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HomeMy WebLinkAboutVERN HAIK LT 1Vern Hal*k Lot 1 #051-061-79 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division - 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name f Manufacturer DISTANCES 11 TO FROM SEPTIC TANK ABSORPTION FIELD WELL Addfe55 WELL 7 ZG�� 1 >ZCd original grade 461 FT Phones) Permit No. ����z I Noooms . cf Bedr 3 LOT LINE zZ1 �/ I 7zOU LEGAL DESCRIPTION Lot Block Subdivision I -I FOUNDATION Number of lines Soil rating Pipe material Township. Range, Section ,I — — - _- AS -BUILT DIAGRAM (Show location of well, septic system. property lines, foundation, TANKS SEPTIC ❑ HOLDING Manufacturer Capacityin gallons 11 Material N of Compartments Z -e' L9� TYPE OF SYSTEM TRENCH O BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from original grade original grade 461 FT t - Fill added above original grade Gravel depth beneath pipe FT c ) Gravel length Gravel width FT j 1 Total absorption area Distance between lines 636- SQ FT Number of lines Soil rating Pipe material /%� SQ FT fi-S-Fm D.ID"t'l ❑ PRIVATE 1 REMARKS: I MEN= IMMMEN' WELLS OTHER (Identity) Total DepthCased to � C FT FT Date Installed: 'n,..... 1 1,) I_1A ( W t.. t Municipal and State guidelines in effect on this Health Department Approval: )13(3/85) 3pections Performed by. Date: that this,inspection was performed according to all 9 itn K 1 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343 4yyj~45AI O N S I T E SEWER & SEPTIC TANK PERMIT F`wmit Number: 890211 UaLe Issued: 09/29/89 Engineer Designed Mwner Name: ALASKA MORTGAGE GROUP Day Phone: Owner Add,ess: 920 W. b7 AVE. 272-6616 ANCHORAGE, AK 99501 Parc"! ld: 051-061-79 Lot |egWa Uuhdivision: ;ERN HAW Lot: 1 Block: - Section: 3 Townships 15N Ranges 1W Lot Size 30000 (sq"ft" or acres'/ Max Bedrooms: This Permit: 3 Total Capacity: 3 SEPTIC TANK: Minimum total septic Lank capacity: 1,000 gallons" Each septic iank must have at 1east 2 compartments. Depth to top of septic tank(s) n 4"0 ;e/L ,=|ui,es insulation over tank (a). INSTALL PER EN8INEERS A[[ACM[D DESIGN. NOTIFY DHHS PRIOR TO EACH inn in[ION" lHIS PERMIT IS ISSUED FOR A 3 BEDROOM SINGLE FAi1lLy DWELLING ONLY AND EXPIRES 12/31/88. [ C[Rl1FY THAT: 1, 1 am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. i will instaL| Ur system in accordance with all MOA codes and regulations, and i,n compliance with the design criteria of this permit, 3. l will ;.]here to all MOA and State of Alaska requirements for the set back distances from any existing wellv wastewater disposal system or public sewc,�1, 1Lhid t nearby lot" 4. I unde maximum of 3 badrooms. I also u al system is 3 bedrooms and any enlpermit., SigneJ: DATE: -7----r-------- OP- <Owne�) 'J_.ASKA MORTSAGE GROUP Issued 8y: !DA HE _.. voa i HO Dov, LOT I BGK.-E �D I �S VEFU HAIK Lommtbv rry vm4L- DAWN WATEe CoARAA Wall over Zoo' F;o,n Wr s Mole d P"po-�J A&soept,o. Sysder , Gw�ier: ,der vc 'G72-ti�lro �, .- I�scr+� P, f �HOVse I 0 Q) 000 00 X41 �E%IST, SYSTe M IJ N SCALE:NOTE• II _ o' THE ACCURACY OF LOCATION OF EXISTING 31 n Tv -5 ,I Des -1-' Vk Xy dQ nC�k �r'° ctnTsePr c �a 5 d e x ...r5'r-F, ice•"-i-r-e� 1-7g X3 24 r 0� u��rPrfllOe.-_535s..fi. q SEWER SYSTEM LOCATION PLAN DATE, SHEET OF I 1 -B' 1 VEIEWSOW E SECTION/ TOWNSHIP/ RANGE Sr -A SF -C- Z i SCALE:NOTE• II _ o' THE ACCURACY OF LOCATION OF EXISTING PROPERTY CORNERS, WELLS, AND 3EPTIC D AWN DYE dY3TEM3 INDICATED 13 NOT EXACT, NORTH DIMENSIONS INDICATED HAVE BEEN DETERMINED BY USE OF CLOTH TAPE AND NOT BY SURVEYING TECHNIQUES. "M liI PREPARED FOR, DATE, SHEET OF y Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOGp— PERCOLATION TEST PERFORMED FOR: P ul 4�=7�� DATE PE LEGAL DESCRIPTION: Loo- / RIK.e- LLEM f4/41CS` Township, Range, Section: 004 v s S 013 01 U sf© N SLOPE WAS ND 10 n .- o ENCOUNTERED? ER Y11.CL ENCOUNTERED? r' H IF YES, AT WHAT / L W J O DEPTH? p 12 TALI) No G-ro0d rfu i)-�,-E �hccvn fere;[ Depth to Water Atter NO Grtu ` 13 Monitoring? Dale: qlrila 14- 15- 16- 17 4151617 18- 19- 20- COMMENTS 81920 COMMENTS SITZ PLAN Reading ( A C sa7[o �G�aPeL 1 L 000 V00 L -F, grn. 20 3 U p o mr 4 c " d)sa i 12"t ¢t' ,d- 6 fl 04 s; ! f, 0 6 6 rGwA w /;�j M tKfV"e_ 8 j 9 i a SLOPE WAS ND 10 n .- o ENCOUNTERED? ER Y11.CL ENCOUNTERED? r' H IF YES, AT WHAT / L W J O DEPTH? p 12 TALI) No G-ro0d rfu i)-�,-E �hccvn fere;[ Depth to Water Atter NO Grtu ` 13 Monitoring? Dale: qlrila 14- 15- 16- 17 4151617 18- 19- 20- COMMENTS 81920 COMMENTS SITZ PLAN Reading Date Gross Time Net Depth to Net Time Water Drop L 20 q o mr PERCOLATION RATE 1l, f r t�% (minutesnnch) PERC HOLE DIAMETER TEST RUN BETWEEN 4 FT AND FT PERFORMED BY: �) �.�/ . ri K'_FTS I �SYL CC— -J' `'_1''t' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: �:. � /a C� 72-008 (Rev. 4/85) 1 Municipality of Anchorage -.•\ Development Services Department Building Safety Division K ' On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage. AK 99507 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1)51- Olt! 1- —4 C; COSA # 59A Expiration Date: q .3 D — U 9 1. GENERAL INFORMATION Complete legal description Lot 1; Vem Haik Subdivision Location (site address) 24616 Dawn Ln. Chugiak. AK 99567 Curte�nt;Property owner(s) Joe Hail Day phone 688-6162 Mailing addres3 Lending agency Day phone Mailing address Real Estate Agent Nancy Stahly / King's Real Estate Day phone 307-4113 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site❑ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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 lime of installation. Name of Firm S a s Engineering Phone 694-2979 Address 15861 S. Birchwood Loop Chugiak, AK 99567 Engineer's Printed Name Q C Q Lye : C _ Co c✓i3, Date `7 Ay A 5. DSD SIGNATUREm coeattCE-88o C. COWAN � �Approved for j� bedrooms. si� r,�fo Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By Original Certificate Date:=�=VB Municipality of Anchorage Development Services Department Building Safety Division ` On -Site Water& Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: LT ``r VK–W &IK a0& ParcelID:OJrI -OCI '79 1' A. WELL DATA! Well type sl3i..1C. If A, B, or C provide PWSID # _ Well Log (YIN) Date completed _ Sanitary seal (YIN) _ Wires properly protected (YIN) Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water level _ Well production _ WATER SAMPLE RESUL Coliformonies ft. 00 mL Nitrate mg/L Casing height (above nd) in. AT ft. Other bacteria colonies/100 mL Arse ' . _ ug/L date of sample: _ Collected by: B. SEPTIC/HOLDING TANK DATA Tank TypelMaterial . - . "Siml G STE-CL Date installed �� D Tank size 1000 gala ,, ,umber of Compartments a CleanoutsON) ; 1155 Foundation cleanout`)N)) ' Dep s ion over tank (Y� High water alarm (Yfi�ji� l,ue 1� LVILvA r Date of pumping --_ Pumper C. ABSORPTION FI LD DATA Q ^–�– Date installed X&IPgg Soil rating (g.p.d./ft2 or t2/bdrm 178 System type c�I41i11 11Zfrl7Cil r Length ft. Width 6' ft. Gravel below pipe o7•b ft. r Total depth ft. Ef . absorption area iP Monitoring tube Depression over field Date of adequacy test Result (Pas aiq For 3— bedrooms „ n Fluid depth in absorption field before test 0 in. Water added gal.: New depth in. Elapsed Time: 10 min. min. Final fluid depth 3 in. A Absorption rate >= So t g.p.d. Any rejuvenation treatment (past 12 mo.) (Y� type) NO If yes, give date D. LIFT STATION N 1h Date installed Size in gallons "Pump on' level at _in. 'Pump off' I Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: f OBLUC- High water alarm level at in. Meets alarm & circuit requirements? Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service lin Animal c ment areas QD AQP— On adjacent lots Qn.adcentlots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: I r r Building foundation S4 Property line $ Absorption field $ '/ 1 � � Water main Water service line /D Surface water /00 r� Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /D t'r Building foundation /O '/ Water main I r / Water Service line 104, Surface water 100 f Driveway, parking/vehicle storage Curtain drain )UC)M /WftdA) Wells on adjacent lots 4L F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and 7 review of Municipal records that the above systems are in'r conformance with MOA COSA guidelines in effect on this date. n �^ ? Rolf Rt C COWAN Engineer's Printed Name K Q X -47-` a wA.� �ic\ CE-88ot' Date COSA Fee $ Date of Payment 9 Receipt Number. A/✓RN)b (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number 3cF61S D+1wN LAID t l T. I A. ur n i � C j i m Y i ice) -'i I �'• y � — N Ii AS -BUILT , > 0 1 hereby certify that 1 have surveyed the following described property. G 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 hying adjacent thereto, that no IT on property lying adjacent thereto encroach on the premises in question and that there are no roadw'avc, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska this ` c aay of 200= ROBERT C. JOHNSON SCALE: Registered Land Surveyor No. 890 -LS v y el' Box 7-0456, Eagle Rivir, Alaska 9957 Phone (907) 694-2543 r• , rj ; i f t. ••' e; • i ur n i � C j i m Y i ice) -'i I �'• y � — N Ii AS -BUILT , > 0 1 hereby certify that 1 have surveyed the following described property. G 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 hying adjacent thereto, that no IT on property lying adjacent thereto encroach on the premises in question and that there are no roadw'avc, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska this ` c aay of 200= ROBERT C. JOHNSON SCALE: Registered Land Surveyor No. 890 -LS v y el' Box 7-0456, Eagle Rivir, Alaska 9957 Phone (907) 694-2543