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HomeMy WebLinkAboutALPINE VILLAGE BLK 3 LT 8GAAB-HD-I GP""'~tER ANCHORAGE AREA BOROP' ~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION SEPTIC TANK: DISTANCE FROM WELl LIQUID CAPACITY /GOO MI MATERIAL ~)/k) C~-..~ T~_..... NUMBER OF COMPARTMENTS GALLONS. INSIDE LENGTH INSIDE WIDTH SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAL NEAREST LOT LINE SEEPAGE PIT: / OUTSIDE DIAMETER '~'~' ' OR WIDTH LENGTH ~ , DEPTH ,~(.v'...~ DISTANCE FROM WELL /(~)~.~ / BUILDING FOUNDATION ~ll"'J! TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~(~'C] SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA FOUNDATION .DISTANCE BETWEEN LINES SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE NEAREST LOT LINE TOTAL LENGTH OF LINES TRENCH WIDTH IN. TOTAL EFFECTIVE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE__ WELL: TYPE ~';//,~ DEPTH NEAREST LOT LINE ~'"~ J , SEWER LINE SEPTIC , TANK DISTANCE FROM BUILDING FOUNDATION. SEEPAGE , SYSTEM WATER · SAMPLE , CESSPOOL , NEAREST OTHER , SOURCES__ DISTANCES: DATE DIAGRAM OF SYSTEM APPROVED ~'~ ~ J~ HEALTH AUTHORITY GAAB-H D-2 GREATEk ANCHORAGE AREA ,.. ~ROUGH HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 Case No. SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT ~£L ~. RESIDENCE ADDRESS ~~ ~/¢ LOCATION OF INSTALLATION LEGAL DESCRIPTION Z~ ~ ~ ~ ~ ~/~ APPLICATION TO INSTALL: SEPTIC TANK ~ , SEEPAGE PIT / ,DRAIN FIELD TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH ~5~ ~ PERCOLATION TEST RESULTS PHONE NO., ,OTHER ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS ~;':;A ..... ( //'¢'? ~' ' PERMIT TO INSTALL A .. AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED . SEPTIC TANK SIZE.- ~-;-,>~? TYPE ~':'c'/ SEEPAGE AREA ~ '.:~.3 .t // TYPE ...... ,~:~: DIAGRAM OF SYSTEM I certify that I am familiar with the requirements of Greater Anchorage Area above described system is in accordance with said code. ',fl' Iorough Ordinance No. 28-68 and that the MUNICIPALITY OF ANCHORAGE c ,A€ f, 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. 014-133-08-000 Legal description ALPINE VILLAGE BLK 3 LT 8 Site address 7332 BERN ST Anchorage AK 99507 Expiration Date: 1/13/2023 Current property owner(s) VAN HEEST THOMAS J & SANDRA M X The On-site system(s) is/are approved for 6 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 10/13/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUMC�PAUTY OF ANCHORAGE Development Services De artment ^ P P �= Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 014-133-08 Complete legal description Alpine Village Block 3, Lot 8 Location (site address) 7332 Bern Street *Anchorage, AK Current property owner(s) Sandra Van Heest Day phone 907-431-1865 2. ON-SITE SYSTEMS SIZED FOR 6 BEDROOMS 3. TYPE OF WATER SUPPLY: X Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank 0 Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age NSA - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑Wide Trench ❑ Seepage Pit Waiver request for: N/A Expedited review requested: ❑ Distance: - By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 2-F50 Date of Payment (o 2o 2 j COSA # D 5C 2 -313591 Waiver Fee $ Date of Payment Waiver # COSA Applicadon_June 2022 COSA Checklist Legal Description: Alpine Village Block 3, Lot 8 Parcel ID: 014-133-08 If more than 1 well andlor septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Date drilled 2/11/15 Total depth 111 ft Cased to 111 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 9/26/23 Static water level at beginning of test 35.4 ft Comments B. TANK DATA Measured operating fluid level in septic tank Date of pumping ❑ Required maintenance completed, if AWWTS Comments: Public Sewer D. ABSORPTION FIELD DATA 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 N/A fi ❑ N/A — pressurized field. ❑Per record drawings, field is insula ❑ Monitor tubes go to bottom of effe2 ive. If not, state depth into El Pre soakedired if (Reqse va nt or field not used for more than or date of test) Galloed gallons date Any rejueatment (past 12 months) N/A If yes COSA Cheddist June 2022 Well production at time of test 5+ qpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes © No -Coliform bacteria is Negative Nitrate mg/L 9 -Nitrate less than MRL (ND) Arsenic 1`:g/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD Date 9/26/23 C. LIFT STATION ❑ Required maintenance Age of lift station Lift station material 77 Comments: Public Sewer ,Adequacy test date Results ❑ Pass Fluid depth prior to test in Water added - gal New fluid depth in Elapsed time - min Final fluid depth in Absorption rate gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) in Effective depth used - in Effective depth remaining in 0 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or community well on lot) Septic Tank/Lift Station on Lot > 100' NSA Community Sewer Manhole/Cleanout > 100' [:]Yes if No *40+ ft ❑ Yes if No ft ❑ Yes if No ft Wel s on Adjacent Lots: Neighboring Tank > 100' ❑o Yes if No ft Private Sewer/Septic Line > 25' [:]Yes if No *15+ ft Absorption Field on Lot > 100' ❑ Yes if No NIA ft Holding Tank > 100' 5■ Yes if No ft Neighboring Absorption Fields > 100' ervice Line > 10' Animal Containment > 50' Q Yes if No ft Yes if No ft *OSP151019 *40+ Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft R- Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than require� Building Foundations > 10' ❑ Yes if No ft Surface Water > 1 00�',_"'�• ❑ Yes if No ft Tank to Property Line > 5' ❑ Yes if No ft Wel s on Adjacent Lots: to Property Line > 10' ❑ Yew s i ft Private Wells > 100' ❑Yes ifNoft r Main > 10' E ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft ervice Line > 10' ❑ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *OSP151019 G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gamess Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Gamess Date iv h o 2,? 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 o�6o�p0� practices. The reported results describe the condition of the system/s on the date/s of the evaluation. �o Separation distances were measured to readily identifiable features. Hidden defects or encroachments may o �F exist that were not identified during the evaluation. The operational life of all wells and septic systems depend �' <<<'' Sip 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 9 T the systems. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an altemative well O ................ or septic system can be installed on the property in the event either of the current systems fail to perform (j Je y Garn ss. adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG QQ 9 CE 79 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. Q Pre ! • • �o`�O 0 LICENSEap�ofesso�oo COSA Checklist June 2022 #AECceSa ��Opp000