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Home My WebLink AboutWYNTER PARK #1 BLK 2 LT 11Wynter Park #1 Block 2 Lot I I #051-492-12 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, A[aska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELL INSPECTION REPORT LEGAL DESCRIPTION LOCATION ~ ~ ILiq capacit~y~ i~tgal onsl NOMEMADE: DISTANCE TO: [Well NO. OF BEDROOMS Dwelling DISTANCE TO: No. of lines ~'¢ Top of tile to fi~jsl~gryte L0ngth Width Type of crib Well DISTANCE TO: Depth Inside length Width Material Nearest Io~-~ine f' ~ Liquid depth PERMIT NO. Liquid capacity in gallons iti¢'l area PERMIT NQ. DISTANCE TO: OTHER PIPEMATER ALS (// SOIL TEST RATING . Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line Sewer line Septic tank (Rev. 3/78) DATE LEGAL GRE,' ANCHORAGE AREA BOP "'"H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME LOCATION MAILING ADDRESS PHONE LEGAL DESCRIPTION L/ // ,/~'Z /~ ,/~"b~ SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH COMPARTMENTS 7.._ INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /000 GALLONS. SEEPAGE Pit: NUMBER OF PITS / DIAMETER ~1 OR WIDTH , LENGTH ~'~,' DEPTH (f~ ! LINING MATERIAL CRIB SIZE: DIAMETER ~ DEPTH ~t DISTANCE FROM: I TOTAL EFFECTIVE BUILDING FOUNDATION , NEAREST LOT LINE -~.~.~l, ABSORPTION AREA (WALL AREA) WELL 3~ SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE ~I~____CONSTRUCTION DEPTH BUILDING NEAREST NEAREST SEPTIC FOUNDATION LOT LINE SEWER LINE TANK CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No, EQ-031 7 DATE App ROV E~"'~ ~ L PERMIT NO. ~'""il Ell IP41 :~ O ~ Il"-"" IF=ti L DEPFIR. TMENT t"*- NEFILTFI RND ENVIRONMENTRL ' "OTEC'T"rOI'.,I Nfl F'EET'' qi'4_.HLF,HbE, BK. ( 800543~ ) RPPLIC:RNT ERICKSONS BRC:KFIOE S.R. LOCR'f' 101'.~ F'RRK I.':,R I ',,,'E LEGFII... LO]" 2L~L BL,~,": ;2 14'eNTER PI=IRK SUB BOX 90~0 'TYPE OF' SOIL FIBSORPTION SYSTEM IS: TRENCFI LOT SIZE 688-D280 ~0000 SQURRE FEET MRXIMUM NUMBER OF BEDROOMS = 4. SOIl.. RRTINO (SQ FT/BR)= 276 THE RI;S:6I]JIRED SIZE OF I'HE SOIL RBSORPTION SYSTEM IS: TFIE LENGTH DIMENSION IS THE LENGTH (IN F'EET) OF THE TRENCH OR C, RRINFIEL[.',. THE DEPTM OF R 'rRENBM OR PIT I"S THE DISTRNCE BETI.4EEN 'rile SURFRCE OF ]"HE GROUND RND THE BOTTOM OF THE EXCR',,,'RTION (IN FEET). THERE iS NO SET 1.4I[:,TH FOR TRENCHES. TFIE GRFIVEL DEPTM IS THE MINIMUM DEPTM OF' GRRVEL BETNEEN THE OUTFRLL PIPE BND THE BOTTOM OF THE EXCRVRTION (IN FEET). PERMIT FIPPLIF:~NT H~S THE RESPONSIBILI"rY TO INFORM THIS [:,EP~RTMENT DURING THE INSTRI_LI~TION INSPECTIONS OF' RNY NELLS RDJ~CENI' TO THIS F'ROPERT~' RNE:, THE NUMBER OF RESIDENCES THFiT THE NELL MILL SERYE, ....... -F ~..~ 0 ( 2-3 ::. ]: t"-~ 5~ P El C~ 1- ~: t--~ I'-! S Iq R E F-: E (7! ti ][ F: E [:) BFICKFILLING OF ~NY SYSTEM NITHOUT FINRL INSPEC;I'ION RN[:, RPPRO'¥'~L BY TNIS DEF'FIRTMENT I.,.IIL. L BE SUBJECT TO PROSECLITION. MINIMUM DISTANCE BETWEEN R t.,.IELL RND RNY ON-SITE SENRGE DISPOSRL SYSTEM IS d. 00 FEET FOR R PRIVRTE NELl. OR J. 50 TO 208 FEE';' FROM R PUBLIC NELL DEPENDING UPON THE TYPE OF PUBLIC NELL MINIMLIM [:,ISTRNCE FROM FI PR.I',,,'RTE NELL TO R PRI'¢RTE SENER LINE IS 25 PEET RND TO R COMMUNI'T'Y SENER LINE IS 75 FEET. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRFtMS BF.'E RVRILRBLE TO INSURE PROPER INSTRL. LBTION. I CERTIF'Y THRT ].: I RH FFIMILIRR NITFI THE REQUIREMENTS FOR ON-SITE SENERS FORTH B"r' TNE MI. .IT'¥' OF FINCHOR. RGE. 2: I MILL INS7 THE S'¢STEM IN RCCORDRNCE NITH THE CODES. ]:: I SENER SYSTEM MR'~' RE6~UIRE RESIDENCE I', MORE THRN 4 BEDROOMS. AND NEL. LS RS SE]' ENLRRGEHENT IF THE _ f ~E, E:FIE:KHOE ISSUE[:, B --. [ PTE .... ~- '¢4, 0 PERFORMED FOR: LEGAL DESCRIPTION: 1 2 §- 7 8 12 1~- 17- 20- COMMENTS PERFORMED BY: 72-008 (6/79) [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLOPE )ERFORME£ PERCOLATION TEST SITE PLAN Rober~ A. Nc,. ENCOUNTERED? ~/'/~,'¢ ~) P IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop ,,/,'::7 i:" ¢S.~: S Engmeerm9, BETWEEN , (minutes/inch) , ~- ""~ FT AND ~ FT // �a e 5�1b/o� Municipality of Anchorage Development Services Department Building Safety Division , On -Site Water and Wastewater Program ' 4700 Bragaw Street *A. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orgtonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 05I-uq21-12 COSA #_ DtCDlR Expiration Date: 5 = 12 — O '7 1. GENERAL INFORMATION Complete legal description Lot 11; Block 2; Wynter Park Subdivision tl/ Location (site address) 24575 Park Dr. Chugiak, AK 99567 Current Propertyowner(s) Jerome Raychel Day phone 753-2681 Mailing address same Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will behold by DSD for pickup. 2. --NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System 13 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ 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 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 Onsite 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. 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 S b S Engineering Phone 694-2979 Address17034 N Eagle River Loon Ste. 204 Eagle River, AK 9957 Engineer's Printed Name Robert A. Shafer 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Date 4A x tn,.t. pb , 1474 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 O,�j�� / /(/, Original Certificate Date: — (Rer. 11105) Municipality of Anchorage .• • Development Services Department Building Safety Division On -Site Water & Wastewater Program ' • °' 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsfte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: LT ') TjL'ne ( 02 ', (- 4AJ7L5-2 i7Parcel ID: 00— Ll q;t -/a A. WELL DATA_PUP)UC- (t)ATnz(DQA-00J Well type _ It A. B, or C provide PWSID # _ Well Log (Y/N) Date completed _ Sanitary seal (Y/N) _ Wires properly prof /N) Total depth ft. Cased to ft. Casing (above ground) in. FROM WELL LOG T INSPECTION Date of test Static water level Well production g.p.m. g.p.m. WATER SAMPLE R TS: Coliform colonies/100 mL Nitrate mg/L Other bacteria colonies/100 mL Ar ic: _ mg/I Date of sample: _ Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material S'&i>(-1 C C . Date installed I `y4 4b0 Tank size 12-60 gal. Number of Compartments 2 Cleanouts&) c --S Foundation clearwut&) ';, Depression over tank (Y R� _L2LD High water alarm (YM Date of pumping qh7hb Pumper WrltS (�y4YlplAjil r C. ABSORPTION FIELD DATA Date installed JklLeo Soil rating (g.p.d./fly ftz/bdrm L970 System type _1�f �P T_ E-0 CAi Length r) ft. Width rN(tKf, Gravel below pipe -7 Total depth JQ_ ft. Eff. absorption area 1571le Monitoring tube Depression over field _L_)4 Date of adequacy test Z 0 Resu Pas ail For -Lbedrooms Fluid depth in absorption field before test in. Water added�( gal. New depth in. Elapsed Time: iU0min. Final fluid depth �r ps p �, in. Absorption rate >_ & -f _� g.p.d. Any rejuvenation treatment (past 12 mo.) (Ygk type) N If yes, give date — D. LIFT STATION Date installed Size in gallons 'Pump on' level at —in. 'Pump ofr leve Datum Cycles tested E. SEPARATION DISTANCES High water alarm level at Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: fw8(•tL LOATtf- Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service areas On adjacent lots Public sewer manhole/cleanout "OOMgtank �y&xl.V /"A Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: l Building foundation 5 r4- Property line C,4- Absorption field S t Water main b lI Water service line to r4 Surface water 1 oo '+ Wells on adjacent lots 2-6ff5 -✓ T11 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: I Property line 10'4- Building foundation 10-1- Water main Water Service line It 14' Surface water 100 � Driveway, parking/vehicle storage I 0 I4 Curtain drain #k)AC* I140mwV • Wells on adjacent lots ?eo D4 - F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined review of Municipal records td conformance with MOA COSAA Engineer's Printed Name J/� C Date COSA Fee E o Date of Payment 5//0 Receipt Number (Rev. 17/05) h field inspections and f •% *r4 above SySt m are • t r sinpri e t f` 'F Waiver Fee $ Date of Payment Receipt Number E ' •.fid \ •ti•"' ' .7131.01 �. , E"Gtr L I. hereby certify that I have surveyed the following described ProPert :_LO_�ii � n/- AS -BUILT A ' W• l . a .. (7 •h•pw•M•! r ! � . Anchorage Recording Precinct, Alaska, and that the hnprovements situated thereon are within the Property lines and do not overtop or encroach on the property - lying odjuvrit thereto, that no iml,rovementa on prop. erly lying adjacent thereto encroach on the premises ,n- flgPAtlOn and th,l theft are no roadways, lto nSmlElion hnes'or olh-•r visible easements on said properly except aslndicnted hereon. Dated at Engle Ri:er, Alaska this_ 13_m day Ro3ERT C. Jo11NSot1F�.� SCA I.E: / Registered Land Surveyor No.foo-Ls Bot 456, Eagle River, Alaska ' Phone 694 2543