HomeMy WebLinkAboutVERN HAIK LT 9Vcrn Hoik
Lot 9
#051-061-87
Municipality of Anchorage Page I of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, _Al,~ska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
SW000320 051 -061 -87
Permit Number: PIP Number:
.ama: MM&M Contracting Wastewater System: ~ New FI Upgrade
AddmSS:P.Oo BOX 670495 Chugiak, AK 995( 7 ABSORPTION FIELD
Pho.e: 688--1236 I T~ree (~)NO of Bedroom · f~DeepTrench D Shallow Trench DBed I-IMound I'lOther
Total Depth from original grade:
LEGAL DESCRIPTION so~..~,~n=~ 1.2 <~.o/s~ r, 9'
9 1 Vern Naik 3 rt 6 F,.
Townsnip: I.,.0e: Is.~o.: Fill added above orlginal grade: Gravel length:
· .5 · Ft. 32
Numbelr of line~:
WELL: n New [] Upgrade Gravelwidth: 3 Ft N
Classihcat mn (P~vate. A.B,C): Total Depth: I Cased TO: Total abSOrption area: Pipe material:
Class A F~ FL: 384 soF, ASTM D3034 PVC
Ft MM&M Contractin.q '9/15/00
SEPARATION DISTANCES ~[Septic r3 Holding D $.T.F-P.
From ~..~ F.. 'Sa~ ~=.~ fS~U~ Anchoraqe Tank 1 ~
Wel~ N/A N/A N/A N/A N/A uate~:
Steel Two
Sudace )100' )100' N/A N/A N/A LIFT STATION - N/A
Water
Lot >5' >10' N/A N/A N/A' Size I. g~,,o~:
Line
Foundation
I
I
Curtain Pump IZa~e & Model I Electrical Inspections perforated b~
Drain None Noted on Lo ..
Remarks: 2" I~sulation Over Septic BENCH MARK
Garage Slab
Department of Health and Human Services approval ~.~-~ ~.'~'~ ~"' 4 ..:~';:!'~
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
,P.O. Box 196650 -Anchorage, AK 99519-6650 -343-4744 ·
On-Site Wastewater Disposal System Or Well Inspe~:tion Report
Permit Number $W000320 PID No. 051-061-67
Page 2 of 3
A B
S1 33.7 9.0
S2 34.5 13.0
C3 36.6 20.0
M1 17.3 32.0
C4' 16.7 32.0
three ·
Bedroom
Home
. S1
S2'~
C3
... ~) TIll
".' : ':" .30' -Otili[y':Ea~dment-- ~ -
' PLAN AS-BUILT
SCALE 1" = 30'
Municipality of Anchorage . .
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744
On-Site Wastewater Disposal System or Well Inspection Report
Permit N'umber SW000320
P, age 3 of 3
PID No. 051-061-87
.... -. /
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Municipality o~ Anchorage
Department of Health & Human Services
825 L Street, Anchorage. AK 99502-0650
SOILS LOG - PERCOLATION TEST
Performed For. MM&M Contmctin9
Legal Description: Lot 10. Veto Halk Subdivision
SLOPE
Date Performed:
SITE PLAN
7
8
9
10
.11
12
13
14
15
16
· 17
21
OG/OL
SW '
Well Graded
Sands
with
Gra~/el
See Site Plan
Bottom' of
Hole
Was G~oundwater
Encountered? No
If Yes. What Depth?
Depth to Water - ·
A~er Monitoring . None
Date: ' 9115/00
S
O
P
E
Reading Date Gross Net Depth To Net· ..
Time Time Water Drop-
2 · 9:1,5 5 6' 5'
4 9:21 5 . . 5.75' 4.75'
5 ' 9:22 1'
6 9:27 5 5.75" . 4.75'
Comments: Soil Materials in TH3 Are Identical to TH1 and TH2.
Perc. Rate: Min./~nch Perc. Hole Diameter:. 6'
Test Run Between 4.5 FL and 5.5 Ft.
Performed By: Mike Anderson. I, ' ' - .' .: Certi~ That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 12/18100
ANDERSON ENGINEERING
' ' P.O.' BOX 240773 .
~NCHORAGE, AK 99524
522 7773 - 522-6779 (FAX)
August16,2000'
Municipality 6fAnchorage . .
Department of Health and Human Services
825 "L, Street
· Anchorage, AK 99502-0650 :
. Subject:
'Lot 9, Veto Haik Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear'Onsite Services'Engineer:
The owner of Lot 9, Veto Haik SubdMsion intends to construct a three-bedroom home
on the lot. We are therefore applying for a permit to construct a new'absorption septic
,system on the lot to serve the home. The attached Site Plan and backup.
documentation identify the location and configuration of the new septic system and the
parameters used in the design. The lot and surrounding area are served by a
community water system and separation distances are .easily met between the septic
system and the water service on the lot.
Two test h01es were recently placed on the lot in the area of the new absorption trench.
Both holes revealed similar materials with well graded sand with some gravel with a
percolation'rate of 1 minute per inch. No groundwater was encountered in either
excavation and none accumulated during the monitoring period. We have therefore
designed a deep absorption trench with 6'. of gravel beneath the distribution pipe. The
total length of the tre.nch will be 32'.' The total depth of the trench from original grade
will be 9'.
The ground surface on the lot slopes from south to north at appro:dmately 2%. It also
slopes from east to west again at 2%. The new trench will be constructed parallel to
the contours of the surface in conforma, nce w. ith Municipat require.nents. Grading will
-be accomplished to assure surface drainage ,s away from the new trench: Mounding
will be required over the trench to provide a minimum of 3' of cover or 2" of insulation
will be placed and 2' of cover to provide protection against freezing.
If the system is constructed in accordance with' our design the following Statements
apply:
1. The system, if constructed as designed, will have no adverse impact or~ the wells
in the area or those to be constructed in the future. The area is currently served
' by a community water system. - ' · '
· 2. The system, if constructed as designed, will hm/e no adverse'impact on existing
septic systems in the area or those to be constructed in the future.
· Lot 9, Vern Haik Subdivision
August 16, 2000
Page Two
The system, if constructed as designed; Will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely,
Michael E. Anderson, P.E.
Attachments
. III ,
~cce~$
· · "' AREA MAP
: ~ ,.. "...' .". .~' '~;?. 5' . ':-'
NOTE:.· Area· Served By Publt~ ater System~
2%+
{ouse
I 1,000 Gallol
Septic Tank
LOT 8
.(~ TH1
I
~2~ Long X 3' Wid~
' Effective
Absorption
.~TH2
I' Alternate
30' utility Easement
SITE PLAN.:.
SCALE 1" = 30'
LOT 9, VERN HAIK SUBDIVISION
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Three Bedroom Home
Perc. Rate: I Min./Inch
Application Rate: 1.2 GPDISF
Deep Trench System
1,000 Gallon Septic Tank
6' Drainfield Rock
3 Bedrooms X 150 GPD 11.2 GPD/SF = 375 SF of Absorption Area
375 SFI12 SF/LF = 31.25 LF Trench Length
Therefore: Construct a New Absorption Trench 32' in Length With 6' of Drainfield Rock
Beneath the Distribution Lateral. Distribution Lateral to Be Placed 3' Below Existing
Ground. Total Depth of Trench to Be 9' from Existing Surface. Mound Over Trench to
Provided Minimum Cover of 3'.
NOTE:
'TYPICAL'WIDE TRENCH SECTION
Grade Area Over Trench to Dra,n Away. ~ ~ ~'~ '
Minimum 6' Sepa~tion From Bedrock. ,~ ~ ~:~ ~ .~.~ .-~, '.
Minimum 17 Separation From Lot Line.
Minimum 4 Separation From Groundwater.
Minimum 10' Separation From Water Se~ice Line. ~',
Municipality of Anchorage
Department of Health & Human Services
825 L Street, Anchorage, AK 99502-0650
SOILS LOG - PERCOLATION TEST
Performed For:. MM&M Contracting
Legal Descripfioni Lot 9. Veto Hail< Subdivision
SLOPE
6
7
OGIOL
SW
Well Graded
. Sands
· with
Gravel
See Site Plan
1
11
13
14
15
17
· 18
21
Bottom of
Hole
Was Groundwater '
Encountered?
If Yet, What Depth?.
Depth to Water
After Monitoring
Date:
None
8115100
Reading Date Gross Net Depth To Net
Time Time Water Drop
I 9-Aug 1:00 1 '
2 1:12 12 .13" 12'
3. 1:13 . 1'
4 1:25 12 13" ' 12'
5 1:26 1 '
6 1:38 12 13" 12"
Perc. Rate: 1 Min./Inch Perc. Hole Diameter:. 6'
Test Run Between 4.5 Ft. and 5.5 FL
Comments: Percolation Cavity Presoaked Prior to Testing. .
Perfon'ned By: Tim Kimbrough- I, Michael E. Andemon Certify That This Test Was Performed
In Accordance With All State and Municipal Guidelines In Effect On This Date: 8115100
Municipality of Anchorage
Department of Health & Human Services
825 L Street, Anchorage, AK 99502-0650
SOILS LOG - PERCOLATION TEST
Performed Fen MM&M Contracting
Legal Description: Lot 9. Vem Halk Subdivision
OG/OL
SW
Well Graded
Sands
with
Gravel
SLOPE
SITE PLAN'
See Site Plan
Was Groundwater
Encountered? No
If Yes, What Depth?'
Depth Io Water
After Monitoring None
Date: 8115100
S
L
O
P
E
13
14
15
16
17
18
Bottom of
Hole
Reading Date ~ross Net Depth To Net
rime Time Water Drop
I 9-Aug 1:20 1 '
2 1:32 12 13" 12"
3 1:33 1 *
4 1:45 12 · 13' 12"
5 1:46 1"
6 1:58 12 13" 12"
21
Pero. Rate: I Min./Inch Pero. Hole Diameter. 6"
Test Run Between 4.5 Ft. and 5.5 FL
Comments: Percolation Cavity Presoaked Pdor to Testing. Same Material as Test Hole No. 1.
Performed By: Tim Kimbrough. I. ~ Ce~f'/That This Test Was Performed
In Accordance With .,aJI State and Municipal Guidelines In Effect On This Date: 8115/00
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 9, VERN HAIK SUBDIVISION
GENERAL:
The scope of this project includes the procurement and placement of a
new 1,000 gallon septic tank at the location shown on the Site Plan.
Work also includes the construction of a new 32' long X 3' wide X 6'
effective depth absorption trench at the location shown. Distribution
pipe will be placed at 3' below the odginal ground surface. The total
depth of the trench from original ground will be 9', Mounding over the
trench will be required to provide a minimum of 3.0' of protective cover.
In lieu of 3' of cover 2" of insulation and 2' of cover is acceptable,
o
Construction shall be in accordance with the approved site plan,
design drawings, Municipal Permit with any special provisions or
.conditions, and all applicable State and Municipal Wastewater
Disposal Regulations.
The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the
location of all lot lines.
Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
Contractors installing wastewater disposal systems must be certified
by the Municipal Department of Health and Human Services for
system installations. Owners installing their own systems must receive
prior approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,000 gallon septic tank must be be procured from an approved
souroe and installed at the location shown on the plans.
A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
Lot 9, Vern Haik Subdivision
August 16, 2000
Page 2 of 3
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
Distribution piping must be placed level with perforations down atop a
level bed of drainfield reck. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
A silt barrier or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
Contractor shall vedfy the septic tank and drainfield are a minimum
100' away from any private water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
Direct bury insulation must be placed over the distribution system if
less than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trenches to drain away.
A minimum 2' of accepting soil is required below the drainfield rock for
a 5' wide trench. Contractor shall verify this condition prior to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
Lot 9, Vern Haik Subdivision
August 16, 2000
Page 3 of 3
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing
the #200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These
inspections must be conducted under the supervision of a professional
engineer registered in the State of Alaska. The first inspection must be
conducted after the excavation of trenches, beds or pits and before the
installation of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement of the
geotextile fabdc, gravel, distribution piping, standpipes, cleanouts and
insulation. No backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction
notes for use in preparing the certified as-built of the completed system.
MUNICIPALITY OF
OF. -And
Development Services Department
On -Site Water & Wastewater Section
Parcel I.D. 051-061-87
ANCHORAGE
Certificate of On -Site Systems Approval
fi WelAlkIA LMI'k1I&IRiyil_rAIs]ki
Complete legal description VERN HAIK LOT 9
EPL49-Al
Phone: 907-343-7904
Fax: 907-343-7997
Expiration Date: 7" 2-2_ Z02- 6
Location (site address) 21400 MONRON STREET, CHUGIAK, AK 99567
Current property owner(s) DEREK & LYDIA HAIGH
Mailing address
Real estate agent
Day phone
21400 MONRON STREET, CHUGIAK, AK 99567
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
Private Well
❑
Water Storage
❑
Community Well A
Community
Public Water System
❑
Waiver request for:
Received by:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 55D /
Date of Payment 7 19 L /9
Receipt Number 0) p 9.1-0 D
COSA # 5C1g133a
Day phone
TYPE OF WASTEWATER DISPOSAL:
Private Septic
Holding Tank
❑
Community
❑
Public Sewer
❑
Date:
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
Distance:
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. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377
Address 4641 SHOSHONI DRIVE, ANCHORAGE, AK 99516
Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 07/23/2019
Comments: This investigation was completed in compliance with MOA guidelines, regulations, `
Nk
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change OFA / \
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of or
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to * : L�9
these various and dynamic characteristics and are outside the control of the evaluator of the �%�`
well and septic system. Therefore, any estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by US and Anderson Construction & Engineering. WCHAEL N. ANDERSON. /
1 No. 9489 /
'••.7/23/3/ 19 ,, V AW
6. DSD SIGNATURE ' \
ssio��' i
System #1 Approved for bedrooms ���►��
System #2 Approved for bedrooms
Disapproved
CITY OF
Conditional approval for bedrooms, with the followinations:yO
ON -Sl TF
yQ _
� ER q ND m
PROD ' ' ER
ByOriginal Certificate Date: �� 3 d J C(
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 engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
Legal Description: VERN HAIK LOT 9 Parcel ID: 051-061-87
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA — CLASS A
❑ Well log is filed with Onsite (or attached)
Date drilled
Total depth _ft
Cased to _ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA
Static water level at beginning of test _ft.
Comments
B. TANK DATA —9115/00 1000 -Gal
Age of tank(s) 19 years
Tank type/material SEPTIC / STEEL
Measured operating fluid level in septic tank 48"
® Standpipes/foundation cleanout per record drawing
Date of pumping 7/22/2019
Structure served by this system
Well production at time of test _gpm
Water storage tank volume_ gallons
Well disinfected for coliform test? ❑ Yes ❑ N
❑ Coliform bacteria is Negative
Nitrate _ mg/L [:1Nitrate less than MRL (ND)
Arsenic — ug/L ❑ Arsenic less than MRL (ND)
Collected by
Date of Sample
C. LIFT STATION - NA
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA — 32'L x 3'W x 6'ED — @ 1.2 gpd/sf = 384 SF
Which system tested (date installed) 9/15/2000 Adequacy test date 7/22/2019
® ALL standpipes present per record drawing Results E Pass For 3 bedrooms
Total measured depth from grade 9_8 ft (max) Fluid depth prior to test 0 in
Measured depth to pipe invert from grade 3.5 ft (min) Water added 450 gal
❑ N/A — pressurized field
New depth 1 in
® Monitor tubes go to bottom of effective. If not, state
depth into effective Elapsed time 15 min
® Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced _gallons
Comments/Deficiencies 6.3'+/- ED
COSA Checklist.docx
Final fluid depth 0 in
Absorption rate 450 gpd
Any rejuvenation treatment (past 12 months) N
If yes, enter date
s
FWES
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'
® Yes
if No
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
® Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' ® Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ❑ Yes if No *5+ ft Wells on Adjacent Lots:
Property Line > 5' ® Yes if No ft Private Wells > 100' ® Yes if No
Absorption Field > 5' ® Yes if No ft
Water Main > 10' ® Yes if No ft
Water Service Line > 10' ®Yes if No ft Community Wells > 200' ® Yes if No
Surface Water > 100' ®Yes if No ft If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
ft Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft Private Wells > 100' ® Yes if No
Water Service Line > 10'
® Yes
if No
ft Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
*Per code at installation.
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.docx
•0�.��
*:49 *�
.;1 %MICHAEL N. ANDERSON:
�rs No. CE 9469 w
7/22/19 �4'Alf
' • • ..... •
nsstOS1A1�
ft
ft
ft
ft
ft
ft
ft
ft
ft
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 SYSTEHS APPROVAL
FOR A SINGLE FAHILY DWELLING
Parcel I.D. 05~)-061-87
1. GENERAL INFORMATION
Expiration Date: ,~ .~ ]~ 0 - / ¢~_
.¸
Complete legal description VERN HAIK LOT 9
Location (site address) 21400 MONRON STREET *CHUGIAK, AK 99567
Current Property owner(s)
Mailing address
TODD AND TAMMY KLEMENTZ Day phone
21400 MONRON STREET *CHUGIAK, AK 99567
582-9200
Lending agency
Mailing address
Day phone
Real Estate Agent WALDEN TEAM W/ KELLER WILLIAMS Day phone 865-6407
Mai'lin~'~ddress 101 W. BENSON BLVD. SUITE 503 *ANCHORAGE, AK 99503
.Unless. ~then/vise :,requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS:
5
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well [] Individual On-site ·
Individual Water Storage [] Individual Holding tank []
Community Class A Well · Community On-site []
Public Water System [] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the vafidation' date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this appfication,
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.
Phone 557-6179
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Date
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being sewed 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
!~j Approved for 3
bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: ~ .- ~ (.O- / I
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 SYSTEHS APPROVAL
CHECKLIST
Ao
Legal Description:
WELL DATA
VERN HAIK LOT 9 Parcel ID: 050-061-87
COMMUNITY WATER
__ ug./L. Date of sample:
Well type IfA, B, or C provide PWSID# 211451 Well Log (Y/N)
Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) J
Total depth __ .ft. Cased to ___ ft. Casing height ~nd) in.
FROM WELL LOG ~..SPECTION
Date of test ___ ~ __ i
Stwaetl;CprWt~tieoVne' _--~ ~ Z ~: p.m.
~Vo~:oEr: SAMPLE~ Nitrate mg./L. Collected by:
SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1000 gal. Number of Compartments 2
Foundation cleanout (Y/N) YES
Date of pumping ~//~,/
!
I
ABSORPTION FIELD DATA
Date installed 9/15/00
Length 52 ft.
Total depth *9.68 ft.
Date installed
Cleanouts (Y/N)
NO High water alarm(Y/N)
9/15/00
YES
N/A
Depression over tank (Y/N) __
Pumper
[*BELOW EXISTING GRADEI
Soil rating (g.p.d./ft2orO 1.2 System type DEEP
Width 5 ft. Gravel below pipe 6 ft.
Eft. absorption area 584 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 8/16/11 Results (Pass/Fail) PASS
Fluid depth in absorption field before test 0.75 in. Water added 750 gal.
Elapsed Time: 860 min. Final fluid depth 2.25 in.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN
TRENCH
For 5 bedrooms
New depth 4.75 in.
450+ g.p.d.
If yes, give date -
Absorption rate >=
D. LIFT STATION
Date installed
"Pump on" level at in.
E=
Size in gallons Manhole/Access ~_.~_) __
"Pump off" level ~.-----h~-------~igh water alarm level at
Cycles tested,
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Meets alarm & circuit requirements?.
COMMUNITY WATER
On adjacent lots
in.
On adjacent lots ~
~anout
Sewer/septic service line ~ Holding tank
~ Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line * 10'+ Surface water. 100'+
Wells on adjacent lots 100'+
F=
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
Water service line * 10' +
Curtain drain NONE KNOWN
COMMENTS
· PER MIKE ANDERSON, P.E.
Building foundation 10%
Surface water 100'+
Wells on adjacent lots 100'+
Water main. 10'+
Driveway, parking/vehicle storage
1'-t-
INSPECTION REPORT APPROVED 12/22/00
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 Pdnted Name JEFFREY A. GARNESS
Date ~ 17...c"/I,
COSA Fee $ (~C~
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
CO
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30r UTILITY & TELECOMM ESM'T,
N O0 07' 25" W 194.91
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MONRON
DRIVE
'"" ; _; ,On-Sit~lSe;"'vicbs SeCtiOh 825 YL' SEe'e[: R~:)r~ 50 '"
, : . " ' ;' ~vww ci anchorag&ak:ds ...
· ',' ' :t~.,urrent Properly'owner(s). MM&M Contract n,q ,. ':" .:'*'Da~iph0ne"688.1236 ....." ' "' :
.....,a ng address ..................
',.". ,. U~le ss Oth e rvvis~'requb sted, HAAwillbeheldbyDHHSfor pickup'. HA,~' 'pickedup~,: ' .... '
'2. NUMBER.OF, BEDROOMS:
· ' 3~ .tTYPE OF WATER' SUPPLY!
· · '. ':, Individual Well"
Individual Water Storage
'' ~ " Community Class Well
Public Water Sys~en'i ' ' '
Thr~e (3)
[]
[]
[]
[]
TYPE OF WASTEW/~'I:ER.DISPOSAL: .:
Individual On-site.· .~ ...::. ' '~] ~,. -.
Individual Holding tank · - irI
Community On-site 'i . '[711'
Publi~ Sewer []
The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certific_~te~'of Health' .
Authority Approval (HM] based only upon the representations given in paragraph 5 by an indep&ndent professional
civil engineer registered in Ihe State of Alaska. Certificates of Health Authority Approval are required for lhe transfer
of title (exCept between spouses) on propedie~ served by a single family on-site wastewater disposal and/or water
supply system. DHHS also issues HMs upon request to home owners. 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 bo reissued
with new water sample results less Ihan 30 days old. Certificates are valid for one year for propedies served by
Class A or B wells or a public water system. The Municipality of Anchorage is not responsibl~ for errors or
om~ssions.in the professional engineer's work .... ' .
5. STATEMENT OF INSPECTION BY ENGINEER" ' . -'
As certified by my seal affixed hereto and as of the vahdat~on date shown below I verify that my nvestigation ~.' :".".
, based on procedures outhned ~n the Heal.th Authority Approval Gu~del,nes for~th~s Health 'Authority Approval; · .. ;,.- ': .;:
.. . appl!cahon shows that .the on-s~te .water supply and/or ,wastewater.d~sposal ,system. ~s 'safe functional .and
· adequate for the numlSer'of bedr06ms'and typi~ of ~th)ctu'~e' ndic~ ~d here n' furtlqe['~/~'r ~ U~at b~sed 'o'n'th~"'" ~. '-: :"
· - mformahon obtained from the Mun~c~pal~ty of Anchorage files and from my ~nvesfigatio, n and nspect on, the on-',:' :' ". ·
; ". site water SUl~ply and/or wast~w~tei' di~p6~el s~;sten~ is in compliance With'~ll a'pplicabl'e' ~Jfii¢ipal'~nd s{ate~ '~' · :" -'
-: . -. codes, ordinances,' and regulations m effect at the t~me of. installatton.~ .. . . , -, ..,.'., . .......... ,.. . ........~ . ...
· Additional Commen{s ·
Attachments:
HAA Checklist
Septi~ System Advisory
Well Flow Advisory ..
X
'Maintenance Agreements' ' ' "' ' ".'
Supplemental Engineers Report . ·
Other , · .: - ' "" '-..-" .,:'.": '- ·. ' i
· Expiration Date:
Origir{al cedificate Date:
Reissue Date:
Legal Description:
.... Municipality of Anchorage *,'
Department of Health and Human Sen/Ices
Division of Environmental Sen~ces
On-Site Services Section 825 'L' Street Room 502
P.O. Box 196650 Anchorage, AK 99519-6650
www. ci.anchorage.ak.us
(907) 343-4744
HEALTH AUTHORITY APPROVAL CHECKLIST
Lot 9, Vern Haik Subdivision
WELL DATA
Well type A
Date completed __
Total depth
Dawn Community Water System
If A, B, or C provide PWSID # __
Sanitary seal
It Cased to It
FROM WELL LOG
Date of test
Static water level It
Well production g.p.m
WATER SAMPLE RESULTS:
Coliform colonies/100 mi
Date of sample:.
SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Date installed 9 / 1 5/00 Tank size
Cleanouts ¥ Foundation cleanout Y
Date of pumping ]~gw Construction
ABSORPTION FIELD DATA
Nitrate__ mi;FI
Collected by:
1,000 gal
ParcelI.D.:
051-061-87
Well Log
Wires properly protected __
Casing height (above ground)
AT INSPECTION
ft
. g.p.m
Other bacteria
in.
colonies/100 mi
Number of Compartments 2
Depression over tank ~] High water alarm .
Pumper ti/A
Date installed 9/1 5 / 00 Soil rating (g.p.d./it2 or It2/bdrm) I. 2
Length _,12..__it Width 3 It Gravel below pipe 6
Total depth 9,5 It Effective absoq3tion area384 ~ Monitoring tube _
Date of adequacy test New Const. Results (Pass/Fail)
Fluid depth in absorption field before test in Water added
Elapsed Time: rain Final fluid depth, in
Any rejuvenation treatment (pest 12 mo.) (Y/N & type) N
System type Deep Trench
ft
¥ Depression over field ti
For bedrooms
gal. New depth
Absorption rate >= __
.If yes, give date .
in.
g.p.d.
N/A
72.026 (Rev. 01/oo)'
D. LIFT STATION - N/A
Date installed
'Pump on" level at in
Datum
E. SEPARATION DISTANCES
Size in gallons
"Pump off" level at __
Cycles tested
in
Manhole/Access
High water alarm level at __ in
Meets alarm & circuit requirements
SEPARATION DISTANCES FROM WELL ON LOT TO: No Nell on lot
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Building foundation > 5 ' Properly line > 5 '
Water main ~ ~)' ~'k' Water service line > 10'
Drainage > 100 ' Wells on adjacent lots > 100 '
Sewer/septic service line Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Absorption field
Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line > 10 ' Building foundation > 10 ' Water main
Water Service line >10' Surface water >100'
Curtain drain None Noted Wells on adjacent lots __
F. COMMENTS
Driveway, parking/vehicle storage
>100'
>5'
>100'
>5'
HAA Fee $ Waiver Fee $
Date of Payment ~ ~::) Date of Payment
Num . R e p, .um .
G. ENGINEER'S CERTIRCATION·
review of Muni~ip. re.rds that the =ye s~tems are in
D~e 12/18/00