HomeMy WebLinkAboutSEA TURN BLK 1 LT 2Sen Turn
Block i
Lot 2
#017-121-53
Municipality of Anchorage Page ---iOf211�—
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 ® Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: `1a 0PID Number: —0/1 �3
Name: DAL–vfL
Wastewater System New ❑ Upgrade
Address:
ABSORPTION FIELD
Phone: I �T
No. of Bedr oms:
O Deep Trench Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:��11
6
Total Depth from original grader
'0
r GPD/Sq. Ft.
Lot: Block: Subdivision.:•
Depth to pipe bottom from originaylI do:
Gravel depth beneath pipe
„
Township:
:1
Range:
i? '3 %%
Section:
�� ?> ?
Fill added above original grade:
Gravel length:
�I )
�f`
C-
t�qFt.
Ft.
WELL: �JVew �❑ Upgrade
Grave l �deplll: V/t r i
Number of lines:
Distance between lines:
.t� FL
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material:
lo Ft.
10 I Ft.
7 FL
10
Driller: A _
Date Drilled:
i
Static Water Level:
i
Installer:
Date installed: j
lj ?-0 i
t N t
8- pl-7- 9
Ft.
1 VL LOh/ �.
Yield:
Pump Set at:
Casing Height Above Ground:
y
TANK
7 GPM
Pst) T Tu M Ft.
2 Ft.
SEPARATION DISTANCES
VSeptic ❑ Holding ❑ S.T. E. P.
To
Septic
Absorption
Litt
Holding
Public/Private
Manufacturer:
n (��f11
4i r- 0
Capacity in gallons:
11 u
From
Tank
Field
Station
Tank
Sewer Lines
l�-- � I-- ,
-.5
Well
7? )
i v.
I(f'if1 P
;/�.
(-/�-��
Material: j^C
k
bar of Compartments:
If
Surface
----
-_
LIFT STATION
_
Water
Lot
j)
_
Size in gallons:
�
Manufacturer:
Line
(•9
Foundation
_
_
"Pump on" level at:
"Pump off" level at:
High water alarm at:
Curtain
1�
�•-ti
Pump Make & Model
Electrical Inspections performed by:
Drain
/A
Remarks:
_
BENCH MARK
Location and DescriptiolL.
o4 L
Assumed Elevation:
10,6) Ft.
— ----
ENOINEER'S SEAL
Inspections performed by: r Dates: 1st ( —
't
2nd 2a> _
)
Department of Health,ainq�Hu a vices approval
Reviewed and approved b �' '�'–T—Date:
72-013 (1/91) MOA 26
96,00
Monitor
Clean Glut
Clean Out
Wide Trench+
96' LONG
5' WIDE
4' DEEP
25' OF SEWER ROCK
3' min, Cover
1250 gal
Septic tank
Greer
Founda ti
Clean out
Cleanouts
Monitor
4' Topsoil
3' Co ver
4' Min Cover
L
$91
- - over Tank
861
MlraF; 140
mmm
83.21
2,5 Peet of Septic Rock
GW 721
LL
BEN SPURKLAND RE.
LOT 21 BLOCK 1, SEA TURN
SEPTIC SYSTEM ASBUILT
W 15TH. AVENUE
SECTION 35, T12N,
R3W
DA,TE� NOV, 21, 1991
H, AK. 99501
CORT PNAL.P
SHEET, 313 GRID- 3138
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW910157
DESIGN ENGINEER:TOBBEN SPURKLAND, P.E.
OWNER NAME:DALCOR INC
OWNER ADDRESS:5841 AZALEA DR
PARCEL ID:01712153
.LEGAL DESCRIPTION: SEA TURN BLK 1 LT 2
LOT SIZE: 49277 (SQ. FT.)
NUMI3ER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
PAGE 1 OF
b.P0
DATE ISSUED: 6/17/91
EXPIRATION DATE: 6/17/92
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PR
RECEIVED B
ISSUED BY:
Cl/ - l
DATE:_
DATE:4,;' —47- //
1
HilloR BIND.
AVHORME, ALASKA 99Y)7')90il
NO) 248-5095
SEPTIC SYSTEM DESIGN
LOT 2 B L 0 C K I SEA T U R t -A So U B Ul
CORT PHALP
)"oln Broulld wat-or- co,
Ulllw! it! i.dc4, Tr(i-Mic:1)
c0
t IVI v
7.1 y
mi I i /:i t
L
u c I L.O. r d i:;F I, 1-lo.dir ocarl
+
r-- c ca i= I, -1c
4 2
o c i r
aO: AhT: rl
.i 0 11 D (.. J. c.) I I
1-c-ngl:h nr 1"lec".1fic-h 4 x :::- 9,-.) 1J..
S y S "T E 31 1—� 0 AJ F X S U IR Am T1 014
WIDE TRENCH
TOTAL LENGTH
116
FT.
TOTAL WIDTH
5
FT.
TOTAL DEPT"
4
FT.
ROCK DEP-ri-i
30
IN.
ADDITIONAL FILL
2
FT.
SEPTIC TANK
1250
SAL.
The installation of this well and septic system will not impact
adjacent lots. The well lncation conforms to the siting of the
existing wells in the area, and will not prevent the adjacent lot
owners from developing these lots or replacing the existing
septic systems.
The insta]lation of this septic system will not prevent wells
from be installed on the adjacen� lots.
There are no developed or natural surface / sub surface drainage
courses on this or the adjacent lots.
The proposed septic system will not change the general drainage
of the area. Ponding and/or concentration of surface runoff will
not result from this installation.
Septic SystemDesign
Lot 2 111ock 1 Sea 1urn
I - 11 IIFFI I
. . . . . . . . . . .
OR
to L I
III yl i i
D #11
R�mmmm
TOITHEN
6751 W. DDION1.) ft
WAL At 99502-390--1
ITT I i ix x 4 9
b I I =
-I rl� K'1� I
It
I Y
------------
It. A
. . . . . . . . . . .
OR
to L I
III yl i i
D #11
R�mmmm
TOITHEN
6751 W. DDION1.) ft
WAL At 99502-390--1
ITT I i ix x 4 9
b I I =
"., . , I I 76I.-
.i f �4r.i 11.51'._
;? F�: Z.I r . 4,.,F.L1F ii i'it'.lh.a4
ir'. Jt;i �i5',1;1 ;Dl (?�i'f Str;lJ nl'I
-�(ha,'il.i', �: ll j.�'t i. �I ff'Jli I.I�iI s. �`„"�_' to
1f1t,h�`P� r Inifr�l Irar, I. -.,� ,w, �.�I_, �� � rl1
I. -
IEA
7.51 'Id. I M 1. 1 N 1) 11", 1. """J,
... ... ... . bAly
I IlLIQ
... ..... ....
J
'irii' ifrJ:Til+.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
r
PERFORMED FOR: - I e ii �TYCt rY'� {' DATE PERFORMED:
LEGAL DESCRIPTION: Township, Range, Section:
DEPTH SLOPE SITE PLAN (FEET) I
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water Aller
Monitoring? Data:
S
L
O
P
E
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
I/
r/
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
1 TEST RUN BET/yJEEN/ IT NO -FT `
f`-C1�if�Fo
7
PERFORMED BY: I CERTIFY THT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EF ECT ON THIS DATE. DATE: C N -f.. &O Lt
72-008 (Rev. 4/85)
o Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOC — PERCOLATION TEST
PERFORMED FOR: CO R ,t L-F� DATE PERFORMED: •`'3/ZJI �I I
LEGAL DESCRIPTION: t ... QTa Bu., Township, Range, Section:
�� E_ �� SLOPE SITE PLAN
Y%iY.IL I 1�-'tIT t -1' -1'T -f--
1-
2
3
4
5 `E-
F .�
6
7 6•.
8 ..`
c
9 C
_L
10
11
12 • c��
13
c
14• .
Y
15-
1,��1L� hh�s •�� � 1�
16- I 141,L -E-:
17
18--
19-
20
819•20
COMMENTS
WAS GROUND WATER K) v
ENCOUNTERED?
S
L
0
P —
E
ti�la t
IF YES, AT WHAT
DEPTH?
Depihtri Water A
Monitoring? Y••YWe:
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
;3o
s'SlJ
l3°
l y
'; 3v
12
3v
11
130
1 3
6' A
rl
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
1
TEST RUN BETWEEN — FT AND �% ?—FT
PERFORMED BY: 7� 1 , / CERTIFY TH T THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
u Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
(ENGINEER'S SEAL)
PERFORMED FOR: {-1-�'LC'i l�Q fit. V1�'��-C DATE PERFORMED:_ / "7
LEGAL DESCRIPTION: Township, Range, Section:
DEPTH SLOPE SITE PLAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
(n G�
WAS GROUND WATER
ENCOUNTERED?
S
IF YES, AT WHAT L
O
DEPTH? P
E
Oepth to Water Alter
Monitoring? Bale:
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
a-4 j -Q' f�
7 i lt1 c
I! it e)
i
1
/.5 Xf 2!
+ ] rte_
/f,` , a 0
> IVY
(a% z7_
M4.
�)(
PERCOLATION RATE ZZ 62 _ (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND Yt — FT
PERFORMED BY:��_\ I . JSP CERTIFY T41AT THIS TEST WAS PERFORMED IN
r"
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFF CT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Municipality of Anchorage00
,.,
DEPARTMENT OF HEALTH & HUMAN SERVICES tti
825 "L" Street, Anchorage, Alaska 99502-0650 ........"c
�' �r• ; chben 5pur(donci ; A,�
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: Int✓ y2 " F t /'CL—? DATE PERFORMED:
LEGAL DESCRIPTION: Y� 10�� ry ` �[—::A l JetyTownship, Range, Section: C 16 1 12Nt'z:'3 (b%
SLOPE SITE PLAN
1 !�AplD Y S 1 i � I R4
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
AUL
e) t=
WAS GROUND WATER
y ,
ENCOUNTERED?
Net
Drop
S
IF YES, AT WHAT
L
O
DEPTH?
_ p
E
Depth to Water Alter
Monitoring? Dale:
_
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
aj' L)!�
2'y
tr
l�
t(
PERCOLATION RATE �5 (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 3 FT AND 2= FT
PERFORMED BY: / a I CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Q5lU.V0ON0BLVD.
ANCHORAGE, ALkSKKYY50^'PO4
SPECIFICATIQNS FOR SEPTIC SYSTEM INSTALLATION
LOT 2 BLOCK 1 SEA TURN SEC 35 T12N R3W
1.0 GENERAL
1.:1 Owner is Sam Johnson. 8uilder is DelCor, Cort Phalp,
1201 E 70th. �9518. Phone: 344~3353
1.2 Engineer is the person or entity hired by the Owner to
inspect this project. The Engineer must be recogNzed by the
Municipality of Anchorage/ Department of Health and Human
Services.
1, 3 Contractor is the person or entity hired by the Owner
to install this project. The Contractor must be recognizod
by the Municipality of Anchorage, Department of Health and
Husan Services,
1.4 The Drawings, sheets 1 through 3, shall be part of this
specification.
1.5 All materials and workmanship shal] meet the require-
ments of the Municipality, of Anchorage, Department of Health
and Human Services, the conditions of the permit, and all
applicable rules and regulations currently in effect.
1.6 All excavation depths are advisory, and are to be
verified and may be modified in the field by the EngAMUM .
1.7 It is the responsibi1ity of the Owner or the Contractor
to adhere to the approved design, to verify that the sIli eci�
fied separation distances are met, and that the required
inspections are performed.
1.8 The Contractor or the Owner shall report to the Engi --
f I t?R tI,
-neer any observed condition which would put the septic
system in violation of State or Municipal regulations.
2.0 SEPTIC TANK
2.1 If there is an existing septic tank, it may be used if
it meets the capacity requirement for the residence. The
tank shall be inspocted by the Eli gioCar r, and its water
tightness and structural integrity shall be verified.
2.2 A now septic tank shall be one fahricated by either
Anchorage Tank and Welding or by Greer Tank
Specifications for septic system installation
Lot 2 Block 1 Sea Turn
The
septic tank
shall be a UPC
-approved twocompartment
tank,
constructcd
of 12 gauge, or
better, steel with bitu
mastic
coating.
The tank shall be
set level o undisturbed
sojl.The
tank
shall be covered with
the equivalent of four
feet
of soil,
2.5
2.3 The septic iank shall be installed a minimum of five
feet from the house foundation and a minimum of five feet
from the absorption area.
3.0 ABSORPTION FIELAD
3,1 Gravel used in the absorption field shall be 0.5 to 2.5
inch screened rock, with less than 3% passing the No0
sieve.
3.� Sand, used for leveling or for filtering, shall have an
effective grain size between No. 40 sieve and No. 18 sieve.
Uniformity coefficient shall be less than 4. Not more than
weight shall pass the No. 200 sieve.
3.3 4`inch perforated pipe shall be ASTM F810. For pres-
sure distribution, pipe shall be Schedule 40 PVC or ABS.
3.4 Solid 4 -inch pipe shall be Cast Iron or ASTM D3034.
3.5 Monitor standpipes shall be installed as shown. That
section of the pipe penetrating the gravel shall he perfo-
rated, either by drilling 0.5" holes on 6 -inch centers or by
joining a secLion of F810 perforated pile to a solid section
of pipe.
3.6 Geotextile shall be Ph. rafi 140.
3.7 Insulatioo shall be extruded direct burial polystyrene.
Dow Chnmical Styrofoam HI 40.
3.8 Topsoil shall be a mixture of 40~10% organic matter,
sand and more that 20% silt. All quantities are
measured by volume.
S�ecificatiarm for septj system installation
Lot 2 Block J. Sea Turn
pg.2
septic tank shall be a ainimum of 100 feet from
any
well
serving a single residence:
100 feet from any body
of
water,
creeks or drainage ditches
with flowing water;
150
feet
from Class "C» wells; and
200 foet from Class A
or
Class
B wells.
2.5
0ll pipe connections to the
tank shall be mechanical
watertight
calder couplings. Cleanouts
shall be insta1led
as designated
and capped with air
- tight rain caps. Clean
-
outs
shall extend a minimum of 12
inches above final ground
e]evation.
Provisions shall be
made for landscaping
and
importation
if topsoil.
3.0 ABSORPTION FIELAD
3,1 Gravel used in the absorption field shall be 0.5 to 2.5
inch screened rock, with less than 3% passing the No0
sieve.
3.� Sand, used for leveling or for filtering, shall have an
effective grain size between No. 40 sieve and No. 18 sieve.
Uniformity coefficient shall be less than 4. Not more than
weight shall pass the No. 200 sieve.
3.3 4`inch perforated pipe shall be ASTM F810. For pres-
sure distribution, pipe shall be Schedule 40 PVC or ABS.
3.4 Solid 4 -inch pipe shall be Cast Iron or ASTM D3034.
3.5 Monitor standpipes shall be installed as shown. That
section of the pipe penetrating the gravel shall he perfo-
rated, either by drilling 0.5" holes on 6 -inch centers or by
joining a secLion of F810 perforated pile to a solid section
of pipe.
3.6 Geotextile shall be Ph. rafi 140.
3.7 Insulatioo shall be extruded direct burial polystyrene.
Dow Chnmical Styrofoam HI 40.
3.8 Topsoil shall be a mixture of 40~10% organic matter,
sand and more that 20% silt. All quantities are
measured by volume.
S�ecificatiarm for septj system installation
Lot 2 Block J. Sea Turn
pg.2
3.9 Grass seed shall be Kentucky bluegrass,
4.0 INSTALLATION
4.1 Locate
all underground utilities, property liHem
future driveways,
existing or proposed water wells, water
ways, surface and sub surface drainage facilities, lakes,
ponds, and
all other facilities requiring separation dis-
tances from
the proposed septic system. Notify Owner or
Engineer of
any observed possible conflict.
4.2 Stake
alignment of system with markers showing the
protectjve distances
from wells and water bodies.
4.3 Establish
an elevation benchmark. This BM shall be
easily identifiable,
stable and permanent. An arbitrary
elevation of
100 can be assigned.
4.4 Install
the tank as shown on the drawings. Record the
inlM and
outlet elevations of ths tank. Tank shall be
placed on undisturbed
native soil.
4,5 Excavate
the absorption fie\d. Bottom of excavation
shalbe level
and scarifjcad. If sidewalls smears, they
shall also
be scarified. Record elevation of beginning'
middle and end
of trench. Construction equipment shall not
operate on
the floor of the excavation. Any material com�
pacted by the
operation of the construction equipment shall
I emoved and
replaced with uncompacted materials.
4.6 Place the
rock to the depth specified. Do not contami-
nate rock with
native materials or spoils from the excava~
tion. Level
the rock sur{ace (+- 1"> before installing the
perforated pipe.
4,7 Install
the distribution pipe. Record the elevation of
each jo:int.
For pressure system solvent weld Ill to joints.
4B Cover
the distribution pipe with rock, and cover the
excavation
with geotextile before backfilling and placing
insulation,
if required.
19 Record
the finished ground elevation at the beginning,
middle and
end (OF trench. Record the finish ground eleva-
tion at each
corner and at the midpoint of the bed.
4.10 Furnish
a copy of all survey notes to the Eogxneer.
5.0 INSPECTIONS
5.1 A minimum of three inspections are required. The
firsL inspection will be of the open excavation. At th."s
Specifications for septic system installation
Lot 2 Block 1 Sea Turn
time the soil conditions will be observed and compared to
the design assumptions.
Ground water conditions or presence
of bedrock will be verified.
The second inspection
will ba after placement of gravel,
standpipes' distribution
piping, tank(s> and other compo-
nents as speci{ied.
The third jnspection will
be after completion of the work.
Any deficiencies will be
noted and the Contractor notified.
Such deficiencies shall
be corrected within ten days
5.2 All electrical work
requires either an MOA electrical
inspection or certification
by an licensed electrician.
Submit proof of inspection
or certification to the Engineer.
5.3 Submit catalog data
of all mechanical equipment.
5.4 Notify Engineer at
least 24 hours jn advance of begin-
ning any work
SpecifjcatiClio Sow- septic system insta]lation
Lot 2 Dlock 1 Sea Turn
[,(,6 >1V '> d :-mom
v' L
e 4 UWf6
Inv 70,
N."A III 11H
L UN —;OLIT1�11g F) C4,1
ollu1VL ;d I.-
NOXIk7
;. W Mt4f, 130,T3V2iMOD
Hlcl�l(l "1;1V1NI mnj
I A ONV
9NT CI I,
-A.4 OKI
UV jo
AON
- -- --------
;bu I troclo jo F. 11
T
S DINJ
44
F1
-7 - ------ ---- ----
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:.loq �Ic) o-4 �)Jquq�
oc
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IMM UlVM DIM$ ...... .
viva oq
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NO A 0 H J, V C lRIOd QN11MUIM
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NQTLDFNJ' ? NOT31AIC190S nnouoe
T) "!,.1 146, W.)XITAIDO I
cldc)DU 11TIM W41EVII,
SA2[MICIS 'lV%VAHd05V (]IqV dC) tIOl$lAlCI
sS' o`rmos,qu rTv-anmvN ao jNmiaAivduc
V-Ag%rllv 10 a(j,VLs
Municipality.of Anchorage .,
• Development Services Department �i •:
Building Safety Division \
On -Site Water 8 Wastewater Program a
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519519.6650 �� cccCCCy
www.muni.org/onsite
(907)343-7904 \ \v
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. Qlq-IA1-53 h COSA# f r- n
1. GENERAL INFORMATION Expiration Date: 9 � -2 0 - Q %
Complete legal description SEA TURN SUBDMSION: LOT 2 _BLOCK 1
Location (site address) 5841 _AZALEA DRIVE ► ANCHORAGE. AK 99516
Current Property owner(s) SAMUEL AND KATHLEEN JOHNSON Day phone C/O AGENT
Mailing address HC3 BOX 8425 • PALMER. AK 99645
Lending agency Day phone
Mailing address
Real Estate Agent NICHOLETTE WILSON w/ REMAX PROPERTIES Day phone 301-1441
Mailing address 110 W. 38th SURE 100 • ANCHORAGE. AK 99503
Unless otherwise requested, COSA will be held by DSD /or pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:.
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
0
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 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 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 samples. (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, 1 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. 1 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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines 8 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
_LZ Approved for _�/_ bedrooms.
Disapproved.
Phone 337-6179
Date �' I V- A 7 -
Conditional approval for bedrooms, with the fllowing stipulations:
Attachments: C/
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
...... ...:...°.
�� • ON-SITE • ���
WATERAND ; m-
: WASTEWATER :
a•,. PROGRAM
R
.ill
/Q,04ty \l\��
By: Original Certificate Date: � -' 2 � '" 0
ar
(Ra. 11105)
Municipality of Anchorage
f ' Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Boz 195650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: SEA TURN SUBDIVISION: LOT 2. BLOCK 1 Parcel ID:
A. WELL DATA
Well type PRIVATE If A. B. or C provide PWSID# N/A
Date completed 8/27/1991 Sanitary seal (Y/N) YES
Total depth 101 ft. Cased to 101 ft.
FROM WELL LOG
Date of test 8/27/1991
Static water level 52 ft,
Well production 7.0 g.p.m.
WATER SAMPLE RESULTS:
Coliform 43l" colonies/100 ml.
A►,
Arsenic: � ug./L.
B. SEPTIC/FIOLDING TANK DATA
Nitrate AjamgJL.
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 18+ in.
AT INSPECTION
6/5/2007
52 ft,
5.91 g.p.m.
Other bacteria � colonies/100 ml.
Date of sample: 6/5/2007 Collected by: GEG Ltd.
Tank Type/Material SEPTIC/STEEL Date installed 9/20/1991
Tank size 1250 gal, Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YM) _ N/A
Date of pumping 6/6/2007 Pumper McDONALD'S PUMPING
C. ABSORPTION FIELD DATA POELOW EXISTING 0 -RA -DU
Date installed 9/20/1991 Soil rating .p.d. r ft2/bdrm) 0_8 System type SHALLOW TRENCH
Length 96 ft. Width 5 ft. Gravel below pipe 2.5 ft.
Total depth "6.4 ft. Eff. absorption area 750 ft' Monitoring tube YES Depression over field NO
Date of adequacy test - "•6/6/2007 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 6 In. Water added '•• 1208 gal. New depth "•• 16 in.
Elapsed Time: 995 min. Final fluid depth 13 In. Absorption rate >= 600+ g.p.d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date -
•• SYSTEM WAS PRE-SOAKED WITH 1000 GALLONS ON 6/4/2007
••• THE LAST 523 GALLONS ONLY CAUSED A 3 INCH RISE IN THE TRENCH
D. LIFT STATION
Date installed
"Pump on" level at —in.
Size in gallons
"Pump Or
Manhole/Access
water alarm level at in.
n r Cvdes tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot 1001+ On adjacent lots 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
Animal containment areas 'S0'+
On adjacent lots 100'+
Public sewer manhole/deanout N/A
Holding tank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A 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 10'+ Water main N/A
Water service line
10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I cot* that r have determined through field inspections and...... a':' y •
........... ..... .
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines m effect on this ................
date. Je A. s:
r s Printed Name
JEFFREY A. GARNESS
Engines ' 3
�p�•�. khw�4.���`
Date 6�rw/c, ^�dprofoss
COSA Fee $ 7 3U. D 0
Date of Payment A/! 4,2 7
Receipt Number �/ y L —
(Rw. I Ift)
Waiver Fee $
Date of Payment
Receipt Number
yt.
f.
•ao•oo.c
.. 1v1
�- I/0.Op�a
jseo
O,uaua7
w wr" m ia' wt
Ar E.t?..•.+•--�'f--�
;� J^��'
i h.a S ►.w FrI+.Y � Wwj•
•h
�
40�
v. MOYM�b W
• •. • • •
•
1�"n1} IM 4.p"} NAA -v.Y�� Nn.
SGS Refp
1072543001
Client Name
Gamess Engineering Group, Ltd.
Project NameN
Sca Tum LI D2
Client Sample ID
Sea Tum LI D2
Matrix
Drinking Watcr
PN'SID 0
All Date%/Times are Alaska Standard Time
Printed Daterfime
06/13/2007 16:21
Collected Date rime
06/05/2007 12:00
Recehed Date(1'ime
06/052007 14:05
Technical Director
Stephen C. Ede
Sample Rcmarks:
4500-NO3 - Total NitratclNitritc - The matrix spike recovered below the QC criteria. The batch LCS is within QC limits.
Pammder Allowable Prep Analysis
Results PQL Units Method Contamer ID Limits Date Date
Init
Metals by ICP/MS
Arsenic ND 5.00
waters Department
Total Nitmtc/Nitritc-N ND 0.100
Microbiolovy Eaboratory
Total Colifitnn 0
ug/L EP200.8 C (<I0)
mg/L SM204500NO3-F D (<10)
coUl00mL SM209222D A (<I)
06/07/07 06/12/07 TK
06/09/07 JDS
06/05/07 DLC
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES klftl
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 017— /f g) - 3
2.
3.
4.
GENERAL INFORMATION
HAA # & Zi -1 MY
Complete legal description
Se� y J
Location (site address or directions) Ll
Property owner Teo-"(- Day phone 3 -f
�c.c - �
Mailing address I"?_0 1 .7 U ",
Lending agency
Mailing address
Agent
Address
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF 13EDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site —�
Holding tank
Community on-site
Public sewer _
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA N21
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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is 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 in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm �6=fit r /- Phone _A W
Address
Engineer's signature
6. DHHS SIGNATURE.
Approved for
Disapproved.
0
Conditional approval for
/L/vA1 %
Additional Comments
bedrooms.
Date
` ( ;?-)
bedrooms, with the following stipulations:
411Th
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA #21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lo 1 '2_ � K I g v_cn i (,w 617-
A.
I 7-=-
9 P Parcel I.D. —
A. WELL DATA
Well type Pe-,!, If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed � ��` c� % _ Driller_
Total depth /0 Cased toCasing height—
Sanitary
eight
Sanitary seal (Y/N)
Wires properly protected (Y/N)
FROM WELL LOG
AT INSPECTION z
Date of test 9-- a� 7" �t
ILI
Static water level
_ z U
cr'
P
>
Well flow7
0 V)
..m. g.p.m.
LO
cv
�9
ilk
Pump level
W
v_
20
Q__.J
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
On adjacent lots >
Absorption field on lot
On adjacent lots —> /
Public sewer main �
Public sewer manhole/cleanout
Sewer service line �/ /
Petroleum tank
WATER SAMPLE RESULTS:
Coliform Nitrate
Other bacteria
Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed q �o! �/ Tank size /0Tg 0 Compartments
Cleanouts (Y/N) -Foundation cleanout (Y/N). / Depression (Y/N) 114
High water alarm (Y/N) Alarm tested (Y/N)_ t�411S,
Date of pumping N
Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot r 30 { On adjacent lotsFoundation_
To property line Absorption field `U —Water main/service line
Surface water/drainage/_- ,
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
l\�/
Date installed
Size in gallons
Vent(Y/N)
High water alarm level _
"Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
"Pump off' level at
Cycles tested
Surface water _
D. ABSORPTION FIELD DATA j
Date installed gl�Or �1 Soil rating ` System type a2/ ,1A 1"V6_`�
Length Width Gravel thickness -Total depth "'/
y
Total absorption area / sy Cleanouts present (Y/N)
Depression over field (Y/N) N Date of adequacy test
Results (pass/fail) I ��.-�_S for bedrooms
Peroxide treatment (past 12 months) (Y/N) ' T If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO: ,
Well on lot /60 4- On adjacent lots > / a_6�' Property line
To building foundation �%� To ex``isting or abandoned system on lot
On adjacent lots > Cutbank �//1Water main/service line U
Surface water /A Driveway, parking/vehicle storage area >50
Curtain drain�«
E. ENGINEER'S CERTIFICATION
I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature vT
Engineer's Name
Date �A? ✓
HAA Fee $
Date of Payment �� 1
Receipt Numbed
72-026 (Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
ANALYSIS RESULTS for INVOICE # 40509
Chemlab Re£.# 91.6292 Semple # 1 Matrix: WATER
Client Sample ID POTABLE WATER 2./1 SBATURN Client Name :TOBBEN SPURRLAND, P.E.
PWSID UA Client Acct :TOBBENS
Collected NOV 22 91 @ 13:15 hrs. BPO# POW :NONE RECEIVED
Received NOV 22 91 @ 14:00 his. Req#
Preserved with AS REQUIRED Ordered By
Analysis Completed NOV 25 91
Laboratory Supervisor STEPHEN C. EDE
Released By : m G Cj//
.......,.....................................
Parameter
---------------------------------------------
NITRATE-N
Sample ROUTINE SAMPLE COLLECTED BY: T.S.
Remarks:
..........................
1. Teets Performed
ND- None Detected
NA- Not Analyzed
Send Reports to:
1)TOBBEN SPURELAND, P.E.
2)
.......................................................I............................
Results
Unite
Method
Allowable Limits
---------------------------------------------------------------------------------
ND(0.10)
mg/1
EPA 353.2
10
RECEIVED
NOV 2 6 1991
Municipallty of Anchorage
Dept. Health & Human Services
.............................................................................................. I........
' See Special Instructions Above UA -Unavailable
See Sample Remarks Above
LT -Less Than, GT -Greater Than
ey�� SGS Member of the SGS Group (SociM6 Generale de Surveillance)