HomeMy WebLinkAboutBERNARD BLK 2 LT G-1Bernard
Block 2
Lot G1
#060-321-09
OWNER OF LAND*
ADDRESS*
LEGAL DESCRIPTION- J -:e4 eae0 01 Q
1,17 6/a
DATE: �/7 79
PERMIT NUMBER: 05'T, 0 3 ! Date of Issuer_ -L -
TAX IDENTIFICATION NUMBER: ., C n
- 3-3+ 0
Is well located at approved permit location? O Yes 0 No
Method of Drilling: Llan rotary 0 cable tool
Depth of well- 3 of
Casing Type Cir -FL Wall Thickness
Diameter % // inches, depth
Liner Type: A -106-i r
Casing Stickup Above Ground*
Static Water Level: cc -D
Recover Rate: OZ gpm
Method of Testing- A f /9
Well Intake Opening Type: 0 open end O•operrhole
O Screened; Start feet Stopped
O Perforations Start feet Stopped
c/sf P.3
Grout Type l�c�T��rr= Volume
Depth: from 0 feet to a f.1 feet
Well Disinfected Upon Completion? IE Yes 0 No�
Method of Disinfection- 0.44 z,x,n$ Ct /4.7.1
&rtttteb artuing log
by
DOC CO. tlba
SULLIVAN WATER WELLS
P.O. 130X 670272, CHUGIAK, ALASKA 99567 .TELEPHONE 688-2759
tofrrtic 40483»
9)Sat inches
(noR feet
a.
feet
feet
feet
feet
Comments:
BORE HOLE DATA
DEPTH
From To
f)
4
'9
s
qcf
7C
-775-
?bd
C.4( rJ S;-1 cMJ4
v r e hJ
Sig i I 64:?4,. G. CCd7
.7)11.),
114:20-Z4l-i',;%
Z Co6164a7
/VO
acy/c 64.4r u./
/1J 4/7L CC/9ns
t '
e - & c 03421 L. . fe:1-05
toev c-
Rrs 2aCc 6 4 C,c?.fit<v
Driller's Name C,x. F ..ftwor..i
ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality
of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough:
Department of Environmental Conservation.
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 WATER SUPPLY PERMIT
Initial
Permit Number: SW060084
Legal Description: BERNARD BLK 2 LT G-1
Design Engineer: 0855 Garness Engineering Group, LTD
Owner Name: KRISTAL MARTIN
Owner Address: 18949 ELNORA LANE
EAGLE RIVER , AK 99577 -
Date Issued: May 09, 2006
Expiration Date: May 09, 2007
Parcel ID: 060-321-09
Site Address: 018949 ELNORA LN
Lot Size: 28069 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit Is for the construction of:
❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ Water Storage
All construction must be In accordance with:
1. The attached approved design.
2. All requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By 5
Issued By
i ifin-0 Date• g
(N Date: S 7-06
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. b19D - 3f-1- 01
Property owner(s) KRISTAL MARTIN Day phone 250-3282
Mailing address 18949 ELNORA LANE * EAGLE RIVER. AK
Site address Zip Code 99577
Legal description (Sub'd, Block & Lot) BERNARD S/D: BLOCK 2. LOT G1
Legal description (Township, Section & Range) N/A
Lot Size o2s pboi Acres/Sq.Ft. Number of Bedrooms 4
THIS APPLICATION IS FOR ( ®all that apply): THIS APPLICATION IS AN:
Absorption Field ❑ Initial
Septic Tank ❑ Upgrade 0
Holding Tank 0 Renewal 0
Privy 0
Private Well
Water Storage 0
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
Permit/Rush Fees: ti (76.6a to ea Waiver Fees:
Date of Payment•7/ui/o6J Date of Payment:
,!
Receipt Number: i) / C-/ 9 7 Receipt Number:
(Rev. 11/05)
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS 8 GENERAL CONTRACTORS a
May 3, 2006
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907) 343-7904
Ref: Proposed Well for Bernard Subdivsion; Lot G1, Block 2,
To whom it may concern:
The existing 4 bedroom house is served by a community water system and a private septic
system. The owner would like to disconnect from the public water system and drill her own
well. Attached is a site plan which shows the proposed well location. The owner is planning to
use the existing water service. We are unaware of any adverse impacts this installation would
have on adjacent wells or septic systems. If you have any questions, please contact us at 337-
6179. ThaJ1c you for your assistance.
n
ess, P.E., M.S.
3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507
Ph: (907) 337-6179 * Fax: (907) 338-3246' Websitc: garnessengincering.com
TRACT E— I;
BERNARD S/D
6.:401-1)
..0 EXISTING
4 BEDROOM
HOUSE
EXISTING
SEPTIC
SYSTEM
O• ALLEY
ISTINC'W(ITER i NE
POSED WELL
7�
ISTINC KEY BOX
I
LOT 1k BLK 2;
BERNARD S/D / I
/
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BERD
1 • — 1 OPTIC
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\%.� i/ LOT UL BLK 4; 1 // /////
` BERNARD 5/0 1 -- 1 / / / /
I1 _ ///
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GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
Al 1 TAM 0300. LII[ 101 • YIUWIL(. Y 09507 • /.bt /0071337-e1T • fM ((OfiM-]fM IKeLI(
PREPARED FOR:
KRISTAL MARTIN
PHONE NUMBER:
250-3282
re000M000•00eon.
PAGE NUMBER:
1 OF 1 1
DRAWN BY: Va p. WE -795,,3
J.L.M. 0� c1140 0
P'o/ess;o^do
40�oc�
LEGAL DESCRIPTION:
BERNARD SUBDIVSION; LOT G1, BLOCK 2
A. Go -nese
TYPE OF WORK:
SITE PLAN FOR PROPOSED WELL
DATE:
5/2/2006
(Rev. 07/05)
Municipality of Anchorage Page 1 of 3
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 825 'L' Street Room 502
P.O. Sox 196650 Anchorage, AK 99519-6650
www.cianchorage.ak.us (907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SW000485 PID Number. 060-321.09
Nam
Spinel! Homes, Inc.
Wastewater System: New
Merino
9210 Vanguard Drive Anch., AK 99507
ABSORPTION FIELD
Flom Numb. ol
3445678 Four (4)
Deep Trench
Sol Rain;
Toa Depen from
LEGAL DESCRIPTION
1.2 GPD/Ft'
mon grade.
7 Ft.
Snot La S,pd„meal:
2 G-1 Bernard
Depa, m pA bottom from anginal Vada.
3 Ft.
Gravel Own beneath pp..
4 rt
Tawalap: n.maa S.ann:
Fa added .bon anginal WKS
7 FI.
Gran Length,
50 Ft.
Gran men
Number re Inn
Pon
Well: Public Water
5 Fl.
1
Eine! Wn.
• FL
Cl.ua,ratcn (Fins A e. C):
Total POT
FI.
Caen to:
Ft
Taa rowp9on area
500 Ft'
Pp. Mannar
ASTM 03034 PVC
Dreier
D.I. Dna.O.
Stan www L..et
Ft
loan;
Sanders & Sanders
Data k.1ad.
8/29/01
Vold.
GPM
Pup Sal at
FI.
Camp
Mont Abe..Gto,nd.
FI
TANK
SEPARATION DISTANCES
0 Septic 0 Holding 0 S.T.E.P. • Other.
To
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
>ublic/Prlvate
Sewer Dna
Mi"`0*""w'
Anchorage Tank _
Lancer ^ rat
1,250
Wel
N/A
N/A
N/A
N/A
N/A
Steel
N Two (mber or Compartments.2
Sulam Wan
>100'
>100'
N/A
NIA
LIFT STATION — NONE ON LOT
Lot Line
>5'
>10'
N/A
N/A
„L.
Ga
Mrxrta ae
Four aan
>5'
>10'
N/A
N/A
gimp On level N
In
Pump on I..N N.
In
BO van arm N.
In.
cwm Gran
None
Noted
Pip M w & Laos
imams frdv.��«,e patine
aine a
R ""'a
BENCH MARK
LoraLm and Uewpbon
Back Door Threshold
Anon] unman.
100.0 FL
Ent^. +tkticeP
Inspections performed by: Alan Harala Dates: 1 8129101
•
.L tin eeeee ... .. ,
rd 8129/01
ir..e
C°sit
•` .. ....».: '
Department of Health and Human Services approval •
Reviewed and approved by: Date: —/ - O2
►x 5.cf Aimuitsaf ' ~'e
� �',w.,.r n. t: 4.
(Rae. 10.991
� �/
'��t Af;r.ad4�;"A
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 995194650 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number SW000485
Page 2 of 3
PID No. 060321-09
ELNORA LANE
PLAN AS -BUILT
SCALE 1" = 30'
.••0 .,--x --. ,'••1
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4444444444
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. SW000485
97.2
Page 3 of 3
PID No.: 060-321-09
01
u
87.4—
Gegtextje
bcic. _
Droinfietd R
ck
75.4 / 83.4
50'
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
MEMORANDUM
DATE: April 10, 2002
TO: Jeff Poet
FROM: Mike Anderson, P.E.
SUBJECT: Lot G-1, Block 2, Bernard Subdivision
Septic System As -Built
Certificate of Health Authority Approval
We have reviewed the field survey data for the septic system constructed on the
subject lot and revised the as -built drawing to reflect that information. Previous
measurements were hampered by deep snow and the inability to find some of the
cleanouts. We have determined, however, that the septic tank has slightly more than 5'
of cover and is structurally capable of supporting this Toad. The attached drawing
shows the final configuration of the septic system.
The system was constructed on August 29, 2001. The inspector who documented the
construction called in two inspections on that date. The City has only one of the
inspections documented. We are unable to determine why this occurred. We will make
efforts in the future to assure that all inspections are called in and documented.
Please let me know if additional information is required prior to the issuance of the
Certificate of Health Authority Approval. The originals for the as -built drawing will be
delivered to you later today. Thank you.
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Permit Number: SW000485
Legal Description: BERNARD BLK 2 LT G-1
Design Engineer: 0014 Anderson Engineering
Owner Name: SpinelI Homes
Owner Address: 9210 Vanguard Dr.
Anchorage , AK 99507 -
This permit is for the construction of:
V Disposal Field I ✓ Septic Tank Holding Tank
T/9-1 kioett4
Date Issued: Nov 21, 2000
Expiration Date: Nov 21, 2001
Parcel ID: 060-321-09
Site Address -
Lot Size: 28069 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
Privy
Private Well
Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 (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:
'r.::r-. Yrl^11w-#11# :Kl.e""0,•.r.'.1H1; #21"• Wr,
•
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
November 9, 2000
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject: Lot G-1, Block 2, Bemard Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner Lot G-1, Block 2, Bernard Subdivision intends to construct a four-bedroom
home on the currently vacant lot. We are therefore applying for a permit to construct a
new septic system on the lot to serve the new home. 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 new water
service line. The subdivision is currently served by a community water system and no
conflicts exist between the new septic system and the community well or water service
lines.
Two test holes were placed on the lot at the location shown which indicated silty gravel
"with some cobbles to a depths of 14' and 16'. Seeping occurred at the bottom of the
excavation in each hole and was found at 13' below the surface during the monitoring
period. We are therefore proposing to place a 5' wide shallow absorption trench system
with 4' of drainfied rock beneath the distribution pipe. The pipe will be placed at 3.0'
below the existing ground surface and the total depth of the trench will be 7.0'. The
length of the trench will be 50'. A minimum of 3' of cover will be placed over the trench
to prevent frost penetration and possible freezing.
The ground surface on the lot slopes as shown on the attached Site Plan. The area for
the new absorption trench, however, is fairly flat. 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 trench.
If the system is constructed in accordance with our design the following statements
apply:
I. 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 subdivision is currently
served by a community water system.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
Lot G-1, Block 2, Bernard Subdivision
November 9, 2000
Page Two
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any Tots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
pattems in the area. The current drainage pattern will be maintained.
Sincerely, /�
�'✓� � � It a vC. G aA
Michael E. Anderson, P.E.
Attachments
TRACT `D
TR
14A;
�1D)
397
/ -240.77'
7.200.00
g 'A 0 I
#, ., .ft,'ri
fliCkaa.
141.frik.Tr`r •`f.
t`Z.
.w:1 CC 4.
ALLEY
50' Long X •5' Wide
X 4' Eff. Depth
Absorption. Trench 1,250 Gal
Septic
Tank
ELNORA LANE
SITE PLAN
SCALE 1" = 30'
45;;;;cis:AZ„,� ?
fa. .0:s :' »
-74e.
i'
/:4 mee JL,cC ,amaarr
•
ts
LOT G-1, BLOCK 2, BERNARD SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Four Bedroom Home
Perc. Rate: 2 Min./inch
Application Rate: 1.2 GPD/SF
5' Wide Trench System
1,250 Gallon Septic Tank
4' Drainfield Rock
4 Bedrooms X 150 GPD / 1.2 GPD/SF = 500 SF of Absorption Area
500 SF/5 LF (Width)'.5 (Red. Factor) = 50 LF Trench Length
Therefore: Construct a 50' Long X 5' Wide X 4' Effective Depth Absorption Trench.
Flowline Elevation In Trench to be 3.0' Below Original Ground Surface. Total Depth to be
7.0' Below Existing Ground. Mound Over Trench to Provide Minimum of 3' of Cover or
Provide 2" of Direct Bury Insulation.
TYPICAL WIDE TRENCH SECTION
(NO SCALE)
NOTE: Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 10' Separation From Lot Line.
Minimum 4' Separation From Groundwater.
Municipality of Anchorage
Department of Health & Human Services
825 L Street, Anchorage, AK 99502-0650
SOILS LOG -PERCOLATION TEST
Performed For. Sninell Homes
Legal Description: ► of G-1 Rlock 9 Remard Subdivision
SLOPE
1
2
3
4
5
6
7
8
9
10
12
13
14
15
16
17
18
21
Perc.
Zone
OG/OL
GM
TESTHOI E N0.1
Gravel
with
Silt
Cobbles
Seeps
Bottom of
Hole
Date Performed:
Was Groundwater
Encountered? Yes
If Yes, What Depth? 15'
Depth to Water
After Monitoring
Date:
13'
10/27/00
S
L
0
P
E
SITE PLAN
an, of ALA ,
to v.ht7r. .'•:r 11
t, ila --"ik t 0 ,
rtittiCLI
j" 4 d ;
W
049
}4 -Te • -cv
+" '«
10/20/004Gt� [ t.44:$ a^5.TS::1/2-
See Site Plan
Reading
Date
Gross
Time
Net
Time
Depth To
Water
Net
Drop
1
22 -Oct
1:30
1'
2
1:45
15
Dry
8'
3
1:46
1"
4
2:01
15
Dry
8'
5 -
2:02
1"
6
2:17
15
Dry
8'
Perc. Rate: 2 MinJlnch Perc. Hole Diameter. 6'
Test Run Between 4.5 Ft. and 5.5 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: Mike Anderson, I, Michael E Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 11/8100
Municipality of Anchorage
Department of Health 8 Human Services
825 L Street, Anchorage, AK 99502-0650
SOILS LOG - PERCOLATION TEST
Performed For. ,Spinell Homes
Legal Description. 1 nt f;-1 Rlnck 2 Rrmard Si hdivision
SLOPE
Date Performed:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
21
Perc.
Zone
OG/OL
GM
TESTHOI F NO 4
Gravel
with
Silt
Cobbles
Seeps
Bottom of
Hole
Was Groundwater •
Encountered? Yes
If Yes, What Depth? 13'
Depth to Water .
After Monitoring 13'
Date:
10/27/00
S
L
0
P
SITE PLAN
OEN 'AL
isey@t a 6W
10/20/00 ` A0 .
See Site Plan
Reading
Date
Gross
Time
Net .
Time
Depth To
Water
Net
Drop
1
22 -Oct
2:25
2.5'
2
2:40
15 •
Dry
8'
3
2:41
2.5'
4
2:56
15
Dry
8'
5
2:57
2.5'
6
3:12
15
Dry
8'
Perc. Rate: 2 Min./Inch Pero. Hole Diameter. 6'
Test Run Between 4.5 Ft. and 5.5 Ft.
Comments: Percolation Cavity Presoaked Prior to Testing.
Performed By: Mike Anderson. I Michael E Anderson Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 11/8/00
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS •
SUBJECT: LOT G-1, BLOCK 2, BERNARD SUBDIVISION
GENERAL:
1. The scope of this project includes the procurement and placement of a
new 1,250 gallon septic tank at the location shown on the site plan.
Work also includes the construction of a new 50' long X 5' wide X 4'
effective depth absorption trench at the location shown. The
distribution line in the trench will be placed at 3.0' below the existing
ground surface. Total depth of the trench will be 7.0' below the
existing ground surface. All components of the septic system must be
placed outside the 10' protective radius of the water service linel on
the lot.
2. 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.
3. 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.
4. 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.
5. 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 1,250 gallon septic tank must be be procured from an approved
source and installed at the location shown.
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
Lot G-1, Block 2, Bernard
November 8, 2000
Page 2 of 3
6. A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
5. Contractor shall verify the septic tank and drainfield are a minimum
100' away from any private water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
6. 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.
7. Grade area surrounding the absorption trenches to drain away.
8. 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.
2. 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 solid) and
ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
•
Lot G-1, Block 2, Bernard
November 8, 2000
Page3of3
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with Tess 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.
• '� Municipality of Anchorage {�
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 060-321-09
1. GENERAL INFORMATION:
Expiration Date:
Complete legal description BERNARD• BLOCK 2 LOT G1
Location (site address) 18949 Elnora Lane *Eagle River
Current Property owner(s) Phillip Watson Day phone
Mailing address
Real. Estate. -Agent .. .
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
. Day phone
3. NUMBER OF BEDROOMS:
4
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ 550 Waiver Fee $
Date of Payment Y 0 Date of Payment
Receipt Number _ / Z�ZZ Receipt Number,
COSA # 0 SCa2 1 01 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101 -Anchorage,_ Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: i 13I 7—
In
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system
in accordance with the guidelines and regulations established by the Municipality of Anchorage and
industry practices. The reported results describe the condition of the system/s on the date/s of the
evaluation. Separation distances were measured to readily identifiable features. Hidden defects or
encroachments may exist that were not identified during the evaluation. The operational life of all wells
and septic systems depend upon a variety of variables, including but not limited to, soil conditions,
groundwater levels (that may fluctuate during the year), quality of construction (materials and
workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the
- system/s; therefore,-GEG makes rc warranty (express or implied) regarding the future performance of
the well or septic system. GEG makes no representation whether an alternative well or septic system
can be installed on the property in the event either of the current systems fail to perform adequately in
the future. The content of this report is for the sole benefit of the person/party that retained GEG to
perform the evaluation. Reliance upon the information provided in this report by any other person or
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for
bedrooms, with the fol
1
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itin�S40'�ATCb%.:SAT R z
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Original Certificate Date: —20 aZ
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Other --�]L� 4-A do CZ
cl
COSA Checklist
Legal Description: BERNARD; BLOCK 2, LOT G1
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑■ Well log is filed with Onsite (or attached)
Date drilled 5/7/07
Total depth 300 ft
Cased to 62 ft
0 Sanitary seal is functioning correctly
0 Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 1
2/29/21
Static water level at beginning of test 31.1
Comments
B. TANK DATA
Age of tank(s) 20 years
Tank type/materia T
Measured op ating flu* evel in septic to
0 Stand 3 s/foun tion cleanout per re
Date o pumping /0 —2
ft.
drawing
Parcel ID: 060-321-09
Structure served by this system
Well production at time of test 2.4+ gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes 0 No
0 Coliform bacteria is Negative
Nitrate mg/L 0 Nitrate less than MRL (ND)
Arsenic 8.93 ug/L ❑ Arsenic less than MRL (ND)
Collected by GEG
Date of Sample 12/29/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments: N/A
D. ABSORPTIO-N-FILCD DATA
Which system tested (date installed) 8129/02
ALL standpipes present per record drawing
Total measured depth from grade 14.0 ft (max)
Measured depth to pipe invert from grade 9.5 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective 3.75'
0 Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced N/A gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Adequacy test date 1029121
Results P/ Pass For 4 bedrooms
Fluid depth prior to test 32 in
Water added 680 gal
New depth 36 in
Elapsed time 30 min
Final fluid depth 32 in
Absorption rate 600+ gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date N/A
NONE
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
0 Yes
Neighboring Tank > 100' 0 Yes
Absorption Field on Lot > 100' 0 Yes
Neighboring Absorption Fields > 100'
0 Yes
Community Sewer Main > 75' R Yes
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑ Yes if No *5'+ ft Surface Water > 100'
[D Yes if No ft
Property Line > 5'
❑✓ Yes
Community Sewer Manhole/Cleanout > 100'
if No
ft
[] Yes
if No ft
if No
ft
Private Sewer/Septic Line > 25' ❑✓ Yes
if No ft
if No
ft
Holding Tank > 100' ❑✓ Yes
if No ft
Water Service Line > 10'
Yes
Animal Containment > 50' n Yes
_
if No ft
if No
ft
0 Yes
if No
ft
Manure/Animal Excreta Storage > 100'
if No
ft
Q Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑ Yes if No *5'+ ft Surface Water > 100'
[D Yes if No ft
Property Line > 5'
❑✓ Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Z✓ Yes
if No
ft
Private Wells > 100' 0 Yes if No.
_-Water Main > 10'
0 Yes
if No
ft
Community Wells > 200' [] Yes if No _
Water Service Line > 10'
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'
Q Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
0 Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
0 Yes
if No
ft
Private Wells > 100' Yes if No
Water Service Line > 10'
0 Yes
if No
ft
Community Wells > 200' Yes if No
Surface Water > 100'
0 Yes
if No
ft
F. ENGINEER'S COMMENTS
*MET CODE AT TIME OF INSTALL -
TANK APRXIMATELY 7.5' AWAY FROM
DECK ON CINDER BLOCKS
G. ENGINEER'S CERTIFICATION OFv�
f certify that l have determined through field inspections and review
of Municipal records that the above systems are in conformance with p T
MOA COSA guidelines in effect on this date. ,
•.J ff� Gar ess.-
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COSA Checklist yellow sheet� �oe p"o 0
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#AECC884 44�D000dd
ft
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ft
Septic Tank Advisory
Certificate of On -Site Systems Approval #OSC 221012
Subdivision: Bernard Block 2 lot G1
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 20 years old. Typical replacement costs range from $9,000 to $12,000
This advisory must be attached to all copies of the subject Certificate of On -Site Systems
Approval.
This is an example of what the metal of a 20 -year-old steel tank MAY look like.
Ma�lirg Address P O Box 196650 *Anchorage, Alaska 99519 6650 "un org
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Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 060-321-09
COSA # Off IWS
Expiration Date: S ' %' 0 7
1. GENERAL INFORMATION
Complete legal description Lot G-1, Block 2, Bemard Subdivision
Location (site address) 18949 Elmore Lane Eagle River, AK 99577
Current Property owner(s) Kristat A. Martin Day phone 250-3282
Mailing address
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Four (4)
18949 Elnora Lane Eagle River, AK 99577
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class A Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
❑ Individual On-site
❑ Individual Holding Tank
Community On-site
❑ Public Sewer
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite 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 sample results. (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 Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SIGNATURE
V Approved for I' bedrooms.
Phone 522-7773
Date 727/2006
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
•
Jam• ON-SITE . ci
WATER AND :'9
WASTEWATER :
PROGRAM
o'•ti
)n))))))9)))))
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
By ile{7 eer(7-
(Rev „usr
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: g , r' - O C
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/enslte
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 0-1, Block 2, Bernard Subdivision Parcel ID: 060-321-09
A. WELL DATA
Well type _ If A, B, or C provide PWSID ti _ Well Log (YIN)
Date completed _ Sanitary seal (Y/N) _ Writs properly protected (YIN)
Total depth it. Cased to It. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level R ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L Other bacteria colonies/100 mL
Arsenic: _ mg/I Date of sample: _ Collected by:
B. SEPTICIHOLDING TANK DATA
Tank Type Material SeptklSteel Date installed 8/292001
Tank size 1,250 gal. Number of Compartments 2 CleangBs (Y/N)
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 2/24/2006 Pumper JRs Pumpkta
C. ABSORPTION FIELD DATA
Date installed 012912001 Soli rating (g.p.d./ft= or ft%Podrn)1.2 GPD/SF yin type 5' Wide Trench
Length 50 R VVIdth 5 fl. Gravel below pipe 4 it
Total depth 14 t Eff. absorption erea. 500 ft= Monitoring tube Y Depression aver field N
Date of adequacy test 3/212005 Results (Pass/Fail) Pass For 4 bedrooms
Fluid depth in absorption field before test 22 in. Water added, 625 gal. New depth 22 in.
Elapsed Time: 0 min. Final fluid depth 22 in. Absorption rate >= 600 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
Pump on' level at _ in. 'Pump atT level at _ in. High water alarm level at in.
Dahlin Cycles tested Meets alarm & circuit requiemen s?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankNft station on lot On adjacent Ids
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer /septic service Nne Holding tank
Animal containment areas None Manure/animal excrete storage areas None
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line>S Absorption field >10'
Water main >10' Water service line >10' Surface water >100'
Wells on adjacent lots >200'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10'
Building foundation >10' Water main >10'
Water Service Nne >10' Surface water >100' Driveway, parkirghashicle storage >25'
Curtain drain None Noted
Wells on adjacent lots >200'
F. COMMENTS: Lot is Served by Public Water System.
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspections and
review of Municipal records that the above systems am in
cordormanca with MOA COSA guidelines le effed on this date.
Engineer's Printed Name Mitred E. Anderson, P.E.
Date 7/272000
COSA Fee E Li 30
Date of Payment ��a'1►%NiNe
Receipt Number 8 3$ 31
(Rev. 11105)
Waiver Fee S
Date of Payment
Receipt Number
Ktt
Jac ru JJcdr
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
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 060.321.09
1. GENERAL INFORMATION
Complete legal description Lot G-1, Block 2, Bernard Skibdivlslon
HAA # D5DOT,{o
Expiration Date: 3 "/ 0 - 0 6
- Location (site address or directions) 18949 Elnora Lane -
Current Property owner(s) Scott and Kathy Boska Day phone 441.2287
Mailing address 18949 Elnora Lane Emile River, AK 99577
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Four (4)
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class A Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
❑ Individual On-site
❑ Individual Holding tank 0
O Community On-site 0
❑ Public Sewer 0
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.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify hat my
shoi ve tligation,
based on procedures outlined in the Health Authority Approval Guidelines for this app'
the
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 Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
5. DSD SIGNATURE
\/ Approved for 1-t bedrooms.
Disapproved.
Conditional approval for
•
Phone 522-7773
Date 3/8/2005
bedrooms, with the following stipulations:
Additional Comments
at(tlt(((O(ffg1/4,AN'Eri/
: ON-SITE . Q
•-▪ z• WAlbKANU : rr
WASTEWATER
• •
PROGRAM :,
•
SENT D,
1U//lIJ))1` .
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: yl
(Rev.12/00)
Original Certificate Date: 3 " / 0 — 05�
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water fi Wastewater Program
4700 South Bragaw St
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot G1, Block 2. Bernard Subdivision
A. WELL DATA
Well type Class A If A, B, or C provide PWSID # Well Log (Y/N)
Date completed _ Sanitary seal (Y/N) _ Wires properly protected (WN)
Total depth ft Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Parcel ID: 060.321.09
Date of test
Static water level ft ft.
Well production g.p.m.
g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 ml. Nitrate mg.A. Other bacteria colonies/100 ml.
Date of sample: Collected by:
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 812912001
Tank size 1250 gal. Number of Compartments j Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (WN) g High water alarm (Y/N) N
Date of pumping 319/2005 Pumper Chualak Pumpers
C. ABSORPTION FIELD DATA
Date installed 8129/2001 Soil rating (g.p.d./IP or fl9Ibdrm)12 GPD/SF System type 5 Wide Shallow Trench
Length 50
ft Width 5 ft. Gravel below pipe 4 ft
Total depth j4 ft Eff. absorption area ¢Q0 ft2 Monitoring tube f Depression over field f4
Date of adequacy test 3/3/2005 Results (Pass/Fail) Pass For for bedrooms
Fluid depth in absorption field before test $ in. Water added gal. New de
pthg in.
Elapsed Time: 9 min. Final fluid depth a in. Absorption rate >= 600 g.p.d.
My rejuvenation treatment (past 12 mo.) (Y/N & type) 14 If
yes, give date
D. LIFT STATION
Date installed Size in gallons
'Pump on° level at _ in. 'Pump offs level at
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO
Septic tank/lift station on lot NIA
Absorption field on lot WA
Public sewer main NIA
Sewer /septic service line NIA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Manhole/Access (Y/N)
in. High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots N/A
in.
On adjacent lots NIA
Public sewer manhole/cleanout WA
Holding tank NIA
Building foundation >5' Property line>S'
Water main >10' Water service line >10'
Wells on adjacent lots >200'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10' Water main >10'
Surface water >100' Driveway, parking/vehicle storage
Wells on adjacent lots >200'
Absorption field >5'
Surface water >100'
Water Service line >10'
Curtain drain None Noted
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that ► have determined through field ids and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson. P.E.
Date 3M2005
>5'
''• •No. CE -43e1 :+,4
eCE-43e1; oftESS s.
rnat
HAA Fee S IRO
Date of Payment 3 I 1 Ili
Receipt Number
(Rev. 12/00)
teq S55
Waiver Fee
Date of Payment
Receipt Number
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81-245
BERNARD SUBDIVISION
LOT G-1, BLOCK 2
28,069 S.F.
ALLEY
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ELNORA 1 -PIC
FINAL STRUCTUIRI
AS -BUILT
I HEREBY (
PROPERTY
IS THE I
GASTALDI LAND SURVEYINGNCROACI-IA
JEFF A. GASTALDI, R.L.SIT
4726 WEST 88TH AVENUDETERMINE
ANCHORAGE, ALASKA 9950VENANTS
PHONE 248-5454
APPEAR OP
UNDER NO
GRID
DATE
HEREON DI'
sw 254
11/2/2001
ESTABLISIIR
ANCHOR/
F.B.
.108 NO.
NOTE:
01-16
65612
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20'
L=10.00.
R=1902.33
II \I I HAVE SURVEYE
• AI U)VE AND THAT N
Id I •XCEPT AS INDIC
'u IIY OF THE OWNER
r -Il FICE OF ANY EASE
• .111':1IONS WHICH DO
• • ''.' II:I )1:D SUBDIVISION
• 1.\IIC1:S SHOULD ANY
• •1; CONSTRUCTION 0
r :" \l f OR FENCE LINE
a• 1 `INC DISTRICT, ALAS
;E -.T THIS DATE.
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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.clanchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 060-321-09
1.
HM# I -J A 0 L 0 0 S'/
Expiration Date: 7 - / o - 0� .
GENERAL INFORMATION
Complete legal description Lot G-1, Block 2, Bernard Subdivision
Location (site address or directions) Elnora Lane
Current Property owner(s) Spinell Homes, Inc. Day phone 344-5678
Mailing address 9210 Vanguard Drive, Anchorage, AK 99507
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class A Well
Public Water System
Four (4)
TYPE OF WASTEWATER DISPOSAL:
❑ Individual On-site
❑ Individual Holding tank
O Community On-site
❑ Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 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. DSO 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.
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 Health Authority 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 Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Phone 522.7773
Engineer's Printed Name Michael E. Anderson. P.E. Date 2/18/02
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V, ,. ?Alava I. ANDERSON :��, d•
5. DSD SIGNATURE
e",..
CE.4381 u
L Approved for 1-{ bedrooms. cv�0 •.il ... S ...•.,1v
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
By:
Additional Comments
OFA
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:WATER AND i' • oo
WASTEWATER
o •, FROt,KAM :
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
1(� Original Certificate Date: 4 /0 - O 2
(Rev. 1200)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6850
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot G.l. Block 2, Bernard Subdivision
A. WELL DATA
Well type _ If A, B, or C provide PWSID # _ Well Log (Y/N)
Date completed Sanitary seal (Y/N) _ Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
•
Parcel ID: 060-321-09
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform cobnies/100 mi. Nitrate mg./1. Other bacteria colonies/100 ml.
Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SeoticISteel Date installed 8129/2001
Tank size 1.250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping Pumper WA
C. ABSORPTION FIELD DATA
Date installed 812912001 Soil rating (g.p.d./ft2 or ft2/bdrm)1.2 OPD/SF System type 5' Wide Shallow Trench
Length 50 ft. Width 5 ftGravel below pipe 4 ft.
Total depth 14 ft. Eff. absorption area,'�00_ftMonitoring tube Y , Depression over field N
Date of adequacy test Results (Pass/Fail) For _ bedrooms
Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in.
Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
g.p.d.
D. LIFT STATION
Date installed Size in gallons
'Pump on level at _ in. 'Pump off- level at _ in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot NIA
Absorption field on lot NIA
Public sewer main NIA
Sewer /septic service line NIA
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots NIA
On adjacent lots N1A
in.
Public sewer manhole/cleanout NIA
Holding tank NIA
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line>5
Water main >10' Water service line >10'
Absorption field >5'
Surface water >100'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >70' Building foundation >10'
Water Service line >10' Surface water >100'
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
Lot is served by oubllic water system.
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P1.
Date 2118/2002
Water main >10'
Driveway, parking/vehicle storage >25'
OFA 114
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1;.' , M.104404381 ass. 2cr
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HAA Fee $ 3 7 $�, o O
Date of Payment Z - O- O - 0 7 -
Receipt
Receipt Number / 6 2 72
(Rev. 12/00)
Waiver Fee $
Date of Payment
Receipt Number
tNt : GASTALD1 LAPD SURVEY
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PHONE N0. : 9072489362 Feb. 12 2222 94:5881 P1
• 81-24S
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FINAL STRUCTURE AS••otV T • •
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