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HomeMy WebLinkAboutSIEFKER #3 TR 5 LT 8$iefker #3 Tract Lot 8 #015-281-46 O o v x o� acn ypCD P-ZJ W t.--fyv�y o`�M�� O� ° -R'.r aP,w X68 79? o O 0 14 ��� ty �p� CD 0CD o CD 00 gig �y d O OD = 4 CD Z � �. co b �3 m pwZ pso&T A �O \��QY0r: �0 04 w y0rA � p p K yi �z�> m> sN i� N rL pa.�c arop p� o�'�'�00 o`�, CODCDy .,V4p.,w�' (Do•O �� p O Ngo Sp:; !'� •a' y °R O 5g�Nz � U)�N.ti UI�N .. gyp: °� 0 �y�o n O Q.ffn•.� W y 0 0 a � o.§4M.� A a 5 o4 g FT a z m� I? C:CO � C0 W V F j B. (aj 0 p'g5 N ooa ONo (D °' EL P. E' w g a1 a o- 000, lb 01 I =off X68 79? o N`n`".`'�"I� oma' :'TJ n: / FAX (907) C,-- Gr \��QY0r: .cu"Ifl HVJ I b e� o `3 -VgRa zd "A • • S 00,°07'40" m mm • Z V DECK 10.7' 48.0' CIO c14 18.8' m Cli EXISTING V Ps- -H OUSE - - 19.2 0 15.5'N' 20.0' • f • DECK S00°07'40"E J E R 11 ME N -P 0.30' 150.30' W +� • m W 0 STREET- 0 fTl 'J X68 79? g6 / FAX (907) • • S 00,°07'40" m mm • Z V DECK 10.7' 48.0' CIO c14 18.8' m Cli EXISTING V Ps- -H OUSE - - 19.2 0 15.5'N' 20.0' • f • DECK S00°07'40"E J E R 11 ME N -P 0.30' 150.30' W +� • m W 0 STREET- 0 fTl Gr ER ANCHORAGE AREA BORO~ D~z. rARTMENT OF ENVIRONMENTAL QUALI' 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 ~/9-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM ) ~L MAILING .2K.~Zj~)j/./.. ~z~.5--~/ NAME ~)' ~ ~~ ~ ADDRESS PHONE LOCATION__~/~/~-~~ ............. LEG AL DESCRIPTION SEPTIC TANK: ~_') }, ~ :),?5 ~;~ / ~ NUMBER OF DISTANCE FROM WELL~ ~'~ r~_~MATERIAI.~'~ ~~ COMPARTMENTS LIQUID CAPACITY GAt.tONS. INSIDE LENGIH . INSIDE WIDTH // SEEPAGE SYSTEM: SEEPAGE NUMBER OF PITS LINING MATERIA[ NEAREST LOT LINE / OUTSIDE DIAMETER /'"'-'~ _OR WIDTH __//=r~ / / _, LENGTH -/~.~/ ,DEPTH ..~ / ~)/~~J~. D~STANCE FROM WELL ~P~ ~_~ ~ , BUILDING FOUNDATION ~2,/ _ TOTAL EFFECHVE ABSORPTION AREA (WALL AREAJ~ ~ SQ FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF ~ A BSORP~O~N AREA ..~----'---~'~-, ~0~ , NEAREST LOT LINE DISTANCE BETT~E,~.i J'J;~~ TRENCH WIDTH SQ. FT. LENGTH OF EACH LINE TOIAL LENGTH OF LINES IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISIt GRADE DEPTH OF FILTER MATERIAL EENcAIH TILE __ IN. ABOVE TILE__ WELL: TYPE ~'~r'~,X,//. /~/~/'~, DEPTH ~ / NEAREST SEPTIC LOT LINE , SEWER LINE_ ~TANK DISTANCE FROM WATER , BUILDING FOUNDATION ":-'~ SAMPLE__ ~ , NEAREST SEEPAGE OTHER ~'"'-- , SYSTEM ~T CESSPOOL ~-~ , SOURCES DIAGRAM OF SYSTEM DISIANCES: GREA,ER ANCHORAGE AREA BOF,:u.~GH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 279-8686 PERM,T.O. 2'? SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION LOCATION / - *// ~ ' ' ~ . ,Z ~. '* ' ' FINAL INSPECTION: ~4 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK · /' FOUNDATION TO SEEPAGE PIt -~(~9 DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL DRAIN FIELD SEPTIC TANK, ., SEEPAGE PIT . TO RIVER, LAKE, STREAM, , DRAIN FIELD 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. OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATERhNCHO/pAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN AC;~/r. DANCE WITH SAID CODE, ,~.! A . ii'~R.:'%~ . 'd,P'!-<A 'F~R)! Perfc. z.med !,':,r O. Ho Atchley h~'~'~ Peri'~r,~,~ed 7/23/71 ~ '~' ~'~ .;>'_'~?~7,~i'~:~'~ii?-'~ ...... f~7~['%~ ............. '~3~/~'~"~?~'7~ Siefker No,'~ ,, . +~. Tract 5 "',~t' ~;:~ ;. :2,~. '"" .... ~ ' ~,'~caz~o~ Sketch 6~i { Gray sand and fine gravel - ~ ! (GW) · uare feet of drainage area is required per bedroom. Data Certified iv! :..~lI~g.~ip~!l~.,l~.,T.~C~t.~.I~g..-.~2~i,.~,Ds, Inc, [)ate ' H :[ N :111','ll.IH [::, :1: :~!;TF:II'.,IC[~i ~:[:.'ii'YI.,.IE:EiI'.,I F:I I-,.IE!iI..L FIND, i:::ll'.,l"r' I.,.IE:LI.. I.J){:!ili:!; FIF~:?[~: F;i:[:~{~:!LI~.I:;?,EIi:, FINE:, I"11...1~:~;'1' fE:E: f;i!E:TI. JRI'.,IE~'[::, 'FEI 'FHE DEiF'F:IF;:'.'T'HI~i'.,I'I' I.,.I]:T'I...I]:N :ii:ii!ii 1:::,1:::1'.~.':5 O1:: ']"l...tli~: I.,.IIii~L.I.. COhlI:::'L.t~iFI"}: ON. c)A Marl( Beglch Mayor ®evelOPMent Services ®epartment Building Sole° y bivision '011 -Site Water A Wos$ewatep Ppoopom 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni org/onsite (907) 34�3_7gpq PUMP �Wafla on Log WV, Drilling Permit Number: SW Parcel Identification Nujuber:' , 5 Legal Description T,r 5 L h Pump Installation Date: Pump Intake Depth -Below Top of Well Casing: feet Pump Manufacturer's Name: Pump Model: 85 r2. Pump Size !2 hp Pitless Adapter Burial (Depth; / ,�—? feet Pitless Adapter Manufacturer's blame: Pitless Adapter Installer: Date of issue: Property Qwner Mame& Address: Well Disinfected Upon Completion: es 0 Method of Disinfection: No Comments: �e�1Q ILS Pump Installer Naane;,Olog ANCHORAGE WELL & PUMP SERV. e 330 E� TH T76 AVENUE ANCHCRAGE, AK 99518 PHONE! 907-243-0740 A WPS. COM gq,5-1 (o Attention: The pump installer shall provide a pump installatioWithin 30 day _ n log to the DSD s Of pump installation. Certificate of On -Site Systems Approval Parcel I.D. 015-281-46 1. GENERAL INFORMATION Complete legal description SIEFKER #3 TRACT 5, LOT 8 Expiration Date: 10 —Z� — 17 Location (site address) 12040 JEROME STREET, ANCHORAGE, AK 99516 Current property owner(s) RONALD & SHERI SCHMITZ Day phone Mailing address Real estate agent 12040 JEROME STREET, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic 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 $ ST Waiver Fee $ Date of Payment 1-2-z Date of Payment Receipt Number en a 3 Receipt Number C COSA # dJ (_ I a 9 3Zq Waiver # 71 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm ANDERSON CONSTRUCTION & ENGINEE Address 4661 NATRONA DRIVE, ANCHORAGE, AK 99516 Engineer's Printed Name MICHAEL N. ANDERSON, PE Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by 4_- and Anderson Construction & Engineering. 6. DSD SIGNATURE System #1 Approved for A_ bedrooms System #2 Approved for bedrooms Disapproved Phone 345-3377 Date 7/19/2019 ® e s F.:�L� 0 MICHAEL N. ANDERSON: No. CE 9469 �s .7/1,9/1.9.' Conditional approval for bedrooms, with the followi`g`GQOP(((/���i ON_S rg�v VA O v v W ER AND m ROOR'T11VI Original Certificate Date: 7-2-1 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 Legal Description: SIEFKER #3 TRACT 5 LOT 8 Parcel ID: 015-281-46 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 8/5/1976 Total depth 110 ft Cased to 110 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 7/12/2019 Static water level at beginning of test 51 ft. Well production at time of test 3.9 gpm Comments B. TANK DATA — 8/23/1971 1448 -GALLONS Age of tank(s) 48 years Tank type/material SEPTIC / CONCRETE Measured operating fluid level in septic tank 63" ® Standpipes/foundation cleanout per record drawing ' Date of pumping 7/12/19 Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes N Nc ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) F_W.`l 5 Collected by « Date of Sample 7/12/2019 C. LIFT STATION - NA ❑ Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA — 57'L x 5'W x 4.1'ED — 1.2 GPD/SF = 570 SF Which system tested (date installed) 9/8/2007 Adequacy test date 7/12/2019 Qj ALL standpipes present per record drawing Results Z Pass For 4 bedrooms Total measured depth from grade 9_5 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 5_1 ft (min) Water added 660 gal ❑ N/A — pressurized field New depth 14 in ' ® Monitor tubes go to bottom of effective. If not, state depth into effective Elapsed time 1390 min ® Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: 4.4' +/- ED. t FW'G5 COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than requir2d or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes if No ft Community Sewer Manhole/Cleanout > 100' ❑ Yes if No *98.5 it ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' Yes if No Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft Z Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5'+ ft Wells on Adjacent Lots: Property Line > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Absorption Field > 5' (ED Yes if No ft Water Main > 10' Yes if No ft Water Service Line > 10' Community Wells > 200' ® Yes if No. _ ®Yes if No ft Surface Water > 100' If septic tank is under driveway comment below _ ®Yes if No _ ft From Absorption Field on Lot to: (Please enter distances if less than required) ft ft ft ft ft ft ft Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' © Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS `Per code at time of installation. G. ENGINEER'S CERTIFICATION I certify that 1 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. COSA Checklist.docx ® <. OF`� d 49Tx *� .p MICHAEL N. ANDERSON: No. CE 9469 AZP Ilk FESS10�� Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0t5-28~-46 1. Expiration Date: GENERAL INFORMATION . Complete legal descript on. Siefker ff-3,~Tract 5, Lot 8 Location (site address o~ directions) Current Property owner(s) Mailing address Lending agency 12040 Jerome Street, Anchorage, AK O'~k(;;L .~ ,l~gC~~) ~C-/lJ¢~.~ Dayphone Day phone Mailing address Real Estate Agent Preston Phillips--Totem Realty Mailing Addres¢ Unless otherwise reqqested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 4 Day phone 272-0571 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 Department of Health and Human Services (DHHS) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on propedies served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for propedies served by a private or Class C well and may be reissued with new water sample results less than 30 days old. 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. .. (Rev, I flgg) 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 Health Authority Approval Guidelines for this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm KND Address ~fl.441 pfnrmlgatt_~=n~l~ Riv~_r~ Al,( _q_qR77 Engineer's Printed Name 14~nn~fh Phone R.qR-Rt11 Date 1NIN412NNI)____ DHHS SIGNATURE Approved for Disapproved. 4 Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: .- HAAT~hecklist: X Septic System Advisory Well Flow Advisory / Expiration Date (Rev. 11199) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date:,,/ Reissue Date: Municipality of Anchorage ~ Department of Health and Human Serv~E C E ! V E Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 OCT 0 5 2000 www.ci.anchorage.ak.us (907) 343-4744 MUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL CHE~[~NTAL SERVICES DIVISION Legal Description: A. WELL DATA Well type private Date completed 8/$/1976 Total depth '110 ft Siefker #3, Tract 5, Lot 8 IfA, B, or C provide PWSID #__ Sanitary seal Y Casedto 110 ft FROM WELL LOG Date of test 8/5/1976 Static water level 60 Well production 10 g.p.m WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi Nitrate 4.16 mg/I Date of sample: 9/27/2000 Collected by: KND B. SEPTIC/HOLDING TANK DATA Tank Type/Material Concrete Parcel I.D.: 015-282-46 Date installed _8/23/'1971 Tank size 1448 gal Cleanouts ¥ Foundation cleanout_n Depression over tank _n Date of pumping 9/21/2000 Pumper Northland C. ABSORPTION FIELD DATA Date installed ~l~'~/l'}"'l I Soil rating (g.p.d./ff2 or ft2/bdrm) 150 Length 14 ff Width 12 ft Total depth _9 ft Effective absorption area 468 ft2 Date of adequacy test 0~t> Results (Pass/Fail) Fluid depth in absorption field before test dry in Elapsed Time: _1380 min Final fluid depth ~ in Any rejuvenation treatment (past 12 mo.) (Y/N & type) n (Rev. 'i 1/99) Well Log Y Wires properly protected Y Casing height (above ground) 30 AT INSPECTION 9/27/2000 45 ft 4.44 g.p.m in. Other bacteria 0 colonies/100 mi Nbmber of Compartments 1_ High water alarm na Water added600 gal. System type pit Gravel below pipe 0.5 ft Monitoring tube V Depression over field n~ pass For _3 bedrooms New depth23.5 in. Absorption rate >= 600 g.p.d. If yes, give date LIFT STATION o~--'-' Date installed Size in gall ~n High water alarm level at in "Pump onl' level at in"Pum_p..~C4e'ceT~ ' D~~ Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ~an' Absorption field on lot Public sewer main 7,~'+ Sewer/septic service line ~.~'+ On adjacent lets 100'+ On adjacent lots Public sewer manhole/cleanout _1/~'+ Holding tank 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~,' Water main 10'+ Drainage 100'+ Property line 4.~' Water service line 10'+ Wells on adjacent lots ton'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~7' Water Service line ~t0'+ Curtain drain F, COMMENTS Building foundation 14' Surface water Wells on adjacent lots Absorption field 10'+ Surface water ~na'+ Water main 10'+ Driveway, parking/vehicle storage _25'~__ ENGINEERIS CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Knnn~th I'Jllf:[us Date '1N/N41~NNN HAA Fee Date of Payment Receipt Number ~-~ (Rev, 11/99) Waiver Fee $. Date of Payment Receipt Number _ orar¥ oencn marg shown he eon unles~ o~l~r~,"' ....... ' ........w UTILITY 3Z~t 3~6.~ · 4"S£~VER ~E~/T 0 6"].VE/L C,4$1A/~9~k'/EZZ To JEW~ F~NT. BS~T Fl~/3H[O ~ TOP FLO0~ U~DE~ CO~ ~O~E8 e~