HomeMy WebLinkAboutZODIAK MANOR ALASKA BLK 5 LT 23odl'oak Manor
Block 5
Lot 23
#015-012-26
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: ________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion? XX Yes No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
Residence Address~/~_~,~._. Location of Ins%allation
Application to Install: Septic tankages%~._ Seepage plt___,P~ Dmain field___, Other
To Serve the Following Faaili~y % /~ p
ercolation Test Results
..... ~nttcipated Date of Comp~etion_~~
~ H -
.,. BELOW~.~TO BE FILLED~ _OUT BYe. HEALTH. ....... DEPARTMENT~ ~ , ..
This is to serveaa~ ~ ..... ~~,z/ permit to install a ~!~ ~
............. 3s descmibed below.
DISTANCES:
Si e unit to
. ~Dtic tank szze 3 T e ~
...... _~__Yp _____.Seepage
~ _ DIAGRAM OF SYSTEM
I certify that I am familiar 'with the requirements of Greater Anchorage Area Borough
Ordinance No. 28-68 and that ~he above described .~;ystem is in accordance with said code.
,~ItV /07,3
C_~]i%IFICATE OF
I hereby certLfy t~at I have sn~rveyed the fol]owi~g described
?rope-,c,;;: ~m~"Z~ , ~0~ ~'~,
~/~ ~M~m~ ~/V/Y/~ as recorded in the Anchor-
~'v~- R.--e~ rding ~ecinct~ Alaska, ~d that the impro~ments ~tuated
t~uerec':~ are located as sho~ on this plat, and that there are no
roadv~ays~ tr~s~ission ]ines or other ~sible easermnts on said
pro~rty except as indicated hereon.
Dated at AnchoraLe, Alaska, this_~__day of ~:~ ,~
Earl R. Barnard, P.E.
ReT, istered Civil Engineer
Reg. ~;o. 75~-E
Addre s s:
5h2 FaJ. rbanks St.
AnchoraTe, Alaska 99501
~hone: 272-0~?O
Dra~n ~/~
Book ,,
Checked ,.., o~
Municipality of Anchorage
Development Services Department !
Building Safety Division
Onsite Water& Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite (! 1
(907) 343-7904 IV(
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING /'-
Parcell.D. n1 5 -01,"L �(n COSA# Gl�LUa�
I. GENERAL INFORMATION Expiration Date: — — O %
Complete legal description ZODIAC MANOR SUBDMSION LOT 23 BLOCK 5
Location (site address) 8630 JUPITER DRIVE 0 ANCHORAGE AK 99507
Current Property owner(s) ED I AMM
Day phone 346-3664
Mailing address 8630 JUPITER DRIVE • ANCHORAGE AK 99507
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
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 El
Water System ❑ Public Sewer
The Municipality of Anchorage DevelopmentServices Department (DSD) Issues Certificates oLOn-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 engineers work.
4. 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 riles and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system fs(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, LID. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results doscribed 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 lost
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
isted above.
liance upon or use
the sole benefit of the owner
person or party Is not aluthorized, nor will it confer any legal right y any
whatsoeverthis report .
5. DSD SIGNATURE
Phone 337-6179
Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the filowing stipulations: \\ttttllif (ffff//f����
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'831VM31SV�M
� • 311S NO
Attachments: I-vi�ryd,A 0
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Maintenance Agreements
Supplemental Engineers Reort
Other
Original Certificate Date: % 0 —
By:
IP_, •11151
Municipality of Anchorage
Development Services Department
Building Safety Division
On -SRO Water & Wastewater Program • ,
4700 Bragaw Street
P.O. Bout 196650
Anchorage, AK 99519.86W
www.muni.orgforgfle
(907)343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: ZOD K MANOR SUBDIVISION* LOT 23 BLOCK 5 Parcel ID: 0 (S— O
A. WELL DATA
Well type EMTE if A, 8. or C provide PWSID# N/A Wali Log (YM) YES
Date completed 7/30/1986 Sandy seal (y/N)iES Wires ProPWiY protected (Y/N) YES
Total depth 165 ft. Cased to 165 ft. Casing height (above ground) 12+ In.
FROM WELL LOG AT INSPECTION
Date of test 7/30/1986 _ 9/13/2008
Static water level 127 ft. 119 ft.
Well production 10 9 -P.M. 7.78
g.p.m.
WATER SAMPLE RESULTS:
Cofrform r Af coioniesl100 ml. MOWS 0354 mgA. Other bacterie ' coloniesho0 mi.
N
Arsenic: V ug jL• Data of sample: 9/13/2006 Collected by: GEG. Ltd.
S. SEPTIC/HOLDING TANK DATA
Tank Typa/Material
Tank size gal.
Foundation cleanout (Y/N)
Number of
PUBLIC SEWER
Date
over tank (YM) _
�. •._
C. ABSORPTION FIELD DATA PUBLIC SEWER
Date installed SON rating (g.p.dJft'or ft%drm)_
(Y/N)
Migh water alarm (Y/N)
System we _
Length ft. Width ft. Gravel bei
Total depth k. Eff. absorption area_ ft' Monitoring Depression over field
Date of adequacy test Results all) For bedrooms
Fluid depth in absorption field be _ in. Water added —gal. New depth _in.
Elapsed Time: Final fluid depth _ in. Absorption rate >_
g.p.d.
treatment (past 12 mo.) (Y/N & type)
If yes. give date
D. LIFT STATION
Date installed Size in gallons
"Pump on• level at _in- "Pump
High water alerm level at In.
notaim
Cyder tasted Meets alarm & dreud requirements4
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO: 100,+
Septic tankAifl station on lot N/A On adjacent lots
N/A On adjacent lots 100'+
Absorption field on lot t �,+
75'+ Public sewer manhole/deanout
Public sewer main
Sewer /septic service line 2� 5V— Holding tank N/A700'+
Animal containment areas 50 + Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTICJHOLDING TANK ON LOT TO:
Building foundation Property line
Wat�mainW NSurface water
W oIs
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Budding foundation Water ma
Water service line
Surfa Driveway, pe�nglvehide storage
A _ Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 car* that I have determined through Held inspections and •
......... .
review of Municipal records that the above systems are in
conformance with MOA COSH guidelines in effect on this A. Gam
date. p _t
GARNESS
Engineer's Printed Name JEFFREY A sem.' ��Ztd o6�
Date `t/29 06 r'ro►ssda`�
COSA Fee S `%
Date of Payment
Receipt Number
(Rev. IUM
Waiver Fee $
Date of Payment
Receipt Number
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SCS Ret#
1065417001
Client Name
Gamcss Engineering Group, Ltd
Project Name/i1
Lt 23 Dik 5 Zodiak Manor
Client Sample ID
Lt 23 dlk 5 Zodiak Manor
Matrix
Drinking Watcr
['"SID 0
Sample Remarks:
Parameter
Metals by ICP/MS
Arsenic
Waters Department
Nitrate -N
Microbiology Laboratory
Results PQL
ND 5.00
0.756 0.100
All Dates/rim" are Alaska Standard Time
Printed Date/time
09/27/2006 9:31
Collected Date/time
09/13/2006 8:28
Received Dale/Tim,
09/13/2006 10:21
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Units Method Container ID Limits Date Date [nit
ug/L EP200.8
mg/L EPA 353.2
C (<10) 09/18/06 09/23/06 MI
D (<IO)
09/13/06 AZS
Total Coliform 0 col/IOOmL Sh12092220 A (<I)
09/13/06 TLF