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Home My WebLink AboutWALTER G PIPPEL ADDITION BLK 9 LT 4Walter G IPP e I Addition Block 9 Lot 4 #050-123-27 TpI.NOlA4F APS - EtaL-1.0L,_')F11 Ci 62Q('�, GREATER ANCHORAGE AREA BOROUGH Department of nvironmental Quality 3330 "C" Street, Anchor ge, .Alaska 99503 274-4561 0 �U01Osu' ZO Date Received July 23, 1976 ��. � 0 ar xo' 0 Time of Inspection /,&0 pry( -�� J Date of Inspection p ��QQ� REQUEST FOR APPROVAL OF / IVIDUAL SEWER & WATER FACILITIES FOR v. A. 1. Approval requested by: First National Bank of Anchorage Mailing Address: Post Office Box 4-2090 99509 Phone: 2. Property Owner: Robert & Doris Lace Phone: Mailing Address: Post Office Box 279, Chugiak 99567 % Debbie 274-1561 694-9125 3. Legal Description: Lot 4 Block 9 Walter G. Pipple Subdivision 4. Location:NHN Park Way Eagle River 5. Type of facility to be inspected Single Family No.,of bedrooms 3 6. Well Data: Individual A. Type C. Construction 7. Sewage Disposal System: A. Installed 1972 B. Depth D. Bacterial Analysis On—site system B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank / Absorption area e , Sewer Lines Nearest lot line --- 777 --Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages MUNICIPALITY OF ANCHORAGE �rr< • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA ASHA FHA CONV 2. Property Owner: ROBERT AND DORIS LACE Mailing Address: P.O. Box 279, chugiak, Ak. Day Phone: 694-9125 3. Name of Buyer: Josh Corley Jr., and Thela Corley Mailing Address: 103 Heintzleman Dr. Day Phone: 277-3328 4. Name of Lending Institution: lst National Bank , South Center, ATtn: Debby Mailing Address: P.O. Box 4-2090 Phone: 274-1561 5. Name of Realtor or Agent: GREAT LAND REALTY Mailing Add 6. Legal Description Location P. O. Box 279, Chugiak, one: 694-9354 Lot 4, Block 9, WALTER G. PIPPEL Sub. NHN Park Way, Eagle River,Ak. 7. Type of Facility to be Inspected: Single family No. Bdrms. 3 8. Water Supply Type of Supply: Public Utility Individual drilled well If Individual, number of dwellings presently served l 96' If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) x If Individual, date of installation 1972 72-003(3/76) Page'2 of -two pages - ReG�t for Approval of Individual ;�!r & Water Facilities 'Legal Description lot 4 Block 9 Walter G. Pipple Subdivision Comments Approved . isapproved Dated Approval;Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true anc accurate representation of the subject sewer ano water taciiities ana tinese TaG1116ieb are operating satisfactorily. SIGNED (�VAJ Date 11 EQ -034 (1/74) ADHW - LI,iB 2W DATE �IHIC vr.. /iLMJnM D _�RTMENT OF HEALTH AND WEL qE DIVISION OF !PUBLIC HEALTH BACTERIOLOGICAL.VATER ANALYSIS PUBLIC F1 SEMI-PUBLIC F-1 INDIVIDUAL OTHER REPORT RESULTS TO NAME ADDRESS CITY ADDRESS OF SOURCE SAMPLE COLLECTED BY - - .DATE COLLECTED TIME Sample Collected From D Klmhen Tap D Other (list) LLECTED -- Balhroorn Top Basement Wen- U Das 0 Driven U Drilled U Bored - SOURCE: - U Spring U Cistern D Other Dug Well or Cistern Construction: - . - Ca Walls - U Wood U Concrete U Metal -❑ Tile TOP - -0 Wood U Concrete - U Metal - D Open Top LOCATION: -❑ In Basement D Basement Onset 'U Under House - - _ ❑ In Yard ❑ Other Building S Septic - - DISTANCE TO: rorother D inagoPipa Feet. Took - Tile - Seepage - Cess- . Field -Feet Pit Feet. Pool Feet. Privy Other Possible ' c GENERAL: Does Water Become Muddy. or Discolored? 'D Yes U No l Lab. No. OFFICE Records in this office indicate this WATER SUPPLY to be of. El S 64crdory D Qaeshonable U Unsatisfactory Sanitary Status. Analysis shows this Water SAMPLE to be: -� U Satisfactory D Questionable D Unsatisfactory. -' If an "Unsatisfactory" or"Questionable" status is indicated above am pra you should take immediate action as recommended below I. Notifyconsumers water is polluted. Boil or chemically- . - treat this wafer as outlined in the enclosed leallef "Drink If Pure." - I 2. Increase chlorination sufficiently to meet recommended residual standards Determine source of contamination and take action necessary to maintain' - a safe water supply of all limes. - - - - - _3.-Check'chlorination and other mechanical equipment Make cerlain-it is functioning properly. - -4. If :offer checking equipment a -disinfecting residual is not obtained, please w;re this office for emergency assistance or advisory services. - - - S. This iso surface water scarce b ad subject to pollution by man and animals. An approved water supply source should be developed. - .. —F. Improve your ❑spring - U dug well ❑ drivenwell _ - 1 O. drilled well ❑ cistern. - - - _7. Relocateyour well to a-sule location in relationship toyoursewage - disposal system. D see enclosure - 8. Sample -Foo long in transit; sample should not be over 48 hours old at examination to indicate reliable results; please send new sample. U Bottle Broken in transit, please send new sample. 9. Contact your. nearest ❑local Health. Department or EJ Alaska _ Division of Public Health, sanitationofficeforbulletins, consulfalion and -- assisfance.- - - - - SANITARIAN'S REMARKS - '- Diameter of Well Iocc - IOcc LOcc O.lcc Depth Feel - Well Ca ing - tMate ial Brilliant Green Diameter Depth - - Length of - Drop Pipm—From Water Depth - - Bollom Feet. - PUMP LOCATION: D In Well D _Offset1. D In Basement ❑ RoamIn ilityBasemen_ - On TOP-.. - 00 I Well - ❑ Other - PURPOSE OF EXAMINATION: Illness Suspected? El Yes D No - New Source al Sepaly? U Yes O No Repairs to System? U Yes U No.: - _. - - Signature - BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS am Data Received r (� / r1 Time Received pm `. Lob. No REVERSE SIDE BEFORE COLLECTING SAMPLE OIL Lactose Broth - - -IOcc IOcc IOc< Iocc - IOcc LOcc O.lcc 24 hours - - - 48 hours - .-'- Brilliant Green - 24 hours - - - 48 hours EMB 'La'ctose Broth, 24 hrs. 48 his: Coliform Density MF resells Reported byDote This analysis indicates Ccliferm Organismstobe: AGAR probable No. per 100cc.) Parcel I.D. 050-123-27 p.P4fr ,l'9Oi Municipality of Anchorage G On -Site Water and Wastewater Program '; s (907) 343-7904 Certificate of On -Site Systems Approval Expiration Date: 14 —4 `/ 1. GENERAL INFORMATION Complete legal description Walter G Pippel Addition, Block 9, Lot 4 Location (site address) 17105 Park Place Street Current Property owner(s) Travis Baker, Curtis Edward, Trudy Bouslaugh Day phone Mailing address Real Estate Agent P.O. Box 381, Sterling, AK 99672 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 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 0 WaiverNariance request for: Received by: � /91 L AIV° - Date: COSA to be released to the engineer, unless otherMse requested by the engineer. COSA Fee $ 4ARC) '11 Waiver Fee $ Date of Payment _I i a t ) l a P � Date of Payment Receipt Number b6(c(4 Receipt Number, COSA#_ DCAD-1 5 -?g 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 Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Alk. 99510 Engineer's Printed Name Steven R Pannone 6. DSD NATURE VS System #1 Approved for bedrooms System #2 Approved for _ bedrooms Disapproved Date Conditional approval for bedrooms, with the following stipulations: By: / Original Certificate Date: Th uniciali of orage Development Services Division (DSD) issues Certificates of Onsite 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 f 1.. c If more than 1 septic system is on the lot: COSA Checklist # + of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Walter G Pippel Addition, Block 9, Lot 4 Parcel ID: 050-123-27 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (YIN) N Date completed Unknown Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth Unk ft. Cased to Unk ft. Casing height (above ground) 24 in. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform Nea colonies/100 mL Nitrate 0.158 mg/L Arsenic AQ ug/L Date of sample: 12/11/2012 B. SEPTIC/HOLDING TANK DATA Tank size gal. m artmenl Foundation cleanout (YIN) _ Depression over tank Date of pumping Pumper AT INSPECTION 2012-12-19 55 ft 1.0 9 -P.M. Collected by: P.E.S. Date installed Cleanouts(Y/N) alarm (YIN) C. ABSORPTION FIELD DATA installed Soil rating (g.p.d./ft2 or ft2/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. abso rea ftz Date of adequacy test Resu Fluid depth in absorption field before test in. Elapsed Time: min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (YIN & type) _ Monitoring tube _ Depression over field _ s/Fail) For—bedrooms Water added gal. New depth in. in. Absorption rate If yes, give date D. LIFT STATION Date installe-J� "Pump on" level at Datum Size in gallons _ in. "Pump off' level at Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot N/A Absorption field on lot N/A Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ SEPTIC/HOLDING TANK ON LOT TO: Building foun Property line Water main Water service line Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Building foundation _ Water Service line Surface water Curtain drain Wells on adjacent lots F. COMMENTS Manhole/Access (YIN) #g r alarm level at in. Meets alarm &circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ G. ENGINEER'S CERTIFICATION i certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 12/21/2012 COSA brown sheet -1 0-10-1 2.doc Absorption field water Water main storage PeOPC® M9[D {10011 E1Ev. tA54\m1 S890 57'00"W wSB�J Gale"228.64' eunlo SEreAa 10' SAN. SEWER. ESMT. Bayer c sr a VX -----------�----- �a.arlaanwyc v g n vi � Cl) O LOT 3 o LOT 5 W TOR .A. LU 40.0 CD O D �OJ�O in O STORAGE N r r22.3 N \5�� o �G�40.0 25.4 Z A A V WELL • N890 57'00"E 228.64' M PARK PLACE STREET ---------------------------- UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPROOUCTION MAY CAUSE ERRORS IN SCALE. LUT suR sY SURVEY TYPE SYMBOLS iIX1NOAn011 AS-BU0.T [] FINAL STRUCTURE AS-BUILT ........... SET REBAR DRAINAGE ASPHALT ❑ PLOT PLAN ... AS-BUILT ... Lar SURIEY ... TOPOGRAPHY O FOUND REBAR ,A" � FENCE I CONCRETE As-Bux.T .. ND An QIAT ... NO 001 s T � ASSUMED ELEV. METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER. PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS. SEPTIC CLEANOUT% SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTIUTY CONNECTIONS AND TO DETERMINE ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION..+,��rr, Prepared by PLOT PLAN .••�E,4F,•;q�b� Robert E. Johns, Jr. &Assoc. �p;••' ••''•. Professional Land Surveyors 4w AV •.• ` 1700 Brink Driw. rayryr aN a lnn111nr Ares b« jr.� . � G • ANCHORAGE, ALASKA 995D4 Scale. 11 30, Rev. Lot S.F. Rec. Plat File No. Ar th FOUNDATION AS-BUILT •••'•••• •• •• • •..•.. ..... 1. lawl c AYnr. a, M!T wllN tl,el , - / "N •"'A Date Surveyed: 10/08/12 Drawn b Y REJ Checked by •"^eiww°A w °'Nw'^�`w ROBERT • 5"` W L Date Drawn: 10(0$/12 Grid: NW0252 WO 12-440 Me.n qM,w �j ''••. FINAL STRUCTURE AS-BUILT w 21 ��a.1 ♦e^'•.,• ,........ Legal Description: .^.•a ^� �^ « „•',� « "' a • ♦ ° P ° . WALTER G PIPPEL ADDITION +i�� BLOCK 9 LOT 4