HomeMy WebLinkAboutCLEARVIEW LT 23Clearview
Lot 23
#015-242-62
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM A-ND/OR WELL INSPECTION REPORT
Name
�l�/I^✓.�P.D G,ZG�j�//CK DISTANCES
Address TO SEPTIC ABSORPTION
FROM TANK FIELD WELL
-���% � i_,1rA/.4 Atte-, , AAic�. �s/6
Phone(s) Permit No. No of Bedrooms WELL 1301, /5-8 /
3 S-4LLt3 6810/5,19 1 S
LEGAL DESCRIPTION LOT LINE /j /_ / /� 9 1
Lot Block Subdivision Y4G `7` G
23 Cz-6-'q'eV"e-W (� FOUNDATION i 6¢ ( 67'
Township, Range, SecLon 3A,
SCG, 2.4 7 -12 -Al, _? W S, AS -BUILT DIAGRAM (Show location of well, septic system, property lines, founaauon,
driveway, water bodies, eta)
TANKS TT
SEPTIC ❑ HOLDING
Manuiactuter
Capacity In gallons
Cj/�EE2
/� So 0
Material
No of Compartments
5 i'�EC
2
TYPE OF SYSTEM
TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER
Depth to pipe bottom from
Total depth from original grade
original grade
5--'5- FT
A) FT
Fill added above original grade
Gravel depth beneath pipe
_ 2 t FT
S FT
Gravel length
Gravel width
FT
Total absorption area
Distance between lines
17!5-7— SO FT
FT
K_u_rnberoliines
Soil rating
Pipe matena
ONE
/ Z S SO FT I
PV61CA5 i /Ro/v
Installer 4:qWA1E_1z
Date Installed
/ 0/88
WELLS
PRIVATE ❑ OTHER (Identity)
Classi kation (AB.C) Total Depth Cased to
3Z 0 FT 66' FT
ins[aLei Date Installed.
I REMARKS:
6'E'/�j / i it
iNs��lc.irff l-/ 0/V1
F:9 C L CA /A/ SL
0
itlp'k; �u
Scale: /i(^�
Inspections Performed by.
arm 4 aooeo c..,
-ff
' '�-=•— Date. /7'CV�oy4 �i 9
/ ;� to. •a ooae e-oa moN000�
X-1 eo
I f}�O .S � G -¢i►/• THOMAS RIZ (1�`0 if
certify that this inspection was performed according to all CE - 7125 3
/¢I�lj Us %
Municipal and State guidelines in eflect on this date: w_' ,
Health Department Approval:
Date..
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
825 L Street, Anchorage, Alaska 99501 343-4720
ON - SITE SEWER & SEPTIC TANK PERMIT
Permit Number: 880155 Upgrade
Date Issued: 08/09/88 Engineer Designed
Owner Name: EDWARD S. CRONICK Day Phone:
Owner Address: 7851 ALATNA AVE. 561-1970
ANCHORAGE, AK 99516
Parcel Id: 015-242-62
Lot Legal: Subdivision: CLEARVIEW Lot: 23 Block: -
Section: 24 Township: 12N Range: 3W
Lot Size 51000 (sq.ft. or acres)
Max Bedrooms: This Permit: 5 Total Capacity: 5
SEPTIC TANK: Minimum total septic tank capacity: 1,500 gallons. Each septic
tank must have at least 2 compartments. Depth to top of septic tank(s) < 4.0
feet requires insulation over tank(s).
INSTALL PER ENGINEERS DESIGN A TRENCH TYPE ABSORPTION SYSTEM.
LENGTH: 45'; GRAVEL DEPTH: 7'; TOTAL DEPTH: 12'.
THIS PERMIT IS ISSUED FOR A SINGLE FAMILY RESIDENCE ONLY AND
EXPIRES 12/31/88. NOTIFY DHHS PRIOR TO ALL INSPECTIONS.
I CERTIFY THAT:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances From any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 5 bedrooms. I
also understand that the capacity of the total system is 5 bedrooms and
anv enla re an additional permit.
Signed: DATE: +/On
_________________________________ ------------------
(Owner
______________(Owner) EDWA
Issued By: \ DATE:
----------------------------
TO
4r j
.�•ili JIJ�.t -� . F
7,7
0
M eqz
DETACH AND FILE FOR FOLLOW-UP
LOT 24
4S O A
jor -N
�y n r • r �++�sO
• '
• 11
vf•0a� 0000•••00 •i•/•
4i : THOMAS REGAN
0� CE - 7125 �• I
p E��
•
L'o T 23
5,000S.F. I
WASTEWATER D/SP05gL
_ RfSERVf _AREA_
I
0
I
NEW 4y5rr
•
•
..... tib.
Exlsi+NG
I
Neer ADD' 1`10N
L 0 T 22
System Type: Deep Trench
Total Depth: 12'
Gravel Depth Below Pipe: 7'
Gravcl Length: 45'
Tank Site: I,S00 Gallon
Soil Rating: 12SS.F./BR.
Max. Bedrooms: S
Lot Site: 51,000 S.F.
LEGEND
®
EX15T/Ny STRUCTURE
\D
PROPOSER ADO/T/ON
0 •
EXIST/N4 {PROPOSED SiANOP+PC
i �•
WATER WELL
O
TEST HOLE
ARCTIC PROJECT NO.: [ OT 23 , CLEARVI£W SUBDIVISION
DEBIOMF O: TR
DRAWN: ED CRONICK
o ENGINEERS TR SEC. 24, TI2N, R3W, s. M.
CHECKED: DISPOSAL
INC. ANCHORAGE. U -TE: JULY,/BBB LOT S/ZE 5/,000 S.F. ON-S/TE WASTEWATER �[•/�A�•J SYSTEM UPGRADE
ALASKA 6CALE: R E V I a 1 0 N DATE BY EM[Ef OI
®o Ap
a %
e Municipality of Anchorage �' * 49TH� f
DEPARTMENT OF HEALTH & HUMAN SERVICES
^9
825 "L" Street, Anchorage, Alaska 99502-0650
�)�
SOILS LOG — PERCOLATION TEST ���o TM°M Rec
.•
CE - 7125
c�
n y �
PERFORMED FOR: EDWAR�+D C ROIV ICK DATE PERFORMED:�� 5�
LEGAL DESCRIPTION: 4, 23 C(, E./i/�IO/EW SUCJ-Township, Range. Section: SES, Z4 -rIZAI, R 3 W
SLOPE SITE PLAN
(FEET) I P -L PEAT -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
ORgANiC i_OAM t TAN
GM — 6R -ow N i 511 LTY )
$ANDY C RAVeL
' 15W GQAVEL,L.y 5—AND
C,0AR5E CLEAN
i
SAND LENSES
9c>rT-oM pF
I-10L.E
WAS GROUND WATER A/v
ENCOUNTERED? !r
S
IF YES, AT WHATL o
�. O
DEPTH? P
�(f E
Depth to Water After/VWE �8
Monitoring? 6NK0 N1Y"e:
Depth to pppp-
Water
PERCOLATION RATE 4A.- (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT/AND FT
�/ `
COMMENTS Y IS I)AL- AN A LY S 1 S bAi LY �� 15W
l ILLS -�'2 f?IZt�l.l
Acce i' t N C;I Sn f L rzE& rA RE L W EE ri Col AP40 1Z' QF 21:0
PERFORMED BY: T 12FKAN I 2/25—'a 1q, CERTIFY THAT HIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 8
72-008 (Rev. 4/85)
-MUNICIPALITY OF ANCHORAGE
fe
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
XNEW
E—b 6�oA lLo�
❑ UPGRADE
MAI LI NG ADDRESS
LEGAL DESCRIPTION
LL 1ZV,(Ec cJ 4,c7T' 2_3
LOCATION /
NO. OF BEDROOMS
3
L T
UY
DISTANCE TO:
Well
Absorption area
S
Dwelling (
PERMIT NO.
J
H Z
Manufacturer
Material
No. of compartments
W
�-+
C O eC
/ aF4G _
rn
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
�C7Z
DISTANCE TO:
Well r
Dwelling
PERMIT NO.
= Z
Manufacturer
Material
Liquid capacity in gallons
O
DISTANCE TO:
Well
1141
Foundation
c�
Nearest lot line i
PERMIT NO. �[ SzS
T
W =
W u. U
w
No. of lines
Len th of each line r
g 'f r
Total len th of lines
g
Trench wi th
Distance between lines r
Z
(
/
k inches
Top to finish
Material beneath the
Total effective absorpt'on area
I.-
of tile grade, [
k ,c�
In
f /
4� inches
Length
Width
Depth
PERMIT NO.
W
0
4 h_
Type of crib
Crib diameter
Crib depth
Total effective absorption
area
LU
W
rn
Well
Building foundation
Nearest lot line
DISTANCE TO:
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
FLT.
OTHER
g
PIPE MATERIALS
SOIL TEST RA -MG
Z
f=
INLLER
/
f4 MARKS
_
a
_
CA-)
o .
e•• • • °°
see
•
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g TFf
Ar' • t,
• e
•
APPROVED DATE®�®
72-013 (Rev. 3/78)
. �����`�'+' '
. . ����� ��� �� ����������=`
�
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720
^
C3 P4_!S I -Y- 1—= E3 e7 t4 EL FR W IFE I L_ F="F= FZ M I -T
PERMIT NO: 840525
DATE ISSUED: 06/28/84
APPLICANT: ED CRONICK
ADDRESS: 2610 LEGACY ST
`
ANCHORAGE, AK 99516 v
CONTACT PHONE: 345-4715
LEGAL DESCRIP: SUBDIVISION: CLEARVIEW LOT: 23
SECTION: 24 TOWNSHIP: 12N RANGE: 3W
LOT SIZE: 51000 (SQ.FT. OR ACRES)
MAX BEDROOMS: 3
Listed below are the options available to you in designing
system. Choose the option that best {its your site.
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
BLOCK-. NA
your septic
I certify that:
1. I am familiar with the requirements for on-site sewers and wells asset
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 3 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED DATE:
APPLICANT: ED CRONICK
ISSUED BY DATE: '
--r'---------------------------------- -----�--7------
-FF:Z FEE k4C_-
E�&= ID
DEPTH TO PIPE BOTTOM (FT.)
7.0
6.5
GRAVEL DEPTH (FT.)
5.0
0.5
TOTAL DEPTH (FT.)
12.0
^ 7.0
GRAVEL WIDTH (FT.)
2.5
17.0
GRAVEL LENGTH (FT.)
38.0
34.0
GRAVEL VOLUME (CU.YDS.)
19.3
21.4
TANK SIZE (GALS)
1,000.0 **
1,000.0 **
SOIL RATING (SQ.FT./BR)
125
125
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
BLOCK-. NA
your septic
I certify that:
1. I am familiar with the requirements for on-site sewers and wells asset
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 3 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
SIGNED DATE:
APPLICANT: ED CRONICK
ISSUED BY DATE: '
--r'---------------------------------- -----�--7------
MUt%4X[-_XF::'f=5&1 IIF�)K C)F=
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720
C:)P4—'E3X-1FE= E3E=h4E=FT to 5JEwL_L_F"E=F&F1JL_1T'
PERMIT NO:
DATE ISSUED:
APPLICANT:
ADDRESS:
CONTACT PHONE:
840525
06/28/84-
ED
6/28/84
ED CRQNICK
2610 LEGACY ST
ANCHORAGE, AK 99516
345-4715
LEGAL DESCRIP: SUBDIVISION: CLEARVIBa LOT: 23 BLOCK: NA
SECTION: 24 TOWNSHIP: 12N RANGE: 3W
LOT SIZE: 51000 (SQ.FT. OR ACRES)
MAX BEDROOMS: 3
Listed below are the options available to you in designing your septic
system. Choose the option that best {its your site.
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
1. I am familiar with the requirements for on-site sewers and wells am set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements � for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of -3 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WO MUST ONE BY A LICENSED ELECTRICIAN.
VSIGNED DATE:-±�__�=��_��----______________-
APPLICANT:ED CRONICK
ISSUED BY DATE:
I-KT&n P4 C1 VA
10:K=0D
DEPTH TO PIPE BOTTOM (FT.)
7.0
�ma 7.o
�r �
GRAVEL DEPTH (FT.)
5.0
0.5
TOTAL DEPTH (FT.)
12.0
7.0
GRAVEL WIDTH (FT.)
^
2 5
^
17.0
.
GRAVEL LENGTH (FT.)
.
38 0
�4 0
.
yn o
GRAVEL VOLUME (CU.YDS.)
19.3
21.4
--
TANK SIZE (GALS)
1,000.0 **
1,000.0
SOIL RATING (SQ.FT./BR)
125
125
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
1. I am familiar with the requirements for on-site sewers and wells am set
forth by the Municipality of Anchorage (MOA) and the State of Alaska.
2. I will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements � for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of -3 bedrooms and
any enlargement will require an additional permit.
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WO MUST ONE BY A LICENSED ELECTRICIAN.
VSIGNED DATE:-±�__�=��_��----______________-
APPLICANT:ED CRONICK
ISSUED BY DATE:
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D SOILS LOG
MUNICIPALITY OF ANCHORAGE X PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: F—'b `•Q-0DATE PERFORMED: 7- Y4
LEGAL DESCRIPTION:e�'lv -7
i ,—
klf-W—
SLOPE SITE PLAN
1-1 w--4-4 " M^ w 4-.4 niv
2
3..
4
A
tA,/ ��OL;IrS C_ C,U6
(2 A
6 I 61 AA
7
9
P
10-
WAS GROUND WATER S
11 - ENCOUNTERED? L
0
P
12 - E
IF YES, AT WHAT
DEPTH?
13-
14-
15-
f
16 tlYC
17-
18 -
Net
Reading Time
Depth to
Water
Net
Drop
•J;i
co
-16.A A CA
A.
% C 5067
0
"R0 FE 0
20 ATE /;Z:5, ✓ ISo 4, e- !minutes/inch)
4+EST RUN BETWEENP
FT AND FT
COMMENTS
PERFORMED By:-
----_CERTIFIED BY: DATE:
'12-008 (6/79)
1-1 l-
MUNICIPALITY OF ANCHORAGE �-
�.r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
•
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: "CC) C Ry l 1. DATE PERFORMED: • `� 1
LEGAL DESCRIPTION:_LO�_ JL E A _�Y __y�_� 2 �i� �1 N - R `Y
SLOPE SITE PLAN
ORGANICS 113LAC1-/
1
2 ORGANIC LOAM
TAN
3
17
I 'I � 1 I
s►LT -1 6 2Av r L
4
I' b�
�i,rK ✓��/tt s o F
5
°Ic
J I
� 612At/P- L
d
B
6
•2225•E
`I
s
; :
C LF=A,N SAM-
AM-
J't i+[ 2:, 1971
�
9
9-
��`• .;' Ems..,
10-
10
11 t I 1 VA'S GROUND WATER O
FNCOU `:TERED? __
1 1
1
12 t 1
I I 1 IF YES, AT WHAT
1 T> DEPTH?
13 I 1
1 t ,
14 '
1 1 ,
1 ' �
15 1 1'
16 �► I! 1 150TTO M O
20
COMMENTS
S
O
E
Gess I Net Depth to ! Net
Rcadino Date T me ! Time �',,:�e• Drop
ws . 't �• d� I �
r � !
•
•JUNE T171 � all,
Pc FICOLATIGN��J4 _' ✓ •�y� •"�_�f/�m.inute=_inch).
_
TEST RUN BETI'vEEN FT Arm FT
17
.�� �F
�
18
d
49TH 1
•2225•E
`I
J't i+[ 2:, 1971
�
AO
��`• .;' Ems..,
20
COMMENTS
S
O
E
Gess I Net Depth to ! Net
Rcadino Date T me ! Time �',,:�e• Drop
ws . 't �• d� I �
r � !
•
•JUNE T171 � all,
Pc FICOLATIGN��J4 _' ✓ •�y� •"�_�f/�m.inute=_inch).
_
TEST RUN BETI'vEEN FT Arm FT
�
�_SL FT
PERFORMED BY: – _ _CERTIFIED BY: 7—,15 DATE: 1L
72-008 (6/79)
• Municipality of Anchorage 46 -_
On -Site Water and Wastewater Program(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I. D. 015-242-62
1. GENERAL INFORMATION
Complete legal description
Clearview Lt 23
Expiration Date: _ 1 A 9 -
Location (site address) 7851 Alatna Ave., Anchorage Ak.
Current Property owner(s) Edward & Laura Cronlck Day phone
Mailing address
Real Estate Agent
2267 Allegheny
, San Mateo Ca. 94402
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual
n
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Date: r C �) r -1
otherwise requested by the engineer
COSA Fee $ X10 .0o Waiver Fee $
Date of Paymentl OI S� al C_ Date of Payment
Receipt Number ()(6q 3SG Receipt Number
COSA # 05C l 2 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 Certif icate of On -Site System s 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 Pannone Engineering Services LLC Phone 272-8218
Address P.O. Box 100217, Anchorage AK 99510
Engineer's Printed Name Steven R. Pannone Date
6. DSD SIGNATURE
J System #1 Approved for. bedrooms.
System #2 Approved for, bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
By: (i11 a Original Certificate Date:
The Municip o n orage Development Sew ices Division (DSD) issues Certificates of On -Site Sy stems 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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet -9.1 .12.d..
If more than 1 septic system is on the lot:
COSA Checklist # of _
Structure served by this syste_m
Certificate of On -Site Systems Approval Checklist
Legal Description: Clearview Lt 23
A. WELL DATA
Well type Pova'e If A, B, or C provide PWSID #
Date completed 8!1/84 Sanitary seal (YIN) Y
Total depth 320 ft. Cased to 320 ft.
FROM WELL LOG
Date of test 8/1/84
Static water level 280 ft.
Well production 2.5 g.p,m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate 5-,)r13 mg/L
Arsenic: OT) ug/L date of sample: 16 "S- /a
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel
Tank size 1500 gal. Number of Compartments 2
Y N
Parcel ID: 015-242-62
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 19 in.
AT INSPECTION
10/5/12
37
4.5
ft.
g.p.m.
Other bacteria A�ec colonies/100 mL
Collected by: PE S
Date installed 8/10/88
Cleanouts (YIN) Y
N/
Foundation cleanout (Y/N) _ Depression over tank (Y/N) _ High water alarm (Y/N) A
Date of pumping IPumper. -j-Sc.cC15 Y CAMQ;na Je_f(JtGe
C. ABSORPTION FIELD DATA
Date installed 8/10/88 Soil rating (g.p.d./ftz or fe/bdrm) t25 sflbd
Length 47 ft. Width 3-5 ft.
Total depth 10-1z_ ft. Eff. absorption area 752 ft Monitoring tube
Date of adequacy test 10/5/12 Results (Pass/Fail) Pass
System type
Trench
Gravel below pipe 8 ft.
Y Depression over field N
Fluid depth in absorption field before test 0 in. Water added 765 gal.
Elapsed Time: 1170 min. Final fluid depth 0 in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N
For 5 bedrooms
New depth 0 in.
Absorption rate >= 750+ g.p.d.
If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at _ in.
Datum
E. SEPARATION DISTANCES
WELL ON LOT TO:
Size in gallons
"Pump ofF' level at _ in.
Cycles tested
Septic tank/lift station on lot 100+
Absorption field on lot 100+
Public sewer main 75+
Sewer /septic service line 25+
Animal containment areas 100+
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+
Water main 10+ Water service line 10+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+
Water Service line 10+ Surface water 100+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that / 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.
Engineer's Printed Name Steven R. Pannone
Date z/ 0"! f
COSA brown sheet 9-1-12.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 110+
in.
Municipality of Anchorage s
Community Development Department
Development Services Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # osc121489
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
23 of Clearview subdivision. This inspection revealed a nitrate concentration
of 5.28 milligrams per liter (mg/L) was reported for the property's well
water sample. The Environmental Protection Agency (EPA) has established
a maximum contaminant level (MCL) of 10.0 mg/L for public drinking
water systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
I
Lot _�3 , Block .a�
r vie Sub�'ivisioh . �QoAV
� •.ar= ��
Anchoroge Recording District, Alaska Edwn»ats of record other than thou shown en
the Plot of record are not shown hereon unless,
othsrwlso noted, m' mxa ♦m.. maeaem.a e.
LOT SURVEY CERTIFICATION LEGEND V. � R.r.��� ; o
1'"by Wtlfy that Ih.w swveyed the Pr*Psrty shown and dss.rlbed
Ql Brass or Aluminum Dapped monument rap d a
arty lin and that the ovarian
Or
r 00 situated an thanon oro within the PraF. O .lron pipe and/or rebor recovered. t�' as
5
arty Ihws and do not overlaB orsaar000h an od jaoent pr.perty and that _® 2 x 2 hub & took recovered nR�p�F&S70Nh� .A
" ht,wovareants .n adjooent pr'Warty averlop or encroach on the promises 0 rJ/8" x .0" rebar set this survey p y
In awatlon and that than are no roadways, utility lines, or other visible ���=
sass,sente on "Id Property •s.spt as Indlaatsd hers... ' f8rlce LIiIB {Approx. Location)
Scale / ; 5�r Dote / ? Prepared by: R. L. BUTTON
a O (Q —�� ��L RegIvered Lord 55jrv6Yw
(907)279-6200 519 W. 60tAAve. Anaw W Atoaka 01
Ref. 0740
F B. No.. Property of:
30-40 Edward �ronick
��
�y i
g
...�_, .�W Pi
SGS ReEff
1124918001
Client Name
Pannone Eng. Srv.
Protect Namelt0
Clearview L23
Client Sample ID
Clearview L23
Matrix
Drinking Water
Sample Remarks:
Parameter
Results
LOQ
Metals by ICP/MS
Received Date/Time
10/05/2012 16:21
Arsenic
ND
5.00
Waters Department
10/12/12
CMA
Total Nitrate/Nitrite-N
5.28
0.100
Microbiology Laboratory
E. Coli
Negative
1
Total Coliform
Negative
I
Printed Date/Time
10/15/2012 16:00
Collected Date/Time
10/05/2012 13:21
Received Date/Time
10/05/2012 16:21
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Units Method Container ID Limits Date Date lint
ug/L
EP200.8
C
(Q0)
10/08/12 10/09/12
SCL
mg/L
SM214500NO3-F
B
(<10)
10/12/12
CMA
100mL SM219223B A
100mL SM219223B A
10/05/12 DLC
10/05/12 DLC
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application DateS/
Tom,/o 'S—
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range) '
Location (address or directions)
(b) Applicant Name Telephone: Ho a Business
Applicant Address 7 S
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder K; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution X� `a �' Telephone
Address -
(e) Real Estate Company and Agent 14—) `D ^j
Address
T�eleephho.,�nee
410
(f) -Afk�-the AAA to the following address:
L W
SRO 153:(
�IVER, ALASKA ti.,
PH.
i
I,F05 ,
2. TYPE OF RESIDENCE
Single -Family �( Multi -Family ❑ Other
Number of Bedrooms
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 the legality and status.
4. SEWAGE DISPOSAL
Onsite K 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.
Page 1 of 2 72-025 (11 84)
t
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.
S & E' GINEERNW-
Name of Firm SRS IQ= Telephone n
C7 � --
"LE RIVER, ALASKA ".0:5'1.7
Address — Pd- 04-237:3
Date
6. DHEP APPROVA
Approved for bedroom
Approved Disapp
Terms of Conditional Approval
i • A 1_4�t
111
s b Date'
1
r y d Conditional
i
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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.
Page 2 of 2
UNICIPALITY OF ANCHORAGE
K MUNICIPALITY OF ANCHORAGE ( MOA" DEPT.
IRONMEN HEALTH &
NTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984 MAY 13 1985
A. WELL DATA
Legal DescriptiorR
FUP
Well Classification S / If A, B, or C, D.E.C. Approved(Y/N)
Well Log Present(7,/N) Date Completed Yield ] Sc.> +�
Total Depth 3 Cased to Depth of Grouting
Static Water Level :7- Pump Set At
Casing Height Above Ground 340 a Sanitary Seal on Casing 4MM)
Electrical Wiring in Conduit .) Depression Around Wirllhead (YAD
Separation Distances from Well:
To Septic 4;e Tank on Lot I(D-5 On Adjoining Lots )e-`
To Nearest Edge of Absorption Field on Lot 114 ; On Adjoining Lots l L) -(-p 1+
To Nearest Public Sewer Line ")/A To Nearest Public Sewer
Cleancut/Manhole --'IA To Nearest Sewer Service Line on Lot 9_0 r�
Water Sample Collected By Date
Water Sample Test Results
CamL rts
B. SEPTICS TANK DATA
Date Installed N - '60- Size 1 C -50C -:> No. of Compartments 2
Standpipesn/N) Air -tight Caps Y- ) Foundation Cleanout ([yN)
Depression over Tank (X6J) _ Date Last Pumped / J 67 1-J
Pumping/Maintenance Contract on File (Y/N)'�A1 ; for
Holding Tank High -Water Alarm (Y/N) ' /i Temporary Holding Tank Permit (Y/N)
Separation Distances fran Septic/lie± ing Tank:
r r
To Water -Supply Wall 1o,S To Building Foundation
r
To Property Line 1c'(1- To Disposal Field
To Water Main/Service Line A ->_O r To Stream, Pond, Lake, cr Major Drainage
Course
Comments
Receipt #
Date Paid:
Amount:
[ Page 1 of 21
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 12---5-Q1/�-�WL--- Type of System Design '-rK r- JC- N
Date Installed Length of Field
i
Width of Field 7;0 44 Depth of Field Z
Gravel Fled Thickness
Square Feet of Absorption Area SI Standpipes Present1)
Depression over Field (YAV Date of Last Adequacy Test ,161•-1
Results of Last Adequacy Test /JIA
Separation Distance from Absorption Field: f
To Water -Supply iaell f 14-1 To Property Line 151- To Building Foundation -r) To Existing or Abandoned System cn
^-'/
Lot A On Adjoining Lots `�0 "f
To Water Main/Service Line
r To Cutba ' (if present)
To Stream/�and ke% Major Drainage Course
/P
To Driveway, Parking Area, or Vehicle Storage Area
Ccm rants
D. LIFT STATION
Date Installed I Dimensions
Size in Gallons Ma ole/Access (YM)
"Pump On" Level at Off" Level at
High Water Alarm Level at Vent (Y/1V)
Tested for amp/no6yAes during Adequacy Zest. Nisets MOA
Electrical Codes(Y/N)
Comments
** Check Permitted Bedrocin Rating Against HAA Faequest
I certify that I have checked, verified, cr conformed to all MOA HAA Guidelines in effe^t
on the date of this inspection.
' .. Date
Signed F""G;NE�r,,4
ompan %�S iAINER,
J ° r MOA No. OJ 3
�J
KBl /d5/s
[Page 2 of 21
Ar '% x
Aabert A. shaf"r =;
•, Na. 1.157-E 4a`
2-15-84