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Home My WebLink AboutCAMPBELL HEIGHTS BLK 1 LT 4Do"l I PERMIT NO: DATE ISSUED: MUIqICIF'AI_ITY O? ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, AMCHORAGE, AK 99501 264-4720 ON--S T TE 850054 02/07/85 I.,,I E L L APPLICANT: ADDRESS: CONTACT PHONS: WILLIAM A BELENSKI 4029 E 68TH ANCHORAGE, AK 99507 349-6245 ~ LEGAL DESCRIP: SUBDIVISION: CAMPBELL HEIGHTS LOT: 4D BLOCK: SECTI0N: 4 TOWNSHIP: 12N RANGE: ~W LOT SIZE: 7450 ¢SQ.FT. OR ACRES) I certi£y that: 1. I am familiar with the requirements (or' on-site ~ewer~ and wells'as set ~orth by the Municipality of Anchorage (MOA) and .the State o~ Alaska. 2. I will install the system in accordance with all MOA co~es and regulations~ and in compliance with the design criteria o~ this permit. 5. I will adhere to all MOA and ~tate o~ Alaska requirements for the set back distances ~rom any existing well, wastewater disposal system or public sewerage s~stem on this or anymadjacent or nearby lot. SIGNED. -~A~/~__¢~_2i~.,~.,.~' DATE: APPLICANT: ISSUED BY WILLIAM A BELENSKI DATE: P.O. '~OX 5650 ANCHORAGE, ALASKA ~9502-0650 (907) 264-4111 DEPARTMENT OF HEALTH & HUMAN SERVtC£S January 10, 1986 TO: Permit Applicant Subject: Permit ~ 850054 Lot 4D BLock 1 Campbell Heights Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1985. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as-built inspection report(three part form) must be sent to this office for review and approval,and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Susan E. Oswalt Program Manager On-site Services SEO/lJw eric: Copy of Permit 1201 \ ~,a~a,uz SZ. 9~515 ANCHORAGE~ ALASKA SIX INCH WATER WELL DRILLED. ......... OUT TO THE DEPTH DRILLED AT THE RATE OF ~2~.00 PER FOOT. ~¢ ~o~ 2152 ~ $,f.. 9950~,. ProPerTY OWNER LOCATION OF WELL DRILLER B~ ~ WELL LOG: 0 .... 18' $,U.,Q; '~'~t' ~e,f., ~ .~,bf.~ 15~ c~, 333-7260 MUNICIPALITY OF ANCHO~N~[ ENVIRONMENTAL PROTEClIO~ RECEIVED 53'--55' Caa.,z,o¢ ~/',.au~ ,~Z,U,. 35~ ,~.~ 4~ Zh.¢ u~t,~,~ ¢o,uza. t~n. C.~e~ /ca 55 ~,~. D~.,L]_ed au, f..to 60 7h~ MeJ. J...%0 ~ Zen. f~S. $~,~.L hau,'~ a.~. puap. A'u]. ,l.~.p,,~v~ ,U~.e ~ 100'5. 7h.e,'~ ~ ho~.~.~., zu. ch p.'~.~,~u,'~ 1/3 Ra,'~¢ Su.b~.,Z~Ze ~ .,1~.1~ .be .bv~Jed .~e.,,.~ ~ oft bo44o~--35 ,~ d,o~n-- o,,'~:~, ,to pu~p. 'cJ_e~.' u~t~,. But ~ IZa ~e ~ Set up o4 pu~p,~. To.~J. co~ a~ Z),t,CLL,~: II23.00 ~ ~ X 55 ~Ct.. COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF $112~5o00 THANK YOU VERY MUCH. ~,.. --~ BERNIE CLAUS OF RAMPART DRILLING WORKS DATE Dez:em/r~ 30~o 1985 SERVICE CHARGE O F 1½% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. MUMC0 P UTTOF "HCHO' GEE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 014-071-70-000 Expiration Date: Legal description CAMPBELL HEIGHTS BLK 1 LT 4D Site address 4030 E 67TH AVE Anchorage AK 99507 7/27/2023 Current property owner(s) BELENSKI JUDY,ADMIN OF THEESTATE OF WILLIAM BELENSKI X The On-site system(s) is/are approved for 2 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 4/27/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval June 2022 1. GENERAL INFORMATION Parcel I.D. 014-071-70 Complete legal description Campbell Heights Block 1 Lot 4D Location (site address) 4030 East 67th Avenue Current property owner(s) Judy Belenski 2. ON-SITE SYSTEMS SIZED FOR 2 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: FO -1 Private Well E] Private Well serving 2 dwelling units 1-71 Private Well serving 3+ dwelling units 171 Community Well or Public n Water Storage 4. TYPE OF WASTEWATER DISPOSAL: F-1 Private Septic R Private Septic serving 2 dwelling units 1771 Holding Tank INE Community Septic or Public Sewer 5. SEPTIC TANK: E] Steel ❑ Plastic E] Concrete F-1 Fiberglass Age - See advisory if steel older than 20 years 6. ABSORPTION FIELD: 1771 AWWTS F] Bed El Deep Trench n Wide Trench El Seepage Pit Waiver request for: Expedited review requested: M Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 2- To Waiver Fee $ -,7 3 Z'zo Date of Payment ?0 Date of Payment COSA # Waiver # COSA Application—June 2022 W vi Legal Description: Campbell Heights Block 1 Lot 4D Parcel ID: 014-071-70 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 12/30/85 Total depth 60 Cased to 55 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 30.5 in Date of flow test for COSA 04/13/23 Static water level at beginning of test 20.6 Comments ft ft. B. TANK DATA Measured operating fluid level in septic tank _ Date of pumping ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Well production at time of test 3.22 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 1.1 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L IF Arsenic less than MRL (ND) Collected by PES Date 04/13/23 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ❑ Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) Effective depth used in Effective depth remaining in Comments/Deficiencies: LOT SERVED BY COMMUNITY SEWER COSA Checklist June 2022 H From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' Yes if No ft rm� Yes if No ft Neighboring Tank > 100' n Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No ft no Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' no Yes if No ft 0 Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water> 100' ❑ Yes if No ft Tank to Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Pannone Engineering Services Phone 907-745-8200 Engineer's Printed Name Steven R Pannone P.E., F. ASCE COSA Checklist—June 2022 Date Ter R cn. or;e E. 67th Avenue _ - _ _ _ _ LO C �t EAST 62.97 6 Asphalt 14.0 �Q 00 CD N L I deck Lr) 3.5 -- 8A -�— c c> 5.a 25.5 Lot 4C co 2 Story Frame Lot 3B House C 13.3 C! 22.760 - . _ 1.7 OH deck E C Lot 4D Wood fence (typ) O Well NOTE: Asphalt location is approximate — — — — — — — due to snow and ice. 10' T & E Easement EAST 63.01 Lot 4B AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following )F • �iL described property: LOT 4D. BLOCK 1, �Q • • ° ° • 9,$`� CAMPBELL HEIGHTS . ` 49th , Sr Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines �and do not overlap or encroach on the property Tying adjacent thereto, that no improvements on the property lying ,} • • • • ° e adjacent thereto encroach on the premises in question and 00 s� ° Elizabeth L. Walatka , ,Q Po that there are no roadways, transmission lines or other SCALE: 1 0� 1p� * 8036 — LS • • ®� visible easements on said property except as indicated MW hereon. _ • ' .�o5 Dated at Anchorage, Alaska oF'essiotAM- LP this 22nd _day of MARCH 2023. EASEMENTSRECORD, OTHER THAN THOSE SHOWNN ON THE RECORDED FRED WALATKA & ASSOCIATES, L.L.C. � PLAT ARE NOT SHOWN HEREON ° ~ "l' ryEngineers and Surveyors UNLESS OTHERWISE NOTED. FB 22-4, pg 57 BE 907-248-1666 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product.