HomeMy WebLinkAboutCLYDE M DICKSON BLK 2 LT 6Clyde M.
Dickson
Block 2
Lot 6
#007-055-16
'!I` PAf BG
• Municipality of Anchorage ="
-
On -Site Water and Wastewater Program <"' ' = � `-
(907)343-7904 sw Er.
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 007-055-16
1. GENERAL INFORMATION
Expiration Date: s-- `7` — 13
Complete legal description CLYDE M. DICKSON BLOCK 2 LOT 6
Location (site address) _ 7695 EAST 36TH AVE. ANCHORAGE, AK 99504
Current Property owner(s) KIMBERLI POPPE-SMART Day phone
Mailing address 3514 OLD MULDOON ROAD ANCHORAGE AK 99504
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:
2
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
Received by_ --
if / Date:
COSA to be relea engineer, unless otherwise requested by the engineer.
COSA Fee $ Waiver Fee $
Date of Payment ` / / 3 Date of Payment
Receipt Number `{eOCfao Receipt Number
COSA# 13S61,91ocq� 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 ARCTERRA CONSULTING INC. Phone 868-3791
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 01/2412013
Engineers 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 R
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
6. DSD SIGNATURE Amamm M, e
System #1 Approved for bedrooms. rv��� � _�*�Ar
System #2 Approved for. bedrooms. V asro,
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
By: Original Certificate Date: .1 )' - 13
Theunicipab y 5?horage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory_
Well Flow Advisory Other
COSA hlue sheet 9 1-12 doc
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: CLYDE M. DICKSON BLOCK 2, LOT 6 Parcel ID: 007.055.16
A. WELL DATA*
Well type PRVT * If A, B, or C provide PWSID # _
Date completed 12102/1985 Sanitary seal (YIN) Y
Total depth 113 ft. Cased to 40+ ft.
FROM WELL LOG
Date of test
121211985
Static water level
NA ft.
Well production
8.33 g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate ND mg/L
Arsenic: 12.6 ug/L Date of sample: 1/1812013
B. SEPTIC/HOLDING TANK DATA — PUBLIC SEWER
Tank Type/Material
Tank size _ gal. Number of Compartments
Foundation cleanout (YIN) Depression over tank (YIN)
Date of pumping
C. ABSORPTION FIELD DATA
Date installed
Length
Total depth ft.
Pumper
Well Log (YIN) N
Wires properly protected (YIN) Y
Casing height (above ground) 18+ in.
AT INSPECTION
1/1812013
ft.
9—
p.m-
Collected by: ARCTERRA
Date installed
Cleanouts (YIN)
High water alarm (YIN)
Soil rating (g.p.d./ft2 or ft2/bdrm) _ System type
ft. Width ft. Gravel below pipe ft.
Eff. absorption area ft2 Monitoring tube Depression over field
Date of adequacy test Results (Pass/Fail)
Fluid depth in absorption field before test in.
Elapsed Time: _min. Final fluid depth in.
Any rejuvenation treatment (past 12 mo.) (YIN & type) _
Water added al.
Absorption rate >=
For bedrooms
New depth_ in.
If yes, give date
...
D. LIFT STATION
Date installed
"Pump on" level at _ in.
Datum
Size in gallons
"Pump off" level at —in.
Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot NA
Absorption field on lot NA
Public sewer main 751+
Sewer /septic service line 25'+
Animal containment areas 50'+
SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER
Building foundation Property line
Water main Water service line
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO: PUBLIC SEWER
Property line
Water Service line
Curtain drain
F. COMMENTS
Building foundation
Surface water
Wells on adjacent lots
`Well data per MOA records (DNR water rights application)
G. ENGINEER'S CERTIFICATION
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots NA
On adjacent lots NA
Public sewer manhole/cleanout 100'+
Holding tank NA
Manure/animal excrete storage areas 100'+
Absorption
Surface water
Water main
Driveway, parking/vehicle storage
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 0112412013
COSA brown sheet 9-1-12.doc
. OFAI X I
u ma�iaJ,�,
in.
Municipality of Anchorage FrG£
Community Development Department
Development Services Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Arsenic Advisory
Certificate of On -Site Systems Approval # 131025
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 2, Lot 6 of
Clyde M. Dixon Subdivision. This inspection revealed an arsenic
concentration of 12.6 micrograms per liter (ug/L) for the property's well
water sample. The Environmental Protection Agency (EPA) has established
a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water
systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Information on
arsenic is available from the On -Site Water and Wastewater Program
website(www.muni.or /og nsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
C"s0!!:4�
Development
of Anchorage
Services Department
Building Safety Division .. ... ••
OnSito Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.enchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 007-055-16 HAA# 650,111Q
1. GENERAL INFORMATION Expiration Date: / D — 0
Complete legal description CLYDE M. DICKSON SUBDIVISION: LOT 6. BLOCK 2,
Location (site address or directions) 3514 OLD MULDOON ROAD • ANCHORAGE. AK. 99504
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
TED M. CODMAN payphone (907) 337-0174
3212 CREEKSIDE DRIVE • ANCHORAGE. AK. 99504
Day phone
JOYCE w/ PRUDENTIAL VISTA REAL ESTATE Day phone
244-6780
3801 CENTERPOINT DRIVE, SUITE #200 * ANCHORAGE, AK. 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
Individual Well
0
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
❑
Individual Holding tank
❑
Community On-site
❑
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 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 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 Health Authority 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 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. Phone 337-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS. P.E. Date '7 6 S'
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 & 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
fuctuate 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
otherperson or party Is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
—lef:� Approved for bedrooms.
Disapproved.
OF
°..41,15°.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
ness:
C
ATER AND :
wDDnnRAM
Maintenance Agreements lJ'J J/jL
Supplemental Engineer's Report
Other
By: VII/
I�(4-Z Original Certificate Date: 7-11-05-
(R".
-Ifr05-
(Rw. 11)01)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water 6 Wastewater Program
4700 South Bragew St.
P.O. Box 196650 Anchorage, AK 99519.66W
www.ci.anchomge.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: CLYDE M. DICKSON SUBDIVISION: LOT 6. BLOCK 2 Parcel ID: 007-055-16
A. WELL DATA *PER DNR WATER RIGHTS APPLICATION.
Well type PRIVATE If A B, or C provide PWSIDN N/A Well Log (YM) NO
Date completed *12/2/1985 Sanitary seal (Y/N) YES
Total depth •113 ft. Cased to 40+ ft.
FROM WELL LOG
Date of test 12/2/1985
Static water level N/A ft.
Well production •8.33 g.p.m.
Wires property protected (Y/N) YES
Casing height (above ground) 12+ In,
AT INSPECTION
6/28/2005
75 ft.
8.85 g.p.m.
WATER SAMPLE RESULTS:
Coliform '6% colonies/100 ml. Nitrate .10 mgJL. Other bacteria N_coloniesl100 ml.
Arsenic: N/A mg,/L, Date of sample: 6/28/2005 Collected by: GEG. LtD.
B. SEPTICIHOLDING TANK DATA
Tank Type/MaterW
Tank size gal. Number of Compartments
Foundation cleanout (Y/NN over tank (Y/N) _
Pumper
C. ABSORPTION FIELD DATA
PUBLIC SEWER
Date installed
(Y/N)
High water alarm (YM)
PUBLIC SEWER
Date installed Soil rating (g.p.dAiDr fl1bdrn)_ System type
Length ft. Width ft. G � pipe ft.
Total depth ft. Eft. absorption area _ ft'Z
ito �tCibe Depression over field
Date of adequacy test aA) For bedrooms
Fluid depth in absorption field _ in. Water added —gal. New depth _in.
Elapsed Time: Final fluid depth _ In. Absorption rate >= g.p.d.
treatment (past 12 mo.) (YM 8 type) If yes, give date
D. UFT STATION
Date installed Size in gallons
"Pump on' level at _in.
E. SEPARATION DISTANCES
High water alarm level at
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAilt station on lot N/A
Absorption field on lot N/A
On adjacent lots N/A
On adjacent lots N/A
Public sewer main 75'+ Public sewer manhole/deenout 1001+
Sewer /septic service line 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC WATER
Building foundation
Water main
Property line
Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: PUBLIC WATER
Property line Building foundation Water mai
Water service line S Driveway, parking/vehicle storage
Wells on adjacent kits
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined Mrough field kapectkm and t 14 �'
review of Munkipal records that the above systems are kr 1 .............
conformance with MOA HAA guidelines in effect on this date.
A'
Engineer's Printed Neme JEFFREY A GARNESS CE—
Date ! f b/0S' • °5.•�c�
HAAFee$ 43(T _
Date of Payment 7-7-0T
Receipt Number b M
Mo. 12101)
Waiver Fee $
Date of Payment
Receipt Number
LOT 12 //'
LOT 10 t
� L•�, o r
� 2oY. 7o.2 Gu.R `h.�o�Jt3
S&+. St OL G -z -mow%
G.B.A. e&zm"eI n 5
L4 FeNC.6
!'. :•:
r_ 0 4-
�,:
0.
1 LOT '1 4
LOT
.�Y
o
C)
o° {l�'
w
j,G� CIat.G\7LAT�P P'RAfI 1LrFCOM1O t�LBS•
PLOT PLAN _ ASBUILT Y- SCALE 1`10' GRID trio Project No. os•Idz
Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515
907 522-6476 Phone
Reglstered Land Surveyors 907 522-4625 Fax OF ,q�
1 hereby certify that I have surveyed the following described .ry '�� '.... .
t.crr_C. tiFrS-oaK-yti...v�c1�+R�swtii C fia+C P•33c.� �Q '�
Anchorage Recordlna Dlemcf, Alaska. and that fM Improvements sMuated
thereon an wHhln the properly Ones and do not encroach onto tFw property .............................
adjacent thereto, that no Improvements on the property lying adjacent thereto
encroach on the surveyed premises and that then are no roadways. fronemlalon
lines or other visiblemr
easements on sold property except as Indicated heron...
••
:KENNETH 0. L .0
Dated this the r Day of Tu T ICOS at Anohoroge. Alaska LS -5202 .
It la the responsibility of the owner to determine the exlsMoe of any ssgNM-�
eaeemenfs, covenants, or restrictions which do not appear on the rmmrded
subdMolon plat.
LOT 5
07-06-05:11:26 ;
SGS
SGS Ref 4
1053828001
Client name
Garness Engineering Group, Ltd.
Project Names
Clvda Dickson S/D L6 B2
ClicntSamplcm
Clyde Dickson SID L6 B2
Matrix
Drinking Water
Sample Remarks:
;907 561 5301 # 2/ 4
All Dates/Times aro Alaska Standard Time
Printed Datefrime 07/06/2005 12:03
Collected DateMme 06/28/2005 9:30
Received Datte/iime 06/28/2005 15:44
Technical Director Stephen C.1Cdc
Allowable Prep Analysis
Parameter Results PQL Units Method Container ID Limits Date Datc Init
Waters Department
NilratcdQ 0.100 U 0.100
Microbiology Laboratory
Total Coliform 0
m8/L EPA300.0 B ("10) 06/29/05 JJB
col/100mL SM2092220 A (<-1) 06/28/05 TLF