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HomeMy WebLinkAboutMCCARREY LT 4McCarrey Lot 4 #017-092-84 Municipality of Anchorage Page —hof �— DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: _�7(_Q_) T 0.32— PID Number: Name: -14X Wastewater System: JKNew ❑ Upgrade o7 e 01qEA11VA-Aj Address: ABSORPTION FIELD Phone: _p 7 7 No. of B Brooms: eep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION $oilRa,t,issn��g: Total Depth from original grade: rte. GPD/S . Ft. Lot: Block: Subdivision: Depth to pipe 2-,97 bottomfromoriginal grade: Gravel depth beneath pipe 0, C) Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel length: �2- 3 FL Ft. WELL: ua�iew El Upgrade Gravel width: / Number of lines: Distance between lines: N ' Ft. Ft. Classif ation (Private, A,B,C): c Total Depth: 3 I Cased To: Total abssQrption area: Pipe material: ST 3 G� 3 �+ �, Q-.. �' Ft. Ft. r`J SQ. Ft. E Driller: C)P Date Drilled: D G Static W ter Level: / Ft. Installer: h/ C J✓P Date in talled- Yield:Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES eptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: 2—L5—U From Tank Field Station Tank Sewer Lines Well / r 'Z¢4,/ fl /r Material: 71—�7_ Number of Compartments: Surface Water 09) f ®f A— A� /Y !4 fi LIFT STATION %© / /Lot 0 Size in gallons: Manufacturer: Line /t /Y I k /V//4- Foundation/ ll.s 40 Nhr /YA- "Pump on" level at: "Pump off' level at: High water alarm at: Curtain/' Pump Make & Model Electrical Inspections performed by: Drain a 1 /+ �s BENCH MARK Remarks: Location and Description: .. L/C. 51- 2pIC7 ff0()SC:,_ Assumed Elevation: qa 0 Inspections performed by: /�ldrr AlIAP /�'s'm�tl Dates: 1st .. l�f/: ,., �� JP,i ��3. VU,t;t�iT 2nd D f 3 �:• Department of He d H rf Services approval It;oFEBs�d�P� t���`�.► Reviewed and approvedDater 72-013 (Rev. 9/91) MOA 25 Permit No.5CVY3032_g Page 2 of —� Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 *Anchorage, Alaska 99519-6650 *Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: MC,6-4.4�ey _W, L 67- `F PID No. f' Permit No. .W T2232-9 Page 3 of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 *Anchorage, Alaska 99519-6650 *Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: 51213, L07- 4 PID No. P Permit No. S q3 b32-8 Page ` of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 *Anchorage, Alaska 99519-6650 *Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: a�✓ev .SUS o i PID No IA Q M = z t2 -_, 0 z - ,� 0 0 ry 0 > w Q > w 0 0 r z z Q z f- U)I 0 > z C1 17.3' 19.3' 97.8' 94.38' C2 18.7' 20.3' 97.8' 93.35' T1 21.3' 17.6' 97.7' 90.34' BOTTOM OF TANK T21 27.8' 13.6' 97.7' 90.34' BOTTOM OF TANK C3 32.0' 13.8' 97.7' 93.50' C4 36.7' 16.0' 97.7' 92.85' C5 65.6' 38.8' 90.9' 87.00' C6 67.2' 40.4' 90.9' 86.84 I,5_ jo iNI/C-/4T 6/= � /{ M1 92.4' 65.0' 89.3' 77.34 BOTTOM OF ROCK C7 117.8' 90.4' 88.2' 85.30 ®mss OF OV�� ..........'�k ®® c / t a 0 O:O 7_ ]'-o : /7 c."e, ret- 1) c -� am q 9TH i 1omeo o �l�.lm�YGH �m. o mom 000q ;JAMES M.m.W e ° CE 8841 li9��% Sc ®® �°mmmm.. °poo a ®%4 'PROFESS\ONS®��� IA m 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:SW930328 DESIGN ENGINEER:STEVEN R. PANNONE OWNER NAME:BRENNAN TIMOTHY P & OWNER ADDRESS:11311 PYRAMID DR ANCHORAGE AK 99516 PARCEL ID:01709284 LEGAL DESCRIPTION: MCCARREY LT 4 LOT SIZE: 68694 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 8/26/93 EXPIRATION DATE: 8/26/94 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: SYSTEM MUST BE INSTALLED BY A DHHS PERMITTED INSTALLER. RECEIVED BY: DATE: 2� 3 ISSUED BY: jOt4R GIA/P�- DATE: 611461 August 3, 1992 Department of Health and Human Services Anchorage, Alaska Re: Onsite Sewer system design for Tim and Stacey Brennan McCarrey Subdivision Lot 4 Dear DHHS, This is a request for an onsite sewer permit for a new residence located at the above address. The original soil test done for the subdivision is located near the house and will be used as the reserve area. One new soil test was done showing good soils for an original system. The well is located at the East corner of the property as shown on the plot plan. The lot is large (approx. 2 acres) and has an abundant area of reserve room to place the different systems. No impacts to the surrounding properties are foreseen. All have onsite systems already and appear to be performing adequately. The required set -backs and reserve areas are easily obtained due to the large lot size and good soils. The lot footprint is rectangular shaped in the East-West direction, gently shoping to the West. Sincerely Steven R. Pannone P.E. O cr F.: c0 W N , WU) CIP) Z E U C6 ,a � p `ti u 0WLn i W I I M O u NI ti M ON P � O i a I Z I" an I ri O � I �Z6'661 u 0WLn I v u NI I M � � i a O I" an I ri I N _ v • v 1- I I I 4i 1 0 ' �zd _1MS3 m , OI �d �6 _VI 66 n NCO I a: I a I I I I I i I I '^• i CM LU W I LU L. P I CY an I v °i co I ClI � 3 • 0 In 0'e! & u 0WLn I v NI I M 1 w O N • 0 In 0'e! & ec4i; c, NI I� � i a O I" P ri I N '1 . 10 �NI of 01 M � � •6S80o00 111 1 u e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:—T Q, Pl DATE PER LEGAL DESCRIPTION: r-cGYf-e 1, SU 6 Loi- 1 Township, Range, Section: SLOPE SITE PLAN DEPTH (FEET) 1 C9 f Q In 2 �� 67 �d0.vpp� rl 3- 45 4- 5 6 7 8 9 10 WAS GROUND WATER 140 ENCOUNTERED? S 11 L IF YES, AT WHAT O DEPTH? P 12 E 13 Depth to Water Atlgqr3 Monitoring? —&-a 14- 15- 16- 17 4151617 1s 19 20 COMMENTS v�l40L—� it PERCOLATION RATE (mmuteshnch) PERC HOLE DIAMETER TEST RUN BETWEEN 60 FT AND FT PERFORMED BY: Nis 2 �i� �I ilk 2 rrt <i� Qrt (7or r y •+ G p CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) I • �� Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVI 825 "L" Street, Anchorage, Alaska 99502-0650) i� Pa . SOILS LOG — PERCOLATION TEST � O. CE- 149'' , �ilk ��PROFESSIO� �. A .......... s PERFORMED FOR: �N�A �- I ��=�-�T DATE 1-to'CIL Pe°cesEa �,{ LEGAL DESCRIPTION: Z -07,'l 1PIC`n keQEy, 5'OBD. Township, Range, Section: DEPTH SLOPE SITE PLAN (FEET) %NI L 1 N 2 SL G f CL4gEY � 3- 4 4 1 I — • t - 5 /87 i I 6 .5 W G2•E-1, A(OiS�, WELL GRADr-,0 5k. 3° S w1 G ¢A /6L z 5 7 1 8 9- 10- WAS GROUND WATER No ENCOUNTERED? S 11L A IF YES, AT WHAT N �O b'e GE 12 ^QOI ST-/ 31t.+-e� DEPTH. E sAl SILTY 5? . +o Spepth to Water Ager 131 Montterino? M 6.1. Date: y"Zy-9Z 14 -} 15 60TTDM OF HOLrL 16- 17 18- 19- Reading 81s Reading Date Gross �11N Time Net MIS\ Depth to Time 1 Water Net /N Drop ( I y -r8 -9z b a to l0 1 . z S 2D ro 1, 4 3° r0 1.25 yv IC7 .zs zo 6 „ PERCOLATION RATE cg (minutewinch) PERC HOLE DIAMETER TEST RUN BETWEEN b FT AND 7 FT MMENTS PERFORMED BY: MIt<'t=- Ajpe'5,j I 1 `II Cg Ake 944P14- CERTIFYTHATTHIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE.- 72"A ATE 72"A /rine d/A51 ,S£1 .Sbl r y�r 1r63 1LLIll1f1 Ir 02 ,04 F03-13 '3131 ,01 I -G 7r` ` L o I P O N P Y I\ I ryo �J 2//O 3NNt/ I Sapp m / V I � I I I C i ,SEI m I L M� 3 I I r � i opt WI M ON �` JI 3 N of N OD 1 ,591 ,591 I �� v .r. I I Q I 4 a P J m U v m y,J v 01 I j r I � _ I i I I 3 ze I r s '1Y/S3 M .01 I o • ° fn CM -0'21 031V�I0 : x / �l0 M3/11 709J 1S S303� Q I O _:IZ 21 i •ro /V 8 9 o S� / 05e 47� It h the responsibility of the owner or builder, Prior to construction, to verify proposed building Wade relative to finished grade and utility con. Sections and to determine the existence of any '4MW-m—v@F,' covenants, or restrictions which do 02 appear on the recorded subdivWon plat. 45 - a U /1-7-- 6-/61-76 „w SEPT/G Y otf _ Oil .Ex/STi,✓G SLOG m� .t',aoposao A.��-/N_s-Iv 'ul 1 USE ZONE MR 10 V E D By Data I /y/6eE t3Y CECTvFY Ts/AT All uvrrk %;r., l;r rintrr us .;irr,i tr n;, firiar�` OF 11.4 V'6- S t/ /C V &- y z-) .1 0 7- e�( 4 plat �"+. '. 3j1�)rot$'(�_ J,lii 1,. wit! ���.•�. •••�•ei �3✓NNy Sto/ d5 SuBO. eQ'or shall not b <°4,.• / c cha7 _ed, nrc�{{ r• Or :.Its ria withow lire nbjc:r117:=r •i...nu• order. 01 s•.•.•.,.......... 9c � William S. E I's EMArAl 7' '� ° 5 !o' ~t LOT SURVEY CERTIFICATION LOT_ BLOCK — REvlGlous ,3 SUBDIVISION �n/C//oPAGE RECORDING DISTRICT, ALASKA PREPARED BYr RESIDENCE OF: DeCamp—Brown, Land Surveying P.O. BOX 1 Or WASILLAr ALASKA 99687 L EA : 4,o cs ,C -4r'4 1- —0-4 PH:745-4932 (OR) 344-8042 (OR) 243-4558 ti 4111 CA 0 X n DRAWN BY, DATE: W.O. N0. DRAWING 40. FIELD GOOK NO. 141 ,5 g I 40-16-7(q �e CHECKED GY:SCALE: i PLAT FILMS NO. TOWNSHIP Si RANGE GRID NO. DATE Municipality of Anchorage On -Site Water and Wastewater Program 4 (907) 343-7904 y F T Certificate of On -Site Systems Approval Parcel I. D.017-092-84 1. GENERAL INFORMATION: Complete legal description MCCARREY• LOT 4 Expiration Date: `7' 10 - 2 ( Location (site address) 6045 EAST 144TH AVENUE *ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Real Estate Agent DEREK HERT 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 907-242-4968 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 ❑ WaiverNariance request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_,550 Date of Payment g Receipt Number o21 3 Z COSA # 0-':5 C_ 2 1110 Date: 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: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 J Engineer's Printed Name: Jeffrey A. Garness Dates f S 1 71) 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 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, o %� • GF���.gS4p,� (� d 1 '... 6. ... ........ fff, A. Ge�ness• f • 'f CE—, -79r,) U�,_ro f es siol�obo #AECC884 0 F,446 gON-SITE `9m% with the ' llloowin��gb DR �m monr-G AhA rO= J� �O Q FNT SERv�G In� Original Certificate Date: Ll— 2 d 2 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 Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other nyl RFvrS_Eo L'11q`21 COSA Checklist � Legal Description: MCCARREY; LOT 4 Parcel ID: 017-092-84 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 4110194 Total depth 347 ft Cased to 96 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 4/6/21 Static water level at beginning of test 94.5 ft. Comments B. TANK DATA Age of tank(s) 28 years Tank type/material SES"0"" Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping 4/12/2021 D. ABSORPTION FIELD DATA TRENCH Which system tested (date installed) 10118193 *ALL standpipes present per record drawing Total measured depth from grade 11.2 ft (max) Measured depth to pipe invert from grade **2.5 ft(min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 7.33 Well production at time of test 3.18 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L IN Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD Date of Sample 4/6/21 C. LIFT STATION ❑ Required maintenance com Age of lift station _ye Lift station material/ Adequacy test date 4/7/21 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 614 gal New depth 8 in Elapsed time 120 min 'Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NO date of test) NIA Gallons introduced 2006 gallons If yes, enter date Comments/Deficiencies: MT IN CENTER OF FIELD COULD NOT BE LOCATED **STEEL DRIVEN MT AT NORTH END OF FIELD—DRAINFIELD IS SHY ON COVER -SEE ATTACHED EMAIL) COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes Community Sewer Manhole/Cleanout > 100' r,7, Yes if No ft �j✓" Yes if No ft Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' p Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' Q Yes if No ft F✓ Yes if No ft 0 Yes if No ft Water Service Line > 10' 0 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' , Yes if No ft r✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water> 100' ®Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' M Yes if No ft Private Wells > 100'[]✓ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓(] Yes if No ft Private Wells > 100' Q✓ Yes if No ft Water Service Line > 10' M Yes if No ft Community Wells > 200' Q✓ Yes if No ft Surface Water > 100' ✓0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION / 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. COSA Checklist yellow sheet OF q 9 H y*I Gar e... 9- ' E--7`953 e o f esst00000 #AECC884 Septic 'Tank Advisory Certificate of On -Site Systems Approval #OSC osc211181 Subdivision: McCarrey lot 4 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 28 years old. Typical replacement costs range from $8,000 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 20 -year-old steel tank MAY look like. °� � - � � MaiUng Address PCO Box 196650 *Anchorage; Ataska 99519 6650 uuww muni or M * � a s-,�..,ak #. Naw'.:,;.,, d+,x..a.�:;r� ,..�✓.�_ �;. � .�.�.. x.. � .� ,.'�i-.�t`r r.�S r. ,�n _..3 �2s�,.as�, � �.�=�' '".ua g :,''Y.;=,,a..�..�..�..r,�a.:�; Jeff Garness From: Joel Cladouhos <joelcladouhos@gmail.com> Sent: Monday, April 12, 2021 1:58 PM To: Sonja Blewett Cc: Erik.Widger; Derek Hert; David Garness; Jeff Garness Subject: Re: 6045E 144th Ave. 2021 COSA Hi Erik, We've never had any type of freezing issue with our septic system.----�� Joel On Fri, Apr 9, 2021, 1:29 PM Joel Cladouhos <joelcladouhos@gmail.com> wrote: They just called and said Monday is preferable - does that work? Thanks, Joel On Fri, Apr 9, 2021, 1:13 PM Sonja Blewett <Sonja@garnessengineering.com> wrote: Thank you! Sincerely, Sonja Blewett Corporate Secretary/Treasurer Garness Engineering Group, Ltd. 3701 E. Tudor Road, Suite 101 Anchorage, Alaska 99507 Phone: (907) 337-6179 Fax: (907) 338-3246 Website: www.garnessengineering.corn From: Joel Cladouhos <ioelcladouhos@gmail.com> Sent: Friday, April 09, 20211:11 PM 1 • � Municipality of Anchorage i �4gE 84,0 On -Site Water and Wastewater Program (907)343-7904 p SA 9'T r CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I. D. ( r2 - 0 Q 2- 11. 1. GENERAL INFORMATION Expiration Date: ® `l " 1 J Complete legal description h/( c C tx r r r u. 1^u i- L4 Location (site address) ( U( -IS 4F- C'5 Current Property owner(s) s L\ c cy (3rT h r an Day phone 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: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Individual -q2tc.. vto- C2_ ;1 -nlVinn Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by: ?L- (/ w I Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Lf 9D f P1V-J� Date of Payment 7L-71-/ 3 Receipt Number `(!j (o 5-f COSA # q�G 13131-(8' 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 Address �4L� I /J ct�rl+trt_ 4vG Phone 7 2 ? - 5r S t+' -f Engineer's Printed Name Date ) ?Z / 3 6. DSD SIGNATURE _1z System #1 Approved for A bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, OF Ate P moi.•' � !� P 49TH •.* �j .......... ............P /.... �� -0- MICH , 'LI kv 1DER5ON with the following stipulations: By:o / Original Certificate Date: " Th unicipal Anc ge 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 9-t-12Am 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: M c C a v r 2 Lf Parcel ID: 01 74 0 q2 - g A. WELL DATA Well type nµ If A, B, or C provide PWSID # / Well Log (Y/N) Y Date completed `( !ri 4 Sanitary seal (Y/N) Wires properly protected (Y/N) Y Total depth Cased to 4 ft. Casing height (above ground) Z- 0 in. FROM WEL} LO'JG AT INSPECTION Date of test y l d l q -1-711 /)/ 3 Static water level 9 ( ft. y ft• Well production g.p,m. i.D ¢ 9•P•m, WATER SAMPLE RESULTS: Coliform(' colonies/100 mL Nitrate Arsenic CV ug/L Date of sample: 7 9 Collected by: __/���✓9 . B. SEPTIC/HOLDING TANK DATA Tank Type/Material 5 � Date installed / ir i 9 Tank size / 2 4D gal. Number of Compartments Z Cleanouts (Y/N) Foundation cleanout (Y/N) _Y__ Depression over tank (YIN) High water alarm (Y/N) Date of pumping < ! Pumper � f 0 V Cc., C. ABSORPTION FIELD DATA 7 Date installed/ ( 9 of Soil rating (g.p.d./ft2 or ftZ/bdrm) n. zS System type 1)-v--eID �J * �� �7 . Length _5-Z, ft. Width 21f7 ft. Gravel below pipe 10 ft. i Total depth _LL ft. Eff. absorption area `659-ff Monitoring tube Depression over field N Date of adequacy test 7 f L ( Results (Pass/Fail) P& s 5 For bedrooms Fluid depth in absorption field before test tP 19 in. Water added 00 gal. . New depth 51'7— in. Elapsed Time: I qOO min. Final fluid depth W in. Absorption rate >= 7fiOD 4-- g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date .� D. LIFT STATION Date installed _ "Pump on" level at Datum Size in gallons in. "Pump off E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tank/lift station on lot tri d / >L Absorption field on lot eve `f Public sewer main N l.1, Sewer /septic service line l V 0 < Animal containment areas 1 u 0 .4 High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots /00' � On adjacent lots (V-0 1 - Public sewer manhole/cleanout X/ U, Holding tank Manure/animal excrete storage areas /U D +L SEPTIC/HOLDING TANK ON LOT TO: Building foundation 119 1 f Property line 5 D14- Absorption field /D r Water main Water service line / D D Surface water /D 40 F Wells on adjacent lots 10 0 ABSORPTION FIELD ON LOT TO: Property line 2 S 1L Building foundation Z p Water Service line Curtain drain 14(90!:-,Z (,1 rl i2 Vw0 ✓1 F. COMMENTS G. ENGINEER'S CERTIFICATION Surfacewater too * Wells on adjacent lots 10 d 14 - Water f I certify that 1 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 MV�u¢i cj er4®n Date I/ to l j COSA brown sheet_10-10-12.doc Water main Al /� r r Driveway, parking/vehicle storage Z .: 1�,OF Al%'k %-, MICHAELN. ANgDERSON %�it 0 a r� U r o PL � n C7 0 N n C: m Q II� � o O. D Cf) rt r+ Q C) -Ti O co Q F- 0 m cc C z z U) O -o m IsoMME C O z ress �3 TYPE OF WATER SUPPLY L Ii Individual well ?x3*,c�rrr�'aa T,i., t..ry k3 y Public water 3 !DO. .„NOTE. ►f,commumty well system, provide written confirmation from,State 3��+�.��w <� ing to the legality ands#atus ofsystem`""'” ILI .. M 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 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 invest'ic�ation 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 ' �7`41i ?z5 lVae • L (0151 -&—/rte - Phone 2 43 -43 � Address Z a 33--Z A-*- S-/7 Engineer's signature Date? y ; JAMES M. CE 8841, 'Additional Comments x;�r ' f Date10-2 7 94 u ::` .,•' (• 4, QTY% „'rF X ' u_. w ,, i+ lam a -• CAUTION . — The un%ipaiity 4 n horage pepartment of Health and Human Seryices' (DHHS) issues Health Authority .,,,.Approval i�ertificat��,based only upon the representations given in.paragraph. 5 above by an independent �s}professional eng�r�der registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of ho1.mes `and thokiendlstitutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections oranalyze data before a certificate Is issued The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work 72-M (Nw ,9i) Back MOA N21 1' rvy f 1 1y � :huakO ., ,. vy .. ^ ��n,9J-",. ... ..........w .. .v.._.r . ..b..<s..wa.. ,m.v. .� +........+...E... Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L -o7_ Parcel I.D. A. Well Data Well type fl- > 2 If A, B, or C, attach ADEC letter. ADEC water system number Log present0j) e,S Date completed O Driller tiAaE: 14�a-AP-rL4 Total depth 7 Cased to G% lv Casing height Z Sanitary seal (Y/N) Y Wires properly protected (Y/N) V S J'tt FROM WELL LOG Date of test Static water level "t Well flow 3, 57� 9 -P.M. Pump levell 330 SEPARATION DISTANCES FROM WELL TO: AT INSPECTION � / Z epti olding tank on lot I !ffl 7 ; On adjacent lots 2- Q 2, % 1 Absorption field on lot e / ; On adjacent lots Public sewer main N//- Public sewer man hole/cleanout %1✓�,�J Sewer service line P414:: Petroleum tank WATER SAMPLE RESULTS: Coliform 4216-S_5 1*A1E_- Nitrate PAS 5S S Other bacteria me) &F Date of sample: 0'hip I Collected by: r F SEP /HOLDING TANK DATA Date installed R Tank size ���'� Compartments Z-- Cleanouts (Y/N) iloiS Foundation cleanout (Y/N) yes Depression (Y/N) High water alarm (Y/N) L /A— Alarm tested ((Y/N) Date of pumping l ,5a% YS7 "' /1 Pumper SEPARATION DISTANCES FROM EPTIC/ OLDING TANK TO: Well(s) on lot qq, 7 On adjacent lotsi l`� Z. % Foundation f 5 To property line 70 Absorption field Z Water main/service line r Surface water/drainage "f" CONTINUED ON BACK PAGE 72.026 (3/93)" Front M ~' a 9 -P.M. o rM to 4W rn " O C7 Z v' m � / Z epti olding tank on lot I !ffl 7 ; On adjacent lots 2- Q 2, % 1 Absorption field on lot e / ; On adjacent lots Public sewer main N//- Public sewer man hole/cleanout %1✓�,�J Sewer service line P414:: Petroleum tank WATER SAMPLE RESULTS: Coliform 4216-S_5 1*A1E_- Nitrate PAS 5S S Other bacteria me) &F Date of sample: 0'hip I Collected by: r F SEP /HOLDING TANK DATA Date installed R Tank size ���'� Compartments Z-- Cleanouts (Y/N) iloiS Foundation cleanout (Y/N) yes Depression (Y/N) High water alarm (Y/N) L /A— Alarm tested ((Y/N) Date of pumping l ,5a% YS7 "' /1 Pumper SEPARATION DISTANCES FROM EPTIC/ OLDING TANK TO: Well(s) on lot qq, 7 On adjacent lotsi l`� Z. % Foundation f 5 To property line 70 Absorption field Z Water main/service line r Surface water/drainage "f" CONTINUED ON BACK PAGE 72.026 (3/93)" Front C. LIFT STATION /f/� Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (YIN) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" Level at Cycles tested Surface water Date installed /6)1/�g q� ' Soil rating (GPD/Ft) Or 9 System type PE 9:7P Length ;-2 . 3 Width 2 Gravel thickness B Total depth /Q• ? Total absorption area 93 7 SQ. :�T. Cleanout present (Y/N) YC -5; Depression over field (Y/N) /V Date of adequacy test IS* A(" 140MOResults (pass/fail) — Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: test If yes, give date Well on lot 2 �`i �����yj On adjacent lots �S , y / Property line To building foundation % CFS l To existing or abandoned system on lot h /VxE' N07+,;r/4rty �/3i�/vis/vv� On adjacent ots ( Cutbank �i� Water main/service line /41A - Surface water s ,��� � Driveway, parking/vehicle storage area �_ Curtain drain PAP E. ENGINEER'S CERTIFICATION Bedrooms I certify that l have checked, verified, or conformed to all MOA and HAA guidelines in effer� this inspection. 100, TH q: Signature / Engine s Name J azgJg a S MR it)A r!`/ T f fir'. JA1Ji S i�. W IGj I1 <<7 Date ®/� %,�'' •' CC 88�+t 1 : V YU/1rrM1(�Rft��� HAA Fee $ �CO0 - Date of Payment i/rl �2/ %` 94�4 Receipt Number T - ✓ C7✓ 72.026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCE; DIVISION OF WATER WATER WELL RECORD BOROUGH SUBDIVISION LOT BLOCK SECTION QTRS SECTION TOWNSHIP RANGE MERIDIAN ❑N ❑E ( ❑S ❑W LOCATION/SKETCH: WELL OWNER: DEPTHS MEASURED FROM:❑casing top ❑ground surface WELL DEPTH: DATE OF COMPLETION Depth of hole:*� ft Depth of casing: ft /' / BOREHOLE DATA: Depth Material Type and Color From TO DEPTH TO STATIC WATER LEVEL: " G R ft below top oofa casing ❑ ground surface Date: l 1 Ct^+ iii^ .� ► 4 METHOD OF DRILLING: air rotary ❑ cable tool (7- 4° ❑ other /l„ ..�/❑ 44 USE OF WELL: 45 domestic El irrigation. ❑ monitor public supply ❑ other _,. CASING STICK-UP ft. Diam: in. to ' ft Gl%! Casing type:_.""' ".. toft WELL INTAKE OPENING TYPE: ❑ open M1en screened ❑ perforated ❑ open hole Depths of openings: to ft SCREEN TYPE: Diam: in. Slot/Mesh Size: Length: ft GRAVEL PACK TYPE: Volume used: Depth to top: GROUT TYPE: Volume: Depth: from ft to ft DEVELOPMENT METHOD: FAf IC, Duration: -- „ PUMPING LEVEL AND YIELD: `'^ 6,`/ ft after - hrs pumping < gpm PUMP INTAKE DEPTH: ft Horsepower: WELL DISINFECTED UPON COMPLETION? �Q YES ❑ NO CONTRACTOR INFORM47VON: REMARKS: PLEASE MAIL WHITE COPY LOG "TO: DNR/DIVISION OF WATERER nature of Authorized Resp�entative Date PO BOX 772116 EAGLE RIVER AK 99577-2116