HomeMy WebLinkAboutELMORE #1 BLK 4 LT 3 /','"~,TER ANCHORAGE AREA BO~"'~.~'~H HEALTH DEPARTMENT ' ' 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 o. ?$$ INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELl ~ ~'~"//)J'-'"-~' LIQUID CAPACITY . ,,"~,~ r~.]/,9 GALLONS. NUMBER OF MATERIAl/f~'~,'~//~" ~/?~-/~'~-"-/-~ COMPARTMENTS INSIDE LENGTH ~ .INSIDE WIDTH ~ LIQUID ,DEPTH SEEPAGE SYSTEM: SEEPAGE NUMBER OF PITS / OUTSIDE DIAMETER . LENGTH LINING MATERIAl ~/~/. ~/~.~ w . DISTANCE FROM WELl TILE DRAIN FIELD: DISTANCE FROM WELL /,FOUNDATION '~ . NEAREST LOT LINE ABSORPTIO/~REA SQ. FI. LENGTH OF EACH LINE DEPTH: TOP OF TILE JO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH . OF LINES IN. TOTAL EFFECTIVE .IN. ABOVE TILE W ELL:/~'I'/~'/~'~;~- -'- -~'~-~'~-'~ '~° DISTANCE FROM TYPE .~.~'""~'~"~" DEPTH 'Z.~-'"- , BUILDING FOUNDATION NEAREST /.....--- SEPTIC / SEEPAGE LOT LINE / SEWER LINE , TANK , SYSTEM WATER SAMPLE~''''-, NEAREST ~'"'"-CESSPOOI ~ OTHER , SOURCES DISTANCES: DIAGRAM OF SYSTEM NAME OF APPLICANT J~ INSTALLATION LOCATION LEGAL DESCRIPTION ' ~ GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK SEEPAGE PIT ~ /DRAIN FIELD OTHER FINAL INSPECTION~ 24 HOUR NOTICE NEQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL DE ~UBJECT TO PROSECUTION. sE,mc 'rA.K SIZE SEPTIC TANK TO SEEPAGE PIT WALL DIAGRAM OF SYSTEM SEEPAGE PiT ALSO CONSIDER AREA WELLS, WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD /~ CA RON INTO AND O~IT ~1~ ~EPTIC TANK AND INT.~O CRIB CROSSING GAP OF' EXCAVATION ~ FEET INTO UNDISTURBED SOIL. GRAVEL BACKFILL III I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 26.68 AND THAT THE ABOVE CREATER ANCHORAGE A?~A hb..~U,,H IIgALTH 327 EAGLE ~TREET ANCHORAGE, A~%CKA' 99501 CASE # ,Performed For ('~n/ C~,,drW Date Performed /~ .~-tr/r, f~7(' This Form ~eports a: S~Lc~, - , .. . ' ~ 't'ercoia~ion ~es~.,, Soll Char~c:erisIics ~epth Feet Was Ground Water Encountered?_ If Yes, At What Depth.. Reading Date Gross Time Location Sketch I II Ne: Ti~,e Depth To Net Drcp ! Froposed Instal~Seepaze Pit (/ Drain Field Deo:h Of Inlet ~ ' ~, Deni * , ~ · · ,T- .,~n fo 8otto~ Of P~t Or ,rench /r,, CO~qEI;TS: . , ~ , - ~, ~ , -,. Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 018-171-38Expiration Date: 3 — ©Z Z 1. GENERAL INFORMATION 7-2-6-2-®zz. Complete legal description Elmore #1 Block 4 Lot 3 Location (site address) 4900 Shoshoni Ave. Anchorage, AK Current Property owner(s) _Carl Snyder Life Estate Day phone Mailing address 4900 Shoshoni Ave. Anchorage, AK Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (W/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 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 ❑ Waiver/Variance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer - Date: •C COSA Fee Waiver Fee $ Date of Payment, Receipt Number _ COSA # © 5 C� W1 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. Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111 Address _20443 PTARMIGAN BLVD. EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date f ZA&-ki Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen , deficiencies or discrepancies exist. t� 01 <�L� :Tr- f �. 6. DSD SIGNATURE System # A roved far bedrooms. rcesr;eri.i M. uv - pp Sys t tit 4 1 proved for _ bedrooms. '�a �e-A c c' /i 4LS _-- - Disapproved.��`�" Conditional approval for bedrooms, with the following stipuPtXlMt((f���� OF AA/Cypj (ori PVA JJfJ�IrVT 5V�\�\� BY:--� Original Certificate Date: ' 2 rZ © " 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 engineers work. 7. ATTACHMENTS: COSA Checklist X;_ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheer_10-10-12.doc Legal Description: COSA Checklist Elmore #1 Block 4 Lot 3 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth 132* ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 7/15/21 Static water level at beginning of test 81.6 ft. " Comments *Based on 1/20/1976 request for approval. B. TANK DATA Age of tank(s). 50 years Lank tvpe/matdeiai'SO tic/Concrete k/ieasurod operating fluid level in septic tank 401: Standpipes/foundation cleanout per record drawing Date of pumping 7/14/21 D. ABSORPTION FIELD DATA Which system tested (date installed) 7/14/1971 ALL standpipes present per record drawing Total measured depth from grade 11 ft (max) Measured depth to pipe invert from grade 4.8* ft (min) ❑ N/A — pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 018-171-38 Structure served by this system Well production at time of test 5.5 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes No Coliform b cteria j Negative T 1 � ,J Nitrate mg/� F1 Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 12/7/21 C. LIFT STATION L uired maintenance completed Age of !ft`sta yearn !_ift station*rbdte:laE Comments Adequacy test date 7/15/21 Results FV -]Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 18 in Elapsed time 225 min Code -required soil cover over field Final fluid depth 0 in 10 System presoaked Absorption rate 450+gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 2000 gallons If yes, enter date Comments/Deficiencies: *Top of crib measured @ 4.8' from grade. COSA Checklist yellow sheet 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' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No 88* ft 0 Yes if No ft Neighboring Tank > 100' ® 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' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Community Sewer Main > 75' ®Yes if No ft Manure/Animal Excreta Storage > 100' ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft .Yes if -No.- -- ft - - _ _Co,, munit7Ole!ls > 200' 0 Yes. _. if No Water Service Line > 10' ® 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 Fourtd tion,>.;.16 Yes if No ft If absorption field is under driveway comment below Property. Line >,10 -Yes, If No ft Wells on Adjacent t_i?i5. <: Water Main >J0' ® 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 *Meet code at time of installation G. ENGINEER'S CERTIFICATION I certify that I 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 4 49 a CE 11 izi �bpaan �bFFSS\� F�Gc BG, Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 018-171-38 1. GENERAL INFORMATION Complete legal description Elmore #1 Block 4 Lot 3 Expiration Date: Location (site address) __4900 Shoshoni Ave. Anchorage, AK Current Property owner(s) Carl Snyder Life Estate ______ Day phone Mailing address Real Estate Agent 4900 Shoshoni Ave. Anchorage 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class _ Well ❑ Public Water System ❑ WaiverNariance request for: Received by: 3 Day phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer.. Date: COSA Fee $ JO Waiver Fee $ Date of Payment Receipt Number COSA # © 5 C/ 1 1 a Date of Payment Receipt Number Waiver # istance: 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 ARCTERRA CONSULTING, INC. Phone 696-6111 Address _20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date f.2. 4 -Ano, Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future +��1►\ \ occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. �01�- A C1 T FT 6. DSD SIGNATURE System #1 Approved for bedrooms. a System #2 Approved for bedrooms. Disapproved. fKENNETH Ni. UC / Conditional approval for bedrooms, with the following stiput*9M0:((((((, OF AtV cll tri, -- FTER p,1ER�^ NS w P T SER����`�\ Original Certificate Date: 12--Z 0 W 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc Legal Description: Elmore #1 Block 4 Lot 3 Parcel ID: 018-171-38 If more than 4 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 5.5 qpm Date drilled Water storage tank volume gallons Total depth 132* ft Well disinfected for coliform test? ❑ Yes E No Cased to ft Coliform bacteria is Negative Sanitary seal is functioning correctly Nitrate 1.50 mg/L ❑ Nitrate less than MRL (ND) IN Wires are properly protected Arsenic ug/L 01 Arsenic less than MRL (ND) Casing height (above ground) 18+ in. Collected by Arcterra Consulting Date of flow test for COSA 7/15/21 Date of Sample 12/7/21 Static water level at beginning of test 81.6 ft. Comments *Based on 1/20/1976 request for approval. B. TANK DATA Age of tank(s) 50 years Tank type/material Se tic/Concrete Measured operating fluid level in septic tank 40" Standpipes/foundation cleanout per record drawing Date of pumping 7/14/21 D. ABSORPTION FIELD DATA C. LIFT STATION uired maintenance completed Age of lift sta years Lift station material Comments: Which system tested (date installed) 7/14/1971 Adequacy test date 7/15/21 ALL standpipes present per record drawing Results Q Pass For 3 bedrooms Total measured depth from grade 11 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 4.8* ft (min) Water added 450 gal ❑ N/A — pressurized field 18 New depth in 11 Monitor tubes go to bottom of effective. If not, state depth into effective Elapsed time 225 min ME Code -required soil cover over field Final fluid depth 0 in 11 System presoaked Absorption rate 450+gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) _ date of test) Gallons introduced 2000 gallons If yes, enter date Comments/Deficiencies: *Top of crib measured @ 4.8' from grade. COSA Checklist yellow sheet 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' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No 88* ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'21 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 ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® 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 septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) 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 Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *Meet code at time of installation G. ENGINEER'S CERTIFICATION 1 certify that / have determined through field inspections and review 1`-9'10 , `',¢�'1I, of Municipal records that the above systems are in conformance with V �` 49 g1'# MOA COSA guidelines in effect on this date. p IJ- A.- „a KENNETH A CE COSA Checklist yellow sheet ft ft 0 r7 o SHOSHONI AVE N89»46'30"E 132.00' ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: ELMORE SUBDIVISION ADD NO 1 LOT 3 BLOCK 4 PLAT P -635A SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property tines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. R11110121.14 21-093-2 2021 I 1"=30' I schullerfbknet JLS I SW3035 L_ 210267 = FND I" IRON PIPE low OF *.:.. 4 .... . 1 f�..... k'JOHN L. SCHULLER. LS -10408 c ho• .'0 :'•�..`•�-� ado essi0no\ o Q,�T3 S VR LAND t1� � 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax I TER ANCHORAGE AREA BOROUGH · ~A~partment of Environmental Quality 3330 ~treet, Anchorage, Alaska 99503 274-4561 ~ _~ Date Received January 20, 1976  ~,e~/~ . Time of Inspection~ Ut/x..' Date of Inspection 310 East Northern Lights Blvd. Carl Shader Star Route A Box 334, Alaska Mailing Address: 2. Property Owner: Mailing Address: COI%V. 1. Approval requested by: Alaska State Bank % Rosie Parks Phone: Phone: 99507 3. Legal Description: Lots 3 and 4 Block 4 Elmore ~1 4. Location: Off of De Armoun Road 5. Type of facility to be inspected Single Family 6. ~ell Data: Individual A. Type C. Construction 7. Sewage Disposal System: A. Installed 1971 C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank 279-7637 x 37 L~7-(--~4~%~-or 277-4524 No. of bedrooms B. Depth Approx. 132' D. Bacterial Analysis On-site syst~. B. Installer 2. Manufacturer ., Absorption area , Other contamination , Absorption area C. Absorption area to nearest lot line 2. Material , Sewer Lines , EQ-034 (1/74) Page 1 of two pages MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 'C" Street. Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUN~¢IPALI~f OF ANCHORAGE DEPAP, Tk',~NT ~)F HEALTH & ENVIROI'~L~[ N TAL PP, OTECTIO~ JAN 0 Jg78 RECEIVED 1. Type of Inspection: CMRO Carl Snyder 2. Property Owner: VA FHA CONV__ XXX Mailing Address: SRA Box 33~+ Anchorage 3. Name of Buyer: sRme a~ Mailing Address: ~m, ~ ~hnv~ 4. Name of Lending Institution: Mailing Address: ATTfl Rn~ ~ P~-I~ 5. Name of Realtor or Agent: Mailing Address: Phone Day Phone 27': ?~;3d or his work # 277 Day Phone Phone ~'~ 6. Legal Description: L3&~ Blk ~ Elmore #1 off De Aarmon Rd Location: 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: sgl family No. Bdrms. ~. Public Utility Individual xxx If Individual, number of dwellings presently served 1 If Individual, depth of well not known exactly approx 132ft Sewage Disposal System Type of System: Public Utility If Individual, date of installation 1971 Individual (on-site) xxx E0-037 (1/74) Page 2 of two pages - ReK~'~st for Approval of Individual :~'X~-r & Water Facilities · Legal. Description Ia3t 3 ancl 4 Block 4 Elmore %1 DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) - "1-½-mile in'on DeArmoun"fr0~ New Seward 'Highway, where DeArmdund goes straight a.t the curve up.the hill,.continue on the stra~ight part (132nd Avenue) 'cross the bridge'then you are forced to turn to the south, a short distance the road goes parallel to DeArmoun "-west on -Shoshone Avenue, 1st driveway on the northeast-corner -' - natural wood siding, lots of trees,--can be seen form the road.. 310 ]~aot Northern L~ghts Blvd. Sub~t Lo~ 3 an~ 4 ~Iock4~ ~l~ore O1 Leo t&. BuGh~,olz ~unL~u:L&n ~n~L~on~n~al yrotection ., 27~.2221 Februarff' 2, 1976 ' 310 ~a~c ~orthern ~nchor&qe, ~las~a 99503 SuB, eot: Lot~ 3 and'4 ~lock 4 Z~or~ ~1 ~ub~l~i~lon The~lldo~s~k~et co~mt~uot~onxequ~re~tm an~ th~cae~nq ~ust'be ext~n~d t~elve (12) inches above 9ro~ muzface. Sincerely, Les N. Buch)~l=