HomeMy WebLinkAboutPROSPECT HEIGHTS #4 BLK 2 LT 7 ~----. MUNICIPALITY OF ANCHORAGE ~..
DL RTMENT OF HEALTH AND HUMAN SER ES
? Environmental Health Division
~- 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
D,STA.CES
Address ~0 SEPTIC ABSORPTION
Phone(s, JPermltNo. ~ ~LL ~0~,'~ . ,.
.ownshi.,L°t ~Range, 1 BlOCk ~SectiOn f SubdJvlsi°n ~2 ~¢~ ~¢ F0,N,~T,0N ~.~
%/~ ~3 ~ ~O/~ AS-BUILT DIAGRAM (Show Iocahon of well. septic system, property I ..... foundahon
~SEPTIC ~ HOLDING
Material ~1 L No.o, Compad~ents [~ ~
_.~ TRENCH ~ED ~ W. DRAIN ~ OTHER
Depth to p,pe boltom from ~ ~otal depth from orig,nal grade
Gravel ~ength Grave~ wmdth
f r,
Total ~bsorpNon area Distance betwee. Ii.es ~ a~ O~.' ~'
I
WELLS ~ ~0 /~
:PRIVATE :, OTHER ,Identifv,
., . -
Classd~cation (A,B,C) ' Total Dept~ Cased to ~
FT
REMARKS: .. ~-~ - ,"; :':
Inspections' Pedo;~ed by:
[ ,.f;~ . ' - .
~unicipal and State guidelines in effect on this date: I~/IG/~G
Health Depadmen, Approval. -: ~' ~~ Date' /--/~--~ ~ N ~ '~' * ~:'F" ._....':'°' '.., , .."~
WATER WELL. RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geologiool ~t Geophyslool Surveys.
LOCATION OF WI~LL (Pleaee complete either lo, U; or lc.)
~IOI~ANO,E,ANO ~IR~C, TIO~FROM ROAD INTERSECTIONS ~, OWNER OF WELL=
Street Addre$~~ and Area of Well Lobation
WELL
Mgle~ol Type
,,,
Top
Orilling Permit No,
A, O.L. NO,
E.[~] Merldl<~D ~d~
4. WELL D[PTH~ [final} 5, DATE OF ¢O, MPLETION
[] IrriggHon ~ Recharge
[] Tell Well [] Other~
GA$1NOI [] Threaded [~ Welded
.la, te~, Depth S/Iokup~ft.
FINISH OF WELL~ .,.''
OlOt/M~h 81~l[ Lengfht_ %&~,.' ..............
Set between fl, and "ft.
II, PUMPING LEVEL below I,~ carload ohd YI[i.C
~f,. ~ft~( / .hr,. pumpl~.p.m.
~.~ft. ~fler ~hr~. pumplng~.g,p,m,
[~'.~ROU'flNO Well Grouletl; ~ Ye,~ Nc,
Malarial; ~ Neat Oemeat [] otKrer:
IE, PUMP; {if ~valleble) HP
Length of Drop Pipe __fl. eope~lty ~g,p.m.
14, REMARK$~
060427 I--iANr~ WR!']-TEN
i:c,r, th by '?,.he ?}un:[cipa].i!:y o~: Arlchor, age (I"ICJA) arid 't.h,~:.~ S!:.ate c~f Alaska.
............. ~..,..~.~ ..~ ~M ...... . .........
BED CROSS-SECTION
SAND ~ILTER SPECIFICATIONS
Sieve Size (mm)
#4 (4.75)
#1o (2)
#60 (0.25)
#200 (0.074)
Percent Passing by Weight
100
75 - 100
5 - 75
0 - 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVI FIONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
LI:GAL DESCRIPTION:
4-
5
6
7
8
9
10
:11
12
13
~4
17
20
LOT
SLOPE
IF YES, AT WHAT
DEPTH?
SITE PLAN
Reading Date Gross Net Depth to Net
Time -rime Water Drop
,
PERCOLATION RATE
(minutes/inch
TEST RUN BETWEEN
-.
~ ~~ ~' ~ 4 ' - '
~ ~ ~%~R~q~ . ~ ..//
//
' f ~ ~ ~t~
/
SEWER SYSTEM LOCATION PLAN
~ ~= .~-J ~ t DRAWN
~ ~ NORTH ~- O~ ~rs~z~s ~o~cAr~o ~s no~ ~x~c~.
'f~g~~,~ ~ ,:;,' :X ' ' ....... , . ' ' ~".'<.:~¥ ............................. ~ ~ .- ' .................................. ~ .... .'~* ~Of
· .. .~. -~, . ....
~=~ .~ . . - · ....
.... ;.'.'.'.': ............. ~ ............................ ~':~:tE
Municipality of Anchor
On -Site Water and Wastewater Progr;
(907) 343-7904
<bb 'a 1 8 9
4,
JUL 17 2017 $ A F E
Certificate of On -Site Systems Approv
Parcel I.D. 015-132-41 Expiration Date: �-- l �l 7
Complete legal description Prospect Heights #4; Block 2, Lot 7
Location (site address) 10200 Hillhaven Circle *Anchorage, AK 99507
Current Property owner(s) Jan Maki Day phone 339-4832
Mailing address
Real Estate Agent
10200 Hillhaven Circle *Anchorage, AK 99507
Patty Gapinski Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual
Individual Water Storage
0
Holding Tank
❑
Community Class Well
D
Community
F1
Public Water System
0
Public Sewer
0
WaiverNadance request for: Distance:
Received by: r`fDate:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 5VO
Date of Payment VnII-4
Receipt Number 6366 46 '
COSA #0)'5(_14[W6
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
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: Gayness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 f
Engineer's Printed Name: _Jeffrey A. Garness Date:(
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but'not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. DSD SIGNATURE Y
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
OF A
o -`� ... ... -9,40
di�Q ;. • � li ..'T' �1
4 !...........7
y,, A. tGorness:'
U CE er •/��.t?� JcO�cG
hh 7
tUQ�p�c f e s sion°�c
Conditional approval for bedrooms, with the following stipulations:
#AECC884
Original Certificate Date:
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::• v
7. ATTACHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
COSA blue sheet 10-10-12.doc
a
Nitrate Advisorj;,`"
Arsenic Advisory,,,
Other `
Ifmore than 1septic system is onthe lot:
CDSAChecklist #
Structure served by this system
'11311111 Fill, liplippiq �11p�
Legal : Parcel |[l 015-132-41
Well type _PrivateIf A, B.orCprovide PVVS|D# N/A Well Log (YYN) Yes
Date completed Sanitary seal (Y/N) Yeo Wires properly protected (Y/N) Yes
Total depth _-3b0_.ft, Cased to 28 ft, Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date oftest 12/18/1986 6/26/2017
Static water level 7 ft. 19.5
VVATERSAMPLE RESULTS:
(l
Coliform _��oo}uniea/1O0ml. Nitrate Collected by: GEG. Ltd.
Araenic:��bg./L Date of sample: 6/26/2017
B. SEPT|C/HQLD/NGT4NK DATA 1*31 year old steel septic tank is approaching the end of its useful lif
TonkTvpe/Mabeha| Date installed 12/12/1986
Tank size _'C250_gal. Number ofCompartments 2 C(eonouba(Y/N) Yes
Foundation cleanout (YYN) Yea Depression over tank (y/N) No High water alarm (YYN)
Date of pumping Pumper ot, C
C. ABSORPTION FIELD DATA FBelow Existing Grade at MT [�Ti —year old bed may be approaching
the end of its useful life.
Doha installed Soil rating (o.p.d./fl:26125 System type Bed
Length Width 1 Gravel below pipe
Total depth *4.5 ft. Ef[absorption area 756 M^ Monitoring tube Yes Depression over field No
Date ofadequacy test Reou|ta(Paee/FeU) Pass For 4 bedrooms
Fluid depth in absorption field before test O in.
Water added 708 gal.
New depth
**1in.
Elapsed Time: 10 min. Final fluid depth
0 in. Absorption rate >=
600+
–g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
None Known
Ifyes, give date –
Pipe at south end of bed appears non–functional and, given the location, could be o curtain drain
cleanout.
It should also be noted that, per homeowner on 17` the home was occupied for approximately
Date installed Size in gallons ManholetAccess (Y/N)
"Pump on" level at n. "Pump ofF' level in.
Cycles tested Meets alarm & circuit requirements? -------M
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankffift station on lot 100'+ — On adjacent lots
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+
Sewer /septic service line 25'+
Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5+ 411
Water main 10'+
Water service line 10'+
Surface water
Wells on adjacent lots 100'+
5'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ — Building foundation 10'+ Water main 10'+
U
Water service line 10'+ Surface water Driveway, parkingivehicle storage 10 , +
Curtain drain 30' Per 1987 Inspection Report Wells on adjacent lots 100'+
*Per 1986 inspection
outlet pipe for the curtain drain was not located and there is a drainage swale (with running
water in OA approximatley 59 feet to the southeast of the droinOe|d. Per conversations with
Jeff Poet and Joy Crewdoon' P.E. on 15, it was in their opinion that the surface water
issues were addressed at the time of installation.
eview of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
Engineer's Printed Name JEFFREY A. GARNESS
Date — :i'�/ e, Ll I i-
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
Certificate of On -Site Systems Approval (COSA) 4 OSC171300
During a recent COSA on-site inspection and test of the potable water
supply well on Block 2, Lot 7 of Prospect Heights #4 subdivision, the well's
productivity was determined to be .96 gallons per minute. The minimum
well productivity required by this Department (AMC 15.55) for a 4 -bedroom
residence is .41 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
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
\~-')- \~-~- \ HAA#
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (addres~s or directions)
(b) Property owner
Mailing Address
Telephone: (home).
Business" ·
(c) Lending Institution
Mailing Address
Telephone
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (c~'check here E~,if hold for Pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENC~E
Single-Family ~ Number of bedrooms z/
3. WATER SUPPLY
Individual Well ~/ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site E~ Public [] Community [] Holding Tank []
Note; If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
6. DHHS APPROVAL
Approved for // ._bedrooms by
Approved ~ Disapproved
Terms of Conditional Approval
Conditional
Engineer's Seal
The Municipality of Anchorage Department of H~alth and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections
or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions
in the professional engineer's work.
72-025 (Rev. 7/88) Back Page 2 of 2
~ o~~
A. ELL DAT%
Well Classification /~.~'/¢64z/~
Well Log Present (Y/N) y Date Completed
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description:
If A, B, C, D.E.C. Approved (Y/N) /V/,¢
/ Z -/P - ~¢~ Yield
Total Depth 35'0'
Static Water Level /~ '¢/"
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot /?-~
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line /')¢/d~'$
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments U-) 1E~/..
Cased to ,2,¢' C-
Depth of Grouting /v'~
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
Y
; On Adjoining Lots /¢¢ '"/'
; On Adjoining Lots /do '-/
To Nearest Public Sewer Cleanout/Manhole
;Date
, $ 9 /J t T[a4'-r~
B. SEPTIC/HOLDING TANK DATA
'Date Insta,ed Size
Standpipes (Y/N) y
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N) /v'///¢
Air-tight Caps (Y/N)
No. of Compartments
~/ Foundation Cleanout (Y/N) )/
Date Last Pumped S~
S _~E ; for
Temporary Holding Tank Permit (Y/N) ?,~'/'~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well ! 'A'2 ' To*B[~ilding Foundation
To Property Line /~'E? / To Disposal Field ¢¢~'~
To Water Main/Service Line q ~
To Stream, Pond, Lake or Major Drainage Course ~q~
Comments 5'~'p7'~c ~,~r~fd A-D E~, u~r~ - ~u~ ,~4 ~r
72-026 (Rev. 7/88) Front Page 1 of 2
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /~ -/Z-2~'/~
Width of Field /~'
To Water-Supply Well
To Building Foundation
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
/~,~t
Lot NO/~fE o~J LoT'
To Water Main/Service Line
Type of System Design
Length of Field /'/'~ '
Depth of Field ~, ~' '
Gravel Bed Thickness O, .5' '
Statndpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line ~;~'
To Existing or Abandoned System on
; On Adjoining Lots /~O
To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle. Storage Area
Comments
"Pump On Level at ~
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
~ Pumping Cycles during Adequacy Test.
Comments
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I ha. ve c.heck~d, verified~.or co. nformed to all MOA and
Signed ~l~ ~-~
Company ~0 ~O~
MOA No.
Receipt No. ~
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
in on the date of this
Engineer's Seal