HomeMy WebLinkAboutTHIBODEAU LT 7Thibodeau
Lot 7
#008-032-36
Municipality of Anchorage Page 1 of 2
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 1966,50 Anchorage, Alaska 99519-6650 Telephone: 545-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW000046 PID Number: 008--032--38
Name:MIKE MULLER Wastewater System: [] New · Upgrade
Address:
2810 KIMBERLIE CT. ANCHORAGE, AK 99508 ABSORPTION FIELD
No. of Bedrooms:
Ph°ne:(907) 562--0707 4 ·Deep Trench DShallow Trench [3Bed E]Mound [3Other
LEGAL DESCRIPTION 1.2 S.D/S..
7 -- THIBODEAU 2,3.3 MAX, Ft. 5,67
- - - 0 - 0,5 F~ 45
Ft.510 SO. F~ D 3034/ F-810/SCH 40 PVC
Ft.DENALI SEWER AND DRAIN 6/1/00 - 6/2/2000
· ..~ TANK
SEPARATION DISTANCES [] Beptio D Holdi.g · S.T.E.P.*
=rom Tank FTeld Station Tank s.,~.r u,o, ANCHORAGE TANK *500
Well 100'+ 100'+ 100'+ 25'+ STEEL 1
Sa,ace 100'+ tOO'+ 100'+ - LIFT STATION
Water
Lot 5'+ *'1' 5'+ -I ANCHORAGE TANK/ORENCO PRODUCTS
Line 500
Foundation 5'+ 10'+ 5'+ _ _ 28- 28"i 347,
Drain '. NONE KNOWN 20 OSI 05 HHF M.O.A.
I I
~emorks: * EXISTING 1250 GALLON CONCREI-E TANK FEEDS INTO BENCH MARK
A 550 GALLON S.T.E.P. TANK. SLAB OF PORCH @ SOUTHWEST CORNER.
NIsum°d Uevation: 100.00 Ft.
Inspections performed by:. AWWC, INC. Dates: 1st 2nd 6/~/20005/1/2000
3rd 6/2/2000
Department of Health an.d. Human. Services approval
Reviewed and approved by:/').///...-~/ ~/, /'"~ Date: ~-.2.(~-o o '~,~.~ofe~s~o~.'='
AS BUILT DRAWING P^RBEL,B .uMBeR:
PERMIT NUMBER:
5W000046 ' 008-05,2-56
KIMBERLIE Kw BOX ,
COURT ~/-~:' ~4' WIDE BY 4 OF BLUE BOARD INSULATION.
J J , / / ~ N~ 500 eAtON
J I ~ /~ / S.T.E,P. T~K
~ ~ ~¢o,c.~ ~,,,c J~.
I I'T' ~¢ I o ST1 / INTEGR~ ~RIREO
I I Aj
i i ~ 001 19.9 54.8 --
j I I , MH 18.9 52.8 -
~ I j K~BO) 57.4 34.9 -
I I i MT1 - 17.5 56.2
I I J MT2 - 5~.2 18.0
j j J BEDROOM HOUSE
I I
I i
6/12/2000
A~S~ WATER & WASTEWATER SCAre K.g.w.
MIKE MULLER (907) 562-0707/561-1892 2 OF 2
THIBODEAU SUBDIVISION; LOT 7
~PE OF WORK:
AS-BUILT OF SEPTIC SYSTEM UPGRADE
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On-Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Apr 06, 2000
Expiration Date: Apr 06, 2001
Permit Number: SW000046
Legal Description: THIBODEAU LT 7
Design Engineer: 0041 AK Water & Wastewater Consultant
Owner Name: Mike Muller
Owner Address: 2810 Kimberlie Court Total Bedrooms: 3
Anchorage, AK 99508-
ParcellD: 008-032-36
Site Address: 002810 KIMBERLIE CT
Lot Size: 8090 SQ. FT.
Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By: ./~.~,~,¢~ (~ Date:
Rick Mystrom,
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-8850
http://www.ci.anchorage.ak.us
April 6, 2000
Jeffrey Gamess
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2-B
Anchorage, AK 99504
Subject:
Waiver Request for Thibodeau Subdivision, Lot 7
Waiver Request #WR cc~'c'£,l ~
Parcel ID #008-032-36
SW000046
Dear Mr. Gamess:
Your request for a waiver of the required 10 feet horizontal separation from the
on-site wastewater disposal system to property line has been approved. The approved
separation distance is 1.0 foot.
This waiver approval applies to the existing on-site wastewater disposal system to
property line separation only. Any future upgrade to the on-site wastewater disposal
system will require all separation distances be met or another approval from this
department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-4744.
Sincerely,
Daniel J. Roth
Civil Engineer
On-Site Water Quality Program
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
On-Site Services
Waiver Review Worksheet
WR# WR000013 PID#: 008-032-36 HA#:
Date Received: March 20, 2000
Legal Description: Thibodeau Subdivision, Lot 7
Engineer: Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Road, Suite 2-B, Anchorage, AK 99503
Applicant: Mike Muller
Waiver Requested: 1 foot lot-line-waiver
Criteria: 1.
2. Special Conditions:
3. Other:
Geology
A. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Points:
Total:
Waiver is Granted:
List Conditions or Reasons for above: .~' ~. ,c
Waiver is not Granted:
Date:
Name of Reviewer
Rec#: 05791 Amount: $115.00 Date Paid: 03/20/00
ALASI WATER & WASTEWATER
March 14, 2000
Municipality of Anchorage
Department of Health & Human Services
Division of Environmental Services
On-Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Septic System Upgrade Design for Lot 7, ThibOdeau Subdivision
To whom it may concern:
The existing 4 bedroom house is served by a public water system and a private septic system.
The existing septic system consists of a 1250 gallon septic tank and a deep trench type drainfield.
The existing drainfield is completely surcharged and must be upgraded. A test hole was
excavated southwest of the existing drainfield. We are proposing that a new 1250 gallon septic
tank and a deep trench type drainfield be installed. Comments regarding the proposed design are
summarized as follows:
1. SOILS: Attached is a log which shows the soil classifications, groundwater monitoring, and
the percolation test results. The soils below the organic layers is a GW to GW/SW material to a
depth of 5 to 6 feet and than transitions to a SP to SP/SM material to a depth of 16 feet (bottom
of test hole). No groundwater was encountered during the excavation of the test hole. A
percolation test was performed between the depth of 6.5 feet to 7.0 feet which had a percolation
rate of<l minute/inch. It is our opinion that the insitu sandy soils should act as a sand filter and
that a application rate of 1.2 gallons/day/ft2 should be used.
2. TRENCH DESIGN:
a. Percolation Rate: <1 minutes/inch
b. Allowable Application Rate: 1.2 gallons/day/ft2
¢. Number of Bedrooms: 4
d. Design Flow: 600 gallons per day
e. Minimum Absorption Area: 500 ft2
f. Total Depth: 10 feet (max.)
g. Effective Depth: 6 feet
h. Width: 2.5 feet
i. Reduction Factor: N/A
j. Minimum Length: 45 feet long
k. Effective absorption area = 540 fi2
6901 Debarr Road, Suite 2B - Anchorage, AK 99504 ~ Pr: (907)337-6179 N Fax: (907)338-3246
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed
upgrade.
4. TOPOGRAPHY: The general topography of this property is mostly flat; in short, there are
no slope concerns.
5. LOT LINE WAIVER REQUEST: We request that a 1 foot lot line waiver be granted from
the west property line to the proposed drainfield upgrade. The adjacent property to the west is
vacant and we are unaware of any adverse effects this would have on any neighboring properties.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 33%6179. Thank you for your
assistance.
amess, P.E., M.S.
NOTE: Attached is a site plan drawing, a design drawing, a soils logs, and a 7 page
construction specification letter which are all part of the design package for this septic system.
6901 Debarr Road, Suite 2B ~ Anchorage, AK 99504 ~ Ph: (907)33%6179 - Fax: (907)338-3246
I J EXISTING
J j SEPTIC KIMBERLIE COUTRT
~ PROPOSED SEPTIC UPGRADE --SYSTEM-- PROPOSED SEPTIC UPBRADE
, HOUSE . ~ ~ TH~BODF~U S/D
J ,,q' "~ ~ ~' c~Y W^T~
o)', /.. ~ cm' SE~WR LOT 1 lA
~o --- ~ . 0_4~' PAUL W. SMITH
~ "-~,,~t ' ~ LOT ~0 I ~:J
/ ~l~ \~'~ THIBODEAU S/D
! LOT 12, BLOCK 10 -~ --- C~RBE~ DRIVE
I PURINGTON S D ~* LOT 1 BLOCK 10
/ ,1 PURINGTON S/D
X PURINGTON S/D PURINOTON S/D ~ J LOT 3A
(C~ S~ER) ~ I c~ wA~ I C~RBERT S/D
~ ~ I LOT 5. BLOCK 10 J
~ ~[~T 10, BLOCK 10
PURINGTON S/D J PURINGTON S/D
~ J
I
LOT 9. BLOCK 10 ~ LOT 4. BLOCK 10 ~ J
PURINGTON s/g ~ PURINGTON S/~ I J i LOT 3B
J C~BERT S/D
J ' ,
I ,
j LOT 8, BLOCK 10 m LOT 5, BLOCK 10 J
PURINGTON S/D J PURINGTON S/D
I
I il LOT 5C
LOT 7, BLOCK 10 ~ LOT 6, BLOCK 10 J C~BERT S/D
PURINGTON S/D J PURINGTON S/D ~ I
j J L-
5/14/2000
........ CONSULTANTS, ~NC.~ 1" ~'[' ' ''~ '
RR[P~ED FOR PHONE NUWBER; PA~E NUMBER: :
, .'kt'~ ............... ;'""~
WIKE WULLER (907) 562-0707/561-1892 1 OF 2
~mL g~SORm~T~ON= ~j~'". ~ ~--79S~ ..-"
THIBODEAU SUBDIVISION; LOT 7 ~"J .......... .'
SITE P~N FOR SEPTIC SYSTEM UPGRADE
INSULATE UNDER DRIVEWAY WITH
KIMBERLIE COURT, 4' w~oE B~ 4' OrKwSLUE. ox
~/z--/--NO JOINTS WITHIN 10 FEET
OF THE CROSSING OF THE
WATER SERVICE LINE
II I I .% I I I I_..~l I 11~1 I I ~INSTALL DDL CO
EXISllNG TRENCH TO BE ~: ' o CO
ABANDONED COMPLETELY lCI ~ I
~ ~-PROPOSED 1250 GALLON
~ SEPTIC TANK
MI
PROPOSED DP. AINFIELD. EXCAVATE ABANDONED COMPLETELY
A TRENCH THAT IS 10 FEET DEEP
45' LONG. ADD 6 FEET OF CLEAN
WASHED SEWER DRAINROCK. EXISTING
4 BEDROOM ~-WA'mR SERWCE UNE
HOUSE (SEE NOTE)
CO
/ 2. THE CONTRACTOR IS TO HAVE THE ~"ER SERVICE
/ LINE PROFESSIONALLY LOCATED PRIOR TO CONSTRUCTION.
3/~ 4/2ooo ~¢. ~..~.
'*; "'~ q J.L.M.
AI ASKA WA~I'ER & WASI EWAI ER
- ......... ......... CONSULTANTS, INC.''~'~ ......... '" ..... ':~ sCq£'"' -- 20 , ,~'~r~'""' ,,,.c/,~.~.'.L..:,.,,/~....:.~..
690l DEBARR ROAO, SUITE 28 *' ANCHORAGE, AN 9950~. · PHONE (907)557,~179 FAX (907)3~8-~g~,6
MIKE MULLER (907) 562-0707/561-1892 2 OF 2
' .,LDESDR,.,ON:
THIBODEAU SUBDIVISION; LoT 7 q~o~ ............. ~.~,~
WPE OF WORK:
DESIGN OF SEPTIC SYSTEM UPGRADE
ALASKA WATER & WASTEWATER CONSULTANTS, INC. ~ OF
,90, DE~, ,o~, so~ 2,. ~o.o~cE, ~. ,9~o~ ~¢., ........ :..4,
[SOIL LOG - PERCOLATION TEST]~;.,...i .,~ut/)~: ,, ,, ../.~
DATE PERFORMED: 5/2/2000 ~0/1'~.(/"..
I I ......... '"
DEPTH(f~,t) ~ OReAN'CS TEST HOLE #1 u.~,{,~,~
o ~ ~,}~¢,7 SOIL C~SSIFICATIONS 1
- :~.~¢p~og -~ ~ fSI E P
I: '~;~.0 ~..,~.~:.,:~, >~':'~%-L4 GW ~ ..... ~ ~ ~. ORG] ~ = I00' ~ KIMBERLIE COUTRT
I~:~s 6~ , CL .............
5- :~<~ ~°~
,~ ~ DEPTH TO DATE .__/_ ~ .......
,~.. . GROUNDWATER LOT 12, BLOCK 10 ,
8 ~.,,t ] DRY 5/2/2000 I , ¢~
..~o " DRY 3/10/2000
,ege , SP TO
11 -- e'' ~' * SP/SM DATE READING CLOCK NET TIHE WATER LEVEL NEI DROP
,...2 ~ Tl~E (H~NUTES) REAmNO 0NCHES)
,,~,~ 3/2/2000 PERCO~TION HOLE FILLED TO AND COMPL~ELY
,e~e ABSORBED IN S~EN MINUTES. REP~ED ~lCE WITH
15-- pe,~fw ~SAME RESULTS
16-~
17~
~8~
~9~ PERCOLATION ~TE <1 (~I~./INOH) ~ER0. HOLE DIA. 6 (I~CHES)
20 TEST RUN BETWEEN ~.5 FI. AND 7.0 FT.
CO~ENTS: THE' INSIIU SANDY SOILS SHOULD ACT AS A SAMD FILTER.
PERFORMED BY A~SKA WATER & WA$1EWAIER. I. JEFFR~ A. GARNESS, CERTI~ THAT THIS
WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON
.*T~:
DEPTH TO DATE
GROUNDWATER
DRY 5/2/2000
DRY 3/10/2000
GREA', R ANCHORAGE AREA BOR[,,,GH
,,. ; Department of Environmental Quality
t~.~' 3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON:SI~TE SEWAGE DISPOSAL SYSTEM
NAME
SEPTIC TANK:
J.4_ NUMBER OF
DISTANCE ~- (~ ~..J ,.~ O
FROM WELL k~,.,~'* · MANUFACTURER MATERIAL_ _ COMPARTMENTS
INSIDE LENGqH __[~ INSIDE WIDTH __ LIQUID DEPTH LIQUID CAPACITY LLONS.
TILE [)RAIN FIELD:.. .~ IJ~ ~ ,, / / / TOTAL LENGTH...,
DISTANCE FROM WELL~¢' "~ 'FOLJNDATION.. '~ _ _NEAREST LOT LINE .__
NUMBER OF LINES _~___ DISTANCE BETWEEN LINES .. TRENCII WIDF[I IN. TOTAL EFFECTIVE
AI3SO RPTION AREA -~
DEPTH
OF
DEPTH: TOP OF TILE TO FINISN GRADE'
WELL:
TYPE Tv'~- ~";~ CONSTRUCTION
DEPTH
DISTANCE FROM:
BUlL_DING NEAREST
FOUNDATION__ , LOT LINE
NEAREST SEPTIC SEEPAGE
SEWER LINE_ __, TANK SYSFEM
CESSPOOL . , OTHER SOURCES
APPROVED DISAPPROVE[)
REMARKS
DISTANCES:
SEWER LINE DEPTH:
PIPE MATERIAL:
DIAGRAM OF SYSTEM
LOT SLOPE:
REMARKS: ~/~2 --/' ,/~/~- ~ '~''/''~
Form EQ-032
I::}l:(.
il::':"
I...1 I II ,I .I .I .{ !..
11::' 'i t } :1: ]:i (: [:,i:'F:ll i
!: '1 ::ll::i ':; ':d F::II:-:'[:' !:'!::l: !
l']i:]:;:',:l'i'ilti"i i",llll'i[i:l:l:;i: O1::: I:!:I!:i:DF;:(3()H:ii; ...... I
I'i ii:: ~ Ii:l",tEi II I I):l:Hl;l'd:;]:Oi",l :t:~i; 'ill[i: I [i:i",l(:itll ':: :1:1",1 I:'li;l:i:"l'::' OF 1111: 'l'l'd::H(::l I OF;: I::'I:;;:I:::iZ [",IF I:1:1 I)
!iii:: ]::'h:F:'lll O1:: I:::l II:;i:l;hE:ll Ell;i: I::':1:'£ ]:'ii; Fill:; i::, :[ :i!i;Tl::lhlE:ff:
I:ii::~:Ol.ll",l[::~ FII",I[) -Illl: li',o'r'fCIH OF Till: I:i:X(::F:IVI:::ITI(:ti'.,f ,:;:[1'.,I I::li:l::'l'::,.
'l'iql::i:,::F: :[:=; F,il) :;t:'1' ~.,1:1 DI'] I I:::'O1:;i: IIi:[:t'.,t(::l
~111: GI4:i:::i',,,'I~:i_ ]::,[ :[:::' I FI ]:i; TI.Il: I',lll',]]:l,tlJl',t D[J:I:::'Tll ()F: (!il:;;:l::t'vq:!
'::ff.,ii::, 'llll: ii',Oi'/()l'! ()1:: lllli: K::.O::I:::!VFIFIEd'.,I ,:::[1'.,I
GI(EAIER ANCIIOId\(;L Al(LA UOROUGil
IJepartment of LnvironmenLal Qualit. y
3330 "C" Street
Anchorage, Alaska 99503
SOII,S i,O(; - I EROI,AIiON ll;Sl
Performed f o r_ j~ j~._.__/~,__~-_ _~-~..~
Legal Description
lhis form reports: Soils log__ ~-- Percolation test
Depth
Feet
10-
ll -
12-
13-
14-
Was ground water encountered? _ Gl
If yes, at wirat depth?
Reading Date
Gross Time
Percol at,on r-a t--e ...... minute.
Net Time Depth to Water Net Urop
.Proposed installa-t-f~-n-: Seepage Pit
DepHi of Inlel; . ~klepth to bottom of pit or trench r~ ,
L~D~ain Field
I��/�UHJU UTY OF NCHORAL GE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 008-032-36
1. GENERAL INFORMATION
Complete legal description Thibodeau Lot 7
Expiration Date: �J —2-0 Z
Location (Site address) 2810 Kimberlie Ct, Anchorage, AK 99508
Current property owner(s)
Mailing address
Real estate agent
Charles & Socorro Meister Day phone
2810 Kimberlie Ct, Anchorage, AK 99508
Boston Hoppman - -
2. TYPE OF DWELLING:
Fmil Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone (907)441-9945
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
❑
Private Septic
❑■
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
■❑
Public Sewer
❑
Waiver request for: Distan
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $_�6 Sb
Date of Payment _ z _qf z7
Receipt Number 05 Y_, 9D
COSA# 05C2_21()34;
Date:
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering NJ) Phone (907) 522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller, P.E.
6. DSD SIGNATURE
System #1 Approved for 3
System #2 Approved for
Disapproved
Conditional approval for
bedrooms
bedrooms
Date 2/4/22
r co
49 TH
r• . ��' .....�.�.
•Ben)a"' ,Schiller
�29
�� �•. CE 12592 •�c`��/�
iJ�� • _ 2/4/22
\ROFESS100
bedrooms, with the following stipulations:
gJ
ON SIT
r
WAS
M:
r-RAND
o
PROO�AM
o
By Original Certificate Date:^� , -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
Septic System Advisory
Well Flow Advisory
COSA Checklist blue sheet
Nitrate Advisory
Arsenic Advisory
Other S' eg) �' ,S (16) V
Legal Description: Thibodeau Lot 7
If more than 1 septic system on lot: COSA Checklist # 1 of 1
LL DATA
❑ Well log i with Onsite (or attached)
Date drilled
Total depth ft \\
Cased to ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Comments Property served by public water system.
B. TANK DATA
Age of tank(s) 45 years
Tank type/material Septic/Concrete
Measured operating fluid level in septic tank 53
M Standpipes/foundation cleanout per record drawing
Date of pumping A+ Plus 2/11/22
D. ABSORPTION FIELD DATA Deep Trench
Which system tested (date installed) 6/1/2000
0 ALL standpipes present per record drawing
Total measured depth from grade _ 7.8 ft (max)
Measured depth to pipe invert from grade n/a ft (min)
❑ N/A — pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective
0 Code -required soil cover over field
0 System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Parcel ID:
Structure served by this system 1
008-032-36
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
itrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
C. LIFT STATION
0 Required maintenance completed
Age of lift station 21 years
Lift station material Steel
Comments: A+ Home Services 1/22/22
Adequacy test date 1/31/22
Results 21 Pass For 4 bedrooms
Fluid depth prior to test- 7 in
Water added 1024 gal
New depth 17 in
Elapsed time 1440 min
Final fluid depth 4 in
Absorption rate >600 gpd
Any rejuvenation treatment (past 12 months) No
1435 If yes, enter date N/A
Gallons introduced gallons
Comments/Deficiencies: Presoak - 5.67 x 45 x 2.5 = 637.815^3 x.3 x 7.5 = 1435 gallons.
COSA Checklist yellow sheet
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'
0
Yes
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
ft
❑ Yes
if No ft
Neighboring Tank > 100' ❑ Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No ft
Absorption Field on Lot > 100' ❑ Yes
if No
ft
Holding Tank > 100' ❑ Yes
if No ft
Neighboring Absorption Fields > 100'
0 Yes if No ft
Water Main > 10'
Animal Containment > 50' ❑ Yes
if No ft
❑ Yes
if No
ft
❑✓ Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway comment below
Community Sewer Main > 75' ❑Yes
if No
ft
0 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
0
Yes
if No
ft
Surface Water > 100'
❑✓ Yes if No ft
Property Line > 5'
0
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'✓❑
Yes
if No
ft
Private Wells > 100'
0 Yes if No ft
Water Main > 10'
❑
Yes.
if No ..
ft
Community Wells > 200'
❑✓ Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to:
(Please enter distances if
less than required)
Building Foundation > 1.0'
Yes .
if No
ft
If absorption field is under driveway comment below
1
Property Line > 10'
❑
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
✓❑
Yes
if No
_ ft
Private Wells > 100'
Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
ft
Community Wells > 200'
Yes if No ft
Surface Water > 100'
0
Yes
if No
ft
F. ENGINEER'S COMMENTS
*WR #000013 _(Property _line _to_trench)
___
G. ENGINEER'S CERTIFICATION
l certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
OF
5.
11-t
�. BenjarrJ. chiller •.�
Fc CE 12592 w
2/10/22 • '�G�
AM".
www.muni.org/onsite
Septic Tank Advisory
Certificate of On -Site Systems Approval #OSC 221038
Subdivision: Thibodeau Lot 7
Starting at 20 years of age the MOA issues Advisory's for steel STEP tanks. The STEP tank for this
property is 21 years old. Typical replacement costs range from $9,000 to $12,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of what the metal of a 20 -year-old steel tank MAY look like.
Madmg Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org
i�
MUNICIPALITY OF ANCHORAGE
Devconrnpnt Ser,ices Deparimwen,, 014
Cn-&te V11ater & 'QV wsfte'water ScC71"lon
Maintenance Log
ov,r,
Stree"A V_ CIL
�§Pptic Tank:
.S'u,c'CC: level i n c orn p 1.1
-pumping: roquirec, YL64;1�),_�,) -PLIMD
Lm station:
-Pulmp basket cleaned
Rrlo
- C c., n I ro I fl o atz, c I e a n e o" /,,e
-Operatior, saVE�ffaoto�-y g� -, no
-Effluent fille, Cleaned t, .s nn
-Proper float settimas �.,-nfirmoc
Alarm System:
-Dedicated elect`cal alarnn circuiL SrG
C, -Auf'ble arld-',Asua--flarn ir1s;de
-A'auri sys1erm a:7jc,,..ra tion 'Sailer?
Manhole Riser
.Ground v.,azter -Mtrusiun at isi?r to tank conner'',iun ves Irnc",
-G,rcund v.,ater rtrL1Si0r1 a7-01Jr-ldpir)-
-,-Veep hole ftjn-fiir-:,D!
-NI'a-incle lid- 5unctioa!/1711_971^0 fnsu!ated Properly Secured -,c
Other
-Al manufacturer required 'Ins;pcctiona and maintenance completed tees n
Comments:
Qualified Maintenance Provider:
Techn.cian 1pj\--,)
Company
Siar....-tj rc
Di�
,a 'I, o- m a., nte n, Pip o
MtJNICIPA LITY OF ANCHORAGE —J/�_ /O 0 _—OO2
WATER CONNECTION — Location R—ld ACCT. NO. //
. i NAME ADDRESS
%Y LOT_._ -..—
%Y SIZ[ CONN. DATE MADE _ NC -W CONN. _ REPLACEMENT CONN.
LOCATION
_ALLEY I -J STRE[T_ tJ___ TV PE DP
CORP STOP
MAIN( lar•v..-.•�•_•.-••..•-••-----------
THAW PLATE PERMIT NO.
CURB STOP C TO C
KEARNY WIRE CONNECTOR W
CURB STOP C TO I
OTHER: _ CONN.%S
—
CORP CONNECTOR
INSP.! <_
---
'—
COUPLING C TO i
- - PERMIT
_ ..
X BRASS 6VSNING
TOTAL �PL
X GALVANIZED BUSHING
COMMENTS: QROKEN MAIN. EXT. CONNECTION. EXTRA PIPE
2 PART UNION --_
---�- CASING. DELAYS, ETC. �T. reir
3 PART UNION
PI LA
SERVICE CLAMP X
PAID PREY.
COPPER PIPE
.
5-:i++•• SLY QOX �._
r PAID CASH
.. ..__ _. - _.__. ._--_.
_
2" KEY BOX
CI SUB AGREE -EI
5
THAW WIRE
_
DISCONNECTS ALT
LOCATION
�
EXCAVATOR C,/}. '<./ I:� Q IMP. DIST_
APPOINTMENT TIME:
TIME READY: EXT.AGREEMI
CONNECTION MADE BY
-INSPECTED BY
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