HomeMy WebLinkAboutSHANE LEE ESTATES BLK 2 LT 1BShone Lee
Estates
Block
Lot 1 B
2
#014-061-88
KNIDENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
11/FAX (907)696-8111
January 6, 1997
Mr. Ev Honegger
Hearthstone Homes, Inc.
1403A Hyder Street
Anchorage, Alaska 99501
Subject: Lot 1B, Block 2, Shane Lee Estates
t� i)Vi -CCS\-0A&
RECEIVED
APR 11997
Municipality of Anchorage
Dept. Health & Human Services
On December 14th, we attempted to run a well flow test for the subject property.
However, we were unable to do so until a path was cleared to the well head, thus
enabling us to drive a rig in. After waiting for the path to freeze, we were able to
access the well for the test on December 23, 1996.
Your research indicated that the Municipality does not have a well log. The
Water and Wastewater Utility as -built does not show the existence of this well in
1977; however, due to its location it is likely that the well was simply not found
at that time. The well is drilled and has a 6 steel casing which extends
approximately 34.5" above ground level. Static water level was 19' below the top
of casing. We verified that casing extends to the bottom of the well, and that the
well is 56.5' below top of casing. Although we were unable to detect the location
of the pump, our calculations show that it is probably between 46 and 48 feet
below top of casing.
This well contains a bladder which serves to pressurize the water line. The
bladder is situated just below static water level on the water line from the pump.
The bladder has an approximate 4.5 gallon drawdown. The bladder was pulled
for examination and found to be in good working order, thus it could be used for
future development if your client desires. Otherwise a new pressure tank could
be installed in the proposed dwelling.
The presence of the bladder, once inflated, prevents the use of a probe to follow
static water level as the well is tested. As a result we established baseline data
and withdrew the probe. The flow was set to a point where pump cavitation
sounds were no longer audible. At this level production was estimated at 6.5
gpm•
A full four hour test was run, during which a total of 1,456 gallons of water were
pumped. Based on four hours of this test, the calculated well flow is 6.067 gpm
for that period. Following the testing, we measured recovery in the well 28
Z/- -1 - 97 %141s tvt--L-A 412VF/IR5 4Orr- tip E irUP &5L' 6d/ 71 frOPoom
51AI&LF F11M t J- HOI`E, WA% E� G��+�IL I l i f�LSO %9PPFi9R3 "¢fi�` 4u i9?[.
Subject: Lot 1B, Block 2, Shane Lee Estates
January 6, 1997
Page 2 of 2
minutes later and found static water level at 22.5'. We would expect the well to
return to 19' within a few hours.
The distance between this well and the public sewer line and manhole on Tiffany
Circle is greater than 75 and 100' respectively, as required by Municipal and State
regulations. The water analysis for coliform was zero and the nitrate was 0.28
mg/1. Both results were satisfactory. Based on the above this well is in
compliance with Municipal and state regulations for single family wells.
If you have any questions about this report, please contact me at 696-6111/FAX
696-8111.
Respectfully submitted,
KND Engineering
Kenneth M. Duffus,
attachments: water samples
JAN 06 '97 04:29PM NTL ANCHORAGE
P.2
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL. AVENUE FAIRBANKS, ALASKA 99701 (90'7) 456-3116 0 FAX 456-3125
3005 SCHOON STREET ANCHORAGE, ALASKA 99518 (90'7)349-1000 • FAX 349.1016
DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA
KND Engineering Public Water System I.D.#
20441 Ptarmigan Blvd,
Eagle River, AK 99577-3736 Date Received: 12/23/96 Time Received: 15:40
Date Analyzed: 12/23/96 Time Analyzed: 16:30
Date Reported: 12/26/96 Time Reported: 17:05
Next Sample Due:
Phone No.
Purchase Order No.
Collected by: SO
Sample Type:
Routine Untreated
Method of Analysis:
Membrane Filtration
Comments:
Comments:
S - Satisfactory
U - Unsatisfactory
POS - Positive Test Result
ND = None Detected
TNTC = Too Numerous To Count (>200 Colonies)
CG = Confluent Growth
HSM = Heavy Sediment Masking, Results May
Not Be Reliable
SA - Sample Age >30 Hours But <48 Hours,
Results May Not Be Reliable
Old = Sample Age >48 Hours, Too Old For
Analysis
R = Resample Required
NT = No Test
* # Colonies/100 ml ** # Colonies/ml
Sample Sample Total* Fecal* Other* HPC**
Date Time Coliform Coliform Bacteria Result Lab# Location Comments
----- I --- -------------------------------------- - -----.----------------------
1 12/23/96 14:30 0 ND 0 NT AC2352 Lot 1 B Block 2/Shane Satisfactory
Lee Est
Jul1� Sehaefj N
Environmental Analyst
JAN 06 197 04:30PM NTL ANCHORAGE
P. 3
NORTHERN TESTING LABORATORIES, INC.
Y�l
3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (90'7)456.3116 • FAX 4563125
13005 SCHOON STREET ANCHORAGE, ALASKA 99516 (90'%) 349.1000 6 FAX 349.1016
KND Engineering
20441 Ptarmigan Blvd.
Eagle River, AK 99577-3736
Attn:
Our Lab 0:
Location/Project:
Your Sample TO:
Sample Matrix:
Comments:
Lab
A142534
Shane Lee Estates
Lt 18 Block 2
Seater
Number Method Parameter units
-----------------------
A14S534 SM 4500E Nitrate -N mg/L
RaForted Sy: An'hOny J. Longa
Chemistry Supervisor
Report Cate: 01/02/97
Date Arrived: 12/24/96
Date Sampled: 12/23/96
Time Sampled: 1430
Collected By: EH / NTL
** Definitions **
B Proment in Blank
H . Above Regulatory Max
E Estimated Value
M Matrix Interference
D = Lost: to Dilution
MDL - Method Detection Limit
Date Date
Result y' MDL Prepared Analysed
........., ........................
0.25 0.10 12/30/96
•
- 4� ,_ Municipality of Anchorage
On-Site Water and Wastewater Program ' 6
(907) 343-7904 SA ETY
Certificate of On-Site Systems Approval 1
Parcel I.D. 014-061-88 Expiration Date: l -30 !r 7
1. GENERAL INFORMATION:
Complete legal description Shane Lee Estates; Block 2, Lot 1B
Location (site address) 6741 Tiffany Terrace*Anchorage, AK 99507
Current Property owner(s) Joe&Lisa Hess Day phone 903-7674
Mailing address 6741 Tiffany Terrace*Anchorage,AK 99507
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual ❑
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer
WaiverNariance request for: Distance:
Received by: Date: 6/300'
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ SSD - Waiver Fee $
Date of Payment (v' L 111 Date of Payment
Receipt Number f701noa56 Receipt Number
COSA# 05G`1LS' 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.
Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road,Suite 101-Anchorage,Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: E"(2.6,43-
��ooaa44
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o OF A/ 40n
in accordance with the guidelines and regulations established by the Municipality of Anchorage and ,�c,.•••..•••. 7'k / o
industry practices. The reported results describe the condition of the system/s on the date/s of the O Q- Qn
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or if ' ' 9 l �� LUQ
encroachments may exist that were not identified during the evaluation. The operational life of all wells . D
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, Q Q
groundwater levels (that may fluctuate during the year), quality of construction (materials and / I
workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and Q.. 1
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the r i�fr. •. - ness:
system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of QA .79 3
the well or septic system. GEG makes no representation whether an alternative well or septic system Q
can be installed on the property in the event either of the current systems fail to perform adequately in �� P, L�.Z� � ��
the future. The content of this report is for the sole benefit of the person/party that retained GEG to 4ZQa pr o f e s sio�°o
perform the evaluation. Reliance upon the information provided in this report by any other person or �p4��pod
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipL tions�NCho
:Zr G•
es of Q
\N, C.
Ku
- r
Original Certificate Date: 6 --30- (l
7
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 Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_10.1412.tloc
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: Shane Lee Estates; Block 2, Lot 1B Parcel ID: 014-061-88
A. WELL DATA *Per Aarow Pump & Well Service inspection in MOA records.
Well type Private If A, B, or C provide PWSID# N/A Well Log (Y/N) No
Date completed Unknown Sanitary seal (Y/N) Yes Wires properly protected (Y/N) Yes
Total depth *70 ft. Cased to *50 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 6/19/2017
Static water level 1ye�\ °�J
ft. 16.8 ft.
N°
Well production / g.p.m. 2.7+ g.p.m.
WATER SAMPLE RESULTS:
Coliform . colonies/100 ml. Nitrate' mg./L. Collected by: GEG. Ltd.
Arsenic: /\. -.- ug./L. Date of sample: 6/19/2017
B. SEPTIC/HOLDING TANK DATA AWWU
Tank Type/Material Date installed
Tank size gal. Number of Compartments Cleanouts (Y/N)
Foundation cleanout (Y/N) Depression over tank (Y/N) High water alarm
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft or ft'/bdr . System type
Length ft. Width ft. Gravel below pipe ft.
Total depth ft. Eff. absorptio . ea ft' Monitoring tube Depression over field
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in abso • on field before test in. Water added gal. New depth in.
Elapsed e: min. Final fluid depth in. Absorption rate >= g.p.d.
y rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off' level at . wa er alarm level at in.
D. •- Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A On adjacent lots 100'+
Absorption field on lot N/A On adjacent lots 100'+
Public sewer main 75 + Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: AWWU
Building foundation Property line Absorption field
Water main Water service line Surface water
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION Fl ! + I LOT TO:
Property line : g foundation Water main
Water service li - Surface water Driveway, parking/vehicle storage
•• ain drain Wells on adjacent lots
F. COMMENTS
00�4444‘
G. ENGINEER'S CERTIFICATION of 4 4��
QQ�` • Qs��q
i certify that I have determined through field inspections and 0 ' 9 H ' '•7�0
4D
review of Municipal records that the above systems are in
VA conformance with MOA COSA guidelines in effect on this �-
date. Je, r j`. A. •r -ss. aO
Engineer's Printed Name JEFFREY A. GARNESS ° 4 _ 7 5 fop
• •
Date (ol,)Cl1 r d.,ec, • fess L. oma
k�444oq�a
#AECC884
(Rev.11/05)
Municipality of Anchorage
1�1'� tp6E. ALI
• Development Services Department r
Building Safety Division <-
On -Site Water and Wastewater Program s a E r r
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FORA SINGLE FAMILY DWELLING
Parcell.D. o14-o6s-88 COSA# Qse/atasb
Expiration Date: /0 r iia _ %�;L.
1. GENERAL INFORMATION
Complete legal description Shane Lee Estates Blk z Lt iB
Location (site address) 6741 Tiffany Terrace, Anchorage Ak. 995o7
Current Property owner(s) John M Jr & Deann L Peterson Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
6742 Tiffany Terrace, Anchorage Ak. 995o7
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: I
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 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 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 Pannone Engineering Services, LLC Phone 272-8218
Address P.O. Box 100217, Anchorage AK 99510
Engineer's Printed Name Steven R. Pannone, P.E. Date f&0`_�
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe 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 soil condition, ground water
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 this system. All systems eventually fail and
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future
performance nor give any estimate of how long the system will continue to meet the operational
requirements of the 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
Approved for __ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: i % PCZ , cs Cif' Original Certificate Date:( l
(Rev. 11105),, 1�
Municipality of Anchorage
• Development Services Department u
Building Safety Division
Onsite 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: Shane Lee Estates Blk2 LtiB Parcel ID: o24, -o62-88
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed unknown Sanitary seal (Y/N) Y_
5-0
Total depth eft. Cased to eft.
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
ft.
g.p.m.
Coliform N colonies/100 mL Nitrate 6.N40k mg/L
Arsenic: ugh Date of sample: L _ aL
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tank size gal.
Foundation cleanout (Y
-Date—o-f pumping
C. ABSORPTION FIELD DATA
Date installed
Length
Total depth
Number of
Date
Well Log (YIN)
Wires properly protected (Y/N) Y
Casing height (above ground) X24 in.
AT INSPECTION
6/25/2012
si (bladder placed at 22) ft.
6.3 g.p.m.
Collected by:
(Y/N)
over tank (Y/N) _ High water alarm (Y/N)
Pumper
Soil rating (g.p.d./ftz or ftp/bdrm)
ft. Width ft.
ft. Eff. absorption area ft2
Date of adequacy test Results (ft
Fluid depth in absorption field b _ in.
min. Final fluid depth
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
System type
Gravel below pipe ft.
Monitoring tube Depre n-ov€r field _
For _ bedrooms
Water added_ gal. New depth in.
in. Absorption rate >= g.p.d.
If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at _ in.
Size in gallons _
Pump off' level at
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot ioo+
Absorption field on lot i.00+
Public sewer main _7c+
Sewer /septic service line 2t+
Animal containment areas ioo+
Manhole/Access (Y/N)
+1wJ"-ocateT—aTarm level at in.
Meets alarm & circuit requirements?
On adjacent lots ioo+
On adjacent lots ioo+
Public sewer manhole/cleanout ioo+
Holding tank ioo+
Manure/animal excrete storage areas ioo+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line Absorption
Water main
Wells on adjacent lots
SEPARATION DISTANCE FROM
Property line
Water service line
foundation
Surface water
Curtain drain Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
t 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 Steven R. Pannone, P.E.
Date i-20-fO3
COSA Fee $_ LN0
Date of Payment 2z3_&2
Receipt Number 70
(Rev. 11/05)
Surface water
TO:
Water main
Driveway, parking/vehicle storage
Waiver Fee $
Date of Payment
Receipt Number
19
No. CE 8149
Id
SGS
SGS Ref.#
1122466001
Client Name
Pannone Eng. Srv.
Project Name/#
Shanelee Estates
Client Sample ID
Blk 2 Lt 1B
Matrix
Drinking Water
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
07/02/2012 11:28
06/21/2012 13:15
06/21/2012 14:14
Stephen C. Ede
Sample Remarks:
Allowable
Prep Analysis
Parameter
Results LOQ
Units
Method Container ID Limits
Date Date Init
Metals by ICP/MS
Arsenic
ND 5.00
ug/L
EP200.8 C (<10)
06/26/12 06/27/12 NRB
Waters Department
Total Nitrate/Nitrite-N
0.462 0.100
mg/L
SM214500NO3-F B (40)
06/27/12 CMA
Microbiology Laboratory
E. Coli Negative 1 100mL SM21 9223B A 0621/12 DLC
Total Coliform Negative I 100mL SM21 9223B A 06/21/12 DLC
7/2/12
0(1700x2338)
AAROLU PUn1.P & WER SEROCE, LLC ,t'�fh IGT�L C
P.O. Box 110096 s
Anchorage, AK 99511 1'id t,r`` No. 9454
Office. 007) 346-9356 - Fax (907) 333-8976�
p
Eagle River. (907) 622-9335 lr'
t4�4t. (�
£4 {1
ZI cusr>3a9eR
0 . 7 &`<-�2 >
JOB SITE
y
J L
I'4wvu ngrTu J
Ve..e1Pi - h`N,L
Uep"Bse�
.JW
OUPATITY
DESCRIPTION PRICE
:< pA4GUN7ry
3�:%c74'_..tS.__?v"� Ipi�T 7`r_'...__.._.. .... .__--`__ _.....___ _:.,�...•�-'�.
r�iy"';
4-9
:.....-----
LABOR
HOURS c
RATE
AMOUNT
TOTAL MATERIAL.,
3
TOTAL LABOR
WORK ORDERED BY
DAiE COMP.
TOTAL
LABOR
PAY THIS AMOUNT
,-
ScJ..
.
ThahkYou
SKINA`-1 -HE
(I Hereby Acknowledge The Satisfactory completion at the Above Desohbed Work and agree that if almVe mole tont paid for in 90 days i agree to allow Aarow
PUMP & Wall Service, L LO the right to remove unpaid mrequipment and charge for labor almadyperformad &labor to remove unpaid far equipment.)
TERMS:. ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE.
SERVICE CHARGE AT BATE OF 1,5% PER MONTH WILL 9E CHARGED ON OVERDUE ACCOUNTS.
https://mail-attachment.googieusercontent.com/attachmenVu/0/7ui=2&ik=a1 badc1666&view=aft&th=13... 1/1
Municipality of Anchorage
• Development Services Department
Building Safety Division
k
On -Site Water and Wastewater Program s k F E 7 v
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite � 4, 5`
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 014-o61-88 COSA # 0
Expiration Date: v _
1. GENERAL INFORMATION
Complete legal description Shane Lee Estates, Block 2, Lot 113
Location (site address) 6741 Tiffany Terrace
Current Property owner(s) Emily Gillies
Day phone
Mailing address 6741 Tiffany
Terrace
Lending agency
Day phone
Mailing address
Real Estate Agent Colin Roth /
ReMax
Day phone 727-1191
Mailing Address
Unless otherwise requested, COSA will be held by DSD
for pickup.
2. NUMBER OF BEDROOMS:
3_
3. 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 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 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 _Pannone Engineering Services, LLC Phone 272-823.8
Address _P.O. Box 3.00217 Anchorage, AK gg53.o
Engineer's Printed Name Steven R. Pannone, P.E. Date 2/28/2011
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe 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 soil condition, round water
levels
�"1L1kjk
.�� ���
OF �
�. ��� ♦1
that may fluctuate during the year, and the water usage of the family being served by the system.
These
�•
�P •,,.......... ••••
conditions are outside the control of the evaluator of this system. All systems eventually fail and
•S�0
�,.• •
�
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that
4 rH ';♦♦♦
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future
�•••• 6••••••• ••.• •••••• .••••1.•...0o
performance nor give any estimate of how long the system will continue to meet the operational—
..............
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed
above. Any reliance by
�: . .......
♦•:Steven R. Pannone; jr
♦1�� •':, i
upon or use of this report any other person or party is not authorized nor will it
No. CE 8149 •,.••�
♦1
confer any legal right whatsoever..
.•°'+
♦����••��.•'4V
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
..
WATER ANDVVAOILVVNER
PROGRAM
-s- I
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
i
By: �POriginal Certificate Date: 3
(Rev. 11105)
Municipality of Anchorage *AE
Development Services DepartmentBuilding Safety Division aOn-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: Shane Lee Estates, Block 2. Lot 1B Parcel ID: o14 -o61-88
A. WELL DATA
Well type Private If A, B, or C provide PWSID # Well Log (Y/N) N
Date completed M A77 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth _6,5 * ft. Cased to 40+ * ft. Casing height (above ground) min.
FROM WELL LOG AT INSPECTION
Date of test
Static water level `1 ft.
Well production �'O g.p.m,
WATER SAMPLE RESULTS:
Coliform Neg..-..Colonies/100 colonies/100 mL
Arsenic: ND ug/I
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Tank size gal. Number of Compartm
Foundation cleanout (Y/N) D over to
Date of 2 Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft2 or
Length ft. Width
Total depth ft. Eff. absorption area ft2
Date of adequacy test Results (Pass/F,
Fluid depth in absorption field befor in.
Elapsed Time- in. Final fluid depth —
ny rejuvenation treatment (past 12 mo.) (Y/N & type)
Nitrate o.SSg mg/L
Date of sample: 2115/2011
ents _
nk (Y/N)
ft2/bdrm)
5/25/2011
6.6+ g.p.m.
Other bacteria Nea colonies/100 mL
Collected by: DRM
Date installed
etisanouts (Y/N)
High water alarm (Y/N)
System type
ft. Gravel below pipe
Monitoring tube
over field
R#
For bedrooms
Water added gal. New depth in.
in. Absorption rate >= g.p.d.
If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
in.
Size in gallons _
"Pump off' level at
Cycles tested
Manhole/Access (Y/N)
H. water alarm level at
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot NIA On adjacent lots soo+
Absorption field on lot N/A On adjacent lots ioo+
Public sewer main 75+ Public sewer manhole/cleanout zoo+
Sewer /septic service line 25+ Holding tank zoo+
Animal containment areas 5o+ Manure/animal excrete storage areas zoo+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line Absorption field
Water main Water service f Surface water
Wells on
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation Water main
Water Service line Surface wate Driveway, parking/vehicle storage
n Wells on adjacent lots
F. COMMENTS
* No well loa available. Data taken from KND Engineering re ort on file with On -Site dated Janua 6 i -
gep
G. ENGINEER'S CERTIFICATION WHr4V POMP cooter OC Yege,0 OF
C-AWTfI`rtX6-. •�.`p� ..... q<
I certify that / have determined through held inspections and �x., 49TH
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date. .
...., .. ..... ............;.
Engineer's Printed Name Steven R. Pannone, P.E. % ;Steven R. Pannone;
No. CE 8149
Date 2/28/2oiz ���� •.••''••••........ ....•''.� 4
COSA Fee $
U
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $ _
Date of Payment
Receipt Number
in.
SGS Ref.#
1110524001
Client Name
Pannone Eng. Srv.
Project Name/#
Shane Lee Estates B2,L1B
Client Sample ID
Shane Lee Estates B2,L1B
Matrix
Drinking Water
Printed Date/Time
02/24/2011 13:51
Collected Date/Time
02/15/2011 18:00
Received Date/Time
02/16/2011 8:15
Technical Director
Stephen C. Ede
Sample Remarks:
450ONO3-F - Nitrate/Nitrite - MS recovery is outside of QC criteria.
Refer to LCS for accuracy requirements.
Allowable
Prep Analysis
Parameter
Results
LOQ
Units
Method Container ID
Limits
Date Date
Init
Metals by ICP/MS
Arsenic
ND
5.00
ug/L
EP200.8 C
(<10)
02/17/11 02/23/11
NRB
Waters Department
Total Nitrate/Nitrite-N
0.559
0.100
mg/L
SM20 450ONO3-F B
(<10)
02/19/11
AYC
Microbiology Laboratory
E. Coli
Negative
1
100mL
SM20 9223B A
02/16/11
DLC
Total Coliform
Negative
1
100mL
SM20 9223B A
02/16/11
DLC
Municipality of Afic deluge
'� •'•` Y
p' Development Services Department = '
(� L Building Safety Division
,1^�C OnSHe Water 6 Wastewater Probrain
4700 South Bragaw SL ,
P.O. Boz 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ek.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 014-061-88 HAA# 0 iio 101
1. GENERAL INFORMATION Expiration Date: 6 —a q — O
Complete legal description SHANE LEE ESTATES LOT 18 BLOCK 2
Location (site address or directions) 6741 TiFFANY TERRACE ANCHORAGE AK. 99507
Current Property owner(s)
Mailing address
Lending agency
Mailing address
r-.
Real Estate Agent
Mailing address
KENNETH TURNER Day phone 317-5171
6741 TIFFANY TERRACE ANCHORAGE AK. 99507
Day phone
ELUABETH HOOPER w/ PRUDDUL4L J9X WHRE Day phone
727-4488
3801 CENTERPOINi DRIVE, 0200 • ANCHORAGE, AK. 99503
Unless otherwise requested, HAA will be held by DSD forpickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
❑
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
0
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 samples. (Certificates maybe 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 Health Authority Approval Guidelines for this application,
shows that the onsite 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 riles and from my Investigation and Inspection, the
onsite 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, SUITE 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 analysts of the system in accordance with ADEC and MOA
DSD Guidelines Q Regulations. The reported results described the performance ofthe
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 orfuture 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
Approved for 3 bedrooms.
Disapproved.
Phone 337-6179
Date Z b y L,:
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
ON-SITE
y( Tp FR AND
WASTEWATER
PROGRAM
.`.`�,: ••... :moo
im
By: Original Certificate Date: 3 0�
Mw.,zo,r
Municipality of Anchorage
' Development Services Department
Building Safety Division `
On -Sae Water 6 Wastewater Program '
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorsge.sk.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: SHANE LEE ESTATES; LOT 18, BLOCK 2. Parcel ID: 014-061-88
A. WELL DATA *PER 1/6/1997 KND REPORT
Well type PWAM If A. B, or C provide PWSIDR N/A Well Log (YM) NO
Date completed PRE 1977 Sanitary seal (YM) YES Wires property protected (YM) YES
Total depth *56.5' OTC R. Cased to 40+ ft. Casing height (above ground) 24 in.
FROM WELL LOO
Date of test
Static water level ft.
Well production N� G.P.M.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml.
Arsenic: N/A mgJL,
S. SEPTICfHOLDINO TANK DATA
Tank Type/Material
Tank size gal.
Foundation cleanout
C. ABSORPTION FIELD DATA
Date installed
AT INSPECTION
2/4/2005
23 ft.
5.33 9—
p.m-
Nitrate 0.148 mgA. Other bacteria 0 colonies/100 mi.
Date of sample: 2/4/2005 Collected by: GEG. LtD.
Number of
PUBLIC SEWER
Date installed
(YM)
over tank (YM) _ High water mann (YM)
Soll rating (g.p.dAbr ft%drm) _ System type
Length ft. Width ft. Gravel 1pe ft.
Total depth ft. Eft. absorption area _ ft' Monitorin Depression over field
Date of adequacytest Res aalFap) For ms
bedroo
Fluid depth In absorption field be s _ in. Water added —Cal. New depth _in.
Elapsed Time: n. Film fluid depth _ h. Absorption rate >= g.p.d.
treatment (past 12 mo.) (YIN 6 type) If yes, give date
D. LIFT STATION
Data Installed
'Pump on' level at _in.
E. SEPARATION DISTANCES
Size in gallons
High water alar level at
Cycles tested Meets alar 8 circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAltt station on lot N/A On adjacent lots 100'+
Absorption Held on lot N/A On adjacent lots 1000+
Public sewer main 75'+ Public sewer manhole/deanout 100+
Sewer /septic service line 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC HOLDING TANK ON LOTTO: PUBLIC SEWER _
Building foundation
Water main
Property line
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Surface water
PUBLIC SEWER
Property line Building foundation Water main
Water service line Su Driveway, parking/vehicle storage
Cwrlzn Wells on adjacent lots
F. COMMENTS
G. ENOINEER'S
I ceMly that I have determined through Neal inspections and # !' f,%; r*
review of Municipal records that the above systems are lo .......... . ........ ...
conformance with MOA HAA guidellnes in effect on this date.
Gams
Engineers Printed N JEFFREY A GARNESS _ ... s.
CE -79 •; �`
Date 2/24k�•�• '' •......• '' iS
P�of•esb°d
HAA Fee E Waiver Fee $ _
Date of Payment Date of Payment
Receipt Number Receipt Number
Mov.1?lotl
FEB -09-2005 13:48 PRUDENTIAL JACK WHITE P.02
goo vard tae. dill r71t-`i Ora ... A --- r. .. r-« ....
'I
88-187 ,
SHANE LEE ESTATES
LOT 1 B, BLOC 2
r
2 ..
1
� i 1
1 I
1 1
N
258 1 LAT 113 1.1
t
t ,er
�r WEST 124.46'
t'
nK& SMCTURE Ali -IMT
AS _ 1 hereby darllt7 1141 1 dove aarvyal tba_ Of
Pf*yort7 dtPlcldd above add that ne 1�7�••�•r+9., r_ •.
J1At;T1101 LAND StIRVEY111t1 oneteaeeueat19 *19101 ••earl a Inoleeua• �q•••49IIi l��r•
Jeff A. lieel*ldl. e.L.e. I1 is the res0a0e1b11111 at the "mar t1 • •: •.••••at•••• ••••
om Vaal 64111 Ave. detarmlee the ailalence at fh7
Aathar*Oa. Alaska 1130t tavonaatt or realrlaflellt which da eel -
ePNer eh the recorded tobdlVle10a Plot -
No MG 94"404 Dater no clrtoael*nc/t ebevld fay doff �, q �...N" . e••• .•�
berate be aced ter coaelractNn Of 14? as
pt�rt DATC taldhltehlhf bovedet7 of 10010 Ilade. •R�*tt\�r�
zona �/oe/ae atxeoRAat PECf7NIN0 71ai111CT. ALaf11a
rod go. 1 "�20'
I1E-01
"lea Ism No COMM SET YNIP 0A1E.
TOTAL P.02
02-15-05 03:53PM FROM-CTiE ESI, SGS ENV SERVICES
—SW
SCS ReLN
1050623001
Client Name
Gamess Engineering Group, Ltd.
Project Name/11
Shane Lee Est. LIB B2
Client Sample ID
Shane Lee Est. LIB B2
Matrix
Drinking Water
Sample Remarks:
9075615301 T-993 P.02/06 F-476
All Dates/flmes are Alaska Standard Time
Printed Date/time
02/152005 12:06
Collected Date/time
02/042005 11:00
Received Date/time
02/0'4`2005 13:45
Technical Director
Stegpen C. Ede
Results PQL Units Method ContainerID Allowable Prep Analysis Init
Parametn Limit+ Date Dem
Haters Department
Nitrwe-N 0.148 0.100
Microbiology Laboratory
Total Coliform 0
mp/L EPA 300.0 D (<=10) 02/05/05 CAM
coI/100mL SM209222D A (<-1) 02/04/05 DKC
02-15-05 03:53PM FROM-CTiE ESI, SGS ENV SERVICES 9075615301 T-883 P.03/06 F-476
SGSICr&E ENVIRONMENTAL SERVICES
Drinking Water Analysis Report for Total Coliform. Bacteria
AERO mTAiCT m ON AI vm vm moor, eom ma UmP" • .
MUST ISE COMPLETED 6Y WATER SUPPLIER '
Pq1L= *AIM SY"M Of
'200 W. POTTER DRIVE.
ANCHORAGE, ALASKA 9951E
Tet 907-582.2343
FA -c 907-561-5301
La not ft
10�50623p'/A
NtlltlYlll
$AMPLECOILECT1oN: srr_=^�� •
pre Ilr._ L�•f•���I f vw
a... a"
dT eau ur.r
as coomcw
m
TO 8E COMPLETED 6Y L AsORATDRY
; y
". E
RUSH 3AIIPLnow
2,K
❑Srpaanar7elrwri
psom 0.
TOS
k Larausis
FaxR' ,
Ddve7 Medm& G
Reaped
p.r
�.:. • I:
n•r�a -
.'
.. . '• i _...
.....•.•.•.....•••.....•••..•...•.•••••.•..•...••.•.«•••.•.••••.•••..••••••••.•.•..•.....:«...••:•.......S.bw.«�i•.••.••••:«.».••••.••••
'n�rioloakelYVeMrAMtisbReeotd;:..�;
•�����•.'
...
ANO F1K •iIi
.
•
�Tae�Ceia!e
'
zlN�oy •1'7BD
Anavic —
8**Ck*
I�eAANEYLTIA
AnalyecN NrMae: ..
�
•
MembmnsF9W .�
MMO-MUG (PIA)-{L�
erx
SEttsCactory
Unsatisfactory
�
,•
1-�^";
�L T ° w •a.rrwA
�l
Reported vy:�
.�.«..
Detemme: .
Form}FW Do53 1211T103