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HomeMy WebLinkAboutT13N R3W SEC 13 LT 108 N81' W2'TI 3N R3W SECTION 13 N81' W2 Lot 108 #006-063-17 %1. m Q C/7iu •- ''� UNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEMA DOR WELL INSPECTION REPORT NAME f. (.,1 /Clsk -D '7� ankf a � PHONE - ❑NEW W UPGRADE MAILING ADDRESS CoxcQks `Pp 3-0/o LEGAL DESCRIPTION ru 8 t 01� I/ Lo+ /a8 3 7 -my l7 w LOCATION 5/! Pats NO. OF BEDROOMS ?_Wellll U Y area �� >7m DISTANCE TO: .� A _`� Dwelling PERMIT NO. a2 W F Manufacturer �� • •••• ••••, 6S 1 •• / •51 Material No. of compartments ur Liq. capacity in gallons IF 1-10n"91:-.; nsi - eng , -.I Width Liquid depth bU,Z C Q = I' DISTANCE TO: Well / w "' Manufacturer 9 8 Material d r^ S William F. • Robertson rcr® PERMIT NO. Liquid capacity in gallons w = DISTANCE TO: Well• • o. I /ic °••® tioq• C>r Nearest lot line PERMIT NO. J w Z P 2W F O No. of lines Length of eac p e A� E 603 fines Trench width 1V e� inches eneath tile inches Distance between lines Total effective absorption area Top of tile to finish grade W Length Width Depth PERMIT NO. d F wa Type of crib Crib diameter Crib depth Total effective absorption area ti DISTANCE TO: Well Building foundation Nearest lot line J ClassxnatV,a�, Depth 7 Driller Distanc toot line PERMIT NO. 3 DISTANCE TO: Building foundation Sewer line . Septic tank ry O zhJ0 Absorption areas) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS ILA LA ' t 4 lr N APPROVED DATE LEGAL 72-013 IRev. 3178) OCL -PO -17 — -_ f CA 1001! Gasil a_ Fo pi _.-- _jll" I DEPj OH 4 N- t£ f 1----- rE 111- N- NV 231 26 AV PRIVATE �\ I ."� I ' IO'UTILITY I I Lot EASEMENT TIF 1 �_ I a 243.21 _ - 4 x 3 i z; 2-MIVVT9LL 1 — r II ]'.�VOiEL� ' S 4 z/� 6 . 251 c _ I , I 1UCONST EASEMENT 15'�I Y Z �.� 3 / PrtF FSY ST. 30 CO T EASE NT 10 PERM r 15' COISST E f. �l o FOUND ONLY A I . .S IIlalCCCrNii aw � pI I �PRIWaTEx �z �TERTIGI-IT INSTALL 6$J D MANHOLE � 4> E7 --30r+ 33 L X� N LNOT7:. O ` I t I 11 I SERVICES IN no BEV LP '- L L � `' ' PIPE Cyt IN WITHOUT BOROUH GI' fj REQUIRED TEES. LOCATIONS CIL 'I ECTLIOIR FROM PROPERTY CLr -+113 01 I � CAUTION GAS L s — _I EXI i { r ism y w 7.,-I - I PSE L 2Q'J� '.003 7 L .fir L-1 1 s^' — JI I UTION LOGY/ATERLINE I VV 6V 3L 2G- - _.� ( 'i ,S NV 23275:. ! CAlj{0 LOC TE:-yfATERLINES: ORE %LAVATION 1 N INV tir2U� '- -N INV, Z sP3rr BE6RE EdCA�IATING .._ —F- E I /K_ PLATE keo L4N- Parcel I.D. 006-063-17 _t, 5Sucvt.cC� Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval Expiration Date: g -,6-- IJP 1. GENERAL INFORMATION I08 Complete legal description T13N R3W SEC13 LOT IQ&N81' W2' Location (site address) 511 PATSY *ANCHORAGE, AK 99504 Current Property owner(s) SPEEDY, NANCY LEE Day phone 333-0470 Mailing address Real Estate Agent 511 PATSY "ANCHORAGE, AK 99504 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: Individual Well lid Individual Water Storage ❑ Community Class_ Well ❑ Public Water System ❑ Waiver/Variance request for:= Received by: Day phonE TYPE OF WASTEWATER DISPOSAL: Individual ❑ Holding Tank ❑ Community ❑ Public Sewer IR COSA to be released to the engineer, unless othemise requested by the engineer. COSA Fee Date of Payment Receipt Number COSA #_ 0 S li l V Date: Waiver Fee $ Date of Payment Receipt Number Waiver # N/A 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 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 date/sof the evaluation. Separation distances were measured to readily identifiable 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 system/s. 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 V System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the following 1v,k(l( i l t lr,tt �OF Z_ d �V y ON-SITE' WATER AND r =� WASTEWATER PROGRAM By: Original Certificate Date: LJ The ni ali chorage 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 9-112.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: T13N R3W SEC13 LOT )OJ -N81' W2' Parcel ID: 006-063-17 A. WELL DATA *PER AAROW PUMP AND WELL INSPECTION ON 4/12/2004 Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) NO Date completed 1967 Sanitary seal (YIN) YES Wires properly protected (Y/N) YES Total depth *121.5 ft. Cased to *121.5 ft. Casing height (above ground) 12+ in. FROM WELL LOG Date of test G Static water level L �0 ft. NO Well production g.p.m. WATER SAMPLE RESULTS: AT INSPECTION 7/23/14 32 ft, 6.41 g.p.m. Coliform Q_ colonies/100 ml. Nitrate Arsenic: mug./L. Date of sample: 4/24/2015 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size Igal. Foundation cleanout (Y/N) C. ABSORPTION FIELD DATA Collected by: GEG. Ltd. Date installed Number of Compartments _ Clea Date installed Soil rating (g.13.d./ft2or ft'/bdrm)_ Length ft. Width ft. Total depth ft. Eff. absorption area_ ft2 Monitoring Date of adequacy test Results (P PUBLIC SEWER High water alarm (Y/N) PUBLIC SEWER System type _ Gravel below Ision over field For bedrooms Fluid depth in absorption field before to _ in. Water added _gal. New depth _in. Elapsed Time: _Final fluid depth _ in. Absorption rate >= g.p.d. An notion treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off level at High water alar level Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A Absorption Heid on lot N/A Public sewer main *50'+ On adjacent On adjacent lots Public sewer manhole/deanout *50' Sewer /septic service line **25 + Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 10.0'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main Wells on 1i =Uz Water service SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line Building foundation Water Water service line Surface water Curtain drain a on adjacent lots F. COMMENTS *WELL DRILLED PRIOR TO 1983 **PER GEG 2009 INSPECTION IN CRAWLSPACE 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 wfih MOA COSA guidelines in etfed on this data. Engineer's Printed Ne n JEFFREY A. GARNESS Date �r 1 1 (Rev. 11/05) W Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 Sutsm'AL CERTIFICATE OF ON-SITE SYSTEMS APPROVAL AUG 8 2014 Parcel I.D. 006-063-17 Expiration Date:A� 1. GENERAL INFORMATION Complete legal description T13N R3W SEC 13 LOT 10$—N81' W2' Location (site address) Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: 511 PATSY STREET, 99504 SPEEDY, NANCY LEE Day phone 333-0470 LINDA SPEEDY Day phone 306-0458 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance Received by: /19 COSA to be released to the engineer, unless otherwise requested by the engineer. Date: Distance: — 4 COSA Fee $ 52(p . Waiver Fee $ Date of Payment 3/2./q Date of Payment Receipt Number 03(1 Receipt Number COSA # Qw l qeq 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. 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 T System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for 0 bedrooms. bedrooms, with the following Phone 337-6179 Date `3 % f!{ P��AV OF Ati/ohD�/r/�'' ON-SITE WATER AND WASTEW ,TF -F' ALI Original Certificate Date: _ C9 r / V_ e The Wniciftyd'Alichorage Develop, emt 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 1 V05) 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: T13N R3W SEC13 LOT 108—N81' W2' Parcel ID: 006-063-17 A. WELL DATA *PER AAROW PUMP AND WELL INSPECTION ON 4/12/2004 Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 1967 Sanitary seal (YIN) YES Wires properly protected (YIN) _y Total depth *121.5 ft. Cased to *121.5 ft. Casing height (above ground) 12+ in. FROM WELL LOG Date of test 0� Static water level ft. 0 Well production N g.p.m. WATER SAMPLE RESULTS: a. 234 Coliform tl�r colonies/100 ml. Nitrate mg./L. Arsenic: �� Ug./L. S Date of sample: 7/23/14 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size gal. Number of Compartments Foundation cleanout (YIN) Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2or ft2/bdrm) AT INSPECTION 7/23/14 32 ft. 6.41 g.p.m. Length ft. Width ft. Total depth ft. Eff. absorption area ft2 Monitoring Date of adequacy test Results (Pa Collected by: GEG. Ltd. PUBLIC SEWER Date installed High water alarm (YIN) System type _ Gravel below PUBLIC SEWER over field For bedrooms Fluid depth in absorptionFeld before tes _ in. Water added _gal. New depth __in. Elapsed Time: Final fluid depth _ in. Absorption rate >= g.p.d. An nation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YM "Pump on" level at in. "Pump off" level at High water alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAlft station on lot N/A On adjacent lots 100'+ Absorption field on lot N/A Public sewer main *50'+ Sewer/septic service line **25'+ Animal containment areas 50'+ On adjacent lots 100'+ Public sewer manhole/cleanout *50' Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption Water main Wells on Water service SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water Water service line Surface water Curtain drain e s on adjacent lots F. COMMENTS *WELL DRILLED PRIOR TO 1983 **PER GEG 2009 INSPECTION IN CRAWLSPACE 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 9,1711(t (Rev. 11105) storage Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.rnuni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. _ C06-063-1-7 COSA# f f A 0q 0 Z?H q 1. GENERAL INFORMATION Expiration Date: / — �2_-10 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address T13N, R3W SECTION 13• LOT 108, N81', W2 511 PATSY STREET * ANCHORAGE, AK * 99504 DAVE HALLER Day phone 801-472-2488 511 PATSY STREET * ANCHORAGE, AK * 99504 Day phone JULY LESLIE W/ REMAX Day phone 110 W. 38TH AVE, #100 * ANCHORAGE, AK * 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 830-1291 TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer N The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage 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 Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, UD. 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. 5. DSD, SIGNATURE 1/ Approved for bedrooms. Disapproved. Conditional approval for Attachments CO SA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Phone 337-6179 Date ci 4?- bedrooms, Z bedrooms, with the fllowing stipulations: Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: �: I Original Certificate Date: U — Lo s (Rev. W05) / Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: T13N, R3W, SECTION 13; LOT 108, N 81', W2 Parcel ID: e2C%G — OG 3-! % A. WELL DATA Well type PRIVATE *PER ARROW PUMP AND WELL INSPECTION ON 4/12/2004. If A, B, or C provide PWSID# N/A Well Log (Y/N) Date completed —1966 Sanitary seal (Y/N) YES Total depth *121.5 ft. Cased to *121.5 ft. FROM WELL LOG Date of test L Static water level v Well production g.p.m. Mi Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 9/16/2009 23 ft. 7.42 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate Ai0mg./L. Other bacteria colonies/100 ml. Arsenic: IS, 5 ug./L. Date of sample: 9/15/2009 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size gal. Foundation cleanout (Y/N) _ Date -e mping C. ABSORPTION FIELD DATA Date installed Length ft. Number of Compartments _ (Y/N) Pumper. Soil rating (g.p.d./ft2or ft2/bdrm)_ Width Total depth ft. Eff. absorption area ft' Monitoring Date of adequacy test PUBLIC SEWER Date installed High water alarm (Y/N) PUBLIC SEWER System type Gravel below pjpo— ft. over Feld For bedrooms Fluid depth in absorption field befor ®std in. Water added _gal. New depth _in. Elapsed Time: n. Final fluid depth _ in. Absorption rate >= g.p.d. rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off"Level-at High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: *WELL DRILLED PRIOR TO 1983. Septic tank/lift station on lot N/A On adjacent lots 100'+ Absorption field on lot N/A On adjacent lots 100'+ Public sewer main *50'+ Public sewer manhole/cleanout *50'+ Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Water main Property Water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water service line F. COMMENTS G. ENGINEER'S CERTIFICATION Absorption Building foundation Water Surface water Wells on adjacent lots I certify that / 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 R/ Jzo/0.9 COSA Fee $ Vfd ea Waiver Fee $ Date of Payment U Receipt Number o y3z 9 s (Rev. 11105) Date of Payment Receipt Number water PUBLIC SEWER storage .J y Gar E 7953 Municipality of Anchorage g, £ • Development Services Department Building Safety Division ° a $♦ £TT On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 0905 87 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 108 N81' W2 of T13N R3W Section 13 Subdivision. This inspection revealed an arsenic concentration of 13.5 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage Development Services Department L Building Safety Division � s r,l,\ On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 0,5[)) Parcel I.D. �.� li " i�`�'� 0 HAA# 7-,9-0 746 / 1. GENERAL INFORMATION Expiration Date: - a 0 -0,57 Complete legal description T13N R3W, SECTION 13; LOT 108, N81% W2, Location (site address or directions) 511 PATSY STREET * ANCHORAGE, AK 99504 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SCOTT SMITH Day phone 333-0218 511 PATSY STREET * ANCHORAGE, AK 99504 Day phone BLAKE BUTLER w/ REMAX PROPERTIES Day phone 110 WEST 38TH AVENUE * ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 RMVI»01:11111=I:&*11Ia a WA Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 257-0161 TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, t verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm 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. 5. DSD SIGNATURE (/ Approved for __�L bedrooms. Disapproved. Phone 337-6179 Date t ov Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other 0-1 J ON.S11 I: *.V • WATER AND . ^' WASTEWATER : •nR GE0 By:� e ,/L "Z v" p� ' Original Certificate Date: (Rev. 12101) Municipality of Anchorage e Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: T13N, R3W, SECTION 13, LOT 108, N81', W2, Parcel ID: 006-063-17 A. WELL DATA *PER BRIAN WILLE w/ AAROW PUMP AND WELL SERVICES ON 4/12/2004. Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) NO Date completed –1966 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth *121.5 ft. Cased to *121.5 ft. Casing height (above ground) 12+ in. FROM WELL LOG Date of test �oCj Static water level _ ���� ft. Well production N� g.p.m. WATER SAMPLE RESULTS: AT INSPECTION 3/31/2005 *20 ft. 6.29 g.p.m. Coliform © colonies/100 ml. Nitrate (:). i mg./L. Other bacteria colonies/100 ml. Arsenic: N/A mg./L. Date of sample: 3/31/2005 Collected by: GEG, LtD. B. SEPTICIHOLDING TANK DATA PUBLIC SEWER Tank Type/Material Date installed Tank size gal. Number of Compartments _ N) Foundation cleanout(Y/N) _ overtank (Y/N) _ High water alarm (Y/N) Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft or ft'/bdrm) _ System type Length ft. Width ft. Gravel belolv.i ft. Total depth ft. Eff. absorption area ft2 Date of adequacy test Result Fluid depth in absorption field befor Depression over field For bedrooms Water added _gal. New depth _in. Elapsed Time: in. Final fluid depth _ in. eluvenation treatment (past 12 mo.) (Y/N & type) — Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons Cycles High water alarm level at in. Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots_ Absorption field on lot N/A On adjacent lots_ Public sewer main *50'+ Public sewer manhole/cleanout Sewer /septic service line 25'+ Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption field _ Water main Surface water. 100'+ 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water service line Surface wat Driveway, parking/vehicle storage F. COMMENTS Wells on adjacent lots *WELL DRILLED PRIOR TO 1983. G. ENGINEER'S CERTIFICATION '+ I certify that I have determined through field inspections and i review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Q P..�.... ... . 5... Y Garn: Engineer's Printed Name JEFFREY A. GARNESS Q 9j E s 5 Date 1 J� p o \\�l_prn se�dan0� o C>= HAA Fee $ i-1'S�, J Date of Payment 9-9 -cG Receipt Number 0 L, L277 (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number � n 0 o 4 < a z N � m 0 O m m 0 °m A m O A y D y f Z D D Z xmP mD 0 y m D0 v❑%m ❑ oomy zor m i Z m m x m ❑ D Z m PZDt a ❑ z FEz m m Z <5ip 0 1mr 0p [im m 2 m y0r Ipm mm0 m y 00 0M m Mo Q omm 21 Zm—D� nOmm zo'za A y Amy m<yy 3rmi� OD y Ot m O mp Q 00 y rl O ZO ZD m m mm n� y N 11C o� i I r r p 0 O i J m h I I ---------- ----------- 133H -LS AS1`dd Amt 0> 0 z m Pm.. 0 y OD zm m m m ❑ m 0z m 9Z Dy m< M 0 m m m 0 mm D° z= O [ mm mn Dm r mM m y -❑1m =n m 9 A 9 m m P S O°1214911E 81.161 - leg 30'4a 'a. 1 A ... )AM Jo 10.1. sl C l mE 34 tlr�'L l JI009)1 N3 W 36b3 H['l1VM iPE m O DP t Z D W o N m N A ❑ o� m a ONE BiORV FRAME BOILOINP N a tP P� N 0'1 2149"W 81.161 N GR :ATE t ANCHORAGE AR,..: BOROUGH Department of Environr,Tec,tal Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 RFQUEST FOR APPROh'AL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspectiorr: CiiRO —� y;i x =HA CONV 2. Property Owner: xenry sano Mailing Address: 511 Patsy St. Da�Phone 333-0718 3. Name of Buyer: Robert E._& Noma R. Moore Mailing Address: 3701 Eureka_St. #20-D Day Phone 277-8001 4. Name -of Lending Institution: Kassier & Co. Mailing Address: _ 319 W. 5th -Ave.- Phone 272-9501 5. Name of Realtor or Agent: syndic Mailing Address: _ 206 E. Fireweed Lane Phone 274-8536 6. Legal Description: _Section 13, TownsljiLp , Range 3, West 108 to be inspected: Location: s11 D„-- Qt 8. Water Supply Type of Supply: Public Ui;ility _ Individual x If Individual, number of dwellings presently served 1 If Individual, dept,, 0i7.wull unknown 9. Sewage Disposal System Type .of System: Public Utility —i _ _Anchorage Alaska 99504 7. Type of Facility to be inspected: water, septic No. Bdrms 2 8. Water Supply Type of Supply: Public Ui;ility _ Individual x If Individual, number of dwellings presently served 1 If Individual, dept,, 0i7.wull unknown 9. Sewage Disposal System Type .of System: Public Utility —i Individual (on-site) x If Individual, date of installation _ approximately 15 years ***PLEASE SEND REPORTS TO KASSLER & CO., Sincerely yours, ��R pp 319 5T11 AVENUE ANGHOR&CZ, ALASKA 99501, a • GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received S �O /7,44 Time of Inspection /U = O 0 Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: 2. Property Owner: Phone: Phone: 33 3- 07/P Mailing Address: 3. Legal Description: 4. Location: 5. Type of facility to be inspected 6. Well Data: A. Type C. Construction % 7. Sewage Disposal System: No. of bedrooms B. Depth •Z D. Bacterial Analysis O/` y - A. Installed 'Yt er�/ B. Installer C. Septic Tank: 1. Size 1(// 2. Manufacturer�� D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank Absorption area Sewer Lines , Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - Re0kt for Approval of Individual Or & Water Facilities Legal Description Comments Approved , Disapproved Date 1d kpproval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM C/ <- I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date