HomeMy WebLinkAboutRIVER VIEW ESTATES BLK 8 LT 10River'view
Estates
Block 8
Lot 10
#0§0-792-41
Municipality of Anchorage Page / of~-Z'
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 ¢_~B
On-Site wastewater Disposal System and/or Well Inspection Report
"~m"~~ /¢¢ ~/&¢ Wastewater.. System: ~ew B Upg~
~*~'~'~:~3~ ~/~/~ ~ ~/c ~$o¢ ABSORPTION FIELD,. ~.~
No~edrooms:-- ~p Trench D Shallow Trench
B~ther
~': ~ ~¢'¢__ . ,,.
Bed
Mound
LEGAL D ES CRI PTI 0 N Soil Rating:/ ~ _ GPD/Sq. Ft.Total Depth//,fr°m original grade:
Lot: /~ Bl~k: ~ SubdN~ion: ' ~plh Io pi~ ~ lr~ ~i~l g~de: G~vel depth ~neath pi~
'" "' Num~r'~ lines: Ois~ li~:
WELL: Cew D Upgrade G~e~ width: ~ Ft. / Ft.
Classifi~tion {Private, A,B,C): To~l Depth: Oa~ To: To~l abso~tion am~: ' Pi~ material:
SEPARATION DISTANCES ~ptic D Holding G S.T.E.P.
~¢~/; Mstedal; Number of Compadments:
Su~'~'o~ LIFT STATION
Water ~/o0 ,~/00 -- -- , .
Size in gallons: ~ Manufa~uren
Line
' ' "Pump on" level at: ~Pump o~ level ~: ~ High water ala~
Foundation ~ ~ ~ ~ ~ -- ~ ~~
'" D~tric~l Ins~ctions pedo~
Cudain ~ ~O ~ ~ ~ ~ Pump Make &
Drain ~ ,
BENCH MARK
Remarks: . ,.
L~lion and ~ription:
I
1o~ ~ 0 ~,
Inspections pedormed by: /¢'/¢' ¢/&*/ Dates: 1st
Department of Hel,lth~Aan:PHI ~1,[~, ._tSe~ices approv¢,~ ,X4( 'a:~>.'-. ~ 6>.;:71 ..... ~' - ~¢:~,{:~-
Reviewed and approved ~,~ Date: ~,,.,¢ //' /~' ¢~
12-0t3 (Rev 9/91) MOA 25
Permit B~o.
P.O. Box 1
On-Site
Legal Description:
DEPAR'
Page
Municipality of
HEALTH AND HUMAN ES
qTAL SERVICES DIVISION
· Anchorage, Alaska 99519-t3050 · Telephone: 343-4744
Disposal System and/or Well Inspection Report
88 ~/vE/~'/'~ ~F,~ PIDNo.:
72~013 A (1/93)
by
DOC Co, d~
SULLIVAN WATER WELLS
P,O, BOX 670272, CHU(3IAK, ALASKA 01)8§7 · TELEPHONE
OWNER OF LAND .~M~ DEPTH OF WELl. _~
~ss L.~ ~.~ ,~~ ?~ _~ ~ ~ s'r~T~C b~v~b O~','~'E~ ~;'r.
' ' · -.. DRAW DOWN FT,
RECEIVED
NOV 1 7 ]995
ol Anchorage
Human Services
PERMIT NUMBER
KIND OF FORHATION:
r,o,,,_ () _r,..,o ,;2. F~ _c]~4,,0,-J_Z,,
From .... FI, to~ FI
From ~., Ft. Io FI, _
FrOltl~.Fl. Io .... Ft,
From~Ft. ~¢~
From
From_ FI, to, Ft,
From __Ft. to~Ft,
From, ~Ft. to
MISCL, INFORMATION:
From
From., --FI. to_
From_. _FL ~o
From__, Fl, to,
From~ FL ~o ....
From. , F/, ~o ....
, P,
· l. VEU
_Fi. ~0 ..... Ft._
.... Ft. ~o~_ m..~. NOV 1 ? 1995
Ft Municipah~y o~ Anchorage
__Ft,_
Ft.
Ft~
PERFORMED FOR:
NOV I 7 1995
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: ,~/4:) /-'38 ,,g',,"~/~ET~///~c-'/-'C,/ Township, Range, Section: ~"/~'A/ ,,~///b/ ~ ~,O
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
WAS GROUND WATER
ENCOUNTERED?
L
IF YES, AT WHAT O
DEPTFI? p
SLOPE SITE PLAN
E
Oeplh to Water Alter
Monttoriflo? - Oale: ~' Z~/'7'''(''
Gross Net Depth to Net
Reading Date Time Time Water Drop
~ ~ ~" y"
/~ ~ ~ ~" / ',
PERCOLATION RATE Y (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~ FT AND ¢~ ~
__ FT
PERFORMED BY: C~¢lb'~' ~'~,~/"~ , /~' ~ /D/,/~,~. CERTIFY THAT THiS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-O08 (Rev. 4/85)
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW950260
DESIGN ENGINEER:CONSTRUCTING ENGINEERS, INC.
OWNER NAME:HOWARD RANDY A
OWNER ADDRESS:8032 E 10 TH
ANCHORAGE, AK. 99504
PARCEL ID:05079241
LEGAL DESCRIPTION:
RIVER VIEW ESTATES BLK
8 LT 10
DATE ISSUED: 9/07/95
EXPIRATION DATE: 9/07/96
LOT SIZE: 40064 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0) .
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
THE ACCEPTING SOIL STRATUM MUST BE PERCED BETWEEN 9 AND 10
FT. DURING CONSTRUCTION TO CONFIRM THE PERC RATE OF 3 MIN.
PER INCH USED IN THE DESIGN. A SOIL~PERC LOG MUST BE SUB-
MITTED TO DHHS ON THIS ADDITIONAL PERC TEST.
DATE:
DATE:
I~OT A~A ~ 40,0~4 ~F
D~IV~WAY AND HQU~ FQOTP~INTg ~Ag~M~NT
22,120 ~F AVAI~A~ ~O~ 5~PTIO SYSTEM
~ANPY HOWARD PHON=: 3a~-~544 ~ ~,~~
OWNER:
OONgT~UOTIN&
I]NVIRONMENTAL ,SERVICES DIVISION
SEP 0 I 1995
RECEIVED
I ~ ~OUND ~U~FAO~
PLAN VIeW - ~OH~MAT~O
MINIMUM ~QUI~D,. ~ ~BD~OOM9 X 150 ~PD/~D~OOM
=450 ~PP CAPACITY SiP 0 I 1995
M,NiMUM GIZ'~ : 450/,.~ : ~75 ~ T~NOH WALL A~A RECEIVED
P~OBA~g~ IMPAOl'~ TO ADZAO~NT Lo'r~: A~ SHOWN O~ TH~ ~IT~ PLAN, D~VgLOPM~NT OF
TH~. WB~ AND 8LPTIO ~Y~TBM~ FO~ THI~ LOT WILL HAV~ ~0 ~I~NIPIOANT ADV~B
THE AD~AOBNT
~. WAST~WAT~ CYCTEM~
O. ~F.~VbD ~PAGB / ~U~FAO~ AND ~UB~U~FAGL
P.
LE-~AL: LOT I0 I~£OCK 6 P. IV~P. VILW BgTATF..5 5UbD ,
IN 9W I/4, G20, TI4N, ~lW, GM
DAT~: 6/3/35
OONgT~UOTIN~ UN~INB~ 346-2000
9~01 ~UDDY W~NL~ D~IV~ 2 OF
ANOHO~A~g, ALASKA ~1~
)N
PERFORMED FOR:
LEGAL DESCRIPTION:
MUNIC ~ALITY OF ANCHo~ii
EI"~IRONM~NTAL SERVICES DIVISION
~ng~:ee~s, ~eyo~ I ~ ~ ~o.~.~
~/~ ~ ~ ~m~wn~htp, Range, Section:
(FEET)
I
2
3
?
16
17,
SITE PLAN
F'ERMtT NO.
DEPFIR'I"MEhtT 6 HERLTH AND EN","ZRONMENTAL , .OTEC'f'ZOH
825 '"L'" STREET,
264-4720
( 83:0E~1~: )
FIPF'L I C:FII'.~T
L. OCFIT 1 ON
LEGRL
J'OHN GROSS
I;..'ENEI.qRL F'E[;.:I'"II T ~820024
LtOE:S RI'¢ER'v'IEP.I ESTRTES
F'O BO;:.,; i±6:1. 99577
LOT SIZE
"I"'¢PE OF '=;OIL. flBSORF'TION S'¢STEM IS: TRENCH
694 91]:8
' E E "['
MF~XII"iUM NUMBFR OF E:E[:,F.:OOMS = ¢' 0% ~ SOIL RR'FIHG ,:;SL:.! FT,.."E~R':,= i~:.~
"['HE RE~Z~.UIRE[:, SIZE OF THE 50IL FIE:SORPTION S'~'STEI','I IS:
THE LE[,tGTH DIMENSION IS ]'FIE LENGTH (IN FEET) OF TtiE TRENCH OR DRFIINF'IEL[:,.
THE C, EF'Ttt OF FI TRENCH OR PIT IS THE [:,ISTRNC:E E~ETWEEN THE :SLIRF'RC:E OF THE
GROUND RND THE BOTTOM OF THE EXCR',,,'RTION ,::IN FEET>.
THERE IS NO SET P~IE:,TH FOR TRENC:HES.
THE GRR',,,'EL DEPTH IS THE MINIMUM DEPTH OF GRRN,'EL BETI4EEN THE OUTFRLL PIPE
~f.,ID THE BOTTOM OF THE E::.,;C:R'v'FiTIi]N ,::IN FEET.'.',.
PERM I T FIPF'L. I CANT HIg..S THE F.:ESF'Oht'.-3181L I ]%.' 'FO I NFOF.:M TH I $ DEPFIRTMENT [:,UF.: I I'.,IG THE
INSTI~LLF~TION INSF'ECTION.S, OF RNY 1.4ELL:S RDJRCEHT TO THIS PROPERTY FIN[:, THE
HUME:ER OF RESIDENCES THRT THE NELL 1.4ILL SERVE.
8RCKFILLING OF RN'¢ SYSTEM 1.4ITHOU]" FINRL INL=;F'EI]:TION RI'.,ID RF'PRO',,,'RL E:'¢ THIS
I]:,EPRRTMENT klILL BE SUBJECT TO F'ROL=;ECUTION.
MI[.,IIMUM [:,IS]~FiNCE BETP.IEEN FI 1.4ELL RND FIN"r' ON-SITE SEP~RGE DISF'OSRL S'¢S]'EM IS';
:'LClO FEET FOR R F'RI',,,'RTE I.,.IELL OR ±SCl TO 200 FEE]' FROM R F'UBLiC I.'.IELL DEPENDIIqG
UPON THE TYPE OF PUBL. IC: I.,.IELL.
MINIMUId DISTRNCE FROM R PR I ',,,'RTE WELL 'TO FI F'RI'¢I~]'E SE[4ER LINE IS 25 FEE']" RN[>
TO r"~ COMI',iUNIT'¢ SEHER L. INE IFS 75 FEET.
OTHER REL.]LIII~:EMEI'.~TS IdR'¢ I-]PPL'¢. SPECIFICF~TIOI'4:S RND CONSTRUCTION [:,IFIGRRMS FIRE
FI',2RILFIE:LE TO INLZ.,LIRE F'F.:OF'ER IHIE, TRLLR'FION.
I CERTIP"'¢ THRT
t: I Iql','l FRMILIFIR P.tlTH THE REL.]UIREMENTS FOR ON-SITE SEWER5; RND P.IELLE; FtS SET
FORTH B'.r' TFIE MUNICIF'RLIT'¢ OF RNCHORRGE.
2: I WILL INSTFtLL THE SYSTEM IN RCCOR[:,RNCE WITH THE CO[:,ES.
~:: I UNDERS'TFIND "FHRT THE ON-SITE SE[qER S'¢STEM MR'¢ RE6IUIRE ENLRRGEIdENT IF THE
RES;I[:,ENCE IS REMI]I}ELE[:, ]'0 INCLU[:,E MORE THRN ~ BE[:,ROOMS.
FI~LICFIN'[' JOHN GROLSS
MUNICIPALITY OF ANCHORAGE
Department f Health and Environmenta Protection
825 L Street, Anchorage, AK. 99501
P~:~A~\ ~ ~L~_C_~,' ~-/ 264-4720
* * * HANDWRITTEN PERMIT * * -x.
C~)~' Phone Nu~er:
Location, )';~ ~',,~. ~'~ , ~ ~~
Legal Description $~t~ ~e p~,¢=(~zgJ ~ Lot Size:
Type of Soil ~sorption System Is:
Trench: ~ Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: ~{ Soil Rating(sq.ft/br)
DEPTH
The Required Size of the Soil Absorption System Is:
LENGTH ///~-'~ GRAVEL DEPTH (50 / WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance be[ween 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 = ,~S~D GALLONS
Permit applicant has the responsibility to inform this department during ~he
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 feet
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 conm~unity 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 ~1~ 1 9 ~ 2 * * *
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 J.f
the residence is remodeled to include more that 3 ,bedrooms~.~-~
SWP/024(1/81)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
SLOPE
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DATE PERFORMED:.
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SITE PLAN
Reading
72-008 (6/79)
PERCOLATION RATE
-~'~ ~.EST RUN ~h)
COMMENTS // ) -'~ J/ BETWEEN F TAND ~ FT
Time j Time ~ Water ! Drop
5`
• '� Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I. D.050-792-41
1. GENERAL INFORMATION:
Complete legal description Riv,
913$3
Location (site address) —%W&V
Expiration Date:y U"f) e- I, a o I
e. R;v eA--
efaee. AK
Current Property owner(s) Joseph Klusewitz . Day phone 610-790-4426
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver/Variance request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ % S-0 r`- as, H
Date of Payment '3/4'n'21
Receipt Number Oil I R CO
COSA# OSC-21IO�'a
Waiver Fee $ _
Date of Payment
Receipt Number.
Waiver #
n'14
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 East Tudor Road, Suite 101 -Anchorage, Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness
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 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 upon 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
system/s; 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 to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. DSD SIGNATURE
System #1 Approved for \3 bedrooms
Date: ?I 31 Zr
0` 'A
H 1 9;
. ..
�f
?.� 1 CE -7 �3
�i s •�ceG
f e
#AECC884
System #2 Approved for bedrooms
Disapproved OF��r
Conditional approval for bedrooms, with the followit� pula5"ITE
WATER AND
By: &bwo -�_.^C. Q Original Certificate Date: 3 `{ 2 012
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other _X 0-r- a8 t S i3O
a�
COSA Checklist
Legal Description: RIVER VIEW ESTATES; BLOCK 8, LOT 10 Parcel ID: 050-792-41
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A. WELL DATA
Fil Well log is filed with Onsite (or attached)
Date drilled 9/1995
Total depth 225 ft
Cased to 52.5 ft
❑ Sanitary seal is functioning correctly
Al Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 2/23/21
Well production at time of test 2.1+ gpm
Water storage tank volume N/A gallons
disinfected for coliform test? ❑ Yes � N
Coliform bacteria is ;PNitrate
tive
Nitrate mg/L less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by GEG, LTD.
Date of Sample 2/23/21
Static water level at beginning of test 15.5 ft
Comments SEE WATER WELL ADVISORY IN MOA RECORDS DATED 1/16/96
B. TANK DATA
Age of tank(s) 26 years
Tank type/material SEPIICISIEE
Measured operating fluid level in septic tank 51
Fm� Standpipes/foundation cleanout per record drawing
Date of pumping'
D. ABSORPTION FIELD DATA
Which system tested (date installed) 9/24/95
FW ALL standpipes present per record drawing
Total measured depth from grade 12.7 ft (max)
Measured depth to pipe invert from grade 5.7+ ft (min)
❑ N/A — pressurized field
Q Monitor tubes go to bottom of effective. If not, state
depth into effective
FO -1 Code -required soil cover over field
Q System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced 2153 gallons
Comments/Deficiencies: *SYSTEM PRE-SOAKED ON 2/23/21
COSA Checklist yellow sheet
C. LIFT STATION
❑ Required maintenance completed
Age of lift station year
Lift station material
Adequacy test date 2/24/21
Results ❑✓ Pass For 3 bedrooms
Fluid depth prior to test 0 in
Water added 630 gal
New depth 7 in
Elapsed time 85 min
Final fluid depth 0 in
Absorption rate 450+ gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date N/A
Heil
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
Yes
if No
Community Sewer Manhole/Cleanout > 100'
(Z✓ Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100' M✓ Yes
if No
ft
Private Sewer/Septic Line > 25' 0✓ Yes
if No ft
Absorption Field on Lot > 100' M✓ Yes
if No
ft
Holding Tank > 100'0 Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' Q✓ Yes
if No ft
M Yes
if No
ft
ft
If septic tank is under driveway comment below
F. ENGINEER'S COMMENTS
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' E✓ Yes
if No
ft
My Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
Yes
if No
ft
Surface Water > 100'
Yes if No ft
Property Line > 5'
Yes
if No
ft
Wells on Adjacent Lots:
Wells on Adjacent Lots:
Absorption Field > 5'
Yes
if No
ft
Private Wells > 100'✓Q
Yes if No ft
Water Main > 10'
0 Yes
if No
ft
Community Wells > 200'
✓v Yes if No ft
Water Service Line > 10'
❑✓ Yes
if No
ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Q✓
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'✓0
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'✓0
Yes
if No
ft
Private Wells > 100' Q Yes if No ft
Water Service Line > 10'
P/
Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water > 100'✓0
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l 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.
COSA Checklist yellow sheet
#AECC884
4
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904
On‐Site Water and Wastewater Section Fax: 343‐7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org
Septic Tank Advisory
Certificate of On‐Site Systems Approval # OSC211082
Subdivision: River View Estates Block:8, Lot: 10
The septic tank for this property is 26 years old. The average life for a steel septic
tank is 20 years. Typical replacement costs range from $7,000 to $11,000.
This advisory must be attached to all copies of the subject Certificate of On‐Site
Systems Approval.
This is an example of what the metal of a 30 year old steel tank MAY look like.
10 CT : T,
Q O
GJ
O c o (D
(3) St v)
D
(D 0^ Cn v<
rt
3 m f7
F :3
n S
c p
v
(D
K SD
ao
30
In
LO
00
C
ID FD
3
K
0-
(D (D
n
n
O
In
c
(D
d
4,
0
rD
Q
C3'
3
m
N D O i
X v O J
u O Q n
n
O
N
a � c �
�
O
N
o v
m 3
d
m
c N ron
m 3
rn
N N C =
P D N U
_ c
0 Q (D U
o
r
C N O
0
0a
o N C (i
0 1D 3 co
o
O < a
N
< D i
iD Cr 0 CD N 7
O CL
,aZ �I<,
py O N �
(D C
ID m m s
a v N v m
v p �
N
(D -
�
c m
mID
m a �
a N CT
(D O C N
O D O
o
3 CD
N .Zr
6 (D N
CD �
N Q
aP,N-'G)
DDX s�
Q 3 N (D
a°
(D
3 C C O
T.
D p N
3
n (D 4
p N N (1
Q
N N (D
Kowa
N = O
�vc5
(D m D 7
v �
mom �
<' 6�
N
. N K o
N
F3! (D N (D
(D o0
a N
o'm
V7 _
DO
o o
(D v
M. x O
(D o'
n v
�Q
(D
oo
N
o `m'
m O
v (D
a
�
CD
wo
N �o
C �
r
l_,
9
!t
dMi o' j
V) G) m
� � o
(p n
(D
fD
(D
(D
`o
Q
Q v_
co Q
n (D
((D -o
0
ID
� f
/ f
f f
/ f
1 /
�OYV
w /
cn
n
r (D
O
y A
0
S„po
Op,
�O9
s,.
f
r
O
I
~
I
N
mmrd.
`U
ZZ,
n
W -A
A'
N
mmrd.
`U
CD
�
o- o CD
tU
N -Tl
� CSD -TI
Vd
2,
CD (D
C
ZZ,
n
W -A
A'
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 0N-SITE SYSTENS APPROVAL
FOR A $1NGLE*FAHILY DWELLING
Parcel I.D. 05079241
1. GENERAL INFORMATION
Expiration Date: //- /7/--/0
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
RIVERVIEW ESTATES BLOCK 8, LOT 10
21585 WHITEWATER CIRCLE *EAGLE RIVER, AK 99577
WANDA PHILLIPS Day phone
21585 WHITEWATER CIRCLE *EAGLE RIVER, AK 99577
C/O AGENT
Day phone
ALLISON LANE W/ PRUDENTIAL Day phone 565-5500
5801 CENTERPOINT DR. #200 *ANCHORAGE, AK 99505
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: '~' ~' ~
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well · 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 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 Certificate of Qn-Site Systems Approval Guidelines for this appfication,
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 337-6179
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 warrant.v 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 3 bedrooms.
Disapproved.
Conditional approval for
......
~. 1't.I :'CE-.795~ .."
'~ rof esSiQ,~~
~; WATER
~ ~ WASTEWATER
bedrooms, with the fllowing supu~auons: ~ ,,
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
,-, o=,,,~ ,-,dvlou, y
Maintenance Agreements
Supplemental Engineer's Report'
Other
Original Certificate Date:
CERTIFICATE
Legal Description:
WELL DATA
Well type PRIVATE
Date completed 9/1995
Total depth 240 ft.
Municipality of Anchorage
Development Se ices Department
Building .Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907) 3,43,-7904
OF ON-SITE SYSTEMS APPROVAL
CHECKLIST
RIVERVIEW ESTATES BLOCK 8, LOT 10
Parcel ID: 05079241
Date of test
Static water level
Well productiOn 0.65
WATER SAMPLE RESULTS:
Coliform colonies/100 mi.
Areenic~ug./L
SEPTIC/HOLDING TANK DATA
If A, B, or C provide PWSID# N/A
Sanitary seal (Y/N) YES
Cased to 52 ft.
FROM WELL LOG
9/1995
12 ft.
g.p.m.
Nitrat~~g~/L.
Date of sample: 7/20/2010
Tank Type/Material SEPTIC/STEEL
Tank size 1000 gal. Number of Compartments 2
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
Date of pumping 10/28/2009 Pumper
ABSORPTION FIELD: DATA
Date installed 9/24-25/1995
Length 50 ft.
ffBELOW EXISTING GRADEJ
Soil rating (g.p.d./ft2o~
Width 3 ft.
Total depth .12.9 ft.
Date of adequacy test
Fluid depth in absorption field before test 1 in..
Elapsed Time: 120 min. Final fluid depth 14
Any rejuvenation treatment (past 12 mo.)(YIN & type)
Eft. absorption area 420 ft2 Monitoring tube YES
7/20/2010 ResultS (Pass/Fail) PASS
Water added 685 gal.
Date installed 9/24-25/1995
Cleanouts (Y/N) YES
High water alarm (Y/N) N/A ~
dR'S PUMPING
System type DEEP TRENCH
GraVel below pipe 7 ft.
Depression over field: NO
For 4 bedrooms
New depth 27 in.
600+ g.p.d.
If yes, give date -
in.
NONE
Absorption rate >=
KNOWN
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
7/20/2010
12 .ft.
* 1.75 g.p.m.
*SEE WELL WATER ADVISORY
DATED 1/16/1996
Other bacte~!' colonies/lO0 mi.
Collected by: GE(; Ltd.
D. LIFT STATION
Date installed
',Pump on" level at
in.
Size in gallons Manhole/Access (Y_(.~_) --
"Pump off" leve~_.a~. High water alarm level at
Cycles tested. Meets alarm & circuit requirements?
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic service line 25'+
Animal containment areas. 50'+
.in.
On adjacent lots. 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding tank N/A
N/A
Manure/animal excrete storage areas 100'+
Building foundation
Water main
Wells on adjacent lots
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
5'+ Property line 5'+
N~A Water service line 10'+
100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'-I- Building foundation. 10'+
Water service line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
Absorption field. 5'+
Surface water 100'+
Water main
Driveway, parking/vehicle storage
10'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
confommnce with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date -'//~,~//O
COSA Fee $ y'~O _aP.-
Date of Payment ~/J'~o/_/ O
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
SGS Ref.# 1103549001
Client Name Garness Engineering Group, Ltd Printed Date/Time 07/28/2010 8:15
Project Name/# River View Est BS,L 10 Collected Date/Time 07/20/2010 16:05
Client Sample ID River View Est BS,L10 Received Date/Time 07/21/2010 12:05
Matrix Drinking Water Technical Director Stevhen C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10) 07/22/10 07/26/10 KDC
Waters Department
TotalNitrate/Nitrite-N 0.129 0.100 mg/L SM20 4500NO3-F B (<I0) 07/23/10 AYC
Microbiology Laboratory
E. Coli Negative 1 100mL SM20 9223B A 07/21/10 DLC
Total Coliform Negative I 100mL SM20 9223B A 07/21/10 DLC
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 995196650
www. munLorg/onsite
(907) 343-79O4
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.. o5c)- ~z- H( '
t. GENERAL INFORMATION
" ple't leg dpti
,~ Corn e al desc on u~.~
·Location (site address) 2.13@.~
· . · Cun'ent Property owne~(s)
Mailing address
Lending agency
cos^# O OqlS'
· Expiration Date:
Mailing address
Real Estate Agent
Mailing Address
Unless othem, ise requested, COSA will be held by DSD for pickup.
2. NUMBER OFBEDROOMS: ~
Day phone
Day phone
Day phone 33~,-
3. TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage ["]
Community Class Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding Tank . []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Se~ces Department (DSD) issues Certificates of On-Site Systems
Approval (CO,SA) based onJy 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 ara required for the transfer of
title (except between spouses) for propeffies 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
ara valid for 90 days from the date of issue fro' properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Ce~cates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I vedfy 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 vedfy 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 .~"~c~
Address ~o;5
Engineer's Pdnted Name
5. DSD SIGNATURE
~,.,"/' Approved for
Disapproved.
Conditional approval for
Phone
Date
....
· '/' ' 'CL-'/'t'.." ll
~,. ~ ..~.1~:.. :~
t.
h ~'~-. t t 50o .~,~
bedrooms, with the tallowing mipu~afions:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By:
Municipality of Anchorage
Development Services Department
Building S~;e~y
O~Slte Water & WastewKer Program
4700 emgaw Street
P.O. Box 196650
Anc~xsge, A~ 99519-665O
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
A. ~LL DATA
Dat~
B. SF. PT1C/NOLDING TANK DATA
]
' I
Tank~ze I00~ gal. Numl~rofCompallments ~.~
Foun~Uon deanout (Y/N) 'f Oepress~n over tank (Y/N)
Other bacteria ~ colonies/100 mL
Collectad by: ~
Date Jn~lllled
Caeanouts (Y/N)
High water almm (Y/N) A/
Tataldefl~ Jl ~t. Eff. al)sorl~ianema ~2o ~ Monito~ngtube 'y Depmssionoverrmld
m:~quacy test ~ Re~dt~ (Pass/Fall) I~s For ~ bedrooms
Flu~ddepthineb~(l~onfleid~forete~ ~ in. Wateradded 450 gal. Newdeplh ZG, in.
Elal~edTIme: lO min. Final fluid deplh "As in. A~rate >= ~/~o g.p.d.
AnymJuvenaUonicma~ment(past12rno.)(Y/N&type) A/'o.¢ /(.o~n Ifyes, givedate
_
D. UFT STAllON
Date installed _ Size in gallons ~ Manbole/A.__~_ (Y/N)
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tonlulllt ~,o~ on lot Io5I
Absoq~on field on lot IOO'~-
Public sewer main IOO ~ '''
Sewer Iseptlc se~ice line I°~+
I
Animal containment areas 5 *P
On adjacent lots Ioo '+
On adjacent lots IOO'~-
Public sewer manhole/deanout I oo ~ +
Holding tank ./v'/~.
Manure/animal excrete ~(.-&ge areas IOO 't
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 1o'+ Property line
warm main I(~ ' 'Ir VVatef .en~:e line lO' 1"
Wells on adjacent lots JOo' ~
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Propeffy line I0'~- Building foundsflon
Curtaindreln N'~ O~,,w,~ Wells on adjacont lots
Surface watm IooLP
Water main
D~vaway, pa~g/ve~e
F. COMMENTS:
G. ENGINEER'S CERllFICATION
I certify that I have determined through ~eld inspections and
review (~I Mun~rpal mcomb that the above systems are in
confommnce with MOA COSA guidelines in ef~ct on this dele.
D.
Wa~mr Fee $
Date of Payment
Recei~ Number
' - ~' TH~ INFORMATION H~R~ON I$ FO~ TH~
· ~ o~ ' LENDING INSTIT~IONS SPECIFICALLY TO SHOW
EA~M~ ...................... ~ ~ ANY CONFLICTS BE~EEN EXISTING STRUC~RES
......... ~/~ UP H~UHU, U/H~H I HAN ~ AND P~ED LOT LINES OR EASEMENTS AND
THOSE SHOWN ON THE RECORDED ~ NOT TO BE USED FOR POSITIONING ADDITIONAL
P~T, ARE NOT SHOWN HEREON. ~ STRUCTURES OR FENCELINES
"ASBUILT" N0 corners set Book Pg
I hereby ce~i~ that I have su~eyed the following aescriOed prope~. Lot ~O B~ock ~ ,.~,,*'**,ee.~.~
~,V~V,~ ~5r~T~S Anc~o,age recording Oiatrict Alaska. an~ mat me ~., ~
improvements situate~ t~ereon are within t~e prope~ lines an~ ~o not overlap or ,n~o,c~ on ~ */49 ~ ~
encroach on the premises i, question eq~ thai there are no roadways, tra~s~iss/o~ lines or other ~ ~~
~,:.~ ..... ~ ..............
~. ~ *, N~. 13084
e, e,,'..l~ -~.~7...'L~
SGS Ref.#
Cl~en! Name
Project ,Name/#
Clienl Sample ID
107522900!
Tobben Spurkland P.E. ·
River View Estates B8 LI0
River View Estates B8 LI0
Drinking Water
Ail Date~Time~ are Alaska Standard Time
Printed Date/Time 10/15/2007 9:56
Collected Date/Time 09/28/2007 12:00
Recelved Date/Time 09/28/2007 14:50
Technical Direttor Slephen C. Ede
PWSID 0
Samol¢ Remarks:
Allowable Prep Analysis
Paramete~ ResulL~ PQL Units Method Container ID Limits Date Date Init
Ar~:nic
ND
ug/L EP200.8 C (<10) 10/05/07 10/11/07 Mil
Waters Department
Total Nitratc/Nitrite.N
ND 0.100 mg/L SM204500NO3-F B (<10) 10/02/07 JDS
I~Lt crob J. ol oc~r l'-al-,ora t:o zy
TotalColiform 0 col/100mL SM209222B A (<1) 09/28/07 SDP
MUNICIPALITY OF ANCHORAGE'
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519~6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
D50-792-41. ~J HAA# ~F~'~'~-('- \~'~/
1o GENERAL INFORMATION
Complete legal description Lot 1 0, Block 8 R±verview Estates
Location (site address or directions) ~_e_~n house on Wh~ tewat.er off
Prope~yowner Department of Veteran Affairs Day phone
Mailing address :]9;{.5 DeBarr Road,
Lending agency Gr~_a~-] an4 M(~r'r'gag~
Mailing address 3201 c Street, Suite 305~
Agent A.A.R. Investments
Anchorag~ AK 99503
Day phone
Anchoraqe~ AK
Address P.O. Box 190727, Anchoraqe, AK
257-4743
563-3894
99503
Dayphone 277-3446
99519-0727
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual well ×
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
x
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA It21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN
Environmental 8e~i~es Division
825"L" Street, Room 502 · Anchorage, Alaska 99501~ma~4,7~..
Health Authority Approval Checklist
Legal Description: L10 B8 R.LVgR VIEW EoT. SUBlCarcel LD.:
A. WELL DATA
050-'792-41
Well type RESD If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) YES Date completed 9 / 95
Total depth 240 ~
Sanitao, seal (Y/N) YES
Cased to 5 2
Casing height (above ground)
Wires properly protected (Y/N) YES
Date of test
Static water level 12 ~
Well production 0.64
WATER SAMPLE RESULTS:
FROM WELL LOG
1_1/17/95
see
g.p.m.
well water
AT INSPECTION
4/27/98
2.3' *
.g.p.m.
advisory dated 1-16-96
Coliform 0
Date of sample:. 4/24/98
B. SEPTIC/HOLDING TANK DATA
Nitrate
0.1 Other bacteria
Collected by: Dustin High
Date installed 9 [ (~5 Tank size 1 000 Nmnber of Compartments 2 Cleanouts (Y/N~ES
Fonndation cleanout (y/N) YES Depression (Y/N) _ NO High water' alarm (Y/N) NONE
Date of Pumping _ 4/29/98 pmnper JR's Pumping ,Service
C. ABSORPTION FIELD DATA
Date iostalled 9 / 95
Length 3 0 ' Width
Effective absorption area 420
Soil rating (g.p.d./ft2 or ft2/bdrm) 1 - 2 System typeDEEP TRENCH
3~
. Gravel thickness below pipe 7 ' Total depth 13.08 '
s, £ Monitoring Tube present(Y/N) Y Depression over field (Y/N) NO
Date of adeqnacy test 4 / 2'//9 8 Resnlts (Pass/Fail) Pa s s For 3 bedrooms
Flnid depth in absorption field before test (in.); _ _. 0" immediately after.53.7gal, water added (in.): 18
Fluid del)th 0" (ins.) Minutes later: 24h. Absorption rate = 500 *
g.p.d.
· system presoaked prior to running test
Peroxide treatment (past 12 months) (Y/N) _ IXlo If yes, give date
Do
LIFT STATION
Date installed
Manhole/Access (Y/N)
.~.~ize in gallons
~on" level at*
Fo
High waler alarm level a *~~'~'~ *Datum
Cycles teste~~'''~
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot 1 0 5 ' -
Absorption field on lot ' '171 0: '
Public sewer main NONE
Sewer/septic service line NONE
Building foundation 61]_' '+
Surface water NONE
Curtain drain NONE
ENGINEER'S CERTIFICATION
"Pump off' level at*
.; On adjacent lots. 1 1 0 ' +
.; On adjacent lots 1 2 0 ' +
Public sewer manhole/cleanout _ NONE
Lift station NONE
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 4 8 ' Property line 6 5 ' : Absorption field 1 6.
Water main/service line 5 0.' + Surface water/drainage NONE Wells on adjacent lots 1 0 5
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Water main/service line 7 0'
Driveway, parking/vehicle storage area 7 0 '
Wells on adjacent lots 1 0 5 ' + Property line
I certe th~q*a~determmed thrufield ineections and review o/Municipal r,
in conJb,',~ancq with~OA lt~'l gTidel/nes in effect on this date.
Signatur . D~
q;~peerthg-Se~l~
HAA Fee $ }~ (~> 0. ~) 0
Date of Payment
Receipt Number
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number
~ CT~E Env'Jronment~l Serv)ee~ Inc,
CT&E
Client
Client Sample ID
JN4atHx
Ord.'ed ~y
PWSID
D H ] Consulting Eugiuecrs
L 10 rd8 River View
L10 Bm River View
Drinking W~ter
Clie. nt POff
PHnted Dnte/Time 04/27/98 11:02
Colle~lcd Date/P/me ~/24/98
~civ~ ~te~me ~4/98 13:45
T~Jm~ ~e~or: ~ephe~ C. Edo
....
0.100
Units
0,100 mg/L
~o[/~OOmL
~ . - P. 02
~4-~??-1998 10: 49RH 90r~615501
Parcel I.D. #
1.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
GENERAL INFORMATION
Complete legal description /- ,"~
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address.
Agent
Address
Day phone
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ,.~
TYPE OF WATER SUPPLy:
NOTE:
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State AD£C
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA//21
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I 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 in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm -- ,z~ ~,J g/¥
Address ~'~/ X~4.,~/.p,,/ ~,~-,.~/,l~/& /.~/~
Date /
Engineer's signature
DHHS SIGNATURE
__~/,__ Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Appro~i Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
MuniciPality of Anchorage R E ~ E I V [~ D
DEPARTMENT OF HEALTH & HUMAN
Environmental Services Division SERVICES JAN 2. ;:( 1995
825"L" Street, Room 502 · Anchorage, Alaska 99501 · (90~ 340~;4~7~1i[y of Anchora
uepf, Health & Human Ser~
Health Authority Approval Checklist
Legal Descril)tioa:
A. WELL DATA
7"/':/~/ z~ / t.o ,,7 8o
_ Parcel I.D.:
Well type /e~ If A, B. or C, attach ADEC letter. ADEC water system nomber
Log present (Y/N) _ y Date completed ~ - '~.5'-
Total depth Z ~o Cased to 5" Z '
Sanitary seal (Y/N tV'
Date of test
Static xw~ter level
FROM WELL LOG
7'-
/7_
Casing height (above gronnd) .-t- /"
Wires properly protected (Y/N) /
AT INSPECTION
_ /- / ~-~' ~.
Well production
WATER SAMPLE RESULTS:
Coliform ,O
Nitrate
Date ofsantple: /~'- d - ¢'5- __ Collected by: //,
B. SE~IC/ItOLDING TANK DATA
Date installed ~' q~ Tank size leO0
_ Number of Compartments _ ~ Cleanouts (Y~)_.
Foundation cleanout (Y~) ~ Depression (Y~) ~ High water alarm (Y~)
DateofPumping_ ~- W~umper
C. ABSORPTION FIELD DATA
Date installed ~?.-' ¢.5"' Soil rating (g.p.d/fl: ov4xt!,tl~l) / Z System type _ /~")-e~ 7k~;O~,k.
Length ~0 ' Width ~ Gravel thickuess below pipe_ 7 ' ~
- Total depth // '
Effective absorption area c/'Z() Monitoring Tube present(Y/N)_ ~ Depression over field (Y/N) /~
Date of adequacy test 4-/~'~'/'6/- ~ . Results (Pass,Tail) ~
For ~ bedrooms
Fhfid depth in absorption field before test (in.); _ hnmediately after -- _ gal. water added (in.): ~
Fhfid depth -- (ins.) Minutes later: ~
-- Absorption rate =
Peroxide treatment (past 12 months) (Y/N) ~O
~ If yes give date
_g.p.d.
Do
LIFT STATION /k/O ~" U 5 ~
~ Size in gallons
Date installed
Maaholc/Acccss (Y/N) '%m~p on" level at* _
"Pump off' level at*
High water alarm level at*
*Datum
Cycles tested --
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot ff ! oD
Absorption field on lot
Public sewer main '/' / o o
Sewer/septic service line -g 5'0
; On adjacent lots
~ On adjacent lots
Poblic sewer manhole/clcanout
Lift station
......... NK ON LOT TO:
SEPARATION DISTANCES FROM SEPTIC/H,-.,~,~, .... TA
Building foundation 4.- ~o Property line 4- effO Absorption field
Water main/service line 4' ~50
4- /o
Surface water/drainage 4- /O o Wells on adjacent lots -/'/~ ~
SEPARATION DISTANCE FROM ABSORPTION HELD ON LOT TO:
Building foundation -~ t/o Water malt#service line
Surfilce water 'f"' / O O
--e 5"o
Curtain drain -4..5'0
Driveway, parking/vehicle storage area .~ .50
Wells oo adjacent lots y-/OO Property line
F. ENGINEER'S CERTIFICATION -~'.'~?~'%'~, ., .
· ' · ' ' s ectio,,s a,d ,'eview of Municipal reco,'d&~t thd.ab~,,s a,e
I certify that I have determined thtufleld m p ~ '~6, ~ ~ ~
. '~. . , ' ,' " e ectonthisdate. ~ ~' ~ -o~ ~
.................................................. ~5~ ~
HAA Fee $ ~3~0, ~ Waiver Fee $
Date of Payment X ~_ ?3.q~. Date of Payment
Receipt Number ~,~q~ / d?~ Receipt Number
Rev. 8/95 OSS: haa.wk.doc
MUNICIPALITY OF ~NCnORAGm
M E M O R A N D U M
WATER WELL ADVISORY
n~Lz,. AUTHCRiTY APPROVAL N~O
Durinc a recent Health.,_e..o_~'¼ ~itv_ Asprova!_ on-site inssection
and test of tbs potable water supply well on Lot
Block 8 of ~[[)~[e~ ~%Subdivision, the well's
~os~ -'-{,-{~ determined to be 0,~ gallons Der minute
n - ~C ..... '-~l WaS = .
The minimum well preductivity required by this Department
{~2~C i~.55) for a ~ bedroom residence is O,B~ gallons
per minute. ' -'~ ' the subiec "~'
:-.~.~c~.~ ~ ~ ~,~e~z currently exceeds this
' ' ~:~ concerned are aevzsee that the
production cauacit'f of the well may fluctuate. Restrictien
of non-critical wauer uses s~ch as washing cars~.~nd '-.~ae~:~_~g
lawns an! sardens may be required.
This advisory must be atlached to all copies 0f the subject
~ - ........... A~Droval. I l~ ~
n~f '
~ ~ ~iO~ ~ ~ ~ ~tY ~ ~t t~ that
~ q~fll~ ~ t~ll l~l o~ ~ ~wlyL tranlm~tt~n N~I ~
2505 FAIRBANKS SIREE r ANCIIOHAGE, ALASKA $~B503 (907) 277 8378. FAX 274 9645
Re~o~E Date: ~2/08/95
Consk~ucting Bng~nee~s DaEe A~t~ved: ~2/0~/95
9601 Buddy Werner Dr. Date Sampled: 12/03/95
Anchorage, AK 99516 Time Sampled: 1100
Collected By: HW
Attn: Henry Wilsos
Our Lab #:
Location/Project:
Your Sample ID:
Sample Matrix:
Comments:
Lab
Number Hethod
A142179
River View Est.(Hose Bib)
Lot l0 Block 8
Water
Parameter
Units
** Definitions
B = Present in Blank
Fl = Above Regulatory Hax.
E = Estimated Value
H = Matrix Interference
D = Lost to Dilution
HDL - Hethod Detection Llmit
Result * ~,IDL Prepared An-~ lyzed
A142179 EPA 353.3 Nitrate-N mg/L <HDL 0.10 12/06/95
Reported By: Anthony J. Lange
Chemistry Supervisor
RECEIVED
dAN 2 ,¥ 19o.6
t)ept, t leaifh ~)'1 -~]nch°rage
-~uman Ser~;iees
3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 456 3116, FAX 456 3125
2505 FAIRBANKS S'I REET ANCHORAGff, ALASKA 99503 (907) 277-8378 · FAX 274 9645
DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA
Construction Engineers
9601 Buddy Werner
Anchorage, AK 99516
Public Water System I.D.#
Date Received:
Date Analyzed:
Date Reported:
Next Sample Due:
Comments:
S
Phone No. U
Purchase Order No. POS
ND
Collected by: TNTC
Sample Type: CG
Routine Untreated HSM
Method of Analysis:
Membrane Filtration
Comments:
12/04/95 Time Received: 12:00
12/04/95 Time Analyzed: 15:30
12/05/95 Time Reported: 17:27
SA =
Old :
Satisfactory
Unsatisfactory
Positive Test Result
None Detected
Too Numerous To Count (>200 Colonies)
Confluent Growth
Heavy Sediment Masking, Results May
Not Be Reliable
Sample Age >30 Hours But <48 Hours,
Results May Not Be Reliable
Sample Age >48 Hours, Too Old For
Analysis
Resample Required
No Test
* # Colonies/lO0 ml ** # Colonies/mi
Sample Sample Total* Fecal* Other* HPC**
Location Date Time Lab# Coliform Coliform Bacteria Result Comments
LiO B8 River View 12/03/95 1]:0~ AB9044 0 ND 0 NT - S ,HSM - --
Estates
Ju 1 i~'Sch-ae feT // '~'
Ec[~v4ronmental Analyst ~/
3330 INDUSTRIAL AVENUE FAI~'~BANKS, ALASKA 99701 1907) 455 3110 · FAX 400 3125
2505 FAIRBANKS S1REE'I ANCIiORAGE, ALASKA 99503 (907) 277 8378. FAX 274-9645
DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA
Constructing Engineers
9601 Buddy Werner Dr.
Anchorage, AK 99516
Phone No.
Purchase Order No.
Collected by: HW
Sample Type:
Routine Untreated
Method of Analysis:
Membrane Filtration
Comments:
Public Water System I.D.#
Date Received:
Date Analyzed:
Date Reported:
Next Sample Due:
12/18/95 Time Received: 12:25
12/19/95 Time Analyzed 10:00
12/22/95 Time Reported: 10:20
Comments:
S
U
POS
ND
TNTC
CG
HSM
SA =
Old =
Satisfactory
Unsatisfactory
Positive Test Result
None Detected
Too Numerous To Count (>200 Colonies)
Confluent Growth
Heavy Sediment Maskinq, Results May
Not Be Reliable
Sample Age >30 Hours But <48 Hours,
Results May Not Be Reliable
Sample Age >48 Hours, Too Old For
Analysis
Resample Required
No Test
* # Colonies/lO0 ml ** # Colonies/mi
Sample Sample Total* Fecal* Other* HPC**
Location Date Time Lab# Coliform Coliform Bacteria Result Comments
i LiO B8 River Hose Bib 12/17/95 12:00 AB95~---~-- -~- --~- NT S
RECEIVED
A s -,/'dr.,,//_. T
I her.~by certify that a surveyofl, ot_/~ , BIock_L~
Subdivision was made on __ /~' - ~/_~,.~ __ and
that the improvements situated thereon are within the property lines and
do not overlap or encroach on the property lying adjacent thereto, that no
improvements on property lying adjacent thereto encroach on the premises
in question and that there are no roadways, transmission lines or other
visibieeasements on said property except as indicated hereon. It is the
responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision
31at. Under no circumstances should any data hereon be used for
construction or for establishing boundary or fence lines.
Dated at Anchorage, Alaska, th,s 3"~ day of
CONSTRUCTING ENGINEERS,
9601 Buddy Werner Dr.
Anchorage, Alaska
346.2000 1