HomeMy WebLinkAboutLAKEWOOD HILLS LT 12AGREA,ER ANCHORAGE AREA BOR jGH
Dep@rtment of EnvironmentsI Ouslity
3330 C Street
Anchorsge, AIssk8 ggs03
INSPECTION
NAME ~.. ,~~
LOCAT,ON
REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
MANUFACTURER
INSIDE WIDTH
LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY~/~ GALLONS.
TILE DRAIN
DISTANCE FROM WELL FOUNDATION
NEAREST LOT LINE
TOTAL LENGTH ~(,~::~
OF LINES
NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE
ABSORPTION AREA ~'/G¢') t SQ. FT, LENGTH OF EACH LINE
DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE ~--~' IN. ABOVE TILE IN.
TYPE _
BUILDING
FOUNDATION
CESSPOOL
APPROVED
CONSTRUCTION
NEAREST
LOT LINE_
OTHER SOURCES
DISAPPROVED
NEAREST
SEWER LINE__
DEPTH
SEPTIC SEEPAGE
, TANK__ SYSTEM.
REMARKS
DISTANCE FROM:
DISTANCES:
SEWER LINE DEPTH:
PiPE MATERIAL' ~J ~0'~)..~0 ¢
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
DATE
G.A.A.B.
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GFi:OUP',J[::, FIND THE EK:YT'TOM Eft: T'HE E::'::CFIVFITtON '.'.' IN FE:IET::'.
THEi:RE IS NEJ :E;IET .LIZlZ:'"t"H I::'OIR TRENE:HI:Z':'~;.
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:~:;I:::'EE:IF:':[CF:IT!OI",I:E; FII",I[.':' E:ON:E;'I"FdJE:TION C, tF:IGF.'.I::ff"t'S FIFi:E F:fVF!II....F!E',L.JE TO :[N'."~;L.tRE
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~- .-~, ,, }),~:n'tment of tlealth:;md Environmc?--',~Protection
A~horag'e, Alaska 99507
N()[I,S [,()(1 [)I':I{()I,A'I'I()N ']'I';~T
/Ill~ ~Orl,/reporks: SOilS log F' · Percolatio Les-~
Dep th
Fec t
Y~- v~o ~or us~ -rP4s
14 - -.
-- was ground water enco[mtered?
I41 Ii '
........... · l;f: .YES, aL' what
Proposed installa~'J}~:-'~eiq>~fqe Pit Ur'aim~ I-icld
Ik:pLh of lnlct l)eptl-i-i}J"]J~)'Ci~2n"}[l" pit or trenci, ...........................
fi,Ill II'; / ? l ~
GreaTer ANCHORAGE ArEA BOROUGh
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4§6!
SEWAGE DJ~SPOSAL
legal DESCRIPTION ~-0~-" ~ r'Or C~-~h~x~"~;'~) /0~ ~2,~ ~?/,~ l
INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT ~>' DRAIN FIELD , OTHER
PERMIT NO.
SYSTEM -- APPLICATION AND PERMIT
f~/~ ~/
TYPE AND SIZE OF faCILitY TO BE SERVED
FINANCED THROUGH
SOIL TEST RESULTS
TO BE INSTALLED BY
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL iNSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TA K
SEPT,C TaNK TO LWAL,
TO NEAREST LOT LINE.
WEll TO SEPTIC TaNK
DRAIN FIELD
WATER MAiN TO SEPTIC TANK
DRAIN FIELD
TO RIVER, lAKE, STREAM.
, DRAIN FIELD
ALSO CONSIDER AREA WELLS.
· ~ PIT
DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAge Pit
FITTED WITH AIRTIGHT REMOVABLe CAPS.
GRAVEL BACKFILL
C:ONFORM TO BOROUGH REGULATIONS R~ING INSTALLATION.
/ /
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
..................... /', ' · l_~. t:: ,~.,:,,...~(t : 1i: . ,.' .,..
Location ..... /_.- c, 7'- .... ::~_.,.<:/ ......................................
_ _ I /-~ :~ /~ ,'~
Depth of well -o ~/.
S~ze of casing ......... (::...':
Distance to water ...........
Distance to water while pumping ...... :.,~...c, ................................ : ........ a~ rate
/'": ¢> ,I
of ......... ;.: .... ,... ................................ gallons per hour.
Formation
~RA ~OX 394 ~
ANCHORAGE ALASKA 99507
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501 .
ENVIRONMENTAL ENGINEERING DIVISION
Telephone 264-4720 : : . ' i !
REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER PHONE
Eoyd A/Morma Jean Skille 349-3393
MAILING ADDRESS
3742 Lake Otis Parkway 99502
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER PHONE
MAI LiNG ADDRESS
3. LENDING INSTITUTION PHONE
Alaska Mutual Savinqs Bank % Ruthanne 274-3561
MAILING ADDRESS
Post Office Box 1120 99510
4. REALTOR/AGENT I PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION ~ ' ~
Lot 12A Lakewood Hills Subdivision
;TREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One ~ Four [] Other
SINGLE FAMILY __e,, [] Two [] Five
[] MULTIPLE FAMILY ~,,~ ~, Three [] Six
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
*ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available,)
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
**If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010{3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS April 25, 1978
TIME
TI ME
INSPECTOR/-~
DIRECTIONS:
'tIME
DA-rE
DATE
INSPECTOR
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
13~./"Si N G LE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
~J~" INDIVIDUAL
~--) COMMUNITY
PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
EI;~i~) l V I DUAL/ON -SITE
E~ PUBLIC UTILITY
Connection Verified
[~eptic Tank or L~ Holding Tank
Size:_lOOO If Tank is homemade
give dimensions:
TYPE OF TANK
4. DISTANCES
WELL TO:
Absorption Area to nearest Lot Line
5, COMMENTS
[] ONE ~f~ THREE [] FIVE
[] TWO [] FOUR [] SIX
PERMIT NUMBER
7 '7
[] OTHER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
7'7 9r3
DATE INSTALLED
INSTALLER
SOILS RATING
/.!>-o
MANUFACTURER
MATERIAl.
Septic/Holding Tank Absorption Area
Sewer Line I Nearest Lot Line
DATE
72-010 (Rev, 3/78)
APPROVED FOR ~ BEDROOMS
CONDITIONAL APPROVAL (letter must accompany certificate)
DISAPPROVED
BY (Title) ~_/~,~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION . , ,
825 L Street, Anchorage, Alaska 9950].
279-2511, ext. 224, 225 '
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: VA
2. Property Owner: SKILLE, Boyd A. & Norton 3ean
FHA CONV
Mailing Ad'dress: 3742 Lake Otis Parkway
e of Buyer: SKILLE, Boyd A. & Norton Jean
Day Phone: 349-3393
Mailing Address: Same as above ' Day Phone: Same .as above
Name of Lending Institution: Alaska Mutual Savings Bank - Ruthanne
Mailing Address:P.o. Box 1120, Anchorage
5. Name of Realtor or Agent: None
Mailing Address:
6. Legal Description:.. Lot 12A, Lakewood Hills S/D
Location:
Phone: 274-3561
Phone:
7. Type of Facility to be Inspectsd: SFR
No. Bdrms.__4
8. Water Supply
~ ' ....'-Type of Sbpply: ?~blic Utility.
If Individual, number of dwellings presently served
If Individual, depth of well__ £?i~
9. Sewage Disposal System
.... Type of System: ....... ~_u_'olic Utility
If Individual, date of installation_
Individual (on-site)
ao
•'t _ RUSH GE
Municipality of Anchora17.
On-Site Water and Wastewater Program " JUNzO1T �,1 i
(907) 343-7904 E*Y
ti
Certificate of On-Site Systems Approva °I 6 9 L
Parcel I.D. 015-312-02 Expiration Date: q'– 9
1. GENERAL INFORMATION:
Complete legal description LAKEWOOD HILLS; LOT 12A
Location (site address) 10500 Hillside Drive`Anchorage 99507
Current Property owner(s) Eric Worthington Day phone 244-4070
Mailing address
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® 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 Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: Date: 4 / 14 / 17
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 52- 3\5+°D— D (I ("O Waiver Fee $
Date of Payment Date of Payment
Receipt Number 0 211(46 Receipt Number
COSA#, CIC.11 V2-4 a 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: l zit
oQ000p�.
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system Q Q r ra
in accordance with the guidelines and regulations established by the Municipality of Anchorage andd K-,• ••• Q
industry practices. The reported results describe the condition of the system/s on the date/s of the P. ' I .,boon
•
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or V
encroachments may exist that were not identified during the evaluation. The operational life of all wells 4 ,4*OV�
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, Or
groundwater levels (that may fluctuate during the year), quality of construction (materials and 1
workmanship),and the water usage of the family utilizing the system/s. These conditions can vary, and /. •.•�..
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the / f r-y A. -.mess.: Q
system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of V0 0 /' C —79 3�• ' c �
the well or septic system. GEG makes no representation whether an alternative well or septic system Q •f a c6O
can be installed on the property in the event either of the current systems fail to perform adequately in � P, '/•�._. 1 T s
the future. The content of this report is for the sole benefit of the person/party that retained GEG to p�°Pr ofesS;o0�4Q
perform the evaluation. Reliance upon the information provided in this report by any other person or ��Opp'
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE 1\ OFAA;
j System #1 Approved for 3 bedrooms
ON-SITE �
System #2 Approved for bedrooms :•
WATER AND r"
Disapproved ,c WASTEWATER oz
PROGRAM
Conditional approval for bedrooms, with the following stip" ti
Ser: —4--- 111-(C '40 Yeewc nd vex 0-ye . 1/46D
2a z�
B !� �!aS / Original Certificate Date: 41-/
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 Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 10.10.12.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 LAKEWOOD HILLS: LOT12A Parcel ID. 015-312-02
A. WELL DATA
Well type PRIVATE If A. B, or C provide PWSID# NA Well Log (Y/N) YES
Date completed 6,22%77 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 256 ft. Cased to UNK ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 6./22/77 6/6/17
Static water level 191 ft. 195.2 ft.
Well production 28 g.p.m. 7.6+ g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 7.81 mg./L. Collected by: GEG, Ltd.
Arsenic: ND ug./L. Date of sample: 6/2/17
40 YEAR OLD STEEL SEPTIC TANK IS APPROACHING THE
B. SEPTIC/HOLDING TANK DATA END OF ITS USEFUL LIFE.
Tank Type/Material SEPTIC/STEEL Date installed 6/1/77
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 6/3/17 Pumper MCDONALD'S PUMPING
C. ABSORPTION FIELD DATA * BELOW EXISTING GRADE TO BOTTOM OF SUMP
Date installed 6%1!77 Soil rating (g.p.d./ft'or(Jbd)) 150 System type DEEP TRENCH
Length 46 ft. Width UNK ft. Gravel below pipe 5 ft.
Total depth '10+ ft. Eff. absorption area 460 ft' Monitoring tube "YES Depression over field NO
Date of adequacy test 6/6/17 Results (Pass/Fail) _ PASS For 3 bedrooms
Fluid depth in absorption field before test 4 in. Water added 462 gal New depth 26 in.
Elapsed Time: 130 min Final fluid depth 14 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date -
"SUMP ONLY GOES 57" INTO THE EFFECTIVE DEPTH
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off' level at •• wa er alarm level at in.
■ _ • Cycles tested _ Meets alarm &circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/cleanout *100'+
Sewer/septic service line 25'+ Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5+
Water main 10'+ Water service line_ 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION '�P••'''' '• i •. ...
ap i *y g I i•k• •*#i
i certify that l have determined through field inspections and �, r i
review of Municipal records that the above systems are in • r
conformance with MOA COSA guidelines in effect on this •
•
date. s�01: J f :( A. Ga ess'; f
Engineer's Printed Nam JEFFREY A.GARNESS 0. ,),% •
�• 3 ,�
Date 0'( / '4 'ROFESSI '.•
LICENSE 11i sem
MAECC884
(Rev. 10112112)
• Municipality of Anchorage
• Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
N ii rate Advisory
Certificate of On-Site Systems Approval # OSC 171240
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
12A of Lakewood Hills subdivision. This inspection revealed a nitrate
concentration of 7.81 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble
in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass
rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is
in the form of ammonia or protein first, which through contact with oxygen and certain
bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from
wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also
result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or
three years, but is associated with a potentially fatal infant disease called
methemoglobinemia. In the digestive system of young children, nitrate converts to
nitrite, which can pass through the intestinal wall into the blood stream. There it
combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The
EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The
standard has been lowered from a previous level of 45 mg/L set by the US Public Health
Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and
other common home water treatment systems such as softening or iron filtration does not
readily remove nitrate. The best method for limiting nitrate in well water is source
control. This can include avoiding overdosing of fertilizer near the well and maintaining
good separation distances between septic tank leach fields and the well. A special anion
exchange filter that contains a media with a strong affinity for negatively charged ions in
water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical"
methods using a spectrophotometer to read the final color endpoint. Specific ion
electrodes also can be used to detect the activity of nitrate in water. This laboratory uses
several different wet chemical methods approved under the public water supply
laboratory certification program. They also have test kits available, which the laboratory
uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test
kit results against a certified analysis from the lab occasionally to verify the accuracy of
the kit. We recommend using a specially prepared bottle that has been rinsed in
hydrochloric acid for collecting samples.