HomeMy WebLinkAboutPETERS CREEK BLK 2 LTS 8 & 9Peters Creek
Block 2
Lot 8 & 9
#051-114-44
GREA' 'R ANCHORAGE AREA BOR~
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
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INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
Z-ov
NAME ,
OCA ,O.
SEPTIC TANK:
DISTANCE /0~/
FROM WELL
INSIDE LENGTH
MANUFACTURER
INSIDE WIDTH
NUMBER OF
MATERIAL COMPARTMENTS. /
LIQUID DEPTH __.LIQUID CAPACITY /i¢~ GALLONS.
SEEPAGE PIT:
NUMBER OF PITS .
LINING MATERIAL
BUILDING FOUNDATION ,
ADDITIONAL ABSORPTION
/, ~,/'
DIAMETER OR WIDTH
~~ CRIB SIZE: DIAMETER
NEAREST LOT LINE__
/g~'/q ,k'%?
f
, LENGTH , DEPTH (-¢
/'/'DEPTH ~::~/ DISTANCE FROM:
TOTAL EFFECTIVE
ABSORPTION AREA (WALL AREA)
WELL
'
.SQ. FT.
WELL:
TYPE
CONSTRUCTION
BUILDING /~' NEAREST
FOUNDATION --, LOT LINE
CESSPOOL
OTHER SOURCES
~2~~¢.~ DEPTH DISTANCE FROM:
NEAREST SEPTIC/,~l~-~ I SEEPAGE
/Vt/
, SEWER LINE , TANK__/f'//"' , SYSTEM
APPROVED DISAPPROVED REMARKS
DISTANCES:
INSTALLED BY:
PIPE MATERIAl ·
LOT SLOPE:
Form No, LQ-031
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503
274-4561
Date Received October ~. 1973
Time of Inspection 3:00 pm
Date of Inspection October 29,'73
REQUEST FOR APPROVAL OF
INDIVIDUAI. SEWER & WA/lfR FACILITIES
FOR
Conventional
1. Aoproval Requested By: Spokan.iMqrtgage
Address~ 523 W. 8th Avenue Anchora_qe AK 9950l
Prooertv Owner
Phone
Ron Ashwil I Phone,
Legal Description: ..... Lots 8&9., Block 2, Peters
LocafCon:
Four Wheel Drive. Peters Creek
Type of Facility to be Inspected:
Number of Bedrooms: . Three (3)
6. Well Data:
Single Family ~e!!!gg
*7.
A. T~qoe Drilled B. Depth
· !75'. ,
C. Construction Standard
Sewage Disgosal System:
D. Bacterial Analysis
A. Installed
C. Septic Tank:
D. Seepage Pit: 1.
Dtsposal Field'.
1973 ~.
1. Size 1000 2.
Installer Wallace. ..
Size 19'xlg'x23~.
Manufacturer W~]]aca
Material Concret~
Total Length of Lines
Distances:
A. ~el.L To: Septic Tank 102' , Absorption Area 14&' , Sewer Lines
, Nearest Lot Line
, Other Contamination
Foundation to Septic Tank
Absorption Area
C. Absorption Area to Nearest Lot Line .
Requ-ast.for Approval of ~ndivi~ual Sewer ~ Wate~ Faoilitl~s
Page-Two
9. Comments=
G~ter Approval Valid for One Year From Date Signed
Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for appreval to be a true
and accurate representation of the sub.~ect sewer and water facilities located at:
Signed
Date
Municipality of Anchorage
-. Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsfe
(907)343-7904
Parcel I.D.
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
051.114-44
1. GENERAL INFORMATION
Complete legal description
:.it -IL -e ((i .
COSA # 07001)
Expiration Date: I ho%fz
Lots 8 d 9. Block 2, Peters Creek SubdMsion
Location (site address) 21013 Four Wheel Drive Chugiak, AK 99567
Current Property owner(s) Steven Aman Day phone 688.2325
Mailing address
Lending agency
Mailing address
21030 Bowery Lane Chugiak. AK 99567
Day phone
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD forpickup.
2. NUMBER OF BEDROOMS:
me OI
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
0
_
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class -A A Well
0
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of Onsite Systems 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 engineer's 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 Certificate of Onsite Systems Approval Guidelines for this application,
shows that the on-site water supply andfor 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. Date 1015=7
16
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ow C')
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S. DSD�SIGNATURE 1 �;•"``45Or'
t/ 0I f'i • v`
Approved for 3 bedrooms. f� �vFo •.,, �t
Disapproved. ,+iR��O�ESSrO"P
Conditional approval for bedrooms, with the following stipulations:
Y OFq
r . G>=
WASTFWATFR
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: Original Certificate Date: kb
v�
(RW.,,,S)
Municipality of Anchorage
• Development Services Department
Building Safety Division
Onsite water 6 wastewater Program • • `
4700 Bragaw Street
P.O. BOX 196650
Anchorage. AK 995196650
vwvw. muni.orglonslte
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lots e a 9. Block $ Perm Creek SubdWWM Parcel ID: 051-11444
A. WELL DATA
Weti type OM A
Date competed —
Total depth R
Date of test
Static water level
Wall production
ifA, B, or C provide PWSID fI—
Sanitary seal (Y/N) _
Cased to R
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform ookmies/1W mL
Arsenic: _ r gA
B. SEPTIWHOLDINO TANK DATA
R
9 -P.M.
Nitrate mgt.
Well Log (YAV)
Wires property protected (YM)
Casing height (above ground) k1.
AT INSPECTION
R
9 -P.M.
Other bacteria coloniesMOO mL
Date of sample: _ Collected by:
Tank TypelMatertat 8eoriec"mers
Tank size 1.000 gal. Number of Compartments O"R
Data Installed WIO?s
Y
Foundation deanout (YIN) Y Depression over tank (YM) N High water alarm (YIN) N
Date of pumping 9152037 Pumper SarAwy Punpm
C. ABSORPTION FIELD DATA
Data installed MOM" Soil rating (g.p.dJfe or le/bdrrn)U*n0wn System type swmce Ps
Length 29 fL' Width 19 A. Gravel below pipe e R
Total depth _2_fL Eff. absorption area j ft Monito t tube Y Depression over field N
Date of adequacy test WSW Results (Pass/Fad) Pan For 3 bedrooms
Fluid depth in absorption field before test __Lin. Water added 477 gal. New depth—L2—in.
Elapsed Time: 120 min. Final fluid depth _1in. Absorption rate >= eco 9-p.d.
Any rejuvenation treatment (past 12 mo.) (YM 6 type) N If yes, give date
D. LIFT STATION
Data ktatelted Size In gallons ManhoWAccess (YIN)
'Pump on' level at _ In. 'Pump ofr level at _ in. High water alarm oval at in.
Datum CydeS tested Meets alarm 6 dmus mqui anwo?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAifi station an lot On adjacent lots
Absorption field an lot
Public sewer mein
Sewer !septic service Nne
Hoklktg tank
Animal aontakurtent areas Manuratanlmal excrete storage areas
SEPARATION DISTANCES FROM SEPTIGHOLDINO TANK ON LOT TO:
BuIldinp foundation W Prop" am >S
water main >td
Web on adjacent kits >=
Absorption field >6
Water servi a line >19 Surface water >1W
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property ane >ta Sudding foundation >ta Water main >ta
Water Service tine >10 Surface water >1W Ddvsway pwMnghWdde soorspa >2&
Curtain drain None Nmd Wells on adjacennt kris AW
F. COMMENTS: Smits Una From Tank b FINd AuPaMd 10 Remove Graeae aufWp.
G. ENGINEER'S CERTIFICATION
I certlry that l have detem*Wd MMLgh field kupectlms and
review Of MuNdpal records that the above systems are h
aonftnu nce *0 U04 COSA guldelkies in efled on WS data
Engineers Printed Name Michael E Anderson, P.E.
Date 1015MM
COSA Fee S W30
Date of payment 1
Receipt Number _ / 23 -!
pt". 1 LOS)
Waiver Fee S
Date of Payment
Receipt Number
49D*:
o Municipality of Anchorage
Development Services Department j-
Building Safety Division ' N
z. .
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
FORA SINGLE FAMILY DWELLINmn``�
G
Parcel I.D. 051.114-44 HAA # f_7�f 0 3�9-
Expiration Date:_1 0 - -rz 01 - e 5
1. GENERAL INFORMATION
Complete legal description Lots 8 & 9. Block 2, Peters Creek Subdivision
Location (site address or directions) 21013 Four Wheel Drive Chugiak AK
Current Property owner(s) Jerry and Jeness Bums Day phone 688.8804
Mailing address 21013 Four Wheel Drive Chugiak AK 99567
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup:
2. NUMBER OF BEDROOMS: Three 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 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 less than 30 days old.' (Certificates may be reissued for a period of up to one year with
valid water sales. Certifcates are valid for one year for_properties served byClass A or B wells or a public water
--- —
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
TYPE OF WASTEWATER DISPOSAL:
❑
Individual On-site
❑
Individual Holding tank
❑
❑
Community On-site
❑
®
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 5 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 less than 30 days old.' (Certificates may be reissued for a period of up to one year with
valid water sales. Certifcates are valid for one year for_properties served byClass A or B wells or a public water
--- —
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
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 Anderson Engineering Phone 522.7773
Address P 0 Box 240773 Anchorage AK 99524
Engineer's Printed Name Michael E. Anderson P.E. Date 10/26/2004
.•�cE � rgC,o��e.
E,
l
... _
BI Z MICHAEL & ANDERMN'S
5. DSD SIGNATURE �t, No. cE-aael
♦�
_jZ Approved for 3 bedrooms. ��s,',S":••••
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
vitt`�:jj OF
Additional Comments------------------
Sz:WATER AND : m
. 1NASTE
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: �� �� / Original Certificate Dater
(Rev. 11/00)
IVIU tC ality of Anchorage
DeveOopmeret ServicesbepartmeInt ;
Building SafetyDivision <
O_n Site Water & Wastewater Program S A E'
7 ou` tai rag w St
pox by nc mge AK g5 646T
'Manchorage ak us
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ripfion ots' 9. oc ers ree u wston Parcel
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n
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ipapei�if u
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Cycles tested Meets alarm & circuit'
def`ermfietl through field rnspections and 49th ♦Q
jl records that fhe above systems are in •
MOA HAA guidelines in effect on this date
„, �, ♦ ,MICHAEL E. AG'RSON t
. i
. , ' m .• '♦ l No. CE -4381 ti
i Name 06hael E An P E ♦j♦sj� ,e
3 Waiver 'Fee $ .,. ...��.._ .,•�,.,�aaM;
Date of Paym4���v. •*N9' m�sna*,77si '"i�'"t%R' .yw.•�'"e�aq�`",.,
ent„
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J�jv' Receipt Number
On lots
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on' lof NIA
adjacent
A
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On adjacent lots
NIA
def`ermfietl through field rnspections and 49th ♦Q
jl records that fhe above systems are in •
MOA HAA guidelines in effect on this date
„, �, ♦ ,MICHAEL E. AG'RSON t
. i
. , ' m .• '♦ l No. CE -4381 ti
i Name 06hael E An P E ♦j♦sj� ,e
3 Waiver 'Fee $ .,. ...��.._ .,•�,.,�aaM;
Date of Paym4���v. •*N9' m�sna*,77si '"i�'"t%R' .yw.•�'"e�aq�`",.,
ent„
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OCT -26-2004 TUE 06;27 AM VETECH/TIMOTHY.KIMBROUGH 9073576305 P. 01
Oct 25 04 06,:47p EAGLES AERIE 4174
SANITARY PUMPERS
20627 UPPER BOWERY
CHUGIAK AK 99567
907.68ANE
84602, Faor 907488.0993
CUSTOMER'S ORDER ND.
PRONE
NAME DAYS '
T..
U l Y ��
`` DtSCRl P'fIOfJ
1
l' I
I
10 DAY LATE !�6
$2040
I
1
i
1
1
RECEIyEp BY 1
TA:( �
TOTAL
7566 MUST a accom rAtumad goods
by tills bill,
Thank iv
PR0DU,1;Y 2531 Qi.i�
G
SaRVrTOR'S CaRY7�lCATd
I HEREBY CERTIFY THAT I AM A PROFESSIONAL LAND SURVEYOR, R
A SURVEY WAS MADE BY ME OR UNDER MY DIRECT SUPERVISION OF THE
IMPROVEMENTS SITUATED AS -BUILT ARE WITHIN THE PROPERTY LINES AND
ALSO ALL LOTS, ROADS, AND EASEMENTS ARE, TO THE BEST OF MY KN
Z� 7' 200
DATE
LOT 9
BLOCK 3
7 IN THE STATE OF ALASKA AND THAT
SHOWN HEREON AND THAT THE SURFACE
ENCROACH'ON THE ADJACENT PROPERTY.
SHOWN HEREON.
- —r-- - TUNDRA ROSE ATE.
LINK
FENCE
ION
L INE)
(EAST -
210/3 FOUR
WHEEL DRIVE
CHUGIAK, AK.
SEPTI
PIPES
O
(EAST — 70.00')
_.._�a4p-....-p.--
-- —.—
li OPEN III --CHAIN
N
INK
PORT-FENCE —=J I
a
DECK SHED
i
.Thomas M. Kirchner]
AW
r
ME
CHAIN
LINK
FENCE
ION LINE)
LOT 8 o LOT 9
BLOCK 2
I
'-t--26.5' O
GREEN,.o- z
/I LINK CHAIN -- 24.6'
WOOD TERRACE FENCE LINK
ICITY FENCE
IMPROVEMENT) 12.5'
INSIDE) 3: pL
�P
too,
30.0p.__U
TILITY
(EAST - 70.00') (EAST - 70.00')
EASEMENT
—LOT 5— — — — — — —i— — -
BLOCK 1
AS -BUILT DRAWING
LOTS 8 & 9, BLOCK 2
PETERS CREEK SUBDIVISION
CITY OF CHUGIAK, ANCHORAGE RECORDING DIST.
FILE NO: 04503.01A/4003 DATE: 8 OCT 2004
ALASKA LAND SURVEYING CO,
�� PALMER, ALASKA 907-745-149/ OFF/CE 907-745-/490
0
0
o
o
I
K
�
o
z
.`" CA TCI -O
BASIN
(EAST -
210/3 FOUR
WHEEL DRIVE
CHUGIAK, AK.
SEPTI
PIPES
O
(EAST — 70.00')
_.._�a4p-....-p.--
-- —.—
li OPEN III --CHAIN
N
INK
PORT-FENCE —=J I
a
DECK SHED
i
.Thomas M. Kirchner]
AW
r
ME
CHAIN
LINK
FENCE
ION LINE)
LOT 8 o LOT 9
BLOCK 2
I
'-t--26.5' O
GREEN,.o- z
/I LINK CHAIN -- 24.6'
WOOD TERRACE FENCE LINK
ICITY FENCE
IMPROVEMENT) 12.5'
INSIDE) 3: pL
�P
too,
30.0p.__U
TILITY
(EAST - 70.00') (EAST - 70.00')
EASEMENT
—LOT 5— — — — — — —i— — -
BLOCK 1
AS -BUILT DRAWING
LOTS 8 & 9, BLOCK 2
PETERS CREEK SUBDIVISION
CITY OF CHUGIAK, ANCHORAGE RECORDING DIST.
FILE NO: 04503.01A/4003 DATE: 8 OCT 2004
ALASKA LAND SURVEYING CO,
�� PALMER, ALASKA 907-745-149/ OFF/CE 907-745-/490
