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HomeMy WebLinkAboutT15N R1W SEC 5 LT 120T15N R1W Sec 5 Lot 120 #051-082-28 U ' !- l Municipality of Anchorage Development Services Department - •. . Building Safety Division On -Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage. AK 99507 Page www.ci.anchorage ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. 051-062.26 PID Number: SW080043 of Nam. BETTY FIELDS Wastewater System: p New ❑ Upgrade Address 355A MELLISA ROSECIR PALMER. AK 99645 ABSORPTION FIELD Photo Number a Bedrooms 5'. 0 Deep Trend) 0 Shallow Trsafh 0 Bed 0 Mand 0 Mac LEGAL DESCRIPTION Block Sod 0.8 Ratty 0'8 GPD/F9 Total Depen from anginal pada 6 La 120 S,Odrvuwn Tanv NOM to P9e baton ham ergs.. Oade 1.8 FI. FI. G'aa h �ih pps 4 wv 15N Bane 1w Sacco 5 FYI added above aril pad. 0.6 Fl. Gravel Lerch Ft 94 i, Well: ■ New Upgra Gravelagm Number a Inn Distance between. CluerlrJtan 51+ FI. Yys 2 110 MIN (Pmais, A, B, C) G a1Y°r Taal Deom Dated to rt Total endplay) area 750 r Ft Pee MaterialFI. ASTM 03034/F810 EXISTING Yea Dna Dialed Stew Water Leval Inlallar TWEED EXCAVATING Del. installed 6/4/08 �"' Pump Ser M FI• I Camp Haight Abram Cxaeid FL TANK SEPARATION DISTANCES i Septic 0 Holding 0 S.T.E.P. 0 Other. To Septic Tank Absorption Field Lot Station Holding Tank >ubliclPnvate Sewer Line Mana 'i"uan ANCHORAGE TANK capacityFrom 1500 Gal VIM 157 161' malarialNumber) 01 Damr,eriniay. 75'' STEEL 2 Surface Water 700•. 100'. LIFT STATION La LM 5'• 104 T. Sae Menusaws. 28673.1, IR :'::G•i NCS' Fautdelan 5.� 1u'. 'Pump of drat r . . i . 'Pun v err level at j Kph water alrm al 46 n 51.5 n H, -I.5 tunas pan NONE Pump Meks6 MOOS Ergnni ln.V.aane n KNOWN &I0.SQr performed by RISING SUN manna SEPTIC TANK 10 GUAGE FOR DEEP BURY. BENCH MARK r • Laotian and Dam/pan BOTTOM 6F CORNER TRIM AT POINT -13' Assumed Elevation 103.8 FL Engineering Inspections performed by: 1386 BirchwoodRd. Dates: 1't 6/3/08 11AM j OF t"tNlplak, Alaska 99567 2and 6/3/08 2PM 1.«•... �+ �Sh. $$ ••• 4" ltd .' • •• Development Services Department Approval Conditional Approval Date: i*'• TM1Ly� /•• • .. .• ••• / ir ti \.k ......... .a• • •.«�••. ••••• •• Reviewed and approved b /�?/i /11 dell/ Date: . I4841 J ,1 %%Co" ermow (Bev CM/06) f��l�(}f �, 9/25/71 PERMIT NO SW080043 PAGE 2 OF 4 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET P.O. Box 196650 *Anchorage, Alaska 99519-6650 • Telephone (907) 343-7904 • www.ci.anchorage.ak.us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL T15N R1W SEC 5 LT 120 MT3 GREENHOUSE 00 Z O N I— D FCO WO]2 L CARPORT MT1 CO FAILED CRIB ABANDONED IN ACCORDANCE WITH PERMIT REQ. P.I.D. NO. 051-082-28 �. / / C 4(T • ATE, M 4 MT2 ST2 ST1 BL1 r-aw T N FXISTIN PERMIT No. SW080043 PACE 3 of 4 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET P.O. Box 196650 •Anchorage, Alaska 99519-6650 • Telephone (907) 343-7904 • www.ci.anchorage.ak.us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT .-7 A W 00 OD LEGAL T15N RIW SEC 5 LT 120 P.I.D. NO. 051-082-28 50' B.L EXISTIrgl CLASS C WELL T2 P L 1 PANED CRIB ACCORD NCC WITH PERMIT REO. T2 'SSAI IAHIC I I :, BCPrIC r1Hl( SHE m ax EXISTING OBILE HOME L BLAIR AVENUE EN Jfrw� if 434, ,•r.1 60' Nie trims •...• 'f S ovvf 61,49 I"••••• y TrR It. ad. . 14574 it . SO PERMIT N0. SW080043 PAGE 4 of 4 Municipality of' Anchorage DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: <907) 343-7904 • www. ci.anchorage.ak.u• ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL T15N R1W SEC 5 LT 120 P.I.D. NO. 051-082-28 A 1 MT2 ORIGINAL GRADE 98.7' mil_ ELEV 96.9' 11 PVC SCH 40 1111 M_3 M 4 99.7' 99.8' / FINAL GRADE\I I x99.8, INSULATION MTI =92.8' MT2 = 92.8' MT3=92.8' -ELEV 96.8' 14 PVC SCH 40 • WATER FOUND © 88.8' 86.8' 8.011. FINAL GRADE ST1 512 CO MT4=92.8' TOP OF TANK 93.4' 92.8'/ 99.4' NEW 1500 GALLON \92.6' SEPTIC TANK TOP 4. g INSULATED - EFFLUENT OUTLET A B C D FCO - - - 7.0' CO - 37.0' 39.5' - STI - 7.0' 27.5' - ST2 29.0' 7.0' 36.0' - MH 29.5' 10.5' 40.0' - MT1 40.0' 24.5' 53.5' - MT2 11.0' 26.0' - - MT3 55.0' 47.0' 77.0' - MT4 25.5' 40.5' - - DBL1 29.0' 8.5' 38.0' - TOP OF TANK 93.4' 92.8'/ 99.4' NEW 1500 GALLON \92.6' SEPTIC TANK TOP 4. g INSULATED - EFFLUENT OUTLET 3 z SQ e. irg ., to • i h :u • "••7. E . II ClN M1 tr Y l� D e LI T• 1 j 1 � J p4 -A IP, AVE let • '•. -Snit. ?3c' AS -BUILT I hereby certify that I have surveyed the following described property. C. i ,." - • - 7 / 2_ C 5E t Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property Lying adjacent there- to, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska thi. i6 day of 5-7 .4 • 19? RODr-RT C. JOHNSON -fr SCALE: Registered Land Surveyor No. 030 -LS _-o ' Box 45', Eagle River, Alaska Phone (907) 694-2543 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW080043 Legal Description: T15N R1W SEC 5 LT 120 Design Engineer: 0003 S & S ENGINEERING Owner Name: BETTY FIELDS Owner Address: 355A MELLISSA ROSE CIRCLE PALMER , AK 99645- (� 3 • 09 (t //: �•, Date Issued: May 12, 2008 Expiration Date: May 12.2009 Parcel ID: 051-082-28 Site Address: 021423 BLAIR AVE Lot Size: 108900 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (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 Issued By Date: Date: 5710 9 1 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 051- OP- 9 t Property owner(s) Edify FieMt Ids [� Day /phhone7416-;o/aq Mailing address 3554 /'1e1lisset Rose (-ir e. 1'AIMev4j� Zip Code �%gp /S Site address 211437 Nor AV'o 1 Uye. Zip Code Legal description (Sub'd, Block & Lot) LO 1 Po �— / `1 /� An Legal description (Township, Section & Range) See:l on 5 T7S)V K I �a S,, Lot Size I ng i CID 0 Sq. Ft. Number of Bedrooms S THIS APPLICATION IS FOR (®all that apply): THIS APPLICATION IS AN: Cg Initial tRi' Upgrade 0 Renewal Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage 0 k I certify that the above information is crect. I further certify that this application is being made for a Single Family Dwelling and is in acc• dance with applicable Municipal Codes. (Signature of property o jaudizedagent) Permit/Rush Fees: i Date of Payment: 55L7 0 Receipt Number: O Z 581-b (Rev. 11/05) Waiver Fees: Date of Payment: Receipt Number: S&S igineeizii1G Ity HEALTH AUTHORITY APPROVALS SEWER a WATER MAN EXTENSIONS SEWER WATER INSPECTION ENGINEERING STUDIES ANO REPORTS WELL INSPECTION a FLOW TEST SITE PLANS ROADOESIGN SOIL TEST PERCOLATION TEST STRUCTUULa MECHANICAL INSPECTIONS ONSITE WASTEWATER DSPOSALSVSTEM DESIGN ROBERT C. COWAN, P.E. May 2, 2008 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 120; Section 5; T15N; R1 W; S.M. CML ENGINEERS (907) 694-2979 FAX (907)694-1211 It is requested that you issue a permit to install a new septic system to upgrade the existing three bedroom dwelling on the referenced property to five bedrooms. The existing system did not pass an adequacy test for three bedrooms, and is also within the 150' well radius for the Class C well. This new design brings the system into compliance with the Class C well separation distances. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Enclosure er, P.E. 15681 S. Birchwood Lp. Rd. — Chuglak, AK 99567 r. �T + ^^S&S Ei1G1neeRI1IG HEALTH ARI:IRY APPROJA9 SEWER & WATER MAN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING ST WES ANG REPORTS WELL INSPECTION 8 PLOW TEST SITE PLATS ROAD DESIGN SOIL TEST PERCOLATION LEST STRUCTURAL S MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES an d MATERIAL SPECIFICATIONS REFERENCE: Lot 120; Section 5; TISK, RI W, S.M. May 2, 2008 GENERAL: CML ENGINEERS (907) 6942979 FAX (907) 6941211 1. The scope of this project includes the installation of a new 1500 gallon steel septic tank, a pump basin, and 2 new pressurized trenches to upgrade the existing three bedroom residence located on the referenced property to five bedrooms. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Development Services Department or ADEC if required, for system installations. Owners installing their own systems must also receive prior approval from the respective agency. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. Tank construction must be adequate for the proposed burial depth. All HDPE septic tanks are required to have a 4" monitoring pipe installed next to the tank extending to the bottom of the tank. 15681 S. Birchwood Lp. Rd. — Chuglak, AK 99567 1" = 40' SC.AI _sig ROAD EASEMENT • A." ONE.O / c... ^i.20 w i s DESIGN /So. 4 or; - mo O _o0 -r( zrX or _Z xzo 30 -4 0 r rI y — *0ti rn rn� SITE -PLAN EXISTING 3 BEDROOM HOUSE pm) • =y-4 A=nZ m O oa0 Q.xo O s,__o uI m Z0s ,.,oO omrn00 o06 sm mz m Drut Si Kz0 •0 .. GQ� 0 . 4; r 0 l0(PA 0`i ?000 tl r�m0 C/3 rrl m-0 rnm C: 0 l�J < m C7 •-3 C7 0 0 A O O O HL AM MO 00 211 mm 00 ti N m P/ m 0 0 2 C7 CTJ Go z 0zmo AA=A s.• Ocy H >FA K •� VI 00A 000 sso amp N 0 O o z 0 m n 0 8002 -Z -S 0 N 1, -3 7 (1) • "4 •• % ;AO SI14.40 .1 4 d" V .4 1" = 100' St. At r DESIGN SITE -PLAN l BOWERY LANE -r 3ARI0 833N0Td r. 0 FUOCI O aw0 x07:Z A Zs O C 2 =ryA KYI 0 • A A 1.1D D p Z - \O CD 8001—Z—S N 0 N L SO' PATENT POW SCSCRVC • 4_ S "C3/4 Sd E1 menung 110DEfrr C. COWAN, PE. t100E11t A. S) IAFEn, P.E. PERFORMED Fon: CIVIL ENGINEE11S (907)694-2979 FAx 907)694.1211 EG4 1 r 21 sm LEGAL DESCRIPTION: L p% Ste., C7750/..L. township. flange. Section: DEP NI —oa�1L•G SLOPE 41.5..E21— J 2- ..: 3- .• . DATE PERFORMED: 1 D14 6 6 7 8 9 10 11 17 13 14- 15- 18 17 18 - 19 _ son SIt7y SF,vbs - STAP VMS GROUND WATER ENCOUNTERED? IF YES. AT WIIAT DEPTH? 1 fD� � wller kat F� 1AonMaing? _ 1 Bale SITE I'LAN SE SIVE N frigLILL� —4_ 30nn», 7n•Oly, —7,5• / ID Pleading Dos Grme off Ti Ne 71me D pth o Water Not Drop ,1J 7i K 7/27oy sut3 a7r i 5 O q% P' 533 b;olf /S 30 �'ly art 6 Y2 /O"— 1ju— P ,. O 5Yz" Fju 61,0S o :3 S3D fad__ to', 3 , O 0 _ 3T 7:o ( -r 30 /0 ' 200 ER PCOLA11OtI RAZE Sa(7 (mul ineREM ti inch) REM DIAMETER t' TESL RUN BETWEEN 3FTAND it F1 COMMENTS PERFORMED BY- I - CERTIFY THAT THIS LEST WAS PERFORMED III ACCORDANCE WITII ALL STALE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DA7 E. DATE' 72-00e IRev bast /• \\ ll r \ ,1V '1 , DEPARTMENT! ENVIRONMENTAL 825 L Streets ON-SITE SEWAGE DISPOSAL I MUNICIPALITY OF ANCHORAGE OF HEALTH & ENVIRONMENTAL PROTECTION ENGINEERING DIVISION Anchorage, Alaska 99501 Telephone 264-4720 SYSTEM AND/OR WELL INSPECTION REPORT NAME (A C J �`�j p ) 9-1-07 , y/ P t-F-,1 -A / SPe. Ce-IC —axe- PHONE ie '. Z3"l KNEW • UPGRADE MAILING ADDRESS . 9- 1 Box 1l sic cJ (21 1� A-K. 995 &7 LEGAL DESCRIPTION Lsan r 2-CLsaca sr- %Ci w %n.514 LOCATION NO. OF BEDROOMS ../7- .-..) 1 1 SEPTIC TANK DISTANCE TO: Well / •j (40 Absorption area / S 4 Dwelling / Is .d. PERMIT NO. ��^ 1- , ei Manufacturer Material No. of compartments Lig. capacity in gallons ��� f Inside length IF HOMEMADE: Width � Liquid depth 0 �' 7 ,caz z FQ- DISTANCE TO: Well ��//-�//nI Dwelling 1 /Y�/a PERMITNOae- Manufacturer Material Liquid capacity in gallons 0 wX uJ a- It z ¢ F 0 DISTANCE TO: Well C-� / / 5-0 T Foundation -7— t Nearest lot e / PERMIT NO. lc �f No. of lines / Length of Fac/h_lipe , (!/ h Total lent yf !ides fCj tLl wit Trench wit t ,` inches Distance between lines Top of tile to finish grade 7 / 7 Material beneath tile ) 2,4 inches Total effective absorptio ' e 12-5 1 SEEPAGE PIT Length Width Depth PERMIT NO. Type of crib Crib diameter I ' ib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line w Class' D'��'�e tip. t �n-- Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ,n V SOIL TEST RATING INSTALLER C REMARKS .551Sitn'1 /rJSuL_/97 L, �% C a .1w(, � /s7.r94I #1,---0Ye a efE2r 7` �— 1 yy` _(l L- �"�1_j-n it T., '-..;o^`i1�J.' ,Cv {1fT-S'1 k //v v f/ o, J 1 somqrr-r—..error— ,;,) -:r. P o_ No. 1457-1i ,' 111"pp —ter+ E t t '�� LI Int E. ':1{I��V1� APP) iVEP - - DATE LEGAL f. % /' ���, �� .„r. jb3 iatl. k�9 k 2�1� t 2-'13 (Rev. 3/7 Permit # 1s K Applicant: /J Location: CS62- f (.I1,s l . /'� Legal Description: 0205 MUeALanEvinmeA Department 'rotection 825 L Street, Anchorage, AK. X9501 emivZ re' ;?-4' 264-4720 * * *iHANDWRITTEN PERMIT WELL AND/OR ON-SITE SEWER PERMIT j er: g 8 g- Zj Z,Z__ Mailing Address: Phone Hui 773 --AI if/ Type of Soil Absorption System Is: Trench: _ Drainfield: Maximum Number of Bedrooms: DEPTH The The length depth of a the bottom The gravel the bottom Lot Size: Seepage Bed: __ Holding Tank: _ Soil Rat.ing(sq.ft/br) Ss 7/dc Required Size of the Soil Absorption System Is: LENGTH GRAVEL DEPTH / WIDTH 1` dimension is the len'h(in feat)�o thhtrench or drainfield. The trench or pit is the distance between the surface of the ground and of the excavation(iri feet). There is no set width for trenches. depth is the minimum depth of gravel between the outfall pipe and of the excavation(in feet). * REQUIRED SEPTIC(HOLDING) TANK SIZE = //2a - Permit applicant has the responsibility to inform this installation inspections of any wells adjacent to this of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. GALLONS department during the property and the number * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 * I certify that: (1) 1 am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) [ wipr 'nstall system in accordance with codes. the on-site sewer system may require en elude more tha 3roo s Issued by: (3) I tidend Date: SWP/024(1/81) PERFORMED FOR: LEGAL DESCRIPTION: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST OUICION Fri OLDS Tr SOILS LOG 0 PERCOLATION TEST DATE PERFORMED: / - 83 L or /LC) ec s T r y N ni La COMMENTS f n PERFORMED BY: SLOPE WAS GROUND WATER S ENCOUNTERED? _-I+ 5 I a P IF YES, AT WHAT DEPTH? C7 , E SITE PLAN A r Reading Date Gross Time No Tirne Depth to Water Net Drop / ' PERCOLATION RATE 4 JEST. RUN Bj�TV/EEN .--` /—FT ND (U AJC' LVG S Bi Snu 1OGX ra 1nIVER, Al AM(%% "Sri7z-ooa (6/79) 094-2979 CERTIFIED 13Y• . (mi, utes/inch FT DATE: G 'TER ANCHORAGE AREA BORO'""i HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 N? 650 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING /i 0a eo,f' -.46-53: 1.5 /- NAME✓- //-Z- /� i /�c.f' ADDRESS /-7Sd/-i= iC'/i/ % PHONE --5 y54_ ,/1, PG .M0/4:1S-/"/->�/i1/ice) . LOCATION,6ijJZ/f1./vkW114//p/'Gc'� 4f�6�/� LEGAI. DESCRIPTION .�_�1�L��/7-�`�/�� /Gl��.f./7� SEPTIC TANK: / DISTANCE FROM WELL _ LIQUID CAPACITY ..---"Zie:24%.2 MATERIAL STS=a/- GALLONS. INSIDE LENGTH ' INSIDE W NUMBER OF COMPARTMENTS QUID 1171 IDTH _z DEPTH = SEEPAGE SYSTEM: SEEPAGE PIT: c.-- !0,7Z'')/1 NUMBER OF NTS— / LINING MATERIAL—./c0 6-- NEAREST LOT LINE OUTSIDE DIAMETER v OR WIDTH_ ! _ LENGTH_ -7/5e-/DEPTH U' / C/C-/ DISTANCE FROM WELL BUILDING FOUNDATIOKhr4e4-' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) 179,2-• 5Q. FT. TILE DRAIN FIELD: /f///9- TOTAL y/ DISTANCE FROM N MARE F LINES_ A ORPTION AREA FOUNDATION DISTANCE BETWEEN LINES DEPTH: TOP OF TILE TO FINISH GRADE SQ FT LENGTH OF EACH LI TOTAL LENGTH— NEAREST LOT LINE O TRENCH WIDTH DEPTH OF FILTER MATERIAL BENEATH TILE IN TOTAL EFFECTIVE IN ABOVE TILE- 4,//�1/'/'6:%" el),.. ;0 /!CT/G.1i// —� /I c4/7 -47:44e= id,:01/A9/214-0) oYr WELL: ER TYPE_"',C7 � DEPT'' BUIDISLDINGNCE FRO TIO',n y/n ;r/��S PL BUILDING FOUNDATION S MPLE �/O NEAREST NEAREST S4TIC/ SEEPAGE / _ OTHER A/ LOT LINE 70 .f-- SEWER LINE/9/a1, TANK G� SYSTEM /�'SJ CESSPOOL /�/4�° SOURCES—�/� DISTANCES: �1/G6✓// Oi✓ DATE DIAGRAM OF SYSTEM APPROVED --•<-_ "�✓ HEALTH AUTHORITY GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE. ALASKA 99502 TELEPHONE 279.6686 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT ro)(4 Aa,,,//curs INSTALLATION LOCATION JI..LL/J�✓�� LEGAL DESCRIPTION 40 a LdneWit-fI O ' �2c' -tcth. 7-7 !MI PERMIT NO. MAI,LIINNG ADDRESS/6&M//«V) A-/`I%'r PHONE iterAida,C1 12_07P y`072&1•i�J V' !� INSTALLATION OF: SEPTIC TANK / /SEEPAGE/� PIT DRAIN FIELD OTHER -�')J TYPE AND SIZE OF FACILITY TO BE SERVED 3 / /7 T�Jr c /fl / `i-79 �rerk Axr'/I�a 'J-4 FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED TO BE INSTALLED BY ak/ NOTE: THIS PERMIT 1S NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE Aeli /">9�5 TYPE `-� Ca MINIMUM DISTANCES. 'REQUIREMENTS FOUNDATION TO SEPTIC TANK SEEPAGE AREA SIZE FOUNDATION TO SEEPAGE PIT ._- DRAIN FIELD SEPTIC TANK TO SEE SEPTIC TANK - TO NEARE DRAIN FIELD WELL TO SEPri'IC TAN19/ SEEPAGE PIT DRAI'�1 FIELD W$(TERMAIN T� DRAI ALSO CONSIDER AREA WELLS. SEEPAGE PIT SEP' IC I'f1A,N K. - SEEPAGE PIT DRAIN FIELD TO VER. LAKE, STREAM. 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 CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. HEALTH AUTHORITY OR LICENSED DESIGNER 1 TYPE DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMkNTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE 1- `� 44 MUNICIPALITY OF Development Services Departments 1 On -Site Water & Wastewater Section Parcel I.D. 051 X31 �3 Certificate of On -Site Systems Approval (_c U' 1, fl-il / VS Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: I `l — Z ©ZO 1. GENERAL INFORMATION Complete legal description T1 5N R1 W SEC 5 LOT 120 Location (site address) 21437 BLAIR Ave, Current property owner(s) TARA PETRICCA Day phone Mailing address Real estate agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well F Private Septic El Water Storage ❑ Holding Tank' ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ J`-S� Waiver Fee $ Date of Payment ��� U ��� Date of Payment Receipt Number Receipt Number COSA # Q 5C l q 1 L/" 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 C&M ENGINEERING Phone 8545558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI Date 9/20/2019 ,Aw OF A��sll� 49 r . — -•* 6. DSDSIGNATURE _ : ;C�•1.� • • O System #1 Approved for bedrooms /� � CHARLES G BALZARINI System #2 Approved for bedrooms t✓�F��s.• CE-13854 •.Aiw� Disapproved �l�iF�PROFESS1oNP� �r� Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: 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 Checklist blue sheet COSA Checklist Legal Description: T15N R1 W SEC 5 LOT 120 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled unk Total depth 50 ft Cased to 50 ft Al Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) +12 in. Date of flow test for COSA 8/20/19 Static water level at beginning of test 14 ft. Comments well was previously a class c water supply B. TANK DATA Age of tank(s) 11 years Tank type/material STEEL Q Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA SHALLOW TRENCH Which system tested (date installed) 2008 V ALL standpipes present per record drawing Total measured depth from grade 7 ft (max) Measured depth to pipe invert from grade ft (min) ❑Q N/A — pressurized field ❑■ Monitor tubes go to bottom of drainfield. If not, state depth into effective ❑■ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced NA gallons Comments/Deficiencies: see general comments COSA Checklist yellow sheet Parcel ID: 051 082 28 Structure served by this system 2 Well production at time of test +3 gpm Water storage tank volume na gallons Well disinfected for coliform test? ❑ Yes 0 Nc Q Coliform bacteria is Negative Nitrate 1.15 mg/L ❑ Nitrate less than MRL (ND) Arsenic 8.63 ug/L 0Arsenic less than MRL (ND) Collected by C&M ENGINEERING Date of Sample 8/20/19 C. LIFT STATION ❑■ Required maintenance completed Age of lift station 11 years Lift station material steel Comments: step tank, steel tank with plastic riser Adequacy test date 5/6/19 Results ® Pass For 5 bedrooms Fluid depth prior to test 3 in Water added 750 gal New depth 14 in Elapsed time 1440 min Final fluid depth 2 in Absorption rate 750 gpd Any rejuvenation treatment (past 12 months) NO If yes, enter date N/A E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' F./ Yes if No Community Sewer Manhole/Cleanout > 100' Q Yes if No ft Q Yes if No ft Neighboring Tank > 100' QYes if No ft Private Sewer/Septic Line > 25' 2Yes if No ft Absorption Field on Lot > 100' Q✓ Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Q✓ Yes if No ft Q Yes if No ft ft Community Wells > 200' Q✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ✓❑ Yes if No ft 7Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' F./ Yes if No ft Surface Water > 100' Q✓ Yes if No ft Property Line > 5' Q✓ Yes if No ft Driveway/Parking > 0' 0✓ Yes if No, comment Absorption Field > 5' QYes if No ft Wells on Adjacent Lots: Water Main > 10' F✓ Yes if No ft Private Wells > 100' Q✓ Yes if No ft Water Service Line > 10' Q Yes if No ft Community Wells > 200' Q✓ Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Q✓ Yes if No ft Driveway/Parking > 0' OYes if No, comment Property Line > 10' ✓0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' 0✓ Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' QYes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS The system servicing the garage was decommissioned. The garage is now tied into the 5 bedroom system. Maximum bedroom count can not exceed 5 between the home and garage unit without system upgrade. Damaged field and tank cleanouts were repaired. G. ENGINEER'S CERTIFICATION a-�4~��®`� Aaw Pkv A�'qs��� I certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with ,;:r ll -I '91 MOA COSA guidelines in effect on this date. 09/16/19 • 4. CHARLES G BALZARIKI ;Fc.�TF� CE -13854 �� COSA Checklist yellow sheet i £ s n F LI ' 6f § s racaww,«wwe i � p y 9 i M• } s �c d r� a f AS -BUILT Thereby certify that 1, have surveyed the folYov,hig'•descril ed property: ss� Anchorage Recording gPrecinct, Alaska, and that the improve- i £ s n LI 6f § s racaww,«wwe i � p y 9 r� a f AS -BUILT Thereby certify that 1, have surveyed the folYov,hig'•descril ed property: ss� Anchorage Recording gPrecinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent there- �q ' E _ „.• � to, that no improvements on property lying adjacent thereto .-maw encroach on the premises in question and that there are no roadways,, transmission lines or other visible easements on said propertyexcept as indicated hereon. p vw N� Dated at Eagle River, Alaska ! < this L 4 � day of 7� 19 ROB RT C. JOIMSUN a SCALE:Regzstered Land Sur No. 880 -LS 1>' - Box 456, Eagle Raver Alaska Phone (907) 694-254.3 Owner Petricca Septic Tank: -Sludge level inches Lift station: -Pump basket cleaned$es no -Control floats cleanednc -Operation satisfactorync Lift Station/Pump Vault Street Address 21437 Blair Pumping: requiredey s no -Pumping completedey s no Effluent filter cleaned es no Proper float settings confirmed (jjD no Alarm System: -Dedicated electrical alarm circuit es no -Audible and visual alarm inside dwellin es no -Alarm system operation not satisfactory Manhole Riser -Ground water intrusion at riser to tank connection es no -Ground water intrusion around pipe penetrations ygs no -Manhole lid: Functional es no Insulated es no Other -Weep hole functional es no Properly Secured es no -All manufacturer required inspections and maintenance completed es no Comments: No issues noted, manhole lid was loose. Qualified Maintenance Provider: Technician C.Balzarini Company C&M Engineering Signature Lam - Date of maintenance 8/20/19 Date 10/7/19 APPLIC \IT FILLS OUT UPPER HAL ONLY Properly Owner fie / d" 4/3„, (0 I D /) Mal:ing Address P0, it; Ox r CAI,/ % i0 = Zip Code q CI`, ,47 %'�.c -},cern..— Zip Code Phone (p e("„2ii / Buyer //lJ Address / 4 Lending Institution Address .. li Zip Code Phone Really Co. & Agent ///� Address / A f Zip Code Phone 111, i Legal Description d/aa {.G r r/S/✓ Street Location j A/%%, e d(/ (,7 / /`) /Z/id i /' :Ji4'7 s' in • N- fJ l/ 0 Lf. cif A/ c' f Li .i / Type of Residence /' t Single Family o Multiple Family No. of Bedrooms�i ❑ Other Walleer Supply p Individual ❑ Community 0 Public Utility ATTAGFI WELL LOG. A well log is required for all wells drilled since Junb 1975: For wells drilled prior to that date, give well depth (attach log IL available). Sewer Disposal Individual 0 Public Utility ❑ Holding Tank --- Year Individual Installed: / VW -� When Connected to Public Utility: Solis Rating Et 1 NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH FnEOUEST BOAF PROCFS$ING CAN BE INITIATED. JP er_Ill_n/min- Time Time Time Time lot .. + Date Date Dale <, Date Inspector ��., v � 0' Inspector "' Cn,1)(PA • Inspector 2dn Y \ inspector Inspector pyo ///'`� ✓" Field Notes ,..)--b // MUN CIPALITY OF ANCHORAGE Y` DEPT CP F.•.. IX ' -TION FiNVROill;ti.PilA_;.,U.• — u C T 1 8 1982 RECEIVED ( Lt -APPROVED BEDROOMS3 ( ) DISAPPROVED.,; ( ) CONDITIONAL APPROVAL' DATE /r7 - 'CONDITIONS OF APPROVAL ��<< /l ciee _c_. Solis Rating Date Sewer Installed LD-'` 1 1 Well To Absorption Well to Tank C.‘ \‘ Area )q Well Log Received Septic Tank Size / Q U 0 1023 (3032) 3330 IID❑ GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality Street, Anchorage, Alaska 99503 274-4561 Date Received 8/5/74 Time of Inspection ln•nn am Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR VA 1. Approval requested by: Selective [malty Mailing Address: (Pat ;Tarry) Eagle River AK 2. Property Owner: Gerald L. Arthurs Phone: Mailing Address: 3. Legal Description: Lot 120 Sec 5, T15N, R1W SM 4. Location: Off Bowery Lane .—i1/ ,/'74 Phone: —64E4-2112 5. Type of facility to be inspected Single 6. Well Data: A. Type Drilled No. of bedrooms 3 _ B. Depth _ 50' C. Construction 6" Casing _ D. Bacterial Analysis Sa 7. Sewage Disposal System: A. Installed 1971 B. Installer _ Spring Craellxc:ava.i-ing C. Septic Tank: 1. Size,Rxt#xix 2. Manufacturer Mark S,mml (1000 gals D. Seepage Pit: 1. Absorption Area 17x14x6' 2. Material jog E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank 61Absorption area my , Sewer Lines _, Nearest lot line ____10p , Other contamination B. Foundation to septic tank j' , Absorption area C. Absorption area to nearest lot line file EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - Rec., Legal Description st;for Approval of Individual er & Water Facilities tad 77(5//1 Comments e n s 11ow 11; Sewer unknow:- Approved nknalc Approved Disapprov Approval Valid for Greater Anchorage Area Borough, n DIAGRAM year from date signed epartment of Environmental Quality Date I/9/7/ OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date