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HomeMy WebLinkAboutKEE-TOO ACRES TR AI ee- Too cres 017-101 -43  Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 Elmore St. P,O. Box 196650 Anchorage, AK 99519-6650 Page www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: ~o /O 1,/'~ ~ PIDNumber: O/7/o/ Name: ~1~O~ ~r~O~l.~ WastewaterSystem: ~New ~pgrade Address: ~o( ~/~ ~u~ ~ ~ ABSORPTION FIELD Phone: Number of Bedrooms: ~ ~Deep Trench ~ Shallow Trench ~ Bed D Mound D Other: Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION ¢-q ~ GPD/Ft2 ~'~ Ft. Block: ~¢~Lot:~ ~ ~~Subdivisi°n: ~~ ~ Depth to pipe bottom from original(~grade: Ft. Gravel depth beneath pipe: ~ Ft. Township: Range: Section: Fill added above original grade: Grave~ Length: Well: ~ New ~U~ Gravel width: ~10 Ft. Number of fines:~ Distance between lines:Ft. Classification (Private, A, B, C): Total ~ Cased to: Total absorption area: Pipe Material: ~ Ft. Ft. ~ Ft2 Driller: ~ Date Drilled: Static Water Leveh Installer: ~ DateInstallS: Ft. ~ ~ 'Yield: / Pump Set at: Casing Height Above Ground: .~. TANK GPM Ft. SEPARATION DISTANCES ~ Septic ~ Holding ~ S.T.E,P. ~ Other: ~ Manufacturer: ~ Capacity: To Septic Absorption Lift Holding ~ublic/Private Tank Field Station Tank Sewer Line ~¢ ~ ~ ~ ~ Gal. Material: Number of Compartments: Lot tine SO ¢ W+ Size: Manufacturer: "Pump off' ievei at: Gal. "~~ Foundation 20 ~ 501 ~ ~ ~ in.I in. ~ ~ Pump Make &~ Electrical Inspections performed by: Remarks: BENCH ~ARK Location and Description: Assumed [levotiom .Jq~, Enq~eer's Stamp Inspections performed by: ~t ~¢~ 1 d~ Dates: 1st ...... Development Services Depa~ment Approval ¢~ "4 Conditional Approval Date: ~ ¢_' --,C.A~, Pe'rmit No. 0SP101156 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 545-4744 On-Site W(]stewoter Dispos(]l System (]nd/or Well Inspection Report Legal Description: TR A, KEE-TO0 ACERS S/D PID No.' 017-101-45 GRIND. PIPE MARK A B ELE~. . E LE~':'. FCO 12 1~ ~09 C02 55 58 105 101.6 C03 58 60 105 100.9 t- TC01 62 63 104.~2 TC02 67 70 104.~2 C04 75 80 103.~ 100.4 C05 77 83 103L4 100.4 C06 85 100 10215 99 C07 119 142 10212 99 ~T 118 140 102.2 i X I C06 X / / ~A. / ~ / t 1~ / ~ ./~ X, // ~ ~ HOUSE ~ ~ II ~/ XTH 1 / I ~ ~ ~ H GARAGE S~B~ ,I IJI " 'k~ EXIS~ WELL RADIUS / -~--~ SCALE: / I _ ~6 ~,250 GALLON ~4 s~e ~K ~ 9g SEP~C SECTION N.T.S. 8o.o Permit Number: Tax Code Number: Work Type: On-Site Wastewater Disposal System Permit OSP101136 0171O143OOO Septic MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade Permit Effective Dates: August 10, 2010 to August 10, 2011 Design Engineer: ANDERSON CONSTRUCTION & ENG'G Subdivision: KEE-TOO ACRES Site Legal Address: KEE-TOO ACRES TR A G:3037 Owner/Address: MOUSTAKIS JAMES L & KAY 5401 E 142ND AVENUE ANCHORAGE AK 995164225 Site Mailing Address: 5401 E 142ND AVE, Anchorage Lot Size in Sq Ft: 126071 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: ;,/~ ~ I ss u ed ~/~ ,~/~,/~~¢~,~"~ Date: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99507 www. muni.org/onsite (907) 343:7904 ON-SITE SEWER/VVELL PERMIT APPLICATION C~_~ £/~ I (~ (~ FOR A SINGLE FAMILY DWELLING Parcel I.D. (?/'-'~- / C 1 -- C/._~ Property owner(s).' L~¢~ ~c~-'~,1 H~(,~. ~'"~ ~ ~ ;'5 Day phone Mailing address .Zip Code Site address Legal description (Sub'd., Block & Lot) Zip Code Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOP, ([~ all that apply): Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage THIS APPLICATION IS AN: Initial [] Upgrade {~ Renewal [] I certify that the above information is correct. I further certify that this application is being made for a Single Fanli~ Dwelling and,'~ ~n accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment:. Receipt Number: (Rev. 11/05) Waiver Fees: Date of Payment: Receipt Number: Michael N. Anderson, P.E. Civil/Structural Engineering & Construction 4661 Natrona Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 July 27, 2010 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Kee-Too Acres Tr A To Whom it may concern: This is a request for a new 4 bedroom replacement septic system. The current 3 bedroom log crib has failed and needs to be replaced. Two new test holes were excavated along the west property line to show that a 4 bedroom system can be installed with the reserve area. Both test holes consisted of 20 feet of poorly graded silty sandy gravel. No water was observed after the 7 day monitoring period and the perc rates were 24 minutes per inch. The existing log crib will be demolished in-place and filled. The lot has a gentle slope of about 3 to4 percent which runs to the west. The existing 1250 gallon tank is inside the well radius therefore it will be pumped and crushed as required. None of the neighboring lots will be impacted by this new installation due to the large lot size. If you have any question please call me at 727-8864. Michael N. Anderson, P.E. DESION CRITERIA: ~ r ~--MOUND OVER ' GRADE 4 BDRM X 150 = 600 OPD o.5 ORe SOILS = .600/0.55 = 1090 OPD m R FABRIC 1000 0A/14 = 72' USE 75' sP -3.0- ~~4 ¢ PIPE (1) TRENCH ~S~ER ROCK 10.0' DEEP 7.0' E~ECTNE -~o.o 2.0' WIDE I?.°', SE~IC RELD SEC~ON / T12N R3W SEC 27 LT 68 T12N R3W SEC 27 T12N R3W SEC 27 LT 69 S2 LT 70 S2 SLOPE GRATER ~N PROPE~ LINE 25~ ~ · - EAST 140TH AVEN U E- ~' I ~I~NG HOUSE sEP~c PROPOSED TANK , I~ ACR~ PROPOSED D~INRE~ TIMBER ~IL IL~MNA ACRES 100' ~DIUS, ~ -EAST 1 42 N D AVENUE- IL~MNA ACRES I~M~ ACRES I~NA ACRES IL~M~ ACRES IUAM~ ACRES T~CT 6 LOT 5A LOT 5B ~CT ~ ~CT 3A Sep[ic Design Prepared for LINTON MOUSTAKIS KEE-TO0 ACRES, TRACT A ~ Anchorage, Alaska - -- ' Michael N. Anderson P.E. DATE: 7/14/2010 ~ ~ ~,~Michael N. Anderson:,~ ~,~p~% CE-9469 4661 NATRONA AVE. DRAWN: D JR ANCHORAGE, ALASKA 99516 345-3377 / FAX: 345-1391 SCALE: 1"=200' DESIGN CRITERIA: ~MOUND OVER 0~) (~.#2) ~ f -.,~~OE 4. BDRMX 150 == SO0 OPD ORO ' -3\0\ ~/4FI~TE~I~A SOILS = 6.000.PD/0.55 = 1090 OPD 0.5_ 0.5 i--OEO i BRIC 1090 GPD/SF/14 FT = 78FT sP ' sP -. -~ (1) TRENCH ~SEWER ROCK 10.0' DEEP 7.0' EFFECTNE -lo.o 2.0' WIDE ,o< I?'°',1 sEFnc REm SEC~gN / T12N R3W SEC 27 LT 68 T12N R3W SEC 27 T12N R3W SEC 27 LT 69 S2 LT 70 S2 SLOPE GREATER THAN PROPER'IY UNE 25% ~ · -EAST ~OT. AVE.UR- i~.T~ .--f"-- ~ J..J ~1 ~--. ,.~- --~-' EXISTING HOUSE PROPOSED S,£PTIC TANK ~ ~ ~/'~/~/~ ~ ~ ,u~.~ ,ORES PRO.OSE~ ~?..EU~ '-'y/~/ \~ ,, I / / F'/~'''-_-~"'~ I TIMBER TRNL //// KEE-'ro0 ACRES I~ EXISTING WELL ~U~4NA ,ORES Il~ 'r~CTB I ~00' P, AD~US, 'n'P //~ ~xxx} ~-~ ~x ~EXI~'ING SEPTIC \ /// .2_--__ .--- ..... .J -EAST 142ND AVENUE- ILIAMNA ,ORES ILIAMNA ACRES ILIAMNA ACRES ILIAMNA ,ORES ILIAMNA ACRES TI~,CT 6 LOT 5A LOT 5B TE*OT 4A TRACT 3A Septic Design Prepared for LINTON MOUSTAKIS .~.~ .V.... KEE-TO0 ACRES, TRACT A ~, ~./ 4-~TM ~ ~ ~..~..~.~,.~.,~ ...... ~.~'~.M~choel N.. Anderson Micho~l N. Anderson, P.~. DAME: S~6~20~0 '**~:'-.. C.~¢~ 4661 NATRONA AVE. DRAWN: D JR ~,;.~?.0.0.C.~.~//,~.:..'~.~,o,, ANCHORAGE. ALASKA 99516 ,,.,.,~,:./::_-_'%'\~,,~,v$~,.:~U~ESS.~:~+ 545-5577 / FAX: 545-1591 SCALE: 1"=200' Performed For: Legal Description: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 ~j,. MICHAEL N. ANDERSON www.ci.anchoraqe.ak.us ~ ~'~,~". CE - 9469 (907) 343-7904 , ~ . ~.. ...,~ ~ ~'~ ~' ...... ,~ Soils Log - Percolation Test I ~ ~O~ ~ ~H , ~ Dat~ Pedormed: ~U ~ /~/ S,o.e Sit ..an ~, 't' P__.. )( ~, ?, 5- 6- 7- 8- 9- 10- 11- 12- 17- 18- 19- 20- COMMENTS WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? L O Depth to Water After .! P Monitoring? ~.O/~ E Date: "'~/"~ F~ Reading Date Gross Time Net Time Depth to Water Net Drop # PERCOLATION RATE "~.y (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ,~ FT AND ~- FT PERFORMED BY: /~[ ~',~-, I CERTIFY THAT THIS TES~ WAS,/ PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~/~. ~_//,~¢ 5- 6- 7- 8- 9- 10- 13- 14- 15- 17- 18- 19- 20- Performed For: Legal Description: Municipality of Anchorage __. ,,,o(~E GINEE~S Development Se~ices DepaKment ~ · ~OTH Building Safety Division ,, - z ..... On-Site Water4700 Elmore Roadand Wastewater Program ~~~* ' ' ' P.O. Box 196650 Anchorage, AK 99507 ¢~. MICHAEL N. ~.gi,anchora e.ak.us ¢; - ' ..... ,* '~% , CE - 9469 (907) 343-7904 [~ ~ · Soils Log -Percolation Test ~ [ ~c ~ ~C~ ~ Township, Range, Section: ~ ~ Slope Site Plan COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? s L O Reading Date Gross Time Net Time Depth to Water Net Drop /! PERCOLATION RATE ~ ? (minutes/inch) PERC HOLE DIAMETER TESTRUN BETWEEN /t' FT A.D FT CERTIFY THAT THIS TEST/¥VAS / PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7/~' yet2 OAAB-HD-I GR,F-~TER ANCHORAGE AREA BOROU'"~ DI:raFITMENT OF ENVIRONMENTAL QUALI'I, 3§00 TUDOR ROAD ANCHORAGE, ALASKA 99§07 279-8§86 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ,~/---,)(d-~/-/,,(//,.~'~/7~,,,~'-J'- LOCATION ~¢~./~."~-~/"~'~--"~-'~J"- SEPTIC TANK: MAILING ADDRESS LEGAL OESCRmT~ON DISTANCE FROM WELL LIQUID CAPACITY ./'/~.) ~-1~/ GALLONS. NUMBER OF MATERIAL '~<~7~¢~-'~-/--~" COMPARTMENTS INSIDE LENGTH ~ INSIDE WIDTH LIQUID DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: ,,A",c-'A'/~¢/,--d,-~/t',..z_~'" NUMBER OF PITS .,/ OUTSIDE DIAMETER OR WIDTH , LENGTH ~-,,,C¢-fc~.d,.~- ./:~...v"~;~' /"'~'? / , BUILDING FOUNDATION ~/:?~ LIN. JNG MATERIAl ~ ~ ~?--,,.~-/,,~S'~¢- . DISTA. N,CE FROM WELL ~ c' ~/~'J ~k~'.f~f'',~'~-~/-''~ ~'~:~ /.'~' NEAREST LOT LINE,'~) /~' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~.-~ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL ~UNDATION ABsoB~NUMBER OF LIN . DISTANCE BETWEEN LINES DEPTH: TOP GE TILE TO FINISH GRADE TOTAL LENGTH NEAREST LOT LINE , OF LINES SQ. FT. LENGTH OF EACH LINE ~N~REN CH WIDTH DEPTH OF FILTER MATERIAL BENEATH TILE IN. TOTAL EFFECTIVE .IN, ABOVE TILE -- WELL: LOT LINE TYPE ~' ~ W./~r/~'~ DEPTH .~'</'-//~', NEAREST SEPTIC ~Y/G/'~'' , SEWER LINE/.~Z'~..-,'~- , TANK DISTANCE FROM · BUILDING FOUNDATION.~,~'~Z&,'~- ~.~ .' SEEPAGE , SYSTEM WATER _SAMPLE .,/j'/~ , NEAREST OTHER CESSPOOl ,,-"'{/~'/f/.~'~--, SOURCEs~/~/~/~/'''r/ DISTANCES: DIAGRAM OF SYSTEM ~,A,A.B, · " GREAl'ER ANCHORAGE AREA BOROUGH ~' DEPARTMENT O~' ENVIRONMENTAL QUALITY PERMIT NO. 21 ~'8 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION OF: ~EPTIC TANK ~ ' SEEPAGE Pit _. DRAIN FIELD , OTHER SEPT]C TANK SIZE /~L~"~ ~'4~" ~YPE'~'~/;'~'~Z~'~5'~ ' ' ~'~ FOUNDATION TO SEEPAGE PET ~f~) j , DRAIN FIELD WELL TO SEPTIC TANK J~'K~) / DRAIN FIELD ~//~ .~) /~ WATER MAIN TO SEPTIC TANK d/'~''/ / DRAIN FIELD /0 / SEEPAGE AR~A SIZE ,~'~'""~'~'//'J~'~'~/~'//'~' TYPE DIAGRAM OF BYSTEM · SEEPAGE PET ~'*/d) ~.~ / ALSO CONSIDER AREA WELLS. seEPAge PIT .~/~ ~ 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. HEALTH AUTHO/RITY OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESC"'BED__/S'"'*TE"" 'S ,N ACCO"DANCE W'~ ~o 3o ~o ~o 80 9o too ~0 RECEIVED ?"~MUNICIPALITY OF ANCHORAGE~'"~ DEPARTMEN, OF HEALTH AND ENVIR~NMENT,._~PROTECTION 825 L Street, Anchorage, Alaska -99501 279-2511, ext. 224 or 225 Date Received: April 19, 1977 #1: Time 1~ p,,~ #2: Time ;~)~q~. #3: Time Date Z/_c~-~7 ~_~ Date ~-~77 /~. Date Insp ~n~ Insp ~ Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Mailing Address: Institution Request: Alaska Mutual Savings Bank % Debbie Johnson Post Office Box 1120 99510 Phone: 274-3561/216 2. Property Owner: James L. Moustakis Phone: Mailing-Address: Legal Description: Star Route A Box 461-M 99507 ~t2N RBW Sect~6~ 34 NW~ NW¼ NE¼ NE¼ 344-093~ Single Family Residence: Multiple Family Residence: Number of Bedrooms: Number of Bedrooms: ¸5. Well System: Public/Community System: ( ) Permit # Depth of Well / Individual Well: (x) Well Log on File~ Construction Bacterial Analysis Sewage Disposal System: Permit ~ Septic Tank Size Absorption Area On-site System ~x) Publ~ic Utility Insyalled /~7~_] Installer ~ ~ Manufacturer _~ ~ Soils Rate ~'~D Material Distances: Well ~o Septic Tank ~ to Sewer Line // Nearest Lot line to Absorption ;~rea Absorption Area to Nearest Lot Line Department of Request for Approval Health and Environmental Protection of Individual Sewe~ an~ W~ter Facilities Legal Description: T12N R3W Section 34 NW¼ Nq~ NE¼ NE¼ Comments~ Affadavit Attached: ( ) Letter Attached: ( ) Approved: ~ Date: Disapproved: ~ Date: Department Worksheet: t April 14~ 1977 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVI RONNIENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 279-2221 REQUEST FOR. APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO. VA James L, Moustakis 2. Property Owner: Mailing Address: SM Bo× 461-M James L. Moustakis 3. Name of Buyer: FHA CONV. X Day Phone: 344~0935 Mailing Address: SRA Box 461-M Day Phone: 4. Name of Lending Institution: Alaska Mutual Savings Bank Mailing Address: P, O, Box 1120 Phone:. N/A 5. Name of Realtor or Agent: 344-0935 274-3561 ext. 216 Debbie Johnson Mailing Address: Legal Description: Phone: NW 1/4 NW 1/4 NE 1/4 NE 1/4 S34 T12N R3W Rabbit Creek A~ea Location: 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: SF Public Utility No. Bdrms. ? 3 rlndividual X If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility Individual (on-site) × If Individual, date of installation 72 003(3/76) Certificate of On -Site Systems Approval Parcel I. D. 017-101-43 1. GENERAL INFORMATION Complete legal description KEE-TOO ACRES TRACT A Expiration Date: :36 _ W z"6 Location (site address) 5401 E 142ND AVENUE ANCHORAGE AK 99516 Current property owner(s) LYLE LANGSTON Mailing address Real estate agent Day phone 2469B MISTY FJORD COURT. EIELSON AFB. AK 99702 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: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 5-S-0 Waiver Fee $ Date of Payment "2-Z"('l Date of Payment Receipt Number a3 T22 D Receipt Number COSA # %r_' 1 a I eco Waiver # 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 & ENGINEERING Address 4661 NATRONA AVENUE, ANCHORAGE, AI< 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 F�ii S and Anderson Construction & Engineering 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Phone 345-3377 Date 12126/2019 Aft OF AL4k 49TH MICHAEL N. ANDERSON: No. CE 9489 .-• . . �' •12/26/19• • �cs�' �YOPESSIOO Conditional approval for bedrooms, with the following stipulations: By: VIAL Original Certificate Date:, 3d `, 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisory Arsenic Advisory Other Legal Description: KEE-T00 ACRES TRACT A Parcel ID: 017-101-43 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) Water storage tank volume NA gallons Date drilled * June 1973 Well disinfected for coliform test? ❑ Yes ® No Total depth * 183 ft ® Coliform bacteria is Negative Cased to * 180 ft Nitrate 1.0 mg/L ❑ Nitrate less than MRL (ND) ® Sanitary seal is functioning correctly Arsenic ND ug/L ® Arsenic less than MRL (ND) ® Wires are properly protected WES Casing height (above ground) 24+ in. Collected Date of flow test for COSA 12/16/2019 Static water level at beginning of test 87 ft. Date of Sample 12/12/2019 Well production at time of test **2.3+ gpm Comments *Per MOA data. **Production appeared restrained (condition / size) of plumbing / water system. B. TANK DATA Age of tank(s) 9 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 49" ® Standpipes/foundation cleanout per record drawing Date of pumping 12/13/2019 D. ABSORPTION FIELD DATA Which system tested (date installed) 8/14/2010 ® ALL standpipes present per record drawing Total measured depth from grade 10.5 ft (max) Measured depth to pipe invert from grade 3 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective 7.5' +/- into the 8' ED C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 12/14/2019 Results R Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 44 in Elapsed time 1400 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 1200 gallons If yes, enter date Comments/Deficiencies: Levels dropped 16" the first 2 hours and MT found dry the next day. F 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' ® Yes if No ft Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No _ ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ft ft ft ft ft ® 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 _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® 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 Foundation > 10' ® 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 Surface Water > 100' ® 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. *:49!H* 06 MICHAEL N. ANDERSON: No. CE 9489 w 12J27J12.•'o'� X Ilk Essio-O" ft ft Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I,D. ¢ / ~ - /¢/' - ff '7 GENERAL .INFORMATION Complete legal description Location (site address) Current 'Property owner(s) COSA# Expiration Date: ',% Day phone c/-/© Mailing address Lending agency Day phone Mailing address Real Esta[e.'Agent . Day phone Mailing Address UnleSs otherwise requested, COSA will be held by DSD for pickup. NUMBER ,OF BEDROOMS: m TYPE OF WATER. SUPPLY: Individual Well Individual Water Storage Community Class Well Public-Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~ Individual Holding Tank Community On-site [] Public SeWer [] r The Municipality of Ancl~Orage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional.civil engineer registered in the State of Alaska. Certificates of On-Site System's Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or class c well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) 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 theprofessional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER .5. As certified by my seal affixed hereto and as of the validation date shown beloW, I verify that ny. 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,-¢dequate for the numb~er~T bedrooms and type of structure indicated herein. I further verify that based on tJ:i~e~j0formation obtained fro~J~e Municipality of Anchorage files and from my investigation and inspection, the o~'::'s[te Wa!er 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. Address ~/N~~ ~ Engineer's Printed Name f¢(i ~'¢'w c[.A(,/Ct/. ~-~--i-~-¢¢t DSD SIGNATURE Approved for J"'/" bedrooms. Disapproved, Conditional approval for Phone Date ~ ~' M,CHAEL N. ANDERSON ~.~ bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well .Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other .. (Rev. 11105) Original Certificate Date: c~ _ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: 7("~ ~ '" ~" ~' LZ'¢_~ ,~e r~' '~. Parcel ID: O/~Z A. WELL DATA Well type Date completed. Total depth ~ ~" ~ ft. Date of test IfA, B, orC provide PWSID # ~ Sanitary seal (Y/N) ~ Cased to ( ~rO ft.~" FROM ~ ~,et~,v' ~ Static water level Well production WATER SAMPLE RESULTS:. Coliform Well Log (Y/N).. f~ Wires properly protected (Y/N) casing height (above ground) AT INSPEC/TION '7..~ in. g.p.m. Other bacteria. (~r ..'colonies/100 mL Collected by: /~f'/ ~/ t" A( .,,{/ct ~ ~-v 6 x~ Date installed ~,~?~e////0 Cleanouts (Y/N) ...... ~ (~ colonies/100 mL Nitrate C0,"2o( mg/L ' Arsenic: ~ ~,, O ug/L' 'date of sample: ~'/~),~0 B. SEPTIC/HOLDING TANK DATA Tank Type/Material ,~ ~..e ~, C Tank size { 2 ~'0 gal..... Number of Compartments Foundation cleanout (Y/N). '~ Depression over tank (Y/N) ~Date of pumping '~ ~ Pumper · C. ABSORPTION FIELD DATA Date installed ~"/~/~1 Soil rating (g.p.d./ft2 or ft~/bdrm) Length ~ ~, ft. Width. ~ O ft. Total depth .~ ,~) ft. Eft. absorption area leeS'ft~ Monitoring tube ,~' Date of adequacy test ~ Results (Pass/Fail) Fluid depth in absorption field before test ,,-'""~in. Water added. ,,,-"~gal. Elapsed Time:/'"'~min. Final fluid depth,,,-'~n. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) High water alarm (Y/N) System type O ~ ~P Gravel below pipe ~'C-~ ft. Depression over field For ~ bedrooms New depth ~ g.p.d. If yes, give date D. EIFT .STATION Date installed Size in gallons ManholelAcc.~-~-~ (Y/N) "Pump on" level at . in.?.~~~'-- in. High water alarm level at D,atu~m _..-.--~ Cycles tested Meets alarm & cimuit requirements? E. SEPARATION DISTANCES · SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot / 'Public sewer main ~/,~I", .. Sewer/septic service line On adjacent lots ! O O r 7/.. On adjacent lots /~ t ~. Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas Animal containment areas SEPARATION DISTANCES FROM SEPTICl ~R'3~'~__..~G TANK ON LOT TO: Building foundation ~z. 0 Water main · Wells on adjacent lots ! Property line ~"0 tF Water service line /'06 ¢-~. Absorption field 7..~ Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water Service line /co t./. Curtain drain Building foundation. ,-F Surface water / ~a ¢'F-- ' Wells on adjacent lots /00 (4- Water main ! cPO t '~ Driveway, parking/vehicle storage *' ~-~" COMMENTS 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. Engineer's Printed Name /~ ~0.~f' ~ ~ ~(-f¢ f~ Date ?/6,/0 COSAFee $. ~ ~ ~ .~' /~5' ~a,~K Date of Payment '~~ ~/~/'[ ~ q/~/~ Date of Payment Receipt Number / '~ ~ L~ ~ ~ ~'~}q~ Receipt Number (Rev. 11/05) N 90'00'00" W 330.15' 10' UTILITY EASEMENT i,i LO LiJ .... I TRACT A I / e· · eee ~/ / ,'v/r- BASEMENT ~"','..., I S T,C , .... f VENTS~ /'NN~./-~' ,~ ENTRY ro ~ 166.8' o II/_: / / \ / r~ '~-*'Q'.~-'*'~ \SHED\ ~ / / / / ~ '.-w':,.~;~ DOG / / / / ~ ~¢--~..~.~.-~-.~"~, ~ KENNELS <~ ~ ' 280.25 (280.17' R) ~ ~ TRACT B , ~ ~-~"W:~l. ~ O = FND 5/8" ~BAR W/YELLOW PLASTIC CAP ANCHO~GE RECO~ING DIST~CT ~s~um~ oF: EAST 142ND ~VE KEE-TOO AC~S T~CTA PLAT97-119 b~O ~ ~L LAN/) SURVEY CERTIFICATION: I, John L. Schuller, have conducted a --~XX}}X1 ~ ~XO physical su~ey of this prope~ as shown on this &awing and that the ~ ~'~' ~ W,% ~ - ~ improvements si~ated thereon are within the prope~ lines and no ~'" ~.." .... ~ ~ . .~ ~%~ ~ enchroac~ents exist other that noted. ~."' 49TM ~ }"-. EXCLUSION NOTES: It is the o~ers responsibility to dete~ine ~e ~ ~ (' '~~ ~ *~x existence of ~y easements, covenants, or res~ictions which do not ............. ..... _7 appear on the recorded subdivision plat. Under no circumstance should ~ ~. ~N~ L SCHU~R..' ~ ~ any info~ation on ~is &awing be used for cons~ction offences, ~.~¢~ ~ L8-10408 .. ~ ~ . ~ "..~ _._ ...-' ~¢~ 'X- structures, improvements, or for establishing bound~ lines. ~ J.. Z..I.D. o~ ' ' "" WORK ORDER NUMBER: DAm: SCA~: ,, 50' [-NAI~ '~ ~fessionON~ 18~1 Talkeetna Street SEPT 1, 2010 1= ~~ Anchorage, Alaska 99508 1 O-- 032 )~ ~v:[c,[c~a ~ oRI0 ~UNa[R: ~o0~/~aOE: (907) 227--1455 office I JLS 3037 100271 (907) 274-4992 fax Page 1 of 1 Poet, Jeff W. From: Michael Anderson [mnanderson58@gmail.com] Sent: Thursday, September 09, 2010 4:08 PM To: Poet, Jeff W. Subject: Fwd: 142nd M. Anderson Begin forwarded message: From: Brian Wille <brian.willel ~gmail.com> Date: September 9, 2010 1:31:21 PM AKDT To: mnanderson58 ~grnail.com Subject: 142nd Well at 5401 E. 142nd was scoped with camera down to 45'. No perforations were found. 9/9/2010 Brian R. Wille Aarow Pump & Well Service (907)346-9355 9/9/2010