HomeMy WebLinkAboutDALE BRIGGS BLK 2 LT 8Briggs
Block
Lo1- 8
#050-182-08
Municipality of AnchoragePage
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
Permit Number: SW940414 PIDNumber: ,qsfllR?,qR
Name:
KN~ Engineering Wastewater System: [] New I~ Upgrade
Address:
20441 Ptarmigan Blvd E.R' AK ABSORPTION FIELD
Phone: I No. of Bedrooms:
6 ~ ~- ~ 111I ~ )(]XDeep Trench [] Shallow Trench [] Bed [] Mound [] Other
Total Depth f!ompriginal grade:
LEGAL DESCRIPTION SoilRating: 0.6 GPD/Sq. Ft. 11 . 5'
Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe
8 2 Dale Bri ggs 6.82 Ft. 4 . 58 Ft.
Township: I Range: I Section: Fill added above original grade: Gravel length:
I
WELL: JNew [] Upg~e Gravel width: Number of lines: Distance between lines:
2 Ft. 2 10- ~ 4 Ft.
Classification (Private,~,B,C): Total Dep~ Cased To: Total absorption area: Pipe material: A S T m F 8 ] 0
t~rill Ft. Ft. 7 9 5 SQ. Ft. D 3 0 3 4
Driller: J'/ Da ed: Ft. Static Water Level: Installer: Date installed:
/
/. Ft. ,alndPrRnn Cnn 11 /11 /94
I Casing Height Above Ground:
Yield: Pump Set at:/
GPM / Ft. F,. TANK
/
" SEPARATION DISTANCES )~Septic [] Holding [] S.T.E.P.
To Septic Absorption Lift Holding 3ubiic/Private Manufacturer: ~,~//__),~ ~J'/~'JZ_ Capacity in gallons:
From Tank Field Station Tank Sewer Lines '~ K S t C C 1. /. e. 1000
Material: Number of Compartments: 2
Weir 04 ' 1 00 '+ .... 1 00 ' + ,St, PP1
Surface / STATI(~ /
Water 100'+ 1 00'+ ...... LIFT
Lot i Size in gallon~rManufacturer: / aT~L
Line 4 8' 1 0 ' ......
Foundation 33' 40' _ ..... i"Pump ~ve, at: I "Pump o."yat: I.,..w at:
Curtain Pump~ake & Model I Electrical Insp~tions performed by:/
Drain ..........
I/
Remarks: Tank and each'trench were BENCH MARK
Location and Description:
excavated and installed on the same Entry level of house.
day. End of trench excavated to 16'
Variations in distances between 1 ines I Assumed Elevation:
due tn largm hnuld~rt P. rlcF)l'lrltPrPdI 101.5 FI,
d u r i n g e x c a v a t i o n. ENGINEER'S SEAL
Inspections performed by: KND Engineering Dates: 1st11/9/94
2nd~ t~ ~n~ .... ;, . .
/ "', ',~'. ,i ~::-:"
Department of Health and Human Services approval
Reviewed and approved by: /~~,~- ~ Date://-27-~
72-013 (Rev, 9/91) MOA 25
i,i
AS-BUILT DESIGN DETAILS
NVASTEWATER DISPOSAL SYSTEM
FINISHED GRADE
TRENCH EX)
FABRIC
T° LOT 8, BLock 2, I]~le Br;ggs
~__~J . ~' INSULATION
i~'~ ORIGINAL ~ F NISHEI
P,I,D, 050-182-08
SW940414
42'/43'
I
BOTTOM OF TEST HOLE 16'~
FROM CONFIRMING TEST
HOLE DURING CONSTRUCTION
43'
1000 GAL !C,O,VT,~.~l
o=o
CO M,T,
c;°'ol
42'
M,T,
PREPARED FOR,
S, KAY I)UTTDN
P,D, BOX 77846B
EAGLE RIVER, ALASKA 99577
KND ENGINEERING
80441 PTARMIGAN BLVD
EAGLE RIVER, AK, 99577
907-696-6111
DATE, 11-1B-94 DRA~/ING ii
NOT TO SOALE A$-BLII~T
A/COn/rE. ,~OAO -,~
! /..~9.~.~%.-.~.o'-----~-' ,,.
/, , ,~ ~ ~rz~ .. ~
~"'~""~'~..% ~ ~ X ~=~= / :
~gOr 5~%~~ ~
,
~""~ =' . ~ ~T&IA~ .O~.~
Anchorage Recording Disttict~ Alaska ~,.~.t. of .,o,d othw tho. ~fl ,~ ~
~OT 8URV~ OERTIFIOATION LEGEND
~ I~le ~ ~J~nt ~tl ~QP ~ ~ch ~ I~ ~mleel ~ 5/8"~ ~" rebar set this tully
Pre.red by: ~ ~'
, Re~isle~ ~ ~v~or
"'"~ /sz~,.,o. /7-~ ~o~0,,,o,: ~. Da/lan
PAGE I OF 1
"1; 'l
MUNICIPALITY OF ANCHORAGE
DEPARTMENT
OF
HEALTH
P.O. BOX 196650, 825 "L" STREET, ROOM 502--A~]~ ~ ' o-,- - ~
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUlHBER:SW940414
DESIGN ENGINEER:KND ENGINEERING
OWNER NAME:DUTTON SYLVIA KAY
OWNER ADDRESS:17514 MONTE RD
EAGLE RIVER, AK 99577
DATE ISSUED:10/27/94
EXPIRATION DATE:10/27/95
PARCEL ID:05018208
LEGAL DESCRIPTION: DALE BRIGGS BLK 2 LT 8
LOT SIZE: 45000 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOURS)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
DURING CONSTRUCTION, THE TEST HOLE MUST BE DEEPENEND TO
15 FEET FOR THE THENCK TO BE 9.0 FEET DEEP.
ISSUED BY: ,~~--~~'*-~
DATE:
~,~D ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
October 20, 1994
On-Site Services
DH]IS
825 L Street
Anchorage, AK 99501
Dear Sirs:
REF: Lot 8 Block 2 Dale Briggs Homestead Subdivision
Attached is our request for an on-site septic permit for the above lot to upgrade
an existing system that is in failure.
As shown on the site plan, the proposed system falls outside the existing well
radii and a minimum of 10' away from the existing septic system that is to be
abandoned. This lot is gently sloping to the west and north. There is adequate
area to the east directly north of the proposed septic site on the lot to another
replacement system as well as the availability or sewer if it becomes necessary.
The soils percolation tests were good and no water was encountered during the
excavation, and was monitored seven days later with no water. The existing
system has been operational for over 21 years with no known problems.
There is no open water within 500'+ of the existing site and the area drains away
from the proposed septic site.
Thank you for your consideration of this request. If there are any questions,
please call me at 696-6111 or leave a message.
Sincerely,
Kenneth M. Duffus, P.E.
KND Engineering
Attachments:
On-Site Well and Sewer Application
Wastewater Absorption System Details
Site Plan
Soils Log/Percolation Test
SIT£ PI AN
WASTEWATER DISPHSAL SYSTEM
LOT 8, ]]lock
'7
Undeveloped
8C
Public water
9
Public water
P.I.D. 050-182-08
and seepage pil Io be ~-'~
properly abandoned in plac~. ~
Exist. Well ~ Bxlst. I \
,~x~isl. Well ,' ?~bli~ 'water
XXa ½ h'~ Dri v6
Surrounding lots served by public water and sewer.
Lot Size:
Less perimeter house footprint
Total area available for absorption system
45,000 S.F.
1,008 S.F.
43,992 S.F.
~REPARED FOR,
~. KAY I)UTTDN
P.O. llOX 772468
EAGLE RIVER, ALASKA
99577
KND ENGINEERING
~0441 PTARMIGAN BLVD
EAGLE RIVE~ A~ 99577
907-696-6111
DESIGN DETAILS
'.' WASTEV/ATER DISPOSAL SYSTEM
LOT 8, Block ~ D:le Brlggs P.I.I). 050-182-08
UNCLASSIFIEI) FILL(FROM TRENCH EX)
FABRIC
SEWER ROCK
42'
~BDTTDM DF BED 8.5
I
BOTTOM DF TEST HOLE 13'
MoT,
42'
I
10' i Min.
C.0.
M.T.
'DESIGN DETAILS
3 ~EI]RonM I]VELLINr, VITH I]AIL¥ FLnV OF 150 GP~ - 45~ ~P~
~DIL RATE 1~5 MIN/IN~ ~E ~PLICATION RATE ~F 0.6 GP~/~F
450 GPO / 0.6 GPD/SF = 750 ~F T~TAL A~DRPTION
~E 2 e~. 4~% x 4~'~ x ~'W TRENCH FOR B4' L~
~TZR: SYSTEM VZLL B~ C~ER~O V~TH FABRIC.
~: tODD GALLON ~TE~ SEPTIC TANK.
ALL PIP~ MUST M:ET R~ SPECIFICATIONS.
MAI~RIN MIN. S~ERATION OF 10' FROM EXISTING SYSTEM
PREPARED FOR'
S. KAY ~UTTON
P~. ~OX 77~468
EAGLE RIVE~ ALASKA
99577
KND ENGINEERING
20441 PTARMIGAN BLVD
EAGLE RIVER, AK, 99577
907-696-6111
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR:
LEGALDESCRIPTIONIOt 8 ~1~ 2 Dale
Organic
I
Nedium loose Red
Silty Sand w/8" cobbles
3- Tight Sandy Silt
w/ 8" cobbles
Test
7-
8-
9.:
10-
11
13-
14-
15-
16-
17-
18'
19-
20-
COMMENTS H 01 e
Kay Dutton/ KND Engineering
Medium
Silty Sand w/
SLOPE SITE PLAN
Mo ~t~ R:~
cobbles
WAS GROUNDWATER ~
ENCOUNTERED?
s
IF YES, AT WHAT N / A ~
DEPTH? p
Gross Net Depth to Net
Reading Date Time Time Water Drop
0 10/14' 0 0 3 3/4" 0
1 6 min 6 rain 4" 1/4"
2 12 mi 6 rain ~ 3/8" 3/8"
) 18 mi 6 rain 4 1/2" 1/8"
4 24 mi 6 min 4 3/4" 1/4"
5 30 mi 6 rain "5" 1/4"
30 min 1 1/4"
PERCOLATION RATE 2 4 Imlnutes,'mch) PERC HOLE DIAMETER
TEST RUN BETWEEN 4 FT AND ~ FT
presoaked prior to test
PERrOnMEDO¥: KMD m Ken Duffus
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE
724~08 (Rev 4/85!
CERIlFY THAT THIS TEST WAS PERFORMED IN
DATE 1 0/14/94
GpF.~.TER ANCHORAGE AREA BORO,~.H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY
NUMBER OF /
MATERIAL C~*'''~-,.,,~ ~ ~'~'.(-,' '''-~ ''' COMPARTMENTS
GALLONS. INSIDE LENGTH / INSIDE WIDTH ~ DEPTH___
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
LINING MATERIA~'~)~'q''~'~;~'~jD'~''''/Ljf '~'~/~'/~-~' · DISTANCE
NEAREST LOT LINE
OR W,DTH /,~ '
FROM WELL //'~"'~ _~ /
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
· LENGTH,,~-~ ~ , DEPTH ~ /
, BU,LD,NG FOUNDA.ON. ?. --
so. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL /~"~UNDATION NEAREST LOT LINE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
· OF LINES
IN. TOTAL EFFECTIVE
IN. ABOVE TILE
WELL:
LOT LINE
TYPE~ DEPTH ~ DISTANCE FROM SAMPLE J~,,/~'., NEAREST
.BUILDING FOUNDATION. "~.~ i WATER
NEAREST ~ SEPTIC /~ / SEEPAGE / ~ I OTHER
//O / ~'~ . SEWER LINE , TANK /~?/ . SYSIEM /-~/ : CESSPOOL
DISTANCES:
DIAGRAM OF SYSTEM
DATE
APPROVED
GREATEY"'~NCHORAGE AREA .~-")ROUGH Case
GAAB-HD-2
IIEALTI! DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
~..4 ~ .=.,., LEGAL 0ESCR,PTION
APd'CATiO"TO IN~TALL' SE"ISTAN"
To SERVE THE FOLLOWING FACIL.Y
FINANCE0 THROUGH
PERCOLATION TEST RESULTS
MAILING ADDRESS
~ LOCATION OF INST~ALLATION
t~'~, SEEPAGE PIT ,~"~"'.:,~ Ah~PPIE"L'D'-'''~
T0 BE INSTALLED BY .
/
BELOWTO BE FILLED OUT BY HEALTH DEPARTMENT
PHONE
T,,S,ST0SE"VEAS'_~-'""--'/~ ~ .PER,ITTO,NSTALLA .~_~,----.-.-,-,~ .~..,-~.
,.,.,.~......__.- AS DESCAE" SE'OW. S'ZE OF ,,,T TO BE SERVE,-_~/'-~'~.~-':
/ .... SE,,CTAN,S,ZE~TVPE~W'~'~' SEEPAOE AREA y,~.z
· ~ ~DIAGRAM OF sYSTEM /
DISTANCES:
v,f- ~ -
c_.. --D--
Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
above described system is in accordance with said code.
DATE ! . /.. . /,,.- -
Municipality of Anchorage
Development Services Department
Building Safety Division
o -s,te Wa,er W s wa er
4700 Braoaw Street
P0. B0~< I 9~65-0 ¢
Anchorage, 343-7904AK 99519-6650 /:'?,,~
www.muni.org/onsite
(907) o
C__.ERTIFICATE OF ON-SITE SYSTEMS APPRO~/AL
FOR A SINGLE FAHILY DWELLING
Parcel I.D. 050-182-08
1. GENERAL INFORMATION
COSA# ¢,'-~C l ¢ ( .,;¢. 6 )
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
DALE BRIGGS; BLOCK 2, LOT 8
17514 MONTE ROAD *EAGLE RIVER~ AK 99577
ELIZABETH BERGH Day phone
17514- MONTE ROAD *EAGLE RIVER~ AK 99577
688-8751
Day phone
Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 5
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 .E~ Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 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 Municipafity of Anchorage files and fi'om 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 557-6179
Address 5701 Eo TUDOR ROAD, SUITE 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 of the test, and separation
distances measured to readily identifiable features, 'The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
[/'"/~ Approved for Z~)
Disapproved.
' Conditional approval for
bedrooms.
A
....
ON-SITE
WATER AND
WASTEWATER
bedrooms, with the following stipulations: ~ ~;o, PROGRAM ..
~,. ~.'- ."Z'-'.-~
-'~,: ~.."- ..... .- ~,¢..,-~,
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
N:u ~ Auw~u, .y
(Rev. 11/05)
Arsenic Adviso,?
Maintenance Agreements
Supplemental Engineer's Report
Other
/~,-~~ Original Certificate Date:
C=
CERTIFICATE
Legal Description:
WELL DATA
Well type PRIVATE
Date completed UKN
Total depth 178 ft.
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
OF 0N-SITE SYSTEHS APPROVAL
CHECKLIST
DALE BRIGGS;. BLOCK 2, LOT 8
Parcel ID:
If A, B, or C provide PWSID# N/A
Sanitary seal (Y/N) YES
Cased to 45+ ft.
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi.
Arsenic: 22.6 ug./L.
SEPTIC/HOLDING TANK DATA
g.p.m.
050-182-08
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
10/5/2010
110 .ft.
5.46 g.p.m.
Nitrate 0.985 rog.IL. Other bacteria __
Date of sample: 10/5/2010 Collected by:
Tank Type/Material SEPTIC/ STEEL
Tank size 1000 gal. Number of Compartments 2
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
Date of pumping 10/14/2010 PuT per.
I'BELOW EXISTING CRADEI
Soil rating (g.p.d./ft2o~ 0.6
Width 2 ft,
NO
colonies/100 mi.
GEG Ltd.
System type TRENCH
Gravel below pipe 4.58 ft.
Total depth *8.25+ ft. Eft. absorption area 795 f¢ Monitoring tube YES Depression over field NO
Date of adequacy test *'10/6/2010 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 6 in. Water added. 450 gal. New depth 42 in.
Elapsed Time: 130 min. Final fluid depth 57 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date -
**TRENCH WAS PRESOAKED WITH 2000 GALLONS OF WATER ON SAME DAY.
YES
12+ in.
ABSORPTION FIELD DATA
Date installed 11/~9-11/'94
Length 85 ft.
High water alarm (Y/N) N/A
JR'S PUMPING
Date installed 11/'9-11/94
Cleanouts (Y/N) YES
D. LIFT STATION
Date installed
"Pump on" level at
De__tM m J
in.
Size in gallons Manhole/Access (Y__~ ~
"Pump off', level .a~igh water alarm level at
Cycles tested
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on Iot~ 100'+
Public sewer main 75'+
Sewer/septic serVice line 25'+
Animal containment areas. 50'+
in.
*95'
Meets alarm & circuit requirements~
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 100'+
Holding tank N/A
Manure/animal excrete storage areas
100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water main 10'+ Water serVice line. 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
Water serVice line 10'+
Curtain drain NONE KNOWN
COMMENTS
*WAIVER
Building foundation. 10'+
Surface water 100'+
Wells on adjacent lots 100'+
#WR080078
Absorption field 5'+
Surface water. 100'+
Water main 10'+
Driveway, parking/vehicle storage 10'+
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date·
Engineer's Printed Name JEFFREY A, GARNESS
Date
COSA Fee $
Date of Payment
ReCeipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
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
Arsenic Advisory
Certificate of On-Site Systems Approval # 101261
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 2, Lot 8 of
Dale Briggs Subdivision. This inspection revealed an arsenic concentration
of 22.6 micrograms per liter (ug/L) for the property's well water sample.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 ug/L for public drinking water systems.
While private wells are not subject to this regulation, EPA standards are
based on existing health information and can therefore be used to gauge the
relative quality of water from private wells. Information on arsenic is
available from the On-Site Water and Wastewater Program website
(www.muni.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
SGS Ref.# 1105358001
Client Name Garness Engineering Group, Ltd Printed Date/Time 10/08/2010 16:44
Project Name/# Dale Briggs B2,L8 Collected Date/Time 10/05/2010 12:00
Client Sample ID Dale Briggs B2,L8 Received Date/Time 10/05/2010 12:45
Matrix Drinking Water Technical Director Stephen C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic 22.6 * 5.00 ug/L EP200.8 C (<10) 10/05/10 10/06/10 KDC
Waters Department
Total Nitrate/Nitrite-N 0.985 0.100 mo~rL SM20 4500NO3-F B (<10) 10/05/10 AYC
Microbiology Laboratory
E. Coli Negative I 100mL SM20 9223B A 10/05/10 DLC
Total Coliform Negative 1 100mL SM20 9223B A 10/05/10 DLC
Municipality of Anchorage
Development Services Department
Building Safety DMsion
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.munLorg/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Expiration Date: ,~ - .J "~ -' O C~
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
DALE BRI(;GS; BLOCK 2, LOT 8
17514 MONTE ROAD *EAGLE RIVER, AK 99577
BETH BER(;H Day phone
17514 MONTE ROAD *EAGLE RIVER, AK 99577
Day phone.
688-3367
ANN ROBERTS W/ PRUDENTIAL Dayphone 244-3392
16635 CENTERFIELD DRIVE 'EAGLE RIVER, AK 99577
Unlessotherw~erequeste~ COSAwillbeheMbyDSD ~rpick~.
2. NUMBER OFBEDROOMS: 5
3. TYPE OF WATER SUPPLY:
Individual Well
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 ~f 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 pdvate or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a pedod 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 vedfy 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/orwastewater disposal system is (are) safe, functional and adequate
for the number of bedrcores and type of structure indicated herein. I further veri[y that based on the
information obtained from the Municipality of Anchorage files and frore 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 regulatlons in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP. Ltd.
Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE. AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Phone, 337-6179
Date C~/2c~ /0~)
Engineer's Comments:
In conducting this evaluation, GEG, LtD. a~lernpted to provide a thorough,
conscientious engineering analy~s of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of alt wells end
septic systems depend on the local soils condition, groundwater levels that may
ifuc~uato during the year, and the water usage of the farn]Ty being served by the system.
These conditions are ~utside the control of the evaluator of the system. Satis~actoo, test
results do not guarantee future perfon'nance of the system, nor do they guarantee that
there are no I~idden defects or encroachments. GEG, LTD. can therefore not pro~fde
any warranty or future estirnate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The co, tent of this report is for
the sdie 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 if confer any legal dght whatsoever.
5. DSD SIGNATURE
~ Approved for ~ bedrooms.
Disapproved.
Conditional approval for __
bedrooms, with the ~owing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
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 SYSTEHS APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Well type PRIVATE ,
Date completed
Totaldepth .178 ff.
Date of test
Static water level
Well production
UKN
DALE BRIGGS; BLOCK 21 LOT 8
*SEE ATi'ACHED LETTER FROM
ARCTIC PUMP AND WELL
IfA, B, or C provide PWSID#
Sanitary seal (Y/N) YES Wires
Casedto *45+ ft. Casin
FROM WELL LOG
WATER SAMPLE RESULTS:
Coliform O colonies/100 mi.
Arsenic: 2.77 ug./L.
Parcel ID: O_~"'~) - I _~,,-~.--' O~,
Well Log (Y/N) NO
)roperly protected (Y/N) YES
Iheight (above ground) 18+ in.
AT INSPECTION
'8/8/o8
1 14 ft.
6.5 g,p.m.
Nitrate 1.16 rog.IL. Other bacteria (~ coloniesll00 mi.
Date 0f samPle: 8`/12`/08, Colle~tedby: GEG Ltd.
SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC`/ STEEL
Tank Size' 1000 ,gal. Number of Compartments 2
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
Date of pumping 8,/15`/2008 Pumper
ABSORPTION FIELD DATA
Date installed ll/9-11/g4
Length 85 ,fl.
~'BELOW EXISTING GRADE]
Soil rating (g.p.dJft~o~
0.6,
Width 2 ft.
Date installed 11 `/9-11 `/94 ·
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
· JR'S
System type TRENCH
Gravel below pipe 4.58 ft.
Depression over field. NO
For 3 bedrooms
New depth15`/19 in.
450+ g,p.d.
NONE KNOWN If yes, give date -
Totaldepth .8.25-9ft. Eft. absorption area 795 ft~ Monitoring tube YES,
Date of adequacy test 8`/8`/08 "Results (Pass/Fail) PASS !
Fluid depth in absorption field before test15`/DRYin. Water added 780 gal.
Elapsed Time: 120 min. Final fluid depthlS`/DRYin. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
D. LIFT STATION
Date installed. Size in gallons ~ ..._.-.
"Pump on" level at ~High water alarm level at
Da__.~p_utum ~ Cycles tested. Meets alarm & circuit requirements?
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot 100'+
Public sewer main 75'+
Sewer/septic service line 25'+
*95'
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
Animal containment areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+
Water main 10'+ Water service line 10'+
Wells on adjacent lots 100'+
100'+
50'+ Manure/animal excrete storage areas 100'+
Absorption field, 5'+
Surface water. 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Propertyline 10'+ . Building foundation 10'+
Water service line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
Water main 10'+
Driveway. parking/vehicle storage 10'+
F. COMMENTS
*SEE WAIVER REQUEST
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A, GARNESS
Date
COSA Fee
Receipt Number
(Rev. 11/05)
Waiver Fee $ ~ ~, ~')
Date of Payment ' '/O~/P/~,,~
Receipt Number ~) ~; ~--~
Mayor Mark Begich
Mtmicipality ofAnd oragc
Oflk'e: (007) ,~:1-~)1 * Fax: (907) 5:13*,t~t}0
Development Sersnlces I)cpartment
Department
November 13, 2008
Jeff Garness, P.E.
Garness Engineering Group, Ltd.
Subject:
Waiver Request for Dale Briggs, Block 2, Lot 8
Waiver Request Number: WR080078 Eh'od Reference source not found.
Parcel ID:
Permit Number: IIA08039'1
Dear Jeff Garness, P.E.:
Your request for the separation distance waiver(s) listed below;
1. 95 foot well to septic tank,
has been approved.
This waiver approval applies to the item(s) listed above only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-7904.
Sinc~/~ly, .. t
~ames Jay' Crc , ·
Civil Engineer
On-Site Water & Wastewater Program
Community, Security, Prosperity
Municipality of Anchorage
Development Services Department
Building Saf~y Division
On-Site Water and Wastcwater Program
470{) Bragaw Strcct
P.O. Box 196650 Anchorage, AK 9951%6650
www.ci.anchorage.ak.us
{907) 343-7~.,~4
Waiver Review Worksheet
Waiver WRQ800078 PID 050-182-08
Date Received: November 6, 2008
Legal Description: Dale Brlggs Block 2 Lot 8
Engineer:. Jeff Garness, P.E.
Applicant: Beth Bergh
COSA HA080391
Waiver Requested: 95' well to septic tank separation distance.
Criteria: Geology
^. Water Table
B. Soil Sorption
C. Permeability
D. Water Table Gradient
E. Horizontal Separation
Points:
8.3
3.0
2.0
1,2
2.8
Date: 11113/08 By: Jay Crewdson
Name of Reviewer
Rec#: 035838 Amount: $920 Date Paid: 11106108
Total: 17.3
Waiver is Granted: ~ Waiver is not Granted:
Est Conditions or Reasons for above: See attached for scoring of points.
1. Encroachment has existed for 14 years, recent water samples indicate nitrate level is 1.16.
2. Well is 178 feet deep and cased to at least 45 feet.
3. Topography does not allow surface flow from the septic tank to the well.
4. High level of monitoring due to the house location between the well and septic tank.
GARNESS ENGINEERING GROUP, Ltd.
.......... CONSULTANTS & GENERAL CONTRACTORS ..,* ','~'= ..... * ........ ,".'~
September 4, 2008
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Dale Birggs, Lot 8, Block 2. Waiver of Separation Distance Between the Well on Property and the Septic
Tank on Property.
The existing three (3) bedroom house is served by a private well and septic system. The septic system was installed
on November of 1994 and the well was drilled in January of 1984. Per the MOA inspection report, the separation
distance between the well and the septic tank is 100 feet. Per the asbuilt survey (prepared by Mark Seward) the
separation distance appeared to be less than 100 feet. We shot the separation distance with a Topcon total station
and determined the separation distance between the well and the first tank clean-out to be 97.56 feet. Attached is a
site plan. Based upon the graphical drawing, it appears that the septic tank is as close as 95 feet from the well;
therefore, we are requesting a separation distance waiver of 95 feet. Justification for the waiver is summarized as
follows:
· The encroachment has existed for approximately 14 years and recent water samples indicated nitrate levels
at 1.16 and no bacteria to be present.
· Attached is a well survey from Arctic Pump and Well for the subject property. The well is 178 feet deep
and cased 45 feet plus.
· The well head extends at least 18 inches above grade, has a sanitary seal, and has appropriate drainage
around it.
· The topography is such that overflowing wastewater from the septic tank would not flow towards the well.
· There is a house between the septic tank and the well, so it would be impossible for overflowing
wastewater to reach the well unnoticed.
Based upon the
requested 95 feel
Presi~
iforementioned facts, it appears that there Is minimal risk associated with granting the
waiver between the well and the septic tank.
ons, please contact us at 337-6179. Thank you for your assistance.
D., M.S.
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com
I I ~K* ~ BLACK HILL I BLACK HELL
BLOCK 1, LOT 6 BLO0( 1, LOT 3 I (y~ BLOCK 1, LOT 8C I lrERRACr.
BLOCK 1. LOT 9 I N
MONTE IrSTAl~S, i ~ ~ I~RRACE, I
BLOC)< 1, LOT 4
I LTJ ~ BLOCK 1, LOT 80 I I I
.... ~ .... s --o MONTE ROAD / c~,~T
LOT 7, BLOCK 2
PUeUC WA'~R . r ./~,~,- I|~
/~' ~; ~ 3 BEDROOM
HOUSE I J/l I \
, ,,oc,,.,OT,
LOT 6, BLOCK 2
LOT DALE BRIGGS' 2
\\~. ~ J/ I <~ bEADOWeROC~'<
I @LOC~
y..J
\ ~ ~KATLIAN DRIVE-
\ M£ADOW eRO0~, / /
~ I I
Well Waiver Guidelines
IDa ........... e Briggs Block 2 Lot 8
Water Table
Soil Sorption 3.0
Permeability 2.0
Water Table Gradient 1.2
Horizontal Separation 2.8
~ total point value 17.31
Notes:
1. The calculations are based on Bruce Erickson/State of Alaska memorandum dated 1/3/85.
2. The well log is not available.
3. Example wells: use well logs for Dale Briggs Block 2 Lots 3.5 and 9.
4. No bedrock found in the example wells.
5. Example wells are all cased to near full depth, assume Lot 8 well is too.
6. The two closest wells do not appear to have any intermediate level aquifers, assume Lot 8 doesn't
either.
7. Assume Lot 8 soil strata is similar to nearby wells.
point values
8 Pollution is iminent from both chemical and bacteria.*
8
12
16
12 Contamination is unlikely from bacteria but could be possible from chemicals or
virus.*
16 No bacteriological pollution possible but chemical pollution possible but unlikely
from household chemicals.*
25 Almost sure to be free from any form of contamination from household sewage.
25
35 No contamination possible.
*Values less than 16 should not bo waived without mitigation.
Distance (Z middle) from the bottom of the system to the highest water table in feet.
1. Lot 8 well depth is 178',
assume cased to 158
Interpolate to find point value.
Z above 100 ft
Z actual 158 ft
Z below 290 ft
Y above 8 ft
Y below 9 ft
point value 8.3
Z Y
distance (ft) point value
0 0
8 1
17 2
24 3
30 4
36 5
40 6
85 7
100 8
1/3 11113/2008
Well Waiver Guidelines
29O 9
1000 10
point value 8.3
1. Well log is not available, no soils data below sewer system test holes.
Assume soils are similar to lots 3, 5, and 9 (closest lots with well logs).
soil tTpe point value
Clean gravel 0.0
Fractrued Rock 1.0
Course clean sand 1.5
Sand with small amounts of clay 2.5
Silt 3.5
Clay and sand Equal 4.5
Clay 6.0
soil type point value depth weighted point value
GM-SM-Mt 3 10'- 158' 3
sum 3.0
point value 3.0
soil b/pe point value
Clay ( will channel) 0.0
Silt or sandy clay 2.0
Clayey sand or soil with a perc rate of_> 50 3.0
Fine sand 1.5
Sandy gravel 1.0
Fractured rock 0.9
Course sand ( 30 grit or river run) 0.4
Clean gravel 0.0
soil type point value depth weighted point value
GM-SM-MI. 2 10'- 158' 2.0
sum 2.0
point value 2.0
- Slopes toward water source
+ Slopes away from water source
% slope point value
-60 0.0
-30 0.3
-20 0.7
-10 1.2
-5 2.0
0 2.9
5 4.5
10 6.0
2/3 1111312008
Well Waiver Guidelines
60 7,0
separation distance: well to tank/field
well depth: subject property
well depth: Let 9
Lot 5
Lot 3
gradient between wells
95 ft
ft
158 ft - assumed bottom of casing
135 ft - bottom of casing
133 ft - assumed bottom of casing
200 ft - assumed bottom of casing
10.0 % - Lot 9 well -200' away
point value 1,2
point value 1.2
Interpolate to find point value. HS (It) point value
HS above 75 ft 0 0.0
HS actual 95 ft 25 0.7
HS below 100 ft 50 1.0
75 2.0
point value above 2 ft 100 3.0
point value below 3 ft 150 5.0
200 6.0
300 7.0
point value 2.8
point value 2.8
313
11/13/2008
SGS Ref.~ 1084265001
Client.Name Gamess Engineering Group, Ltd. Prlnted Date/Time 08/25/2008 15:18
Project Namel# Dale Brlggs Collected Date/Time 08/13/2008 10:20
Cllent Sample ID Dale Brlggs Receb.'ed Date/'Tlme 08/13/2008 15:35
Matrix Drinking Water Technical Director Stephen C. Ede
I'WSII) 0
Sample Remarks:
Allowable Prep Analysis
Parameter ResuILs PQL Units Method Contair~r ID LimiL~ Dale Date Init
Arsenic 2.77J 5.00 ug/L EP200.8 C (<10) 08;20/08 08/22/08 Mil
Wate=s De~&r tment
Total NitratefNitrite-N
1.16 0.100 mg/L SM204500NO3-F B (<10) 08/21108 JDZ
Hicrob£oloc~ar Labora toz~
Colony Count 0
Toul Coliform 0
Fecal Coli£onn 0
co!/100mL SM20 9222B A (<200)
col/100mL SM20 9222B A (<1)
col/100mL SM20 9222B A (<l)
08/13/08 DLC
08/13/08 DLC
08/13/08 DLC
ARCTIC PUMP & WELL INC.
Jim Sullivan, CPI
PO Box 770197
Eagle River, AK 99577
(907) 688-2510
(907) 258-2510
(907) 745-2510
apw~'gci.net
Garness Engineering
Kyle
R.E, 17541 Monte RD
On 8-20-08 I completed a well Survey on this property.
· Total Depth 178'
· Static 118'
· Pump Dempster Mod//10F2-75-S2
· Pump set 140'
· S-50pit adapter 14'
· Casing with no perforations 45'+
All measurements were taken after we extended well casing 20" above existing grade.
On completion we installed a MOA seal and conduit.
I have made arrangements to Bill the customer.
Thank you for the opportunity to work on this project.
Jim Sullivan CPI
Arctic Pump & Well, Inc.
Page I of I
;~2P.15.2008
#022? P.O01 /001
't
[,]
ASDUILT S~,'IA-RD & Af';.~OCIA'I'I,:S I.ANI) SURVI.,'Y
I HF'P. EBY CERTIFY .THAT I HGV~ ~URV[Y[D
AND THAT NO EN~OACHMENTS EXIST ~CE~ AS
OWN~ TO D~ERMINE THE ~ISTENC[ OF ANY GRID= . ~" ~'"~'/-'-.~
OF FENCE LIN~ OR FOR EST~LISHING ~ND- DRAWN~
MUNICIPALITY OF ANCHORAGE .
DEPARTMENT OF HEAl'TH & HUMAN SERVICES.
· ,~ ~.L;': Division of Environmental Services
· .,, , ~ On-Site Services Section
P.O- Box ,19665.0 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. ~ 050-182-08
GENERAL INFORMATION. ·.
Complete legal description ~ n t
Location (site address or directions) 1 7514 MDnte Rd
..,. Eagle Rtver,
Property owner S'. I~ay Outton/ KNO Engtneer.Dayphone 696-6111
Mailing address ?qa41' p1;a~'mtoan Blvd. Eaqle R~ve~'. /~1( 99577
Lending agency ~'ie~,.~ ue~,e -e~-+0~g? Dayphone
Mailing address '' p.0.Box 196850 Anchoraqe, Al( 99519
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
..~ ..... *. *. "' .... ~L ............. ...~ .,'., ,.~. '!"
- 2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well X
comm'unity well '.
Public w.a. te r .,
NOTE: if'-co;n~*unity We}i-s'~s't~m, pro¢ide ~v'~itten confirmation from St'ai~-A-DEd~ttest- '*
..... lng to the legality and status of system." ' , ,;'.,,;;7- ~ I;)61,/. -, ·
· ... , , .._ , . · ;..~'~ ,,. .~ . ~, .;~, ...
- 4. ' T~PE OF WASTEWATER DISPOSA~ ...... . .-' -'. .... ? ~?,,' ' ~'{':. '.~ ~.:'~
' .' '~, '~ --1 '.
.... o_~,._ · ¥ :~,%~ ~ · J ;~4 ·', ·
inalvlaual on 5lie ' ~ . -~; .j , :j .,,-J .'t'.
·~.' :.'..-':'-: ..' .... ;_, ':..,__,.,. :', , ~.,.:~ ~.....' ',.,,,.:-~,'~..-...',.'... .~ .--~: .:. ~.'."~:.::Ur',"~.":.""~
, .-*, .& ... ; . t,..:,~;_ :. ~' : -.*_-, ;~;.'..'!- ~,~ '.*'~:'!.': . ' ",.~.%.'.: !.1.,~ .'~, .;'
4' ..... Community on-site - ' ' - '. ';;'2 ',,' ;'~ .... -~ ·
:,,~.~ .,,~-~: · . '..ruu icsewer ........ ~- ,~ ...... '.. '. - *. ,,. ~/,:,~ ~.¢,.-~-~,., *
NOTE:' If community wastewater system, provtde written confirmabon from State?. DE~ ~·, t ; ' '
· - ~ .-.. .*-. . .... . .... ~ ...... , ,.~ ,,. -.-, ,; .... . . .~,,,..;,,.,,~.~. ,~..%:.;. _
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my"
investigation of this Health Authority Approval appllcation 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 verifythat 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,
ordnances, and regulations in effect on the date of th s inspection.
Name of Firm KN~ Engineering Phone
Blvd Eaqle ~ve~-~
A,ddress ~044~ Ptarm~qan
Engineer's signature' ~
DHHS SIGNATURE
Approved for
~ Disapproved.
Conditional .approval for
bedrooms.'
696-6111
AK 99577
Date
bed~room.s,' with the following stipulations:
Additional Comments
.. ~.'rhe, Municipality.of.J~nchorage Department of Hea th and Human Services (DHHS) Issues Hea th Authority
~Ap.~,rova!.,. -- --~ t~.~rtifi. ,ca.tas .be~ed only upon the re43resentafions graven in paragraph 5 above by an Independent
· pr ,d,fe~, t,.o.oa! eA~.'.eer'reglstered In the State of Alaska. The DHHS do~s this as a courtesy to purchasers of homes
a~d ~h~i~ lending Institutions in orderto satisfy c~rtain federal and state requ remands. Employees of DHHS do not
'~o'n~tJct'ln~s~:)ectiohs or analyze data'before a certificate '1~ Issued. The Municipality of Anchorage is not
.~ :'~ re,sP~n.~Ib!.e' fo. r.~r~rs or omissions In the professional enginee~s'worl~ :,~4:1 '..'~\+ ~ ~:;c'i.'.,.:..?~~ :~ '..' ' . .
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescdption: Lot 8 Blk. 2 ~)ale Bri~lr~s ParcelI.D. 050-182-08
A. Well Data
Well type [ n d i v i d u a 1 If A, B, or C, attach ADEC letter. ADEC water system number ',
Log present (Y/N) N Date completed 1970 Driller unkn
Total depth 294 ' .Cased to 294 ' .Casing height 6"
Sanitary seal (Y/N) y Wires properly protected (Y/N) '
FROM WELL LOG AT INSPECTION
Date of test / 9
Static Water level / 1 ~ 6 '
Well flow / g.p.m. 3. O
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 1'0 ~ '
Absorption field on lot 1 Rn ' +
Public sewer main 100 ' +
Sewer service line 1 fin, +
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
Y
100'4'
WATER SAMPLE RESULTS:
Date of sample: 1 1 !1 ~!Otl
Nitrate
Collected by:
Otherbacte'ria
KNI3 Fnn~'lnr,~'r'in0
B. SEPTIC/HOLDING TANK DATA
Date installed 11 / 11 / 94
Cleanouts (Y/N) Y
High water alarm (Y/N)
Date of pumPing. ~1 /
Tank size 1000
Foundation cleanout (Y/N)
N/A
Compa~lments 2
y Depression (Y/N)
Alarm tested (Y/N) .~1 / A
Pumper fl / A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 1 0z~ ' On adjacent lots
To property line 48 ~ Absorption field
Surface water/drainage 1 00 ' +
100'+
7~-02~ (&l)3)' Fm~
Foundation 33 *
Water main/sen/ice line
50°
CONTINUED ON BACK PAGE
C. UFT STATION
Date Installed / Manufacturer /
Size in gallons / Manhole/Access (Y/N) /
Vent(Y/N) "/on' level at ', 'Pu~fff Level at ,
Well one/" On adjacent ~ots/ Sudace water
D. ABSORPTION FIELD DATA
Date installed 11 / 11 / q 4
Length ~ 42-43'' ' Width
Total abSo~tlon are~ ~ 795 sf
Date Of adequacy lest N / A
Water level In absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/FF) 0. G .System type
2 ' Gravel thidmess 5.2 Total depth
Cleanout present (Y/N) Y Depression over field (Y/N)
Results (pass/far) ~1 ! A for N ! ^
Alter test ~l ! ~
If yes, give date
~eep trench
11,5'
N
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ,104 '
To building foundation
On adjacent lots N / A
Surface water 113 ri ' +
Curtain drain '" ' N / ^
F_.. ENGINEER'S CERTIFICATION
33'
On adjacent lots 100 ' + Properly line 10 '
.To ex st ng or abandoned system on lot 10'
Cutbank N / A Water main/service line 50 '
Driveway, parking/Vehicle storage area 4 R '
I cer~fy ~at I have checked, verified, or conformed to all MOA~and HAA guidelines in effect on the date of this inspec~on.
Signature
Engineer's Name
Date ll/21/g4
HM Fee $ '~O ?~
' Waiver Fee $
Date of Payment
Date of Payment
Receipt Number
MUNICIPALITY OF ANCtlORAGE '~2 --
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~"'~"
ENV,RONMENTALENG,NEERINGD'V'S'ON ox
DIRECTIONS: Complete all parts on page 1. Incomplele requett~ will not be proc,ssed. Please allow ten (10I days for pro~essing.
99577
I PHONE
PHONE
PHONE
1. PROPERTY OWNER
Dutton, Lawrence A. and Sylvia Kay
MAI LING ADDRESS
½ Mile Monte Rd., Eagle River, Ak.
PROPERTY RESIDENT (if dillerent from at}omi
Same
~ BUYER
N/A (Refinance)
MAILING ADDRESS
3. LENDING INSTITUTION I PHONE
I
279-7511
Peoples Bank & Trust
Co.
MAILING ADDRESS
Pouch 7-007
PHONE
4. REALTOR/AGENT
N/A
MAILING ADDRESS
N/A
LEGAL DESCRIPTION
Lot 8, BiE. 2, Dale Briggs Subdivision
,TREET LOCATION
NtlN Monte Road, Ea~le Rtver~ Alaska 99577
e. TYPEOP RESIDENCE
I'~ SINGLE FAMILY
[] MULTIPLE FAMILY
7. WATER SUPPLY~
INDIVIDUAL*
[] COMMUNITY
E] PUBLIC UTILITY
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
F-1 PUBLIC UTILITY
I
NUMBER OF BEDROOMS
[] One ~ Four [] Other
[]F ve
hree [] Six
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
'*If individual/on-site, give installation date unknn,..m .
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
lt4UNICIPA~ITY Or ~CHORAG~
~E~p[. OF HE '
EN1/IRo~J^ ..... ALTH &
*Syl~i'a- D~tton ~o*rk //272-5501 .... ~[AL PRO7Ec*IiO,,~
72010(3/78)
La~rence Dutton w~rk #279-7691
'.fAY 3 197
RECEIVED
GRSATER AK~HOPAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
Date Received
Time of Inspection
Date of Inspection ~
REQUEST FOR APPROVAL OF
INDIVIDUAL SB~ER & WATER FACILITIES
FOR
'1. A~proval Requested By:_q'~./z~ ~Z,~/~'~
Address:
.1
2. PrOoertv Owner: ~/~
4. location: ~. ~,
5.' TVDe of Facility to be Inspected:
,, . Number of Bedrooms: ~
6. Well Data:
' C. Const~ctton
~71 Sewage Dtsnosal System:
Phone:
Phone ~.~? '/~ 7
B.' Depth ~
D. Bacterial Analysis
C. Septic Tank: 1. Size/_~2~ 2. ~lanufacturer/~/~/~~',
E. Disposal Fie]d:, Total Length of L~nes ~
Dlstences:
' ; Absorption Area~ , Sewer Lines
A.
?:ell To: Septic Tankff~!
~ ,., Neerest Lot Line /,~1_/_ , Other Conte~tnation
Foundation to Septic Tank ~' "~ Absorption Area
Absorption Area to Nearest Lot Line /0~
~Request far Approval of ~ ,vtdua! Sewer & Water Fac~lttt¢~
P~ge Two
9. Comments:
Apor~ Valid for One Year Prom Date St~ned
Greater Anchorage Area Borough, De~rtment of ~nvtro~mental ~ality
DIAGRA~ OF SYSTEK:
! certify that the Information contained tn this request 'for approval~to be~attrue
and accurate representation of the sub.tect sewer and water fectltt~es'locat~d~at=
Signed Date