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HomeMy WebLinkAboutHOFFBECK LT 1Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page ( of 'Z www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: )CO 0146 Z SPID Number: 0(% •- D0( ,� Name: p' ✓� }(J. �� Y L G S r� Wastewater System: [P New ❑ Upgrade Address: y ,'� O & A4111S ABSORPTION FIELD Phone: Number of Bedrooms: Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other. LEGAL DESCRIPTION Soil Rating: �i Total Depth from original grade: (i GPD/Ft? Ft. Block: Lot: Sybvis' ''Yr jrj Depth to pipe bottom from original de: Gravel depth beneath pipe: / 2-- (J O 2 ?�� Ft. Ft. Township: Range: Section: Fill added above original grade:: ^^ / 2 Gravel Length: ,Z�— (1 V Ft. l Ft. Well: New ❑ Upgrade Gravel width: zr Number of lines: % Distance between lines: - — Ft. FL Classifi tion (Private, A, B. C): Total Depth: Cased to: 2% Total absorption area: U Pipe Material: �[ X7(1 �j it UQtU Ft. Ft. O r Ft2 l Driller.Date D Iledj (�� Static Water Level: Insla ler.' _ L 7`1 Ot Date Install d: % t 9 Prn� Fl. f2/ Yield: S' Pump Setat: Casing Height Above Ground: 7,0 TANK GPM til 41 11 Qw el FL Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding W.T.E.P. ❑ Other: To Septic Absorption Lift Holding ublic/Private Manufacturer //� XVI) (/) Capacity: From Tank Field Station Tank Sewer Line (j -yt FZ /2 SO Gal. Well /00I.� !//n�nn /VV 1% r r�a (� l ✓I` 10a \ Material: f l/' S r`"�� Number of Compartments: `_i Surface Water 1l(?Jl01_1L� ,00',F, (p�l� LIFT STATION Lot Line '��j /L 1 :DI�� J'v Z,�/� Size: (2�O Gal. Manufacturer. _( X y�0 „ j`Gf'j Foundation t ZO r,� r D / 7— "Pump on" level at � 0 r r in. "Pump off' level at: � '0 r t in. High water alarm at: 2 it in. Curtain Drain X //� / / x H W Pump Make & Model .rte O, ;rf �0 V C�. Electrical Inspections performed by: i * f 0,,�, v r� ^ 4,2,? Remarks: ��� t � (�, �,�, � S c n �1 �i`f [ BENCHMARK Location and Description: C-, ekr�,�� sla Assumed Elevation: l Lrj o Ft. Inspections performed by: Dates: 1 st 5-// 1 D L N / En�r�et�s�.5r��fR O ®a�1 c� 4� F A: I 2nd -1/1 2�e `f L�'o-�'��. •. • • • • `��_ a •°e°r Development Services Department Approval N ; 49YN Conditional Approval Date: ® •9 • • • • • • . ° g "'� • MICHAEL N. ANDERSON • C"c CE 94 9 �,,/�° Reviewed and approved by: Date: % �'�� S •�•'��i•`i���."� (Rev. 04/06) Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 • Fax (907) 343-7997 http://www.m u nLorq/Onsite Development Services Department On -Site Water and Wastewater Program went S O Department * * * * VARIANCE/WAIVER REVIEW * * * * WR#: 090041 HA#: Permit#: 040325 PID#: 017-093-16 Legal Description: HofFbeck, Lot 1 Engineer: Mike N. Anderson Applicant: Bob Rodrigues Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 8.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: 7/22/09 Approved by: Q4,1411-411, , n „ Name of Reviewer .............................. ■ .................. 0 . I ........ ■ ................ . Rec#: 122558 Amount: $200.00 Date Paid: 7/17/09 **** VARIAN C E/WAIVER REVIEW **** Permit No. SW040325 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 1, HOFFBECK SUBDIVISION MARKB GRND. ELV. PIPE ELEV. FC01 6 7 99.8\ 96.7 CO2 7 10 99.8 6.6 TC01 8 12 99 1 TCO2 12 15 99.4 \ MH LID I 16 17 109et MT 53 45 63.4 I II I I I \ HOUSE XTH11 PID No.: 017-093-16 i EDGE OF 25% SLOPE I I \ AmnrrI TREAM 1,250 GALLON SECONDARY SITE LIFT STATION _ 1 pI 1 " 1 /I.ST5 1AM OFFSET I I \ MT/ SL01PE OFFSEr 10'nt3lo I\ I � .w*�������1 •W �� OF Al i' 49 TH MICHAEL N. ANDERSON;' 10 No. CE 9469••x= Michael N. Anderson, P.E. Civil/Structural Engineering 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 July 19, 2009 Municipality of Anchorage Department of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Re: Lot 1 Hoffbeck Subd. Dear Debbie, Please consider this my official letter requesting a waiver of 2 foot into the 10 foot offset from the property line along the south property line. If you have any question please call me at 345-3377 Sincerely Michael N. Anderson, P.E. WAIVER FEES: 200 DATE OF PAYMENT: RECEIPT NUMBER: I 2zs�g Sent By: LGL ALASKA RESEARCH; 9075627223; Jun -30-03 1:09PM; Page 2/2 /Q va -0 Aa Kt LSM n vc r .la • �- iia , '.» t►. d! 6�®��.,be--..eo6 —Z ue8 --+rq,o-- d e3h�K+a o.aaabvvv. vo F var asysva ►av D DdavvaMva o.o o.a V i-v.i `�• -00' 1^.t/. UUA 1.`9VU:JV I111t-lIVI QI�G, 1114J1�0 `J"JV la -U U:/V - Rick Mystrom hiTi>•/Avww ri anchn— - ak 115 Mayor Permit Number. #SAN 030046 Date of Tssue: 3-97-03 Parcel Identifii nation NaMber: 017-093-16 Date Started: 6-1-03 Hate Completed: 6-5-03 is well located at approved permit location'? � —Yes®iso Legal DeseriptiOn: Hoffback Lot 1 Vropes€y Owner Nzme & Address: Robert Rodrigues_ Anchorage, Alasko 995W.- 17 Borehole Data; Depth (ft) Method of Drilling ® air rotary ❑ cable tool Soil Type, Micknoss & water Swam from TO Casing typs: steel Stick-up 0 2 Wall Thickness: .250 inches organics & silt 2 3 Diameter: 6 inches Depth: 2 & feat gravelly silt 3 22 Liner Type: Bedrock 22 387 Diameter: inches Depth: feet Casing sticl?up above ground: 2 feet Static water level (from ground level): 25 feet. Pumping level: 387 feet after 2 hours pumping .75 gpm Recovery Rate- .75 gpm Method of Testing: airlift.. Wen intake Opening Type: [3 ()pm End ® Open hole ❑ Scrccned Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: benionile granules Volume. 1 bg Depth: Start 0 feet Stopprd ? feet Pump: inti-ke Depth feet Pump size hp Brand Name `hJell Disinfected Upon Completion? M Ves 0 N Method of Disinfection: chlorine tablets , Comments: Well Driller: Alpine Drilling & Enterprises PO Box 190496 Anchorage Alaska 99519 AtWntion: Tae well driller shall provide a well log to the property owner within 30 clays of coimplction and the property 1i a -,From +19078308507 Tue Oct 25 05:54:30 2005 Page'1 of 1 INSPECTION REPORT MUNICIPALITY OF ANCHORAGE,' BUILDING SAFETY DIVISION 4700 SOUTH BRAGAW INSPECTION INFORMATION &HELP: 343-7962 INSPECTION: VOICE 343-8300 INSPECTION: FAX (907)249-7777 www.muni.org/BSD/Inspections.cfm NAME: BOB RODRIGUEZ PERMIT #:'63--0279 COMPANY: OWNER INSPECT DATE: 10/25/2005 PHONE * 644-2706 PHONE #: PHONE #: ADDRESS: 14441 PRATOR ST LOT 1 SUBDIVISION: HOFFBECK GRID #: SW3039 COMMENTS or DIRECTIONS CALL 20 MIN B4 FOR ONSITE MTG TYPE OF INSPECTION: Final Electrical J COMMENTS: (FOR INSPECTOR USEONLY) //I o./Ji r�Vv � m//A, 76 �T /)AJ,4 s MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SW040325 Legal Description: Hoffbeck Lot 1 Design Engineer: 0014 Anderson Engineering Owner Name: ROBERT RODRIGUES Owner Address: 14441 PRATOR STREET ANCHORAGE, AK 99516 - This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank Date Issued: Aug 09, 2004 Expiration Date: Aug 09, 2005 Parcel ID: 017-093-16 Site Address: 4806 Mills Dr. Lot Size: 81791 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 ❑ Holding Tank ❑ 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 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: Dale: Issued By: Date: % & 0 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Nj- 013-- 1& Permit Number SW Property owner(s) v, �!?Q1 CG Ud Day phone Mailing address (1) -Nfaftg address (2) lQgLE 1 PI'GL-�D r 54 • {}rNGn, K Zip Code cIG� lto Legal description (Lot, Block & Sub'd.) j� F ( 13cGt, U I Legal description (Section, Township & Range) Lot Size %f 4 :_+9 i= - (;;ores q.Ft. Number of Bedrooms THIS APPLICATION IS FOR: 3 Sewer Only � Well Only El Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub - ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool I ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: 4(o 0, Waiver Fees: Date of Payment: Q Date of Payment: Receipt Number: %'s (o ( 1/ Receipt Number: (Rev. 12/00) Michael N. Anderson, P.E. Civil/Structural Engineering 4640 Shoshoni Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 August 2, 2004 Municipality of Anchorage Department of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Re: Lot 1 Hoffbeck Subd. To Whom it may concern: This is a request for a septic permit for the above residence. The original permit has expired and the owner has requested that we change the design from an Advantex system to a conventional system. The well was drilled during the permit period. A new deeper test hole was drilled at the same location as the previous test hole to -24 feet. A soil log has been included showing the depth and water monitoring through the seasonal high water period, April thru June of 2004. Water was observed at elevation -23 feet which is about the elevation of the small creek located to the east, on the plan. No bedrock was observed and the soils were silty sand. The new design is a deep trench with 7 feet of effective, for a total depth of 9 feet. Two trenches have also been reserved for future leach fields. The 100 feet creek setback and the 50 bluff setback have been shown on the proposed plan. The new system is located 10 foot both the south and west property lines. The original perc was 2 minutes per inch and application rate has been lowered to around 1.0 gpd/sqft. This new system will not impact the neighboring properties due to the large lot sizes and layout of the existing systems. The slope of the drainage is generally flat from the bluff to the Prator street where the new septic system will be located. If you have any question please call me at 345-3377 Sincerely Michael N. Anderson, P.E. DESIGN CRITERIA: 4 BDRM X 150 = 600 GPD SOILS = 450/1.2 = 375 SQ FT REQ'D 375/14 = 27' USE 33 FEET —1' DEEP TRENCH SYSTEM 9' DEEP —6.0' 7' EFFECTIVE 2.0' WIDE 33' LONG �SpFN NEIGHBORING i v-- X /5V:'NT LOTCD �r PRO OSED iSEPTIC SYSTEM W/ BACKUP 1 Septic Design Prepared For � BOB RODRIGUEZ _�� OF Aj� LOT 1��� HOFFBECK SUBDIVISION 49Th .% Prepared By � e...� MICHAEL N. ANDERSON, P.E. MICHAEL N. ANDERSON ;,�Qc 4640 SHOSHONI DRIVE (907) 345-3377 / FAX (907) 345-1391 Jl.. CE 946 —24.0' "BUND OVER ;ADE DRAIN ROCK (((Qlz � a 100' W LL RADIUS' I I r I Ir � ' � r i I r 3 �EIRO0 HOUSE Qo II II II I I II Iv SCALE: 1"=200' AUGUST 17, 2004 OR SM SP DRAIN ROCK (((Qlz � a 100' W LL RADIUS' I I r I Ir � ' � r i I r 3 �EIRO0 HOUSE Qo II II II I I II Iv SCALE: 1"=200' AUGUST 17, 2004 PROPOSED WELL ; i I i � \ � 100CREEK \ iI SET BACK 35.0' I / 25% BLUFF LINE Z _ --_----- - \ 100' EXISTING i WELL RADIUS o �� \ o ~ \ o �\ TANK C.O. \ � �\ DOUBLE C.O. C.O. PROPOSED ,250 GALLON \ /-CENTERLINE OF g 1 STEP TANK x \ CREEK ' N \ 10' CREEK \ T BACK 25% BLUFF LINE MTI i MT i BLUFF \ ACK \ 32.8' �\ Septic Design Prepared For �q®� BOB RODRIGUEZ ��• OF At���t LOT 1 �Q°• HOFFBECK SUBDIVISION '40 49TH Prepared By � 40-Al MICHAEL N. ANDERSON, P.E. 4640 SHOSHONI DRIVE -11 MICHAEL N. ANDERSON ; (907) 345-3377 / FAX (907) 345-1391 s 9449 SCALE: 1"=30' AUGUST 17, 2004 r r A r Municipality of Anchorage ;Z(fHt'Wq IyOt 0R,8� Development Services Department Building Safety Division ® a„� On -Site Water and Wastewater Program mT 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 • _ e www.ci.anchorage.ak.us O MICHAEL N. ANDERSON(907)343-7904 94 9 "° Soils Lo - Percolation Test a���•` 9 �P,n* rcrm�d For: � n h .�_�� t,�s _ Dv'e Perormed- tr Y= � u r7 t 200 l Legal Description: LG #- ( lfy ("F z z �'/ Township, Range, Section: Slope Site Plan - 1- 2- 2- 3- 3- 4- 5- 4-5-6-7- 6- 7- 8- 8- 9- 9- 12- 12-13- 13- s®11 14- 15- 16- 17- 6�tj 18- 8-19-20-Z 19- 20- 'z COiNili ENTS �� e I i ( I I I I I II WAS GROUND WATER ENCOUNTERED?/ 2, s IF YES, AT WHAT DEPTH? `2 7 L 0 Depth to Water After ^ 2 2 p Monitoring.T 7 E Date: ,tWNe aq- Reading Date Gross Time Net Time Depth to Water Net Drop Iq C9 I I I I ( I I I I I I I I I (� I PERCOLaTiON RA I= / (rnmutevmc^) F {L YVLt ulr, at I tR r TEST RUN BETPIEEN F ND ,«/- FT I Alt �'' �• c/" Cir o r (lam PERFORMED BY: l �' k eAdk r'( M—Av lOt 6:'i CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: •7vh MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date Issued: Mar 17, 2003 Expiration Date: Mar 16, 2004 Permit Number: SW030046 Parcel ID: 017-093-16 Legal Description: Hoffbeck Lot 1 Design Engineer: 0088 Anderson Construction & Eng'g Site Address: 4806 Mills Dr. Owner Name: Robert Rodrigues Lot Size: 81791 SQ. FT. Owner Address: 4806 Mills Dr. Total Bedrooms: 4 Permit Bedrooms: 4 Anchorage , AK 99508 - This permit is for the construction of: g✓ Disposal Field [✓ Septic Tank Holding Tank ❑ 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: D Date:3./,/7/0,-3 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 5 p E T Y 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-665C(U) .— 22 www.ci.anchorage.ak.us (907) 343-7904 -- .l N -SITE SEWER,AVEL L PERM IT.A:PPLICA/TIQN . FOR A SINGLE FAMILY DWELLING Parcel I.D. o( 7^ o R r3i Property owner(s Mailing address (1 Mailing address (sib La 11 .C�_ d eco 6 Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) C Lot Size P �' 39 ta6q.Ft. THIS APPLICATION IS FOR: Permit Number SW Day phone c U _i& Zip Code Number of Bedrooms Z4 Sewer Only Sewer and Well ❑ Well Only '-ell eWc( Water Storage ❑ ❑ Sewer Upgrade THIS PROPERTY CONTAINS: ' Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: 00,08 Waiver Fees: Date of Payment: + Date of Payment: Receipt Number: Receipt Number: (Rev. 12/00) � Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Z)l 7-- Oq 'l Permit Number SW030046 Property owner(s) T�v �p Vim' K z S ,Day phone Mailing address (1) '4 S-0 G Mailing address ( Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size %, A_cres 5q. Ft. '?l'711 THIS APPLICATION IS FOR: r A,\,h /t ?9Sv Zip Code Number of Bedrooms IS, Sewer Only ❑ Well Only ❑ Sewer and Well Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: '55, 7 . 0 0 Waiver Fees: Date of Payment: y�,z 0 tel' Date of Payment: Receipt Number: Receipt Number: _ (Rev. 12/00) Michael N. Anderson, P.E. Civil/Structural Engineering 4640 Shoshoni Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 March 5, 2003 Municipality of Anchorage Department of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Re: Lot 1 Hoffbeck Subd. To Whom it may concern: This is a request for a new well and septic permit for the above residence. As the design engineer on the development of this property, Hoffbeck subdivision, I have done the perc on the lot for the subdivision platting process. The soils investigation showed sandy silts from 0' to about 10' then clean sand from 10' to the bottom of the hole. No water or bedrock was ever observed. The perc was 2 minutes per inch, but due to the restrictions from the creek setback and the bluff setback only a Advantex system will work on this lot per the plat note. Therefore I am proposing using the Advantex system per this layout. This new system will not impact the neighboring properties due to the large lot sizes and layout of the existing systems. If you have any question please call me at 345-3377 Sinier , 343-6-22f Mcha�AP Feb -21-03 03:43P Permit Counter 907 343 8250 D.01 —r A M1� U*;ZE IIAAiPiipptllity o! Attietea�rnga � OEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Streat. Anchorage. Alma 88502-0850• •Y -f• • '��J`s• z5� SOILS LOG -- PERCOLATION TEST 1 PERFORMED FOR t r GATE PERFORMED: LEGAL DESCRIPTION. 4'I(a tOi^ Sli7 or-r=G Township, Range, Section: SLnPF SITE PLAN 7 L—CO�t°. 17 18 19 WAS GROUND WATER x j ENCOUNTERED? 1 s P E t IF YES, AT WHAT DEPTH? 090 in wow pjw MmmmuT N2 1`15- IIft j I 20 PERCOLATION RATE 2 a imtnuteuincnl FERC !-COLE DIAMETER � TEST RUN BETWEEN {`' FT AND � FT :OMMENTS kcj'nU,snc :'v� l�k ��� b�aS r� rnt (00 p17 t� Flooding QstM Groff Nat Depth to Tuna Time water Nat j Oro* i 1� PERFORMED BY t r Rk d.f r r [ y ✓1 1 CERTIFY THAT THIS TEST WAS PERFORMED 1.'3 f ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: lt��oc %2 -ON iFler.4,85! 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 < K, $n ETY :!! 1 7; CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 017-09316 COSA# 1. GENERAL INFORMATION Expiration Date: 3 G ! /0 Complete legal description HOFFBECK LOT 1 Location (site address) 14441 PRATOR STREET *ANCHORAGE, AK 99516 Current Property owner(s) BOB RODRIGUES Day phone 644-2706 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 14441 PRATOR STREET *ANCHORAGE, AK 99516 Unless otherwise requested, COSA will be held by DSD for pickup. Day phone Day phone 2. NUMBER OF BEDROOMS: 3- 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/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 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, UD. 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. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone 337-6179 Date ,D r = t effe A. Gar ess:' o09�s '• CE— ••' cGG o f e s S7W_'- � Conditional approval for bedrooms, with the filowing stipulation Attachments: COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report vY'0. lON-SITE '•;`�'Gi WATER AND ; mp WASTEWATER PROGRAM Q 1 rr Nitrate Advisory _ `Other By: 0 h Original Certificate Date: -2-1 _/Q (Rev. 11/05) hrfunEcfpsllty of Anchorage Development Servlces 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: HOFFBECK LOT 1 A. WELL DATA *CASED TO BEDROCK Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 6/5/03 Sanitary seal (Y/N) YES Total depth 387 ft. Cased to *26 ft. FROM WELL LOG Parcel ID: 017-09-316 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION YES YES 24+ in. Date of test 6/5/03 1/25/10 Static water level 25 ft. 45 ft. Well production 0.75 g,p,m. 0.82 g.p.m. WATER SAMPLE RESULTS: Coliform (3 colonies/100 ml. Nitrate US mg./L. Other bacteria 0 colonies/100 ml. Arsenic 5•-O'Dug./L. Date of sample: 1/25/10 Collected by: GEG Ltd. 2/1/10 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 9/12/04 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES Date of pumping 7/22/09 Pumper ISAACS PUMPING C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 9/12/04 Soil rating (g.p.d./ft2or Z/bdrm 1.0 System type TRENCH Length 35 ft. Width 2 ft. Gravel below pipe 12 ft. Total depth *17.58 ft. Eff. absorption area 840 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 1/25/10 Results (Pass/Fail) PASS For 3 • bedrooms Fluid depth in absorption field before test 97 in. Water added 592 gal. New depth 105 in. e Elapsed Time: • 45 min. Final fluid depth 97 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed 9/12/04 Size in gallons 1250 Manhole/Access (Y/N) YES "Pump on" level at 36 in. "Pump off' level at 30 in. High water alarm level at 42 in. Datum BOTTOM OF TANK Cycles tested 3 Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots Absorption field on lot 100'+ On adjacent lots 100'+ 100'+ Public sewer main NSA Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water **100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *8'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water **100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *WR#090041 **SEPARATION TO CREEK COULD NOT BE VERIFIED DUE TO SNOW COVER. THE DEFINED EDGE OF CREEK COULD NOT BE OBSERVED. G. ENGINEER'S CERTIFICATION o� 0Fv� ..qA�0 I certify that I have determined through field inspections and p 4 g H /✓ E*i review of Municipal records that the above systems are in 7l' conformance with MOA COSA guidelines in effect on this .... ........ date. Jeffrey . Gar ess;' Engineer's Printed Name JEFFREY A. GARNESS �o49�s • F/ /CE—,7 c�G Date'_7 c) I b Date_ ofession o COSA Fee $ 1 M L/ Waiver Fee $ Date of Payment -7 I / y Date of Payment Receipt Number G,,g �� .� Receipt Number (Rev. 11/05) a , ®. •t Z t t AV v) m AV � Q- 75 o�,� �s�"Q 00 m n rD . 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