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Home My WebLink AboutASPEN RIDGE BLK 1 LT 6Aspen Ridge Block 1 Lot 6 #017-093-06 MUNICIPALITY OF ANCHORAGE 67..;.:Development Services Department __ ` Phone: 907-343-7904 On -Site Water & Wastewater Section �. f /I Fax: 907-343-7997 Well Drilling Permit Number: Parcel Identification Number: Pump Installation Lag Date of Issue: - - Legal Description Block Lot Property Owner Name & Address: AsPeh �e B 1 L. G f4( Pump Installation Date: 9' - - 2-L Pump Intake Depth Below Top of Well Casing: Z feet Pump Manufacturer's Name: Z�t Pump Model: 1%&�� Pump Size: hp Pitless Adapter Burial Depth: LS_ feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: Well Disinfected Upon Coi letion? o"Y�s ❑ No Method of Disinfection: P Comments: Pump Installer Name: _ ANCHORAGE WELL & PUMP SERVICE 7540 King Street Company- Anchorage, AK 99518 p Y PH: (907) 243-0740 Mailing Address: City: State: Zip: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE DEPARTMENT 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 PHONE NEW Z& //,;�v 746 ❑ UPGRADE J4.t tap MAI LING AD E C. &=� Of )4 LEGAL DESCRIPTION 1c, to,- 5:yz'::V, LOCATION NO. OF BEDROOMS Well Absorption area Dwelling PERMIT NO. DISTANCE TO: r U :zS Z _Y i Z Manufacturer MateriW No. of compartments Width Liq. capacity in gallons Inside length Liquid depth IF HOMEMADE: AA 0 Y DISTANCE TO: Well Dwelling PERMIT NO. Jaz 0z 4 Manufacturer Material Liquid capacity in gallons Well IfFoundation Nearest lot line PERMIT NO. = DISTANCE TO: w -3 J u Z No. of lines/ Length of each lin Total length,? lines Trench wi th�� Distancebetween lines PZw � �p inches . Q F- Top of tile to finish grade Material beneath tile Total effective absorption area Oinches Length Width Depth PERMIT NO. w O a H Type of crib Crib diameter Crib depth Total effective absorption area wa W Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) A�w OTHER _- P PMATERIALS RIG. II 0 00 901 LlrEST RATING I STALLER RE ARKS •� Ta K r d uc� w t rOF07, 4 or V"61606 *see* Vol y�ZA 1 9th del ��, :• JOHN E. SWANSON.. APPROVED`",'�',r. R0FESSI0N,// DATE LEGAL S^ �v 72-013 (Rev. 3/78) Rms 111 " I 1=� I F=:" F-1 I I -r O -e C, F:�' ��" 1=1 Ric Fl 1:1 F= DEPARTMENT Or HEALTH AND ENVIRONMENTAL PROTECTION 825 'L TREET, ANCHORAGE.- HK 99 264-4720 PERMIT NO ( 8]0262 ) ' APPLICANT WILLIAM D. GIFFORD SRH BOX 880 345-5276 LOCATION 999999 LEGAL LOT 6 BLK 1 ASPEN RIDGE SUB LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS 3. SOIL RATING (SQ FT/BR)= 270 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ��F::"-r "= �� 1 FEN 0 -r "= �A- 0 V a I E_ -v [-= F�' -r "= � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F;;?. E: 1.7-! 11 11 F;;-- F= c- --7. F= F=�- -r i ' �F=i r -.i t< !E3 T��E-== �� |�� 13 n L_ L_ 17-1 r-4� PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ___ -rL-Jl::l < ;2 > I N'H. F"EK 17-- -F I f_-1 N:F. ��a F -t a 0 U I F..."FE E-- BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL HND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. �FEE �M I -r �X F=* I F -"F= -=-. ��FEE 1 -1 e. E: FZ 2clL^ �-"=-4�� I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED*T0 THAN ] BEDROOMS. `________ ---- ____________________ HPPLICHN IAM D. GIFFORD ISSUED BY__3�� _� DHTE /)T��~ Y4 0 -_�_-___�� , . n �`\ F)�+~ MUNICIPALITY OF ANCHORAGE Department Health and Environmentz `rotection 825 L Street, Anchorage, AK. j9501 264-4720 \\v # � # HANDWRITTEN PERMIT # # # Permit # g�C» �I WELL AND ON-SITE SEWER PERMIT Applicant: U5111 1M j� . i (�or D Mailing Address: SPI` ACV Yeo l ffSb,> Location: Phone Number: 3(/ 5- 5,) 7� Legal Description: L G 19 1 aSpPYI 12 (s(2(2 Lot Size: Type of Soil Absorption System Is: Trench: _kDrainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: 3 Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is:' Oc> 1D< -P !D -err i DEPTH LENGTH a 7-3 . GRAVEL DEPTH WIDTH Y,/C-, S tf `T �zO 10 cue_ )) (he The length dimension is the length(in feet) of trench 6r drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ d GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. ' * # * TWO(2) INSPECTIONS ARE REQUIRED # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feel for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is odeled to include more that 3 bedrooms. 4 Signe'a: I � ,�/' Issued by: ` _-- Applicant Date: 4- . SWP/024(1/81) 6;rD O SOILS LOG MUNICIPALITY OF ANCHORAGE �I*111�' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION X TER OLATION 825 L. Street, Anchorage, Alaska 99501 264-4720 '-- SOILS LOG - PERCOLATION TEST PERFORMED FOR: R I %/ �'�_Z>�1"�� DATE PERFORMED:T/�a LEGAL DESCRIPTION: r SLOPE SITE PLAN S/fSao w 4 5 --. 7 ' -10 . 11 WAS GROUND WATER �o S 1-114 L • ENCOUNTERED? O P IF YES, AT WHAT E0000 13 DEPTH? 14 Reading Date Gross Net Depth to Net • Time Time Water Drop •` ..c OF 41 ¢ F.% e 3 /i' /ems 2 Ll� %i I �V••„•.••,e�• s �: ; ••' a ,r 14974 •; /o: �O /'�/' .�i.�iF.,► :rte •• 0” elm N.M • S 19 tia 1516-f �. 20- PERCOLATION RATE 35.7 (minutes/inch) z70 SF�� TEST RUN BETWEEN ____� FT AND 4f FT COMMENTS ��Q%r g� �• 2 = 7 7� S� �L'!L/i!.1/i��11 //� , /� PERFORMED BY: CERTIFIED DATE �r 72-008 (6/79) DEPARTMENT HEALTH ENVIRONMENTAL OTEC:T I Cita 825 L; STREET: f-W,lE'::F-IORAGE, AFS::. 99501 PERMIT NO. < 8_30945 -5276 APPLICANT WILLIAM D GIFF`F.D RA EO �0'hpCHCFA�iEW.2 x4_ LOCATION L6B_l. ASPEN RIDGE LOT SIZE 999999=�i�tLfh= RE FEET LEGAL MINIMUM D I:m TF=14C:E BETWEEN A WELL AND t=1t•d`r ON-SITE SEWAGE DISPOSAL SYSTEI'''! IS L� 1:1 FEET FOR A PRIVATE WELL OR -150 50 TCS C.�' 0 FEET FROM A F'I. BL I+.: WELL DEPENDING UPON THE TYPE OF PUBLIC. WELL.. MINIMUM DISTANCE FROM A PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE 4lE-.L.L_ COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS ' FIND CONSTRUCTION D I t=l�aF�'AI'TS F+•IRE AVAILABLE TO INSURE PROPER INSTALLATION. IF • r• "� ` a- -n F= I 'F-: EE °" e 01 FE -1 E-="- E: F." ==L- I CERTIFY THAT 1: I AM FAMILIAR WITH TH THE REQUIREMENT'S FOR ON-SITE SEWERS AND WELLS AS 'SET FORTH BY THE i'll. N I C: I PAL I T4' OF' ANCHORAGE. 2: I WILL INS.TALL THE SYSTEt'I iff ACCORDANCE WITH THE CODES. APPLICANT WILLIAF 131:FFCiRD _ V4. 0 o ti 11 Zu� w I�"1^ J Cep ��2 V r EE D -to r WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysicol Surveys Drilling Permit No. LOCATION OF WELL (Please complete either la, Ib or Ic.) A.D.L. No. la. Borough Subdivision Lot I Block ib. 1/44trs. Section No. Township No Range E[:] Meridian _ Of— Of— ot— S13 W Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: !-' Address: Street Address and Area of Well Location Feet 2. WELL LOG Below 4. WE1 (final) 5. •DATE OF COMPLETIO•Ny urface ,DEPTH: Material Type Top Bottom ff. l.. } 6. C]Cable tool Q Rotary E]Driven Dug E]Auger Jetted E]Bored Other 7. USE: Q'- Domestic ❑ Public Supply Q Industry Irrigation ❑ Recharge Q Commerical Test Well Q Other: _ rJ B. CASING: E] Threaded Q Welded diam. in, to ft. Depth Weight Ibs./ft. diem. in. to ft. Depth Stickup ft. 9. FINISH OF WELL: Type: Diameter: Slot/Mesh Size: Length: Set between ft. and ft. Backfilling Gravel pack 10. STATIC WATER LEVEL: ft. Dote Above or C] Below land surface Equipment used: I I , PUMPING LEVEL below land surface and YIELD ft, after __hrs, pumping g.p.m. ft. after hrs. pumping g.p.m. 12.GROUTING Well Grouted: r] Yes -':E] No Material: E] Neat Cement E] Other: 13, PUMP: (if available) HP Length of Drop Pipe ft. capacity g.p.m. Subm. Jet C] Centrifical Other 14. REMARKS: - 1 1€ 4 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature F C This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief; Registered Business Name Contract License Number Address: i ,r Signed Date: Authorized Representative Form 02-WWR (II/BI) Copy Distribution: WHITE -State DGGS, PINK -Driller, CANARY- Customer C w r 0 Z 0 APPLIC NT FILLS OUT UPPER HAI ONLY Time Property OwnerGtr Time Phone Mailing Address l �� Zip Code Date Buyer Date Date Inspector Inspector Address i , a ,;j _ZL u ; c°` r Zip Code Inspector Lending Institution Phoneme a� Address Zip Code j -`cam pEPT. PROTECTION Realty Co. & Agent Phone Address Zip Code SEP 1� Legal Description RECE`V ED Street Location 'CONDITIONS OF APPROVAL Type of Residence O'fingle Family ❑ Multiple Family No. of Bedrooms ❑ Other DATEt Water Supply 0 ye BY: K --s 3 Individual 1 Date Sever Installed ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community ll Log Received For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Well to Tank Sewer Disposal / ❑ Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 0 Cr ' 4-4klA l 1 r*rA-Rpt 0,7- Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: MUNICIPALIT' OF A OF HEALTH pEPT. PROTECTION ENVIRONiv1ENTAL SEP 1� RECE`V ED APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATEt BY: K --s Soils Rating Date Sever Installed Well To Absorption Area/ d0 ll Log Received �SeptiTnkSize on C) Well to Tank 72023 X3182) Parcel I.D. 017-093-06 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Aspen Ridge; Block 1, Lot 6 Expiration Date: 7- 7 — 15— Complete Jr Location (site address) 6641 Aspen Ridge Circle, Anchorage AK Current Property owner(s) Austin Mailing address Real Estate Agent Day phone 980-1234 6641 Aspen Ridge Circle, Anchorage AK 99516 Dar Walden 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: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ WaiverNadance request for: N/A Day phone 865-6404 TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: /� Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5oZL Date of Payment Receipt Number aglRRC$ COSA # dlolfJ521221 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. (GEG) Phone (907) 337-6179 Address 3701 E. Tudor Road, Suite 101, Anchorage AK, 99507-1259 Engineer's Printed Name Jeffrey A. Gamess Date Z 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 systems on the dates 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 systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no - representation whether an alternative 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 of the person/party who retained GEG. Reliance upon the information provided in this report by any other person 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 person/party who paid for this report. 6. DSD SIGNATURE d � V System #1 Approved for J bedrooms System #2 Approved for Disapproved Conditional approval for M bedrooms bedrooms, with the following Original Certificate Date: OF AA(,' f y�z ON-SITE =� WATER AND =o�{'t WASTEWATER 00 PROGRAM 1�51 tiolis�Oo The /Icipaliry oT/Apchor a Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representa 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 Septic System Advisory Well Flow Advisory COSA blue sheet 91-12.doo Nitrate Advisory Arsenic Advisory Other If more than I septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: ASPEN RIDGE S/D; BLOCK 1, LOT 6 Parcel ID: 017-093-06 A. WELL DATA *WELL LOG IS ILLEGIBLE. BEDROCK AT 98 FEET. Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 9/1953 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 255 ft. Cased to *100+ ft. FROM WELL LOG Date of test 9/1983 Static water level UNSPECIFIED ft. Casing height (above ground) 12+ in. AT INSPECTION 4/14/2015 59 ft. Well production 1.5-2 g,p,m, 1.44 — 9 -p.m -WATER SAMPLE RESULTS: Coliform 10 es colonies/100 ml. Nitrat. 10 mg./L. Collected by: GEG, Ltd. Arsenic: &K1g./L. Date of sample: 4115/2015 B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (YIN)NO Date of pumping ) Pumper/q 4- C. AESORPTION FIELD DATA VBELOW EXISTING GRADE Date installed 5/1983 Soil rating (g.p.ddft`br bdrm 270 Length 61 ft. Width 3.3 ft. Date installed 5/1983 Cleanouts(Y/N) YES High water alarm (YIN) N/A System type TRENCH Gravel below pipe 8+ ft. Total depth '13.6 ft. Eff. absorption area 976 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 4/14/2015 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test DRY in. Water added 740 gal. New depth DRY in, Elapsed Time: = min. Final fluid depth DRY in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - NOTE: MONITORING TUBE EXTENDS TO 15' ABOVE BOTTOM OF TRENCH. TESTING RESULTS WERE DISCUSSED WITH DEB WOCKENFUSS PRIOR TO SUBMITTAL. D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump off' level E. SEPARATION DISTANCES level Cycles tested - Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on Public sewer main Sewer /septic service line *85'+ *90'+ NIA 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout NIA Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 1001+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main 51+ Wells on adjacent lots 100'+ Property line 5'+ Absorption field 51+ Water service line 104 Surface water 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 101+ Water main N/A Water service line 10'+ Surface water 109+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *PER WAIVER #OSP101270. 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�2Z�/,( (Rev. MUM) PROFESSI� >f Municipality of Anchorage AS ,Community Development Department �Development Services Division E,. 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 # 151172 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 6 of Aspen Ridge subdivision. This inspection revealed a nitrate concentration of 5.1 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. lO unicipatity' of Anchorage �t Development Services Department Building Safety Division S h E T On -Site Water & Wastewater Program 4700 Braw Street P.O Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Vc.ariance- 05,�i0�Z7�� Parcel I.D. 017-093-06 COSA# ;).5CiJV J3QZ- 1. GENERAL INFORMATION Expiration Date: GL I L,) a Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address ASPEN RIDGE S/D• BLOCK 1, LOT 6 6641 ASPEN RIDGE CIRCLE * ANCHORAGE, AK * 99516 TERRY GIFFORD Day phone 440-4500 6641 ASPEN RIDGE CIRCLE * ANCHORAGE, AK * 99516 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual Well 0 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 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 a -e 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 mixed hereto and as of the validation, date shown, be'wovr, 1 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. 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 fest, 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 repos: 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 Approved for bedrooms. Disapproved. Conditional approval for Phone 337-6179 Date 1112110 �4 OF°gyp op��.•• .�s�oo e1frd6 AAGarndss: �e i13.1.v•••. �D��prof essi0�:_.5 bedrooms, with the following stipulations: Attachments: COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report tNltrate dvisory Other B ':" CZ'1117101-well, (Rev. 11/05) Original Certificate Date: 07)16 Municipality of Anchorage • Development Services Department s Building Safety Division - On -Site Water & Wastewater Program ' A ` T T 4700 Bragaw Street RO. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: ASPEN RIDGE S/D; BLOCK 1, LOT 6 Parcel ID: A. WELL DATA *WELL LOG IS ILLEGIBLE. BEDROCK ® 98' Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 9/1983 Sanitary seal (Y/N) YES Wires properly protected (Y/N) Total depth 255 ft. Cased to *100+ ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 9/1983 8/31/2010 Static water level UNSPECIFIED ft, 57 ft, Well production 1.5-2 g.p.m. 1.96 .. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 6.56 mg./L: Other bacteria 0 colonies/100 ml. Arsenic: ND ug./L. Date of sample: 9/1/2010 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 5/1983 Tank size 1000 gal. Number of Compartments 2 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 $ 1 IS I 10 Pumper MDONALDS PUMPING C. ABSORPTION FIELD DATA BELOW EXISTING GRADE Date installed 5/1983 Soil rating (g.p.ddft2o 2/bdr 270 Length 61 ft. Width 3.3 ft. System. type TRENCH Gravel below pipe 8+ ft. Total depth *14.6 ft. Eff. absorption area 976 ft' Monitoring tube YES Depression over field NO Date of adequacy test 8/31/2010 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 470 gal. New depth 0 in. Elapsed Time: — min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' E. SEPARATION DISTANCES Manhole/Access water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot *85'+ On adjacent lots 100'+ Absorption field on lot Public sewer main *90'+ N/A Sewer /septic service line 25'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A 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 50+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: 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 *SEE ATTACHED WAIVER REQUEST. c�c60®O G. ENGINEER'S CERTIFICATION ► certify that I have determined through field inspections and, p ,� 9T review of Municipal records that the above systems are in . ' . ' ' ' ' '' .. ' ' ' ' ' ' ' ' ' ' ' ' conformance with MOA COSA guidelines in effect on this date. J r arne s Engineer's Printed Name JEFFREY A. GARNESS QQ �� 9 Date �l/ 3�/p fl . 3. w''�� 4�ofessiod1 ,1� COSA Fee $ ��d Waiver. Fee $ y S o Date of Payment I I 1 l 0 Date of Payment 11/1,2-1110 Receipt Number Receipt Receipt Number (Rev. 11/05) Municipality of Anchorage • Development Services Department r` Building Safety Division ` S A C T Y 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 # OSC101302 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 6 of Aspen Ridge subdivision. This inspection revealed a nitrate concentration of 6.56 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. G / W I 3 Q Aarow Pump & Well Service LLC (907)346-9355 Well Abandonment 6641 Aspen Ridge Circle Anchorage, AK The 300' well to the south of house and west of driveway was decommissioned by grout slurry from the bottom up. Casing was cut off 2' below grade with steel cap welded on top. There was no pump to be removed from well. Brian R. Wille Aarow Pump & Well Service LLC 10/28/2010 Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.or-q/Onsite Development Services Department On -Site Water and Wastewater Program went S C � Ply u n F Department **** VARIANCE/WAIVER REVIEW **** WR#: OSP101270 PID#: 017-093-06 HAM OSC101302 Permit#: Legal Description: Aspen Ridge, Block 1. Lot 6 Engineer: GEG Applicant: Terry Gifford Your request for a waiver of the required 100 feet horizontal separation from the absorption field to the private well has been approved. The approved separation distance is 90 feet. Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 85 feet. This waiver approval applies to the existing absorption field to well separation and septic tank to well separations only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ■ .. / ...... n Runs ME . \ E o n s o m ............ t ..... \ .. ■ ■ / t ....... / . \ .moss . \ ...... ON PENN Waiver is Granted: X Waiver is not Granted: Date: 11/19/2010 Approved by: NdTfie of Reviewer some ............................................■............................on Rec#: 014059 Amount: $1,050.00 Date Paid: 11/12/10 **** VARIANCE/WAIVER REVIEW **** G1 RNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS November 2, 2010 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Waiver Request for Aspen Ridge S/D; Block 1, Lot 6, To whom it may concern: The subject property is served by a private well and septic system. We inspected the property for the purpose of obtaining a C.O.S.A. During the course of our inspections, it was noted that the distance from the well to the septic tank was 89.6' and the distance between the well and the drainfield was 95.2'. These distances were shot with a total station. We are requesting an 85 foot waiver from the well to the septic tank and a 90 foot waiver from the well to the drainfield. The following items are justification for these waivers. • A water sample was taken recently, indicating no bacteria present and nitrates to be 6.56 mg/L. Attached are water sample results from several surrounding lots. The nitrate levels range from 0.219 mg/L to 4.53 mg/L. The nitrate levels are moderately high throughout the area, thus the 6.5 mg/L concentration from the subject well is not abnormal for the area. • Attached is the well log. The well is 255 feet deep. The well is drilled through 98 feet of various hardpan and clay soils, and cased into bedrock. • The septic system is downhill from the well. If effluent were ever to surface, it would flow away from the well. • The existing encroachment has existed for 27 years. Based upon the aforementioned facts, we believe there is minimal risk associated with granting the requested waivers. ;'1 If you have any qu0stilons, please contact us at 337-6179. Thank you for your assistance. , P.E. M.S. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com 7 DRAINFIIELD / EXISTING SEPTIC TANK I 10' TELE. & ELEC. ESM'T. PFOG� � ' 100' WELL RADIUS •� WELL I V I 1 o EXISTING 3 ' BEDROOM HOUSE OLD WELL ----O / ABANDONED \ PER CODE. SEE ATTACHED / DOCUMENTATION / / ASPEN RIDGE CIRCLE GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 • PHONE (907)337-8179 • FAX (907)338-3248 • WEBSITE: www.gort senginwing.wm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: TERRY GIFFORD 907-440-4500 1 OF 1 LEGAL DESCRIPTION: DRAWN BY: ASPEN RIDGE S/D; BLOCK 1, LOT 6 A.J.G. TYPE OF WORK: DATE: OF '*: 49 SITE PLAN FOR WAIVER 10/14/2010 (Rev. 01/05) Garness: —7953 / • c0G ,profess -10