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Home My WebLink AboutSHANE LEE ESTATES BLK 2 LT 50 I Tj Z -7- Vill (24 rn U3 K a DEPARTMENT k_•F HEALTH AND Erd'v'l:F'i=iNMENTAL f'ROTECT ION `L` STREET.- 1=1P•di� HOF: AGE, F• K. ::49501 279-`1511 A=`PLIC,ANT F.:l",WIN RINNER. =:310 WELLSLEY CT LOCATION LEGAL, L5 Ft;; SHANE LEE ESTATES LCAT SIZE ,000 SCAJARE FEET M I N I MUrl, DISTANCE BET WEEN A WELL FIND r-Ir'aY oN—SITE SEWAGE DISPOSAL. SYSTErl I 1.00 FEET FOR A PRIVATE ATEr WEL._L. OR 200 FEET FOR A PUBLIC WELL. WELL LOG'S FIRE REi•il._IIRED AND MUST T BE RETI._IRNE[s TO T'HE DEPARTMENT WITHIN �>O [;1=1YS OF' THE WELL COMPLETION. SPECIFICATIONS :: Ar'aD Ct hISTRUC T I C:iF•J DIAGRAMS ARE I=1V A I LAE%LE: TO I N LIRE PROPER Irr TALLATION. I -T' V FA L__ I 11C. -a IF= A =i Fn .. Ca r -J s -EE °-e F:-7 a=N R= F.= s _ a r G 1 _ 0-i - _ I CERTIFY THAI.. i AM FAMILIAR WITH THE RE 1- U I REIIENTS FOR ON --SITE SEWERS AND WELL' AS 'SET FCiR M E,',•' THE r'iUN'l. C:.I PAL I TY OF ANCHORAGE. I WILL I.N :TALL THE ' 5'r STEM IN ACCORDANCE WITH THE CODE' id APPLICANT EDWIN RI r' NER_C QA 7 INSPECTION APPOINTMENTS DATE RECEIVED STRE T LO�'C}ATION /�" 0 1 �Cr.. TIME " TIME / TIME NUMBER OF,BEDROOMS . DATE DATE DATE Three ❑ Six 7. WATER SUPPLY 9 - a '?_� - of N10 -n INSPECTOR INSPECTOR INSPECTOR since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY " MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF i''.: -r,1 : 21 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL '.- C7LECTION • ENVIRONMENTAL SANITATION DIVISION J ! Telephone 264-4720 jj�� JJ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWAUL11 i DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. P OPERTYOWNER 4 Ge - V) -e 0 'r PHONE MAILING ADDRESS s �� PROPERTY RESIDENT (If different from ab ve) -y" tjN I A I (. C? �-u __? (SG- PHONE 2. -BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION `i''F- -T-\ PHONE Gt. i t'1 v— Y/ MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION L 5 3) a STRE T LO�'C}ATION /�" 0 1 �Cr.. ( r-. (' ' 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS EDOne E]Four E3Other J—SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY ,12f�--INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. _PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) (` THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS 9� APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED i DATE BY V 72-010 (Rev. 6/79) in "0 n �j2t..6- ►-�� GL 5. LEGAL DESCRIPTION MUNIc 1 ` ® MUNICIPALITY OF ANCHORAGE DEPT. G ''_ CT I ON STREET LOCATION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC1yIQ 'D0j', ,'.,-INT'' 825 L Street - Anchorage, Alaska 99501 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS LJ JINGLE FAMILY ENVIRONMENTAL ENGINEERING DIVISION Telephone 264.4720 R E C E I V ILD REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWN!t,, ` _/) i , Qryi( PHONE L� 7 MAILING ADDRESS �� 3LjL/-amu--7 PROPERTY RES ENT (If different f fr above PHONE G d . 2. BUYER **If individual/on-site, give installation date PHONE MAILING ADDRESS PUBLIC UTILITY 3. L ING INSTITUTION d Crj'� CXa(Ile� PHONE MAILING ADDRESS Les 1 I v ICIC, 4. REALTOR/AGENT / PHONE �Gvw MAILING ADDRESS 5. LEGAL DESCRIPTION ® L -v G✓" � �i � 'E'- � .✓mss STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS LJ JINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY E;)�ree ❑ Six 7. WATER * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ❑ INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS 4 APPROVED FOR S BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION - 72-010 (Rev. 3/78) • E • Municipality of Anchorage On-Site Water and Wastewater Program 4,1311-i (907) 343-7904 SA ETY CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 014-061-71 Expiration Date: 1170/// 1. GENERAL INFORMATION Complete legal description Shane Lee Estates Block 2 Lot 5 Location (site address) 6701 Tiffany Terrace, Anchorage Current Property owner(s) Robin Horst Day phone Mailing address 6701 Tiffany Terrace, Anchorage, AK 99507 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: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual ❑ Individual Well ® Holding Tank ❑ • Individual Water Storage ❑ Community ❑ Community Class Well ❑ Public Sewer Public Water System ❑ WaiverNariance request for: Distance: Received by: "-e i Date: '/g i g COSA to be released to the engineer,unless otherwi j er ted by the engineer. COSA Fee $ 550 Waiver Fee $ Date of Payment `713el/g Date of Payment Receipt Number 0/195-6 Receipt Number COSA# 05il4/3(4c 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 ARCTERRA CONSULTING,INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date -1/z-4/1 Engineer's Comments:This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the 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 systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future -dib:46''44.N. occupants or can ArcTerra guarantee that no unseenOFA encroachments,deficiencies or discrepancies exist. / �� L`9.� ,, 49TH *, - # 6. DSD S GNATURE `-';r bedrooms. ;rim System#1 Approved for -P KENNETH W. nue •. r / 3 �, , ,,6 - �,, System#2 Approved for bedrooms. k T''k4o 7 '5 Pc# AI Disapproved. Nit.'`411114.". Conditional approval for bedrooms, with the following stipulatio o g_ITY(0Fr1/4 4J aN-siTE ti� o WATER A L� �'� W/STE ND m o PRkJGRAA,WATER o J +T - jSERV10Eso��,\� ))�)))) > By: %� „ k!u Original Certificate Date: 0/o/f q The Municipality of �horage 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 rnSA PA.chat., 1rL121,dr, COSA Checklist Legal Description: SHANE LEE EST BLK 2 LOT 5 Parcel ID: 014-061-71 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system 1 A. WELL DATA • Well log is filed with Onsite(or attached) Well production at time of test1.1 gpm Date drilled 2120178 Water storage tank volume gallons Total depth 106 ft Well disinfected for coliform test? 0 Yes I No Cased to ft 106 P" ' �' /Pr ®Coliform bacteria is Negative $Sanitary seal is functioning correctly Nitrate mg/L m Nitrate less than MRL (ND) $Wires are properly protected Arsenic ug/L I1 Arsenic less than MRL(ND) Casing height(above ground) 27 in. Collected by ARCTERRA CONSULTING Date of flow test for COSA 7/18/i9 Date of Sample 7/17/19 Static water level at beginning of test 28 ft. Comments B. TANK DATA C. LIFT STATION Age of tank(s) NA years 0 Required maintenance completed Tank type/material NA Age of lift station years Measured operating fluid level in septic tank NA Lift station material Standpipes/foundation cleanout per record drawing Comments: Date of pumping NA D. ABSORPTION FIELD DATA PUBLIC SEWER Which system tested(date installed) Adequacy test date ❑ALL standpipes present per record drawing Results ❑Pass For bedrooms Total measured depth from grade ft(max) Fluid depth prior to test in Measured depth to pipe invert from grade ft(min) Water added_ gal 0 N/A—pressurized field New depth in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time min depth into effective Code-required soil cover over field Final fluid depth in 0 System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: 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' Community _ Sewer Manhole/Cleanout> 100' 0 Yes if No ft El Yes if No ft Neighboring Tank> 100' 0 Yes if No ft Private Sewer/Septic Line>25'23 Yes if No ft 1 Absorption Field on Lot> 100' 0 Yes if No ft Holding Tank> 100' 0 Yes if No ft Neighboring Absorption Fields> 100' Animal Containment> 50' 0 Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage> 100' Community Sewer Main>75' 0 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' ❑Yes if No ft Surface Water> 100' ❑Yes if No ft Property Line>5' ❑Yes if No ft Wells on Adjacent Lots: Absorption Field>5' 0 Yes if No ft Private Wells> 100' ❑Yes if No ft Water Main > 10' 0 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 > 10' ❑Yes if No ft If absorption field is under driveway comment below Property Line> 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main> 10' 0 Yes if No ft Private Wells> 100' 0 Yes if No ft Water Service Line> 10' ❑Yes if No ft Community Wells>200' ❑Yes if No ft Surface Water> 100' ❑Yes if No ft F. ENGINEER'S COMMENTS WELL ONLY PUBLIC SEWER rr,< tieNi • G. ENGINEER'S CERTIFICATION `��"SE CF �1�1.•. and review •6. *t 49111 I certify that I have determined through field inspections *t of Municipal records that the above systems are in conformance with i qg�i I • MOA COSA guidelines in effect on this date. • mul/r M #S�.KENN - ds ♦VA�+ ,. CE 11. _el.,* �•1� .44 c V +11eE *.-4 COSA Checklist yellow sheet 1 . I 6 . ; • . . • i • i 1 • -7-.1 Ca": ::-..... --.:., • i ,:.7,.:fs.-::•-•''':•-•:',•••:.). . b . i EAST • 143.6 fir.'..‘ ••. --. i...... , --3 ___ . • a.. 50.5 k.4 0 :4-..v..., .- ....,..- ...: . . r5 • 140 ' -- .?...LL ! • . E-• .t It, ./`, 1 ii: 4A-ii-c*,..11.•.4-,14,<,,,:•-4') .‘.4 v 24 • yr..% icm..-• 2. Sizt- 04 ".. 7.! : ...'.1 co -2 - --- --.70..,:IsS.T.:ING • :.-4 *s7s.'•.:... ......•..0.• • • .0 ! - 12:14 s 0 \ C.. 4..4....••.,,, • 0 1.‘ t'...)P4;:::r".".:•"."..;' • 0 A 36 LOT 5c, --6 • so . 1. ..... 0 '-'4.-...‘:<.: •- 0 0 • .•. 101 UTILITY • SiE • .•• :::: C:.. = 251 25' .'"." _ EASET•riZT . . -----.1- r--- 1 in. 33'e,. . 9D I 69.0 ..• WEST 138.5 . i IC : TH:S IS AN AS - BUILT SURv....i. . 1 . ___-- . 1 I I —.: . 1 iii•LitEBY CiaTIFY THAT I HAVE SI-1'...:....r..D 1::f. it::.!..0"..:ING PF....s.::tv.:-.E.D 1 t • • F.'.0:-an: LOT 5, BL 2, SII S 11...i. EST.,2H5UHE.1. CF 1.".1.:S.:7ES :•:-C?. 3J ALC::C:1AGL F.I.:CC:-.I•ING 1•IST:t1C.T, A.!.AA: A:."..' TT TH..: In1::::: :-. . '..4 SITUATED Ti API. '.41711.11: Tli:::. ITIGI'l:!3.7f LI:: AND LC 1.IIT eir.f?.- Olt I.NCECACH O;; TEF. PaC.:'E.P.TY LII1.5 Ar..;A:-..1::.T TH.I.:.F.E..70, T..AT • ir. . • : : •-• • NO I1-'.??.CVE.:• 1.TS a PP.O:T..'.1-1 LYING 4.11,.!AC::1.1* T7.1.:!..:•.TO ::::.2.:-..CACI: a : c-• . .1 • Ti::: Pi.*:.::1SES I:: cuzsric: ;.:.3 TEAT 7F..*:::::... 1.Ra :.0 1-.C.:':.7.*:'..., THA. -- .;. . . • 1 P.ISSIC.:. 1.112.-*.S CB CaliKil VIS1....1.1". F.A....:•*. . .; C. SA:1.: 1."..i....:.E.:1 1 ; . EXCEI•T AS II.DICATED iii--Tf..'...0::. ') V.A7ED AT ANCHCRAGF, ALASKA . THIS -2.., 3 ,./.... DAY OF f• — 8 lr::Z9 i • 01:1 at,._at; - fe-'44:7:4:-.- I .. SP...I.GU-..P. SU : ,.G - P.O. !XX 33, c:ii.; AX, ALASK.'. 995'67 __— --_.— — •, .t. 5-./ )4/L.e - 06-(4- aSkr-c-44-2--. • —. .— en.?/ .. ..,.. ., ,—.....,. :.„..,.ra:„rnrs :, X, ,,,, m taxa'Nr-.Y. :1,,wi `,mmyrAmettfr st c y,,,r 7y wk4f,s,,r,,.$:.i TAX CODE No. / '—, 7--- 7/ 0 GRID No. ��yU . MUNICIPALITY OF ANCHORAGE — SEWER UTILITY ..• PROPERTY: i;:' Name Address 670/ f7i' 4y TQrizce. Acct.No 86-0o13 -Y.7-O Plat No. Subd. ,SXnne AR l Lot S" Block ` Residential •,Q Commerial 0 Industrial 0 No. of units CONNECT:31'go$S°L _ • 'a Main Tap 1g On Property I Permit No. /65 p• Size Sol'" Type C/ Drawing No. 378g Size Main g' Type /9C. Depth at Connect 7' (:, Insulation 0 Cleanouts / Type C / I Connect Agent EIIc,eT Inspector f. Date fob WV Comments • Connect Location 5-///o'/ cotetwes i 4' Age, Qam-f corH.er f'Aoc,o2. , S•3"io" /or-il4,--j- aF Sol.t Pn Sr Coc i,4'Lina t-t, • ASSESSMENTS: L.I.D. No. Private Dev. No. Subd.Agreement 0 No. Sewer Agreement 0 No. P.T.E. 0 Roll No. DYE TEST: Positive 0 Negative 0 N.S.A. 0 Date - . Page No. M.H. No. Billing Cycle 'rested By Comments 0 R M NUN ICA CONNECTION RF.CO3t.D rpt llnto, e ti 6. I -?7 ock" Inopactur _(} '\./ r .Gi[ion „5HANrc I,EC _ - RTES oparty Oeencr, ED irks NNelk. lariats . •tor_ bisoNU i _ Application, 'tea ' WJ r v t7 tut l' a APP1 kation, Y,ro No LO TLara amitu 1 i L L N 1i un p A . 1I %' \ - , JY r.� )�, YYr M Ri I I c \ : i T I .. \ . . . .i: u. f I. S' .. • C- .. ,,..,...5,...-Are..,.. R�a •+ fT.,,,,, f+,rrnr rwntIPTn'AgrHR^+71111f. �f4w r1. M . t'::^:„,-..,-,-, y+ Liwi 7A'fun1.,',3. i x .On �•' ,' '�� wr ,»i.t� dIh!li IH • y ;ta4.-..*::* ' l6 ' S.1 . . 7 'j.P ..„ .4- cz. .. ,, ♦ , .t*. _ . . :.'i`.` :177...7;?;...' . 7%.:.,`.C.(a f. .•R t.,:..fn-n. .. . . .. . . 7 "ON PROPERTY Service Line Locatior. By Sketch 3 11 •E Show Location of Control Manhole ALLEY Z 14 STREET o c...'..: t,, .. k,.. I —T-- , ., , ---74 1 �� i 4 H F o t is 4II" I '3 n Comments 1