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HomeMy WebLinkAboutMALLORY TR AMallory Tr.ct A #020-0 9 3-46 '�\\I Municipality of Anchorage �. On -Site Water and Wastewater Program (907) 343-7904 s a E T Y Certificate of On -Site Systems Approval Parcel I.D. 020-093-46 1. GENERAL INFORMATION: Complete legal description MALLORY; TRACT A Expiration Date: to - 3c9 —z oZ Z Location (site address) 4661 Virgo Avenue *Anchorage Current Property owner(s) Matthew Conley Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer Waiver/Variance request for. Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 2 GO 1 Waiver Fee $ Date of Payment 3 a N d-0 1a Date of Payment Receipt Number © 3 a (X) G Receipt Number COSA # O✓ G ZZ i 1 a7 . Waiver # 4 5. 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: Gamess Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: J Z3 /22- In ZZ In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the dates of the OF�1•�,`1 evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells ����.• / 5�1� and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may Fluctuate during the year), quality of construction (materials and (u ': 4 workmanship), and the water usage of the family utilizing the systems. These conditions can vary, and .... .. . ............. - are outside the GEG. • Satisfactory test results do not guarantee future performance of uie - s stems; therefore, GEG makes no warranty ....... ... Y ty (express or implied) regarding the future performance of �� • • • • . the well or septic system. GEG makes no representation whether an alternative well or septic system ey A. C ar ess,: can be installed on the roe in the event either of the currents systems fail to perform adequately in �� CE --7Q5--, ` P P rtY • Ys P eq Y • ��',�: �G the future. The content of this report is for the sole benefit of the person/party that retained GEG to ��Zs�z perform the evaluation. Reliance upon the information provided in this report by any other person or �i� ed ` E o party (including subsequent property purchasers) is not authorized, nor will it confer any legal right #AECC884 6. 11?SP�SIGNATfIRE _jV_ System #1 Approved for bedrooms System #2 Approved for bedrooms ``lll<<((tt(((///���/ Disapproved ` \\�Q��\V OFq Q3 Conditional approval for bedrooms, with the foll ` � stirwNti� WATER -Amin �' T WAST`_v'ATER z= PROGRAM 0,:Z, SERA ,�,��` . � 2)l ,.N, Original Certificate Date: ! '370 _70ZZ The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist_ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other AS COSA Checklist Legal Description: MALLORY; TRACT A Parcel ID: 020-093-46 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system — A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 3.8+ gpm Date drilled 4117/91 Water storage tank volume N/A gallons Total depth 428 ft Well disinfected for coliform test? ❑ Yes Fol No Cased to 47 ftColiform bacteria is Negative ❑ Sanitary seal is functioning correctly Lift station material Nitrate Ur(a--ung/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L Eq�rsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by GEG, LTD. Date of flow test for COSA 3/14/22 Date of Sample 3/14/22 Static water level at beginning of test ft. ❑ ALL standpipes present per record drawing Comments *ARTESIAN WELL WITH PACKER - PUMPED OUT 1421 GALLONS IN 200 MINUTES AWWU SEWER; B. TANK DATA C. LIFT STATION Age of tank(s) years ❑ Required maintenance completed Tank type/material Age of lift station years Measured operating fluid level in septic tank Lift station material ❑ Standpipes/foundation cleanout per record drawing Comments: Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) dequacy test date ❑ ALL standpipes present per record drawing Results ❑Pass For bedrooms Total measured depth from grade ft (ma Fluid depth prior to test in Measured depth to pipe invert from grade ft (min) Water added gal ❑ N/A – pressurized field ❑ Monitor tubes go to bottom of ective. If not, state New depth in depth into effective Elapsed time min ❑ Code -required soil er over field Final fluid depth in ❑ System pres ed Absorption rate and- (Required if cant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of t ons introduced _gallons If yes, enter date COSA Checklist yellow sheet PH E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' NSA Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft [] Yes if No ft Neighboring Tank > 100' [D Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No N/A ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' Private Wells > 100' Animal Containment > 50' ❑✓ Yes if No ft (v Yes if No ft ft Communit ells > 200' ❑ Yes if No ft Water Service Line > 10' Manure/Animal Excreta Storage > 100' if No Community Sewer Main > 75' Q Yes if No ft r-1 Yes if No ft f1YYVYV JGYVCri From Septic/Holding Tank on Lot to: (Please enter distances if less than required) 1,- - Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑(es if N ft Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: if No ft Absorption Field > 5' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No ft Water Main > 10' ❑ Yes if No ft Communit ells > 200' ❑ Yes if No ft Water Service Line > 10' ❑ Yes if No ft If 3pptrc tank is under driveway comment below From Absorption Field on Lot to: (Please enter Building Foundation > 10' ❑ Yes i ft Property Line > 10' es if No ft Water Main > 10' ❑ Yes if No ft Water Se ine > 10' ❑ Yes if No ft ace Water > 100' ❑ Yes if No ft F. ENGINEER'S COMMENTS less than required) If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100' ❑ Yes if No ft Community Wells > 200' ❑ Yes if No ft 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 COSA guidelines in effect on this date. COSA Checklist yellow sheet OF . A �'s, J !!� �i .:...i . ... ........... Gorness,, CE -7 53 e 4,%:,Pro f ession°4� #AEccasa Municipality of AnChorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O, Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 O CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-095-46 1. GENERAL INFORMATION COSA# ('~(~L. Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency MALLORY TRACT A 4661 VIRGO AVENUE *ANCHORAGE, AK 99516 DOUGLAS & KAMI HOWLETT Day phone C/O AGENT 4661 VIRGO AVENUE *ANCHORAGE, AK 99516 Day phone Mailing address Real Estate Agent Mailirig aFIdress BETH SIMPSON W/ KELLER WILLIAMS Day phone 865-6556 101 W. BENSON BLVD SUITE 503 *ANCHORAGE, AK 99505 Unless otherwise'requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: 4 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. STATEMENT OF iNSPECTiON BY ENG,NEER ~ cu~ u,ed uy ,~y seal ~mxeu he~ e~o and asu~ u~e validation u~e shown ~ ..... ve~l~y ~h=~ my investigation, based on procedures ouNned in the CeRificate of On-Site Systems Approval bulaefines for this application, shows that...the on-stye'* water sypp!y and~r ,4~*t~4~.~r disposal system is (~re)~. ~ safe, function~! and adequate for the number of bedrooms and type of structure indicated herein. I fu~her verify that based on the on-site water supply and/or wastewater disposal system is(are) in compliance with afl applicable Municipal and S~ate codes, ordinances, and regulations in effect at the Eme of instaflation, Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 557-6179 Address 5701 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. bedrooms. Conditional approval for ~ ..-' " 5 ~t ~ATERAND · ~ ~ ~ WASTEWATER ~ ~ ..... ~ ~ PROG~M .' bedrooms, with the following supu~auons: ~ ~ % ... &. ~ Attachments: COSA Checklist Septic System Advisow Well Flow Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: d~ _ ~- / / Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MALLORY TRACT A Parcel ID: 020-09.3-46 A. WELL DATA Well type PRIVATE Date completed Total depth 428 4/22/91 Date of test Static water level 65 Well production 0.75 WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi. Arsenic: ~ [~ ug./L. B, SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size__ gal. Foundation cleanout (Y/N) __ *ARTESIAN PLUG If A, B, or C provide PWSID# Sanitary seal (Y/N) YES Cased to 47 ft. FROM WELL LOG 4/22/91 N/A ft. g.p.m. PUMPED Nitrate ~)/'~ mg./L. Date of sample: 9/9/11 Number of Compartments Date of P u~J~Cn9-~--- Pumper ABSORPTION FIELD DATA YES A TOTAL OF 1440 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 9/8/11 *ARTESISN ft. 5.46 g.p.m. GALLONS GEG/CAMPBELL Collected by: PUBLIC SEWER YES 12+ in. Date installed High water alarm (Y/N) Date installed Soil rating (g.p.d./ft2or ft2/bdrm)~ System type Length ft. Width ft. Grave~. Total depth ft. Eft. absorption area ft2 Monito~/Depression over field Date of adequacy test ~Resul~) ~_ For_ __bedrooms Fluid depth in absorption fiel~ in. . Water added ~_~__ gal. New depth _in. Elapsed Ti~ ~i_nal fl~i~,~,e.p~h., in. Absorption rate >= g.p.d. An ' enation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at__in. Datum __ SEPARATION DISTANCES Size in gallons Manhole/Access?_~.~N_) ~ "Pump off" level~. High water alarm level at Cycles tested. Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/^ 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 Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: PUBLIC SEWER Building foundation Property line Absorption field Water main Water service line Surface water ~ Wells on adjacent lots ~ SEPARATION DISTANCE FROM ABSORPTION FI E__..J.D-OI~-T_'~TO:---' :':'''''~''~ Property line B~l~lflg3~ndation Water main. Water service lin~ Surface water Driveway, parking/vehicle storage .Cattai~rain Wells on adjacent lots F. COMMENTS 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 COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date ~ / l & COSA Fee $ /-JfC[ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number 95-18 MALLORY SUBDIVISIONI TRACT A 86,994 S.F. 89'59'55"E 22.5.85' ] '~' .~ I I SAN. SEWER ESMT. 20' GAS ESMT, N 89°58'27"E 508.00' ILDING DETAIL SCALE: 1"=20' FINAL S As-BU IL T "' GASTALDI LAND SURVEYING JEFF A. GASTALDI, R.LS. 4-726 WE. ST 88TH AVENUE ANCHORAGE, ALAS~ 99502 PHONE 248-5454. GRID DATE 3336 4/10/2004. F.B. JOB NO. 03-19 MSTA O0~/ENANTS OR R~,, APPEAR ON THE R! UN~ER NO CIRCUM. TRUCTURE AS-'.BUILT I H~REm' CE~FY THAT I HAVE PROPERW DEP~C~D A~OVE AND ~ N [NeRO~CH~[Nm [~ ~C[~ ~m~ mE RESINS BIL~ OF THE O~NEI D~RMINE ~E ~I~NCE ~ ~ ~I~IONS WHICH~ :CORDED SUBD~SIO~ ~C~ SHOULD HEFEON BE USED Ir OR CON~RUC~ ~USHING BOUti~ OR ~NCE ~INI ~CHO~GE RECORDING DI~,~ Ab ~o~E: No cO~NERS s~T TH~ SGS Reft# 1114348001 Client Name Gamess Engineering Group, Ltd Printed Date/Time 09/15/2011 16:14 Project Name/# Mallory Sld Tract A Collected Date/Time 09/08/2011 18:30 Client Sample ID Mallory Sld Tract A Received Date/Time 09/09/2011 9:00 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Hardness as CaCO3 129 5.00 mg/L SM20 2340B C 09/13/11 09/15/11 NRB Waters Department TotaINitrate/Nitrite-N ND 0.100 mg/L SM20 4500NO3-F B 09/12/11 AYC Microbiology Laboratory E. Coli Ne~oative 1 100mL SM20 9223B A 09/09/11 CR Total Coliform Nezative I 100mL SM20 9223B A 09/09/11 CR Private Individual Analysis Alkalinity 129 10.0 mg/L SM20 2320B D 09/09/11 ACF Aluminum 2110 20.0 ug/L EP200.8 C 09/13/11 09/15/11 NRB Antimony ND 1.00 ugFL EP200.8 C (<6) 09/13/11 09/15/11 NRB Barium 109 3.00 ug/L EP200.8 C (<2000) 09/13/11 09/15/11 NRB Cadmium ND 0.500 ug/L EP200.8 C (<5) 09/13/11 09/15/11 NRB Calcium 38100 500 ug/L EP200.8 C 09/13/11 09/15/11 NRB Chloride 26.1 0.100 mg/L EPA 300.0 C (<250) 09/10/11 09/11/I 1 SDP Chromium 7.19 2.00 ug/L EP200.8 C (<100) 09/13/11 09/15/11 NRB CO3 Alkalinity ND I0.0 mg/L SM20 2320B D 09/09/11 ACF Conductivity 383 1.00 umhos/cm SM20 2510B D 09/09/11 ACF Copper 35.3 1.00 ug/L EP200.8 C (<1300) 09/13/11 09/15/1 l NRB Fluoride 0.157 0.100 mg/L EPA 300.0 C (<2) 09/10/11 09/11/11 SDP HCO3 Alkalinity 129 10.0 mg/L SM20 2320B D 09/09/11 ACF Iron 2960 * 250 ug/L EP200.8 C (<300) 09/13/11 09/15/11 NRB Lead 2.14 0.200 ug/L EP200.8 C (<15) 09/13/11 09/15/11 NRB SGS Ref.# 1114348001 Client Name Gamess Engineering Group, Ltd Printed Date/Time 09/15/2011 16:14 Project Name/# Mallory Sld Tract A Collected Date/Time 09/08/2011 18:30 Client Sample ID Mallory Sld Tract A Received Date/Time 09/09/2011 9:00 Matrix Drinking Water Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Private Individual Analysis Magnesium 8230 50.0 ug/L EP200.8 C 09/13/11 09/15/11 NRB Manganese 147 * 1.00 ug/L EP200.8 C (<50) 09/13/11 09/15/11 NRB Nickel 7.98 2.00 ug/L EP200.8 C (<100) 09/13/11 09/15/11 NRB OH Alkalinity ND 10.0 mg/L SM20 2320B D 09/09/11 ACF pH 8.00 0.100 pH units SM20 4500-H B D (6.5-8.5) 09/09/11 ACF Selenium ND 5.00 ug/L EP200.8 C (<50) 09/13/11 09/15/11 NRB Silver ND 1.00 ug~L EP200.8 C (<100) 09/13/11 09/15/11 NRB Sodium 34700 500 ug/L EP200.8 C (<250000) 09/13/11 09/15/11 NRB Sulfate 24.4 0.100 mg/L EPA 300.0 C (<250) 09/10/11 09/11/11 SDP Total Dissolved Solids 233 10.0 mg/L SM20 2540C D (<500) 09/14/11 AYC Zinc 11.0 5.00 ug/L EP200.8 C (<5000) 09/13/11 09/15/11 NRB Arsenic ND 5.00 ug/L EP200.8 C (<10) 09/13/11 09/15/11 NRB Thallium ND 1.00 ug~L EP200.8 C (<2) 09/13/11 09/15/11 NRB Municipality of Anchorage Development Services Department Building Safety Division ' On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 ,~..'; - www.ci.anchorage.ak.us ,,, . (907) 343-7904 ,.. ~'.,.~ ~ ~ · ~i~ ~ ERT FICATE OF HEALTH AUTHORITY APPRovAL Par~,el I.D. 020-093-46 1. GENEi~J~,L INFORMATION DWELLING 0¼°[ Z°l ExPiration Date: ~- .r~- ! -- ~/~ /-~' FoR A SINGLE FAMILY Complete I(~[~al desCription MALLORY LoCation (site address oi; di~ebtions) Current Propei'ty owhei;(s) BILL TAYLOR Mailing ~ddi-ess 9420 vANGUA'I~D S~E~I~, LenSing agency Mailing address Real Estate Agent Mailing address SUBDIVISION; TRACT A 4661 vIi~G0 AVENUE * ANCHORAGE~ AK * 99516 Day phone 345-0371 UNIT A * ANCHORAGE~ AK * 99516 Day p~one TAMMY TAYLOR .W/ PRUDENTIAL JACK WHrfE Day phone 762-3141 3201 C s¥i~EET, SUI~I'E 200 * ANCHORAGE, AK * 99503 e Unless otherwise r~quested, HAA will be held by DSD for pickup. NUMBER OF BEDR~dOMS: 4 TYPE OF WA;i'ER sUPPLY: TYPE OF WASTEWATER I~ISPOSAL: Individual Well ~ Individual On-site r-] Individual Water Storage I--'1 Individual Holding tank I--I CommunitY Class Well D Corflmunity On-site D Public water System ~] Public Sewer [] ' The Municipality of Anchorage Development serVices Dep~ftfner~t (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 wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. CertifiCates 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. STATEMENT OF INSPECTION BY ENGINEER As certified by my sea/affixed hereto and as of the validation dale shown be/ow, I verify that my investigation, based on procedures 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 dumber of bedreoms and type of structure indicated herein. I further verify that based on the information obta/ned from the Municipality of Anchorage fi/es and from my investigafion 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' 1(~1 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone 337-6179 . Date Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, .conscientious engineetfng 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 durfng 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 futura 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 t../ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: : ~ WASTEWATER · Attachments: Manitenance A~reements' HAA Checklist Septic System Advisory Well Flow Advisory ..suPplemental Engineer's Reort ' Other ' (rev. 12/01) Original Certificate Date: i ' Municipality 0fAnchorage Development Services DePartment . Building Safe~, Division . On-S~te Water & Wastewater Program : 4700 South Bragaw St.- P.O. Box 196650 Anchorage, 'AK 99519-6650 www.cz.anch0rage.ak.us (907) 343-7904 ~" i. ~ ~ ' FROM WELL LOG Da~t~ of test ;,;: !: 4/22/1991 Static water level i Coliform ~: 0 ~ Colonies/100 'mi. 'ft. :/" g.p.m. Nitrate' 2.82 'mg./L.'. AT 'INSPECTION *10/24/200~ O' (ARTESIAN WELL) ft. *3.75 g.p.m. Other bac~teria . ' 0 colonies/lO0 mi. Flbid de h Ela~!ed ArSEjl~ic: ;;N/A n~g./L.' ': i. ' - Date of sample: 4/5/2004 : "" ~'"~' !~TA. pUBL C!:S' W B. SEe.TIC/HOLDING TANK I E Tank Type/Material ~ , ' Tank size ..... ~gal.~ ,i Number of Compartments FoUhdatibncleanoUt (Y/) __ (WN) : .... c. ,.~'o,,,,,o. ~i.~".ArA: PUB E,I C EWE R' D~t~:installed I~' ::F:::' . Length:'~ L ~:; ~,.. : i~,; ~,' fl;' , ~, .- Width ' · ' fl. - TOtal depth t~ ,,fl. {Eft. abso~tion area Collected by: Date installed High water alarm (Y/N) SystFmtYpe ~ Gr%e~ below Dateofadequacytest.:. : i: . field Final fluid depth · . ~t' Monit0dng tu Depression over field ) .... For. bedrooms Wate,r added gal'. i :, ! New depth in. ' ' :" Absorpti°~ rate > ~n. g.p.d. treatment (past 12 mo.)(Y/N & type~)l ! If yes, give date' ,, - BRIAN WILLIE 12+. in. ii ~' .~ HEALTH AUTHORITY· /~PPROVAL CHECKEIST De,scrlptlon:,~ - '; MALLORY SUBDIVISION; TRACT A Parcel ID: 020-093-46 A.. WELL DATA i!TEST:'!PE~FORMED BY BRIAN WILLIE WITH AAROW :PUMP AND.,WELL SERVICE ' !; ; i *ARTES AN PLUG INSTALLED BYi' BR AN WILLE Well"{vpe;' PRIvATe:li, . . : If A,'B, or C provide PW~ID~ N/A "-.wel ~og (WN) YES Dat~ ~mPlete~d 4/22/1991 ' Sanita~.seal ~/N) YES . .' .: Wires properly protected ~/N) YES Total,depth 428 ~ff. :,::; Cased to 47 ,fl~ . - Casing heigh~ (above ground) D. LIFT STATION · .: ..... i, . : Date installed i. Size in g!llo s ~ ~ :"pump on" level at in. '" n '. . ~ Pump off' i, ' ~n.' r 'High watei' alarm level at ' - · in. ~ ~ , Cycles tested Meets alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/li{'t station'on lot N/A Absorption field on lot N/A Public sewer main :. '75'+ SeWer/septic service line ' 25'+ On ad acen't lots ~ 100'+ · 100'+ On adjacent lots Public Sewer manhole/cleanout 100'+ Holding tank . N/A · SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: · Building foundation ' Water main , ~. ~ lots PUBLIC Property line ' AbsorPtion field Water service_e.[~ ~ water, SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water service line :SEWER PUBLIC, SEWER Building foundation Water main .' Surface w~ter._.__ __ ~arking/vehicle storage Wells on adjacent lots F. COMMENTS. G. ENGINEER'S CERTIJ=ICATi0N i certify that I have determined th'rough fieId inspections and' review of Municipal records that the above systems are in . · conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS HAA Fee $ ~ ~ Waiver Fee $ ; Date of Payment .... Date of Payment Receipt NUmber (Rev. 12/01) .. Receipt Number 04-16-04 08:27AU FROU-CT&E ESI, SGS ENV SERVICES 9075615301 T-Olg P.02/03 F-46B 'SGS Rcf,# CUent Name Project Name/# Client Sample ID Matrix 1041600001 Anrow Pump & W~ll Service Tract ^, Mallory Tract A, Mallory Drinking Water PWSID 0 All Dat./Times are Alaska Standard Time Printed Date/Time 04108/2004 8:36 Collected Date/Time 04105/2004 8:15 Received Date/Time 04/05/2004 11:45 Technical Directo~/,~- Stephen C. Ede f _ Released BY Sample R~ra~u~s: Allowable Prep Analysis Paramem' Results PQL Units Method Container ID Limits Dale Dale Irli! Waters Department Nitrate-N 2.82 0. i00 mg/L EPA 300.0 B (<=10) 04/0S/04 Microbiology Laboratory Total C01ifonn 0 col/100mL SM18 9222B A (<=1') 04/05104 DKC === ~ 95-18 ,,. i MALLORY SUBDIVISION TRACT A .I "'1 l.,Jl .,31 i--:1 I I I I I I I I '1 I '.~. ..L 86,994- S.F. S 8g°59'55"E 223.85' I .I i I 2 SAN, SEWER ESM'F. O' GAS ESMT. N 89°58'27"E 308.00' o/ P.O1 1 "=4C ............ : "~'~~<-"'"" ~ ~ATERi WELL RECORD : ~ ~ STATE OF ALASK~ ~F~ ~~' : .= ..... '-- ! , _.,_a,_0,_ .oJ i wo $.rfecl 4. W~LL DEPTH: (fl.~) 5. DATt OFCOM~ETION , I : ..... Backfilling _ . Gr~vil "' :' I~.PUMPI (If ovo;Igbl.} NP "'' LO~gtk of D~op i TOTAL P.02