The URL can be used to link to this page

Home My WebLink AboutCAMPBELL HEIGHTS BLK 1 LT 8Campbell Heights Block 1 Lot 8 #014-071-09 December 29, 1978 ~780551 Larry tIembree 9811 Tolsona Anchorage, Alaska 99502 Subject: Lot 8 Block I Campbell Heights Subdivision A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If there are any further questions, please contact this office at 264-4720. Sincerely, Les M. Buchholz, R.S. Senior Environmental Specialist Ik;B/lJw enc~ copy of permit PERMIT ~'~0. DEPARTMEHT O, ~EALTH ~ND EN¥IRONMENTAL ~..~ECTIO~'~ · 825 'L' STREET, ANCHORAGE, AK. ~9501 264-4728 WELL PERMIT ( 780551 ) APPLICANT LOCATION LEGAL LARRY HEMBREE 67T~uk~ WIHCHESTER LB Bi CAMPBELL HTS 9811 TOLSONA LOT SIZE 349 3744 35280 SQUARE FEET MINIMUM DISTRt. JCE BETWEEN R WELL AND Rt~Y ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL; OR 150 TO 200 FEET FROM R PUBLIC WELL DEPEt.~DI~.~G UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DRYS OF THE WELL COMPLETIOti. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T E×P I RES DECEtIBER I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS At~D WELLS AS SET iFORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. APPLICB~IT! LARRY HEMBREE V1 2 MUHMPAUTY OF Development Services Department - On -Site Water & Wastewater Section - Parcel I.D. 014-071-09 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: �`A —1 l Complete legal description Campbell Heights Block 1 Lot 8 Location (site address) 3900 E. 67th Avenue, Anchorage, AK Current property owners) John Gillis Day phone Mailing address 3900 E. 67th Avenue, Anchorage, AK 99507 Real estate agent Lisa Conner Day phone 907-224-2013 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic ❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer El Waiver request for: Dista Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 61-16-6 Date of Payment (' LI? A Receipt Number 015_(_1() C) COSA# - _&1919 Z46 Date: Waiver Fee $ Date of Payment Receipt Number 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 6/14/19 6. DSD SIGNATURE System #1 Approved for 4 System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms bedrooms, with the following stipulations: WASTEWATER Z,1 PROGRAM Original Certificate Date: Z:�, 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 Iffel."fivel7-MOM, Legal Description: Campbell Heights Block 1 Lot 8 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Unknown Total depth <100 ft Cased to '40 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 6/12/19 Parcel ID: 014-071-09 Structure served by this system Well production at time of test 8 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate •497 mg/L E]Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 6/11/19 Static water level at beginning of test 38 ft. Comments No well log on file. Casing protrudes through deck. Well data from MOA File. B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping PUBLIC SEWER D. ABSORPTION FIELD DATA PUBLIC SEWER 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 ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ❑Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ✓l Yes Community Sewer Manhole/Cleanout > 100' ✓Q Yes if No ft [✓ Yes if No ft Neighboring Tank > 100' [D Yes if No ft Private Sewer/Septic Line > 25'✓0 Yes if No ft Absorption Field on Lot > 100' ✓� Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Q Yes if No ft Water Main > 10' Animal Containment > 50' P/ Yes if No ft ✓� Yes if No ft 0 Yes if No ft Water Service Line > 10' ✓V Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75'✓0 Yes if No ft [Z] Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ✓l Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5'✓Q Yes Yes if No ft Wells on Adjacent Lots: ✓D Absorption Field > 5' ✓V Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' ✓V Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' ✓V Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ✓l 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' ✓D Yes if No ft Private Wells > 100' Q Yes if No ft Water Service Line > 10' ✓V Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l 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. COSA Checklist yellow sheet 0. 49 th t: N4ICHAEL E. ANDERSON ' No CE -4381 6/25/19 ................. tC. � ,)OROFE5SS ,�� • -� Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 sa E* Certificate of On -Site Systems Approval Parcel I.D. 014-071-09 Expiration Date: 1. GENERAL INFORMATION Complete legal description Campbell Heights, Block 1; Lot 8 Location (site address) 3900 East 67th Avenue Anchorage, AK 99507 Current Property owner(s) Larry & Cheryl Hembree Day phone Mailing address 3900 East 67th Avenue Anchorage, AK 99507 Real Estate Agent 2. TYPE OF DWELLING: F Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF 4. TYPE OF WATER SUPPLY: Individual Well Fx� Individual Water Storage ❑ Community Class Well ❑ Public Water System U Waiver/Variance request Received by: Four Day phone TYPE OF WASTEWATER DISPOSAL: Individual ❑ Holding Tank ❑ Community ❑ Public Sewer ❑I COSA to be releasy to the _'ngineer, unless otherwise requested by the engineer. COSA Fee $_ Date of Payment Receipt Number COSA# Date: 1 Waiver Fee $ bate of Payment Receipt Number 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms Phone 522-7773 Date 10/15/2013 bedrooms, with the following By: J Original Certificate Date: % 0 —� The M Iple i ofl n o ge 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 blue sheet: - .� > If more than 1 septic system is on the lot: COSA Checklist # of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Campbell Heights, Block 1, Lot 8 Parcel ID: 014-071-09 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) N Date completed Pre 1980 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth <100' ft. Cased to >40' ft. Casing height (above ground) >12 in. FROM WELL LOG AT INSPECTION Date of test— - -- — 10/15/13/13 -- - -- Staticwaterlevel - ft. 32 - - ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate N/D mg/L Arsenic N/D ug/L Dateofsample: 10/1/13 B. SEPTIC/HOLDING TANK DATA 6.5 Collected by: Anderson Eng. AWVVU Sewer Tank Type/Material Date installed Tank size gal. Number of Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) _ Depression over tank (Y/N) High water alarm (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ftz or ftz/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area ft2 Monitoring tube _ Depression over field _ Date of adequacy test Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) I If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum Size in gallons _ "Pump off' level at Cycles tested _ in. Manhole/Access (YIN) High water alarm level at Meets alarm & circuit requirements? in. E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots N/A Absorption Feld on lot N/A On adjacent lots N/A Public sewer main >75' Public sewer manhole/cleanout >100' Sewer/septic service line >25_- -- Holding tank N/A Animal containment areas >50 ManurelanimaLexcr..etesa_ torage reas >.100' —_ SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption field Water main Water service line Surface water Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water Service line Surface water Driveway, parking/vehicle storage -. Curtain drain Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that t 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 Michael E. Anderson, P.E. Date 10/15/2013 COSA brown sheet 10-10-U.doc @ ANDERSON •�? 4381 I o PCF.. OF A,UU��40o1 n 'SHANE A. HCLT F LS-6914.'n�04 EAST 67TH AVENUE WEST 126.00 ------ ---EAST 68TH AVENUE THE INFORMATION HEREON I5 FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS, AND I5 NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING: ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. NOTE: NO EASEMENTS APPEAR ON THIS LOT ON THE RECORD PLAT AS -BUILT SURVEY 1" =30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 8 , BLOCK 1, CAMPBELL HEIGHTS ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _4TH_ DAY OF _APRIL , 2013. HOLT LAND SURVEYING 600 HIGHVIEW DRIVE 12159, F8 158-10 ANCHORA6E,AK 99515 345-5513