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Home My WebLink AboutMANN BLK 4 LT 4BMann Block 4 Lot 4B #020-041-16 i1 �1 WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological 6 Geophysical Surveys LOCATION OF WELL (Plea FO cOmPIa10 either 10, Its or Ia.) lo. Baraugn Subdivision Lot Block le. 1/4e111. ANGN MANN 484—of_of—of— Ic j DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS Sliest Address and Area of Wall Location 2. WELL LOG Foot as Burfe Material Type I Too a\eroY eRAt//y WF1 hefnv <PIAOP user At ;y ,Ir A 17L 11C S I (IPr'I rI?C tr'17t/nt .Sn•— Ii r; 1 Drilling Permit No. A.D.L. No. Section No. To.asnlp No I Range E0 Morldlon Bp wQ S. OWNER OF WELL: Address: IoW 4. WELL DEPTH: (final) S. DATE OF COMPLETION co _ Bottom--E2—ft' -� A• F I�l� - 4. B. ❑Cable tool Q. Rotary 0Driven 0Dug Auger [jJetted O Bored [3 Other: 13 7.USE: K❑ Domestic O Public Supply O Industry S Cj irrigation O Recharge O Commerical �y O Test wait D Other: S. CASING: C] Tnreoded Q Welded /q did-. C. In. to 1 ' fl. Depth Weight ti. 1_lbs./ diom. In. to_ 11. Depth Stic Yup fl. 9. FINISH OF WELL: Type! Diameter% Slot/Mash BIAe: Length: Set baleen ft and ft. Backfilling Gravel pact r 10. STATIC WATER LEVEL' t / ft. -4 /1 / ClAbove at Q Belo. land surface Date Equipment used: - /ri Is),yG i7 -- I1. PUMPING LEVEL beta. land surface and YIELD �t OFHc, r4S ft. after�Ors. pumping 9.p.m. 0l` _ft. after his. pumping_9.p.m. 12.GROUTING Well Grouted: O Yes Q No Material: ONeat Cement 00ther: IS. PUMP: (If available) HP Length of Drop Pipe ft. capacity 9 P.M. Subm. O Jet O Centrifical 0 Other 14. RE MARK S: —_--_— %.IIZ Llf i P(%N!1'1Nil I'R:'VJCLS Ig. WATER WELL CONTRACTOR'S CERTIFICATION: IS. Water Temperature 0 F ❑ C Tiis .sll rut drilled under my jurisdiction and this report Is true to the best of my knowledge and belief; .cl_L__v/>ilTi larf� 01N"UtWel A- Ir•11-n PTI --,-d Business Nome Controcl License Number Ad.", •.._1.5'..$� jz ._.fll�I.1J_7L1y�' rf-� t� A t•Il t I � !/ S,Yoed: l.' /f (lin 1/ /r) / :// Dote: i APl<l it Repro Nntalive Fa.m 02-WWP(91/31) COPY DntnOubon: WHITE •Sias DOGS,PINK - Driller, CANARY• CatlOmer PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: n MUNI I C I Fes- ni__ I TV Cif= n"CI -I-IC36ZnCGE= DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 C3"—E3 I T Q= 850076 03/29/85 WILLIAM D GILLIAM 12961 NORA DRIVE ANCHORAGE, AK 99515 345-6154 �^JELL 0=`�ftiM I T 3 SUBDIVISION: MANN LOT: 4 SECTION: 2 TOWNSHIP: 11N RANGE: 3W 45000 (SO..FT. OR ACRES) BLOCK: 4D I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. �. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. I will adhere to all MOA and State of Alaska requirements for the sett bac;<: distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. SIGNED /•' DATE: 1A/ ;t L_'L t�atr-s------- --------------- APPLICANT: 4JILLIAM D G LLIAM . ISSUED By -------------- -- ---=-'-`i ---e.W Q-- --- DATE: 3z> /K r.y W t rn \ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street . Anchorage, Alaska 99501 Telephone 264-0720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME /+ Wool" G1'W-k1+t-�- PHONE NEW LUPGRADE MAILING ADDRESS i 6 I Nora arrve_ A vlc',22ti, AK 4St 5 LEGAL DESCRIPTION Lo f- Lf B Flock 44 M An n Ce, . T II tJ fz3.-j LOCATION Luny NO. OF BEDROOMS 3 DISTANCE TO: Well PIo'I' i/1 Absorption area � Dwelling h0+f7 PERMIT NO. t" LL� tila/Ict DY a.Yi 7iC/4— n Q Manufacturer ^ Material Se I No. of compartments z W F Il n� to Liq. capacity in gallons 1000 IF HOMEMADE: Inside length Width Liquid depth Z DISTANCE TO: Well Dwelling PERMIT NO. d O _ Manufacturer Material Liquid capacity in gallons W= DISTANCE TO: Well r%0+ ivt- Foundati ne In Nearest lot line �3 PERMIT ryO. rw�d M Z No. of lines Lengtfsof ea h line ICC Total length pf lines Trench width Distance between lines 6 h?¢ 0 Z1D 3e'0 Inches Q h- Top of file to finish grade -�st D— ;` Material beneath tile TpL71 c�tiy' ab r t o »� f2 H p " O 6 inches � W Length Width Depth PEHMIT NO. l7 i f W LL Type of crib Crib diameter Crib depth Total effective absorption area Lu a DISTANCE TO: Well AA r Building foundation Nearest lot line Clas fw9 Depth v Driller Distance to lot line PEHMIT NO. Iv DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER �I �_1,� I . [ PIPE MATERIALS ��""..��111 SOIL TEST RA.TTIINSG_OQr/� / INSTALLER cr«e CX By /fFj 6 REMARKS E r)1eeT I 06S %9 aS i' C/ S d 76 b s 4t 7. t {fir' Kf_6 ars' Sts /or/l isn o ' �erJ _ Q hS�� RK�• I7vh ST"8 oz 5 a° t t rYls- m -4,r4.1 re 2-`/ d•rf M• Gc.J _ � Cr•edr-f- .i, enfY y.Vrn '�" 53'F � deJ VC 7A _ IV e jd of o APPHO ED DATE LEGAL t 26 lf Myo, R-013 (Rev. 3/781 1 _!MUNICIPALITY"OF ANCHORAGE Department (-7 Health and Environmental"!rotection 825 i Street, Anchorage, AK. �.4501 264-4720 Permit # * * * HANDWRITTEN PERMIT WELL AND ON-SITE SEWER PERMIT Applicant: CJl6emxi (rleelAM Mailing Address: I.P96( ffdRA DR. Location: IOCIM,p46_,1c , AK 99S Phone Number: 3 yS- 6 /5'q Legal Description: L Y-6 , ,d S/ , /f%/iyiy S12 Lot Size: ;Zz coo Type of Soil Absorption System Is: �n/G/i(/FEi('�O l%ES/G/V See/fffncl,�•,e.,F� Trench: .Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms:Soil Rating(sq.ft/br) o5286 U<oa.A . The Required Size of the Soil Absorption System Is: <SQ e CQes�S n 1 DEPTH LENGTH GRAVEL DEPTH WIDTH The length dimension is the length(in 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(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). * * REQUIRED SEPTICS TANK SIZE _ GALLONS 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. * *.* TWO(Z) INSPECTIONS ARE REQUIRED 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 is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 31-* 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 in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence ' .remodeled to include more that 3 bedrooms. Signed: Issued by: Applicant Date: y SWP/024 (1/81) &�tse;I,��«�h4 G�a�rx ALASKA ENVIRONWNTAL CONTROL SERVIC 1 INC. 120C West 33rd Avenue Suite B • ANCHORAGE, ALASKA 99503 Phone 561.5040 Joe n.114 B 9"J;.. �•., 1..,ky L +4R SHEET NO. /^ 1 Or 1 CALCULATED BY D"' q "'q DATE *!A'I+ CHECKED BY SCALE I . , C • DATE t yr I_'_ I=I— ! 1 I 7-i- ' S`3 ! ..12 3 2 _1 s; s 61 1 I P.la< ! '.w;I,C_.., F..r._Y-ri .irt.Y. �xJrT!J00_Dr_ I I I I Ie I..D..--PI,-<h is•esa^I< - { •i+.}�,_!._S.i7a�a. •i Y`tl I �- I I �—�— { 1 I I 1 it S I i I I I !� I I I — Ir i Ti, 1 � I i I I' ! i � i� ! I i ! 1 ! b•f.. ALASKA ENVIRONUFNTAL CONTROL SERVIC ', INC. 1230 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 561.5040 MAnn $7,dJ:v.7/•q E/es% Lafy� JOB Y $MEET NO. OF 2 - CALCULATED BY D<ir •7 DATE aH�(}• It,/Q�/- CMECRED BY DATE SCALE N 1 i _� _�. r— ! � Ir,/ / rte,_— - —'--• 1 T' I i I I I waAeite�- �1u ♦.a�.- O<l i ' I '~ I �-I I I I i i I I I—•-- �—I �– I—� !— I i-----: iI 1 —�_,—r _Dn—j�r./�daed•7/�a4_�'�i�rl 1or15•»a� i ITIi IIT I I � _ —' /.'ra ��.r9 /'__1.'7{1!—T_✓^""I I�..r. 'w�i _ ! fSe �'/� _-C 7�� _y i I I I 1� ; OF A%%I I No —�_4 •• NNS -yw� I _.._._� - I.__. L-�_. I —.-_1 _. _ _ I _�— �._� i—�.— —1 L•`C �.. roy.. L' _geld, Jr� :��,r----'---�---.—,_.-�.—.. ' ' ` I_ !� �+ '• ND. 2251•& ,: \�a:l I I I I i I _--��_ i i. �—�'----r- 4 � I q PROFESS\� i• �wlNrls, w.a w .. .• T1 JCTLt1< carY SOILS LOG MUNICIPALITY OF ANCHORAGE /• DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 7 PERCOLATION 825 L. Street, Anchorage, Alaska 99501 2644720 TEST \ " SOILS LOG — PERCOLATION TEST PERFORMED FOR: I% C44 1 kmt DATE PERFORMED: A4I satjq / S y LEGAL DESCRIPTION:Mann S„ Aiyi slei bloc -V Lat- 4,B 1 4 -L EP n SLOPE SITE PLAN P4 P ltt1:1 1 1 2 pnL. ♦� Ik 3 GM Eruw,n t�tf,� swndy `1^"�t 4 7 8 9 10 11 12 13 14 15 16 17 18 19 WAS GROUND WATER S ENCOUNTERED? �� S L O (' on 8-114-811E IFYES,ATWHAT DEPTH? R"eL:w oort hr.l. Reading Date Gross Net Depth to Net Time Time Water Drop / a� /y ar -4 td - IYs- io 376 day - 9rr /o S'Y •oz 9YT 3 Ioor /0 s loos- —— 63 h /ot1- /0 .03 to,r - (,S - /o:r /0 63 03 20/02r — bi - PERC6LATION RATE yi 10 S s— /o (minutes/inch) 03 t, TEST RUN BETWEEN `� FT AND 3 r_ FT PER FORM E D BY: 7> MOA iT Aq 0'2q CERTIFIED BY: DATE: O 72.009 (6/79) MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-041-16 Legal description MANN BLK 4 LT 4B Site address 16334 LUNA ST Expiration Date: 10/29/23 Current property owner(s) DESAI SAARANSH RAKESH &SETH NAINY X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: By: k'15i gid Original Certificate Date: 7/29/23 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE O A—, Development Services Department 14 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 020-041-16 Complete legal description MANN BLOCK 4 LOT 413 Location (site address) 16334 LUNA ST ANCHORAGE, AK 99516 Current property owner(s) DESAI SAARANSH RAKESH Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ® Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Z �0 Waiver Fee $ Date of Payment 7*2� AZa Date of Payment COSA # V S C z- 3/ Z S J Waiver # COSA Application.doc COSA Checklist WELL ONLY.docx COSA Checklist Legal Description: MANN BLOCK 4 LOT 4B Parcel ID: 02004116 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 4/5/1985 Total depth 187 ft Cased to 18.5* ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 7/12/2023 Static water level at beginning of test 46 ft. Well production at time of test 4.5+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 7/12/2023 Comments _*CASED INTO BEDROCK_________________________________________________________ B. TANK DATA – PUBLIC SEWER Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA - PUBLIC SEWER Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: COSA Checklist WELL ONLY.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No NA ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No NA ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS FYI – there was only 1 dog on the adjacent property & is not considered an animal containment area. G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 7/19/23 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 7/19/23 • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Q A F E N p�9 � �� Certificate of On -Site Systems Approval �`6� U 149 — o ti Parcel I.D. 05A-1 5 Expiration Date: I- 1. 1. GENERAL INFORMATION: Complete legal description MANN; BLOCK 4, LOT 4B Location (site address) 16334 Luna Street *Anchorage Current Property owner(s) John Wetherby Day phone 907-244-7437 Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer WaiverNariance request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 55b Waiver Fee $ Date of Payment It 116710 Date of Payment Receipt Number aaGM Receipt Number COSA # 05X1 Q l55 1 Waiver # X1 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. • • , Name of Firm: Garness Enaineerina Group, Ltd (GEG) Phone: 907=337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 1 oap0r0-0��0 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the QQ155, /� O evaluation. Separation distances were measured to readily identifiable features. Hidden defects or 4g T OO encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, ""' .. ... "''""""""'Q groundwater levels (that may fluctuate during the year), quality of construction (materials and Q workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the Je f y ness system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of �O CE -795 the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to rofessl°�°oma perform the evaluation. Reliance upon the information provided in this report by any other person or �D�O�OpOd party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD/SIGNATURE I/ System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: 7% a.-i� fs1(.ls- .r'N ri, a lnli )1'4um r -S-' ra' -ho an a0na( rrfar'✓ meA f- rarr-n, .�P�ini=hcn Gr an an r/Ial ��i"air7►til�nfi ar , tsar c i5 i�tafi i con In y or morn By: Original Certificate Date: /( 2 The Municipality of Ano/,age 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 Adv cry.• �: � Septic System Advisory Arsenic Adv* isor_X r Well Flow Advisory Other < ~ 4,4 3 3... '.. COSA blue sheet 10-10-12.doc COSA Checklist Legal Description: MANN; BLOCK 4, LOT 4B If more than 1 septic system on lot: COSA Checklist # A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 4/5/85 Total depth 187 ft Cased to 18.5 ft ■❑ Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 11/1/19 Static water level at beginning of test 47.8 ft. Comments CASED TO BEDROCK B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (m Measured depth to pipe invert from grade ❑ N/A — pressurized field (min) F-1 Monitor tubes go to bottom of ctive. If not, state depth into effective ❑ Code -required soil c r over field ❑ System presoa (Required if va t for greater than 30 days prior to date of tes Gall s introduced gallons Co ents/Deficiencies: COSA Checklist yellow sheet of Parcel ID: Structure served by this system 1 020-041-16 Well production at time of test 6.4.+ gpm Water storage tank volume NSA gallons Well disinfected for coliform test? ❑ Yes ❑■ Nc 0 Coliform bacteria is Negative Nitrate mg/L [�itrate less than MRL (ND) Arsenic ug/L VArsenic less than MRL (ND) Collected by Date of Sample 10/31/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: J% ��quacy test date Results L) Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date a!; E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' NSA Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft✓❑ Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' ✓❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No NSA ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Private Wells > 100' Animal Containment > 50' ❑ Yes if No *1 ft ❑✓ Yes if No ft ft Communit Is > 200' ❑ Yes if No ft Water Service Line > 10' Manure/Animal Excreta Storage > 100' if No Community Sewer Main > 75' ✓❑ Yes if No ft F/I Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) 1 "vim q Building Foundations > 10' ❑Yes if No ft Surface Water > 100' El if No ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: if No ft Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Communit Is > 200' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If s tank is under driveway comment below From Absorption Field on Lot to: (Please enter dista Building Foundation > 10' ❑ Yes ft Property Line > 10' es if No ft Water Main > 10' ❑ Yes if No ft Water Se • e Line > 10' ❑ Yes if No ft rface Water > 100' ❑Yes if No ft less than required) If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft F. ENGINEER'S COMMENTS *WELL IS RIGHT BESIDE FENCE THAT APEARS TO BE A DOG RUN G. ENGINEER'S CERTIFICATION o G. S I certify that / have determined through field inspections and review �O of Municipal records that the above systems are in conformance withp TH P MOA COSH guidelines in effect on this date. g .:......4.n ...........:.*. COSA Checklist yellow sheet .... Je fr Gayness.• n9• E--79 T3 .• �� l o rofessto� o #AECC884 r N vP`LiA ` •-1'9S�p 49TH c Kon offman,- o Of- Un`nL"iJLO a�'G c °fessior<61=cam LOT 3A I LOT 4A N90'00'00"W 300.00' I i 0 0 0l -I C4 I 28.1 o �I Q rn 2X C OD LOT 3B D � LOT 4B o m � m z c� -I I S 28.1 I rn 22.2 I ai GARAGE I '- 22.2 0 `x— 6 32.9 I x w O Is=&& `96j Am LAND & GONS rnUCIION SUitVEYORS—PLANNERS—ENf INE�RS 440 West Benson Boulevard, Suite 200 Phone: 562-5291 Anchors a Alaska 99503 Fax: 561-6626 Date: June 18, 2009 iDrown By. CB Work order: 2009L86 lChecked a.y. JMZ N90'00'00"E 300.00' 164TH AVENUE (152ND AVENUE) Ordered BY Rick Barrier Legal Description: AS -BUILT S_BUILT Lot 4B, Block 4, Legend: Mann Subdivision Septic Stondpipe0 ?lot: 65-125 Scale: 1 "=40' water Well Fence—X—X- 3rld: 3238 Ref: 20051-199 FB 745/22 ved 4.4 30' NOTE: THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LANTECH. SURVEY CER7IFICATiON: LANTECH has conducted a physical survey of the property as shown on this drowing and certifies that the improvements situated thereon are within the property lines and no encroachments exist ,halt; :c;€ other than noted. 'ick EXCLUSIONARY NOTE: It Is the owners' responsibility to determine the existence of any easements, covenants, restrictions or right—of—way fiang takings which do not appear an the recorded subdivision plat. Under eck no circumstances should any data hereon be used for construction, for establishing property lines, or for plot—plan purposes. Municipality og iilitf Anchorage : -- --� DavelOpmEnt Services Department s Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. oc20-6t-ll-Ir10 COSAff Cg0QQS? 1. GENERAL INFORMATION Expiration Date: / (9 - / O - O Complete legal description MANN S/D: BLOCK 4, LOT 48 Community Class Well ❑ Location (site address) 16334 LUNA STREET • ANCHORAGE. AK + 99516 Current Property owner(s) RICHARD BARRIER Day phone 250-5698 Mailing address 16334 LUNA STREET ► ANCHORAGE. AK + 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing address 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 0 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 SY 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 applicalion, 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. Phone 337-6179 Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date % 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 ofthe test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for _4- bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report 11l1 1 L,.1 1 1-1 \ PROGRAM Nitrate Advisory � 4 Other q By: (,(/r p �_ Original Certificate Date: 7 — 0 — 0 1 (Rev. 11M) Municipality of Anchorage Development Services Department Building Safety Division �— On -Site Water & Wastewater Program ' 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST 2 Legal Description: MANN S/0: BLOCK 4, LOT 4B ParcellD:�O�Olil'l� A. WELL DATA *TO BEDROCK Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 4/5/1985 Sanitary seat (Y/N) YES Total depth 187 ft. Cased to '18.5 ft. FROM WELL LOG Date of test 4/5/1985 Static water level 35 ft. Well production 25 g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml Arsenic: (Jug./L. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size gal. Number of Compartments Foundation cleanout (Y/N) Date of pumping C. ABSORPTION FIELD DATA Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ In. AT INSPECTION 6/15/2009 48 - ft. 4.36 g.p.m. Nitrate • V CJ mg./L. Other bacteria 0colonies/100 ml. Date of sample: 6/15/2009 Collected by: GEG Ltd. Depression over tank (YIN) Pumper PUBLIC SEWER Date installed. Cleanouts(Y/N) High water alarm Date Installed Soil rating (g.p.d.lft'or ft'/bd System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorptio ea_ ft' Monitoring tube_ Depression over field Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in abso i n field before test _ in. Water added _gal. New depth _in. Elapsed e: _ min. Final fluid depth_ in. Absorption rate >= g.p.d. y rejuvenation treatment (past 12 mo.) (YM & 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 High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot NSA On adjacent lots 100'+ Absorption field on lot NSA On adjacent lots 100'+ Public sewer main 75'+Public sewer manhole/cleanout 100'+ Sewer /septic service line 25'+ Holding tank NSA Animal containment areas '6. Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Property line Absorption field_ Water main Water service line Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION Property line . Water service m drain F. COMMENTS G. ENGINEER'S CERTIFICATION Surface water Wells on adjacent lots TO: PUBLIC SEWER Water main Driveway, parking/vehicle storage I certify that I have determined through field inspections and p ! I4 1 ! vo review of Municipal records that the above systems are in 0""" """" conformance with MOA COSA guidelines in effect on this I date. ' J f y A... a essr ... 0 Engineers Printed Name JEFFREY A. GARNESS �Q a CE -753 Date 1=— COSA Fee 5 y 9 0 Date of Payment T% 01 Receipt Number O N 0 4 0 3 (Rev. 11105) i Waiver Fee $ Date of Payment Receipt Number DATE SCHEDULED I- TIME os- d- INSPECTOR 14K4 - SUBDIVISION MANN BLOCK/LOTITRACTBLK 4 LT 4B IN ICATE NORTH J7i 14 .r •0b V 9 J o J ° G � C. J SIZE MAIN: TYPE MAIN: DEPTAT MAINq: AT PROP. LINE: ( Q CONNECT LOCATION: (� (� �� COMMENTS: S/ / �� RC1[• C O INSPECTED BY: DATE: iD 3 6 S ADW (� A oqh O (N N O m^;ma W N I N N !D N U � OUi O Ln N F O, ' 0f Z p> � N W W r D O D Z Z c c F- - U m c O ,;A n / r VI O -'L a.•: o Qno "0q0 ol1G w »may _s »�w0 "d - O Y y 1 0 r O —I W W L2'617l 3„00,£O.00S ,0£ 1NROSV3 ),iniln ,Ol ---------------------------- z �I o 4�1 o —I T_ o m Z C m O \ 0'84 3SnoH FO o oNUSix3 0 16.9 0'94 45.9 2%a” .x 6'SZ 6.0 n 4.0 A N N !. M w 26.9 D 14 r .. mss..• ,0£ z 0 0 O (5 O L4 O O O ,L2'6t, L M„OO,CO.00N C., W O O 1332J1S VN n <ilyii a�O1 ": m I o N :h m r m ; C I V sO. N nI o QC•J �^ O N X ; y om I g� 113, m 7. Oo r O —I W W L2'617l 3„00,£O.00S ,0£ 1NROSV3 ),iniln ,Ol ---------------------------- z �I o 4�1 o —I T_ o m Z C m O \ 0'84 3SnoH FO o oNUSix3 0 16.9 0'94 45.9 2%a” .x 6'SZ 6.0 n 4.0 A N N !. 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AWWU Plan set No. $082 1 rd02%283 to �j` 11 m T r•.:: [ [ jiji• o .1 ; c .! tt ,�jO+sO}eF'() p` I� 4—P r IQ R62./B(lR) /l 1 I.n� 0 In a> I ' 1� I � I I I►>r I' Its I � R Ij I I � O I lI %J Ij� 18a I O 6-1 I II°� I pyo r l IF. N i V ~ .... L�J L 1 I g L I b Oi I y I I a I II j9 0 1 I IIIA O� I� •Is f II �"I �t 151 cl(n)5�� CJI Imo• � ; I ��n � I wi�iv�nruiuuu.� • YbYikliMli�ii.. ii i.. �. AWWU Plan set No. $082 1 rd02%283 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH 8 HUMAN SERVICES Division of Environmental Services On-Site Services Section . A - P.O. Box 196650 'Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# Oao —o~f ,t 6 HAA#CIA'11k5 1. GENERAL INFORMATION Complete legal description Lot 413, Block 4, Mann Subdivision Location (site address or directions) Luna Street Property owner -'Martha Gilliam Day phone Wendy/563-4858 101 Winchester Drive, Ocean Spring, Mississippi -39564 Mailing address. -• Lending agency Day phone Mailing address Agent The Real Estate Co./Wendy Micowski Day phone Address4155 Centre Tudor Dr., Suite 204, Anchorage, AK 99508 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF -WATER SUPPLY: Individual well XXX Community well Public water 563-4858 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: XXX Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025M".1191) front M0A,21 5. C� M_ STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone 6� — °� q 7�% ago Kaver LOCP nad Address Eaete River. Alaska 99577 , Engineer's signature DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for c Additional Comments • Date z//as/`c) y \'RCBERT G COVJAN ec cE-esoi It %;•� ..; bedrooms, with the following stipulations: M Date 12-2-9"00 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 engineers work. 72-M (A..1191( Back MOA 121 ECEIVE� Municipality of Anchorage APR 28 1999 DEPARTMENT OF HEALTH & HUMAN SE airy cw AhK-w'.Ao, Environmental Services Division 'u SERVCAS oms 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: LO r q6 R Lo c t< y M*rrN SID Parcel I.D.: O � c-,, — o '{ / — I (,, A. WELL DATA Well type PR , v 4 T E If A. B, or C, attach ADEC letter. ADEC water system number Log present &N) Y f, S Data completed 4 S/ S S' Total depth ) `a 9 r Cased to fa 'Ltl. R. Casing height (above ground) r ,4 Sanitary seal O/N) Y E I FROM WELL LOG Date of test 141 s / V S - Static water level 3s - Well S Well production a i g"p.m, WATER SAMPLE RESULTS: Net con. tc rte _ Wires properly protected (YM) +v o d.. s 4. AT INSPECTION a I I el cl 3a 7. S t g.p.m. x Q 07a,cria 13y Mn A Coliform 0 / Nitrate 0. S Other bacteria 0 Date of sample: 413 /91 4 Collected by: S & S ENGINEERING B. SEPTIWHOLDINO TANK DATA Eayla Rl"r, Alaska 99577 Date Installed /� / S y Tank size ) 0 0 0 Number of Compartments Cleanouts &/N) YEI N 0 Foundation cleanout (YM) F0 v-94 114,4 Depression (Y60 N 0 High water alarm (Y/Q N 0 r v544 Date of Pumping NSA +r Pumper C. ABSORPTION FIELD DATA Data Installed Soil rating (g.p.dJIN or a 0 System type Q 0 Length r Width - r Gravel thickness below pipe 0 • S Total depth y 1).13* )ll ( f`t'� ,'tf. A"O,tr) Effective absorption area Monitoring Tube present &N)N E If Depression over field (Ye N 0 Date of adequacy test 345129 5129 Resutts�Fail) PA s I For 3 bedrooms Fluid depth In absorption field before test (in.); Day Immediately afterS63 gal, water added (in.): _ Fluid depth U ^ y (ins) Minutes later: ) `1 Absorption rate = y 6-0 + c.p.d. Peroxide treatment (past 12 months) (Y/N) N 0,+4. kJ 0 w A/ If yes, give date 72-026 (Rev. 3196)' 0. LIFT STATION Data Installed — Manhole/Access (Y/N) High water alarm level 'Datum Size In gallons at. "Pump otr level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /00 On adjacent lots /00 Absorption field on lot /00 On adjacent lots /00 -f Public sewer main V /,# Public sewer manhole/cleanout Sewer /septic service line /0a '4 Lift station .4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Property line 0 -t- Absorption field S, 4 f-0 7- /00 4 Water main/service line ___L&_Surface watBr/drainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 4 Building foundation 11 a 7- 1 W Water main/servios line Surface water Driveway, parldngtvehide storage area Curtain drain 0 o x J 0 ta Wells on adjacent lots )00 + F. ENGINEER'S CERTIFICATION I cer* that I have determined thru field inspections and review of Municipal records are in conformance with MOA guidegas in effed on this date. ............ :711 Signature Enginear'sName R4,0#47 - C. CO AN Date E - 80^01 HAA Fee S Waiver Fee $ Data of Payment 41 A-7 Date of Payment Receipt Number,�7-,I/,?,,� -7 Receipt Number 72-026 (Rev. V96Y