HomeMy WebLinkAboutEMILY'S LT 1Emily's
Lot 1
#020-091-79
Tom Fink,
Mayor
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P O Bo~1:196650 Anchorage, Alaska 99519-6650
343-4744
May 18, 1993
Arthur H. & Martha W. Peck
761 High View Drive
Anchorage, Alaska 99515-3720
Subject: TllN R3W Section 3 Lot 4 NW¼ SW¼ PTN
Permit #SW920083, PID #020-091-75
The subject permit, issued May 18, 1992 by this office for
single family well and/or on-site wastewater system, has
expired as of May 18, 1993.
A new permit must be obtained from this office for a well
and/or on-site wastewater system NOT installed by 'the
expiration date.
If you have drilled the well, a well
this office for documentation of the
close the permit.
log must be sent to
installation and to
If a licensed Professional Engineer has inspected the
installation of the on-site wastewater system, the original
as-built inspection report must be sent to this office for
review, approval and documentation. All inspection reports
must be submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $200.00 for an
on-site wastewater permit; $75.00 for a well permit and
$275.00 for a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
~Y~p. ~E~sin erely,
~rogram Manager
On-site Services
enc: Copy of Permit
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 SYSTEM PERMIT
PERMIT NUMBER:SW920083
DESIGN ENGINEER:DUMMY COMPANY
OWNER NAME:PECK H ARTHUR &
OWNER ADDRESS:761 HIGHVIEW DRIVE
ANCHORAGE, ALASKA
99515
DATE ISSUED: 5/18/92
EXPIRATION DATE: 5/18/93
PARCEL ID:02009175
LEGAL DESCRIPTION: TllN R3W SEC 3 LT
4 PTN
4 NW4 SW
LOT SIZE: 10766 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
o
THE ATTACHED APPROVED DESIGN.
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
THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
1. THIS LOT MUST CONNECT TO PUBLIC SEWER.
2. SUBMIT WELL LOG WITHIN 30 DAYS OF COMPLETION OF WELL.
RECEIVED BY: ~/~Q~ ~---~ DATE:
DATE:
NOTE: THE PROPERTY IS SURROUNDED
BY UNDEVELOPED PROPERTY ON
THE SOUTHWEST SIDE OF THE
~\ ~ HIGHWAY.
X~X~ ~ ~ SOME DEVELOPMENT IS
OCCURING ON T~E NORTHEAST
SIDE OF THE HIGHWAY BEYOND
THE 100' PROTECTIVE WELL
RADIUS.
FO~ M~IN~
MAIN (PUBLIC)
; 25" 00" E 105.59' \
\
Wellkocation Plan
1" = 30'-0"
Faulkenberry PECK RESIDENCE
& Assoc. Legal Description: T12N R3W SEC 3, LOT 4
(907) 561-5499
to× (907) s~2-6379WELL LOCATION
WL-1
9206
5/14/~2
MUNICIP~ITY OF ANCHORAGE
MEMORANDUM
DATE:
May 9, 1991
TO: Gene Green, Manag~ Customer Service Division, AWWU
THRU: iDonald S. Alspac~lj lanager, Planning Division
J
Department of E~¢ lic Development and Planning
FROM: ¢~Tom Nelson, Land Ule Planning Supervisor
SUBJECT: Request for Sewer Hook-up to Property on Old Seward
Highway near Potter Marsh
The owner of Lot 4 NWl/4 SWl/4 portion, in TllN R3W Section 3, has
requested permission to extend a line from a gravity sewer trunk
that is located along the east side of the Old Seward Highway to
her lot located on the west side of the roadway. The lot is less
than 12,000 square feet in size. It was created from the vacation
of a portion of the roadway easement for the Old Seward Highway.
In order to receive sewer service, the lot must be within the sewer
service area as designated in the Hillside Wastewater Management
Plan. The boundary of the service area in this particular case is
the Old Seward Highway easement. We believe that this lot is on
the boundary, and as such, should be considered as being included
within the sewer service area.
I also reviewed this particular lot with officials from the
Department of Health and Human Services relative to its suitability
for an on-site wastewater disposal system. The lot is too small to
meet the requirements for having an on-site system. Additionally,
they also feel that public sewer is available along the length of
one side of the property (the roadway side). They believe the most
practical solution for providing wastewater disposal for the lot is
to tie into public sewer.
We believe that extending a sewer line to this lot is in keeping .
with the Hillside Wastewater Management Plan. It appears to be the
most practical and feasible way of providing a wastewater disposal
system for the property. The actual means of extending the sewer
line to the lot, however, will have to be resolved with AWWU and
the Alaska Department of Transportation and Public Facilities.
Gene Green, Manager,
May 9, 1991
Page 2
Customer Service Division, AWWU
Cathy Fickes, Anchorage Water and Wastewater Utility
Wayne Bennett, Anchorage Water and Wastewater Utility
John Smith, Department of Health and Human Services
Susan Oswalt, Department of Health and Human Services
Gloria' Bowman, Lot Owner
N
W I/4 Cor.,Sec.3
-, 6 60100~'
I
I
I
',-51-2-027-1 --
EAST ~ &66.57'
EAST - 303.20'
z o
I
~"¢ 82! ~L Streea, An. oho:age, AK.
, ~ ~ 264-4720
'. .................... ,Vd.L AND/OR ON-S~'rE SP,'¢E~4
_~: ._ o1: S''] Absorption SysLem
/
~ -~ ~- ~ i.,~. ,' II' ~ollt~,
[},?, ?..e:
/ _./el.._
POU~,H 6 650
ANGHOFaAGE, /\! /',SK.,', 905 )2 0650
(907) 2.64-4111
~Permit ~: 820410
~January 31, 1983
TO: Permit Applicant
Subject: Ti~N R3W Section 3 Lot 4
A permit issued by this department for an individual well
and/or on-site sewer system has expired as of December 31,
1982.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log needs to be sent
to this department for documentation of the installation
date and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, please have them send us the as-builts
for our files and documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerel~
Robert C. Pratt, R.S.
Acting Program Manager
Sewer and Water Program
RCP/ljw
enc: Copy of Permit
SWP/057
Permit
Applicant:
Location:
MUNICIPALITY OF ANCHORAGE
Department/~ Health and Environmenta~rotection__
825 ~ Street, Anchorage, AK. ~9501 ' ~/~-
264-4720
* * * HANDWRITTEN PERMIT * * *
WELL AND/OR ON-SITE SEWER PERMIT
~/~,, Mailing Address:
Phone Number:
Legal Description: ~N ~
Type of Soil Absorption System Is:
Trench: Drainfield: ~
Maximum Number of Bedrooms: ~
The Required Size of
DEPTH ' .LENGTH ~ ~
Seepage BeG: H01dingX"~ankk:
soil Rating(sq.ft/br) ;~
the Soil Absorption System Is:
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) TANK SIZE = ~'-0 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 prosecutionzl~r ~0~2 ~/~,
Minimum distance between a welland any on-site sewage ~isposal 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 com~nunity sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the welt completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 3L 1 9 8 2 * * *
(!) I am familiar with the requirements or on-si e 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 en~a~ement if
the residence is remodeled to include more tha~/3bedrgo~. /
~cant ' '
Date:
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
PERFORMED FOR:
LEGAL DESCRIPTION:
SOILS LOG'
[] PERCOLATION
TEST
DATE PERFORMED:
Iq
SLOPE SITE PLAN
1
2
3
4
5
6
7
8-
9-
10-
11
13-
14-
15-
16-
17
18
19
2O
WAS GROUND WATER
ENCOUNTERED? ,/~'/~ ~
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
COMMENTS
PERFORMED BY: ,/~ & C
72-008 (6/79)
TEST RUN BETWEEN FT AND FT
ALASKA 6FIUIROFImenTAL CONTROL SE!RUICeS,
SPECIFICATIONS FOR ELEVATED BED ALTERNATIVE WASTEWATER
TREATMENT SYSTEM- LOT 4/SEC 3/T llN/R 3W/SM
1.0 GENERAL
1.1 THE DRAWINGS, SHEETS 1 THRU 2, SHALL BE A PART OF THIS
SPECIFICATION.
1.2 ALL MATERIALS AND WORKMANSHIP SHALL MEET THE
REQUIREMENTS OF ANCHORAGE DEPARTMENT OF HEALTH AND
ENVIRONMENTAL PROTECTION PERMIT.
1.3 ALL EXCAVATIONS AND DEPTHS ARE ADVISORY AND ARE TO BE
VERIFIED OR MODIFIED IN THE FIELD BY THE ENGINEER.
1.4 IT IS THE RESPONSIBILITY OF THE OWNER TO OBTAIN ALL
NECESSARY PERMITS OR EASEMENTS.
2.0 THE LIFT STATION
2.1 THE STOCK MATERIAL FOR THE LIFT STATION SHALL BE EITHER
GALVANIZED STEEL (ASTM A-4444-76), OR ALUMINUM CULVERT,.
CAPABLE OF BURIAL TO 10 FT.
2.2 THE 24" PIPE FOR THE LIFT STATION SHALL HAVE A WELDED
WATER TIGHT BOTTOM OF THE SAME THICKNESS AND
COMPOSITION AS THE CULVERT.
2.3 ALL PENETRATIONS OF THE LIFT STATION SHALL BE WELDED
AND WATER TIGHT. ALL WELDS SHALL BE CLEANED OF SLAG.
WELDS ON GALVANIZED STEEL WILL BE SPRAYED WITH ZINC
RICH PAINT OR COATED WITH BITUMASTIC. THE BOTTOM 2' OF
THE INTERIOR SHALL BE COATED WITH BITUMASTIC PAINT.
2.4 THE TOP CAP SHALL BE RAIN TIGHT AND SECURELY FASTENED
WITH SCREWS.
2.5 ALL ELECTRICAL FITTINGS AND CONNECTIONS IN THE LIFT
STATION SHALL MEET THE REQUIREMENTS FOR A WATER TIGHT
SERVICE.
2.6 THERE SHALL BE A HIGH LEVEL ALARM SET AT THE LEVEL OF
THE SOIL PIPE FROM THE SEPTIC TANK. THE BUZZER SHALL
BE LOCATED NEAR THE ELECTRICAL CONTROL PANEL OR IN A
LOCATION DESIGNATED BY THE HOMEOWNER.
2.7 THE'SUMP PUMP SHALL BE CAPABLE OF DELIVERING 10 GPM AT
A HEAD OF 20 FEET.
2.8 THE SUMP PUMP SHALL BE SUSPENDED NOT LESS THAN 6 INCHES
OFF THE BOTTOM OF THE LIFT STATION WITH A CHAIN OR
NYLON LINE.
3.0 SHALLOW TRENCH
3.1 THE GRAVEL FOR THE TRENCH SHALL BE SCREENED TO THE
SIZES INDICATED.
3.2 THE BOTTOM OF THE EXCAVATION SHALL BE RAKED WITH THE
BACKHOE BLADE TO INSURE THAT THE BOTTOM HAS NOT BEEN
COMPACTED DURING EXCAVATION. THE BOTTOM ELEVATION SHALL
BE PLUS OR MINUS 2".
3.3 IF INSULATION IS REQUIRED THE INSULATION SHALL BE DOW
EXTRUDED BLUE STYROFOAM INSUI~TION BOARD OF THE
THICKNESS SHOWN ON THE DRAWINGS.
3.4 THE SEPTIC TANK OR TRENCH MUST NOT BE CLOSER THAN 100
FEET FROM THE CREEK.
3.5 THE SEPTIC TANK OR TRENCH MUST NOT BE CLOSER THAN 100
FEET FROM THE WELL.
INC.
1220 UJcs! 25th Au~nu~ · Ancimro% 99503 · (907) 270-1361
ALASKA ENVIRONMENTAL
CONTROL SERVlCE~'-~IC.
1220 West 25th Aven~
ANCHORAGE, ALASKA 99503
Phone 276-1361
CHECKED BY DATE
SCALF
Z
,ALASKA ENVIRONNI~U~,TAL
CONTROL SERVICEL NC.
1220 West 25th Avenue
ANCHORAGE, ALASKA 99503
Phone 276-1361
i, URETHANE FOAM
BELOW GROUND
2, COAT BOTTOM 2
3, USE
4, SEE
SHOLJLD
SURPACE A'I A TtlICI41",IE$S OF
FEET INSIDE WITtl ~FITUMASTIC
#
11/4 OR 11~'FLEXIBLr.. HOSE FO FIT PUMP.
SPECIFICATIONS FO~ PiATERI/,LS.
NOTES
INCH,
PAINT
LIFT ST&T IOl, I
S CRE\"/S 7,]1
GROUND .........
HEIMA 4 BOX-4,
FILLET WELD .- ?1//
CHAIN OR NYLON ROPE
PUMP POWF R CORD '
/~L_ARM CORD
STEEL NIPPL E--~
F L[_ET WELD ~ ~ ~,~
ALL AROUND
PIPE .....
,~ METAL PLATE ..... '- 24
/_M, ETAL CAP WITH'
2'URETHANE F(]~R
.FILLET. WELD.
AROL.IND
~*TO 4" COUPLING
NIPPLE:
----1 ¼ FLEX HOSE 7
]¼"c,Ec vALVE
SUMP PUMP .
PERCOLATION TEST
TABLE I
JIM ARNESAN
R&M NO. 85113
TIME
ELAPSED TI~
FEET
DROP IN INCHES
12:30
12:31
12:32
12:33
12:34
12:35
12:36
12:37
12:38
12:39
12:40
12:45
12:50
12:55
1:00
1:10
1:20
1:30
1
2
3
4
5
6
7
8
9
10
15
2O
25
3O
4O
5O
60
3.75
3.75
3.75
3.75
3.8
3.8
3.8
3.85
.3.85
3.85
3.9
3.95
4.0
4.05
4.1
4.2
4.3
4.4
0
0
0
0.6
0
0
0.6
0
0
0.6
0.6
0.6
0.6
0°6
1.2
1.2
1.2
7.8 Inches Total Drop
7.7 Minutes Per Inch
¸jr
BORING NUMBER
Dote Completed: 7-26-78
SOIL DESCRIPTION
ORGANIC I.~TERIAL
Dark Brown, Slightly ~ist,
Soft 3.5'
SANDY SILT W/TRACE
GP~XVEL AND CLAY (SM-~tL)
Occasional cobbles
Gray to Brown, slightly Moist to
Dry, Dense
12.0'
SILTY GRAVEL (GM)
Gray, slightly F~ist, Very
Dense 15.0' T.
Refusal on Boulder
No Water Table Encountered
LOCATION
SKETCH
T.H. ~1 35'
70' Lot 3
No Scale
NOTE; DISTANCES SHOWN ARE APPROXIMATE AND HAVE
EXPLANATION
ORGANIC MATERIAL
Little Visible Ice O-I0' ~x
(~Ss,72,57.1% ,85.9pcf
BEDROCK
TYPICAL SOILS LO~"~ J Aa-,4£TERBORING
SAMPLER TYPE SYMBOLS L
BOULDERS
SOIL ~
GRID.
..o. 85133
MUNICIPALITY OF ANCHORAGE
Development Services Department p p Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 020-091-79
Legal description EMILY'S LT 1
Site address 16750 Old Seward Hwy Anchorage
Current property owner(s) Troy and Kari Fritzel
Expiration Date: 1/3/2023
X The On-site system(s) is/are approved for 5 bedrooms
Conditional approval for
Comments or advisories:
bedrooms, with the following stipulations:
Original Certificate Date: 10/3/2022
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
MUNICIPALITY 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. 020-091-79
Complete legal description EmllyS, Lot 1
Location (site address) 16750 Old Seward Hwy, Anchorage, AK 99516
Current property owner(s) Troy & Karl FrltZel Day phone (907) 575-5333
2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS
3. TYPE OF WATER SUPPLY: ❑■ 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 X Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass
Age - See advisory if steel older than 20 years
S. 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 $ 4 a g o Waiver Fee $
Date of Payment q� i�iJa Date of Payment
COSA # Waiver #
COSA Application—June 2022
COSA Checklist_June 2022
COSA Checklist
Legal Description: Parcel ID:
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 Total depth ft
Cased to ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test ft.
Well production at time of test gpm
Water storage tank volume gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by
Date
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
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 more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months)
If yes, enter date
Adequacy test date
Results Pass
Fluid depth prior to test in
Water added gal
New fluid depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) in
Effective depth used in
Effective depth remaining in
Comments/Deficiencies:
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'
❑ Yes
if No
Community Sewer Manhole/Cleanout > 100'
Fol Yes
if No
ft
5-1 Yes
if No ft
Neighboring Tank > 100' Fol Yes
if No
ft
Private Sewer/Septic Line > 25' R Yes
if No ft
Absorption Field on Lot > 100' F±] Yes
if No
ft
Holding Tank > 100' DYes
if No ft
Neighboring Absorption Fields > 100'
Water Service Line > 10'
❑ Yes
Animal Containment > 50' FMJ Yes
if No ft
oo Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' Yes
if No
ft
Q Yes
if No ft
❑ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No
NSA ft
Surface Water > 100' ❑ Yes if No NSA ft
Tank to Property Line > 5'
E] Yes
if No
NSA ft
Wells on Adjacent Lots:
Field to Property Line > 10'
❑ Yes
if No
NSA ft
Private Wells > 100' ❑ Yes if No NSA ft
Water Main > 10'
❑ Yes
if No
NSA ft
Community Wells > 200' ❑ Yes if No NSA ft
Water Service Line > 10'
❑ Yes
if No
NSA ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
Well pumped down to 158' and monitored. Over the next hour the water rose
to 96', for a total rise of 62' or 91 gallons.
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 Forge Engineering
Engineer's Printed Name Benjamin Schiller, P. E.
COSA Checklist—June 2022
Phone (907) 522-7773
Date 9/15/22
Ale
Benjarri chiller
CE 12592
���� PROFESSIONA
Municipality of Anchorage
' Development Services Department
Building Safety Division
On -Site Water S Wastewater Program
4700 Bragaw Street
P.O. Box 196650
a Anchorage, AK 99519-6650
<7 www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 0.�6 -ogi - 7cl COSA# wossl
1. GENERAL INFORMATION Expiration Date: I —a 52 07
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
EMILY'S SUBDIVISION: LOT 1
16750 OLD SEWARD HIGHWAY • ANCHORAGE. AK 99516
LAVERNE DAVIDHIZR Da phone c o AGENT
CY
fJL¢ h-k1a0.
)1. —loan. PNL Uto
Day phone
Real Estate Agent MIKE Mct ANF w/ PR tDF At ,t w Day phone 276-8507
Mailing address 3801 CENTERPOINT DR. X200 • ANCHORAGE. K 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 6
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
0
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, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineers Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, Lt D. 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 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
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 (0 bedrooms.
Disapproved.
Phone 337-6179
Date to l�3/0('
Conditional approval for bedrooms, with the allowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
A. Gorness:
Pro f essio^°6o
40000��� i O Firf(rrr1r/((
�� � • ON-SITE •••yPNO
R,:
��.:• WASTEW MR
• VROGRA
I)
By: 0=lze Li✓• C Original Certificate Date: 5' O
M. 11I i
Municipality of Anchorage
• Development Services Department
SuiWing Safety Division `
On -Sits Water & Wastewater Program
4700 Bragew Street
P.O. Boot 196650
Anchorage, AK 995196850
www.muni.orglonsite
(907)343.7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: EMILYS SUBDIVISION, LOT i Parcel ID: 0 -011-71
A WELL DATA 0500 GALLONS OF STORAGE IN HOUSE
Well type SATE H A, 8, or C provide PWSID# N/A Well Log (YM) YES
Date completed 5/22/1992 Sanitary seat (YM)YES Wires property protected (YIN) YES
Total depth 350 ft. Cased to 43.5 ft. Casing height (above ground) 12+ in.
FROM WELL LOG
Data of test 5/27/1992
Static water level 19 ft.
Well production 0.875 O.P.M.
AT INSPECTION
10/11/2006
40 ft.
•0.99 G.P.M.
WATER SAMPLE RESULTS:
ColUom 0 colonies/100 ml. Nitrate SDL-mgJL. Other bacteria _Q_coloNW100 ml.
Arsenic: _a_ugA. Date of sample: 10/10/200 Collected by: GEG. Ltd.
S. SEPTIGIMOLDING TANK DATA PUBLIC SEWER
Tank TyperWterial
Tank sirs gal.
Foundation deanout (YIN)
Date Installed
Number of Compartments
(YM) _ High water alarm (YM)
C. A8SORPTIONFIELDDATA PUBLIC SEWER
Date installed Soil rating (g.p.dJftV ftlbdrm)_ System type
Length ft. Width
Gravel
Total depth ft. Eft. absorption area _ ft' Mo791 o Depression over fieldDate of adequacy test Resultss For bedrooms
Fluid depth in absorption field before ! in. Water added —gal. Now depth —in.
Elapsed Tune: Final fluid depth _ In. Absorption rate g p.d.
treatment (past 12 mo.) (YM & type) If yes, give date
D. UFT STATION
Date installed
"Pump on" level at _in.
Size in gallons
Ii
High water alar level at
Datum Cycles tested Meets alar 6 circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot N/A On adjacent lots 100'+
Absorption field on lot N/A
Public sewer main 75'+
Sewer /septic service line 25'+
On adjacent lots 100'+
Public sewer manhdeldeanout 100'+
Holding tank N/A
Animal containment areas 500+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER
Building foundation
Water main
Property line
Water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line
Water service line
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Absorption field
Building foundation Water
Surface
Wells on adjacent lots
I cer* that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance wAh MOA COSH guidelines kr effed on this
date.
Engineer's Printed Name JEFFREY A. WNESS
Date 10123 /ab
COSA Fees 1-1� h of? U U
Date of Payment I U I y�C74
Receipt Number
(Rev. 1145)
Waiver Fee S
water
PUBLIC SEWER
parkinglveWe storage
Date of Payment
Receipt Number
SGS Reta
1066149001
Client Name
Ganness Engineering Group, Ltd.
Project lame/#
Lot I Emilys SD
Client Sample ID
Lot I E•milys SD
Matrix
Drinking Water
Sample Remarks:
All Dates rimes are Alaska Standard Time
Printed Date rime
10120/2006 10:09
Collected Date rime
10/1012006 14:38
Received Date rime
10/10/2006 15:10
Technical Director
Stephen C. Ede
Alloxablc Prep Analysis
Parameter Results PQL Units Method Container ID Limits Date Date but
Metals by ICP/MS
Arsenic ND 5.00 u8/L EP200.8 C (<10) 10/16/06 10120/06 WAW
Waters Department
Nitrate -N ND 0.100
Microbiology Laboratory
Total Coliform 0
mg/L EPA 353.2 0 (<10) 10/11/06 XZ
col/IOOmL SN1209222B A (<I) 10/10/06 DPT
12 .1·
AS-BUILT
~Al.DI LAND
SURVEY I NG , LLC
JEFF A. ~ALDI, R.LS .
2000 E. OOWUNG RD .. SUITE 8
ANCHORAGE, ALASKA 99507
PHONE 248-5~5~
GRID DATE
SWJJJ6 B/J0/2022
F.8. JOB NO .
10-08 LOT 1ES
PLAT NO. 94-51
EMILY'S SUBDIVISION
LOT 1
\
\
I~
DRAINAGE ESMT.
\
\
\ CONC. DRIVE \
18.7'
\
\
12,473 S.F.
\
\ \
,i,'.!\'.;.',,o,_,.,,,,.. \
shown on this record drawing \
(as-built) complies with Title 21 , AMC •
8~--0'.),0Mooldamhin \ Dale 'il 3 0 [P-@
I{ S-\)w,'l\4rt m ~
CONC . DRIVE
\
\ L.L...J=~a!d,,bd,!,,,~~=-L_!. _____
N go•oo ·oo"E , , , . , e·
I HERESY CERTIFY 'THAT I HAVE SUR\IEYED lHE
PROPER'IY DEPICTED ABOVE AND 'THAT NO
ENCROACHMENTS EXIST EXCEPT N3 INDICATED.
rT IS lHE RESPONSIBILITY OF lHE OWNER TO
DETERMINE lHE EXISTENCE OF ANY EN3EMENTS,
COVENANrs OR RESmlCTIONS WHICH DO NOT
APPEAR ON lHE RECORDED SUBDMSION PLAT.
UNDER NO CIRCUMSTANCES SHOULD ANY DATA
HEREON BE USED FOR CONSTRUCTION OR FOR
ESTABLISHING BOUNDARY OR FENCE LINES .
ANCHORAGE RECORDING DIS'TRICT, ALASKA
NOTE: NO CORNERS SET THIS DATE.
..........
OF 4, '\v ....... ~4
•• A..."?-_.···· ..LL:··. '5'1-
: "':" 49Itl '/J{ -...~ ... ····················~ . .... ···············• .. " •• Je lle ry A. Gas 1aldl : : • ~-•• LS-609 1 : t,
• ~-;.,.l"•· ••• 8/J0/202: •• -··":)_§ ..••
• q,o •••••••• • ,..o ,",,1 anol \.ot' ••••••••
b
n
N
W
J
a.
CL
W
a
',a6ar
X&/f//
NOl"! r The pial of /of 1, r-Mi/y �Y gell) 'ivi:sior�,
Case S- 92')% s• hee-n alrbrrlfv
the MOA l>r rr°rDrdll7�.
t%`
i hereby certify that an accurate survey of the
p F -44 t ` following described properly:
••'• `•. "� �w EMIL KV SUB.
�r ♦c ��
49th
was made on_._-__ , and that the 'Improve-
ments situated thereon are within the propertylines and do not
4: overlap or encroach on the property lying adjacent thereto
F, UE RhAA UNJ OFF Ihot no improvements on the property lying ad acent thereto
LP ' leo. 3143•$ : � encroach on the premises In quastlon and that There are no
,• Q roadways, transmission lines or other visible easements on
n9�.„ •,.,��.,o• 5a/ said property except as Indicated hereon. '
Aachoroge, Alaska, this_ day of Ii/%ArG _,19 94
PREPARED I -OR:
James D0k00LI
AS -:BUILT
DWN. DATE GRID
GR 3 /�{ 94 333a
0403 Pg. 4±---A 9239
KARABEL NIKOFF
SURVEYING ,"7-3454
Municipality of Anchorage
• ''` Development Services Department
j Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
Water Well Advisory
Health Authority Approval # 060531
During a recent Health Authority Approval on-site inspection and test of the
potable water supply well on Block , Lot 1 of Emily's subdivision, the
well's productivity was determined to be 0.99 gallons per minute. The
minimum well productivity required by this Department (AMC 15.55) for a
6 -bedroom residence is 0.62 gallons per minute. Although the subject well
currently exceeds this minimum requirement, all parties concerned are
advised that the production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering lawns and
gardens may be required.
This advisory must be attached to all copies of the subject Health Authority
Approval.
• " Municipality of Anchorage
• Development Services Department
Building Safety Division
Onsite Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519.6650
www.d.anchorage sk us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING p
Parcel I.D. 020-091-79 HAA# V y!
1. GENERAL INFORMATION
Expiration Date:
Complete legal description EMILY'S SUBOMSION: LOT 1
Location (site address or directions)
16750
OLD SEWARD
HIGHWAY
Individual Water Storage
Individual Holding tank
Current Property owner(s) CURTIS
& NAOMI
ELTON
Day phone 345-2011
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
16750 OLD SEWARD HIGHWAY ANCHORACE AK 99516
Dayphone 276-2761
REMAx PROPERTIES/CAROL BUTLER Day phone
2600 CORDOVA ANCHORAGE, AK 99518
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 6
3. TYPE OF WATER SUPPLY:
276-2761
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
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 Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 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 sample results less than 30 days old. (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.
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $600.00 at, or prior
to closing for the engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, l verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines forthis application,
shows that the on-site water supply and/or wastewater disposal system fs(are) safe, functional and adequate
for the number of bedrooms and type of structure Indicated herein. 1 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 is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD. SUITE 28 • ANCHORAGE. AK 99504
Engineer's Printed Name JEFFREY A. GARNESS. P.E.
Engineer's Comments:
In conducting this evaluation, AWWC, Inc. attempted to provide a thorough,
conscientious engineering anaWls of the system in accordance with ADEC and MOA
DSD Guidelines 8 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. AWWC, Inc. 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 G bedrooms.
Disapproved.
Conditional approval for bedrooms, with the tllowing
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Phone 337-6179
Date 'T DI
Manitenance Agreements
Supplemental Engineer's Reort
Other
Ilt
Oi
WAI
WASTEWATER
PROGRAM :
By; Original Certificate Date:
(Rev, 12 C0)
Municipality of Anchorage ,.
Development Services Department
JSullft Solely Divisionprogram .....
4700 South Bragew St.
P.O. Soot 198850 Anchorage, AK 995198850
vwvw.cIAnchorage.ak.ua
(907) 943.7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
EMILY'S SUBDIVISION; LOT 1
Parcel ID:
020-D91-79
A. WELL DATAII-POSITIVE
DRAINAGE ON ALL SIDES. COULD
SHOVEL TO CREATE
12" STICK-UP.
Well type PRIVATE
If A, 8, or C provide PWSID# N/A
Well Log (YIN)
YES
Date completed 5/22/1992 Sanitary seal (YM) YES
Total depth 350 fL Cased to 43.5 ft.
FROM WELL LOG
Data of test 5/27/1992
Static water level 19 ft.
Well production .875 —
9 -p.m -WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi. Nitrate 0.5 mgA.
Wires properly protected (Y/N) YES
1a
Casing height (above ground) 10 In.
AT INSPECTION
8/16/2001
41
000.52 g.p.m.
••500 GALLONS OF
T RAG INRSIDENCEJ
Other bacteria 0 colonies/100 ml.
Date of sample:
8/16/2001 Collected by: AWWC. INC.
B. SEPTIC/HOLDINGTANKDATA PUBLIC SEWER
Tank Type/Material
Tank size gal.
Foundation deanout�(YM) _
Diaa of�u nmpl 9
c. ABSORPTION FIELD DATA
Date installed
Length 1L
Number of Compartments
over tank (YIN) —
Pumper
Soil rating (g•p.dJfeor fe/bdrm)—
Width
Date installed
(Y/N)
High water alarm (YIN)
System type
pipe ft.
Total depth ft. Eft. absorptlon area_ ft' Monito Depression over field
Date of adequacy test R ass/Fail) For bedrooms
Fluid depth In absorption field st t—In. Water added _. gal. New depth —in.
ElapsedTime, —min. Final fluid depth — in. Absorption rate K g•p.d•
treatment (past 12 mo.) (YIN & type) If yes, give date
D. UFT STATION
Date installed Size in gallons Manhole/
"Pump on' level at _in. 'Pump o _ n. High water alarm level at
m.
Cycles tested Meets alarm & circuit requirements?.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot — On adjacent lots 100'+
Absorption field on lot — On adjacent lots 100'+
Public sewer main 75'+ Public sewer manhole/deanout 100'+
Sewer /septic service line 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation Property line on field
Water main vWce line Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line Building foundation Water ma
Water service line Surfs Driveway, parking/vehicle storage
Wells on adjacent lots
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and 4U-Grn..ess
review of Muniolpa/ records that the above systems are inconformance with MOA HAA guidelines in effect on this dateJEngineers Printed Nam JEFFREY A. GARNESS �A.�Date Gf30/ 0.��p_._.... �°°
HAA Fee $ R UD
Date of Payment Of 0/
Receipt Number nil b
(Rev. 12M)
Waiver Fee $
Date of Payment
Receipt Number
AUG -24-01 09:44 FROM-CT&E ENVIRONIENTAL SRV
CUE Environmental Services Inc.
Cr&EReLH
1015435001
Client Name
AK Water & Wastewater Consultants Inc.
Project Name/M
Lot 1 Etnilv's
Client Sample ID
16750 Old Seward Hwy
Alatria
Drinking Water
Ordered By
PWSID
0
Sample Remarks:
9075615301 T-304 P.01/03 F-163
Client PON
Printed Date/Time
Collected Date/rime
Received Datefrime
Techalcal Director
Released By A
08/23/2001 11:21
08/172001 7:59
081172001 10:25
Stephen C. EAde � ��
�FY�7�Y+'v�.��
Allowable Prep Analysis
Parameter Results PQL Units methm! Limits Date Date Init
Waters Department
Nitrate -N 0.500 U 0.500 mg/L EPA 300.0 (<10) 08/17/01 SCL
Microbiology Laboratory
Total Coliform 0 0 coV100mL 5M189222B (<1) 08/17/01 SKW
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
\
Parcel I.D. # _(�, - (� "1 1 - 1 rl HAA # '_-1
1. GENERAL INFORMATION
Complete legal description l nT l B tr 1,
Location (site address or directions) Ito i.7 G G 1, S -est
Property owner F L I O t`l . C C' (` k i S Day phone
Mailing address Ib -i O 61 Id �_IfVYcc'
Lending agency
Mailing address
Agent
Address
L.t_ H i
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: b
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
Day phone
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: 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 1121
5.
6.
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 l • S pu r Y ( � • G Phone 97 G - s �1 t k)
Address 97; L4 A- v., alC5 cVl
Engineer's signature S4 ���4--�, Date ,qb
DHHS SIGNATURE
—x Approved for �_ bedrooms.
Disapproved.
Conditional approval for
Additional Comments
y
bedrooms, with the following stipulations:
By: zav/�� ���7___
Date % - 3 / - c/g
CAUTION
The Mwiicipa- achorage Department of Health and Human Services (DHHS) issues Health { .,ihority
Approval Cei based only upon the representations given in paragraph 5 above by an ind� ,Fndent
professional < :r registered in the State of Alaska. The DHHS does this as a courtesyto purchasers homes
and their ie^ stitutions in orderto satisfy certain federal and state requirements. Employees of DHr:u 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.
72-025 (Rev. 1/91 ) Back MOA #21
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 • Anchorage, Alaska 99601 • (907) 343-4744
IJI1NtGtAI,gERVtCkS 0IVI31014
Health Authority Approval Checklist eN�lRo
,t :3�� 161996
Legal Description: z�.14 f o t�--1 !j ` _ Parcel I.D.: D
A. WELL DATA
RE'
Well type n If A, B, or C, attach ADEC letter.rrA''DEC water system number
Log present (Y/N) ` Date completed
11 t,l w
Total depth Cased to Casing height (above ground) 13
Sanitary seal (Y/N) ' Wires properly protected (YIN)
FROM WELL LOG AT INSPECTION
Date of test .I 71 i ip
Static water level J //
Well production a/ g.p.m, 6). /0610 9 -p -m,
WATER SAMPLE RESULTS:
Coliform / Nitrate U Other bacteria
Date of sample: n 7,olt �b Collected by: 7
B. SEPTIC/HOLDING TANK DATA Noy 1 F
Date installed Tank size Number of Compartments Cleanouts (Y/N)
Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N)
Date of Pumping Pumper
C. ABSORPTION FIELD DATA N ON
Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) System type
Length Width Gravel thickness below pipe Total depth
Effective absorption area Monitoring Tube present(Y/N) . Depression over field (YIN)
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test (in.); Immediately after_ gal. water added (in.):
Fluid depth (ins.) Minutes later: Absorption rate = ` g.p.d.
Peroxide treatment (past 12 months) (Y/N) If yes, give date
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
"Pump off' level at*
Septic/holding tank on lot Irl0 Vl 0- ; On adjacent lots N a til -0—
Absorption
2Absorption field on lot h VL I ; On adjacent lots ^ N O KA,
Public sewer main J no i" Public sewer manhole/cleanout 7 /o -o
Sewer /septic service line 2! 95 Lift station No n.P
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation Property line Absorption field
Water main/service line Surface water/drainage Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Surface water
Curtain drain
F. ENGINEER'S CERTIFICATION
Water main/service line
y��
Driveway, parking/vehicle storage area
Wells on adjacent lots
Property line
I certify that 1 have determined thru field inspections and review of Municipal records• 1flaot the abov sys`tieyns are
in conformance with MOA HAA guidelines in effect on this date.
�; '•- ` '
Signature
"
En ineer's Name -
g
,I J
1 . �.
S ued'ring 9adl fele
Date_
HAA Fee $ e O -D , elD Waiver Fee $ _
Date of Payment % La A/ Date of Payment
Receipt Number ��C- l 0� % / Receipt Number
Rev. 8/95 OSS: haa.wk.doc
0
M
N
w
8
0 8�
WELL '
LOCATI�N
L..—..
PROPERTY
Site Plan
to".
\ NUO
1C" . .
5 26' 25' 00" E
0 4
�J UI6' . I'•0'
Lo 7L
�V\
103.39'
`3 2 QCT 1 1992
o
:U \, \♦ \
\ ARPROXI ATE sod,-
\� oF� 4uA 0 ` \
\ ♦ ♦ �� ♦ \
9Q
S \
\ ♦ ♦ 'Cy ♦ C
5D FEEr
o0
?
SEP- 1-95 FRI 8:37 KLEBS MECHANICAL INC 9073443935 P.01
✓L Martha Peck
Well Log
,%[asks Now-Well/Vern s Drlllling
12241 Avlon
Anchorage. Alaska 99516
(907) 345-4417
AA 27
Borough ISubdIvIslonlLot I Block jSecLIonNolTownshIp
chorage I Potter Marsh Area
1N R3W SEC 3 Lj 4 NW4 %W 4 PTN
:II Log Ft. Below Surface
Material Type Top Bottom
I till, loam
0
1
[vel in sill
1
8
L & clay,. gray -black
8
26
:k
26
28
Ly cls w/ ravel
28
38
composed rock, gray -block w/ brown suet
30
42
Brock, gray -black w/seeps a on top
42
50
drock, liht ra , seams of white rock
50
ep 0 50'
65
drock, black, Increase In seepage
65
75
drock, conglomerate
75
220
10' 1/4 qpm
?0' 1/2 gpm
:drock, gray -black w/[race of reenstone
220
230
:drock, conglomerate
230
300
!drock, gray -black w/seams of white rock
300
350
-oak 0 307"
10' 7/0 p m
E
Nnchora e
ith & Human
T
(4\
n Q 3t.la %ac 3
SW920083
Well Depth Vt)
350
Drilling Method
roter
Date of Completion
5/22/92
Use
Class C '�
,'� x��
Casing Type
welded
Diameter (in.) Depth (ft.) Weight (lbs/ft)
61 to 43' 6"
to
Finish of Weil
Type Diameter
open hole
Static Walter Level
Level (ft.) Date
19' Top of Casing 1 5/27/92
Pumping Level
Below T of C (ft.) After (hrs) Pumping (.p.m)
C�
Grouting
YNo xMaterial
—
Pump
H.P. Capacity T pa
submersible
Setting (ft)
Remarks
well flow may Improve with pumping
rock very firm from 42' down
496 gallons of water store a In well 0 19' static
was drilled under my Jurisdiction and this report Is true to the best of my knowledge and belier.
kuthorized Representative Date
lernonn 1 Nowell a In 5/27/921 1
MUNICIPALITY OF ANCHORAGE
M E M O R A N D U M
WATER WELL ADVISORY
HEALTH AUTHORITY APPROVAL NO. iA 1G
During a recent Health Authority Approval on-site inspection
and test of the potable water supply well on Lot _ /
Block--/ of r/`f/j j1's Subdivision, the well's
productivity was determined to be ,66 gallons per minute.
The minimum well productivity required by this Department
(AMC 15.55) for a bedroom residence is .63 gallons
per minute. Although the subject well currently exceeds this
minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering
lawns and gardens may be required.
This advisory must be attached to all copies of the subject
Health Authority Approval.
T.SPURKLAND P.E.
WEST 15TH. AVENUE SUITE 203
ANCHORAGE, ALASKA 99502-3904
(907)279-3916
Fax (907)-276-6013
RESIDENTIAL WELL INSPECTION
LEGAL: Lot 1, Block 1 Emily S/D
LOCATION: 16750 Old Seward Highway
OWNER: Curtis Elton
TYPE OF WELL: Private, Single Family 6 bedrooms 7
WELL LOG AVAILABLE: Yes 1
INSTALLATION REQUIREMENTS MET: Yes <'
WAIVERS GRANTED: None Required
WELL YIELD FROM WELL LOG: Gallons per Minute
WELL YIELD FROM TEST: 0.666 Gallons per Minute
DATE OF INSPECTION: July 1, 1996
TEST PROCEDURE: Well was pumped at a constant rate while the drawdown was monitored with an acoustic
probe. At the beginning of the test water level was found at 75 feet below top of casing. At a pumping rate of 5 gallons
per minute the water level dropped to 337 feet. At that level the pump shut off. A total of 460 gallons were pumped.
During the next 60 minutes the well recovered to 317 feet. The pump automatically started during this period and
dropped the water level from 328 to 335. During the 60 minutes 40 gallons flowed into the well (( 335 - 328 + 337 -
317) x 1.5) giving an average recharge of 40/60 = 2/3 gallons per minute.
TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli and total nitrogen on
E.Coli 0. Other Bacteria 0 Total Nitrogen NONE DETECTED.
Max. allowable Total Nitrogen 10 mg/1.
No Bacteria Allowed
TEST RESULTS: This well meets the requirements of the Municipality of Anchorage.
The Municipal requirement for well flow is 150 gallons of water per bedroom per day. This well exceed this
requirement. The assessment of the condition of the well applies only to the conditions as of the day tested. The flow
rate may change due to subsurface conditions that may not be observed from the surface, and changes in the land use
and other factors that may impact the aquifer feeding the well.
911 Owner _
t & Martha Peck
nun UMV
,.looks Now-Well/Vern's Willing
12241 Avlon
Anchorage. Alaska 99516
(907)345-4417
AA3327
cation or well rcra n-ow7wvuv
Borough Subdlvlslon Lot Block Section No Township N Ran e E Merdlan
1N R3W SEC 3 LT 4 NW4 SW
all Log
Material Type
4 PTN
Ft. Below Surface
Top Bottom
n till, loam
01
1
avel In silt
1
8
L & clay, gray -black
8
26
ck
26
28
Ly cls w/ ravel
28
38
composed rock, gray -black w/ brown strei
38
42
drock, gray -black w/seeps a on top
42
50
drock, it hL- ra , seams of white rock
50
ep 0 50'
65
drock, black, increase In seepage
65
75
drock, conglomerate
75
220
10' 1/4 gpm
10' 1/2 gpm
drock, gray -black w/trace of greensLone
220
230
drock, conglomerate
230
300
drock, ray -black w/seams of white rock
300
350
oak O 307'
0' 7/8 p m
is well was
Well Depth (ft) Date of Completion
_350 5/22/92
DO ng Method Use
LI otor -� Class C
Casing Type
welded`
Diameter (In.) Depth (ft.) i Weight (Ibs/ro
61 to ' 1436*
Finish or Well
Type �Diameter-��
openhole
Static Water Level
Level (ft.) Date
19' Top of Casing 5/27/92
Pumping Level
Below T of C (ft.) After (hrs) Pumpin_ 4_(q p,m)
Grouting
Yes Material
No x
Pump
H.P. Capacity Type
submersible
Setting (ft)
Remarks
well flow may Improve with pumping
rock very firm from 42' down
496 gallons of water storage in well a 19' static
ed under my Jurisdiction and this report is true to the best of my knowledge and boiler.
Lhorized Representative Date _
rnoo 1/.. Nowell 1517 ,A 5/27/92
ME Environmental Services Inc.
Laboratory Division
Laboratory Analysis Report
CT&E Ref.# 962661.962661002 Collected Date 07/01/96
Client Sample ID 16750 Old Seward
Matrix Drinking Water Technical Director: Stephen C. Ede
PWSID 0 Released By o
Sample Remarks:
Parameter
Nitrate -N
Total Coliform
Results QC PQL Units Method Allowable Prep Analysis Init
Qual Limits Date Date _
0.100 U 0.100 mg/L EPA 353.2 07/02/96 ESC
0 0 col/100mL SM18 92228 07/01/96 TAV
U - Undetected
LT - Less than
GT - Greater than
D - Secondary Dilution
J - Below the calibration range
r;
v
n
200 W. Potter Drive, Anchorage, AK 99518-1605 — Tel: (907) 562-2343 Fax: (907) 561-5301
3180 Peger Road, Fairbanks, AK 99709-5471 — Tel: (907) 474-8656 Fax: (907) 474-9685
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA
o-- �
r- Clf 6NA NN
IV NW
Lai
r.
A;.
rn
r
61
o s
All
S1'
PP
61
o s