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HomeMy WebLinkAboutDOROTHY MARIE ESTATES LT 1Dorothy Marie
Estates
Lot 1
#015-273-64
Municipality of Anchorage Page t of _2__
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: 6crl 860012 PID Number: 015 -- Z73 -.V!� 1a!A
Name:
gAi 40AA04'16 14A1VY-or4,s
Wastewater System: I(New ❑ Upgrade
A00
Address: 99SO-4
A43SORPTION FIELD
3 565 A t-A M GSA 00-. A JI-A . AI_
Phone:
Zt3 — 3 $ oL
No. of Bedrooms:
4❑Deep
Trench JN Shallow Trench ❑Bed ❑Mound ❑Other
LEGAL DESCRIPTION
Soil Rating:
/ • 2 GPD/S2. Ft.
Total Depth from original grade:
8
Lot: ' Block: __..- Subdivision: �A
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
' 0e,o'r"Y r�lA1r. r GST.
q Ft.
'I Ft.
Township:
Range:
Section:
z CL011.�
Fill added above original grade:
Gravel length: 1
T12f,
GJ
O
-QS Ft.
50 Ft.
WELL: I� New ❑Upgrade
Gravel width: 5
Number of lines:
i
Distance between lines:
Ft.
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material: p,5-rte O 3034
P6 w A--E
Z I Z Ft.
2 I Z Ft.
5 00 S. Ft,
1 0
Driller:Date
y�
�A.AFAfLT VItILL)14
Drilled:
57 &-IL
Static Water Level:
90 Ft.
Installer:
GGI.OST'Ar,,
Date installed:
°I%
Yield:
Pump Set at:
-Z05
Casing Height Above Ground:
I
TANK
/0 GPM
Ft.
I + Ft.
SEPARATION DISTANCES
j&Septic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
1250
Weltyl
/oo.I-
too f +
'-�
._--_
_
Material:
sTi:Et-
Number of Compartments:
Z
Surface
a
100 i +
foo f t
--
--
—
LIFT STATION
Lot
t
Ifo ±
t
30
—
--
Size in gallons:
Manufacturer:
Line
Foundation
• 7 i
t 7 t
. --
__.
"Pump on" level at: "Pum evel at:
High water alarm at:
Curtain
Grp
KEG
Pump Make 8
Electrical Inspections performed by:
Drain
Remarks:
BENCH MARK
Location and Description:
TB M - 7o P o F"
n N
F0JA410AiY1 00 BY Po1nlr A
Assumed Elevation:
,'` • IAC �
//ff M` ��•E
Inspections performed by:S & S ENGINEERING Dates: l st 6-3`14
17034 Eagle River Loop Road, No. 204
2nd
mac"` ROBERT C. COWAN NAN ," , -
Ea
Eagle Rivar, Alaska 99577
9 r 3rd L``t-9b
�G�J�i�ygCE-$'�1
w
Department of Hea h and H rvices approval"
;'
��,� , •... ,`` ,y
Reviewed and approved b ate: 0
• - `�
72-013 (Rev. 9/91) MOA 25 f
Permit No.
SW960012
Page 2 of 2
REVISED 7-3-96
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: LOT 1, DOROTHY MARIE ESTATES S/D PID No.:
015-273-03
A
B C
FCO 18'
11' -
ST 1 16'
12' -
ST2 21'
16' -
STI
ST2
.
FINAL GRADE
D131_2 2 4'
20' —
j
C01 37'
32' -
MT 1 38'
33' -
--�
N
CO2 58'
- 31'
I
96.11 1250
GAL
95.
'
MT2 59'
- 33'
I
I
I
I
LOT
I
I
FINAL GRADE7
ALT. SITE
MT CO
I
.
I
I
INSUL
TION
�^
SR
10'
MIN.
CQ1 Ar CO2
_
M
c 02&_TH#2A
7
i
\
�#1
T
_ _ --
���7
4°01
M
�F
1 = 92'
M12
= 91.9'
I
o0
B ST1
NO GROU
85.9'
D WATER
B.O.H.
�
;111�
4 BDRM
FCO
AE
S\-NEW
ISTNKLHO
ETCA
n
WN
�,
ti
I
"9
I
I
WELL
a�„� ROBERT C. COWAN
�y� CE - 8801 <w
- - - - - -
-------
-- —- - -
- - - - - - -
UTIL. E
'ALE i" 40
,,...........•�����
�10
�t,'� p�RafESS1C�k�`
iVE.1�►►
EAT
112
h
72-013 A (Rev. 9/91) MOA 25
IF3�I�iP��' ��Iy%IIRC§} �Y��33I6i�
1201 Ramona S t . 99 515 ANCH01EtA0Rv ALASKA
344-7'714
SIX INCH WATER WELL DRILLED ----------OUT TO THE DEPTH OF 21 P feet.
DRILLED AT THE RATE OF $24.00 PER FOOT. Steel casing seated out to 212 ft.
PROPERTY OWNER Mr. George Moore Bruin Builders, Inc. 562-3640
LOCATION OF WELL SITE Lot 1 Dorothy Marie Estates.
DRILLER Bernie Claus o f . Ra.mnart Drilling Works.
WEL.I, LOG -
0 - 18' Sandy gravel with 40% brown clay.
18 - 67' Coarse gravel with 15% clay.
67 - 134' Hardra.n. A cemented gravel material with several small boulders.
134 - 190' Sandy gravel & small boulders. 35% clay.
190 - 2.06' Hardra.n. A blue clay tyre cemented gravel.
206 - 212' 'v`Jater bearing fine gravel going into a good coarse water bearing
gravel at 212 feet. 'Nater recovery back ur to 90 feet of surface. This
water well making •:a. full ten grm. One horser3ower submersible -cum should
be install five to seven feet off bottom.
X1,500.00 aid on this well 5-8-96. Total cost of drilling: 9b24.00 rer ft.
x 212 ft.: $5,088.00. Muni arrroved well carr: $30.00
;v VTl.Lte check to Ra.rri �rU.rt Drilling 'Works for: 3, 618.00.
No set-ur cost. No mob or demob cost.
RECEIVED
JUN 20 1996
Municipality of Anchorage
Dept. Health & Human Services
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF 3 a 618. 00
THANK YOU VERY MUCH.7-� -, --'�
_
BERNIE CLAUS OF RAMPART DRILLING WORKS
DATE may 16, 1996
Th,n.nk you Geo You've mot class!
SERVICE CHUG31i O F It/=% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS.
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
Co_�-�CA
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT --
PERMIT NUMBER:SW960012
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:MATUKONIS RALPH J SR
OWNER ADDRESS:3565 ALAMOSA DRIVE
ANCHORAGE, ALASKA 99502
PARCEL
s�u
DATE ISSUED: 1/23/9610-2,-'l
EXPIRATION DATE: 1/23/97
LEGAL DESCRIPTION: plcc)gnqj
T12N R3W SEC 21 LT 30 fffJii l
LOT SIZE: 217800 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
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 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:
ISSUED BY:
L1= �tSS
'ow
(9
J com,-
DATE•
/ -mss"-,y'6
DATE: — 24 — 7
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ONSITE
WASTEWATER
DISPOSALSYSTEM
DESIGN
s&S�
,-in eRinq
December 12, 1995
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
P.O. Box 196650
Anchorage, AK. 99519
REFERENCE: (Proposed) Lot 1, Dorothy Marie Estates
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
Request you issue a permit to drill a well and install a
septic system to serve the proposed four bedroom house on
the referenced property.
Two test holes were excavated and percolation tests
performed. The approximate location of the test holes are
located on the attached site plan.
At the time of excavation no water was encountered in the
test holes and after seven day ground water monitoring,
the monitoring tubes were found to be dry.
This property has enough area for a future septic upgrade
which can be seen on the attached site plan.
We do not anticipate any adverse effects on neighboring
wells, septic systems or drainage patterns by the
installation of the proposed septic system.
There are no points of contamination within the proposed
well radius which can be seen on the attached site plan.
If you require additional information, please contact us.
Sincerely,
&/Z+�,_
Robert C. Cowan, P.E.
RCC/gk
Enclosure
17034 NORTH EAGLE RIVER LOOP • SUITE 204 0 EAGLE RIVER, ALASKA 99577
50' SITE PLAN DESIGN
SCALE
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OF .4 WL)
e Municipality of Anchorage �C'`' ,''•.3'<? Y
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650 ,�•.••' :... •y.., `: 'x+
SOILS LOG — PERCOLATION TEST
• ROBERT C. COWAN
n f .�
PERFORMED FOR: I�o x #w mi ANO 1i4 y M }% 1 V ICON f S �f� ^�^^ ,� (y���y\�
DATE PERFOR • `
r'e 't., LJ J..•' ..r
LEGAL DESCRIPTION: 407 3a Township, Range, Section: Yf C7/o,v a / `jf5l;w " Je 31✓
DEPTH T J i f{ v( - r jw-
I SLOPE SITE PLAN
(FEET)
1 ��. 0 ✓t.
13
14-
15-
16-
17-
18-
19-
In
4151617181920
G- 4 /4- v i L Iv %
C-013gL_f j
S, Lr 1-14Y4f4
Los 5 j
C--24%tf, L,
C 4%4 1'V C-
WAS GROUND WATER N
ENCOUNTERED?
IF YES, AT WHAT t
DEPTH? F
F
E
Depth to Water After
Monitoring) Date:
■■■■..■"■■
■■■■■■■"�h� 1-0, ■■EMNO-1
MINN 0Mri��l
MINN MMM110'1111
MEN EMENE MR I
11111111910 ■EwNINE
MINN ■MMAI MI
Raw MENUMS Al
910H WENMES
1Ii001NMmmw w
Reading Date Gross
Time
Net Depth to
Time Water
Net
Drop
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3-
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In
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G- 4 /4- v i L Iv %
C-013gL_f j
S, Lr 1-14Y4f4
Los 5 j
C--24%tf, L,
C 4%4 1'V C-
WAS GROUND WATER N
ENCOUNTERED?
IF YES, AT WHAT t
DEPTH? F
F
E
Depth to Water After
Monitoring) Date:
■■■■..■"■■
■■■■■■■"�h� 1-0, ■■EMNO-1
MINN 0Mri��l
MINN MMM110'1111
MEN EMENE MR I
11111111910 ■EwNINE
MINN ■MMAI MI
Raw MENUMS Al
910H WENMES
1Ii001NMmmw w
Reading Date Gross
Time
Net Depth to
Time Water
Net
Drop
ri.Su�K
'7 ..
3
—
7
7S*
r, -,
PERCOLATION RATE / (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND S FT
COMMENTS f XCfV.4 )r/di✓ Q j/ 7 -W -Cf - 4 E X.
PERFORMED BY: S & S ENGINEERING I CERTIFY THAT THIS TEST WAS PERFORMED IN
17094 Eagia Riwr Loop Road No. NX y / pl r
ACCORDANCE WI t TEX"64 IWAL 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:�0ICAMNt 4NQ RAY M/jTVKOA/1 s DATEPERFORME���;?�A"I••�J��7'
LEGAL DESCRIPTION: 1'O 1 30 Township, Range, Section: s'f Gd
7io.� / T'f' "�✓ f 3ti✓
DEPTH T9 -S7— #01 1 a, SLOPE SITE PLAN
(FEET)
1 z 7
06?G.4'V r C_ S
2 � 1 G
2 �� d? I
64 411 C L w /
3 P. 5 FiNw
4 a O C-cAS40,, A L
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7
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SANn AkN SE
MEMO MENEM
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■Io■ iiM1N M1§1
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Minn ■iirii�i it
Mica NONE N1
NINE MENOW N!
Norma
G 2RV k L WAS GROUND WATER N a
�/ Ir"i S ENCOUNTERED?
S
IF YES, AT WHAT -- L
DEPTH? 0 r` i 70 0-t
P
E
Depth to Water Afterbb__,, {{ ^
Monitoring? � Date:
Reading Date Gross
Time
Net Depth to
Time Water
Net
Drop
SAS t) o
Q
.�
Y.3?J-
1 0
q. 0
1 • xs" '"
20
PERCOLATION RATE � (minutes/inch) PERC HOLE DIAMETER ('
TEST RUN BETWEEN FT AND 6 FT
COMMENTS ExcAVAr/O"/ QY 'Tw£EA "_X' s )T'r. Sv t7-19QL#— G©/Z-
-S tPP
SEPi r c SY S_roto Df, S rS e
PERFORMED BY: S & S ENGINEERING. 41LCERTIFY THAT T IS TESTAS PERFORMED IN
17004 Eagle River Loop Road No. 404 8- �cl
ACCORDANCE WI I E h4y#WAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
s&S�
,in epunq
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION PRACTICES
and
MATERIAL SPECIFICATIONS
HEALTH AUTHORITY
APPROVALS REFERENCE: (Proposed) Lot 1, Dorothy Marie Estates
December 12, 1995
ROBERT C. COWAN, P.E.
ROBERTA. SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX (907) 694-1211
SEWER&WATER
`�"+•i'•`'i'•
MAIN EXTENSIONS
1. The scope of this project includes the installation of
a 1250 gallon septic tank and leachfield trench to
serve the proposed four bedroom residence located on
SEWER&WATER
the referenced property.
INSPECTION
2. Construction shall be in accordance with the approved
site plan and design drawings, Municipal permit with
any special provisions or conditions, and all
ENGINEERING STUDIES
applicable State and Municipal Wastewater Disposal
AND REPORTS
Regulations.
3. The contractor shall be responsible for obtaining any
necessary underground utility locates.
WELL INSPECTION
& FLOW TEST
4. Unless specifically agreed otherwise, the property
owner shall be responsible for final grading areas
subsequently depressed from soil settling.
SITE PLANS
5. Contractors installing wastewater disposal systems
must be certified by the Municipal Health Department
for system installations. Owners installing their own
ROADDESIGN
systems must also receive prior approval from the
Municipal Health Department.
SOILTEST
SEPTIC TANK INSTALLATION:
1. A septic tank is to be constructed by a certified
septic tank manufacturer. Construction shall include
two 4" cleanouts for pumping access.
PERCOLATION
TEST
2. The septic tank shall be sufficiently bedded to
prevent settling or shifting of the tank.
STRUCTURAL&
3. All standpipes on the septic tank shall extend a
MECHANICAL
minimum of 12 inches above final grade.
INSPECTIONS
ON SITE
WASTEWATER
DISPOSAL SYSTEM
DESIGN
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
Page Two
(Proposed) Lot 1, Dorothy Marie Estates
December 12, 1995
4. Septic tanks installed with less than 4 ft. of cover shall
be insulated.
5. A foundation cleanout shall be installed one to four feet
from the building foundation. In the line between the tank
and the leachfield there shall be two adjacent cleanouts
(unless an effluent pumping system exists within the septic
tank). These cleanouts shall be located on undisturbed
soil not more than 10 ft. from the tank. The first
cleanout, in line, shall be to clean toward the leachfield.
The second cleanout shall be to clean toward the septic
tank.
6. Final grading over the septic tank shall be such that a
positive slope exists away from the septic tank.
ABSORPTION TRENCH/DRAINFIELD INSTALLATION:
1. Excavate the proposed trench to the dimensions shown on the
design. The bottom of the excavation shall be within 2
inches of level. If the sidewalls of the excavation become
smeared, they must be raked or scratched (ruffed -up) before
gravel (sewer rock) placement.
2. Once the gravel is installed, the distribution pipe is to
be installed level with the perforations faced downward.
Gravel is then to be placed over the distribution pipe to
provide a minimum of 2 inches of cover over the pipe.
3. A silt barrier must be installed between the final gravel
layer and the native soil backfill. Ensure the silt
barrier covers the entire gravel surface before placing
backfill.
4. Monitor tubes shall be of four (4) inch diameter,
installed approximately in the locations shown on the
design, and extend a minimum of 12 inches above final
grade. The portion of the monitoring tube extending
through the gravel shall be perforated from the bottom of
the trench to the invert of the distribution pipe. This is
equivalent to the effective depth of the gravel as noted on
the design.
Page Three
(Proposed) Lot 1, Dorothy Marie Estates
December 12, 1995
5. Backfill over the final gravel layer must not be less than
twenty-four (24) inches. Insulation must be installed when
the backfill depth is less than thirty-six (36) inches.
The finish grade over the trench must be mounded to prevent
the formation of a depression after settling.
MINIMUM MATERIAL SPECIFICATIONS:
1. Any septic tank proposed for installation 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:
Type of Pipe Perforated Solid
Cast Iron Yes Yes
ASTM D3034 (PVC) Yes Yes
ASTM F810 (HDPE) Yes No
ASTM D2662 (ABS) Yes Yes
Use of a type of pipe other than listed above must be
approved by the inspecting engineer.
3. Insulation shall be at least 2" thick extruded direct
burial polystyrene (Dow Chemical Company Styrofoam HI or
equal).
4. Septic tank inlets and outlets shall be fitted with
watertight couplings (Caulder, Fernco, or equal).
5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N,
or equal) must be installed between the final leachfield
gravel layer and the native soil backfill.
6. All leachfield gravel (sewer rock) shall be 0.5"-2.5"
screened gravel with less than 3% passing the #200 sieve.
7. When sand is being used as a filter material, its gradation
specifications must conform to current M.O.A. or D.E.C.
requirements.
Page Four
(Proposed) Lot 1, Dorothy Marie Estates
December 12, 1995
INSPECTIONS:
Typically there will be a minimum of three (3) inspections
required during the installation of the wastewater disposal
system. These inspections will occur as follows:
1. The first inspection must be conducted after the
excavation of ditches, pits, trenches, or beds and
before the installation of any gravel. A septic tank
may be set in place, but may not be backfilled before
this inspection.
2. The second inspection must be conducted after the
placement of the silt barrier, gravel, distribution
lines, standpipes, cleanouts, and insulation, but
before the placement of any other backfill.
3. The final inspection is to occur upon final grading of
the property.
Often there will be more than these 3 inspections required.
Especially with the installation of multiple trenches, sand
filters, pressurized distribution systems, etc. Thus, the
inspecting engineer is to be contacted at least 24 hours prior
to the start of construction. If necessary, a pre -construction
meeting will take place on-site. The inspecting engineer will
not coordinate, direct or control in any way the contractors
activities.
The owner shall contract with the contractor to perform the work
outlined in these specifications and plans and in accordance
with the attached M.O.A. permit. There will be no contractual
arrangement existing between the contractor and S & S
Engineering. S & S Engineering shall be the owner's
representative and will inspect the work as stated above to
document the contractors activities. Final acceptance of the
contractors work rests with the owner and the M.O.A.
Page Five
(Proposed) Lot 1, Dorothy Marie Estates
December 12, 1995
S & S Engineering shall have no liability to the owner or to
others for acts or omissions of the contractor or any other
persons performing work on this project or the failure of the
contractor to carry out the work in accordance with these
construction documents. S & S Engineering's inspecting engineer
will not be responsible for the construction means, methods,
techniques, sequence, procedures or the safety precautions
incident to this project.
CONTRACTOR/INSTALLER
Municipality of Anchorag
• j Development Services Depart
Building Safety Division
On -Site Water 8 Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsito
(907) 343-7904
e
ment
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcell.D. 0/5%255-i! COSA# 0L00�
1. GENERAL INFORMATION Expiration Date: / — 2 S" 7
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
DOROTHY MARIE EST! LOT 1
3901 E. 112th * ANCHORAGE AK 99516
MICHELLE BARR Day phone 240-3748
3901 E. 112th * ANCHORAGE AK 99516
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
Day phone
Day phone
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
❑
Public Water System
❑
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I 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 riles 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.
Engineers 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 life of all wells and
septic systems depend on the local soils condition, groundwaterlevels 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.
5. DSD SIGNATURE
___Z Approved for 14 bedrooms.
Disapproved.
337-6179
Date 10h, 0
Conditional approval for bedrooms, with the Illowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineers Reort
Other
ey: �
(Rev. 11A5)
Pro
(f((fI /r
I O F ANC''%
JR.••' '••.,4p'���
ON-SITE • G+=
WATER AND
WASTEWATER
'. PROGRAM
OPA,
Original Certificate Date: / O —.2— 5�' O G
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water d Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.orglonsite
(907) 3437904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: DOROTHY MARIE EST: LOT 1 Parcel ID: D 15'-2734tf
A. WELL DATA
Well type PRIVAIE If A. B, or C provide PWSID# N/A Well Log (YM) YES
Date completed 5/16/1996 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 212 ft. Cased to 212 ft. Casing height (above ground) 18' in.
FROM WELL LOG AT INSPECTION
Date of test 5/16/1996 10/18/2006
Static water level 90 ft. 143 ft.
Well production 10 g.p.m. 6.95 g.p.m.
WATER SAMPLE RESULTS:
Coliform _Q _ colonies/100 ml. Nitrate JJ25-mgJL. Other bacteria 0 colonies/100 ml.
Arsenic:-h&—ugJL. Data of sample: 10/5/2006 Collected by: GEG Ltd.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 6/4/1996
Tank size 1250 gal, Number of Compartments E Cleanouts (Y/N) YES
Foundation deanout (YM) YES Depression over tank (YM) NO High water alarm (YM) N/A
Date of pumping 10/18/2006 Pumper McDONALDS PUMPING
C. ABSORPTION FIELD DATA
Date installed 6/4/1996 Soil rating .p.d. ft9bdrm) 1_2 System type SWALLOW TRENCH
Length 50 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 07J ft. Eff. absorption area 500 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 10/18/2006 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 In. Water added 632 gal. New depth 0_5 In.
Elapsed Tane: 2 min. Final fluid depth 0 in. Absorption rate >- 600+ g,p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N 3 type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Acoess (YM
"Pump on" level at _in. "Pump otr leHigh water alarm level at
Cycles tested Meets alarm & circuit requirements?.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift 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'+
Animal containment areas 500+
Public sewer manhole/cleanout N/A
Holding tank N/A
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 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 102+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 100'+ Driveway, parkingfvehide storage 10'+
Curtain drain NONE KNOWN Wells on adjacent kits 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through fleld inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guideNnes In effect on this
date.
Engineer's Printed Name JEFFREY A GARNESS
Date IQ/I,>A(
COSA Fee S 1%3o. C)C7
Date of Payment
Receipt Number
(Pw 1IMS)
Waiver Fee $
Date of Payment
Receipt Number
SCS ReLN
1066043001
Client Name
Gamess Engineering Group, Ltd.
Project Name/N
Lot I Dorothy Marie Est
Client Sample ID
Lot 1 Dorothy Marie Est
Matrix
Drinking Water
Sample Remarks:
All Dates/times are Alaska Standard Time
Printed Date/time 10/17/2006 9:24
Collected Date/rime 10/052006 17:24
Received Date/time 10/06/2006 14:34
Technical Director Stephen C. Ede
Parameter Results PQL Units Method
Metals by SCP/14S
Arsenic ND 5.00 ug/L EP200.8
Waters Department
Nitratc•N 1.09 0.100 mg/L EPA 353.2
Allowable Prep Analysis
Container ID Limits Dale Date Init
C (<10) 10/11/06 10/12/06 TK
D (<10)
10/06/06 XZ
Microbioloay Laboratory
Total Coliform 0 col/100mL SM209222B A (<I) 10/06/06 DPT
Municipality of Anchorage
• Development Services Department u
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-273-64 HAA #_ QQ tNgS
Expiration Date: 720' nH
1. GENERAL INFORMATION
Complete legal description Dorothy Marie Estates, Lot 1
Location (site address or directions) 3901 E. 112th Ave., Anchorage
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
& Roxanne Matukonis Day phone 522-9439
3901 E. 112th Ave. Anchorage, AK 99516
Day phone
Lori Hackenburger Day phone 727-4444
3111 C Street, Suite 100, Anchorage, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Q
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 Watkins Engineering, Inc. Phone 349-1851
Address P.O. Box 110443, Anchorage, AK 99511-0443
Engineer's Printed Name Cindy W. Ellis
5. DSD NATURE
Approved for _
Disapproved.
bedrooms.
Date
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
BYt_�
(Rev. 01102)
))W 1;
Original Certificate Date: S o -4
U
Develo
1PUIRy of anchorage °t
ent Services'Deparfinent
°x
3uild'mg SafetyDivrswn
V1�ater &Wastewater Program s ^ ITY
n or 7onsife
HORITYAPPROVAL CHECKLIST' -
1' y;ParcellD 015 273-6d
proVide' PW §Tb # " 1Nell Loa'(Y%Kl Y `
rr we ft
g.p.m. 9 -P.M.
k .
7t1. " I rafe mg O er ac ena coiomes/100 ml.
Date. f sample:'s,-ts-on Collected by Cindv Eltis'
'rv. ,0.W'.. �xx.w^h5�,♦,4w+Fs�L�%'°w+T'k"pv^+.f�.��L�� 'C?i�m'at4+.m. ew�
Date installed 6-4-96
Vumber of Compartments 2 Cleanouts (Y!N) Y'
epresslon o 7 tank n Ig wa er alarm'
Pumper Northland Pumping
t/6it rating (g p d/ft feme)
System type s a ow trent
Width 5.0 ft. Gravel below pipe 4.0 '' ft
sorp ion area ° Monitoring tube Y Depression over field n
O'Q
Results (Pal's/Fail) PASS Fora bedrooms
ore test m Water added gal New depth 0 in
rrra ur ep irr: corp ion ra e > g p d
Pe :n known �" If ve5 dive date
oN
Pr
49TH
(YIN)
*
Size in gallons
Manhole/Access
3/ records that the abovesystemsare in
•••..,
MOA HAA guidelines in effect on this date.CI'
y W. Ellis
"Pump
in.
High water alarm level at
�n
0"e7-_
"' °^ '�
w'.
�'•�' °`"Meets alarm & circw
'? g.
k
Cydles tested
oN
Pr
49TH
RI�ICA
*
de"Cermmed through field inspbctions�and
3/ records that the abovesystemsare in
•••..,
MOA HAA guidelines in effect on this date.CI'
y W. Ellis
�: _ .• „K.•
Name Cmdy W Ellls
CE 1057
I >� :Fo;:••Q-3
Waiver Fee $ nix
"A Date of Payment
14 - Receipt Number
SGS Ref.#
1045313001
Client Name
Watkins Engineering
ProjectName/#
Dorothy Marie Est Lot I
Client Sample ID
Dorothy Marie Est Lot I
Matrix
Drinking Water
PWSID
0
Sample Remarks:
All Dates/Times are Alaska Standard Time
Printed Date/Time 08/24/2004 6:56
Collected Date/time 08/19/2004 13:00
Received Date/Time 08/19/2004 14:34
Technical Director!'�/ Stephen C de
Released
Parameter Results P L Units Method Container ID Allowable Prep Analysis
Q Limits Date Date Init
Waters Department
Nitrate -N 1.06 0.100 mg/L EPA 300.0 B (<=10) 08/20/04 JIB
Microbiology Laboratory
Total Coliform 0
coU100mL SM209222B A (<=1) 08/19/04 DKC
t' _09h02/2004 1E:33 9072432091
f
�1
I\^
t,
Scale; =30'
FRED WALATKA & ASSO
r 6G ZS L 16-.00 OL /L.
' I
i
s:
� na IlS'
Sef1;c vC,is_-,, y,eJ
'2' 0. K.
¢0=e
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-Sty. ", t_Z9O10 .H4o� N
MFrt"
Hse. 16= O
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kr '
lio
lo' Tele. Elect: Es.nt.—
N89`58'2&"E' 165 Co
M
M
E, I1Zra Ave.
A"UILT HO CORNERS SET THIS DATE
1 M j certify that I have peflormod a Matt
PAGE 01
C
Anchorage Recording PMCIr1CI, Alaska, and matma
im,ro.emanta ahueted thereon are w"Min the Property fines and
do na wenap or encroach on the property IYing adjacent
ret,, that re, Improvements on Property tying adjacent !helot,
'-,d '�'"""c'}°1*•x encroach an the prembes In question and that there are no
.YY, roadways, narasmtselon Ilnas a ,mer vlslWe ea9emerrts on said
yh�a'`•.. o,,,,°, :'� �d Property e>Cept as Indleeea hereon.
�?'i ° .::9x9:aN_`•` ea .' Dated M Anchorage. Aleake
EASEMENTS OF RECORD, OTHER THAN t+:s - I f f day ,t se 8004
THOSE SHOWN ON THE RECORDED FRED W tATKA 8 ASSOCIATES
PUT ARE NOT SHOWN HEREON. L0/7 (907) 208-1886 Engineers and Surveyors
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel 1. D. # 5" - ? 3 -ME; Lc�c� HAA # �aLE L:.?1�
1. GENERAL INFORMATION
Complete legal description Loi: 1; Vorcothy (t,antie. E.6tates
Location (site address or directions) E. 1124"h Avenue. -
Ar;.chokaoe. AK
Property owner
Rays
9 Roxanne. hIatukonis
Day phone 248-3802
Mailing address
3565
A2cuCosa Dkive Anchokage.,
A:' --z
Lending agency
Mailing address
Day phone
Agent Day phone
Address
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
.Inn
Community well
Public water
NOTE: if community we!! system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site '"XX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
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 of this Health Authority Approval application 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 furtherverify 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 in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
S & S ENGINEERING9 ,ver Loop Phone
Road No. 204 (� c( tf — 2 �f 76
Name of Firm 17034 Eagle �
Address Eagle River, Alaska 99577
Engineer's signature
6. DHHS SIGNATURE
Approved ,for
Disapproved.
-661 -M bedrooms.
Date
Ln
ROBERT C. COWAN /,:,k-
CE
,Q
�,, • CE - 8801 +`-
FESSION
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
4UTIC
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA 821
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISIO
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICESJUL 19 1996
U*
Environmental Services Division r' Ft����
825 L Street, Room 502 • Anchorage, Alaska 99501 * (907)UG E D
Health Authority Approval Checklist
Legal Description: Lo -r I , 0.,t.rH-t tMA,c,r Esr: Parcel I.D.: -C)IS - 273 -03-
A.
-a3A. WELL DATA
Well type ell, "J E If A, B, or C, attach ADEC letter. ADEC water system number
Log present&N) Y Date completed 5 "i -91:
Total depth I Z Cased to 2/Z Casing height (above ground) 14'
Sanitary seal CTN) y Wires properly protected AVN) y
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well production O g.p.m. g.p.m:
WATER SAMPLE RESULTS:
Coliform Nitrate tOhl Other bacteria
Date of sample:ZIZ21 Collected by: Ea�,N EEcint c ,
B. giffaHOLDING TANK DATA
Date installed r? - `� - 9 �` Tank size 1 zSb Number of Compartments Z Cleanouts ON) Y
Foundation cleanout (VN) Y Depression (Y.Q N High water alarm (Y6) hi
Date of.Pumpitg <. Pumper
b
C. ABSORRTION FIELD DATIi!►R,
Date installed ,.(o' 4=`q"6'`
Soil rating (g.p.dJft2 or ft2/btlrm) 1.2- .System type 72G He 4
Lengthy Width `f Gravel thickness below pipe y Total depth 8
Effective absorption area o Monitoring Tube present ON) Y Depression over field (Y/M AJ
Date of, adequacy test fJ F-0 Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test (in,); Immediately after gal. water added (in.):
Fluid depth (ins) Minutes later: Absorption rate = g.p.d.
Peroxide treatment (past 12 months) (Y/N) — If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
E. SEPARATION DISTANCES
*Datum
Size in gallons
"Pump off" level at*
SEPARATION DISTANCES FROM WELL ON LOT TO:
Se tic holding tank on lot 10014- On adjacent lots .100 ► +
Absorption field on lot 1 00 + On adjacent lots / o ► t
Public sewer main tJ %A Public sewer manhole/cleanout t4 / A
Sewer /septic service line 25 + Lift station
SEPARATION DISTANCES FROM SEPTIC HOLDING TANK ON LOT TO:
Foundation 7 Property line 1-t0 Absorption field 10
Water main/service line ► 0 14- Surface water/drainage 10014 Wells on adjacent lots /00 # f
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: V.
Property line SO' f Building foundation ) 7 Water main/service line Z5 +
Surface water 100 1 F- Driveway, parking/vehicle storage area Soy+
Curtain drain /00 + Wells on adjacent lots 100
f
F ENGINEER'S CERTIFICATION
1 certify that I have determined thru field inspections and review of Municipal records "Af. s are
in conformance with MOA ideline in effect on this date.
y�P•"""'•''
9
Signature
Engineer's Name
' R / 6 �F ftOBEtr C ryCSWAN !
Date ( �3 •� CE 8801
HAA Fee $ '✓08 �� Waiver Fee $
Date of Payment ` Lz�Date of Payment
Receipt Number Receipt Number
72-026 (Rev. 3/96)*
+E, 17:11 ME ESI ANCHORAGE 4 9076941211
CT&E Environmental Services Inc,
Laboratory Division i
Laboratory Analysis Report
NO. 018 003
962700.962700001 Collected Date 07/02/96
10 Lot 1 Dorothy Marie Est.
Drinking Water Technical Director: Stephen C. Ede
�> Released
Results QC PQL
Units
method
allowable
Prep analysis Init
Qual
Limits
Date Date
- 1.04
0.100 mg/L
EPA 353.2
_
07/03/96 ESC
0.100 U
0.700 mg/L
EPA 353.2
07/03/96 ESC
col/100mL
Sm18 92226
07/06/96 TAV
TNTC 08 W/O COLI
V
Undetected
LT
- less than
GT
Greater than
D
Secondary Dilution
J
Below the calibration range
200 w. Poller drive, Anchorage, AK 88618-1605 — Tel. (907) 562-2343 Fax; (907) 561-5301
3180 F'eger Road, Fairbanks. AK 98709-6471 — Tel: (907) 474.8656 Fax: (907) 474-9685
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