HomeMy WebLinkAboutDRAKE BLK 3 LT 1Drake
Block 3
Lot 1
#017-462-15
(z1 --S
Municipality of Anchorage Page of Z
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: SW93oZ197 PID Number: 017y(v7-/5"
Name:
Wastewater System: 4 New ❑ Upgrade
E
Address:
Pg. 2-3ZNS-
ABSORPTION FIELD
PheRe:
6 9952
No. of Bedrooms:
�( Deep Trench ❑Shallow Trench ❑Bed ❑Mound ❑Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
• 2�GPD/S . Ft.
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
3 f?.A It 6- t ;? P.
Z Ft.
Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
—�
Ft.
Ft.
WELL: 0 New ❑ Upgrade
'
Gravel width:
Number of lines:
Distance between lines:
I
Z.S"Ft.
0-I Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material: --0,16 IF XR..
f} C
Ft.
Ft.
so 41 SO. Ft.
Ih
Driller:
A s ,q AJo - I'LL..
Date Drilled:
7 (9y
Static Water Level:
ZP Ft.
Installer:
/4)S7?U-/_
Date installed:
9 -19 -91
Yield:
Pump Set at: I
Casing Height Above Ground:
TANK
D "/S" GPM
U Ft.
Z Ft.
SEPARATION DISTANCES
0Septic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
&6_ 74,ULIL
ZSQ
Well
ivr'
/Z -9.P
_,
.^
Z5 r+
Material:
s
Number of Compartments:
Eet-
Z
Watee
/oo f
goo ;�
--
LIFT STATION
Lot
Line
/Q' /
/6",
Size in gallons:
Manufacturer:
Foundation
_^
"Pump on" level at: "Pum evel at:
High water alarm at:
Curtain
NO/1
6_1
OWN
Pump Make el
Electrical Inspections performed by:
Drain
Remarks:
BENCH MARK
Location and Description:
,Brh — oAop ,5' s7-ear- -- .v7 -
Assumed Elevation:
/OC1.o0Ft
Al
17034 Eagle River Loop Road, No. 204 1
l,,,
oV ua N..a.n tosoas:.a:.one(f
,.asa
Inspections performed by: Eagle River, Alaska 99577 Dates: lst 9 -7— 9y
ee
2nd 9 — p - 97 �I
-n �j ROBERT C. COWAN t
CE - 8801
Department of Hea h and Services approv 1
%.
��� <�>''�••.,, ., ,..••••''�; AV
Reviewed and approved bY�1_04 Date:
72-013 (Rev. 9/91) MOA 25
Permit Nci5.W930257 Page 2 of
I
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 DescriptionRAKE SUBDIVISION, BLOCK 3 , LOT 1 PID No.; 01746215
C01 CO2 94.5' 94.5'
96.7'
FILIAL GRADE C07 MT CO C06&
MT1
NEW
INSULATION
.........................................................................
92.1'
1250 GAL
:
r9j.,
S.T,
SR
N.T.S.
................................. ............... ..........................:........................................... .........................
..............................
87.5'
♦ 81.5' NO WATER FOUND
NEW TRENCH
MT1
— �c l C07
... _...moo
_;.. _. _.:.. :.<
- :.
C04
I?CO
A
6.0
B
—
co3't
CO1
38.5
44.8
002 �`'�CO2
47.0
51.4
NEW 1250 GAL. C01 ii
603
48.0
52.6
SEPTIC:: TANK
C04
56.1
60.4
........ ......... .................... .......... ............................
...... _ C.QS.:fz0
0
6.9.,4
.:
C06
67.6
67.1
C07
81.8
91.0
B A FC
................ ............... ...................
................
...... .............. .......................................................................
...... . .. ........... .... ........ .....................
a o
�vti
�
H
H
WELL
���•e�aIN66 't}�$
nett � t to atteatac+a:.co.�i
C.
• _e......,. .. a
Jt Ne tet'" •� ^` !. • �Oa �pj�
...........,. .,
ROBERT C. COWAN
CE ,�a�
+�0��qp
SCALE 1" = 40'
-8801 •' fG
`%%
,� ...ease.• .�� way
72-013 A (1/93)'
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
July 27, 1994
Joseph P Randazzo
Roslyn D Finnigan
PO Box 232895
Anchorage, Alaska 99523 2895
Subject: Lot 1 Block 3 Drake Subdivision
Permit #SW930257, PID #017-462-15
The subject permit, issued July 27, 1993 by this office for a
single family well and/or on-site wastewater system, has
expired as of July 27, 1994.
A new permit must be obtained from this office for a well
and/or on-site wastewater system NOT installed by the
expiration date.
If you have drilled the well, a well log must be sent to
this office for documentation of the installation and to
close the permit.
If a licensed Professional Engineer has inspected the
installation of the on-site wastewater system, the original
as -built inspection report must be sent to this office for
review, approval and documentation. All inspection reports
must be submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $320.00 for an
on-site wastewater permit; $120.00 for a well permit and
$440.00 for a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
qSi.cerely,
J mes Cross, P.E.
P ogram Manager
On-site Services
cc: S & S Engineering
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930257
DESIGN ENGINEER:S & S ENGINEERING
OWNER NAME:RANDAZZO JOSEPH P &
OWNER ADDRESS:P.O. BOX 232895
ANCHORAGE, AK 99523-2895
PARCEL ID:01746215
LEGAL DESCRIPTION: DRAKE BLK .3 LT 1
0
LOT SIZE: 89807 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
PAGE 1 OF 1
DATE ISSUED: 7/27/93
EXPIRATION DATE: 7/27/94
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 343-4329 OR 343-4681 AFTER BUSINESS HOURS
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:
DATE:
DATE: ��
U,
HEALTH AUTHORITY
APPROVALS
July 12, 1993
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
SEWER & WATER
MAIN EXTENSIONS 825 L Street
Anchorage, AK 99519-6650
SEWER & WATER
INSPECTION EFERENCE: Drake Subdivision, Block 3, Lot 1
ROBERT SHAFER, P.E.
ROGER SHAFER, P.E.
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
ENGINEERING STUDIES a request you issue a permit to drill a well and install a
AND REPORTS septic system to serve the proposed four bedroom house on the
referenced property.
Two test holes were performed on the property. The
WELL INSPECTION
&FLOW TEST approximate location of the test holes are located on the
attached site plan. The monitoring tubes within the holes
have been checked and found to be dry.
SITE PLANS 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 properties by
the installation of the proposed septic system.
ROAD DESIGN If you have any questions, or require additional information
for your review, please contact us.
nc
SOIL TEST
PERCOLATION
�P� A. Shafer, P.E.
TEST
STRUCTURAL&
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
DESIGN
/LSU/lsu
17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577
A
Bb'
,n wk,Y II u
4 y;� F s�
•+p�4;i ., fA
LL -
z FOZ
OO
3 cn a a I-
a� �Z<o a�
M< � �LJ Of
V)Q dpi
U W W
wLUm ��z
oaz
UW
�zao
yy�
G� E
TFw i$
w
CL
O
y,��
CO
>
W
e-� M
1-1
0Qfn�LAJ�
E O
O \
FF-�I�0 h w
wWmF-p
a � I
W
Q
� o
oz�W
I
Uj ?"
tz
U
O
pyo
I
ofOX
J
New zm�
� w
N Lo
O a
z [xia
in
� Q
W=V) C`� a- ZZ
a
h—I Y I Gn
U
I z
Q Q
II r- II
c�
�� I of
o�r
cr
w
w
I-�- Wa o
Z cn J W �
In N
J I
_
W �
�Wa
oa(x
azl-
Mom W wLW X
�z I w �UJZX
N
�z
o \
mho
Gr w
W own
aH�
W
UJ
boa w N>�z
J �
W
0 0
't V) (D
N
W Co ;t (D
0
4-0
d Ci
omwo
0 0 CL
r =z N
V) V) a F � � 0
j
o
O Li
I-"� Z
U-
o
z FOZ
OO
3 cn a a I-
a� �Z<o a�
M< � �LJ Of
V)Q dpi
U W W
wLUm ��z
oaz
UW
�zao
yy�
G� E
TFw i$
w
CL
O
y,��
z
>
W
W
0Qfn�LAJ�
�V)p
FF-�I�0 h w
wWmF-p
U
oz�W
Uj ?"
tz
pyo
�JLLI
ofOX
J
New zm�
N Lo
W �
z [xia
N�-W
� Q
W=V) C`� a- ZZ
a
I
II r- II
�Z
o�r
cr
�r
ofJq
0�p
I-�- Wa o
Z cn J W �
I
I
_
-j
w t,,
w
�Wa
oa(x
azl-
Mom W wLW X
�z I w �UJZX
U1
o \
mho
Gr w
W own
aH�
z�ox
UJ
boa w N>�z
W
0 0
't V) (D
N
W Co ;t (D
0
4-0
d Ci
omwo
0 0 CL
r =z N
V) V) a F � � 0
j
ri'
I
x
!
I
I
I
\/O
E-
%
W
I
�
I
I
I
z
U)
aoa.
o
E ;
C)
=
n
o
I
o
a
w
E-+
II I o0
owe
IXI 0
o l
H
II �II0
CO
o
I
II'oI�
o
Pa,
I
I
n
I
I
o
5% V
O
I
I
J j 13 S 2�3aNd�
3ldOS
NVd 311S '05 = "I
4FKK ) U 1011�tU%
1
2
3
0I
GW
0, ea
0
%a
e Municipality of Anchorage
(j
DEPARTMENT OF HEALTH & HUMAN SERVICES
to V. a n® °�~"�°a•'"'�°'��69&"'"'
825 "L" Street, Anchorage, Alaska 99502-0650
9 �
SOILS LOG - PERCOLATION TEST
� `
% 4
j�
PERFORMED FOR: '-Cl
DATE PERF r MED
LEGAL DESCRIPTION:I/IZAKF S([ Township, Range, Section:
SLOPE
DEPTH
SITE PLAN
4FKK ) U 1011�tU%
1
2
3
0I
GW
..
0
4
(j
^o
5
� `
6
7
-',
8
9
V
C --"'-'T
0
10-
12
12
13-
14-
15-
16-
17
314151617
81920 18-
19-
20
COMMENTS
WAS GROUND WATER NO
ENCOUNTERED?
S
IF YES, AT WHAT L
�— O
DEPTH? p
E
Depth
tri Wale r Atte
Monitoring? L Date:
®®®Depth
to
Water
..
h
PERCOLATION RATE S (minutes/inch) PERC HOLE DIAMETER
D FT
`7 E f BETWEENS .�/ 61%V .AN�� W V //T/I ���l/i
S & S EN0lN1:Ctc11Vv
PERFORMED BYI7034 Eaglf, River Loop Road Nei_ 9o4 I Ar CERTIFY THAT THIS TEST WAS PERFORMED IN
��aa ��@@ RRrver Alaska 99577
ACCORDANCE WfF�ALL Sl'ATE AND MUNICIPAL GUIDELINES I FE 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
(lb.
OF . 'i*.j,� R
or
W'' r
Vs�a
wT w .•-fr.—p H"o n.i n
0 A. Shan w
PERFORMED FOR: �r� V �F� DATE PERF RM SpA
. ' a+• .� roe"
`` Imo) �,�"� /
LEGAL DESCRIPTIONL / �. l/�[t'tl:.r �l i? Township, Range, Section:
DF,E�H SLOPE SITE PLAN
SA ` I I I p9p I I IU
2
3
9
WIC
W
4
o k`rj,'G
5
6
7
F`
8-
9
9-
10-
10
11
11
I
�l
lr
12
13
14-
15-
16-
17-
18-
191
41516171819
20
COMMENTS
SA�o 4 Csr►�►•u�.�-.
— P60e ' C"Osp C �
S & S ENGINEERING
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
I ul)
S
L
0
P
E
Depth to Water After
Monitoring? Date:
MEE-
09M . .
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
17034 Eagle River Loop Road No. 204
PERFORMED BY: Eagle River, AI -6k - 99427i
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINE
72-008 (Rev. 4/85)
CERTIFY THAT THIS TEST WAS PERFORMED IN
ON THIS DATE. DATE:
01/05/1995 15:13
9076941211
IF
S AND S ENGINEERING
Well L"
Alaeks Mow-WHIVerWis ON1111nl
12241 Avloo
Anchorage. Alwks 94616
st1! +tewe>or*
tendetto AA 7
Loo Ft. below $wine
Well Well Depth (ft)
Date of CW44stion
82
7/�,1/SIA
W1111112 Method
toter
49u;L-
PAGE 02
Depth (ft.) weight (bbs/tt)
to
42 7
to
sf Mlii, I
T
n hole b
SUM Water Level
Levet (ft.)
L 7Z%
Poole$ Level
Btio�w,t at C(il,.) AftAr (hre) Pftn (..nrl�
! 6rwtt�p
POW
Comity T
���� submersible
seutrq (ft)
ltMwks
well WN drilled wrder my juriedlcWon no Ods roaewt - e true to the best of my knowle* OW belts'.
. y
EP0M/S
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On-Site Systems Approval /
Parcel I.D. 017-462-15 Expiration Date: ( a c `F
1. GENERAL INFORMATION
Complete legal description Drake Block 3 Lot 1
Location (site address) 12611 Gander St.
Current property owner(s) Kevin & Sveta Cross Day phone 360-5778
Mailing address 12611 Gander St., Anchorage, AK 99516
Real estate agent Day phone
2. TYPE OF DWELLING:
U Single Family (w/wo ADU)
[l Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well Private Septic
Water Storage ❑ Holding Tank n
Community Well ❑ Community n
Public Water System n Public Sewer ❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer.unless otherwise requested by the engineer.
COSA Fee $ 556 V Waiver Fee $
Date of Payment L-/W/ 7i/'g Date of Payment
Receipt Number O0.9O3b Receipt Number
COSA# o5C/9 / WI 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. I acknowledge that On-Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone 907-522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503
Engineer's Printed Name Michael E. Anderson, P.E. Date 4/17/2019
ii,..`�E.°F•.44 ..
_4 4'9 thy._ -� \**
6. DSD SIGNATURE •7 .— -� �-�'
4 �7 MICHAEL E. ANDERSON f� J
System #1 Approved for bedrooms '�,,
�10,1,Is. No. CE-4381 l��
System #2 Approved for bedrooms . „.<<,:e....0 4l17/19�,..'°�'��
Disapproved ♦+N;;��SS\ 64
Conditional approval for bedrooms, with the following stipulations:
G�,0 .ITYf 0Fq((( (
5/T
E
'i,,,:;
I. WAT BLASTER/INO M
WATERprpROo A
o,i
J19i/i,, R SEilc s�•�`
kiBy: t 1,,...,_ �� Original Certificate Date: zd1-2q --(P
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 Arse�isAdvisory �, _t
Well Flow Advisory Other C/►�.1C rct OVc)r,
COSA Checklist blue sheet
COSA Checklist
Legal Description: Drake Block 3 Lot 1 Parcel ID: 017-462-15
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system
A. WELL DATA
❑■ Well log is filed with Onsite (or attached) Well production at time of test 4.9 gpm
Date drilled 7-29-1994 Water storage tank volume NA gallons
Total depth 82 ft Well disinfected for coliform test? ❑ Yes 0 No
Cased to 82 ft EU Coliform bacteria is Negative
0 Sanitary seal is functioning correctly Nitrate 6.36 mg/L [' Nitrate less than MRL (ND)
[' Wires are properly protected Arsenic ug/L ❑■ Arsenic less than MRL (ND)
Casing height (above ground) 25 in. Collected by Forge Engineering
Date of flow test for COSA 4/4/19 Date of Sample 3/29/19
Static water level at beginning of test 24 ft.
Comments
B. TANK DATA C. LIFT STATION
Age of tank(s) 25 years ❑ Required maintenance completed
Tank type/material Septic/Steel Age of lift station years
rI
Measured operating fluid level in septic tank,S/ Lift station material
❑■ Standpipes/foundation cleanout per record drawing Comments: NA
Date of pumping 7/16/2018
D. ABSORPTION FIELD DATA Deep Trench
Which system tested (date installed) 9/7/94 Adequacy test date 4/5/19
❑■ ALL standpipes present per record drawing Results Q✓ Pass For 4 bedrooms
Total measured depth from grade 8'6" ft (max) Fluid depth prior to test 25"
in
Measured depth to pipe invert from grade 5 ft (min) Water added 600 gal
❑ N/A— pressurized field New depth 38" in
■❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min
depth into effective
El Code-required soil cover over field Final fluid depth 25., in
Absorption rate >600 gpd
❑ System presoaked NA
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months)
date of test) NA If yes, enter date
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
✓0 Yes if No ft Ei Yes if No ft
Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft
Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft
0 Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' E Yes if No ft 0 Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' 0 Yes if No ft Surface Water> 100' 0 Yes if No ft
Property Line > 5' ✓0 Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' 0 Yes if No ft Private Wells > 100' ❑✓ Yes if No ft
Water Main > 10' ✓0 Yes if No ft Community Wells > 200' 0✓ Yes if No ft
Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below
Property Line > 10' 0✓ Yes if No ft Wells on Adjacent Lots:
Water Main > 10' 0 Yes if No ft Private Wells > 100' ❑✓ Yes if No ft
Water Service Line > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No ft
Surface Water> 100' 0 Yes if No ft
F. ENGINEER'S COMMENTS
48.1 :_triyi 44,
G. ENGINEER'S CERTIFICATION ���P��••U.t... `'9 4.
..
I certify that I have determined through field inspections and review .••• `1,, t
I •
of Municipal records that the above systems are in conformance with 4 49th �\ * •o
MOA COSA guidelines in effect on this date. s r. .... .... A
•
°� MICHAEL E. ANDERSON • :
.
•/.ten .• No. CE-4381 ••.....c..74.,
�t♦��`�'•• 04/17/19 ••.
COSA Checklist yellow sheet FQ••......■••......•p�. �4•
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT • b., 907-343-7904
On-Site Water and Wastewater Section Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory'
Certificate of On-Site Systems Approval # 0SC191114
Subdivision: Drake, Block: 3, Lot: 1
A water sample revealed a nitrate concentration of 6.36 milligrams per liter (mg/L).
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.
Mailing Address: P.0. Box 196650* Anchorage,Alaska 99519-6650 *www.muni.org
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT • ` .. 907-343-7904
On-Site Water and Wastewater Section ` Fax: 343-7997
www.muni.org/onsite /
Septic Tank Advisory
Certificate of On-Site Systems Approval #0SC OSC191114
Subdivision: Drake Block 3, lot 1
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 25 years old. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On-Site Systems
Approval.
This is an example of what the metal of a 20 year old steel tank MAY look like.
� .' - —4ag-ii.i. 4
. .......•
� A?. it. r F
.. ,,,,,,,,.., -.,, ,. - ,-. .-..
„ _ ,,„,,g 4 Ark
a +i. i r• i R as 4.'".”'
ilr':*",::
f F3A
/ -
f '"", J�400.4 �.. fry} 1 f 4 -~ "
4
-„- 7 � 2 o 1'8 6n-22
j ZR
Mailing Address: P.0. Box 196650 * Anchorage,Alaska 99519-6650 *www.muni.org
Municipality of Anchorage <
On -Site Water & Wastewater Program,
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 017-462-15 Expiration Date: 3-1/4-3
1. GENERAL INFORMATION
Complete legal description DRAKE S/D; BLOCK 3, LOT 1
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
12611 GANDER STREET, ANCHORAGE, AK 99516
ROSLYN RANDAZZO Day phone C/0 AGENT
12611 GANDER STREET, ANCHORAGE, AK, 99516
CECLIE STOTT W/ REMAX Day phone
Q Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY:
980-0466
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
E
Individual Water Storage
❑
Individual Holding tank
❑
Community Class - Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $gl t b
Date of Payment lia l
Receipt Number 013W1
COSA# C6Cl;lE� 5 0
Date: 1211311,z _
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, f verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. t 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.
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 identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system. will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
_Z System #1 Approved for bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone 337-6179
Date
bedrooms, with the following stipulations:
OF
ON-SITE
WATER AND
WASTEWATER
PROGRAM
The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
V
E1,
Nitrate Advisory
Arsenic Advisory
Other
By:
r
(Rev. 17 NS)
L/
Original Certificate Date: —
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: DRAKE S/D; BLOCK 3, LOT 1 Parcel ID: 017-462-15
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 7/1994 Sanitary seal (Y/N)Y--
Total depth 82 ft. Cased to 82 ft.
FROM WELL LOG
Date of test 7/1994
Static water level 28 ft.
Well Log (Y/N) YES
Wires properly protected (Y/N) __
Casing height (above ground) 19 in.
AT INSPECTION
10/20/2012
25 ft.
Well production 10-15 g,p.m. 6.4+ 9.p -m.
WATER SAMPLE RESULTS:
Coliform -8� colonies/100 ml. Nitrate Sof m g./L. Collected by: GEG. Ltd.
Arsenic: ND ug./L. Dateofsample: 10/18/2012 I fD/3i�i2
B. SEPTIC/HOLDING TANK DATA
*INSIDE HOUSE
Tank Type/Material SEPTIC/STEEL Date installed 9/7-8/1994
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (YIN) *YES Depression over tank (Y/N) NO High water alarm (Y/N)_YES n!T
Date of pumping 8/17/2012 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE TO BOTTOM OF MT
Date installed 9/7-8/1994 Soil rating (.p.d./ r ftlbdrm) 1-2 System type TRENCH
Length 63 ft. Width 2.5 ft. Gravel below pipe 4 ft.
Total depth *8.5 ft. Eff. absorption area 504 ft' Monitoring tube **YES Depression over field NO
Date of adequacy test 10/20/2012 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test ***37in. Water added 680 gal. New depth ****45 in.
Elapsed Time: 380 min. Final fluid depth 38 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date -
**MT ONLY EXTENDS ABOUT 41" BELOW THE INVERT OF THE LATERAL.
***4" BELOW INVERT OF LATERAL. SYSTEM 927 FULL.
****4" ABOVE INVERT OF LATERAL.
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pump off"
E. SEPARATION DISTANCES
Manhole/Access
water alarm level
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot * 100- 0 On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main
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/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
EAA� eF We Ll }ro edile S'T\•
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 COSH guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date I 1 l a7 // 2
(Rev. 11/05)
SGS
SGS Ref.#
1125189001
Client Name
Gaanne�ss Engineering Group, Ltd
Project Name/!t
t btr_Gander
Client Sample ID
],2 Gander
Matrix
6211
nnki Water
Sample Remarks:
Printed Daterrime 11/05/2012 8:42
Collected Date/time 10/18/2012 11:05
Received Date/Time 10/18/2012 11:41
Technical Director Stephen C. Ede
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic
Waters Department
Total Nitrate/Nitrite-N
Microbiology Laboratory
E. Coli
Total Coliform
ND 5.00
5.15 0.100
Negative
Positive
ug/L EP200.8 C (<10) 10/25/12 10/30/12 SCL
mg/L SM214500NO3-F B (<10)
I OOmL SM219223D A
100ml- SM219223B A
10/30/12 CMA
10/18/12 DLC
10/18/12 DLC
SGS
SGS Ref.#
1125492001
Client Name
Aarow Pump & Well Service
Printed Date/Time
11/06/2012 13:22
Project Name/#
12611 Gander St
Collected Date/Time
10/31/2012 15:30
Client Sample ID
12611 Gander St
Received Date/Time
10/31/2012 15:48
Matrix
Drinking Water
Technical Director
Stephen C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Microbiology Laboratory
E. Coli Negative I 100mL SM21 9223B
Total Coliform Negative 1 100mL SM21 9223B
A 10/31/12 DLC
A 10/31/12 DLC
Municipality of Anchorage te°
Community Development Department
Development Services Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 121558
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 3, Lot 1 of
Drake subdivision. This inspection revealed a nitrate concentration of 5.15
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.
30'
PLAT NO. 65•-106
DRAKE SUBDIVISION
LOT 1t BLOCK 3
69,927 S.F.
MERGANSER AVENUE
N 90.00'00"E 270.02'(R)
N 90.00'nn'F lAo in -IM)
SEPTIC SYSTEM
t,
�} A.C. DRNE
Po� rl
EMONG BUILDING
' n n
30'szz•------- — — — —— — — — — —— 70'U— —
MI
N 69°57'41"E 299.16'(M)
N 90600'00"E 300.07'(R)
IBUILDING
DECK0' DETAIL1 "=20' 16.0'0DECyK LLi 12.0' y(ACBELOW)
LEGEND
,(R) RECORD DIMENSION PER PLAT NO. 65-106
(M) MEASURED DIMENSION THIS SURVEY
AS—BU I
LT-
1 HEREBY CERTIFY THAT I HAVE SURVEYED THE
GASTALDI LAND
PROPERTY DEPICTED ABOVE AND THAT NO
SURVEYING,
SURVEYING, LLC
NG,
ENCROACHMENTS EXIST EXCEPT AS INDICATED.
JEFF A. R.L S.
RIS THE RESPONSIBIL17Y OF THE OWNER TO
2000 E. DOWLING RD., SURE 8
DETERMINE THE EXISTENCE OF ANY EASEMENTS,
COVENANTS OR
ANCHORAGE, ALASKA 99507
RESTRICTIONS WHICH DO NOT
APPEAR ON THE RECORDED SUBDIVISION PLAT.
PHONE 248-5454
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
GRID
DATE
HEREON BE USED FOR CONSTRUCTION OR FOR
SW2834
12/4/2012 ''.
ESTABLISHING BOUNDARY OR FENCE LINES.
F.D.
JOB NO.
ANCHORAGE RECORDING DISTRICT, ALASKA
12-06
DS13
NOTE: NO CORNERS SET THIS DATE.
OF A
r: •49M �,1�I� •.:9
............ ..* M
JeNe •••• mmlal •: •� �
s LS -6091 m"� N
e y�
1��lOfessi°nal �°c ��e
VoT
F
AAROW PUMP & WE11 SERVICE, LLC
P.O. Box 110496
Anchorage, AK 99611
Office: (907) 346-9355 • Fax (907) 345.0202
Eagle River, (907) 622-9335
CUSTOMER JOB SITE
7 role
omw(oocz
No. 9595
. INVOICE DATE
WELL DEPTH
.3WL CHLORINATED
POMP DEPTH
/
S�EHSON,
".DESCRIPTION. ''" :.; .,..••: -.: '•
UNOUNT':
I
LABOR
HOURS
RATE
AMOUNT
TOTAL MATERIAL
73
TOTAL LABOR
X
WORK ORDERED BY
DATE COMP.
TOTAL
LABOR
PAY THIS AMOUNT
73,5;
Thank You
SIGNATURE
(I Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work is not pald for In 90 days I agree to allow Aa(ow
Pump & Well Service, L.L.C. the right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for equipment.)
TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE.
SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS,
Td WUVV:TT ZTOZ 2-0-AON ZOZO S72 L06: 'ON XUJ 6ullltuQ aurdld; WO