HomeMy WebLinkAboutUS SURVEY 3200 LT 16U S Survey
3200
Lot 16
#090-041-18
Municipality of Anchorage Page ,'~ ' of '~ /
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~'¢~/~5'-~ $ qR.- PID Number: ~ ~- ~/- i~~
Name:
~~~- ~~c~ WaStewater System: ~ew D Upgrade
Address:
ABSORPTION FIELD
Phone: J No. ofBedrooms:
~ ~ Deep Trench ~hallowTrench ~ Bed ~ Mound ~ Other
i
Total Depth from original grade:
LEGAL DESCRIPTION Sol, Rating: ~ ~GPD/Sq. Ft.
Lot: / ~ Block: Subdiv~ion: Depth to pipe bottom from origin~ade: Gravel depth beneath pipe
' Ft. ~Ft.
Township: . I Range: I 8eotion:
~ ~~ C: C~[ Fill added above original grade: Gravel length:
'~ Ft. ~ ~ ~ ¢ ~ Ft.
~ Number of lines: J Distance between lines:
WELL: ~New ~ Upgrade Gravel width: ~ Ft. ~I /O~ Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
Driller: Date Drilled:
1~~ Static Water Level: Installer: Date installed:
Pump Set at: J Casing Height Above Ground:
~,d: /~ G~u F,. ~'/ F~. TANK
SEPARATION DISTANCES ~eptic D Holding D S.T.E.P.
TO Septic Absorption Lift Holding Public/Privat~ Manufacturer: Capacity in gallons:
From Tank Field Station Tank Sewer Lines ~~- ~'~
Wel~ /~.~ /~. ~ ~ ~, ~ ~ ~ Material: ~~ Number of Compa~ments:
S~oew~t~ ~;;; r~;~ ~ ~/~ -~O~ LIFT STATION
Lot /~:~ /~Z~ ~ ~ ~ Size in gallons: Manufacturer:
Line P I ~[. ~
Foundation ~ ~&/~. ~ ~ ~ "um~o,",~v~,~,:~~',~v~,~t:
I
Cu~ainDrain ~'~':~' ~' ~'''t- "-- ~ ~Electricallnspecti°nspeff°rmedby:
Remarks: BENCH MARK
Location and Description:
Assumed Elevation:
~ ENG~[~EAL
nsp otionsp ,orm d by:
Department of Health and Human Se~ices approval /~;~. c[~6
72-013 (Rev. 9/91) MOA 25
Page 1
State of Alaska
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
of 3
P.O. Box 1064 · Wosillo, Alaska 99687 · Telephone 376-5038
Appli¢,~fion for On-Site W~Lter and Sewer System Approval
Le al Description: US SURVEY 3200 LOT 16
/
/
PID No.:
ENGINEER'S SEAL
Page 2
State of Alaska
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
of. .3
P.O. Box 1064 · Wasilla, Alaska 99687 · Telephone 376-5038
Application for On-Site Water and Sewer System Approval
Legal Description: US SURVEY 3200 LOT 16
I ~
I
PID No.:
ENGINEER'S SEAL
Permit No.
3
Page 3 of
State of Alaska
DEPARTMENT OF ENVIRONMENTAL CONSERVATION
P.O. Box 1064 · Wasilla, Alaska 99687 · Telephone 376-5038
Application for On-Site Water and Sewer System Approval
Legal Description: US
SURVEY LOT 16
PID No.:
Well Owner
dOE HITCHCOCK
M'~'~ DRILUNG, Inc.
p.o. Box 1103~8 · 1(~10 Old ~ward HIg~vay '
ANCHORAGE. ALASKA 99511
DIULUNO LOO ,
LTu o! Well DOMESTIC
locatI°ri' (addrem of: Township, l~n~e, Section, ff known'; or distance main road
LOT 16m US SURVEY t3200
INDIANm ALASIOk '
~t~of,~,~._~ 6" nep~ofHol~ 183 fe~t'.:, cu~tA 116 ~eet
- '%'F' ~' , '
~ ( . ); Pe~or,ted(.,.w), .
(mL, mte) tot 1 ~ours w]~' ~00[
Depth ~n fat ~rom
I~ouad sxtrfaee
6 "1'0 20
20 TO 2S
VAIL tOO
. Olg~'~'~ t[rmatlons ~ne~lt~. ,i~ of material, ~lor ~d
.G~VE~ GREI, ~O~LE~/CLA~Y .'
;~UCD~ PATCH
:'~ ~I~ {~ ~ V ~ Oept. Health & Human 8e~ices
GRAV~,. GRE~, .CO~LS~TY ~. :.....'....-.,
~ALL-~RAVEL'=-S~TY-~c~_ . .
x );
25' TO 50
50 TO 75
75 ~ 77
77 TO g0
g0 TO 100
100 TO 110
110 TO 116
116 TO 158
158,1,0 165
65,,ro,,, po
18O~o 183
RECEIVED '
· DFC 1 F, 199~
Municip~liw'of Anchor~q~,
GRAVELLY CLA~
BEDROCK** GREAY' BLACK STLTSTONE ARGZLLTTE: ,~. ,
A/A; NOT, AS FRACTURED; .GOOD NATER ..A C.¢~' i' '~' .
'A/A: NOT FRACTURED, I{ARD .~g~, .tr,~.
· I --CUSTOMER
FROHt 3~COSU~*LEGRCK[*LEBO
/
Lot :49 /
FRX NO.I 2784848
Lot
!
Lc 16
I:ound
Lot lg
]2tO?P P.G2
N/A
Joe Hitc~¢oc~
I
Lot 18 r..0 ~ v2' ~.
on Olu. p:p~ ext.endin
f 0.7' Obow ground.
Found .5/B' reber
flCh to ground ~';tl~
HO'lES
2. Eefe~e. nce F~e d ~o¢.~ ~.~-01 Pga. 52-S~- &
Cdd Mop 44', 5,
A[~)M L~-~,d Surveys
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PAGE 1 OF 1
PERMIT NUMBER:SW950392
DESIGN ENGINEER:DOUGLAS T. KENLEY, P.E.
OWNER NAME:HITCHCOCK DONALD JOE
OWNER ADDRESS:P.O. BOX 233475
ANCHORAGE, ALASKA 99523
DATE ISSUED:ll/2i/95
EXPIRATION DATE:il/21/96
PARCEL ID:09004118
LEGAL DESCRIPTION:
US SURVEY 3200 LT 16
NUMBER OF BEDROOMS: 5 THIS PERMIT:
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
1.) PERFORM ADDITIONAL SOILS TEST(S) AS DESCRIBED BY
AMC 15.65.060.B PRIOR TO TRENCH INSTALLATION AND
SUBMIT SOILS LOG WITH ASBUILT/INSPECTION REPORT.
2.) SEE ATTACHED ENGINEER BULLETIN #91-6 REGARDING
DEPTH OF PERCOLATION TESTS.
ISSUED BY. //~b6~ ~ U ~37L,%'~
:
Dos~las T. I~ley, PE
November 6, 1995
Municipality of Anchorage
Health & Human Services
On-site Services
RECEIVED
NOV 9 1995
· . ~.-~ y o! Anchorage
~taa~th & Human Services
Re:
Lot 16, USS 3200, Indian, Alaska - Percolation Test Results and General Site
Investigation
Owner;
Mr. Joe Hitchcock
On September 30, 1995 the above referenced parcel was inspected to determine it's suitability
for construction of an on-site waste water disposal system and well. The site is located in
Indian, Alaska approximately 20 miles south of Anchorage, on the Seward Highway. The
system is being designed to meet the requirements of a three bedroom home that will be moved
to the site this fall. The planned system will include a new 1,000 gallon steel septic tank and a
standard 5 foot wide shallow trench absorption system.
The site slopes from north to south and from west to east with grades ranging from 0-5%. The
immediate area that has been selected for the waste water disposal system has an average slope
of 2% towards the south. The site is moderately treed with birch, spruce, and alders. It appears
that there are no obstructions that would prevent surface water runoff.
On-site observation and physical survey shows that there are no water wells nor private waste
water disposal systems within 150' of any of the property lines. No surface water was observed
at the time of the inspection and it appears that there is no potential for contamination of future
water wells.
Two percolation tests were performed at the site in determining an adequate location for the
waste water disposal system. Test Pit logs describing subsurface conditions and percolation
rates are attached. The proposed location for the system is near Test Pit #2 where the
percolation rate was determined to be 1.45 inches per minute. Groundwater was detected at (12)
feet below grade on November 4, 1995. The substrata consisted of l-foot of organic overburden
overlying 2-foot of silty gravel (fracture rock) underlain by a black colored sandy gravel with
some silt. Bedrock was not observed in the 14 foot deep test pit.
At the time of the percolation test it was thought that the subsurface conditions near Test Pit # 1
could support both the primary and secondary absorption trenches. Therefore, the percolation
rate at Test Pit #2 was determined by visual inspection only. However, on November 4,
groundwater was measured at (7) feet below grade at the monitor tube for Test Pit #1 (a rise of
24" from the date of the initial investigation. The absorption system site was subsequently
changed to the area near Test Pit #2 where the groundwater was measeured at (12) feet below
grade after the required (7) day waiting period. The area near Test Pit #2 is approximately (4)
feet higher in elevation than Test Pit # 1
Lot'l 6, USS 3200
1/6/95 ·
If there should be any questions concerning the percolation rates or characteristics of the site
please call Doug Kenley at 746-1073
RECEIVED
NOV 91995
Municipality of Anchorage
Dept, Health & Human Services
Page 2
MR. JOE HITCHCOCK
LOT 16, U,$.$ 3200
ALASKA
~0UI, II)A ITON
C~O~GUT
1/2'-2' 0(A. ~V~R ROG( --
N~,~FU:~fi~ ~¥~T~vl ,~-C'TI~ (DESI~',I)
NTS
96-06-07 ! .~ RI I
TUG~ AT UD pOINT
BOT.
'TRENCH LENGTH CALCULA'T1ONS:
J
I8EPTIO 8¥STEM 8P~CFIOA'flON~:
FGR DEEP ~CH[$ (SEE AnACHED).
AREA -
LF..NG'I14 OF TRENCH =
SANOy GRAVEL ~TH TRACE ~LT
3.0 MIN. PER
1.20 ~
7~ CAL./(~) - 625
L2 ~
~25 ~
REDUCTIO~ FACT(~R FOR AD0~TI014AL OEPI~I = 125 X 0.64 - 80 LF
US~ ~ 40 FOOT TRFJ'4CHES.
I I
0
PERFORMED FOR:
Municipality D! Anchorage ·
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street, Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
5
6
7
8
9-
10-
11-
12-
13
14,
15
16
17.
'18 -
19-
20-
WASGROUNDWATER
ENCOUNTERED?
2,2: 49;rH_~.
DATE PERFORMEI .~
Township. Range, Section:
SLOPE SITE PLAN
/
/
/,
t
/
/
t
IF YES, AT WHAT
'~
Gross Net Depth to Net
Re,ding Date Time Time Water Drop
PERCOLATION RATE I./~/ tm,nutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~f~q ~l
FT AND FT
Munlclpalityof Anchorage I
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street. Anchorage. Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
LEGAL DESCRIPTION: ~.oT'16i ¢ ~ ~,~
2
, 4-
I0
11
12
13.
WAS GROUND WATER
ENCOUNTERED?
SLOPE SITE PLAN
/
/
/
/
/
16 - c,.~ ~ I"'I"1
~_=__ ,-,
17 - ;"'~ f'l"l
18- ~ ~ .
lg -
20-
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE , J -'~ (;'" (m,nutes/mch) PERC HOLE DIAMETER
T£S? RUN e£TW£EN ~'~[ ' FT A.D ~[ ~T
' COMMENT$.~I\;r[~--~_C~I~.,,' t[{~_t~,L,~..J '"'~"~"~ ~1. t[)~O'
_ '~O ' ~ /~ '
ACCORDANCE ~TH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS OAT[~AT~ I J · ~ '~
72-008 (Re~. 4/85)
Municipality o! Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 'L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PERFORMED FOR: ·
LEGAL DESCRIPTION:
1
2
3
4
5
?
8
g
'~_,'~.~Township, Range, Se~ion:
SLOPE
II
t~
WAS GROUND WATER
ENCOUNTERED?
IF YES. AT WHAT I ~_.. :~ ,~/
DEPTH?
Water Alter
MoAitetino?
13 - Ihte:
14-
15-
16-
17-
18-
19-
SITE PLAN
II II I I I I.I I I
, IN-
I~:i'i-iiFiq-i I IAI I
I1~1111 I I I I II1~1
I II I~? I /\~-~,&~l II \\l
1'iii ii'i' 'i'll
Gross Net Depth to Net
Reading Date Time Time Water Drop
20
PERCOLATION RATE ~)' ~ Imlnutes~nch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~" ~FT AND~"'. FT
PERFORMED BY ~ ~(~ I ~ CEflTIFYTHATTHISTESTW~PERFORMEDIN
72-008 (Rev. 4/85)
96-06-0~ 1~:02 RCVD
ALAS
T E S T L A B
A Division of C)DWI.~ Incorporated
4040 B S~ct Am;~ra~c, Alaska 99503
(907) $62-2000 FAX (907) $63-3953
Client: Doug' Kenlcy
Project: Lot 16, USS 3200, Indian Alaska
Location: Lot 16, USS 3200, Indian, Alaska
Submitted by Client
100%
90%
80%
~eg 7o%
~60%
.E 50%
~ 40%
~ 30%
10%
O%
100
Engineering Classification: Welt Graded SAND with Silt and Gravel. SW-SM
Frost Classification: Not Measured!
,.~ '~ · . , . -.
10 I 0.1 0.01 0.00
Particle Size (mm)
PARTICLE-SIZE
DISTRIBUTION
W.O. A26831
Lab No. 490
Received: June 5, 1996
slzz P~SSLX~ SV£CmCAnO.~
+3 in Not Included in Test =
3"
2"
I ID"
1"
3/4" 100% o
1/2" 100%
3/8" 97%
No. 4 75%
Total Wt. of Coan¢ Fraction = 9405g
No. 8
No. 10 50%
No. 16
No. 20 29%
No. 30
No. 40 18%
No. 50
No, 60 12%
No. 80
ND. lO0 8%
No.200 5.9%
Total WL of Fine Fraction - 51 I.$g
0.02 mm
To: Municaplity of Anchorage
Department of Health and lluman Services
RECEIVED
JUN 5 1996
Municipality o! Anchorage
Oept. Health & Human Services
June 4,1996
From: Joe Hitchcock
Owner US Survey 3200 lot 16
Permit # SW950392
'[his letter is to address the owner installation of a septic, permit #sw 950392 us survey 3200 It 16.
I have worked in the construction industry for ten years with experience ranging from surveying to
operating to purchasing and logistics for multi-million dollar construction projects. I have also done two
complete remodels on my first two properties. One properly required a drain tile around the foundation
which I installed by excavating the foundation and shooting slope on the pipe to a central sump.
I have also installed a 4 bedroom system in November of 1994 for my mother Irene Hithchock, my
brother John Hitchcock submitted a similar letter to fulfill the requirements for that installation
All work is being performed under the guidance and supervision of my engineer Douglas T Kenly and
will conform to all required specs.
Sincerely f'
· ' Municipality of Anchorage
Development' Services Department
Building Safety Division
On-Site Water & Wastewater Progra~~'/"J,z~
4700 Bragaw Street
P.O. Box 196650 '
Anchorage, AK 99519-6650
www.munl.org/onsite I
(907) 343-7904
CERTIFICATE OF 0N-SITE SYSTEHS ~,PPROVAL
FOR .b, SINGLE FAHILY DWELLING
Parcel I.D. O o~ ~ , ~)/,~/~
t. GENERAL INFORMATION
COSA#
Exp,ration Date:
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
USS 3200 LOT 16
15654 KARALYSSA *INDIAN~ AK 99540
DONALD H~CHCOCK
15654 KARALYSSA 'INDIAN, AK 99540
Day phone
Day phone
303-356-4568
Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBEROF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
Individual Well ~]
Individual Water Storage
Community Class Well [~]
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-sit~
Public Sewer
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
· As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my
investigation, based on procedures outlined in the Cerb'ficate 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 vedfy 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.
NameofFirm GARNESS ENGINEERING GROUP, Ltd.
Address' 3701-E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Phone 337-6179
Data
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 desc#bed the performance of the
system under the conditions encountered ,~t the lime of the test, and separation
distances measured to readily Identifiable features. The operational life of ell 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 ~fll conb'nue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report i$ for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other peraon or party is not authorized, nor will it confer any legal ~_ght what$cev, e. ~.
DSD SIGNATURE
~ Approved for ~ bedrooms.
Disapproved.
Conditional approval for ~
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report'
Other
Original Certificate Date: & ... ~,~ L//_//()
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEHS APPROVAL C-;.HECKLIST
Legal Description:
A. WELL DATA
USS 3200 LOT 16
Parcel ID:
Well type PRIVATE
Date completed t2/30/95
Total depth 183
ff. Cased to
FROM WELL LOG
Date of test 12/30/95
Static water level 110
Well production 10
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mi.
Arsenic: ND ug./L.
SEPTIC/HOLDING TANK DATA
If A, B, or C provide PWSlD# N,./A
Sanitary seal (Y/N) %'/
116 ff.
g.p.m.
Welt Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
10/2/09
114 ft.
8.O3 g.p.m.
YES
YES
12+ .in.
Nitrate 2.49 mg./L, Other bacteria 0 coloniesll00 mi.
Date of sample: 6/18/10 Collected by: DEG Ltd.
Date installed 7/15-30/96
Cleanouts (Y/N} YES
High water alarm (y/N) N/A
MCDONALDS PUMPING
Tank Type/Material SEPTIC,/STEEL
Tanksize 1500 gal. Number of Compartments 2
Foundation cleanout (Y/N) YES
Date of pumping 10/8/2009
ABSORPTION FIELD DATA
Date installed 7/15-3o/96
44&:46
Length 90 TOTAL ft.
Depression over tank (Y/N) NO
Pumper
~' E~EIrOW [XlSTING
Soil rating (g.p.dJft~oQ
1
Width 5 ft.
Total depth '6.83 ft. Eft. absorption area 625+, ft~ Monitoring tube YES
Date ofadequacytest *.10/2/09 Results (Pass/Fail) PASS
FluiddepthinabsorptionfieldbeforetestDRY in. Wateradded 750 gal.
Elapsed Time: 15 min. Final fluid depth DRY in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN
*.TESTED SOUTH TRENCH ONLY. NORTH TRENCH WAS ALSO DRY.
System type SHALLOW TRENCH
Gravel below pipe 2,5 ft.
Depression over field NO
For 2 bedrooms
New depth 4 in.
750+ g.p.d.
If yes, give date -
D. LIFT STATION
Date installed Size in ga/Ions Manhole/Access (Y/N~ ~
'Pump on" level at in. "Pump off" lever alarm level at in.
~ Cycles tested. Meets alarm & circuit requirements?.
SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot 100'+
Public sewer main N/A
Sewer/septic service line 25'+
Animal containment areas 50'+
100'+
On adjacent lots 100'+
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:
Building foundation 5% Property line 5'+
Water main N,/A Water service line 10'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation. 10'+
Water service line 10'+ Surface water 100'+
Curtain drain NONE KNOWN Wellson adjacentlots. 100'+
F. COMMENTS
Absorption field 5'+'
Surface water 100'+
G. ENGINEER'S CERTIFICATION
I cetlify 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. CARNESS
Date /~/2-q'll ~'
COSA Fee $
Date of Payment.
Receipt Number
(Rev. 11/05)
Water main 'N/A! '"'
Driveway, parking/vehido stora ~" 10'+
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage ~o,,~:,: ..-;.,~
Development Services Department ~..'~ ~; '~ · ':
Building Safety Division '~ ' '""-'~
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box ~966~o /~,---"'-~J4-~,,~
Anchorage, AK 99519-6650 ~
www.muni.org/onsit~
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEHS APPROVAL
FOR A SINGLE FAHILY DWELLING
1. GENERAL INFORMATION
COSA.
Expiration Date: ~.~ - ~ --~/O
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
USS 3200 LOT 16
15654 KARALYSSA *INDIAN, AK 99540
DONALD H~CHCOCK
15654 KARALYSSA *INDIAN, AK 99540
Day phone
Day phone
303-356-4568
Day phone '
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBEROF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
Individual Well ~
Individual Water Storage
Community Class Well ~E]
Public Water System
TYPE OF WASTEWATER DISPOSAL:
Individual On-site ~]
Individual Holding tank
Community On-site ~E]
Public Sewer
The Municipality of Anchorage Development Sen/ices 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 sen/ed 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 sen/ed 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 sen/ed 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.
o
STATEMENT OF INSPECTION BY ENGINEER
AS certified by my sea/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 heroin. 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(aro) in compliance with ali applicable Municipal
and State codes, ordinances, and rogulations in effect at the time of installation.
Name of Finn GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Phone
337-6179
Date IO/Z'/!Oc/
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 tho
system under the conditions encountered at the time of the test. and separation
distances measured to readily identifiable features. The operational life of ali wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the fam~?y being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactoql test
results do not guarantee futura 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 pa,ty is not authorized, nor will it confer any legal right whatsoever.
DSD SIGNATURE
j Approved for ~
Disapproved.
Conditional approval for __
......
bedrooms.
yp ..
Attachments:
COSA Checklist
Septic System Advisory
Weft Flow Advisory
Nitrate Advisory
.y:
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
//~~ Original Certificate Date:
· Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O, Box 196650
Anchorage. AK 99519-6650
www,munLorg/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: USS 3200 LOT 16
A. WELL DATA
Well type pR~VA~ IfA, B, orC provide PWSID# N/A
Date completed 12/30/95 Sanitary seal (Y/N) Y
Total depth 183 ft. Cased to 116 ft.
FROM WELL LOG
Date of test 12/30/95
Static water level 110 .ft.
Well p~;oduction 10 gp.m.
WATER SAMPLE RESULTS:
Colifom~ 0 coloniesll00 mi.
Arsenic: ND ug./L
Parcel ID: O ~70-O ~'///'"/~
Well Log (Y/N)
Wires propedy prOtected (Y/N)
Casing height (above ground)
AT INsPEcTION
10/2/09
114: ft.
8.03: .g.p.m.
YES
YES
12+ in.
Nitrate 2.~7 rog.IL, Other bacteria 0 colonies/100 ml,
Date of sample: 10/2/09 Collected by: GEC Ltd.
SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL
Tank size 1500 gal. Number of Compartments ,, 2.,
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO
Date of pumping 10/8/2009 Pumper~
ABSORPTION FIELD DATA
Date installed 7/15-3o/9s
44&46
Length = 90 TOTAL ff.
Date installed 7/15-30/96
Cleanouts (Y/N) YES
High wate,r alarm (Y/N) N/A
MCDONALDS PUMPING
: ~B~;t~OW {~XtSTING CRADEJ
Soil rating (g.P.d./ft'oO
1.2
Width 5 ff.
Totaldepth *6.83 ft. Eft. absorption area625+, ft~ Monitoring tube YES
Date of edequacy test '*'10/2/09 ~Resutts(Pass/Fail) PASS
Fluid depih in absorption field before test DRY in, Water added 750 gal.
Elapsed 'rime: 15 min. Final fluid depth DRY in. · Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN
· *TESTED SOUTH TRENCH ONLY. NORTH TRENCH WAS ALSO DRY.
System type SHALLOW TRENCH
Gravel below pipe 2.5 ft.
i Depression over field. NO
For 2 bedrooms
New depth 4 in.
750+ g.p.d.
If yes, give date -
D. LIFT STATION
Date installed Size in gallor~s Manhole/Access (Y/N~ ~
on" level at ~vel at ~ ,in.
"Pump
Da._.~F_utum ~ C~larm & circuit requirements?
Eo SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot, 100'+
Public sewer main N/A
Sewer/septic service line 25'+
Animal containment areas 50'+
100'+
On adjacent lots 1OO'+
On adjacent lots 100°+
Public sewer manhole/cleanout ' N/A'
Holding tank N/A
Manure/animal excrete storage areas '~ 00'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field
Water main N/A Water service line 1 O'+ Surface water,
Wells on adjacent lots 100'+
100'+
Property line. 10'+
Water service line . 1 O'+
Curtain drain NONE KNOWN
F. COMMENTS
Building foundation 10'+
Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Water main , N/A '
Driveway, parking/vehicle storage" 10'+
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 10 /2-1}0 ~
COSA Fee S ~ ~'~ O
Date of Payment I 0 I ~"-~/0¢~
Receipt NumberO '"7 ~) "7 t_~ ;~.
(Rev, 11/~5)
Waiver Fee $
Date of Payment
Receipt Number
3:0
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NIO°O7'OO"E 330.00
50' Patent Right.~fd Way and Public
BYERs ROAD Utility Easement
50' Patent Right-of-Way and
Public Utilitiy Easement
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N01°24'00"E 333.83