HomeMy WebLinkAboutLAMPERT ESTATES BLK 2 LT 11Lampert
Estates
Block 2
Lot 11
#051-791-12
MUNICIPALITY OF ANCHORAGE
C :- \
II ,-,-'t-(-.11
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
Torn yYlC. C a2n'1 1 c_K
PHONE
la 06-3DB
1 NEIN
EUPGRADE
MAILING ADDRESS
13oX la-(0-7 c.,141A C>IP-K
LEGAL DESCRIPTION i I A_
'-Aril PRT Es-rff s-7-..Are 510
LOCATION
PCS c teK
NO. OF BEDROOMS
:3
I I
SEPTIC
L TANK
DISTANCE TO:
Well
N A
Absorption area
- /'!•
.
Dwelling 1.±
I.'�#•
PERMIT NO.
E.th.c._-79
Manufacturer
GMER
Material
5TE EI_
No. of compartments
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
coo Q
�—
O z Z
DISTANCE TO:
Well
.
Dwelling
PERMIT NO.
T _ H
Manufacturer
!
Material
Liquid capacity in gallons
TILE
DitAtTtlFdit9
TRENCH
DISTANCE TO:
Well i4
/
i`/
Foundation 3 1 i t.
J
Nearest lot line /
PERMIT NO.
d t 7 S
No. of lines/
- Length of ea h lin
6 fi"
Total length of lines)
SO t
Trench width
3 0 inches
Distance between lines /^
'I
Top of tile to finish grade
3 � + (.v1 LL ./•1-b (:
Material beneath tile 1��
3V inches
Depth
Total effective absoy on area
3D "' '1'
PERMIT NO.
SEEPAGE
PIT
Length
Width
Type of crib
Crib diameter
ar depth
Total effective absorption area
DISTANCE TO:
Well
13 i di
ig foundation
Nearest lot line
Class
Depth
I i'I
Driller
•
Distance to lot line
PERMIT NO.
w
li
DISTANCE TO:
Building fou t 1
ew• line
Septic tank
Absorption weals)
OTHER
-
PIPE MATERIALS
N
pv0.
SOIL TEST RATING /
/00 "/i
INSTALLER
en ;CV• ENC.,,
REMARKS
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APP '"� !1 � DATE LEGAL g it t qr.�, P
✓�i J ��,?.11 1 M iv °1LA81'P2 tJ I L�♦f�
•
72-01/3 (Rev. 3/78)
1.1-H;������� `����^�� ��� ���;�� ���;1:11.11JE
DEPHRTMENT HEHLTH EHYIROHMENT9L .R(.1.1TEC7ION
325 'L' STREE7' HNCHORHGE, HK. 99381
"~���
PERMIT NO. ( 820278 )
APPLICANT TOM MCCORMICK BOX 1267 CHUG{RK
LOCHTIOH PETERS CREEK
LEGAL.LmMFLkT ESTHTES S/D
LA \\ &mx2 - p'En �(Th.l&.
TYPOF SOIL 9BSORPTION SYSTEM IS: TRENCH
MRXIMUM OF ]
19S]] SQUPRE FEET
SOIL RATING (SO FT/BR)`130
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM I�
THE LENGTH DIMENSION I5 |HE LFNGTH (IN FEET) UF THE TRENCH OR DAA IHF[ELD.
THE DEPTH OF H TRENCH OR PIT IS THE DlSTHNCE BETWE�N THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FLET)
TH�RE IS
NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL THE OUTFALL A 111
AND !HE BOTTOM OF THE �XCHYHTION (IN FEET)
PFRMIT HPPLICAN | HAS THF RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING |HE
• INSTHLLHTION INSPECTIOHS OF ANY WELLS H0JHCENT TO THIS PROPERTY AND THE
• HUMBER OF RES1DENCES THAT THE NELL WIL|, SERVE
..............................................................:::T1:::..:IL) -----
BACKFILLING OF ANY SYSTEM WITHOUT FINAL IHSqHCTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN H NELL AND ANY DN -SITE SEWAGE DISPOSHL SYSTEM IS
1G8 FELT FOR H PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC NELL �EPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM H PRIYHTE WF|L TO A PRIVHTE SEWER LIHE IS 25 FEET AND
TO H COMMUNITY SEWER LINE IS 75 FEEL
• OTHER REQUIREMENTS MAY CHTIONS AND CONSTRUCT IAN DIAGRAMS APE
HYHILHB!s TO INSURE PROPER INSTHLL8TION.
CERTIFY THAT
1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPH1 ITY O[- HNCHORHGL
2T I WILL INSTALL THE SYSTEM IN HCCORDHNAE NITH THE CODES
• I UNDERSTAND THAT THE ON -ITA SENER SYSTEM HAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THHN I BEDROOMS.
_
IGNED�.
APPLICANT TOM MCCORMICK
0 & E ENL-.,NEERING & DEVELC _ 'MENT CO.
Fussell Oyster
694-2774
Performed for: Name:
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
SOIL LOG
Mailing Address:
Legal Description: Z--&9 %� ///
`
Depth (feet) Soil Characteristics
0
2 /
--. 3
4 _ C,,„--1A.°V f247---el-
5
Ji” /-
.11✓f?,4
Earl Flit.
688-.2266
i
6 i 6. � -�� r /
7
8 3!4)7.
9
Gc1 i —*t
10
11
12
13
14
15 ._
16
A-40
IU'
L "-11
Ground Water Encountered: Yes
Proposed Installation: Seep ge Pit
Comments: irrr—
No
If yes, what depth
Drain Field__
•r— %i 4/ ..
Performed by:
PLOT PLAN
PERC. TEST
t`7 q•
• r
91406o,re
AL_
,Y9e9.,
i
g u��d'.nr�Q=r�e✓<J
b:Ft
Yea rGr o ussu.i L. Oy:der .° t(i4;
Un,a, No. 4286-E \ r0
°a °
SS L% k r gR
/ A%L. e�.' b'('.'^"7••iy./1:-
/17/!
Date: 444 %/
•
Municipality of Anchorage 0*'
On-Site Water and Wastewater Program
(907) 343-7904 s. ;<T.
Certificate of On-Site Systems Approval
Parcel I.D. 051-791 -12 Expiration Date: 3—2C, —( l
1. GENERAL INFORMATION
Completgjggal description Lot 11 , Block 2, Lampert Estates
'" o22544 Lampert Circle, Chugiak, Alaska 99567
04.e.relio
10,
yrr •,,�� fperty d ) Federal Home Loan Day phone
w°' 4: e i ,`. Mortgage Corporation
,�sa:eaYA�NGi#i�►�l��iceS��.�� `�k
BY:t1M 7�i�,t< �� �� pry:.l
;,R g1�47. 'e�M.g :;, ;3 Katie Likkel/Keller Withal* phone (907) 313-7929
YPE•OF DWELLING: •
p Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ❑ Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class A Well Q Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
5 (C
Received by: f Date:
COSA to be release the engineer,unless otherwise requested by the engineer.
COSA Fee $ 52- aIV Waiver Fee $
Date of Payment 3(2'l?O Date of Payment
Receipt Number Ch C'K ' act'73 Receipt Number
COSA# 0�CI5?I113 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 Pinard Engineering Phone (907) 232-1347
Address PO Box 871347, Wasilla, Alaska 99687
Engineer's Printed Name Paul E. Pinard Date 3/21 / i ,
, WAY.*:49m i
6. DSD SIGNATURE 71.r.:.,_-”,..-.7-:- •
ySystem#1 Approved for bedrooms • ` fs'�•srM•�•••••••:'��
i`E. Pinard ;�f
System#2 Approved for bedrooms 11151;-3.;•7••CE-4793 •i OZ��
• Disapproved mil •••••••••`���r
illl.,,,°ROFESS10%••••
Conditional approval for bedrooms, with the following stipulatiot !W1xe'k. •
�� ?;�1I'Y OF:
J* 7 .
DN-SI 1 t=
WATER AND rri
m WASTEWATER z
PROc;RAM �
�c'l'r.Qrzt)\n('F .6
By: N--- .Th Original Certificate Date: S----3 I
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 blue sheet r : c
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: Lot11 , Block 2, Lampert Estates Parcel ID: 051-791-12
A. WELL DATA
Well type Public (A) If A, B, or C provide PWSID# 210697 Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height(above ground) in.
FROM WELL LOG AT INSPECTION
Date of test.
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA See l t 'tel
Tank Type/Material Septic/Steel Date installed *W4140 ��
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Depression over tank(Y/N) N High water alarm (Y/N) N
2
Date of pumping 3/'Hifi Pumper JRs Pumping
C. ABSORPTION FIELD DATA
g Trench
Date installed July 1982 Soil rating (cam. . fir ft2/bdrm) 100 System type
Length 50 Width 3 ft. Gravel below pipe 3 ft.
Total de t11,,i I' 1 orption area 300 ft2 Monitoring tube Y Depression over field N
••
Date q1j degua• . ' 3 w. Results (Pass/Fail) Pass For 3 -bedrooms
Fluid el3th" - • •+• - , •-* test 0 in. Water added 480 gal. New depth 0 in.
Elapsed Time:_er 8 Mist... .Fti,al fluid depth 0 in. Absorption rate >= 450+ g.p.d.
Any rejuvenationnt 0`,dsti1 mo.) (Y/N &type) No If yes, give date
;'Z'3309�° af0 f
D. LIFT STATION NA
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO: NA
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 + Property line 101+ Absorption field 5 +
Water main 1 0'+ Water service linel 0'+ Surface water 100'+
Wells on adjacent lots 200'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 50'+
Curtain drain None Known Wells on adjacent lots 200' +
F. COMMENTS
Home had been vacant so the septic system was pre-soaked with 2000
gallons of water immediately preceeding the adequacy test.
G. ENGINEER'S CERTIFICATION
I certify that / have determined through field inspections and
review of Municipal records that the above systems are in t Y
conformance with MOA COSA guidelines in effect on this date. f' " '.ate
Engineer's Printed Name Paul E. Pinard *AIM •••:
_7190
Date 3/21 /18 4..•• •••••21.=:!•_,N { 4
COSA yellow sheet_2-6-15.doc
MUNICIPALITY OF ANCHORAGE
r 1 I
Community Development Department
' 11111— ►/ Phone: 907-343-7904
Development Services Division '�-- Fax: 907-343-7997
On-Site Water& Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051 -791 -12
Property owner(s) Federal Home Loan Mortgage Corp.
p y c/o Katie r.i kkcl KPI 1 er wi 1 1 i amsDay phone (907) 313-7929
Mailing address 101 W. Benson Blvd. ,Suite 101 Anchorage, AK 99503
Site address 22544 Lampert Circle Chugiak, AK 99567
Legal description (Sub'd., Block & Lot) Lampert Subdivision, Bk 2, Lot 11
Legal description (Township, Range & Section)
Lot Size 1 9, 833 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑ Initial ❑ Single Family (SF)
(w/wo ADU)
Septic Tank IXi Upgrade [
Holding Tank I 1 Renewal Duplex (D) ❑
u Multiple Dwellings ❑
Privy n (SF and/or D)
Private Well
Water Storage n
THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: � � Waiver Fees:
Date of Payment: 57—S0 —/ Date of Payment:
Receipt Number: Receipt Number:
Permit No. Waiver No.
Permit App_:-: :._.,c
Municipality of Anchorage
On-Site Water and Wastewater Program • (907)343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: PID Number: 051-791-12
Dwelling: ® Single Family(SF) ❑ Duplex(D) ❑ Multiple(SF and/or D) Project: ❑ New ® Upgrade
Name:
ederal Home Loan Mortgage Corp. ABSORPTION FIELD
0/0 Katie Likkel/Keller Williams
AddressTrench ❑ Bed / Mound
01 W. Benson Blvd, Suite 1 01 ❑ Deep ❑ Shallow Trench
Anchorage, Alaska 99503 ❑Other
Phone Number of Bedrooms Soil Rating Total depth fr• original grade
(907) 313-7929 3 GPD/SF Ft.
LEGAL DESCRIPTION Depth to pipe invert from original g •:.. Gravel depth beneath pipe
Subdivision Block Lot Ft. Ft.
Fill added above original g .' Gravel length
Township Range Section Ft. Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES Ft. Ft.
To
Septic Absorption Holding Sewer Total a• orption area Number of trenches Dist.between trenches
Tank Field Lift Station Tank Line
From Ft2 Ft.
Well 200'+ - - - - TANK fid Septic ❑S.T.E.P. ❑Holding 0 Other
Manufacturer Capacity
Surface Water 100'+ – – – – Unknown 1000 Gal.
Material Number of compartments
Lot Line 10'+ – _ _ NA Steel 2
Foundation 10'+ – – – LIFT STATION
Manufacturer Capacity
Curtain Drain None _ – – Gal.
Known .
Remarks Pump on level at Pump off leve . High water alarm at
See attached letter for
additional details regarding N.•- in. in.
the installation of th 1 c Pump make a odel Electrical Inspections performed by
septic tank,
PIPE MATERIAL House to tank Tank to
Installer drainfield
Unknown Drainfield CO/MT
Inspector Unknown BENCH MARK (Assumed elevation) ft
Inspection u Location and description
dates: 1 2nd
3rd 4th
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL � ip
.aye,OF x4;411
Conditional Approval: Date �. •44
- t
-�_ 1n/( r 00 wa'e e TH e ...kw
1 Om.(c poi- i - a I mChi'a\ A 49--
2.z91CQ ce[ I Pv' na,CC( c,✓' �/l..t _4— �� ee 00000011..a:70111100
/ 0' / leo same mise .
�,a Paul E. Pinard
.i % CE-4793 ;=evFe° ee
VApproved re (LU Vw�Cr � Date �� Js•e�eee � �
� ?0FESS10N .r
ibill
Inspection Report_9-1-12.doc 1(z4 ( is
re---- ---
SWING --
SWING TIE MEASUREMENTS
- - - A B _.
1 ) ST CO 27. 8' 23. 2'
2) ST CO 31 . 3' 27. 3' Note: Recent Inspection
measurements show
a depth of soil
cover of 6. 3 ' over
1!
the septic tank •
and a bottom depth
of 1 1 . 0 ' .
Garage
Residence
B A
In-- Newer Septic Tank ,�ti.....
Vi.......�1��—....
(Installed in or about 201 6) �A:,"i Til�� eL
�
'; PAUL E.PINARD ...m
im°�••. CE-4793 ,'o•
PROFESS�‘14444 �''��``�
Lot 11, Bk 2, Lampert Est
Wastewater Disposal System
Record Drawing
PLAN VIEW PINARD ENGINEERING
Scale' 1" = 30' P.O. Box 871347 Wasilla, AK 99687
(907) 357- ENGR (3647)
Project:18-007 Date: 4/24/18
PINARD ENGINEERING
i/la1
° A` Paul E. Pinard , J
Registered Engineer/AK& ID
P.O. Box 871347,Wasilla,Ak 99687
(907) 357-ENGR(3647)
Tim Ecklund April 24, 2018
On-Site Water&Wastewater
Municipality of Anchorage
4700 S. Bragaw Street
Anchorage, Alaska 99519
RE: Lot 11,Block 2,Lampert Subdivision;New Septic Tank Installation&COSA
Dear Mr. Ecklund:
Reference is made to your review comments of March 30,2018,regarding the COSA
application that I had submitted for Lot 11, Block 2,Lampert Subdivision. The following is
provided in response to your comments:
1) The separation between the septic tank and the foundation is in excess of the new code
requirement of 10'. The measured distance is 15'.
2) The septic tank was holding water when we conducted the Adequacy test and 3 weeks
later when it was pumped,the pumping receipt showed that was still full. Based on our
discussion of this subject,I advised you that during the time that we were conducting the
test,a neighborhood resident,walking his dog,stopped to see what we were doing.
During our conversation with him,he stated that he had seen a new septic tank being
installed here not too long ago.
Based on that information,you requested that I submit a permit application and an
Inspection Report with as much information as I could provide on this newer tank. The
permit application and my inspection report are attached. While we were unable to
locate the original neighbor,we did interview the resident next door, who confirmed that
he witnessed a new steel,septic tank that was being installed on this property about 2
years ago. His name is Craig McCracken,at 22534 Lampert Circle and phone number
(907) 696-6971.
3) In response to your comment on the need to presoak the drainfield prior to our testing.
We did presoak it,as was stated in the comment section on the COSA Checklist.
I hope that this adequately addresses your review comments. If you have any questions or
need any additional information,please do not hesitate to contact me.
2 Attach (as) Sincerely,
Paul E. Pinard, P.E.
y. f
94/
.....P"
. OOO/OO• OOOOOE
o Paul E. Pinard ��pift
�V. CE-4793
.. ..•._ir
PROFESSzON�-'
ZcCCI
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Expiration Date: ///10
Parcel I.D. 051-791-12
1. GENERAL INFORMATION
Complete legal description Lampert Estates Block 2 Lot 11
Location (site address)
22544 Lampert Circle, Chugiak, AK
Current Property owri r(s) Hoover, Joann
Mailing address same
Day phone 257-0470
Real Estate Agent s' Dan Wolf Day phone 257-0470
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well ❑
Individual Water Storage ❑
Community ClassA Well
Public Water System
AUBM1TTA
Nov 1 `f 2014
TYPE OF WASTEWATER DISPOSAL:
Individual
Holding Tank
Community
Public Sewer
Received by:
COSA to be released to the engineer, unless otherwise requBested by the engineer.
Date: rx.7,,,
COSA Fee $ t24 Date:
Date of Payment kill 1/4-1 l)y c. _ Date of Payment
Receipt Number D55? G. Receipt Number
COSA #. 05C-1'4 51-1 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. 1 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 NorthRim Engineering
Address PO Box 770724, Eagle River
Engineer's Printed Name Steve Eng
Phone 694-7028
Date H.:J./ /2014
14
y2
D oe%Q
6. DSD SIGNATURE 49L r' 's o
`� JDD tD�/i
t' onD DDO System #1 Approved for A bedrooms. o• • °e0 11
t
re‘' Steven W. fang : It;
System #2 Approved for bedrooms. 050�,°D6Oht° pE gg 8 ,'
Disapproved. 4,4 * .,--, 3
Conditional approval for bedrooms, with the following stipulat os��
�`octutilitt;rr
S`'� ti OF ,Mb -,10f,
j ON-SITE
WATFRAND
WASTEWATER oz_
• NROGRAM ate?
52?% sFR\1‘-'
, l))/1)»»-ovt -
Original Certificate Date:
The Municipality of Anchorage Devlopment 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 9-1-12.doc
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: L' W, 4 7 /C i<JT4,f f2 L// Parcel ID:CS/ 7 %/ /Z
A. WELL DATA fQSL(c- w6%Ct2 C L4 S.tie 4 S ySTe-f-.rt
Well type - If A, B, or C provide PWSID # Well Log (Y/N)
Date completed Sanitary seal (Y/N) _ Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level fL ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material S (C./ STEL Date installed IL/ Ly f2
Tank size /000 gal. Number of Compartments 0 Cleanouts (Y/N) /
Foundation cleanout (Y/N) 7 Depression over tank (YIN) N High water alarm (Y/N) /V
Date of pumping ///Z lit (1 Pumper San , 1.--c 7 R. -neve S
C. ABSORPTION FIELD DATA
Date installed 0 7/82 Soil rating (g.p.d./ft2 or ft2lbdrm) /00 System type Jt'PziOc f!
Length 50 ft. Width ? ft. Gravel below pipe 3 ft.
Total depth of ft. Eff. absorption area 30o ft2 Monitoring tube y Depression over field Al
Date of adequacy test /0/3//1 y Results (Pass/Fail) PASS 7 For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 4/50 gal. • New depth tD in.
Elapsed Time: 3 O min. Final fluid depth 0 in. Absorption rate >= 4/ 50 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) A/O If yes, give date
D. LIFT STATION rt/A
Date installed Size in gallons Manhole/Access {Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO: NA
Septic tanWlift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer /septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 � t Property line /0 ''f Absorption field 5 f
Water main /0 'F Water service line / D fi Surface water /D0 4 -
Wells on adjacent lots 2Gv
ABSORPTION FIELD ON LOT TO:
Property line /act Building foundation / 0 -f Water main /a"?'
- �-
Water Service line /0 Cf- . Surface water /00 1- Driveway, parking/vehicle storage 50
Curtain drain r/Nlt Wells on adjacent lots 00° '+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that I have determined through field inspections and
review of Municipal records that the above systems are in 1212 acc
conformance with MOA COSA guidelines in effect on this date. o "
Engineer's Printed Name Ser -e- t /4 E -tea
Date/fvy�/y tic-
PA
•0
GQ
C
COSA brown sheet 10-10-12.doc
ASBUILT-NO CORNERS SET THIS DATE.
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
2-9, ea4S.rifirrr. "ate Cdr/'lr-re a- •
AND THAT NO ENCROACHMENTS EXIST 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 CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
SCALE:
SEWARD & ASSOCIATES LAND SURVEYING 694-0829
DATE:
GRID:
. 4 rri /PCS-52
FB:
y�-sy
DRAWN:
tisw�nt�
ib
estOF..
ire'y 49th ..11
•. Duane Mark Seward 7 /
.t,„%.LS 6918 �► 4
a Tkxa M
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I D # 05-I- 79/ - / 7.
1. GENERAL INFORMATION
Complete legal description /or l/
HAA# QQ`1
Z 4'9797,',LST— (5:57—
Location
5:5T
Location (site address or directions) 2-Z5Y51
Property owner /44-44 - F2 --443G
Day phone 2.49 7- YVSfl
Mailing address P o >� /I3 -9J 141,04 5 rrw GUA-s» 9S-j/C
Lending agency iiuu� C-041- Day phone
Mailing address
Agent fhe'7/ tea- Z4 -.5.051 -c -Day phone 49y V97'
t/6 fAJ4 OMMl//Se-5ov
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
x
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #t21
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 of this Health Authority Approval application 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 on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address
Engineer's signature
David R. Dayton P.E.
20210 Donalar St.
Chugiak, Alaska 99567
6. DHHS SIGNATURE
Approved for 3 bedrooms.
Disapproved.
B
Phone (P90-2 //7
Date (2/c,/ 3
f (..n
4 •°
p,•yr.'L..,. i 10
004
10
Q %y ;
H r David R. Dayton @/
'., •_ NO. 2205-E 4•.Z:470,11
•••°ot7r y i
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Date /
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DH HS 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 engineers work.
72-025 (Rev. 1/91) Back MOA tr21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: 6(„oc-z-1— Parcel I.D. 057 ? 9/ / z
A. Well Data
r ars /75
Well type 4- If A, B, or C, attach ADEC letter. ADEC water system number il476 9 7
Log present (Y/N) Date completed Driller
Total depth Cased to Casing height ,,,
Sanitary seal (Y/N) Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well flow g.p.m. g.p.m.
Pump levell
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot Zee v,— ; On adjacent lots /--
Absorption field on lot 0 -f- ; On adjacent lots Z -e) -)--
Public
Public sewer main Public sewer manhole/cleanout PA
Sewer service line Petroleum tank 'KA
WATER SAMPLE RESULTS:
Coliform Nitrate Other bacteria
Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed J ut-y 02— Tank size / o 0o Compartments Z
Cleanouts (Y/N) Y Foundation cleanout (Y/N) /( Depression (Y/N) A/
High water alarm (Y/N) a/% 4— Alarm tested (Y/N) M//9
Date of pumping /0—/9 .. - — Pumper %i-Af:J.�rruy 1 -k-,1
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: /[./
Well(s) on lot /1//m On adjacent lots N///— Foundation / /
To property line ____a____Absorption field Water main/service line Z e) ?-
Surf ace
'Surface water/drainage / C /-
72-026(3/93)'Front CONTINUED ON BACK PAGE
C. LIFT STATION /
Date installed N/` Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) "Pump on" level at "Pump off" Level at
High water alarm level Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
Date installed ,.?y 1-y ?Z--- Soil rating (GPD/Ft2) /o6) S �/i'-System type /2,
Length Sb Width 2 /`: Gravel thickness 3 Total depth 6. 7
Total absorption area 300 Cleanout present (Y/N)171 7—
N Depression over field (Y/N)
Date of adequacy test /
/93
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Results (pass/fail) rrfor 3 Bedrooms
® After test O
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
^'//
To building foundation 3 Y.
On adjacent lots
Property line �3
To existing or abandoned system on lot Naz
On adjacent lots Cutbank �✓/,�— Water main/service line Zf
Surface water / c) /- Driveway, parking/vehicle storage area
Curtain drain A '- /et)
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name
Date
David R. Dayton P.E.
20210 Donalar St.
Chugiak, Alaska 67
L./ gam
HAA Fee $ ADD ° C) Waiver Fee $
Date of Payment /.2 2 % ? 3 Date of Payment
Receipt Number A-5 b 3 23 < l (p/I ) Receipt Number
72-026 (3/93)* Back
D. R. DAYTON, P.E., R.L.S.
Chugiak, Alaska 99567
20210 Donalar
December 4, 1993
ADEQUACY 'ihST
Legal Description: Lot 11, Block 2, Lampert Estates
Date of Test: December 1, 1993
Septic Tank: 1,000 gallon, 2 compartment, steel tank
Absorption system: 50' long x 21' wide x 3'
•
Soils Rating: 100 sq. ft. per bedroom
Requirements: 3 BR - 450 gallons per day
(907) ( kigUx7c
696-2417
(DHHS
effective depth trench (DHHS
(DHHS
Records)
Records)
Records)
Test:
Water was pumped into the absorption trench while measuring time, volume,
and water level rise.
After pumping was stopped the water level dropp was measured at timed
interals.
Results:
The trench accepted 500 gallons with no rise in the water level.
The system is currently functioning adequately for a 3 BR home
,'
eCeriS �? •a � t..
Iii �7 . 2
NO.O'i 4 4-4'; e V
f . .eta
.!. 9 x.o 0x4ux.o e..��• { {Ui
7
,
n..*Clio*
11.3, V. David I. Doyon
CP •• NO. 2205-E �'
-311-:\\C".:-.5
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
Mr. Dick Dayton
20210 Donalar
Chugiak, AK 99567
WALTER J. NICKEL, GOVERNOR
December 21, 1993
SUBJECT: Lot 11, Block 2 (22544 Lampert Circle), Lampert Estates/
McKinley View Estates
Class "A" Public Water System, PWSID #210697
Dear Mr. Dayton:
(907) 349-7755
I have completed a review of this office's files concerning the monitoring status of the
above -referenced Class "A" Public Water System and found the following:
1. The last satisfactory Total Coliform Bacteria Sample results was submitted
to this Department on December 14,1993. This does meet the provisions
of 18 AAC 80.200(a), of the State Drinking Water Regulations.
2. The last inorganic Chemical Contaminants Sample results were submitted
to this Department on February 4, 1991. This does meet the provisions of
18 AAC 80.200(a), of the State Drinking Water Regulations.
3. The last Radioactive Contaminants Sample results were submitted to the
Department on February 18, 1993. This does meet the provisions of 18
AAC 80.200(a), State Drinking Water Regulations.
4. The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC)
were submitted to this Department on December 14, 1993. Based on
analysis of the previous VOC samples results have been satisfactory. This
does meet the provisions of 18 AAC 80.200(a), State Drinking Water
Regulations.
Issuance of this letter does not imply that the above -referenced Class "A" Public Water
System is in compliance with other provisions of the State Drinking Regulations. Unless
otherwise noted, this letter is valid for 30 days and is for the specified legal description
noted above only.
printed on recycled paper b y C.D.
Mr. Dick Dayton 2 December 21, 19931
If you have any questions on the above information, please do not hesitate to contact this
office at 349-7755.
J
Sincerely,
tr;.Lt.
Michael Lu
Environmental Eng. Asst. II
MLU/cf
APPLIC NIT FILLS OUT UPPER HAL' JNLY
Time
Time
Property Owner "7-0
t j',1 r/%rn.a r),E//2J it. -p
Mailing Address /3o �/ za / e7z/a
✓�Phone
/g/� Zip Code /PS -6 7
Zip Code
/ < „ /921e -/
/-j/ Zip Code
6,?7
Phone
3
'y
Buyer `1/!i /// _ FLle4..U6 / V /e3
Address /7Ale-1/ t%/e `91-0 ' , it9"/
Lending Institution/�//,9$ r „vAi7-/Uit/w4 Al2,
//"t
Address WL D 00 it)a /2/-1 /V L
Realty Co. & Agent /�-'/L,4 %'/A%/ j 726-/1
L T
Zip Code -� ''lP7
Phone
( l) APPROVED BEDROOMS
( ) DISAPPROVED
( ) CONDITIONAL APPR VAL'
DATE'S /7''
7
Address GCr 6� /! J
Legal Description / 0 r— //
Street Location MUNICIPALITY OF ANcHCRAG
Solis Rating
Type of Residence
Single Family
❑ Multiple Family No. of Bedrooms
DEPT. (7 I !r:/.1_1-'1
ENVIR.:i)tvi lirF HU
n �
.'.
r_ il:-.1
since
ha lable).
Septic Tank Size / Q 0 0
1975.
0 Other
Water Supply
❑Community
,<Publlc Utility
r1 1 6
LL G. A well log all wells drilled
For welindividual ls drilled pririor o that date, give wpl7s regui c€p�(�llat tf
111111����33 LL ((� ((��id
Sewer Disposal
X Individual
0 Publlc Utility
❑ Holding Tank
,y
Year Individual Installed: �9,7� c�
When Connected to Public Utility ,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time \\
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector ('1nI�, t
L_ �L .YDS
Field Notes: a L O .- tj1',
( l) APPROVED BEDROOMS
( ) DISAPPROVED
( ) CONDITIONAL APPR VAL'
DATE'S /7''
'CONDITIONS OF APPROVAL
/
t 1.11,,_✓
,ABY:
Solis Rating
Date Sewer Installed
'� ®. ?,C) d y 1_„
WellWell To Absorption Area aomoot
Well to Tank 41 0
Well Log Received /4v00
Septic Tank Size / Q 0 0
72.023 (3182)