HomeMy WebLinkAboutPELLISSIER LT 2Onsite File
Tf supposed agricultural well is not in use it
must be decommissioned. . Engineer to verify
and so state on future permits or COSA's
Municipality of Anchorage
On -Site Water and Wastewater Section • 343-79
(907) PSA of
x
ON-SITE WASTEWATER INSPECTION REP
SEP 12022
Permit Number: OSP221117 PID Number: 051-104-61
Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade
Name
ROY THOMAS
ABSORPTION FIELD - EXISTING
❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound
Site Address
20527 STEFFES ST, CHUGIAK, AK 99567
❑ Other
Phone
Phone 7��
f Bedrooms
Soil Rating
Total depth from original grade
3
GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
PELLISSIER LT 2 1 7
Fill added above original grade
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 absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
FtZ
Ft.
Well
100'+
--
25'.+
TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
GREER
Capacity
1000 Gal.
Surface Water
100'+
--
Material
Number of compartments
Lot Line
5'+
_-
NA
HDPE
2
Foundation
10'+
__
LIFT STATION
Manufacturer
Capacity
Gal.
Remarks 4" OF INSULATION ADDED FOR S.T.
Alarm location
Electrical installed by
Installer J R's
PIPE MATERIAL House to tank 3034 Tank to 3034
drainfield
Drainfield CO/MT 3034
Inspector FWCS
BENCH MARK (Assumed elevation) 100 ft
Inspection 15, 6/22/22Location
dates: 2nd 6/23/22
and description
3rd 4`h
TOP OF MANHOLE
ON-SITE WATER AND WASTEWATER SECTION APPROVALOF
Conditional
A tl
Approval: Date
% •• •••• ••••••••••%
Septic System
A
�� Curtis Huffman
rov
pp /
cis •. CE 128991
Date - -ZZ
�3
•.��/�
2
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t,F�F"PROFESSlONPsoW�
Note.. this approval does not include well permit requirements.
PID: 051-104-61 PERMIT: OSP221117
/-WOODEN FENCE
100' WELL
RADII
LOt BM: MH TOP
01
�1149,564 S.F. D80 � 1
C DCO CO EXISTING
WELL D
MH F FIELD MT
24.3' "AGRICULTURAL WELL --
NOT DECOMMISSIONED" 40' WATER EASEMENT
N
0 4.2'x6.3' SHED (BK. 1195, PG. 151)
o GARAGE
w
24.3' WELL 15' TELECOM EASEMENT
(BK. 3065, PG. 26)
6.5' 3.1'x3.8' CANT /
20.2'
GRAVEL �y m DFCO
i
3.8'03.2' DECK -/N MM � N 6.2' DECK
N£
20.2 75' POWE EASEMENT
(BK. 3133, PG 544-546)
20' R.O.W. & .p /
A -C=100,7'
B -C=119,1'
A -D=102,3'
B -D=120.2'
A -E=105.8'
B -E=123.0'
A -F=112,0'
B -F=128.0'
DCO EXISTS BETWEEN
TANK & HOUSE &
EXISTING FIELD
PELLISSIER LOT 2
PREPARED FOR:
ROY L. THOMAS
20507 STEFFES ST
CHUGIAK, AK 99567
FIRST WATER CONSULTING
SEPTIC SECTION
SCALEi NTS
13030 SUES WAY
ANCHORAGE, AK 99516
907-350-9566 FirstWaterAK@gmail.com
iUPPORT SERVICE
C •
DATE:
8/04/22
SURVEY:
LANG
DRAWN:
FWCS
SCALE:
1" = 30'
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8/04/2022
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R.O.W. &
UTILITY EASEMENT
Lot 2
49,564 S.F.
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SCALE: 1"=30'
MANHOLE
PIPES_ze::�
40' WATER EASEMENT
(BK. 1195, PG. 151)
15' TELECOM EASEMENT—'
(8K. 3065, PG. 26)
75' POWER EASEMENT
(BK. 3133, PGS. 544-546)
S 89'56'36"W 300.31'//
BLM Lot 95
BLM Lot 85
FA
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0 10 25 50 100
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SCALE: 1"=30'
MANHOLE
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40' WATER EASEMENT
(BK. 1195, PG. 151)
15' TELECOM EASEMENT—'
(8K. 3065, PG. 26)
75' POWER EASEMENT
(BK. 3133, PGS. 544-546)
S 89'56'36"W 300.31'//
BLM Lot 95
BLM Lot 85
FA
5/26/22
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221117, Rebecca Carroll, 05/26/22
MUNICIPALITY OF ANCHORAGE
Development Services DepartmentPhone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 051-104-61
Property owner(s) ROY THOMAS Day phone
Mailing address PO BOX 670816, CHUGIAK, AK 99567
Site address 20507 STEFFES STREET, CHUGIAK, AK 99567
Legal description (Sub'd., Block & Lot) PELLISSIER LOT 2
Legal description (Township, Range & Section)
Lot Size 49,583 Sq. Ft. Number of Bedrooms 3 TOTAL
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) 0
(w/wo AD U)
Septic Tank
0
Upgrade El
Duplex (D) ❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION
INCLUDES A WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
nature of property owner or autnorized agent)
Permit/Rush Fees:Waiver Fees:
Date of Payment: Date of Payment:
Receipt Number: Receipt Number:
Permit No. C52 Z -Z-1117 Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
13030 Sues Way, Anchorage, AK 99516
907-350-9566 / firstwaterAK@gmail.com
May 16, 2022
Municipalities of Anchorage
On-Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
RE: SEPTIC TANK UPGRADE PERMIT
LEGAL: PELLISSIER LOT 2
The property owner has requested we obtain a permit to upgrade the aged steel septic system of
the above referenced lot. We propose to install one 1000-gallon tank to serve the existing 2-
bedroom and 1-bedroom ADU residences. The design is based on the existing MOA documents
and per our site visit.
The lot and area are served by private water. The design will not impact any of the neighboring
properties. Please contact us if you have any questions.
Sincerely,
Curtis Huffman, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221117, Rebecca Carroll, 05/26/22
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FENCE
SHED
WELL
3.1'x3.8'
A
A
N
Lot 1
I
N 89'56'36"E 300.30'
DECK
Lot 2
49,564 S.F.
PIPES--//
IPES _
40' WATER EASEMENT \ /
(BK. 1195, PG. 151)--/-
51) / \
15' TELECOM EASEMENT- / /
(BK. 3065, PG. 26)
75' POWER EASEMENT
(BK. 3133, PGS. 544-546)
S 89'56'36"W 300.31" /
BLM Lot 95/
/
/
31.9 C
24.3'
Z
I N O
P GARAGE
0
o
Ij
GRAVEL
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UTILITY EASEMENT
FENCE
SHED
WELL
3.1'x3.8'
A
A
N
Lot 1
I
N 89'56'36"E 300.30'
DECK
Lot 2
49,564 S.F.
PIPES--//
IPES _
40' WATER EASEMENT \ /
(BK. 1195, PG. 151)--/-
51) / \
15' TELECOM EASEMENT- / /
(BK. 3065, PG. 26)
75' POWER EASEMENT
(BK. 3133, PGS. 544-546)
S 89'56'36"W 300.31" /
BLM Lot 95/
/
/
BLM Lot 85
/
/
/
BLM Lot 85
Lot 96B
N
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Lot 96B
Municipality of Anchorage
On -Site Water & Wastewater
(907) 343-7904
m MJT1 A
31.�P
JAN 1 7 2014
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-104-61
1. GENERAL INFORMATION
Complete legal description PELLISSIER- LOT 2
Expiration Date:
490
Location (site address) 20507 STEFFES STREET *CHUGIAK AK 99567
4/
Current Property owner(s) JAMES MCPHEE • Day phone 261-7605
Mailing address 20507 STEFFES STREET *CHUGIAK, AK 99567
Real Estate Agent Day phone
2. TYPE OF DWELLING:
▪ Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 2
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
WaiverNariance request for:
N/A
•
SUBMInAL
JAN la 2014
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
Received bp-
COSA to be released to the engineer, unless otherwise requested by the engineer.
•
Distance: —
Date: /` :7 /2c7
COSA Fee $ 5267 I / ILA1�6'° Waiver Fee $
Date of Payment /7 /91/ yII 1 �i" Date of Payment
Receipt Number Oq CO 33 (539/?4 Receipt Number
COSA# OSC Lii°10 ! 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. l 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 aft applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179
Address
3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date I/P�/f`f
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit ofthe owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
v7 System #1 Approved for Z bedrooms.
System #2 Approved for bedrooms.
Disapproved.
Conditional approval for
*vocO
VA
ry ;. Ga ness.. r°
CE—7•- Q.`,0O
Icdl'rof es siocNoo
,,_C: -``-`c• tOFtANC (4-,-
``�Qe"- 6'0/tri
0N1 -SITE �0 r
bedrooms, with the following stipgl ti nsWATER AND z
�o WASTEWATER o=
0,0
- PROGRAM
l
5,0
By: f _ G..� _ ��� Original Certificate Date: j,2- 1 /)
The Municipality or Anchor -?e Develop,emt 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. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
(Pow 19HL9
Nitrate Advisory
Arsenic Advisory
Other
*BELOW EXISTING GRADE TO BOTTOM OF MT (SEE NOTE BELOW)I
Soil rating (g.p.d./ft or(2/bdr) 85
If more than 1 septic system is on the lot:
COSA Checklist* of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: PELLISIER; LOT 2
Parcel ID: 051-104-61
A. WELL DATA *ASSUMED BASED UPON SURROUNDING WELL LOGS (ON FILE WITH MOA)
Well type PRIVATE If A, 3, or C provide PWSID# N/A
Well Log (YIN) YES
Date completed 5/24/1979 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 105 ft. Cased to *40+ ft.
Casing height (above ground) 24+ in
FROM WELL LOG AT INSPECTION
Date of test 5/24/1979 12/4/13
Static water level 35 ft. 56
ft.
Well production 4
WATER SAMPLE RESULTS:
o/
Coliform 0 colonies/1o0 nil.
N o
Arsenic: �tisO ug./L.
B. SEPTIC/HOLDING TANK DATA
g.p.m.
47, ogi
Nitrate 0.55 4mg./L.
0.22 g.p.m.
Collected by: GEG. Ltd.
Date of sample: lit 5Jiy/lcvricud irw,wt t, <<(
ix(tzjl3,Inan(rlt
*DOUBLES AT HOUSE
Tank Type/Material SEPTIC/STEEL
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO
Date installed
7/25/1979
Date of pumping // / `1/) Y Pumper
C. ABSORPTION FIELD DATA
Date installed 7/25/1979
Length 36 ft.
Gravel below pipe 4 ft
Total depth *7.75 ft. Eff. absorption area 2-85- ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 12/4/13 Results (Pass/Fail) PASS
For? bedrooms
Fluid depth in absorption field before test 0 in. Water added 505 gal. New depth E in.
Elapsed Time: 0 min. Final fluid depth 0 in.
Absorption rate >= 300+ g p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE
If yes, give date —
*MT ONLY EXTENDS 2.25 FEET BELOW THE INVERT OF THE DRAINPIPE.
High water alarm (Y/N) N/A
Width 3
ft.
System type TRENCH
ae8re
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump off' level = High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+/100'+
Absorption field on lot 100'+/1001+
Public sewer main
N/A
Sewer /septic service line
Animal containment areas
*10'/*10'
50'+/50'+
AGRICULTURAL WELL/DOMESTIC WELL
On adjacent lots
On adjacent lots
100'+/100'+
100'+/1001+
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excrete storage areas
100'+/100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Properly line 5'+ Absorption field 5'+
Water main
N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
*WELL DRILLED PRIOR TO 1983
G. ENGINEER'S CERTIFICATION
1 certify that t 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 JEFFREY A. GARNESS
Date t)IbJI#
(Rev. 11/05)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Water Well Advisory
Certificate of On -Site Systems Approval (COSA) # OSC141009
During a recent COSA on-site inspection and test of the potable water
supply well on Lot 2 of Pellissier subdivision, the well's productivity was
determined to be .22 gallons per minute. The minimum well productivity
required by this Department (AMC 15.55) for a 2 -bedroom residence is .21
gallons per minute. Although the subject well currently exceeds this
minimum requirement, all parties concerned are advised that the production
capacity of the well may fluctuate. Restriction of non-critical water uses
such as washing cars and watering lawns and gardens may be required.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Municipality of Anchorage
Community Development Department
Development Services Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.orgionsite
(907) 343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC141009
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the agricultural well water on Lot 2 of
Pellissier subdivision. This inspection revealed a nitrate concentration of
9.08 milligrams per liter (mg/L) was reported for the property's well water
sample. The Environmental Protection Agency (EPA) has established a
maximum contaminant level (MCL) of 10.0 mg/L for public drinking water
systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
GARNESS ENGINEERING GROUP, Ltd.
.. ..,...-:, _ CONSULTANTS & GENERAL CONTRACTORS
January 20, 2014
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Rd.
P.O. Box 196650,
Anchorage, AK 99519-6650
(907) 343-7904
Ref: Septic Adequacy Test Results for Pellissier ; Lot 2,
To whom it may concern:
The referenced property is served by a two bedroom septic system. The septic system is
composed of a 1000 gallon septic tank, and a trench type drainfield that is 3' wide with 4' of
effective. It should be noted that after determining elevations, it was observed that the
monitoring tube is 1.75' shy of reaching the bottom of the drainfield. GEG tested this septic
system on 12/4/13. Prior to the start of the test, the monitoring tube was dry. During the test, a
total of 505 gallons was introduced into the drainfield, and the monitoring tube was dry. Looking
the pore space calculations for this drainfield, it was determined that it takes approximately 269
gallons per foot to fill this drainfield (assuming there is no absorption). In short, it would take
approximately 470 gallons to bring water up into the visible portion of the monitoring tube. The
last 325 gallons of water introduced into the septic system was imported via water haul, and was
introduced in less than 5 minutes, which did not cause water to rise in the monitoring tube. It
should also be noted that during the last septic test completed on this system (approximately 4
years ago), a total of 1590 gallons of water was introduced into the drainfield, which did not
cause water to rise in the monitoring tube. In closing, taking the above information into account,
combined with the fact that this house is and has been occupied full time, we believe that this
system meets the minimum absorption requirements for a 2 -bedroom septic system
If you have any gt}4stions, please contact us at 337-6179. Thank you for your assistance.
Jeffs
Pres
.E., M.S.
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
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M s
\F4'T 94%,,,, \ 93 A6 �\ �co
r \ • 3°6A A 73 / O
28
m
Riser Pipes
for Septic System
N
LOT 2
PELLISSIER SUBDIVISION (76-208)
58.9' 16.3
Wood n.
Shed �11.1ow !
1 16.3'1
59.8'
1-
0
0
Wood Deck
& Stairs
—45.8'
2 -Level
Wood Frame
House
Well
Wood Frame Shed N/G Meter-"
on Conc. Slab Elec. Meter
54.9' 4.21
M
54.6' 20.3
I Wood M
To Frame e
p, Garage
20.3'
56.4
y -Power P Gravel
(Typ.) Drive
N
'0
a+
to
Wood Deck
& Stairs
0
Tel. Ped.
3 P.P.
Elec. Ped.
20' R.O.W. & UTILITY
EASEMENT
4.2
165.00'
�' pF .ally
J SE......
�tPe A ,a,
it OA
y:
* 49E1
:tiaa.w
01
I,3 . Lee Kareheln:koFr. g/
• Na. 3143-5 ; cyi
lllll.sos
N 00'03'00"
A` 4/1.41
STEFFES STREET
0
rn
S 89'56'36" W
95
I hereby certify that an accurate survey of the following described
property:
LOT 2
PELLISSIER SUBDIVISION (76-208)
was mode on December 10, 2010 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 ore no roadways,
transmission lines or other visible easements on said property except
as indicated hereon.
Anchorage Alaska, this 14th day of December 2010
xi -
N
/1`12{,a0�
0' 75' 30' 50'
PREPARED FOR:
WORTHING PROPERTIES
OF ALASKA
AS—BUILT
OWN.
JSP
DATE
12/14/2010
GRID
NM 1358
FILE NO
022
F.E. 2010
PG. 44
JOB 1110
1055
KARABELNIKOFF
SURVEYIN Gwn�
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 PROVQL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-104— 61
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
PELLISIER S/D; LOT 2
COSA# '').Sc./6/,?_)6(r2
Expiration Date: 3 " 2 - f/
20507 STEFFES ST * CHUGIAK, AK * 99567
KRYSTAL HOKE Day phone 261-7605
20507 STEFFES ST * CHUGIAK, AK * 99567
Day phone
Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 1 Individual On-site 1
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 samples. (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, 1 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.
Address
3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for ____3_____bedrooms.
Disapproved.
Conditional approval for
Phone
Date
337-6179
2.j17�rc,
.i
eft' e, •. arne.s
E-795 GHQ
? .2.E1117:71911.5.
ZJ1. Z . f°6(\:;77::(41;6:::;
l� rAQ'
dt-rofessioaQo
. f(�itlr
Y OF'�N�f''��
ON-SfTE4;�.
•
WATER AND m=
V STEWATc-
•
•
PROGRAM .'
bedrooms, with the following stipulations%O ,`
l)�11111 SE\19\
- JJ/,lS,lll�• �
By:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
(Rev. 11/05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
/6/ G---e--t— Original Certificate Date: J v2 ' a vZ 0
'PROV ,L CHECKti..ST. •
( 6 J. c n PELL1 1Ef2. LOT 2 Parcet l�
CULTUR�4L.. WELL :LOG A1A'CHED - w._
,ASS{i BASED Ui t SUF23 OU1 k1WELL LOSS Si=E ATTACNEb.
t4110- ! F , �; or C a Ovide PWS D# L N/A Well Log (YIN ) YES
to c % d. 5/24/1979Sa ar l (Y/N) YES Wiresproperly protec%1'(YIN) YES.
a pttt 105. ft. Cased to *40'+ ft. Casing heig € (. "v . gt d)
'PELLi`SSiE LOT :2
2'21
colonies/100 mi
£r.
12//201e,
atm of sample: `12/3/201'0 Collected• i y: CEG ..:k Ltd.
SEPTIC/STEEL flake ii;"" < ed 7/25/1978
..,, ttments
� C,or� � / 2 Cloa#s tY/liy YES
aVer tank .(Y/N) NO . H gnsr e . t ('/ ) ',N/A
3 ft. Gravel below. pipe 4
ft2 Monitor g tube• 1 ,ess n over field
5 YES: NO
9`. R sui `(Pas /fail). 'PASS or 3 bedrooms
test 173 Y in. 1Nater ad d, gat. New depth DRY in.
ft.
g .d.
>e 12 me #) ('/N',`& type) NONE KNOWN • it yes, give .date -
**PR'ESOAKED WITH 764 GALLONS ON 11/12/2009',•
D. LIFT STATION
Date installed
"Pump on" to
Dahl
Size, in gallons Manhole/Access (Y/N°
level at in. "Pump off" level High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
TOOT"+
Septic tank/lift station on lot 1W+
100'+
Absorption field on lot 1 ao'+
Public sewer main
N/A
*1'01
Sewer /septic service.line Holding tank N/A.
50'+ 100'+
Animal containment areas 50'+ Manure/animal excrete storage areas 1001+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON ,LOT TO:
AGRICULTIJRA`L WELL/
DOMESTIC WELL
,DR{LLED
RTO 1983
1.O.o'+
On adjacent lots 100'+
l00'+
On adjacent lots oo'+
Public sewer manhole/cleanout N/A
Building foundation 5'+ Property line 5'+ Absorption field`
Water main N/A Water service line 10+,. Surface water
Welts on adjacent lots 1013'+
SEPARATION DISTA ICE FROM
Property line 1 Q''+
5'+'
100'+:,
RPTION FIELD ON LOTTO:
g foundation 1 O'+ Water main N/A
Curtain drain NONE KNCNIN
F. COMMENTS
G. ENGINEERS CERTIFICATION
ice thak have detrained Ilarou ifewd:inspecfions and
reviewof Municipal ror ,hat the above systems are in
a.
confonraa e, with 1 F COS,4 iidel nes in effect on this
date.
Engineer's
Date
COSA, Fee .$:
Date of Payrner't
Receipt Number
(Rev. 11/05)
Waiver Fee
Date of Payment
Receipt Number
LOT 1
113.82'
28.48'
85
S 00'03'31" E
96B
a)
N 89°56'36" E
165.00'
N
0 0 6 S
N `°' \ 1'9T \ h X00
//�7s T,<\ \ F/,� cxi \ `3 ,33 A4 q Power
\ FO \ \ FM \ S SF Pole •
OM FqS \ /lit B� S51;v4
FMF'�T \ 7/95 \ A6
Oss \ S7 0
0
M
0
0
\\ \
\\ N
Riser Pipes \\
for Septic System
LOT 2
rn
PELLISSIER SUBDIVISION (76-208)
58.9'
Wood
Shed
16.3'
� M
0 0
N N
16.3'
In
59.8'
C.O.
Well
Wood Frame Shed N/G Meter J
on Conc. Slab Elec. Meter
54.9'
— 54.6'
56.4'
Well
20.3'
Wood "
Frame 4
Garage
20.3'
-Power Pole
O" (TYP•)
N
Gravel
Drive
Wood Deck
& Stairs
1111111
32.2
\-cc:31
32.2'
wow
N
0
Wood Deck
& Stairs
m
Tel. Ped.
P.P.
Elec. Ped.
20'
165.00'
5.8'
-2—Level
Wood Frame
House
4.2'
N)
0
0
0i
co
K)
0
co
N
00
rn
S 89°56'36" W
R.O.W. & UTILITY
EASEMENT
of *.•49TH ?*.0
•
•
*Ptt
r♦ •. Lee Karabelnikof f:.0
C c<4,•. No. 3143-S .• ow
• 11 ssDNPL i‘��
i�»��
0
N 00°03'00" W
STEFFES STREET
0
95
I hereby certify that an accurate survey of the following described
property:
LOT 2
PELLISSIER SUBDIVISION (76-208)
was mode on December 10, 2010 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.
Anchorage Alaska, this 22nd day of December
M
tri
_ 30'
0' 15' 30' 60'
PREPARED FDR:
WORTHING PROPERTIES
OF ALASKA
AS-3UILT
DWN.
JSP
FILE NO.
1022
DATE
12/14/2010
F.B. 2010
PG. 44
GRID
NW 1358
JOB NO.
1055
,2010. KA RA BEL NI KE/EE
SURVEYING(907) 337-3434
SGS
SGS Ref.#
Client Name
Project Name/#
Client Sample ID
Matrix
1106414002
Garness Engineering Group, Ltd
Pellissier S/D
Pellissier; L2 Well #2 Agri
Drinking Water
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
12/16/2010 16:54
12/03/2010 8:15
12/03/2010 13:42
Stephen C. Ede
Sample Remarks:
Parameter
Results
LOQ
Units Method
Allowable Prep Analysis
Container ID Limits Date Date
Init
Metals by ICP/MS
Arsenic
Waters Department
ND
Total Nitrate/Nitrite-N 2.21
Microbiology Laboratory
E. Coli
Total Coliform
Negative
Negative
5.00 ug/L EP200.8 C (<10) 12/08/10 12/16/10 KDC
0.100 mg/L SM20 4500NO3-F B (<10) 12/08/10 AYC
1
100mL SM20 9223B A 12/03/10 DLC
100mL SM20 9223B A 12/03/10 DLC
SGS
SGS Refit
Client Name
Project Name/#
Client Sample ID
Matrix
1106414001
Garness Engineering Group, Ltd
Pellissier S/D
Pellissier; L2 Well #1 Primary
Drinking Water
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
12/16/2010 16:54
12/03/2010 8:17
12/03/2010 13:42
Stephen C. Ede
Sample Remarks:
Parameter
Results
LOQ
Units Method
Allowable Prep Analysis
Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic
Waters Department
Total Nitrate/Nitrite-N
Microbiology Laboratory
E. Coli
Total Coliform
ND
5.00 ug/L EP200.8 C (<10) 12/08/10 12/16/10 KDC
(<10) 12/08/10 AYC
0.215 0.100 mg/L SM20 4500NO3-F B
Negative
Negative
1
1
100mL SM20 9223B A 12/03/10 DLC
100mL SM20 9223B A 12/03/10 DLC
r
r I7aTO7 „ '
,Burk ,99V f.'''? 7AT 8 0'b 7
3
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33
Zn: 3 3 3 3: 3 3 3 3
O
/53y9
0 0
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H H H H H H H H 'H H H H
0 :0 0
0 .0 0 0 0 0 0 .0 ,0
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Its
P z9i] P
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7.�; P ‘1,
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tti
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ors 'TS
70 2Z
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ori ori ori oti
XI PI 24 7Z 74 Pi
444444343
0 0 0 0 0 0 0 0 "00 0 0 0
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Larry Pellissier's 11e11
Drilled by Lon curmin.gs .
NEWTON DRILLING
Drilled for Larry Pellissier. :For home use.
Located Birchwood Loop North - g mile off main road on left side.
Size of casing ' 6" .
water level 52' below land surface.. Finish of well. Open-end..
Cased to 71 . Static
.Remarks : Fell pumps 60 gal,at first pumping, then drops off
to 1 gal every three minutes:
Depth in feet :from ground surface;
0' ' to .18'4" Rock & dirty s;'.:L►e 02� �iaou�
to/ nw451`i5i)fJ
18'4" to 3747" _ .. . Rock - hardpan �, r y �.ec. • 9, / SN, R 44),
37'7" to 54'4" Ra'rdpan '� N 6 . �+/ 58
.54`4" to 61'10° Sandstone
61'10"to 68'0" - ;Nater .& Sand (non coxntrolable, cannot clear or
68' separate)
-Rock'
68' to 70'5" Clay -sand
70`5" to 91'. Rook
Stopped drilling.. Rock turned green. Casing is
03
sitting on top -of rock at.70'5" and water seep is from around 03
casing.
-011
"-(I—A5 8007 1111:P65 V/Ps
Q 6 Rt at wivai4-t..
WP -44.
•
Data of Completion 3 /30/2010 I
FROM:Dynamic Properties TO:3383246 12/07/2010 16:26:36 #1317 P.002
fili; Arctic Pump & Well, Inc.
PO Box 770197
Eagle River, AK 9957
Krystal Hoke
Nt.
AR C
& WELL .1
.,4 Mc.
VA OMR TI 1":3vi
JIm Sullivan
688-2510
or
258-2510
745-2510
Fax:688-2543
Email: apw@gcl.net
Alaska Distributor
IInvoice # 616
PO:
Customer Contact Information:
Phone:
Email Address: krystalhoke@gmail.com
Property Information:
Legal:
Cell Phone:
Street: 20507 Steffes
Fax Number:
Qty Description Price par Unit Price Amount
1 Set up temp lest lirg well head and reset $750.00 $750.00 $750.00
1 Chlorine 8 Flush $250.00 $0.00 $0,00
1 temp wire to house $200.00 $0,00 60.00
1 MOA Seal $86.00 $86.00 688.00
Received in Satisfactory Condition
Total: $836.00
Payment due on receipt of invoice unless prior arrangements made.
Alt account Past Dua will be charged 1 1/2% per month.
$25 second billing charge.
THANK YOU
A604 cut Lftisa4t.
Well Owner
M -W DRILLING, Inc.
(..z P. O. Box 4-1728 • 2811 Dawson
A C 907-279-1741
Ca D a ANCHORAGE, ALASKA 99509
DRILLING LOG
rpt liit
Judy Lane
// c3
Use of Well
Location (address of: Township, Range, Section, if known; or distance main roan
R$, . L88. • Saa 9, TI,. R11r.i s....
f
Dom
11. Birchvoodloop White Bireh Rd area
Size of casing 6 nepth'of Hole 302 feet Cased to '' 7 feet
Static water level 2+4 ft. (8 (below) land surface. Finish of well (check one) open end ( X ) ;
u
Screen ( -) ; Perforated ( ):
Describe screen or perforation boo
Well pumping test at 2: allonsminute far 1 hours with 1 r
p P 8 g per 1( ,
of drawdown from static level. -
Date of completion_TR x s O' .. '''
WELL LOG.
Depth in feet from
Give details of torniatfons penetrated,size of material, color and hardness
`ground surface
o. TO 2
•
TO
1.
TO
TO
TO
Dlsy.
iRf1ts": Gr•y1i vat = -
*ilty Oreel 1 dry
030>
Bonfd"r
J 1
soviet, tit+y
4:
�aMt4b►rsel aadeogtkc. L..r
F
Sktrr naps ibioVmitt.:.
.17
Ik.Rs, 14aitnor
r. . r.tt-tri) tinitivqj
by .:T,... •
DOC Co. clba
SULLIVAN WATER WELLS
P. 0. BOX 272, CHUGlAK, ALASKA 99567 • TELEPHONE 688-2759
•••• ••••
'OF LAND tie:- /.4{ /71 4. (Fc,4,,..).0 DEPTH OF WELL 0
t •
114 A•• •
IESS 1F-.• .5 /-4, 6 A 1,tt1/4„_ STATIC LEVEL OF WATER FT 4
It" • ..)
„JAL: DESCRIPTION_ 4 e• -Cee *`1 /4-,- -'44) DRAW DOWN FT.
eTE. Started 451 / C.° Ended .5/1 i/;-0 GALS. PER HR
.7? °
PERMIT NUMBER PO* IA4IW KIND OF CASING (-)
OF FORMATION:
:rom—L- Ft.' to 3 Ft
. • , • ,
rom 3 Ft 'to 't 6 Ft
t9 Ft
Fr9m....14._.r Ft; tO. 0-5 Ft
"7-= •••;r: 4:1•• . •
From '
07 1),4
64i4,e4,
ir?0,.)404",,Ej
,tr
13a st4 S
From ;-.7.,) 3 Ft. to 3 Ft.
From ' = Ft. to Ft.
Froin'-;12:*5 •:' Ft. to 44 I Ft
..•
From44 Ft.to `1-60, Ft.
• I
Ft.
Froni;;$-Kb "
From ek Ft. to' 0 Ft
•
Ft 'to----cil• Ft.
•
From Ft to Ft
From Ft to Ft.
. • .
From ' Ft. to Ft.". ."
From Ft to
Ft to
Ft. to Ft.
Ft. to Ft.
• From
f, SArvi, From
Froin
F' 4'Q From Ft. to
A fd 0 St7 6.02' 411,7 . From
n /, 14 rst Ft to
Ft
Ft
From Ft. to Ft.
•
. • -
•
Ft.
•
MUNICIPALITY OF ANCHORAGE
Ft to Ft. OFPT, QF 117A171-1 &
ENVIRONMENTAL Pg0TECTION
Ft
C,L,41
. .0';'„,::;::. , ..., •
Ft.,.to it) I- Ft.
41-.0. rp,--.4t...,4.,'...;.• ,
7*
From...L-.....Ft. to'.....L...-___..-Ft
444,14.00-.411;"%;,::.I.I.:- ......: • • ..7 ' '
From';‘,.....;'•....' • ,Ft. to Ft;
'11-'irir.ele .e...f,.;:),:-i'.1
..:fr•ke••••.! •::". -- , .. * : . .
From Ft: to ° - "Ft.
1.,
,_ t -r, ---
:N. Nii::!:.'...... i' ,.!-....-.' .•
'11.. i. 1- - • , • ,;:•:
ett0.41 • ,.z.,, :... :-. fit 10--..... . ...ft
CII
° From Ft to JUR 8 1980
Ft
•Ft RECEIVED
• From Ft to.
•
From Ft to Ft
From Ft. to Ft.
•
• •
•
rn
From Ft. to Ft.
, From Ft to Ft
o • 0 .r.
=W
DRILLING, !NE*
\9-9
DRILLING LOG
Well Owner
Keith Nelson Ute of Wel] 6"
• Location (address of: Township, Range, Section, if known; or distance main road
T 15N, R1W, ':74c. 9, Lot 69B
GN
Size of casing 6" Depth of Hole 350 feet Cased to 115' feet
Static water level 100' ft (a n901
Screen ( ) ; Perforated (
Describe screen or perforation
Well pumping test at 8 gallons peri ( aC.) (minute) for 1 hours with 1009•
of drawdown from static level
(below) land surface. Finish of well (check one) open end
( XX)
Date of completion 1011 /76
WELL LOG
Depth in feet from a ;
ground surface Give details of formations penetrated, size of material, color and hardness
O TO 2 Casing ''Stickup
2TO 20. Si,iy Cobbles
20 TO 40 Silty. Gravel and Cobbles
40 TO 50
Clay - Brown
50 TO 55 Clay and Gravel
Bedrock - Fracture 20n0 - water
2 STATE'
Andrew Gray
From: Dennis McCormick [mccormicksedge@yahoo.com]
Sent: Thursday, December 16, 2010 10:02 AM
To: Andrew Gray
Cc: krystalhoke@gmail.com
Subject: Septic system demo
McCormicks Edge took care of the demo of old septic system on steffes st. On date 5/24/10
Sent from my iPhone
L�Ii 1 c c,,
tri A
4-te G 7.1141 l SS; eft C
r�f�CL'c V t G c
COS A r
C (�
1
crtL ti / v
647 y al
Ak.
rn
W'
MUNICIPALITY OF ANCHORAGESi 2._ it 2
3 I'/" 2()
,r rf DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION %`
4 ENVIRONMENTAL ENGINEERING DIVISION s- ,e,c z_ .:-.. �6f
sx
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME L
o . Pe L./ s S /ER
PHONE
c p a '2?
.T NEW
■ UPGRADE
MAILIN17, eG ADDRESS C-- ? i%�7 /t'9K., XX. ?9J"C 7
LEGAL DESCRIPTION
' �� L/ 5 s/,�/e 5o/s/or 2
d ap .
LOCATION
O,/ A/0X.7-,E 8/4c� uk)o , b,
NO. OF BEDROOMS
..
SEPTIC
TANK
DISTANCE TO:
Well
//2
Absorptionr'a
Dwellin//
,^/�
PERMIT
T.7O 4/.5-.
Manufacturer 1a,e
,
Material��
No, of compartments
Liq. capacity in gallons
/DOO
IF HOMEMADE:
Inside length
Width
Liquid depth
c Y
_Iaz
= 2 F
DISTANCE TO:
Well
Dwelling
PERMIT NO.
Manufacturer
Material
Liquid capacity in gallons
TILE
DRAINFIELD
TRENCH
DISTANCE TO:
Well / 2 2
Found74
Nearest II
PERMIT ?NOD 4.495
No. of lines/
Length of each
Total length lines
,3co
Trench width
inches
Distance between lines
Top of tile to finish grade /
Material beneath tile�� inches
Total effectivg�bsorption area
a 6-a `-�Q, F
SEEPAGE
PIT
Length
Width
Depth
PERMIT NO.
Type of crib
Crib diameter
Crib depth
Total effective absorption area
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
w
Class
Depth
Driller
Distance to lot line
PERMIT NO.
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
01 -sr //zoN li, PVC P477.--1
,
SOIL TEST RATING
$
/
3�6'
p
INSTALLER
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REMARKS ,�1
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�fn Earl P. Ellis
� •• NIA 1745E :
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C•Fo ••.... a�(�
ill
APPROVEDDATE LEGAL
eaze p, 7/.2 o/79 Z o7- 5, Loc/< g'L L./ 6 S/4" g -de -
72 -013 (Rev. 3/78)
MUNICIF
DEPARTMENT OF
\825 'L'
CAN 55}
PERMIT NO. t 790401 )
�... I TY OF ! INCIMf 'ROE
riEALTH AND ENVIRONMENTAL Pk.... fECT ION
STREET. ANCHORAGE.. AK. 99501
264-4720
I T11,4E M 'E Fit r 1 I T
APPLICANT R.L. PELLISSIER
LOCATION NORTH BIRCHWOOD LOOP
LEGAL L2 PELL I SS I ER Sr'D
PO BOSS 146
688 2906
LOT SIZE 54450 SQUARE
TYPE OF SOIL ABSORBT I ON SYS 3 MIS: rv5� TRCHr I (K15 E' l 1 + E' t`
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING r<S( FT/BR)m 85
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
C>EF 'TM -,1 0 LENOTHatm 3t2 OPFIVEIL_ C'EPTH= _ 4
FEET
onkf
THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION CIN FEET).
FREQUIFRID EMP'T X C TF3Nt I ZM A-000 OIRL.L_.OlS1
PERMIT APPLICANT' HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
_...�. TIAJo <2> I N F''ECT I OM" -.1S PIF E REQU I mEMD .-.........--
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL) OR
150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
FERN I T. E)<P X SES DECE.MEEP �....•
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE
RESIDENCE_XS REMODEL INCLUDE MORE THAN 3 BEDROOMS.
IONED:
PPLI
ANT R. L. PELL I SS I ER
AND WELLS AS SET
ENLARGEMENT IF THE
SSUED DATE-.. 7_M 3,C __ Y1 2
IMIAL-fl` O( 4- {\-rer \J bf A Se( o'n Sewer CsTEr,-\ Cin rt Arc 1-
L.017
L -OT i>t f7` r1 T Cori w. ( T u1 -E (pprO0 t-- af' % 4 +a -. L
Russell Oyster
694-2774
O & E ENGINEERING & DEVELOr MENT CO
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Performed for: Name.
SOIL LOG
///%R . /" E L e SS /E
Mailing Address.
Legal Description.
Depth (feet)
0
1
, Ea / t ,
Lpr ,2, Pezc/ss/L Sdap.
Soli Characteristics
/LT TOP So/t rZ
O-0 47/e,
2
3
P 54dc/D Y�.� i✓EG
42 s '6'%.�2.
eLE4A4, G oo S
5
6
7
8
�P 6,e/4 VEL, cvl CO6ACE5
9 tt36 oz- s To /41 „O /oo
•
Earl Ellis
688-2280
Tel. No 6• 69 -2'706
C°itit)k / 1q i ,
LOT 86 , cS-&c. 9, 77S/1. ,e/ g7)7 --
Lor
i
10
Gf.1 �/hvi� Y �ie.��/EL �GF crs(40/8.,e.
6esE SOTT3.ti/ f/%
11
12
13
14
15
16
PLOT LPLAN
do de Le.
PERC. TEST
Ground Water Encountered: Yes No If yes, what depth
Proposed Installation: Seepage Pit Drain Field
Comments.
Performed by:
Date• 7/Z/77
7
-Lor
3Sini,
/,s '
'a
Z. 0 r z
-
PLOT LPLAN
do de Le.
PERC. TEST
Ground Water Encountered: Yes No If yes, what depth
Proposed Installation: Seepage Pit Drain Field
Comments.
Performed by:
Date• 7/Z/77
Municipality
of
Anchorage
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 264-4111
GEORGE M. SULLIVAN,
MAYOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Th
Kic'TAL pfr ou'a I
eV tiL e.,97 oc:P
\c -c) IV I S iDUr
CA-tA \re.