HomeMy WebLinkAboutDAWN VILLAGE BLK 2 LT 2
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PERI'lIT N0.
I'--ILII'-I l' ~1:1 FIL T TY i-iF F~t'-,ll~_-I-
DEPRRTNENT OF HEOLTH RND ENVIRONHENTRL PROTECTION
2516 E. TUDOR RD. ~ ANCHORRGE, RK.. 9958'/'
276-2221
IMBUE PFR£4 I T
( ??Ol~ )
AF'PLICRNT
LOCATION
LEGAL
P._~EI'ERSON CONSTRUCTION
TESHCAR ST
L2 B2 DAHN VILLRGE
SRR BOX i?lOX
LOT SIZE
~44-B6~8
10000 SQUARE FEET
itlNIIILIH DISTANCE BETHEEN R HELL AND ANY ON-SITE SEHRGE DISPOSRL SYSTEH IS
i00 FEET FOR R PRIVATE HELL OR 280 FEET FOR R PUBLIC HELL.
HELL LOa=, RRE RE6!UIRED AND MUST BE RETURHED TO THE DEPARTMENT HITHIN ~:0 DAYS
OF THE HELL COftPLETION.
SPECIFICATIONS AND CONSTRUCTION DIRGRRHS ARE AVAILABLE TO INSURE PROPER
INSTRLLRTION.
PEi~::i",~ I T ',v'l=lL I [:, FOR C~ f-,i E '"r'ERF4 FF-:Lq f"l I --c-SIJE
I CERTIFY THAT
i: I RH FAHILIRR 14ITH THE REQUIREI'1ENTS FOR ON-SITE SEHERS AND HELLS RS SET
FORTH BY THE 1,1UNICIPRLITY OF ANCHORAGE.
2: I HILL INSTALL THE SYSTEM IN ACCORDANCE HITH THE CODES.
689 �� -,
•./,-)
• • " PM
Municipality of Anchor . g' MAY 11 2011 '
On-Site Water and Wastewater Progra
(907) 343-7904 - ti E
Ol fi 8 Lch
Certificate of On-Site Systems Approva
Parcel ID. 014-061-40 Expiration Date:
1. GENERAL INFORMATION:
Complete legal description Dawn Village; Block 2, Lot 2
Location (site address) 6751 Teshlar Drive
Current Property owner(s) Molly Collum Day phone
Mailing address 6751 Teshlar Drive
Real Estate Agent Tyler Dunlap Day phone 227-9025
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
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: Distance:
-
Received by: v Date: l" �C
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 2-6'f 1 — Waiver Fee $
Date of Payment `SJ ll'1 Date of Payment
Receipt Number 07)g-53 Receipt Number
COSA# °5C1 7I. I -)Li Waiver#
5. STATEMENT QF 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 Grout), Ltd (GEG) Phone: 907-337-6179
Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507
Engineer's Printed Name: Jeffrey A. Garness Date: f' /19'
oQO��p�t�.
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system -7 OF A 1+Q�
in accordance with the guidelines and regulations established by the Municipality of Anchorage and � .••'•'•.••.,�s�o
industry practices. The reported results describe the condition of the system/s on the date/s of the p Q•
•' Qn
evaluation, Separation distances were measured to readily identifiable features. Hidden defects or �� .' 49 H %\ "�V)
encroachments may exist that were not identified during the evaluation. The operational life of all wells /J e VO
and septic systems depend upon a variety of variables, including but not limited to, soil conditions, /•-•-•••• •. ol
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 Q. . ,
are outside the control of GEG. Satisfactory test results do not guarantee future performance of the O J-ff _ A. • ess,"
system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of On CE-79 3 • oQG'
the well or septic system. GEG makes no representation whether an alternative well or septic system �9 l �
can be installed on the property in the event either of the current systems fail to perform adequately in 0� e ` c°o�
the future. The content of this report is for the sole benefit of the person/party that retained GEG to 4P�profess on°pQ
perform the evaluation. Reliance upon the information provided in this report by any other person or D 00q*
party (including subsequent property purchasers) is not authorized, nor will it confer any legal right
whatsoever.
#AECC884
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following AsViRi71""atiafis;AvCh
O.
ON-sn E
WATER AND m.
ri WASTEWATER
l'ROGRA1vf
By: a,• Original Certificate Date: 5 /6—'—//
The Municipality of Anchorage Development Services Di'•sion (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 Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_10-10-12.doc
,
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Dawn Village; Block 2, Lot 2 Parcel ID: 014-061-40
A. WELL DATA
Well type Private If A. B, or C provide PWSID# N/A Well Log (YIN) Yes
Date completed 4/21/1977 Sanitary seal (Y/N) Yes Wires properly protected (Y/N) Yes
Total depth 101 ft. Cased to UNK ft. Casing height (above ground) 124- in.
FROM WELL LOG AT INSPECTION
Date of test 4/21/1977 4/25/2017
Static water level 41 ft. 25.2 ft.
Well production 10 g.p.m. 4.5+ g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 0 mg./L. Collected by: GFG. Ltd.
Arsenic: 15.5 ug./L. Date of sample: 4/25/2017
B. SEPTIC/HOLDING TANK DATA AWWU
Tank Type/Material Date installed
Tank size gal. Number of Compartments Cleanouts (Y/N)
Foundation cleanout (Y/N) Depression over tank (Y/N) High water alarm
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed Soil rating (g.p,d./ft'or ft`/bdr System type
Length ft. Width ft. Gravel below pipe ft.
Total depth ft. Eff. absorption . -a ft` Monitoring tube Depression over field
Date of adequacy test Results (Pass/Fail) For bedrooms
Fluid depth in absor. .n field before test in. Water added gal. New depth in.
Elapsed T.-- -: min. Final fluid depth in. Absorption rate >= g.p.d.
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 off" level at • wa er alarm level at in.
I- - Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot N/A On adjacent lots 100'+
Absorption field on lot N/A On adjacent lots 100'+
Public sewer main *50 Public sewer manhole/cleanout *50'+
Sewer/septic service line **22' Holding tank 75'+
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: AWWU
Building foundation Property line Absorption field
Water main Water service line Surface water
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIE i : 4 OT TO:
Property line Bu ••• • oundation Water main
Water service line Surface water Driveway, parking/vehicle storage
drain Wells on adjacent lots
F. COMMENTS
*Per code at time of installation. **No required separation distance in 1977.
�d���pI D'
G. ENGINEER'S CERTIFICATION �F q4�Q
d
fr,.'
;r certify that t have determined through field inspections and 4 •,1*t0
review of Municipal records that the above systems are in P d
conformance with MOA COSA guidelines in effect on this Q _ Q
date. v p '•, , A. ••mess.= G)
45/
Engineer's Printed Name JEFFREY A. GARNESS v E-7 5 . fop
Date c/1/17._ uO%r",.' •5.11(•i' aog
4Q aprofession64
�040ooQ��
#AECC844
(Rev. 11;05)
i
z i 8456H
,:t- f Lot 3 _
CO f f
25 Block Ret. Wall EAST 154.69
L ., x x I X
Chain Link Fence
`r' x
i N 0
E Gravel �. coCC o'
0o co XW Q
ct O a) — — _ _ i��I c 34.0
o Lot 2 15
c�
Lo �
II = I o D x �-
2 cn 1 112 Story o b 0
CO H Er) Well N Frame House N b o
H 0 2 OH Deck X o
Z 34.0 (j)
-+-31.8
C34 Deck 11111111, -4. Shed
1: Block Ret. Wall
25 ___II
-..---------Wood Ret. Wall t EAST 154.72iii
I
Note: Lot served by public sewer Lot 1 I
AS-BUILT NO CORNERS SET THIS DATE
♦�`"`Ilk
44.` (I , I hereby certify that I have performed a Mortgagee's inspection
�F. OF • ,1 of the following described roperrttyy:Lot 2. Block 2
�P. • .S,r +t DAWN VILLAGE SUBDIVISION
r CPI
—• 49th ��5 ••• �I
*. %* / Anchorage Recording District,Alaska,and that the
00 •• / improvements situated thereon are within the property Ines
• and do not overlap or encroach on the property lying
V�; adjacent thereto,that no improvements on the property lying
N I / .Fred Walatka.
o adjacent thereto encroach on the premises in question and
;i�•• 3255 – S .•• ogr
Am, that there are no roadways,transmission lines or other
lb • h aw visible easements on said property except as indicated
SCALE: 1"= 20' 4 o�FEssloNl•�•JAim! hereon.
Dated at Anchorage,Alaska
EASEMENTS OF RECORD,OTHER THAN 1%\\\ . this 1st day of May ,2017.
THOSE SHOWN ON THE RECORDED FRED WALATKA&ASSOCIATES
PLAT ARE NOT SHOWN HEREON. Engineers and Surveyors
FB 17-6 pg.2 CH (907-248-1666)
•
Municipality of Anchorage R. v ,
Development Services Department z`
Building Safety DivisionSA ETA
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Arsenic Advisory
Certificate of On-Site Systems Approval # OSC 171174
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 2, Lot 2 of
Dawn Village Subdivision. This inspection revealed an arsenic concentration
of 15.5 micrograms per liter (ug/L) for the property's well water sample.
The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 ug/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. Information on arsenic is
available from the On-Site Water and Wastewater Program website
(www.muni.org/onsite) or at 343-7904.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 2~ B~ock £i Dawn
Location (address or directions)
6751 T~ hlar
(b) Property owner Chu. ck D~Kru~
Mailing Address
(c) Lending Institution
Mailing Address
Telephone: (home)
Dc~tv~.r t Colorado
, Business
Telephone
(d)
(e)
Real Estate Company and Agent
Address 3230 C Stre~l~
Telephone ,~; ~- 1 ~ ~'
HERITAGE REAL ESTATE A~-FN: Rob~
Anchorage, A~a~ka 99503
Mail the HAA to the following address: (or check here i~if hold for pick up.)
List contact person and day phone number below:
5 & $ ENGINP-["I~ING
17034 Eagle River Loop Road No. 204
~agle Kiver~ A!aska YY3~',
2. TYPE OF RESIDENCE
Single-Family [~ Number of bedrooms
3. WATER SUPPLY
Individual Well ~ Community r3 Public i-i
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site r-i Public ~ Community r-i Holding Tank I-I ..
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and .status.
72-025 {Rev. 7/88) Page 1 of 2
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MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
' 'CHECKLIST - FEBRUARY 1984
:. , . 343-4744
WELL DATA
Well Classification'
Legal Description:
: '' ~P,~Jk)
Well Log Present (Y/N) ~ ' Date ComPleted
Total Depth ! o ! ' Cased to ~ohf
Static Water Level '~' ~'
ZJ_~I- 7 ~ Yield
Depth of Grouti%
~" 'f' ' Sanitary Seal on Casing (Y/N)
~ Depression Around Wellhead (Y/N)
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line 'X-
;"On Adjoining Lots __ ~'.
.
'; On Adjo'ining Lo'ts _~: ;i( ~ 'q-
To Nearest PubliC Sewer CleanouqManhole /
To Nearest Sewer Service Line on Lot '~ ,~- ~- ~ '~
WaterSampleCollectedby -~,'~ ~ ~,UqiP~e41'll~ ;Date "~' - I~-?0
Bo
SEPTIC/HOLDING TANK DATA
Date Installed Size
Standpipes (Y/N)
No. of Compartments
Iht Ca'ps (Y/N)
Depression over Tank (Y/N)
PumPing/Maintenance Contact on
Holding Tank High-Water Alarm
SEPARATION DISTANCES FROM S
FoundatiOn Cleanout (Y/N)
Date 'Last Pumped
; for
g Tank Permit (Y/N)
TANK:
T° water-SupPiy Well
· To. Property .Line '
To Water Main/Service
To Stream, Pond, Lake or Major Drainage Course
,g Foundation "
)osal:Field
72-026 (Rev. 7/88) Front
Page ! of 2
C. ABSORPTION FIELD DATA
Soils Rating in ,~sorption Strata
Date Installed"% :
Width of Field, * '~' t. ..
Square Feet of Absortion A~ea~
Depression OTM Field'(Y/N!: ~
' ' ' Type of System Design
Length of Field ·
Depth of Field
. Gravel Bed Thickness
Statndpipes Present (Y/N)
Date of Last Adequacy.Test
Results of Last Adequacy ,Test
SEPARATiON'~' 'DISTANCE FROM A~O~~I E L'
I~: To Property Lihe
T° ~Vate~-~suPply Well
To Building Foundation- ~' ' ' .... '~ To'EXisting or Abandoned System on
~_ :~ :~ ~ '_':~ £:~: ; On~djoining ~'o~s _'. '
Lot
To Water* Main/Service Line.. L -.: ..... % ~ Cutback (if present)
To Stream, Pond,, Lake, or Major Drainage Course '%%' "
To
.Driveway, Parking Area, o~' Vehicle Storage Area
D. LIFT STATION
Date Installed
Size in Gallons
,..,'Pump on" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
'* comments
Dimensions
- { )
',~" i V../...~ : 'Manhoo/Access
·" .... Pump Off" Level at
· , Vent
**Check Permitted Bedroom Rating Against HAA Request**
Pumping Cycles during Adequacy Test.
I certify that I have checked, ~erified,'or conformed to all MOA a'nd HAA gmdehnes in effect on the date of this
inspections .~, s ~;,~:~:;t ~ERING ~ ' ' ·
Signed I 7~;~. ,;..,.; ,~Iver Loop Rc~ ~;~. ~na :'
C Eagle'~v~;'Alaska~
ompany er L~ g~d N~ 2~
MOANo, 0-~ ~ ~OO~
?
Receipt No " .......
Date of Payment ~-- ~ .~-- ?p
Amount: $ /' 7~) ~
72-026 (Rev. 7/88) Back
Re~:eipt No:"
Waiver Fee: $
Date of Payment
Page 2 of 2
7
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343
FEDERAL TAX I.D. #92-0040440
ANALISIS ~EPO~T B! SAMPLE fox Mock Order ! 25392
Date ~eport Printed: 3UL 18 90 i 10:08
Client Sample ID:L2 B2 DAWN VILLAGE
PW~ID :UA
Collected JUL 11 90 ! 15:15 lme.
~eceived ~ 13 90 t 16:45 l~s.
Client Name
Client Jcct
P.O.! ~ONE ~[CEIVED
~eq !
Analysis Completed :JU~ 16 90 Send l~eports to:
Laboratory Supe~!isor .~.EPHEN C. ~-DE l)S & $ [NGINK~.RING
Special CALL ~!E hESULT$ AT 694-2979 UPON C016'LETION.
Instruct:
Chemlab Ref t: 902434 Lab Smpl ID: I Matrix: MATER
Allovable
Pa~amete~ Tested ~eeult Units Method Limits
NITRATE-N ND(O.IO) m~/1 EPA 353.2 l0
~mple RO~INE SA!~PLE.
I Tests Performed ' See Special Instructions Above UA-Unavailable
~D- Mona Detected "See Sample ~eme~ks Above
MA- Not Analyzed LT-Leee Than, CT-C~eater Than
' MUHICIPALITY OF.ANCHORAGE
DEPARTME''~'OF HEALTH AND ENVIRONMEN"~. PROTECTION
855 .L Street, Anchorage, Alas0.a 99501
279-2511, ext. 224 or 225
%1: TAme 2:30 p.m.
Date 5-4-77 Tues
#2: Time
Date Received: _May 4, 1977
93: Time
Date Date
Insp Pratt Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Alaska Mutual savings Bank
Mailing Address: Post Office Box 1120 99510 Phone: 274-3561
2. Property Owner: Pederson Construction Phone: 344-8638
Mailing Address: Star Route A Box 1718X 99507
3.' Legal Description: Lot 2 Block 2 Dawn Village Subdivision
4: Single Family Residence: (x) Number of Bedrooms: 2
Multiple Family Residence: ( ) Number of Bedrooms:
Well System: Individual well (x) Community/Public System ( )
Permit % 77013 Depth of Well 101' · Well Log on File ( )
Construction Bacterial Analysis
Sewage Disposal System:
Permit #
Septic Tank Size
Absorption Area
On-site System ( ) Public Utility (x~
Installed Installer
Manufacturer
Soils Rate Material
Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Nearest Lot Line
to Absorption Area
Absorption Area
Pa~e Two
., ~ Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot'2 Block"2 Dawn Village Subdivision
Comments:
Affadavit,, Attached~ (})
Disapproved:
Department Worksheet:
Letter Attached:
Date
Date