HomeMy WebLinkAboutFASSLER LT 2Lot 2
#051-531
Municipality o f Anchorage Page 1
Department of Health and Human Services
Division of Environmental Se~ices
On-Site Sewices Section 825 'L' Street Room 502
P.O. Box 19~o650 Anchorage. AK 99519-6650
www.cLanc~homge.ak.us (907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM ANDIOR WELL INSPECTION REPORT '
Permit Number:. SW010083 PID Number: 051-531-33
MM&M Contracting Wastewater System: New
P.O. Box 670495 Chugiak~ AK 99567 ABSORPTION FIELD
a,o~.: ~k.~, ,~ e.,a ~..~ Deep Trench'
688-1236 Three (3)
LEGAL DESCRIPTION 1.2
2 Fassler Subdivision 2.0
1.5
Well: New
Private 175 F,. 174 . 432 ~ ASTM D3034 PVC
Sullivan Water Wells 6/20/2001 144,~ MM&M Contractinl~ 4/11-12/01
7v"'": mu I-s"'F,. ic,.~, ,.,~,~.. c..,,,~:>2 ~ TANK
SEPARATION DISTANCES E3 Septic I"1 Holding n S.T.E.P. n Other:.
Septic Absorption lift Holding ,ublic/Pm~te
Tank Field Station 'ranti S~.~U,. Anchorage Tank 1,000
w,, >100' >100' N/A N/A >25' Steel Two (2)
~=w.~ >100' >100' N/A N/A ~ / LIFT STATION - NONE ON LOT
~ >5' >10' N/A N/A
F..,,,.~ >5' >10' N/A N/A '~'~ ~'"~": '~ ~'~'~
c.~ None Noted
~ BENCH MARK
2" Insulatior~ Over Septic Tank.
Front Deck
100.0
Engineers Stamp
-.~?..
Inspections performed by: MEA Dates:
Department of Health and Human Services approval -
.ev,ewe an a rov y: %?;;'....' .....
,,...,~, ,~//~' 'h."*o~s~,'~"~<,-'", ~ ~ ,,,.-'--"
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 99519-6650 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number SW010083
PID No. 051-531-33
Page 2 of 3
A B
S_1 .18.9 43.4
S2 23.3 46.2
C3 28.3 49.6
M1 64.9 87.7
C4 64.7 87.5
Alternat
Site
Three
HOUS~
PLAN AS-BUILT
SCALE 1" = 40'
Well
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 99519-6650 - 343-7904
On-Site Wastewater Disposal System or Well Inspection Report
Permit Number SW010083
PID No. 051-531-33
Page 3 of 3
~,,84~5
10'
PROFILE AS-BUILT
10'
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: Apr 25, 2001
Expiration Date: Apr 25, 2002
Permit Number: SW010083
Legal Description: FASSLER SUBDIVISION LOT 2
Design Engineer: 0014 Anderson Engineering
Owner Name: MM&M CONTRACTING
Owner Address: P.O. BOX 670495
CHUGIAK, AL 99567-
Parcel ID: 051-531-33
Site Address: NHN FASSLER CIRCLE CHUGIAK, AK 9
Lot Size: 22140 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well
[] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. Ail 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.
5. The following special provisions.
THE MAXIMUM DEPTH OF THE PROPOSED ABSORPTION TRENCH SHALL BE NO DEEPER THAN 8 FEET
FROM ORIGINAL GRADE AT ANY POINT.
Received By:
Issued By:
Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and 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
ParcelI.D. O,~/'-,~"~ I - 3 ~
Permit Number
Property owner(s) MM&M Contracting
Mailing address (1) P.O. Box 670495 Chuglak, AK 995657
Mailing address (2)
Legal description (Lot, Block & Sub'd.) Lot 2, Fassler Subdivision
Legal description (Section, Township & Range)
Lot Size ;~.~,.Q.//.~ Acres/Sq. Ft.
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Day phone 688-1236
Zip Code
Number of Bedrooms Three
Well Only
Water Storage
Jacuzzi
Water Softening Unit
Waiver Fees:
Date of Payment:
Receipt Number:
Permit Fees: ~ ~
Date of Payment:
(Rev. ~2/0o)
(Signature of property owner or authorized agent)
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.
Apd112,2001.
Municipality of Anchorage
Development Services Department ....
On-Site Water and Wastewater program
4700 South BragaW Street
Anchorage. AK 99519-6650
Subject: Lot 2. Fas{ler Subdivision
Septic System Design and Permit Application,
Impacts to Adjacent Properties ...,.
Dear Onsite Services Engineer, . - '
i-The owner of lot 2. Fassler Subdivision intends to place a new 3-bedroom home on "
· the lot. We are therefore applying for a permit to construct a septic system on the lot to
'. serve the proposed home. · The lot is currently served by a community water system.
The attached Site Plan;and backup documentation identify the location and
.configuration of the new septic system and the parameters used in the design..It also
shows the location of the water service line and the alternate septic site. Existing
drainage patterns are sh.own and will not be altered by the developmen! of the lot. _
· Two test holes were pla~:ed at'the,proposed Iocatio.n. for the new and al!emate
absorption trenches and revealed well-graded gravel with minor amounts of slit. No
groundwater was noted in the test holes during excavation and none was noted during
the monitoring period. 'The soil percolated at a rate of 1 minute per inch. Conditions
'ar.e excellent for an onsite septic system., ,.We ara therefore proposing to place a 3'
w de by 32' long by 6' effective depth absorpbon trench to treat the septic effluent.' The
:pipe will be placed at 3' below the existing ground surface and the total de pth of the
,trench will be 9'. A minimum of 3' of cover will be placed over the bed to prevent frost
pen. etration and possible freezing. .. ; · -
"The ground surface on the lot slopes as shown on the attached Site Plan with slight
grades from south to north and west to east. The new trench will be constructed
parallel to the contours 'of the surface in conformance with Municipal requirements...
'Grading will be accomplished.to assure 'surface drainage is away from the new .-.
trenches. The existing drainage pattern on the lot ,will not be affected during-
development.. . --- . · . · .
. If the system is constructed in accordance with our design the following statements
apply: " . . .
t. The.system. if constructed as designed, will have no adverse' Impact on the wells
In the area or those to be constructed in the future.. The lot is currently served by
a community water system. .. - . .
Lot 2, Fassler Subdivision
~Apri112, 2001
· Page Two
2.. .The.system, if c. onstructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if Constructed as~ designed, will have no adverse Impa'ct on reserve
space, either sudace or subsur[ace, on any lots located in the area. . .
4. The system, if constructed as designed, wiil have no adverse Impact on drainage
patterns in the area. The current drainage pattern will be maintained..
...-.Sincerely, .... .- _ .;-
"...' ..
· .,' ..r,o-~. :~- -..-.~... . . ..'.. . .. '..~. O~...A/-~ . ..
' '. *Michael'E. Anderson P.E. .'... . -. ' . . "_,~,~..~'"" ~>'.~..~.'~,,, :. :' *'.':
· · ' · . . - , . : * ~"C'r) ..... 'r".~ ~ · ,, * -
- :..Attachments , . . ... . , '~',:' 4u-,-~ t~'~ ,,:: - :. · ..
(Vacant)
I
i
· !
I :./
I
~ ~ eoea
PROJECT
/
/
AREA MAP
SCALE 1' = 100'= "·
NOTE:
Site
~e
' Wide
~th
TIt 2
?' /~hree
'.'/ Bedusr~6om
.,.o
This subdivision and.. ~ .
others in the area ar~ ~ ~-~
served by a community ~
Water system. There are ~
conflicts .with the pro~sed
septic system and others in
the area. .. . ·
TE PLAN'
',~'.. c.-~, ..'%~'
SCALE 1" = 40'
~ -~ q;?~.. ....... ~'.
NOTE:
Site
TH2'
?' ~hree
· '/ Bedr6om
;e
' Wide
,e Depth
'erich
This subdivisio .
others in the area ar~ no ~ .
served by a community ~. ~\'
Water system.' There-are .~ ' \
conflicts .with'the' proposed
septic system and others in ~.
the area.. .. ·
SITE PLAN'
..SCALE 1" =40'
LOT 2, FASSLER SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Three Be4room Home Deep Trench System
Perc. Rate: 1 MinJInch 1,000 Gallon Septic Tank
Application Rate: 1.2 GPD/SF 6' Drain Field Rock
3 Bedrooms X 150 GPD 113. GPD/SF = 375 SF of Absorption Area
375 SFI12SF/l_F = 31.25 LF Trench Length
Therefore: Construct an Absorption Trench 32' in Length by 3' Wkle W"~h 6' .of D_ral.nfi..eld
Rock Beneath the Distribution Lateral. Distribution Lateral to Be Placed 3' Bemw ~_xms;{ng
Ground. Total Depth of Trench to Be 9' from Existing Surface. Mound Over Trench if
Necessaw to Provide Minimum Cover of 3'.
NOTE:
CeoteXtile· . ..
: '-Fabric ~
.Perforated
· . PVC (Slots Down)
Drainfield
· '.-. Rock i.' ? .'-
-'.' :L".; ::"' '"~ '
'3' "' ~; I"'-':":'"
TYPICAL DEEP TRENCH SECTION
(NO SCALE)
Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 10' Separation From Lot Line.
Minimum 4' Separation From Groundwater.
Minimum 10' Separation From Water Service Line.
5--
6--
7
8
9
II--
PERFORMED FOR:
18,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH 8, HUMAN SERVICES
825 L STREET, .ANCHORAGE, AJ~ g9502-0605
SOILS LOG - PERCOLATION TEST
M J, M CONTRACTING
LEGAL DESCRIPTION: LOT 2, FASSLER SUBD
TEST HOLE -fi' 1
PT I 0L
PERC. LEVEL
WELL-GRAOEO GRAVEL-SAND-CLAY
MIXTURES WITH COBBLES: GC
SLOPE
SITE PLAN
WAS GROUNDWATER
ENCOUNTERED?
BOTTOM OF IF YES, WHAT DEPTH?
HOLE DEPTH TO WATER
AFTER MONITORING:
DATE:
.o S
l
0
P
None E
4/12/01
GROSS NET DEPTH OF NET
READING DATE TIME TIME WATER DROP
Start 3-April 2.1.0 12"
I 2;50 10 2" 10'
Recharge 12'
2 300 10 2' 10'
Recharge 12'
3 340 I0 2' 10'
PERC RATE: I MIN./INCH PERC. HOLE DIAMETER:. 6'
TEST RUN BETWEEN L.~) FT. AND 5.5 FT.
COMMENTS: TEST HOLE PRESOAKED PRIOR To TEST,
TEST PERFOt~EO BY: T.L. KIMBROUGH I, M~CHAFL E. ANDERSON. CERTIFY THAT THIS TEST WAS PERECt~ IN .~CCORDANCE
WITH ALL STATE ,6~ND MUNICIPAL GUIDELINES ON THIS DATE:
5
6
7
8
9
II--
18
PERFORMED FOR:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH ~ HUMAN SERVICES
825 L STREET,.BJ',ICHORAGE,.6~,ggS02-0605
SOILS LOG -PERCOLATION TEST
M ~, M CONTRACTING
LEGAL DESCRIPTION: tOT 2, FASSLER SUBD
TEST HOLE #
PT I 0L
PERC. LEVEL
2
WELL-GRADED GRAVEL-SAND-CLAY
MIXTURES WITH COBBLES: GC
SLOPE SITE PLAN
BOTTOM OF
HOLE
WAS GROUNDWATER
ENCOUNTERED? NO S
L
IF YES, WHAT DEPTH? O
DEPTH TO WATER None P
AFTER MONITORING: ' E
DATE: 4/12/01
GROSS NET DEPTH OF NET
READING DATE
TIME TIME WATER DROP
Starl ]-April 3:30 12'
1 3:/.0 10 2" 10"
Recharge 12'
2 350 10 2' lO'
Recharge 12'
3 /.:00 10 2' 10'
PERC RATE: . I MIN./INCH PERC. HOLE DIAMETER:.
TEST RUN BETWEEN /',~ FT. AND 5.5 FT.
C0HMENTS: TEST MOLE PRESOAKED PmoR TO TEST,
TEST PERFOI~IEO BY: T,L. KIMBROUGH l, J'llCHAEL E, ANDERSON. CERTIFY THAT THIS TEST WAS PEI~0~IED IN ~CCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: ~/~.c;/OI
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 2, FASSLERSUBDIVlSION
GENERAL:
The scope of this project includes the procurement and placement of a
new 1,000 gallon septic tank at the location shown on the site plan.
Work also includes the construction of a new 32' long X 3' wide X 6'
effective depth absorption trench at the location shown. The
distribution line in the trench will be placed at 3' below the existing
ground surface. Total depth of the trench will be 9' below the existing
ground surface. All components of the septic system must be placed a
minimum of 10' from the water service line on the lot.
Construction shall be in accordance with the approved site plan,
design drawings, Municipal Permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater
Disposal Regulations.
The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the
location of all lot lines.
Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
Contractors installing wastewater disposal systems must be certified
by the Municipal Department of Health and Human Services for
system installations. Owners installing their own systems must receive
prior approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,000 gallon septic tank must be be procured from an approved
source and installed at the location shown.
A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
o
The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
Lot 2, Fassler Subdivision
April 12, 2001
Page 2 of 3
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
Distribution pipi.ng must be placed level with perforations down atop a
level bed of dramfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
A silt barrier or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill.
Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated,
Contractor shall vedfy the septic tank and drainfleld are a minimum
100' away from any pdvate water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
Direct bury insulation must be placed over the distribution system if
less than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
Grade area surrounding the absorption trenches to drain away.
A minimum 2' of accepting soil is required below the drainfield rock for
a 5' wide trench. Contractor shall verify this condition prior to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid) ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not sold) and
ASTM D2662 or A.B.S. (perforated and solid).
Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
Lot 2, Fassler Subdivision
April 12, 2001
Page 3 of 3
5. A permeable geotextile fabdc (Typar, Mirafl or equ .a.I) must be installed
between the final drain rock layer and the native sod layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing
the #200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These
inspections must be conducted under the supervision of a professional
engineer registered in the State of Alaska. The first inspection must be
conducted after the excavation of trenches, beds or pits and before the
installation of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement of the
geotextile fabric, gravel, distribution piping, standpipes, cleanouts and
insulation. No backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction
notes for use in preparing the certified as-built of the completed system.
~ N0. : 9076881238
ADC . . .....,.. ..... ..~. ..
LEGAL DES:GRIPTIO ~ ~ .... ;.
pERMIT N'~IMBE~'~ O.~te of..L~-~-:'. ~_._ _~..~ I.
Is well located at approve~, pem~t IocatJ~.'.. · .O No. ...
Depth of .. · · .' :
~w ;~5'~' ' ' * ' '*
~'~, C '~"
u,~T;,;;, ....... . ......
Casing cku e n ' , feet
Method of Testing."_' ~/~' '
· ." : .... "
Well Intake Op~'~i~ T~pg.:.' er~.,' n hole
~J Screened; ~,Stact: _fe~t .Sto~.ped.." -feet,
· '" ' ' t · · feet.
.-*. o^,~^,= ,',nS Start feet_ St,~pped.. . . ,.
· r~nthj'from O"; :;" ..' . ..'feet, to~ 7 -:' f'
E DATA
'.DEPTH..
of A,-,chorage: Department o! ~ea~m c, num~,, ,~,=,,,,- ,,~ . · . '.
Oepar~ent of ~R e'c e i v e'cl 'T'i ~'eY-~ :"i'.% 12: 42PM
MUNICIPALITY OF ANCHORAGE
Development Sen/ices Deparfmenl
On-Sire Wafer & Wastewater Program
4700 South Bragaw Slraet
P.O, Box f~)6650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Initial
Date Issued: Jun 06, 2001
Expiration Date: Jun 06, 2002
Permit Number: SW010170
~Legal Description: FASSLER SUBDIVISION LOT 2 ·
Design Engineer: 0014 Anderson Engineering
Owner Name: MM&M CONTRACTING
Owner Address: P.O. BOX 670495
CHUGIAK, AK 99567-
Parcel ID: 051-531-33
Site Address: NHN FASSLER CIRCLE CHUGIAK, AK 9
Lot Size: 22140 SQ. FT,
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. Ail 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:
Date:
Date:
Municipality of Anchorage
Development Services Department
Budding Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage. AK 99519-6650
www.cLanchorage.ak.us
(907) 343-7904
ON-SITE SEWERJVVELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-53¶-33
Permit Number SW O I O 1 70
Property owner(s) MM&M Contracting
Mailing address (1) P.O. Box 670495 Chugiak~ AK 99567
Mailing address (2)
Legal description (Lot. Block & Sub'd.) Lot 2, Fassler Subdivision
Legal description (Section. Township & Range)
Lot S, e 22.140
THiS APPUCATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Day phone. 688-1236
Zip Code
Number of Bedrooms Three (3)
[--I Well Only []
[] Water Storage []
Jacuzzi
Water Softening Unit
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.
(Signature of property owner or authorized agent)
Permit Fees.~t~)
Date of Payment: 8° gq
Receipt Number,
Waiver Fees:
Date of Payment:
Receipt Number:.
UDsubdivided iS PROJECT
(Vacant) -~
// ~"7 J
AREA MAP'
SCALE ¶" = t00'-~ "'
LOT 2
Site
~hree
Bedr6om
~th
SITE pEA ~
Certificate of On -Site Systems Approval
Parcel I.D. 051 531 33
1. GENERAL INFORMATION
Complete legal description FASSLER LOT 2
Location (site address) 24835 FASSLER CIR
Current property owner(s) OAKES
Mailing address
Real estate agent
2. TYPE OF DWELLING:
E] Single Family (w/ADU)
F] Duplex
F-1 Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
Expiration Date:. J M e- 5,
Day phone
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Private Septic
Fx]
Water Storage
❑
Holding Tank
n
Community Well
E]
Community
El
Public Water System
n
Public Sewer
11
Waiver request for: NONE Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee$ 550
Date of Payment 3/4/2021
Receipt Number. 0 5 3 q Tb
Waiver Fee $
Date of Payment
Receipt Number
COSA # OSC211080 Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation.
Name of Firm C&M ENGINEERING Phone 8545558
Address 20182 TULWAR
Engineer's Printed Name CHARLES BALZARINI Date 3/1/21
Ae
*: 49 TH •.
6. DSD SIGNATURE W ••• , •—
A•
V/ System #1 Approved for' ' %' '� '� •_. , .. .
3 bedrooms CHARLES G BALZARIW
System #2 Approved for bedrooms ��$ �F�,�.CE-13854
Disapproved ����F�pROFEssso��4
Conditional approval for bedrooms, with the following stipulations:
.,ttll(ttttf(((r�,.
. , WAST'Ev`1ATER
By: Original Certificate Date:315o2e%2
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory X
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist yellow sheet
COSA Checklist
Legal Description: Parcel ID:
If more than 1 septic system on lot: COSA Checklist # of Structure served by this system
A.WELL DATA
W ell 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 of Sample
Comments __________________________________________________________________________________
B.T ANK DATA
Age of tank(s) years
Tank type/material
Measured operating fluid level in septic tank
Standpipes/foundation cleanout per record drawing
Date of pumping
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
Monitor tubes go to bottom of effective. If not, state
depth into effective
Code-required soil cover over field
System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Adequacy test date
Results Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth in
Elapsed time min
Final fluid depth in
Absorption rate gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
Comments/Deficiencies:
STEEL
Fassler Lot 2 051 531 3
1 1 1
+6.75
6/2001 -
175
174
6.26
+18 C.BALZARINI
2/25/21
153
2/25/21
CASING EXTENDED TO MEET CODE.
20
SEPTIC
51
9/29/20
TRENCH
2001 2/25/21
3
11.9 33
4 450
33
5
32
450
NA
NA NA
✔
3
COSA Checklist yellow sheet
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Property Line > 5’ Yes if No ft
Absorption Field > 5’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10’ Yes if No ft
Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
If absorption field is under driveway comment below
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
F. ENGINEER’S COMMENTS
G. ENGINEER’S CERTIFICATION
I certify that I have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
✔✔
✔
✔
✔
✔
✔
✔
✔✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
THERE IS LIMITED COVER OVER THE SEWER LINE BETWEEN THE HOUSE
AND TANK. LINE IS LIKELY INSULATED, NO SIGNS OF FREEZING WERE
OBSERVED.
✔
3/1/21
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907-343-7904
On-Site Water and Wastewater Section Fax: 343-
7997
www.muni.org/onsite
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
Nitrate Advisory
Certificate of On-Site Systems Approval # OSC211080
Subdivision: Fassler, Lot: 2
A water sample revealed a nitrate concentration of 6.26 milligrams per liter
(mg/L). The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on
existing health information and can therefore be used to gauge the relative
quality of water from private wells. Since nitrates are known to slowly increase,
we recommend you monitor the water quality. Please see the attached “Nitrate
Fact Sheet” for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water.
Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water
wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the
soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as “blue baby” disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively
charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several “wet chemical” methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive “screening test”, and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
100' WELL RADIUSLot 2
Fassler Subdivision
22,140 Sq. Ft. +/-
24835 Fassler Circle
1 Story Wood Frame House
With Attached 1 Car Garage
N89° 57' 19"W 290.00 REC.S3
0
°
4
1
'
0
2
"
W
1
3
9
.
4
8
R
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C
.
L=39.71
R=50.00
S
SSSS
SS
TEE
MBMBW
℄ FASSLER CIR.56.22
6
.
2
56.22
6
.
2
12.1 16.14.2
6.2
LOT 8
RICLIN SUB.
LOT 7
RICLIN SUB.
LOT 3
LOT 4
LOT 1
50'
R.O.W.24.021.5
94
.
9
G
R
A
V
E
L
D
R
I
V
E
W
A
Y
SHED
CLUB HOUSE
19.0
S67° 31
'
09"W
352
.30
REC.
3.7
G
E
10'
D
R
A
I
N
A
G
E
E
A
S
E
M
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T
15' TEL. & ELEC.
EASEMENT
PROFESSIONAL SEAL
Date:Frontier Surveys, LLC Project No:
650 W. 58th Ave. Suite E Anchorage, Alaska 99518
As-Built Survey of:
www.frontiersurveys.com
Frontier Surveys, LLC
I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or
under my direct supervision on
Plat:Grid:Ordered By:
907.460.1686 - info@frontiersurveys.com
This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and
conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any
inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the
existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances
should this document be used for construction or for establishing a boundary or fence line.
February 24th, 2021.
Legend:
Scale 1" = 50'
Gas Meter
Electric Meter/Outside Power
Deck
Septic MailboxS
G
E
Lot 2 Fassler Subdivision
General Notes:
1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws.
2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey.
3. All measurements/setbacks are to the visual/apparent building footprint.
4. All dimensions to property lines are plus/minus 0.1ft.
Kasey Moua
21-111 03/01/2021
86-86 1462
E
T
W
Elec. Pedestal
Water Well
Tel. Pedestal
STA T E O F ALA
S
K
A49 TH
ROYEVRUSDNALLANOISSEFORP
DERE
T
S
IGER Pierre M. Stragier
NO. LS-9812
03/02/2021 MB
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
CERTIFICATE
FOR A
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650 ~"'~f ,¢ //~'
www.muni.org/onsite "- J .// /~//,t,~
(907) 343-7904
OF ON-SITE SYSTEMS API ROVAL
SINOLE FAMILY DWELLINO
Parcel I.D. 051-531-55
1. GENERAL INFORMATION
COSA# ~'~Cr[
Expiration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
FASSLER S/D; LOT 2
24855 FASSLER CIRCLE *
CHUGIAK, AK * 99567
KYLE LUCEY Day phone 688-5408
CHUGIAK, AK * 99567
Day phone
24855 FASSLER CIRCLE *
ED DAVISON W,/ PRUDENTIAL VISTA Day phone 275-7250
16600 CENTERFIELD DRIVE * EAGLE RIVER, AK * 99577
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well · Individual On-site ·
Individual Water Storage [] Individual Holding tank []
Community Class Well [] Community On-site []
Public Water System [] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 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/er 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 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Phone 557-6179
Date
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.
DSD SIGNATURE
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
By: l...~.//,~'/' ..-.~ ..~'
(Rev. 1 ~105)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
),,"":~"~d-,-¢~~ Original Certificate Date:
CERTIFICATE
Legal Description:
A. WELL DATA
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
(9071 343-7904
OF ON-SITE SYSTEMS APPROVAL
CHECKLIST
FASSLER S/D; LOT 2
Well type PRNATE
Date completed 6/20/2001
Total depth 175 ft.
Date of test
Static water level
Well production
WATER SAMPLE-RESULTS:
If A, B, or C provide PWSID# N/A
Sanitary seal (Y/N) YES
Cased to 174 ft.
FROM' WELL LOG
6/20/2001
'144
7
g.p.m.
Well Log (Y/N)
Wires properly protected (Y/N)
Casing .height (above ground)
AT INSPECTION
8/12/2010
152 ff.
6.71 g.p.m.
YES
YES
24+ in.
Depression over field. NO
For 3 bedrooms
New depth 23 in.
450+ g.p.d.
If yes, give date -
Absorption rate >=
Tank size 1,000 gal. Number of Compartments 2
Depression over tank (Y/N) NO
Pumper
I'BELOW EXISTING (~RADEI
Soil rating ~or ft2/bdrm) 1.2
Width 3 ft.
Total depth '12 ft, Eft. absorption area 432 ft2 Monitoring tube YES
Date of,adequacy test 8/12/2010 Results (Pass/Fail) PASS
Fluid depth, in absorption field beforef~est 13 in. Water added 610 gal.
Elapsed Time: 1027 min. Final fluid depth 8, in.
Any rejuvenation treattnent (past 12 mo.) (Y/N & type) NONE KNOWN
System type DEEP TRENCH
Gravel below pipe 6 ft.
Nitrate~,"7-~mg./L.
Date of sample: 8/12/2010
Foundation cleanout (Y/N) YES.
Date of PU.mPing 8/16/2:010
ABSORPTIOI~'FIE~D DATA
Date installed ,6/4/2001
Length 36 .ff.
Coliform 0 colonies/100 mi.
Arsenic: ~,_) '~) ug./L.
SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
High water alarm (Y/N) N/A
JR'S PUMPING
Date installed 6/4/2001
Cleanouts (Y/N) YES
Other bacteria ~ colonies/100 mi.
Collected by: GEG Ltd.
D. LIFT STATION
Date installed
"Pump on" level at~
in,
Size in gallons Manhole/AcceSs (Y/__y.~ ~
"Pump off" leveL~L~High water alarm level at
CyCles tested, Meets alarm & circuit requirements.*.
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
100'+
Septic tank/lift station On lot
Absorption field on lot: 100'+
Public sewer main N/A
Sewer/septic service line 25'+
Animal containment areas 50'+
in.
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout
Holding ,tank N/A
Manure/animal excrete storage areas
N/A
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 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Absorption field
Surface water.
5'+
100'+
Property line 10'+ Building foundation 10'+
Water service line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wells on adjacent lots. 100'+
COMMENTS
Water main N/A
Driveway, parking/vehicle storage
10'+
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date
COSA Fee $ ~ 0
Date of Payment ~/~ c//}
Receipt Number 0 ~777'
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On-Site Systems Approval # 101180
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
2 of Fassler subdivision. This inspection revealed a nitrate concentration of
7.73 milligrams per liter (mg/L) was reported for the property's well water
sample. The Environmental Protection Agency (EPA) has established a
maximum contaminant level (MCL) of 10.0 mg/L for public drinking water
systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
SGS Ref.# 1104243001
Client Name Garness Engineering Group, Ltd Printed Date/Time 08/24/2010 8:43
Project Name/# Fclbsler L2 Collected Date/Time 08/18/2010 8:23
Client Sample ID Fo0sler L2 Received Date/Time 08/18/2010 12:45
Matrix Drinking Water Technical Director Stel~hen C. Erie
PWSID 0
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (<10) 08/18/10 08/19/10 KDC
Waters Department
Total Nitrate/Nitrite-N 7.73 0.100 mg/L SM20 4500NO3-F B (<10) 08/18/10 AYC
Microbiology Laboratory
E. Coli Negative I 100mL SM20 9223B A 08/18/10 SDP
TotalColiform Negative I 100mL SM20 9223B A 08/18/10 SDP
0872~/2010 12:17 9073~9821
JRS SEPTIC
PAGE
JRs Pumping
PO Box 773415
Eagle River, AK 99577
(907) 694-6454
I~' Information
Gamess Engineering Group
3701 E Tudor Road
Suite 101
Anchorage, AK 99507
(907) 337-6179
bJ_o....b._. _sj.t_e..J. Qf.o rm atio n __
Andrew
24835 Fassler Street
Chugiak, AK 99567
(907) 337-6170
Job Description:
P.O. Number:
Terms:
Salesrep:
Map Book:
Cross Streets:
Job Cemmsnts:
1000g
Net 30
Karlia
Morrow Street
Service Agreement
Numben, 031691
Order Date: 14-Aug-2010
Service Date: 16-A,jg-2010 12:0
Technician: Mike
Tax %: 0
Job Type: Repeat
Map Grid: 24 - -
Last Service *05/28/2008'
tank normal
back flushed 2 times=clean
'clean outs ok
100Og
Additional Location Comments
1- Story Blue ranch Home w/~'s
Septic (~ Back Of home
Service Type
Septic Serv IO00K
Diagram:
Qty
1
S:\Dla0rams~25999.bmp
cl0e
Gallons Planned: 1000
Gal. Actual: _ ,
Hose Length:
Double Tank: [] ..__._.
Pump System: []
Baffles Inlet: E~ ~
Baffles Outlet: ~-1,
Price Each Tax? Extension Actual
$185.00 No $185.00
NonTaxable Total Taxable Total Tax Total Grand Total
Estimated Charges: $185.00 $0.00 $0.00 $185.00
Actual Charges: ,
Customer agrees to the terms and conditions shown. THIS IS A BINDING AGREEMENT,
Signature aJ~d Title of Customer Representative Date
¢lv w t ¢4 . ,
Accepted by JRs Pumping Date Accepted
For yo~ added convenience we accept; A~erlcan Express, Olcover, Visa and Master C~rd p~yme~ts over the phone,
AEer 30 Days account will be turned over to COLLECTIONS. $30,O0 For NSF Checks Returned.
., . ... ://~,.~..%, .......... ,~. .. , ,,,... ,~ , ..:... , ,..
..... .,.. , ..., , .:..,.._ .....- ~ ,- d ~f .:-..-
~:' .': '.' ,':.,~ ....... ...... '.,-.,":,., :On~te~l~,a~Wa~~.,~.~',. ~_ ,,~: .
:. ~';:'." :. C' ':." CERTIFICATE__. -~--.~.-~-~_..,.,,,,,._~_,~ _ OF ~TH'AuTN~I~,AP~Xt~'; :~,,
, .... . .... .... , EORA S NGLE ~ EY-~E~L NG,,, ~ .... , · ,: .... :.
-: ..... "' .... ,'. ", .~ "' - 0q
~ :... '.,' ,..,>1: GENE~E'IN~ORMATION: ',..., . ;.. ~ ~.~
.... .. .¢omp e~e legal descnpt~o~..rot -
J . ~ ~r,~ "::-. .'.- ,' '~'". v. .............
-- ...... - - - ~.~ - F '
" -. :': Current Properly owner(s); UU&U Contacting; ', ,., r - .':.'. :,.' Day*ph~ne.~1236 ~'. ~:'.. : . .
,.:..:, .:.- :. :Madmg address ,. '., P.O.'Box670495~Chu~ak~99~7~':'.
· .., . .. :,:....., .... , . .... : . :,.: .,.. ..:.......,.~..,,..:~',.~ ,,.- .... . ......
:. '....... Lenongagencv, : -:.~ ', ',:,.': ~. ' .': ..'~" , ".' -
' "'-- ' - ~" ' -'" address " ....
-. ,~,ahm~ ....
~s,a,e ~em ~ .... , .... ...', . , uay pnone ....... .. ".;, .,.~.' ,::.~ ~ .....
. . . ...,~a~uuress: , . .............. .... :..: . . .... - :-- .,.:....:
; ...,,Unless othe~/se ~quested, ~ w/71 be held by DSD forp/ckup.':. ' .,...- ~ .: :,.. -. ', . ~ ...~, ....,: '. '; ', . -, ..
,2. NUMBEROF BEDROOMS: . Three{3),.
' ~PE OF
TYPE OF WATER S,U. PPLY:
IndM,dd.al .Well ~- .. '. : [] i
)lridiv!dufil Wat~r. Siorage '..', .- [7[
· Commtmity CJass -'.Well' ~., [7] .
Public Water Syste'm ' ' -' r'7'} - -
IndN, idbal On:site: .. "' (7: ':' -..
Iddividfial Holdin~j tank-;:,:" ' D '
- Community Omsit6 ........ []'.,' '
Pfibli~ SAwer ..... ' [] ',,' · :
The Municipality of Anchorage Development Services' DepaHmen~ (DSD), Is;u(~ Cedi~c~ates of 'Health Auth,~ ty'
Approval (HAA) bas;ed only upon the representations glve~'in p~r~g~ph 5 by a'r~ ir~dep~d~nt p~:6fe~i6hal Civil
engineer registe?ed in the State of Alaska. Certificates of Health Authori~ Approval are r~qulr~d f0~ th& transfer
title (except between spouses) for properties served by a singI~ family on-site v~astewater Clis~o§al and/6r water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of H~alth Authority Approval
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. {Cedificates may be r~issued 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 fi public
water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
' .' - 'As certified by my sea affixed hereto and as of ~ 9alidat,K)n dal~.~..h~. ,w~.~ b. ,e. low,! ~e.r.'dy ~.a.t m,y,l.n.v?~bg.a!lR ,,.
:.:' based on prod. edures out ned n the Health Aut, ho~ity Approval Gu~dehnes for th~s apphcat~on,, shows that the .,.:
· "' -": '- on-s te water suoovl and/er wastewater d~sposal system ~s(are) safe,~,functmnal .............. and ad. equate fo.[,t,h~ nu .mbe. r of ! . '
.... . .... ,...%- . * * * '- .......... "~ "*' ~ ...... he:' ....
· ' ' h,~drc.3rn_~ ~nd h/De of structure indicated here n, further ver~J that based on the nformation obtained from t ,
'"~' ' '. --.~'.-7'"'~ ;---;,~..,.r ...-,~,-, .,_~ ........... .- .,~· .~, :. ~ ~, , . -. . '. ; , ~'" . . , ~ ....... , ' '
· '' Mun c~pa~ ty of Anchorage fi es and from my investigation a~d m. spection,. ~e oms~te.wa!~, s~upp y and/or ......
' .' ' wastewater d s osa s stem s are in compliance w~th all appl?able ~umclpal and State code,s, erdmances,... .,,
. : .... P,-..:Y. - .-.!-,.), ,, --,-' ........ - ....... ..' ......;- : ..... 't, ; ''. :" : '..
-: Name of Fir~ .Anderson Engineedn.q., -" : .... :,;.:.. ..... ..,,..'."...? ,,,:...,'; ..,Phone..522-77?3, - - , '; .,, :, ...; ,
Addres{ "P.O.
Box 2407'/3
._. _., Anchoraoe~'AK 99524-'; :.,~-~..r .. .... :,,. ,, .,.~' ~ - :,...; ,- .,. ..... .-, ,: ,' ....
- Engineers Pdntsd Name ,M chae E:Anderson~,P.E..,., ,., .; , - ,' .... "~ '-'?. -
..... '' ' ' ~'~' '1.~"~--~,~ ~ f
.. .... . . . ,. . ~ .., .'~. . . . ."F
/, Approved for .'. ~,'~. bedroo . ...... ~-_,. · ,: . .... ~ ~.A~,.~. . .. .... .....
-" '. ',- .' , D{app~ov~d. , '~,. ; :"?.'...:.', ,': ' ,'.:"'",,., '.."." ":;?,-~?,tV.~,{OFA,~;~,f~-,.;-'. ..
· "- ' "' '' '' ' '~' bedrooms;with" ' the ' .,_ _, _~-.~. · -- ,y. o-. t.. -.-,~'.:,~.- ..
. '-. , . Cond,t,onal approval for. , .' · following_ ..~t'pu~at'q~'-~ .o ... , ..,.-;~-.;....
. . . , .. ;,._ - .... ., ,: .,..: , ,. ~ .. PF, OGRAIA.o. ~.
, '. .- ..... , , . .: .';"::"~1'~' , ¢;%':'"~".' '-'~- . . '.~,.~.~.A.,,t,.;;.,.oo,,"~c.,~.~',~,
Additional Comments,. Thez'e :J.s a d~.sct'epancy.on th:ts ~z"o~)ez'tv in that a ~lnt .nnr~, .
Attachments:
HAA Checklist
. Septic System Advisory -
Well Flow Advisory
X
Maintenance Agreements
Supl~lemental Engineer's Rep6rt
Other
Original Cedificate Date: ~- ,~. ~ - f') I
Municipality. of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Westswatar Program
4700 South Bl-~]aw St.
P.O. Box 196650 Anchorage, Al( 995196650
(gO7) 343-7g04
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal DesorlpUon: Lot 2, Fassler Subdivision
Parcel ID: 051.531.33
A. WELL DATA
W~ type Pdvate
Date coml~etad sr2or2OOl
Total depth 175 fl.
If ~ B, or C provide PWSID #
Casep to 174 ft.
FROM WELL LOG
Well Log (Y/N) Y
Wires property protected (Y/N) Y
Casing height (ebov~ ground) >24
AT INSPECTION
Date of test
Static water level 144 ft.
Well production ?
WATER SAMPLE RESULTS:
g.p.m.
. g.p.m.
Cerdorm 0 celonies/100 nd.
B. 6EPT~C/Ho~ nlNG TANK DATA
Tank Type/Material ~eptlcJSteel
Nib'ata 2.38 m0~.
Cellected by: I~e Anderson
~ bects~a 0 coionies/lO0 mi.
Tank size 11,000 gal.
Foundat~n deanout (Y/N) Y_
Data of pumping
Numbe~ of Compartments _2
Depression over tank (Y/N) N_.
Pumpe~ 14ew Con,~'uctlo~
Cta~nouts (y/N) Y
High water elarm (Y/N) N
C. ABSORPTION FIELD DATA
Data instaaed 6/4/2001
Length 36
Total depth 9.5 fl.
Date of adequacy test
Soil rating (g.p.dJfl~ or ffafndrm) t,2 GPD/SF System type Deep Trench
ft. Width 3 ft. Gravel below pipe 6
Eft. absorption area 432 fi2 Monitoring lube Y Depression over field N_.
Results (Pass/Faa)
Ruid depth in absorption field before test __ in. Water added gal. '
Elapsed Time'. min. Final fluid depth in. Absorption rate >=
A~y rejuvenation treatment (past 12 mo.) (Y/N & type) N
New depth in.
If yes, give data
g.p.d.
D. LIFT STATION
Date installed
'Pump on' level at in.
Datum
E. SEPARATION DISTANCES
Size in gallons
'Pump off' level at
Cycles tested
SEPARATION DISTANCES FROM V~EJ-L ON LOT TO:
Septic tank/tiff station on lot >100'
Absorption field on lot >100'
Public sewer main N/A
Sewer Ise{~c service line >25'
in*
High water ~tarm level at.
Meets alarm & circuit requirements?
in.
On adjacent lots >100'
On adjacent lots >100'
Public sewer manhble/deanout
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
property line >5'
Water a line MI)'
Building foundation >5'
Water main N/A '
Wells on adjacent lots >100-
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10'
Water Service line >10-
Curtain drain None Noted
F. COMMENTS ~
Building foundation >t0'
Sudace water >100'
Wells on adjacent lots >100-
G. ENGINEER'S CERTIFICATION
I certify that I have determined through ~eld inspections and
mvfew of Municipal records that Ere above systems are in
conformance with MOA HA,4 guidelines in effect on ff~l$ date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date ~/12
HAA Fee $
no e of Paym
Receipt Number
(Rev.
Absorption field >5'
Surface water >100'
Water main >10-
Dn~e~ay, pamingNehlcie ~tomge >10'
.Waiver Fee $
Date of Payment
Receipt Number
AUG-09-01 18:28 FROE-CT&[ ENVli~tEHTA~ SRV
,~1'~ CTIE Environmental Services Inc.
9075615801
T*4Z5 P.03/05 F-083
CT&£ Ret'.# 1015051002
Client Name Anderson £ngin~ring
Proleet Name~ HA
Ciltnt Sample ID Lot 2 Fasslcr
Matrix Drinking Water
Ordered By
PWSID 0
Sample Remarks:
Client PO~
Printed Date/Time 08/09/2001 15:57
CoHetted Date/Time 0~/03/2001 15:17
Received Date/Time 08/03/2001 16:30
Technical Dlrettor Stephen C. Ede
Released BY~~~ ~
Wa~ers Depar~m~n~
Nitratc-N 2.38
P~ An~lys~
Date Date Init
0.500 mg/L EPA 300.0 (<lO) 0~03/01 SCL
M'tcrobiology Labora~:ory
Total Cditonn
0 coVlOOmL SMIS 9222B
(<1) 08/03/01 KAP
Received 'i'iRe ^ug. 9. 5:29PM