HomeMy WebLinkAboutFASSLER LT 3Fussier
Lot 3
#051-531-34
Municipality of Anchorage Page 1 of 3
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
w .&anchorage.ak.us (907) 3437904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SWO10082 PID Number: 051-531-34
M":
MM&M ContractingWastewater
System: New
Aaaass:
P.O. Box 670495 Chu iak AK 99567
ABSORPTION FIELD
°oa'" "'"n°°`aeeda"" :
688-1236 Three 3
Deep Trench
LEGAL DESCRIPTION
Ta Depth k.er.y.W9.aee.
1.2 Gpme
9.0 Ft.
bock W: Subdw.m:
DeDN b ptw bottom Man a1.w yraee:
Cx Impin Cm ,, pp:
3 Fassler Subdivision
3.0 Ft.
6 FL
Toawq: Rage: Sectors:
F. waea abo.e aq+w ir+be:
Dr.M Lmgm:
1 Ft.
39 Ft.
Well: New
3
''
1!
'N'/FL
N/A A
Ft.
FL
CWnft ban (Pm G. A B. C):
TaW Depth: Cnee W.
rdd obwPeon area:
F" ma ami.
Private
200 Ft.161 Ft.
468 Fe
ASTM D3034 PVC
pneer.
Dara D U ; $b Waw Levet:
k M4Mbf.
Date MUYeee:
Sullivan Water Wells
7/18/2001 147 Ft.
MM&M Contracting
8/11-25/01
rave.
PM Set M:Ca"
AbeveCr :
TANK
2 GPM
Ft.
>2 Fl
SEPARATION DISTANCES
® Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
From
Septic
Tank
Absorption
Field
Llft
Station
Holding
Tank
rivate
sewerurro
Anchorage Tank
1,000
we$
>100'
>100'
N/A
N/A
>25'
m.
Steel
Two (2)
S.Wewatn
>100'
>100'
N/A
N/A
LIFT STATION — NONE ON LOT
LW tine
>5'
>10,
N/A
N/A
Dr.
WLY
Fe.rbeux,
>5'
>10'
N/A
N/A
Pm w°
M.
.ata at
ti.
b
in.
INone
Noted
I
I
°inipMake &W N
M"°°p'""ptr1ana0Dy
c.1m,Dnb
22Insulation nsulation Over Septic Tank.
BENCH MARK
Top of Well Head.
Amoned r:tembn:
100.0 FL
ngineer s btamp
..•••��wa�a�4Ma
�� 111
• ..'�
3 49th •s=♦♦�
Inspections performed by: MEA Dates: 1" 8/11/01
2n0 1/19/0G
y MICHAEL E. ANDERSON {�
♦♦,f%f+".O
Department of Health and Human Services approval
CE -43 81
•
11 ��
ll/ � �' 2 2 �
Reviewed b Date: �0")
1 IMM ES :'••
�r sta' •
and approved : • rn
PP Y
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
MEMORANDUM
DATE: January 20, 2002
TO:
Jeff Poet/Dan Roth
FROM:
A �/�
Mike Anderson, P.E. �✓�1�--
SUBJECT: Lot 3, Fassler Subdivision
Test Hole Locations
The test hole locations shown on the septic system as -built are the actual surveyed
locations of the holes. The locations shown on the septic system design were based on
field measurements, which turned out to be inaccurate. The septic system absorption
trench was constructed entirely within the 30' radius of Test Hole No. 1. We apologize
for any confusion this may cause. Please let me know if you have further questions
concerning the test hole locations on this lot.
Municipality of Anchorage Page 2 of 3
DEVELOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 99519-6650-343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit N ber SWO10082 PID No. 051-531-34
_0�"_444_
7II2
® �Iternate
TH1 Site
49tn-6V�'�I•�: I \ \ 1 i1eI1
M-CHAEL E. ANDERSON
S, No. CE -4381 o
15 Ilgli
FASSLER
CIRCLE
PLAN AS -BUILT
SCALE 1" = 40'
A
B
S1
36.6
27.1
S2
0.9
31.1
C4
8.9
48.4
M1
!43.3
45.7C5
9.5
30.7
49tn-6V�'�I•�: I \ \ 1 i1eI1
M-CHAEL E. ANDERSON
S, No. CE -4381 o
15 Ilgli
FASSLER
CIRCLE
PLAN AS -BUILT
SCALE 1" = 40'
Municipality of Anchorage Page 3 of 3
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. SW010082
v2 Ln
L) 2 ' U
PID No.: 051-531-34
e I r I fifle
BOX 670=. CHUGEWALASO
FROM
■
COU!,ffRY
FSPIL-TY
r.:v-vvrA
MetiiOd'bfDisinfection:
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OWNER OF
rA
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:S
LEGAL DESCROTION:142a7 : 3.
e I r I fifle
PHONE NO. : 9076881239
•
BOX 670=. CHUGEWALASO
Weli Disinfea66 Upoirl Co;�pletion?.b'-Ie'ilb
-DEPTkj
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PHONE NO. : 9076881239
•
BOX 670=. CHUGEWALASO
Weli Disinfea66 Upoirl Co;�pletion?.b'-Ie'ilb
-DEPTkj
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MetiiOd'bfDisinfection:
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OWNER OF
.1, All
ADDRESS:. -
LEGAL DESCROTION:142a7 : 3.
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, -rSeC.#L
Z.
DATF_
•
PERMIT NUMBER:-0-LQJ-Lj-- Dite of is
TAX IDENTIFICATION NUMBER:: .
Is I locat&d at approved permit location? u Yes* C,
Method of Dri ary.:u cable tool
Depth- of well:
Casing Type f-'Lr4F Wall T'hickn*es*s
Diameter (a!
Inches, depth
Liner Type:
Casing StickupAbove.Ground;' feet'
Static Water Level; ---feet
7
Recover Rate:
Method of Testing; '411
Well Intake Opening Type: 0 open.end (loped h6le
Ci Screehed; t stan f6ei Stopped feet
4-Krforatjc*ni. Start, Z-fe-et
p p e d
Groui Type: Aer-J121- r. 4
"the propt
A Human
.Received Time' 6e c -27. :'#'A.*("'
Dec. 27 2001 09:01AM P1
rtrr[r�g ogz.
d
.4
IT -ER:. -W -ELL -,S`-'-'
;�R6N%'E IMS -2750 t*
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-DEPTkj
*
MetiiOd'bfDisinfection:
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6A 4 Jit #+-j4o
4,
"the propt
A Human
.Received Time' 6e c -27. :'#'A.*("'
Dec. 27 2001 09:01AM P1
rtrr[r�g ogz.
d
.4
IT -ER:. -W -ELL -,S`-'-'
;�R6N%'E IMS -2750 t*
mita copy Of the -Well 109 to the Pr0W'WthOrIty..Munic.iI5ao�-
uepartment I of Env . Ironmental Conservation. MatSu'Boi6
-DEPTkj
6A 4 Jit #+-j4o
S
OjA -Odcc V
..J
7
ia7
YA*
mita copy Of the -Well 109 to the Pr0W'WthOrIty..Munic.iI5ao�-
uepartment I of Env . Ironmental Conservation. MatSu'Boi6
MUNICIPALITY OF ANCHORAGE l Pol
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Date Issued: Apr 25, 2001
Expiration Date: Apr 25, 2002
Permit Number: SWO10082 Parcel ID: 051-531-34
Legal Description: 'FASSLER SUBDIVISION LOT 3
Design Engineer: 0014 Anderson Engineering Site Address: NHN FASSLER CIRCLE
Owner Name: MM & M CONTRACTING Lot Size: 29639 SO. FT.
Owner Address: PO BOX 995657 Total Bedrooms: 3 Permit Bedrooms: 3
CHUGIAK . AK 99567 -
This permit is for the construction of:
[✓� Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued
Date: °r'35 a of
Date: it2.50l
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 05-1 — 331 — 34 Permit Number SWO10082
Property owner(s)_MM&M Contractinq Day phone 688.1236
Mailing address (1) P.O. Box 670495 Chugiak, AK 995657
SITE
Meilit address(2)YHA/ 8/455LER C1R6Lr_r Zip Code 99567
Legal description (Lot, Block & Sub'd.) Lot 3. Fasster Subdivision
Legal description (Section, Township & Range)
Lot Size 296 17 Acres/
THIS APPLICATION IS FOR:
Number of Bedrooms Three (3)
Sewer Only ® Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
E Com„
(Signature of property owner or authorized agent)
Permit Fees:
Waiver Fees:
Date of Payment: 4,13007 Date of Payment:
Receipt Number: Receipt Number:
(Rev. 12100)
April 12, 2001
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street '
Anchorage, AK 99519-6650
Subject: Lot 3, Fassler Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer.
The owner of Lot 3, Fassler Subdivision intends to place a new 3 -bedroom home on
'the lot. We are therefore applying for a permit to'construct a septic system on the lot to
serve the proposed home. The lot is currently served by.a'community water system.
The attached Site Plan and backup documentation identify, the location and
configuration of the new septic system and the parameters used in the design. It also
shows the location of the water service line and the alternate septic site. Existing .
drainage patterns are shown and will not be altered by the development of the lot.
Two test holes were placed at the "proposed location for the new and alternate
absorption trenches and revealed well -graded gravel with minor amounts of silt. No
groundwater was noted in the test holes during excavation and none was noted during
the monitoring period. The soil percolated at a rate of 1 minute per inch. Conditions
are excellent for an onsite septic system. We are therefore proposing to place a 3'
wide by 32' long by 6' effective depth absorption trench to treat the septic effluent. The
pipe will be placed at 3' below the existing ground surface and the total depth,of the
trench will be 9'. A minimum of 3' of cover will be placed over the bed to prevent frost
penetration and possible freezing.'
The ground surface on the lot slopes as shown on the'attached Site Plan with slight
grades from south to north and west to east. The new trench will be constructed .
parallel to the contours of the surface in conformance with Municipal requirements.
Grading will be accomplished to assure surface drainage is away from the new
trenches. The existing drainage pattern on the lot will not be affected during
development.
If the system is constructed In accordance with our design the following statements •
apply:.
1. 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. 'The lot is currently served by
a community water system.
Lot 3, Fassler Subdivision
April 12, 2001
Page Two
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 reserve
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;
ee\\L\p,l
s•� E��p
Michael E. Anderson; P.E. ` �� OF
Attachments
.40 TH
MICHAEL E.•ANCERSCN •,^--r
CE -4381
unsubdivided
(Vacant)
30
„
h -
30
n
O
O
1 �
33 1
�I� 609s
I I •! C
33 4
I
THIS PROJECT
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^^ ♦' 957.17 RDM'
14:
LAST / 506 (72-f56) 19.85 •f ,.
AREA MAP
SCALE I"= I 00':
�•' OF 4 4 e
..........
o
moi,• • � ^• �✓ �'•�_ ',
,49TH
so
r• MICHAEL E ANDERSCN :?: 0
,i CE -4381
�H2
terna _
to
U
NOTE: This Subdivision and I
those in the area are
served by a community
water system. There are
no conflicts between the
an�rfhosenin ��ietarealot
.
qq
Z6'LEffectir ve
SITE PLAN
SCALE 1" = 40'
\OGa"
1,Ion
Septic Tank
Three
Bedroom
House
I
I
I
I
W
v
W
J
N
N
lat.
OF.. Al Te
.... 49
MICHAEL E. ANDERSON
P ter'• CE - 4381 r
s
LOT 3, FASSLER SUBDIVISION
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Three Bedroom Home Deep Trench System
Perc. Rate: 1 MinAnch 1,000 Gallon Septic Tank
Application Rate: 12 GPD/SF 6' Drain Field Rock
3 Bedrooms X 150 GPD 112 GPD/SF = 375 SF of Absorption Area
375 SF112SFILF = 3125 LF Trench Length
Therefore: Construct an Absorption Trench 32' in Length by 3' Wide With 6' of Drainfield
Rock Beneath the Distribution Lateral. Distribution Lateral to Be Placed 3' Below Existing
Ground. Total Depth of Trench to Be 9' from Existing Surface. Mound Over Trench if
Necessary to Provide Minimum Cover of 3'.
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away. OF eg
Minimum 6' Separation From Bedrock
Minimum 10' Separation From Lot Line.
Minimum 4' Separation From Groundwater. 4 9.LH
Minimum 10' Separation From Water Service Line. '0.../ ........ ... ... * �,
00
01 'p„ MICHAEL E. ANDERSCN
J� CE • 4381
Ilk PROFES%jOLI���
ts\�������
Natural
2.6.,
i
Backfill
-. -
Geotextile
60
y
:Fabric
O'
4^ Perforated
_
PVC (Slots Down)
6,
Drainfield'
'
Rock' L
JR. -
.3.
39
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away. OF eg
Minimum 6' Separation From Bedrock
Minimum 10' Separation From Lot Line.
Minimum 4' Separation From Groundwater. 4 9.LH
Minimum 10' Separation From Water Service Line. '0.../ ........ ... ... * �,
00
01 'p„ MICHAEL E. ANDERSCN
J� CE • 4381
Ilk PROFES%jOLI���
ts\�������
2
3
4
5
6
8
9
NA
13
R,
17
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 L STREET, ANCHORAGE, AK 99502-0605
SOILS LOG - PERCOLATION TEST
M R M CONTRACTING
LEGAL DESCRIPTION: LOT 3 FASSLER SUBD
TEST HOLE #
PT / OL
PERC.LEVEL
WELL -GRADED GRAVEL -SAND -CLAY
MIXTURES WITH COBBLES: GC
WAS GROUNDWATER
ENCOUNTERED?
IF YES, WHAT DEPTH?
DEPTH TO WATER
AFTER MONITORING:
DATE:
BOTTOM OF
HOLE
COMMENTS: TEST HOLE PRESOAKED PRIOR TO TEST.
NO S
L
0
None E
4/12/01
40�_ OF A4
49 -LH Y e
0 ..............
• MICHAEL E. ANDERSCN•Oro'
CE • 4381 . �=
DATE YLTk KiSMIff6V) �%1903/2001
G'L%`
SITE PLAN
0%
READING DATE
O
T
DEPTH OF
WATER
NET
DROP
T0 2
2.00
N
s
1
2.10
10
L 3
91/2 -
to u
12"
2
u
10
21/2"
91/2"
Recharge I
I 1
0%
READING DATE
GROSS
TIME
NET
TIME
DEPTH OF
WATER
NET
DROP
Start 3 -April
2.00
12"
1
2.10
10
21/2"
91/2 -
Recharge
12"
2
2.20
10
21/2"
91/2"
Recharge I
I 1
1 12"
3
2:30
10
21/2"
91/2"
PERC RATE:i•I MIN./INCH PERC. HOLE DIAMETER: 6'
TEST RUN BETWEEN 4.5 FT. AND 5.5 T.
TEST PERFORMED BY: T.L. KIM13ROUGH 1, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALLSTATE AND MUNICIPAL GUIDELINES ON THIS DATE: 4IZ-0
2
3
4
5
6
7
8
9
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH S HUMAN SERVICES
825 L STREET, ANCHORAGE, AK 99502-0605
SOILS LOG - PERCOLATION TEST
M E M CONTRACTING
LEGAL DESCRIPTION: LOT 3 FASSLER SUBO
TEST HOLE # 1 SLOPE
PT/OL
PERC.LEVEL
WELL -GRADED GRAVEL -SAND -CLAY
MIXTURES WITH COBBLES: GC
WAS GROUNDWATER
ENCOUNTERED?
NO
0
NO
10 IF YES, WHAT DEPTH?
DEPTH TO WATER None
11 AFTER MONITORING:
DATE: 4/12/01
17
BOTTOM OF
HOLE
S
L
0
P
E
.e
e0 OF A�
S* P491"-
i...u.... ....... t"'. ...:
# •P *.MICHAEL E. ANDERSON
�; r
CE.4381=o
�,,s�f9Fn..•
DEPTH OF
WATER
T
TO
DATE PE�gRINEDiSS1'Zi
>2001
°%vvw.%
a
SITE PLAN
READING DATE
0
NET
TIME
DEPTH OF
WATER
T
TO
1.15
N
a
1
1.25
10
LOT 3
10"
J J
V, v
N 6
2
Q V
10
2-
W
Recharge
READING DATE
GROSS
TIME
NET
TIME
DEPTH OF
WATER
NET
DROP
Start 3 -April
1.15
12-
1
1.25
10
2-
10"
Recharge
12-
2
1.3S
10
2-
10"
Recharge
12-
3
1 1.45 1
10
2' 1
10-
PERC RATE: I MIN./INCH PERC. HOLE DIAMETER: 6'
TEST RLN BETWEEN--L.5—FT. AND5.5 T.
COMMENTS: TEST HOLE PRESOAKED PRIOR TO TEST.
TEST PERFORMED BY: T.L. KIMBROUGH I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 4-17--01
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 3, FASSLER SUBDIVISION
GENERAL:
1. The scope of this project includes the procurement and placement of a
new 1,000 gallon septic tank at the location shown on the site plan.
Work also includes the construction of a new 32' long X 3' wide X 6'
effective depth absorption trench at the location shown. The
distribution line in the trench will be placed at 3' below the existing
ground surface. Total depth of the trench will be 9' below the existing
ground surface. All components of the septic system must be placed a
minimum of 10' from the water service line on the lot.
2. Construction shall be in accordance with the approved site plan,
design drawings, Municipal Permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater
Disposal Regulations.
3. The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the
location of all lot lines.
4. Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must be certified
by the Municipal Department of Health and Human Services for
system installations. Owners installing their own systems must receive
prior approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,000 gallon septic tank must be be procured from an approved
source and installed at the location shown.
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
6. A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
-Lot 3, Fassler Subdivision
April 12, 2001
Page 2 of 3
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
5. Contractor shall verify the septic tank and drainfield are a minimum
100' away from any private water wells in the area, 150' from a Class
'C" Well or 200' from any community well.
6. Direct bury insulation must be placed over the distribution system if
less than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trenches to drain away.
8. A minimum 2' of accepting soil is required below the drainfield rock for
a 5' wide trench. Contractor shall verify this condition prior to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
- Lot 3, Fassler Subdivision
April 12, 2001
Page 3 of 3
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing
the #200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These
inspections must be conducted under the supervision of a professional
engineer registered in the State of Alaska. The first inspection must be
conducted after the excavation of trenches, beds or pits and before the
installation of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement of the
geotextile fabric, gravel, distribution piping, standpipes, cleanouts and
insulation. No backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction
notes for use in preparing the certified as -built of the completed system.
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water& Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Initial
Permit Number: SWO10167
Legal Description: FASSLER SUBDIVISION LOT 3
Date Issued: Jun 06, 2001
Expiration Date: Jun 06, 2002
Parcel ID: 051-531-34
Design Engineer: 0014 Anderson Engineering Site Address: NHN FASSLER CIRCLE
Owner Name: MM & M CONTRACTING Lot Size: 29639 S0. FT.
Owner Address: PO BOX 995657 Total Bedrooms: 3 Permit Bedrooms: 3
CHUGIAK . AK 99567 -
This permit is for the construction of:
Disposal Field ❑ Septic Tank _ Holding Tank Privy Private Well F] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 (24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
7. �(—Q/ DELL ORILIP)? b✓)9A/TSTO/_fOv,6 wELL TO XafA77-( PROPFIPTY
L WE 100' 7-0 714e E )`-ST of PERM 17'e 0 c, -FC [ 5'/7-4. 9
Received By:
Issued By:
74J. -L LQ'j'
Date:
c -7-11i
Date: 6—IC-0/
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-531.34 Permit Number SW O /O /6 %
Property owner(s) MM&M Contracting Day phone 688.1236
Mailing address (1) P.O. Box 670495 Chuoiak, AK 99567
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) _Lot 3, Fassler Subdivision
Legal description (Section, Township & Range)
Lot Size 21639 Acre Sq.Ft
THIS APPLICATION IS FOR:
Number of Bedrooms Three (3)
Sewer Only ❑ Well Only ED
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit FeesA iD0 Waiver Fees:
Date of Payment b°yaq a dt Date of Payment:
Receipt Number: Receipt Number.
(Rev.12*0)
Unsubdivided
(Vacant)
THIS PROJECT
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AREA MAP
SCALE 1" =100':
• Municipality of Anc
On -Site Water and Wastewater
(907) 343-7904
Certificate of On -Site Systems
Parcel I.D. 051-531-34
1. GENERAL INFORMATION
Complete legal description
Fassler, Lot 3
N g 0 2016
Expiration Date: I 1 "s '1 b
Location (site address) 24847 Fassler Circle Chugiak, AK 99567
Current Property owner(s) Josh Henthorne Day phone _
Mailing address
Real Estate Agent
24847 Fassler Circle Chugiak, AK 99567
Becky Powell
2. TYPE OF DWELLING:
ix Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Three
Day phone 244-5881
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
El
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver/Variance
Received by: (�Pd�(',a, i'h / '�/12Pi Date:?
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ r.Z 6 ' oy Waiver Fee $
Date of Payment G —30 - (�� Date of Payment
Receipt Number 6 t Receipt Number.
COSA# QSC!(oil27-/ 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 Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SIGNATURE
Date 6/30/2016
°�F.....Al I F,
491"`�
System #1 Approved for bedrooms p:;�, eM15 ANDERSON y
•.
System #2 Approved for bedrooms 4®®T�9Fo -a $
Disapproved 0���a ®��,'°
Conditional approval for bedrooms, with the following stipulations:
Original Certificate Date: g -
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.
7. ATTACHMENTS:.
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSAbluesheeLE' ., c
If more than 1 septic system is on the lot:
COSA Checklist #
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: FaSSIer, Lot 3
A. WELL DATA
Parcel ID: 051-531-34
Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y
Date completed 7/18/01 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 200 ft. Cased to 161 ft. Casing height (above ground) >12 in.
FROM WELL LOG AT INSPECTION
Date of test 7/18/01 6/3/2016
Static water level
Well production
147
2
ft. 156 ft.
g.p.m. 2.25 g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate 8.02 mg/L
Arsenic ND ug/L Date of sample: 6/16/16 collected by: And. Engineering
B. SEPTIC/HOLDING TANK DATA
TankType/Material Septic/Steel Date installed 8/11/01-1/19/02
Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) , Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 1/2016 Pumper One Stop Pumping
C. ABSORPTION FIELD DATA
Date installed 1/19/02 Soil rating (g.p.d./ft2 or fe/bdrm) 1.2 GPD/SF System type Deep Trench
Length 39 ft. Width 3 ft. Gravel below pipe 6 ft.
Total depth 9'25 ft. Eff. absorption area 468 fe Monitoring tube Y Depression over field N
Date of adequacy test 10/5/15 Results (Pass/Fail) PAS�Sv/ For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water adde �" ✓a New depth 2 in.
Elapsed Time: 20 min. Final fluid depth 0 in. Absorption rate >= 450 g.p.d.
Any rejuvenation treatment (past 12 mo,) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Size in gallons _
in. "Pump off' level at
Datum Cycles tested
E: SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot >100'
Absorption field on lot >100'
Public sewer main >75'
Sewer /septic service line >25'
>50'
Manhole/Access (Y/N) _
in. High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots >100,
On adjacent lots >100,
Public sewer manhole/cleanout >100,
Holding tank >75'
Animal containment areas Manurelanimal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO
Building foundation >51 Property line >5 Absorption field >51
Water main 10' Water service line >10, Surface water 100' >
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10, Building foundation >10,
Water Service line > Surface water >100
Curtain drain None Noted Wells on adjacent lots >100,
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that l 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 Withael E. Anderson, P.E.
Date 6/34/201
COSA brown sheet 10-10-12.doc
Water main >10'
Driveway, parking/vehicle storage >10'
MICHAEL E. ANDERSON
CE -4381 ._
in.
Municipality of Anchorage
Development Services Department =: x3,t2.;
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC161271
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
3 of Fassler subdivision. This inspection revealed a nitrate concentration of
8.02 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.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble
in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass
rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is
in the form of ammonia or protein first, which through contact with oxygen and certain
bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from
wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also
result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or
three years, but is associated with a potentially fatal infant disease called
methemoglobinemia. In the digestive system of young children, nitrate converts to
nitrite, which can pass through the intestinal wall into the blood stream. There it
combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The
EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The
standard has been lowered from a previous level of 45 mg/L set by the US Public Health
Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and
other common home water treatment systems such as softening or iron filtration does not
readily remove nitrate. The best method for limiting nitrate in well water is source
control. This can include avoiding overdosing of fertilizer near the well and maintaining
good separation distances between septic tank leach fields and the well. A special anion
exchange filter that contains a media with a strong affinity for negatively charged ions in
water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical'
methods using a spectrophotometer to read the final color endpoint. Specific ion
electrodes also can be used to detect the activity of nitrate in water. This laboratory uses
several different wet chemical methods approved under the public water supply
laboratory certification program. They also have test kits available, which the laboratory
uses to perform an inexpensive "screening test', and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test
kit results against a certified analysis from the lab occasionally to verify the accuracy of
the kit. We recommend using a specially prepared bottle that has been rinsed in
hydrochloric acid for collecting samples.
Municipality of Anchorage
On -Site Water & Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I. D. 051-531-34 Expiration Date: 7- -1-3
1. GENERAL INFORMATION
Complete legal description FASSLER LOT 3
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
24847 FASSLER *CHUGIAK, AK 99567
KYLE & DANA PATTERSON Day phone
24847 FASSLER *CHUGIAK. AK 99567
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
Day phone
441-1334
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
E
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
Received by Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 9610
Date of Payment y I
Receipt Number oq I j n a
COSA# C�6L13 IU 14
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 GARNESS ENGINEERING GROUP, Ltd. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 : ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E
Engineer's Comments:
In conducting this evaluation, GEG, LID. 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 rife of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
_ Z System #1 Approved for 3 bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
L2
bedrooms.
bedrooms, with the following
337-6179
Date 3 /3
OF
owsiTE
WATER AND
Original Certificate Date: q — — 13
The<M"udeXl/ ,a, chorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon th rep a stations 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 Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
(Rev. 1110.5)
V
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: FASSLER LOT 3 Parcel ID: 051-531-34
A. WELL DATA
Well type PRIVATE If A, B. or C provide PWSID# N/A
Date completed 7/18/01 Sanitary seal (Y/N) YES
Total depth 200 ft. Cased to 161 ft.
FROM WELL LOG
Date of test 7/18/01
Static water level 147 ft.
Well production 2 g.p.m.
WATER SAMPLE RESULTS
Coliform U colonies/100 ml.
Arsenic:L ug./L.
B. SEPTIC/HOLDING TANK DATA
Nitrate t• 1 a mg./L.
Date of sample: 3/19/13
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
3/19/13
WEI
II =3
Collected by: GEG. Ltd.
Tank Type/Material SEPTIC/STEEL Date installed 8/11/01-1/19/02
Tank size 1000 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping (016/2014 2012 Pumper Sf►N1-9'*" D0MPz<J"'
C. ABSORPTION FIELD DATA
Date installed;/>>/Ot-i/i9/o2 Soil rating (g.p.d./ftor � 1.2 System type TRENCH
Length 39 ft. Width 3 ft. Gravel below pipe 6 ft.
Total depth *9.25 ft. Eff. absorption area 468 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test **3/19/13 Results (Pass/Fail) PASS For E bedrooms
Fluid depth in absorption field before test E in. Water added 2475gal. New depth 6 in.
Elapsed Time: E min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date -
**PRE-SOAKED WITH 2000 GALLONS OF WATER ON SAME DAY PRIOR TO START OF TEST.
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YM
"Pump on" level at in. "Pump oft" level ' . High water alarm level at
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankfiift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main N/A
Sewer /septic service line 25'+
Public sewer manhole/cleanout N/A
Holding tank
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehic a storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S
I certify that i have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSH guidelines in effect on this
date.
Engineer's Printe Name JEFFREY A. GARNESS
Date /,13 /j?
(Rev. »ros)
Municipality of Anchorage
Community Development Department p `_
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 # 131114
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
3 of Fassler subdivision. This inspection revealed a nitrate concentration of
7.1 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
Development Services Department
Building Safety Division
On -Site Water 8 Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEM:
FOR A SINGLE FAMILY DWELLING
Parcel I.D. y5I •-*I-3q COSA# 014-056
1. GENERAL INFORMATION Expiration Date: / d - / S - b?
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
FASSLER SUBDIVISION, LOT 3
24847 FASSLER CIRCLE * CHUGAIK. AK 99567
ADAM SEAHOLM Day phone 748-1115
24847 FASSLER CIRCLE * CHUGAIK. AK 99567
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
❑
Community On-site
❑
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 Onsite 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 seat 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 (les 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
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
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 identif able 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 moot the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole bonefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will H confer any legal fight whatsoever.
S. DSD SIGNATURE
`' Approved for bedrooms.
Disapproved.
337-6179
Date :7 113/07-
........
13 07-
. . ...... ..........
J f rnessr
' E-7953 a
••�Ij3/�� �_�Apdo
40OdPr0 /efs10(�jjfttl ( (ft
Conditional approval for bedrooms, with the filowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Reort
Other
ONSITE
WATER AND •:
WASTEWATER
PROGRAM
••.
BY: Original Certificate Date: 7-19—M
(RW 71N5(
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water 8 Wastewater Program
4700 Bragew Street
P.O. Boz 198050
Anchorage, AK 99519-6850
www.murJ.org/o=W
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: FASSLER SUBDMSION, LOT 3 Parcel ID: OS1 - S --J 31 -.3 Ll-
A- WELL DATA
Well type PRIVATE If A. B, or C provide PWSID# N A
Date completed 7/18/2001 Sanitary seal (YIN) YES
Total depth 200 ft. Cased to 161 ft.
FROM WELL LOG
Date of test 7/18/2001
Static water level 147 ft.
Well production 2 g.p.m.
WATER SAMPLE RESULTS:
Coliform (k colonies/100 ml. Nitrate*• le mgJL.
Well Log (YIN) YES
Wires property protected (YIN) YES
Casing height (above ground) 18+ in.
AT INSPECTION
6/26/2007
153 ft.
1.65+ g,p,m,
Other bacteria 6 colonies/100 mi.
Arsenic: NO ug./L. Date of sample: 6/25/2007 Collected by: GEG Ltd.
B. SEPTIC/HOLDINO TANK DATA
Tank Type/Material STEEL Date installed 8/11-25/2001
Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) YES
Foundation cieanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A
Date of pumping 6/28/2007 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA
Date installed 5/1 1-29/20001 Soil rating .p.d. ft'/bdnn) 1_2 System type TRENCH
Length 39 ft. Width 3 ft. Gravel below pipe 6 ft.
Total depth +9.41 ft. Eft. absorption area 468 fe Monitoring tube YES Depression over field NO
Date of adequacy test 6/26/2007 Results (Pass/Fall) PASS For 3 bedrooms
Fluid depth in absorption field before testD8' in. Water added 480 gal. New depth DRY in.
Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >= 450+ g,p,d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date
D. UFT STATION
Date installed
"Pump on" level at —in.
Datum
E. SEPARATION DISTANCES
Size in gallons Manhole/Access (YIN)
"Pump ofr High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankfliR station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parkingivehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
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
date.
Engineer's PrintedName JEFFREY A. GARNESS
.
Date 7: 1316-1
COSA Fee $ L-16 0. U U
Date of Payment
Receipt Number —^5 (� % C� //►7A/
(Rw. 11105)
Waiver Fee $
Date of Payment
Receipt Number
-\ Municipality of Anchorage
• Development Services Department '
j Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsitc
(907) 343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 070250
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Lot 3 of Fassler
subdivision. This inspection revealed a nitrate concentration of 7.18
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.
SOS RcE#
1072943001
Client Name
Garness Engineering Group, Ltd.
Project Name/p
passlcr L3
Client Sample ID
Fassier L3
Matrix
Drinking Water
PWSID
0
All Dates/times arc Alaska Standard Time
PrintedDate/lime
07/11/2007 14:51
Collected Date/time
06/252007 18:45
Received Daterrime
06262007 10:15
Technical Director
Stephen C. Ede
Sample Remarks:
Allowable
Prep Analysis
Parameter
Results
PQL Units
Mcthod Container ID
Limits
Date Date
[nit
Metals by ICP/MS
Arsenic
ND
5.00 ug/L
EP200.8 C
(<10)
0627/07 07/09/07
TK
Waters Department
Total Nitmtc/Nitritc-N
7.18
0.100 mg/L
511204500NO3-P D
(<10)
07/03/07
1DS
Microbiology Laboratory
Total Coliform
0
coVIOOmL
S%120 9222B A
(<I)
0626/07
DLC
07/13/2007 11:05 9073449821
i■
man JRs Painping
PO Box 773415
Eagle River, AK 99577
(907) 694-6454
1pilling information
Adam Seaholm
24847 Fassler Circle
Chugiak, AK 99567
(907) 68&2581
ob Site Information
Adam
24847 Fassler Circle
Chugiak, AK 99567
(907)688-2581
JRS SEPTIC
Job Desatpaen: 1 DOOG
P.O. Number:
Terms:
Below":
Map Book:
Crose Strews:
Job Comments:
Net 30
Karlia
Homestead Road
PAGE 01
Service Agreement
Number:
023344
Order Date:
25 -Jun -2007
Service Date:
28 -Jun -2007 12:00
Technician:
Dan
Ta(%: 0
Job Type' New
Map Grid: 24
tank and checked field
Additlonal Location Comments Disgram: St0Ltarem2=3A4 bm0 Gallons Planned: 1000
ws on gray home w/ maroon -red trim. Gal. Actual:
Hose Length: 2
Double Tank: O
Pump System: 95
Baffles Inlet: ❑
Baffles Outlet: O
Iaea :a
Service Type Qty Price Each Tax? Extension Actual
Septic Service 15K 1 $135.00 No $135.00
NonTaxable Total Taxable Total Tac Total Grand Total
Estlnlaled Charges: $135.00 $0.00 $0.00 $135.00
Actual Charges: �� r
Customer agrees to the terms and condiecns shown. THIS IS A BINDING AGREEMENT.
Signature and Title of Customer Reproeenlatlw
Accepted by JRs Pumping
Date
Date Accepted
For your added convenience we accept American E)Preaa, Dicover, Visa and Mastw Card payments over the Phone.
Aver 30 Days account will be turned over 10 COLLECTIONS. $30.00 Fa NS F Checks Returned.
Municipality of Anchorage
-� Development Services Department
Building Safety Division '
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 _
www.ci.anchorage.ak.us /d/1 X)4/t/-r
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051- 531- 34 HAA#
Expiration Date:^
1. GENERAL INFORMATION
Complete legal description LE 3 F4ssl..,. SID
Location(site,addrirssordirections) '2494_f &5s It... Circle..
4
Current Property owner(s) -r.-, LyJot, Day phone (089 - O0b9
Mailing address
Lending agency
Mailing address
2yg47 FQsslt, G-cic
Day phone
Real Estate Agent Ton (ilk¢ Day phone 632-OS13
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:_
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Weil
19
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 Health Authority
Approval (HAA) based only upon the representations given In paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.)
Certificates are valid for one year for properties served by Class A or B wells or a public water system. The
Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Health Authority 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 SPURKLANO CMGuJE6R%N& Phone 2i9.391fo
Address '701 w istl` Ave S,,:k.- 203 ,,+
Engineer's Printed Name `i'0956 Al SPyQK LANG Date 1u2-4' 2004
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Note: The well for this property meets existing State and Municipal Codes. There are nitrates
present. It is suggested that periodic testing be performed to Insure the wells continued suitabilih
Current nitrate concentration Is 5.65 mg/I. EPA maximum concentration is 10.0 mg/l. More
informs on on nitrates Is available from the On -Site Services Program, at 343-7904.
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: Original Certificate Date:
(Rev. 01102)
r..
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Foss ler Lt .3 Parcel ID: 051- 53/- 3Y
A. WELL DATA
Well type tori 9 -Aft
Date completed A7, 2001
If A, B. or C provide PWSID # =
Sanitary seal (YIN) y
Total depth iQ_ft. Cased to 151_ft.
FROM WELL LOG
Date of test -�) 16 1 200 1
Static water level 117- ft.
Well production Z g.p.m.
Well Log (YIN) i/
Wires properly protected (YIN) y
Casing height (above ground) 2Qo in.
AT INSPECTION
2 -111 2004
154 : ft.
I.9 g.p.m.
WATER SAMPLE RESULTS:
Coliform--0--colonies/100 ml. Nitrate S•b mg./I. Other bacteria _colonies/100 mi.
Arsenic: mg./I. Date of sample: IZ 2J 04 y Collected by: Lars Spma do l
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material S heel Date installed 8')+f U01
Tank size Io0 0 gal. Number of Compartments Cleanouts (YIN) Y
Foundation cleanout (YIN) L Depression over lank (YIN) A/ 'High water alarm (YIN) A/
Date of pumping V41 -0 `1 Pumper SO
C. ABSORPTION FIELD DATA
Dateinstalled S1111120ol Soil rating (g.p.d.lftZ or ft2/bdrm) I_Z System type Do cp Trtnt-�
Length 39 ft. Width 3 ft. Gravel below pipe (0 ft.
Total depth 10 ft. Eff. absorption area y�_fta Monitoring tube Depression over field !�
Dale of adequacy test 12 Zt 2004 Results (Pass/Fail) P -M, For __3 bedrooms
Fluid depth in absorption field before test 11 in. Water added1-10 gal. New depth I in.
Elapsed Time: 0 min. Final fluid depth L in. Absorption rate >= 99C) g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) A/o If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN)
'Pump on' level _ in. 'Pump off" level _ in. High water alarm level in.
Datum Cycles to Meets alarm & ' uit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot i 100' On adjacent lots
i 1100'
Absorption field on lot � 10V On adjacent lots i /00'
Public sewer main N/A Public sewer manhole/cleanout N�
Sewer /septic service line 'r 25 Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
112.
Water main
Wells on adjacent lots )/00'
Property line '? 10' Absorption field 7 5 '
o
Water service line 710' Surface water /V
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
%/D'
Building foundation 32'
Water main N�A
Water Service line
i f0
Surface water N. 0.
Driveway, parking/vehicle storage /o'
Curtain drain N 0 • Wells on adjacent lots 7100'
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 HAA guidelines in effec1 on ihis date.
1p""
�(//�j
Engineer's Printed Name l nlobQ H
SoL r 1�1hN[� Cita°
Date
HAA Fee 5 L 3� 3 0 Waiver Fee $
Date of Payment /!� / g' O ., Date of Payment
Receipt Number .2, 9� Receipt Number
(Rev. 12/01) e/
12-23-03 12:0411 FRC4-CT1E ESI, SCS ENV SERVICES
SCS RcEN
1048195001
Client Name
Tohhen Spurkland P.E.
Project Name/#
Fa:slen. Lot 3
Client Sample 10
Fasslen. Lot 3
h1strix
Drinking Water
Sample Ranarks:
ICT5515301 T-355 P.WGS F-TH
All Dates?Imef are Alaska Standard Time
Printed Date/Time 12/28/2014 13.25
Collected Dalt/Time 12212003 14:30
Received Dalerlime 122120d{7:30
Technical Director _,Stephen r de
Released By
It n.11s --- PQL Valla Metnd Commna lD AnowaWe Prep Aadysia Intt
Pnameut Liroin Dace Dau
watara• Department
Nitrme N 5.65 0.100
Microbiology Laboratory
Total Coliform . TNLC OB
m;4 EPA 300D B (<-10) 1222/03 81A
ccl/100m1 Sts12092226 A (<-1) 12.21.93 DKC
Tobben SDurkland
Tobben SDurkland P.E.
203 W 15th #203
Anchorase. AK 99501
Work Order: 1048052
Alpine Terrace Lt 2 B 3
Client: Tobben Spurkland P.E.
Report Date: December 22, 2004
Enclosed arc the analytical results associated with the above workordcr.
Laboratory Analysis Report
200 W. Potter Drive
Anchorage, AK 99518-1605
Tel: (907) 562-2343
Fax: (907)561.5301
Web: http://%%ivw.sgscnvironmental.com
As required by the state of Alaska and the USEPA, a formal Quality Assurance/Quality Control Program is maintained by
SGS. A copy of our Quality Control Manual that outlines this program is available at your request. The laboratory ADEC
certification numbers arc AK08-03 (DW), UST -005 (CS) and AK00971 (Micro).
Except as specifically noted, all statements and data in this report arc in conformance to the provisions set forth by the SGS
Quality Assurance Program Plan and the National Environmental Laboratory Accreditation Conference.
If you have any questions regarding this report or if we can be of any other assistance, please call your SGS Project Manager a
(907) 562-2343.
The following descriptors may be found on your report which will serve to further qualify the data.
PQL Practical Quantitation Limit (reporting limit).
U Indicates the analytc was analyzed for but not detected.
F Indicates an estimated value that falls below PQL, but is greater than the MDL.
J The quantitation is an estimation.
4 Indicates the analyte is found in a blank associated with the sample.
• The analyte has exceeded allowable regulatory or control limits.
GT GrcatcrThan
D The analyte concentration is the result of a dilution.
LT Less Than
! Surrogate out of control limits.
Q QC parameter out of acceptance range.
M A matrix effect was present.
JL The analytc was positively identified, but the quantitation is a low estimation.
E The analyte result is high outside of calibrated range.
Note: Soil samples arc reported on a dry weight basis unless otherwise specified
SGS Environmental Services Inc. _ 1200 W. Potter Dr, Anchorage AK. 99518.1605 t (907) 562-2343 f (907) 561-5301 %mw.us.sgs.eom
-SG$- SGS/CT&E ENVIRONMENTAL SERVICES
Drinking Water Analysis Report for Total Coliform Bacteria
READ e15TRUCT*W ON REVERSE GIDE BEFORE COLLECTING !AMPLE
MUST BE COMPLETED BY WATER SUPPLIER
13
PM-"IC WATER SYSTEM IW
F&FUVATE WATER SYSTEM
77 Q Sww R"uft
❑ Sww brvcua
13 Sand Raaub
200 W. POTTER DRIVE
ANCHORAGE, ALASKA 99518
Tet: 907582-2343
Fax: 9075815301
Lob RN No.
1050235'V�-
111111111111
13 Send enoloa
SAMPLE COLLECTION:
•..r wwr. wy+�+ ..w nwr•wr r.r
Dae.: Fb1 IV 12 200S
er+ 0•r r.w
Tl. : . 11.=A r Q1 PM 0 ..)
Loca&w LE ?, rnSS1G�
SAMPLE TYPE:
Tmmporbd �,J_l
to Lab By: fame as Collector Other.
TO BE COMPLETTED BY LABORATORY
o❑ Routine
13 Treated Water
Y^Repeat Sample A<ntreatad Water
(refer to tab no. ►
❑ Special Purpose
Sample Recelvina:
Date: �� / 2 CSS ❑ Sw" e 30 h0•+01d; ❑ RUSH SAMPLE
Rnuae maybe va•liabla
Tune: Itro
Temp: ❑ 4e Nou Wakw Phone N:
Delivery Me9wd: r For Locow" Fax
Received By:
Comm•wa
...........................................................................................................................................
Bacteriological Water Anatole Record:
Sent b ADEC
urAowlo (PIA) REaOIYa:
ANC FSK JUN
AmyslalWW^� 1 �it J Total coworm
-
WtdTinr�
Amhati E. Coo
Sard b cNe t
Amylkal McOwd: MEMBRANE FRYER RESULTS:
Phoned 'Q faxed Q
Dycl Count
CabnbW00mL
DaWnWw:_,��.
Membrane Fitter vwnuaon
S VAV''
❑ MMO-MUG (PIA)
Satisfactory
{ EC:
❑
Unsatisfactory
...�..
Reported By: DateMme: II14Ia��
avwr•
(Yi
Trre•r»la•r.»rf:w
a•ew.e.+rw
Form f FW 0053 17/17/03
..
o. -
Jv
A/
I
Asa.
ks�D" ✓
AS -BUILT
F>fJl.r tt'Ei�e �T f...e-. w. Ern�-•
...
C -MIA
1 hereby certify that I have surveyed the following described
t,
property: Lnr 3
II
EV r -f
F..•iio..2. TIS"lJ,KrWSr'r,.... .....
.x+,11.��
r or- At�t'ei>
Anchorathat ve-
ments situated hereon are within the prorid
lines don
:.'.�."� f>•'" •`ty`S.� dq
y and t
overlap or encroach on the property ly 1g property
thereto, that
`•yy
-
�'t` f „y y 1
k .��
's
no Improvements on property lying adjacent thereto encroach
on the premises in question and that there are no roadways;
* '�49 th� J"- -
-
transmission lines or other visible easements on said property.
r ��
except as indicated hereon. .
ie
`'ate
Dated at Eagle River, Alaska
ff s�! a
d ` Ho..NUCion
: J -
3
this &Y u.n..c2001
360-
e �•., a:� `•,�
4 `• > • , t +�+
ROBERT C. JOHNSON
SCALE: Registered Land Surveyor No 880-L5
4 j •• «✓ �'
.,
y o Box 77-0456, Eagle River, Alaska 99577 .
�1'�'ai.%%, •o-' -
Phone (907) 6942543 ..
r `
Municipalityof AncHorage;;
Development Services Department
r Building Safety Division •,- { ,
On Site Water and,Wastewater Program ,, C„
,,, < ,
P.O. Box 196650:Anchorage`AK.99519-6650
e • ., www.ct.anchorage;ak.us,',
(907)343-7904 r>
CERTIFICATE'OF-HEALTH AUTHORITY ;PPROVAL�
' f FORA'SINGLE FAMILY DWELLING'
cy`
Parcel I D 051-531-34 HAA# «-� J. p. , ,
Expiration Date: Z
1. GENERAL INFORMATION ^.
Complete legal description Ar, Lot 3,FasslerSubdivision
Location site address or ilirections Monron Street and Fassler Circle*,,J
Current Property owner(s)MMBM Construction Day phone 1688.1236 is
Mailing address , • P.O. Box 670495 Chugiak, AK 99567. "
Lending agency Day phorie
Mailing address,;... '
f
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER Three Three 3
.BE -
3. ;.TYPE OFrWATER SUPPLY:: ,TYPE OF WASTEWATER DISPOSAL ,
In Well ® Individual On-site
Individual Water Storage - ❑ -Individual Holding tank' ❑
r_-ommunit Class`+ Well __
y ❑ t Community.On site ' ❑ i
Public Water System' ❑ Public Sewer Q
The Municipality of Anchorage Development Services Department (DSD) Issues Cert�cate's`of Heaitti Authority
Approval (HAA) based,only upon;the representations given in paragraph 5 by an independent:professional civl
engineer registered iii the State of Alaska. Certificates of Health Authority Approval are required for -M' transfer of
title (except between spouses) for, properties senied by a single family.on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are. `
valid for 90 days from the date of issue for properties served by a private orClass C well and may be ressued with '
new water sample results less than 30 days old: (Certificates may be reissued for a period of up to one year with `
...
valid water samples.) �Cert�cates_'are. `valid for one year for properties served by Class A w B 'well s'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 seat affi; hereto and as'of the validation' date shown below, I verify that my investigation;','
based on'procedures'ou0ined in the Health Authority 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 numberpf
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 supplyiandlor
wastewater disposal system'is(are) in compliance with'aII applicable Municipal and Stale codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm Anderson Engineering Phone 522.7773
•Address P.O.Box 240773'Anchoraae, AK 99524 i
Engineer's Printed Name, Michael E.`Anderson, P.E. Date 1120102
f to
•rf s��r,
49 TONNliZ E
r,.... ...... ..:
.. ..'
R,
,
P f : MICHAEL E. AERSON
O,i' CE -43811 NV. y`vi
5. DSD SIGNATURE p�Of��F , • ; ��vpm
3 . bedrooms. _ 444 4t�o�^ao oo•° :;
Approved for i o
Disapproved.,. t
Conditional approval for bedrooms, with the following stipulations:. .
Municipality of Anchorage
' Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 9951846650
www.ci.androrage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 3. Fasster Subdivision Parcel ID: 051331.34
A. WELL DATA
Well type rte
Date completed TnWM1
Total depth 200 ft.
If A, B, or C provide PWSID #
Sanitary seal (YIN) I
FROM WELL LOG
Date of test 71`1812001
Static water level 147 ft. .
Well production 2 g.p.m.
WATER SAMPLE RESULTS:
Well Log (YAV)
Wires properly protected (YIN) Y
Casing height (above ground) >24 in.
AT INSPECTION
ft.
Collars —L—colonies/100 mi. Nitrate 4.67 mg.A. Other bacteria 0 colonies/1W ml.
Date of sample: iD211=1 Collected by: T.10mbmuph
S. SEPTICIHOLDING TANK DATA
Tanis TypefMateriat SeotidSteel
Tank size 1.000 gal. Number of Compartments a
Foundation deanout (YAd) Y Depression over tank (YIN) N
Date installed 111`111=
Cleancuts (YIN) Y
High water alarm (YIN) N
Date of pumping Pumper NowConsWction
C. ABSORPTION FIELD DATA
Date installed Bn112001 Soo rating (g.p.d.AP or ftAbdrn)12 GPDISF System type Deep Trench
Length 39 ft. Width 1 ft. Gravel below pipe 6 ft.
Total depth 10 ft. Eff. absorption area 468 fl Monitoring tube Y Depression over field N
Date of adequacy test Results (PosslFail) 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 k g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date
0. LIFT STATION
Date installed
'Pump on' level at _ in.
Datum
E. SEPARATION DISTANCES
Size in gallons
'Pump otP level at _ in.
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lt@ station on lot 1100'
Absorption field on lot >100'
Public sewer main WA
Sewer /septic service line >25'
Manhole/Access (YM)
High water alarm level at in.
Meets alamr b davit requirements?
On adjacent lots >IW
On adjacent lots >1W
Public sewer manhole%Jeancut WA
Holding tank WA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Budding foundation >8 Property line� T Absorption field >S
Water main WA Water service tine 110' Surface water MW
Weds on adjacent lots >1W
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10' Water main >17
Water Service line >I(r Surface water >100' Driveway. pargngtvehicte storage >10'
Curtain drain None Noted Weds on adjacent lots 3,1110'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I cer* that I have determined through field inspectlons and
review of Munklpaf records that the above systems are in
conformance with MOA HAA guidelines in effect on dile date.
Engineer's Printed Name Michael E Anderson, RE
9
HAA Fee
Date of Payment
+3`75'
/-ZZ-o
Waiver Fee S
Date of Payment
Receipt Number l µL 94 Receipt Number
(Rev. t?roo)
ar V-
X
e.f�.....a....... A....'.� ...
�i•,SSI\�r5ai� ��w.�
JAN -03-02 03:05PM FROM -ME ENVIRONWNTAL SRV
CT&E Environmental Services Inc.
9075615301 T-392 P.02/03 F-504
CME RcL#
1018674001
Client PON
Client Name
rson Engineering
Printed Datenime
01/03/2002 9:00
Project Name/#
Lo /Fassler Subd Hose Dtb
Collected Datdrlme
12/28/2001 13:30
Client Sample ID
Lot 7Fassler Subd Hose Bib
Received Date/time
12/26/2001 14:25
512tria
Drinfing Water
Technical Director
Stephen C. Ede
Ordered By
PWSID
0
Cor 3 GASsu�
Released Oy
Sample Remarks
Parameter Resale Allowable Prep Analysis
PQL Units Method Limits Date Date [nit
Waters Department
Nitrate•N 4.87
Microbiology Laboratory
Total Coliform 0
0
n
4
Received Time Jan. 3. 3:01PN
0.200 m8/L EPA 300.0 (<10) 12/28/01 SCL
coU100mL SM1892220 (<1) 1228/01 KAP
JAN -03-02 03:05PU
.jZ11�
FROLKTIE ENVIRONIENTAL SRV
9075615301 T-392 P.03/03 F-504
ME Environmental Services Inc.
Laboratory Division
200 W. Potter Drive
DrinkingWater Analysis Report for Total Coliform Bacteria Anchorage, AK 99518.1605
Y P Tet 19071562.2343
READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Fax: (°07) 561.5301
MUST BE COMPLETED BY WATER SUPPLIER I TO BE COMPLETED BY LABORATORY
❑ PUBLIC WATER SYSTEM I.D. N
,d PRIVATE WATER SYSTEM
❑ Send Resaht ❑ Sendfneoice
o 4 FAStii-PyLl 1-3 0,
W. wa n.n. ,>u.YY au.r.YY.
FW. N.r Y• N. (
y W
SsndRerahr O Stndinroice
a{.YW AY•.a
C" R c^
SAMPLE DATE:
Month Day Year
An lysis shows this Water SAMPLE to be:
Satisfactory
❑ Unsatisfactory
❑ Sample over 30 hours old, results may
be unreliable
Cl Sample too long in transit; sample should
not be over 49 hotl-s old at examination
to indicate reliable results. Please send
new sample via special deliveryil.
Date Received 27
Time Received 1qp
Analysis Began \, l,v
Analytical Method: Membrane Filter
t2D MMO-MUG
• Numberofcolonies/100m1.
Result* Analyst
1018574
SAMPLE TYPE:
.4u' Routine a Treated Water
o Repeat Sample (for routine sample D Untreated Watts
with lab ref. no. )
❑ Special Purpose
'time Collected
SAMPLE LOCATION Collected By
/33x30
is /iigi3 '
rkue Prim
Comments:
�I 6
Date:
LTJ
.ach Fbks
Jun ❑
Fazed
Time:
Client notified or unsatisfactory results:
Phoned
Date:
BACTERIOLOGICAL WATER ANALYSIS RECORD
Spoke with
Time:
MMO-MUG Result: Total Coliform E Ceti
Membrane Filter: Direct Count �/ Coloniestt00ml
Verification: LTB BGB COLIFIRM
Fecal Coliform Confirmation _
Final Membrane Filter Results _ 0 Coliform/100 ml
Reported By '— Date 17-ZCj Time /5-30 hrs
•v BM Member of the SGS Group (Societe Generale de Surveillance)
TNW- rw NY.m.I re C.Y"
oa-a...a:(Ime
ENVIRONMENTAL Received TImer-Jan • LIN 3:0jPWIA. ILLINOIS. MARYLAND. MICHIGAN. MISSOURI. NEW JERSEY. OHIO. WEST VIRGINIA
SITE PLAN
SCALE -1"=4W
' W
J
N
Q