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Home My WebLink AboutUS SURVEY 3043 LT 16 T10N R2E SEC 18US Survey 3043 Lot 16 #075- 092 - 13 c~,~,B.,o.~ . GR£~TER ANCHORAGE AREA BOROU~'] Dkr~RTMENT OF ENVIRONMENTAL OUALh. 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION MAILING ADDRESS LEGAL DESCRIPTION SEPTIC TANK: LIQUID CAPACITY MATERiAL~,~_~/~/' .~'%_///~ .- ~%~ ~.. NUMBER OF ~.~/.~:.._-:~6-~ ~2~c~.~ -COMPARTMENTS LIQUID GALLONS. INSIDE LENGTH. INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: / NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH LINING MATERIAL~-- ~?/:/~d~>~ ~'.~-%5- , DlSfAN6E FRO~ WEb[ NEAREST LOT LINE ~ / ::3/ / TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) / / LENGTH ¢~' , DEPTH , BU,LD,NG FOUNDATION'~'~'~ --- TIL~~F I ELD: ~--~ TOTAL LENGTH DISTANCE FROM WELl ~-OUND,~LTJ~N , NEAREST LOT LINE , OF LINES NUMBER OF LINES .DISTANCE BETWEEN LINES IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. DEPTH: TOP OF TILE TO FINISH GRADE LOT LINE / , SEWER LINE , TANK DISTANCES: ~TREN~H~ WIDTH LENGTH OF EACH LINE -~% OEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE DISTANCE FROM WATER ,BUILDING FOUNDATION.__/~' SAMPLE,,' - NEAREST , SYSTEM , CESSPOOL DIAGRAM OF SYSTEM G,A.A.B. GREAi ER ANCHORAGE AREA BOR,.J~GH SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT PERM ~T NO. 2169 INSTALLATION LOCATION MAILING ADDRESS LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH COMPLETION DATE ANTICIPATED seEPage Pit TO BE INSTALLED BY , DRAIN FIELD , OTHER NOTE: THIS PE~ V--~.~[D-WITH U SOIL 'T~.ST,.., ,. FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY~YSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. / WELL TO SEPTIC TANK DRAIN PIELD / ALSO CONSIDER AREA WELLS. / , SEEPAGE PIT / ~} DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXC,A.~,~-,i~E~,~O UNDISTURBED SOIL 4 INCH DIAMETER CAST IBON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PiT FITTED WITH AIRTIGHT REMOVABLE CAPS. AREA SIZE DIAGRAM OF SYSTEM GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. DESCRIBED SYSTEM IS IN ACCORDANCE WITH SA]e) CODE. HEALTIi DEPAkTMENT. 'CAS£ t/ ,,, ' · 327 t:AGLE STREET.. ANCHORAGE, ALASKA 99501 Leaal Desc~,ipt-~on: Lot SY%¢k ,...S~%-i~l-6'n '~ ' This F¢~m Reports a: S~-i~'-Log ]/, . TPo~cola~ion fcst .... Depth Feet Soil Cha.~act ePistics ~ . '/~ .. z ~ . ,.., . Was Ground Water Encountered? If Yes, AT What Depth Reading _. i. Date Gmoss Time Proposed Insral~Seepage Pit Location Sketch l, ,,.,,!,, ~ I l-"--k~ j Net Time Deoth To H20 ~' Drop DPain Field Depth Of Inlet Depth To Bo'~to'm' Of Pit Or Trench '~ ~; ._ ~__ . _ 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 FOR A SINGLE FAHILY DWELLING Parcel I.D. 075-092-13 1. GENERAL INFORMATION Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address U.S.S. ,3043; LOT 16 1063 ALYESKA HIGHWAY * GIRDWOOD, AK * 99587 SCOTT & NICOLE KIRK Day phone P.O. BOX 576 * GIRDWOOD~ AK * 99587 223-9651 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 [] 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 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/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further redly that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 357-6179 Address 3701 E' 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 afl 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 encraachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ~ Approved for ~ bedrooms. Disapproved. Conditional approval for ,_~' ON-SITE E~ WATER AND bedrooms, with the following stipulations~C~ WASTEWATER ~ PROGRAM Attachments: CaSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ~-"- //-'-/ - l '~'~ Municipaiity of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-79O4 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: U.S.S. 3043; LOT 16 Parcel ID: 075-092-15 A. WELL DATA *PER GEG INSPECTION. **PER AAROW PUMP AND WELL INSPECTION. SEE ATFACHED. Well type PRIVATE IfA, B, or C provide PVVSID~ N/A Date completed UNKNOWN Sanitary seal (Y/N) YES Total depth ~ ft. Cased to **40+ ft. FROM WELL LOG g.p.m. Date of test Static water level Well production Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ .in. AT INSPECTION 5/3/2012 36 f. 6.0+ g.p.m. Nitrate ~ [ ~'~mg./L. Date of sample: WATER SAMPLE RESULTS: Coliform /VJ~ colonies/100 mi. Arsenic: ~J~ ug./L. B, SEPTIC/HOLDING TANK DATA Tank Type/Material IPUBLIC SEWERI Tank size I gal. Number of Compartments __ Foundation deanout (Y/N) __ Date of pumping Depression over tank (Y/N) __ Pumper Collected by: (b~/L.,-f-cl, Date installed Cleanouts (Y/N) High wat~ C. ABSORPTION FIELD DATA ft~/Syst Date installed Soil rating (g.p.d./ft~or em type Length ft. Width / ft. Gravel below pipe Total depth ft. Eft. abs~ ft2 Monitoring tube Date of adequacy test ~ Results (Pass/Fail) Fluid depth in~ before test in. EI~: __ min. Final fluid depth ~enation treatment (past 12 mo.) (Y/N & type) Depression over field__ Water added __ gal. in. Absorption rate >= If yes, give date For__bedrooms New depth __in. g.p.d. D. LIFT STATION Date installed ,Size in gallons ~ ~ 'Pump on" level at in.~ High water alarm level at in. Datum ~ Cycles tasted Meets alarm & circuit requirements? SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanldlift station on lot N/A Absorption field on lot N/A Public sewer main 75'+ Sewer/septic service line 25'+ Animal containment areas 50'+ On adjacent lots N/A On adjacent lots N/A Public sewer manhole/cleanout 100'+ Holding tank N/A Manure/animal excreta storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Properbj line Absorption field Water main Water sewice line Surface water Wells on adjacent lots ~ SEPARATION DISTANCE FROM ABSOR~LOT- TO: Preper[y line B~..~oundafion___ Water main IPUBLIC SEWER] Driveway, parking/vehicle storage F. COMMENTS 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 data. Engineer's Printed Name JEFFREY A. GARNESS Data ~'/~/'/'7~ COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number. Aarow Pump & well Service, LLC P.O. Box 110496 Ancho[age, AK 99511 Office: (907) 346-9355 · Fax (907) 333-8976 Eagle River; (907) 622-9335 No. 9359 CUSTOMER JOB SITE L J L J . ~/~;' ,/ ,'~ .... ~,.~ ~,,~ iD~l/ ~BOR HOURS RATE AMOUNI lOlAk MATfiRIAL TOTAL ~ WORK ORDERED BY DATE COMP. TOTAL ~ / '//'~ PaY THIS amOUNT / ~. / "' ~'~ +" SIGNATURE ' (I Hereby AcknowlC=~J~e the Satisfactory Completion o~ the Above Describe_d Work and agree that if ~bove work s not paid for in 90 days agree to allow Aerow Pump & Well Service, EEC. the right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for equipment.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. } , 8. Go ?LANNERS SURVEYORS '' GREATER ANCHOPAGE AREA BOROU6H < Department of Environmental Quality 3500 Tudor Road, Anchorage, Al'ask8 99507 279-8686 Date Received ~- 5~ gate Of Inspection REQUEST FOR APPROVAL' OF INDIVIDUAL SEWER & WATER FACILITIES FOR h Approval Requested By: , Address, q 3. Legal Description: ]/,'/~ ff/~ ~t 4. Location: ~~ · 5. Type of Facility to be Inspected: Number of Bedrooms: ~ Phone ,. Well Data: A. Type , B. Depth C. Construction '0,~ D. Bacterial Analysis' ~ ~-- Sewage Disgosal System: C. Septic Tank: 1. Size 2. ~anufacturer D. Seepage Pit: h Size 2. Uaterial E. Disposal Field: Total Length of Lines 8. Distances: A. Well To: Septic Tank Absorption Area · Sewer Lines , Nearest Lot Line · Other Contamination Foundation to Septic Tank "~ Absorption Area C. Absorption Area to Nearest Lot Line ~ ~equest for Approval ~'k%dividual Sewer & Water Faaili/-~s ~Page Two 9. Comments= DIAGRAM OF o. STEM I certify that the information contained in this request for approval to be a true and accurate represent~tlen of the subject' sewer and water facilities located at: Signed Date Aporoved Disapproved ~/f73 Appr~l Valid for One Year From Date Sl'qne~'/ ' Greater Anchorage Area Borough, De~artmen~ of Environmental Quality