HomeMy WebLinkAboutFOX HILL BLK 1 LT 6Fox Hill
Block 1
Lot 6
#051-073-24
dill,■ ■w�aawweww .-x s
Municipality of Anchorage
Community Development Department p�,g� 1 pf 3
On -Site Water& Wastewater Program OCT UO 2(Jf4
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • httpJAvww.muni.or910nsite • (907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP 141247 PID Number: 051-073-24 ❑ New ®Upgrade
Name: MICHAEL JOHNS
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ® Bed ❑ Mound
❑ Other
Address:
21829 WOODCLIFF DRIVE CHUGIAK, AK 99567
Phone: No. of Bedrooms:
(907) 688-4935 3
Soil Rating:
0.7 GPD/Sq, FL
Total Depth from original grade:
SEE DWG. Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade:
Gravel depth beneath pipe:
SEE DWG. ft
0.5 n.
Subdivision: Block: Lot:
FOX HILL 1 6
FlII added alcove original grade:
SEE DWG. Ft.
Gravel length:
35 Ft.
Township; — Range: — Section: —
Gravel width:
aed. Number of lines:
Distance between lines:
20 Ft.
4
5
R.
SEPARATION
DISTANCES
Total absorption area:
700 5a. Ft.
umber o! trenches:
—
Dist. between trenches:
— Ft.
TO
From
Septic Absorption Lift Holding Public/Private
Tank Field Station ToSewer ansa
Well
*90'
*90'
-
-
25'+
TANK ® Septic ❑ S.T.E.P. 01-Iolding ❑Other
Surface Water
100'+
100'+
—
—
Manufacturer:
ANCHORAGE TANK
Capacity:
1000 cal.
Lot Line
5'+
*, •
-
-
Material:
Number of compartments:
N /A
STEEL
2
Foundation
5'+
LIFT STATION
Curtain Drain
NONE KNOWN
Manufacturer: Capacity:
cm.
Remarks: *WR#OSP141248; INCLUDES 35' TO EXCESSIVE
'Pump on' level at:amp
off' bush at:
Hi r olann at:
SLOPE & 20' WIDE BED.
Pump Make d: Mode
ctdcaI Inspections performed by.
PIPE MATERIAL
House to tank D3034 Tank to D3034
drainfield
Installer
RPC CONSTRUCTION
Drainfield D3034 CO/MT D3034
Inspector GEG, Ltd.
BENCHMARK (Assumed elevation)
100.00 Ft,
Inspection
Dates: 1st 9/10/14 2nd 9/11/ 4
Location and Description'
3rd 9/12/14 4th —
BOTTOM OF SIDING ® BACK OF HOUSE
Community Development Department Approval
Conditional approval: Date:
ENGINEER -111 MAL
ooOF oAL
coo Q • Sir00Q
............ ..............
QO J. f A.._Ga...ess..
E 793
444e �coof4.
Professo,�� 4w0p
o�
�ooO000��
rod• Date:
Illy
PERMIT NUMBER:
OSP141247
AS -BUILT DRAWING
I
\
\
01,
'. 1984 TESTHOLE o
a• '
y'° ,.`a ,.•. . PARKING
CONC. A •''D•
J' Jy0 $T1�
B
1
�0 1
�.+may II
EXISTING FCO
20'X 35' BED
GALLON
GARNESS ENGINEERING GROUP, Ltd
CIVIL 3 ENVIRONMENTAL ENGINEERS
3701 ETUOORPOAO.SUITE 101'A HORNGE.AN99507' PHONE (WiJ 3363246'W BSRE:uyM.9ame¢[enghwdgxom
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
MICHAEL JOHNS 6884935 2 OF 3
LEGAL DESCRIPTION: DRAWN BY:
FOX HILL; BLOCK 1, LOT 6 PNB
AS -BUILT DRAWING 1 9/23/14
PARCEL ID NUMBER:
051-073-24
FOX HILL SID;
BLOCK 1, LOT 7
im
A.
A
6
STI
43.2
1 14.9
ST2
45.9
1 20.3
DBL1
45.5
22.6
DBL2
44.6
23.2
C01
40.7
53.5
MT1
35.0
18.3
CO2
35.6
50.1
MT2
48.5
35.0
CO3
31.3
47.7
MT3
41.8
54.2
C04
25.8
44.89
Fm—T4—
24.7
43.7
FOX HILL SID;
BLOCK 1, LOT 7
im
A.
PERMIT NUMBER: PARCEL ID NUMBER:
OSP141247 AS -BUILT DRAWING 051-073-24
TOP OF TANK
AT INLET = 95.56
INVERT OF BUNG
AT INLET = 94.95
FINAL GRADE = 100.44-100.51
ST1 / ST2
NEW 1000 GALLON
SEPTIC TANK
FINAL GRADE
= 99.02+
SAND FIL
OF SAND / - ..__.-.....-., ., ...>,__.,-...
= 94.19 I yC WIDE
Ro'
RELATIVE ELEVATION OF BOTTOM OF TESTHOLE = 80.63 ( GROUNDWATER @86.63)
Qom- i cli @ 4 .-rFsi "z it
— TOP OF TANK
AT OUTLET = 95.55
INVERT OF BUNG
AT OUTLET = 94.77
INSULATION
FABRIC
-L GRADE
IN 2014
ORIGINAL
GRADE
=96.63 IN 19'
INVERT OF
DISTRIBUTION
LINE = 94.69
BOTTOM OF BED
=92.12
NEW DRAINFIELD WAS INSTALLED
0.7 FEET BELOW OLD BED.
APPROVED BY JAY CREWDSON, P.E.
GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS
PREPARED FOR:
MICHAEL JOHNS
LEGAL DESCRIPTION:
FOX HILL; BLOCK 1, LOT 6
TYPE OF WORK:
�, APROFILE S -BUILT DRAWING
ZONE NUMBER: PAGE NUMBER:
688-4935 3 OF 3
DRAWN BY:
PNB
DATE:
9/23/14
CE -7953
On -Site Wastewater Disposal System Permit
Permit Number: OSP141247
Tax Code Number: 05107324000
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Work Type: Septic Upgrade
Permit Effective Dates: August 18, 2014 to August 18, 2015
Design Engineer: GARNESS ENGINEERING GROUP LTD
Subdivision: FOX HILL
Site Legal Address: FOX HILL BLK 1 LT 6 G:1458
Owner/Address: JOHNS MICHAEL D & APRIL L
21829 WOODCLIFF DR CHUGIAKAK 995675308
Site Mailing Address: 21829 WOODCLIFF DR, Chugiak
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank
V911y 1-1.,30
Lot Size in Sq Ft: 40002
Total Bedrooms: 3
N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions: A soils log with percolation test results verifying the soils used for design shall
be submitted with the final inspection report.
Receive
COt v%e v ies Ae ara)",&JJ ele vat ho t, .
d
Issued B
By: / f¢'r Date:
y: %� Date:
Municipality of Anchorage
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
hftp://www.muni.orn/Onsite
Development Services Division
On -Site Water and Wastewater Program
,Hent S
ti° ill
Department
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSP141248 COSA#: Permit#:OSP141247
PID#:051-073-24
Legal Description: Fox Hill, Block 1. Lot 6
Engineer: Garness Engineering Group
Applicant: Michael Johns
Your request for a waiver of the required 100 feet horizontal separation froLthep�.Ir�ption fieldto the private well has been approved. The approved separation distance is
Your request for a waiver of the required 50 feet horizontal separation from the absorption field
to the 25% or greater slope has been approved. The approved separation distance is 35.0 feet.
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 1.0 feet.
Your request for a waiver of the required 15 feet maximum drainfield bed width has been
approved. The approved maximum bed width is 20.0 feet.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
® The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected
adjacent property.
❑ Adjacent properties are not affected by this waiver.
...............................................................................
Waiver is Granted: X Waiver is not Granted:
Date: lg l Approved b .
Name of Reviewer
.................................. a ........ ................. . ................i
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Fax: 907- 343-7997
On -Site Water & Wastewater Program
Mayor Dan Sullivan
On -Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. 051-073-24
Property owner(s) MICHAEL JOHNS
Mailing address 21829 WOODCLIFF DRIVE, CHUGIAK, AK, 99567
Site address 21829 WOODCLIFF DRIVE, CHUGIAK, AK, 99567
Day phone 688-4935
Legal description (Sub'd, Block & Lot ) FOX HILL S/D; BLOCK 1, LOT 6
Legal description (Township, Section & Range)
Lot Size
3
APPLICATION IS FOR:
APPLICATION IS AN:
( ® all that apply)
Initial ❑
Absorption Field
Septic Tank
(w/wo ADU)
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
Sq. Ft. Number of Bedrooms
3
APPLICATION IS AN:
TYPE OF DEWELLING:
Initial ❑
Single Family (SF)
Upgrade ®
(w/wo ADU)
F-1
Duplex(D)
F-1Renewal
Multiple Dwellings
❑
(SF and/or D)
THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR:
WELL TO SEPTIC SYSTEM, DRAINFIELD TO CUTBANK, 90', 35'
DRAINFIELD TO LOT LINE. & BED WIDTH Distance: 6', 20'
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees: -%q Waiver Fees: t I a$ 4�16
Date of Payment: ��y��<<1 Date of Payment:
Receipt Number: � �E� Receipt Number: Cit t }0G
Permit No. CIC 101If424-;`- Waiver No. Os,>'1400Y 9
(Rev. 01/11)
GARNESS ENGINEERING GROUP, Ltd
- --- - = CIViL 8. ENVIRONMENTAL ENGINEERS --. -
"rt _
,' `i
July', 2014
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road,
P.O. Box 196650,
Anchorage, Ak 99519-6650
Ref: Septic Design for Fox Hill S/D; Block 1, Lot 6.
To whom it may concern:
The existing 3 bedroom house is served by a private well and septic system consisting of a 1000
gallon septic tank and a bed type drainfield. The drainfield is in a ,tate of failure and needs to be
upgraded. We are proposing to excavate the bed, remove all contaminated material, install at least
2 feet of M.O.A. filter sand and re -build the drainfield in place.
1. SOILS: See the 1984 permit package for the soil logs which shows the soil classifications,
groundwater monitoring, percolation test results and application rate. The proposed drainfield will
not be completely within the 30 foot radius of the 1984 testhole. The soil listed on the testhole
that the drainfield was built in is listed as a GW, visually rated at 85 ft'/bedroom. Based upon the
high porosity of this soil and the fact that we will be installing a sand filter, we are proposing to
visually confirm the soils, or perform a percolation test if the soil encountered is deemed
significantly different than the soil expected.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. According
to the 1984 soil log and as -built documents, the system was installed with 7 foot separation to
groundwater (based upon the 3/24/1984 groundwater reading). The drainfield is to be re -built at
the same elevation. The existing drainfield was sized based upon a soil application rate of 85ft2
per bedroom. Current regulations will require a 0.7 gpd/ft2 application rate. The proposed bed will
be 63% larger than the existing bed, which has functioned for 30 years.
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic
system.
4. TOPOGRAPHY: The average topography around the drainfield is approximately 0-5%
running southeast to northwest. However, the drainfield is only 35 feet away from a 35% slope (at
the steepest point). We request you waive the distance to 35 feet. Attached is a profile drawing
showing how effluent is unlikely to daylight within 50 feet. The existing drainfield (currently
3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www,garnessengineering.com
Page 2 of
surcharged) has been in this location for 30 years and daylighting is not occurring.
5. WAIVERS: The current drainfield appears to be 97 feet from the existing well and the tank is
approximately 96 feet from the existing well. To re -build the system in place, we request you
waive the distance to 90 feet. The following items are justification for the waiver:
• The house is directly between the well and septic system. If effluent were to daylight, it
would not travel towards the well head.
• A water sample was recently collected. No bacteria was present and nitrates were found
to be 2.35 mg/L. In short, the deficiency has existed for 30 years without significant
adverse impact on the aquifer.
• Although our proposal will place the drainfield closer to the well than it is currently, we
will be adding 2 feet of sand to a system that likely should have had a sand filter installed
originally. In short, we will be taking steps to further protect the aquifer.
Due to site constraints, we request that you waive the distance from the septic system to the north
property line to 1 foot.
Because of topographical constraints, we are proposing to install a 20 foot wide bed. During
construction, care will be taken to ensure that heavy equipment does not "walk" on the bottom of
the bed.
6. CLOSING: I am unaware of any adverse impacts this installation would have on adjacent
wells or septic systems. If you have any questions, please contact me at 337-6179. Thank you
for your assistance.
.S.
3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www. garnessengineering.com
i
i
Col
CL
aFSeA-o�� t"S
pf�( cij 0 1 Za 1
J?60 Eye \_,,4 °vn/
❑ SOILS LOG
0 Gio
MUNICIPALITY OF ANCHORAGE
_ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION
TEST
f
825 L. Street, Anchorage, Alaska 99501 2644720
SOILS LOG
(/-PERCOLATION TEST
PERFORMED FOR; `.-•{ // /YCV �!'Y/liC�/ `� "'S DATE PERFORMED:/L
LEGAL DESCRIPTION: L— C� L->' l L�,7� HIL // -s-
D6RTH G " o fclv,f c SST �I 71 i (--ISITT
WATE
-IF. YES_AT WHAT
IlF
p.Tux;_____.::...
FA
Reading
Date
Gross
Time
Net
-rime
Depth to
Water
Net
Drop
TA
PERCOLATION RATE
TEST RUN BETWEEN
PERFORMED BY: CERTIFIED
72-008 (6/79)
- (minutes/inch)
FT AND- 44 t FT
DATE:- /�"
C01
/
- MUNICIPALITY OF ANCHORAGE
eDEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
Sc_+kici±nq,� Cot"s`f�
+
LW
�Y �—Zi'1 %�
� UPGRADE
MAILING
MAI LING ADf�R� S C
5 �- S cafq &t / IVF-
«LEGAL
LEGALDESCRIPTION
LOCATION2 n � '
- 1 ( I�•C__(C"�L�
NO. OF BEDROOMS
[) Y
DISTANCE TO:
Well
�
Absorptio are
"��
w-. /
DwellingJ•L'
�
PERMIT�y57
C/
2
Manufacturer �
No, of compartments
Licycg y+ly.gPlions
-TO
IF HOMEMADE:
Inside length
Width
Liquid depth
D Z
DISTANCE :
Well ,rt /
welling
PERMIT NO.
O
/�
09
=zF
Manufacturer
Material
Liquid capacityingallons
p
w=
DISTANCE TO:
Well
F u atipst� of
Nearest I I'
PERMIT NO.
,u2
z
No. of lines
Length of each lineY
length of lines
Trench width
Distance between lines
P ¢
inches
-
Q H
¢
Tap of tile to finish grade
a ben ath file
Total effective absorption area
I inches
D
Lengths
Width
Pro/ :. �T /j s 0e, P/ pe PERMITjNQ� /
�'jj
i FjQ
Type of crib
Crib diameterCrib
d th ... Total effective a
W
rn
DISTANCE TO:
Wekl�.yr
[V/(,,J
Building,teyydp' n
Nearest Jot
T
J
Class
Depth
Ur' er
Distance to lot line
PERMIT NO.
J
W
D E TO:
u' ' 9 klonda&g
a er line
Septic tank
Absorption area{sl
OTHER
INI
' PIPEMATERIALS
//^^'
V c,r
SOIL TEST RATING J)
1
1---r—I--f
tNST�
I
REMARKS
-. %
-2 2n sum �
vo
'
it
C,.tivw
APPROVED ,,� . ,.tDATE EG
a:inlli 111w.. r,
�a
�So
S�
01
y9 ... i .....
<p O �'
TOP OF SAND IN
THE NEW BED
SHALLBE,0.1 FEET
HIGHER THAN THE
BOTTOM OF THE
DRAINROCK IN THt
EXISTING BED
U
'. 1984 TESTHOLE
Y . 6
PARKING/
CONC.
1
1
1
1
I
h y CC)
yo
✓✓✓ ��\ i 4 MT
0 MT \\
MTo
Mo 'co
\\ \\ /i SCO 20/
SCO
DRAINFIELD DETAIL 1"=20'
GRAVEL DRIVEWAY TO
BE ABANDONED IN AREA _
- OF SEPTIC UPGRADE s�A
0 P \
slGA� V
QUEST $' LOT LINE WAIVER
EXISTING 14'x28' BED TO BE FOX HILL S/D;
REBUILT AS 20'x35' BED W! BLOCK 1, LOT 7
2 0'+ OF MOA FILTER SAND
SEE DETAIL DWG
NOTE: DRAINFIELD
DESIGN CRITERIA:
GEG, Ltd. HAS AN 8 PAGE SPECIFICATION
ON LOT 7 I OVER
NUMBER OF BEDROOMS: 3
LETTER THAT PERTAINS TO THIS DESIGN. TO
,
GALLONS PER DAY (GPD): 450
THE LOT LINE
OBTAIN A COPY OF THE LETTER CONTACT
1
PERCOLATION RATEJS: 'VISUALLY RATED 1984
GEE. BY PROCEEDING FORWARD WITH THIS
INSTALLATION, THE ENGINEER, WELL DRILLER,
1
\
PROPOSED APPLICATION RATE. 0.7
CONTRACTOR AND PROPERTY OWNER AGREE
1
MINIMUM DRAINFIELDSO.FT.: 643
THAT THEY HAVE READ THESE
1
'PER 1984 DESIGN& INSPECTION REPORT
SPECIFICATIONS AND AGREE TO ACCEPT THE
\
DRAINFIELD DESIGN:
TERMS AND CONDITIONS OUTLINED.
\
\
\
MAXIMUM DEPTH: REMOVAL OF CONTAMINATED
WIDTH: 20 FEET MATERIAL
NOTE: CONTRACTOR SHALL HAVE THE
'
LENGTH: 35 FEET
LOT LINE AND THE 90 FOOT WELL
M.O.A. APPROVED SAND FILTER: 2 FEET MIN
RADIUS FLAGGED BY A REGISTERED
EFFECTIVE: 0.5FEET
PROFESSIONAL LAND SURVEYOR
REDUCTION FACTOR: N/A
PRIOR TO CONSTRUCTION
ACTUAL SOFT .: 700
�So
S�
01
y9 ... i .....
<p O �'
TOP OF SAND IN
THE NEW BED
SHALLBE,0.1 FEET
HIGHER THAN THE
BOTTOM OF THE
DRAINROCK IN THt
EXISTING BED
U
'. 1984 TESTHOLE
Y . 6
PARKING/
CONC.
1
1
1
1
I
h y CC)
yo
✓✓✓ ��\ i 4 MT
0 MT \\
MTo
Mo 'co
\\ \\ /i SCO 20/
SCO
DRAINFIELD DETAIL 1"=20'
GRAVEL DRIVEWAY TO
BE ABANDONED IN AREA _
- OF SEPTIC UPGRADE s�A
0 P \
slGA� V
QUEST $' LOT LINE WAIVER
EXISTING 14'x28' BED TO BE FOX HILL S/D;
REBUILT AS 20'x35' BED W! BLOCK 1, LOT 7
2 0'+ OF MOA FILTER SAND
SEE DETAIL DWG
Qe \\ / \\ SHED NOT ON FOUNDATION
I EXISTING 1000 GALLON SEPTIC
I TANK TO BE REMOVED AND
I REPLACED WITH NEW 1000 \
I GALLON SEPTIC TANK
I
I
r
1
ul "mi 0 0 , + s 1.
PREPARED FOR. PHONE NUMBER: PAGE NUMBER:
MICHAEL JOHNS ( 907) 688-4935 2 OF 3
LEGAL DESCRIPTION: DRAWN BY'
FOX HILL S/D; BLOCK 1, LOT 6 A.J.G.
TYPE OF WORK: DATE:
�_ DESIGN DRAWING OF PROPOSED SEPTIC UPGRADE 7/7/2014
7_1
e2
NOTE: DRAINFIELD
—INSTALL
ON LOT 7 I OVER
DOUBLE
20 FEET AWAY FROM
CLEANOUTS
THE LOT LINE
Qe \\ / \\ SHED NOT ON FOUNDATION
I EXISTING 1000 GALLON SEPTIC
I TANK TO BE REMOVED AND
I REPLACED WITH NEW 1000 \
I GALLON SEPTIC TANK
I
I
r
1
ul "mi 0 0 , + s 1.
PREPARED FOR. PHONE NUMBER: PAGE NUMBER:
MICHAEL JOHNS ( 907) 688-4935 2 OF 3
LEGAL DESCRIPTION: DRAWN BY'
FOX HILL S/D; BLOCK 1, LOT 6 A.J.G.
TYPE OF WORK: DATE:
�_ DESIGN DRAWING OF PROPOSED SEPTIC UPGRADE 7/7/2014
7_1
e2
SGS Ref.#
1142629001
Chem Name
Garness Engineering Group, Ltd
Project Name/#
Fox Hill Bt, L6
Client Sample ID
Fox Hill Bl. L6
Matrix
Drinking Water
Sample Remarks:
Printed Date/Time
06/27/2014 16:12
Collected Date/Time
06/23/2014 7:45
Received Date/Time
06/23/2014 12:19
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date hit
Metals by ICP/MS
At ND 5.00
Waters Department
Total Nitrate/Nitrite-N 2.35 0.100
Microbiology Laboratory
E. Coli Negative 1
Total Coliform Negative 1
❑g/L
EP200.8
C
(<10)
06/24/14 06/26/14
CDE
mg/L
SM21450ONO3-F
B
(<10)
06/25/14
CDE
100mL SM219223B A
100mL SM219223B A
06/23/14 MEV
06/23/14 MEV
Page 1 of 1
Crewdson, James A.
From: Rob Campbell [Rob@garnessengineering.com]
Sent: Thursday, July 31, 2014 4:45 PM
To: Crewdson, James A.
Cc: Jeff Gar
Subject: Fox Hill B1 L6 and rq aeien+FiMa- Septic design submittals
Attachments: I M G_1886. pdf
Hello Jay,
1. Jeff asked me to pass along this photo along with the report that the total depth of the bed is
somewhere between 5'-6'. The owner covered up the monitoring tube to get access to his 5th wheel for
camping over the last few weeks. I was unable to stab the total depth of the recently installed
monitoring tube. I did however find some pictures that he had sent me when we were finding the
closest edge of the bed (excavating) so that we knew the exact distance to the well (for the waiver). See
the attached PDF photo. He indicated that he was 36" down to some insulation, and then another 30"-
36" down to the bottom of the bed. He said that he began scooting over slowly with a shovel, and found
the bottom of the drainrock. It then started trickling in at the bottom of their hole, and then blew out
and filled up the hole with 36" of water, covering the insulation.
Is this acceptable, or do we need to need to dig up the bed again?
2. ills Deb informed me about the notary gal bein ou out
about it this week When did our - an ing down? My client is asking me when
he can h^'g�,y` ca�iun�iorscneduied tostart. �—
Thanks so much. I hope you're feeling much better!
Rob Campbell
Superintendent/Engineering Consultant
Garness Engineering Group, Ltd.
3701 E. Tudor Road, Suite 101
Anchorage, AK 99507
Office: (907) 337-6179
Cell: (907) 317-9433
Fax: (907) 338-3246
http://www.garnessengineering.com/
8/1/2014
OF ANCHORAGE
/MUNICIPALITY
® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 204-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAMEG
PHONE
'5JL EEW
II❑UP--GRADE
� .�-ZiJ%��I
MAI LING ADDejF S
LEGAL DESCRIPTION r
L ("p�
LOCATION F I R
NO. OF BEDROOMS
DISTANCE TO:
Well
�'
Absorptio are /
-�
Dwelling /
'Z
PERMIT C
U X
_g
c�
"
P Q
N
Manufacturer
Ma�g�r�y (�_ �^
No. of compartments
�Lic{p
C� iy.gallons
�� C / v
IF HOMEMADE:
Inside length
e,
Width —
Liquid depth
DISTANCE TO:
WeIIwelling
PERMIT NO.
2 z F
Manufacturer
Material
Liquid capacity in gallons
Ct
�=
DISTANCE TO:
Well
F u ati
Nearest to I' e
PERMIT NO.
J LL z
No. of lines
Length of each line
length aF lines
Trench width
Distance between lines
N z a
inches
Xb
Top of tile to finish grade
Material beneath tile
Total effective absorption area
O
inches
ut
Length
Width J, /
7
Dep PERMIT
r' to act Pim
Type
Crib diar�ne�ter_
o
w
w
of crib
'�-`,�
Crib dept___. Total effective a
N
DISTANCE TO:
Well / y
_ (/
Buildina�3 ' n
Nearest �
_j
Class
Depth
D/er
Distance to lot line
PERMIT NO.
a
W
u' g f unda ion
a er line
Septic tank
Absorption areas)
OTHER
fy
PIPE MATERIALS
Y c.
SOIL TEST RATING
INST<_W_ER
Lx_14i4A,&/ 6 r�IS—, 7
-
-14
7w
f /
REMARI<S
11,A
I
I
,n
W
APPROVED , i w r/3,i�f`))IIktl`y DATE EG
,J
`
�vUU H 41 1: ny! 3: 10" low T. v E—E:
DEPHRTMENT OF HEHLTH FINE) ENVJRONMENTHL P�OT�CTION
825 L STREET, RNCHORHGE/ HK 99501
264-4720
PERMIT NO� 84010]
DHTE ISSUED� 0]/29/84
FPP.ICHKIT C/O S & S
�DDRESS� SRB 196X
EHGLE RIVER/ HK 99577
CONTHCT PHONE� 694~2979
L�GHL DESCRIP� SUBDIVISIONFOXHILL 1.0T: 6 BLOCK� �
SECTION� 4 TOWNSHIP� 151'-J RHNGE� 1W
LOT SIZE� 40001 (SQFTOR HCRE�)
LOT LOCHTION� NOODCLIFF DRIVE
MHX BEDROOMS� ]
** DEPTH TO PIPE BOTTOM { 5 Fm REQUImS INSULHTION
** DEPTH TO PIPE BOTTOM { 40 FTMHY RE8U�RE H LIFT STRTION
** THNK MUST HAW AT LEHST TWO CO�|P�RTM�NT�
I CERTIFY THHT:
iI RM FRMILIHR WITH THE REQUIREMENTS FOR ON~SITE SEWERS HND WELLS HS SET
FORTH BY THE MUNICIPHLITY OF HNCHORHGE (MOH) HND THE STH�E OF HLHSKH
2I WILL INSJ' HLL THE SYSTEM IN RCCORDHNCE WITH FILL MOH CODES HND REGULHTIONS/
HND IN C01PLIHNCE WITH THE �ESIGN CRITERIO OF THIS PE�MIT
]I WILL HDHERE TO HLL MO� RND �T�T� OF H[RSKH RE��I�EMENTS �OR THE �ET B�CK
DISTHNCES FROM HNY EXISTING WELL/ WTEWHTER EM OR PUBLIC
SEWERHGE SYSTEM ON THIS OR ANY ADJACENT OR NEMBY LOT.
4 I UNDERSTHND THOT THIS P�RMIT I� VHLID FOf;�! H MAXIMUM 01", ] BEDHND
HNY EP.]LHRGEMENT WILL REQUIRE HN HDDITIONHL PERMIT
IF H LIFT STHTION IS INSTHLLED IN AN HEMA COVERED BY MOH 8UILDING CODES,
THEN (1) HN ELECTRICHL PERMIT FIN INSPECTION MUST (2) HS~BUILTS
WILL �OT BE HPPROVED WITHOUT HN HND (]) THE
ELECTRICAHL ROM MUST BE DONE BY H �ICENSED �L�CTRICIRN
SIGN�D ^ DHTE
~7
9/'�r�
❑ SOILS LOG
MUNICIPALITY OF ANCHORAGE 0 c
• ae: DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG/ -/PERCOLATION TEST
PERFORMED FOR: �---
vGv. Mal) t✓ �t AJY-- DATE PERFORMED:.'
LEGAL DESCRIPTION:/ .L--
D ERT H G L
I TIP
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
`V /Aw
LJii-�
SLOPE
/ VEVNHUrSNVTVEIRVVEDVV?H�ctS JL
`
0
P
IF YES, AT WHAT
DEPTH?
SITE PLAN
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
72-008 (6/79)..!.1.
PERCOLATION RATE
TEST RUN BETWEEN
PERFORMED BY: -
CERTIFIED
72-008 (6/79)..!.1.
_(minutes/inch)
FT AND- syt FT
a
DATE: �'l'
Trrtifipb Drilling log
by
DOC Co. dba
SULLIVAN WATER WELLS
P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 6BB-2759
OWNER OF LAND DEPTH OF WELL
ADDRESS STATIC LEVEL OF WATER FT.
LEGAL DESCRIPTION DRAW DOWN FT. _
DATE - Started Ended GALS. PER HR
PERMIT NUMBER KIND OF CASING
KIND OF FORMATION:
From -
Ft. to
Ft
From
Ft. to
Ft.
From --Ft.
to
Ft.
Froin
Ft. to
__Ft.
From—,
Ft. to
Ft.
From
Ft. to
_Ft.
From
Ft. to
Ft.`<
From
Ft. to
_Ft,
From -
- Ft. to -
Ft.
Front
Ft. to
Ft.
From
Ft. to
Ft._ '
From
Ft. to
__Ft.
From__
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Pt.
From
Ft. to
Ft.
Front
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From—Ft.
to
Ft.
From
Ft. to—
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft..
Front
Ft. to
Ft.
From
—Ft. to
Ft.
Front
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft_
MISCL. INFORMATION:
DRILLER'S NAME
MUNICIPALITY OF ANCHORAGE
DTVI:HION OF ENVIRONMENTAL HI A1,111
DEPAWMENT OF HEAUIE AND F,NVT.RONMENTPJ PROTECTION
APPLICATION FOR I-IE,AL11i AUTHORTTY APPROVAL CER'rIFICATE
1, Cmneral Information Application Date
(a) 1p -gal Doseription (MCluc)n l/ot, block, subdivision, section, twnshi.p, range)
T.ocjation (address or directions)
LL
(b) Applicants Nam__-_�e Ib lophone
Applicants Address � C
/
(c) Applicant is (check one) Lending Institution �r�� Omxsr;/builder '[
Buyer OOthergg(explain);
(d) Tending Institut.i.on�_,_m- �.�_•",._� T-_��m.�._.-.
Address
(e)
(e) Ileal Estate Co. & Agent
Address
Telephone _�__
2 , lype of R s ide noaa
Single-Familyf-EQ
Number_ of Bedrooms
3. Water Sup_pl-y
Multi -Family
Other (descri.lx)
Individual WD.1.1 Conmiunity Public
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and/status.
I's the well adequate.; for the nLunber of b::drocros specified in this HAA( (X}i )
4. Sewaqe Disposal
Onsite 1`ubli-c r=1 Community ! T Holding Tank
Is the wastewater_ disposal system adequate for the nun�r of Leclrooms 4y'�—)
[Page 1 of 21
2-.15-84
;-0
5. E ineerirq Firm Rrovidina Inspections, 7bstso Data and Information
1: corti.fy that l: haye-Ihekkod, verified, crr conforma-d to all MOA HAA Guicb.linc�s in
effect on the dt4 f t�t s -/.tri F on.
xx
Signed _% f ,�._ t�M ` E. _. �....�..T_.o_._. skate
Nzu[y-- of Firm
xm
Address
;iigrx)d by
Date
(ENGINL;ER SEAL)
6. DHEP ,ApwovaI
J �
Approve -gid Eor.�� Ix: dr caw, By
Approved!,A� Disapproved Conditional.
Tereus of Conditional Approval
Date Cn'
The Municipality of Anchorage IA)partmerit of Health and Envi.rcnapntal Protection does
riot guarantee the continued satisfactory performance of il-g-- water supply ai-d/(-)r the
wastewater d sposal system. This approval indicates that, as of the validation date
shawl above, based on t -M data and information furnished I -y an engineer registered in
the ;hate or Alaska, the water supply and srastewaterR disposal system is :safe and func-
tional for the n_rd)or of bedrooms and type of str uctutre indicated,
(DHEP SEA"1)
7. 6'.�ail the HAA to the following address:
IB2/d5/s
[Page 2 of 21
2-15-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1964
A. WELL DATA
MUNICIPAL] T1Y OF, F
!)Fff. OF }ZEAL
Jull I
1
Well Classificatioa If A, B, or Cr D.E.C. Approved(YM)
Well Log Presen (Y ) v� Date Completed `y" � Yielder" r j
Total Depth Cased to /2-u De "td of Grouting 7—
Static Water Level
'% f Pump Set At
3
Casing Height Above Ground' J( Sanitary Seal on Casing%(X i
Electrical Wiring in Conduit (1')P) Depression Around Vbllhead
Separation Distances from Wall:
To Septic/Holding Tank on Lot_ /Co _
On Adjoining Lots elIJ!QP-(-.1�__
To Nearest Edge of Absorption Field on Lot/670 ; On Adjoining Lots Ce A./ 0/`U
To Nearest Public Sewer Line /4� To Nearest Public Sewer
Cleanout/Manhole /J To Nearest Sewer Service Line on Lot
Water Sample Collected By a�}, S� 20gLA,6 �,; Date //9If'
Water Sample Test Results
Connrents �®
B. SEPTIC/HOLDING TANK DATA
Date Installed 6 C.> Size ��')� No. of Compartments f.
Standpipes (Y/j Air -tight Cap /N� Foundation Cleanout ( �_
Depression over Tank Irk Date Last,�P/umped
Pumping/Maintenance Contract on File (YM4 L, for - —�-
Holding Tank High -Water Alarm (Y Temporary Holding Tank Permit (Y
Separation Distances from Septic/Holding Tank:
To Water -Supply Wb11 �4 To Building Foundation_ �7
To Property Line e % To Disposal Field
To Water Mater/Service Line To Stream, Pond, Lake, or Major Drainage
Course
[Page 1 of 21 -, .�_. /J
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of System Design a/
Date Installed G���� �` Length of Field'
Width of Field / Depth of Field 1 r
Gravel Bed Thickness `rG� �r U
Square Feet of Absorption Area Standpipes Present N/N)
Depression over Field (7f Date of Last Adequacy Test
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply X11 G To Property Line /0 {
To Building Foundations To Existing or Abandoned System on
Lot �� /� On Adjoining Lots
To Water •Marn/Service Line To Cutbank ( i£ present)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, (Parking Area, or Vehicle Storage Area
Comments /�✓ lei 5 / 6- -k' C) )'I_ Cj P� J Ay & 61 C�
D. LIFT STATION
Date Installed Dimensions
Size in Gallons M nhole/Access (YM)
"Pump On" Level at 0 Level at
High Water Alarm Level at Vent (Y/N)
Tested for Pumping ycles during Adequacy Test. Meets MOA
Electrical Codes(Y/N)
Comments
** Check Permi
I certify that"
on the date /of
Signed
Company,
KBl /d5/s
(Page 2 of 21
tted dr ocm Rating Against HAA Request
I hd, verified, or conformed to all MOA HAA Guidelines in effect
Wln
Date' r% ?,��;.••• •`��;���
goo
MOA No. l,r�aj
2-15-84
j •'l Municipality of Anchorage
1 On -Site Water and Wastewater Program
(907)343-7904
Parcel I.D. 051-073-24
pa -t5s u -no.Jc-
Certificate of On -Site Systems Approval�Z s sv
Expiration Date:
1. GENERAL INFORMATION
Complete legal description FOX HILL; BLOCK 1, LOT 6
Location (site address) 21829 WOODCLIFF DRIVE *CHUGIAK 99567
Current Property owner(s) MICHAEL JOHNS
Day phone 688-4935
Mailing address 21829 WOODCLIFF DRIVE *CHUGIAK
99567
Real Estate Agent
Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family
and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual 19
Individual Water Storage
❑
Holding Tank ❑
Community Class _ Well
❑
Community ❑
Public Water System
❑
Public Sewer ❑
Waiver/Variance request
Received by: — ' Date:
COSA to be relead to the engineer, unless otherwise requested by the engineer.
COSA Fee
Date of Payment
Receipt Number
COSA # Iq / 5� 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, 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 (907) 337-6179
Address 3701 E. Tudor Rd Suite 101 Anchorage AK 99507-3246
Engineer's Printed Name Jeffrey A. Garness Date �) /S -
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic
system in accordance with the guidelines and regulations established by the Municipality of
Anchorage and industry practices. The reported results describe the condition of the system/s
on the date/s of the evaluation. Separation distances were measured to readily identsable
features. Hidden defects or encroachments may exist that were not identified during the
evaluation. The operational life of all wells and septic systems depend on a variety of variables
including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the
year), quality of construction (materials and workmanship), and the water usage of the family
utilizing the systems. These conditions can vary, and are outside the control of GEG.
Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG
makes no warranty (express or implied) regarOng the future performance of the well or septic
system. GEG makes no representation whether an altemative well or septic system can be
installed on the property in the event either of the current systems fail. The content of this report
is for the sole benefit ofthe person/party who retained GEG. Reliance upon the information
provided in this report by any otherperson or party, including but not limited to subsequent
property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other
than the person1party who paid for this report
6. DSD SIGNATURE
!/ System #1 Approved for 3 bedrooms
System #2 Approved for
Disapproved
Conditional approval for
0
bedrooms
bedrooms, with the following
.���.�`eY toFr�cy
c
ON-SITE
WATER AND
WASTEWATER
PROGRAM
Original Certificate Date:
The MhhiciparitVIVAgE(iorage 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 engineers work.
7. ATTACHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
COSA blue sheet 9-1-12.doc
Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: FOX HILL; BLOCK 1, LOT 6
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 4/1984 Sanitary seal (Y/N) YES
Total depth 121 ft. Cased to120'-8"ft.
Date of test
Static water level
Well production
FROM WELL LOG
4/1984
`CI
Parcel ID: 051-073-24
Well Log (Y/N) YES
Wires properly protected (YIN) YES
Casing height (above ground) 12+ in.
AT INSPECTION
10/13/2014
87 ft.
3.74 g.p.m.
WATER SAMPLE RESULTS: .
Coliform 0 colonies/100 ml. Nitrate d• (,0mg./L. Collected by: GEG. Ltd.
Arsenic: ZU ug./L. Date of sample: 5/29 /2015
tolla/1v
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Date installed 9/10-12/2014
Tank size 1000 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping
NEW
C. ABSORPTION FIELD DATA BELOW EXISTING GRAD]
Date installed 9/10-12/2014 Soil rating (g.p.d.lfeorj��/EEO 0_7
Length 35 ft. Width 20 ft.
System type
FWD
Gravel below pipe 0.5 ft.
Total depth *4.8-5.8 ft. Eff. absorption area 700 ft2 Monitoring tube YES
Date of adequacy test NEW Results (Pass/Fail) PASS
Fluid depth in absorption field before test= in. Water added =gal.
Elapsed Time: = min. Final fluid depth= in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) _
Depression over field NO
For 3 bedrooms
New depth =in.
Absorption rate >= 450+ g.p,d.
NONE If yes, give date -
D. LIFT STATION
Date installed Size in gallons Manhole/Access
"Pump on" level at in. "Pump off' level High water alarm level at
In.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot
*90'+
On adjacent lots
100'+
Water main N/A
Absorption field on lot
*90'+
On adjacent lots
100'+
100'+
Public sewer main - N/A
Sewer/septic service line 25'+
Animal containment areas 50'+
Public sewer manholefdeanout 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 N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
*1'+
Building foundation
10'+
Water main N/A
Water service line
10'+
Surface water
100'+
Driveway, parkin gNehicle storage 0'
Curtain drain NONE KNOWN Wells on adjacent lots 100+
F. COMMENTS
*SEE WR#OSP141248
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 affect on this
data.
Engineer's PrinteclName JEFFREY A. GARNESS
Date % l-5-
(Rev. I IM)
rrO VGarness'.
C7)53
.•.l�qi�.•' A`cmOO
SGS
SGS Ref.#
1145134001
Client Name
Gatness Engineering Group, Ltd
Project Name/#
Fox Hill B 1, L6
Client Sample III
Fox Hill Bl, L6
Matrix
Drinking Water
Sample Remarks:
Parameter
Results
LOQ
Metals by ICP/MS
Received Date/Time
10/14/2014 14:42
Arsenic
ND
5.00
Waters Department
10/16/14
NLL
Total Nitrate/Nitrite-N
2.38
0.100
Microbiology Laboratory
E. Cott
Negative
1
Total Coliform
Negative
I
Printed Date/Time
10/17/2014 16:38
Collected Date/Time
10/13/2014 16:00
Received Date/Time
10/14/2014 14:42
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Units Method Container ID Limits Date Date [nit
ug/L
EP200.8
C
(<10)
10/15/14 10/17/14
ACF
mg/L
SM21450ONO3-F
B
(<10)
10/16/14
NLL
100ml- SM219223B A
100ml- SM219221313 ^.
10/14/14 MEV
10/14/14 MEV
Municipality of Anchorage
On -Site Water& Wastewater Program ns,
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcell.D. 051-073-24 ExpiradonDate: f�
1. GENERAL INFORMATION
Complete legal description FOX HILL; BLOCK 1, LOT 6
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
21829 WOODCLIFF DRIVE *CHUGIAK 99567
MICHAEL JOHNS Day phone
21829 WOODCLIFF DRIVE *CHUGIAK 99567
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER. SUPPLY:
Individual Well
nrlivirhial WnfAr Rfnrana
..._...___..._._. _._._✓-
Community Class—Well
Public Water System
WaiverNariance request
3
Day phone
688-4935
U A 1 01 0 TA L
K)v 1 1014
Received by: �✓i
COSA to be released to the engineer, unless othevulse requested by the engineer.
COSA Fee $ JliSor,
Date of Payment
Receipt Number C)
COSA # 45L1,41 ✓ ' 2
has d re4itd shed -hr
Date: __L�z
Waiver Fee $
Date of Payment
Receipt Number_
Waiver #
Distance:
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
❑
Individual Holding tank
❑
❑
Community On-site
❑
❑
Public Sewer
❑
Received by: �✓i
COSA to be released to the engineer, unless othevulse requested by the engineer.
COSA Fee $ JliSor,
Date of Payment
Receipt Number C)
COSA # 45L1,41 ✓ ' 2
has d re4itd shed -hr
Date: __L�z
Waiver Fee $
Date of Payment
Receipt Number_
Waiver #
Distance:
5. 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. 1 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, Lt). 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 Prow 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
otherperson or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
System #1 Approved for
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms.
bedrooms, with the following
Phone 337-6179
Date
Original Certificate Date:
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
IRAQ +vnsi
Nitrate Advisory
Arsenic Advisory
Other
ON
�G
S
vyP�nOQP
�=
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
IRAQ +vnsi
Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: FOX HILL; BLOCK 1, LOT 6
A. WELL DATA
Parcel ID: 051-073-24
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 4/1 84 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 121 ft. Cased to120'-8"ft. Casing height (above ground) 12+ in.
FROM WELL LOG
Date of test 4/1984
Static water level 87 ft.
Well production 20 g.p.m.
WATER SAMPLE RESULTS:
AT INSPECTION
10/13/2014
Coliform 0 colonies/100 ml. Nitrate L. ; mg./L
Arsenic: N Q ug./L. Date of sample: 10/13/2014
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1000 gal. Number of Compartments E
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
Date of pumping NEW Pumper —
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADEI
Date installed 9/10-12/2014 Soil rating (g.p.d./feo /bdr 0.7 System type BED
Length 35 ft. Width 20 ft. Gravel below pipe 0.5 ft.
Total depth *4.8-5.8 ft. Eff. absorption area 700 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test NEW Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test in. Water added =gal. New depth =in.
Elapsed Time: = min. Final fluid depth = in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date
ft.
M
Collected by: GEG. Ltd.
Date installed 9/10-12/2014
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump ofP level atHigh 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 *90'+ On adjacent lots 100'+
Absorption field on lot *90'+ On adjacent lots 100'+
Public sewer main N/A Public sewer manholelcleanout
Sewer /septic service line 25'+ 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:
Properly line *1'+ Building foundation 10'+ Water main_ N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 0'
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
*SEE WR#OSP141248
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date I' I i Z / i
(Rev. 11105)
4G �0
i 5
r{n
i