HomeMy WebLinkAboutTUNDRA JEWEL RANCH LT 9Tundra
wel
Ranch
Lot 9
#051-193-08
/-% MUNICIPALITY OF ANCHORAGE ~.'~,
o.. DE ATMENT OF HEALTH AND HUMAN SER. ES
" Environmental Health Division
· ' 825 "L" Street, Anchorage, Alaska 99502, Telephone 2~-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
,~m. DISTANCES
~. A. ~,~. ~ Tn SEPTIC ABSORPTION
~e~,essFROM~ TANK FIELD WELL
,
Phone(si i...m,,.o, i.o o, ~.~s WELL
~' ~ ~ ~~ LOT LINE
Township. Range, ~hon
AS-BUILT DIAGRAM (5how Iocahon of well. ~p=~c system, p~operty hnes. Ioun~at,on.
TANKS
~ SEPTIC D HOLDING ~
Maleha] NO, of Compa~menls
TYPE OF SYSTEM
~ BED ~ W. ORAIN D OTHER .I
'~'
~r~ve~ lengm G~avel w,O~h
ZOtal abs0rptl0n area Number ol I,nes~,,~,.t,.9 SQ FI I ~'s~ce ~t~ """s P,p~ materla~ ~ /~ FT
I I~SQFT
WELLS
~PRIVATE D OTHER fldentifvl
~ ~ ~N~INEE.IN~ ce.ily, a, th. ,nspe~i0n was ped0rmed amrding, all
72-013 (3/85)
M U N I 0 I P A L I T Y 0 F A N C H 0 R A G E
Department o£ Health & Human Services
825 L Street, Anchorage, Alaska ~9501 545-4720
ON-S I TE SEWER PERM I T
Permit Number: 880084 upgrade
Date Issued: 06/14/88' Engineer Designed
Owner Name: ALASKA HOUSING FINANCE CORPORATION
Owner Address: P.O. BOX 101020
ANCHORAGE, AK 99510-1020
Day Phone:
694-2979
Parcel Id: 051-195-08
Lot Legal: Subdivision: '~UNDRA 'BEWEL~RANCH Lot: 9 Block: -
Section: 16 Township: 15N Range: 1W
Lot Size 15444 (sq. ft. or acres)
Max Bedrooms: This Permit: 5 Total Capacity: 5
SEPTIC TANK: Minimum total septic tank capacity: 1~000 gallons. Each septic
tank must have at least 2 compartments. Depth to top o~ septic tank(s) < 4.0
feet requires insulation over tank(s).
INFORM D.H.H.S. PRIOR TO 1ST & 2ND INSPECTIONS BY ENGINEER, IF
AFTER OFFICE HOURS CALL 545-4681 AND LEAVE A MESSAGE
INSTALL PER ENGINEERS ATTACHED APPROVED DESIGN
THIS PERMIT EXPIRES 12/51/88
THIS PERMIT VALID FOR A SINGLE FAMILY RESIDENCE ONLY
CERTIFY THAT:
1. I am familiar with the requirements for on-site sewers and wells as set
[orth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
5. I will adhere to all MOA and State o~ Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system o~s or any adjacent or.nearby lot.
4. I understand th~t~th~s permit is valid for a maximum of 5 bedrooms.
also underst~dtha~Z the capacity o~ the total system is 5 bedrooms and
any en!.arge~nt wix~l~require ~ additional permit.
,O ner - ORPORATION 7-v .
....... ~__~'__3_~' ~ __ ....
S & S ENGINEERING
1'7054 E. R. LOOP ~204
EAGLE RIVER, AK 99577
PHONE ~694-2979
*****~*******~.****ON-SITE SEWER PERMIT APPLICATION*****'*****.*******
DATE:
APPL1CAN'I:
ADDRESS:
6\15\88
AH~:C ~58427
S&S Engineering 17054 E.R. Loop Rd
Eagle River Ak 99577
Cf]NfAC 1' PHONE: 694-2979
LEGAl. DESCR1P'I1ON: L9 Tundra Jewel Ranch
SEC 16 ,T15N,R1W
t..Ol SIZE: 15444 (SO FT OR ACRES)
MAX. NUMBER OF ~EDROOMS: 5
SOIL RATINO: 1]*.5 SO FT/BR
SOIL ]ESI DEP'fH: 15 FT
NO WATER PRESENT IN TEST HOLE.
]HIS IS AN UPGRADE OF 5 BEDROOM TO ]'HE EXISTING SEP]lC SYS]EN
'fRENCH BED
EFFEC/'IVE DEPI'tt 5 0
COVER DEF:'-IH 4 0
'I'0'I'AI_ DEP I-H 9 0
I_ENG'I H 58 0
W I D TH 2 · 5 0
St;~ F'I. 580 ¢)
W. DRAINF1ELD
2
4
53
5
SPEC]'AL CONL)ITIONS OR iNS] RUCTIONS:
SCALE
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street. Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTIO ~ Township. Range. Section:
SLOPE
WASGROUNDWATER ~ Ch
ENCOUNTERED?
11
IF YES, AT WHAT O
DEPTH? p
12 E
Monitoring? , /Y '"'- Hale:
Gross Net Depth to Net
Reading Date Time Time Water Drop
I ~./~/;~ z'./o p I~" -
?_ z: ~,o~ ~o" zo'N" 67q-"
~ R~Pf Ite'~ ....../z ,, _
14
15
16
17
18
19-
PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~FTAND ~ FT
COMMENTS
ACCORDANCE
72~8 (Rev. 4/85~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date J[{~/'~' ~, 1988
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 9; Tcmd,.c~ Se~u~ Sabc~vZ6J. on
Location (address or directions)
She~n R0~.d
(b) Property Owner AHF(~". Telephone: Home Business
Mailing Address it $ 84 ~ 7
(c) Le'nding Institution '~{GIC' Telephone
(d) Reai Estate Company and.A~lent ./ACK WHITE COMPANY/L~'n~t
Telephone 694- 5500
(e) Mail the HAA to the followina address: or: Check here I~, if hold for pick up.
List contact person and day phone number below.
._~ ~ $ E~ZNEERZN$/694-2919
................ 1702'4 Eagle ~/ue~ Loop Raod. Suite 204
Eagle R~ue~. A~[~ 99577
TYPE OF RESIDENCE
Single-Family,~
Number of Bedrooms
3. WATER SUPPLY
Individual Well ~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite [] Public [] Community I-I 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 1 of 2
72~)25 IRev 8,'86i Fronl
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ' , ·
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
, Telephone
Name of Firm 5 & $ENc, INE. F-EiNG
Date F. agte PJvere Alaska 99577
DHHS APPROVAL '
Approved for -~
App~'oved .,~
Disapproved ' Cor~ditional
Terms of Conditional Approval
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
certificates based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in
order to satisfy certain federal and state requirements. Employees of DHHS 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.
72-025 ~Rev 8.'86} Back
Page 2 of 2
,,.~
.~\~'{ O~ ~.A~.~'I AUTHORITY APPROVAL (HAA)
~- ., ~\~\C\t)~.,z~F.~,%'~" CHECKLIST - FEBRUARY 19~ ,
~" '.. ~, ~ 2~744
WELL DATA ~. ~. :....-,.,
Well Classificatio~ ' ~ ~~ If A, B, C, D.~C. Approved (Y/N)
Well Log Present ~) ~ 'Date'c~mplete~ "~ ~'~ ~ Yield
/
Total Depth ~ ~ Cased to ~ I Depth of Grouting ~
Static Water Level ~ ~ ~ ~ ~ ' ~
' Pump Set At '",
Casing Height Above Ground Sanitary Seal ~n Casing ~)
Electrical Wiring in Co'n'duit'l~/N)
Separation Dista'n(~es fr(Sm Well:
To Septic/l"~ Tank on Lot
'7'
Depression Around Wellhead (Y~ ~
; On Adjoining Lots ~ ~::)c:~ I ~
, On Adjoining Lots
To Nearest Edge of Absorption Field on L?t: '1 '~- ' '
To Nearest Public Sewer Line ~ ) ~/~" To Nearest Public Sewer
Cleanout/Manhole /f3, To Nearest Sewer Service Line on Lot
Water Sa m pla Collect ed by ~"~_ '~ ,-~- ~-~_/'¢/~'//'~'~ ~'/'/'/',~ ;Date ~ ~2--- ?~oc" ~c'''
WaterSampleTestResults~?A"r¢'.5'/~,"~cT'~/~_ ~'"O~/(,~,c~¢.*,..~ ,~/'~ ~ ~/tJf~
Comments ~ ~ ~ ~I~==D '"'7--~l(~::)~i~'
SEPTIC/I~OL~ TANK DATA .
Date Installed/~, ~¢~"/Z:lr Size ~ "No:' ~)f Compartments
Standpipes {~N) ~-/ Air-tight Caps t~) y Foundation Cleanout(~)
Depression over Tank'(YZ~ 1.-4 Date Last Pumped Lp .--
Pumpin[~}Maintenance Contract on File (Y/N) . t'"J,/4Z:~ ;for -
Holding Tank High-Water Alarm (Y/N) ~ Temporary Holding Tank Permit (Y/N)
Separation Distances from Septich~Tank:
TO Water-Supply Well ~ "O~:::~ ' ' ~'~' --
· TO Building Foundation ' ::;:~' :~''':
!
To Property Line.
To Water Main/Service Line __ _ C::)
, ,Course ....
To Disposal Field"
To Stream, Pond,. Lake. or Maior Drainage
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~ -- "Z..'2.--'-
Width of Field ' .,,~...~..
Square Feet of Absorption Area
Depression over Fiel;::l (Y,~
Results ,of ,La.st Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ' ~ ~ ~,..~
To Building Foundation ~
Lot ~ '= ~ I
Length of Field -'
Depth of Field.
Gravel Bed Thickne~'s ".';I ~'
'"'~ ~::> c~F' Standpipes Prese~t'~~'~1
Date of Last Adequacy .'rest
Type of System 'Design
To Water Main/Service Line
To Stream/Pon~/Lake/0r Major Drainage Course
To Driveway,! P;r~i~g Ar~a, or Vehicle Storage Area
Comments '' ,'. ~ .'
To Property Line
I
To Existing or Abandoned System on
; On Adjoining Lots
To, Cutbank (iflpresent) ~/~"~
"Pump On" Level a ~""---.
High Water Alarm Level at
Tested for
Electrical Cod~s (Y/N)'
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
d~equa:c~"T;~st. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request °*
I certify that I have checked, verified, or conformed to all MgA§nd HAA guidelines in-effect on the date of this inspection.
S & S ENGINEERING ....,
Signed i~0~4 E.g;- ~.;.~r L~,1.~ ~,~ ~oa!~04 ~ ~'/' ¢' '
Company Eaele p.i~yer~ Alaska
Receipt No. ~.-c,~
Date of Payment 7~ ~:x..._~)¢~," , '
Amount: $
Page 2 of 2
72-0'26 (Rev 8/861 Back
~
,. ,W'" m'VV .DKILLING, In¢ .... '~"
. :.' ',, ;'. P,O. Bo~4-1224 · ?3i0CInternatlonalAirport Road "
(907) 274-461]
ANCHORAGE; ALASKA 99509
DRILLING LOG
Well Owner
Blackburn
Use of WellD°m
Location (address of: Township, Range, Section, if known; or distance main road
Lg, Tundra'Subdiv., Chuoiak
Size of casing 6' k Depth of Hole 244 feet Casedto 241 feet
Static water level ' 200 ft. (a~: (below) land surface. Finish Of well (check one) open end ( X
None
(minute) for 1 hours with
Screen ( ); Perforated ( ).
Describe screen or perforation ~ : ·
Well pumping test at 7 gallons pe?
of drawdown, from static level.
18
Date of completion
" WELL LOG
Depth in feet from "
ground surface Give details of formations penetrated, size of material, color and hardness
0 .TO 1 Organics .
);
1 .TO 45 Silty Cobble Gravel
45
.TO Gravelly Hardpan
68 .TO 69
69 ~0. 238
238 ~0 244
Water Gravel: dry
Gravelly.ll~rdpan Till ......
Water Sand '& Gravel
.TO
TO
TO
TO
TO
lxW%VA Ccr~fied Contractor
Certificate No's. 814 /% ?,'3
TO
TO
TO
To
2 -- STATE
Time 'Time
Da~'G Date Date
Inspector Inspector Inspector
Comments Conditional Approval
/~I '"
Date Sewer Installed Permit No.
Holding Tank SIze
Soils Rating Well To Absorption Area Well Log Received
Well lo Tank
APPLICANT FILLS OUT LOWER HALF ONLY
P,o .yO. na. : zL, c'
Address
R~lty Co. & Agent ~ ~one
Address
Type~f Residence
~Slngle Family
D Multiple Family No. of ~drooms
~ Other
Wat~Supply
~ndividual ~ /~ A~ACH WELL LOG. A well log Is required for all wells drillsd since June
~ ~mmunlty a ~0 '~ 1975. For wells drilled prior to t~t date, one well ~eplh (~tt~ log If
~ Public Utility~ ~1' available.)
Sew~ Disposal
~ Individual Year Individual InstallS;
~ Public Utility When ~nnect~ to Public Utility;
~ Holdin~ Tank
NOTE: THE INSPECTION FEE ~UST ACCOMPANY EACH REQUEST BEFORE PROCE~ING CAN BE INITIATED.
EXCAVATION '
May 2, .1982 '
ROBERT A. SHAFER
CIVIL ENGINEER
694-2979
Nan Blackburn
Box 521
'ChQgiak, Alaska 99567
Dear Mr. Blackburn,
&~UNICIPALIT~' OF ANCHORAGE
["'-r C; .... ~" ~'.
RECEIVED
Reference: Lot 9; Tundra Jewel Subdivision
.A sewer system adequacy test'was performed on the system located
on the referenced property as you requested. The septic
pumped and verified to have a capacity of lO00 g~llons, tank was
pit was dry at the beginning of theist. 1000 gallons of fresh water
The seepage
was added to the crib and after a period of 24 hours the seepage
pit was again dry.
It can be concluded from'this test that~he waste Water"disposal
system serving the three bedroom residence located on the referenced
property is currently fugctioning adequately. However,
cannot be guaranteed against subsequent failures,the system
If we may be of further service, please do ~ot hesitate to call.
cc: Municipality of Anchorage
Department of Health and Environmental Protection
SRB 196X EAGLE RIVER, ALASKA
WR#: WR000105 PID~: 051-1934)8
Date Received: November 29~ 2000
Legal Description: Tundra Jewel Ranch~ Lot 9
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Sawlcea
On-Site Sm'~ices
Waiver Review Worksheet
HA~: HA000604
Perrnit~:
Engineer. Alaska Water & Westewater Conaultanta~ Inc.
6901 DeBan' Roadr Suite 2-B~ Anchorage~ AK 99504
Applicant: Mike & Shannon Brunke
Waiver Requested: separation distance waiver between well on subject properbJ and septic tank
on Skyline Vtaw~ lot 28~ Block I (80 feet); dralnfleld on lot 28; block 1 (90 feet).
Cdtaria: 1. Geology Points:
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Total:
2. Special Conditions:
3. Other:.
Waiver is Granted:
List Conditions or Reasons for above:
Waiver is not Granted:
Date: II- Z 7--00
Rec//: 0000 Amount: 0
Date Paid:
By: P~L/
Name of Reviewer
V;ELL PARR.-
I
_t
I
~OIL $oRsrlow
7.7
Z.Z
/g.q
ALASKA WATER & WASTEWATER
J CONSULTANTS, INC.
November 27, 2000
t t)r__..oo0 I
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Reft Waiver Request and Health Authority Approval for
Tundra Jewel Ranch Subdivision; Lot 9.
The existing 3 bedroom house is served by a private well and septic system. We request you
grant a 80 feet separation distance waiver from the well on the referenced property to the septic
tank on Lot 28, Block I, Skyline View S/D; and a 90 feet separation distance waiver from the
well to the drainfield on Lot 28, Block 1, Skyline View S/D. The following items are
justification for the waivers:
· The lots are generally flat in the area. There is a slight mound and heavy vegetation between
the well on the subject property and the neighboring septic system. If the septic system was
to overflow, it appears that the effluent ~ travel toward the well head.
· The location of the septic system is in a very visible area so that if any effluent was to
surface, it would be noticed and the problem corrected.
The other path of contamination is subsurface migration wastewater should the tank begin to
leak. As can be seen on the attached well log, the aquifer is relatively deep, with approximately
190 feet of silt, sand, and hardpan soils that have served to inhibit the migration of untreated
wastewater into the aquifer. Recent water sample results indicated nitrate levels and coliform
bacteria results to be satisfactory. Based upon the aforementioned facts, it appears that there is
minimal risk associated with the 80 feet and 90 feet separation distance waivers.
The well that serves the subject property was drilled on July ! 8, 1975, and the septic system that
serves Lot 28, Block 1, Skyline View S/D was installed on 5/10/1983. It is our understanding
that the property owner of Lot 28, Block I; Skyline View S/D is responsible for the waiver fees.
We also request that your department issue a Health Authority Approval
If you h.avc
PresJd~t
testions, please contact us at 337-6179. Thank you for your assistance.
P.E., M.S.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
1 ! \
! I
~ ~i~NG HOUSE ~I~NG
d~ ~CH./d~ ~CH ff ~q~ ~ ~ d~ ~CH ~ ~CH
i ' · ~'-
J ~ ~ */F - ~--~ ~ ..............
............... ~ ~-~ r--?~ ~ ..... ~ , ~-~ .... %---~
I I K I ~T 2. BL K 2 I
~T 27, 9L~ % I
Si / ', g' '
I I 0 I I
~ ~ s~.~ ~ s/~ o, s~.~ ~ s/~
I I I I
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I
11/27/2000
MIKE & SHANNON BRUNKE (907) 696-1579 1 OF 2
TUNDRA dEWEL RANCH SUBDIVISION; LOT 9,
~[ OF WORK:
SITE P~N FOR WAIVER REQUEST
~'I ~A ~ ~ /
I I ' ~
TUNDRA JEWEL RANCH SUBDIVISION; LOT 9,
DRAWING FOR WAIVER REQUEST
I~1-'V~ DRILLINO, Inc.
DRILLING LOG
~lion (add~ of: Township. Range. ~lion. if ~own; of ~i~lan~ m~m f:md . ~.
$~tfcwatetlevel~~ ft. (a~.~) (~low) land surfak. Finish of well Icheckone) c~nend ( );
~en ( ); Petforat~ ( ).
D~¢rlbe screen or perforation,
Well pumping test at T gallons per (h~r)
et drawdo~,m Item atatfc level.
Date of completion
{minute) tor...~.__.hour~ with
WELL LOG
Depth in feet fr~m
J~ound surface Give details ~f t'o~-mations Ix'netrat~:f. sizp of' m~terial, color and hardness
_o po_J__
2--STAT£
DEP,%:'IT,",'t[NT OF IIEALTH & [NVIRONMEN rAL PROTECTION
ON.S~TE SEWAGE DISPOSAL SYSTEM AND/OR WE'LL INSPECTION REPORT
14-
......... ~-~ %-_ ~ ~ ..~,.:. ~ /:~ {.r ~ . · ~ ~
,,,,,,,,,, ......-..:. :':.~~2:~}~..:~.:T g}- .
Collect~l . .101/25/93 !.lt:O0 luJ.
~ecitved /'-~=01/25/91 1.15;45 lat.'-.:.
® Municipality of Anchorage ° r ��
On -Site Water and Wastewater Program
(907) 343-7904 5 A r E T
Certificate of On -Site Systems Approval
Parcel I. D.051-193-08
1. GENERAL INFORMATION:
Complete legal description Tundra Jewel Ranch S/0• Lot 9
Expiration Date: L — Z7-2-1
Location (site address) 22830 Sherman Street *Chugiak AK 99567
Current Property owner(s)
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
X Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
Day phone
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Q
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑ ,
Waiver/Variance request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 590
Date of Payment lA,6h-
Receipt Number
cosA # DSG 2 I I D25
Waiver Fee $
Date of Payment
Receipt Number
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.
Name of Firm: Garness Engineering Group, Ltd (GEG) _ Phone: 907-337-6179
Address: 3701 East Tudor Road Suite 101- Anchorage Alaska 99507
Engineer's Printed Name: Jeffrey A Garness _ 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. 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 upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding 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 adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
\`\\\�\kt,Y t( (
(F((A (t�AE� C884
O
9ON-SITE m
WATER AND
o WASTLv,'ATER oz
ri/t>;ttiptQlRAM
1I2_t IZ1
0
OF A-""
gH y
�l9f:i►
'•i/ CE. -79513
� • cv,�
&
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms, with the fol
y. Original Certificate Date: -2.7- 2
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X— Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist
Legal Description: TUNDRA JEWEL RANCH S/D; LOT 9
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
0 Well log is filed with Onsite (or attached)
Date drilled 7/18/75
Total depth 244 ft
Cased to 241 ft
iq 0 Sanitary seal is functioning correctly
FEW Wires are properly protected
Casing height (above ground) 18+ in.
I -zr Date of flow test for COSA '2'22/2°
Static water level at beginning of test 188.5 ft.
`A
1
Comments
B. TANK DATA
Age of tank(s) 32 years
I
Tank type/material SEPTXICONI
Measured operating fluid level in septic tank
*58"
R Standpipes/foundation cleanout per record drawing
Date of pumping 1/15/21 - CAMERA INSPECTION OF BAFFLES ON 1/22/21
D. ABSORPTION FIELD DATA
Parcel ID: 051-193-08
Structure served by this system
Well production at time of test 7.7+ gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes 0 No
Q Coliform bacteria is Negative
Nitrate 3.35 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L n Arsenic less than MRL (ND)
Collected by GEG
Date of Sample 1 12/22/20 & 1/5/2021
C. LIFT STATION
❑ Required maintenance com
Age of lift station rs
Lift station materi
Comments:
Which system tested (date installed) 7/8/$$ Adequacy test date 12/23/20
LFEI ALL standpipes present per record drawing Results ❑✓ Pass For 3 bedrooms
Total measured depth from grade *8.08 ft (max) Fluid depth prior to test 3 in
Measured depth to pipe invert from grade 4.1 ft (min) Water added 654 gal
❑ N/A — pressurized field New depth 11 in
❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 120 min
depth into effective 3.91 ,
51-1Code-requiredsoil cover over field Final fluid depth 5 in
Absorption rate 450+ gpd
0 System presoaked
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months)
date of test) N/A
Gallons introduced *'2021 gallons If yes, enter date
Comments/Deficiencies: 'To BOTOM OF MT "PRE-SOAK PERFORMED ON 12/22/20
COSA Checklist yellow sheet
iE
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
❑ Yes
if No
Community Sewer Manhole/Cleanout > 100'
❑✓ Yes
if No
ft
❑✓ Yes
if No
Neighboring Tank > 100' ❑ Yes
if No
**80+ ft
Private Sewer/Septic Line > 25'✓Q Yes
if No
Absorption Field on Lot > 100' ❑✓ Yes
if No
ft
Holding Tank > 100' ❑✓ Yes
if No
Neighboring Absorption Fields > 100'
Water Main > 10'
**901+
Animal Containment > 50' Yes
if No
❑ Yes
if No
ft
Water Service Line > 10'
[71
Yes
if No
ft
Manure/Animal Excreta Storage > 100'
comment below
Community Sewer Main > 75'✓Q Yes
if No
ft
0 Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No
*51+ ft
Surface Water > 100'
O✓ Yes if No.
Property Line > 5'
F,71
Yes
if No
ft
Wells on Adjacent Lots:
Water Service Line > 10'
Absorption Field > 5'
F/I
Yes
if No
ft
Private Wells > 100'
Yes if No_
Water Main > 10'
0
Yes
if No
ft
Community Wells > 200'
Yes if No.
Water Service Line > 10'
[71
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' El Yes if No ft If absorption field is under driveway comment below
Property Line > 10'
F/I
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Yes
if No
ft
Private Wells > 100' Yes if No
Water Service Line > 10'
Yes
if No
ft
Community Wells > 200' 0✓ Yes if No
Surface Water > 100'
✓0
Yes
if No
ft
F. ENGINEER'S COMMENTS
*PER INSPECTION REPORT **WR#000105 AND OSX101003
G. ENGINEER'S CERTIFICATION
l certify that l 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
MECC884
ft
ft
ft
ft
ft
ft
ft
ft
19
ft
FCO in crawl space at
Sherman Street
ary
ONE STOP SERVICES1,
au
fi�' ZEMMM��
2440 E. Tudor Rd. #120, Anchorage, Alaska 99507
(907) 338-5563
INVOICE
#7416
Andrew Wilson JOB LOCATION INVOICE NO. 7416
22830 Sherman St
DATE 01/22/2021
Chugiak, AK 99567
PO #
DATE ACTIVITY
QTY RATE AMOUNT
01/22/2021 Jetter
1.50 300.00 450.00
Used Hydro-Jetter to clean the outlet of the septic tank to remove bio buildup for
camera inspection of baffles.
01/22/2021 Camera
1.50 300.00 450.00
Camera inspection of 3 separate access points to the tank.
-First cleanout we accessed is a capped off line that is open ended in the
crawispace.
-Access from the cleanout on the outlet of the septic tank was able to verify there is
an intact outlet baffle on the tank.
-There is no cleanout on the inlet side of the tank. We were able to drop the camera
directly into the tank from the tank cleanout and lift the camera head to verify there
is an intact inlet baffle on the tank.
Thank you for your business, please have a great day! SUBTOTAL
DISCOUNT
PAYMENTS
TOTAL DUE
Page 1 of 1
$900.00
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'f:'.:"' ' .' .?. '~:'' '? ~ :;~ '~?:~' :V~:''': ~':~'~cL'~PROV~FOWA:S NGLE F~ LLY,D~ NG t '.~"' "l.~ ::~-~'
;.~ 7:? ~.I::G~INFO~ON '~.-.,. ' '
ii Note.; Alaska W. ater. and. Wast.ewate. r Consu. ltants, lnc. Shall be pald $1,5OO. OO at, t ' ~'~
. ;'.~.~lorpnor. to,~ctostngrorrneengtneerin~lserwcespfovided.';,Lii:~.' ,. ::~.~:~..-,,~.~ '. I';~:,, ~
· , ' .... Seal affixed h~mto a'nd' '
.,.~: .;./7m~..ujred la
~:'.:,
· *' "6,'*:DHHS SIGNATURE ':' ' - '~ ...... :,, ' ,' ;:--,. , · "
~. ,.:'... ,,,' ": ~ .... -~;~',.'Approved for-.' :.~ ',- -,bedmoms~ ;~.;i~'."';:,'/'- ;t ' ., ,
,; ..... D~appmved .............
...... · ....... Conditional approval for bedrooms, with :l, ~ { . .. · ..
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~.. .., · ~., ~, . ',,:*,.,): ... ;.~ .,,~ ; ~. ~.,-~ ~;*.:~ ~:.~:,~,,'~,-~,~.:.~.-~ ?..~,:~., ~,~:-~,.7.,~ ....~ . :.',,. .
'; '.% .... . '~-' Additional Comments
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'.. · ,The Muntdpality of Anchorage Depadment of Health and Human Se~ces (DHHS) Issues Health Authority ;. , ,- ..
· ,-: :Approval Ced~cates.,b~_sed p.n, ly upon Ihe. mp .re~e~talions given In pqmgrap.h._5...al~.,_v?..b~,an]ndepe.~l.e, nt ', L
~:: .-.' ~pmfe`~na`eh~i~ri;~st~md~n~sta~fA~a~a;;TheDHH~d~sth~sas~pu~m~f~:~ '
.:-.. :homes and 5helr lending Institutions In Order to satisfy certain rede_mi,. ,and~late requlm.m, ents. Employees of.~ ,.,
· '. r2.o~ ~O~,~.~l~,~uo~v.~, .._.. ~- ~ : - .. .. ;-.'. ~....~.-,' ..'..
Legal Descdpfion:
A. WElL DATA
Well Type PRIVAT[
Log present (Y/N)
Total deplh 2,1.,1.'
Municipality of Anchorage R E C E I V I:: p,c~'
DEPARTMENT OF HEALTH & HUMAN SERVICES
Envlmnmentnl sondces Division
625 "L" Street. Rm 502 Anchorage, AJaska 99501 (907) 343~ 2 9 2000
Health Authority Approval Checldl{~~. ~CESO~0~
TUNDRA JEWEL RANCH S/D; LOT 9, Parcel I.D.:
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed
051-193-08
Cased to 241'
YEs
FROM WELL LOG
6/18/1975
Date of test
Static water level 200'
Well preducfien 7.0
WATER SAMPLE RESULTS:
· Colifoml 0 Nib'ate
Date of ~ample: 11/27/2000
B. SEPTIC/HOLDING TANK DATA
Date Installed PRIOR TO 6t/19~ Tm~k size
Foundation de~nout (Y/N) YES
Date of Pumping 10/24/00
C. ABSORPTION FIELD DATA
Date installed 6/21 - 22/66
Effective eb~on area
Date of edaquacy test
Fluid depth in ab~on field before test (In.);
Fluid depth g" (ins) Minutes later.
Perox]da trealment (past 12 months) (Y/N)
72-o2~ (l~v. ~6)' C. mpu~ wmm
6/18/1976
Dasln0 hel0ht (above 0round)
Wires pmpedy protected (Y/N)
AT INSPECTION
10/25/00
109'
g.p.m. 4.56 g.p.m.
1.87 m.q/L Other becte~ 10
Collected by:. A.W.W.C, INC.
*THIS IS A CONCRETE SEPTIC TANK
* 1250 Number of Comperlmente 1 Cteanoots (Y/N)
Depression (Y/N) NO High water alarm (Y/N) N/A
Pomber ,,IRS PUMPING
Soil rating (g.p.d~2 0~) 12.5 System t~'pe TRENCH
Width 2.5' Gravel lhlckness below pipe ,~' Total dapth 8.4'
580 Sq. FT. Monltmtng Tube present (Y/N) YES Depression over field (Y/N)
10/25/00 Results (Pass/Fell) PASSED For~ ,3
0" Immediately alter 8:~8 gel. water added (in.): ..
1059 Absorption mte - 4,50+
N/^ If ~S, ONe date -
14"
D. UFT STATION .
*Datum
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
SepEcrnoldlng tank on lot 100'+
Absorpfion field on lot
Public sewer main
*WELL WAIVER REQUESTED.
SEE An'ACHED LETTER
On adjacent lots *80%
100'+ On adjacent lots '90'+
N//A Public ~ewer manhole/cleanout N/A
Sewar/se~c service line
25'+ Mit stefion N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+ Absorption field 5'+
Water maln/sewlne line. 10'+ Surface waterldmlnege 100'+ Wells on adjacent lots 100'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
Building foundation 10'+ Water maln/sen4ce line 10'+
Surface water, lOO'+ Driveway, parldng/v~hlcle storage ama lO'+
Curteln drain NONE KNOWN Wells on adjacent Iote 100'+
F. ENGINEER'S C E,,~r!FI ~A//TIO~//
I cerey that I hi[ye 8~et~n~//t,/~u~ield inspec~:~ne end review
of Municipal n/cerd.~ t~f///~ ~l/~ve~stems em/n conformance
v/eh MOA HA~ gul~f~j~n.~l~n this date.
Slgnatum~ _ __
Engineers NameI I v JEFFREY A. GARNESS
Date~
HAA Fee $
Date of Payment ._~..C~~- ~
Waiver Fee $
Date of Payment
Receipt Number