HomeMy WebLinkAboutLAKEWOOD HILLS LT 14ALakewood Hills
Lot 14A
#015-312-01
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
Well
DISTANCE TO: ~
I Manufacturer I i
Liq. capacity in gallons I ............
j ..~.~'~-,~ ,v Hu,v,~,v,~u~:
DISTANCE TO' Well
I Well
D STANCE TO
I No. of,i.es J Length of each ,ine ~)~
Top of tile to finish grade
w ot,
Type of ~ ~
DISTANCE TO: Well
JClass ~ Depth .
DISTANCE TO: Building foundation
Absorption area f
Inside length
Dwelling
Foundation
Total length of lines
Material beneath tile
Depth
Crib depth
Building foundation
Driller
Sewer line
Dwelling
Material
Width
Material
Nearest ]ct line
Trench width
PHONE [~]NEW
NO. OF BEDROOMS 4
PERMIT NO,
No, of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO,
Distance between lines
inches
Total effective absorption area
inches
PERMIT NO.
Total effective absorption area
Nearest lot line
Distance to lot line PERMIT NO.
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
SOl L TEST I~ATI NG
INSTALLER
REMARKS
APPROVED
~', ~, '"' ,~. ~, A~ '.oi ~. ~e~':.=',~'
DEI='ARTMIE]q:T JIF HEALT'H AND ENVIRONMENTAL PROT'ECTION
825 L STREET, ANCHORAGE, Al< 9950:[
264-4'720
F'ERM I T NO,~
DATE ISSUiED:
85047'7 UPGRADE
u c /07, ~:L.
AF'F'L :1: CAI"-IT:
CC)Iq'I'ACTT'
RAYMOND 14. 'T'REMBLIEY
].04:1.00 H ILLS I DE:. DR,,
ANCHC)RAGE, AK 995 :[6
346- 17 ;[ 7
L. EGAL. :OESCR I F:': ;~1)~: I) I \41S :I: ON ~ LAKEWOOD H I LL.S LOT: 14A BLOCI<: NA
SECTION: :[4 TOWNSHIF': i~.M RANGE: ::.W
LOT S I ZE: 3A .... '~ ..... ""'"'
~;:t~.,, 1:::'"t". OR AC,REo)
I cer'ti[y that:
1,, I am fami].iar' w:Lth 'Lhe r'equipements far on-site sewer, s and wells as set
l'or"Lh by the Mun~cipal:i. ty. of Anchopage (MOA) and the State
2, Z w:i.].l, ins'La].]: the system in actor-dance with a~I M~A cc:des and regu].ations~
and :i.n compliance t,¢J.'~.h the design Er'iter:La of this perm:i.t.
3,, ] wi].], adher'e '~.o a].l MOA ar'id State of ~lasl.::a pequirements for. the .set back
dis'Lal]CeS fr'om any exist:Lng well, wastewa'Ler disposal system of public
s6~l.~]E¢l"&tg8 system on this E)P any adjacen'L, or neapby ].at.
IF' A. L. IF:'T STATI[)N IS INSTALLED IN .AN AREA DOVERED BY MOA BUILDING CODES,
"f'HEI*~ (:t.) AN I:LI:CIRICA* ......... .... F'ERMIT AND INSF'ECTION MLIST BE OBTAINED~. (2.) AS-EL~ '[."?tS
W]:LJ... NOT BE AFF'ROVED WITHOLJ]' AN E[...EC'[~ICAL INSF'IECTION REF'C~RT; AND (5) THE_
GAAB-HD-I
GP~-~,TER ANCHORAGE AREA BORO~"GH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
ADDRESS
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
'/"~'-~ ~ ~/4 NUMBER OF
· /, ., COMPARTMENTS
MATERIAL ~." C'2~/:&~ g ~ {,~Z~'' ~'~
¢" 7' LIQUID
INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
~ ,~,
OUISIDE DIAMETER OR WIDTH
? "~- ~" DISTANCE FROM WELL
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA).
LENGTH / Z.-
, , DEPTH
, BUiLDiNG EOUNDATION
<~ g SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
, FOUNDATIQN
DISTANCE B ET w E E~-d~l~q-~'~~
LENGTH OF EACH LINE
~:-~'~AREST LOT LINE
TRENCH WIDTH
DEPTH: TOP OF TILE TO FINISH GRADE
DEPTH OF FILTER MATERIAL BENEATH TIL[;
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL: TYPE t~/ ' DEPTH ~_..~ ~z~-O
/% NEAREST ~; / SEPTIC
LOT LINE ' , SEWER LINE , TANK
DISTANCE FROM
BU LDING FOUNDATION.
~ ~;' r~ SEEPAGE
, SYSTEM
WATER ,'
SAMPLE ~ ~
CESSPOOl '~r
NEAREST
OTHER
, SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
l
DATE
APPROVED
GREATEK ANC]tORAGE AREA .. ROUGH Case No.
~" HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPLICANT ?~t./' '-'~-'"~g',~'~,~/~. t/ MAILING ADDRESS/,),2. L/~/6l'/~ .~_ (~,~:/.~YHONE NO~~/'''~
RESIDENCE ADDRESS/7~/-/ ,-~'/~, /~ 1~/ e/~c/~,LOCATION OF INSTALLATION ~/t'}/~]~ ~;,-e ~/1~
/
APPLICATION TO INSTALL: SEPTIC TANK
TO SERVE THE FOLLOWING FACILITY
FINANCED THROUGH /k././} ·
PERCOLATION TEST RESULTS
SEEPAGE PIT. '/'/, DRAIN FIELD
,OTHER.
TO BE INSTALLED BY
ANTICIPATED DATE OF COMPLETION
//://
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS /~/~' 7~,,, /.¢ (/ty '% , PERMIT TO INSTALL A " AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED ~4 /~'./~-~//)[~C~'(2-/t'1
· SEPTIC TANK SIZE. /-':2 (-~) TYPE (~C;'/V: SEEPAGE AREA TYPE
DISTANCES:
DIAGRAM OF SYSTEM
Health Authority
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.
n^-r: APPl IP.A AITR glRNATIIRE
Municipality of Anchorage'
Development Services Department
Building Safety Division
On -She Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-0650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-312-01
1. GENERAL INFORMATION
Complete legal description Lakewood Hills Lot 14A
COSA9 Mr&61
Expiration Date:—�� 0
Location (site address) 10400 Hillside Drive, Anchorage, AK 99507
Current Property owner(s) Elsie Tremblay Day phone
Mailing address 10400 Hillside Drive, Anchorage, AK 99507
Lending agency Day phone
Mailing address
Real Estate Agent Mary Tutterow/Dynamic Properties Day phone 907 261-7682
Mailing Address 3111 "C' Street, Suite 100, Anchorage, AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
4
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 OnSfle 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 Onsite 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 OnSfte 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, 1 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 Finn Watkins Engineering, Inc. Phone 907 349-1851
Address P.O. Box 110443, Anchorage. AK 99511-0443
Engineer's Printed Name Cindy W. Ellis
6. DSD SIGNATURE
__jZ Approved for 4_ bedrooms.
Disapproved.
Date January 10, 2008
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: / Original Certificate Date:
v
(R« tyros)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box I96650
Anchorage, AK 99519-6650
www.muni.orglonsfte
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lakewood Hills Lot 14A Parcel ID: 015-312-01
A. WELL DATA
Well type Pri if A, B, or C provide PWSID # Well Log (Y/N) No
Date completed 1969 Sanitary seal (Y/N) le
s Wires property protected (Y/N) Yes
Total depth 220 ft. Cased to 40+ Casing height (above ground) 12+ in.
—
FROM WELL LOG
AT INSPECTION
Date of test 1969 June 12, 2007
Static water level unknown
177 ft
Well production unknown
gV-m 4.99 -P.M.
WATER SAMPLE RESULTS:
Coliform 2--L_colonies/1 00 mL Nitrate 7.491
mgfL Other bacteria 0 colonies/1 00 mL
Arsenic: 0 mgn Date of sample: 12/12107 Collected by: Rocky Trainor/Watkins Eng,
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Steel Septic Tank
Date installed 1985
Tank size 1250
gal. Number of Compartments 2 Cleanouts (YIN) Yes
Foundation cleanout (YIN) Les Depression over tank (Y/N) 110 High water alarm (Y/N)
Date of pumping 6/12/2007 Pumper Anchorage Cesspool
C. ABSORPTION FIELD DATA
Date installed 1969 Soil ratio (g.p.d.eorft/bdrm)288 System type seepage pit
Length 12 ft. Width 12 ft. Gravel below pipe 6 ft.
Total depth 6 ft. Eff. absorption area 268,1 fe Monitoring tube Yes Depression over field No
Date of adequacy test done 12, 2007
Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 19 n. Wateradded716 gal. New depth 28.25 In.
Elapsed Time: 60 min. Final fluid depth 23 in.l Absorption rate >= 600 g.p-d.
Any rejuvenation treatment r (past 12 mo.) (YIN & type!) No If yes, give date
D. LIFT STATION
Date installed NIA Size in gallons
'Pump on' level at_ in. 'Pump ofr level at _ in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot 109'
Absorption field on lot 107'
Public sewer main 100'+
Sewer/septic service line 40+
Manhole/Access (YIN)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 100'+
Holding tank NIA
Animal containment areas 100'+ Manurelanimal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 79' Property line 15+ Absorption field 14
Water main 100'+ Water service line 1000+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 17 Building foundation 50+ Water main 100'+
Water Service line 100'+ Surface water 100'+ Driveway, parking/vehicle storage 50+
Curtain drain NIA Wells on adjacent lots 100'+
F. COMMENTS:
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in oi, tldyVy EUjS
conformance with MOA COSA guidelines in effect on this date.
CE.1osn
Engineers Printed Name Cindy W. Ellis9a ................
in.
Date January
10, 2008
COSA Fee $
�% � Waiver Fee $
Date of Payment
1/1,9 LLOF Date of Payment
Receipt Number
D -2)1 -4 Receipt Number
(Rev. 11/05)
I LOT 15 I 853
N89°58'00"E 280.00
1 50.03 I
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N89°58'00"E 280.00I d
LOT 12A Access Easement—' ; I
I
AS -BUILT NO CORNERS SET THIS DATE
1 hereby certify that I have performed a Mortgagee's Inspection
\ of the follow ng described property. LOT 140.
,�F qCq 1� LAKEWOOD HILLS SUBDIVISIONFAQ ...........
5��1
9 r/AnC11GMgG
/ 49!H* :,a, / Improvements situated thereon are within the property Ines
. ....
/ and do not overlap or encroach on the property"
.... . �..J. adjacent thereto, that no Improvements on the property lying
Fred Walatka ' % adjacent thereto encroach on the promises In question and
that there are no roadways. transmission Iris orother
No. 3255-S r/, visible easements on said property except as ind"tad
SCALE: 1"=40' tll�\ \ = this 2f cnorage.aadyef JULY 2007
EASEMENTS OF RECORD, OTHER THAN FRED WALATKA & ASSOCIATES
THOSE SHOWN ON THE RECORDED Engineers and Surveyors
PLAT ARE NOT SHOWN HEREON. Fb 07-4, pg 74-75 13E (907_248-1669)
Municipality of Anchorage
,N •v.
' Development Services Department y°
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
Nitrate Advisory
Certificate of On -Site Systems Approval # 080009
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
14A of Lakewood Hills subdivision. This inspection revealed a nitrate
concentration of 7.49 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.
SCS Rer.B
1076483001
Client Name
Watkins Engineering
Project Name/M
Lakewood hills Lot 14A
Client Sample ID
Lakewood hills Lot 14A
Matrix
Drinking Watcr
PWSID
0
Sample Remarks:
All Dates/Flmes arc Alaska Standard Time
Printed Date/rime
12/262007 10:58
Collected Date/time
12/122007 15:50
Received Datdthne
12/12/2007 17:10
Technkd Director
Stephen C. Ede
Allowable Prep Analysis
Parameter Results PQL Units Method Container ID Limits Date Date
Init
Metals by ICP/M9
Arsenic ND 5.00 ug/L EP200.8 C (<10) 12/14/071221/07 TK
Slaters Department
Total Nitratc/Nitritc-N 7.49 0.100
Microbiology Laboratory
Total Coliform 0
mg/L SM204500NO3-F D (<I0)
coUl00mL SM209222B A (<I)
12/17/07 1DS
12/12/07 SDP