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Home My WebLink AboutSKYWAY PARK ESTATES BLK 8 LT 10OAAB-HD.I GR' TER ANCHORAGE AREA BOROL' ~1 Dbt-AFII'MENT OF ENVIRONMENTAL 0.UALI1 ~ 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM DISTANCE FROM WELL ~/'~ ~" LIQUID CAPACITY /_.~:~.'~'.2 ADDRESS ~-~_/~/~ ~'~ ~o~E LEGAL DESCRIPTION. ~¢~/¢ ¢~ / ~ NUMBER OF COMPARTMENTS LIQUID INSIDE WIDTH___ DEPTH_ .MATERIAl GALLONS. INSIDE LENGTH_ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL ~'62-~ NEAREST LOT LINE OUTSIDE DIAMETER_ __OR W,DTH / ¢ DISTANCE FROM WELL ___~:.J~'~_..~_ ' ., LENGT.__ DEPTH_ ., BUILDING FOUNDATION TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL , FOUNDATION . NEAREST LOT LINE_ , OF LINES NUMBER OF LINES__ .~_/~--_ _DI~WE,..~EN LINES_~...~.~ .~,~-~-"~'-"~'-'-'~'~.~'"'~H"~IDTIDTH--:~'""~'"~~,.OTAL EFFECTIVE ABSOR~~ SQ. FT. LENGTH OF EACH LINE DEPTH: fOP OF TILE TO FINISH GRADE ...... DEPTH OF FILTER MATERIAL BENEATH TILE IN, ABOVE TILE ~/ /'/'~d DISTANCE FROM WATER WELL: TYPE__~ DEPTH , BUILDING FOUNDAIION .... SAMPLE , NEAREST NEAREST SEPIIC ~) SEEPAGE /' OTHER LOT LINE ., SEWER LINE__ __, TANK , SYSIEM. , CESSPOOL_ , SOURCES__ DISTANCES: A6: ~o' ~(~ = qo' DIAGRAM OF SYSTEM _ APPROVED_ ~ - G.A,A,B, / GREATER ANCHORAGE AREA BORuUGH DEPARTMENT OF ENVIRONMENTAL QUALITY' PERM'TNO. /*7 ,,oo T~,,:,oR ROAD "':'"CH 0."SO ~' / ~ s.w^6 D S.OSAL SYSTEM -- ^..UC^'nON ^ND . .Mrr INSTALLATION LOCATION '""/"'~- ~_~ ~'~'~ O~" /~/'// - FINAL INSPECTION~ 24 HOUR NOTIClz REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION DY THE HEALTH DEPARTMENT AUTHORITY WILL BI'" SUBJECT TO PROSECUTION. SEPTIC TANK SI TYPE / / / / DIAGRAM OF ~Y~TEM MINI~IUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL 7~=~ ~'~'~'~')'//~/¢ ,,~ f ~'~";~ , DRAIN FIELD /t~'/'~'//'/~:' ~-0 / /-00 WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD 'b"~2PT-IC TA.K, ~"~' , SEEPAGE PIT , DRAIN fIELD TO RIVER, LAKE, STREAM. CA.~ST IRONINTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GaP OF FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION, dA:i:~ ~ lq:~ aPPlICaNT'S $1gNATU., For Edward R, Saunder Jr. Date Pez'! >z'ned 7/26/71 · ,~ '~F%T'.'T~".T% .... .~:t,-'~-~, .............. . .... ¢ .... 2:;,, ,. :,,,., . .......................... ;'eOt: ,(]o.! ! m. ~. .:. B dy rown san silt (ML) .... i-Dare'gray silt cia - y mlx t with sandy silt seams .¢,.,.a Cerl:ified By, · · ,~Ng. tlonal Testznm Services Inc, ~- I~ DAT~. RECEIVED INSPECTION APP~)I NTMENTS TIME TI~E TIME DATE DATE DATE MUNICIPALITY OF ANCHORAGE MUNICIPALt~ OF ANCHORAG~ ~'~ ) DEPARTMENT OE HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF I: ',W'[i I,.,_,r~Ci.iON & 825 L Street - Anchorage, Alaska 99501 ~NV[RONMEi~IAL ENVIRONMENTAL SANITATION DIVISION I,~AY 8 1980 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten {10) days for processing. MAILINGADD~S ~ L .~ e S S / ~7¢--g'¢~. PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS ~LENDING INSTITUTION PHON~ 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STF EET .OCAT ON I 6, TYPE OF RESIDENCE NUMBER OF.BEDROOMS One [] Four [~""~SI N G L E FAMILY Two r-] Five [] MULTIPLE: FAMILY [] Three [] Six [] Other 7. WAT , UPPLY '~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilied ' [] COMMUNITY since June 1975. For wells drilled prior m ma~ oa[e, give well [] PUBLIC UTI LITY depth (attach log if availableJ 8, SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALl-ED. PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2, WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTI LITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE []PUBLIC UTI LITY Connection Verified []Septic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATEINSTALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Septic/Ho]ding Tank 4, DISTANCES WELL TO: Absorption Area Sewer Line Absorption Area to nearest Lot Line [] OTHER Nearest Lot Line 5. COMMENTS DATE [~APP ROV ED FOR ~1 BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) 72-010 (Rev, 6/79) DE PAllTPiEN U 2 5 5'IUN[CIPAL_ITY OF ANCHORAGE DF HLALTt AND FNV!ROI,II'IEI',I'I' PROTEC/'I ')N 26,1-472[ I!].: Date Insp Pratt RE(,).UZ[~iST NOR APPROVAL OF Lendnng ]'nsb'i tutJ.on .Request: Fia :i.]. ing Addre s s: Post Office Box 720 99510 TinLe ,~o: T J.ntt~ D/tho D;t _o ZNDZV'IDUA% SF;WER AND WA~R PAC[LFI"f),;S First Nahional Bank of Anchorage Propect_y Owner: William/Nina Anderson Phone: 344-3696 MailJ_ng Address: % Pat Newton, Century 21 Heritage Homes Legal DcscrzpLn.on: Lot l0 Block 8 Skyway Park Estates 4: S in¢l l.e Faln.i.].y Residence: (X) Numbeu oC Bedro,)ms: Three Multip]e Fam:i. ly Residence: ~ ) Number of Bndrooms: 5. We].l SysLenl: Individual wc~l.] (x) £:ommun&ty/Publir: c, ..~ . ,,) .t.n ) '7. Absorpuion Area SoL-Is Ralze Maker.La] Dls-~al~ces: We].]. ~;o Septic '.l.'ttnk t.o AbsorDtzon Request For Approval Health and EnvJronmonLal. P~oLechion o~ h~divJdua Sewe~~ and WahoL' [,Mcili_ ~es Affadavi{_ Aktachod: t ) Lether A'h~ached: ( [)019arlllllt~llh Workshoou: MUNICIPALITY OF ANCHORA~ '~--':7 Department of tlealhh and Environlnen/al Protection ~?o~h~=~ 825 L Shreek, Anchoraqe, A].aska 99501 ~ "i'R~eques~ for Approval of Individual Sewer and Water FadJlf%ii~ Mailing Address Phone: Name of Buyer: Mailing Address: _~_p_--~_/~ ,_ Phone Realtor/Agent ........ '~ '. Legal Description Street Location Sinqle Family Residence: Multiple Family Residence: Nuinber of Bedrooms: Number of Bedrooms: Water Supply: *Individual Well (2~ If Individual Well, we].l depth l). tf Communi ty Syntem, name of system Public/Conm~unity System ( ) Sewage Disposal. System: *'~On-site System ( ) Public System If Oil--si he System, date of installation: .___/.~p~_ *NOTE: A we].] log Js required on AL1, wells drilled since 6/75. ** if on-site sewer system is ovor two(2) years eld, an adequacy test is required by this department. A fee of $25.00 must accompany each request befere precessing can be inJ tiatect. 3/77 MUNICIPALITY OF ANCHORAGE oma; lJft� 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. 019-102-15 1. GENERAL INFORMATION Expiration Date: �b I LI d 0,')o Complete legal description SKYWAY PARK ESTATES BLOCK 8, LOT 10 Location (site address) 1510 SHORE DRIVE ANCHORAGE, AK 99515 Current property owner(s) THROCKMORTON FAMILY TRUST... Day phone Mailing address Real estate agent 1510 SHORE DRIVE, ANCHORAGE, AK 99515 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic ❑ 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 $ S so — Waiver Fee $ Date of Payment Date of Payment Receipt Number�� a��o� Receipt Number COSA # 0'5CAO� S 3Z 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377 Address 4661 NATRONA AVENUE, ANCHORAGE, AK 99516 Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 11/7/2019 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due ` due to subsurface conditions that may not be observed from the surface, changes in land use, O AZ local soil characteristics, groundwater levels that may fluctuate during the year, quality of Aor �S , construction (workmanship & materials), the water usage of the family being served by the �ra� • , system and maintenance. The operational life of all well and septic systems are subject to ✓>_ f these various and dynamic characteristics and are outside the control of the evaluator of the J well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or / discrepancies exist can be given byAM and Anderson Construction & Engineering. ,a. CE 4t89 �� 6. DSD SIGNATURE 11/7/19.. �� v/ System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipu atioW (OF((((((,('// WATER AND By: )Od&n4 Original Certificate Date: l �� 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 COSA Checklist.docx COSA Checklist Legal Description: SKYWAY PARK ESTATES BLOCK 8, LOT 10 Parcel ID: 019-102-15 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled UNKN – CIRCA 1971 Total depth 52 ft Cased to UNKN ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 11/6/2019 Static water level at beginning of test 43 ft. Well production at time of test 5.5+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 0.756 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample 11/6/2019 Comments B. TANK DATA – PUBLIC SEWER Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA – PUBLIC SEWER 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 ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist.docx 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’ Yes if No NA ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No NA ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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’ Yes if No ft Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No F. ENGINEER’S COMMENTS G. ENGINEER’S CERTIFICATION I certify that I 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. 11/14/19