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