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Home My WebLink AboutZODIAK MANOR ALASKA BLK 4 LT 15Zobi Lo ' D~te Drilled I Static Water Level -~. feet~ Gallons Per Minute Draw Down feet Total Feet of 'Casing j i ~ T~Mat_.__geria]. Dr._____~[lle____d_~ feet to _lq f~'~! , to __1_![I Hefty Drilling S,fl,Ao Box 1553 H Anchol~ge,Alaeka 99507 MUNICIPALii¥ OF ANCHOR , DEPT OF - AGE ENV RoNM-, . HE:ALTH & ~TAL PROTECTION OCT 5 ~g84 RECTEIVED I'-'lLtl'-,i JIG: .71: F~FilL i~ T%r~ (.iF FII'-.IC:i-iORF~IF31F_ DEPFIRTt'IENT OF"' HERLTH ~NI::, IENV~RONI'.~ENTFIL PROTEE:T'rON Oi'-,i--'~: 1: 'rE t-4ELL F"E F..."tl J: T FERIIIT NO: 840349 ,~,-':; ~. bRTE I__ UE[.. 05/:l. 6/84 RPF'LICRNT: RDDRES$: CONTRCT PHCINE: DRVI [:, BR][SCOE 482;0 ZENITH STREET RNCHOF.'.RGE., RK 99507 346-3:63::L BL JL, I-,: ' CER"FIFV THRT: .'1. :[ RH FRMILIRR NITH TFIE REQUIREI',IENTS FOR ON-SITE SEWERS RND HELL.'_=, .RS SET FORTH B'./ THE PIUN:[C}[PRLIT'~.' OF RNCHORRQE (MOR) RND THE 5TRTE OF RLRSKR. ;~. I N~LL ~NSTRLL THE SVST.Et~I ~N RCCORDRNCE N~TH RLL FlOR CODES RND REGULRT~ONS., RND ~N COr'IPL.~RNCE N~TFI THE DEg~GN CR~TER~R OF THIS F:'ERR~T. :3. I N~LL RDHERE TO RLL NOR RND STRTE OF RLRSKR REC4~J~REt'"IENTS FOR THE SET BRCK D~STRNE:ES FROM RN~EXIST~NG ~,IISLL., b. IRSTENRTER I>~SPOSRL SVSTEN OR PUBL ~C ~PF'L I CRNT: DflVID Municipality of Anchorrr_� s_do-Site Water & Wastewater Progra(90� 343-7904s CERTIFICATE OF ON-SITE SYSTEMS °\ FRO�� 8 Z 9 G h Parcel I.D. 015-011-28 r 1 Expiration Date: P2_0 ` r 7. GENERAL INFORMATION L Complete legal description ZODIAK MANOR ALASKA; BLOCK 4, LOT 15 Location (site address) 8511 SOLAR DRIVE *ANCHORAGE, AK Current Property owner(s) KAREN KROWS Day phone Mailing address 8511 SOLAR DRIVE *ANCHORAGE, AK Real Estate Agent STEPHANIE OLENDORFF Day phone 229-6099 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex)' 3. NUMBER OF BEDROOMS: 3 4. 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 WaiverNariance request for. IN / A - Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ CJ2 / Waiver Fee $ Date of Payment `1r(P Date of Payment Receipt Number bbReceipt Number COSA# ocd-Ii o I t g2 Waiver# 1�/SE1 Fee. 5126)%!6� � /24-4, 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, f 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 GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 *ANCHORAGE, AK, 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG provided an engineering evaluation of the well andlusepflc system in accordance with the guidelines and regulations established by the Municipality of Anchorage and indusbypractices. The reported results describe the condition of the systeMs on the dates of the evaluation. Separation distances were measured to readily dentiliable 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 landed 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 systems. These conditions on vary and are outside the control of GEG. Satisfactory test results do not guarantee future perfomlancs of the systems therefore, GEG makes no warranty texpress orimplied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative yell or septic system can be installed on the property in the event eltherof the current systems fail. The content of this report is fa the sole benefit of the persor✓pady who retained GEG. Reliance upon the information provided in this report by any ofherperson orpady, including but not limited to svbsequentpropertypurchasers, is not authalzed. In shat. GEG disavows any legal duty to anyone other than the persoNparty who paid for this report, 6. DSD SIGNATURE t ✓`/ System #1 Approved for 3 bedrooms. System *2 Approved for Disapproved. Conditional approval for bedrooms. 337-6179 Date 'Ib r` bedrooms, with the following stipulations: Original Certificate Date: Z E The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Septic. System Advisory Well Flow Advisory (Rev. 10112112) 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: ZODIAK MANOR ALASKA; BLOCK 4, LOT 15 ParcellD: 015-011-28 A. WELL DATA Well type PRIVATE IFA, B, or C provide PWSID# N/A Date completed 9/25/1984 Sanitary seal (Y/N) YES Total depth 115 ft.. Cased to 115 ft. FROM WELL LOG Date of test 9/25/1984 Static water level 91 ft. Well production 12 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies1100 mi. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 5/5/2016 77 Nitrate 2.92 mg./L. Collected by: _GEG. Ltd. Arsenic: ND<5 ug./L. Date of sample: 5/5/2016 B. SEPTIC/HOLDING TANK DATA P U B LI C Tank Type/Material Date installed Tank size gal. Number of Compartments _ Foundation cleanout (Y/N) _ Depression over tank (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Cleanouts (Y/N) High water alarm Date Installed Soil rating (g.p.d.lfCorft7bd System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff.absorptio a—ft'-Monitoring tube_- Depressionover field -- Date of adequacy test Results (Pass/Fail) For bedrooms Fluid depth in abso ' n field before test _ in. Water added _gal New depth _in. sed e: _ min. Final fluid depth _ in. Absorption rate >= g.p.d. rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Skein gallons Manhole/Access (YIN "Pump on" level at in. "Pump oft" level High water alarm level at In. Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAi(t station on lot NSA On adjacent lots 100'+ Absorption field on lot NSA On adjacent lots 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ Public sewer manhole/deanout 100'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 1001+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main Wells on adjacent lots PUBLIC Property line Absorption field Water service line Surface SEPARATION DISTANCE FROM ABSOR�FIEOT TO: Property line Bu Water main Water service line Surface water Driveway, parking/vehicle, storage Wells on adjacent F. COMMENTS G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Munkipa/ 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 S/l I & (Rev. 11105) :117HE SURVEYOR TAKESS µ AS-BUH.7 SE 179E'D' FONCANg'IR�(:�(j - ,FST ONSIDWA FOR niE PJIILAI. nrws�GnON ONLY AND LIA81 .. 80llImANY OR FENCE UNES, LLSlEO OL5rANtre3 PREVAIL OVtR. SCNIN6 REPROIX7C'fPotI.MAY-OMJ.SE �Y FOR! 7W Ow OF 7HE SURVEY. toT S4Ri;Y Su T ERRORS IN'SM4LE. AIN. S11gICItRIL Al.ptT • � .......... Mol MAN ... SAM... ... =URMW �O �•••••• .v-841.7... Lor �,� FQU1m �A �[ r—�"--� AS�IAI.T T_mti:.:/ ASSUiIED ELE1L ,� MCIOD � :•:.°�'�"x WHCREIE PLOT PLANS &. RTu xuoD DEa O,...... .... _. . RMPON IT IS RU nam. To mtr OF OP &JLLB OR OWNER, PRIOR TO ONLY THOSE 1 TOO FWWMED GR'ADDEE ANG L�jn(�TYOPOSEO OTION N 1 GRADE RELA iHONN. MPROH�IEN73 As OROLRiD AND VISIBLE MILL ISE THE EGSTENCE OF ANY EASEIIENTI ONS AND TO OE7ERMWE tTO., ARE ONO"W" IN 3VnW OLEANOUTS, SIDEWALKS. DRIVEWAYS, WHICH. DO NOT APPEAR ON THE RECOR ED SUBDINSIgJ OR PLA�T's, A" DISTANCES ARE RECOR OMMATE LINLE98 OTyER SEYNOTEp. PREVENT EONS UIPROVFMMTS FROM: BEWO SEEN AND LOCATED. suRVEY artnr�cAnoN -- DT-nAR- � repore Y _... .. + Robert E. Johns, Jr. & Assoc. -Profmionot Land Surveyors •Wrw1YY.rrYY w•+ ` rw.. •a M u R,• w r 'J,� __ ••"-E-13 AVE — .. i.. w ....a / {i / •t -- MOLOI{AOE, ALASKA "m M,tY, w YY. Y wi Mr.l w'� Odd�w.ur..�r.....•.`. w•1•.ir .� � L ..,. $ +R �.....� 12-7'92 D'�0'"'_b: ChWi•d by, ':As°w.R,T."' ,��1i'•.,�121-S r�.i12-7-92 Grp 2336 W.C. 92_191 7o•r asR.er ' pow «.�W", See r•cw 10Rr1I M"" Y°1O x"01 4PPRdY LOCVTioN 34t,• ] ij j WYFfL!_ � N Woop � • % Q 12.ti ,b 3 s 2.1 a. Q G •/4 O :117HE SURVEYOR TAKESS µ AS-BUH.7 SE 179E'D' FONCANg'IR�(:�(j - ,FST ONSIDWA FOR niE PJIILAI. nrws�GnON ONLY AND LIA81 .. 80llImANY OR FENCE UNES, LLSlEO OL5rANtre3 PREVAIL OVtR. SCNIN6 REPROIX7C'fPotI.MAY-OMJ.SE �Y FOR! 7W Ow OF 7HE SURVEY. toT S4Ri;Y Su T ERRORS IN'SM4LE. AIN. S11gICItRIL Al.ptT • � .......... Mol MAN ... SAM... ... =URMW �O �•••••• .v-841.7... Lor �,� FQU1m �A �[ r—�"--� AS�IAI.T T_mti:.:/ ASSUiIED ELE1L ,� MCIOD � :•:.°�'�"x WHCREIE PLOT PLANS &. RTu xuoD DEa O,...... .... _. . RMPON IT IS RU nam. To mtr OF OP &JLLB OR OWNER, PRIOR TO ONLY THOSE 1 TOO FWWMED GR'ADDEE ANG L�jn(�TYOPOSEO OTION N 1 GRADE RELA iHONN. MPROH�IEN73 As OROLRiD AND VISIBLE MILL ISE THE EGSTENCE OF ANY EASEIIENTI ONS AND TO OE7ERMWE tTO., ARE ONO"W" IN 3VnW OLEANOUTS, SIDEWALKS. DRIVEWAYS, WHICH. DO NOT APPEAR ON THE RECOR ED SUBDINSIgJ OR PLA�T's, A" DISTANCES ARE RECOR OMMATE LINLE98 OTyER SEYNOTEp. PREVENT EONS UIPROVFMMTS FROM: BEWO SEEN AND LOCATED. suRVEY artnr�cAnoN -- DT-nAR- � repore Y _... .. + Robert E. Johns, Jr. & Assoc. -Profmionot Land Surveyors •Wrw1YY.rrYY w•+ ` rw.. •a M u R,• w r 'J,� __ ••"-E-13 AVE — .. i.. w ....a / {i / •t -- MOLOI{AOE, ALASKA "m M,tY, w YY. Y wi Mr.l w'� Odd�w.ur..�r.....•.`. w•1•.ir .� � L ..,. $ +R �.....� 12-7'92 D'�0'"'_b: ChWi•d by, ':As°w.R,T."' ,��1i'•.,�121-S r�.i12-7-92 Grp 2336 W.C. 92_191 MUNICIPALITY OF ANCHORAG% DIVISION OF ENVIRON~.NTAL HEALTH DEPAR~./4~NT OF HEALTH AND ENVIRONME~NTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ///~(J/~. ,~ /~:~ (aD Legal )Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name '~P'! {~ ~9/({/% tko ¢~ TalepJhone -' ____H°rae Applicants Address (cD Applicant is (check one) Lending Institution Buyer [~--~ ; Other ~--~ (explain); (d) Lending Institution Address Telephone (eD Real Estate Co. & Agent Address (f) Telephon'e Mail the HAA to the :following address: 2o T_y~e of Residence Single-Family Number of Bedrooms Individual Other (describe) Community ~_: Public Note: If community well system, must have written confi~ation from the State Department of Environmental Conservation attesting to the legality and status~ 4. Sewa_~_~Dis o~a_l_ Onsite ~__~ Public ~ Community [~ Holding Tank I--~: Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. Engineering Fimn Providing Insp.eg.t~o~s, 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 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 verify that~ based on the information obtained from the M~nicipaiity of Anchorage files and from my investigation and inspection, the o~'site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinaeces, and regula- tions in effect on the date of this inspection° Tests~ File Search_~ Data and Information (gNOI R SE ) Approved for ~,-iSC/~ bedrooms By Approved ___ Disapproved ,f;~ Terms of Conditional Approval Condit ion~f[ CAUTION THE I~ONICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESEnt- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY ~N INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. T}~ DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND T~IR I~NDiNG INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. F~PLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NO~ RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 B® Well Classification A4UNICIPALffy OF ANCHORAOE DEPT. OF HEALfPi & MUNICIPALITY OF ANCHORAGE (MOA) fNvIRONMENTAL C~CKLI~ - FEBRU~Y 1984 Legal Cased to Well Log P~esent (Y/N) Total D~pth Static Water Level If A, B, o~ C, D.E.C. Approved(Y/N) Date Completed ~-7_$~-~q __ Yield /'~- //g ' ~pth of G~outing Pump Set At Casing Height Above Ground Elect~i=al Wi~ing in Conduit (Y/N.) ~ Sepa~ation Distances f~om Well~, To Septic/Holding Tank on L~t /,7//~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewe~ Line 7 5- ~ Sanitary Seal on Casing (_Y/N) Depression Atzound Wellhead (._Y/N) ; On k]joining Lots ,~'7" ~ On Adjoining Lots ~0' To Ne~estPublicSewer Cleancut/Manhole ~- /oo To Nearest Sew~r Service Line on Lot Water Sample Collected By _ d~. ~o~,~) Date Water Sample Test P~sults _~._ >~/ /D [z/g~ ir3/~ -- 35' SEPTIC/HOLDING TANK DATA Date 'rnstelled Standpipes (Y/N) Eep~ession ove~ Tank (Y/N) Pumping/Maintenance Cont~a(~ on File _(Y/N) Size Air-tight Caps (Y/N) Date Last Pumped ; No. of Compartments Foundation Cleanout (Y/N) for Holding Tank High-Water Alarm.(Y/N) Temporary Holdirg Tank Permit (Y/N) Separation Distances f~omseptic/Holding Tank: 97o Water-SupplyWell__ __To Building Foundation To Property Line To Disposal Field TO Weter Main/Service Line To Stream, ]Pond, Lake, c~ Major D~,ainage Course Date Pa~.d: _ ~/' Amount: _ [Pa~) 1 of 2] 2-15--84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed Width of Field Square Feet of Absorption A~ea Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes P~esent (Y/N) Date of list Adequacy Test Separation Distance from Absorption Field: To kl~ter-Supply Well To Building Foundation Lot To Water Main/Service Line To P~operty Line To Existing Or Abandoned System cn ; On Adjoining Lots To Cutbank(if present) To Stream/Pond/Lake/or Major D~ainage Ccurse · To D~iveway, Parking Area, or Vehicle Storage Amea Com~=nts Do Date Installed Size in Gallons "Pump On" Level at High Weter Alarm Level at Tested for Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Conm~nts Check Permitted Bedroc~ Rating Against HAA Request I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed ~ ~3~ ~Z~l_~ Date ~z/~ - ~J~' Company ~no',/, ~w~ fZ~//f/ MOA No. ~3-'~z~z-J KB1/d5/s [Page 2 of 2] 2-15-84