HomeMy WebLinkAboutELDON BLK 2 LT 6Eldon
BIO k 2
Lot 6
#016-202-31
\ ` MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
I� ENVIRONMENTAL ENGINEERING DIVISION
825 L Street. Anchorage, Alaska 99501 Telephone 264-4720
ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
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PHONE
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LEGAL DESCRIPTIO
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LOCATION „/7
�..C.
/W,
NO. OF BEDROOMS
O Y
DISTAANCECET0::
ell
too
Absorption area
Dwelling
PERMITN O
EQ
W t-
Manufacturer
Material
No, of compartments
CSG.
Liq, capacity in 68 ns
Inside length
IF HOMEMADE:
Width
Liquid depth
d Y
Jam$
DISTANC
Well Dwelling
PERMIT NO.
_? h
Manu urer
nal-Liquid
ca yin gallons
0=
W
DISTANCE TO:
Well r Foundation-1" Nearest lot line/D.
PERMIT NO. oaO�L7
O '!
1 LL Z
�?�
No. of lines .�
Length Qf each line Total length of line Trench width
L, S�J �! Fomes
Distance between I' es
0.i
F-
Top of the to finish grade Material beneath the
Total effective aUsgar9nxion area
w
l7
Length
Width Depth
PERMIT NO.
c1-
W L
Type of tr
Crib diamete Crib depth Total eflec ' sorptio t area
DISTANCE TO:
(ding foundation Barest lot line
J
J
C
Depth Driller Distance to lot line
PERMIT NO.
DISTANCE TO:
Building foundation Sewer line Septic tank
Absorption area(s)
OTHER �
PIPE MATERIALS
SOILTEP RATING
-��i/—Ayl`L/ to 8S
—e
INSTALL
I CuT.
S
REMARKS
'4-f�I�GCL.
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34
77114
1
r
PROVED
DATE LEGAL
Z 9iS o L (o G
72-013 IRM. 3/78) v
PERMIT NO.
MIJtJ I C I F-FiL I TY 4F nrJ(-,HQf,;ZFICaE
DEPARTMENT fQALTH AND ENVIRONMENTAL f'OOTECTION
825 STREET, ANCHORAGE, AK. 95 1
264-4720
CD M— S I T E S E W E R B E R M jr T
C 800468 >
APPLICANT JOHN BENEDICT STAR ROUTE A BOX 1371 99507
LOCATION BILL STREET., Z
LEGAL iOT 6'BLOCk./ ELDOtJ 5!D LOT SIZE 11400
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
n �
344-1rrg�9��j/ �U11
0?� IS iGY1t57
SQUARE FEET
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING C50 FT/DR)= 125
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
�, /
C7EFaTH= r--. LEFVGTH= -4-7 ORFiVEFL F7EFl-rH= 4
THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION CIN FEET).
RECnIJ I REO SEPTIC TFitJK S I E= Z0110ED, GFiLLC7tJS
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
--- TIJQ C 2 7 FARE RE:GU I REO ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE I5 75 FEET.
OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
F�-ERM I T aXF} I RES F7ECEMCER 31.. 1Suo
I CERTIFY THAT
1: I AM FAMILIAR, WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IH ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE OW -SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE I5 REMODELED TO INCLUDE MORE THAN 3 BEDROOM_.
SIGNED:
APPLICANT JOHN BENEDICT
ISSUED BY ------------------------------ DATE- :1- lln---- V4.0 I-
/ r•11 -t r4 I r` I F=n L_ I -r . C -I F' Ft N r H 0 Fz: n 0 E
DEPARTMEti"OF HEALTH ArID ErIVIP.OrlrtENTfI--�PROTECTIOr1
825 L' STF'EET, ANCHORAGE, AK. r .501
2264-4720
t•IEL_L_ uric• clr•a-S I TE =•FRIER= PERM I T
PERMIT NO.
APPLICANT�Lc �� A %fix
LOCATION �tfi
LEGAL
TYPE OF SOIL ABSORPTION SYSTEM IS:�
SOIL RATING CSQ FT/BP.)= /2.�-SJ
MAXIMUM NUMBER OF BEDROOMS =
F�371
LOT SIZE ✓ 121on
SQUARE FEET
THE PEQUIRED SIZE OF THE SOIL FIBSOPPTION SYSTEM IS:
OEF=•TF-i= 0 L_EFJr3TH- �� uRFiti� EL G�EF�TH�
THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DtSTWICE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
F:Ec!IJ I F2EC? SEPT I C TtRr4K S I � .E= IQDv 0"L_I-or l
PERMIT APPLICANT HAS THE RESPONSIBILITY"TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
--- TI40 C 2 > I rJSPEr'T I or -4 t=o F? F- EGILI I F�F_C- ---
BACKFILLING OF ANY SYSTEM WITHOUT FINAL IN=PECTION AND APPF.OVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC 1 -JELL.
P1I14I11!Ir1 DISTANCE FROM A PRIVATE I -JELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COr1MUf:ITY SEWER LIME IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN _0 DAYS
OF THE WELL COMPLETION.
OTHER. PEQUIPEMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
PCF=:M I T IMXF=* I F-;:: C- L,ECEMEDEFZ :3:1-.. -,lLvg91
I CERTIFY THAT
1: I AM FRMILIAR WITH THE F.EQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM III ACCORDANCE WITH THE CODES.
2: I UNDEPSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
PESIDENCE IS REM DE)ED TO INCLUDE Mi PE THAN 3 BEDROOMS.
APF L I CAr
V4. 0
ISSUED BY_
BK808 Rem(y.T
RECEIPT
Date L P4
q -19 9,( 6139
o
Received From
A�gress
`
P„� <
For
Dollars $
n & ;
Y
OUNT
HOW PAID
AMLOF
USN
CACC
G
h
= Y
—ACCOUNT
AMT. PAID
CHECK\(�)
BAIATaCE
DUE
MONEY
ORDER
D
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BK808 Rem(y.T
CONSTF7JCTION
• TEST LAB
180L W 48TH AVE. STE. 'C
ANCHORAGE, ALASKA 99503
248-1333
PERFORMED FOR: John Benedict DATE PERFORMED: 9/8/1980
LEGAL DESCRIPTION: Lot 6 Block 2 Subdivision Eldon Subdivision
THIS FORM REPORTS: W Visual Sails Examination O Percolation Test
DEPTH SOIL
FEET DESCRIPTION
NOTES
BOTTOM OF HOLE
WAS GROUND WATER ENCOUNTERED Yes
IF YES, WHAT DEPTH 12' fo•••
LEGEND
m — Perc zone
ix S —Sample token
■ — Frozen zone
♦ — Water table
Kinney R. Ba r
1655 -
V
• _w
Topsoil
Dry
125 SF/BR
SA—GRV w/Boulders
tma■ ■tmu■ototsl■■■I
—GP—
go
_
25 s.f./
—B.R.
_
DRY
SA—GRV
— 12 ,V I
_GP"
BOTTOM OF HOLE
WAS GROUND WATER ENCOUNTERED Yes
IF YES, WHAT DEPTH 12' fo•••
LEGEND
m — Perc zone
ix S —Sample token
■ — Frozen zone
♦ — Water table
Kinney R. Ba r
1655 -
V
• _w
GENERAL SITE SLOPE
READING DATE GROSS TIME NET TIME DEPTH TO H2O NET DRAINAGE
PERCOLATION RATE: DRAINAGE REQUIREMENTS' See Above
PROPOSED INSTALLATION: - O SEEPAGE PIT IN DRAIN FIELD O OTHER
COMMENTS: PAID 9/9/80
TEST PERFORMED BY: L.S. DATA CERTIFIED BY: Kinney R. Baxter, P.E.
DATE: 9/08/80
tma■ ■tmu■ototsl■■■I
ear•■■■'l■u■w■
ice■
■
■p
so�e■�I
moil
■o
Motione■o
e■emoo
I,�e■■e■■a■■m■ma■
GENERAL SITE SLOPE
READING DATE GROSS TIME NET TIME DEPTH TO H2O NET DRAINAGE
PERCOLATION RATE: DRAINAGE REQUIREMENTS' See Above
PROPOSED INSTALLATION: - O SEEPAGE PIT IN DRAIN FIELD O OTHER
COMMENTS: PAID 9/9/80
TEST PERFORMED BY: L.S. DATA CERTIFIED BY: Kinney R. Baxter, P.E.
DATE: 9/08/80
rI
r
Cly( 4u-�Ccj �)Cc�o+ �-�C,-0- ISA ,����a Y -4.0L
pCLAO �- L Cd-, C;N-\ etQ A n — �o L1 c uD L..,—� V -Y. C,,, A C�
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T
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�'.M1 ' •:' I 1' j�'�.1i'���\))((II''j��j���((II'',��,��pp.��I''}.pp F. lam; (\����Q .���'��\ '
���lri��• ri/Y�/�it�irL����M: `I `I. �r\Iri�i� "• .•, i1•`,-..'.
x.13690 STAR ROUTE A '% ANCSORAGjs: AzAsmA 99$02.:
SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OR 110 T �1
DRILLED AT THE RATE OF---- -- PER FOOT.
PROPERTY OWNER B"Ale 0444 144-7714
LOCATION OF WELL SITE Lt, 6 BLE• 2 Udon Sub,
DRILLER BeAnU Clatta at Raa=,tt D.LLl G n4 G7o2k4.
WELL LOG:
0 ---- 23► 9tavet, Seuewt amaU LomtdeA4.
68---107' Xmtdpan. Cearented g2av"
107--110' 74ne glawet. VateA ptaducenq. 15giR pumping .Gem deet ag bottom.
80 deet of mat.e-t o-tan.dinq 4n. caiinq. 1/2 Kothe Sub. pump 4hotttd be bwta,Lte.d
20 Aet ag Uottam.
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF --------------
THANK YOU VERY MUCH.
BERNIE CLAUS OF RAMPART
DRILLIN
WORKS
DATE Rpt,U 11th, 1977
61 B g 10 - 0
•- .tom Municipality of Anchorage ,,`'4� �G'`o
-t .�_ On-Site Water and Wastewater Program
\ (907) AY ]. 7 20 s 94
I. r r
(�� M y
Q� ti
Certificate of On-Site Systems Approva `�,
a g g
Parcel I.D. 016-202-31 Expiration Date: 7—I - 1 7
1. GENERAL INFORMATION
Complete legal description Eldon Block 2 Lot 6
Location (site address) 710 Bill Street
Current Property owner(s) Victoria & Calvin Ross Day phone
Mailing address 710 Bill Street Anchorage, AK 99515
Real Estate Agent Day phone
2. TYPE OF DWELLING:
O Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Q Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received b, • __di 4,4< /22, I!LIII.II Date: OM
COSA to be released to the engineer, unless otherwise requested by he engineer.
COSA Fee $ ' ,•/ Waiver Fee $
Date of Payment 41-1 !1 -7 Date of Payment
Receipt Number 02-101 &. Receipt Number
COSA# O`>C., L t ?7 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 info/ i' ie:from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply
and/or wastewater�ispos:21' m is(are) in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at
the time of installation.
In conducting an adequacy test, I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regul •�• reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation di ured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition,ground w vels 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.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 5/16/2017
�-of AL ,g•
sk
*: 49TH j /1 . * /
6. DSD SIGNATURE 0 s4��t ". �-
v System #1 Approved for C( bedrooms d ....Ski;ten. ,'Paririorie:*'Ali
System #2 Approved for bedrooms 1T
...,. CE-8149 Air
Disapproved li;\DFES i� '"'
Conditional approval for bedrooms, with the following stipulations:
By: t Original Certificate Date: .3 —31 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 X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet i - 0
If more than 1 septic system is on the lot:
COSA Checklist# 1 of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Eldon Block 2 Lot 6 Parcel ID: 016-202-31
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 4/11/1977 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y
Total depth 110 ftCased to 110 ftCasing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 4/11/1977 5/2/2017
Static water level 30 ft 37 ft.
Well production 15 g p m 4.6 g p m
WATER SAMPLE RESULTS
Coliform NEG colonies/100 mL Nitrate ND mg/L
Arsenic 42.8ug/L Date of sample: 5/2/2017 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Greer/SteelDate installed 9/15/1980
Tank size 1 000 gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 5/9/2017 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Date installed 9/15/1980 Soil rating (g p.d./ft' or ft?/bdrm) 125 GPD/SF System type Deep Trench
Length 50 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 7.5 ft. Eff. absorption area 400 ft` Monitoring tube Y Depression over field N
Date of adequacy test 5/2/2017 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 661 gal. New depth 21 in.
Elapsed Time: 1440 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d.
NAny rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
'A
Septic tank/lift station on lot " On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent 10 ''v" ' �j A-
ABSORP I N FIELD ON LOT TO'
f
Property liney4-1 Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain _50+ Wells on adjacent lots 100+
F. COMMENTS
1 viaiveS eo rt\-& ' 20u3CO3A(14-5}
G. ENGINEER'S CERTIFICATION ,��4 9F ,4L„ilk kA
I certify that 1 have determined through field inspections and ��p,'�Q.' !+) :.9t#
review of Municipal records that the above systems are in 7*; ' • /—\ *f�
conformance with MOA COSA guidelines in effect on this date. 1 '%VP ... 0
Engineer's Printed Name Steven Pannone /r ''. levee i. 'anriorie: j
Date 5/16/2017 011IQs. CE-8149 ` ��
+i
COSA canary sheet_2-6-15.doc
• Municipality of Anchorage
uE BV
Development Services Department :: '":
4' _
Building Safety Division <r.S• ET
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 # OSC 171187
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
Eldon Subdivision. This inspection revealed an arsenic concentration of 42.8
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.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
Parcel I.D. 016-202-31
Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Expiration Date: q - 3 / 3
Eldon Block 2 Lot 6
710 Bill Street, Anchorage, AK 99515
Current Property owner(s) Nick Dighiera
Mailing address
Real Estate Agent
Tim Rittal
2. TYPE OF DWELLING:
E] Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Day phone 306-0686
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
n
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver/Variance request for: NONE Distance:
Received by: �t' *�) jw� " Date:
COSA to be released to thongineer, unless otherwise requested by the engineer.
COSA Fee $ Lig o, C3
Date of Payment5�a4�13
Receipt NumberQ3coQg4
COSA# a S61310qr2
Waiver Fee $
Date of Payment
Receipt Number
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 SPURKLAND ENGINEERING
Phone 279-3916
Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501
Engineer's Printed Name LARS SPURKLAND Date 10/16/12
M
c,��.� F• Aegs�!� rel
fes.
-49 t P�
S. DSD SIGNATURE i
System #1 Approved for bedrooms /� P' E. SPURKLAND.�u
� "!'• 1 50 .fir
System #2 Approved for bedrooms It 5 f3 • ti
Disapproved 1��OFsSitr�� '
Conditional approval for bedrooms, with the following stipulations:
By: Original Certificate Date:
The Municip f 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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
OOSAbl.sh f .�
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: Eldon Block 2 Lot 6
A. WELL DATA
Well type Private If A, B, or C provide PWSID # -
Date completed 4/11/77 Sanitary seal (Y/N) Y
Total depth 110 ft. Cased to 110 ft
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Greer/Steel
Tank size 1000 gal. Number of Compartments
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
Date of pumping 5/22/13 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Parcel ID: 016-202-31
Well Log (Y/N) Y
Wires properly protected (Y!N) Y
Casing height (above ground) 12+ in.
AT INSPECTION
5/14/2013
36
4.9
ft.
[l"
Collected by: Anson Moxnes
Date installed 9/15/1980
Cleanouts (YIN) Y
High water alarm (Y/N) N
Date installed 9115/1980 Soil rating (g.p.d./fe or ftz/bdrm) 125 System type Deep Trench
Length 50 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 7'5 ft. Eff. absorption area 400 fe Monitoring tube y Depression over field n
Date of adequacy test 5/14/13 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 10 in. Water added 480 gal. New depth 20'5 in.
Elapsed Time: 1195 min. Final fluid depth 11 in. Absorption rate >= 450 9 p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date
FROM WELL LOG
Date of test
4/11/1977
Static water level
30 ft
Well production
15 9.p -m.
WATER SAMPLE
RESULTS:
Coliform Reg
colonies/100 mL Nitrate ND mg/L
Arsenic 23'7
ug/L Date of sample: 5/17/13
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Greer/Steel
Tank size 1000 gal. Number of Compartments
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N
Date of pumping 5/22/13 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Parcel ID: 016-202-31
Well Log (Y/N) Y
Wires properly protected (Y!N) Y
Casing height (above ground) 12+ in.
AT INSPECTION
5/14/2013
36
4.9
ft.
[l"
Collected by: Anson Moxnes
Date installed 9/15/1980
Cleanouts (YIN) Y
High water alarm (Y/N) N
Date installed 9115/1980 Soil rating (g.p.d./fe or ftz/bdrm) 125 System type Deep Trench
Length 50 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 7'5 ft. Eff. absorption area 400 fe Monitoring tube y Depression over field n
Date of adequacy test 5/14/13 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 10 in. Water added 480 gal. New depth 20'5 in.
Elapsed Time: 1195 min. Final fluid depth 11 in. Absorption rate >= 450 9 p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons _
in. "Pump off" level at -
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot *97
Absorption field on lot '1001
Public sewer main N/A
Sewer /septic service line 25
Animal containment areas >50'
Cycles tested -
Manhole/Access (YIN)
in. High water alarm level at _
Meets alarm & circuit requirements?
On adjacent lots >100,
On adjacent lots >100
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5 Properly line >5
Water main NIA Water service line >10'
Wells on adjacent lots *93
ABSORPTION FIELD ON LOT TO:
Property line *9 Building foundation >10,
Water Service line >10 Surface water >100,
>50' (N.O.) >100,
Curtain drain Wells on adjacent lots
F. COMMENTS
*Waivers On File
G. ENGINEER'S CERTIFICATION
I certify that l 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
Date
COSA brown sheet_10.10.12.doc
Absorption field >5
Surface water >100,
Water main NIA
Driveway, parking/vehicle storage >100
i g P��. O F .410
t'+
10.
49
1 .....
LA E.SPURKLAND. 10,
SS�NP���U�s
in.
Municipality of Anchorage s
+ ` 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 # 131218
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
Eldon Subdivision. This inspection revealed an arsenic concentration of 23.7
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
()"ww.muni.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Municipality of Anchorage Q e
• '� Development Services Department
Building Safety Division 5 '
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE"FAMILY DWELLING
Parcel I.D. 016-202-31
1. GENERAL INFORMATION
Complete legal description ELDON
BLOCK 2. LOT 6
COSA# (�C_ l e // �q
Expiration Date: I i q / C,
Location (site address) 710 BILL STREET * ANCHORAGE, AK * 99515
Current Property owner(s) MARIAN DE LA PENA Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
710 BILL STREET * ANCHORAGE. AK * 99515
Day phone
CAROL MARVEL W/ REMAX Day phone
440-7551
884-8912
3801 CENTERPOINT DRIVE. #200 * ANCHORAGE. AK * 99503
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
N
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. 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.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name
Engineer's Comments:
JEFFREY A. GARNESS, P.E.
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
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.
DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Phone
337-6179
Date�����'
Conditional approval for bedrooms, with the fllowing stipulations
ess:
J'.VCE— 95
Pro f e s s10 L,zo
Z
j = ON-SITE
WATER AND m
WASTEWATER
o.
PROGRAM
. ,moi .• •.•Q6'.�R
,-,
Attachments: �• (..-�
COSA Checklist j� A:0 A A
ruse t r%Uvlouny
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: Original Certificate Date: tl
(Rev. 11105)
Municipality of Anchorage
o� e�
• Development Services Department
4L �%
Building Safety Division w
On -Site Water & Wastewater Program J ° ° ' Y
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: ELDON S/D; BLOCK 2, LOT 6 Parcel ID: Q / to -o2 (09-- 3
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 4/11/1977 Sanitary seal (Y/N) YES
Total depth 110 ft. Cased to 80 ft.
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 4/11/1977 7/19/2010
Static water level 30 ft. 39 ft,
Well production 15 g.p.m. 2.12 g,p,m,
WATER SAMPLE RESULTS: *FILTERS INSTALLED IN HOUSE.
Coliform 0 colonies/100 ml. Nitrate ND mg./L. Other bacteria 0 colonies/100 ml.
Arsenic: 25.9 ug./L. Date of sample: 7/19/2010 Collected by: GEG Ltd.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 9/15/1980
Tank size 1000 gal Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 7/26/2010 Pumper MCDONALDS PUMPING
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE
Date installed 9/15/1980 Soil rating (g.p.d./Wo 2/bdr 125 System type TRENCH
Length 50 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth *6.9 ft. Eff. absorption area 400 ft2 Monitoring be' YES Depression over field NO
Date of adequacy test 7/27/2010 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 450` gal. New depth 18 in.
Elapsed Time: 120 min. Final fluid depth 10 in. Absorption rate >= 450+ g_p_d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date —
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pump off'
E. SEPARATION DISTANCES
Manhole/Access
water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot *97'+ On adjacent lots
100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main N/A
Sewer /septic service line 25'+
Public sewer manhole/cleanout N/A
Holding tank N/A
Animal containment areas 50'+ 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 **93'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line *9' 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
*PER EXISTING WAIVER #WR050109. **PER EXISTING WAIVER #WR85-015.
G. ENGINEER'S CERTIFICATION
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 JEFFREY A. GARNESS
Date 6 N- b o
COSA Fee l 0 Waiver Fee $
Date of Payment7-
Date of Payment
Receipt Number b-7 Receipt Number
(Rev. 11/05)
Municipality of Anchorage
¢UE A&
• Development Services Department
Building Safety Division �
S A E z Y
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 # 101154
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
Eldon Subdivision. This inspection revealed an arsenic concentration of 25.9
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.
SGS Ref.#
1103511001
Client Name
Garness Engineering Group, Ltd
Project Name/#
Eldon S/D B2,L6
Client Sample ID
Eldon S/D B2,L6
Matrix
Drinking Water
Printed Date/Time
07/22/2010 16:29
Collected Date/Time
07/19/2010 13:00
Received Date/Time
07/19/2010 13:25
Technical Director
Stephen C. Ede
Sample Remarks:
450ONO3 - Total Nitrate/ Nitrite - MS did not meet QC criteria, biased low. LCS meets QC criteria.
Allowable
Prep Analysis
Parameter
Results
LOQ
Units
Method Container ID
Limits
Date Date
Mit
Metals by ICP/MS
Arsenic
25.9
* 5.00
ug/L
EP200.8
C
(<10)
07/21/10 07/22/10
KDC
Waters Department
Total Nitrate/Nitrite-N
ND
0.100
mg/L
SM20 450ONO3-F
B
(40)
07/19/10
AYC
Microbiology Laboratory
E. Coli
Negative
I
100mL
SM20 9223B
A
07/19/10
DLC
Total Coliform
Negative
1
100mL
SM20 9223B
A
07/19/10
DLC
BILL St.
—
—�— — —
8294A
0
co
0
Ch
N89055'45"E 60.00
—
Wood ,
—
Fence
Well p I I
I I
I I
I I
C:)
C)
I
C3
rn
I " I
dk
o
r-
4 deck
24.0 1 •
O
1 Story Frame I I
O
r
LO
o House o
with N
Basement
24.0
13. L
t- -
a0
�
_J
story
C under o
d'
1-1
0
Z
1 deck N
21.3
o
L Deck OH —
m
O
O
LL
ZN
3
0
Se°y°1-e�,
Lot 7 Scale: 1'=30'
Lot 5
LOT 6 Sep��
OF A �1
S 1
�e
,.;•.�?
Co
•
/ : 49 TH /
..
Fred Wafatka
No. 3255-S .%
Wood
Fence
Wood
Fence
— — — — — — — — —
AS -BUILT NO CORNERS SET THIS DATE
10' Utility Easement
I hereby certify that I have performed a Mortgagee's inspection
— _
of the following described property: Lot 6, Block 2.
N89055'45"E 60.00
ELDON SUBDIVISION
Anchorage Recoraing Precinct, AlaSKa, and thate
Lot 13
improvements situated thereon are within the property lines
Lot 14
and do not overlap or encroach on the property lying
I
`''
Q
adjacent thereto, that no improvements on the g
1 P Property lying
J
adjacent thereto encroach on the premises in question and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
EASEMENTS OF RECORD, OTHER THAN
this 13th day of December 2005
THOSE SHOWN ON THE RECORDED
FRED WALATKA & ASSOCIATES
PLAT ARE NOT SHOWN HEREON. Fb05-7, pg59
Engineers and Surveyors
BE
(907-248-1666)
e-1 &Ni�- Noon".
-� Municipality of Anchorage
-. Development Services Department
Building Safety Division
Onsite Water and Wastewater Program *A'
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. O l 6 — 20 Z - 3 I COSA # 661 X43
Expiration Date: 2 o
1. GENERAL INFORMATION
Complete legal description
1-0 t 6,
13 to c k 2,
E l aan S iy
Community Class Well
Location (site address)
7/0
33 r l f St.
Current Property owner(s)
Den 1 c e
f) a Fran c;,r
Day phone
2 Z Z - l► o�
Mailing address
?SZ99
Se b, -,;r Cir -c le . , fnctiy!a
' +it 99,S- 1�
Lending agency
L4 -.S A- .4
Dayphone
Mailing address
l o-7S'O
He De - Md h4
Freeg",o Sen
A -n 16,010. Tac 78 Z81F
Real Estate Agent Elena Ne,c Js ky. Pry o?*nfi&/ V*& Day phone 2'Vo -Y3 esu
Mailing Address 14635 Can /Yr,Fi eta Ori, Eagle R1,.« A•k 9 9,' 7 7
Unless otherwise requested, COSA will be held by DSD for pickup. P leave cn ll Rau l /o � (EZYO -Y.AV
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Is
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 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 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 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. the fr - Sar, he Ta+ 4 Cin i.K�
Name of Firm _rlaf lop 'r con ica f Phone 3V r -)ss -
Address IYC30 Lc46 Sf /4nc4omgQ� tfk 99SlC
u
Engineer's Printed Name TX¢odc—e r• /-too.e Date 124 r9 / 2-e—c�s-
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: f2 1717 oy
U lo
(Rw. 11N5)
r..H\
5. DSD SIGNATURE
p."'• ••••••"'•"""'�
�TF.fODORE F. J:OCRE Ir
Approved for �
bedrooms. `,".'• c:-3584
Disapproved.
+' ;��
.•,.....;.;�k,r
s J•fra�e`.,
Conditional approval for
bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: f2 1717 oy
U lo
(Rw. 11N5)
Municipality of Anchorage
Development Services Department
Budding Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 198850
Anchorage, AK 99519.8850
www.muni.org/ortsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lo 6 to e k 4 rE / dA n S /p Parcel ID: Old- ZO E - I/
A. WELL DATA
Well type _v t if A. B, or C provide PWSID # J✓• �.
Date completed _R_/1/ r9/ r 9469 Sanitary seal (YM) Y
Total depth J-9-1 ft.
Date of test
Static water level
Well production
Cased to —L7—ft.
FROM WELL LOG
f/ ft.
30 g.p.m.
WATER SAMPLE RESULTS:
Well Log (Y/N) Y
Wires property protected (Y/N)
CI n J r/t 4,L000dtn box)
Casing height (above ground) rd- in.
AT INSPECTION
2 / 13 / 7,005-
37
,005-
37 ft.
5,81- g.p.m.
Coliform __A9__colonkW100 mL Nitrate 40.1 mg/L Other bacteria O colonlW100 mL
Arsenic: W.A. mgn Date of sample: 1 i/ r3 /oi Collected by: 1=4kkkto 7 om4 S f e
Tat e4MW rA 2.00C
B. SEPTIC/HOLDING TANK DATA
Tank TypelMaterial Sr4 fic / t /Ye / Date installed 9 115- /807
Tank sizeYXW gal. Number of Compartments Clearwuts (Y/N) Y e r)
Foundation cleanout (YM) Y Depression over tank (YM) N High water alarm (Y/N) N. A..
Date of pumping & / 12 /Ol Pumper flan o 1
C. ABSORPTION FIELD DATA
Date installed 9 /r5- /e`b Soil rating (g.p.d.e or fe/bdrm) t ZS' Or System type Tnn es
e4wrol
Length N9 ft. Width S —( ft. Gravel below pipe `/ ft.
Total depth _7 ft. Eff. absorption areaYa? ft2 Monitoring lube _� Depression over field AL
Date of adequacy test 12. / 13 /os Results (Pass/Fail) PA,4r_ . For 3 bedrooms
Fluid depth in absorption field before test _Z in. Water added O&C-Agai. New depth23.2in.
Elapsed Time: 65- min. Final fluid depth 9z5- in. Absorption rate >= h'Sb g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) NO of 1407 0 ewn If yes, give date N. A,
D. UFT STATION V -A -
Date
•/i.Date installed
'Pump on' level at _ in.
Datum
E. SEPARATION DISTANCES
Size in gallons
'Pump off" level at _ in.
Cycles tested
Manhole/Acoess (YM)
High water alarm level at
Meets alarm 6 circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankilift station on lot 9 7 t On adjacent tots >10c>1
Absorption field on tot
> 16a 1
Public sewer main
> tW'
Sewer /septic service line
> ZS
Animal containment areas
P. A.
On adjacent lots 7 (co ,
Public sewer manhole/cleanout _> tua
Holding tank N. A.
Manure/animal excrete storage areas #J-4,
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation x 131 Property line 7S, Absorption field S"
Water main N • +� • Water service line _> to ' Surface water > t co
Wells on adjacent lots 3 /►pp. sy Wel Ss —616-Y
in.
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
t�
Properly line -- 9 r Building foundation 2 S ' Water main > 14 '
Water Service line > 10Surface water '�P, te+o' Driveway, parking/vehicle storage 3S'
Curtain drain l*ne Sten Wells on adjacent lots > [Cam r
F. COMMENTS
See QhACC;ft-,eC[!C<(lien re�uVf a �r k,%Sr.
G �.
G. ENGINEER'S CERTIFICATION rT'<'. �• +� �t
I certify that I have determined through field inspections and • • • ° • •. • • .. •• •: •.• D/
review of Municipal records that the above systems are in
conformance with MOA COSH guidalkws In effect on this date. . • °'
Engineer's Printed Name Theo alc'VV F. /'-[Co.•e /2/cr1
Date 12.119 / 2OC/S"
COSA Fee $ *13O �- Waiver Fee $ 20 IS,
Date of Payment / 2 / 4 /42�1O a„y- Date of Payment I try,,/4,k / 20
�l0,-
Receipt Number `I O 'I % Receipt Number 4` 2 i
(Rev. 11/05)
Mwiicipaliiy of Anchorage B�
P.O. Ik,x 1000n0 • Anchu +e, Alaska 019-C)CM • ! t
ny, Tcicph�xic (N17) S4.2fCi01 • rux (007) a31A.°IN)
4700 nmpw S(met • Ambom ;e, Alaska (Y.A( s • +
u munl.nrg
Mayor Dlark I3c#ich I3utlding Safety Division
December 27, 2005
Ted Moore, P.E.
Flattop Technical Services
14530 Echo Street
Anchorage, AK 99577
Subject: Waiver Request for Eldon S/D Block 2 Lot 6
Waiver Request WR#: 050109
Parcel ID # 016-202-31
HA050643
Dear Ted Moore, P.E.:
Your request for a waiver of the required 100 feet horizontal separation from the
septic tank to the private well has been approved. The approved separation distance is
97.0 feet. And a 9 foot lot line waiver from septic trench to east property line is approved.
This waiver approval applies to the existing septic tank to private well separation only.
Any future upgrade to the on-site wastewater disposal system will require all separation
distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sincerely,
roodCivilEngll
ineerr
On -Site Water R. Wastewater Program
Community, Security, Prosperity
Municipality of Anchorage
Development Services Department
• �r Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.arehoragc.ak.us
(907)343.7904
Waiver Review Worksheet
WR#:050109 PID#:016-202-31 HA/Pernit# IIA050643
Date Received: December 27, 2005
Legal Description: Eldon S/D Block 2 Lot 6
Engineer.
Ted Moore, P.E.
Flattop Technical Services
14530 Echo Street
Anchorage, AK 99577
Applicant: Denise DeFransis
Waiver Requested: A 97 foot horizontal separation waiver from well on -lot to septic tank on -lot.
And a 9 foot lot line waiver from septic trench to east property line.
Criteria: Geology Points:
A. Water Table 7.00
B. Soil Sorption 3.47
C. Permeability 2.68
D. Water Table Gradient 4.50
E. Horizontal Separation 2.88
Total: I 20.525
...m......................................................................
Waiver Is Granted: X Waiver is not Granted.,
List Conditions or Reasons for above:
Date: 12127/05 By: Joe Goodall
Name of Reviewer
............................. 0 ...... ......... ............ ........ massages
Rec#: 74871 Amount: $M Date Paid: 12/27/2005
State of Alaska:
Separation Distance Waiver Guidelines for S.C.R.O.
(State of Alaska Memorandum to District Office Engineers dated January 3,1985)
Waiver Request for. Eldon S/D Block 2 Lot 6
Parcel I D#: 016-202-31
Waiver Request Number WR#: 050109
Waiver Requested: A 97 foot horizontal separation waiver from well on -lot to septic tank
on -lot. And a 9 foot lot line waiver from septic trench to east property line.
Engineer Ted Moore, P.E.
IIA050643
Septic Tank Data
The septic tank was installed september of 1980 and has encroached
the well on -lot for approximately 25 years. For purposes of
calculating th D.E.C. points the bottom of the septic was assumed to
have a total depth of 7 feet from grade as is the septic field. Flat -top
Technical Services determined the tank and septic field is working
adequately.
Well Data
The well on -lot was installed in 1977. The septic tank has
encroached this well for approximately 25 years. Flat -top Technical
Services took water samples from this well and found the water
samples are with -in municipal standards. 0 colifrom, .1 nitrates, and
0 other bacteria sampled on 12/13/05.
State of Alaska:
Separation Distance Waiver Guidelines for S.C.R.O.
(State of Alaska Memorandum to District Office Engineers dated January 3,1985)
Waiver Request for. Eldon S/D Block 2 Lot 6 -
Parcel ID#: 016-202-31
Waiver Request Number WR#: 050109
Waiver Requested: A 97 foot horizontal separation waiver from well on -lot to septic tank
on -lot. And a 9 foot lot line waiver from septic trench to east property line.
Engineer Ted Moore, P.E.
IIA050643
Water Table Points ma
Depth of well: 107 7.00
Depth of septic system: 7
1o0,
Distance from the bottom Point
of the system to the highest Value
water table In feet
0 0
8 1
17 2
24
3
30
4
40
5
85
6
100
7
290
8
1000
9
10
• Straight line Interpolation is permitted
between any two values
Soil Sorbtion
Points
A�
3.47
Soil Type
Point Valuel
16 0
+ 45 2.5 +
39 6
+ 0 0
Clean Gravel
0
100
100
100
1o0
Fractured Rock
1
Course Clean Sand
1.5
I 0 1 0
+1-700-0)
+ r 0 1 0 +
0 1 0
+ x 0 1 0
Sand w/ Small Amt of Clay
2.5
100 J
100 J
1-1-000-)
100 J
100 J
Silt
3.5
Clay and Sand Equal
4.5
0
+ 1.1 +
2.3
+ 0
Clay
6
0
+ 0 +
0
+ 0
'Use the predominant soil type but values can be averaged for a mixture
Permeability
Soil Type
jPoIntValuel
Clay(will channel)
0
Silt and Sandy Clay
2
Clayey Sand
3
Fine Sand
1.5
Sandy Gravel
1
Fractured Rock
0.9
Course Sand (30 grit)
0.4
Clean Gravel
0
Points no
2.68
[ 16
100, 1 +f 45 00, 3 +[ 00, 3 + l 100, 1
+ [ 100, 1 +[ 100 ) 1 + 100] 1 + r TMO 1
0.16 + 1.35 + 1.17 + 0.00
0.00 + 0.00 + 0.00 + 0.00
*Use the predominant soil type but values can be averaged for a mixture
Gradient
4.5
-60%
0
Separation
-30%
0.3
-20%
0.7
slopes toward well
-10%
1.2
1
-5%
2
100
0%
2.93-
Oat
5%
4.5
300
10%
6
slopes away from well
60%
7
*If the gradient is unknown, assume the worst case
Horizontal
0
Horizontal
Point
Separation
Value
in Feet
0
0
25
0.7
50
1
75
2
100
3
150
5
200
6
300
7
Points no
4.50
Points no
2.88
•Linear Interpolation between two point value is acceptable. Horizontally means
straight line distance to the well not the contaminate travel distance to water table
which may be greater.
Conclusion: Grant Waiver Total Points:1 20.5251
FLATTOP _TEGTINIGAL SEMGE$':�
CIVQ. d ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS
THEODORE F. MOORE, P.E. 14530 ECHO ST.
PH: (907) 345.1355 December 19, 2005 ANCHORAGE, ALASKA 99516
M.O.A. DSD On -Site Services
P.O. Box 19-6650
Anchorage, AK 99519
Dear Sir or Madam:
By means of this letter I wish to request issuance of a waiver approving the 97 -foot separation
distance between the existing well and septic tank on Lot 6, Block 2, Eldon S/D. The waiver should also
address and approve the existing separation distance of approximately 9 feet between the cleanout pipe
at the end of the soil absorption trench and the property line. A site plan along with water sample test
results, as -built property survey, copies of relevant documents from your files and an application for a
COSA are enclosed, plus payment of the Municipal $920 waiver review fee.
According to the driller's log the well serving this lot was drilled in April of 1977 and has a total
depth of 110 feet and a yield of 15 gpm. On the date of a recent adequacy test conducted on December
13, 2005 the static water level stood at 37 -feet below the top of the casing. Steady pumping of 1000
gallons of water from the well at the maximum pump output of 5.8 gpm caused the water level in the
well to be drawn down to 66 feet below the top of the casing, but no further. Based on this test data I
concluded that the total well yield is greater than 5.8 gpm, which is more than adequate for approval of a
single family residential well. Water samples collected on December 13, 2005 were satisfactory,
showing 0 coliform of other bacteria and <0.1 mg/l of nitrate -N. The wellhead is protected inside a -
wooden enclosure.
According the septic inspection report prepared by a Municipal inspector the septic tank was
installed in September of 1981 and is a 1000 -gallon Greer steel tank located 100 feet from the well.
Effluent from the septic tank discharges into a 50 -foot long by 5 -foot wide soil absorption trench with an
effective gravel depth of 4 feet. Since the lot is only 60 feet wide and the trench has a 40 -foot long east -
west leg it is not clear how the inspector determined it achieved the required 10 -foot separation from the
property line, or the 100 -foot separation from the well. According to the most recent as -built survey the
sump at the end of the trench is approximately 9 feet from the east property line. Subsequent HAA
inspections and certificates issued in 2000 and 2001 also failed to pick up on these separation distance
discrepancies, thereby forcing the present owner to bear the significant financial burden associated with
previous errors made by others.
During a recent adequacy test conducted on December 13, 2005 I added 1000 gallons of water to
the system through the septic tank cleanout. The initial fluid depth in the existing 2" diameter steel
monitor tube located near the end of the trench was 2 inches and the maximum depth achieved was
approximately 23 inches. 75 -minutes after the flow of water was stopped the fluid depth in the steel
monitor lube was 9.25 inches. Based on this test procedure I concluded that the tank and absorption
field are still functioning adequately for approval of a 3 -bedroom residence.
The following is a breakdown of how waiver analysis points could be assigned using DEC's
1985 "Separation Distance Waiver Guidelines for SCRO". The depth of the bottom of the septic tank is
14 feet and soil classification data is derived from information contained on the well log.
Category
Points
Water table (107'— 14' = 93' to top of aquifer) 6.5
Soil Sorption ((9' x 0 + 45' x 2.5 + 39' x 6)/93') 3.7
Permeability ((9' x 0 + 45' x 1.5 +39' x 3)/93') 2.0
Water table gradient (assume +5% parallel to ground surface) 4.5
Horizontal separation (971 2.9
Total points 19.6
Based on this point assignment it appears that the requested waiver can be safely granted without
undue concern as to the potential for this septic tank to contaminate this well. It should also be noted
that a waiver was already issued in 1985 allowing this same septic tank to be approved at a distance of
93 feet from the private well located on Lot 5, Block 2, Eldon S/D.
Please give me a call if you have any questions on this analysis.
Sincerely,
ix 9htwl -
Ted Moore, P.E.
cc: Dcnice DeFrancis, property owner
Elena Novitsky, Prudential Vista by FAX 689-6499
BILL St.
CD
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N89055'45"E 60.00
I
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Lot 5
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LOT 6��! gbh +1 9,
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10' U111; EasemaM
I N89055145"E 60.00
Lot 13 I Lot 14
I
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. FbpS.T. pgsg
Ito
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I
BE
hed Wdm",
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AS -BUILT NO CORNERS SET THIS DATE
1 hereby cmW that I have perbmrod a Mortgagee's Inspection
of lie folowing described proparp!.Lk3--
ELDON SUMMON
Improvements situated thereon are vMhln ft properly lines
and do not overlap or encroach on the property"
agaant thereto, that no Improvemeraa on the properly "V
agacent thereto encroach on the prennisea In gjesWn and
that there are no roadways, transtr amen Ines or saner
vls0le enemannts on acid property except as indicwAd
hereon.
Dated at Andtoraga. Alaska
this 13m day of Dn
FRED WALATKA d ASSOCIATES
Engineers and Sunroyors
12-20-05;17:44
—S
SCS ReLM
1058113001
Client Name
Flattop Technical SN.
rrojeet Nama/tl
Lot 6 Block 2 Eldon SD
Client Sample ID
Lot 6 Block 2 Eldon SD
Matrix
Drinking Water
PWSID 0
SamplC Remarks:
;907 $61 5301 If 2/ 4
All Datcw7i=3 are Alaska Standard Time
PrintedNte/Time
17)10/2005 15:07
Collected DateMme
12/1311005 12:15
Received Datc/Time
12/13/2005 14.00
Technkal Director
Stephen C. Ede
Alkwabk Prep Analysis
parameter Results PQL Unita Method Container ID Limits Nate Date Inh
Ni=(, -N OADOU 0.100 mg/L. EPA 3532 B (<=10) 12/13/05
Microbiology Laboratory
Total Coliform 0
coVI00mL S.N209222B A (o-1) 12/13/05 •TI
Ar E..q,��'
........................
• • THEODORE F. MOORE i
LOT 6, BLOCK 2, ELDON SID
WELL - SEPTIC TANK WAIVER
SITE PLAN
FLATTOP TECHNICAL SERVICES
1 INCH = 50 FEET
�
DRAWN BY TFM
,
'�
"'-- ----
Y
R 100'
, r WELL
�d (APPROXIMATE
LOT 15
WELL
WELL
BLOCK 1
LOT 16
LOT 6
BLK. 2
WELL J
BLOCK 1
HOUSE
SEPTIC
;
♦ i
-----
- _�; -------
--
,
-:.
AREA
;
i'
WELL- .'
i)
�----------
SEPTIC AREA
LOT 14
(APPROXIMATE
-
_SEPTIC TANK
LOT 13, BLOCK 1
BLOCK 1
"'
""'-"
PER OWNER) _
--------
'"-
_-
50' TRENCH
NO WELL
OR SEPTIC
BILL STREET
LOT 5
®
LOT 8
BLOCK 2
SHED
LOT 7
BLOCK 2
BLOCK2
_____________
____________ _.._____�Y
______
,
______________
Ar E..q,��'
........................
• • THEODORE F. MOORE i
LOT 6, BLOCK 2, ELDON SID
WELL - SEPTIC TANK WAIVER
SITE PLAN
FLATTOP TECHNICAL SERVICES
1 INCH = 50 FEET
�
DRAWN BY TFM
,
'�
"'-- ----
Y
R 100'
, r WELL
�d (APPROXIMATE
J '
WELL
WELL
LOCArw,
PER OWNER)
_
LOT 6
BLK. 2
HOUSE
HOUSE
HED
;
♦ i
OUSE
i'
UNDOCUMENTED
i)
SEPTIC AREA
1000 -GAL
(APPROXIMATE
-
_SEPTIC TANK
�''
LOCATION
"'
""'-"
PER OWNER) _
--------
'"-
_-
50' TRENCH
NO WELL
OR SEPTIC
PER OWNER
LOT 5
®
LOT 8
BLOCK 2
SHED
LOT 7
BLOCK 2
BLOCK2
_____________
____________ _.._____�Y
______
_____________
______________
/T♦
\
LOT 13,
LOT 14,
LOT 15,
LOT 16,
BLOCK 2
BLOCK 2
BLOCK 2
BLOCK 2
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........................
• • THEODORE F. MOORE i
LOT 6, BLOCK 2, ELDON SID
WELL - SEPTIC TANK WAIVER
SITE PLAN
FLATTOP TECHNICAL SERVICES
1 INCH = 50 FEET
14530 ECI10 STREET
DRAWN BY TFM
ANCHORAGE, ALASKA 99516
DECEMBER, 2005
NOTE: THIS IS NOT A SURVEYED PLAT.
�E IsS�E
Municipality o nchorage
Development Services Department
.p p �:
Building Safety Division
On -Site Water 8 Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519.6650
www.d.anchorage.sk us -
(907)3437904
1SSuA.•1Lr-- Cr
CERTIFICATE OF HEALTH AUTHORITY APPROVAL VLA,& ooa all
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 016 202 31 HAA#
1. GENERAL INFORMATION
Expiration Date: 0 -PS -01
Complete legal description ELDON SUBDNSION; LOT 6, BLOCK 2
Location (site address or directions) 710 BILL STREET
Current Property owners)
Malting address
Lending agency
Mailing address
Real Estate Agent
Mailing address
MICHAEL MCSWAIN Day phone 727-5914
710 BILL STREET 99515
Day phone
VANGUARD REAL ESTATE Dayphone 222-8800
Unless otherwise requested, HAA 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 Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may
be reissued with new water sample results less than 30 days old. (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 data shown below, I verify that my
Investigation, based on procedures outlined In the Health AuthorityApproval 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 typo of structure Indicated heroin. I further verify that based on the
Information obtained from the Munlclpality of Anchorage files and from my Invostigatlon and Inspection, the
on-site water supply and/or wastewater disposal system is(are) In compliance with all applicable Munlclpal
and State codes, ordinances, and regulations In effect at the time of Installation.
Name of Finn ALASKA WATER & WASTEWATER CONSULTANTS. INC.
Address 6901 DEBARR ROAD, SURE 28 ' ANCHORAGE. AK 99504
Engineers Printed Name JEFFREY A GARNESS. P.E.
Engineers Comments:
in conducting this evaluation, AMM, Inc. attempted to provide a thorough,
conscientious engineering anaysls of the system In accordance with ADEC and MOA
DSD Guidelines b 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, groundwaterlevels that may
fluctuate during the year, and the water usage of the family being served by the system.
Those conditions are outside the control of the evaluator of the system. Satisfactory lest
results do not guarantee future performance of the system, nor do theyguarantee that
there are no hidden defects or encroachments. AMW, Ina can therefore not provide
any warranty or future estimate of how long the system will continue to moot the
operational requirements of the ADEC crMOA DSD. The content of this report is for
the solo bonefit of the owner listed above. Any reliance upon or use of this report by any
other person or parry Is not authorfzed, nor will It confer any legal right whatsoever.
5. DSD SIGNATURE
_I� Approved for 3 bedrooms.
Disapproved.
Conditional approval for
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Phone 337-6179
Date 6 1b D/
......t..
e fr A..Gorness.
—7953 e,
0pp�� •,•'•.. .• •� SFO
V4�ey pro f sss)o(\a
bedrooms, with the filowing stipulations:
Manitenance Agreements
Supplemental Engineers Reort
Other
ON-SITE .
WATER AND
WASTEWATER
�•,. PROGRAM
By:- &__4 e"_✓ Gl/• �ov( Original Certificate Date: " ��'
(Rw.1zm)
Municipality of Anchorage
' Development Services Department ,
Budding Safety Division .. .
On -Sits We* & wastewater Program
47W South Bragaw SL
P.O. Box 196850 Anchorage, AK 99519650
www.cIAnchorage.ak.ue
(907)943.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ELDON SUBONISION: LOT 6. BLOCK 2. Parcel ID: 016-202-31
A. WELL DATA
Well type PRIVATE BA, B. or C provide PWSIDN N A
Date Completed 4/11/77 Sanitary reel (Y/N)_M
Total depth 110 R Cased to 80 R
FROM WELL LOO
Date of test 4/11/77
Static water level 30 fL
Well production 15 g.p.m.
Wen Log (Y/N) YES
Casing height (above ground) 13 in.
AT INSPECTION
5/5/00
36 fL
5.8 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colon) 100 ml. CoftUmotceted
• ` n' OCrer bacteria—�colordes/100 ml.
g iyoUl
Data of sample; 5 11 01 by: AWWC. INC.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL Data installed 9/15/80
Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 5/5/2000 Pumper ROTOROOTER
C. ABSORPTION FIELD DATA
Date Installed 9/15/80 Sod rating .p.d ft'/bdrrn)125
Length 50 R. Width 5 1L
Sym type TRENCH
Gravel below pipe 4 ft.
Total depth r +/_ fL ER absorption area 400 fe Maftring tube YES Depression over field NO
Data of adequacy test 5/12/2000 Results (Pass/Fall) PASS For 3 bedrooms
Fluid depth in absorption field before test 3_5 In. Water added 639 gal. New depth 20.5 In.
Elapsed Time: 15 min. Final fluid depth 9_5 In. Absorption rate » 450+ g.pd.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN K yea. ghre date —
D. LIFT STATION
Date instalted Stze in gaOoro
"Pump on' level at—in.
E. SEPARATION DISTANCES
High water alarm level at In.
Cycles tested Meets alarm & circult requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tenIdUt station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption Held 5'+
Water main N/A Water service One 10'+ Surface water 100'+
Weis on adjacent lots aw
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Bulklft foundation 10'+ Water main N/A
Water service One 10'+ Surface water 100'+ Driveway, parldngNehlale storage 10'+
Curtain drain NONE KNOWN W911S on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I caMy that I have determined through field LrspecBons and
revlow of Munfdpal records that the above systems are in
conformence with MOA HAA guidelines In effect on this date.
Engineer s P Name JEFFREY A GARNESS
•
Date /ILIO �.i�o' ••......••'' �o
JD�ur...w�a
HAA Fees 300."3
Date of Payment 6—Ar-01
Receipt Number 415 92
Sw. 12W)
Walver Fee
Date of Payment
Receipt Number
MAY -18-01 07:22 FROM-
.- A&L CT&E Environmental Services Inc.
CT&E Rete
1012471001
Client Name
AK Water & Wastewater Consultants Inc.
Project NameN
Eldon S/D Lot 6, Bk 2
Client Sample ID
Eldon S/D Lot 6. BK 2
Matrix
Drinking Water
Ordered By
PWSID
0
Sample Remarks:
T-794 P.02/03 F-116
Client PO#
Printed DateMme 05/17/2001
Collected Date/Fime 05/11/2001
Received Date/Time 05/11/2001
Technical Direc_to-r, Stephen C.
Released Byr
AUowable Prep Analysis
Pammeta Results PQL Units Method Limits Date Dote Init
Waters Department
Nitrate -N 0.5000 0.500 Tn/L EPA300.0 (<10) 05/11101 SCL
Microbiology Laboratory
Ton] Coliform TNTC OB
V
W
co1/I00mL SM189222D
1
05/11/01 KAP
P6
MUNICIPALITY OF ANCHORAGE
\� "! DEPARTMENT OF HEALTH & HUMAN SERVICES a
Division of Environmental Services
_ On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
(907) 343A744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
Parcel I.D. # 016-202-31 HAA # 1�190!:�Q—� / -i
1. GENERAL INFORMATION
Complete legal description FLDON SUBDIVISION- Lor 6. BLOCK 2
Location (site address or directions) 710 PILL STRFEr
Mailingaddress 710 PILL STRFEr- ANCHORAGF, AK 99515
Lending agency
Mailing address
Day phone
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
3
XXX
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site xxx
Holding Tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
Ing to the legality and status of system.
72-025 (Rev. 1191) Fmnt MOA #21 Computer Version
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1400.00 at,
or prior to, closing for the engineering services provided.
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 andfor wastewater
disposal system is in compliance with all Municipal and State codes, ordinances, and regulations In effect
on the date of this inspection. / n
Name of Finn
Engineer's Signature
Phone (907)337-6179
Date
In conducting this evaluation, AIMNC, c aN,,pinptedlvL r de a thorough, conscientious engineering'analysis of the
system In accordance with ADEC an M A DHHS 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 focal soils condition, ground water levels that may fluctuate during the year, and the
usage of the family being served by the system. These conditions are outside the control C
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.
Aw=, Inc. can therefore not provide any warranty for future estimate of how long the
system will continue to meet the operational requirements of the ADEC or MOA DHHS.
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.
6. DHHS SIGNATURE
—kff- Approved for 3 bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
M
Date - .3/-60
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 order to 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 A10A 1721 Computer Version
Municipality of Anchorage RECEIVED
DEPARTMENT OF HEALTH & HUMAN SERVICEMY 30Mo
Environmental Services Division
L"
825 " Street, Rm 502 Anchorage, Alaska 99501 (907) �I rr r Ct-
'"PON 64"AL SEWJaS O
Health Authority Approval Checklist
Legal Description: ELDON SUBDMSION: LOT 6. BLOCK 2 Parcel I.D.: 016-202-31
A. WELL DATA
Wen Type PRIVATE HA. B, or C, attach ADEC letter. ADEC water system number N/A
Log present (Y/N) Y Date completed 4/11/77
Total depth 110' Cased to 80'+ Casing height (above ground) 13"
Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
FROM WELL LOG
Data of test 4/11/77
Static water level 30'
Wen production
WATER SAMPLE RESULTS:
AT INSPECTION
5/5/00
5.8 g.p.m.
Coliform 0 Nitrate 0.500 mg/L Other bacteria 0
Date of sample: 5/12/2000 Collected by: A.W.W.C., INC.
B. SEPTIC/HOLDING TANK DATA
Data installed 9/15/80 Tank size 1000 Number of Compartments _2 Cieanouts (YM) YES 1
Foundation cleanout (YM) YES Depression (Y/N) NO High water alarm (Y/N) N/A
Date of Pumping 5/5/2000 Pumper ROTOROOTER
C. ABSORPTION FIELD DATA [WATER WAS INTRODUCED INTO THE MONITORING TUBE.[
Date installed 9/15/80 Soil rating (g.p.dJtt2 or ft2/bdnn) 125 System type TRENCH
Length 50' Wtdth 5' Gravel thickness below pipe 4' Total depth 7' +/—
EffecBve absorption area 400 SQ FT Monitoring Tube present (YM) YES Depression over field (Y/N) NO
Date of adequacy test 5/12/2000 Results (Pass/Fall) PASS For 3 Bedrooms
Fluid depth in absorption held before test (In.). 3.5" Immediately after 639 gal. water added (In.): 20.5"
Fluid depth 9.5 (Ins) Minutes later. • 15 Absorption rete = 450+ GPD
Perowdde treatment (past 12 months) (Y/N) NONE KNOWN if yes, give data -----
72-M Mm. 31if3r Computer VNWM
D. LIFT STATION
Date Installed
Manhole/Access (v/N)
High water alarm k
size
level at*
'Datum
"Pump ofF level ar
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septidholding tank on lot 100'+ On adjacent kits 100'+
Absorption told on lot 100'+ On adjacent knits 100'+
Public sewer main
Public sewer manhole/cleanout N/A
Sewer/septic service line 25'+ Lift station N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 50+ Property line 5'+ Absorption field 5'+
Water ma►nlsery oe line 10'+ Surface water/dralnege 100'+ Wells on adjacent kits `93'+
• WR85-015
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property One 10'+ Building foundation 10'+ Water ma►n/seMce line 10'+
Surface water
Curtain drain _
F. ENGINEER'S CETMFI
I certify that I
of Munldpal
w116 MOA
Signature
Engineers Na
nsm S So 00
Driveway, paddngNehide storage area 10'+
inspedlons and review
Pens are /n conformance
Fs date.
HAA Fee S C-�QO ' t�
Date of Payment a� — o a
Receipt Number�76
n -M (Rev. 3=r CWWUtW v.mon
Wells on adjacent late 100'+
Walver Fee
Date of Payment
Receipt Number
ALASKA WATER F> WASTEWATER
CONSULTANTS, INC.
May 27, 2000
Municipality of Anchorage
DIII1S, On -Site Services Section
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Well and Septic System Evaluation at Eldon, Lot 6, Bk 2
To whom it may concern:
We inspected the subject well and septic system for the purpose of obtaining a municipal health
authority approval. The following is a summarization of our findings:
WELL: The static water level in the well was 36 feet below the top of the casing (BTC). Water
was pumped from the well at an average rate of 4.78 gpm for a total of 151 minutes (722
gallons). The maximum drawdown achieved was 47 feet BTC. Based upon this data, it was
determined that the well production exceeds the Af..O.A minimum requirements for a 3 bedroom
house (0.31 gallons per minute).
SEPTIC SYSTEM: Per MOA records, the existing septic system consists of a 1000 gallon steel
septic tank and a trench type drainfield. The trench is 50 feet long, 5-6 feet wide, and has an
effective depth of 48 inches. On 5/5/00 the sump was dry (only extends 43.75 inches below the
drainpipe invert). After adding only 95 gallons into the sump it was noted that the liquid level had
rose 50 inches, submerging the drainpipe under approximately 2 inches of water. The water was
shut off and the level only dropped 3 inches during a 2 hour period. Given the fact that the sump
was dry prior to starting the test, the functionality of the sump was questioned. The property
owner retained Stuart Gilbert to hand drive a steel monitoring tube into the trench.
On 5/12/00 the liquid level in the monitoring tube was 40.25 inches below the drainpipe invert.
Water was introduced into the MT. The first 95 gallons rose the liquid level 16 inches, and the
introduction of an additional 544 gallons (639 gallons total) caused further rise of 1 inch
(approximately 25 inches below the drainpipe invert). The recovery was monitored for 15
minutes and the liquid level dropped 11 inches. Based upon this data it was determined that the
absorption rate exceeds the MOA requirements for a 3 bedroom house (450 gallons per day).
6901 Debarr Road, Suite 2-13 • Anchorage, Alaska 99504
Ph: (907) 337.6179' Fax: (907) 338-3246' Website: akwwc.corn
If you have any questions, please contact us at 337-6179.
M.S.
6901 Dcbarr Road, Suite 2-13 " Anchorage, Alaska 99504
Ph: (907) 337-6179' Far: (907) 338-3246 • Website: akwwc.com
05-16-00 18:56 FROM -CTE ENVIRONIENTAL
Ah'. CUE Environmental Services Inc.
CUE Reftl
1002226001
Client Name
AKWater RWastewater Consultants fnc.
Project Namem
Eldon S/D Lot 6, Bk 2
Client Sample W
Eldon S/D Lot 6, BK 2
Matrix
Drinking Water
Ordered By
PWS1D
U
5615301 T-130 P.02/03 F-638
Client POD
Printed DatetThne
Collected DatcMme
Received Datelfime
Techalcal Direetor
05/16/2000 16:57
03/12/2000 11-30
05/12/2000 12:50
Stephen C. Ede
49-16�
Parameter ReaulTS POL Units Heth6d LiefisDle Date DateAnala
Data Inti
HATERS DEPT
Nitrate•a 0.500 u 0.300 ep/L EPA 300.0 10 INA 05/12/00 SCL
Wan LIB
Total Cottfore
a cot/1oomL Sn10 U2228
05/12/00 JDT
05/02/00 15:30 FAX
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I hereby ear lily That a far+ellJl LOt. G • B:oCk.�— - -•
Subdivision was made on _ �'�aq�G —_-- and
that the Improvements situated (hereon are within the property lines and
do not overlap or encroach on the properly lying adjacent therelo. that no -
improvements on property lying adjacent thereto encroach on the premises
in question and that there are no roadways, transmission lines or other
visible easements on said property except as indicated hereon, It Is the
responsibility OI the Owner 10 determine the existence of any easements.
covenants, or restrictions which do not appear on the recorded Subdivision
plat. Under no circumstances should any data hereon be used for
construction or for establishing boundary or lance lines.
nis `', d9yol �1•ay.._--
Dated St AnChorage. AISSka. l -.—_ — •--• .,_,
CONSTRUCTING ENGINEERS, INC. AS -BUILT SUBVEi
9601 Buddy Wemer Dr. a
Anchorage, Alaska &ale i am
316.2000 6949096
Z001
w/�Il •a�sa�•
eeyte•••••ae•�
N0.7062-5 �; Az
GO:
��
Sep:.'rr �•
le
N89--;`-g4E 40.00
Z
I hereby ear lily That a far+ellJl LOt. G • B:oCk.�— - -•
Subdivision was made on _ �'�aq�G —_-- and
that the Improvements situated (hereon are within the property lines and
do not overlap or encroach on the properly lying adjacent therelo. that no -
improvements on property lying adjacent thereto encroach on the premises
in question and that there are no roadways, transmission lines or other
visible easements on said property except as indicated hereon, It Is the
responsibility OI the Owner 10 determine the existence of any easements.
covenants, or restrictions which do not appear on the recorded Subdivision
plat. Under no circumstances should any data hereon be used for
construction or for establishing boundary or lance lines.
nis `', d9yol �1•ay.._--
Dated St AnChorage. AISSka. l -.—_ — •--• .,_,
CONSTRUCTING ENGINEERS, INC. AS -BUILT SUBVEi
9601 Buddy Wemer Dr. a
Anchorage, Alaska &ale i am
316.2000 6949096
Z001
w/�Il •a�sa�•
eeyte•••••ae•�
N0.7062-5 �; Az
GO:
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5. LEGAL DESCRIPcTION
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME
TIME
TIME
6. TYPEOF R SIDENCE
1
DATE
DATE
DATE
Two ❑ Five
MULTIPLE FAMILY
13 MULTIPLE
_ _ 1
INSPECTOR
INSPECTOR
INSPECTOR
MUNICIPALITY OF ANCHO&AGE
MUNICIPALITY OF ANCHORAGE DLP! OF P- _.;.I u
DEPARTMENT OF HEALTH 1k ENVIRONMENTAL PROTECTIRN/IgC`::dENL:L =..;;LECTION
S25 L Street . Anchorsge, Afasks 99601
OCT 291981
C*
ENVIRONMENTAL SANITATION DIVISION
Telephone 2644720 R EE CC E VV TIE
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FA�TL�ESD
DIRECTIONS: Complete all pans at page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPn,RTYOWN n •
PHONE
4
OhD1 SSS \ktd i vl
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
MAILING ADDRESS
PROPERTY RESIDENT I If different from above)
PHONE
`u
2. BUYER
PHONE
MAILING ADDRESS
3. LENDING INSTITUTION
PHONE
MAILING ADS.—RES
Tn�i
1
.
4. REALTOR/AGENT �
(\
ickm
PHONE �C
MAILING ADDRESS.
Sa
5. LEGAL DESCRIPcTION
Gid
STREET LOCATION
6. TYPEOF R SIDENCE
NUMBER OF,BEDROOMS
❑ One ❑ Four ❑ Other
SINGLE FAMILY
Two ❑ Five
MULTIPLE FAMILY
13 MULTIPLE
Three ❑ Six
7. WATER SUPPLY
INDIVIDUAL' '
ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ ' PUBLIC UTILITY
depth (attach log if available.)
S. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE"
YEAR ONSITE SYSTEM WAS INSTALLED.
❑ PUBLICUTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72 010 (Rev. 6/79) 14.>
rw lta-e ..9,,(
THIS SIDE FOR OFFICIAL USE ONLY '
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE GRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON-SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATEINSTALLED
INSTALLER
❑SepticTankor ❑Holding Tank
Size: If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL TO:
SepticlHolding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
LD---�APPROVED FOR -� BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE ♦
1 l0 1 0 `
BV
V
72010 (Rev. 6/79)