HomeMy WebLinkAboutGREAT LAND ESTATES #3 BLK 5 LT 6Onsite File
Municipality of Anchorage Page of --Z=
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ��Jq t b I S!�j PID Number: oS 11 Z2 O
Name: Slk�l L� M. t,
Wastewater System: ew ❑ Upgrade
Address :�O (p -q- I (A 34_
ABSORPTION FIELD
Phone: ^ `
L'
No. of B room$:
-Deep Trench E3 Shallow Trench ❑ Bed 13 Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating: i7
(• ZGPD/S
Total Depth from original rade: f
Ft
.45
Lot: Block: f S bdlvi$.on:
L�
Depth to pipe bottom from original grade
f5
Gravel depth beneath pipe
4
YxzA
Ft
Ft
Township:
Range:
Section:
Fill added above original Grade:
Gravel length: / - r
U)
n
Q/— • Ft
(t3 Ft
WELL: = New ❑ Upgrade
Gravet8eptic wiDTN
Number of lines:
I
Ootance between lines:
Ft
— Ft
Cls kation (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Rpe metenal:f15 lO
_
FL
Ft.
O FI
i
Driller.i�
bete Drilled:
Stator Wafer Laval:
Installer.
Date Installed:
Ft.
yield:Pump
set
Casing Height Above Ground:
TANK
GPM
Ft.
Ft
SEPARATION DISTANCES
eptic ❑Holding 0S.T.E.P.
To
septic
Absorplion
Uh
Holdnp bI1UPrivale
Man lacturer:
Capacity In gallons: ,
From
Tank
field
station
Tank Sewer Llnr
Well
�-- W
1 �_
Material:
Number of Compartments:
Surface(fir+
i _^f�
—
•�_
LIFT STATIO
wattererW
LotIDI
101�
Size in gallons:
Manufacturer.
Line
Foundation
' (
�0 y
..i
"Pump on' level at:
p off' levet at: 7777er
alarm at:
Curtain
10 IV�
iUCAVO
/l, (00
Pump Make el
Electrical Inspection;performed by:
Drain
Remarks:
BENCH MARK
Location and Description:
01;� C1 1
Assumed Elevation:
40111, 4F% L
t
.y55l0%,e • •` • s�'�
% '
* `
49THt
Inspections performed by:io
2nd 0 —11(41
m
It k ' �r w
e"l,\���i:��rj
Department of He rad uman Se es approval
+..• .•'
P~�
Reviewed and approved by: Datep
72-013 (1/91) MOA 25
Permit No. Page of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: .0:j1 QTY— 1.7. L:r(, PID No.: OS f 1 :3�S
7 i�tp�V Ad 57
tats IA1 "�y :.W • v� 1�a
�,�: ; X57
X19 .
SCALti 1 10' y_ 15s2 )JO WaT.,2.
64' -r0; ktr e+14 r-'.
N
too
Ira
WaW t250 4M, WgW -f1aNLg 03' IoW
P to
0V
' �P1••t�+4.g••s��lr
: 49TH
9�IRMCRI 1AFEK P.E.
AW
OFESi*
72-017 A (MI) MOA 25
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMI
PAGE 1 OF
TZD Pm
17-/Q-,71
SSS Enc,
PERMIT NUMBER:SW910159 DATE ISSUED: 6/18/91
DESIGN ENGINEER:S & S ENGINEERS EXPIRATION DATE: 6/18/92
OWNER NAME:CLARSON SHEILA M
OWNER ADDRESS:PO BOX 671634
CHUGIAK, AK 99567
PARCEL ID:05113305
LEGAL DESCRIPTION: GREAT LAND ESTATES 43 BLK 5 L6
SEC 10, T15N, R1W, SM
LOT SIZE: 105415 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT; 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RENEWAL OF
RECEIVED BY
�1�/L
DATE
DATE•
Municipality of Anchorage
Department of Health and Human Services
Tom Fink. 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
January 8, 1991
Sheila Clarson
HC 83 Box 2297
Eagle River, Alaska 99577
Subject: Lot 6 Block 5 Greatland Estates Subdivision
Permit #900345, PID #051-133-05
The subject permit, issued by this office for a single family
well and/or on-site wastewater system has expired as of December
31, 1990.
A new permit must be obtained from this office for a well and/or
on-site wastewater system not installed by the expiration date.
If you have drilled the well, a well log needs to be sent to
this office for documentation of the installation and to close
the permit.
If a private engineer inspected the installation of the on-site
wastewater system, the original as -built inspection report
(three-part form) must be sent to this office for review,
approval and documentation. 'All inspection reports must be
submitted within 30 days of -construction completion.
When applying for a new permit, the fees are: $90.00 for an
on-site wastewater permit; $50.00 for a well permit; $140.00 for
a combined on-site wastewater and well permit.
If you have any questi ns, please call this office at 343-4744.
Si4ergly, D
fin Smith(,JP.E.
ogram Ma ager
-site Services
JW/ljm:200
enc: Copy of Permit
"Kids Are Our Future"
N U N 1 U 1 P A L I T Y O F A N C H 0 R A 0 E
Department of Health & Human Services
825 L Street, Anchorage, Alaska 99501 343--4720
0 1'1 - S I T E SEWER &< WELL PERMIT
Permit Number: 900345 `�'-�-���- 3LA. L
Date Issued: 10/23/90 Engineer Designed
ONnor Name: SHEILA CLARSON
Uuna�r fiddrows: HC fl3 BOX 2297
EAGLE RIVER, An V9577
Day Phone:
696-37713
Parcel Id: 051-133-05
[no Legal: Subdivision: GREATLAND ESTATES 93 Lot: 6 Block: 5
Section: 10 Township: 15N Range: 01
Lot Si: e 10541.5 (sq, ft. or acres)
Hv� Dedrooms: This Permit.: 4 Total Capacity: 4
SCPTIC TANK: Minimum total septic tank: capacity: 1,250 gallon,. Each septic
tank must have at least 2 compartments. Depth to top of septic tanks) < 4.0
feat requires insulation over tank(s).
WELL.: Log must be submitted to Municipality of Anchorage Department of Health
and Human Services within 30 days of well completion.
THIS PERMIT EXPIRES 12/31/90 AND VALID FOR A SINGLE FAMILY HOME.
C0114';TRUCT PER ENGINEER'S ATTACHED DESIGN.
I1"IfOR1'1 D.H.H.S. PRIOR TO INSPECTIONS BY ENGINEER, IF AFTER
UnrICE HOURS, CALL 343-4601 AND LEAVE A MESSAGE.
I CERTIFY THAT:
1. 1 am familiar with thn 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 codpa and regulations,
and in compliance with the design criteria of this permit.
n. I will adheres to all MOA and State of Alaska requirements for the set back:
dioLance5 from any existing well, wastewater disposal system or public
_o"Prage system on this or any adjacent or nearby lot.
1 undorstznd that this permit is valid for a maximum of 4 bedrooms. I
vlsn understand that the capacity of the total system is 4 bedrooms and
any enlargement will require an additional permit.
Signed: �14----•-------•----- DATE
(Owner) SH''LA CLAR'ON
Issued Ely: 20_ _1y DATE .�23—
Octobea 16, 1990
ROBERT SHAFER, P.E.
ROGERSHAFER
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
HEALTHAUTHORITY
APPROVALS
Mun4eL at ty oS Anchoaa e
DEPARTMENT OF HEALTH AND HUMAN SERVICES
825 L Staeet
P.O. Box 196650
Anchoaage, Ataska 99519-6650
SEWER&WATER
MAIN EXTENSIONS
REFERENCE: Lot 6; Stock 5; Gaeattand Eatatea 03
PERMIT REQUEST NARRATIVE
SEWER & WATER
INSPECTION
Due to the taage tot size and existing wet£ and septic tocation6 .in the
immediate aaea o6 the ae6eaenced paopeAty we cannot 6oasee any
"paobabte" .impacts to adjacent paope-ties as a aeautt o6 the
.instattation o6 the paopoaed wett and septic systema.
ENGINEERING STUDIES
AND REPORTS
We beet the paopoaed welt and septic design is the beat boa this
paope2ty and wi,tt .impact adjacent paopentiea the teaat because o6 the
6ottow.ing aeaaon6:
WELL INSPECTION
1. With the paopoaed weft in the southwest poation o6 the paopeaty
a PLOW TEST
,it wilt attow the moat septic aaea on the paopeaty without a66ecting
any o6 the neighboaing aeaeave aaeaa because o6 the Location o6 the
neighboaing wetta.
SITE PLANS
2. The paoposed septic system .is toca.ted baa away 6aom the cheek
along the noath paopehty tine and moae than 50 it. 6 -tom a stope
change gaeatea than 25% atteviati.ng potentia£ boa caeek
contamination.
ROAD DESIGN
3. paopoaed taenchea bottow the contoua o6 the atight atope
which
whicexists•
4• The aaea daainage Witt aemain vi4tuatty unchanged. Sua6ace
SOIL TEST
daa.inage 6aom the wet£ and septic Witt not be a paobtem since both
ase on the highea pottion 06 the paopertty.
PERCOLATION;77' TEST
/
ERT A. SHAFER, P.E.
STRUCTURAL&
MECHANICAL/gm
INSPECTIONS WRIJ
ONSITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
e ' " Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR:DATE
LEGAL DESCRIPTION:A..±Zt/_5j_�v_s (a� C,,:W+ nshlp, Range, Section:
1 /
2-
3 /
4-
5
5 �0
s 0.
8
7-
8-
9-
to -
12
8 9to 12 "a
13-
14-
15-
16-
17-
18-
19-
20
3 14 151617181920
COMMENTS
ML
UP / L►I�Nr sl I_r
50VA
WAS GROUND WATER I O
ENCOUNTERED?
S
1 L
T WHAT N/k P V FST
E
a After
— Dile, to- 12.14 o
IF YES, A
DEPTH?
Depth III Wa
tllonitainp?
vim.......
3tobeve A. She1.e• 't
No. 1457.E
PLAN
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
NsvG
R�Se
4 MRs
L4! ro
S
Z
- z. .
aH4N
5-00A415
7 •
9
le�
0444
5 t<e
PERCOLATION RATE ZY (minutes/inch) PERC HOLE DIAMETER
l.a
TEST RUN BETWEEN FT AND S FT
PERFORMED BY:17034 Egg 113skr9' Road No. 204 CERTIFY IS TEST WAS PERFORMED IN
Eyle Ivor, J
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELI IN FECT ON THIS DATE. DATE:
72-008 (Rev. 4165)
a v Municipality of Anchorage
DEPARTMENT OF HEALTH S HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: Si.yn+Pue..t. Co,4L-r"rmoia DATE PER
LEGAL DESCRIPTION: Ltyr.6 5 y S, (ytu,,„rL4,%., j5,r"nship, Range, Section: -r,.7 ,I ,RI�eJ 'Fee_ I D
el noc mac D. aei
1
2-
3-/ 3 /
0'
4-
5- 0
6-
7
7 G
8-
9-
10-' 910 '
11
12-/..t
G,
13-
0
14-
15-
16-
17-
18-
19-
20
4151617181920
COMMENTS
%tPIwt-Hr SeL:r
2 wpr 4
BoH
WAS GROUND WATER
ENCOUNTERED? �t:1
S
T WHAT rill O L +1
P
E
er After
—Date: 11) -IL oto
IF YES, A
DEPTH?
Depth m Wet
Monitoring?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
>roR—
L
T
1
to -ti
Zsrt.•
Z.
�- s. -'.a
'SnN...s
Soru,.�
t g•
.,$ r r
4
1 a-1 v
5-:) .w,.y
O r�
t
Z,•
S
o ."r a
a
t •
Z
�N
PERCOLATION RATE (mmutevmch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND S FT
S 8 S ENGINEtKINLV I
PERFORMED BY�70,1 p {River
mop
THAT THIS T ST WAS PERFORMED IN
ACCORDANCEMORI ACCegik4VMc) zwclPAL GUIDE IN ECT ON THIS DATE. DATE:
72-M (Rev. 4,85)
lig
r' V f ll -
m
(D ��t.cPE taLG-SOS 29`�,� �,}('/
-4P
voske, v CfAliw-AA,.
Guth � I.2 G�/may.
=-�v
\ b�
r
t
C�rx#ifi�d ��tllin�g ��u
h 1ECEIVED
DOC Co. oua
SULLIVAN WATER WELLS JUL 91992
P.O. BOX 670272, CHUGIAK, ALASKA 99567 a TELEPHONE 998.27Municipality of Anchorage
Vept. Health & Human Services
OWNER OF LAND .���! DEPTH 01: DELL 36,q
ADDRESS _(� T � - C t/J /.,-aC STATIC LEVEL OF WATER FL Ia n
LEGAL DESCRIPTIO A(xf 0 t;74 AW DOWN FT.
DATE - Started Ended �9.2 GALS. PER HR 3
PERMIT NUMBER / KIND OF CASING. G1
KIND OF FORMATION:
FromFt. to (—F1._r. 41'62f- S i rr J From Ft. to Ft
From ' Ft. toFt. Oyc.-^ 6 i P /19: )
From
Ft. to
Ft.
From—* --Ft. to_Lf___Ft. YdIJ 6 4,eA✓e- C Cq$b4f nt
Ft. to
Ft.
/S
From-AL_Ft.to/ 14 Ft. �f i ij �
From
Ft. to
Ft
From i Ft. to—Ft. _,_/C 0 da, CS ( ICt4 %J
From Ft. to
Ft
e
Fromv2—.Ft. tolt��Ft. 13 Fl 473 - e (PejCtJ
From
Ft. to
Ft.
From.Ft. to,t_V Ft. R r Ul -From
Ft. to
Ft.
Ex J
From ' Ft. to Ft. SCA;s7S i�)4 A'/
From
Ft. to
Ft. `
L
'NI 1
From -13,3 -Ft. to 6 <c3t ,-0
From
Ft. to
Ft. 7.��
From ! Ft. to Ft. = t "7-,'- 1Z C 11A J i c
From
Ft. to
Ft.
3
From Ft. to Ft. JS ARnc C CSF.-,�.J
From
Ft. to
Ft.
From Ft. to Ft. tfGS ? JR r e? CPO OWFrom
"
Ft. to
Ft.'
From L Ft. to 24,3 Ft.
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft.
From
Ft. to
Ft.
From ; Ft. to Ft.
From
Ft. to
Ft.
From Ft. to Ft. From Ft.
MISCL. INFORMATION:
DRILLER'SNAME
•
G• L LiG
Municipality of Anchorage z
On-Site Water and Wastewater Program I a
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 051-133-05 Expiration Date: dan (2 5) () b 19
1. GENERAL INFORMATION
Complete legal description GREAT LAND ESTATES#3 BLOCK 5, LOT 6
Location (site address) 19631 CREEK WAY,CHUGIAK,AK 99567
Current Property owner(s) DARRELL M NEAL JR. Day phone
Mailing address 19631 CREEK WAY, CHUGIAK,AK 99567
Real Estate Agent Day phone
2. TYPE OF DWELLING:
• Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY: t Individual
Individual Well ® Holding Tank ❑
Individual Water Storage ❑ Community ❑
Community Class Well ❑ Public Sewer ❑
Public Water System ❑
WaiverNariance request for:
Distance:
Received by: /ea n • Date: ,d AJ s
COSA to be released to the engineer,unless otheIs- -quested by the engineer.
COSA Fee $ 59-( Waiver Fee $
Date of Payment /0//b/iO3 Date of Payment
Receipt Number 0510. 10 Receipt Number
COSA# O 0,17!5-51 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm ARCTERRA CONSULTING,INC.
Phone 868-3791
Address 20441 PTARMIGAN BLVD.,EAGLE RIVER,AK 99577
Engineer's Printed Name KENNETH M. DUFFUS
Date 10/12/2018
THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED
WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. Engineer's Comments: This investigation was completed in compliance with
ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested.
The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use,
local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the
system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the
control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function
satisfactory for current or future occupants or can ArcTerra guarantee that no unseen
lik
encroachments,deficiencies or discrepancies exist. ���`\
,��Ar _ S� f
6. DSD SIGNATURE
* q. , r l
System #1 Approved for bedrooms. t' �=�1i v
System #2 Approved + r. hEN\E'I`H u. !!.; ., ,
Y for bedrooms. 1 %f"., '" �`'/
Disapproved. 1;Eo e iL<' .`�i
Conditional approval for \"
bedrooms, with the following stipulations:
4.--,--------e c YID -,t,v�. ( (Sal li.eotitc j
)1k-v-eAge L(6-40 at a U-ed Cl- f-, c_ -----A.Aftc t's 2_0 yv SU)
:� o
_-- ON-SITE -i)
WATER AND 1"
r WASTEWATER Z
- PROGRAM 9=
{9 O.of`':
sy: RJJ /7 m (cic/u� ��,,..
'01_ c� OnglriAlti ate Date: (105/2.018.
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 x) Other Tatem (�o n" X
COSA blue sheet 10-10-12.dcc _�
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: GREAT LAND ESTATES#3 BLOCK 5, LOT 6 Parcel ID: 051-133.05
A. WELL DATA
Well type PRVT If A, B, or C provide PWSID#_ Well Log (Y/N) Y
Date completed 6/1/1992 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y
Total depth 360 ft. Cased to 112 ft. Casing height (above ground) 18 in.
FROM WELL LOG AT INSPECTION
Date of test 61111992 10/11/2018 _
Static water level 120 ft. 117 ft.
Well production 0.5 g.p.m. 0.7 g.p.m.
WATER SAMPLE RESULTS: �1
Coliform NEG colonies/100 mL Nitrate 3,0 7 mg/L
Arsenic: ND ug/L Date of sample: 1011112018 Collected by: ARCTERRA_
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC I STEEL Date installed 911311991
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N
Date of pumping !"2O`1 g Pumper JRS
C. ABSORPTION FIELD DATA
Date installed 9/16/1991 Soil rating (2,p.d./ft2 or ft2/bdrm) 1.2 System type DEEP TRENCH
Length 63 ft. Width 3 ft. Gravel below pipe 4 ft.
Total depth 8.8 ft. (Measured 10/11/2018) Eff. absorption area 504 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 10/11/18 Results(Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 700 gal. New depth 0 in.
Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 600 g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N &type) N 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:
Septic tank/lift station on lot 100'+ 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 10'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+
F. COMMENTS
Septic tank fluid levels appeared normal with no evident issues noted from pumping receipt. Vacant system presoaked per code prior
to testing.
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. ��' �
OF' 4-1L�\
Engineer's Printed Name KENNETH M.DUFFUS j `��' `4t��11
Date 10/12/2018 / * 4 • TH
v +
COSA canary sheet_2-6-15.docA�i
""F'ESSIO' adp-
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT *' 907-343-7904
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Well Water Advisory
Certificate of On-Site Systems Approval # 0SC181551
Subdivision: Great Land Estates, Block: 5 Lot: 6
This well's productivity was determined to be .7 gallons per minute. The
minimum well productivity required under (AMC 15.55) for a 4-bedroom residence
is .41 gallons per minute or 150 gallons per day per bedroom. Although the subject
well currently exceeds this minimum requirement, the production capacity can
fluctuate.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address:P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT ' • , , r 907-343-7904
On Site Water and Wastewater Section ` Fax: 343-7997
www.muni.org/onsite —�
Septic Tank Advisory
Certificate of On-Site Systems Approval # 0SC181551
Subdivision: Great Land Estates#3 Block: 5, Lot: 6
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 27 years old. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On-Site Systems
Approval.
This is an example of what the metal of a 20 year old steel tank MAY look like.
jfe6C4 11?
( . • /• Rte'}h y 4.."4
65
t
y 6`
201'8 6:
Mailing Address: P. 0. Box 196650 * Anchorage,Alaska 99519-6650 *www.muni.org
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and 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
Parcel I.D. o5s-i33-os COSA # o S C i ataa 6
Expiration Date: I
1. GENERAL INFORMATION
Complete legal description Great Land Estates #3, Blocks. Lot 6
Location (site address) sa6ii Creek Way
Current Property owner(s) Craig
& Kimber
Davis Day phone
Mailing address P.O. Box 672328
Chugiak AK 99567
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:
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
❑
?P
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelings for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functiorol and adequate
for the numbeW bedrooms and type of structure indicated herein. I further verify that based ow.Yhe information
obtained frpm t Municipality of Anchorage files and from my investigation and inspection, the on.-pite water
supply dr or4astewater disposal system is(are) in compliance with all applicable Municipal and St to codes,
onilTVncff, and regulations in effect at the time of installation.
Name of Firm Pannone Engineering Services LLC Phone 2Z2 -82i8
Address P.O. Box 1002-17, Anchorage AK 995io
Engineer's Printed Name _Steven R. Pannone P.E. Date d
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions
encountered at the time of the test, and separation distances measured to readily identifiable features.
The operational life of all wells and septic systems depend on the local soil condition, ground waterp�E OF . /V too
%Ik
levels that may fluctuate during the year, and the water usage of the family being served by the system ��4k%, •••........
""• w.,gy��1�.
These conditions are outside the control of the evaluator of this system All systems eventually fail and o G
satisfactory test results do not guarantee future performance of the system nor do they guarantee that -4,/49TH
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future 0•••••n •• -•-••+��•••�
performance nor give any estimate of how long the system will continue to meet the operational i
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed {�; Steven R. Pannone; i
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it �� s \No. CE 8149
confer any legal right whatsoever. �j•,,.•'��
5. DSD SIGNATURE ��a.ta'�.•'
Approved for 4— bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory ^� Supplemental Engineer's Report
Nitrate Advisory Other
By: r6�-� ` Original Certificate Date: /
(Rev. 11/05)
Municipality of Anchorage
•°x
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
Legal Description: Greatland Estates #3. Blocks, Lot 6 Parcel ID: 053..3.13-05
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 612/:Lqq2 Sanitary seal (Y/N) Y_
Total depth 36o ft. Cased to 112 ft.
FROM WELL LOG
Date of test 6/3.hgg2
Static water level 220 ft.
Well production o.5 g.p.m.
WATER SAMPLE RESULTS:
Coliform ,f colonies/100 mL Nitrate )6 mg/L
Arsenic: N19 ug/I Date of sample: *W12
B. SEPTIC/HOLDING TANK DATA
Well Log (Y/N)
Wires properly protected (Y/N) Y
Casing height (above ground) 3.8 in.
AT INSPECTION
2/2/203.2
3.3.8 ft.
Collected by:
Tank Type/Material Steel/ Septic Date installed 913.a13.gg3.
Tank size 3.2So gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N
I I_
Date of pumping Z/3 /2�,iZ _ Pumper JAS
C. ABSORPTION FIELD DATA
Date installed g1z6/3.993. Soil rating (g.p.d./fe or ftz/bdrm) 3..2 System type Deep Trench
Length 63 ft. Width 3 ft. Gravel below pipe ft.
Total depth 8_8 ft. Eff. absorption areao5 _'r ftz Monitoring tube Y Depression over field N
Date of adequacy test 213./203.2 Results (Pass/Fail) Pass For g bedrooms
Fluid depth in absorption field before test o in.
Elapsed Time: 36o min. Final fluid depth o in.
Water added600 gal. New depths in.
Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
"Pump on" level at
Datum
Size in gallons
in. "Pump off'
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot ioo+
Absorption field on lot ioo+
Public sewer main 75+
Sewer /septic service line 25+
Animal containment areas _So+
Manhole/Access (Y/N)
water alarm level at
Meets alarm & circuit
On adjacent lots ioo+
On adjacent lots ioo+
Public sewer manhole/cleanout ioo+
Holding tank ioo+
Manure/animal excrete storage areas ioo+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line io+ Absorption field 5+
Water main io+ Water service line zs+ Surface water ioo+
Wells on adjacent lots ioo+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line io+ Building foundation 2.o+ Water main 75+
Water Service line io+ Surface water ioo+ Driveway, parking/vehicle storage io+
Curtain drain 50+ Wells on adjacent lots ioo+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and NY
review of Municipal records that the above systems are in 49�—"
conformance with MOA COSA guidelines in effect on this date. .... ........8...ryry
y� ;Steven R. Pannone:/
Engineer's Printed Name Steven R. Pannone P.E. ♦jG `• F.
No. CE 8149
♦�
Date 7 �/ f Z ♦♦♦._ 11 �'_"�"r��••
COSA Fee $ 73(4- 14
Date of Payment a 12 G la
Receipt Number oa�Sc�G
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
in.
Municipality of Anchorage s
e"
Development Services Department �' r
r,
Building Safety Division s
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci. anchorage. ak. us
(907) 343-7904
Water Well Advisory
Certificate of On -Site Systems Approval (COSA) # 121026
During a recent COSA on-site inspection and test of the potable water
supply well on Block 5, Lot 6 of Great Land Estates 43 subdivision, the
well's productivity was determined to be 0.9 gallons per minute. The
minimum well productivity required by this Department (AMC 15.55) for a
4 -bedroom residence is 0.42 gallons per minute. Although the subject well
currently exceeds this minimum requirement, all parties concerned are
advised that the production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering lawns and
gardens may be required.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
r RMOC AwAts
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FOUNDATION AS- SUIT
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IAT RAeTY ... Td'0011~
THE
AND TO
S OR Rf
Prepared by
Robert E. Johns, Jr. & Assoc.
Professional Land Surveyors
_ __ 1700 SEWN DR
DworlyFUon.-17-07 1260 �'' 784
qd
Lot 6 Bloc}: 5
Greatlami $3
SYWOLS
• SET RESAR ir= WDRAIN " ASPHALT
O FWnU MBAR ♦-*� WOW FENCE CONCRETE
ASSUMED ELEV.-.,y. MFTAL FENCE W*rD Drr
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE VALL BE
SHOWN. FENCES. WELLS. SEPTIC CLEANDLIM SIDEWALKS. DRIVEWAYS.
ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW
MAY PREVENT SOME IMPROVEMENTS FROM SEINO SEEN AND LOCATED.
11, n.--...--- _--
R ----
UNDER NO dRCUMSTANCCS SHOIRD AN A7-SUILT SE U".,ED FOR CWSTiTUCTION OR FOR ESTAELl%tNC BOUNDARY OR FENCE LINES.
SGS Ret.#
Client Name
Proiect Name/#
Client Sample ID
Matrix
1120294001
Pannone Eng. Srv.
Greatland EST 3 B5 L6
Greatland EST 3 B5 L6
Drinking Water
Printed Date/Time
Collected Date/time
Received Date/Time
Technical Director
02/07/2012 15:07
01/27/2012 10:00
01/27/2012 10:45
Stephen C. Ede
Sample Remarks:
93.7
10.0
mg/L
SM20 2320B
D
01/28/12
SDP
Aluminum
ND
20.0
ug/L
EP200.8
Allowable Prep Analysis
Parameter
Results
LOQ
Units
Method ContainerlD
ug/L
Limits Date Date
Init
Metals by ICP/MS
01/30/12 02/01/12
NRB
Barium
6.87
3.00
ug/L
EP200.8
Hardness as CaCO3
115
5.00
mg/L
SM20 2340B
C
01/30/12 02/01/12
NRB
Waters Department
C
(<5)
01/30/12 02/01/12
NRB
Calcium
33000
500
Total Nitrate/Nitrite-N
4.16
0.100
mg/L
SM20450ONO3-F
B
02/06/12
CMA
Microbiology Laboratory
mg/L
EPA 300.0
D
(<250)
01/29/12 01/29/12
SDP
Chromium
E. Coli
Negative
1
100mL
SM21 9223B
A
01/27/12
DLC
Total Colifomt
Negative
1
100mL
SM21 9223B
A
01/27/12
DLC
Private Individual Analvsis
Alkalinity
93.7
10.0
mg/L
SM20 2320B
D
01/28/12
SDP
Aluminum
ND
20.0
ug/L
EP200.8
C
01/30/12 02/02/12
SCL
Antimony
ND
1.00
ug/L
EP200.8
C
(<6)
01/30/12 02/01/12
NRB
Barium
6.87
3.00
ug/L
EP200.8
C
(<2000)
01/30/12 02/01/12
NRB
Cadmium
ND
0.500
ug/L
EP200.8
C
(<5)
01/30/12 02/01/12
NRB
Calcium
33000
500
ug/L
EP200.8
C
01/30/12 02/01/12
NRB
Chloride
3.91
0.100
mg/L
EPA 300.0
D
(<250)
01/29/12 01/29/12
SDP
Chromium
ND
2.00
ug/L
EP200.8
C
(<100)
01/30/12 02/01/12
NRB
CO3 Alkalinity
ND
10.0
mg/L
SM20 2320B
D
01/28/12
SDP
Conductivity
262
1.00
umhos/cm
SM20 2510B
D
01/28/12
SDP
Copper
17.0
1.00
ug/L
E1`200.8
C
(<1300)
01/30/12 02/01/12
NRB
Fluoride
ND
0.100
mg/L
EPA 300.0
D
(<2)
01/29/12 01/29/12
SDP
HCO3 Alkalinity
93.7
10.0
mg/L
SM20 2320B
D
01/28/12
SDP
Iron
ND
250
ug/L
EP200.8
C
(<300)
01/30/12 02/01/12
NRB
Lead
1.31
0.200
ug/L
EP200.8
C
(<15)
01/30/12 02/01/12
NRB
Municipality of Anchorage UUA'
• -tel Development Services Department IL.IGflvA./.
Building Safety Division
On -Site Water and 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
Parcel I.D. _ 65-1- 133 -D 5� COSA # D D3 6_
Expiration Date: 02 - 5 - o q
1. GENERAL INFORMATION
Complete legal description Great Land Estates No 3 Block 5 Lot 6
Location (site address) 19631 Creek Wav, Chuaiak AK 99567-6502
Current Property owner(s) Christopher & Holly Norton Day phone (619)971-0033
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
19631 Creek Way, Chugiak AK 99567-6502
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage ❑
Community Class • Well ❑
Public Water System ❑
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water
supply and/or wastewater disposal system Islam) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Engineering Services LLC Phone 272-8218
Address P.O. Box 102954 Anchorage AK 99510
Engineer's Printed Name Steven R Pannone. P.E. Date Cq5 to `.
Engineers Comments: In conducting an adequacy test, l attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with hfOA DSD Guidelines & Regulations. Ile reported results describe the performance of the system under the conditions
encountered at the time of the lest, and separation distances measured to readily identifiable features.
The operational life of all wells and septic systems depend on the local soil condition, ground water •••� QF aaah
.• p\, . - .. �
�
levels that may fluctuate during the year, and the water usage of the family being served by the system. � � f,, ••.,,` •
71csc conditions arc outside the control of the evaluator of this system. All systems eventually fail and ; '�, �••
satisfactory lest results do not guarantee future performance of the system, nor do they guarantee that . 497" •
there arc no hidden defects or encroachments. PPS can therefore not provide any warranty for future 00^••• ••' i
performance nor give any estimate of how long the system will continue to meet the operational • .. .0
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed 0C�Steven R. onnone /j 0
above. Any reliance upon or use of this report by any other person or party is not authorixcd nor will it ••�j�., No. CE 8149
confer any legal right whatsoever. ••�ta2ae'D "«• t01'�•0••
5. DSD SIGNATURE aaaa •••
/ Approved for 3 bedrooms.
Disapproved.
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: !�t/, Original Certificate Date:
(nw. ps
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
Legal Description: - Great Land Estates- No 3 Block 5 Lot 6 Parcel ID: 051-133.05
A. WELL DATA
Well type Private
Date completed 6/111992
Total depth X60 ft.
Date of test
Static water level
Well production
If A. B, or C provide PWSID #
Sanitary seal (Y/N)y9ss
Cased to 112 ft.
FROM WELL LOG
6/1 /1992
120 ft.
0.5
WATER SAMPLE RESULTS:
Coliform colonies/100 mL
Arsenic: Q b ug/I
B. SEPTIC/HOLDING TANK DATA
Nitrate 5o b mg/L
Well Log (Y/N) Y$s
Wires properly protected (Y/N) Yes
Casing height (above ground) 20 in.
AT INSPECTION
10/14/2008
116 ft.
0.73 g.p.m.
Other bacteria _C:�r' colonies/100 mL
Date of sample: 10/14/2008 Collected by: M. WEHR
Tank Type/Material Septic/Steel Date installed 9/13.!1991
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Yes
Foundation cleanout (Y/N) Yes Depression over tank (YM) No High water alarm (Y/N) N/A
Date of pumping loll 5120o8 Pumper JR's
C. ABSORPTION FIELD DATA
Date Installed 9/13/1991 Soil rating (g.p.d./ft2 or ft2/bdrm)1.2 System type Deep Trench
Length fi3 ft. Width 3 ft. Gravel below pipe 4.0 ft.
Total depth P5 ft. Eff. absorption area eft' Monitoring tube ygs Depression over field No
Date of adequacy test 4/27/2007 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test DM in. Water added gal. New depthD_yr in.
Elapsed Time:.Q min. Final fluid depth Pry in. Absorption rate >= 600+ g.p,d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date
D. LIFT STATION /A1'/ Irk'
Date Installed / " " Size in gallons
"Pump on" level at _ in.
Datum
E. SEPARATION DISTANCES
"Pump off" level at _ in.
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100+
Absorption field on lot 100+
Public sewer main N/A
Sewer /septic service line 25+
Animal containment areas 100+
Manhole/Access (Y/N)
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout NIA
i
Holding tank 75+
Manure/animal excrete storage areas 100+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 77 Property line 10+ Absorption field 10+
Water main N/A Water service line 50+ Surface water 100+
Wells on adjacent lots 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 90 Water main NIA
Water Service line 50+ Surface water 100+ Driveway, parking/vehicle storage 25+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field Inspections and -v
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date. ti=
Engineer's Printed NameStSt vel Pannone P.E.
Date 10/20/2008 i5 1 o3 L
COSA Fee $' Waiver Fee S
Date of Payment
Receipt Number lJ`t
(Rev. 11105)
Date of Payment
Receipt Number
'en R. P3nr�
No. CE 8 49
0
Municipality of Anchorage
Development Services Department
� Building Safety 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
Nitrate Advisory
Certificate of On -Site Systems Approval # 080365
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 5, Lot 6 of
Great Land Estates No. 3 subdivision. This inspection revealed a nitrate
concentration of 5.15 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/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.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
\ Municipality of Anchorage
• Services
Development Department
P,.:. ;
Building Safety Division
On -Site Water and 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 Rc, -Te s uc,
Parcel I.D. 051-133-05 COSA#_ DO 0 9 o,
Expiration Date: — %
1. GENERAL INFORMATION
Complete legal description Greatland Estates Subdivision #3 Block 5 Lot 6
Location (site address) _19631 Creek Way
Current Property owner(s) Prudential Rellocation Inc Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
16260 North 71s' St 2^4 FI. Scottsdale, AZ 85254
Day phone
Jody Moses (Prudential Jack White) Day phone
_3801 Centerooint Dr. Ste. 200 Anchorage, AK 99503
Unless otherwise requested, COSH will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: -e 4
3. TYPE OF WATER SUPPLY:
Individual Well ID
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 engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Engineering Services, LLC Phone 272-8218
Address P.O. Box 102954, Anchorage, AK 99510
Engineer's Printed Name Steven R. Pannone, P.E. Date 5/6/2009
Engineers Comments: In conducting an adequacy test, l attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions
encountered at the time or the test, and separation distances measured to readily identifiable features.
The operational life of all wells and septic systems depend on the local soil condition, ground water
levels that may fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of this system. All systems eventually fail and
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future
performance nor give any estimate of how long the system will continue to meet the operational
requirements of the hfOA 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 following stipulations:
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory
Well Flow Advisory_
Nitrate Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: 0 9
(Rm. t 1p sa
1..dnicipality 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
Legal Description: Greatlend Estates #; Sk S Lot 6 Parcel ID: o -m -z -Ag -os
A. WELL DATA
Well type Q If A, B, or C provide PWSID # _ Well Log (YIN) Y
Date completed 61111942 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y
Total depth 36o ft. Cased to _tuft. Casing height (above ground) 20 in.
FROM WELL LOG AT INSPECTION
Date of test 6/21%942
so/u./2oc8
Static water level 220 ft. 216 ft.
Well production .c g.p.m. 0.71 9 -
p.m -WATER SAMPLE RESULTS:
Coliform o.00 colonies/100 mL Nitrate 2.24 mg/L Other bacteria o colonies/100 mL
Arsenic: mg/I Date of sample: 417210 Collected by: Mike Wehr
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Septic Steel Date installed 9/2a12gg2
Tank size 1250 gal. Number of Compartments a Cleanouts (Y/N) Y
Foundation cleanout (YM) Y Depression over tank (YIN) NJ High water alarm (YIN) NIA
Date of pumping 10/2U2008 Pumper JR's
C. ABSORPTION FIELD DATA
Date installed 9/a3hggi Soil rating (g.p.d.lfe or ft2lbdrm) 2.2 System type
Deep Trench'
Length 6,4! ft. Width 3 ft. Gravel below pipe c.o ft.
Total depth S ft. Eft. absorption area S24 -W Monitoring tube Y Depression over field N
Date of adequacy test so/ic12oo8 Results (Pass/Fail) Pass For g bedrooms
Fluid depth in absorption field before test Dry in. Water added600 gal. New depthD,_yr in.
Elapsed Time: o min. Final fluid depth ft in. Absorption rate >= 600. g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date
D. LIFT STATION
Date installed Size in
'Pump on' level at_in. `Pump
Datum Cycles
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankllift station on lot zoo+
Absorption field on lot zoo+
Public sewer main NIA
Sewer /septic service line _25+
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots aoo+
On adjacent lots ioo+
Public sewer manhole/cleanout NIA
Holding tank 7S+
Animal containment areas _ aoo+ Manure/animal excrete storage areas loo+
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 77 Property line io+ Absorption field io+
Water main N/A Water service line co+ Surface water _aoo+
Wells on adjacent lots aoo+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line io+ Building foundation go+ Water main NIA
Water Service line So+ Surface water soo+ Driveway, parking/vehide storage ac+
Curtain drain so+ Wells on adjacent lots ioo+
F. COMMENTS
G. ENGINEER'S CERTIFICATION �.•'�� ()F„ q-'
1P........... ,
1 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.
jK ••
Engineeoor s Printed Name Steven R. Pannone. P.E. �f%
�C,?Steven Pn(
No CE alae
Date ... .....................
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number,
in.
SCS ReEN
1091568001
Antimony
ND
Client Name
Pannone Eng. Srv.
Printed Date rime
05/052009 16:13
Project Name/N
Grcatland Est. N3 B5,L6
Collected Date/time
0422/1009 11:30
Client Sample ID
Greatland Est. N3 B5,L6
Received Date rime
04232009 11.10
Islalria
Drinking Water
Technical Director
Stephen C. Ede
Sample Remarks:
Allomble Prep Analysis
Parameter Results PQL Units hlcdad Container ID Limits Date Date Init
Metals by ICP/MS
I lardness as CaCO3 115
Waters Department
Total Nitrate/Nitritc-N 2.24
Private Individual Analvsis
Aluminum
302
Antimony
ND
Arsenic
ND
Barium
5.41
Cadmium
ND
Calcium
31500
Chromium
21.4
Copper
251
Iron
2720
Lead
233
Magnesium
8820
Manganese
10.8
Chloride
4.22
Fluoride
ND
Selenium
ND
Sodium
4490
Silver
ND
Thallium
ND
Sulfate
17.7
Zinc
2010
5.00
mg/L SM20 2340B C
mg/L SN1204500NO3-F B
0428/09 05/01/09 NRB
0428/09 JDZ
20.0
ug/L
EP200.8
C
0428/09 05/01/09
NRB
1.00
ug/L
EP200.8
C
(<6)
0428.09 05/01/09
NRB
5.00
ug/L
EP200.8
C
(<I0)
0428/09 05/01/09
NRB
3.00
ug/L
EP200.8
C
(<2000)
0428109 05/01/09
NRB
0.500
ug/L
EP200.8
C
(<5)
0428109 05/01/09
NRB
500
ug/L
EP200.8
C
0428109 05/01109
NRB
2.00
ug/L
EP200.8
C
(<I00)
0428109 05/01/09
NRB
1.00
ug/L
EP200.8
C
(<1300)
0428,09 05/01/09
NRB
e 250
ug/L
EP200.8
C
(<300)
0428109 05/01109
NRB
e 0.200
ug/L
EP200.8
C
(<15)
0428109 05/01109
NRB
50.0
ug/L
EP200.8
C
0428109 05/01/09
NRB
100
ug/L
EP200.8
C
(<50)
0428/09 05/01/09
NRB
0.100
mg/L
EPA 300.0
D
(<250)
0428/09 0428109
JDZ
0.100
mg/L
EPA 300.0
D
(<2)
0428,09 0428,09
JDZ
9.00
ug/L
EP200.8
C
(<50)
0428/09 05/01109
NRB
500
ug/L
EP200.8
C
(<250000)
042809 05/01109
NRB
1.00
ug/L
EP200.8
C
(<I00)
0428109 05/01/09
NRB
1.00
ug/L
EP200.8
C
(<2)
0428/09 05/01/09
NRB
0.100
mg/L
EPA 300.0
D
(<250)
0428109 0428109
JD7
5.00
ug/L
EP200.8
C
(<5000)
0428/09 05/01/09
NRB
SGS Retia
1091568001
Nickel
3.70
Client Name
Pannone Eng. Srv.
Printed Date rime
05/052009 16:13
Project Name/p
Grcatland Est. k3 B5,L6
Collected Date/rime
04222009 11:30
Client Sample ID
Grcatland Est. H3 B5,L6
Received Date rime
04232009 11:10
Matrix
Drinking Water
Technical Director
Stephen C. Ede
WAW
1.00
umhos/cm
SM20 2510B
D
0423/09
Allowable Prep Analysis
Parameter
Results
POl- Units Method Container ID
Limits Date Date [nit
Private Individual Analvain
Total Dissolved Solids
119
Nickel
3.70
11CO3 Alkalinity
94.7
Conductivity
261
pit
7.20
Alkalinity
94.7
Colony Count
0
Total Coliform
0
Fecal Coliform
0
10.0
mg/L
SM202540C
D
(<500)
0424/09
RJT
2.00
ug/L
EP200.8
C
(<I00)
0428/09 05/01/09
NRB
10.0
mg/L
S%120 2320B
D
0429/09
WAW
1.00
umhos/cm
SM20 2510B
D
0423/09
RJT
0.100
pl1 units
SM20 4500.11 B
D
(6.5-8.5)
0423/09
RJT
10.0
mg/L
SN1202320B
D
0429/09
WAW
col/IOOmL
SN1209222B
A
0423/09
DLC
col/IOOmL
Slf209222B
A
(<1)
0423/09
DLC
col/IOOmL
S%120 9222B
A
0423/09
DLC
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Nater Well Advisory
Certificate of On -Site Systems Approval (COSA) # 080385
During a recent COSA on-site inspection and test of the potable water
supply well on Block 5, Lot 6 of Great Land Estates #3 subdivision, the
well's productivity was determined to be 0.73 gallons per minute. The
minimum well productivity required by this Department (AMC 15.55) for a
4 -bedroom residence is 0.42 gallons per minute. Although the subject well
currently exceeds this minimum requirement, all parties concerned are
advised that the production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering lawns and
gardens may be required.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Municipality of Anchorage
• -- Development Services Department
Building Safety Division
_ On -Site Water and 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
Parcel I.D. 051-133-05 COSA # 15g
1. GENERAL INFORMATION
Expiration Date: S — A9 — 0-7-
1.
'z
Complete legal description Great Land Estates, No. 3. Block 5, Lot 6
Location (site address) 19631 Creek Way
Current Property owner(s) Shelia a sn r 1jkm6en t4 Day phone 688-6404
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
P.O. Box 671634, ChugialeAK 99567
Day phone
Jan Pennington Day phone 244-3099
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site 11
Individual Holding Tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Engineering Services, LLC Phone 272-8218
Address P.O. Box 102954, Anchorage. AK 99510
Engineer's Printed Name Steven R. Pannone, P.E. Date 5-17-2007
Engineers Comments: In conducting an adequacy test, l attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with A10A DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions
encountered at the time of the tat, and separation distances measured to readily identifiable features. �„aa
The operational life of all wells and septic systems depend on the local soil condition, ground water ••.�� OF ash•
levels that may fluctuate during the year, and the water usage of the family being served by the system �•�P,.••""'""""•. ���
These conditions arc outside the control of the evaluator of this system All systems eventually fail and
satisfactory test results do not guarantee future perfomlance of the system, nor do they guarantee that a f n rw
there are no hidden defects or encroachments. PPS can therefore not provide any warranty for future i
perfomunce nor give any estimate of how long the system will continue to meet the operational 0,,..,,...
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed Y0 •tSteven R. anoone/ .
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it op r�Kst No CE 81 ee f `W:
e5 CMwhatsoever.
•,�
DSD SIGNATURESSI
( Approved for _*__ bedrooms.
Disapproved.
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: 0-7
ploy. t IN5)
Municipality of Anchorage
• Development Services Department
Building Safety Division `
On -Site Water 6 Wastewater Program
4700 Bregaw 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: Great Land Estates, No. 3. Block S. Lot 6 Parcel ID: 051-13305
A. WELL DATA
Well type Private If A, B, or C provide PWSID # _
Date completed 6/111992 Sanitary seal (YM) YM
Total depth 360 ft. Cased to 112.3 ft.
FROM WELL LOG
Date of test 6/1/1992
Static water level 120 ft.
Well production OS g.p.m.
WATER SAMPLE RESULTS:
Coliform _9 _colonies/100 mL Nitrate 4.57 mg/L
Well Log (YIN) Yes
Wires properly protected (Y/N) Yes
Casing height (above ground) 18 in.
AT INSPECTION
4/27/2007
128 ft.
0.68 g.p.m.
Other bacteria 0 colonies/100 mL
Arsenic: ,fes ugA Date of sample: 4/27/2007 Collected by: S.R. Pannone
S. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 9/13/1991
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Yes
Foundation cleanout (YIN) In Depression over tank (Y/N) Na High water alarm (Y/N) N/A
Date of pumping 9/15/2006 Pumper _Sanitary Pumpers
C. ABSORPTION FIELD DATA
Date installed 9/13/1991 Soil rating (g.p.d./fe or fe/bdnn) 1.2 System type _Deep Trench
Length 63 ft. Width 3 ft. Gravel below pipe 4.0 ft.
Total depth W ft. Eft. absorption area IQVI? Monitoring tube Xn Depression over field Na
Date of adequacy test 4/27/2007 Results (Pass/Fall) Pass For 4 bedrooms.
Fluid depth In absorption field before test Qry in. Water addedfi" gal. ' '.' . New depthpU in.
Elapsed Time: 9 min. Final fluid depth )gip in.
Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N 6 type) No If yes, give date
D. UFT STATION
Date Installed
"Pump on" level at _ in.
Datum
Size In gallons
"Pump ofP level at _ kr.
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Manhole/Access (YIN) _
High water alar level at
Meets alarm d circuit requirements?
9
Septic tankAtft station on lot 100+
On adjacent lots 100+
Absorption field on lot 100+
On adjacent lots 100+
Public sewer main N/A
Public sewer manhole/deanout N/A
Sewer /septic service line 25+
Holding tank 75+
Animal containment areas 100+
Manure/animal excrete storage areas 100+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 77
Property line 10+ Absorption field 10+
Water main N/A
Water service line 50+ Surface water 100+
Wells on adjacent lots 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10+
Building foundation 90 Water main N/A
Water Service line 50+
Surface water 100+ Driveway, parkinglvehicle storage 25+
Curtain drain 50+
Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION +0 F\t„ ....Ail .-�'.♦♦♦
i "7,r'' •,TY, �
I cer* that I have determined through field inspectlons and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
� S;even k Fcnnone.
Engineer's Printed Name Steven It. Pannone. P.E. ♦i♦�'a, y- F p : 4
s
♦ rS
Date 5/17/2007 ♦�♦� Jrt;• �+
COSA Fee $ f,3000 -
Date
300°Date of Payment V-24 O%
Receipt Number o 9500'5
(Rev. 1 troy)
Waiver Fee $
Date of Peyment
Receipt Number
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Water Well Advisory
Health Authority Approval # 070158
During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Block 5, Lot 6 of Great land Estates #3
subdivision, the well's productivity was determined to be 0.68 gallons per
minute. The minimum well productivity required by this Department (AMC
15.55) for a 4 -bedroom residence is 0.42 gallons per minute. Although the
subject well currently exceeds this minimum requirement, all parties
concerned are advised that the production capacity of the well may fluctuate.
Restriction of non-critical water uses such as washing cars and watering
lawns and gardens may be required.
This advisory must be attached to all copies of the subject Health Authority
Approval.