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HomeMy WebLinkAboutCLYDE M DICKSON BLK 2 LT 8Clyde AR Dick I1 Block Lo1- 8 #007-055-18 Municipality of Anchorage Development Services Department Building Safety Division · On-Site Water & Wastewater Program 470,0 B~agaw S~re.et P.O. BOx 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEHS APP/ROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. 007-055-18 1. GENERAL INFORMATION Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address .,. CLYDE M. DICKSON S/D; BLOCK 2, LOT 8 7651 E. 36TH AVE * ANCHORAGE, AK * 99504 BOB BUCHTA Day phone 3542 OLD MULDOON RD * ANCHORAGE, AK * 99504 Day phone SHEL HENSLEY W/ SHEL HENSLEY REAL ESTATE GROUP Day phone 200 W. 34TH AVE * ANCHORAGE, AK * 99503 360-6340 Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: 4 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 ~NSPECT!ON BY ENGINEER As certified by my seal affixed het~to and as of the ~lidation date shown below, I verify that m,y 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 Municipafity of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with afl applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone .557-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. 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 ~¢~/' Approved for ~' Disapproved. Conditional approval for bedrooms. ...%& bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 11/05) Arsenic Advisory, Maintenance Agreements Supplemental Engineer's Report Other )"/~~'~ Original Certificate Date: ii-_¢'-/0 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: CLYDE M. DICKSON S/D; BLOCK 2, LOT 8 Parcel A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 10/1,3/1965 Sanitary seal (Y/N) YES Total depth 107 .ft. Cased to 107 ft. Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground} YES YES 12+ in. Date of test FROM WELL LOG lO/13/1965 AT INSPECTION 10/26/2010 Static water level 85 .ft. 78 ,ff. Well production 6 g.p.m. WATER SAMPLE RESULTS: Coliform~~' colOnies/100 mi. Arsenic:~g./L. B. SEPTIClHOLDING TANK DATA 5.5 g.p.m. Nitra~mg./L. Date of sample:l 0/25/2010 Collected by: Tank Type/Material Other bacteria ~;~lonies/100 mi. GE(; Ltd. Tank size gal. Foundation cleanout (Y/N) Date of pumping ABSORPTION FIELD DATA Date installed' PUBLIC SEWER Date installed Number of Compartments ~ Cleanouts (Y/N) Depression over tank (Y/N) ~ High water ala~,/N~ Pumper Soil rating (g.p.d./ft2or em type . Width / ft. Gravel below pipe Depression over field~ Length ft. Total depth .ft. Eft. absorptio~at~ ft2 Monitoring tube Date of adequacy test / Results (Pass/Fail) Fluid depth in~ before test in. E!a~i __ min.. Final fluid depth Ar~ rejuvenation treatment (past 12 mo.) (Y/N & type) Water added gal. in. Absorption rate >= If yes, give date .ft. For~bedrooms New depth in. g.p.d. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons Manhole/Access ~ _........~----'~'~'~-- "Pump off' I~igh water alarm leVel at .in. Cycles tested Meets alarm & circuit requirements? Septic tank/lift station ;on lot N/A Absorption field on lot N/'A Public sewer main 75'+ Sewer/septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100,+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Manure/animal excrete storage areas PUBLIC 100'+ SEWER Building foundation Property line Absorption field Water main . Water service line. Surface water Wells on adjacent lots . ~ SEPARATION DISTANCE FROM ABSOR~LOT TO: Property line ~~.~..~;~hlg'3oundation__ Water main~ Water~~ ~wUe~asC~nWaa~arc~n t i~l s Driveway, parking/vehicle storage F. COMMENTS :~rness... '*G. ENGINEER'S CERTIFICATION ! 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 IllS/lO COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SGS ReL# 1105750001 Client Name Garness Engineering Group, Ltd Printed Date/Time 10/29/2010 8:12 Project Name/# 7651 E. 36th Collected Date/Time 10/25/2010 12:30 Client Sample ID 7651 E. 36th Received Date/Time 10/25/2010 14:20 Matrix Drinking Water Technical Director Stei~hen C. Ede PWSID 0 Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND i00 ug/L EP200o8 C (<10) 10/26/10 10/28/10 KDC Waters Department Total Nitrate/Nitrite-N ND 0.100 mg/L SM20 4500NO3-F B (<I 0) 10/25/10 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 10/25/10 DLC Total Coliform Negative 1 100mL SM20 9223B A 10/25/I0 DLC 8355F LOT 10 LOT 9 SECTION LINE r- E. 36th Avenue 'E N89°54'00"E 58.30/r~.LF LOT 8 we"o N89°54'00"E 69.50 LOT 7 SCALE: 1"= 30' Note: The origin Plat No. P-336 does not specify beadngs and curve data for this property. The boundary for this survey was computed by holding record distances and the GLO beadng on E. 36th Avenue. AS-BUILT NO CORNERS SET THIS DATE /.~ t Fred Walat~a ~SEMENTS OF RECORD, OTHER THAN THOS~ SHOWN ON T~: P~T ARE NOT SHOWN HEREON. FBi 0-7, pg &0 BE hereby certify that I have performed a Mortgagee's tnspec~on of the following described property: gOT 8, BLOCK 2, _ CLYDE _M..~_.DICKSON SUBDIVISION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property fines and do not ovedap or encroach on the property lying adjacent thereto, that no improvemen~ on the property lying adjacent thereto encrosch on the promises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska ~is 20th day of October FPt~:D WAL.ATKA & ASSC-C~ATES Engi~ee~ and Surveyo~ (907-248-1866) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.a k.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 007-055-18 1. GENERAL INFORMATION Expiration Date: /'- '~ ° 0 _~ Complete legal description CLYDE M. DICKSON SUBDIVISION; LOT 8, BLOCK 2 Location (site address or directions) 3542 OLD MULDOON ROAD * ANCHORAGE, AK 99504 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JOHN &: ETHEL VEFF Dayphone ,.333-6717 3542 OLD MULDOON ROAD '" ANCHORAGE, AK 99504- Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site DD Individual Holding tank Community On-site ~E] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewatar disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. CeAificatas of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. / Note:Alaska Water and Wastewater Consultants, Inc. shall be paid $ ~ at, or pdor to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER Aa certified by my seal aflTxed hereto and as of the validation date shown below, I verify that my investigation, based on prrocedures 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 bedrooma and type of st[ucturee indicated herein. I further verffy 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. NameofFirm ALASKA WATER & WASTE'WATER CONSULTANTS. INC. Phone 337-6179 Address 6901 DEBARR ROAD. SUITE 2B * ANCHORAGE. AK 99504 / / Engineer's Printed Name JEFFREY A. GAENESS, P.E. Date t o/'Z,~ Engineer's Comments: In conducting this evaluation, AKW1/VC. Inc. attempted to provide a thorough, conscientious engineefing analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results descfibed the perfon~ance of the system under the conditions encountered at the time of the test. and separation distances measured to readily identifiable features. The operetiona/ life of ail 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 resulta do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authofized, nor wifi it confer any legal fight whatsoever. 5. DSD SIGNATURE ~J Approved for L'~ bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the fllowing stipulations: Manitenance Agreements ~-"~ Supplemental Engineer's Reort Other (Rev. 1~01 ) Original Certificate Date: / ~) - 3 0 - 0,,~... Municipality of Anchorage . Development Services Department " Suing Safety O~ · ~ Wa~r & W~r (~) Legal Dr=c=lption: A. WELL DATA Well type PriVATE HEALTH AUTHORITY ~,PPROVAL CHECKLIST CLYDE M. DICKSON S/D; LOT 8. BLOCK 2 If A, B, or C provide PWSID~ .N,/A Date completed t0/1,.3/1965 Sanitepj seal (Y/N) YES Total depth 107 fi. Cased to 107 ff. FROM WELL LOG Date of test 10/13/1965 Static water level 8,5 fl. Well pmductton 6 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Arsenic: N/A mg./L. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size , gal. Foundation cleanout (Y/N) D~t~, ef C. ABSORPTION FIELD DATA Date installed Parcel ID: 007-055-18 Well Log (Y/N) YES Wires pmpedy protected (Y/N).., YES Casing height (above ground) 12+ AT INSPECTION * 10/9/2002 76 lt. 6.25 g.p.m. *BY M&W DRILMNG Nitrate 0.38 mg./L. Other bacteria Date of sample:10/24/2002 Collected by: PUBLIC SEWER Date installed Number of Compartments Denm~i&,. uver tank (Y/N) Pumper 2 colonies/100 mi. AKWWC. INC. Cle:an,',atO High water alarm (Y/N) Soil raUng (g.p.d./ff~or fl~/Ixirm) System type' Length fl. Width . ft. Total depth ft. Eft. absorption ama fl2 Monitoring tube ~Depression over field Date of adequacy test ~ For bedrooms Fluid depth in absorption fle~ in. Water added__gal. ' New depth in. D. LIFT STATION Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES SIze in gallons "Pump off' lev-I st ~ Lin. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lilt station on lotN/A Absorption field on lot N/A Public sewer main 75'+ Sewer/septic sewice line 25'+ Holding tank Manhole/Acc~<~ (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer menhole/cleanout Absorption field Su~lace water SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Water main Water service line Wells on adjae,,nt I&L~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water service line Sudace water Curtain dr'ein Wells on adjacent lots F. COMMENTS Water main .~Oriv~,v,=y, parklng/vehicie storage 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 HAA guide#nas in effecf on this date. Engineer's Printedl~lame . du.~.t<EY A. OARNESS Date Date o, Puym,.t Receipt Number (Rev. 12~01 ) 100'+ Date of Payment Receipt Number in. TOTAL THIS WORK ORDER 10/28/02 02:44:11 PM idle Edill~ew l~o3e Zoom Iools &nno~s~on Help . ................. ~ r...~ ............. , ' i ' 10-28-0Z 15:40 FEOI/-CTtE EKVIROIflEHTAL SlaV a~K CT&E EnvirOnmental Service. Inc. 9075615101 T-4T8 P,02/62 CT&E Ref.# Client Name ?mjt~t l~ame/~ CBen! Sample ID Matrix 0 Sample Remarks: 1027254001 AK Water & Wastewater Consultants Inc. C1V DE M Dickson L8. B2 Cly DE M Dick.son LB. B2 Drinking Water All DaCes'rimes are Alaska Standard Time printed Date/Time 10/28/2002 14:10 Collected Date/Time 10/24/2002 12:29 Re~el~ed Dare. line 10/24/2002 13:15 Technical Director Stephen C. Ede Allow,~Me Pfcp ,~alysis Limits Date l~te Init Nitratc-N 0,380 0,200 ml?/L EPA 300,0 (<=101 10/24/02 PLW I~Lcrob't oXogy Lab o~:a'co z'~ Total Coliform 2 OB,No Coli col/100mL SMI8 9222B I 0/24/02 K. AP