HomeMy WebLinkAboutARVESON LT 10
MUNICIPALITY OF ANCHORAGE
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
MAI LING ADDRESS
LEGAL DESCRIPTION
LOCATION
o,, D,STANCE TO=
~ ~ I Manufacturer ~
~ I ~o~ 'T~
~ [Liq. capacity'id gailon~I' ,~,
/000 ,~u,v,~,v,~:
6,.~ ~ DISTANCE TO' Iwell
~Z I ' I
~ ~ ~ Manufacturer
~ I Well
~ z I DISTANCE TO: I
m m ~ [ No. of hnes LenBth of each hne
~1 ~ I ~'
~ ~ ] Top of tile to finish grade
~ ~ I Type of crib
~ DISTANCE TO:
~ [Cla~ ~ ~ Depth
~ DISTANCE TO: Building foundation
q q,5-o7
I Abs°rPti°n_~m~a
Iinside length
Dwelling
Foundation
Total length of lines
Material beneath tile
Dwelling~ t~ t
Materi~4 ~_
IWidth '
PHONE [ E~I~EW
~.,~ ¥~--3 ~,5~ ? [] UPGRADE
NO. OF BEDROOMS
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
Material Liquid capacity in gallons
Nearest lot line
.~l o t
Trench width ,~
~ ~0 inches
PERMIT NO.
Distance between lines
~"~:) inches
Depth PERMIT NO.
Crib depth Total effective absorption area
Building foundation Nearest lot line
Driller Distance to lot line PERMIT NO.
Sewer line Septic tank Absorpt on area(s)
Total effective absorption area
OTHER
PIPE MATERIALS
SOl L TEST RATING
INSTALLER
REMARKS
APPROVED
DATE
LEGAL
/...or (o ~1 ~ UL~Sr~
IP.lt E k. L ft IP4
PERMIT NO. ( 8]:06]:¢1 )
8PPLICBNT
LOCBTION
LEGBL
][ C: I F"F~L I T'~r' C,F
DEPFIR].'MEI",IT OF HEFILTH 8N[) EN'v'IRONMENTRL PROTECT IO'~
825 "L" STREET, RNCHORRGE., 8K. 99501
264-4720
C,[-&.--S ITE SE~.~EF: F"EF:i'-'! I T
HOWARD VINES
JEROME &SHADY LN
LtO 8RVENSON
SRFI BOX 224 B 99507 2.':452:457
LOT SIZE 444444 SQURRE FEET
T'¢PE OF:' SOIL ABSORPTION SYSTEM IS: TRENCH
MFt×IMUM NUHBER OF BEDROOMS = 3 SOIL RFITING (S6! FT,."BR)= :1.25
]''HE F.:EQ J I RED S I ZE OF THE' SO I L FIBSOF.:F'T i ON S"r'STEM I c';.
[::,E] F" TH = ±2 LEfqt~]iTH= 24 ~]i F: R"-.-" E L [:,,EF'TH= :5:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEF'TH OF 8 TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFFICE OF THE
GROUND FIND THE BOTTOM OF THE EXCFIVFITION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
'THE GRFIVEL DEPTH IS THE MINIMUM DEPTH OF GRFIVEL. BETWEEN THE OUTFFILL PIPE
RND THE BOTTOM OF THE EXC:RVFITION (IN FEET;,.
F..:Ei;!Li I F-: EL:. 5EF'T I C: -f'R~-l~::] '_=. I ZE= :L ~-----i ¢_-"', ,.-E", ,_3RLL. C"~'~:--=-
PERMIT FIPPL. ICFINT HFIS THE RESPONSIBILIT"r' TO INFORM THIS DEF'FIRTMENT DURING ]''HE
INSTFILLFITION INSPECTIONS OF Rl",l"r' WELLS R[.',JFICENT TO THIS F'ROPERT"r' RND THE
NUMBER OF RESIDENCES 'T'HFIT THE 14ELL I.,.IILL SERVE.
'Tl.-.iC" ( 2 ::" 'f i'-,,IS:;F'EE:T I C~1'-,15 RF.:E F.::E,Z-!ILII I i~:E[:"
BFtCKFILLiI",iG OF FIN"r' S"r'STEI'"t WITHOUT FINFIL INSPECTION FIND FIPPROVFIL B"r' THIS
DEPFIRTMENT WILL BE SUBJECT TO PF..:OSECUTION.
MINIMUM [:,ISTFINCE BETWEEN 8 WELL FIND RN'¢ ON-SITE SEWFIGE DISPOSFIL S'¢STEI'"I IS
100 FEET FOF.'. FI PRIVFITE WELL. OF.'. t50 TO 200 FEET FROM FI PUBLIC WELL [:,EPENDING
UPON THE TVF'E OF PUBLIC: WELL.
MINIMUM [:,tSTRNCE FF.:OM FI PRIVFITE WELL TO FI PRIVFITE SEWER LINE tS 25 FEET FIN[:,
TO FI COMMUNIT'¢ SEWER LINE IS 75 FEET.
WELL LOGS RRE REQUIRE[:, FIN[:, MUST BE RETURNED TO THE DEPFIRTMENT WITHIN 3:0 [:,FI'CS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MRV FIF'F'L'¢. SPECIFtCRTIONS RND CONSTRUCTION [:,IFIGRRMS FIRE
FI',,,'RIL..FIBLE TO INSURE PROPER INSTRLL..RTION.
i CERTIF"¢ THFtT
±: I FIM FFIMILIFIR WI]''H THE REQUIREMENTS FOR ON-SITE SEWERS FIND WELLS RS :SET
FORTH B'¢ THE MUNICIPFILITV OF FINCHORFIGE.
;2: I WILL iNSTFILL THE S'¢STEM IN FICCORDFINCE WITH THE CODES.
3: I UN[:,ERSTRN[:, THFtT THE ON-SITE SEWER S'¢STEM MR'¢ REQUIRE ENLFIRGEMENT IF THE
F.:ESI[:'ENE:E IS REMO[:'ELE[:'~TO I¢CLLI[:,E 1"'lORE THFtN ]: BE[:,F.'.OOMS.
FIF'F'L i CRNT HOWRR[:, ',,,' i NES
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~//'SOI LS LOG
[] PERCOLATION
TEST
PER OR ED POR:
LEGAL DESCRIPTION: ~//~/ /~
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
1'-7_ i~ ~ m S / /7/-
SA, wP
NO, T73~E
Jmle ~, IS;68
SLOPE
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SITE PLAN
O
P
E
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND FT
COMMENTS
72-008 (6/79)
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geologic(il ~ Geophysical Surveys
Drilling Permit No.
LOCATION OF WELL (Pleale complete either la~ lb or lc.) A.D.L. NO.
'~"'~'~ /c9 ~-~) ,_ot_o,__o~-- si:] wl--I
t'~.JDI'TAND~ AND DIR~C;ION ~FJ!OM~OA~ INTEESEC~O~ ,. OWNER OF WELL:
5t~eef ~dres~ ond Areo of W~lI.Loc~tlon
Feet B*low 4. WELL DEPTH: (flnol) 5. ~TE OF ~MPLETION
. ~, ~
,.:~.,.j.::, ~ / ~:- ,.,,: ~.om..,,.
,,,~.,~: ~,~~~/ /~-o' ,,... ~ ,.. ,o~,,. 0,,,~ w.,,~, / 7 ,,,./,,.
· ' Boclfllllng . ~r~v~l
· _,_ ....... . . ,o.,,,,,c,,,,,,,v,,..
/ / ~~.. j .u,,..., .,.,:.~. ~.
............. DEPT. O~ ~" ~ /7~ ,. offer ~ ~. ,,mp~,~ W~ g.,.~.
.......... =~T~i PROTECTION
, ~ '~ '~o: . ,~.o. OUT,.~ w.,, o.ou,.: 0 ~'. ~.o
' Meleriel: ~ Neet Cement ~ Other:
LenJlh of Drop Pipe ff. cepoclly g.p.m.
--' ~ ~,~., ~ .,
14. REMARKS:
16. WATER WELL CONTRACTOR'S CERTIFICATION: 15, Wofer Temperofure ~o ~ F ~ C
...
F Registered ~tne~j ~m. / Confracf
A~horl~ld' Re~ell,lotlve --
Form OZ-WWR (11/81) Copy Distribution: WHITE-Stere DGGS, PINK-DrilIIr, CANARY-CulfomIr
Parcel I.D. 015-273-05
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Complete legal description Arveson, Lot 10
Expiration Date: —
Location (site address) 11108 Shady Lane Anchorage, AK 99516
Current Property owner(s) Richard & Marianne Bacon Day phone
Mailing address 11108 Shady Lane Anchorage, AK 99516
Real Estate Agent
Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADLI) $V;%%Aj1TAL'
❑ Duplex
E]Multiple Dwellings (Single Family and/or Duplex) JUL 3 0 Z014
3. NUMBER OF BEDROOMS: Three
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Piihlic Water System
❑
Public Sewer
❑
Waiver/Variance request for:,
j �
Received by: — r > f Date
COSA to be releasfd to tare engineer, unless otherwise requested by the engineer.
COSA Fee $ 'JZ -Fe
Date of Payment 7 iNIN J-vp
Receipt Number O -J 36 G
COSA # OSC 141312 -
Waiver Fee $
Date of Payment
Receipt Number
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.
Name of Firm Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SIGNATURE
Date 7/30/1
4P�F,,,....,,C
49TH ;
.................,. ................v
System #1 Approved for bedrooms j MICHAEL E ANDERSON
System #2 Approved for bedrooms �� !rf , CE -4381 \���
S
Y PP oef�f.,-r-?i-.f �v.
Disapproved �I4jPR FES `0A;%
Conditional approval for bedrooms, with the following stipulations:
By: i �" / Original Certificate Dater—�"
Th ip nchorage 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 blue sheet ( b
If more than 1 septic system is on the lot:
COSA Checklist # _of _
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: Arveson, Lot 10
A. WELL DATA
Well type Private If A, B, or C provide PWSID # _
Date completed 6/21/84 Sanitary seal (YIN) Y
Total depth 188 ft. Cased to 188 ft.
FROM WELL LOG
Date of test 6/21/84
Static water level 163 ft.
Well production 10 9 -
p.m -WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate ND mg/L
Arsenic ND ug/L Date of sample: 7/18/14
Parcel ID: 015-273-05
Well Log (YIN) Y
Wires properly protected (YIN) Y
Casing height (above ground) >12 in.
AT INSPECTION
7/22/14
148 ft
5.4
g.p.m.
Collected by: Anderson Engrg.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 9/7/83
Tank size 1,000 gal. Number of Compartments 2 Cleanouts (YIN)
Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN)
Date of pumping 6/27/14 Pumper A Plus Home Services
C. ABSORPTION FIELD DATA
Y
T
Date installed 9/7/83 Soil rating (g.p.d./ft2 or ftZ/bdrm) 125 SF/BDRM System type Deep Trench
Length 24 ft. Width 2.5 ft. Gravel below pipe 8 ft.
Total depth 12 ft. Eff. absorption area 384 ft, Monitoring tube Y Depression over field N
Date of adequacy test 7/22/14 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 23 in. Water added 450 gal. New depth 27 in.
Elapsed Time: 1,440 min. Final fluid depth 23 in. Absorption rate >= 450 g p d
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date
D. LIFT STATION No Add On Manhole - Gravity Flow to Absorption Trench.
Date installed Size in gallons
"Pump on" level at in. "Pump off" level at
Datum Cycles tested
Manhole/Access (Y/N)
in. High water alarm level at
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot > 100
On adjacent lots 00
Absorption field on lot >100
On adjacent lots >100
Public sewer main N/A
Public sewer manhole/cleanout N/A
Sewer /septic service line >25
Holding tank N/A
Animal containment areas >50'
Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line >5
Water main 0 Water service line
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 None Noted Wells on adjacent lots >100'
Absorption field >5'
Surface water >100'
Water main N/A
Driveway, parking/vehicle storage >10,
F. COMMENTS
Note: Septic Tank and Absorption Trench are more than 30 years old.
G. ENGINEER'S CERTIFICATION
i certify that l 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 Michael E. Anderson, P.E.
Date 7/30/14
COSA brown sheet 10-10-12.dac
Y
# .4
?^ �MICHA !, E MMSON,� a4 0
1 �r CE -4381
++�f� ROFESS1t)NR��`�'�
moot
CHIEF
6 p31WCT
WxDWe QiR..Ck
296.73' 589° 59' 30"E
eawllw ffTF"« 10' UTIL ESMT
F-------------------------------
I �s s•
0
EMSTING 3
HOUSE p
u, o
F®,f
33'
s„Eo t
UNDER NO CIRCUMSTANCES SHOULD AN AS—BUILT BE USED FOR CONSTRUCTION OR FOR ESTABUSHING BOUNDARY UK rLNI.0FINAN
THE SURVEYOR TAKES RELS�IBILI DISTANCES PREVAIL OVER SCAL NGON ONLY
AND REPRUCTIONASSUMES
MAY AUSEGERRORS IN SCALEIAL LIA51UTY . FOR THE COST OF THE SURVEY.
SYMBOLS
LCT SURVEY JUKVtT ItrG
FOUNDATION AS—WILT
FINAL STRUCTURE AS—BUILT
PLOT PLAN ... AS—BUILT ... LOT SURVEY ... TOPOORAPKY
IT IS THE RESPONSIBIUT'
CONSTRUCTION, TO VERA
TO FNISHEO GRADE AND
THE EXISTENCE OF ANY I
WHICH DO NOT APPEAR
SURVEY CERTIFICATION
OF THE BUILDER OR OWNER, PRIOR TO
r PROPOSED BUILDING GRADE RELATIVE
1TILITY CONNECTIONS AND TO DETERMINE
\SEMENTS, COVENANTS OR RESTRICTIONS
ON THE RECORDED SUBDIVISION PLAT,
PLOT PLAN
I n..er surd ” Ina- sA>+�r .�•.�
' yy lot nmm ma �' e! �✓ems• me mot 1
u .vmm cnma.�gm msee em. w.i of mr
mmv m0 mNrle., elmoMm. neM n..
a w. ma s...l.
FOUNDATION AS—BUILT
I. nm.+' Aw+a r.. n-ar amry mat I
na.. p.n*mea m Are.+11 rm.r of mt
rw�doum m EDN mt ma m.t m m. " r
me we me ne enaeMmmta meet ynlep (�
FINAL STRUCTURE AS—BUILT
I• RCO�I L .%f..., r.. fi e y molly Mt l
"Aavc H'M1.*•M m A moll wv.ey,a me
Fi.t unlW
•'
th
'°ROBERT J S_JR
♦♦���� Yo fes sional ��I*
SET REPAIR DRAINAGE ASPHALT
iP..
FOUND REBAR �q WOOD FENCE CONCRETE
ASSUMED ELEV.—"n METAL FENCE ® 'MOOD DEC
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE j
SHOWN. FENCES. WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, I
ETC_ ARE SHOWN NTHEIR
MAY PREVENT SOMEIMPROVEMENTTS FROM BEING I
G SEEN AND LOCATED.
ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. I
Prepared by
Robert E. Johns, Jr. & Assoc.
Professional Land Surveyors j
1700 Brink Drive.
ANCHORAGE, ALASKA 99501
Seale: 1,I _ 601
07/22/14
07/24/14
S.F. IReo. Plat
ircrm oy.. REJ r __ _JMK
Grid: 2635 W -D 14-332
Lot 10
ARVESON