HomeMy WebLinkAboutMALLORY LT 2Mallory
Lot 2
#020�093�45
Mimicipality of Anchorage
Department of Health and Human Services
825 "L" Street
Rick Mystrom. P.O. Box 196650 Anchorage, Alaska 99519-6650
Mayor
343-4744
June 28, 1996
Bryon T Schroder
4681 Virgo Avenue
Anchorage, Alaska 99516 5302
Subject: Lot 2 Mallory Subdivision
Permit #SW960118, PID #020-093-45
The subject permit, issued June 16, 1995 by this office for a
single family well and/or on-site wastewater system, has
expired as of June 16, 1996.
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 must be sent to
this office for documentation of the installation and to
close the permit.
If a licensed Professional Engineer has inspected the
installation of the on-site wastewater system, the original
as -built inspection report 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: $320.00 for an
on-site wastewater permit; $120.00 for a well permit and
$440.00 for a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
;S i rely,
41 �-s A41
Jes Cross, P.E.
Program Manager
On-site Services
enc: Copy of Permit
cc: Anderson Engineering
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "LIT STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW950118
DESIGN ENGINEER:ANDERSON ENGINEERING
OWNER NAME:SPINELL HOMES INC
OWNER ADDRESS:9210 VANGUARD DRIVE
ANCHORAGE, AK 99507
PARCEL ID:02009345
LEGAL DESCRIPTION:
MALLORY LT 2
LOT SIZE: 58663 (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:
PAGE 1 OF 1
DATE ISSUED: 6/16/95
EXPIRATION DATE: 6/16/96
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 (18AAC-72) 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 ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
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:
RECEIVED BY: MJL41 -
ISSUED BY:
DATE:
DATE:
Lot 2, Mallory Subdivision
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Three Bedroom Home Wide Trench System
Perc. Rate: 2 - 5 Min./Inch 1,000 Gal. Septic Tank
Application Rate: 1.0 GPD/SF 6" Drain Rock Beneath Pipe
Reduction Factor: None Replace Organics with Sand
3 Bdrms. X 150 GPD / 1.0 GPD/SF 450 SF of Absorption Area
450 SF / 5' Wide = 90' LF of Trench
Therefore: Construct a Wide Trench System With Two Laterals
Each 45' in Length. Place 6"' of Drainfield Rock Beneath the
Lateral. Place Distribution Pipe at 6" Above Ground Surface. Place
2" of HI Direct Burial Insulation Above Distribution Piping.
7- 14SULA-rIOA1
/'j4'rV ILA L,
0 &u�- nz L. L
24614C.4cC
Wi-m L4g, grs 6a,4,,cL --
TYPICAL WIDE TRENCH SYSTEM
(NO SCALE)
I
NOTE: Maintain 4' Separation From Bottom of Trench to
Groundwater Table.
Grade Area Over Trenches to Drain Away.
Place 2" of Direct Bury Insualtion Above Piping.
Replace Organics with Lake Otis Gravel (Sand)
M
JOB LgT- z-.- mk4uow :5ue:b)qislo&l
SHEET NO. OF
CALCULATED BY- m CA DATE
CHECKED BY DATE
tj a,
PRODUCT 2w (sirlis shmis) 205.1 plow) ��, v_ 6folm MUm 01471. To Ordef PHONE TOLL WEE 16*225"
MEMORANDUM
ANDERSON ENGINEERING
P.O. Box 240773
Anchorage, AK 99524
TO: Jim Cross
WITH: Dept. of Health & Human Services
FROM: Mike Anderson
DATE: June 16, 1995
SUBJECT: Lot 2, Mallory Subdivision
Septic System Redesign
MESSAGE:
RECEIVED
JUN 16 1995
Njw,i c�pahty ol Anchorage
Qapt, Health & �jurnan Services
I have redesigned the septic system for Lot 2, Mallory
Subdivision to include two 5' wide absorption trenches with
6" of gravel beneath the distribution lines. A diversion
valve will be placed to evenly distribute the effluent from
the septic tank. The trenches will be placed at different
elevations due to the slope of the ground on the lot. The
difference in elevation will be approximately 1.5'. Please
review this design and issue the permit for the well and
septic system for this property.
330.42
1 �5.2 1 -7 0 1
165,21
FR-CP4 C+�
*A S C #A WJ -r
14omr.
A4X- 5'17 -6 -
I I
F-4
0
4
�-j
rlcjel�5-eell 1�,B
m
e.10
�D
Z
0
--- Q 41.
fz
Ono
000,� 1644
kji,!...
Z-0
Ln
CL
w 0
ui w
.j
(j) Cl)
e.10
�D
Z
0
--- Q 41.
fz
Ono
000,� 1644
kji,!...
Lot. 2, Mallory Subdivision
DESIGN FACTORS: SYSTEM REQUIRE' MENTS:
Three Bedroom Home Wide Trench System
Pere. Rate: 2 - 5 Min./Inch 1,000 Gal. Septic Tank
Application Rate: 1.2 GPD/SF 6" Drain Rock Beneath Pipe
Reduction Factor: None
3 Bdrms. X 150 GPD 1.2 GPD/SF 375 SIP of Absorption Area
375 SF / 5' Wide = 75' LF of Trench
Therefore: Construct a Wide - Trench System With Two Laterals
Each 38' in Length. Place 6"' of Drainfield Rock Beneath the
Lateral. Place Distribution Pipe at .6" Above Ground Surface. Place
2" of HI Direct Burial Insulation Above Distribution Piping.
AIA-rtj
%A
SAUc-M(.4,
L
0
j9a4)k4jCj; pe:,) LA CC
UJI-M bfZAiMr-'iaL-b ?Pt,,c�
TYPICAL WIDE TRENCH SYSTEM
(NO SCALE)
Maintain 4' Separation From Bottom
Groundwater Table.
Grade Area Over Trenches to Drain
Place 2" of Direct Bury Insualtion
HI L4 5 U LA-ri DAI
of Trench to
Away.
Above Piping.
JOB &07- Z,- MAI-wat 5u5l>)qls)p4
SHEET NO. OF --
CALCULATED BY— M DATE —4 -TO q v
CHECKED BY
PAODUCT 204 1 (S�g4 54114) Mi �PM) 4�, I rc . Grolon, Miss, 01471. To OrM PKME TOLL ME 1.6*225 6W
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, ALASKA 99524
May 29, 1995
Municipality of Anchorage rn
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject: Lot 2, Mallory Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer:
The final plat for Mallory Subdivision was recently recorded to include a
septic system casement allowing the system for Lot 1 to be partially
located on Lot 2. The attached site plan illustrates the location of this
easement. We are now applying for a septic system permit for Lot 2. This
system will be located a minimum of 10' from the system now serving Lot
I at the location also shown on the plan.
A new sewerline is scheduled to be constructed across Mallory Subdivision
in the near future to serve what will be known as Southeast Anchorage
Middle School or Goldenview School. This school is already being
constructed. A.W.W.U., however, is not sure of the exact date when the
new sewerline will be put into service and is therefore reluctant to furnish
a letter stating the lots in Mallory Subdivision will be served by City sewer
within 12 months.
The intention of the owner is to tie into the sewer as soon as it becomes
available. Until that time he would like to install a holding tank. Since
A.W.W.U. will not provide the letter stating sewer service within 12
months the owner has no choice but to apply for a septic system permit. If
we can obtain a letter from A.W.W.U. prior to the installation of the system
we will revise our application for a holding tank. In the mean time a
permit is required to obtain a building permit for the lot,
The terrain of Lot 2
slopes from the east to the west. A french
drain was
installed in 1994 to
provide protection
for the septic systems on
both lots
from groundwater
intrusion. The
highest groundwater levels
noted in
Lot 2, Mallory Subdivision
May 29, 1995
Page Two
Testholes 17 and 20 have been 9.5' below the ground surface. Soils in the
area of these testholes is excellent for an onsite system and the absorption
trench should work effectively.
If the system is installed as designed the following statements may be
made:
I The system, if constructed as designed, will have no adverse impact
on the wells in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact
on existing septic systems in the area or those to be constructed in
the future.
3. The system, if constructed as designed, will have no adverse impact
on reserved space, either surface or subsurface, on any lots located in
the area.
4. The system, if constructed as designed, will have no adverse impact
on drainage patterns in the area. The current drainage pattern will
be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
7�5 Trzo;rcu-
I LOCATION MAP
LIP
rol
330-42
L 165.21
Ld
f::7
-rl4 11
SeE-?,mc— �Vsrcm,.
G*Asr. tAvi-r
14omc
A�9
I
ho
re
J3
z
cn
U)
j
Ol
L U -,Ui
<
.51.
u
.jl
65 U)
A�9
I
ho
re
J3
Lot 2, Mallory Subdivision
DESIGN FACTORS:
Three Bedroom Home
Pere. Rate: 2 - 5 Min./Inch
Application Rate: .7 GPD/SF
SYSTEM REQUIREMENTS:
Shallow Bed System
1,000 Gal. Septic Tank
Min. 2' Accepting Soils
3 Bdrms. X 150 GPD / .7 GPD/SF = 642 SF of Absorption Area
642 SIP / 18 LF Width = 36 LF Length
Therefore: Construct a Shallow Bed System 18' Wide X 36' Lon g at
the Location Shown on the Site Plan. Distribution Pipe Placed at
.5' Above Original Ground Surface.
(ENGINEEP�S SEAL)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG PERCOLATION TEST
PERFORMED FOR: DATE PER =0 �1'
LEGAL DESCRIPTION: MALLDItj 5vgbIVjSJt74 Township, Range, Section:
W TH SLOPE SITE PLAN
S) T>_r
(FEE
1 1 K 7 1 1 L I I FT -T I I I FIA I I
2
3
4
7
8
0
917 10
12 -
13-
14-
15 -
16-
17 -
18-
19-
20 --1
VQ,
Ics-rm-our lVv. /7
61 M WAS GROUND WATER A10
ENCOUNTERED?
S
IF YES, AT WHAT L
EaTro rv.\ 0 r. DEPTH? 0
140,,� P
E
Depth to Water After
Monitoring? Gale:
COMMENTS /C -:'S7— JLIOL4*
FAqJ
Reading Date
Gross
Time
Net
Time
Depth to Net
Water Drop
zV
(0 yis 4
J!5-
/5'
2 �&
e- 4-
7)1 /)1
PERCOLATION RATE Iminutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND (0 - FT
n X14Li�-A Pi -2-j M D 771�-r-7�il.
PERFORMED BY: A 44IL4 L�A mt�-'Aez
CEMIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: ��P/" C—Z—L
LEGAL DESCRIPTION:M4LLOa/
F" PT 7H
M L
4
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20-
67 P
GtA
14mac
DATE PERFORMEU-1; 1.4 '1 -1 -V
.�t) Zb 1\1 I S) Or4 Township, Range, Section:
SLOPE SITE PLAN
-T1C7r1+0L,U tjo. zo
WAS GROUND WATER
ENCOUNTERED? A 0
6
IF YES, AT WHAT L
0
DEPTH? P
E
Depth to Water After
Mo .......... . Date:
Reading
Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
z
1*4
/qz- 0 Z;
Tzwe
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND + FT
-77 7�
COMMENTS 5'7— 14 OL41Z T��SOA li-� 7>/?40X rO 05 r
PERFORMED BY: A t4
�j ��vd- �'��-11-e,�L—�TCZRTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7q5-
72-008 (Rev. 4/85)
Municipality of Anchorage
On -Site Water and Wastewater Program ir
(907) 343-7904
Certificate of Cn-Site Systems Approval
Parcel I.D. 020-093-45 Expiration Date:
1. GENERAL INFORMATION
Complete legal description Mallory, Lot 2
Location (site address) 4681 Virgo Ave.
Current Property owner(s) Rockwell & Elizabeth Baker Day phone
Mailing address 2231 Washington Ave. Anchorage, AK 99515
Real Estate Agent Relocation Company — Day phone
2. TYPE OF DWELLING:
F-1 Single Family (w/wo ADU)
F-1 Duplex
F-1 Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
El
Individual
F�
Individual Water Storage
El
Holding Tank
El
Community Class Well
El
Community
El
Public Water System
El
Public Sewer
I -XI
WalverNariance request
Received by: Date:
COSA to be released to the engineer, unless otherwise reques 1ad by the engineer.
COSA Fee $ 52(10—
Date of Payment Lq JaGlxo
Receipt Number a e�>A (a 06 —
COSA#_ ()t)c 1(0[663 —
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my sea[ 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 th on-sRe—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.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and 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 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 fall and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE
_X System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Date 2/24/2016
Conditional approval for bedrooms, with the following stipulations:
Original Certificate Date:
BY: L
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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSAW.eshWtE - , c
If more than I septic system is on the lot:
COSA Checklist# of 1
Structure served by this system
Certificate of On. -Site -Systems
Approval Checkl�ist
Mallory, Lot'2
Parcel ID: 020-09345
Legal Description:
A. WELL DATA
Well type- Private If A, 13, or C provide PW . SID #
Well Log (Y/N) Y
Date completed 7/10/1995 Sanitary seal (Y/N) Y
Wires properly protected (Y/N) Y
Total depth 266 ft. Cased to -�-O—ft-
Casing height (above ground) 12+ n.
FROM WELL LOG
AT INSPECTION
7/10/1995
2/18/2016
Date of test
Static water level 37
22
1
0.9
Well production 9 -P.M.
9 -p -m -
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate 4.43 mg/L
Arsenic ND ug/L Date of sample: 2/18/2016
Collected bv: PES
B. SEPTICIHOLDING TANK DATA
Tank Type/Material'
Date installed
Tank size gal. Number of Compartments
Cleanouts (Y/N)
Foundation cleanout (Y/N) Depression over tank (YIN)
High water alarm (Y/N)
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d ./ft2 or fl?/bdrm)
System type
Length ft. Width
ft. Gravel belowpipe ft.
Total depth ft. Eff. absorption area ___fe Monitoringtube_ Depression over field
Date of adequacy test Results (Pass/Fail)
For bedrooms
Fluid depth in absorption field before test in. Water added_ gal. New depth- in.
Elapsed Time:_ min. Final fluid depth in.
Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
If yes, give date
D. ILIFTSTATION
Date installed Size in gallons
Manhole/Access (Y/N)
"Pump on" level at in. "Pump off" level at
in. High w ater alarm level at in.
Datum-- Cycles tested
Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tankllift station on lot N/A
On adjacent lots 100+
Absorption field on lot N/A
On adjacent lots 10 0+
Public sewer main 75+
Public sewer manhole/cleanout -100+
Sewer /septic service line 25+
Holdingtank 100+
Animal containment areas 50+
Manure/animal ex . crete store . geareas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line
Absorption field
Water main Water service line.
Surface water
Wells on adjacent lots
ABSORPTION FIELD ON LOTTO:
Property line Buildirig foundation
Water main
Water Service I ine Surface water
Driveway, parlklngtv�hicle storage,
Curtain drain: Wells on adjacent lots
F. COMMENTS
Survey As�Built on File
G. ENGINEER'S CERTIFICATION
i certffy that I have determined through field inspectiqns'6nd
review of MunicIpal records that the above systems are I:p
conformance with MOA COSA guidelines in effect an this date. . ...... ..
Engineer's Printed Name Steven Pannone
�I;Vwaffln 00 no
Date 2/24/20*16 CE -8149
COSA c2na4 sheet-2-6-15.doc
Municipality of Anchorage
Development Services Department
Building Safety Division
Ori -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) # OSC161053
During a recent COSA on-site inspection and test of the potable water
supply well on Block , Lot 2 of Mallory subdivision, the well's
productivity was determined to be .9 gallons per minute. The minimum well
productivity required by this Department (AMC 15.55) for a 3 -bedroom
residence is .31 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.
Parcel LID, 020-093-45
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Complete legal description Mallory, Lot 2
Expiration Date: Zo- Oz 6-j 3
Location (site address) 4681 Virgo Avenue Anchorage, AK 99516
Current Property owner(s) Richard & Patsy Schroeder_ Day phone
Mailing address P.O. Box 113402 Anchorage, AK 99511
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
Duplex
El Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Three
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual
11
Individual Water Storage
El
Holding Tank
El
Community Class _ Well
El
Community
Public Water System
El
Public Sewer
Waiver/Van . ance request for:
Received by: Date:
COSA to be released to the engineer, unless othemise requested by the engineer.
COSA Fee $ 14410— Waiver Fee $
Date of Payment. -7 lk')-h ;S Date of Payment
Rec allot Number 0�). 8 44 12 Receipt Number
COSA # obk—k '�) � -514 —1 Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certfled by my sea] 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 Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. D N TURE 3 bedrooms
System #1 Approved for
System #2 Approved for bedrooms
Disapproved
Conditional approval for — bedrooms,
Phone 522-7773
Date 7/2212013
49TH
0 � '- MTt�lXlft'_E. ANDERSON
# CE - 4381
POFESSVII..
with the following stipulation
B y:: /&,), Z22cyoriginal Certificate Date: 7- -�z 4o -) 3
The r Aunici 4y 5rage 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 responsibie 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 Other
COSA blue sheer r - :., 0
If more than I septic system is on the lot:
COSA Checklist# —of
Structure served by this system —
Certificate of On -Site Systems Approval Checklist
Legal Description: Mallory, Lot 2
A. WELL DATA
Well type Private If A, B, or C provide PWSID #
Date completed 7/10/95 Sanitary sea] (Y/N) Y
Total dept h 266 ft. Cased to - 40 ft.
FROM WELL LOG
Date of test 7/10/95
Static water level
37 ft.
Well production 9 -P.M.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 6.06 mg/L
Arsenic N/D ug/L Date of sample: 7/9/13
Parcel ID: 020-093-45
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >12 in.
AT INSPECTION
7/17/13
25.1
3.4 q.p.m.
Collected by: Anderson Eng.
B. SEPTICIHOLDING TANK DATA AVVWU Sewer
Tank Type/Material
Tank size _ gal. Number of Compartments
Foundation cleanout (Y/N) — Depression over tank (Y/N)
Dateofpumping— Pumper
Date installed
Cleanouts (Y/N)
High water alarm (YIN)
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p.d./ft' or ft2/bdrm) System type
Length ft. Width ft. Gravel below pipe _ ft.
Total depth _ ft. Eff. absorption area ft' Monitoringtube_ Depression over field —
Date of adequacy test Results (Pass/Fail) — For — bedrooms
Fluid depth in absorption field before test in. Water added_ gal. New depth in.
Elapsed Time: min. Final fluid depth — in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at_ in.
Datum
Size in gallons —
"Pump off'level at
Cycles tested —
E. SEPARATION DISTANCES
WELL ON LOT TO:
N/A
Septic tank/lift station on lot
N/A
Absorption field on lot
>75'
Public sewer main
Sewer /septic service line
>25'
>50'
Animal containment areas
SEPTICIHOLDING TANK ON
LOT TO:
Building foundation _ Property line —
Water main Water service line
Wells on adjacent lots
ABSORPTION FIELD ON LOT TO:
Property line Building foundation
Water Service line Surface water —
Curtain drain Wells on adjacent lots
F. COMMENTS
Lot is Served by AWWU Sewer System.
— Manhole/Access(Y/N)—
in. High water alarm level at—
Meets alarm & circuit requirements?
On adjacent lots N/A
On adjacent lots N/A
Public sewer manholeicleanout >1 00'
Holding tank N/A
Manure/animal excrete storage areas >100'
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 Michael E. Anderson, P.E.
Date 7/22/2013
COSA brown sheeUO-IC�12.doc
Absorption field
Surface water
Water main
Driveway, paMng/vehicle storage
in.
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 Advisor
Certificate of On -Site Systems Approval 4 131347
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
2 of Mallory subdivision. This inspection revealed a nitrate concentration of
6.06 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.
PROPOSED ARSh_ WDOR
DIV. (ASSUMED)
lna�. a.haO
C.O' (ASSUMED)
ZN4MC QIAMCT
M001T WIlM0 SWAN�
SDE W.M. DINOOf
REAft BLAMING SES,to<
NOTE
DRIVEWAY GOES
INTO LOT 1
S89� 58'27"W
376.96'
STING
a
DUSE
U,
as 10
VVLUL
0 CZA7SIMT T-
333.21'
N8T 58'27"E
UNDER NO CIRCUMSTANCES SHOULD AN AS—BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY
AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
L1 LOT SURVEY SURVEY TYPE
SYMBOLS
FOUNDATION AS—BUILT
Ej RNAL STRUCTURE AS—BUILT
oese.. ..
SET REBAR <= mI DRAINAGE ASPHALT
El PLOT PLAN . . . AS—BUILT . . � LOT SURVEY ... TOPOGRAPHY
0 FOUND REBAR G G a WOOD FENCE CONCRETE
ELEV.
n AS—BUILT ... NO CORNERS SET Z RECERTIFICATION AS—BUILT NO CORNERS SET
((E�) ASSUMED *—_X� METAL FENCE WOOD DECK
PLOT PLANS & LOT SURVEYS
NOTE:
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS,
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED.
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
SURVEY CERTIFICATION
'J�u
Owe '1111fillItl
Prepared by
Robert E. Johns, Jr. & Assoc.
PLOT PLAN
ho,oby tartly that I ha� aGaTdA
I Me lot droO and d eea,tafd� heedoo. -d XI
4D,
Professional Land Surveyors
1700 Brink Drive.
he. III or ountallah. .11 of Me let catmene
ad a- - no 'Ph no to Me t..t of Of
ANCHORAGE, ALASKA 99504
an, alto end abitit... .11 dinhendon. no. a.
Afeadaread tre. and _t
Scale:
Rec. Lot S.F.
Rec. Plot File No.
60'
FOUNOAnON AS—BUILT
Date Surveyed:
07/10/13
Drawn b
Y' REJ
Checked Is
SMK
I. Athoort L doetel. Jn. h.., .11, Oak I
have perfonned on A.—Milt -y of Me
O� ,
found an Ole lot and Mot all the
alien
. ....... .......
0,
ull—to a. , Man
a. � =
Ga. and ent. I., 0
mom othenefee.
R BERT'E JO JR.
Date Drc.n:
07110/13
Grid;
3336
W.O.
13-311
S—SUtT
.0a
Legal Description:
FINAL STRUCTURE
1, FOI E, Pho., Jr. he", derth, Get I
have lerfornotai an A -80t la�l of Me
.... .1. at -1 Man el the
............
Lot 2
an
dinnetedora. and te a- h—
of�
.1. a and I. anaroundentol. .11 Onee.
.a- M"..
Sion&
41111%
MALLORY
11111so 03 29 2013 21:50 907-0145-0202
M IN
N%
Drilling 9tarted:._
ALPINE DRILLING
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF MINING, LAND & WATER
WATER WELL LOG
Completed; 7 /10 /10V$
Pump Install:
PAGE 01/01
City/Borough:
Subdivision:
Block
I Lot
I Property Qw[iQr Name & Address-
Spinell Homes - Todd Schrock
Anchoraget_
Mallory
I
Latitude Longitude
Meridian — — Township — Range — Section 114 of — 1/4 of — I A of 114
13OREHOLE DATA: (from ground surface)
Suggest T.M. Hahtla'6 hydrugeologic classification system
httosAnto.no" [5erVicecenterlshoppar/PrOductOetoll.S�fm7
N2dcompgrivP n-50 d=nqw&ProdCdPasrr� =ngw-rioaQ
Drilling method:E] Air ratary,00able too], [jot er - —
Well use: FjPublic supply, EDOM08tlo, 0Relnj,ctn:rTHydrofracRing
Fluids used:
Depth
From To
F10ther
Stick up 10
2
Depth of hole: 266 ft Casing stlokup: !_ft
Casing type; -�O Wall thickness _ inches
Casing diameter; 6' inches Casing depth 40 ft
Liner type: It Diameter: Inches
Gravelly silt 12
Bedrock 137
286
Well intake opening type:DOpen end, �Qpon hole �,other
$creentype:_, Assembly From:_ft,To ft
Slot size From: — ft, To —ft
Slot size From: —ft, To ft
0 Perforation description _ Fmm: ft, To ft
From: ft, To_ ft From: ft, To ft
Gravel packedbYes rjNo From ft, To ft
—
—
H20
86
88
260
2(36
Static water (from top of casing): 37 ft on L—LIG � 1995
P um ping level & yie Id: — feet after hours at _ gpm
Method of testing,
Development method:A?r _ Duration: 72h -m
Recovery rate: 1 9pm
Grouttype: Volume
From ft, TO ft
Final pump intake depth: ft Model-
Pumpsizo_hp Brandname
Was well disinfected upon completion? Elyes 1:!No
Methodof disinfection:_ .................. ................................... ........
Weis water quality tested? IlYes rINo
Water quality parameters tested: ......... __ ............................. ....... .......
Well driller name: Rft2 HaMe,
............... ....... .................................
company name: ...... ............................
Mailing address: ...................... ......... ..........................
City: A�.h�,.v. — State: 6K Zip 99511
Phone number � (YO7 24� , 02D2 (
Driller's skinature:
E)ate: 711 a/19% I I
AS 41.08.020(b)(4) and AAC 11 AAC 93.140(s) require
that a copy of the well log be foRvarded to the
Department of Natural Resources within 45 days of
well completion, Please @rnail well legs to:
d rir.water. repo rts@alaska - ci OV ORsendto
Alaska DNR, MLW, Alaska Hydrologic Survey
650 West 7'4 Avenue, Suite 1020
Anchoraqo, AK 99601
----------------- -------------------------
I Guide for Using. the Hydrogeologio Classification System for Logging
Water Welf Boreholes by Thomas M. Han ne NGWA Press
Anchorage Municipal Code 15.55.060(1) requires that a copy
of this well log be forwarded to the Development Services
Department within 30 days of well completion.
City Permit Number.,
Date of Issue: —1
Parcel Identlification Number:
Is well located at approved permit location') Ifflyes No
'IN
i 41r�
MUNICIPALITY OF ANCHORAGE
WATER & WASTEWATER UTILITY
3000 ARCTIC BLVD.
PHONE: (007) W4-2762
SLOCKILOTARACT LT 2
SUSDPVISION MMLORY
NS 96-24
TAXCODE 200934S GRID 003336 AS -BUILT
STREETADDRESS 4681 VIRGO AVE
WASTEWATER
CONNECT PERMIT 96 - 69f*
DATE OF APPLICATION 07/26/96
SCHEDULED COMPLETION DATE 12/31/96
E]
SINGLE FAMILY
F1
MUTI-DWELLING No. APTS
F]
COMMERCIAL
OVMER SCM=ZR BRYON T PHONE
MAILADDRESS ANCHORAGB,Ax 99516-5302 flofj
RqwIr ExiOng Service
On Prop" Only
"nt Only
Main Tap - To Property Une, only
Mein Tap & On Property connect
DwmruKg
R&R - Main Tap Only
Main Line Extension
FlCity Tap Have Been Levied
To Ile Levied
59 or Longer Comments
CONNECT SIZE 4
INSPECTION FEE $
PERMIT FEE $
RWMRSIBLE
44MMR 9314-2587-009 9 DEPOSIT$
TOTAL$
ISSUED BY SAP
0.00 F-] PAID n CASH
35.00 CHECK#
INSPECTED BY
0.00
35.00 DATE
PERIMTEE (Pkme- Print) PHO4E
MAII, ADDRESS
SIGIINATURE
POST IN A CONSPICUOUS PLACE AT THE JOB SITE
AWWU PERMITS C0"*3
MUNICIPALITY OF ANCHORAGE
WATER & WASTEWATER UTILITY
3000 ARCTIC BLVD.
PHONE* (907)564-2762
BLOCKILOTITRACT LT 2
SUBDIVISION MALLORY
Ks 4:n
061?�
WASTEWATER
ASSESSMENTS
CONNECT PERMIT
97 - 9170
DATE OF APPLICATION
07114197
SCHEDULED COMPLETION DATE
12131/97
TAX CODE 2 0093415 GRID 3336 AS -BUILT
STREET ADDRESS 4681 VIRGO AVE
OWNER SCHRODER B RYON T
MAIL ADDRESS 4681 VIRGO AVE At4CHORAGE, AK- 99516
-K SINGLE FAMILY
MULTI -DWELLING No. APTS
COMMERCIAL
PHONE
CONTRACTOR SANDERS & SANDERS
ASSESSMENTS
Repair Existing Service
fk, Main Line Extension
X On Property Only
City Tap
Have Been Levied
Hydrant Only
50' or Longer
To Be Levied
Main Tap - To Property Line Only
Comments:
Main Tap & On Property Connect
Row No.
Disconnect
R & R . Main Tap Only
CONNECT SIZE 4
ISSUED gkrotke
INSPECTION FEE $
104.00
PAID CASH
PERMIT FEE S
3500
CHECK#_____
$
0.00
OTHER
DEPOSIT $
0.00
INSPECTED BY
REIMBURSABLE
TOTAL $
139.00
NUMBER
DATE
REMARKS
PERMITTEE (Please Print)
MAIL ADDRESS
SIGNATURE
PHONE
POST IN A CONSPICUOUS PLACE AT THE JOB SITE
AWWU INSPECTOR
Original
DATESCHEDULED--
TIME
INSPECTOR
SUBDIVISION MALLORY
BLOCKJLOTFrRACTLT 2
INDICATE NORTH
VICATENORTH
z
g
SIZE MAIN:
TYPE MAIN.*
DEPT AT MAIN:
AT PROP. LINE:
CONNECT LOCATION:
COMMENTS:
INSPECTED BY:
DATE: 7,i6,q>
—ja - eo,
7