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HomeMy WebLinkAboutMEADOW BROOK BLK 2 LT 1Meadow Brook Block 2 Lot 1 #050-191-40 Municipality of Anchorage Page of 2 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: Sbt/99 2I PID Number: l�o�Ji-�ln Name: Wastewater System: ❑ New 2 Upgrade Address: ABSORPTION FIELD Dee - Phone: >- No. of Bedrooms: ❑ Dee french ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION ]Depth Soil Rating: Total Depth from original grade: GPD/Sq. Ft. Lot: Block: Subdivision: to pipe bottom fro 'ginal grade: Gravel depth beneath pipe / Z iL9�GJ W Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel length: /4N 2v✓ 1 /2 Ft. WELL: El New ❑Upgrade Gravel width: mber of lines: Distance between line: /,/ /,1 Ft Classification (P ja, A,B,C): Total Depth: Cased To: Total absorption area: Pipe mat I: Ft. Ft. Driller: Date Drilled: Static Water Level: Installer: Date installed: Ft. Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. SEPARATION DISTANCES ASeptic ❑Holding ❑S.T.E.P. To Septic Absorption Lift Holding ublic/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Linea 4 Nth/ 7-/j1✓-,/ /v o0 Material: Number of Compartments: Well Surface ��o� LIFT STATION Water Lot Size in gallons: Manufacturer: Line Foundation / / _ "Pump on" level at: "Pump off" leve High water alarm at: Curtain Pump M e & Model Electric spections performed by: Drain BENCH MARK Remarks: ,y Location and Description: A><�r TA•'�lf G/e....,.„tr g/��F� Tom a� .P�:a� C�cc � /.✓ria/ i.ar fL , zJd Assumed Elevation: %r+✓i> rte./felov ENGINEER'S SEAL � �p to 1�'�t.•.w.a0406. .h• •�`11�-�i�g �r ter. Inspections performed by: Dates:lst 5-�/-9s vvp.. .11R ...�.I.�� ".."44200 . 2nd �.::.. f.... i Louls A. Butera Department of Health and Human Services approval CE-6736 'm Reviewed and approved by: Date: ��► 72-013 (Rev. 9/91) MOA 25 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW990099 Legal Description: MEADOW BROOK BLK 2 LT 1 Design Engineer: 0024 Eagle River Engineering Services Owner Name: Scott Jannette Owner Address: 18339 KANTISHNA DR EAGLE RIVER , AK 99577-8233 Date Issued: May 18, 1999 Expiration Date: May 17, 2000 Parcel ID: 050-191-40 Site Address: 018339 KANTISHNA DR Lot Size: 12873 SO. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field [✓] Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: Issued By: i��y �16a� Date: 5—/a,- 1 % Eagle Diver Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax May 10, 1999 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lot 1, Block 2, Meadowbrook subdv Narrative & Permit Application Dear Mr. Cross: The proposed septic tank upgrade and septic system will have very limited impact on adjacent properties for the following reasons: The surrounding lots are have public water connections, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity of the soil in this area. 4. Drainage will not be affected and is not a major consideration in our design. This is a septic tank replacement in the same area as the old tank, no special considerations. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \1 997\99 -015 -NAR NO WELLS PUBLIC WATER LOT 8 / �I o i 0 of L\T7 I; LOT0� EXISTING r - -i I J LLJ SEEPAGE I I I a l PITL- uw I 130 I EXISTING wU SEPTIC m v TANK -REMOVE & I w N o I z REPLACE I N 10 zEn w X la Iw¢ I o NO WELLS o FRAM I w PUBLIC WATER I DWELLING Yip c- 1� I -d> 1(p I N J H 1- OJ GARAGE LOT 2 1 1 IN —t 0' UTIL. ESMT� 1 s - R = 370' L = 66.91 NO SURFACE WATER NO KNOWN CURTAIN DRAINS KANTIS,NNA DR. SEPTIC TANK UPGRADE PLAN LEGAL: LOT 1, BLOCK 2, MEADOWBROOK OWNER: SCOTT JANNETTE CONTRACTOR: CHARLIE BARR — JOB# 99-015 DATE: 05/10/99 SCALE 1 " = 30' EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-329 NO WELLS AFFECTED +100' ® - TEST HOLE • - MONITOR TUBE o - SEWER CLEANOUT - WELL - - - - - EASEMENT - PROPOSED LEACHFIELD - EXISTING LEACHFIELD �000OF 000pq�0 . . 4 9 TH ........................ �^ LOUIS A. BUTERA s� CE -6736 ,� I"�a goo Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax SPECIFICATIONS FOR SEPTIC TANK REPLACEMENT LEGAL: Lot 1, Block 2, Meadowbrook Subdv. 5/10/99 A. GENERAL 1. The site plan drawing shall be a part of this specification. 2. All materials and workmanship shall meet the requirements of Anchorage Department of Health and Environmental Protection Permit. B. THE SEPTIC TANK Septic tank construction shall be a 1000 gallon steel two compartment tank approved by the Municipality of Anchorage. 2. Septic tank is to be installed level on compacted base material. 3. All connections are to be made with caulder couplings. 4. The existing tank is to be pumped, removed and disposed of properly. 5. New tank to be provided with 2 cleanouts after tank. \1997\99-015-spc G ATTR ANCHORAGE AREA MmFOUGH Department of Environmental Quality 3500 Tudor Road Anchorage, Alaska 99507 -- -- INSPECTION REPORT ON-SITE SYVEM NAM EzsnC.-/�I�¢��.�ath(ILING ADDRESS/= ZY.�K 1__lrv{sY'TIJE- LOCATION W&2� 4�� LEGAL DESCRIPTION--Zl�'l �., Com- ZV- - -- SEPTIC TANK: DI ST AN CEC7ld✓»1714-'������ NUMBER OF FROM WELL /U6' MAIFACTURERtL_ MATERIAL COMPARTMENTS__.?_ INSIDE LENGTH SEEPAGE PIT: NUMBER OF PITS --Z— INSIDE WIDTH _—..—LIQUID DEPTH __LIQUID CAPACITY---/ GALLONS, DIAMETER - --OR WIDTHL�' LENGTHI�.," DEPTH _- LINING MATERIAL____- CRIB SIZE: DIAMETER&DEPTH DISTANCE FROM: WELL_lq/�� 4 TOTAL EFFECTIVE BUILDING FOUNDATION?,?_ , NEAREST LOT LINE_ . ABSORPTION AREA (WALL AREA)__SQ. FT. ADDITIONAL A13SORPl ION WELL: TYPE __CONSTRUCTION BUILDING NEARE-.ST_-_ FOUNDATIONO LINE_______ CISS1)cole OTFIER SOURCES_ APPROVED._______ DISAPPROVED DISTANCES: INSTALLED BY: t� ry' Y ✓`� PIPE MATERIAL: I.-OT SLOPE: SLOPE: REMARKS: Form PW -02G DEPTH _DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE_____.__, TANK SYSTEM. REMARKS DIAGRAM OF SYSTEM DATE �� '�--_ APPROV G.A�'A.B. 1�1' GE 84 L s • .� Municipality of Anchorage s On -Site Water and Wastewater Program ` _ A (907) 343-7904 s E�:�r� CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-191-40- 1. GENERAL INFORMATION Complete legal description Meadow Brook Blk 2 Lt 1 Expiration Date: Location (site address) 18339 Kantishna Eagle River AK 99577 Current Property owner(s) Jay Brewer Day phone Mailing address Real Estate Agent 18339 Kantishna Eagle River AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Com nriunity UGSS vv�n u community u Public Water System ® Public Sewer ❑ WaiverNariance request for: Distance: Received by: _ Date: t� COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 490.00 Date of Payment I a -it �J C Receipt Number �3a5 COSA # 05c_ 1 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 ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date T' 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 d —�F occupants or can ArcTerra guarantee that no unseen S.� L encroachments, deficiencies or discrepancies exist. AV / � � * 4TH �1; 6. DSD SIGNATURE^ ' " /P KENND. >f. / System #1 Approved for 3 bedrooms. ��1n 7tts ' TF' S � AV' System #2 Approved for bedrooms. ,leo ^ ;z. 1 PEH9tOtiP � Disapproved. Conditional approval for bedrooms, with the following stipulations: 0 The Original Certificate Date: icipity of horage 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 COSAbluesheei 7040-12,do 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: Meadow Brook Blk 2 Lt 1 Parcel ID: 050-191-40 A. WELL DATA -- NA -- Well type_ Date completed Total depth _ft. Date of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal (Y/N) _ Cased to _ft. FROM WELL LOG ft. WATER SAMPLE RESULTS: - NA --- Coliform —colonies/100 mL Nitrate _ mg/L Arsenic: _ ug/L Date of sample: B. SEPTICIHOLDING TANK DATA Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) _in. AT INSPECTION g.p.m. Collected by: ARCTERRA Tank Type/Material Steel Date installed 4972- 5 - Zr - 5� Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y . Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping 8/1/13 Pumper JR's Septic C. ABSORPTION FIELD DATA Date installed 1972 Soil rating (g.p.d./ft2 or ft2/bdrm) _ System type Seepage Pit Length 8 ft. Width 8 ft. Gravel below pipe 6 ft. Total depth ft. (Measured) Eff. absorption area 348 ft2 Monitoring tube Y Depression over field N Date of adequacy test 81112013 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 29 in. Water added 935 gal. New depth 47 in. Elapsed Time: 1440 min. Final fluid depth 38 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION---NA--- Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off level at _ in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: -- Public Water -- 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 5'+ Property line 54 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 54 Water main 10'+ Water service line 101+ Surface water 100'+ Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: -- Seepage Pit -- Property line 104 Building foundation 101+ Water main 10'+ Water Service line 104 Surface water 1004 Driveway, parking/vehicle storage 104 Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 1004 F. COMMENTS Leach field pre-soaked prior to testing 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 KENNETH M. DUFFUS Date 811212013 COSA brown sheet_10-10-12.doc in. i �AAW ofAL q TH A" �, 4 9 KENNE'Cl'�M. DUE p / 7116 / sslox .i Municipality of Anchorage +� Development Services Department Building Safety Division 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 FOR A SINGLE FAMILY DWELLING Parcel I.D. _050-1 q1 -40 HAA # 1. GENERAL INFORMATION Expiration Date: Complete legal description_ MEADOW 6ROOK RI O K ` ,SOT 1 Location (site address or directions) 18339 KANTISHNA DR EAGLE RIVER AK. 99s77 Current Property owner(s)—Jannette Srntt Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System I Dayphone 694-3526 Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer El The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registeredin 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. (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 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 KND FNGINEFRING Inc Phone (407) 696-6111 Address 20441 Ptarmig2n Blvd., Eagle River, AK 77 Engineer's Printed Name Kenneth M Duffus 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 in land 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, KND can not give any estimate of how long a system will function satisfactory for current or future occupants or can KND guarantee that no unseen encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE it Approved for bedrooms. Disapproved. Conditional approval for \rYtOFo��' a : • • ON-SITE WATERAND - ; WASTEWATER r PROGRAM : Jiv?PkENT bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: h!! tel/• ��( Original Certificate Date: - Mm ►pment Services Department ti Building Safety Di4i616n -Site Water & Wastewater Program �F. x nc�iorage AK '99519 F;��"0 �.cr anc horage ak.us of ITNC112T'T'� ADDr_rn\Yn1 `!'`ucn�trrrrr.��� Date pfsample: ' — Collscted;by: AM N ,dam i ASBUILT SEWARD &ASSOCIATES LAND SURVEYING 694-0829 I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE SCALE: FOLLOWING; DESCRIBED PROPERTY -ZD �OF AC" % fr?n v! �oo� s� GaT/z DATE: ...... AND THAT NO ENCROACHME4- S EXIST EXCEPT AS �'� . ' 5�0� a� oy INDICATED. 1T 1S THE RESPONSIBILITY "OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID- EASEMENTS, RIDEASEMENTS, COVENANTS, OR RESTRICTIONS yw sa i WHICH DO NOT APPEAR ON THE RECORDED SUBDI- •"' Duane Merk Seward Ar VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' , �1�'•. LS -6918 4 ANY DATA HEREON BE USED FOR CONSTRUCTION os -ice A�,� yr OF FENCE LINES, OR FOR' ESTABLISHING BOUND- A � teaor :1RY LINES. DRAWN R�TLskx4� ' MUNICIPALITY OF ANCHORAGF r'ag.Le River Area DEPARTM OF HEALTH AND ENVIRONMEP L PROTECTION Street, AnchoracrP, Alas. -,a 99501 � � 4, � //� 6 4720 ' ( Date Received: December 28, 1977 #1: Time . _ #2: Time L/ ( M /nn -j_ #3: Time Date - s Date-�-��/��� 11. Date Insp-- Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES C7 1. Lending Institution Request: United Bank Alaska 0/0 Mailing Address: 645 G Street 99501 _ Phone: 278-9526 2. Property Owner: Robert C. Hodel Mailing Address: Star Route Box 230A 99577 Phone: 272--5451/her wk 694--9647 3. Legal Description: Lot 1 Block 2 Meadow Brook Subdivision -3=K—an-tisTina Drive 4: Single Family Residence: (x) Multiple Family Residence: ( ) 5. Well System: Individual Well ( ) Number of Bedrooms: Three Number of Bedrooms: Community/Public System (x) Permit # Depth of Well _ Well Log on File ( ) Construction Bacterial Analysis — 6. Sewage Disposal System: On-site System (x) Permit # Septic Tank Size A ,,I-nsstalled %�D 1973 Public Utility ( ) Installer Manufacturer Absorption Area I Soils Rate 7. Distances Well to Septic Tank _ to Sewer Line to Nearest Lot Line Nearest Lot line Material to Absorption Area Absorption Area Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: T,nt 1 Block 2 Meadow Brook Subdivision. Comments: C� Affadavit Attached: ( ) Approved: Disapproved: Department Worksheet: Letter Attached: ( ) Date: Date: MUNICIPALITY OF ANCHORAGL Department of IIea..]and Pnvironmental Protection © .r`r. 825 L Street, Anchorage, Alaska 99'5 f� 264-4720 �0-]b .:_. —equest for Approval of Individual Sewer and Water Facilit_i_es 1 . Property Owner : �5�L:--=�`� �� �' _-- Mailing Address: �l�Xc-__Phone: 2. Name of Buyer: / %�L�� rI------ --- ----- Mailing Address: �� /�G r <�o i�G_. Phone: 3. Lending Institution: Mailing Address: 4. Realtor/Agent: Mailing Address: Phone: hone: Phone: Phone: 5. 5. Legal Description: ��� � ��✓� __��--1�!C %LL� �iG)�--- Street Location :--- 6. Single Family Residence: ( Number of Bedrooms: _ 3 Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply: *Individual- Well ( ) public/Communi-ty System If Individual Well, well depth —_ If community System, name of.. s stem �( a"c_ ����� L)71��1/G S Y Y Y — ------ -- 8. Sewage Disposal. System: *,On-site System (� Public System ( ) if On-site System, date of: installation: L 1-7a__—_ *NOTE": A well log is required on ALL wells drilled since 6/75. ** If on'-s.t1:e SCWe]" SyStC'.nl l5over --wo(2) years of -d, ,n adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initial—ed. 3/77