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HomeMy WebLinkAboutHYATT ESTATES BLK 1 LT 3Byatt s/D L3 BI #014 !scco Oct_04.2022 10:55 AM Anchorage Well & Pump Service Inc 9072430742 #1055 P 1/ 2 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Puma Installation Log Well Drilling Permit Number: Parcel Identification Number: 014 10 1 - 15 Date of Issue: ----- ...-...._. -� Legal Description I Block Lot Property Owner Name & Address: Lawrence & Dusdee Hunt HYATT ESTATES 1 3 6901 Myatt St Anchorage, AK 99507 Fump Installation Date; 09 - 30 - 2022 Pump ]intake Depth Below Top of Well Casing: � � 1VJlanutacturer's clam : STA -RITE Pump Model: S7P41450523I-0 IPump Size: 1/2 hp 145 feet Pitless Adaptor Burial Depth: 14 feet Pitless Adapter Manufacturer's Name; . MARTINSON II Pitless Adapter Installer: IWell Disinfected Upon Completion? El Yes ❑ No Method of Disinfection: PELLETS Il Comments: Pump Installer Name; company: Anchorage Well & Pump Service Mailing Address: 7640 King Street city: Anchorage _.... State: AK zip: 99518 Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Oct_04.2022 10:55 AM Anchorage Well & Pump Service Inc 9072430742 #1055 P 2/ 2 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: Date of issue: - - Parcel Identification Number: 020 - 581 - 70 Legal Description Block Lot Property Owner Name & Address: CHARLES BERRAY RABBIT GREEK VIEW & HEIGHTS 11H 16A 17015 NICKLEEN ST ANCHORAGE, AK 99516 Pump Installation Date: 14-03- 2022 Pump Intake Depth Below Top of Well Casing. 90 feet Pump Manufacturer's Name: STA -RITE Pump Model: S7P4HS05231-02 11 Pump Size- 112 hp 11 Pitless Adapter Burial Depth. 10 11 Pitless Adapter Manuf9cturer's Name: 11 Pitless Adapter Installer: feet MARTIN ON Well Disinfected Upon Completion? X Yes 1) No Method of Disinfection: PELLETS 11 Comments: Pump Installer dame: Company; ANCHORAGE WELL & PUMP SERVICE Mailing address: 7040 KING ST City. ANCHORAGE State: AK zip: 99518 Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE fqi :4 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. 014-101-15 1. GENERAL INFORMATION Expiration Date: 2 - 6 - Z Q Z7 Complete legal description HYATT ESTATES BLOCK 1 LOT 3 Location (site address) 6901 HYATT STREET ANCHORAGE AK 99507 Current property owner(s) RUTH ANN SCHOENLEBEN Day phone Mailing address Real estate agent 6901 HYATT STREET ANCHORAGE AK 99507 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 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: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ '�01110 Waiver Fee $ Date of Payment i0 0')Z' 1 Date of Payment Receipt Number 3i I �.b C) Receipt Number COSA # 0 S Cl) if 68 5 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 11/24/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the �t I 1V system and maintenance. The operational life of all well and septic systems are subject to +I e' k, these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory ���Q; for current or future occupants or guarantee that no unseen encroachments, deficiencies or g•' discrepancies exist can be given by First Water Consulting & FWC5 ' / *' ili * �/ 6. DSD SIGNATURE ®� Curtis Huffman / System #1 A �/ ��F' CE 128991 y Approved for _�— bedrooms � pis•. .• ��_� .11 /24121 System #2 Approved pproved for bedrooms �lliF�PROF SSIONP���� Disapproved Conditional approval for bedrooms, with the following stipulations: `\```�kkN( (oFrrr�(((r�/ C) WASTWATER oz SEP\\] N By: Original Certificate Date: r 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other i Legal Description: HYATT ESTATES BLOCK 1, LOT 3 Parcel ID: 014-101-15 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled CIRCA 1970 Total depth 171 ft Cased to 171 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 10/28/21 Static water level at beginning of test 57 ft. Comments B. TANK DATA - NA Age of tank(s) _ years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA - NA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade _ft (max) Measured depth to pipe invert from grade _ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Structure served by this system _ Well production at time of test 3+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic 8.57 ug/L ❑ Arsenic less than MRL (ND) Collected by F Date of Sample 10/28/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth _ in Elapsed time min ❑ Code -required soil cover over field Final fluid depth in ❑ 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 EWES Comments/Deficiencies: ., 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' ❑ Yes if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No NA ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Water Service Line > 10' ❑ Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) NA — PUBLIC SEWER Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No 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) NA — PUBLIC SEWER Building Foundation > 10' ❑ Yes if No ft If absorption field is under driveway comment below 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 Surface Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION Adw .�i 0 I certify that I have determined through field inspections and review ���Q.: •' • • .. •���� of Municipal records that the above systems are in conformance •:9' �� with MOA COSA guidelines in effect on this date. : • '. .. ........ «! Curtis Huffman •: 4 �o a� 1028991 ;t•�v��� '°RQFESS1001\�,: ft ft ft ft ft ft ft ft LM— O= D m 0m r �+9 O {� m m �sA =m N 1n mo z 0 z D Z v M G) c O z U) 0 z m m m m m cn Z v m m O n -a x cn •o m -1 D z v m m CMM Z O co m Z �m� 0 Cl)m 03 Z Z N m m M M n 0 m m z M 0 cn 4Ln m W O C) d 0 o ml mr p -t n Rt 0 c W t❑ m ��D to 0 0 0 0 c-) p0D_0D_zmE �D COD ZO�0 Ofzf�mc m' mm m p z t7 �-u M�mCis @M@M Mrr°t M Q0 < � o mm r m an a Z Zm z O m 0 000000 2)CDX 00 o�m�=o- _: Q O � (D (D n CD X CD G N, Q- D m U:j m m�CD0 t!? m m:3 N 3 =3 'S CD CD CD Z �= D ::E --i X c 0 O�> rl tv i D O p ­ :0 z. e— -m•1 m < m_Z p O —0i ern D r U) o Nmn p W r rq i r tz ON Ln t r O fip ►4 n 03� 00 0 =m D Z o Z G M N t-3 C m W 0 � 0r 0 n 'D -4 m® tin m -i OM Z r c� C O .p. _ ai 0 0 �z O Z Z o 0 K Cl) D O C Z --I 0 m - 0 N M m cam_)-DMy y rl tv D --IrK CD r z -rt tv ` e— N SERVICE CONNECTION RECORD Lot Date 0 Block inspector Subdivision or 8ddition — MIT F-5T-AME:5 ZU5Q1\11-51,pW Property Owner Contr. Address Nater 3�z8 Permit Yes No � Sewer ------ Size Permit ----- Y�6 ------ N --~--- LOCATION SKETCH 3K[TCH O///__/(O/., i4e-4 DOOR C,\ Z�e L-or4d go'BEvD CjaAil ou7- z, If Uhl vu ---------- BPI, CjT z f ?a0 V am p C- QL 13! 0 r, Has. Po TT— G 0, Sol kq, AT PROF!;PTf H'fFriT sr 0 O �e L) Tr S'ri���ET V/d 11 C_ Cie P0Y_� Me.fc( 5� ed I hereby certify that I have surveyed the following described property: ::f �2�'��— ,yy� 77- 7-,- r Anchorage Recording Precinct, Alaska, 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 an prop- erty lying adjacent thereto encroach on the premises in question and Lhat there are no roadways, transmission lines or other Visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska Lhis / 71r/day of 19 7O FRED WALATKA & ASSOCIATES Engineers and Surveyors GAAB-HD-I GR~,.~TER ANCHORAGE AREA BOROI~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 NSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION MAILING ~..',~,~/ //--/',,,('/.,,,,~7"?-- PHONE~_-~:~9~d~''~' ADDRESS - LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY /,~-2,-~~ GALLONS. NUMBER OF / MATERIAL ...~J~"-"~--~-"~?'""'~ COMPARTMENTS ,~ ~"'7'"-//~ ~'~' ,~ ,'~"~ LIQUID INSIDE LENGTH ~NSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / OUTSIDE DIAMETER OR WIDTH /'~" LINING MATERIAL ~¢;'./u'~''''~'''-~'~-'''~ "~'/'"'"(/¢¢2~'K~ . DISTANCE FROM WELl ./.,=2 .¢~ NEAREST LOT LINE ~ ~ '~ TOTAL EFFECTIVE ABSORPTION AREA rWALL AREA, LENGTH /~- j · DEPTH BUILDING FOUNDATION~ .~~ SQ. FT. TILE: DRAIN_ FIELD ///~ TOTAL LENGTH ABS,~PTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF =ILTER MATERIAL BENEATH TILE IN. ABOVE TILE__ WELL: TYPE.~.~.~, DEPTH '/"~'/ / DISTANCE FROM ~ / WATER ,/,~ NEAREST · BUILDING FOUNDATION. SAMPLE LOT LINE ,~ ~ .. NEARESI' SEPTIC 7~,.-/ SEEPAGE J ~ OTHER - , SEWER L FIE '~ TANK . SYSTEM /,,,,'~'-~'~ CESSPOOL , SOURCES DISTANCES: DIAGRAM OF SYSTEM GAAB-HD~,g GREATE ANCHORAGE AREA .3OROUGH HEALTH DEPARTMENT ~27 Ea~gle St. Anchorage, Alaska 99501 279-2511 Case No. ~5, ~/ SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT.(~O~...©d ~,) RESIDENCE ADDRESS LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH (./ A PERCOLATION TEST RESULTS MAILING ADDRESS LOCATION OF INSTALLATION SEEPAGE PIT , DRAIN FIELD , OTHER TO BE INSTALLED BY_ ANTICIPATED DATE OF COMPLETION THIS IS TO SERVE AS BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT , PERMIT TO INSTALL A DISTANCES: AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVER · SEPTIC TANK SIZE TYPE SEEPAGE AREA ~ ~/¢'~'~)~..~)TYPE DIAGRAM OF SYSTEM that I am familih~ with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the aboy~ described system~,is in accordance with said code. n~Tr: /~'~ ~ APPLICANTS SIGNATURE. GAAB-HD-2 f GREATE:"ANCHORAGE AREA OROUGIt- c.s~Ng ~ ~/ 327 Eag!e St. Anchorage, Alaska 99501 279-251 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT RESIDENCE ADDRESS ~/~2~ LOCATION OF INSTALLATION LEGA~OESCmPT~O" ~7~ ,~ ~/ ~F~:r APPLICATION TO INSTALL: SEPTIC TANK L/'' ., SEEPAGE PIT ),-/ To SERVE T,E FOLLDW,NG AC, FINANCED THROUGH ~olt ~ P~ TEST RESULTS ,DRAIN FIELD , OTHER TO BE INSTALLED BY.. '~-'-}TL/~- ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS 4~--, ~; '~ (> /" A,~/~¢~/~ ,PERMIT TOINSTALLA ~Z¥-Z~gCe'~- ~ .SEPTICTANKSIZE~ TYPE ~ - o .......... . ' DaG~A~ O~ SVSTm ~ HEALTH AUTHORITY OR LICENSED DESIGNER I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-6_8 and that the above descrlbed>ystem 7 accordance with said code.' tA~y-~i~.~~.Z~gT.t~O~--~.7-\ ,~..,. - ,~ na T~ ,~/,~"~ / ~ A PPI IRA NTg SIGN AT UR E/A"~//~~~ ~ ~ LOG OF DRILLING by A & L DRILLING COMPANY .............................................. DRA'¥ DOW DATI~TAItl'ED ................................................................................................... GALS. ]PER ~R .~...0.0.. ............................................................... FROM....... ................... FT. TO ........................ FT ........................... FROM ......................... FT. TO ......................... FT .................................. FROM ......................... FT. TO ......................... ]PT .................................. FROM ........................ FT. TO .......................... FT ................................... FROM ................... FT. TO .......................... FT ................................... FROM ......................FT. TO .......................... Fl' ................................. FROM .......... FT. TO ................. FT .................................. FROM..~.~._._~_ _._L..L.. ;FT. TO_._L ..?...:*. .......... FT..:. ....... ;~..:.~;:~..._. ~.... FROM .......................... FT. TO .......................... FT ............................... FROM ......................FT. TO .......................... FT .................................. FROM .......................... FT. TO .......................... FT .................................. FROM .......................... FT. TO .......................... FT ............................... MISCL. INFORMATION: DRILLER'S NAME .......... .0~.~.~.~....0.~..1~ .~..~ .................................... REQUEST OR APPROVAL OF ~A/~"' ~) / INDIVIDUA.L SEWAGE AND WATER FACILITIES ~~3i ' 0 ' [~/ (Flll Out in Triplicate) ~ ! ~L/v ~_ ~ame .of person requestlng approval .n. )0 2. ~N~e of prope~yjowner ~ ~~ 5. -Wate~.~ySls: a. Bacterial b. Detergent ..... Well dar a: a. Type ~ .... . b. Depth--'~'/7// · c. Casing Size Distance from well to closest existing or proposed: 3. Seepage , 4. C~sspool[ . 5. Property Line.. ~ ~/ . 6. Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. , .......... · Sewage disposal system. a. Age of system ,, / ~f~ . b.~ Septic tank capacity in gallons., c. Name of septic tank manufactu~r~, 1. If "home made" show diagram on reverse side of this form. -e. Percolation~Te~t~results ............... . ~ f. Percolation Test performed by ......................... ~ , ~8~ Use the reverse ;side of this form to show diagram. Diagram should include ._...~he following, information: ~operty lines;.w~ll location, house location, ~%t~p~ic tank location, disposa~ area location, location of percolation tes~, a~.~ directiOn of ground slope, 9. The l~ormatlon on this form is true and correct ~o the best of my knowledge. Signature of Applzcant ~O. BE FILLED OUT BY HEALTH DEPAET~-~ENT PERSONNEL D~te si~ned ~e above described sanitary facilities Conditions: are hereby approved, sub~e.~, to,~he The above described sanitary facilities are disapproved for the following reasons: Approval as valcd for one year following the date of · ~- CPJ:cw