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HomeMy WebLinkAboutFISCHER BLK 1 LT 4C-2Fischer Block 1 Lot 4C2 #015-292-38 GREAR ANCHORAGE AREA BOROG.H Department of Environmental Quality p Y 3330 C Street Anchorage, Alaska 99503 �j � � INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM s' NAME ��"""" �`��9� MAILING ADDRESS �dC-(" /g''''V f ;�'a 7'1 PHONE LOCATION /� - i� �-d ru9-s'®<f'LEGAL DESCRIPTION T C 2- SEPTIC TANK: DISTANCE _ NUMBER 2® FROM WELL �MATERIAL MANUFACTURER COMPARTMENTS f INSIDE LENGTH /D INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY�S'-"GALLONS. TILE DRAIN FIELD: ! MoD Io DISTANCE FROM WELL FOUNDATION NUMBER OF LINES DISTANCE BETWEEN LINES �C_Zzzl ! TOTAL LENGTH / NEAREST LOT LINE /y OF LINES jo TRENCH WIDTH 3 IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER � DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE_ IN. ABOVE TILE T IN. WELL: TYPE_ G' CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION -,LOT LINE , SEWER LINE , TANK /6a SYSTEM CESSPOOL . OTHER SOURCES APPROVED_ DISAPPROVED DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: Form EQ -032 REMARKS jl pfd DIAGRAM OF SYSTEM !1/rIL--r�2d-ni QJc.Q.J / D �J �lo�! 0 F -T••:• 5 G.A.A.B. r"l U PA I e IL I 9 CA E r uta®_ �_ IF? a �l:o3L� DEPARTMEhdT WHEALTH AND ENVIRONMENTALMOTECTION 2516 E. TUDOR RCS.: ANCHORAGE: AK 99507 276-2221 CA PA—_: I _FE EL-JEFR F•ER_r•-t I —F PERMIT NO. t: 76876 ) APPLICANT U22M FAIR SRA BOX 1727K 344-4472 LOCATION OUR RD t': DOGWOOD LEGAL L4C2 E1 FISHER SUBD LOT SIZE 55000 SQUARE FEET TYPE OF SOIL ABGORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SS? FT/BR)== 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ED, EF^ f 41 "`° I_E=P4C3-i 1-B= _''A C3 FQ F1 %0 EEL_ E> E= F> Itl= 81. THE LENGTH DIMENSION IS. THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELO. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). 1�'E®?'-a I F_EE-a WoEF IFI CV T"F1PAK v I `E_ -Alto CA C3 FI L.L_CA14I EtlAcl is v > I P".1^E,F"EJC-T I CAP -.J0> FAFRE Pte°E= CAtJ"FF°EE• BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER: INSTALLATION. F• E: F -C r7 I T »e"•F:�L I E_• F -CAF:' CArAE NeEFAF1 EFQCAUl I _=._,LjE I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. _. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN BEDROOMS. -�!'---------------- SIGNED r APPLICANT NORM FACER ! ISSUED BY ------------------------------ DATE -------------- /� •.:.;. NAME OF APPLICANT 0 f GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330"C"STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT INSTALLATION LOCATION -'1�C.L.J- 1r -,L LEGAL DESCRIPTION `� ~ -2- INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED \.O 1- /2 PERMIT NO. X10 ADDRESS 0-,q K. PHONE 3T�1-q� L-, DRAIN FIELD OTHER TO BE INSTALLED BY NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE _1 � d�TYPE SEEPAGE AREA SIZE MINIMUM DISTANCES, REQUIREMENTS ,I FOUNDATION TO SEPTIC TANK ti FOUNDATION TO 9£EPAGE'PiTI- , ,DRAIN FIELD . ' ;_,M� I SEPTIC TANK TO ;T'=^'__-; T^'.. '.•:.LL SEPTIC TANK `'D 1 �T� t GRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANKc) I-oG i 1LFM'ZR.` �c EPASE Pi DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK , SEEPAGE PIT DRAIN FIELD /�1-�'��/�i SEPTIC TANK, �a d SEEPAGS•-IIT r0 �1 DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGA IN INSTALLATION. G.A.A.B. OR LICENSED DESIGNER TYPE DIAGRAM OF SYSTEM I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AR A BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYSTEMIS IN //ACCORDANCE WITH SAID CODE. DATE 1 ` gn/IU // APPLICANT'S SIGNATURE FORM NO. EQ -016 GREATER ANCHORAGE AREA BOROUM Department of Environmental QuM ty 3330 "C" Street Anchorage, Alaska 99503 SOILS LOG - PEROLATION TEST Performed for wr 7-,:3- n Date Performed - ig --�5 Legal Description: -/-c -2 3L< This form reports: Soils loa X Percolation test Depth Feet 1- 2- 4- 5- 6 7- 8- 9- I 10 - s)p AP 11 - -M 13 - 14 1 Was ground water encountered? 1.4 i) If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop Percolation rateminute. Proposed installat of n_ Seepage Pit Drain Field Depth of Inlet _— _ Depth to bottom of pit or trench COHMENTS: - —_--- ------------- --- —_�_ Performed By: EQ -040 (6/74) ed By: t M; : I g - Time AP'/PLI T FILLS OUT UPPER HA ONLY Property Oylrier 1 &v,11AA1 /-, -���Q �.fl�%p} q, �—/�('t./� _ Phone x Mailing Address17j iNy- Zip Code (� ;7 Buyer Date Address Zip Code Lending Institutionfn5� %i!d�L»L F�IJ-1< C),,:,/9/tf CjjL),ZJ4TC CJD Phone rlC tt) 62A/�QH— m/?,,� Address —'� _ — Zip Code -`0 Realty Co. & Agent Phone Address Zip Code Field Notes: . Legal Description MUNICIPALITY OF ANCHORAGE Street Location S Type of Residence 8.61ngle Family ❑ Multiple Family No. of Bedrooms ❑ Other 7 1982 Water Supply individual -L41) S14" FA�ACH WELL LOG. A well log Is required for all wells drilled since June 1975, L) Community JJJ lls drilled prior to that date, give well depth (attach log if available). ❑ Public Utility ( %DISAPPROVED Sewer Disposal - Q.individual J QJYL�11 �da. E� `-�`�'i. Year Individual Installed: IGi4 71 Public Utility When Connected to Public Utility: ❑ Holding Tank DATE //�I — 2g�—� �� ( 4—_ �,/8/°)~�//'�/ NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time ©ll"11(LQ1y cy�i \� Date Date Date Date Inspector Inspector Inspector Inspector \- Field Notes: . TT MUNICIPALITY OF ANCHORAGE ENVIk U I.. A. ".O E' T. 7 1982 RECEIVED ( 3) APPROVED BEDROOMS - 'CONDITIONS OF APPROVAL ( %DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE //�I — 2g�—� �� ( 4—_ �,/8/°)~�//'�/ BY: 1Ay SIM"" Soils Fall Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size y ]2023(310?) CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION . PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of public water system located in. ' ` = Alaska, submitted in accordance with 18 AAC 80.100 by -' ' ' z7 , -' =' '' r have been reviewed and are ❑, approved. ❑ conditionally approved (see attached conditions). BY TITLE DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract order no.. - Approved by _ Date or descriptive reference) The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the -' public water system was completed on(date). The system is hereby granted interim approval to operate for 90 days following the cpmpletion date. } r �d19� BY ,1: TITLE DATE ; As -built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. BY TITLE DATE ALASKA 611UIR01111611TAL C011TROL SCrUICCS, Inc. engineerinq & Enuironmental Studies October 5, 1982 Alaska Department ofEnvironmentalConservation 437 E. Street Anchorage, Alaska 99501 Attn: Burce Erickson Dear Mr. Erickson: On October 4, 1982 we inspected the wells and sewer systems for lots 4C1 and 4C2, Block 1, Fischer Subdivision. Both houses share a common well which is located on lot 4C2. The well is located in a small box type enclosure, the location is shown on the attached drawing. The well is located over 100 feet from any sewer system. Results of a bacterological test of the water was provided to us by one of the owners. It was satisfactory. It, along with the well drilling log, is attached. The well is 305 feet deep. Both sewer systems were installed under Municipal supervision. There was no evidence of either system overflowing. I believe that if the requirement for 150 feet separation between class C well and the sewer system were waivered it would not create any health or environmental problems. I therefore recommend that you grant the waiver of distances for this class C well. If you have any questions please let me know. �cvtie r.�� torcy C) Reid, Jr. Sincerely, Leroy C. Reid, Jr., PhD PE President 1220 Test 25th Auenue 9 Anchorage, Alaska 99503 • 907) 276-1361 ALASKA ENVIROTAL CONTROL SERVICW, INC. 1220 West 25th Avenue Suite B ANCHORAGE, ALASKA 99503 276.1361 279-2917 JOB of SHEET NO, I OF CALCULATED BY AAAA FARLANf: DATE CHECKED BYE DATE SCALE N/ T 5 VMIM1YIiN-� �Irc Cmlm Vuv ��1�I CHEMICAL & GAOGICAL LABORATORIES ALASKA, INC. pt. „arPtNaF�T r TELEPHONE (907).2794014 ANCHORAGE INDUSTRIAL CENTER 02` 40 — 274.336.4 - 5533 B Street g �.4 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER,; _ TO BE COMPLETED BY LABORATORY WATER SYSTEM: I I i I I i I Analysis shows this Water SAMPLE to be: I.D. NO satisfactory Water System Name Phgge`_ NO. Unsatisfactory ❑ Sample too long in transit: sample should not be over 48 hours old at examination Mailing Address to indicate rel{",ble ;results. Please. send new sample... .. City St Zip Code Date Received ! SAMPLE DATE: ®ITF51 Mo. Day veer 'Time Received ? i SAMPLE TYPE: Analytical Method: G ioutine ❑ Check Sample p with lab ref. nc ❑ Special Purpose SAMPLE NO. 1 2 3 4 5 LOCATION .( GZ, ISc e simple ,. .,;; faeated mer on Tube Filter Result' Analyst + A& colonies/10eml. or �l�l - 4/..rrcmVVvuaHnL nnlCR nlenLT]I] Rev. 1978 - Data Collected . source— READ ource_READ INSTRUCTIONS a.m. Date Rnalvad Time RaceWed p.m. BEFORE confirmatory 24 Hours 48 Houn EMB Broth 24 hours: Broth 48 haurs: COLLECTING SAMPLE Multiple Tabe Report: 10MI Tubas PoNtka/Total 10ml Portions .Membrane Filter, Direct Count - ColNorm/looml. V4rlfkrtlon: LTB BGB. Final Membrane Filter Resultst, 011form/108ml Reported BY " r� Date mi Ki 7— ve pgrtions. p.m. !■ STANLEY BRUST & ASSOCIATES Engineers - Planners - Surveyors 1317 East 74th Avenue Anchorage, Alaska 99507 (907) 349-6577 *PTIC SYSTEM ADEQUACY REPORT JOB. N0. lJ2 DATE OF REPORT DATE OF TEST���Z, LEGAL DESCRIPTION LOT �� 2 , BLOCK /.Tla Gr' ✓°'��°"`- SUBDIVISION OR SECTION' T.N, R—W, S.M. , ALASKA PERFORMED FOR: sizg / 7; 7 K 9 --y 1 PHONE NO -_ °s�y - .� %� W >-5'x/7 REQUESTED BY fly MUNICIPALITY OF ANCHORAGE :.PT. CF HE: "LTH R.. ENVIE r; JPF,-N-iA. P,O E_-.iJ u ;? 0 f9g9 FHONE NO. --- TYPE OF SYSTEM : W SEPTIC- TANK - SIZE ���V_ —GALLONS ❑ CRIB OR SEEPAGE PIT IT- LEACH FIELD NUMBER OF BEDROOMS._ . SEPTIC TANK WAS PUMPED P4ES ❑ NO NOTES a OBSERVATIONS: 19 -TEST PERFORMED BY: - S/— REPORT FRLPAREC, BY: ..rV;;;-/ _ APPROVED BY:- 17 Esc. - j/ Tom' s� ell e) /, nS� r � _,. "9 �. Y.6� GREATER ANCHORAGE AREA BOROUGH ,' V Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection / r 6170Zj REQUEST FOR APPROVAL OF - INDIVIDUAL SEWER/ & WATER FACILITI€S FOS-v--n-� I . Approval requested by: Mailing Address: i7d7% — S Phone: 3v< -l- 5 2. Property Owner: Phone: Mailing Address: 3. Legal Description: 4. Location: 5. Type of facility to be inspected No. of bedrooms 6. Well Data: A. Type B. Depth C. Construction Pel—D. Bacterial Analysis 7. Sewage Disposal System: A. Installed /y 6 B. Installer 's J C. Septic Tank: 1. Size?`9�/ 2. Mangfactur D. Seepage Pit: 1. Absorption Aria 2. Material E. Disposal Field: Total length of lines 2 . 8. Distances: A. Well to: Septic tank 7 Absorption area —C.. Sewer Lines Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line •Page 2 of two pages - Req#t for Approval of Individual *r & Water Facilities Legal Description Comments Approved Disapproved u.,+. 4el,(er' t-.�c. Date Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to De a true ana accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date o o, j5S�cwt�'� • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval p Parcel I.D. 015-292-38 Expiration Date: r o� 1. GENERAL INFORMATION Complete legal description FISCHER SID; BLOCK 1, LOT 4C-2 Location (site address) 5041 E. 104TH AVE *ANCHORAGE, AK Current Property owner(s) NORMAN FACER Day phone 727-5851 Mailing address 5nAl F 1 n4TH AVE *ANCHORAGE, AK Real Estate Agent KEITH FACER Day phone 727-5851 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings ingle Family an or Duplex) 3. NUMBER OF 4. TYPE OF WATER SUPPL •I I y Individual Well —' U Individual Water Storage ❑ Community Class C_ Well lid Public Water System ❑ WaiverNariance Received by: TYPE OF WASTEWATER DISPOSAL: Individual 19 Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ �VG ^ 1 Date of Payment k l r 4f' Receipt Number co -00/0 G-' COSA # Q �C Z �Zj q I Date: Waiver Fee $ _ Date of Payment _ Receipt Number — Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Gayness Engineering Group, Ltd. Phone (907) 337-6179 Address 3701 E. Tudor Rd., Suite 101 Anchorage AK 99507-3246 Engineer's Printed Name Jeffrey A. Garness Date A2, kc - In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industrypractices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separationdistances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail. The content of this report. is for the sole benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows anylegal dutyto anyone other than the person/party who paid for this report 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for _ bedrooms Disapproved Conditional approval for bedrooms, with the folk Original Certificate The/Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only pon 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 engineers work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_9-1A2.doc 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: FISCHER SID; BLOCK 1, LOT 4C-2 Parcel ID: 015-292-38 A. WELL DATA Well type CLASS C If A, B, or C provide PWSID# 214637 Well Log (Y/N) Date completed Sanitary seal (Y/N)_ Wires properly protected Total depth ft. Cased to ft. Casin (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft_ WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: NO ug./L. B. SEPTIC/HOLDING TANK DATA 9.13 -m - Nitrate b' mg./L. Collected by: GEG, Ltd. Date of sample: 6/3/2015 'FCO IS UNDER DECK W/ NO ACCESS HATCH. Tank Type/Material SEPTIC/FIBERGLASS Date installed 10/25/1976 Tank size 1250 gal. Number of Compartments 22 ( 5 Cleanouts (Y/N) YES Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 8/21/2014 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed 10/25/1976 Soil rating (g.p.d./ft or /bdrm 85 System type TRENCH Length 30 ft. Width 3 ft. Gravel below pipe 9 ft. Total depth `14.25 ft. Eff. absorption area 540 ft' Monitoring tube ***YES Depression over field NO Date of adequacy test 7/9/2014 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 76 in. Water added 710 gal. New depth 80 in. Elapsed Time: 130 min. Final fluid depth 77 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - **NOTE: 6" SUMP EXTENDS 116" BELOW INVERT OF DRAINPIPE. D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump off level at r slam E. SEPARATION DISTANCES level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on Public sewer main Sewer /septic service areas COMMUNITY WELL On adjacent On adjacent lots manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 51+ Absorption field 51+ Water main WA Water service line •10'+ Surface water 100'+ Wells on adjacent lots "1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 101+ Water main NIA Water service line "10'+ Surface water 100'+ Driveway, parking/vehicle storage 101+ Curtain drain NONE KNOWN Wells on adjacent lots "`100'+ F. COMMENTS *ASSUMED BASED UPON WELL LOCATION AND WATER LINE INLET LOCATION. WATER LINE ENTRY POINT IN HOUSE WAS PHYSICALLY OBSERVED BY GEG "APPROVED PER ORIGINAL SUBMnTAL AND APPROVAL TO OPERATE (10112f1984 G. ENGINEER'S CERTIFICATION I ce►iify that l have determined through field inspections and review of Muniapal records that the above systems are in conformance with MOR COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 6(rz)lr (Rev.1a12M2) Municipality of Anchorage Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # OSC141419 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 4C-2 of Fischer subdivision. This inspection revealed a nitrate concentration of 6.93 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° On -Site Water & Wastewater Program 4' (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcell.D. 015-292-38 1. GENERAL INFORMATION Complete legal description FISCHER SID; BLOCK 1, LOT 4C-2 Expiration Date: 0 I "dZ a – LZ -71 Location (site address) 5041 E. 104TH AVENUE, ANCHORAGE, AK, 99507 C/O SON Current Property owner(s) NORMAN FACER Day phone 727-5851 Mailing address Real Estate Agent 2. TYPE OF DWELLING: 5041 E. 104TH AVENUE, ANCHORAGE, AK, 99507 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class C Well Public Water System WaiverNariance request for Received by:: NIA 4 Day phone PAR g 9 n f COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ '52_�' — Date of Payment <'118'W (ice Receipt Number BOG COSA # is–i 4 t '1 �� Date: t /'" r� e' +"" f Waiver Fee $ _ Date of Paymen Receipt Number Waiver # Distance: TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ❑ Individual Holding tank ❑ ® Community On-site H ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ '52_�' — Date of Payment <'118'W (ice Receipt Number BOG COSA # is–i 4 t '1 �� Date: t /'" r� e' +"" f Waiver Fee $ _ Date of Paymen Receipt Number Waiver # Distance: 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 Address GARNESS ENGINEERING GROUP, Ltd. 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name Engineers Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 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 tight whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms. 1 System #2 Approved for Disapproved. Conditional approval for A bedrooms. bedrooms, with the following Phone 337-6179 Date 'a 1,.<//* [ CE 7953 — PROFESS�CN::�'• tataaaa** ON-SITE r WATER AND WASTEVVAic_ Original Certificate Date: D v2 a The AAKicipiffity orA chorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory raa„ mnenei Nitrate Advisory Arsenic Advisory Other 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: A. WELL DATA Well type CLASS C Date completed Total depth ft. Date of test Static water FISCHER S/D; BLOCK 1, LOT 4G-2 Parcel ID: 015-292-38 If A, B, or C provide PWSID# 214837 Well Log (Y/N) Sanitary seal (Y/N)_ Wires properly protected ' Cased to ft. Casin (above ground) in. FROM WELL LOG AT INSPECTION weirproaucuon 9-p M. 9-P M. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 4.65 mg./L. Collected by: GEG, Ltd. Arsenic: ND ug./L. Date of sample: 7/9/2014 B. SEPTIC/HOLDING TANK DATA *FCO IS UNDER DECK W/ NO ACCESS HATCH. Tank Type/Material SEPTIC/FIBERGLASS Date Installed 10/25/1976 Tank size 1250 gal. Number of Compartments 22 (?5 Cleanouts (Y/N) YES Foundation cleanout (Y/N) `YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 9/17/13 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA BELOW EXISTING GRADE Date installed 10/25/1976 Soil rating (g.p.d./ft or /bdrm 85 System type TRENCH Length 30 ft. Width 3 ft. Gravel below pipe 9 ft. Total depth '14.25 ft. Eff. absorption area 540 ft2 Monitoring tube "YES Depression over field NO Date of adequacy test 7/9/2014 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 76 in. Water added 710 gal. New depth 80 in. Elapsed Time: 130 min. Final fluid depth 77 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - "NOTE: 6" SUMP EXTENDS 116" BELOW INVERT OF DRAINPIPE. D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons "Pump oft" level Manhole/Access level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service areas COMMUNITY WELL On adjacent On adjacent lots manholeldeanout Holding tank Manura/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 51+ Absorption field 5'+ Water main WA Water service line "10'+ Surface water 100'+ Wells on adjacent lots "1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line 19+ Building foundation 101+ Water main NIA Water service line 101+ Surface water 1001+ Driveway, parking/vehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots "1004 F. COMMENTS ASSUMED BASED UPON WELL LOCATION AND WATER LINE INLET LOCATION. WATER LINE ENTRY POINT IN HOUSE WAS PHYSICALLY OBSERVED BY GEG .'APPROVED PER ORIGINAL SUBMITTAL AND APPROVAL TO OPERATE (1011211982) 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 fNam�JEFFREY A. GARNESS Date lb/t.0/4, 4 (Rev. 10/12112) Lot 4B-2 I 8402H N89055'17"W 149.69 — — — — 10' Utility Easement ----------I S • I • eA"� sh I I I Lot 365 I d I L I Septic vent LP -mak(UP hain link fence (typ) O W M IH tM M O shed 0 ak I o I b o Lot 3B4 „— SCALE: 1 — 40' Zdeck i Z 2a.0 T. �v oE• I a� i OF gC�S�I, LS *618 -AP 28o LOT 4C-2 I ; 49th *I� / I .... to 00 00 r/ ,Fred Walatka.'/ Gravel driveway I t sit, 3255 - S -� I I I Lot 3B3 FFSSIONP� :'� a• 24.2 24.0 Imp 111 /2 Car (u' O I>I ��/ Port-� o p aI qAS-BUILT NO CORNERS SET THIS DATE / A m p N D� bN o 1 hereby certify that I have performed a Mortgagee's inspection I of the following described property- OT 4C-2. BLOCK 1. `rp ( N I FIS HER SUBDIVISION 24.0 +11 Anchorage Recording District, Alaska, and that the N89°53'45"W 149.69 improvements situated thereon are within the property lines ram / and do not overlap or encroach on the property tying O adjacent thereto, that no improvements on the property lying M M adjacent thereto encroach on the premises in question and —f� E. 104th Avenue that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska EASEMENTS OF RECORD, OTHER THAN this 8th day of August 12014. THOSE SHOWN ON THE RECORDED FRED WALATKA 8 ASSOCIATES PLAT ARE NOT SHOWN HEREON. Engineers and Surveyors FB 14f, pg 689, Pape BE (907-248.1568) 4 CONSTRUCTION ARID OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of J L public water system Located inAlaska, submitted in accordance with 18 AAC 80.100 by NJ �Q�a� have been reviewed and are m�'approved. ❑ conditionally approved (see attached conditions). If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHAN •E ORDERS Change {contract ornar no. - Approved by Date or oeurip"" retewco) The "APPROVAL TO OPERATE" section must be completed before anywater is made available to the public. APPROVAL TO OPERATE The construction of theof public water system was completed on /0 (date). The system is hereby granted interim approval to operate for 90 days following the cpmpletion date. OAT? v As -built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. TITLE DATE EIIIIIIIInw