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HomeMy WebLinkAboutLAKE HILL ACRES #5 TR B1Lake Hill Acres #5 Tract B1 #051-122-74 DEAMUNICIPALITY OF ANCHORAGE TMENT OF HEALTH AND HUMAN SERWWZS Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON—SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT L 2 DISTANCES a TO SEPTIC ABSORPTION WELL 2 qf67 FROM TANK FIELD s) Permit No. No. Df Bedrooms WELL Iwo sb z 6 el 4 LEGAL DESCRIPTION LOT LINE Black Subdivision & LV rL� 11r F FOUNDATION lip, Range, Section - T�S� �, \ /A _ �' AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundaa W "`7[�L tlnveway. water bodies. etc) SEPTIC ❑ HOLDING II Manufacturer I Capacity in gallons A/LZ'1.1 1 Material No. of Compartmel Z TYPE OF SYSTEM ❑ TRENCH 00B BED ❑ W. DRAIN Depth to pipe bottom from Total depth from or original grade 0 OTHER nal grade Z FT PIPe length - LK), O FT Gravel width absorption area Distance between lines t-� C) SOFT erg Ines Soil rating Pipe material iii If S 6 SO FT Plr� T7 7 It- U "44v ��, I LIP- It —ab WELLS PRIVATE ❑ OTHER (Identifv) Classification (A,B,Cf Total Depth Cased to I, I _ \ /f FT FT I REMARKS: 10 scale: I -s Ste' Inspections Pert r Ed by. �0 Date.Lp� 1c-86 - Jr US 'I%blL 'P'�Itil.-,' Lo'1Li'-13b � .'.w:. °. • ..°. MX ' cenily that this inspection was performed according In all ° `book«', A. Shafer JLIN 16IQRF �•, W. 1457.6 i4 Municipal aiGII9*WE9gjCIA9ll "577 / Health Department Approval: Data: ` Z — 7_4 _84 rz-UlB tsiab) ' MtJfq I AR I -IF -V' C) F= ^ DEPARTMEN��OF HEALTH AND ENVIRONMENT#C3 V-� fic% C3 F= PROTECTION 825 L STREET, ANCHORAGE, AK 99501 , 264~4720 ^ C3 P4 ---!E3 I "IF EL E3 E-7 W FE FR , F=� FE F;� M I -F PERMIT NO: 860150 UPGRADE DATE ISSUED: 05/30/86 APPLICANT: S. FORK CONSTRUCTION C/O S&S ENGINEERING ADDRESS: SRB 196X EAGLE RIVER, AK 99577 CONTACT PHONE: 694-2979 LEGAL. � �: ,�W�1Y1b%QN: LAKE MILL ACRES #5 LOT: TR B BLQCKx NA SECTION: 2 TOWNSHIP: 15N RANGE: 1N LOT SIZE: 24800 (SQ"FT" OR ACRES) I certify that: 1. } am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska" 2^ I will instal] the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3" I will adhere to all MOA 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. IFA LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN" SIGNED DATEi , --���---�---------�-----~~~ ^&~ APPLICANT: S. FORK CONSTRUCTION C/O S&S ENGINEERING ISSUED BY ��' ~ DATE: ....... ____~^____-_,`~ � . S & S ENGINEERING SR B 196X EAGLE RIVER, AK 99577 SUOECT: T2Ac 7 4bMPUTATION SHEET L'4Azr N1LG s�cPE s 0 .. MAY 2 4 1986 OF • • ;�. 3 1�_ ._.- .fir 11..4 ✓(c. .3. �i 2, 4.,pvG ua-F- I( �r� WE ALL 0 ! b 6 p c P-�I 1,��E+_ fJAICE/O�AGF ZA/Ulf F<l g. 5FP7-1 7WAlwe 1 L I FT Sr A-5 vctq 13Y N04. SCALE / nc 5pE. i `amu -SLE —_ 4 � T A T 9 y� q N (� 9 �GIN f, O T S9 N PERFORMED LEGAL DESC 1 U 2 � 3- 4 4 5 .� 6- 7 7 u 8 C 9 10 11 12 13- 14- 15- 16- 17- ' 8 31415161718 19 20 COMMENTS • Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST 1i/g z $4- 2 - "meq 0. Township, Ranl 10 DATI Section: WAS GROUND WATER I ENCOUNTERED? N V S IF YES, AT WHAT L DEPTH? e� O P E Depth to Weller After MonilorinD7 Date: VA Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE(minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN —CFT-AND FT PERFORMED BY: -6R-R 1196XCERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH EAGLE PA*R1ML�VELIN Jrl EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) I 0 PERI LEG, e i F E 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: ACCORDANCE WPAOUTIIN / 72-008 (Rev. 4/85) C YCK i TEST RUN BETWEENSAND -�FT CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: --MAY 10 l9ffi GRE4fR ANCHORAGE AREA BOR#"GH �l Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME Richard Digel MAILING ADORESSBOX 1227 CHuaiak AK PHONE_ 688-2733 LOCATION Mirror Lake LEGAL DESCRIPTION Tract B. Lake Hill Acres SEPTIC TANK: DISTANCE NUMBER OF FROM WELL - MANUFACTURER Stack Steel MATERIAL Steel COMPARTMENTS-2— INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY 1000 GALLONS. SEEPAGE PIT: NUMBER OF PITS 1 DIAMETER 12roR WIDTH 151, LENGTH 50' DEPTH LINING MATERIAL COncreteCRIB SIZE: DIAMETER —!!!DEPTH 3r DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) 360 - SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE Drilled - CONSTRUCTION BUILDING GI NEAREST FOUNDATION �+' LOT LINE CESSPOOL—,OTHER SOURCES APPROVED DISAPPROVED DISTANCES: Standard DEPTH 200' DISTANCE FROM: NEAREST- SEPTIC p i SEEPAGE SEWER LINE - TANK I I SYSTEM �✓I�. a INSTALLED BY: T Zed PIPE MATERIAL: LOT SLOPE: C - LL REMARKS: L�UiP �7 D["CSPrsCP °i TXRhICK. DATE Form No. EQ -031 DIAGRAM OF SYSTEM G.A.A.B. GREA ER ANCHORAGE AREA BOUGH � g DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 4 9330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274.4561 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT \�� ' 0 +�t�EL MAILING ADDRESS?"- '7 KC��p IC PHONE 09-2,7r3 INSTALLATION LEGAL DESCRIPTION AKF INSTALLATION OF: SEPTIC TANK Lll� SEEPAGE PIT TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED TO BE INSTALLED BY DRAIN FIELD I_�_ ,OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL SE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE teM TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK 7 / f FOUNDATION TO SEEPAGE PIT zo DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL /15- f I SEPTIC TANK , SEEPAGE PIT © DRAIN FIELD TO NEAREST LOT LINE. SEEPAGE AREA SIZE WELL TO SEPTIC TANK / VD ` SEEPAGE PIT /00 DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD N SEPTIC TANK, 70©' SEEPAGE PIT /0 DRAIN FIELD TO RIVER, LAKE. STREAM. :CAST IRON INTO ANO OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO REGARDING INSTALLATION. G.A.A.S. OR LICENSED DESIGNER 1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF DESCRIBED YST MIS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE FORM TYPE DIAGRAM OF SYSTEM AREA BOROUGH /ORDINANCE NO. 28.66 AND THAT THE ABOVE I _ / ! I /% !a= Municipality of Anchorage • Development Services Department Building Safety Division ��-.`�• �z On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. COSA Expiration Date: q —(97 1. GENERAL INFORMATION Complete legal description Tract B1; Lake Hill Acres #5 Location (site address) 22457 Hilltop Cir. Chugiak, AK 99567 Current Property owner(s) JennlferStacy Day phone 688-2733 Mailing address 1900 E. 3rd Ave. Anchorage, AK 99501 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well✓❑ Individual On-site ❑✓ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ 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 On -Site 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 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 S & S Engineering Phone 694-2979 Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567 Engineer's Printed Name 1C 0 3 i,Qr Co ,� 4N Date c., r' s ROBERT C. COWAN F < 5. DSD SIGNATURE ��t`� `_, CE -8801 Approved for bedrooms. 'i= .. 41, a1 Disapproved. `+ Conditional approval for bedrooms, with the following stipulations: Attachments COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By. Z aZ, L� Original Certificate Date: (Rev. 11 N5) Municipality of Anchorage • '� Development Services Department e - Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: TIZW,7 41LI, &Z&S*S Parcel ID: iJJ 1 2 711 A. WELL DATA Well type l/ E ' j If A, B, or C provide PWSID # = Date completed Vq/7q Sanitary seal ®N) 465 r , Total depth ft. Cased to 7ft. (VT6 $Eb CC _ FROM WELL LOG Date of test ' 7 s Static water level (9 ft. p Well production 9,6 g.p.m. WATER SAMPLE RESULTS: Coliform Q colonies/100 mL Nitrate '"1J Ij " mg/L Arsenic: s•j Lk Date of sample: 3k9 0 B. SEPTIC/HOLDING TANK DATA Tank TypelMaterial ST E ,?. S Tank size 060 gal. Number of Compartments IQ Well Logo) *'' Wires properly protected(!1) Casing height (above ground)--.S—;k. Ff, AT INSPECTION fr weli— 3 'zl O r7 r a 10 9.p -m. Other bacteria O colonies/100 mL Collected by: 59-S ��ylol�t Ec�i��(7Ca Date installed 611018(, CleanouNsm �E3 Foundation cleanout (YM)1AJC Depression over tank (Y(9 Its High water alarm 1&) A ai<,rnE Date of pumping i' 09L_ Pumper T�.S �urt7t>rn�Pv C. ABSORPTION FIELD DATA Date installed iq Soil rating (g.p.d./fer ft //bdrm Q System type M0uA;L;Cb FEB Length ya p ft. Width D ft. Gravel below pipe e)'6' ft. r Total depth q•5 ft. Eff. absorption area gf0ft2 onitoring tube � Depression over field Date of adequacy test 3 /S Result(Pass/ ail)) For ;Z bedrooms Fluid depth in absorption field before test _ in. Water added 505gal. New depth © in. Elapsed Time: — min. Final fluid depth 0 in. Any rejuvenation treatment (past 12 mo.) (Yo type) _ Absorption rate >= 30p'f g.p.d. 0 If yes, give date — D. LIFT STATION Date installed 6 t 0 Size in gallons l ZS6 f! "Pump on" level at AA in. I "Pump off' level at in. Datum _ZkTi-L 3i _ _ ` Cycles tested 5 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /00 f Absorption field on lot too Public sewer main A-) %i Sewer /septic service line �2S l-�- r Animal containment areas �Z -I- Manhole/Acces (Y l �� �'/� fr High water alarm level at. in. Meets alarm & circuit requirements? ifs On adjacent lots 'I'M -� On adjacent lots %,qo Public sewer manhole/cleanout u hj Holding tank oA r Manure/animal excrete storage areas /0 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S Property line '4- Absorption field 5 :4 I / Water main Water service line /0 % Surface water 160 y Wells on adjacent lots IM -/ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: ,� Building founatoIDr Property line Water main rU A r r r Water Service line Surface water yrs t Driveway, parking/vehicle storage /0 f Curtain drain /JOVE Kxxr1'N Wells on adjacent lots LOO F. COMMENTS Yr T 40Ui, �E I SAf'E l G. ENGINEER'S CER t certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSOOA guidelines in effect on this date. Engineer's Printed Name I ii B ",T C - ( 0 ug.y Date i 6 6 /a7 COSA Fee Date of Payment 3/9- /k ? `E. 6"iff, ro2 1T wovt b 7irfy' L/ 3 f 5 aC)PCZLy Waiver Fee $ Date of Payment Receipt Number /3 Receipt Number (Rev. 11/05) ;I ? ROBERT C. COWANCE - 8801 r c r 4 APR -04-2007 12:59 S&S ENGINEERING 937 G94 1211 P.02/02 LOG OF DRILLING by A & L DRILLING COMPANY OWNER OF LAND i ADDRESS......... ................ WELL arrE ........ ........... "r .................. ........ ..... .. DATE—STARTED _ . ...... 2.1_a.5f. .?A ...j .............................................. 2AM-ENDED CINI) OF FORMATI DEPTH Or WELL .. ....... STATIC LEVEL OF WATER FT, ... . .. ... DRAW DOWN FT . ...... _1_6 () ........................... GALL PER km XXXT) or CASING ...... . .................... ..... LRom------ �J............ m ........ _.". TO ........................ FT ............ lRobt-A TO 6............... .... ........... FT. ..... raom .............. ....... :FT. TO .. . ....... ............ FT ...... .. 'ROM.... ....FT. To...L. ....... so, IRON, ........ I ..............FT. TO.................... M MOM.-L-31.- ..... FT. TO. 1.. ...... FT.. t - Ii FIIOM............... ....... FT. TO ....... ................ PT ......................... ..... RON ... I-Ji...........FT. TO.-JIS ....... FT_ 't"Alt IV' FROM .......... ............. P IVI. FT. TO................................................_...... ROM....................._FT. TO ....... --....FT.............................. c FROM..................... -..FT. TO. ....... . ........... FT.- .... . ........... I ........ ROKJJ.� ......... ". TO_- a 0..._ ........... -f FT_& �&SlFROM..._.................. FT. ......... ROK................. ..... ". TO.. -.-...................FT............................... FROM. .. ............... .... FT. TO . ................... ,ISCL IXrORMATI*Xx 9 " To r 4 k c Al , ,v s I DRILLEW8 NAME ,« _1- --_._..l_- ... ........... . TOTAL P.02 f ASBUILT raz I HEREBY CERTIFY .THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY, AND THAT NO ENCROACHMENTS EXIii EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR OFFENCE LINES, OR FOR ESTABLISHING CONSTRUCTION LINES. SCALE, . -otec, OF At any GRID: y 4 F. ...... �s--�.���•cgs' :DRAWNt I , o�••• M•rk 9.w• Q p etr,