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HomeMy WebLinkAboutHOMECREST LT 5Hornecrest Lot 5 #006-042-34 Municipality of Anchorage • , On-Site Water and Wastewater Program • O— L c_ (907) 343-7904 %L A ti f T CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 006-042-34 Expiration Date:IO ` 17 `l 7 1. GENERAL INFORMATION Complete legal description Homecrest Lot 5 Location (site address) 8507 Peck Ave Current Property owner(s) Roberson Day phone 694-1234 Mailing address Same Real Estate Agent Amity Johnson Day phone 694-1234 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex JUL 4 L I f:;.) ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 " "r 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer Received by: Date: 7/I 77/ 7 COSA to be released to the engineer, unless othe ise requested by the engineer. 1_MIMNI COSA Fee $ 2-(0 Date: Date: Date of Payment 7 114-1/1") Date of Payment Receipt Number IS CADb Receipt Number COSA # vie-oe,n 1T - 5 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 7/14/2017 1 �,4 .�� OF AL 6. DSD SIGNATURE` ' r' `'" I.' SI) System #1 Approved for L( bedrooms. Steven w. Eng System #2 Approved for bedrooms. ,GG;"-°. : , q � . PE256 •• Disapproved. we ••.7(t/.40'; `�wZOP •ROF' SS!U\ �- Conditional approval for bedrooms, with the following stipulatior'i w� 9. \- O t Al1/�`y0 C)� pN_S11.6 �cn v\INv R P\ ND `NASTE�vnAMR G f� DROGR • c- 11-or�\ By: Original Certificate Date: 7-1 7-l 7 The Municipality of Anchorage Devlopment Services Division(DSD)Issues Certificates of On-Site Systems Approval(COSA)based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 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: 4Oi f, LAZ-4- [ 4 of -S Parcel ID: °0‘(-1-1 3q A. WELL DATA Well type p If A, B, or C provide PWSID # Well Log (Y/N) Date completed �A-yt Sanitary seal (YIN) 7' Wires properly protected (YIN) i (aboveground) �7 in. Total depth /0 S ft. Cased to l� S ft. Casing height /o{ FROM WELL LOG AT INSPECTION Date of test 61/4-5/ 7/7// 7 Static water level 2 er ft. 7 '( ft. Well production 3 D g.p.m. f g.p.m. WATER SAMPLE RESULTS: Coliform CD colonies/100 mL Nitrate /. S mg/L Arsenic 4/ ) ug/L Date of sample: 7/7/'(7 Collected by: A wp B. SEPTIC/HOLDING TANK DATA Pc13L.1G Tank Type/Material Date installed Tank size gal. Number of Compartments Cleanouts (Y/N) Foundation cleanout(YIN) Depression over tank(Y/N) High water alarm (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA pveziG s Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area ft2 Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION /vim Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at in. High water alarm level at in. Datum Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Abet On adjacent lots /DO "47`-• Absorption field on lot Nom( On adjacent lots /tic) (.14 Public sewer main 50 f Public sewer manhole/cleanout 50� t Sewer/septic service line 2 S Holding tank /6d -f-• Animal containment areas 5 Q 1'- Manure/animal excrete storage areas /do' r SEPTIC/HOLDING TANK ON LOT TO: I oe4 r S EL.JF , Building foundation Property line Absorption field Water main Water service line Surface water Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water Service line Surface water Driveway, parking/vehicle storage Curtain drain Wells on adjacent lots F. COMMENTS A 7 IPZY Rep J rriem.^,2ritJ G. ENGINEER'S CERTIFICATION • u I certify that I have determined through field inspections and •.. review of Municipal records that the above systems are in 4,. r '. conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name ..S I 44 .G 6)4 ` Date 7//e-///7//e-///'7 �(� `7�fyll7'' •{ -w� COSA yellow sheet_2-6-15.doc Municipality of Anchorage • .. Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL _.._ FOR A SINGLE FAMILY DWELLING Parcel I.D. oo[�-n� COSA# OU441 1. GENERAL INFORMATION Expiration Date: Z 2eLo : - Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address HOMECREST LOT 5 8507 PECK AVENUE *ANCHORAGE. AK DEREK FORD Day phone CONTACT AGENT 8507 PECK AVENUE 'ANCHORAGE. AK 995047 Day phone MARIANNE HAMILTON W/ DYNAMIC Day phone 317-5756 3111 C STREET *ANCHORAGE, AK 99577 — - Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 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 N 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 engineers 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 (les 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, 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 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 lest, and separation distances measured to readilyldentifiable 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 solo 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 4— Disapproved. Disapproved. Conditional approval for bedrooms. Attachments: / HAA Checklist I/ Septic System Advisory Well Flow Advisory bedrooms, with the following Phone 337-6179 Date ONSITE tis. ATE R AND : • WASTEWATER non/_RAAA : S, rl�7lIE ► j 11111%>>>1 Maintenance Agreements Supplemental Engineer's Report Other By Original Certificate Date: •_LLh 8 407 ma.,vop Municipality of Anchorage Development Services Department Building Safety Division On -Site Water d Wastewater program ' 4700 Bragaw Street P.O. Box 196660 Anchorage, AK 99519-66W www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: HOMECREST LOT 5 Parcel ID: A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 6/1964 Sanitary seal (Y/N) YES Total depth 105 ft. Cased to 40+ ft. FROM WELL LOG Date of test 6/1964 Static water level 28 ft. Well production 30 —g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate mg./L. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 11/6/2007 46 ft. 7+ Other bacteria colonies/100 mi. Arsenic: ugJL. Date of sample: 11/6/2007 Collected by: GEG Ltd. B. SEPTICfHOLDING TANK DATA PUBLIC SEWER Tank Type/Material _ '• e Tank size gal. Foundation deanout(Y/N) Number of Compartments _ Pumper Date installed (Y/N)_ High water alarm (Y/N) C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft'od/�bd_ System type Length ft. Width ft. Gravel below ft. Total depth ft. Eff. absorption area_ ft' Monitoring tube Depression over field Date of adequacy test Results al)— For bedrooms Fluid depth in absorption field be _ in. Water added _gal. New depth _In. Elapsed Time: Final fluid depth _ in. Absorption rate >= g.p.d. treatment (past 12 mo.) (Y/N 8 type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at _in. "Pump otr ley High water alar level at in. Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A Absorption field on lot N/A Public sewer main '50'+ *WELL DRILLED IN 1964 On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout *50'+ Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manureianimal excrete storage areas 104'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Water main Wells on adjacent lots Property line Absorption field Water service line Surface SEPARATION DISTANCE FROM ABSORPTION Property line TO: Water main Water service lin Surface water Driveway, parking/vehicie storage l;uRai drain Wells on adjacent kits F. COMMENTS G. ENGINEER'S CERTIFICATION( �!l... I car* that I have determined through field inspections and r 9 y+ review of Municipal records that the above systems are in •"''' •' • .. ' . conformance with MOA COSA guidelines in effect on this date. ,Je A. rimes Engineer's Printed Name JEFFREY A. GARNESS A ' • —795 Date 11'2a pa} 44lir�o' •11(Zo�i`�� vim_ Pr..r__.SePa' COSA Fee S 4 o Date of Payment/T f + 7 Receipt Number % 127 (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number Vs SCS Rete - 1075990001 - Client Name Garncss Engineering Group, I.M. Project Name/N Homccrest 1.5 Client Sample ID - Ilomecrest L5' Matrix Drinking N'alcr P%ASID 0 Samplc Remarks:. .. .. . All Dates/rimes an Alaska Standard Time Printed Date/rime 11/13/2007 8:32 CollectedDate/Iime 11/06/2007 12:00 Received Date/Time'' 11/07/2007. 9:20 Technical Director Stephen C. Ede Samplc Remarks:. .. .. . a c Allowable Prep - Analysis Parameter Resuhs PQL Units Method Container ID Limits Date Date Init Metals by 1CP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 11/08/0711/09/07 MII s r Waters Department Total Nitmte/Nitritc-N 0.362 0.100 mg/L SN1204500NO3-F D (<10) 11/07/07 LCP Microbiology Laboratory Total Coliform 0 col/100mL S\72092226 A (<1) 11/07/07 DSII a c •,s SAMPLE COLLECTION:.. ._ _. SAMPLE TYPE .. .. NOTE: For valid results, analysis must begin within 30 hrs of sample collection. Data: a U 7 Fi 6 8 ❑ Membrane Filtration ❑ Presence/Absence Month Day Year //'�s TIM: 17a. D D AM tPM�rtle one) 1. Routine Treated Water Location:rt 5 �'- ❑ Repeat sample ❑ Untreated Water collector PJ'J'rLL $C.aa+-tA- (refer to tab no. 1 Printed Name Signature [3 Special Purpose Transported to Lab By: Same as Collector _ Other. Printed Name Signature Note: SGS analyzes bacteria samples in ADECs 30 hour hold time unless prior arrangements have been made. .. Surcharges wilt be applied for samples received <2 hours before expiration. ' Business hours are Monday -Friday, 8 em -5 pm. Please contact your Project Manager at (907) 562.2343 with any questions. TO BE COMPLETED BY LABORATORY Sample ReceNina: Date: l Delivery Melt Received Coa.eexr: ❑ Sample over 30 hours old. Results maybe unreliable. ❑ 48 Hour Waiver for Remote Locations ❑ Wimple Receiving noted Analyst of Short Hold Time This section used by analyst for Immediate notification of UNSATISFACTORY results only: Result Reported to: By: ❑ Fax []Phone ❑ E nail Reported to: By: ❑ Fax ❑ Phone ❑ E-mail Analysts Signature: DateTme: �• Form a FW --0053 tevised 0521/07 200 W. POTTER pRNE, : y . "ANCHORAGE,'ALASKA99518 SGS ENVIRONMENTAL SERVICES Tel: 407.56z 2343 ' `-• Fax 907-561 5301 !' L _ lea RN No Chain of Custody,for Total Coliform Bacteria Samples 1 ! 599 v READ NSiRIIC"MS ON REVERSE 516E aEFOk COLLECTING aAMME iIIII �ng�pI'I �� - MUST BE COMPLETED BY WATER SUPPLIER Ptl" WATER SYSTEM ON. ❑ PRIVATE 1jATER STEM RJ Send Results ' 0 Send Invoice . ❑ Send Results _ - p Send Invoice. .. . SAMPLE COLLECTION:.. ._ _. SAMPLE TYPE .. .. NOTE: For valid results, analysis must begin within 30 hrs of sample collection. Data: a U 7 Fi 6 8 ❑ Membrane Filtration ❑ Presence/Absence Month Day Year //'�s TIM: 17a. D D AM tPM�rtle one) 1. Routine Treated Water Location:rt 5 �'- ❑ Repeat sample ❑ Untreated Water collector PJ'J'rLL $C.aa+-tA- (refer to tab no. 1 Printed Name Signature [3 Special Purpose Transported to Lab By: Same as Collector _ Other. Printed Name Signature Note: SGS analyzes bacteria samples in ADECs 30 hour hold time unless prior arrangements have been made. .. Surcharges wilt be applied for samples received <2 hours before expiration. ' Business hours are Monday -Friday, 8 em -5 pm. Please contact your Project Manager at (907) 562.2343 with any questions. TO BE COMPLETED BY LABORATORY Sample ReceNina: Date: l Delivery Melt Received Coa.eexr: ❑ Sample over 30 hours old. Results maybe unreliable. ❑ 48 Hour Waiver for Remote Locations ❑ Wimple Receiving noted Analyst of Short Hold Time This section used by analyst for Immediate notification of UNSATISFACTORY results only: Result Reported to: By: ❑ Fax []Phone ❑ E nail Reported to: By: ❑ Fax ❑ Phone ❑ E-mail Analysts Signature: DateTme: �• Form a FW --0053 tevised 0521/07 ^ ^ LOT | LOT | | | LOT 3 `O0"E 7 10' UTILITY EASEMENT / �________________ 0 C5 C3 44mj LOT 6 1"i X 00 00 7.1 co CN OF At 28.0 Michael L. Jokela LS - 7839 N89*59'30"W 75.00' PECK AVENUE �OERED BY: Ic Et "X SION NOTES. It Is the owners' responsibility to deterrnine LEGEND: SET FND W4 x(latenco of any ftsernevt3. covenants. or restrictions 5/a'Ra w/cAPC*) 5/8- RB 0 DAVID VICTORY wh do not appear on the recorded subdivision plot. NOTE: curnstanc*9 should any data hereon be Used far , ONUMENT 1$ const HUB & TACK 0 If 415 4 It it It it 4 motion or for establishing property lines. FENCE- —x� X physical Wmy of this property , shown an this WOOD DECkS- drawing and that the Improvernents sltuGled there- CONCRETE - an are within the pr lines and no encroach- ASPHIALT- Lmffltemm th%ertyt mente exist other no " ed. CRAVEL- ENGINEERS AS—E3 1 0 F: LEGAL DESCRIPTION: WATER WELL - 440 WEST BENSON BLVD. # 200 (fox) 561-6626 ANCHORAGE, ALASKA 99503 (907) 562-5291 LOT 5 �K ORDER NUMB Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Legal description: HOMECREST LOT 5 ❑Permit ®C.O.S.A. ❑Inspection Report The attached paperwork has been reviewed and is being returned for the following reasons: Well location and minimum setbacks. The location of a well shall be at a site readily accessible year round for testing, repair or maintenance purposes. The minimum separation requirements between wells and other specified facilities or areas shall be: TABLE A-1 TABLE INSET: SEPARATION OF WELL FROM: MINIMUM SEPARATION DISTANCE IN FEET Private sewer line 25 Curtain drain 25 Petroleum Hydrocarbon storage tank 5 Sewer trunk line 75 Any other source of potential contamination 7 r J S Holding tank 75 Septic absorption field 00 p , Sewer manhole or cleanout 100 Septictank 0 Animal containment areas 50 ' 9 q - l/ Manurelanimal excreta storage areas 100 S;;I) � Name of reviewer: JOE Date: November 19, 2007 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK n Municipality of Anchorage •. • Development Services Department Building Safety Division Onsite 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 Parcel I.D.n� G — �u'sZ- ?�� HAA# 0 5r 0 to O �o 1. GENERAL INFORMATION Expiration Date: a-1 % -012 Complete legal description HOMECREST S/D: LOT 5, Location (site address or directions) 8507 PECK • ANCHORAGE, AK 99504 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address DAVID & NICOLE VICTORY Day phone 337-2776 8507 PECK 0 ANCHORAGE, AK 99504 Day phone RALPH M. w/ REALTY EXECUTIVES Day phone 261-7313 341 W. TUDOR RD. SURE 103 ' ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 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 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 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, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineefs 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 & 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 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 otherperson orparty Is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE Approved for - bedrooms. Disapproved. Phone 337-6179 Date f r o ZO.11 Conditional approval for bedrooms, with the following stipulations: ON-SITE WASTEWATER : •� rnwrwm Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Rw. 12101) Municipality of Anchorage Development Services Department Building Safety Division OnSke Water & Wastewater Program 4700 South Bragew SL P.O. Box 1966 Anchorage. AK 99519-6650 www.ci.anGwrageAk.us (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST • C1yV w:d'-1` .D Legal Description: HOMECREST S/D: LOT 5. Parcel ID: 0 0 6 - © yZ - 3 �f A. WELL DATA • WELL LOG PROVIDED BY REAL ESTATE AGENT Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed JUNE 1964 Sanitary seal (Y/N) YES Total depth 105 ft. Cased to 40+ ft. FROM WELL LOG Date of test JUNE 1964 Static water level 28 ft. Well production 30 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: N/A mgJL. B. SEPTICfHOLDING TANK DATA Tank Type/Material Nitrate 0.65 mgJL. Weil Log (Y/N) 'YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 11/7/2005 45 ft. 1.73 g.p.m. Other bacteria 0 colonies/100 mi. Date of sample: 10/28/200 Collected by: GEG. LtD. PUBLIC SEWER Date installed Tank size gal. Number of Compartments Foundation cleanout (Y/N) _ Depression over tank (Y/N) _ Date of pumping C. ABSORPTION FIELD DATA Date installed Pumper Cteanouts (Y/N) High water Soil rating (g.p.d./ft'or ftl drff�)_ System type Length ft. Width Total depth ft. Eft. ft' Monitoring tube Gravel below pipe ft. Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth In ab field before test _ kr. Water added _gal. New depth _in. Elapsed _min. Final fluid depth _ in. Absorption rate >= g.p.d. rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed 'Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAtft station on lot N/A Absorption field on lot N/A Public sewer main 50'+ Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manholetdeanout 50'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: PUBLIC S EW E R Building foundation Property line Absorption field I --� Water main Wells on adjacent lots SEPARATION DISTANCE FROM Property line , Water service drain F. COMMENTS G. ENGINEER'S CERTIFICATION Water service line Surface LOT TO: Water main Surface water Driveway, parkingtvehide storage Wells on adjacent lots I certHy that I have determined through field inspections and review of Municipal records that Me above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date lr/110/45 HAA Fee $ L�'�L — Waiver Fee $ Date of Payment \V VU 6 �n Date of Payment Receipt Number -I V1 % P( 021 Receipt Number (Pw. 12101) ......... ........... rev A. Gomess.: ie.Nov.16. 2005.1 4:37PM RmGarness Engineering Group, Ltd.Ar. No -0838 KP. 1; rxea Cn rh c. "s w r �.t� 41 ...... ............. LOG OF DRILL1.\(i br A & 1, DRILLING COM -PAN LAND...Y�__.__�._.._......_.....«......_......_.._� ._.1464. xrgD DEFTIi of STATIC LEM Or }TATER DRAW DOWN GALS. PER xzND or cnszxa .6_3/4 O.D, Host o ._.._._ . To.. 26.. `_vT. bom1dors. &_ clay FROM..___--.,__. Fr. TO ... ... __._. silt._._._.._.. Mone._28 sac M _ ... _......2 r. TO Vii.__ }rl�..._._.:_..._..Fr. FROW. 36 To.._.._...._......Pr... .... ... _..iT. TO.. .__ PT. Silt FROM ...... FaoM..�.�......._.Fr. TO.._72 '.._. mom. ..: .._......._ _..Fr. TO ...... i'ROM_... _YT. TOJP3._.._._.rr. Clay.._ fine gravel FROM._.._..__..._...fz. ...... _. To... rr.. now- FROM_.:_...«. _ ...Fr. To...�__....._...F•r_.__ __.._._.._ _....._tT. To ..... __..._..._FT..._.._.._._. _._.._._.. MI9CL. FROM.__....._ .... ...... FT. To.. FROM... ......_..__..FT To...... FROM.n.............. ._..FT. TO. ..... FROM ...... ........ __...Pr.TO......... DRILLERT SGS W0 1057285003 Client Nome Gamess Engineering Group. Ltd. Project Name/N Water Samples Client Sample In 1lomcerest Lot 5 Mains Drinking Water PW91D 0 Sample Remarks! All Datesfrimes are Alaska Standard Time PrintedDatelTime 11/07/2005 11:41 Collected DatelTime 10282005 9:30 Received Datenime 10282005 14:40 Technical Director Stephen C. rale Microbiology Laboratory Total Coliform 0 cot/100mL SM209222D A (r--1) 1028/05 TLP 8P1-1 10/1,8'd S61-1 10EMS106 MIMS AN3 SOS 'IS3 3210-11081 IIdIZ:10 SO -10-11 Allowable Rep Anaysis Parameter ResulL% POL Units Method Container ID Limits Date Date Init Nitrate -N 0.647 0.IDn mg/L CPA 353.2 0 (<-lo) 1028/05 AZS Microbiology Laboratory Total Coliform 0 cot/100mL SM209222D A (r--1) 1028/05 TLP 8P1-1 10/1,8'd S61-1 10EMS106 MIMS AN3 SOS 'IS3 3210-11081 IIdIZ:10 SO -10-11 s� ....z,.z q LOT 7 1 LOT 4 1 LOT 3 S89'59'00"E 75.00' 10' UTILITY EASEMENT — — — — — — — — — — — — — — M M R�: . 49?H� •�. , LJo..., . . 4a� LS -7839 011 eo. �'•a.{'IpW�_a o M 17 • — a. o NOTES It M the owners responelblilly to determine LEGEND: SET FIND EDEREa BY. the existence of any easements. Oovenonts, or restrictions s/B•RB w/CAP* 5/e• RB O DAVID VICTORY which do not appear on the recorded subdivision plat. NOTE: 3,25' ALMON. 0 MONUMENT Under no circumstances should any data hereon be used for NUB & TACK ❑ 4444 NElf 09444 qqqqqqtj4j4I construction or for establishing property Imes. FENCE-—x—x — OVERHANG- 0 SURVEY CERTIFICATION: LANTECN has conducted o :. :::;.: . }. physical survey of this property as shown on this 'U WOOD DECKS- ECKS- 0 drawing and that the irnprovements situated there CONCRETE- ET M M R�: . 49?H� •�. , LJo..., . . 4a� LS -7839 011 eo. �'•a.{'IpW�_a o M 17 NSON ANCHORAGE.EALASKALw 99503 (907) 562-5291 LOT 5 WORK ORDER NUUBER: oAm stat: NAT M.YeNt JULY 19,2002 1•_20' P-407 HOMECREST SUBDIVISION 2005—L-369 NRB a°�'. �a 1241 Ref: .� NRB DMD 1241 Raf: 02L293 PECK AVENUE t4qqRR444,tlt't-ot"-4-&t7EXCLUSION NOTES It M the owners responelblilly to determine LEGEND: SET FIND EDEREa BY. the existence of any easements. Oovenonts, or restrictions s/B•RB w/CAP* 5/e• RB O DAVID VICTORY which do not appear on the recorded subdivision plat. NOTE: 3,25' ALMON. 0 MONUMENT Under no circumstances should any data hereon be used for NUB & TACK ❑ 4444 NElf 09444 qqqqqqtj4j4I construction or for establishing property Imes. FENCE-—x—x — OVERHANG- 0 SURVEY CERTIFICATION: LANTECN has conducted o physical survey of this property as shown on this 'U WOOD DECKS- ECKS- 0 drawing and that the irnprovements situated there CONCRETE- ET MOW On are wllhln the Drop My Imes and n0 MCFOOCh- ASPHALT- 0 ■ Tants exist Othe NOa noted. GRAVEL- , . ,.,,,r ........ ... ..,.,�..� �.,,,...��,.,. AS—BUILT OF: LEGAL DESCRIPTION: YPTIC SFTANOPiPES- Q ,rB _ NSON ANCHORAGE.EALASKALw 99503 (907) 562-5291 LOT 5 WORK ORDER NUUBER: oAm stat: NAT M.YeNt JULY 19,2002 1•_20' P-407 HOMECREST SUBDIVISION 2005—L-369 NRB a°�'. �a 1241 Ref: .� NRB DMD 1241 Raf: 02L293 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWERIWELL SUBMITTAL COMMENT SHEET To: Jeff Gamess Legal description: Homecrest Lot 5 The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on _ ❑ Calculation error in design. ❑ Additional soils information needed. ❑ Water monitoring results inadequate. ❑ Discrepancy in information submitted. ❑ Topographic information missing or inadequate. ® Incomplete; missing Well log submitted does not have address to match this property. Need to verify unperforated casing to 40 feet and appox. total depth. ❑ Incomplete; missing ❑ Additional adequacy test information needed. ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils information submitted. ❑ Well log required. _ ❑ Omission in narrative. _ ❑ Insufficient fill over tank or field._ ❑ Other. Name of reviewer. Jeff Date: 11/17/2005 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK