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HomeMy WebLinkAboutSEA TURN BLK 2 LT 6Sen Turn Block 2 Lot 6 #017-121-26 72-013 (Rev, 9191) MOA 25 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: 2!IGj � PID Number: Name: I J : U� Wastewater System: , New ❑ Upgrade Addregs,, _ ,�q Vc& - ABSORPTION FIELD Phone: IZ14 - % (:_112 No.Bedrooms: ❑ Deep Trench ❑Shallow Trench N Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: ��Qj Total Depth from original grade: ,9V GPD/Sq Lot: Block rryy C• f �� Subdivision: 5cs ld_7QrloC) Depth to pipe bottom from original grade: `--S Gravel depth beneath pipe � FL n Ft. Township: Range: '� Section 9V ` J�6 J _ - NIU f! Fill added above original grade -, Ft. Gravel length: Z� 1-1-15 Ft. WELL: PS New ❑ Upgrade Gravel width: / Number of lines: Distance between lines: G ,S Ft. J Ft. Classification (Private, A,B,C): Total Depth: Cased{ To: Total absorption area: �- Pipe material: ` Ft. Ft. SO. Ft. C-,) Driller: t1 n G Date Drilleo: /vk7y F < I Static Water Level: Ft. Installer:: 1� f Date installed: .y Yield: Pump Se t:Casing Height Above Ground: AN K GPM Ft. Ft. SEPARATION DISTANCES Cl Septic ❑ Holding �S.T.E.P. To From Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Lines Manuf ctureeCapacity 2 - j in gallons: !� ,/� tC) Well Material: Number of Compartments: Surface NO/%G� _' LIFT STATION Water LotF Line Z3/ iv/ 7 Si e in gallons: Manufacturer: Foundation / r � / V 3 .Cr — 'Pump on" level at: :� // "Pump off" levgl at: High water%arm at: �_ � 6� - Curtain ,(� Pump Make&ModelElectricallnspecti nsperformedb -ca/-l) Drain D ZZ{%�(9J YCif—;"/ 7V Remarks: BENCH MARK Location and Description: p �" ` w e JI a�C> f c) e-2 Assumed Elevation: 6gx) ENGINEER'S SEAL OF 41� ®`44 J ��� ) z�'/��Y� f l Inspections performed by: �. _ Dates: 1st 7-�j`eieey(®«/,�Qeo> 2nd --12— C e {7p619,y�ie0�i44G ed• t1° a James F. slzemgra e W Department of Health and Human Services approval 4Q t,cone9 1517 R Reviewed and approved by: oaA4 '/ii`n. e.Ooa a�Pnooe �(,�j�a�3 ���� Date: _2y_ �� ��� pAiIFE&S1®NP4�^� 7�� 72-013 (Rev, 9191) MOA 25 Permit No. Page _ of Municipality of Anchorage 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 Legal Description: I—LBZ S El 1_ U Fj ></ ;S U b i;_) PID No.: _.. �_�jA1GI1d Te*jAL m Q �9X qy 0 o®Ba°0o0 a a p0000eo6��o 0 ,,,,,., ....... 061St uo dames F. zemore ©�jA'F.P.�Op°uc000epQo° �"� FESS�o ^' 72-013 A (1193) - Permit No. Page _'_� of Z_ Municipality of Anchorage 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 Legal Description: /_ � � Z' PID No.: ............................................._....................._................................_.............._...._............................._.................................._...._...._.........._........._.........._. _._............. - -T--_ Pyr( _T1— zFo_�1 .::..:..:.............. �� _:.. ..�. ...,....w.......M ✓..�� �.F� -- \ )S' l/:: ���'l .�— C-PT IC SYSTC-M PPi9f I L T . OF = 491 eseesese ee o $ eWW® QOO Op p000 Oe o flames F. Sizemore 00 °opo pcdy 72-013 A (1/93) . M -W DRILLING, Inc. P.O. Box 110378 • 10330 Old Seward Highway (907) 349.8535 ANCHORAGE, ALASKA 99511 DRILLiNO LOO Well Owner Use of Well. DOM EST I C _ Location (address of: Township, Mange, Section, if known; or distance main road®_s - LOT 6 BLOCK 2 SEATURN Sj➢ ANCHORAGE ALASKA Size of casing 6° Depth of Hole 154.5 _feet Cased to 156.5 ^feet Static water level_ 89 _--ft. (abov ''. zm) land surface. Finish of well (check one) open end ( X ); Screen ( ); Perforated ( ), Describe screen or perfor&tion '. ,M1N/k. Well pumping test at 15 gak x' pex: (Jjk�) (minute) for 1 hours wit__ it— 65.5 of drawdown from static }e�} L ; NOTES: 1) WELL DRY GROUTED WITH 1 SACK BENTONITE GRANULES - Date of completion_ ,UAY 8. .a 2) ADDED 2f OF CASING STICKUP ALL DEPTHS FROM TOP OF CASING MILL BE 2 GREATER. WELL LOCI Depth in feet from ground surface Gi} _-_Q _ _TO? s_ Z_ _ -TO8� _ $ -TO 58 G' - 58 T062 62 TO$2- 2-96 96 98 TO 106 106 To 117 — 117 138 TO 154 —TO- --TO �TO TO ofsformations penetrated, size of material, color and hardness GRAVFLY 099LEY. SILTY inn n:w rtG7' ��rR eA'11RY RROn CLAY: SANDY GRAVEL: WATER REARING Ur - �,,•: ^ Nlu 1'I,.plttl �.1-luman cej 1 — CUSTOMER k I ;X H :1 trG A "Y LI U A 11 UN-" 90 C) 2 3 4 C 4 !.1V 1.) i Z A T Ii.sM 0 7 86._a2 E RAMI' --3 TELEC 11 C T 1; 5 - 0 3 2 7 A D D R E S 3) 'T 0 -1. G 0 L D F IN V I'E-.'W jjl� D A T E : 09/0 / '95 PHONE 4.1 344 -5439 P11 -!ONE #2: LOT: G BLOCK" 2U 0 0 1 V 13 10 IN E A T U RN COMMENTSO - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - -- -- - -- - - - - - - - - - - - TYPE OF IN)PEECTION' RE Y 1: Electrical Final 24 3. -- - - - -- - - - - - - -- - --- - - - - - - - - - - - - - - - -- - --- I K.1 NO NONCOMPLIANCE OBSERVED F. I CORP -,'CT TONE; E£iSENI:T.Al, AS EXPX.omliai ijia,c C J WILL 11 G"EXAMINE AT NEXT INSM21"'T CON C 'I I'M NCI'' CONMGAL UNTIL REINSPEXTED COMMENTSi CvLl Coj INSPECTOR: 1:1 A T E WHEN TONS AH MAYQ-', P CAI.T.- FOR 1 10 N 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 PERMIT NUMBER:SW940448 DESIGN ENGINEER:JAMES SIZEMOORE & ASSOCIATES OWNER NAME:GLASER JEFF A & KAREN B OWNER ADDRESS:15051 GOLDEN VIEW DR ANCHORAGE, AK 99516 PARCEL ID:01712126 LEGAL DESCRIPTION: SEA TURN BLK 2 LT 6 LOT SIZE: 47775 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: AGE 1 OF 1 DATE ISSUED:12/07/94 EXPIRATION DATE:12/07/95 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) . 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: THE MAXIMUM DEPTH OF THE BED MUST NOT EXCEED 1.5 FEET BELOW GROUND LEVEL, AND A 2.5 FT. SAND FILTER LAYER INSTALLED. SEPTI EFFLUENT MUST ENTER THE BED AT ITS MIDPOINT. RECEIVEDDATE: - Z 4 ISSUED BY: DATE: / A ki m li I >( J7,13 p cri 6? --0/ R C) p 0 I CL Y P'v`l 'AMC S v L G u R, 11-11 S IfDL C, Cfl, James Sizemore & Associates Civil Engineers & Surveyors 6410 Switzerland Drive Anchorage, AK 99516 (907) 345-1572 WASTEWATER DISPOSAL SYSTEM SPECIFICATIONS LOT 6. BLOCK 2 SEA TURN SUBDIVISION 1.0 GENERAL: 1.1 The scope of the project consists of installation of a 1500 gallon septic tank and a 15' by 57.5' bed drainfield. 1.2 Construction shall be as shown on the approved site plan and design drawings. Deviations from the drawings shall be co-ordinated and approved by the engineer conducting the inspections. 1.3 All construction procedures and material used to construct the system shall comply with Municipal and State regulations. 1.4 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading areas after the soil is compacted. Placement of topsoil and reseeding all areas disturbed by construction is also the responsibility of the homeowneer. 2.0 SEPTIC TANK: 2.1 The 1500 gallon septic tank shall be Municipally approved. 2.2 The septic tank shall be set level and shall be bedded as necessary to prevent settling or shifting of the tank. 2.3 All pipe connections to the septic tank shall be equipped with waterproof mechanical couplings. A cleanout shall b e installed within 5 feet of the house foundation. A double cleanout whall be installed within 5 feet downstream of the septic tank. 3.0 SOIL ABSORPTION DRAINFIELD: 3.1 The soil abssodrption drainfield shall be a bed type constructed to the dimensions shown on the drawings. The bottom of the 15' by 57.5' bed shall be excavated to a depth 3' below the original ground level. The bottom shall be excavated level. 3.2 A two foot layer of filter sand shall be placed over the bottom of the excavated area. Sands approved for use by the Municipality are: a) Road sand from Central Paving Products (Palmer) b) ASTM D 33 concrete sand available from Quality Sand (Wasilla). c) Pit run sand from Beaver Lake Sand & Gravel (Wasilla). d) Sand from the Lake Otis Pit. 3.3 A total of 1.0 feet of sewer rock shall be placed over the filter sand. The perforated distribution pipes shall be spaced as shown on the drawings and at least 6 inches of sewer rock shall be beneath the invert, with the pipes being placed level. Sewer rock whall be 0.5 - 2.5" screened gravel, with less than 3 ° passing the 4200 sieve. 3.4 Cleanout pipes and monitor tubes shall be 4" diameter and installed in locations shown on the drawings. The portion of the monitor tube extending through the sewer rock shall be perforated. 3.5 Approved filter fabric shall be placed over the top surface of the sewer rock. A minimum of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover thickness is less than 3 feet, two inches of rigid, burial type insulation will be placed over the entire top surface of the sewer rock. 4.0 INSPECTIONS: 4.1 A minimum of three engineering inspections will be required during construction of the system. One after setting of the septic tank, one after excavation of the bed area prior to placement of the filter sand, and one after placement of the distribution piping. In addition to the three mandatory inspections it is suggested that prior to start of construction that the contractor and the engineer hold a site meeting to discuss the project. 4. The contractor shall coordinate with the engineer at least 24 hours prior to start of construction. PROBABLE IMPACTS TO ADJACENT PROPERTIES A) WELLS: The proposed disposal system is designed in accordance with current Municipal Wastewater Disposal Regulations. The proposed septic tank will comply with current Municipal and State regulations. The separation distance from the proposed well and from from the wells on adjacent properties is greater than 100 ft. Therefore this new system should not cause adverse impacts to wells on surrounding property. B) WASTEWATER SYSTEMS The new drainfield is designed and will be built in conformance with existing Municipal and State regulations. Therefore there should be no unacceptable impacts on adjacent wastewater systems. C) RESERVED SPACE/SURFACE AND SUBSURFACE The proposed drainfield will meet the separation distances required by current regulations. Therefore the system should not adversly impact adjacent properties. D) DRAINAGE The location of the drainfield does not interfere with any drainage. The area disturbed during construction will be graded and sloped so as to not pond water. 0 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 5 (411 C "krUC, t7 7 DATE PERFORMED'L--f LEGAL DESCRIPTION: �— 13Z_ 5C–�A 4 00Township, Range, Section: I / Z-IVf� SLOPE SITE PLAN D�PT1i G- 1 2 _ 1. [4 -If x IH 6- G M ) 3 4 5 6 / 8 9 10 11 12 -- - 13 14- 15 16- 17 18 19 20 COMMENTS WAS GROUND WATER r n e,__ ❑iNl uury i cncur � i — S IF YES, AT WHAT DEPTH? IV a ee IV 9 leplh to Water Aft 1. Cry 7 flonilering7 Date:, Reading Date ■ Gross Time Net Depth to Net Time Water Drop = -C-' 2, -_ (( 7— Y -0- 07, 2 4 z-- ■IN E ON �I ■ ON MINE NOON ■ ❑iNl uury i cncur � i — S IF YES, AT WHAT DEPTH? IV a ee IV 9 leplh to Water Aft 1. Cry 7 flonilering7 Date:, Reading Date Gross Time Net Depth to Net Time Water Drop = -C-' 2, -_ (( 7— Y -0- 07, 2 4 z-- PERCOLATION RATE _ c (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN \ FT AND —' FT C2 fi- cD 6V PERFORMED BY: �� ' G�. i �'G/o I t; _-� Y�t 'J 0 CERTIO THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELIN IN EFFECT ON THIS DATE. DATE: 7— `f .-- / 72-008 (Rev. 4185) , l r "� I Municipality of Anchorage • ie R DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST f ! �� (tNGINEERS$EA!) ,a 'o f•y cc �, ` f PERFORMED FOR: (fdl ��.�/%�/%�«�C" DATE PERFORMED LEGAL DESCRIPTION: f� c� �F'� / '-I�nl�1 Township, Range, Section: L, Al W j �I SLOPE SITE PLAN (FEET) ` 2 C7 -,f7 /t Gi/vc➢((velfl 3 6 ~ 7 — — 8 0 10 ONE WAS GROUND WATER �J Net Drop ENCOUNTERED? S 11 r L IF YES, AT WHAT O MEN■ DEPTH? _ P 12 rf M 13 Depth to Water At Monitoring? Date: 14- 15 16 17 81920 18- 19- 20 COMMENTS Reading Date Gross Time ONE Depth to Water Net Drop ■ MEN■ rf M M1 ��- I■ 0,10 N ON IN No MMOM ME MEMO! Reading Date Gross Time Net Time Depth to Water Net Drop rf ��- l� PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER FT AND L- FT PERFORMED BY: 4` ����.�- c�l� '.�.-�z—,J�.L.�-A `"=��''.ERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: C 72-008 (Rev. 4/85) w (ENGINEERS §L,' Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: JJ c� �— (`% [�%DATE PERFORMED: LEGAL DESCRIPTION: L� �- • � � `�r`( Township, Range, Section: I-/?- fV /� '3'w SLOPE SITE PLAN -DFPT H-- 2 3 4 � 6 7 8 r 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS WAS GROUND WATER ENCOUNTERED? S �� ) IF YES, AT WHAT � - p DEPTH? I�2i p ------ E __-E Depth to Water Alter I Monitoring? 1 7 Dale,. Reading Date Gross Net Time Time Depth to Net Water Drop A In 24 11 U PERCOLATION RATE TEST,RUN BETWEEN PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GU 72-008 (Rev. 4/85) (mmutesimch) PERC HOLE DIAMETER FT AND _, -FT acs I; c.> 0t -- y' / (�--�47 , GLRTIFY THAT THIS TEST WAS PERFORMED IN SIN EFFECT ON THIS DATE. DATE:`(— RU5* MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-121-26 Expiration Date: 3 �2 '2 1. GENERAL INFORMATION Complete legal description SEA TURN BLK 2 LT 6 Location (site address) 15101 GOLDEN VIEW DR, ANCH AK Current property owner(s) Mailing address Real estate agent FREEMAN & PHYLLIS STOLTZFUS Day phone SAME 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) a ❑ Duplex a ❑ Multiple Dwellings (Single Family and/or Duplex) npho 3. NUMBER OF BEDROOMS: 4 Yz�/z 9 q� 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic El Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ g y� Date of Payment Receipt Number COSA # D5C ! R 1589 Waiver Fee $ Date of Payment Receipt Number Waiver # 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 MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. DSD SIGNATURE System #1 Approved for 4 bedrooms System #2 Approved for bedrooms Disapproved Date 1 120`9 : � .N ••°eeeeoo-L . � 4 K o49TH (+ o o o a o o e • e 0 e o 0 0 0 0. e• o ., • MICHA, ANDEll'SON %�°• CE - 94`9 • �;' v Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: _ 2- 2 —1 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other COSA Checklist Legal Description: SEA TURN BLK 2 LT 6 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑® Well log is filed with Onsite (or attached) Date drilled 5/8/95 Total depth 154 ft Cased to 154 ft RK Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 12/6/19 Static water level at beginning of test 112 ft. Comments B. TANK DATA `,7 T L P Age of tank(s) A— years Tank type/material S�--1C t Measured operating fluid level in septic tank 14 19 OF Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which system tested (date installed) 7/14/95 X ALL standpipes present per record drawing Total measured depth from grade 3.3 ft (max) Measured depth to pipe invert from grade 3 ft (min) ❑ N/A — pressurized field 0 Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 017-121-26 Structure served by this system Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ Nc Q Coliform bacteria is Negative Nitrate mg/L X Nitrate less than MRL (ND) Arsenic ug/L 0 Arsenic less than MRL (ND) Collected by MNA Date of Sample 12/6/19 C. LIFT STATION ❑E Required maintenance completed Age of lift station 24 years Lift station material steel Comments: see attached maintenance log tank leak tested by filling with water Adequacy test date 12/6/19 Results Q Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 600+ gal New depth 0 in Elapsed time 1440 min • Code -required soil cover over field Final fluid depth 0 in ❑® System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) _ date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet 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' 0 Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft 0 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' EZ] Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' F/� Yes if No ft Neighboring Absorption Fields > 100' ❑✓ Yes if No ft Water Main > 10' Animal Containment > 50' 0 Yes if No ft FV -1 Yes if No ft Yes if No ft Water Service Line > 10' 21 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' [D Yes if No ft Q Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: 0 Absorption Field > 5' 0 Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' 21 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' El Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' El Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS ft ft G. ENGINEER'S CERTIFICATION 1 certify that l have determined through field inspections and review, of Municipal records that the above systems are in conformance with a"9 V r MOA COSA guidelines in effect on this date. i t `i • f4tlCi-AEL N. ANDE SC Ni h' a O' tai COSA Checklist yellow sheetf r lzw ft ft DEVELOPMENT SERVICES DEPARTMENT I F On -Site Water and Wastewater Section www.muni.org/onsite Septic 'Tank Advisory Certificate of On -Site Systems Approval #OSC191589 Subdivision: Sea Turn Blk 2 Lot 6 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 24 years old. Typical replacement costs range from $8,000 to $11,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. MUNMPAUTY OF << -Ty Development Services Department r' On -Site Water & Wastewater Section ANCHORAGE Lift Station/Pump Vault Phone: 907-343-7904 Fax: 907-343-7997 Maintenance L®g Owner -;,k-A-+ zikm, Street Address /,5-101 C d` \J -�tw b - Septic Tank: -Sludge level %inches I ift ctntinn- •Pumping: required es 0 -Pump basket cleaned Q no -Control floats cleaned es no -Operation satisfactory ORno Alarm System: -Pumping completed C*S- no -Effluent filter cleaned es, no -Proper float settings confirmed es, no -Dedicated electrical alarm circuit es no -Audible and visual alarm inside dwelling es. no -Alarm system operation satisfacto .. not satisfactory Manhole Riser -Ground water intrusion at riser to tank connectiones no -Ground water intrusion around pipe penetrationses no -Manhole lid: Functional es no Insulatedyea no Other -Weep hole functional es no Properly Securedes no -All manufacturer required inspections and maintenance completedey s no Comments: Qualified Maintenance Provider: Technician i31;a.` ,S Company L +S Sc? -y1 C — Signature Date of maintenance _- 4 Date 1 B ra ,e, \ Municipality of Anchorage Kzoivx u-I�'',/; -� Development Services Department i Building Safety Division ., Onsite Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsfte (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0l1-1 PI -910 COSA# f%'l M55 1. GENERAL INFORMATION Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address SEA TURN SUBDMSION: LOT 6. BLOCK 2. 15101 GOLDENVIEW DRIVE • ANCHORAGE. AK 99516 JEFF GLASER Day phone 345-3895 15101 GOLDENVIEW DRIVE ' ANCHORAGE. AK 99516 Day phone Real Estate Agent KAREN GLASER w/ REMAX PROPERTIES Day phone 317-2000 Mailing address 110 W. 38TH AVENUE ' ANCHORAGE. AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ 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 engineers 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 Onsite 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 riles 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 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 3/r4 10 a 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 ofthe system under the conditions encountered at the Gme of the fest, 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 ofthis report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE V Approved for W- bedrooms. Disapproved. Conditional approval for bedrooms, with the flowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory C� Arsenic Advisory Maintenance Agreements Supplemental Engineers Reort Other GHQ.• •�• �•• :O ON-SITE WATER AND WASTEWATER PROGRAM :. !nom ••...•'.e. By: (/i� �� %(/. n Original Certificate Date: 3 d 01".1105) AfA. :�........ .ess: Conditional approval for bedrooms, with the flowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory C� Arsenic Advisory Maintenance Agreements Supplemental Engineers Reort Other GHQ.• •�• �•• :O ON-SITE WATER AND WASTEWATER PROGRAM :. !nom ••...•'.e. By: (/i� �� %(/. n Original Certificate Date: 3 d 01".1105) r Municipality of Anchorage Development Services Department <�* Building Safety Division OnSite Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 9951941M www.muni.org/onske (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SEA TURN SUBDIVISION: LOT 6. BLOCK 2. Parcel ID: A. WELL DATA Well type PWATE If A, B. or C provide PWSID# N/A Date completed 5/8/1995 Sanitary seal (Y/N) YES Total depth 154 ft. Cased to 154 ft. FROM WELL LOG Date of test 5/8/1995 Static water level 89 ft. Well production 15 g.p.m. WATER SAMPLE RESULTS: Well Log (YM) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 3/5/2007 95 ft. 4.9 g.p.m. Coliform 0 colonies/100 ml. Nitrate N_mgJL. Other bacteria 0 oolonies/100 ml. Arsenic: NO ug./L. Date of sample: 3/5/2007 Collected by: GEG, Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 7/8-14/1995 Tank size 1500 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (YM) YES Depression over tank (Y/N) NO High water alar (Y/N) YES Date of pumping 4/11/2006 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed 7/a-14/1995 Soil rating .p.d. r ft%bdr) 0_8 System type BED Length 57.5 ft. Width 15 ft. Gravel below pipe 0.5 ft. Total depth •3.25 ft. Eft. absorption area 862.5 ft' Monitoring tube YES Depression over field NO Date of adequacy test 3/5/2007 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DR' in. Water added 876 gal. New depth DRY in. Elapsed Time: 0 min. Final fluid depthDRY in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN if yes, give date — D. LIFT STATION Date installed 7/8-14/07 Size in gallons 1500 Manhole/Access (YIN) YES "Pump on" level at 43 in. "Pump otP level at 41 in. High water alarm level at 45 in. Datum BOTTOM OF TANK Cycles tested 3 Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic lank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ 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 50+ 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 t 00'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 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 -2/Z � /off COSA Fee S Date of Payment Receipt Number (Rev. 1IMS) Waiver Fee $ Date of Payment Receipt Number SCS Refp 1070880001 Client Name Gamcss Engineering Group, Ltd. Project Name/a Sea Tum SD Lot 6 Block 2 Client Sample ID Sea Tum SD Lot 6 Block 2 Matrix Drinking Water P%i SID 0 Sample Remarks: All Dates/Times are Alaska Standard Time Printed Datc/Time 03/14/2007 8:06 Collected Date rime 03/05/2007 14:15 Received Date/Time 03/05/2007 14:40 Technical Director Stephen C. Ede Allowable Prep Analysis ParameterResults PQL Units Medved Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 03/07107 03/09/07 TK Waters Department Total Nitrate/Nitritc-N ND Microbiology Laboratory Total Coliform 0 0.100 m8/L EPA 351.2 B (<10) col/100ml. SA1209222B A (<I) - PRF.IAMINARY - 03/08107 1DS 03105/07 DPT GOLDEN VIEW DRIVE • u 0 ------------- ':3'SECi10NUNEESLR.—__--------__ —_— �---------_•L20 —IM—LES _ ___--- ___________ __ Ar • f m AV t►ti '�►�� " a.. �s.C7 ZJ m 'w �✓:.. D VvON m w Y er• y^ Ino V 4 w u CO N Cn m• Y p - -o -� p w 4 H Z 0 GOLDEN VIEW DRIVE • u 0 ------------- ':3'SECi10NUNEESLR.—__--------__ —_— �---------_•L20 —IM—LES _ ___--- ___________ __ Ar • f m AV t►ti '�►�� " a.. �s.C7 ZJ m 'w �✓:.. D VvON m w Y er• y^ Ino V 4 w u CO N Cn m• Y p - -o -� p w 4 H Z wln -1 LLn AT 00'09 3.601520 S „•n=: :7:..35 � ,w ... .:: r + • � H z ' w -� _C . Y � -11 `.•A MM. J�4M1 II.I.` IiiCRIC1 Ilii!` CM lfcornrnunity. well, system, provide,written confirmation from State F J ing to the legality and status of system } 'r 4. TYPE OF,WASTEWATER DISPOSAL. � �7 k�Tdin i' oi�u r�aara� i3 Holding tank .li ey;�r- Community on site - ,, } ,; j S. 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate forthe number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING - Phone G� y — ;1-9 7 17034 Eagle River Loop Road No. 204 Address Eagle t /a ..- Engineer's signature r -� Date 9� �� I r il­ '. z �f' J-� 0 F Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 a Anchorage, Alaska 995010 (907) 343-4744 Health Authority Approval Checklist Legal Dcscription: L -o i (o LK 2 Ye 47uArw Sl0 Parcel 1. D.: 01 7 1 A. WELL DATA Well type _ r4Z 1'ya Log present (ON) Total depth i S� �- If A. B. or C, attach ADEC letter. ADEC water systeut number I Date completed S / �- / 11 S Cased to � S_ "%- S- Casing height (above ground) 1 4 - Sanitary seal O/N) %' f S FROM WELL LOG Date of test S `6 i Q S— Static water level °) Well production 5' g. p. Ill. WATER SAMPLE RESULTS: Coliform O Nitrate C) Wires properly protected CqN) _ Y leS AT INSPECTION Other bacteria 0 _ � Clt9 ols– Date of sample: /� 3 / `t S Collected by: s t S ENGINEERING - 17034 Eeille River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eaglo River, Alaska 99577 Date installed -7 /161 ( qS Tauk size /S" 40 0 Number of Compartments Cleanouts O/N) yf 5 Foundatiomcicanout"I&N) ye 1 Depression (Y/P High water alarm ON) Date of Pumping Pumper C. ABSORPTION FIELD DATA Date installed I r 3 I'�l J Soil rating (g.p.d./ft2 or ft`'/bdrm) © System type Length P 7 • S _Width _ 'S Gravel thickness below pipe O, S Total depth 3 t Effective absorption area a , s" Monitoring Tube present(&)M) 'f 1 } Depression over field (Y& A" Date of adequacy test Results (Pass/Fail) ___(yS TFjr O''� Fluid depth in absorption field jjbefore�t(iu.); Inoue er_ gal. water added (in.): Fluid depth _(ins.) Minutes h _ Absorption rate Peroxide trcatmen 2 months) (YIN) If yes. give date U) I� ._a CIO W cn D. LIFT STATION Date installed 7/ 1 `/ f a S— Manhole/Access 6)/N) Y� S "PUP11) &R Size in gallons I S 0 v S YJr/,— High water alarm level at* / *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: " Puutp off' level at* Septic/kel&ig tank on lot ; On adjacent lots i /t9 U `l Absorption field on lot a / ; On adjacent lots J 0 0 Public sewer main �� Public sewer ntanhote/cleanout N Aq Sewer /septic service line 3 $— Lift station l SEPARATION DISTANCES FROM SEPTIC/14-9bBlI•]8 TANK ON LOT TO: Building foundation co 3 Property line a 3 Absorption field 6� Water maitt/service line I ° Surface water/drainage I U Wells on adjacent lots _ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: i Building foundation V0 Water main/service line Surface water U t f Driveway, parking/vehicle storage area Curtain drain t` ' k No w W Wells on adjacent lots t 00 f Property line I V IoU r-)' F. ENGINEER'S CERTIFICATION OF TqN I certify that I /rave determined thru field inspections and review ofLfunicipal records l e�svSreuj�fl, in cmn/ormance w y h 10 IM I gui ines in effect on this date. ' •.'i-'9 �I Signature yia .._......: ......... Engineer's Name T C . Cd [✓ A.✓ g* eiRCOAE&A IdowAN Gif CE -8801 arA Date `I 4,1 R S` �t�``?FD ••« ..«..:.••"' �k�'��,r ,inti PROFES;t6t�*�'� HAA Fee $ 500' &V Waiver Fee $ Date of Payment o7p?— y/C! Date of Payment Receipt Number / 3 oZ C ��%� Receipt Number Rev. 8/95 OSS: haa.wk.doc t', ME Environmental services Inc. -'yl Laboratory Division �'t-.r: Ref -0 95,3975^1 Laboratory Analysis Report --rix WATER .'„ent Sample ID L6 BLK SEATURN &/D ). exit Name 8 & 8 ENOINEERINO RUSH Order 17972 idexed By R. COWAN Printed Date 09/18/95 Q 15:11 hrs. .:eject Name Collected Date 09/13/95 0 15:15 hr€i. ojectjl R6ceivbd Date 09/13/95 rr 15:40 hre. dzi_D UA Technical Director STEPHEN C. EDE R616aeed BY v3- +� +. ���• n yn.,. .,., mule Remarks! SAMPLE COLLECTED BY: JOHN, QC Allowable Ext. Anal Parameter Results Quad Unite Method Limits Date Date Init ----------------------------------------------------------------- -+.orate-N 0.10 U ........... mg/L EPA 353.2 ., _.._... .............. 10, .................. - 09/14/95 00 a. a xaa v i a a n n v¢m¢¢ m n nn m n m m v m m . a n a. n m n... VM n...... n n. n m.. n n n nnmmnmmvmmvnamn m m n a m s m n n n m m . m a m nnvnmsnonnn.�n... .-. See Special Inetructione Above UA n Unavailable See Sample Remarks Above NA m Not Analyzed Undetected, Reportedvalue in the practical quantification limit. LT n Lees Than Secondary dilution, OT m Greater Than 200 W. Patter Drive, Anchorage, AK 99618.1606 — Tei: (907) 662-2343 Fax; (907) 46L6301 f NVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA -: IC] i2bh'ON TTZTG69L06 f 9NI.LS3l -1d102J3WW00 TT:ST 96/PTi60 CT&E Environmental Services Inc. �xi Laboratory Division rs►w®i►i►i®�errosr irrrsl►ri�r�d�►ioir�o�►iiw���� f;t<,;.; v��inking Water Analysis Report for Total Coliform Bacteria 200 W. Potter Drive Anchorage, AK 99515.1605 AD.[iVSTRUCTIONSONREVERSESInE)3EFORECOLLECTINC.9AAIPLE ,. Tel: (907) 562-2343 Fax: (907) 561-5301 MUST BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY 0 PUBLIC WATER SYSTEM I.D. fi �— � � ALnalvsis shows this Water SAMPLE to be: ,W PRIVATE WATER SYSTEM f� Satisfactory Send Resides / W Sehd Invoice 9_4 S LN(r 1,vd.rc.t0t,vC— t�e,tr yl"hl Na"i omP"'I omxtnme i' one, um NFAX .om- e -'6i v end AO rNe Cry swm 0 Sand Raaolls Cl Srnd L,volce on,pnny N7 b, - emoe, none ,r swe SAMPLE DATE: EE F/-Fql L-yIJ I Month Day Year SAMPLE TYPE: Routine ❑ 'treated Water Repeat Sample (for routine sample Untreated Water with lab ref. no, O Special Purpose SAMPLE LOCATION Ltn-rC RLKZ S'fI)To,?(s/ 5110 Time Collected Collected By rlcue Print BACTERIOLOGICAL WATER ANAL O Unsatis actory o Sample over 30 hours old, results may be unreliable © Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample vin special c(tlivery mail. Date Rcccived Time Received 1�0d — Analysis Began R 'f,* 1661-) Analytical Method; j --Membrane Filter Q MMO-MUG Number of colonies/100 ml. Lab Ref. No. Result'' An cyst EL115 f 44n Sent to A.D.E.C• Anel Fhks Ju EI �+'.` 'r'n:rc(1 Dote: �l i— Time: Client notified of unsntisractoty results; ❑ I_, Phoned Spoke with Flu:cd Date: _ _ Time: NIMO-MUG Result: Total Coliform t Coli © � OW Membrane Filter: Direct Count ---0 Colonies/100 nil Verification: LTR BGB `COLIFIRM rNrC- foo NumatnuR To Cu,mr Fecal Cali for Com Final Me mbr n Fit Reported I Comments: ASMember of the SGS Ott -Olhef aptrum �}�Cooliform/100 ml Tim�J—� hrs ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, 2TS'ON TTZTP69LOG 4- 9NI.LS31 a10 d0 Surveillance) 4N, MISSOURI, NEW JERSEY, OHIO, WEV VIRGIfJIp, 3WWOD 90:TT 96/Tzi60