HomeMy WebLinkAboutBILLI JEAN LT 48AOnsite File
Billi Jean
Lot 48A
PID# 051-072-85
Formerly T15N R1W SEC 4 LT 48
MUNICIPALITY OF ANCHORAGE
· DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
~ Absorption area ~'~,~ P~RMIT ~
h~ Manufacturer ,
~h Li~allons IF HOMEMADE: Inside ,engt~ Width~ ~iqui~ deptb
Manufacturer ~aterlal Liquid capacity in gallons
~ ~o. o~ lin~ ken,th of eac~h llne Tota~ ~ lines Tro~ ~th~~ Oistance bot~os
h~ ~ Top of tile to f~ ~ ~ . Material bene~il~ inches inches Total effective absorption area
Length W~dth Depth PERMIT NO.
j ~ype of crib ~ ~iameter Cr b depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
~ Building foundation Sewer llne Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
iNSTALLER
REMARKS
APPROVED DATE LEGAL
72-013 (~ v, 3/78)
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THEi: [::,EZF:'T!..I I'*~:' t::! TF:E:NCH '"F' F'IT T'::; 'Fb!l~!; I . , E ......
CiF?.OLIND Fi?',!D THE: E :: '.".- :: I'"1 -'
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O1:::' THE t,IE:I._.L COH!':'L.E:TION.
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............. ::, : , I::.t'1:!:!"4 FICCO!:;?.DF:!NCE I.,!llr-, "i'H!.E: C:O[:,I~S.
;;i:: 'r I.,!:I:I.~L. T t"1': Tt:::It I THE: "' "- .......... ' .... ' ~
.~i:: i t"I1.:' F:}?':_Tr'F:li~.,hq, "r'HF:!'T' 'FI.!E "1'.,.~.':~ "T::' ..~EIMt. :, r:: I E. I1 t"IF:!'T' t:;;:l!i~l;:!tJ]:t:;;J~E FNLFI1;;:EiEI:'IEiNT !F' THE
t:;~:ii'::'_-E~ i I::;,t:~f",ICE: i :5 F~E'MC~E;,I:E':I....E:E:, "!'C~ i t"I E .._ ._ E,i:E I"iOF::E "I"HFIi"~ 51: E I-. t4:,: ,JUl I.::,.
F:tF:'I::'L ! CFIN"i !"OHN'_:];IEI',ID Ei;l"."f'E.:;:.::'.:;: ]: 'E E;:ii;
GREATEr ANCHORAGE AREA BOROUGH
,,c,, STREET ANC.ORAGE. ALASKA
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PeRmiT
INSTALLATION OF: SEPTIC TANK SEEPAGE PIT -. DRAIN FIELD
FINANCED THROUGH TO BE INSTALLED BY .
, OTHER
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE RE(~UIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
DIAGRAM OF SYSTEM
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK %~"~ ~¢,
FOUNDATION TO SEEPAGE PiT -, DRAIN FIELD
SEPTIC tank TO SEEPAge PIT WALL
SEPTIC TANK ., SEEPAGE PIT
TO NEAREST LOT LINE.
WeLL TO S~TICTANK /~) ~
DRA'N
DRAIN FIELD
, SEEPAGE PIT
· ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
TO RIVER. LAKE, STREAM.
PIT
SEEPAGE PIT
. DRAIN FIELD
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
LICENSED D E$1(~ N ERI
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREAT R A DRAG REA BOROUGH ORDINANCE NO. 2 8 AND THAT THE ABOVE
08-E
GEOTECHNICAL 8' DEVELOPMENT
Box 90, Davis St., Eagle River, Alaska 9957''~''~ 694 2774 or 688-2280
Russe# Oyst. er
694 2774 SOIL LOnG
Soils Et Foundations
Performed for: Name:
Mailing Address:
Legal Description: ~/-, V, ~:' ,
4
5~
6
CO.
Ea,'l EIh~s
688-2280
Land Development
Tel. No, d; ?¢-2VY'¢
13
15
15
Ground Water Encountered: Yes ; No
Proposed Installation: Seepage Pit
Comments:
f
If yes, what depth_~
Perfod~ed by:
Drain Field~
;~, ~t, Box 5063
Chugiak, AK 99567
July 1, i978
Joe Blair
De. pt, of Health & ~nviro~ental ~¥otection
I~iunicipality of Anohorage
A~mhorage, AK 9950i
Dear Mr. Blair:
On June 17, 1978, I ~ade a preliminary and a final inspec-
tion of a sewer system ans~al]atmon by Yates Construction
for Townsend Enterprises on Lot 48 ~m Section l~l, TiSi~,
RiW, ~gM, The installation was ~r~de in reason, hie co?~ormance
to the plan as designed by the Municipality
It should be noted that the new system is within 10'~ of
an existing water source--hand dug well, I was told. The
existing we~l should be vacated and backfilled before the
new system is utilized. The pla~ed location of a new
well as sho~ to me by Mr, Yates is beyond the lO0' limi~
ration.
..~cnael D. Gavin, I .E.
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION
DATE - Started
PERMIT NUMBER
kgerltfieil rtlltng
by
A & L DRILLING COMPANY
BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588
Ended
DEPTH OF WELL
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR /
KIND OF CASING
KIND OF FORMATION:
From L¢9 Ft. to ~ Ft
From ~'> Ft. to ,~',~ Ft.
From 2~ Ft. to ~ ~ Ft.
From Ft. to.__Ft
From Ft. to__Ft.
From Ft. to Ft._
From Ft. to Ft.
From_ Ft. to__Ft.
From__.Ft. to Ft~
From__.Ft. to__Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
Fro]n__.Ft. to Ft~
From Ft. to. Ft.
From Ft. to Ft.
From Ft. to Ft
From Ft. to__.Ft.
vrom Ft. to__Ft
V~O ~)~m Ft. to Ft.
From Ft. to Ft
From Ft. to~Ft
From Ft. to Ft
From Ft. to
From Ft. to Ft.
From Ft. to. Ft.
From~.FLto Ft._
From~Ft. to Ft.
From_~.Ft. to Ft.
From_ Ft. to Ft,
Fromm. FI. to Ft,
From Ft. to.~Ft.
From~.Ft, to Ft.
From Ft. to Ft,
MISCL. INFORMATION:
DRILLER'S NAME
• Municipality of Anchorage
On -Site Water and Wastewater Program 4
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-072-45
1.' GENERAL INFORMATION
Complete legal description T15NR1 W Sec. 4 Lot 48
Expiration Date: 7 � 2 Z —20Z()
Location (site address) 21915 Blair ave. Chugiak, AK
Current Property owner(s) Gary Perkins Day phone (907)-229-7099
Mailing address
Real Estate Agent
21915 Blair ave. Chugiak, AK
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.
COSA Fee $ 65-0
Date of Payment 31 «1abaa
Receipt Number c4 t- u4*;'
COSA# (3�C*2b14Q(
Date:
Waiver Fee $
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 �l 17 1 Zc7
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 i QF' AL� ' 1
encroachments, deficiencies or discrepancies exist.
C) Til
6. DSD SIGNATURE
System #1 Approved for bedrooms. �,r ,� Fri° 100
�/
System #2 Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following l on
. ? r%ki _CITF
�'� aa1A4Cfl min '•'r
l SERV 1\,``�� \.
r
By- 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:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisofjm }
Well Flow Advisory Other
COSA blue sheet 10-10-12.doe
COSA Checklist
Legal Description: T15NR1 W Sec. 4 Lot 4$ Parcel ID: 051-072-45
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 1
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 1978
Total depth 32 ft
Cased to 82 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 30 in.
Date of flow test for COSA 3/9/20
Static water level at beginning of test 27.4 ft.
Comments
Well production at time of. test 5.2 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes No
❑ Coliform bacteria is Negative
Nitrate 0.9 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L X Arsenic less than MRL (ND)
Collected by Arcterra Consulting
Date of Sample 3/9/20
B. TANK DATA C. LIFT STATION
Age of tank(s) 42 years ❑ Required maintenance completed
Tank type/materialFiberalass Age of lift station years
Measured operating fluid level in septic tank Lift station material
FR Standpipes/foundation cleanout per record drawing Comments:
Date o mg Top of tank to top of liquid was at 11" during inspection
-ll
-2-MO
D. ABSORPTION FIELD DATA
Which system tested (date installed) 1978
fJ ALL standpipes present per record drawing
Total measured depth from grade 2.5 ft (max)
Measured depth to pipe invert from grade 2 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
Com ments/Deficiencies:
COSA Checklist yellow sheet
Adequacy test date 3/9/20
Results ®Pass For 3 bedrooms
Fluid depth prior to test 0 in
Water added 450 gal
New depth 0 in
Elapsed time 1 min
Final fluid depth 0 in
Absorption rate 450-1- 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'
® Yes
if No
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
7 Yes
if No ft
Neighboring Tank > 100' ® 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'
if No
ft
Animal Containment > 50' ® Yes
if No ft
�j Yes
if No
ft
less than required)
Building Foundation > 10'
Yes
if No
Manure/Animal Excreta Storage > 100'
If absorption field is under driveway comment below
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'
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'
i
® Yes
if No
ft
Community Wells > 200'
® Yes if No ft
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S 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.
COSA Checklist yellow sheet
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MUNIC(PALITY OF ANCHOP, AGt'
MUNICIPALITY OF ANCHORAGE DEFT, OF HEALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECE~ONMENYAL PROTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL ENGINEERING DIVISION S~'P 'J. 9 t978,
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW~RE~F~J~L~S~ ~
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. PJease allow ten (10) days for processing.
~11, PBOPERTYOWNER
MAILING ADDRESS
PROPERTY RESIDENT (If different from above) ' ' ' PHONE
2. BUYER PHONE
MAILING ADDRESS
3, LENDING INSTITUTION
MAILING ADDRESS
4, REALTOR/AGENT
PHONE
PHONE
MAILING ADDRESS
5. LE~ L DESCR PTION
STF~ EET LOCATION
6. TY~E OF RESIDENCE NUMBER OF BEDROOMS
~ ~ One ~ Four ~ Other
SINGLE
FAMILY
~ Two ~ Five
MULTIPLE
FAMILY
~ Three ~ Six
7, WATER SUPPLY
~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
~ COMMUNITY since June 1975. For wells drilled prio~o that date, give well
~ PUBLIC UTI LITY depth (attach log if available.)
SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
**If individual/on-site, give installation date /('~ .
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
72-010{3/78)
' THISSIDE FOR OFFICIAL USE ONLY ~'
DATE RECEIVED
INSPECTION APPOINTMENTS
'TIME TIME TIME
DATE DATE DATE
INSPECTOR . ~ , INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRI I_LED
[] PUBLIC UTI LITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[] INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Connection Verified INSTALLER
[]Septic Tank or [] Holding Tank
Size:~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/HoldingTank Absorption Area Sewer Line I Nearest Lot Line
WELL TO:
I
Absorption Area to nearest Lot Line
5. COMMENTS
J APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL ([etter must accompany certificate)
[] DISAPPROVED
LEGAL DESCRIPTION ~__~
72-010 (Rev. 3/78)