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HomeMy WebLinkAboutBIRCH TREE ESTATES BLK 1 LT 28Municipality of Anchorage On'-Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: P S( OL4 e?/PID Number: 017 zN( —tip Dwelling: XL Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: -r% ABSORPTION FIELD vr� ❑ Deep Trench ❑ Shallow Trench ❑ Bed EXMound Address 1 ! i (9 cti_ ❑ Other Phone Number of Bedrooms Soil Rating JTotal or depth from original grade Z__ GPD/SF +0 /,19 '� Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade i .�— Fj` Ft Gravel depth beneath pipe (/ � �` Ft Subdiv' ion J -tom j Block Lot Z Fill added above original grade Z, 3 — qi if Ft. Gravel length 30 r� Township Range Section Ft. Gravel width S Ft. Beds: Number of Lines "3 Distance between lines 5" Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line qs 0 re Ft. Well t �tiv /D 0 t.F / /`t jr. 1 .- TANK F-1SepticEl[IS.T.E.P. Holding Other Manufacturer + !' Capacity A Yt'e vV ( 2 S-0 Gal. Surface Water r C f .t l7 Material Number of compartments L Lot Line f0, T- lIL NA Foundation t0 ,L V 1 LIFT STATION Manufacturer Capacity f Curtain Drain t �. 0 Gal. Remarks ��®� Pump on level atTinpump off level at High water alarm at VVQItrCC GipA,y�j,� ?—`1 Lf I' , in. in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank '� 0':i L( Tank to U3e f drainfield 1.41 �� � elt, Ye t Drainfield COIMT Inspector�� Q K+ �� BENCHMARK (Assumed elevation) 11?�f?i ft i Inspection s, dates: 1 2s r� 2"d 3 Z /' Location and description 140(c, t "Tp(� J(� LtC� 3`d 4� COMMUNITY D VELOPM NT DEPARTMENT APPROVAL En ' s Stamp OF Conditional Approval: Date ,,.���•° `•:�`.{ ° 1! '� '� ° 4 9T........... • ',`� ��! e ... 4rvon h S holy.�1%0 .. 1 ° .• •O f .MICHAEL N. ANDERSC q *,rzt• �* °• _ C�- 946940 Pp �_ . Date mspecnon report a-'i-i2.aoc 'TER ANCHORAGE ARtA ' JUbfl Department of Environmental Quality 3500 Tudor Road Anchorage, Alaska 99507 IN.~PECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NUMBER OF COMPARTMENTS r /~'~ ~" INSIDE LENGTH INSIDE WIDTI. I .............. LI©UID DEPTH .LIQUID CAPACI' Y ............... GALLONS. SEEPAGE Pit: NUMBER OF PITS /' DIAMETER OR WIDTH /'"~? LENGTH/'~z/ / / LINING MATERIAL/ ,,~/.~t:~ ('~'~-/.~.RIBc,~ -ZL.:. DIAMETER ...... [')EPTIq__. DISTANCE FROM: WEL. L ~'~ ~ ~.'Z.,,,,_/ .,..,.~'~ ,,z/TOTAL EFFECTIVE , NE/',,I?[.S'I LOT I_INE ABSORP]rlON AREA (WALl_ AREA) ............... ,~/~ ._SQ FT. BUILDING FOUNDATION. ADDITIONAL ABSORPTION WELL: TYPE _,,~_~'''',~ ....... CONSTP, tlCT ON ~¢~2;4-/'~~'~ DEPTH ,~p.~ z ..................................................... DiST/\NCE FROM: BUILDING / NEAREST / NEARES-f' ./ SEPTIC . SEEPAGE .......... /'~ /- FOUNDATION ~ ~ LOT I.INE .................. SEWER LINE ............. TANK_~., SYSTEM CESSPOOL~ OTHER SO,JRCES.__~_ APPROVED DISAPPROVED .............. REMARKS DISTANCES: INSTALl_ED BY:f~''''2¢'-~ PI PE M A'T E R IA L: _¢ t/~'"~Z;/r3-£/~-~'~ LOT SLOPE: REMARKS: Form PW-026 DIAGRAM OF SYSTEM DATE /- /, grEaTe_R ANCHOrage Area BOrOuoH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO.. 3500 TUDOR ROAD POUCH 6-65'0 aNCHOrAGE, ALASKA 99502 TELEPHONe 279-8686 SEWAGE DISPOSAL SYSTEM APPLICATION AND PERMIT INSTALLATION Of: SEPTIC TANK - ~ SEEPAGE PIT ~/~'~ DRAIN FIELD OTHEr SOIZ T~ST ~S~TS J~ ~ ~J~/~ NOTE, THIS~RMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION, 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS / FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT 2L~ // -- , DRAIN FIELD SEPTIC TANK TO SEEPAGE Pit WALL SEPTIC TANK ~ ~-/ / SEEPAGE Pit , , , DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK ~"/~U , SEEPAGE PIT ~/////~ DRAIN FIELD ~ ALSO CONSIDER AREA WELLS. / /L> / 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 REMCO/ABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. '-- H E,~,LTH A/~TI:[O R ITY or LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANChORAGe AREA bOROUGH ort~INANCE NrC. 28-68 AND THAT THE abOVE ' / ~:~'--'/'C-~ '-'-' ~ *'1 DATE /.~ ~/'~ /~-~ APPLICANT'S SIGNATURE' ~_~// ~ '("/U ~"~"d '-( ~ ~ MUNICIPALITY OF ANCHORA(~F OF HEALTH AND ENVIRONMEN1._ PROTECTION 825 ~ L Street, Anchorage, Alaska 99501 ~ 279-2511, ext. 224 or 225 Date Received: August 9, 1977 catch h20 while doing perc test Als°'#2: Tiine #3: Time Date Date Insp Insp ~UE~iT~!i OR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES gstitution Request: ~ss: :: Carl 'W. De Board :~SS: ~608 Kim Place 'Legal ue~,~iption: Phone: Phone: 337-3191 Lot 28 Block I Birch Tree Estates Subdivision Residence: ( ) ' )?~.:Muli~iple/Family Residence: ( ) Number of Bedrooms: Number of Bedrooms: Individual Well (x) Community/Public System ( ) Depth of Well ,.- Well Log on File ( ) .._ . ~,, ~ ........ Bacterial Analysis .... System: On-site System (x) Public Utility ( ) In sta 1 ].ed Instal ler Manufacturer Soils Rate Material Well to Septic Tank Nearest Lot line Line to Absorption Area Absorption Area 6f Heal, Ch:and Environmental Protection APprOval of I'ndl, Vldual Sewer an Water Facilities Lot, 28 BloCk 1 Birch Tree Estates Subdivision ~ed: : Letter Attached: ( ) Date: Date: sheet MUNICIPALITY OF ANCHORAGE ' "' ,,~~ Department of Health and Env[ronmenta]. Prote~t,~O~l,'' ?. 'i:'~~! [ 825 L Street, Anchorage, Alaska ;','[~' '~) , ~[k~~ 279-2511, ext. 224, 225 99501' ",' ~'-"~'~quest for Approval of Individual Sewer and Water. ~i,l~%[~e~~ 1. Property Owner: ~~ ~K~~~ .~ ~~~ ~~ Mailing Ad. dress: ~. /~~~ ~ ~~ '~~~- Lending Institution Mailing Address: Phone: Realtor/Agent: Mailing Address: Phone Legal Description: ~~ ~ ~__~/_~ / _/~_'~Z:~- ~Y Single Family Residence: ( ) Multiple Family Residence: ( ) Number of Bedrooms: Number 6f Bedrooms: Water Supply: *I~dividual Well ( ) If Individual Well, well depth If Community System, name of system Public/Community System ( ) Sewage Disposal System: On-site System ( ) If On-site System, date of installation: Public System ( ) *NOTE: A well log is required on AI,L wells drilled since 6/75. 3/'77 Request for Approval of Individual Sewer & Water Facilities Page Two 9. Con'~nen ts: Approved Disapproved Date Approval Valid for One Year From Date Signed Greater Anci~orage Area Borough, Department of [Znvironmental Quality DIAGRAM OF SYSTEH · / certify that the information contained in thi~ reques[ for approval to be a true and accurate representation of the subject seuer and water facilities located aL: i ne ~ -, Date Decelnber Zg. 1972 Francis L. Hester, Jr. 6517 Greenwood Anchor,ge, Alaska 99502 Subject: Installation of an on-site sewage disposal Lo~ ZL; & 15. ~lock 1, ~lrch Tre~ Lsta't~s. Dear ~,ir. t.ies~er: Earlier this month this office contacted you regarding an on-site sewage disposal per~,~tt taken out by you on April 13, 197~. AL ti~e Lime of our telephone conversation, you slated that the syste~ t)ad been installed tn ti~e s~i,ii~er of 1972. Since our office uade no final i~Fspoctio,) uf the syste~, you are in violatio~l of tile ~]orougil Ordinance 28-6~J. Section 9-71. Paragraph A, sub-pmragraph 4, which states: "~to septic tank... seepage pit or cesspool shall be backfillea without pur~.~isston of the ileal th authority". As previously requested, ~e again re~.~inu you to brint~ ~o our office by January 15, 1973 a coi,~pleted diagrdiii o'F tile syste~;;, tnclcding ~ll (ae~sure~ents froJ~ foundation to sept. it t. ank, seepage pit and well. Also included si)auld b~ septic :ank ~nu seepage pi: size as well' as lot line ~llowancos and Otstances from foundation to septic tank and seepage pit. If, .however, aa elfort is h~ade to, co~,'Jpty with Uorough regulations, this office will be forced ~o treat your sewage syste~,, as an illeg.,1 one on~ we ~vlll be forced to start llJurt proceedings a.jainsc you. A dt~r~n, tlas been enclosed for your convenience. in C~'tis J, atter ,,i~y be directed to ti'lis office. Sincerely. Any questions Deborah A. iJarr EnvironJ;~ental Control officer I l~,'b eric1. MUNICIPALITY OF ANCHORAGE 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. 017-141-10 1. GENERAL INFORMATION Expiration Date: Complete legal description BIRCH TREEESTATES BLK 1 LT 28 Location (site address) 14701 BUFFALO ST, ANCH AK Current property owner(s) MEDINA Day phone Mailing address SAME Real estate agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Waiver Fee $ Date of Payment 7 a5 ,)JaU Date of Payment Receipt Number 6 7515Y % Receipt Number COSA # 6S 0 2 2 1 3 13 Waiver # S. 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 MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 7-24-22 6. DSD SIGNATURE _>L System #1 Approved for 3 System #2 Approved for Disapproved Conditional approval for p�_IT Y OFA ��� ��. O F A �J O yo ••► `�.• .. N -S o WW ATE �`: 49TH ATER A ND• ...... .. .... ..... •'r beg*msAST_U'�ATER �...... ...:....... .. r befit PROGF o MICHAEL N. '.NDER5CN iii/��� 0���\ �� JF, • a,Z'V��s SERVICES bedroc,Mr )With)th`efollowing stip�Ti�I .�,-�•"��`` C�i 3g3_n zg­ t ( Original Certificate Date: �' _ 2 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 COSA Checklist blue sheet CASA Checklist Legal Description: BIRCH TREE ESTATES BLK 1, LOT 28 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth 73 ft Cased to 73 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 20 in. Date of flow test for COSA 6129/22 Static water level at beginning of test 70 ft. Comments _ B. TANK DATA Age of tank(s) '223115 years Tank type/material SEATICISTEE Measured operating fluid level in septic tank *36" ❑■ Standpipes/foundation cleanout per record drawing Date of pumping 6/9/22 / D. ABSORPTION FIELD DATA Which system tested (date installed) 3/23/15 ❑■ ALL standpipes present per record drawing Total measured depth from grade 2.9 ft (max) Measured depth to pipe invert from grade ft (min) A NIA — pressurized field Q Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 017-141-10 Structure served by this system Well production at time of test 4+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes No X Coliform bacteria is Negative Nitrate 0.301 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L *Arsenic less than MRL (ND) Collected by M N Date of Sample 5131/22 C. LIFT STATION X Required maintenance completed Age of lift station 7 years Lift station material STEEL Comments: SEE MAINTENANCE INSPECTION * STEP TANK Adequacy test date 6129122 Results Q Pass For 3 bedrooms Fluid depth prior to test DRY in Water added 460+ gal New depth 0 in Elapsed time 1440 min 0 Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test)0 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' Q Yes Yes Community Sewer Manhole/Cleanout > 100' ® Yes if No ft [7✓ Yes if No ft Neighboring Tank > 100' Rl Yes if No ft Private Sewer/Septic Line > 25'M Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' ❑✓ Yes if No ft Water Main > 10'{❑ Animal Containment : 50' ❑✓ Yes if No ft ❑✓ Yes if No ft Yes if No ft Water Service Line> 10' ✓❑ Yes if No Manure/Animal Excreta Storage > 100' ,� 38 Community Sewer Main > 75' MYes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10'✓❑ Q Yes Yes if No ft Surface Water > 100' ❑ Yes if No *30 ft Property Line > 5'✓❑ ft Yes if No ft Wells on Adjacent Lots: ft Absorption Field > 5' ✓V Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10'{❑ if No *30 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' Q 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' Q Yes if No ft Water Service Line > 10' QQ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' ❑ Yes if No *30 ft F. ENGINEER'S COMMENTS * SEE MOA WAIVER G. ENGINEER'S CERTIFICATION I certify that 1 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. COSA Checklist yellow sheet OF4 f ej ��GI M16AE1 N. 4NDUSCN r,J C - fjr,� .`Ys X11 P� ��'�`�.�. MUNICIPALITY MOR Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Owner Septic Tank: -Sludge level inches Lift station: Lift Station/Pump Vault Maintenance Street Address -LA -701 g c.a _ ^ "::-4 . *Pumping: required yes& -Pumping completed es no *Pump basket cleaned e na *Effluent filter cleaned aLno •Control "floats"cleaned a no *Proper float settings confirmed es no *Operation satisfactory es no Alarm System: *Dedicated electrical alarm circuites no -Audible and visual alarm inside dwelling esno *Alarm system operation not sausfactary Manhole Riser -Ground water intrusion at riser to tank connection es no -Ground water intrusion around pipe penetrations es no -Manhole lid: Functional es no Insulated es no Other •Weep hole functional a no Properly Secured es no -All manufacturer required inspections and maintenance completed es no Comments: Qualified Maintenance Provider: Technician II 4 Lls-_� P, Date of maintenance) q Company h� "�` �E'C�,j t fS Signaturepate 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. of r(Ajo,& l % AA , tl L'V f� PC k , Name of Firm G Phone 345-3377 Address 4661 Natrona Ave. Anch. Ak 99516 Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 03/26/15 6. DSD SIGNATURE F System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. .. Conditional approval for ca bedrooms, with the following stipulations:""' `' " representations given in paragraph 5 by an independent professional civil engineer registered 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 COSA blue sheet10.10-12.doe