HomeMy WebLinkAboutCRESTWOOD LT 19Crestwood
Lot 19
#015-061-22
GREA~,:R ANCHORAGE AREA BOR.~IGH
Department of Environmental Qualitv
3330 C Street
Anchorage, Alaska gg§03
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ~'~O-;P .Ho,~'s MA,LING ADDRESS 0~:~ 3 ~~, ~.o~
SEPTIC TANK:
DISTANCE
FROM WELL MANUFACTURER
INSIDE LENGTH
~' INSIDE WIDTH
DISTANCE FROM WELL FOUNDATION
NUMBER OF LINES ~ DISTANCE BETWEEN LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
WELL:
flf ~,,~.~,.,~"L..-,<-~ COMPARTMENTS
J LIQUID DEPTH /'~L I QU I D C APAC I TY/O~GAOLLONS.
SQ. FT. LENGTH OF EACH LINE
3 /' DEPTH OF FILTER ~,'~/' "~'
MATERIAL BENEATH TILE IN. ABOVE TILE
TYPE CONSTRUCTION
/
~0 TOTAL LENGTH96--
NEAREST LOT LINE OF LINES
f
~/-- )2 TRENCH WIDTH IN. TOTAL EFFECTIVE
?~,N.
DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION LOT LINE__ SEWER LINE__, TANK__ SYSTEM
CESSPOOL
OTHER SOURCES
APPROVED
DISAPPROVED
REMARKS
DISTANCES:
SEWER LINE DEPTH:
Form EQ-032
DIAGRAM OF SYSTEM
DATE
APPROVED
G.A.A.B.
FIF'PL I CFlNT
I... C ':'FI T I 0 N
i_E'.GFIL_
I_':,EF'FtRTMENT F)F HEFtLTH FIND, EN'v'IRI"INMENTFIL. PROTECT IlioN
825 "/..." '.E;TREE'I".. FINI]:HI]RFII:..'iE., FlK. 9'.:)50i
2?9-25ii
C, P-~ --- :E: ::[ "T" E:: "_'-EL; E: i--41E
FOF.:EI"I FIL:;T H .If'lE.=,
Bt~! I E N [:,R
LJ..9 ] F.'ESTNf_' ]E:, SIJE',C,
"t" '¢ F' E 0 F 'E; E t L R B S 0 R E:"f' I 0 N :5'-r' L=; T' E M I S ' t" R E N F: Id
I"'IFIX t MI..tM NLIME:ER C F E:EE:,F.:OOM:E; = :.':i: :E;O I L F.:R'I" I NG ,:: '.-.--.,Ii.! FT,-."SR ::, = ±27:5
THE RE(;!LIZRED SIZE OF THE E;OIL FtSSORF']"I(]N S'¢:E;]"EM I:5 '
IE:, E: F:' -F H = :_'.--Z; L.. E.E !'-,I i:Ei -T' H = ,4 ";:~ L':_~ F..: Fi %-" E: 1 .... [.T.:, EE F" -I- H =-= ~:1t-
THE LENGTH [:, I MENS t ON IS THE LENGTH ,::IN FEE-['::, OF THE TRENCH I]IR DRRINFIELt}.
THE [.',EF'TH OF R TRENCH OR F'IT I E; THE [:,ISTFINCE E:ETWEEN THE 'SLIRFF~CE OF TIdE
GROLtND FIN[:, THE BOTTOM OF ]"HE EXCFIVFtTtON (IN FEET).
THERE IS NO SET WI[:,TH FOR TRENCHES.
THE GRFt',,,'EL. [:,EF'TH IL:; THE MINIML.IM DEF'T'H C)F GRRVEI .... BETNEEN 'THE OUTFFILL PIPE
FIND T'HE BOTTOM OF THE E::.::CFt',,,'FtTION ( IN FEET').
I~:: EZ G:~ El :]; F--: E: IE:, :..-7. E] F" -f" I C: 'T la J"-.~ I-::] :.:_-; :[ ;-~--_ E = ::L IE:-~ ~_.T-~ ~-Z-~ tT:~ R L_ IL_ C~ b,,i '2--3
BRCKFII_LING OF FtN'¢ :_q','~TEM b~ITHOU't' FINFIL. INSPECTION FINC, FIF'PROVFIL B"r' THIS
[:,EF'FIRTMENT NZLL BE '_:,UBJECT TO F'ROL=;EF:I..ITION.
MtNIMLIM DI S'T'taNI::E E:ETNEEN A FJEZI_L AND, FIN'¢ ON-SI]"E SEb. IFtGE [:,i SF'OSFIL_ S'¢STEM I S
2..E)E) FEET FOR R PR I',,,'flTE NEL. L. OR ;2:C~E~ FE:E:T FOR R PUBLIC NEL. L..
14ELI_ LOGS ARE RE:QUIRE[:, AND MUST BE RE'rI.JRNE[:, -ro THE DEPRRTMENT N ITHIN
OF THE WELL E:OMPL. ET ION.
SPECI F'I CRT IONS RN[:, CONSTRUCT I ON D I flGRflMS RRE: fl',,,'R IL. flBLE -ro INSURE PROF'ER
I NS ]"~LI_ R T I ON.
I C E [4..' "[' I F' 'T' T H Ft-I-
:1.: I FlM FFlMILIFlF.: WITH THE REQUIREMENTS FOR ON-SITE SENE:R:E, FINE:, NELLS FlS SET
FORTH Btr' THE MUNICIPFlLIT'¢ OF FlNCHC~F.:FlGE.
2: t NiLI_ INSTFtLL THE: S'¢E;TEM IN FiCCOF.:E:,flNC:E NITH THE CO[:,ES.
ii:: I UNDERSTFlND THFtT THE ON-SITE SENER L--.,'x'STEM I"tFt'¢ REQUIRE ENLFlRGEMENT IF THE
RES J: E:,ENCE IS REMODEl_ED TO INCLU[:,E MORE THFlN '-7-': BEDROOMS.
E; I G N E [:, '
FlF'F'L I CFINT FF~F.:EMOST HOME::.;
I S E; U E [:, E 'T'. .............................................................. [:,R T E ..........................................
GREaTeR aNChORAGE ARea BOROUGH
DEPARTMENT Of ENVIRONMENTAL QUALITY
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
'"STALLAT,O. 'OCAT,O. /3 /";' e---"~ ~,''"
LEGAL DESCRIPTION /~-~ ii ~.~ ~- [ ?
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
so,L TEST RESULTS /~,£ A
SEEPAGE PiT
DRAIN FIELD OTHER
TO BE INSTALLED BY
NOTE: THIS PERMIT IS NOT VALID WITHOUT ~K)IL TEST
COMPLETION DATE ANTICIPATED
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.
SEPTIC TAnk size /~
TYPE SEEPAGE AREA SIZE TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE Pit . DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
. ~%~GE Pit
SEPTIC TANK
TO NEAREST LOT LINE.
WELL TO SEPTIC TANK /{~(~
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEPTIC TANK,
., DRAIN FIELD
ALSO CONSIDER AREA WELLS.
SEEPAGE PIT
SEEPAGE PIT /~'~/ DRAIN FIELD
TO RIVER, LAKE, STREAM.
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.
O.Ao.~..-
L, CE.SE. DES,G.E.
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE /'.-'Z..~7.-- ~ ~' 77 AFPL'CA.T'S S,G.ATU.~__~-~.~-) ~'-~'~.'-.'.-'~
FORM NO. EQ-OI ~
Performed For
Leoal Oescrintion: Lot 1~ Block~
This Korm Renort$ Soils Loo
"On~ ~r~ t~ ~o~h a ~h~sand op~nlon~"
Foremost Homes Date Performed
Subdt vi s i on Crestwood
yes
5/23/77
Percolation Test
Penth
Feet Soil Characteristics
6
Sandy Gravel
10--
Bottom of Tes~ Hole
16--
20
Was Ground Water Encountered? No
I~ Yes, At what Denth?
Readinq Date Grnss Time Net Time Depth to H20 Net Dron
i
Percolation Rate )linute
Prnnosed Insthllation: Seenaoe Pit Drain Field
Deoth of Inlet Depth To Bottom Of Pit Or Trench
C~M~ENTS: 125 Square Feetdra~nmge arum
Test Performed By ~_ ~~ Data Certified BY: CONSTRUCTION TEST
David Paul ~ Date: 5/23/77 LAB
!
; 17 ~o~ ~o-tfo,,~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
· www.cl.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. _ 015-061-22
'1. GENERAL INFORMATION
Expiration Date:
Complete legal description CRESTWOOD LOT 19
Location (site address or directions) 9751 f3RIEN
JUDY KALPAKOFF
Current Property owner(s) __
Mailing address
Lending agency
Day phone 346-3187
JUDY KALPAKOFF C/O MANNY ESCOBEOO PRUDENTIAL JACK WHITE
Day phone
Mailing address
Real Estate Agent
Mailing address
MANNY ESCOBEDO w/ PRUDENTIAL JACK WHITE
Day phone
762-5854
3201 "C" STREET SUITE 200 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. 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 []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska, Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority
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 less than 30 days old. (Certificates may be reissued for a pedod 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 the
professional engineer's work.
Note: ,Naska Water and Wastewater Consultants, Inc. shall be patd $1,0OO. OO at, or pdor I
to closing for the engfneadng services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As cerb'fied by my seal affixed hereto and as of the va#dation da te shown below, I redly that my
investigation, based on proc~lures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supp~ and/or wastawater disposal system is(are) safe, fun~'onal and adequate
for the number of bedrooms and tyl~e of structure Indicated herein. I further vedfy that based on the
Informab'on obtained from the Municipality of,Anchorage files and from my investigation and Inspection, the
on-site water supply and/or waste~¥ater disposal system is(are) in compliance w~th all applicable Municipal
and State codes, ordinances, and regulab'ons in effect at the time of installation.
Name of Firm . ALASKA WATER & WASTEWATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD. SUITE 2B * ANCHORACE, AK 99504-
Engineer's PHnted Name JEFFREY A. CA~N£SS. P.E.
Engineer's Comments:
sc~an~ous engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines & Regulations. The mportad results described the perf~tttance of the
system under the Conditions encountered at the lime of the t~t, and separation
distances measured 10 readily identifiable features. The operattonal lite {~f all wells and
septic systems depend on the local softs candit~'on, groundwater levels that may
tiuctuate during7 the year, and the water usage of the fam#y being sen/ed by the s~tam.
These conditions are outs/do the control of tho e~aluator of the system. Satisfacfoo/ test
results do not guarantae future perfon'nar~ of the system, nor do they guarantee that
there are no h/dEan defects or encreachmenta. AWWC, In~ can therefore not prm/ide
any werren~ or future estimate of how long tho system will c~ntinue to meet the
operetiona! requlremants of the ADEC or MOA DSD. The content of this report Is for
tho Sole benefit of the owner listed above. Any reliance upon or use of this report by any
uther pe~on or lxerty Is not a~thc#zed, nor will lt confer any legal rlght whatsoever.
DSD SIGNATURE
· ~ Approved for '~ bedrooms.
Disappmved.'
Conditional approval for .
Phone. 337-6179
ON-SITE
~: WATERAND ~.
bedims, wi~ ~e fllo~ng s~pulaUon~ : WASTEWATER : ~
~ ~. PROG~M .~ ~
~ <O~ ~ .x~
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manltenance Agreements
Supplemental Engineer's Reort
Other
Odglnal Certificate Date:m ~ - -.g, c~ _~) /
Municipality of Anchorage
Development Services Department
Building 8afe~ Division
On. Site Water & Wastewater Pmg~m
4700 South Bmgaw 6t.
P.O. Box 196650 Ancl~xage, AK 99519-6650
www.ci.snchomge.ak.us
HEALTH AUTHORITY APPROVAL CHECKLIST
LegslDescrlption: CRESTWOOO SUB01VtSION; LOT 19 ParcellD: 015-061-22
W~LL DATA YES
Well type PRIVATE.. If A, B, or C provide PWSID~ N/A Well Log (Y/N)_ .-
Date completed _ 7/77 ? Sonita~/seal (Y/N) YES. Wires properly protected (Y/N) Y£S
Total depth 69 .ft. Cased to 69 lt. Casing height (above ground) 16 in.
AT INSPECTION
/ 9/2oo
52 .ft.
Date of test
Static water level
Well production
WAIER SAMPLE RESULTS:
Collfom~ ~ _ colonies/100 rnl.
Date of sample: 3/19/200 i
B. SEPTICRiOLDING TANK DATA
FROM WELL LOG
7/77 ?
52 ,,lt.
10 . g,p,m.
Tank Type/Material FIBERGLASS _
Tank size 1000 gal. Number of CompartmentS 2 .
Foundation deanout (Y/N) *YE~
6.1 , g.p.m.
Other bacteria ~
AWWC, INC.
Collected by:
J*CLEANOUT INSIDE I~ATNROOI~]
Date installed _
. colonies/100 mi.
Cleanouts(Y/N).
6/77
YES
Depression over tank (Y/N) ~O_ High water alarm (Y/N)_
DENALI
Date of pumping 3/16/2001 Pumper
C. ABSORirnON FIELD DATA Ee°rr0u OF M.T. lEI[LOW GROUN0 LEV~
Date installed. 6/77 .. Soil rating (g.p.dJ~r~) 125. System [~ TRENCH
Length 10, 21. & 24.lt Width 4 .lt. Gravel below pipe 2 lt.
Total depth .5.4-6.6_fl. Eft. absorDtion area:°37(} ltz Monitoring tube YES. Depression over field NO _
Dats of adequacy test 3/19/2001_ Results(Pass/Fell) PASS For_ 3 .bedrooms
Fluid depth in absorption fleld befom tSst 0 _in. Wateradded 712 gal. Newdepth 0 .in.
Elapsed TIme: - min. Final fluid depth _ - in. Abso~tlon rote >= 450 + .. g.p.d.
Any reju,,~nation treatment (past l~~NtsG 0.6; RF.
D. LIFT STATION
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Data insta ed. Size in gallons_ ~
"Pump on' level et in. 'Pum~ High water alarm level at in.
Cycles tasted Meets alarm & circuit requirements?.
Septic tanlUlllt station on lot. 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic service line 25%
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout _
Holding tank. N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5% Absorption field.
Water main 10'+ Water sewice line. 10'+ Surface water.
Wells on adjacent lots _ 100'+
5'+
100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line. 10'+
Water se~ce line 10'+
Curtain dmln. NONE KNOWN
F. COMMENTS
Building foundation I 0'~-
Surface water 100' +
Walls on adjacent lots 10o'+
Water main 10'+
Driveway, perking/vehicle storage. 50'+
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems ere In
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed NaPte . JEFFREY ^.
Data ..7/~.~/O, GARNESS
HAA Fees .~,~ -
Data ot Payment. --~/6Q"//~/'
Receipt Number
waker Fee $.
Data of Payment
Receipt Number
11:17 FI~-CTE ENVII~8~NTAI.
.j~__ CT&E Environmental Services tnc.
5615301 T-766 P.02/0S F-625
CT&E Ret'.#
Client Name
Project NameM
Client Sample ID
Matrix
Ordered
Sample Remarks:
1011359001 Client
AK. Water & Wastewater Consultants Inc. l~rint ~d D~tr./Tlme 03~3~1 12:06
9751 B~en Lt 19 ~es~ Celle~ted Dat~lme 03/19~1 13:30
9751 Bti~ Lt 19 Ocs~d R~ Dat~l~ 03~0~1 8:33
~g Water Technl~ Dieter Stephen C. Ede
0 ReIea~ By
P.~uh, PQL Unlnl Method Limils Date Date
Init
Nir~te-N
4.09 0.500 mg/L EPA300.0 10max
03/20/01 SCL
~tcrob:l. ologY Laborat:o~"y
Total Colifom~ 0
co]/lOOmL SMI 8 9.?.22~
O3/2O/O I KAP
MUNICIPALITY OF ANCHORAGE
DEPARTMEN~F HEALTH AND. ENVIRONMENT,.~PROTECTION. I ~
825 L Street, Anchorage. Alaska 99501
264-4720
Date Received: November 2~, 1977
#1: Time 10:30 a.m.
#2: Time #3: Time
Date 11-3-77 Thursday
Date Date
Insp Pratt Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Alaska Pacific Bank
Mailing Address: 601 West 5th Avenue 99501 Phone: 276-3110
Property Owner:
Mailing Address:
HOward M. Smith
Star Route A Box 85-K 99507
Phone: 349-4631
3. Legal Description: Lot 19 Crestwood Subdivision
4:
Single Family Residence: (x)
Multiple'Family Residence: ( )
Number of Bedrooms: Four
Number of Bedrooms:
5. Well System: Individual well (x) Community/Public System ( )
Permit #
Depth of Well 69'
Well Log on File (x)
~ Bacterial Analysis
Construction ,,.'
Sewage DispOsal System: On-site System (x) Public Utility ( )
Permit # Installed 1977 Installer
Septic Tank Size
Manufacturer
Absorption Area
Soils Rate
Material
Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
P~e Two
Department of Health and Environmental Protection
· Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 19 Crestwood Subdivision
Comments:
Affadavit Attached:
Approved:
Disapproved:
Letter Attached: ( )
Date:
Department Worksheet:
iling
:IPALITY OF AI~CHORAGE
AND ENVIRONME
Alaska
F.;FOR APPROVAL OF
.~ WATER FACILiTiES
, Foremost
Instltut~bn:_~n ~ ~hd'~'fi¢ B~'3k
Mailing AddresS~
:Reai~orgr Agent~ m~;m P~lty
ng Addre~:
':~ T_~T ,~9 C~s~wOod Sub.
Ins~ct~d .... ~ ~:~m~lv~' "" ..... ~ ' '
ply,,, ~~ ~'~'~
Type of Su~tY: .2 ~'~ ' P~bli~ Utility
number of dwellings ~r~ntly se~ed
IA'.
Services
Day
995o7
~ Day
_ Phone:
Phone:_
.No.
_lndividu~
one
Individual