HomeMy WebLinkAboutFROSTAD LT 2Frostad
Lot 2
#017-421-28
Municipality of Anchorage
Community Development Department Page 1 of 2
On-Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite• (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP171061 PID Number: 017-421-28 ❑✓ New [' Upgrade
Name:
GWENDOLYN & GARY GERVELIS ABSORPTION FIELD
Address
❑ Deep Trench ❑ Shallow Trench III Bed 0 Mound
12601 HILLSIDE DRIVE, ANCHORAGE, AK 99516 ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
5 GPD/SF Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot Ft. Ft.
FROSTAD 2 Fill added above original grade Gravel length
Township Range Section Ft. Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES Ft. Ft.
To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Lift Station Tank Line Ft2 Ft.
Well 126.9 N/A 140.7 ' N/A 25+ TANK ❑Septic ID S.T.E.P. ❑Holding ❑Other
Manufacturer Capacity
Surface Water 100+ N/A 100+ N/A Anchorage Tank 2000GaI.
Material Number of compartments
Lot Line 26.5 N/A 26.5 N/A STEEL 2
NA
Foundation 57.8 N/A 57.8 N/A LIFT STATION
Manufacturer Capacity
Curtain Drain 50+ N/A 50+ N/A ORENCO 667GaI.
Pump on level at Pump off level at High water alarm at
Remarks
43 in. 40 in. 45 in.
Pump make and model Electrical Inspections performed by
p2005 CAPSTONE ELECTRIC
Tank to
PIPE MATERIAL House to tank 3034 drainfield 3034
Installer
A+ Home Services Drainfield CO/MT 3034
Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 1055ft
Inspe
ction 1s, 24APR17 2nd Location and description
08MAY17
3rd
4"' House Door Trim
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
Conditional Approval: Date_ �'.OF
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ApprovedZ11-etbk e,1,v Date 5/23/1"1 V‘,yqp OA
Inspection Report_1-1-12.doc
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NOTES: PANNONE ENG SVC, LLC _ Date
•••
RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510 05/09/17
PHONE (907) 272-8218 FAX (907) 272-8211 . 1_.'•. Scale
• 1 Z� •• • P.I.D. NO
FROSTAD L2 . . vi► / 017-421-28
GWENDOLYN & GARY GERVELIS ;° ' °""'.a PERMIT NO.
DRAWN JRL 12601 HILLSIDE DRIVE v• CE 8149 ••
OSP171061
SITE PLAN ANCHORAGE, AK 99516 ';' ,.1 Sheet
1 OF 1
N Ai r" MUNICIPALITY OF ANCHORAGE
�trcnr
/ On-Site Water&Wastewater Program 1° sf�
j PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
/ http://www.muni.org/onsiteIVY I `',
1)cparti l iit
q'YC HOP p,E
On-Site Wastewater Disposal System Permit /i.W/?
Permit Number: OSP171061 Effective Date: 4/21/2017
Work Type: SepticTank Upgrade Expiration Date: 4/21/2018
Tax Code Number: 01742128000
Site Legal Address: FROSTAD LT 2 G:2840
Site Mailing Address: 12601 HILLSIDE DR, Anchorage
Owner: GERVELIS GWENDOLYN M & GARY M Lot Size in Sq Ft: 75400
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 5
This permit is for the construction of:
❑ Disposal Field 0 Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: Tank may not be located under a driveway or parking area. If necessary, protect the tank
from vehicle traffic.
�OM/0W 0441 qReceived By: lW ` Date: �� a
Issued By: Date: Apr/
VS1W2eft0C4 .
MUNICIPALITY OF ANCHORAGE
-,(7/: •-")
Community Development Department le, Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 017-421-28
Property owner(s) Gwendolyn & Gary Gervelis Day phone
Mailing address 12601 Hillside Drive, Anchorage AK 99516
Site address 12601 Hillside Drive
Legal description (Sub'd., Block & Lot) FROSTAD L2
Legal description (Township, Range & Section)
Lot Size 75400 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field ❑ Initial ❑ Single Family (SF) ❑x
(w/wo ADU)
Septic Tank ❑X Upgrade ❑x Duplex (D) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage El
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
_____ __INK-2_____________
(Signature of property owner or authorized agent)
Permit/Rush Fees: iteq(S— Waiver Fees:
Date of Payment: 'IlIl(7- Date of Payment:
Receipt Number: 040366 Receipt Number:
Permit No. OSP1?-/O(7/ Waiver No.
Permit App_ • :: ,c
Pannone Engineering Services «c
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail:steve@panengak.com
April 20, 2017
Subject: FROSTAD L2
Emergency Tank Replace Permit Request
Design Narrative
This is a design narrative for a permit to install an upgrade 2000g STEP Tank to be issued for this property.
The existing 1,500g tank with 500g lift station is collapsing. It will be decommissioned per code and
replaced. Currently the lot is developed. The proposed system will utilize a replacement 2000g STEP tank
that will be connected to the existing drain field. The existing tank is located approximately 100'+ from
the well. The proposed tank will be placed outside the existing well radius. All required separation
distances will be met.
1. Upgrade Tank Design.
A double clean out will be installed after the tank, and a foundation clean out installed before
The tank will be located: 5'+ from any property line or building foundation
10'+ from any water line
100'+ from any surface water
100'+ from any private wells
200'+ from any public wells
The proposed installation will not affect the future development of the surrounding or existing lots.
If you have any questions or concerns, please contact me at 907.272.8218.
Sincerely,
..x.......441,
OF q.SO♦i
T
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♦♦♦vSteven R.Pannone PI
♦� 0 8149.77,E-��
Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 " U' Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
000 A- rP-0.5
Address FROM TO SEPTIC ABSORPTION
17,601 us►)� �ed el4 <I TANK , FIELD WELL
Phone(s) Permit No. No. of Bedrooms WELL / 00
75-7,< 8'8'0733
LEGAL DESCRIPTION LOT LINE > S
Lot Block Subdivision
Z /� FOUNDATION S8 } Sb
Township, Range, Section
l S .3 ��L Ls AS -BUILT DIAGRAM (Show location of well. septic system, property lines, foundation,
LN driveway. water bodies. etc.)
TANKS �Q
SEPTIC' L/Fy' ❑ HOLDING
Manufacturer
Capacity In gallons
Material
STf�L
No. of Compartments
f
TYPE OF SYSTEM
TRENCH ❑ BED
❑ W. DRAIN ❑ OTHER
Depth to pipe bottom from
original grade A-3 FT
otal depth from original grade q
DyE S"PLt S' / FT
Fill added above original grade
---�— FT
Gravel depth beneath pipe
� FT
Gravel length
FT
Gravel width
3 FT
Total absorption area
SOFT
Distance between Imes
S FT
Number of Imes
17—f
Sod rating
�� SQ FT
Pipe material
/fS )53o3
Installer L. A C t/ f� _ Q) _ / •,
t Ary G .Ll� LL/
Date Installed
/to -;t4 -'T8'
WELLS
PRIVATE
❑ OTHER (Identifv)
Classification (A B.C)
Total Depth
FT
Cased to
FT
Installer
I Date Installed:
I REMARKS:
T . IfNLT Scale:1e: S ENGINEER'S SEAL
a
Inspections Performed b
A�Gs D %4:
Date: • �,�,;. `^.L�
certify that this Inspection was pedfirmedaccording it all
Municipal and State guidelines In effect on this date:
Health Department Approval:Date:al'4
i0�
72-013 (3/85)
A'
-_
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^~~ M U N I C I P A L I T Y O F A N C H O R A G E '-- -- - -
Department of Health & Human 'Services CE
825 L Street, Anchorage, Alaska 99501 343-4720 —
----
ON-SITE SEWER PERMIT
Permit Number: 880233 Upgrade
Date Issued: 10/18/88 Engineer Designed
Owner Name: DONNA FROSTAD Day Phone:
Owner Address: 12601 HILLSIDE DRIVE 258-7575
ANCHORAGE, AK 99516
Parcel Id: 017-421-28
Lot Legal: Subdivision: FROSTAD SUBDIVISION Lot: 2 Black: -
Section: 25 Township: 12N Range: 3W'
Lot Size 75837 (sq.[t. or acres)
Max Bedrooms: This Permit: 5 Total Capacity: 5
SEP11C |ANK: Minimum total septic tank capacity: 1,500 gallons. Each septic
tank must have at least 2 compartments. Depth to'top of septic tank(s) < 4.0
feet requires insulation over tank(s).
INFORM D.H.H.S. PRIOR TO IST & 2ND INSPECTIONS BY ENGINEER, IF
AFTER OFFICE HOURS, CALL 343-4681 AND LEAVE A MESSAGE.
CONSTRUCT PER ENGINEERS ATTACHED APPROVED DESIGN.
lHIS PERMIT EXPIRES 12/31/88 AND VALID FOR A SINGLE FAMILY HOME.
| LEH|IFY THAT:
1. l am familiar with the requirements for on' -site sewers and wells as set
forth by the Municipality of Anchorage (MOA).and the State of Alaska.
2. l will install the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alpska requirements for the set back
distances from any existing well, wastewater disposal system or public
sewerage system on this or any adjacent or nearby lot.
4. I understand that this permit is valid for a maximum of 5 bedrooms. I
also understand that the capacity o/ the total system is 5 bedrooms and
any enlargement will require an additional permit.
Signa']: DATE:
______-
- /r
(Owner) OUNNA FIUSTAD _
Tssu,n! y: DATE:
Py:
________-_____
�
LAWRENCE A. SCHACHLE
Penn Jersey -Drilling Co.
"Good Water,Our Specialty"
SR BOX 2201
WASILLA. ALASKA 99687
TELEPHONE 892-7206
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TELEPHONE 892.7206
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' ALASKA ENVIRONMENTAL
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
JOB /07- a Fn0s7h'D 50•8
SHEET NO. a OF 41
CALCULATED BY �� eE c DATE
CHECKED BY
ACALE IV TS
DATE
Municipality of Anchorage *�,4 H�
�( DEPARTMENT OF HEALTH & HUMAN SER bS.. ....
625 "L" Street, Anchorage, Alaska 99502-06'
SOILS LOG — PERCOLATION TE + LERO _2 51 X ; v
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PERFORMED FOR: Do h n 2 10. 3// �
LEGAL DESCRIPTION: Zm1 / Z Fro Township, Range, Section: 7-/ -j S3 s—
I
I SLOPE SITE PLAN
fFl EET) �:-'
C' N4(ENGINEER'S SEAL)
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Si %� .Sa-./ Kr 1
(6M)
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WAS GROUND WATER .�Q—
ENCOUNTERED?
S
IF YES, AT WHAT _ L
DEPTH? p
E "
Depth to Water After 9 Q/g
Monitoring?_ Date:
Gross
Time
De pth to
Weis J2 P
Net
Drop(
-�
-- �1�a����
20
PERCOLATION RATE �� (minutes inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
COMMENTS lei Ge�••,�•ti.,� S�a/o•✓ Syr7� vr� �.f1L SfaTrio-. /�+o., �� ,9ec_erSar�
/r7dwt�/
PERFORMED BY: �Q. r ✓' I / ll CERTIFY TH��AT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
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GARB -HD-1 GRID" ER ANCHORAGE AREA BOROL►"�1
_._;,.. Dr. NRTMENT OF ENVIRONMENTAL .OUALIl
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
MAILING
NAME ���f'�-� STfi2.� ADDRESS 70416? �� �� PHONE--?
LOCATION if/L/�E 4` %1.�/'F� LEGAL DESCRIPTION N ✓/`� �`�l�/'�G 2�
SEPTIC TANK: 7 12 '40NUMBER OF 2��
L � AI �, semis Vis• r�l�? 1�1 �'I�i�l� 1�1 flw
DISTANCE FROM WELL MATERIAL
��EFIi-L ��� OM ARTMENTS
LIUID
LIQUID CAPACITY GALLONS. GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH
DATE APPROVED,
G.A.A.B.
GRE ER ANCHORAGE AREA BOROUGH
DEPARTMENT .OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6.650
2179
PERMIT NO.
ANCHORAGE, ALASKA 99502��� G/l/
� (
TELEPHONE 279.8666
SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT
NAME OF APPLICANT "A' FCS � MAILING ADDRESS +ti�W�On /""yell PHONEO' '460t
INSTALLATION LOCATION /v
INSTALLATION
LEGAL DESCRIPTION /
" "
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
%U. /�/ r .,, . �/ � � / I �7 1 V P,.,,
SEEPAGE PIT DRAIN FIELD 1 OTHER
FINANCED THROUGH TO BE INSTALLED BY
3 P�r„7� -/o -7? gC
SOIL TEST RESULTS N��►'�//�� NOTE_ c THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE T E SEEPAGE A EA SIZE TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FpUNDATION TO SEEPAGE PIT �0 DRAIN FIELD �d
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK SEEPAGE PIT DRAIN FIELD
TO NEAREST LOT LINE.
c'
WELL TO SEPTIC TANK `� .SEEPAGE PIT �()
DRAIN FIELD ��� ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK /0 / SEEPAGE PIT /0 ,
DRAIN FIELD �y !
1
SEPTIC TANK, SEEPAGE PIT _!SL_, DRAIN FIELD .1021.
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
jjut-
-A A'� HEALTH AUTHORITY
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.
DATE' 7� APPLICANT'S SIGNATURE n �'��I-�� 2
i
�ATEP, APICHnRAr,E AREA BORON
DEPARTMENT OF ENVIRONMENTAL QUALITY CASE #,
3500. TLIDOR ROAD
ANCHORAGE,'ALASKA 99502
Performed For , ��� Date Performed —
Legal Descri nti on : Lot Block S u b d i vi s on -W*'. /)/t),</ SPc2s Ti U
This.Form Reoorts Soils Log �( Perco ation Te t_ 3tJ
sN
Depth
Feet Soil Characteristics
1 —
2 —
3 —
Net Time Depth to H2O Net DroD'
a —.
5 —
6 —
I
7 —
9—
10—
/p(� ,3c: I
Was Ground Water Encountered?vir,_
If Yes, At what Depth?
Reading Date Gross Time
Net Time Depth to H2O Net DroD'
I
Percolation Rate Hinute
Proposed Installation:
Depth of Inlet
C O n1 M E N T(S • ate t r:o.` U 42 11
Sal -f i r i V b[7/rl -,*tl Or
Seenacae Pit Drain Field
Denth To Bottom Of Pit Or Trench
Test Performed By Data Certified By:
Date:
Municipality of Anchorage
On -Site Water & Wastewater Program
(907)343-7904
4
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 017-421-28 Expiration Date:r,�
f
i=02101l:11MM
Complete legal description FROSTAD S/D; LOT 2
Location (site address) 12601 HILLSIDE DRIVE, ANCHORAGE, AK, 99516
Current Property owner(s) MICHAEL & DEBORAH MCMANUS Day phone
Mailing address
Real Estate Agent
12601 HILLSIDE DRIVE, ANCHORAGE, AK, 99516
DAWN BURTON W/ ZIMMERMAN TEAM AK Day phone
2. TYPE OF DWELLING:
Single Family (wlwo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY:
331-9599
373-4037
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date: 14
COSA Fee $ qq0 ) 1 Oar,q r I Waiver Fee $
Date of Payment I l[ -j 11 �) C f Date of Payment
Receipt Number t)23-wq Receipt Number.
COSA # 05clJ 1( I 1 Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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 GROU
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineers Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of fne 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 Iota( 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 wamanfy 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.
6. DSD SIGNATURE
System #1 Approved for 1�_ bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following
Phone
337-6179
Date II 17-1 10
Original Certificate Date:
J))
T e unicipality or Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approve! (CDSA) based only
upon the represenatations 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. ATTCHIMENTS:
COSA Checklist l Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
(Rev. 11105)
\\``\G\QP�iTYI OF
C'yr�'o
ON-SITE
y WATER AND
)„
� WASTE WATER
n PRnr�RAM
z
%,.
Original Certificate Date:
J))
T e unicipality or Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approve! (CDSA) based only
upon the represenatations 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. ATTCHIMENTS:
COSA Checklist l Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
(Rev. 11105)
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: FROSTAD S/D; LOT 2 Parcel ID: 017-421-28
A. WELL DATA *BEDROCK @ 29'. **WELL WAS RECENTLY HYDROFRACTURED, PER OWNER.
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 7/19/1972 Sanitary seal (Y/N) YES
Total depth 500 ft.
Date of test
Static water level
Well production
Cased to *32.3 ft
FROM WELL LOG
7/19/1972
38 ft.
3 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml.
Arsenic: NO ug./L.
B. SEPTIC/HOLDING TANK DATA
Nitrate 16.7 mg./L.
Well Log (Y/N) YES
Wires properly protected (YIN) YES
Casing height (above ground) 12+ in.
AT INSPECTION
10/18/2013
21
**3.84
Date of sample: 10/18/201
Collected by: GEG, Ltd.
I�tiPRoFN�✓r+a;7C
..-.�tz- t•ti l-
SEPTIC/STEEL 10/2/1972
Tank Type/Material S.T.E.P./STEEL Date installed 10/26/1988
1500 2
Tank size 500 gal. Number of Compartments i Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES
Date of pumping 7/17/2013 Pumper ISAACS PUMPING
C. ABSORPTION FIELD DATA
Date installed 10/26/1988 Soil rating (g.p.d.lftbr lbdrm 362 System type DUAL TRENCH
(75' & 76')
Length 151 TOTAL ft. Width 3/3 ft. Gravel below pipe 6/6 ft.
Total depth *9.8 9.7ft. Eff. absorption area 1812 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test **10/18/2013 Results (Pass/Fail) PASS
Fluid depth in absorption field before test 60 in. Water added 8100 gal.
Elapsed Time: 285 min. Final fluid depth 62 in. Absorption rate >=
For 5 bedrooms
New depth 68 in.
750+ 9.p -d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date —
**HOUSE WAS VACANT AT TIME OF TEST. SEPTIC SYSTEM WAS PRE—SOAKED WITH 2000 GALLONS.
OF WATER PRIOR TO TEST. SPILLOVER DESIGN RESULTED IN UPPER TRENCH BEING FILLED TO 100%
CAPACITY. TESTED LOWER TRENCH ONLY.
Datum BOTTOM OF BASKET Cycles tested *3 Meets alarm & circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankilift station on lot 100'+ On adjacent lob
Absorption field on lot 100'+ On adjacent lots
Public sewer main
Sewer /septic service line 25'+
Public sewer manhole/cleanout N/A
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 10'+ Building foundation 10'+ Wate. 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
G. ENGINEER'S CERTIFICATION
I certify that t 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 11 /7-1/1
(Rev. 11106)
pr
ALARM PANEL IS
INSIDE HOUSE A -f-
t�MF
SrJ' S
*ACTIVATED FLOAT
WITH HOOK
D.
D. LIFT STATION **APPROXIMATE —
PER FACTORY SETTINGS^
Date installed 10/26/1988 Size in gallons
500 Manhole/Access (Y/N)
YES
�"Pump
46 -
"Pump on" level at **� in. off' level at
**+I' in. High water alarm level at
**47
in.
Datum BOTTOM OF BASKET Cycles tested *3 Meets alarm & circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankilift station on lot 100'+ On adjacent lob
Absorption field on lot 100'+ On adjacent lots
Public sewer main
Sewer /septic service line 25'+
Public sewer manhole/cleanout N/A
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 10'+ Building foundation 10'+ Wate. 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
G. ENGINEER'S CERTIFICATION
I certify that t 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 11 /7-1/1
(Rev. 11106)
Municipality of Anchorage oar H,
' Community Development Department
Development Services Division
SA E T Y
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC 131611
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Lot 2 of Frostad
subdivision. This inspection revealed a nitrate concentration of 16.7
milligrams per liter (mg/L) was reported for the property's well water
sample. The Environmental Protection Agency (EPA) has established a
maximum contaminant level (MCL) of 10.0 mg/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. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
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EL:D!RiyE-',`,.`.'.;'.`;,..... 25' ACCESS EASEMENT
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N89'53'35"W 147.75'
SURVEY CERTIFICATION: LANTECH has conducted a physical survey of the
property as shown on this drawing and certifies that the improvements
Legend:
situated thereon are within the property lines and no encroachments exist
--- -- other than noted. -
Asphalt
-DiQn.
Septic Standpipe
EXCtLSIONAI deterrnright-of-way the
espre
_, Concrete
Water Well_. ®
cownerss. or way
restrictions or r(pl t.
any casements,covenants, restric
existence of any
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-appear-on-the-recorded-subdivisionplat. Under
no -op ear U
tokings- which -do -not
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nocircumstancesshould any data hereon be used for construction.
461
Woad -Deck
for establishingng property lines, or for plat -plan purposes.
Jeff Garness
From: Jeff Garness
Sent: Friday, November 22, 2013 10:53 AM
To: Crewdson, James A. (CrewdsonJA@ci.anchorage.ak.us)
Subject: Frostad, L2 - RUSH COSA
Hello Jay. In reviewing the MOA records, it appears that on (or around) March 7, 1989 Dan Roth (or Dan Bolles) initialed
that the single clean out (near the tee for both trenches) was "OK". I assume that was in response to the other
comment on the inspection report stating "CO to be installed per 15.65.066". Further evidence that this was the case is
the fact that about three weeks later (March 29, 1989) an application was submitted for a Health Authority Approval
(HAA). The signed -off HAA is not in the MOA scanned database, but it is assumed that that it was issued because the
house was sold.
Jeffrey A. Garness, P.E., M.S.
President
Garness Engineering Group, Ltd.
3701 East Tudor Road, Suite 101
Anchorage, Alaska 99507
Ph: 907-337-6179
Fx: 907-338-3246
website: www.garnessengineering.com
wee I #—L
AAROW PUMP & WEU SERVICE, LLC
P.O. Box 110496
Anchorage, AK 99511
Office: (907) 346-9355 • Fax (907) 345-0202
Eagle River: (907) 622-9335
ONCE
No. 10015
L
INVOICE DATE
WELL DEPTH
SWL
CHLORINATED J
PUMP DEPTH/ SALESPE /y
'!n
�i
ANT Y
_ DESCRIPTION PRICE
AMOUNT
/ / r
r A /
I
- -- ---- ---
.........
i
.
LABOR
HOURS
RATE
AMOUNT
TOTAL MATERIAL
TOTAL LABOR
WORKORDERED BY
TOTAL
LABOR
PAY THIS AMOUNT
✓2�
J
Thank You
SIGNATURE
(I Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work is not paid for in 90 days I agree to allow Aarow
Pump & Well service, L.L.O. the right to remove unpaid for equipment and Charge for labor already performed a labor to remove unpaid for equipment.)
TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE.
SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS.
Municipality of Anchorage
Community Development Department
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
Well Decommissioning Log
Legal Address: / //71
Subdivision Block Lot. —
T R Section Lot
On-site Water & Wastewater Program certified contractor performing the well decommissioning:
Names/ /
�/ Signature:
'
�CJG�1 �iJe7%�/'foin G
Well decommissioning date // / Method of decommissioning: AMC 15.55.06OL1 a. ❑ b. ❑ c
Location: Use the space below to provide a drawing of the property showing the following items;
• North arrow
• Decommissioned well,
• Other water wells on the property,
Two separate swing -fie distances for each well shown on the drawing,
Note: The swing -tie distances shall be measured from either permanent structures or the property corners.
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G:\Community Development\Development Services\Buifding Safety\On Site Water and Wastewater\Forms\Client Forms\Well Decommisioning form.doc
MUNICIPALITY OF ANCHORAGE
• -d Department of Health & Human Services : a�
DIVISION OF ENVIRONMENTAL SERVICES
343.4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # )11 -1.1 ;k \ -'.9S HAA # kA Ia 9S°\ G l 1
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, t—
ownship, range)
/�'� 7/ %JL s N•�1 �" -E0ST- / ,z, zj J see_ Zs'
•s
� E -
Location (ad•e�►rec(Orw)%
y •,��•,
• s
�� fish" s ii -•�.
fLGo / OQi..
d ' � •��N�••N �t���rs ��a�a�+
(b) Property gwu3sr., °'`)JA 57
F;ed'A� Telephone : (home) .ZSEr-7'�7SBusiness
'•, i.z: C-2 ,? YCMr� s
Mailing Addregs'
(c) Lending Institut!on'=`*'
Telephone
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here)k, if hold for pick up.) '
List contact person and day phone number below:
/Ws 7144 uA
2. TYPE OF RESIDENCE
Single -Family O
3. WATER SUPPLY
Number of bedrooms
Individual Well'( Community ❑ Public ❑
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)I Public ❑ Community ❑ Holding Tank ❑
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 '.
4_Z_ /-/Cm?/n= ` _
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Name ofFirm
Address
J-3l_/r�
OF. A4
,,Goo 000
.109004, 0000 a 60609"0%
' `
^
.2251 . `
G.DHHS APPROVAL
Approved for _J___bedrooms by Date
Approved Disapproved Conditional
Terms of Conditional Approval
72-025 (Rev. 7188) Back Page 2 of 2
3IPALITY OF ANCHORAGE (MOA)
ealth Authority Approval (HAA)
:HECKLIST - FEBRUARY 1984
343-4744
Legal Description:
. . . - - T/z,,1 R3 sEL z�
A. WELL DATA
Well Classification /-'����E If A, B, C, D.E.C. Approved YIN)
Well Log Present Y N) Da�Completed �" 711��L L�I�6�7� Yield i o ��
Total Depth'°'-<Soo�Cased toDepth of Grouting XIA
Static Water Level... �— -� s, ' y 31 Pump Set At
Casing Height Above Ground �•f Sanitary Seal on Casing (Y N)
Electrical Wiring in Conduit ON) Depression"Around Wellhead (YO
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot ;,On Adjoining Lots
To Nearest Edge of Absorption Field on Lot AIV �t ; On Adjoining Lots
To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lotz
ZS /�
t..i/�� ..✓cu'�/ wErc. n' .
Water Sample Collected by At -Fe -5; Date
Water Sample Test Results' 1firiZ7aK�'•
Comments G✓E�L 1�tn� i�fTf 9 Z'- • Z a/ECLs SES✓r�l6
B. SEPTIC/HOLDING TANK DATA -
�o 2! -
Date -Installed
Date Installed io -ZL_-1181 Size- SOa No.
of Compartments /
Standpipes( YON)- Air -tight Caps�N) Foundation Cleanout (Y(Rb
Depression over Tank (19 /Date Last Pumped
Pumping/Maintenance Contact on File (YIN) 4.4 ; for
Holoing a•nT91-L Water Alarm (Y/N) Temporary Holding Tank Permit ('YIN)
&P3k
� A 161VD AtsI ES FROM SEPTIC/HOLDING TANK:
'Wates 12 re ` To Building Foundation
To Property Line ' To Disposal Field
R T&Water;Mairr/9ervjc �Liine /o
To;Stream,tPond�La 5r Major Drainage Course
Comments
72-026 (Rev. 7/88) Front Page 1.of 2.
L Z I:A�sT�
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 3� Z Type of System Design T4'IeW r�Z�
Date Installed /° - Z& Length of Field 75' f- 76
Width of Field
Depth of Field
Gravel Bed Thickness
Square Feet of Absortion Area /ff/Z Statndpipes PresentCY)N)
Date of Last Adequacy Test
Depression over Field (Yo
Results of Last Adequacy Test 6
SEPARATION DISTANCE FROM ABSORPTION FIELD: /
i
To Water -Supply Well /OZ f To Property Line Z�
>
To Building Foundation So fi" To Existing or Abandoned System on
Lot On Adjoining Lots
To Water Main/Service Line /Q 4- To Cutback (if present)
i
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area /0 /*
Comments
D. LIFT STATION
Date Installed /o
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
- z6 -flfl
3&e
Dimensions — 7
Manhole/Access &N)
"Pump Off" Level at
VentrY)N) _
Tested for +7— > �sirYic.�i•��• Pumping Cycles during Adequacy Test.
x yf 16 /,
Z -.T,//
Meets MOA Electrical Codes
Comments
4Ja_b /.16 L/FT — 7-AJY_
**Check Permitted Bedroom Rating Against HAA Request"
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection.
Signed.Q�•'o......`�1S
�OF q '�`
i
'•
CompanyS
•:�
: Vj;2-1
Date
Osseo* foots 0*000 *600
MOA No.
Oy
C. RE D, JR. �
,,•. CE • 2251 : --
.00
,Pd
Receipt No.
c9/0,5Z3 -9 Receipt No.
Date of Payment �/ `r/
Amount: $ ,1,70—J CJ
Waiver Fee: $
Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
LAWRENCF'A. SCHACHLE
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Penn Jersey Drilling Co.
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APPLK7NT FILLS OUT UPPER HAL7ONLY
Time
Prolierty Owne /` d -
Phone
Mailing Address 5 /Q f} ;L 3 gS Zip Code 9 q s -v -7S
= -3
Buyer �J
Address Zip Code
Lending Institution 0 - 7i't�1n fi=r
Phone
oZ / a Zip Code Q'?
T� /
,:Z
-S7
Address "'
Date
1
Inspector
Phone
Realty Co. 8 Agent
�'
Inspector
7U
Address S \) Zip Code
Field Notes: \
Legal Description N :5 W LI D/ /j W IV L/ N W tJ t� . 9 s: Tib N R 3 w.
MUNICIPALITY OF ANCHORAGE
Street Location
Type of Residence
(Single Family
❑ Multiple Family No. of Bedrooms
ENVIR'D;4t.'—c1.; ._ ...O.:LTION
❑ Other
Ck C 3 1982
— l
Water Supply
I'Individual
ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975.
❑ Community
For wells drilled prior to that date, give well depth (attach log if available).
❑ Public Utility
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
if monies
Sewer Disposal
eindividual Year Individual Installed: ?
(XX ) CONDITIONAL APPROVAL- 4
❑ Public Utility When Connected to Public Utility:
condiut and the seal on the well head
❑ Holding Tank
sealed so
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
n .
necessary by this office after completion of
%A CIn-LLI
Time
Time
Time
Time
I
Date
Date
Date
Date
1
Inspector
Inspector
Inspector
Inspector
Field Notes: \
MUNICIPALITY OF ANCHORAGE
tit
DFPT C'" ,"' �T: I A-
ENVIR'D;4t.'—c1.; ._ ...O.:LTION
r�
Ck C 3 1982
— l
RECEIVED
( LO APPROVED BEDROOMS
'CONDITIONS OF APPROVAL
( ) DISAPPROVED
if monies
are escrowed to have the exposed wiring
(XX ) CONDITIONAL APPROVAL- 4
placed in
condiut and the seal on the well head
12-8-A2
sealed so
that it is water tight. A reinspection
DATE
DATis
necessary by this office after completion of
the above.
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well Log Received
r
Septic Tank Size / p
/Q --) Z.
Well to Tank
72-023 (3!821