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HomeMy WebLinkAboutCOTTONWOOD HEIGHTS BLK 1 LT 3Cottonwood Heights Block 1 Lot 3 #051-431-21 GRE' 'ER ANCHORAGE AREA B0r . UGH Q�)o Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ©� �� � 1/ MAILING ADDRESSPO /soy? ft PHONE , i/y &29bl LOCATION LEGAL DESCRIPTION OKI) �U 773' (Gti 777c-414 SEPTIC TANK: DISTANCE'js NUMBER OF FROM WELL MANUFACTURER fzd �'0�/1 �✓ MATERIAL ����✓CCL'T� COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY % GALLONS. SEEPAGE PIT: NUMBER OF PITS r DIAMETER 6-0 OR WIDTH J!', LENGTH] DEPTH �f CRIB SIZE: DIAMETER DEPTH DISTANCE FROM: WELL LINING MATERIAZ'ter TOTAL EFFECTIVE BUILDING FOUNDATION-� NEAREST LOT LINE�ABSORPTION AREA (WALL AREA) 4'e) SQ. FT. ADDITIONAL ABSORPTION WELL: . Wl of/ kT 7-1i e.) CF ._ry,SPee% e�) , TYPE BUILDING f� FOUNDATION 3h CESSPOOL APPROVED CONSTRUCTION DEPTH DISTANCE FROM: NEAREST NEAREST SEPTIC SEEPAGE / LOT LINE �C SEWER LINE TANK ZeC' SYSTEM L OTHER SOURCES /) /14-, DISAPPROVED REMARKS DISTANCES: DIAGRAM OF SYSTEM salf , ©(0Ch INSTALLED BY: t� PIPE MATERIAL: i ti'"�Q A LOT SLOPE; j � REMARKS: " ' ' S 07� I DATE h =� APPROVED - G.A.A.B. Form No. EQ -031 +�^ AMICIPMITY OF ANGI *Me M -W DRILLING, Ina.DEPr ENVIRONMENTAL PROTECTION P. O. Box 4-1224 • 1310C International Airport Road (907) 74-4611 ANCHORAGE? ALASKA 99509 JUN 17 DRILLING LOG RECEIVED Well Owner B( -)b Dumea1e D FIPENINL Use of Well Location (address of: Township, Range, Section, if known; or distance main road Lot 3 Block 1 CottonWppd Heights NAME OF APPLICANT INSTALLATION LOCAT LEGAL DESCRIPTION GRE/ =R ANCHORAGE AREA BOi UGH PERMIT NO DEPARTMENT OF ENVIRONMENTAL QUALITY ^ ^ 33307"C'. STREET ANCHORAGE, ALASKA 99503 �� ` on/ln �_ �}TE-LE'�NE 274-4561 nS ,,/,► z J G ScL�% lly- SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT 2 MAILING ADDRESS Xq-•Z9% .�� PHONE INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS l ` NOTEt THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK 15—f FOUNDATION TO SEEPAGE PIT Z_cf, DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL A5_ SEPTIC TANK • SEEPAGE PIT _SL_, DRAIN FIELD TO NEAREST LOT LINE. SEEPAGE AREA SIZE `b1iRAM OF WELL TO SEPTIC TANK 441 e SEEPAGE PIT DRAIN FIELD (y ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD SEPTIC TANK,• SEEPAGE PIT � DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. , GRAVEL BACKFILL/ CONFORM TO BOROUGH REGULATIONS REGARDING INSTA TION. G.A.A.B. OR ,�� - LICENSED DESIGNER ��,�r � ti F ..�����'�-ls�Z�'���f'FFY �l I CERTIFY AT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE REA BOROUGH ORDINANCE NO. 28-68 AT THE ABOVE DESCRIBED YSTEM IS IN ACCORDANCE WITH SAID CODE. DAT Zk:zPPLICANT'S SIGNATURE FORM NO. EQ -016 i + 17 t i � G.A.A.B. OR ,�� - LICENSED DESIGNER ��,�r � ti F ..�����'�-ls�Z�'���f'FFY �l I CERTIFY AT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE REA BOROUGH ORDINANCE NO. 28-68 AT THE ABOVE DESCRIBED YSTEM IS IN ACCORDANCE WITH SAID CODE. DAT Zk:zPPLICANT'S SIGNATURE FORM NO. EQ -016 ",•— ----, i�r SAM COTTE'ra r)RTLLING Box 216 Eaglo River, Alaska 93577 ! /or.? s4k / Y /'flaIt 7yy4 `y'k Co��er SAM COTTEN DRILLING CO. Box 296 Eagle River, Alaska 99577 0 & E GE01 .CHNI CAL & DEVEL( WENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russe# Oyster Earl Ellis 694.2774 SOIL LOG 688-2280 Soils Et Foundations Land Development Performed for: Name: )?60E127- 01)10fl-4 C- Tel . No. Nailing Address: Legal Description: Ell< / 447- �y 3` C.. ©TTE'A/ WD0D 1gk&1V i'-5 .S -d8 - Death (feetI Soil characteristics I 2 %f e113' %e 3 4 6 fs +.').,t.C` rf 7et,t 'n.0 9, /j O IJ A'e. 1 15 16 Gpound Water Encountered: YesNo l�/ If yes, what depth_ Proposed Installation: Seepage Pit Drain Field______ Comments : Performed by: Date:L-iz 2 T /�j September 11, 1979 IC1AI_ tISE 0NLN' l lj�f I::� I I�1ni AP 0h' -J I tVi iJT i I C)A7E I f7ATF i DATE SIP FCTOF1 INSPKTOR INSPECTOR I DIRFCTIONS:- 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS n `SINGLE'FAMILY ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER MULTIPLE FAMILY ❑ TWO ❑ FOUR ❑ SEX 2. WATER SUPPLY 'PERMIT NUMBER L 1 INDIVIDUAL — DEPTH OF WELL C._7 COMMUNITY ---- — -- DATE DRILLED - ❑ PUBLIC UTILITY Connostion Verified LOG RI-CEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER IINbivIDUAIJON -SITE DATE INSTALLED ❑PUBLIC UTILITY Connection Verified INSTALLER C_ISepticTank or El Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: —� TYPE OF TANK MANUFACTURER TOTAL. ABSORPTION AREA MATERIAL �.._.. pISTANC{ S Septic/Idolding'Fank Absorption Area Sewer Line ».._ ezirest Lgttme WFLL TO: Absorption Area to nearest Lot Line 5 COMMENTS ---------- IV APPROVED FOR _ �'��� BEDROOMS ❑ CONDITIONAL APPROVAL. (iette.r must acco.mpany'certificate) ❑ DISAPPROVED - LFGAL DESCRY "!"ION I Y2-010 (Rev. 3!78) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. HAA# 05D3�1 ,. Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 3; Block 1; Cottonwood Heights Location (site address ordirections) 20026 Kabob Cir. ChuQiak. AK 99567 Cu'rfent Property owner(s) A c T r r r r. Day phone Mailing address' " Lending agency Day phone Mailing address Real Estate Agent rindStourn .1 Pradentia} Dayphone 351 4845 Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 4. 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 Health Authority 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 S b S Engineering Phone 694-2979 Address River, AK 99577 Engineer's Printed Name Robert C. Cowan Date b' �`/ 170S_ S. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Jam; ON-SITE :q�= :WASTEWATER = PKUUMM tea• moi. /n_ ••••• .L• \� Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: n� l�• �� Original Certificate Date: (Rev 01103) Municipality of Anchorage ,..•� Development Services Department Building Safety Division On' -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST • Legal Description: LOT 'J; 1r3L" rt 1, &iToNu-� t-} • Parcel ID: 0 S1 '" L4 31 -al A. WELL DATA Well tylnQw l& If A, B, or C provide PWSID # = Date completed Sanitary Sanitary seal 8 Total depth (iLft. Cased to FROM WELL LOG Date of test I "3 (e r Static water level �b5 ft. Well production 5t g p•m- WATER SAMPLE RESULTS: Coliform _0 olonies/100 mi. Nitrate 2.51 mg./l. Arsenic: — mg./I. Date of sample: a-29/vs B. SEPTIC/HOLDING TANK DATA Tank Type/Material �E�t�' t C61 eK57 Well Log&) `tes Wires properly protectedVM) `16S Casing height (above ground) IZ: in. AT INSPECTION 1 110e, r ft. 40 g.p.m. Other bacteria O colonies/100 ml. Collected by: Date installed lv 16 1i S Tank size 10bo gal. Number of Compartments �_ Cleanouts Crrr,.0 Foundation cleanout (Y&f y f�. Depression over tank (Y&_ELP High water alarm (Y/&> t 0 '�IZ�S f u wtp/ Fc Date of pumping 21 Ds Pumper � C. ABSORPTION FIELD DATA a Date installed Ib I6 Soil rating (g.p.d.W o ftZ/bdrm 6p System type SEEP+ rr t�ttt r Length 1 S / ft. Width l S r ft. Grove' below pipe Total depth f_o ft. Eff. absorption area 3� ft? Monitoring tube.J Depression over field Q6 Date of adequacy test Zt D� Results ass ail) ' For _3_bedrooms Fluid depth in absorption field before test _2�r in. Water added Z2LCbal. New depth 56 in. Elapsed Time:Wmin. Final fluid depth Win. Absorption rate >= q56+ __g.p.d. Any rejuvenation treatment (past 12 mo.) (Y(A type) M'0 If yes, give date D. LIFT STATION Dale installed Size in gallons 'Pump on" level at _ in. 'Pump of " Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: t Septic tank/lift station on lot 100 'f Absorption field on lot IOb rJ- in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots (60 1A, On adjacent lots _ 160'+ Public sewer main fy p Public sewer manhole/cleanout PA Sewer /septic service line /.r7 t{ Holding tank N� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r Building foundation 6r4- Property line Absorption field S I -(- t Water main &D Ih- Water service line 16 f Surface water 100 I F Wells on adjacent lots t 0 C> 1{' in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /b Building foundation 2,01 Water main M6 rfi Water Service line � 0 � �- Surface water 1 4>0 'j' Driveway, parking/vehicle storage 100 r� NO f,o2Tlol0 � Curtain drain X (4%zwN Wells on adjacent lots v A.9 DEQ Dt?-%%16<1 cr F. COMMENTS SEEPtAGE Leff ©K�LtKAtL pr -i \%T1F0 F02- 2 SOewx 16u FtT- D(r^Erl^sioAJ + -.O%L.5 TESi14. 5wurS SysrEw. q aeuatE- foZa31P¢rm,FM DAO> ouW s{ G. ENGINEER'S CERTIFICATION NOF /�(QL ` Rims. titl7� I certify that I have determined through field inspections and C2 f review of Municipal records that the above systems are in {L conformance with MOA HAA /guidelines in effect on this date. Engineer's Printed Name I` 0 8 f R , C Co w�F.✓ — ~ ' "' 9 ` ROBERT C. COWAN Date `� Yy S �c�� CE -8801 HAA Fee $ All 3 0." Date of Payment T/y /0 S" Waiver Fee $ Date of Payment Receipt Number* Receipt Number (Rev. 12/07) ti 07-12-05 11:53 FROti-Pudential Jack 11hite Eatle River 9076996499 i .. _ .N B9'fJe ASBUILT an"Ax" 01 t SCALE',,'✓_ ` yd FOLLOWING DESCRIBED PROPERTY, r f. AND THAT NO ENCROACH1r1ENTS ES IST EXCEPT AS DATE: f �I•. D GRIDt ys6 EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- F& VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION -. a OFFENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN: ter. ti oast Nom= a � i .. _ .N B9'fJe ASBUILT an"Ax" 01 I HERE13Y CERTIFY THAT I HAVE SURVEYED THE SCALE',,'✓_ ` yd FOLLOWING DESCRIBED PROPERTY, ' AND THAT NO ENCROACH1r1ENTS ES IST EXCEPT AS DATE: f INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRIDt ys6 EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- F& VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OFFENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN: ARY LINES. o'o'f T-100 P.001/001 F-190 I b� 1 It� I� Z9%T o0 ,,b..XL%L%♦ .F- OF. A L4 ay.,. AsA 5....,d : P A ��•. LS -6918 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw Sl. P.O. Box 196650 Anchorage, AK 99519-6650 wwwcl. a nchorage. sk.us (907) 343-7904 Soils Log - Percolation Test Performed For. /7OT 2 J' Z w— . UU?^ Date Perf( Legal Description• (_ _ _! ST' i s i!�K�O 7�� P "'O'^'nship, Range, Section: T Slope Depth tFe=e -oRlo Ic.S ,• a 12- 13- 14- 15- 16- 17- Is- 19- 20- COMMENTS z-13-14-15-16-17- 18- 19- z0- COMMENTS 5 w' ceeet.Es yw I6w\ WAS GROUND WATER J, ENCOUNTERED? O Depth to Water e IF YES, AT WHAT DEPTH? O Depth to Water After P Monitoring? E Dale: 1 _ M p ROBERT G COWAN 6'g CE -8801 99+ ,fq\9/Y057 IIs f0on�,....�Np` Reading Date Gross Time Net Time Depth to Water Net Drop Rid#tK OS O b 61h o to ()I/2 Li I, ,r to 6I/L -' w to WIT y it 10 0 6 `/y — p PERCOLATION RATE ';I,# �P (miMoNnm) PEnc HULL vwme r cn $0 TEST RUN BETWEEN t_FT AND_FT 5 3 5 EMVlnccn.— PERFORMED BY; 17034 Eagle RIYer Loop Road No. $041 CERTIFY THAT THIS TEST WA PERFORMED IN A L E AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: S ;