Waiver Fee $ Date of Payment COSA # 0 S C Date of Payment Waiver # COSA Applioalion—June 2022 Qd COSA Checklist Legal Description: SIEFKER #2; LOT A -5C Parcel ID: 015-272-54 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA K Well log is filed with Onsite (or attached) Date drilled 7/7/86 Total depth 180 ft Cased to 180 ft 0 Sanitary seal is functioning correctly R Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 7/20/2023 Static water level at beginning of test 112.6 ft. Comments B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping N/A ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) *UNK 0 ALL standpipes present per record drawing Total measured depth from grade 9.25 ft (max) Measured depth to pipe invert from grade 5.5 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. X Monitor tubes go to bottom of effective. If not, state depth into effective **4.2 ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced _gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Well production at time of test 4.7+ qpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes IN No ❑■ Coliform bacteria is Negative Nitrate 2.21 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Collected by GEG Date 8/21/2023 0 Arsenic less than MRL (ND) C. LIFT STATION ❑ Required maintenance Age of lift station Lift stationrial Adequacy test date 7/20/2023 Results Q Pass Fluid depth prior to test **11 in Water added 716 gal New fluid depth 22 in Elapsed time 135 min Final fluid depth 16 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 50 in Effective depth used 16 in Effective depth remaining 34 in Comments/Deficiencies: 'THE SYSTEM WAS INITIALLY BOOTLEGGED AND THE INSTALLATION DATE IS UNKNOWN - SYSTEM DOCUMENTED IN 2023 "DURING THE ADEQUACY TEST ONLY THE SOUTHERN MT AND CO (MT1 AND 001) OF THE SOUTHERN TRENCH WAS PRESENT. ALL MEASUREMENTS ARE BASED UPON THAT MT AND CO THE SYSTEM HAS BEEN CONVERTED TO A DUAL TRENCH TYPE SYSTEM. ONLY THE SOUTHERN TRENCH WAS TESTED FOR THE ADEQUACY TEST. A NEW CLEANOUT AND MT WERE INSTALLED ON THE 1976 TRENCH AND BOTH MrS WERE DRY ON 9/28/2023 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' DYes if No ft❑Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' Mn Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft ral Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' E Yes if No ft A 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' pQ Yes if No ft Surface Water > 100' n Yes if No ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS Qo Yes if No ft n Yes if No ft no Yes if No ft QQ Yes if No ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' M Yes if No ft 9 Yes if No ft If tank or field is under driveway comment below G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gamess Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Games Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. opo O q Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend o . • s 0 upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate p©� �0 during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing * L the system/s. These conditions can vary, and are outside the control of GEG. satisfactory test results do not . �............... guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding I the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform `� y A. Gar ess:" G adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG 7CE 795 �p to perform the evaluation. Reliance upon the information provided in this report by any other person or party Q e (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever.CENSE �(� " • " • • o_o COSA Checklist June 2022©OO�oo��©� (b) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CF..RTIFICATE OF iNSPECTION FOR FIEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date '~(~ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name ~.~0.~'0~ ~ ¢iJl~d&¢~Telephone: Home 5¢~'0¢ ~ Business Applicant Address _ ~8~¢. Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other ~ (explain); Lendinglnstitution ' ' ' ~'' '- p~%~hone Address ~~?;.. ~ ¢ ~ .~¢ Real Estate Company and Agent Address Telephone .? (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family ~ Multi-Family [] Number of Bedrooms '~[ Other WATER SUPPLY Individual Well E~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite I~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 (11/84) 5. EI~IGINEERING FIRM PROVID., _.~ INSPECTIONS, TESTS, FILE SEARCH, ~.,,~I'A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this He~,lth Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this i ns. pection. Approved ~"J Disapprove~d Conditional Terms of Conditional Approval CAtJTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska, The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) A. WELL RA A'_1-1,\-\t�\ O\' \ (^ MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: S �k,� .6. Ln1 A SC. Well Cfissification If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ��5 Date Completed -7 Yield 1 S q PM Total Depth �� Cased to g0' Depth of Grouting A• Static Water Level N 5 Pump Set At l Casing Height Above Ground z'S Sanitary Seal on Casing (Y/N) V LS aE- Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) At b Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots I DO` + To Nearest Edge of Absorption Fieldon Lot /bot 4- ; On Adjoining Lots To Nearest Public Sewer Line N Ilk To Nearest Public Sewer Cleanout/Manhole N /A To Nearest Sewer Service Line on Lot N Water Sample Collected by L • 3QO-r ; Date t - I. _L_ _ v c B. SEPTIC/HOLDING TANK DATA + 'r` Date Installed RAZ r 7� Size No. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) N b Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) _ N ILA ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) _ Separation Distances from Septic/Holding Tank: To Water -Supply Well .�bO To Property Line 1 To Building Foundation 410 To Disposal Field X -Q r To Water Main/Service Line sd To Stream, Pond, Lake, or Major Drainage Course -N & t' too' r Comments �r-cm D ht E P Page 1 of 2 72-026(11/84) ( C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata I 5 Type of System Design Date Installed 7 � ZI_ - Length ofFieldZj �-5 po'g e 1Z Width of Field 3l0 Depth of Field Gm kNf0-14:11 I I Gravel Bed Thickness (o OA (u�4/Lti2a Square Feet of Absorption Area _7 zS D S SF¢rxt4e ►�i* Standpipes Present (Y/N) USS r q n' Depression over Field (Y/N) AO Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well /()01 1-- To Property Line '?6r i To Building Foundation X00 To Existing or Abandoned System on Lot ; On Adjoining Lots 4- To Water Main/Service Line 6 -or To Cutbank (if present) N A - To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, 1o�r1'Vehicle Storage Area Comments F'rOYY►1 iJt�E d i �5. D. LIFT STATION Date Insta edDimensions Size in Gallo Manhole/Access (Y/N) "Pump On" Level'at "Pump Off' Level at High Water Alarm Level V(Y/N) Tested for Pumping Cycles during Adequac i est. Meets MOA Electrical Codes (Y/N) Comments * Check- r itted Be room Rating Against HAA Request `* I certify t ��h d, verified, or conformed to all OA nd HAA guidelines in effect on the dateOC scip\�Y Signed �� Date C� ✓ o 6000 .n Company �:?. 2�! MOA No.� Receipt No. Date of Payment" .•�� ��•� r ce J. Corwin Amount: $ sscSe>183 Q 0,0 Ia d ��4�ROFSS1�r"J'9 W r� 5 + wle Page 2 of 2 ��ac�� 1 n 0-0-n 72-026 (11/84)& ZS A,,1us.$,11gN, 4tI► fes �0 ��� �- ~C~~ GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received August 26, 1976 INDIVIDUAL SEWER & WATER FACILITIES FOR Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF Conv. 1. Approval requested by: Alaska Bank of Commerce Mailing Address: Pouch 7012 Phone: 279-5641 x 341 2. Property Owner: Betty Fortin Mailing Address: Star Route A Box 1742 Phone: 3. Legal Description: E½ of Lot A5 Tract 5 Siefker Subdivision Location: Jerome Road Type of facility to be inspected Single Family Well Data: Individual A. Type B. Depth No. of bedrooms 4 C. Construction D. Bacterial Analysis 7. Sewage Disposal System: On-site system A. Installed Approx. 1972 B. Installer C. Septic Tank: 1. Size/__~__ Seepage Pit_i) 1. Absorption Area E. Disposal Eield: Total length of lines 2. Manufacturer 2. Material 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines , Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Pa, ge 1 of two pages Page 2 of two pages - Re st for Approval of Individual er & Water Facilities Legal Description E½ of Lot A5 Tract 5 Siefker Subdivision Comments Approved~, ~_~_.c~.~_~Disapproved Approval Valid for one year from date signed Date ~-- ~ c/-~_7 ~ Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily, SIGNED Date EQ-034 (1/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274.-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION AUG 2, 6 1976 RECEIVED 1. Type of Inspection: CMRO 2. Property Owner:__ Betty Fortin Mailing Address: VA FHA CONV x SRA Box 1742 Jerome Rd. Anchorage 3. Name of Buyer: Ross & Louise A, Carswell Mailing Address: SlOt Box 17~42 Jerome Rd, Anchorage 4. Name of Lending Institution: Alaska Bank of Commerce Mailing Address: Pouch 7012 Anchorage, AK 995~0 5. Name of Realtor or Agent: none Mailing Address: Day Phone 344-1658 Day Phone Phone 279-5641 ex. 341 Phone 6. Legal Description: jF~&s2~i/2 of Lot A5 of Siefker Sub 'X~ Tract 5 Location: SRA An× 17&2 ,Te~'ome Road: AD.F-britAin; AlE 7. Type of Facility to be inspected: Hnmse 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well unknown 9. Sewage Disposal System Type of System: If Individual, date of installation one No. Bdrms. 4 Individual X Public Utility Individual (on-site) approximately 1972 EQ-O37 (1/74)