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Home My WebLink AboutUS SURVEY 3042 LT 94 N 102.25' OF E2 T10N R2E SEC 19USS #3042 Lot 94 N 102.25' of E2 075-093-27 . Municipality of Anchorage • CDevelopment Services Department b_< 1. � Building Safety Division On-Site Water & Wastewater Program, 4700 South Bragaw St. E t t P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW 0 it 035 3 PID Number. 0 75-- 0 93—Q2 of 3 Nome: JOE MORRISON Wastewater System: ❑ New ■ Upgrade Address: 1 61 1 ELMENDORF DRIVE * ANCHORAGE, AK. 99504 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 783-9158 2 0 Deep Trench 0 Shallow Trench 0 Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: GPD/sq. Fe. Total Depth f • original grade: F!. Block: Lot: Subdivision: PTN 94 USS 3042 Depth to pipe bottom from odginol grade: -• :I depth beneath pipe: Ft. Township: — Range: _ Section: — Fill added above original grade: Ft. Grovel length: Ft. WELL: • New ❑ Upgrade Grovel width: Ft. Number of fines Distance between lines: Ft Classification (Private. A.B.C): G Total Dep Ft. Cased To: (BEDRpCs) Ft. Total • •rptian area: SO. Ft. Pipe material: Driller. fX,S�` C Date Drilled: Static Water Level: Ft. Installer. CONRAD CONSTRUCTION Dote installed: Yield: GPM Pump Set At: Ft. Cooing H fight Above Ground: Ft. TANK SEPARATION DISTANCES 0Septic • Holding 0 S.T.E.P. 0 Other To From Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Linea Manufacturer. ANCHORAGE TANK Capacity in gallons: 3000 Well — — — 75'+ 25'+ Material STEEL Number of compartments: 1 Surfoce Water — — — 1001+ — LIFT STATION Lot Line — — — 5'+ — Sim in gallons>fadurar: Manu Foundation — — — 5'+ — "Pump on' level a: High woter alarm at: Curtain Drain Pump Make al: Beatrice! Inspections performed by: NONE KNOWN Remarks: BENCH MARK BOTH OLD HOLDING TANKS WERE Location and Description: BOTTOM OF SIDING ON SOUTHWEST CORNER COMPLETELY ABANDONED. Assumed Elevation: 100.00 Ft. ENGINEER'S SEAL N. �aoo6��i\\\ OF Inspections performed by: GEG, Ltd. Dates: 1st 9/17/2004 ' 't p0 * • / * p� 2nd 0 3rd le.. _ Jjss: Development Servic Department Approval Q 9 09, c 4 r (••�`o� Reviewed and approved by �g„ /9 Date- R-a7_r0 r f QoO,p ' essio' (Rev. 12/01) ra f e5310tt p gr �40poo�a PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER 12.47 100' WELL RADIUS EXISTING WELL NEW 3000 GALLON HOLDING TANK GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS 3701 E. TUDOR ROAD. SUITE 101 * ANCHORAGE, AK 99507 * PHONE (907)337-6179 * FAX (907)3383266 PREPARED FOR: PHONE NUMBER: JOE MORRISON 783-9158 LEGAL DESCRIPTION: U.S. SURVEY 3042; LOT 94, PTN, TYPE OF WORK: AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE DATE: 9/20/2004 DRAWN BY: R.A.L. SCALE: 1" = 40' PAGE NUMBER: 2 OF 3 4" OF INSULATION PER EXCAVATOR TOP OF TANK AT INLET = 93.67 0 tzl INVERT OF BUNG AT INLET = 93.49 FINAL GRADE = 95.67+ ALARM 0 0 1/%/SSA1 TOP OF TANK AT OUTLET = 93.66 NEW 3000 GALLON HOLDING TANK GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS.' 5701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 ' PHONE (907)337-6179 * FAX (907)338-3246 DATE: 9/20/2004 DRAWN BY: R.A.L. SCALE: N.T.S. PREPARED FOR: JOE MORRISON LEGAL DESCRIPTION: USS 3042- LOT 94, PTN, PHONE NUMBER: (907) 783-9158 PAGE NUMBER: 3 OF 3 TYPE OF WORK: AS—BUILT OF NEW HOLDING TANK e A. ess IRCP ND Mlle /LOOS .a„0.3101111)) .M rmumai'rl COMM ml.w moot now WAS !ETNA IDL FALCON aluoc RW ..AMI !MCC UNDER NO CIRCUMSTANCESAN AB -QUILT BE USED NE OR FORESTABUgHMO BOJNDARY OR FENCE UNE& THE SURVEYOR TAKES RESPON J7Y'.FFIjHE WnIAL-TRANSACDON ONLY AND tAS91N'ES FINANCIAL UABIUTY ONLY FOR THE COST OF THE SURVEY. LISTED C EANC S PREVAIL OVER. SCAUNR REPRODUCTEIN :MAY CAUSE ERRORS W SCALE W tar SURWY A1UI ❑ FOUNDATION AS -MALT ❑ FINAL SIRUCIUNE AS -MILT EI El PLOT PLAN ... AS -RAT ... LLT oar.. . SURVEY 'TYPE AS-flT ... NO MOWERS 9T ' PLOT PLANS & LOT SUR IT IS THE RESPONSIBIUTY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED; BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTIUTY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS- COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. tot cameo on SURVEY CERTIFICATION PLOT PUN 1 M.by arty xM 1 Iwo pll$1 arms' Vs M Meal mead I...e GS 1M I Mw twee w eMM.MMS M M M Tet ..1... - Men w Ll.Ss - to Its b.M et my Mewls* end =tin, el ...kr. h.» bort FOUNDATION AS -BUILT L Air tC il.y Jr. heels — Ml Mw Ae,lem.S w .Witlw� r Y MnMMI w OS let elYM' e1 w eMM M IllwnelM M Meal W A e s Ina M M .11vwrnMb — ism M,.., ...... FINAL STRUCTURE AS -BUILT L ISMS 1. rlwedw . S. booby gamy 1 .4l Smite, on IS M M 11114 Mw dM.ebM N Ian w MMM Mew as Ins M w wsentsio Mai lecke age eUw.Y •• _ ROBERT - .f 4121 a SYMBOLS • SET MEW W DRAINAGE .0+�. j MONDMBARy..p_4 YA00 PENCE ARUM ELEV. *—s—* METAL FENCE Il1JJ ASPHALT CONCRETE X000 DECK ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE SHOWN. FENCES; mut SEPTIC CLEANOUTS. SIDEWALKS. DRIVEWAYS, ETC. ARE SHOWN IN THEIR APPROXIMATE -LOCATION, ONLY. SNOW MAY: PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. ALL--DISTANOES ARE RECORD UNLESS OTHERWISE NOTED. Prepared by Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 1142 E. 12 AVE ANCHORAGE ALASKA 99501 MEC 1 11 . 20' R01. lot SJ' Oats 9-22-04 9-22-04 Roo. Plot Flo No. Drown by chocked by REJ REJ Grit 4912/5012 W.O. — DOINXIMM Lot 94 US Survey No. 3042 PTN'T1ON R2E Section 19 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. ®'1 J' 013' Property owner(s) JOE MORRISON Permit Number Day phone 339-8270 Mailing address (1) NHN HOTTENTOT MINE ROAD * GIRDWOOD. ALASKA Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) U.S.S. 3042; LOT 94 PTN to K1 Ra, Sec tq Legal description (Section, Township & Range) Lot Size (0, Acr• /Sq.Ft. Number of Bedrooms 2 THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade • Well Only Water Storage THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi Swimming Pool 0 Water Softening Unit Therapy Pool 0 I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Cignaturc of property owncr or authorizcd agcnt) Permit Fees: Lilco Date of Payment: J6s f ON Receipt Number: Waiver Fees - Date of Payment: 3 5 Co 4115 ;� Receipt Number GARNESS ENGINEERING GROUP, Ltd. August 16, 2004 CONSULTANTS & GENERAL CONTRACTORS Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragraw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Holding Tank Upgrade for U.S.S. 3042, Lot 94 PTN To whom it may concern: The existing 2 -bedroom house is currently served by a private well and holding tanks. The holding tanks are undocumented and must be upgraded prior to sale of the house. We are proposing to install a 3000 -gallon holding tank in accordance with the Municipal standards. There are no surface waters within 100 feet of the proposed upgrade. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. .E., M.S. NOTE: Attached is a site plan drawing, a design drawing„ and a 5 page construction specification letter which are all part of the design package for this septic system. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: garnessengineering.com MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Aug 20, 2004 Expiration Date: Aug 20, 2005 Permit Number: SW040353 Parcel ID: 075-093-27 Legal Description: Ute 30421:17 Opt 'Mil 0N.R2E SEG 10 Design Engineer: 0855 Garness Engineering Group, LTD Site Address: Owner Name: JOE MORRISON Lot Size: 10126 SQ. FT. Owner Address' NHN HOTTENTON MINE ROAD GIRDWOOD , AK 99503-1719 This permit is for the construction of: Disposal Field n Septic Tank Holding Tank Total Bedrooms: 2 Permit Bedrooms: 2 Privy Private Well Water Storage 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 ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By:/ J Date. Date: \h\ 9W4 ` N ° V5• t ti PROPOSED SEPTIC SYSi[M // Oy (SEE PAGE 2 OF 2) / y t J• ° el`\\ / 34,00/- `4i/a�y \\ / JO42 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 ' PHONE (907)337-6179 FAX (907)339-3246 PREPARED FOR PHONE NUMBER: JOE MORRISON 279-1945 LEGAL DESCRIPTION: U.S. SURVEY 3042; LOT 94PTN TYPE OF WORK: SITE PLAN FOR HOLDING TANK UPGRADE DATE: 8/16/2004 DRAWN BY: A.J.G. SCALE: 1" = 100' PAGE NUMBER: 1 OF 2 NOTE: THE CONTRACTOR SHALL HAVE THE SOUTH LOT LINE AND 75' WELL RADIUS FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. H 077-4, 100' WELL RADIUS EXISTING WELL EXISTING UNDOCUMENTED HOLDING TANKS TO BE QMPLETELY ABANDONED INSTALL FOUNDATION CLEANOUT PROPOSED 3000 GALLON HOLDING TANK t-c;s3SE GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS 701 E. TUDOR ROAD. SUITE 101. ANCHORAGE. AK 99507 • PHONE (907)337-6179' FAX (907)338-3266 PREPARED FOR: PHONE NUMBER: JOE MORRISON 279-1945 DATE: 8/16/2004 RAWN BY: A.J.G. CALE: 1" = 40' AGE NUMBER: 2 OF 2 LEGAL DESCRIPTION: U.S. SURVEY 3042; LOT 94PTN RID NUMBER: 4912 TYPE OF WORK: DESIGN OF PROPOSED HOLDING TANK UPGRADE �4Q S�4opt O Je 'r_, A. ess. E-7953 ,�o�p sf �v IDa,C. fessloccrc 04000�00`� Permit # I n4,y ,J/� ON-SITE SEWER PERMIT Applicant: gohalzr 1". s/g Mailing Address: ‘ „AS-Ski/Az e1-/i¢Ad s /fix 4/73%7 Location: 6 j2L( �ooIN �t4C Phone Number: tl�- cj'Yo7� Legal Description: 47 ! cy-. ij 23e9,7Q Lot Size: — Type of Soil Absorption System Is: Trench: may- Drainfield: "5 Seepage Bed: Holding Tank: , OCO Maximum Number of Bedrooms: Soil Rating(sq.ft/br) ///f'j The Required Size of the Soil Absorption System Is: MUNICIPALITY OF ANCHORAGE Department ai Health and Environmenta rotection 825 Street, Anchorage, AK. 1,501 264-4720 * * * HANDWRITTEN PERMIT * * * DEPTH LENGTH GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TAMOSIZE = a4V0 GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 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 community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 31,* * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more thatt•edrooms. Q Signed: C0�"'� e. Issued by: Applicant Date: - SWP/024(1/81) opl-eyry Parcel I.D. 075-093-27 Certificate of On -Site Systems Approval Expiration Date: 1-25-2023 Legal description US Survey 3042 Lot 94 N 102.25 of E 2 T1 ON R2E Sec19 Site address 263 Hottentot Mine Rd. Girdwood Current property owner(s) Brennan X The On-site system(s) is/are approved for 2 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: y- .� Original Certificate Date: 10-25-22 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPAUTY OF ANCHORAGE Development Services Department = Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 075-093-27 Complete legal description US SURVEY 3042 LT 94 N 102.25' OF E2 T10N R2E SEC 19 Location (site address) 263 Hottentot Mine Road *Girdwood Current property owner(s) Will Brennan Day phone 529-9731 2. ON-SITE SYSTEMS SIZED FOR 2 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑E Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑■ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: X Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 18 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ J�J� �{ 33 Gc ,CN, Waiver Fee $ Date of Payment lU� (� �a� Date of Payment COSA # Waiver # COSA Application—June 2022 COSA Checklist Legal Description: US SURVEY 3042 LT 94 N 102.25' OF E2 T10N R2E SEC 19 Parcel ID: 075-093-27 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 9/7/82 Total depth 162 ft Cased to 162 ft On Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 9/20/22 Static water level at beginning of test 60.2 ft. Comments B. TANK DATA H0LD1NG;TA- Measured operating fluid level in septic tank - Date of pumping SEE ATTACHED PUMP HISTORY ❑ Required maintenance completed, if AWWTS _ Comments: _ ' dpi /A t i.s i.,j e - t,t S i. t Cr- E tF D. ABSORPTION FIELD DATA Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for e than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (p 12 months) If yes, enter date COSA Checklist June 2022 Well production at time of test 7.5+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No �liform bacteria is Negative Nitrate mg/L [i] Nitrate less than MRL (ND) Arsenic ug/L P rsenic less than MRL (ND) Collected by GEG, LTD Date 9/20/22 L IFT STATIONequired maintenance comp) of lift station ears ation rial ments: Adequacy test date Results ❑ Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final depth in Absorption rate gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No 75'+ ft 0 Yes if No ft F- Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' ElYes if No N/Aft Holding Tank > 100' ❑ Yes if No 75'+ ft ! Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft ❑■ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft Q Yes if No ft .a `C ❑ N/A — Served by Community Well (not on lot) or Public Water 0 From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑Yes if No *5r+ ft Surface Water > 100' Q Yes if No ft 3 Tank to Property Line > 5' Yes if No ft Wells on Adjacent Lots: i 1 >'� 4L Field to Property Line > 10' ❑Yes if No N/A ft y Private Wells > 100' ❑ Yes if No ft Water Main > 10' ❑■ Yes if No ft Community Wells > 200' Q Yes if No ft J l Water Service Line > 10' Z Yes if No ft If tank or field is under driveway comment below t F. ENGINEER'S COMMENTS *HOLDING TANK MET CODE AT TIME OF INSTALL SEE 4/6/15 LETTER IN MOA RECORDS FROM GEG LTD. REGARDING WELL ON US SURVEY 3042 LT 94 MID1 02.25'OF E2 T1 ON R2E SEC 19 je.)fW ysr d� �M� cYldfvs2i: G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gamess Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the 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. COSA Checklist June 2022 OF � JTI 1 V-7/ voo -.Jef e A�arness.� 9, CE795 P LICENSE` pro f # EC IVI -W DRILLING, Inc. 41374 P. O. Box 4-1224 ® 1310C International Airport Road (907) 274-4611 ANCHORAGE, ALASKA 99509 Well Owner aai 7 l a -:y -es Use of Well _f"-' tee`= -"t 1-0 Location (address of: Township, Range, Section, if known; or distance main road r 1 P. -111 1.11110N, 'P, 2E c �J :aF„v v U Gl_ 19 •'.J sem: d {'rim?'1 C: -s aa Size of casing 6" Depth of Hole 161.1 feet Cased to 161 feet Static water level 60 ft, 4h4'c0e) (below) land surface. Finish of well (check one) open end ( h=am ) Screen ( ); Perforated ( ). Describe screen or perforation rlon� ` Well pumping test at 50 gallons per (j (minute) for 1 hours with 1Uro of drawdown from static level, Date of conipietion Sep-tember7, 1982 Depth in feet from ground surface 0 TO ? ? TO 55 55 -To-7.7— 7` .t TO 1110 110 TO 1.21 TO 15'9 _ ? 5 TO 162 TO- TO- TO- TO- -TO- --TO- -TO- -TO- Give OTOTOTOTOTOTOTO Give details of formations penetrated, size of material, color and hardness Casing s v ckup Loose saz»,Clz'%j gj•a; ej 1 l"."y hexd: hna,-, Parcel I.D. 075-093-27 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of Ort -Site Systems Approval Expiration Date: 7/55 1. GENERAL INFORMATION Complete legal description USS 3042 LOT 94 N102.25 E2 (p[J i22vC SE-Gl9 Location (site address) 263 HOTTENTOT MINE RD. GIRDWOOD, AK 99515 Current Property owner(s) CHARLES LOVELY Mailing address Day phone Real Estate Agent SAM DANIEL Day phone 227-4626 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex o Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS' 2 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual 0 Individual Water Storage ❑ Holding Tank kl Community Class _ Well ❑ Community 0 Public Water System 0 Public Sewer ❑ WaiverNariance request for: NIA Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Distance: - Date: 9/15/19 COSA Fee $ )5210 Waiver Fee $ `t Date of Payment //� c `/ �? Date of Payment Receipt Nurnber U 1-100 Receipt Number COSA# 05C157/51 Waiver # Li /la Gush Ftz t 35.60 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Garness Engineering Group, Ltd. Address 3701 E. Tudor Rd., Suite 101, Anchorage AK, 99507-3246 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 fife of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the 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. The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this report 6. DSD SIGNATURE System #1 Approved for Z bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Phone (907) 337-6179 Date `f /J "'/1S sL s' 1 ' • r 4 \ if�• • _�7 • r 0• 410; 1T` r• fey A.pa88 i �G• • CE -7953 + Ar es. • , .rtM \ice sus• OF AAre ? ON-SITE = WATERANq z= =ten WASTEWATER bedrooms, with the following stip tionw:ROGRt" l i SES` By: Aef �it1 Original Certificate Date: 3/s�/� The Municipality of Anchorage D- elopment 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 COSA blue sheet 9-1-12.doc Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: A. WELL DATA Well type PRIVA Date completed Total depth *162 USS 3042 LOT 94 N102.25 OF E2 Parcel ID: 075-093-27 07 19 PER MOA DIRECTIVE If A, B, or C provide PWSID# N/A Well Log (Y/N) *YES Sanitary seal (Y/N) YES *162 ft. W Date of test Static water level *62 ft. ft. Cased to M WELL LOG 07 1982 Wires properly protected (Y/N) YES Casing height (above ground) AT INSPECTION 3/24/2015 62 ft. Well production *50 g.p.m. 7.0+ g p m. WATER SAMPLE RESULTS: Y Coliform 0 colonies/100 ml. Nitrate 04 k ¥ng./L. Collected by: GEG. Ltd. Arsenic: N 0 ug./L. Date of sample: 3/24/2015 B. SEPTIC/HOLDING TANK DATA Tank Type/Material HOLDING/STEEL Tank size 3000 gal Number of Compartments V Cleanouts (YIN) rcw Data installed 12+ in. 9/17/2004 YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES Date of pumping 1/25/2015 Pumper AROUND THE CLOCK PUMPING C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2or ft2/bdrm) _ System type Length ft. Width ft. Gravel below .i.= ft. Total depth ft Eff. absorption area ft2 Monitoring tube Depression over field Date of adequacy test Results P- = -d) For bedrooms Fluid depth in absorption field before t- _ in Water added _gal New depth in Elapsed Time: Final fluid depth in Absorption rate >= g.p.d. venation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN "Pump on" level at in. "Pump off" level = High water alarm level at in Datu Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots Absorption field on lot N/A On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer /septic service line 25'+ Holding tank 751+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field N/A Water main N/A Water service line 10'+ Surface water 1001+ Wells on adjacent lots *75'+PVf & 1001+ CLASS C SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water service line Surface water - - ng/vehicle storage Curtain drain "ells on adjacent lots F. COMMENTS *SEE ATTACHED LETTER 100'+ G. ENGINEER'S CERTIFICATION 1 certify that 1 have detennined through field inspections and review of Municipal records that the above systems am in conformance with MOA COSA guidelines in effect on this date. Engineer's Printedamje JEFFREY A. GARNESS Date 110501/1/2( (Rev. 11/05) GARNESS ENGINEERING GROUP, Ltd z ,- CIVIL & ENVIRONMENTAL ENGINEERS i -,^_Y. «tnv, April 6, 2015 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 REFERENCE: US Survey 3042; Lot 94N 102.25' of E2 To whom it may concern: A site visit for a COSA was performed on US Survey 3042; Lot 94N 102.25' of E2. The testing has already been completed and the COSA paperwork is attached. The following is several comments regarding our findings: 1. It appears that pipe sleeves have been installed around the holding tank pipes (see attached photographs). We assume this was done to prevent frost jacking. We see no adverse impact associated with this. 2. Since our last inspection in 2008 a new home was constructed on US Survey 3042 Lot 94 Mid 102.25' of E2. We believe they are sharing a well with their neighbor to the south (US Survey 3042 lot 94 S 76' of E2): however we have no documentation to substantiate this. The well is located near the northwest corner of US Survey 3042 Lot 94 S 76' of E2. This well is over 100' from our clients holding tank. Per AWWU, the lot to the south is served by public sewer via treasure box mine road. 3. To the southwest of the holding tank, there were several isolated pockets of water (several feet in diameter) in areas that were dry in past inspections. The snow had just recently melted in this area, so we are attributing these wet areas due to snow melt. If you have any questions, please contact us at 337-6179. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com c Parcel I.D. 1. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 0145-t is -a - GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address cOSA# 05030 (� Expiration Date: %2../970$ USS 3042 L94 /{V / 0:2 , 25 / OG C2 263 HOTTENTOT MINE RD. * GIRDWOOD MATT & KATRA WEDEKING Day phone 263 HOTTENTOT MINE RD. *GIRDWOOD C/0 AGENT Day phone ERIN EKER w/DYNAMIC PROPERTIES Day phone 748-3493 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System • 2 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer • The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) 117 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 alt wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 2- bedrooms. Date Disapproved. Conditional approval for bedrooms, with the fllowing stipula`iorigN• iQ �( fr Y• • • • • Jam`.•ri- \ `• • 1°`: . ON-SITE WATER AND : • WASTEWATER : ' PROGRAM• ' Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory SEN `)) rr Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: g/Ci/OS Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST USS 3042 L94 // / 02:2-5 Parcel ID: 075-- 0q3-27 Legal Description: A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A g -7-$z Date completed -5-2-09 Sanitary seal (Y/N) YES Total depth WS ft. Cased to ft. Date of test Static water level §82' G a ft Well production WATER SAMPLE RESULTS: Coliform U colonies/100 ml. Nitrate NO mg./L. Arsenic'fug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Tank size 3000 gal Number of Compartments Foundation cleanout (Y/N) Y Depression over tank (Y/N) NO Date of pumping 8/6/08 Pumper FROM WELL LOG 5 27 90 2 07 IR8j D.- 50 50 g.p.m. Well Log (YIN) Y Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 8/14/08 C. ABSORPTION FIELD DATA Date installed Length ft Soil rating (g.p.d./ft2ort/bdrin Width ft. Total depth ft. Eff. absorption area Date of adequacy test Fluid depth in absorption field befor- -- _ in. ft2 Results Elapsed Time: 61 ft 8 g.p.m. Other bacteria U YES 12+ in. colonies/100 ml. Collected by: GEG Ltd. Date installed 9-17-04 Cleanouts (Y/N) YES High water alarm (Y/N) Y AROUND—THE—CLOCK Monitoring tub ail) Water added _gal. System type Gravel belo Final fluid depth _ in. uvenation treatment (past 12 mo.) (Y/N & type) Depression over field Absorption rate >= ft. For bedrooms New depth in. If yes, give date g.p.d. D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level Datu Cycles tested Manhole/Access (Y/N High water alarm level at in Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots 100'+ Absorption field on lot Public sewer main N/A N/A Sewer/septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank 75'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 75'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Absorption field Surface water Building foundation Water main Water service line Surface water Curtain d • Wells on adjacent lots F. COMMENTS 5'+ 100'+ Driveway, parking/vehicle storage G. ENGINEER'S CERTIFICATION 1 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 JEFFREY A. GARNESS Date 9/a/09 COSAFee$ ijU-J0 Date of Payment Receipt Number (Rev. 11/05) 1 -/as g8-Y.1ti Waiver Fee $ Date of Payment Receipt Number 94 O6„ 94 UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION CR FOR ESTABLISHING BOUNDARY OR FENCE UNES. THE SURVEYOR TAKES RESPONSIBGJTY FOR 1HE INITIAL TRANSACTION ONLY AND ASSJNES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. US7ED DISTANCES PREVAIL OVER SCALING REPRODUCTION MAY CAeic ERRORS IN SCALE: J Lm suer SURVEY TYPE 95 FOURSAIKN AS--/X/LT 2 FINAL STAJC1URS AS-BIALT 1J Hot PLAN . AS -BUILT ... LOT SANE! ... TOPOSIMPHY J 4S-FULT XO CRNPPS iT m EB.IIE . CPLO-cam T RO =swum on' 'LOT PLANS & LOT SURVEYS SIS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO 'CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE 0 FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE HE EXISTENCE OF ANY EASEMENT$ COVENANTS OR RESTRICTIONS NICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. SURVEY CEJRTIFlCATION SYMBOLS • SET SEEM TA DRAINAGE 0 FOUND FtEBAR W000 'EKE ® ASSUMED ELEV. K K % METAL FENCE 7 PUN my r"+e3 me: a e. FPo y ®....a M *own Int total M.q em the band m rsun. @ if the 1,! ens WMe-Vb- wet M ea .e ma Maim m w — Mirror. . an.e- NDATICN AS-RUILT MO 0 Me 14 mel Mel el the . . w we n _.TMererI 0 : ROK ERT w ww .re..rA...M urn. w `4 P 4 1 L STRUCTURE AS -KILT A% '`• o n. iws. ,, hanky {styIMI 1 '•® � '' ,, -7 . .a.mee . Para ..,.y a fir %4rev . ` ♦/ ea re Mit bl eed thee a MI Nmee ,rem Mn • ` PCO /esstonol L��®�/ :e.,.,Ile .a enamelware m®��l .® ADP OF q<. � As t {1 R NOTE: ONLY THOSE IMPROVEMENTS ABOVE GROUND AND NSSLE WILL BE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW WAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. Prepared by Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 844 E. 12 ME ANCHORAGE. ALASKA 411801 'api ASPHALT CONCRETE WOOD DECK -06-08 4912/5012 Letgd- Ceti -a: Lot 94 US Survey No. 3042 PTN T1ON R2E Section 19 W.O. 24312/8212 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 RUSH RUSH CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. J917 CJ -3g3-c 7 HAA# 1. GENERAL INFORMATION Complete legal description Expiration Date: USS 3042; LOT 94, PTN, -noht Ra Si° I q Location (site address or directions) NHN HOTTENTOT DRIVE * GIRDWOOD, AK. 99503-1719 Current Property owner(s) Mailing address 1611 ELMENDORF DRIVE * ANCHORAGE, AK. 99504 Lending agency Day phone Mailing address Real Estate Agent SAM DANIEL W/ NEXT HOME REAL ESTATE Day phone 783-1910 Mailing address JOE MORRISON Day phone 783-9158 1015 EAST 6TH AVENUE * ANCHORAGE, AK. 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 2 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer • The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my h d on procedures outlined in the Health Authority Approval Guidelines far this application, s� s -site water supply and/or wastewater disposal system is(are) safe, functionai ndade nate f6r ttnumfieMof Hedrooms and type of structure indicated herein. 1 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 warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Date ,)/z4 Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: (Rev. 12101) Manitenance Agreements Supplemental Engineer's Reort Other ✓ Original Certificate Date: 9 - 27- 0 ' Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: USS 3042; LOT 94, PTN Parcel ID: A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 5/25/1999 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 175 ft. Cased to 175 ft. Casing height (above ground) 32 in FROM WELL LOG AT INSPECTION Date of test 5/25/1999 8/6/2004 Static water level 58 ft. 59 ft. Well production 50 g.p m 4.1 g.p,m, WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0.1 mg./L. Other bacteria 0 colonies/100 mi. Arsenic N/A mg./L. Date of sample: 8/6/2004 Collected by: GEG, LtD. B. SEPTIC/HOLDING TANK DATA *HOLDING TANK Tank Type/Material STEEL Tank size *3000 gal. Number of Compartments 1 Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm' (Y/N) YES Date of pumping NEW Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2or ft2/bdrm)_ System type Length ft. Width ft. Gravel be . .ipe ft. Total depth ft. Eff. absorption area ft2 Monitoring t Depression over field Date of adequacy test Result . • s/Fail) For bedrooms Fluid depth in absorption field before -- in. Water added _gal. New depth in Elapsed Time' Final fluid depth in Absorption rate >= g.p.d. Date installed 9/17/2004 An venation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Ac "Pump on" level at in "Pump off" - _ _in. High water alarm level at in. Datu Cycles tested Meets alarm & circuit requirements'? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots Absorption field on lot N/A On adjacent lots Public sewer main 75'+ Public sewer manhole/cleanout 100'+ 100'+ 1 00'+ Sewer /septic service line 25'+ Holding tank 75'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field N/A Water main N/A Water service line 10'+ Surface water 1001+ Wells on adjacent lots 75'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water ma Water service line Surface - - Driveway, parking/vehicle storage Curtai Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name JL.FhKEY A. �AKNLSS Date 1 /270 ti HAA Fee $ Waiver Fee $ Date of Payment Receipt Number (Rev. 12/01) Date of Payment Receipt Number