HomeMy WebLinkAboutPREUSS #2 BLK 1 LT 16OejO,
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GRE/~C.R ANCHORAGE AREA BOR':'~JGH
Department of Environment Quality
3500 Tudor Road
Anchorage, Alaska 99507
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL/(~~r ~'~/~.C~ MANUFACTURER /~ q 17' MATERIAL,
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY 4 ~)OOGALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL /~ /~'Z~'-~FOUNDATI'ON ~. 7 '
NUMBER OF LINES / DISTANCE BETWEEN LINES
.NEAREST LOT LINE "~'/~ ~''' TOTALoF LINEsLENGTH.~o ~*
TRENCH WIDTH*~; IN.' TOTAL EFFECTIVE
ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE
DEPTH OF fILTER
DEPTH: TOP Of TILE TO FINISH GRADE ~'"'Y MATERIAL'BENEATH TILE IN. ABOVE TILE IN.
WELL:
TYPe
CONSTRUCTION
DISTANCE FROM:
BUILDING ~1 NEAREST--- NEAREST
FOUNDATION-'''I'/ ~$ LOT LINEt~(~'~-f'.",, SEWER LINE
CESSPOOL I4 . , OT,ER SOURCES
SEPTIC SEEPAGE
TANK//dO "'~'.. SYSTEM /00 'tt'''
APPROVED. DISAPPROVED REMARKS '
DISTANCES:
SEWER LINE DEPTH:
PIPE MATE RIAL: (J~
LOT SLOPE:
REMARKS:
DIAGRAM OF SYSTEM
DATE APPROVED . . .
G.A.A.B.
Form PW-027
-' ~$$0 'C" STREET "ANCHORAGE, ALASKA 99503
SEWAGE DISPOSAL sYsTE~'':'APPLi~+iON AND PERMIT
INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT~ (T--"~ ~RAIN FIELD OTHER
TYPE AND S''E OP PAC,L,. TO .E SERVED z le ,'
FINANCED THROUGH TO BE INSTALLED BY _ --
SOIL TEST RESULTS ~ NOTE= THIS PERMIT 15 NOT VALID WITHOUT SOIL
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
TYPE
MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM
!
FOUNDATION TO SEPTIC TANK
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP DP
FOUNDATION TO SEEPAGE PIT ~v , DRAIN FIELD
SEPTIC TANK TO SEEPAGE PiT WALL /-- ~f
SEPTIC TANK ., SEEPAGE PIT ~ ~ /' , DRAIN FIELD
TO NEAREST LOT LINE.
WELL TD SEPT,C TA.K /~ ~ / /~ 0
· SEEPAGE PIT
DRAIN FIELD /~ ~ ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE PiT
DRAIN FIELD
~O RIVER. LAKE. STREAM.
EXCAVATION 5 FEET INTO UNDISTURDED SOIL,
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FI~ED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO ~OROUGH REDUCTIONS REOARDIN~ INSTALLATION.
OR
LICENSED DESIGNER
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA E~OROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DATE, APPLICANT'S SIGNATURE ~) .
FORM NO. LQ-01
Russell Oyster
694-2774
Civil Engineering
Soils El. Foundations
'0 ~ E E/,,,GINEERING E~ DEVELOHMENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 333-5240
SOIL LOG
£~rl B/is
333-5240
Surveying
Land Development
Performed for:
Legal Description:
Depth i(feet)
0
1
2
3
4
5
Soil Characteristics
6
7
8
9
10
11
12
Grodnd Water Encountered: Yes No
Proposed Installation: Seepage Ptt~
Co~nents: ~,~'~ ~
Perfomed by:
v'/If yes, whet depth
Drain Field
"~ MUNICIPALITY OF ANCHORAGE
DMSION OF ~%5;IRDNMENTAL HEALTH
DEP~_R17~ENT OF HEALTH AND ~%%;IRf~MENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
.,~
'"' 1. General Infc~.~tion Applicaticn Datec
D~s~ipticn (includp~ lot, block, subdivision,
Applicants Add~ess .~?_
(c) Applicant is (check one) [~nding Insti~on;,~----~; Owner/builder ~--~
(d) Lending Institution~~.L~w~
(e) .al Estate CO. & Agent-
-- ~ ~/ ~ .
Telephone ~ q~-- qZCC)/~ q~-'-
2. of Pesiden ,
Sirgle-Famil~
N~ber of Bedrcc~s
Multi-F~mily ~-~
Other(~s~i~)
3 .' Water Supply
Individual Well~ C~i.,nity ~--~ Public ~--~
Note: If oa~.,nity ~11 system, ~st ~ ~it~n ~ti~ ~ ~ State
~p~nt ~ ~vir~ntal ~n~.atfon attesting to ~ legality ~d status.
,
Is ~e mi1 a~a~ f~ t~ mr of ~m s~cified in this
4. ~ge Dis~al
Is the wastewater disposal system adequate fcr the 'rnmber of
[Page 1 of 2]
2-15-84
5. Engineering Firm Providing Inspectionsr Tests, Data and Infcrmation
certify tha. t..I"h-~v~ checked, ~rified, cr confined to all }DA HAA Guidelines in
ffect on/~t~/date ~jf~_~..~ection. .
. I,e -.", ', ,'
(~GIN~ SF~) , .- . ,. ~
6. DHEP Approval
Apuro%~d for
Appro~d ~
Disapproved ~-~
By ~ C'(~-,-.e_.,o,c~__Z' Date
Cot. alit iorml ~-~
Terms of Conditio~ml Approval
The Municipality cf Anchorage Department cf H~alth and Environmental Protection does
net gaa~antee th~ continued satisfactory [:~rfcrmance of the water supply and/c= t. he
wastewater disposal system. This approval indicates that, as cf the validation date
shown abo%~, based on the data and information furnished by an engineer registered in
the State of Alaska, the water supply a~d wastewater disposal system is safe and func-
tional for the number of badrcoTs and type of structure indicated.
(U ZP SEAL)
7. Mail the H~A to,the ~lowing address}
KB2/d5/s
[Page 2 of 2]
2-15-84
A. }~.~.r. BATA
Well Log Present (~~ ~ '/'~'g' -= '~"'
Total Depth ~( ~ Cased to
Static Water Leal %~.
Casing Hsight Abo~ Ground
Separation Distancss f~cm Wsll:
To SeDtic/~k~l~]4~3 Tank on Lot
Pump Set At
/!
Sanitsry Seal on Casin~/(Y~
Dep=ession Around Wellhead
To N~a~st Edge of absc~ption Field on Lot /2.0 7A : m ~joi~ ~ts /~0 ~
To ~st ~biic ~= Li~ ~ ~ To ~.st ~blic ~=
C~t~le ~ ~ ~ ~ ~ ~st ~= ~rvi~ L~ ~ ~t ~
/
B. SE~IC~I~ T~ ~A
~ IP~tall~d /~~ Si~ /~~ No. ~ ~~nts ~
.oldim Ta~ High~te= Alam (Y~) ~y ~ldim TavR ~t (y~~
~ati~ Dist~s ~ ~ptic~lding Ta~: '
To ~ter-Su~ly ~11' /~ ~
To' Property Line /0 /
To Weter Main/service Line
C~se
C~w~snts
To Building Foundati~~
To Disposal Field ~ ~
To Stream, Pond, T~ke, c~ Major Drainage
[Page 1 of 21
2-15-84
C. ABSORFI~ON FIELD E~TA
Soils Rating in Absorption Strata
Date Installed
width of Field
Dap~e,S.S!O~ OVer Field
V'Results of r~st Ad~qua,.-~ Test
/ Length of Field
~p~ cf Field
Grail ~d ~i~ss
Sta~i~
Sepa~atio~ Distance f~cm Absc~ption Field:
.~o water-Supply '~ll /Od:) ~ TO ~_ .operty Line
--- To Building Foundatic~ Z7 / ~
To Existing or Abandoned System
To Water Main/Service Line/d/~ To Cutback(if pre~t~ /t///~.
· '' ~'St~eam/Pond/Lake/c~ Majo~ Dr-ai~...~ . .Cc~..se ~J //~
To Driveway, Pa~king A~ea, or Vehicl~ ~t.~o~'~ge .A~ea ~t/!/~'-
Size in Gall(ms Manhole/Access ..(Y/N)
"Pur~ On" Ievel at "Pump Off" Le%~l at
· High Water Alarm I~vel at .-- Vent (Y/N)
Tested for Pumping Cycles during Adequacy-Te's.t.'
Elect~i..ca.1 Code~(Y/N)~ ' · ¥'
Ccmmsnts
** Check Permitted Bed~ocm Rating AGainst FAA R~q.uest
I certify that~I-h~ve checked, ~rified, c~ confc~med to all MOA HAA Guidelit.~s in effect
Sig~e
KB1/d5/s ~ PH. C9~=?~ . '~'
[Page 2 of 2] .,.;,%:.~,.:.: .~.~
2-15-84
KW
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•
• : - - Municipality of Anchorage
T On-Site Water and Wastewater Program
f
(907) 343-7904 .,,���.c
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CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-571-12 Expiration Date: I,v 2 "'-t
1. GENERAL INFORMATION
Complete legal description _PREUSS +2 BLK 1 LT 16
Location (site address) _20110 DAVID AVE, EAGLE RIVER AK
Current Property owner(s) _BAKER LEE R & MOLLY Day phone
Mailing address _SAME
Real Estate Agent one
�g 14 5 6 78
N \.9,
2. TYPE OF DWELLING: e4s i Vii, 9 o J
® Single Family (w/wo ADU) JO
❑ Duplex N �Ci ZQ,D AiSe3
❑ Multiple Dwellings (Single Family and/or Duplex) moo` �a
ti\
3. NUMBER OF BEDROOMS: 3 ttik
9 5
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual
Individual Water Storage Cl Holding Tank ❑
Community Class A Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: 1744r r Date: C, _
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 3tt t- V) Waiver Fee $
Date of Payment - 194lig Date of Payment
Receipt Number 6Z.29'60 Receipt Number
COSA# O5C1'f39 Waiver#
t
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 MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE.
Engineer's Printed Name MIKE N ANDERSON, PE Date 7/21/18
¢
-
^0 90 , ¢c o e n c o n e, , n A
n f,
n 0.20.0' ,9"" "n n¢p 0'' n .f
6. DSD SIGNATURE e, .' , MICIlAcL N. ANDER i "
System #1 Approved for 3 bedrooms. Jl777¢,,�`;�:Y,,,
System #2 Approved for bedrooms. � �;; iY
Disapproved.
Conditional approval for bedrooms, with the following stiputlons:
'SG.
ON-SITE ,
WATER AND rt
WASTEWATER z
-Y% PROGRAM
^'r Qr:r)\,Ic c•
r--
By: —� �`eC' Original Certificate Date:
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:
• Q.
COSA Checklist X Nitrate Advisory
Septic System Advisory ArsenicAdvi'seiry',
Well Flow Advisory Other, .�
COSA blue sheet 10-10-12.00c
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: PREUSS #2 BLK 1 LT 16 Parcel ID:_050-571-12
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# Well Log (YIN) N
Date completed UN Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 81° ft. Cased to UN ft. Casing height (above ground) 18"+
FROM WELL LOG AT INSPECTION
Date of test UN 6.29-18
Static water level UN ft. 50 ft.
Well production UN g.p.m. 4+ g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 2.23 mg/L
Arsenic: ND ug/L Date of sample: 6-29-18 Collected by: MNA
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL Date installed 6.10.03
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 6-29-18 Pumper QUALITY PUMPING
C. ABSORPTION FIELD DATA
Date installed 6-10-03 Soil rating (GPD/SF) 0.8 System type DEEP TRENCH
Length 43 ft. . Width 2.5 ft. Gravel below pipe 6.5 ft.
Total depth 10 ft. Eff. absorption area 563 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 6-29.18 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 22 in. Water added 500+gal. new depth 43 in.
Elapsed Time: 1350 min. Final fluid depth 21 in. Absorption rate >_ _500_g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
•
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in.High water alarm level at in.
Datum Cycles tested Meets alarm& circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main 100'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 100'+ Holding tank NA
Animal containment areas 100'+ Manure/animal excrete storage areas 100'+
SEPTIC TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 200'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10 Water main 100'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+(None Known) Wells on adjacent lots 200'+
F. COMMENTS ..�P.• c aj�
• OF , 4�`,
FROM MOA FILE -" • .4
* •
• 49TH �"f
ilw
G. ENGINEER'S CERTIFICATION %.
MICHAEL N. ANDERSON ;4 '
1 certify that I have determined through field inspections and t . . �,
review of Municipal records that the above systems are in �fly.•. „/, ,9 •'\���
conformance with MOA COSA guidelines in effect on this date. k t • ••.••'‘`�`0
Engineer's Printed Name MIKE N. ANDERSON, PE
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Date 7/21/2018
COSA canary sheet_2-6-15.doc
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ASBU1 LT SEWARD & ASSOCIATES LAND SURVEYING 694-0829
I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE' , 4
FOLLOWING DESCRIBED PROPERTY: _ �� 7t OF A z
���e� .ff' "i'•'.�.e,4,oT/�/..74,1"/ • DATE. • J �r
AND THAT NO ENCROACHMENTS-EXIST (CEPT AS ,c 9' .. ' -c--• -•-f-
INDICATED. IT 15 THE RESPONSIBILITY OF THE . , .• 1-,,T•711=1 v-\ >
OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: f+.
EASEMENTS,. COVENANTS., OR RESTRICTIONS WHICH DO NOT APPEARRf CTtONS �.✓ ; f Os°- ,4
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ON THE RECORDED SU - •�- _ `: - werd g
BDI � Duane MC•K Seward �
VISION PLAT. UNDER NO CIRCUMSTANCES Sign' UU E5: •. LS- 8 ....
•AP:
ANY DATA HEREON BE USED FOR CONSTRUCTION /y,-.3 I s'."=° 5
OF PENCE LINES, OR FOR ESTABLISHING BOUND- DP2At�►N= y - �•
f`aRY LI NES.
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