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HomeMy WebLinkAboutCAMPBELL HEIGHTS BLK 4 LT 14CAMPBELL HEIGHTS BLK 4 LT 14 014-072-17 Water well reported to have been drilled prior to 1971. Depth 25' Cased 22' SWL 12' 500 gpd Parcel I.D. 014-072-17 Certificate of On -Site Systems Approval Expiration Date: Legal description CAMPBELL HEIGHTS BLK 4 LT 14 Site address 3529 E 67TH AVE Anchorage AK Current property owner(s) GUMP X The On -site system(s) is/are approved for 2 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: :N Original Certificate Date: 11 /29/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE o '4 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 014-072-17 Complete legal description Campbell Heights Block 4 Lot 14 Location (site address) 3529 East 67th Ave. Anchorage, AK Current property owner(s) Grump Ardra D Virgil & Pansy Lorraine Day phone Revoc LVG Trust 2. ON -SITE SYSTEMS SIZED FOR 2 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank V Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On -site staff to verify the accuracy of the information provided. COSA Fee $_?_ W Date of Payment 20 2 COSA# 0-5C Z3 Waiver Fee $ Date of Payment Waiver # COSA Application —June 2022 COSA Checklist Legal Description: _. _ Campbell Heights Block 4 Lot 14 Parcel ID: _ _ 014-072-17 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ✓❑ Well log is filed with Onsite (or attached) Date drilled UNK* —Total depth 84* ft Cased to 84* ft J❑ Sanitary seal is functioning correctly © Wires are properly protected Casing height (above ground) 31 in. Date of flow test for COSA 9/25/23 Well production at time of test 20+* gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes 0 Nc ✓❑ Coliform bacteria is Negative Nitrate mg/L ❑✓ Nitrate less than MRL (ND) Arsenic ug/L ✓❑ Arsenic less than MRL (ND) Collected by Arcterra Consulting Static water level at beginning of test 14.9* ft. Date 10/30/23 Comments*Fell originally installed prior to 1971 to a depth of 25', well extended to 84' 9/25/23. New well log attached. TA Measured operating fluid a is tank Date of pumping ❑ Required maintenance completed, if AWWTS Comments: ABSORPTION FIELD DATA Which tem tested (date installed) ❑ ALL stand s present per record drawing Total measured dept m grade ft (max) Measured depth to pipe inve om grade ft (min) ❑ N/A — pressurized field ❑ Per record drawings, field is insula ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced _gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies C. LIFT STATION ❑ Required maintenance completed L-\ge of lift station years Lift station Comments: Adequacy test date Results [:]Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd LD STATUS — POST RECOVERY Effec depth (per record drawings) Effective dep used In Effective depth rem ng in Tal COSA Checklist -June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No NA ft 0 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 NA ft Holding Tank > 100' ✓❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft ❑✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑Yes if No 531* ft ✓] Yes if No ft ❑ N/A —Served by Community Well (not on lot) or Public Water Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundation _ I❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft Tank to Property Line > 5' ❑ Yes i ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No ft rivate Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Community _ 9001 ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If tank or field is under driveway com low F. ENGINEER'S COMMENTS *Well installed prior to puwic if, Q I r nZ f/ x L44 G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on -site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Arcterra Consulting Phone 907)-696-5111 Engineer's Printed Name Kenneth Duffus Date e .�3 te Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. �.�' OFr_ W AL �i�+'+ The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The + L flow and absorption rates may change due to subsurface conditions that may not be observed from the w*� surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic Air t� ♦� systems are subject to these various and dynamic characteristics and are outside the control of the evaluator 4 of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will 0 function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist ��* cEN�tETH FF115: COSA Checklist -June 2022 craanvrnrxrenYF 1 EA5T 126, 10 x-ylvJvbL Few Ol A35 ti g"" .OF A L.gs�al 49 1H 0� }a SHANE A. HOLT �R a LS-6914 ys �Q�°�asslona3 VQ� r' f- u� i EAST 126..10 EAST 67TH THE INFORMATION HEREON IS R THE USE OF LENDING INSTITUTIONS SPECIAT4L.L,Y TO SHOW ANY CONFLICTS L3ET{ri£EN EXISFIN STRUCTUr7F5 AND PLATTED LOTGNES ANOVOR EASEMENTS; AND IS NOT TOBE USED FOR POSM NGADDI7TONALSTRUCTURES, IMPROVEMENTS. ORFENCEUNES. EASEMENTSOFRECA4FTOR0 RRIG�HTSOFWAY,ORANVENT3TYNOTONTHERECORDPLAT ARENOTSHOWNHEREON,UN S5NOTE4. NOTE FENCELAVESTHATMAY ON THISDRAWINGARENOTTOOEUSEDTODETERMNE PROPERTYLINESORA7STAOiy 00ITiONALIMPROVEMENTS. ANYPAVING SHOWN HEREON Y aE APPROXIMATE DUE TO EXCESSIVE SNOW ANDU? ICE LIP] A VENUE ASBUILTSURVEY V = 20' NO CORNERS SET THIS DATE IMEREBYCERTIFY THAT; HAVEPERFO.Rf9EDASURVEY LY i},'fr'J:COiY!rIGDESGR.'hEi7FFr�'?ERTV 10T 14, BLOGC4, CAMPELL HELGHTS(PLAT2438J AAA -RAGE RE!:O.R_r NG 0-fS IRICT. AL.SKA. AND THAT Tf; 1!iS15Lf !'�€nROS'EG?Ery'T5 .Si?L'AFED TkERECN.4RE .:;£H!:.i .:HF PA,OPERTY LIVES Aria 7d0 VISIBLE E! CROAC.,'A`E4TS EY,ST OTHER THAN h'C-EO. a 4r=A7M,'CH0RAGRALCSKA Tr,'!S 23RD M0Z7 ESND SURMYINa 9309 GnotSR DIRZM ANC3MtAM,JLK 99507 Certified Drilling Log OWNER OF LAND: George Gump ADDRESS: 3529 E. 67th Ave. Anchorage, AK 99507 LEGAL DESCRIPTION Campbell Heights B4 L14 DATE: 9/25/23 PERMIT NUMBER: DATE OF ISSUE: TAX IDENTIFICATION NUMBER Is well located at approved permit location: Yes No Method of Drilling: air rotary cable tool Depth of Well: 84’ Casing Type: Steel Wall thickness .250 inches Diameter: 6 inches, depth 84 feet Liner type Static Water Level: 14.9 feet Recovery Rate 20+ gpm gph Method of Testing Air Well Intake Opening Type: open end open hole Screened Start feet Stopped Perforations Start feet Stopped Grout Type: Bentonite Volume: 50 lbs. Depth: from 2 feet, to 42 feet Well Disinfected Upon Completion: yes no Method of Disinfection: Chlorine 50 PPM Comments: Bore Hole Data Depth From To 0 20 Existing hole 20 22 Some gravel black water 22 30 Gravel and silt 30 34 Silty sand 34 37 Silt and some gravel 37 55 Gravel and silt 55 57 Silt and some gravel 57 75 Gravel and silt 75 77 Silt some gravel water 77 84 Sand and gravel Drillers Name: Cole Sullivan ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. www.sullivanwaterwells.com Pump Installation Log Well Drilling Permit Number: SW Date of Issue Parcel Identification Number: Legal Description Property Owner Name & Address Campbell Heights B4 L14 George Gump 3529 E. 67th Ave. Anchorage, AK 99507 Pump Installation Date: 10-5-23 Pump Intake Depth Below Top of Well Casing: 70 feet Pump manufacturer’s Name: Myers Pump Model: 3NFL52-12-P4-02 Pump Size: 1/2 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Installer: Northern Excavation Disinfected Upon Completion? yes no Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer: Martinson Pump Installers Name: Sullivan Water Wells Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE WATER & WASTEWATER UTILITY 3000 ARCTIC BLVD. PHONE: (907) 564-2762 BLOCK/LOT/TRACT BLK 4 LT 14 SUBDIVISION CAMPBELL HEIGHTS WASTEWATER CONNECT PERMIT 95 - 0853 DATE OF APPLICATION 07/26/95 SCHEDULED COMPLETION DATE 12/31/95 SINGLE FAMILY MUTT -DWELLING No. APTS COMMERCIAL TAX CODE 1407217 GRID 2034 AS -BUILT STREET ADDRESS 3529 E 67th Ave OWNER GUMP ARDRA D & PANSY PHONE MAILADDRESS ANCHORAGE,AK 99507-2335 CONTRACTOR Nielsen Repair Existing Service ® On Property Only F-1 Hydrant Only Main Tap - To Property Line Only Main Tap & On Property Connect Disconnect R&R - Main Tap Only CONNECT SIZE 4 REIMBURSIBLE NUMBER PERMITEE (Please Print) MAIL ADDRESS SIGNATURE City Tap 50' or Longer ASSESSMENTS Main Line Extension Have Been Levied To Be Levied Comments:J�' lOwner IStaff I ISSUED BY SAP INSPECTION FEE $ 104.00 ❑ PAID ❑ CASH PERMIT FEE $ 35.00 ❑ CHECK# $ INSP CTE - Y DEPOSIT $ 0.00 TOTAL $ 13 9.0 0 DATE PHONE POST IN A CONSPICUOUS PLACE AT THE JOB SITE AWWU INSPECTOR Original DATE SCHEDULED / / TIME INSPECTOR SUBDIVISION CAMPBELL HEIGHTS BLK/LT/TRACT BLK 4 LT 14 INDI&ATE NORTH Q W � O I 0� I� i SIZE MAIN: TYPE MAIN: DEPT AT MAIN: AT PROP. LINE: �2 CONNECT LOCATION: COMMENTS INSPECTED BY: ���� DATE: �� f TAX ,CODE No.. ra GRID N o,. �3 rj • MUNICIPALITY OF ANCHORAGE SEWER UTILITY Name Address AcctNo Plat No. Subd.0 A M 8,oE L of Block Residential 0 Commerlal 0 Industrial M o_ nf tinif CONNECT: Main Tap n property Permit No. S i Type Drawing No. Size Main Type Depth Insulation 0 Cleanouts Type Connect Agent Inspector )<,oF M f:=" 1 Co Dates f Connect Location J?E� 1.41 A) 11 ASSESSMENTS: L.f. D. No. Private Dev. No. _.- Su d+ Agreement No. Sewer Agreement 0 No# T. _ 0 Roll No. DYE TEST. Positive CD Negative N.S.A. Date page N� �. No. Billing Cycle Tested B y comments \.. \� (��k\ i 14 Ws u a LLB L lop- 1 k -L-LS IMP v � h /+ M • i 4 ... J .0 z r _T 3 qpp Y AL w 1 4- 7 / * T ; ■ # T 1 kF t x P. X R } *1 r a a �• 4 1 y # IN A L.. LE7 Pi MUNICIPALITY F ANCHORAGE �Q WATER & WASTEWATER UTILITY LITY 3000 ARCTIC SLID_ PHONE: o7) 564-2762 BLOCK/LOT/TRACT $Lx 4 LT i4 SUBDIVISION CAMPBELL HE2GHTS TAX CODE Z4072�.7 GRID 2034 AS -BUILT k STREET ADDRESS 2 MAIL ADDRESS ANCHORAGE,AK 99507-2335 WASTEWATER CONNECT PERMIT <:::? �- a-7 I i c It f�� 95-0853 DATE of APPLICATION 0 7/2 SCHEDULED COMPLETION DATE M /3M/ - SINGLE FAMILY M UTI-D ELLI r G COMMERCIAL PHONE CONTRACTOR 1q:Lf-3a-S<Br' ASSESSMENTS Repair Existing Service Main Line Extension On Propel only City Tap Have Been Levied Hydrant only f 5r Longer To Be Levied Main Tap -- To Property Lire only omris Main Tap & On Property Connect Disconnect - Main Tap only Owmoe= S *- OONNECT SIZE ISSUED BY SAP INSPECTION FEE 3-04.00r} PERMIT FEE $ 3 r • oo � �K ry $ INS CTED Y I M S I L y NUMBER [DEPOSIT $ 0.00 TOTAL $ 3.39.00 DATE REMARKS ■'ice f f+M%, _ • r ; a &.1 evil a "L" %. Y--I t= k:j rdIPF-iT7E MAIL ADDRESS SIGNATURE X PHONE f POST IN A CONSPICUOUS PLACE AT THE JOB SITE No. A PTS �. AWWU INSPECTOR Original -0 ExlsnwG Mw NOTE: LOT BK . x e.9 1� ;S / / x- X AT If OF $HALL SEW CON2.50 Yll I � � x AT! SHALL BE I]2.50 3 10• v6.o0 BE- FE=1]5.10 `I =]�2 FE=118.55-- L-172..- i 617 20 I /// BE=Ie1.e0 I\\ m / 1 � \ lZ- �,a 5 •m P; JTA.O+OOIfD l n 3roRsew�_ W TA9 IBl�..\. 1 �/ Ise Re6 1 STAS4&G.00(8)Y' li it Ly] I� I STA.112+00.O01B) e I 8T0.11340F.361B) y — .• -_fin __ --_ T✓ 6 S S VE ;•. 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CLASS50 I 8 OU WIN- 12�A9- EAVE _ g0.LF B EINV—SS(BEAVER6L IN S-.03 ITD • • �� = 011 N INV,-13151 G INV J]239 (STUB ONE JOINT 6 004) TOP=16]80 - 4G120 CLASS 50 FINV /7/56 /NY END OFSR/B />2.>9/PLUG/ �WOOLF 0 01 I CEINV 1bZB6 165 CAUTION - -"-- - 4V/NV 16]09 2 GAS LINE 1 1 I S D EINV l6)l4 ' m 39eLFNV - o B D I C1.P66 50 N ILb2-6P o 160 WNV /616> ENCASE PIPE JOINTS I60 -_ 5=011 rINV'=1G2: ]Z _ -. o IN_CONCRE TE + _. m m om o + o 6 ASB /5B24 o-ENCASE PIPE JOINTS o m ENCASE PIPE JOINTS o CUIENCASE P PE JOINTS NATION rN u+ -/rvc E EB5 NV J58-14(EXISTING 8 D L NE) �:;. IN CONCRETE � o IN CONCRETE m. m IN CONCRETE + o_ h r A—— O .Oar OMP[ETiON lO-5-19 I50 _.. _. ICONrgACT NO C.-.402/6 '..-_.._.. T : : 0+00(B)+00(BI 2+00(B) 3+00(B) 4+00(B7 5+00(B) 6+00(B) ]+00(B) B+OOIB) 9+00187 10+00(87 II+00(B i2+00(B)13+00(B) 14 +OOIBI 15 00(B) GRAPHIC SCALEe ANCHORAGE SEWER UTILITY Fl61p ECCRE BCR rtI 6lFl. GTON ' `S'' TO OF/f O N E r '.e' CAMPBELL HEIGHTS SOUTH L.I.D.91 D Gv� EAST SIXTY SEVENTH Avenue ie"^ between SPRUCE Straei anE WINS HEBTEfl Stleel xw^n^crox COOPER CONST CO — nxq�M � RO• /'NOFEs6�0�U'• -' �Ra;��cs� ID 2035 NiLNAfC RfnIR>Rw SCALEH�'I•'� oATEf--/o-E SHEET 5 f xsr CANSTRUCTI!1N RECORD REVISIONS VERTICAL DATUM VERTICAL DATUM RAN CHECK ENGINEERS SEAL VIR-_ 4148 a 6