HomeMy WebLinkAboutARVESON LT 8 flUNICIPALITY 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
IPHONE I []NEW
NAM 'z/'R Y ,J' E Z 0 7T ZUP "ADE
MAILING/ 7~/~ADDRESS ~
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
I Well [ AbsorPtion area Dwelling PERMIT NO.
DISTANCE
TO:
~ Z Manufacturer Material ~ No, of compartments
Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth
~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O Z ~ Manufacturer Material Liquid capacity in gallons
~ DISTANCE TO: Well
~ Foundation Nearest lot line PERMIT NO.
~ No, of lines Length of~ach line Total length of lines Trench width Distance between lines
Top of tile to finish grade Material beneath tile Total effective absorption area
Length Width Depth PERMIT NO,
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
APPR OV E D DATE LEGAL
72-013 (Rev. 3/78)
PERMIT NO.
I ,3 I F'ALIT"T' ~]F ANCHORAGE
DEPARTMENT ~' ~ALI'H AND ENVIRONMENTAL' 'ECTION
825 ~ JTREET~ ANCHORAGE~ AK.
264-4728
Ot~--SITE SELdER PERMIT
800251 )
APPLICANT
LOCATION
LEGAL
GARY MELLOTT
SHADY LANE
L8 ARVESON SUBDIVISON
i741-M SRA
LOT SIZE
~49-~70
10000 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS
SOIL RATING (SQ FT?BR)= 100
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
[)EPTH= l[~ LENGTH= ~4 GRAVEL
DEPTH= 4. 5
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF 8 TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
REQLI I RED SEPT I C TANK
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLHTION INSPECTIONS OF 8NY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
THO ( 2 > INSPECT IONS ARE REQU I RED
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM 8 PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
I CERTIFY THAT
l: I 8M FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS.
SIGNED:
RPPL I C RNT~R~Y ~ELLOTT
PERFORMED FOR=
dAT~ v
CONTRACTIN %'ENt INE I S & ASSOC.
212 E. INTE~TIONAL ~I~PORT ROAD
ANC~GE, ALASka99502
P~O N E ~ ~
b L~ DATE PERFORMED:
,'~ SOILS LOG
PERCOLATION
TEST
LEGAL DESCRIPTION:
SLOPE SITE PLAN
,
I
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
O
P
E
Reading Date Gross ~ Net Depth tO ~ Net
Time Time Water Drop
~1~O LATIO N RATE (minutes/inch)
' TEST RUN BETWEEN FT AND FT
-/~ / .
PERFORMED BY: (~,~'~1,~ ~
CERTIFIED BY: ~~'"'-'--
DATE: ~/,~ ,~d.~
GRE '
ANCHORAGE AREA BOR"
Department of Environmental Quality
3500 Tudor Road
Anchorage, Alaska 99507
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
MAILING ADDRESS ~'
/~A%'~¢7~ .~/". LEGAL DESCRIPTION
PHONE
z. Ol- ,~ ~e~o,
SEPTIC TANK:
DISTANCE
FROM WELL
INSIDE LENGTH
~-~0)
MANUFACTURER~.~P(b:~<~ ~f~'~/-,--/~O. MATERIAL~/-T¢' /'</~;<~..'~ i
NUMBER OF
COMPARTMENTS
INSIDE WIDTH
LIQUID DEPTH
LIQUID CAPACITY. /<9Od) GALLONS.
SEEPAGE PIT:
NUMBER OF PITS /
LINING MATERIAL ~17 ~t?.t~
BUILDING FOUNDATION~, ~0
ADDITIONAL ABSORPTION
DIAMETER ___ OR WIDTH/~//~/¢ ' /
bE N GT'/~-¢~- DEPTH
!
CRIB SIZE: DIAMETE DEPTH ~, DISTANCE FROM:
f f TOTAL EFFECTIVE
NEAREST LOT LINE ~O ABSORPTION AREA (WALL AREA)
.SQ. FT.
WELL:
TYPE p~(~/l~, _L~/¥~))b. CONSTRUCTION
BUILDING NEAREST
FOUNDATION __, LOT LINE
CESSPOOL , OTHER SOURCES
APPROVED DISAPPROVED
DEPTH DISTANCE FROM:
NEAREST SEPTIC SEEPAGE
SEWER LINE TANK __., SYSTEM
REMARKS
DISTANCES:
INSTALLED BY: ~¢g,i ~
PIPE MATERIAL:
LOT SLOPE:
REMARKS: ~-4er~r~ I-~ ~e__b ~
Form PW-026
DIAGRAM OF SYSTEM
DATE ~-~?~Z-~ /¢] '?,~" APPROVED ~--r d ' ~ )~~
G.A.A.B.
GREATER ANCHORAGE AREA BOROLIGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6.050
ANCHORAGE. ALASKA 99502
TELEPHONE 279-8§86
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO. -
INSTALLATION LOCATION., ~ ¢ ~ ~ ~A ¢~: ~ ~0~ .
INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT_
TYPE AND SIZE OF FACILITY TO BE SERVED ~~ ~ ~ ~ ~ ., ~
FINANCED THROUGH ~ ~ TO BE INSTALLED BY
SOIL TEST RESULTS ~ ~ ~ ~T ~ I
COMPLETION DATE ANTICIPATED /~ ~ ~ Z
OTHER
NOTE: THIS PERMIT I$ NOT VALID WITHOUT ~OIL TES?
FINAL IN~,PECTION= 3~4 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE /g~ O 0 TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT 2 (~ DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SI~PTIC TANK ~'~ ~ ~ ~SEEPAGE PIT 2 0
~ DRAIN FIELD
TO NEAREST LOT LINE.
WELL TO 5E~IC TANK ~ I ' SEEPAGE PIT
DRAIN FIELD ALSO CONSIDER AREA WELLS.
(o'
DRAIN FIELD
70 RIVEE, LA~E. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AN[') INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGe: PIT
FtT'rED WITH AIRTIGHT REMOVABLE
GRAVEL BACKFILL
DIAGRAM OF SYBTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2B-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE
DATE APPLICANT'S Stq~;NATURE .~
Performed For
Le~ai Description. Lot ~ Block
This ~'o[n,
..-,enorts Soils
~ TUDOR ROAD, ANCHORA(]m'. ALASKA 99507 · TELEPHONE 333-8472
GARY MALLOTT Date Performed
Subdivision ARW~SON
Percolation Test
9-18-72
nenth
"eet
Soil Characteristics
Rpad*~ nq : Gross Time
l
Net - i me
Percolation Rate Hinute
Proposed Installation. SeeDaae Pit ;~: Drain Field
Deoth of Inlet Depth 7o !~ottom Of Pit Or Trench
CnM~ENTS · , '
__.,k]O s_9~. ft. drainage area re.?~i, red im~r~ bedroom
No bedrock or water table ~'~ihi_n h £+. ~f bottom of seepage pit
Depth to H
20 Ne~ Drop,
i~ I~E'- ' INSPECTION APPOINTMENTS D~
'1 TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR I NSPECTO. B
MUNICIPALITY OF ANCHOP, AGE
MUNICIPALITY OF ANCHORAGE DEPT. OF t!2ALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT~NMENTAL FLOTECTION',
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION JU~ 2 O 1980
Telephone 264-4720
DEr E/~/EI't
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE'~EI'IR~I[1/~I~
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER ' ' I'PHONE
MAI LFNG ADDRF~S '
PROPERTY R ESI I~ENT (If different from above) PHONE
l'?r "l l e. J__
' PHONE
2. 'BI,LYER ,
M~LING ADDRESS ' ~ - ~
, - ~ ~ ~ PHONE
4,' R~AL~OR/AGENT I PHONE'
MAI LING AD D~ ESS t *
I STREET L~CATION ' -
6, TYPE OF RESI~NC~
SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF~BEDROOMS
[] One [] Four
[] Two [] Five
[~ Three [] Six
[] Other
7. WATER SUPPLY ~ INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give wel
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM ~ I NDIVI DUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] IN DIVI DUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or [].Holding Tank
Size:, //<:~(JO If Tank is homemade
give dimensions:
TYPE OF TANK
TOTAL ABSORPTION AREA
[] ONE
[] TWO
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
NUMBER OF BEDROOMS
[] THREE [] FIVE
[] FOUR [] SiX
DATE INSTALLED
INSTALLER
SOl LS RATING
IMANUFACTURER
MATERIAL
4; DISTANCESwELL TO: Sept c/Hold ng Tank
Absorption Area to nearest Lot Line
IAbsorption Area [Sewer
Line
[] OTHER
Nearest Lot Line
5. COMMENTS
DATE
[~/APPROVED FOR -'~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
BY
72-010 (Rev. 6/79)
Municipality
Ancho ag
I)[ PAfVTiVtEN1 Ot: HI Al.lit AND EN\/I;-~ONMFNTAL PROTECTION
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 264-4111
June 23, 1980
Gary Mellott
% Orville F. Lamson
3250 East 68th Avenue
Anchorage, Alaska 99507
Subject: Lot 8 Arveson Subdivision
Approval for the individual sewer and water facilities
can not be granted until the following items have been
completed:
(1.~ The water analysis report be delivered to this
department from Chem Lab, 5633 B Street, for
our review.
(2)
A four(4) inch cast iron cleanout needs to be
installed to the septic tank. This will need to
be re-inspected by 'this department.
, (3) The septic tank pumped with a receipt submitted to
_.~/O~this department.
(4) An adequacy test be performed on the existing leaching
area. This test will determine if the system is adequate
according to National Standards. A listing of private
firms performing the test is enclosed. This report
needs to be submitted to this department for o~ review.
If there are any further questions, please call this d~partment
at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
•
(4...e Municipality of Anchora y6 a 9 �o '' °L, c
On-Site Water and Wastewater Progra ti r,1� iil ' % milli f,
V'
(907) 343-7904
{ JUN 13 '1018 'All E T Y
Certificate of On-Site Systems Apo S al c�
h
zi Parcel I.D. 015-273-13 Expiration Dat0e:6 Bag��-1 3
1. GENERAL INFORMATION
Complete legal description Arveson, Lot 8
Location (site address) 11131 Shady Lane Anchorage, AK 99516
Current Property owner(s) Jusdi McDonald & David Doucet Day phone
Mailing address 11131 Shady Lane, Anchorage AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
H Single Family (w/wo ADU)
I I Duplex
Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Three
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well x Individual H
Individual Water Storage ❑ Holding Tank ❑
Community Class Well H Community ❑
Public Water System 11 Public Sewer ❑
WaiverNariance request for: Distance:
Received by: OA 067/(77 7772/`2/ / Date: (c'/ -9 //tri
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 5a4,,, Waiver Fee $
Date of Payment 62!ab Che Date of Payment
Receipt Number 0q0N9,q0 Receipt Number
COSA# 0,4jC 1 vi a-f 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.
Forge Engineering Phone (907) 522-7773
Name of Firm9 9
Address PO Box 240773 Anchorage, AK 99524
Engineer's Printed Name
Michael E. Anderson, PE Date 6/18/18
OF Aq...c.,••
0 1 liQ )
0*: 49TH /\ ;* /�
6. DSD SIGNATURE -141-""L-e-- --
System
' , i2/1•-&,.�
yj .. Michael E.Anderson .S stem #1 Approved for bedrooms /�
System #2 Approved for bedrooms ��islF9E(438h f �,���`^!�
1 0PROfESS\ '
Disapproved ,,\����\�.t~
Conditional approval for bedrooms, with the following stipulations:
,\C\QPL11.Y or xi/it
ti
. ON-S17-E oy
o W4sTER AND �'
WATER c.:
PROGRAM 64 .
,(,,.r �O\ItrF
Y�
:::---77.._._'
-- (�� 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 Advisory
Well Flow Advisory Other
COSA blue sheet_r .- ': C
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: Arveson, Lot 8 Parcel ID: 015-273-13
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) N
Date completed 9/18/72 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 157* ft. Cased to >40* ft. Casing height (above ground) 12 in.
FROM WELL LOG AT INSPECTION
Date of test 6/11/18
Static water level ft. 138.5 ft.
Well production g.p.m. 4.6 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 1 .01 mg/L
Arsenic ND ug/L Date of sample: 6/6/18 Collected by: Forge Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 9/14/05
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) NA
Date of pumping 6/12/18 Pumper A Plus Home Services
C. ABSORPTION FIELD DATA
Date installed 9/14/05 Soil rating (g.p.d./ft2 or ft2/bdrm) 1 .0 System type Deep Trench
Length 28 & 21 ft. Width 2 5 ft. Gravel below pipe 4.5-5.5 ft.
Total depth 109/9 ft. Eff. absorption area 483 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 6/11/18 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 19.5/23 in. Water added 666 gal. New depth 24/30 in.
Elapsed Time: 1440 min. Final fluid depth 18.5/23 in. Absorption rate >= 450 d
9 P.
N
Any rejuvenation treatment (past 12 mo.) (Y/N & type) 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:
>100' >100'
ad lots
On adjacent Septic tank/lift station on lot j
Absorption field on lot
>100' On adjacent lots >100'
Public sewer main
>75' Public sewer manhole/cleanout >100'
>25' >75'
Sewer/septic service line 25 Holding tank
Animal containment areas >50' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
10' >5'
Building foundation Property line >5 Absorption field
>100'
Water main >10 Water service line >10' Surface water
Wells on adjacent lots >1001
ABSORPTION FIELD ON LOT TO:
2'** >10 1
' > '
Property line Building foundation Water main
Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >10'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
*Per MOA Records. **MOA Waiver #WR050102
C ‘
G. ENGINEER'S CERTIFICATION 'r �p• F A :9sl��
I certify that I have determined through field inspections and /*: 49 TH /'"\ ••*iy
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date. /-(
Michael E. Anderson, PE �j Michael E.Anderson j
Engineer's Printed Name r •
g 6/18/18 r#,«,�•. 4381-E . �,/
Date i sTepi�, - 1 g -11,,,,..�.r
i� F�PROFESS\O '4..
COSA brown sheet 10-10-12.doc