HomeMy WebLinkAboutPETERS CREEK BLK 3 LT 505 � Ii5 05
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/i— 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
PHONE
NEW
u�,
C-29
❑ UPGRADE
MAILING
ADDRESS
S �B 1 C1 LK i&_C_JC- �iv�rt0
/L. S- 7
LEGAL DESCRIPTION
LOCATION 7
n
LUf�/�-
Pr
NO. OF BEDROOMS
T�,25 C,�e c,_ ,Lar !�
�� J
Well
1
Absorption area
/
Dwelling
PERMIT NO. Q
416) y
DISTANCE TO:
6 -7
2
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fU Y
aZQ
Manufacturer
Material
sT d
No, of compartments
LU
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r2
rn �
Liq. capacity in gallons
IF HOMEMADE:
Inside length
------
Width
Liquid depth
/000
6 Y
Well
Dwe Ing
PERMIT NO.
DISTANCE TO:
z
Material
Liquid capacity in gallons
O Q
2 I—
Manufacturer
A
Well
Foundati
Nearest lot line
PERMIT NO.
J=
w
DISTANCE TO:
J LL Z
No. of lines
Length of each line
T al of Iines
Trench width
Distance between lines
H Z w
inches
Fes-
Top of tile to finish grade
Ma erial beneath the
Total effective absorption area
0
inches
w
Length / Width
3 S 1.7
Depth >
S �EG
�, Q' PERMIT NO.
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Q H
Type of crib Crib diameter
Crib depth
Total effective absorption area
'>
w
W
WellBuilding
I
fou
Nearest lot line
DISTANCE TO:
Class Depth
Driller
Distance to lot line
PERMIT NO.
J
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w
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ouildin fndation
Sewer line
Septic tank
Absorption area(s)
DISTANCE TO:
OTHER
PIPE MATERIALS
VeL
SOIL TEST RATING
r
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INSTALLER
xR FA.7-,- s E -s
REMARKS
t
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lot
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DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
$25 L STREET/ ANCHORAGE, HK 99501
264-4720
cl N_��I _r F= ���w F= F;I.l � w F=_ L_ L_ �F-F R m I _r
PERMIT NO:
DATE ISSUED:
APPLICANT
CONTACT PHONE:
LEGHL DE5CRIP:
LOT SIZE:
MAX BEDROOMS:
840446 -
06/12/84
C/O 5 A S ENG'Q. IRA KRUGER
SRB 196X
EAGLE RIVER, HK 99577
694-2979
SUBDIVISION: PETERS CREEK
SECTION: 10 TOWNSHIP: 10N
10500 (SQ.FT. OR ACRES)
3
LOT:-PvA
�e-
RANGE: 1W
BLOCK: 3
LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC
SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE.
**
E�- FE L'.a
L -J. L> F;;?. F=V I��
DEPTH TO PIPE BOTTOM (FT.)
4.0
4.0
3.0 **
GRAVEL DEPTH (FT.),
2.0
0.5
3.0
TOTAL DEPTH (FT.)
60
4.5
6.0 '
GRAVEL WIDTH (FT.)
2.5
17.0
5.0
GRAVEL LENGTH (FT. )
94.0 **
34.0
44.0
GRAVEL VOLUME (CU.YDS. )
21.7
21.4
28.5
THMN SIZE (GALS)
1,000.0 **
1,000.0
1/000.0 �*
SOIL RATING (SQ.FT./BR)
125
125
125
DEPTH TO PIPE BOTTOM { 3.5 FT REQUIRES INSULATION
** DEPTH TO PIPE BOTTOM { 4`0 FT. MAY REQUIRE H LIFT STATION
*�
GRAVEL LENGTH } 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH)
** TANK MUST HAVE AT LEF9ST TWO COMPARTMENTS
--------------------------r-----------~-
I CERTIFY THAT:
1. I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOH) AND THE STATE OF ALASKA.
2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS. -
AND IN
EQULHTION5,AND'IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
]. I WILL ADHERE TO ALL MOH AND STATE OF ALASKA.REQUIREMENTS FOR THE SET BACK
DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC
SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT.
4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR H MAXIMUM OF 3 BEDROOMS AND
ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT.
IF HLIFT STATION IS INSTALLED IN AN AREA COVERED BY MOR BUILDING CODES/
THEN (1) AN ELECTPERMIT AND INSPECTION MUST BE OBTAINED. -(2) HS-BUILT5
WILL NOT ELECTRICAL INSPECTION REPORT/ AND (3) THE
ELECTRICAL H LICENSED ELECTRICIAN.
SIGNED DATE:
APPLICANT: C/60 5MS -IRA KRU0ER Y ^
ISSUED BY DATE: ^~
� �____________________---------------- _ ,
P�—.5.OI LSJLOG
MUNICIPALITY OF ANCHORAGE 5,4 6 I
❑ PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST
\ 825 L. Street, Anchorage, Alaska 99501 264-4720
\--� SOILS LOG — PERCOLATION TEST
PERFORMED FOR: / \ K U DATE PERFORMED:
LEGAL DESCRIPTION:T`�
14-
415,e
Date
SLOPE
ETEf)
r
Depth to
Water
Net
Drop
l F.
2�1
15—
e.
4obis.
k:+
3
4
L 6,0 ,� vez—
C ��1
Li5
0
6
7
8
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9
19
/1 4 .
v
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lo--
11
WAS GROUND WATER S
J ENCOUNTERED?S L
D
P
12
4)-1 -89 -)IF YES, AT WHAT f E
7
13
DEPTH?
—Z�
14-
415,e
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
15—
e.
4obis.
k:+
1�: r
18
Aotawt +�. :I'A�krr
19
eo ,yira
tlK°`W �t
COMMENTS IC 1 UA1 1"I C)K.1 N 1
PERFORMED BY: j ; T41117
72-008 (6/79)
SITE PL
J
Reading
,J
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
k:+
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND FT
1�'�QpGf 8Gr
• Municipality of Anchorage
On -Site Water and Wastewater Program f
(907)343-7904 5A £TT +
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-115-05
1. GENERAL INFORMATION
Complete legal description PETERS CREEK, BLOCK 3, LOT 5
Expiration Date: g
Location (site address) 23307 TUNDRA ROSE AVENUE, CHUGIAK AK 99567
Current Property owner(s) THOMAS & CYNTHIA REINBOLT Day phone
Mailing address
Real Estate Agent
PO BOX 670406, CHUGIAK, AK 99567
2. TYPE OF DWELLING:
M 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:
Individual Well
❑
Individual
M
Individual Water Storage
❑
Holding Tank
❑
Community Class _Well
E]
Comm unity
❑
Public Water System
M
Public Sewer
❑
Waiver/Variance request for: Distance:
Date: �_ %6 _/
COSA to be released to the engineer, unless
COSA Fee $ rJ2,(o � Waiver Fee $
Date of Payment i2(40(5- eA.,, ,
Receipt Number 035 L
COSA# 12(O1
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 ARCTERRA CONSULTING, INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577
Engineer's Printed Name KENNETH M. DUTFUS 5111/15
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a—_`�
system will function satisfactory for current or future QF A
occupants or can ArcTerra guarantee that no unseen L
encroachments, deficiencies or discrepancies exist. / it
�* 4git1
6. DSD SIGNATURE
�v'- System #1 Approved for -3 bedrooms.
0
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the
KENNiIFH 11 D6
7716 &�'°
tt�eo
i/ J �G
1\
FESS7oNb� .i
OF
WATER AND
Original Certificate Date:
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 blue sheet 10-10.12Aw
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: PETERS CREEK, BLOCK 3, LOT 5 Parcel ID: 051-115.05
A. WELL DATA — PUBLIC
Well type
Date completed _
Total depth _ft.
Date of test
Static water level
Well production
If A, 13, or C provide PWSID #
Sanitary seal (Y/N) Y
Cased to _ft.
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform colonies/100 mL
ft.
g.p.m.
Nitrate _ mg/L
Arsenic: _ ug/L Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC / STEEL
Tank size 1000 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
Date of pumping 2112115 Pumper JRs
C. ABSORPTION FIELD DATA
Well Log (Y/N)
Wires properly protected (YIN)
Casing height (above ground) in.
AT INSPECTION
ft.
Collected by:
Date installed 6/3011984
Cleanouts (Y/N) Y
High water alarm (Y/N) N
Date installed 6130/1984 Soil rating (g.p.d./ftz or ft2/bdrm) 125 System type BED
Length 35 ft. Width 17 ft. Gravel below pipe 0.5 ft.
Total depth 4_2 ft. (Measured 515115) Eff. absorption area 595 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 515115 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 500 gal New depth 1 in.
Elapsed Time: 10 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at _ in.
Datum
Size in gallons
"Pump off" level at _ in.
Cycles tested
E. SEPARATION DISTANCES - PUBLIC WATER
WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
Animal containment areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 51+ Property line 51+
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
Manure/animal excrete storage areas
Absorption field 5'+
Water main 10'+ Water service line 101+ Surface water 1004
Wells on adjacent lots 2001+
ABSORPTION FIELD ON LOT TO:
Property line 104 Building foundation 101+ Water main 101+
Water Service line 1.01+ Surface water, 1004 Driveway, parking/vehicle storage 104
Curtain drain 50'+(NONEKNOWN) Wells on adjacent lots 2001+
F. COMMENTS
Vacant system presoaked prior to testing ADEC benzene monitoring well on property,
G. ENGINEER'S CERTIFICATION
1 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.
Engineer's Printed Name KENNETH MJ)UFFUS
Date 5111/15
COSA canary sheet_2-6-15.doc
f� OFA
/ � n i TT -T
z6,711 fs./
IONS' i
LOT 14
N 90'00'00" E 70.05' (70.00' R
.x—x—x—x—x—x—x x—x—x—x—x—x—x—x—x—x-
10' UTILITY ESMT
•
L
1 r -SEPTIC
k VENT
® MONITOR
WELL
N89'58'32"E 70.05'
(N90'00'00"E 70.00' R)
o TUNDRA ROSE AVE
ANCHORAGE RECORDING DISTRICT, ALASKA
ASBUH,T OF:
PETERS CREEK SUBDIVISION
LOT 5 BLOCK3 PLAT P-373
SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchmachments exist other than noted. Under no circumstance should
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
15-015
JL5 I NW1360 1 150140
O = FND 518" REBAR
„OFAl �l
HN L. SCHULLERr
110 LS -10408
E-
0 0
Q11D SUR
w45 LAft
3L?p�l
va'+ �r
to e 0
1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274-4992 fax
(tm)
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1O
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Z
DECK
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E
36.0
C3 m
0
a
3;
N EXISTING
A
o HOUSE
o c
O
36.0'
.
tzo'
0
O
O
0
CONC
22'1
Z
0
DECK
0
0
Z
GRAVEL
D/W
LOT 5
BLOCK 3
® MONITOR
WELL
N89'58'32"E 70.05'
(N90'00'00"E 70.00' R)
o TUNDRA ROSE AVE
ANCHORAGE RECORDING DISTRICT, ALASKA
ASBUH,T OF:
PETERS CREEK SUBDIVISION
LOT 5 BLOCK3 PLAT P-373
SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated hereon are within the property lines and no
enchmachments exist other than noted. Under no circumstance should
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
EXCLUSION NOTES: It is the owners responsibility to determine
the existence of any easements, covenants, or restrictions which
do not appear on the recorded subdivision plat.
15-015
JL5 I NW1360 1 150140
O = FND 518" REBAR
„OFAl �l
HN L. SCHULLERr
110 LS -10408
E-
0 0
Q11D SUR
w45 LAft
3L?p�l
va'+ �r
to e 0
1831 Talkeetna Street
Anchorage, Alaska 99508
(907) 227-1455 office
(907) 274-4992 fax
0
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
(a) Legal Description (include lot, block
_r ' 13Lr�
r S 7
Location (address or directions)
(b) Applicants Name
Application Date
vision, sec5ion, tox ship, range)
-//2,�; -
Telephone - Home Business
Applicants Address
(c) Applicant is (check one) Lending Institution ; Owner/ builder
Buyer ; Other (explain);
e
(d) Lending Institution .� Telephone
Address
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the HAA to the following address:
a
2. Type of Residence
Single -Family �?_`° Multi -Family Other (describe
Number of Bedrooms IS
3. Water Supply
Individual Well Community Public
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4.. Sewage Disposal
Onsited; Public Community r Holding Tank
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status,
[Page 1 of 21
5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information
As certified by my seal affixed hereto and as of the validation date shown below, I
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is 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 ocr-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm Telephone
Address ,:L 8RB INX ()F
Date
6. DHEP Approval
Approved for
Approved
(ENGINEER SEAL)
bedrooms
Disapproved
Terms of Conditional Approval
By
CAUTION
or t.) . •
NY.• .qjV• •
$*bort A. ,.�r•,r r�F�
��� •®` No. 1457•E •
A0 gyp
Conditional
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE: DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2] 7-19-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
L -S B 3 'gee s (fe
Legal Description:
A. WELL DATA
Well Classification 1 aeZ If A, B, C, D.E.C. Approved (Y/N)
Well Log Presen(Y/ ) Date Completed raw Yield
r "4 Depth of Grouting (� r�
Total Depth �� � Cased to p g
Static Water Level 30 Pump Set At
Casing Height Above Ground 440 Sanitary Seal on Casing Y/ )
Electrical Wiring in Conduit (Y N) 760' Depression Around Wellhead (Ya
Separation Distances from Well:
/ t
To Septic/Hukhqg Tank on Lot 10-7 ; On Adjoining Lots /00
To Nearest Edge of Absorption Field on Lot !2Z r ; On Adjoining Lots loa rt
To Nearest Public Sewer Line �`� To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot 24 F
Water Sample Collected by c�.'Zs�tic¢/`i� ; Date
Water Sample Test Results sof zt s.�itcr.�R Gam.
Comments
B. SEPTIC/HOEBM TANK DATA
Date Installed Size Z b No. of Compartments �—
Standpipe (Y/ ) Air -tight Caps (Y N) Foundation Cleanout (Y N)
Depression over Tank (Y�Q / Date Last Pumped n/ 4_1Pumping/Maintenance Contract on File (Y/N) 'AJ `At. ; for
Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/H+ofidirrg Tank:
!
To Water -Supply Well `0% ! To Building Foundation 3�
To Property Line /0 f' To Disposal Field 7
' r
To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage
Course NL9 n! 6
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata —17,5- � Type of System Design
Date Installed Z3,'T 13 `f Length of Field 3 S
Width of Field Depth of Field
Square Feet of Absorption Area
Depression over Field (Ye —
Results of Last Adequacy Test
Gravel Bed Thickness &
=�r_75^ Standpipes Present 6/N)
Date of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well lZ / To Property Line
i
To Building Foundation
Lot N)zr A -re ; On Adjoining Lots
C
A_J -e- &..,-J
To Existing or Abandoned System on
Zc r
To Water CService Line `° _P_ To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course A-, o A -r CL
To Driveway, Parking Area, or Vehicle Storage Area .5 r�
Comments
D. LIFT STATION
Date Installed
Dimensions
Size in Gallons Manhole/Access (Y/N)
N-- .-1 /t
"Pump On" Level at " imp Off" Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed S & S EMIneering _ Date 7 12-
.�
SGB 196x
Compan%agIe River, All &2 99577 _ MOA No. gam- — 3
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
.0f A�,
