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HomeMy WebLinkAboutW-A LT 2W -A Lot 2 #018-092-50 Nems: Man Addieee: 490i Pham: Bloc: Municipality of Anchorage Development Services Department �. Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page Of www.d.anchorage.ak.us (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM ANDIOR WELL INSPECTION REPORT :r: SW040347 PID Number. 018-092-50 Wastewater System: ❑ New ® Upgrade ABSORPTION FIELD N1 MW ed 11* p : O Deep Torun 3 shallow Twcn O Bed O m-4 ghee , Sd ReNp' TOW Dope, hom prIp1N1 prede: LEGAL DESCRIPTION Well: ❑ New ® Upgrade t7aseekaeOe (NE"WA, B, C): ITOtal Dsper.Priva ate DOW: Alpin I POev Wer. Ft. 0.28-1.17 Ft. GrsM wq0: Numlw all lin 5.0 Ft. 1 TeW Wwun wee: P"Matenel G"d ` 500 Fr D30: FI Dau Ir,eleYw sleet WOW Le"I M... 82 Anderson 11 light Aeoye Comm: t TANK O Septic ❑ Holding ❑ S.T.E.P. uWulPmrel, MenulrAww. sewer una EXISTING - Espinoza Wtsnd. 25'+ rnn�roro *none known 1i0 " Previous existing leach field Top of abandoned In place and well decommissioned. Existing concrete septic tank integrity verified In good condition. LIFT STATION Cel til In BENCH MARK Inspections performed by: KKt'n Fngineerina Inc.Dates: 151 11L21)/OA de 2nd 11 /20/04 Development Services Department Approval I' BCIs/�r Reviewed and approved by: Date: - 17 -o-5 flto . 12M) '_.53 FI 64 Ft. Datwce W_ knee -- FL & F810 ❑ Other. Vw y. 1250 cel. mlw d Cor wt 2 K 100 Ft. Engineer's Stamp OF A(A� Kenneth M. SEPARATION DISTANCES Absorphon Field Lift Station Holdlry Tank Septic nk '+ 100'+ NA NA '+ 100'+ W*50'+ NA NA+ 10'+ NA NA+ 10'+ NA NAA *50'+ NA NA O Septic ❑ Holding ❑ S.T.E.P. uWulPmrel, MenulrAww. sewer una EXISTING - Espinoza Wtsnd. 25'+ rnn�roro *none known 1i0 " Previous existing leach field Top of abandoned In place and well decommissioned. Existing concrete septic tank integrity verified In good condition. LIFT STATION Cel til In BENCH MARK Inspections performed by: KKt'n Fngineerina Inc.Dates: 151 11L21)/OA de 2nd 11 /20/04 Development Services Department Approval I' BCIs/�r Reviewed and approved by: Date: - 17 -o-5 flto . 12M) '_.53 FI 64 Ft. Datwce W_ knee -- FL & F810 ❑ Other. Vw y. 1250 cel. mlw d Cor wt 2 K 100 Ft. Engineer's Stamp OF A(A� Kenneth M. AS -BUILT SYSTEM DETAILS/SITE PLAN Permit PID#018 04 50 W -A LOT 2 Lo A -D=20.5' �' ESMt �' '•—EXISTING D0.IVE: lU'Util I � :!UT '< ` I I C -F=15.2' an me sa D1 I I f E%lSTlf1G CO 4 a a HOUSE I I T11 a n I CO DECK Co - 51 •�... 1 /5140 A -D=20.5' B -D=31.5' A -E=48.7' w B -E=36.4' B -F=33.2' C -F=15.2' f 0 vlve SCALE- ;1' � 50' _ �.�\N ��. OF..AL9 ' 1CrNNEfFi _MDU FESSIOx= 64' PREPARED FOR: MARY DITTMAN 4902 DeArnoun RD. Anchorage, AK. 99516 (907) 345-1238 P �urtne"Eaatt KMDD"¢: Sewa ' 2936'°D "°" 04041 SCALE, NTS g6.3 r LE" LU) ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 IA Municipality of Anchorage Department of Health and Human ServicesIm 825'1-' Street P.O. Box 196650 Anchorage. Alaska 99519-6650 Rick Mystrom http://www.ci.anchorage.ak.us Mayor Permit Number: #SW 040347 Date of Issue: 8-17-04 Parcel Identification Number: 018-092-50 Date Started: 9-25-04 Date Completed: 9-30-04 Is well located at approved permit location? ® Yes ❑ No Legal Description: W -A Lt 2 Property Owner Name & Address: MaryDittman 4902 DeArmoun Road AlaSKa Borehole Data: Depth (ft) Soil Type. Thickness &: Water Strata From To 0 2 organics & silt 2 3 gravelly silt 3 6 silty cobbly gravel 6 87 gravelly cobbly silt 87 115 silty gravel H2O 115 121 Method of Drilling ® air rotary ❑ cable tool Casing type: steel Wall Thickness: 250 inches Diameter: 5 inches Depth: 121 feet Liner Type: Diameter: inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): 82 feet Pumping level: 121 feet after 2 hours pumping 20 gpm Recovery Rate: 20 gpm Method of Testing: ALM Well Intake Opening Type: ® Open End ❑ Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: bentonite it 8 Volume: 2 Depth; Start 0 feet Stopped.Z feet II Pump: Intake Depth feet II Pump size hp Brand Name IWell Disinfected Upon Completion? ® Yes ❑ No I Method of Disinfection: chlorine tablets Comments: Well Driller: Alpine Drilling & Enterprises PO Box 110496 Anchorage Alaska 99511 Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 6 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 \\iLbj0d ,Y• Ll ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Upgrade Date Issued: Aug 17, 2004 Permit Number: SW040347 Expiration Date: Aug 17, 2005 Parcel ID: 018-092-50 Legal Description: W -A LT 2 Design Engineer: 0070 KND Engineering Site Address: 004907 DE T. FT. RMOUN RD Owner Name: MARY DITTMAN Lot Size: 45940 SO. F Total Bedrooms: 4 Permit Bedrooms: 4 Owner Address: 4907 DE ARMOUN ROAD ANCHORAGE. AK 99516-3624 This permit is for the construction of: Holding Tank ❑Privy ❑✓ Private Well ❑Water Storage Q Disposal Field ❑ Septic p Tank❑ All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked 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 engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904(24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be e;tl ier: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 13REnlr Fae^- XVP CA"Co F0,2 PFStQn) C Aq jiSc, T/(c JFFrFGT/UE �E"Tri hll/c tNA,i4E ticvn, �/' 7� 2.S1. R,t g0p#rr_w.4( 1c46TN OF 74l Wrvt- BF /4DDE•O To eorN/x/vfATE FO -j i7FfEc7 /uE DcPTH GN/I^/4f Received By: Issued By' Date: 6 1! Date: Municipality of Anchorage , e w V Development Services Department Vilf s;., I! Building Safety Division ' F� On -Site Water and Wastewater Program ., <.. 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 018 —0TZ SO Permit Number SW Property owners Day phone84.5-72 8 Mailing address ( 1) 4Qb2 DeArmoun Rd Anchorage, AK 99516 , { g address (2)� AYm�t�1J x`10. —Zip Code ga51� Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size—!L/5 C) Acreseo THIS APPLICATION IS FOR: Sewer Only ❑ Sewer and Well Sewer Upgrade ❑ Number of Bedrooms Well Only Water Storage THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi Swimming Pool ❑ Water Softening Unit Therapy Pool ❑ I certify that the above Information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Sig re of property owner or authorized agent) Permit Fees: + Waiver Fees: O �o p Date of Payment: Date of Payment: Receipt Number: Receipt Number: (Rev. 17100) KND ENGINEERING, INC. 20441 PTARMIGAN BLVD. F A c :I .R RIVER. AK 99577-8736 FAX (907)696-8111 August 9, 2004 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Upgrade sewer/well permit — WA Lot 2 Gentlemen: The owner has requested we proceed forward to obtain a septic and well permit on the subject lot. The existing septic has been identified as in failure, and to due to the existing on-site well location a new well will need to be drilled to upgrade the septic. On July are atttached. one testhole was The general lopeormed for the of this lot is flat at proposed grde of approximately 0-57ostem. The results of �s We have designed our system utilizing the existing testhole that was excavated for the existing 4 -bedroom house. The existing well will be abandoned and the lot will be served by a new individual well, located on the southern portion of the lot. We propose to install one 5' wide shallow trench. Water was encountered during the excavation at 11', and during monitoring at 11'. There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111 / FAX 696-8111. Respectfully submitted, 1KHD Engineering, Inc. Attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/ Percolation Test 1j' I D ENGINEERING, INC. 20441 PTARMIGAN BLVD. VAMT RIVER, AK 99577-8736 FAX (907)696-8111 August 17, 2004 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Upgrade sewer/well permit — WA Lot 2 Per your request, we have conducted an additional site visit to re -verify data and have added the information you requested on the attached plans. The depth of the insitu surface layer and water monitoring were re -measured. The total depth of the surface layer was 1.7' and no water was encountered in the monitoring tube (see attached soils log). We have adjusted our total depth of the system to 5.7' to allow for an additional T (6' total) separation to the highest observed ground water elevation. We do not adverse t on acent lots this system. expect you have any quest ons, please co tacdtlme at 696 61of 11 /FAX 696--8111. the development Respectfully submitted, MD Engineering, Inc. Kenneth M. D ff , P.E. Attachments: As noted WELL & WASTEWATER DISPOSAL 2SYSTEM DETAILS/SITE PLANI NO PUSLTC WELLS WITHIN 900' 6 PROPOSED SYSTEM. NO PRIVATE WELLS WITHIN ROW Of PROPOSED SYSTEM EXCEPT AS HOTEL SEPTIC SYSTEMS WIPRROPOSED WELL EXCEPTN 2W 13F PIN S MOTEL AW OF.,AL11 Af A: /......:. .... ....../ �.... •• D FUS.• CE 1 I-)?0FESSIO"'a' do► DESIGN DETAILS 4 BDRM X 150 GPD - 600 GPD 600 500/5'(W))2 X P5(RF)PER (4.0 FGRAVEL)M=N 50 FT S 00 SO. FT TRENCH USE 1 TRENCH - 50 (L) X 5' (W) X 4.0'(D) Total depth of system Is 5.7' from original grade. Total depth of gravel below distribution pipe Is 4.0' . NOTES, 1. CONTRACTOR L ENGINEER TO VERIFY INTEGRITY OF SEPTIC TANK AND REPLACE REQUIRED. INSUTE TANK2. INSULATEATRENCHES WITH 2' HD BURIALFFOAMCOVER. INTO SEPTIC 4. ADDITIONALR ILLLWILLURE BE ADDED OVERMINIMUM 2%SSYSTEM TO ACHIEVEANK. MIN. 3' COVER IF REQUIRED. �5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS, LOT LINES, FOUNDATIONS AND ALL OTHER SETBACKS. PREPARED FOR, MARY DITTMAN 4902 DeArmoun RD. Anchorage, AK. 99516 (907) 345-1238 FIELD BOOKS 9aXC"RY: STAKN ASE T: Dw0 MC ACAO FLE' 04041 COWUTED puwc VBG CIwORD. KMD D"TE 8/9/C anm 2936 Jw Ma: 04041 Scale, 1'= 100' PAGE 1 OF 2 ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 111/FAX (907)898-8111 WASTEWATER DISP❑SAL SYSTEM DETAILS W -A LOT 2 ---=- ------ ---------------- ------ / EXYS"Ygt�� ®�E ! FLAT r %r. EXISTI G SEPTIC ISTING PTIC TANK FIE TO BE EX,Snt4G A D❑NED�t a 8104 �IN TA L UBLE ljoUsE \ � CL A ❑U S tiT o� 1 ................./7 ............... 1( eus / ` AOF ' ..�..... , �fESS10Ti�' PREPARED FOR, MARY DITTMAN 4902 DeArmoun RD. Anchorage, AK. 99516 (907) 345-1238 M wTEc1AW:�EtltED: KMOTE:aro:2936 B MO 04041 a ..® Scale: 1'= 20' PAGE 2 OF 2 LE111LU ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (AO7)696-6111/FAX (907)698-8111 OF K��D ENGINEERING, INC. So* �X 9114V s f�.Vi� -•-� 20441 PTARMIGAN BLVD. """0010, EAGLE RIVER, AK 99577-8736 ��'•Kenneth h1. � een SOILS PERCOLATION TEST If�thFppQ^CCS Performed for: Mary Dittman Date Performed: tti i atiu-. Project: WA Lot 2 TEST HOLE u 04-1 Depth (Feet) ARG/OL/SM -overburden 13- SP/GP — med dense, brown w/ cobbles & trace silt B.O.H. (12.21 19- HOLE PRESOAKED 20- PRIOR TO TEST SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Groundwater encountered? YES What depth? 11.8' Depth to water after monitoring? DRY Date? 8� 8/04 Reading Date Gross Net Time Dept to Net Dro Time 1 7/31/04 1:00 6" 2 1:10 10 min 1" 5- 3 1:11 6" _ 4 1:21 10 min 15/16" 51/16" 5 1:22 6" 6 1:32 10 min 13/16" 53/16" 7 1:33 - 6" _ 8 1:43 10 min 14/16" 52/16" 9 1:44 6- 10 1:54 10 min 13/16" 53/16" - 12 2:OS 10 min 13/16" 53/16" • Water Added Percolation Rate 1.93 (min/ in) Perfliole Diameter 6" Test Run Between 4 5 feet and5 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. - W GREs, . ER ANCHORAGE AREA BORt,JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME_'le) )� '-�zT' •2 Vim- ADDRESS LOCATION M&AJ - LEGAL DESCRIPTION C11- A 2. _S � -7- SEPTIC SEPTIC TANK: DISTANCE rG XS �. /v I/ NUMBER OF FROM WELL__4E0 MANUFACTURER ��P_/..L�16 TERIAL l _ COMPARTMENTS / -as -(-j INSIDE LENGTH_ _ INSIDE WIDI"H _ LIQUID DEPTH LIQUID CAPACITY,/-4alALLONS. �?eP_"c T -U E DBAI_N FIED: ( TOTAL LENGTH) / DISTANCE FROM WEL// O _FOUNDATION- / _NEAREST LOT LINE -..2._ OF LINES `5 NUMBER OF LINES_- DISTANCE BETWEEN LINES ---I RENCH WIDTH .)(CIN. TOTAL EFFECTIVE ABSORPTION AREA /-5 - SQ. FT. LENGTH OF EACH LINE__- / DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE _MATERIAL BENEATH TILE_ 62IN. ABOVE TILE __ (WT IN. WELL: / TYPE CONSTRUCTION_ CONSTRUCTION_ ��� DEPTH -----DISTANCE FROM: BUILDING FOUNDATION CESSPOOL - APPROVED__ DISTANCES: .vr 4_ INSTALLED BY: _ NEAREST LOT LINE OTHER SOURCES DISAPPROV SEWER LINE DEPTH: ,4 _ %�/ p2 PIPE MATERIAL:-�^'� LOT SLOPE: REMARKS: Form EQ -032 NEAREST SEPTIC//MM SEEPAGE /�`f C) / SEWER LINE TANKS , SYSTEM__( -_._, REMARKS DIAGRAM OF SYSTEM Noose— lot 5-0-7x- �r p _; Z - DATE APPROVED �����T , FAR., IF -0 n 0 ( A If - �pAtop `Ary,113 F:::� DEPARTMENT OF HEAL TH AND ENV IRUKIENTRL PROTECTION 2516 E. TUDOR RD., ANCHORAGE, HK. 99507 276-2221 -904: ATEENAEOF" FoovivU"l:K-11 PERMIT NO. ( 76877 ) HPPLIC8NT SRH BOX 31:1[� LOCATION DEHRMOUN RD LEGHL W -R SD L2 S27 T12N RAW LOT SlZE 54450 SQUARE FEET TYPE OF SOIL RBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)- 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 450 ������� . (_ii�F:;l F-.� 11 ������ 0:: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. TUE DEPTH OF R 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 PlP� HND THE BOTTOM OF THE EXCAVATION (IN FEET). ����1 F:?, IFE. [_-', IF-- IF I: C." 11- 1:110 K ����� :::Jl,., 11:' 0 Fl L . k . CAU4 5�� -11 I-All-ji R::: :::�' ���IF -"EK Co IF 1 CA 14 So ry ro EK �������E!:-, BRCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE HYHILHRLE TO INSURE PROPFR I1, 1�T1:1LLHTI0N. F OFF FZ V1 l IF "v"HolL_1 Ow 100 11) FY CA VA En Re El F! Fn ry re 13 Iq AE IN 41 L I F:�� I CERTIFY THAI 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FUIRTH BY THE MUNICIPALITY OF ANCHORAGE. 2: { WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: 1 UNDERSTAND THDT THE ON-SITE SEWER SYSTEM MAY REQUIRE EULHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED: APPLICANT TONY WESTERN Q GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C" STREET ANCHORAGE, ALASKA 99503 E TEL EPHONE"Z7,77498'I- SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT G� /r�, - —ry NAME OF APPLICANT � Cv/ MAILING ADDRESS -�"�� ��3./ J PHONE INSTALLATION LOCATION / f � 1 ` y,J ' a c<!L / ' A�� 1/ LEGAL DESCRIPTION - X O r � w- // o a6i Ut ,� I J INSTALLATION OF: SEPTIC TANK Y/ SEEPAGE PIT TYPE AND SIZE OF FACILITY TO BE SERVED "/ �� �i/l G -O_ FINANCED THROUGH CQ /' y�/'X'4./ U .r IL./ DRAIN FIELD OTHER c r. ' � ✓ LL TO BE INSTALLED BY SOIL TEST RESULTS O r. _l NOTE, THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED d,es"�""c r"� -� eel °i/ 't' - 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 d-Ct7) TYPE SEEPAGE AREA SIZE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK %<J FOUNDATION TO SEEPAGE PIT / V DRAIN FIELD _ L) SEPTIC TANK TO SEEPAGE PIT WALL r SEPTIC TANK SEEPAGE PIT DRAIN FIELD 2 TO NEAREST LOT LINE. ,aY tv e. 4L (-B /- 'JS, Ce,9�✓J�'r'- c_/ WELL TO SEPTIC TANK SEEPAGE PIT /0-0 DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD_' s, , SEPTIC TANK, SEEPAGE PIT —Ll DRAIN FIELD[ Gi'—o 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. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. i G.A.A.B. OR LICENSED DESIGNER TYPE / /(r-/� C� DIAGRAM OF SYSTEM 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2868 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE 0 -- 1 O _ & APPLICANT'S SIGNATURE FORM NO. EQ -016 CONSULTING GEOLOGIST ©OX 476-M, S'T'AR Rou-rE A o ANCHORAGE, ALASKA 99507 • PHONE 344-7071 Date- JHO7 / -/- (.� —1 Performed for1 rG SOILS LOG W -e S� Vv, Legal Description ` Sec,1N R 3f, /I j - VV- Depth (feet �� _ Soil Description - - �. 01- .--2-- -8- -16- -18- -20- --2.- ~16- -18- -20- Total. Depth r feet in _ Was groundwater encountered �) ? What depth _—L3 ` �? Depth to bedrock^ Howl determined Respectfully submitted, Gary F. Player Consulting Geologist MUNICIPALITY OF ANCHORAGE DEPARfMEN'r OF HEALTH & ENVIRONMENTAL PROTE Oq / 825 L Street - Anchorage, Alaska 99501 1i I� t \ ENVIRONMENTAL ENGINEERING DIVISI N (/! y/j \\ Telephone 264-4720 \_- / //iG���_ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE FA61L-Ih l -['s �C� DIRECTIONS: Complete all parts on page 1. Incomplete requests will. not be processed. Please allowten110) days for processing. - 1. PROPERTY OWNER- - ' pPHONE MAILING' ADDRESS�� 1, � J 31 , o� a PROPERTY RESIDENT (if from above) - PHONE. 2, BUYER ❑ Two 13 Five MAILING ADDRESS 3, LENDING INSTITUTE—- _ MAILING ADDRESS 4. REALTOR/AGENT ,y�7-- -=NE MAILING ADDRESS - - - - - 5, LEGAL DESCRIPTION ;�7� � - - 72-010(3178) - V"''J / STREET LOCATIO�N/ rEL :l i�7 vG.4� 6. TYP PEDR/ESIDENCE _ RESIDENCE NUMBER -OF BEDROOMS E:1 one -� Four - ❑ Other__ (9 SINGLE FAMILY ❑ Two 13 Five ElMULTIPLE FAMILY El - Three ❑ -Six 7. WATER UU LY —�---J INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ED COMMUNITY 5, LEGAL DESCRIPTION ;�7� � - - 72-010(3178) - V"''J / STREET LOCATIO�N/ rEL :l i�7 vG.4� 6. TYP PEDR/ESIDENCE _ RESIDENCE NUMBER -OF BEDROOMS E:1 one -� Four - ❑ Other__ (9 SINGLE FAMILY ❑ Two 13 Five ElMULTIPLE FAMILY El - Three ❑ -Six 7. WATER UU LY —�---J INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ED COMMUNITY since June 1975. For wells drilled prior to that date, give. well El PUBLIC UTILITY depth (attach log ifavailable:) - _ 8. SEWAGE: DISPOSAL SYSTEM—� �7 INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date—// If system is over two (2) years old an adequacy test Is requlrob El PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.' --�-- THIS SIDE FOR OFFICIAL USE: ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME --- TIME - HATE DATE DATE. INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: - - --- -- 'I. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE. ❑ OTHER SINGLEFAMILY ❑ MULTIPLE FAMILY ❑ TWO FOUR ❑ SIX 2. WATER SUPPLY - PERMIT NUMBER - — y� INDIVIDUAL -. - DEPTH OF WELL ❑\ COMMUNITY --- -- - DAl'E:DRILLED - - ❑ PUBLIC UTILITY Connection Verified - LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER -� ❑INDIVIDUAL/ON-SITE DATEINSTALLED DPUBLIC UTILITY Connection Verified___ �(p INSTALLER - -- - - - - - - -. ❑Septic Tank of ❑ Holding Tank Size: 1.�_ If Tank is homemade- Sol Ls RATING give dimensions:_ 0. TYPE OFTANK - MANUFACTURER TOTAL ABSORPTION AREA MATERIAL�Q r^/1.f^ft-+--� 4. DISTANCESR__ Septic/Holding Tank Absorption. Area —�� Sewer Lme -.. Nearest Lot 4ine T0: _WELL - Absorption Area to nearest Lot Line 5. COMMENTS. --�--- ---- — APPROVED FOR �_ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate)' ❑ DISAPPROVED DATE � Y ITitlel LEGAL DESCRIPTION - - - 72-010 (Rev. 3/78) Municipality of Anchorage ��Ii? �B 41 -� Development Services Department Building Safety Division - . '" e i On -Site Water and Wastewater Program , A , T 4700 Bragaw 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. 018-092-50 COSA # OQ C622- Expiration 3S2Expiration Date: / —,2 a -10 1. GENERAL INFORMATION Complete legal description W -A LOT 2 Location (site address) 4902 DeARMOUN ROAD, ANCHORAGE, AK 99516 Current Property owner(s) TASON L. PITCHER Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 4902 DeARMOUN ROAD, ANCHORAGE, AK 99516 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone 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 Onsite 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 Systems 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 the professional engineer's work. 4. 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 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE: RIVER AK 99577 Engineer's Printed Name KENNET 1 M. DUIFUS Date 10/19/09 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 OF q ,11 system will function satisfactory for current or future 4•q 1� occupants or can ArcTerra guarantee that no unseen ,;.�P, ••"��•"•• S 1 encroachments, deficiencies or discrepancies exist S. DSD SIGNATURE _Z' Approved for �' bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: Original Certificate Date: % 19 - ;2 2'o� (Rev 11105) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw 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: W -A LOT 2 Parcel ID: 018-092-50 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # Well Log (YIN) Y Wires property protected (Y/N) Y Date completed 9/30/2004 Total depth 121 ft. Sanitary seal (YM) Y Cased to 121 ft. FROM WELL LOG Date of test 913WM Static water level 82 ft. Well production 20 g.p.m. Casing height (above ground) 24 in. AT INSPECTION 9/29/2009 76 ft. 5.95+ g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100mL Nitrate 1.25 'mg/L Other bacteria 0 colonies/100 mL Arsenic: ND mgA Date of sample: 10M5109 Collected by. ArcTerra B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Concrete Date Installed 11/1976 Tank size 1250 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 9/16/09 Pumper Northland C. ABSORPTION FIELD DATA Date Installed 1] 004 Soil rating (g.p.d./ft2 or 62/bdrm)1_2 System type Shallow Trench Length 64 ft.' Width 5 ft. .Gravel below pipe _511. Total depth 6_3 ft. (measured on 9/29/09) Eff. absorption area 500 fe Monitoring tube Y Date of adequacy test 9129/2009 Fluid depth in absorption field before test 3.6 in. Depression over field N Results (Pass/Fail) Pass For 4 bedrooms Water added 720 gal. New depth 14.4 in. Elapsed Time: 70 min. Final fluid depth 4_8 In. Absorption rate >= 600+ 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 E. SEPARATION DISTANCES Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot ](p'+ Public sewer main 751+ Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 1001+ Holding tank ]00'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 51+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 101+ Water main 101+ Water Service line 101+ Surface water ]0(Y+ Driveway, parking/vehicle storage 2'+ Curtain drain 50'+ (None Known) Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION „y•.;' �� : *1 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 KENNETH M. DUFFUS Date 10/19/2009 o •pn COSA Fee $490.00 �� Date of Payment bQiQ O q Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number 4,-/V, Municipality of Anchorage Development Services Department V ••" ` Building Safety Division On -Site Water and Wastewater Program4700 Sth j aw St. P.O. Box 196650 A chor ge, AK r99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. _O1 R-092_SO HAA 0:—f)F-Oa�-2 I. GENERAL INFORMATION Expiration Date: Complete legal Location (site address or Current Property owner(s) Day phone _145-19_ q` Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 2. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank Community Class Well ❑ Community On-site Public Water System ❑ 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 4 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. (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 the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shownbelow, I v ores thafort this investigation, based on procedures outlined in the Health Authority Approval application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functithat onal and based on theeinformation obtained bedrooms the Municipality of Anchorage of structure e filestand from myed herein. I fInvestigat ourther n 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. Phone (407) 6a6-6111 Name of Fir Address2Q44�r—n11° Bi °i Rl r. AK q9S�� -h a n„ffuc Date AL29/Q5 Engineer's Printed Name Rer���Gnnet Engineer's Comments: This Investigation was completed in compliance with ADEC and MOA regulations. The assessmentonly to of he condition of the well and septic applies Y stmay change due ttested. The fl o subsurfacec conditions thow and at t rate may not be observed from the surface, n changes evels land use, local soil characteristics, groundwater 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, KND can not give any estimate of how long a system will function satisfactory for current or future occupants or can KND guarantee that no unseen encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following WATER AND t PROGRAM Attachments: HAA Checklist X Maintenance Agreementsr�— Septic System Advisory Supplemental Engineers Report Other Well Flow Advisory , Original Certificate Date: " � + o 5 By: — Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519650 www.d.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:_W-A Lit 2 A. WELL DATA Well type nrtvatg Date oompleted 9/30/04/04 If A, B, or C provide PWSID # Sanitary seal (Y/NLL_ Total depth 121 ft. Cased to 121 ft FROM WELL LOG Date of test 9/30/04 Static water level t3 2 ft Well production _ 2 0 g.p.m WATER SAMPLE RESULTS: Well Log (Y/N) Yom_ Wires properly protected (YM) i_ Casing height (above ground) _Z 4 w AT INSPECTION ft. Coliform -D_colonles/1o0 ml. Nitrate 0.86 mg.p. Other bacteria —L-colonies/100 ml. Arsenic: _A mg -/I. Date of sample: 4/15/0;_ Collected by: KND nein rine 13. SEPTICIHOLDING TANK DATA Tank Type/Materlal MUM _irnur•oEIE ^ate installed11/1976 —__ Tank size X250 gal. Number of Compartments 2 Cleanouts (Y/N) y Foundation Cleanout (Y/N)XJpepression over tank (Y/N)B—High water alarm (Y/N) jy Date of pumping 4/213/05 Pumper _McDonald L. C. ABSORPTION FIELD DATA Date Installed _11/20/04 coil rating (g.p.d./fe or fe/bdrm) _12, System type TRENCH Length S4 ft. Width _5 ft. Gravel belowi PPe2— 5 eft. Total depth LM ft. Eff. absorption area AMfe Monitoring tube Y Depression over field N Date of adequacy test _NA - new system ResultsPass/Fall ( ) For_ bedrooms Fluid depth in absorption field before tesL_in. Water added gal. New dePtb__in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) 'Pump on" level at in. 'Pump ofr level at_ in.High water alarm level at In. Datum Cycles tested Masts alarm & dreuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankflift station on bt 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 1 00'+ Public sewer main 75'+ Public sewer manhole/deanout Sewer /septic service line ?5'+ Hotding tank 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5 ' +' + Absorption field ' + Water main 101+ Water service line –1-Q!±— + Surface water 10 O' + Wells on adjacent lots-19T±— SEPARATION ots100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: property line 10'+ Building foundation �1Q' + Water main 1 Q' + Water Service line 10'++_ Surface water 1 00 + Driveway. Parking/vehicle storage –Z-L±— Curtain drain W+ Wells on adjacent lots 1 Q0'+ F. COMMENTS G. ENGINEER'S CERTIFICATION .� »_ I celtlly that 1 have determined through field inspections and I T� Kenneth M. u�t:.- �, 'ti CE 116 y4� review of Municipal records that the above s in systems are in <<,r, conformance with MOA HAA guidelines in effect on this date. i �P Engineer's Printed Name "^^^^•~ to Mrffrre ti��� +� Date Waiver Fee $ _ HAA Fee Date of Payment 1 r Date of Payment Receipt Number �O�QU 1 Receipt Number. (Rev. 12J01) HOUSE DETAIL SCALE: 1' 30' t '•�� may. �� : na.r J N .coo rre lar SHED DETAIL •r em � or ser SCALE: 1 30' f.Y � �1r / Lot 41A-1 I I'm 8. r /SHED / / 1 oEfAiu 0 N \ 4.5' 4.3' WELL N 44'54000'E 25.00' IAPPROX. TOP OF BANK — R+rT CREEK ILot 1 I \ 10' UTILITY EASEMENT — EAST 140th AVENUE PLOT PLAN _ AS BUILT X SCALE 1� C 50' GRID2936 project No. 04-123 I Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Registered Land Surveyors (907) 522-4625 Faxne 00000p www.longeurveyors.com / InfoOlongsurveyors.com o6 0 Al 1 N O , rT r 1 hereby certify that I -surveyed the following described property: pP �SQOo Lot 2, WA Subdivision on ' •,'j' Anchorage Recording District, Alaska, and that the Improvements situated thereon are 0 491U within the property lines and do not encroach onto the property adjacent thereto. that "" no Improvement* on the property lying adjacent thereto encroach on the surveyed Q Promises and that then are no roadways, fronemission lines or oMer visible easements on sold property except as Indicated hereon. x KENNETH Dated this the 2l`# Day of _Vp{JJA4�1 ,?�W_Z, at Anchorage, Alaska �ON...' —5202 It Is the responsibility of the owner to d� termine the existence Of any easements, 4Q�pRaFESSIONAt moo" covenants, or restrictions which do not appear on the recorded subdMslon plot. ��40400�0