HomeMy WebLinkAboutPALATERRA BLK 1Palaterra
Block 1
#017-151-10
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
/^ M I_ "�
NAME � J t/ J Y/ / / !J O fi (f ill- 11 J
PHONE
>3L�� _/�(nt•�—
❑ NEW
,[X] UPGRADE
MAILING ADDRESS )x
LEGAL DEERRIPTII/0.1N/,
LOCATIO
e/9�'17L �G�o ss f�-� vs f rr
Cir
NO. OF BEDROOMS
Uy
DISTANCE TO:
Well
Absorption area
Dwelling
PERMIT NO.
F- Z
o Q
wF
Manufacturer
Material
No. of compartments
w
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
6 z DISTANCE
TO:
Well
Dwelling
PERMIT NO.
= z F
Manufacturer
Material
Liquid capacity in gallons
p
J
LU
DISTANCE TO:
Well //^'�j} f
ZIJIJ `I'
Foundation /
75
Nearest lot line 4 /� /
U
PER IT NO.,,/ L�
r%G/ ry/ Cil
j LL z
ZLU
No. of lines /
Length of each line -�/
Total length of lines/
iii
width
Trench width /_
Distance between lines
-
q P
Top of tile to finish grade /
Material beneath tile
inches
Total effective s/or tion area
L j 50. F T
Lu
Length
Width
Depth
PERMIT NO.
Q H
wa
Type of crib
Crib diameter
Crib depth
Total effective absorption area
LU
U)
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
w
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
L
11
SOIL TEST RATING
--
INSTALLER
DeAi Q jA
REMARKS
LZ v ^
I
r 1y
Ilk -
i k
410' ;'''' �h
APPROVED DATE LEGAL
Z 2 X13 /2aIaJZrYa, 5L)L-d i ��� /_vf l, 13l k 1
72-013 (Rev. 3/78)
Permit #
MUNICIPALITY OF ANCHORAGE{
Department F Health and Environmental 5rotection ['^;'��."
825 i Street, Anchorage, AK. ',�>3501
264-4720
# # # HANDWRITTEN PERMIT # # #
WI=- /OR ON-SITE SEWER PERMIT (Lp
Applicant: � o ph M. :Cie_ Mailing Address: &373
Location: Phone Number
Legal Description: c) -F '(3(ock I LIAJ_r6teIt- Lot Size:
Type of Soil Absorption System Is:
Trench: ✓ Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms:
Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System
DEPTH N LENGTH 30 GRAVEL DEPTH 11
/ �2S
Is: iy�f� vd
WIDTH 30"
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE _ /aS GALLONS # #
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
# # # TWO(2) INSPECTIONS ARE REQUIRED # # #
Backfilling of any system without final inspection -and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of :public well. Minimum distance from a private well to a private sewer line
is.25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
e residence is re deled to include more that 3 bedrooms.
Signed:— L � Issued by: ���
plicant
Date: � h- 3
SWP/024(1/81)
ti t = 3G
V'
.� SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
• �.c TEST
625 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: • ! 1 • w1-� L e'`/ DATE PERFORMED:
LEGAL C)ESCRIPTION: R` lA 'lel ��L � r� I� � � j%�� Nuck
SLOPE SITE PLAN
16L
1
2
�i lyCk �S
3
4 r
5 III it: 0 C�?V
6-0 91
0 4 �i�� X21 r0w1 1
7
c u 0
g 0 o
0 0
0 0
g u o p o
p u n
� O C
10-
11
0 11 n o
0
° e
12 6,00 n
p 6 0
13 0 °
t b
e
O p O
14-
15
4 15 ° n
�a t
16
d ° d
0 0
17 o d o
d o p p
a n
18
19
20
tj
COMMENTS VI
6-vl-on.b bto-& COAT
WAS GROUND WATER A %
ENCOUNTERED? / V
IF YES, AT WHAT
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND FT
PERFORMED BY:,�1je'1!0fi // CERTIFIED BY:
72-008 (6/79)
DATE: J
DAILY DRILLING LOG
PENN JERSEY DRILLING CO.
2833 East 72nd Avenue Anchorage, Alaska 99502 344-2612
OWNER OF LAND ...... Mr.....,Tna..Jaynar ...................................................... DEPTH OF WELL ................. ...........................................
ADDRESS.................................................................................................................. STATIC LEVEL OF WATER FT ...............192.........................
WELL—SITE .........
DRAW DOWN FT ..................... -
October 1 7 . 1975 ................................................ GALS. PER UR .................. �t ... GPM ... PlU.S ......... I .......................... I ............. .......
6 -inch welded
DATE—ENDED .............. ...19.75............................................... KIND OF CASING ........... ......................................................................................
KIND OF FORMATION:
0
FROM...... ...
FT. TO .......................
FIT2P"...... .. FROM... --------------------...FT. TO .......................... FT .........................................
�R9�..............
FROM ..........................FT.
5
TO
......................W.......................................
Grave' FROM ..............
i...n..e...
........... FT. TO .... ............ ........ FT -- ......................... ..........
FT .........................................
FROM..........................
FT. TO ..........................
FT .........................................
Brown sand & Cffib�.........................FT.TO..........................FT........................................
FROM......80...............FT.TO......152............FT.oarser
.....
....8..0..
...b..r...o...w..n......s...a..n...d...&.
FROM ...
152 ...............
........
FT. TO ......
�AQ ........f,...
p .�pd ... & ... G.r.a.v.e.l ........ FROM.........,................
FT. TO.................. FT .........................................
DATE—STARTED ......... . . . . . .... . ...... . . .
FROM.......................... FT. TO .......................... FT .........................................
FROM........... ..............
FT. TO ..........................
FT .........................................
FROM..........................
FT. TO ..........................
FT .........................................
FROM..........................
FT. TO ..........................
FT .........................................
FROM..........................
FT. TO ..........................
FT .........................................
FROM ..........................
FT. TO ..........................
FT .........................................
FROM.......................... FT. TO ........................ -FT .........................................
FROM.......................... FT. TO .......................... FT .........................................
FROM..................-----..FT. TO ...... ................... Pr .........................................
FROM.......................... FT. TO .......................... FT .........................................
FROM.......................... F'T. TO .......................... FT .........................................
FROM.......................... FT. TO .......................... FT ............................ ............
FROM.......................... FT. TO .......................... FT .........................................
FROM... ...................... FT. TO .......................... FT ...........................
FROM.......................... FT. TO .......................... FT ....... I ................................ FROM.......................... FT. TO .......................... FT ........................... .............
ii[ISCL. INFORMATION:
Large Boulders scattered throughout the drilling,
Very hard well to drill.
DRILLER'S NAMi. -awr.enc.e'o ... Larry ... & ...Nancy. ............................................ .
....... ....... .. . ... .... ..... .. ..... .... .. .
APPLIC NT FILLS
OUT UPPER HAL ONLY
Time
Time �I ;
Q U �iU
Owner t
Date
[PloneProperty
Mailing ASj dress
zip Code 995 7
f,
Inspector
Inspector
Buyer
Inspector
Address
Zip Code
Lending Institution _ /-------- - -
Phone
Address_(,06
Zip Code
Realty Co. & Agent
Phone
DEPT. OF H`Al fri .,
'N
Address
Zip Code
Legal Description
PaZaterra Sux.idvision
v
4-
Street Location 41 ;1 1r
( , ,APPROVED BEDROOMS -
- 'CONDITIONS OF APPROVAL
Type of Residence
( ) DISAPPROVED
Qx,Single Family
0 Multiple Family No. of Bedrooms
.
-
❑ Other
DATE
Water Supply
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
Soils Rating
Date Sewer Installed
Well To Absorption Area '0 0 -��'
Well Log Received .Va-
('7
I
Sewer Disposal
Well to Tank -Q (j 4
Septic Tank Size 7
iIndividual
Year Individual Installed: 9 7
Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY
EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time -
Time
Time
Time �I ;
Q U �iU
Date
Date
Date
Date
Inspector
Inspector
Inspector
Inspector
Field Notes:
MUNICIPALITY OF ANCI •2AGE
DEPT. OF H`Al fri .,
'N
ENVIRONMENTAL PROTECHi
-
JUL
.j
4-
RECEIVED
( , ,APPROVED BEDROOMS -
- 'CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL -
_L_ " 3
' 0 Q'
-
DATE
BY:
r7 _S'
Soils Rating
Date Sewer Installed
Well To Absorption Area '0 0 -��'
Well Log Received .Va-
('7
I
G 6
Well to Tank -Q (j 4
Septic Tank Size 7
72-023 (3182)
July 18, 1983
Joseph and Mary Joyner
Star Route A Box 373
Anchorage, AK 99507
Subject: )clock i, palaterra Subdivision
Approval for the individual sewer and water facilities cannot
to ;;ranted until the follOWinl iterms have been completed.
° The top of the well casing; sYtould be healed so that it is
welter tight.
° Exposed electrical wire* to the well head are in violation
of the fiunicipality of Anchorage codes and must be encased
in conduit.
• The septic tank pumped with a receipt submitted to this
department. The total number of ;;allons pumped needs to be
on the receipt and verified by a registered engineer as to
the actual number of ,,allans pulAPed, this is to verify the
size of the septic tank.
° Ihpose the septic, tani: manhole to verify its es.istence.
° An adequacy test needs to be performed on the el'i.stin8
leaching area. this test will Eletermine if the sYsteTil is
adequate according to ilational Standards. A listing; of
private fires performing the test ifi anclased. this report
needs to be submitted to this office for our review.
Please notify this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questio}z , please call this office at 264--4720.
Sincerely,
J. S. Roberts
Assistant Environmental Specialist
JS113/cj/i2
Enclosure
ALASKA e1TUIROMMAL COnTnOL SCRUIRS, InC.
engineerinq & 6nuironmental Studies
JULY 25 1983
J.M. JOYNER
SRA BOX 373
ANCHORAGE AK 99507
SELLER — J.M. JOYNER BUYER—
SUBDIVISION—PALATERRA BLOCK -1 LOT -1
ADEQUACY TEST FOR SEWER SYSTEM
THE TYPE OF ABSORPTION SYSTEM IS A UNKNOWN WITH AN UNKNOWN AREA.
THE SYSTEM IS CAPABLE OF ACCEPTING 145 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 108 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A
HOME OF 4 BEDROOMS.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1500 IS ADEQUATE FOR
THIS 4 BEDROOM HOUSE.
e° 3
oY C. Reid, Jr. �L
No. 2251 •E
1200 West 33rd Auenue, Suite B • Anchorage, Alaska 99503 9 (907) 276-1361
Municipality of Anchorage r
Development Services Department
Building Safety Division
Onsite Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us C
(907) 343-7904 ^ISS got CL,
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I. D. 017-151-10 COSA* O -S & / / % � f /I
1. GENERAL INFORMATION Expiration Date: / /- / -g--- / �2_
Complete legal description PALATERRA BLOCK 1
Location (site address) 7100 DEARMOUN ROAD *ANCHORAGE, AK 99516
Current Property owner(s) DOREEN JOYNER C/0 MARYJOYNER Day phone 529-4372
Mailing address 7100 DEARMOUN ROAD *ANCHORAGE AK 99516
Lending agency Day phone
Mailing address
Real Estate Agent CYNDIE PARTCH W/ PRUDENTIAL Day phone 440-7775
Mailing address 3801 CENTERPOINT DRIVE *ANCHORAGE AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. 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 maybe 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 JEFFREY A. GARNESS, P.E.
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 unde- 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.
Conditional approval for bedrooms, with the following
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Phone 337-6179
Date $ (3%tz
M' I Arr f1A
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
'.-6 ness.
-1 m�
P,0
ON-SITE
WATER AND
WASTEWATER
PROGRAM
By: Lf1= Original Certificate Date:
(Rev. 1IM5)
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.ci.anchorage.ok.us
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: PALATERRA BLOCK 1
A. WELL DATA
*BASED UPON SURROUNDING WELL LOGS
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 10/18/75 Sanitary seal (Y/N) YES
Total depth 240 ft. Cased to *40+ ft.
FROM WELL LOG
Date of test 10/18/75
Static water level 192 ft.
Well production 4+ 9.p -m.
WATER SAMPLE RESULTS
Coliform 0 colonies/100 ml.
Arsenic: NO ug./L.
B. SEPTIC/HOLDING TANK DATA
Nitrate 1.46 mg./L.
Date of sample: 8/2/12
Parcel ID: 017-151-10
Well Log (Y/N) YES
Wires properly protected (YIN) YES
Casing height (above ground) 12+ in.
AT INSPECTION
8/9/11
193 ft.
1.54 —
9 -p.m -
*DBL C/O'S INSTALLED
PRIOR TO TANK.
Tank Type/Material STEEL
Tank size UNK gal. Number of Compartments UNK
Collected by: GEG Ltd.
TANK IS
UNDOCUMENTED
Date installed UNK
Cleanouts (Y/N) YES
Foundation cleanout (Y/N) * Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 8 /X 2ot2 Pumper A4 118ME GERVIGE-S M 6Doma-w 5 N— O,
C. ABSORPTION FIELD DATA BELOW EXISTING GRADE
UNK UNK ***CRIB
Date installed 8/22/83 Soil rating (g.p.d./ft or/bdrm 125 System type TRENCH
UNK U UNK
Length 37 ft. Width 3 ft. Gravel below pipe 7 ft.
*7.58 UNK
Total depth *10.4 ft. Eff. absorption area5� 88 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 8/9/11 Results (Pass/Fail) **PASS For 4 bedrooms
Fluid depth in absorption field before test 12 in. Water added 609 gal. New depth 20 in.
Elapsed Time: 901 min. Final fluid depth 12 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date —
**CRIB TESTED ONLY ***CRIB IS UNDOCUMENTED AND HAS HAS SPILL OVER TO DOCUMENTED TRENCH.
1983 TRENCH REMAINED DRY THROUGHOUT THE TEST.
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump off level High water alarm level at in.
Cycles tested Meets alar & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
Animal containment areas 50'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
'+ Absorption Building foundation 5'+ Properly line 5field 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'+ Water main N/A
Water service line 10'+ Surfacewater 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
i certify that l have determined through field inspections and0 a : 4 T
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.QO e r Gar ess:'
Engineer's P'nted Name JEFFREY A. GARNESS CE
Date Ul�_F'rniseeioP� o
COSA Fee S Waiver Fee $ _
Date of Payment Date of Payment
Receipt Number Receipt Number
(Rev. 11105)
Municipality of Anchorage
` e Development Services Department
Building Safety Division
On -Site Water &Wastewater Program
4700 Elmore Road
P.O. Sox 196650.
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 017-151-10 COSA# c),L WIA
1. GENERAL INFORMATION Expiration Date: 1 -- 2, 7– 12—
Complete
-12—
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
PALATERRA BLOCK 1
7100 DEARMOUN ROAD *ANCHORAGE, AK 99516
DOREEN JOYNER C/O MARYJOYNER Day phone
7100 DEARMOUN ROAD *ANCHORAGE, AK 99516
Day phone
529-4372
CYNDIE PARTCH W/ PRUDENTIAL Day phone 440-7775
3801 CENTERPOINT DRIVE *ANCHORAGE, AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:.
3. TYPE OF WATER SUPPLY:
a
TYPE OF WASTEWATER DISPOSAL:
Individual Well
N
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 Gelb Jed by my seal afffixed 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,
sho!41s 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. 1 further verify that based on the
information obtained from the Municipality of Anchorage files and from my invest; yation 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, LfD. 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.
Conditional approval for
Att-c l:r.ents:
COSA Checklist
Septic System Advisory
Phone 337-61.79
Date t U a
iJext/Vy. ar ss.-
CE-795
s;CE-•795
j •mac O
%ea�Pr
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J ON-SITE
WATER AND � �=
:. WASTEWATER
bedrooms, with the following stipulations: % �•• PROGRAM T
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S
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Arsenic Advisory
Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate AdL^scry
Other
By: /. r Original Certificate Date: l l
(Rev. 11/05) 'Irl
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: PALATERRA BLOCK 1
Parcel I D: 017-151-10
A. WELL DATA *BASED UPON SURROUNDING WELL LOGS
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed _10/18/75 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 240 ft. Cased to *40+ ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 10/18/75 8/9/1 1
Static water level 192 ft. 193
ft.
Well production 4+ g.p.m 1.54
g. P. m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate_1.55 mg./L. Collected by: GEG, Ltd.
Arsenic: ND ug,/L. Date of sample: 8/8/11
B. SEPTIC/HOLDING TANK DATA *DBL C/O'S INSTALLED TANK IS
PRIOR TO TANK. UNDOCUMENTED
Tank Type/Material STEEL Date installed UNK
Tank size UNK gal. Number of Compartments UNK Cleanouts (Y/N) YES
Foundation cleanout (Y/N) * Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 8/9/11 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATAUNK *BELOW EXISTING GRADE
Date installed $/22/83 Soil rating (g.p.d./ft or Z/bdrm 125 ***CRIB
UNK � System type TRENCH
Length 37 ft. Width U3 UNK
ft. Gravel below pipe 7 ft
*7.58 UNK
Total depth *10.4 ft. Eff. absorption area 518 ftZ Monitoring tube YES Depression over field NO
Date of adequacy test _ 8/9/11 Results (Pass/Fail) **PASS
For 4 bedrooms
Fluid depth in absorption field before test 12 in. Water added 609 gal. New depth p 20 in.
Elapsed Time: 901 min. Final fluid depth 12 in.
Absorption rate >= 600+ —9-p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date —
**CRIB TESTED ONLY ***CRIB IS UNDOCUMENTED AND HAS HAS SPILL OVER TO DOCUMENTED TRENCH.
1983 TRENCH REMAINED DRY THROUGHOUT THE TEST.
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump off' level High water alarm level at in.
Cycles tested Meets alarm $ circuit requirements?
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'+
Public sewer main N/A
Sewer /septic service line
25'+
100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank
N /A
Animal containment areas 50'+ Manuretanimal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
5'+
1 nn, ,
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'+ 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
G. ENGINEER'S CERTIFICATION
dojo
04
P.
'•.ter �0
I certify that I have determined through field inspections and
o
p * X 4
T
review of Municipal records that the above systems are in
' ' ' ' ' ' ' ' '
' ' '
conformance with MOA COSA guidelines in effect on this
0
date.
Engineer's
Je
G
ess.•* Q
Printed Name JEFFREY A. GARNESS�Q4�
CE -79 3
Date l -7
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COSA Fee $ `l h Waiver Fee $
Date of Payment I G Date of Payment
Receipt Number _ 0 � Receipt Number
(Rev. 11/05)
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Eassmots of neord other than those ehowa ••• ••:• ••••••••••.:...
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LOT SURVEY CERTIFICATION
tM plat of rebord ors sot "own he aaleee9 =
othWwtee noted. R. L. Bvtton o
LEGEND % LS-I 192
I hereby esrtlty that I how emeyed the property shown and dswibw
Wean, and that the btprovooNnts
0 Bross or Aluminum capped monument ••••�Jr
{Mooted thereon an wlthla the prop.
Wty lines and do not overlap or snoraaoh on ad Joosnt property and that
O Iron pipe and/ar rebar recovered. fESSI 0dP"\'. 4
D 2 x 2 hub & tack recovered `
no WWr°wmnd• on ad➢amil prop" overlap or .nar000h as the p"lses
in suestlas and Mol then are no roadways, ufiUty Una, or other visible
• $/e" x W' rebar set this survey
_. Fence Litre (Approx. Location)
easstsents an sold property as htdlootsd hereon,
Sc°le
/ 0 501Land
Date
0-13 10-13 1l
Prepared by: R. L. BUTTON
istw SU-v&w
(907)279-6200 5/9 W. DO AnWWW Afawta99ZV
Ref. 2939
F'B. No.. //_080
Property of: --,/ner Esto fe
Page I of I
Poet, Jeff W.
From: Jeff Gorneaa[Jaff@oonnesaengineerng.con]
Sent: Thursday, October 27.2O11 12:17PK8
Subject: Pa|oh*rroQubdkmionCOGA
Jeff. |tseems as the though the past MOA approval to expand upon the old (undocumented) tank and
crib implied MOA approval ofthe old tank and crib. Seems unfair tonow require that they goinan
document everything. |nfact the 1983MOA septic permit required that they hook into the old
(undocumented) system.
Jeffrey A. 6arness, P.E, M.S.
President
GarnessEngineering Group, Ltd.
37O1East Tudor Road, Suite 101
Anchorage, Alaska 995O7-1259
Ph: 907-337-6179
Fax: 807-338-3246
email: jeff@garnessenginee r|ng.comn
website: vxxvxv.gsrnessengineering'cono
From: Poet Jeff W. [maUto:Poet]VV@ci.a k.uul
Sent: Thursday, October 27, 2011 11:48 AM
To: Jeff Gamess
Subject:
10/27/2011