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HomeMy WebLinkAboutSEA TURN BLK 1 LT 2Sen Turn Block i Lot 2 #017-121-53 Municipality of Anchorage Page ---iOf211�— 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: `1a 0PID Number: —0/1 �3 Name: DAL–vfL Wastewater System New ❑ Upgrade Address: ABSORPTION FIELD Phone: I �T No. of Bedr oms: O Deep Trench Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating:��11 6 Total Depth from original grader '0 r GPD/Sq. Ft. Lot: Block: Subdivision.:• Depth to pipe bottom from originaylI do: Gravel depth beneath pipe „ Township: :1 Range: i? '3 %% Section: �� ?> ? Fill added above original grade: Gravel length: �I ) �f` C- t�qFt. Ft. WELL: �JVew �❑ Upgrade Grave l �deplll: V/t r i Number of lines: Distance between lines: .t� FL Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: lo Ft. 10 I Ft. 7 FL 10 Driller: A _ Date Drilled: i Static Water Level: i Installer: Date installed: j lj ?-0 i t N t 8- pl-7- 9 Ft. 1 VL LOh/ �. Yield: Pump Set at: Casing Height Above Ground: y TANK 7 GPM Pst) T Tu M Ft. 2 Ft. SEPARATION DISTANCES VSeptic ❑ Holding ❑ S.T. E. P. To Septic Absorption Litt Holding Public/Private Manufacturer: n (��f11 4i r- 0 Capacity in gallons: 11 u From Tank Field Station Tank Sewer Lines l�-- � I-- , -.5 Well 7? ) i v. I(f'if1 P ;/�. (-/�-�� Material: j^C k bar of Compartments: If Surface ---- -_ LIFT STATION _ Water Lot j) _ Size in gallons: � Manufacturer: Line (•9 Foundation _ _ "Pump on" level at: "Pump off" level at: High water alarm at: Curtain 1� �•-ti Pump Make & Model Electrical Inspections performed by: Drain /A Remarks: _ BENCH MARK Location and DescriptiolL. o4 L Assumed Elevation: 10,6) Ft. — ---- ENOINEER'S SEAL Inspections performed by: r Dates: 1st ( — 't 2nd 2a> _ ) Department of Health,ainq�Hu a vices approval Reviewed and approved b �' '�'–T—Date: 72-013 (1/91) MOA 26 96,00 Monitor Clean Glut Clean Out Wide Trench+ 96' LONG 5' WIDE 4' DEEP 25' OF SEWER ROCK 3' min, Cover 1250 gal Septic tank Greer Founda ti Clean out Cleanouts Monitor 4' Topsoil 3' Co ver 4' Min Cover L $91 - - over Tank 861 MlraF; 140 mmm 83.21 2,5 Peet of Septic Rock GW 721 LL BEN SPURKLAND RE. LOT 21 BLOCK 1, SEA TURN SEPTIC SYSTEM ASBUILT W 15TH. AVENUE SECTION 35, T12N, R3W DA,TE� NOV, 21, 1991 H, AK. 99501 CORT PNAL.P SHEET, 313 GRID- 3138 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:SW910157 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:DALCOR INC OWNER ADDRESS:5841 AZALEA DR PARCEL ID:01712153 .LEGAL DESCRIPTION: SEA TURN BLK 1 LT 2 LOT SIZE: 49277 (SQ. FT.) NUMI3ER 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: PAGE 1 OF b.P0 DATE ISSUED: 6/17/91 EXPIRATION DATE: 6/17/92 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PR RECEIVED B ISSUED BY: Cl/ - l DATE:_ DATE:4,;' —47- // 1 HilloR BIND. AVHORME, ALASKA 99Y)7')90il NO) 248-5095 SEPTIC SYSTEM DESIGN LOT 2 B L 0 C K I SEA T U R t -A So U B Ul CORT PHALP )"oln Broulld wat-or- co, Ulllw! it! i.dc4, Tr(i-Mic:1) c0 t IVI v 7.1 y mi I i /:i t L u c I L.O. r d i:;F I, 1-lo.dir ocarl + r-- c ca i= I, -1c 4 2 o c i r aO: AhT: rl .i 0 11 D (.. J. c.) I I 1-c-ngl:h nr 1"lec".1fic-h 4 x :::- 9,-.) 1J.. S y S "T E 31 1—� 0 AJ F X S U IR Am T1 014 WIDE TRENCH TOTAL LENGTH 116 FT. TOTAL WIDTH 5 FT. TOTAL DEPT" 4 FT. ROCK DEP-ri-i 30 IN. ADDITIONAL FILL 2 FT. SEPTIC TANK 1250 SAL. The installation of this well and septic system will not impact adjacent lots. The well lncation conforms to the siting of the existing wells in the area, and will not prevent the adjacent lot owners from developing these lots or replacing the existing septic systems. The insta]lation of this septic system will not prevent wells from be installed on the adjacen� lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general drainage of the area. Ponding and/or concentration of surface runoff will not result from this installation. Septic SystemDesign Lot 2 111ock 1 Sea 1urn I - 11 IIFFI I . . . . . . . . . . . OR to L I III yl i i D #11 R�mmmm TOITHEN 6751 W. DDION1.) ft WAL At 99502-390--1 ITT I i ix x 4 9 b I I = -I rl� K'1� I It I Y ------------ It. A . . . . . . . . . . . OR to L I III yl i i D #11 R�mmmm TOITHEN 6751 W. DDION1.) ft WAL At 99502-390--1 ITT I i ix x 4 9 b I I = "., . , I I 76I.- .i f �4r.i 11.51'._ ;? F�: Z.I r . 4,.,F.L1F ii i'it'.lh.a4 ir'. Jt;i �i5',1;1 ;Dl (?�i'f Str;lJ nl'I -�(ha,'il.i', �: ll j.�'t i. �I ff'Jli I.I�iI s. �`„"�_' to 1f1t,h�`P� r Inifr�l Irar, I. -.,� ,w, �.�I_, �� � rl1 I. - IEA 7.51 'Id. I M 1. 1 N 1) 11", 1. """J, ... ... ... . bAly I IlLIQ ... ..... .... J 'irii' ifrJ:Til+. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST r PERFORMED FOR: - I e ii �TYCt rY'� {' DATE PERFORMED: LEGAL DESCRIPTION: Township, Range, Section: DEPTH SLOPE SITE PLAN (FEET) I 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Aller Monitoring? Data: S L O P E Reading Date Gross Time Net Time Depth to Water Net Drop I/ r/ PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER 1 TEST RUN BET/yJEEN/ IT NO -FT ` f`-C1�if�Fo 7 PERFORMED BY: I CERTIFY THT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EF ECT ON THIS DATE. DATE: C N -f.. &O Lt 72-008 (Rev. 4/85) o Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOC — PERCOLATION TEST PERFORMED FOR: CO R ,t L-F� DATE PERFORMED: •`'3/ZJI �I I LEGAL DESCRIPTION: t ... QTa Bu., Township, Range, Section: �� E_ �� SLOPE SITE PLAN Y%iY.IL I 1�-'tIT t -1' -1'T -f-- 1- 2 3 4 5 `E- F .� 6 7 6•. 8 ..` c 9 C _L 10 11 12 • c�� 13 c 14• . Y 15- 1,��1L� hh�s •�� � 1� 16- I 141,L -E-: 17 18-- 19- 20 819•20 COMMENTS WAS GROUND WATER K) v ENCOUNTERED? S L 0 P — E ti�la t IF YES, AT WHAT DEPTH? Depihtri Water A Monitoring? Y••YWe: Reading Date Gross Time Net Time Depth to Water Net Drop ;3o s'SlJ l3° l y '; 3v 12 3v 11 130 1 3 6' A rl PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER 1 TEST RUN BETWEEN — FT AND �% ?—FT PERFORMED BY: 7� 1 , / CERTIFY TH T THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) u Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST (ENGINEER'S SEAL) PERFORMED FOR: {-1-�'LC'i l�Q fit. V1�'��-C DATE PERFORMED:_ / "7 LEGAL DESCRIPTION: Township, Range, Section: DEPTH SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS (n G� WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? P E Oepth to Water Alter Monitoring? Bale: Reading Date Gross Time Net Time Depth to Water Net Drop a-4 j -Q' f� 7 i lt1 c I! it e) i 1 /.5 Xf 2! + ] rte_ /f,` , a 0 > IVY (a% z7_ M4. �)( PERCOLATION RATE ZZ 62 _ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND Yt — FT PERFORMED BY:��_\ I . JSP CERTIFY T41AT THIS TEST WAS PERFORMED IN r" ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFF CT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Municipality of Anchorage00 ,., DEPARTMENT OF HEALTH & HUMAN SERVICES tti 825 "L" Street, Anchorage, Alaska 99502-0650 ........"c �' �r• ; chben 5pur(donci ; A,� SOILS LOG — PERCOLATION TEST PERFORMED FOR: Int✓ y2 " F t /'CL—? DATE PERFORMED: LEGAL DESCRIPTION: Y� 10�� ry ` �[—::A l JetyTownship, Range, Section: C 16 1 12Nt'z:'3 (b% SLOPE SITE PLAN 1 !�AplD Y S 1 i � I R4 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS AUL e) t= WAS GROUND WATER y , ENCOUNTERED? Net Drop S IF YES, AT WHAT L O DEPTH? _ p E Depth to Water Alter Monitoring? Dale: _ Reading Date Gross Time Net Time Depth to Water Net Drop aj' L)!� 2'y tr l� t( PERCOLATION RATE �5 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 3 FT AND 2= FT PERFORMED BY: / a I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Q5lU.V0ON0BLVD. ANCHORAGE, ALkSKKYY50^'PO4 SPECIFICATIQNS FOR SEPTIC SYSTEM INSTALLATION LOT 2 BLOCK 1 SEA TURN SEC 35 T12N R3W 1.0 GENERAL 1.:1 Owner is Sam Johnson. 8uilder is DelCor, Cort Phalp, 1201 E 70th. �9518. Phone: 344~3353 1.2 Engineer is the person or entity hired by the Owner to inspect this project. The Engineer must be recogNzed by the Municipality of Anchorage/ Department of Health and Human Services. 1, 3 Contractor is the person or entity hired by the Owner to install this project. The Contractor must be recognizod by the Municipality of Anchorage, Department of Health and Husan Services, 1.4 The Drawings, sheets 1 through 3, shall be part of this specification. 1.5 All materials and workmanship shal] meet the require- ments of the Municipality, of Anchorage, Department of Health and Human Services, the conditions of the permit, and all applicable rules and regulations currently in effect. 1.6 All excavation depths are advisory, and are to be verified and may be modified in the field by the EngAMUM . 1.7 It is the responsibi1ity of the Owner or the Contractor to adhere to the approved design, to verify that the sIli eci� fied separation distances are met, and that the required inspections are performed. 1.8 The Contractor or the Owner shall report to the Engi -- f I t?R tI, -neer any observed condition which would put the septic system in violation of State or Municipal regulations. 2.0 SEPTIC TANK 2.1 If there is an existing septic tank, it may be used if it meets the capacity requirement for the residence. The tank shall be inspocted by the Eli gioCar r, and its water tightness and structural integrity shall be verified. 2.2 A now septic tank shall be one fahricated by either Anchorage Tank and Welding or by Greer Tank Specifications for septic system installation Lot 2 Block 1 Sea Turn The septic tank shall be a UPC -approved twocompartment tank, constructcd of 12 gauge, or better, steel with bitu mastic coating. The tank shall be set level o undisturbed sojl.The tank shall be covered with the equivalent of four feet of soil, 2.5 2.3 The septic iank shall be installed a minimum of five feet from the house foundation and a minimum of five feet from the absorption area. 3.0 ABSORPTION FIELAD 3,1 Gravel used in the absorption field shall be 0.5 to 2.5 inch screened rock, with less than 3% passing the No0 sieve. 3.� Sand, used for leveling or for filtering, shall have an effective grain size between No. 40 sieve and No. 18 sieve. Uniformity coefficient shall be less than 4. Not more than weight shall pass the No. 200 sieve. 3.3 4`inch perforated pipe shall be ASTM F810. For pres- sure distribution, pipe shall be Schedule 40 PVC or ABS. 3.4 Solid 4 -inch pipe shall be Cast Iron or ASTM D3034. 3.5 Monitor standpipes shall be installed as shown. That section of the pipe penetrating the gravel shall he perfo- rated, either by drilling 0.5" holes on 6 -inch centers or by joining a secLion of F810 perforated pile to a solid section of pipe. 3.6 Geotextile shall be Ph. rafi 140. 3.7 Insulatioo shall be extruded direct burial polystyrene. Dow Chnmical Styrofoam HI 40. 3.8 Topsoil shall be a mixture of 40~10% organic matter, sand and more that 20% silt. All quantities are measured by volume. S�ecificatiarm for septj system installation Lot 2 Block J. Sea Turn pg.2 septic tank shall be a ainimum of 100 feet from any well serving a single residence: 100 feet from any body of water, creeks or drainage ditches with flowing water; 150 feet from Class "C» wells; and 200 foet from Class A or Class B wells. 2.5 0ll pipe connections to the tank shall be mechanical watertight calder couplings. Cleanouts shall be insta1led as designated and capped with air - tight rain caps. Clean - outs shall extend a minimum of 12 inches above final ground e]evation. Provisions shall be made for landscaping and importation if topsoil. 3.0 ABSORPTION FIELAD 3,1 Gravel used in the absorption field shall be 0.5 to 2.5 inch screened rock, with less than 3% passing the No0 sieve. 3.� Sand, used for leveling or for filtering, shall have an effective grain size between No. 40 sieve and No. 18 sieve. Uniformity coefficient shall be less than 4. Not more than weight shall pass the No. 200 sieve. 3.3 4`inch perforated pipe shall be ASTM F810. For pres- sure distribution, pipe shall be Schedule 40 PVC or ABS. 3.4 Solid 4 -inch pipe shall be Cast Iron or ASTM D3034. 3.5 Monitor standpipes shall be installed as shown. That section of the pipe penetrating the gravel shall he perfo- rated, either by drilling 0.5" holes on 6 -inch centers or by joining a secLion of F810 perforated pile to a solid section of pipe. 3.6 Geotextile shall be Ph. rafi 140. 3.7 Insulatioo shall be extruded direct burial polystyrene. Dow Chnmical Styrofoam HI 40. 3.8 Topsoil shall be a mixture of 40~10% organic matter, sand and more that 20% silt. All quantities are measured by volume. S�ecificatiarm for septj system installation Lot 2 Block J. Sea Turn pg.2 3.9 Grass seed shall be Kentucky bluegrass, 4.0 INSTALLATION 4.1 Locate all underground utilities, property liHem future driveways, existing or proposed water wells, water ways, surface and sub surface drainage facilities, lakes, ponds, and all other facilities requiring separation dis- tances from the proposed septic system. Notify Owner or Engineer of any observed possible conflict. 4.2 Stake alignment of system with markers showing the protectjve distances from wells and water bodies. 4.3 Establish an elevation benchmark. This BM shall be easily identifiable, stable and permanent. An arbitrary elevation of 100 can be assigned. 4.4 Install the tank as shown on the drawings. Record the inlM and outlet elevations of ths tank. Tank shall be placed on undisturbed native soil. 4,5 Excavate the absorption fie\d. Bottom of excavation shalbe level and scarifjcad. If sidewalls smears, they shall also be scarified. Record elevation of beginning' middle and end of trench. Construction equipment shall not operate on the floor of the excavation. Any material com� pacted by the operation of the construction equipment shall I emoved and replaced with uncompacted materials. 4.6 Place the rock to the depth specified. Do not contami- nate rock with native materials or spoils from the excava~ tion. Level the rock sur{ace (+- 1"> before installing the perforated pipe. 4,7 Install the distribution pipe. Record the elevation of each jo:int. For pressure system solvent weld Ill to joints. 4B Cover the distribution pipe with rock, and cover the excavation with geotextile before backfilling and placing insulation, if required. 19 Record the finished ground elevation at the beginning, middle and end (OF trench. Record the finish ground eleva- tion at each corner and at the midpoint of the bed. 4.10 Furnish a copy of all survey notes to the Eogxneer. 5.0 INSPECTIONS 5.1 A minimum of three inspections are required. The firsL inspection will be of the open excavation. At th."s Specifications for septic system installation Lot 2 Block 1 Sea Turn time the soil conditions will be observed and compared to the design assumptions. Ground water conditions or presence of bedrock will be verified. The second inspection will ba after placement of gravel, standpipes' distribution piping, tank(s> and other compo- nents as speci{ied. The third jnspection will be after completion of the work. Any deficiencies will be noted and the Contractor notified. Such deficiencies shall be corrected within ten days 5.2 All electrical work requires either an MOA electrical inspection or certification by an licensed electrician. Submit proof of inspection or certification to the Engineer. 5.3 Submit catalog data of all mechanical equipment. 5.4 Notify Engineer at least 24 hours jn advance of begin- ning any work SpecifjcatiClio Sow- septic system insta]lation Lot 2 Dlock 1 Sea Turn [,(,6 >1V '> d :-mom v' L e 4 UWf6 Inv 70, N."A III 11H L UN —;OLIT1�11g F) C4,1 ollu1VL ;d I.- NOXIk7 ;. W Mt4f, 130,T3V2iMOD Hlcl�l(l "1;1V1NI mnj I A ONV 9NT CI I, -A.4 OKI UV jo AON - -- -------- ;bu I troclo jo F. 11 T S DINJ 44 F1 -7 - ------ ---- ---- .10 T t10V1 Ll 0T T 7 -C 0 T :.loq �Ic) o-4 �)Jquq� oc I -d II u, IMM UlVM DIM$ ...... . viva oq fj,T-1 T g I, 0, U n o:t b c) Ll j o 14 C3, -,Cl I I �T, (1 -.1 a 'I'l PJ,,4 NO A 0 H J, V C lRIOd QN11MUIM �IZNMO 11ri'M m nP'l X �Vr NQTLDFNJ' ? NOT31AIC190S nnouoe T) "!,.1 146, W.)XITAIDO I cldc)DU 11TIM W41EVII, SA2[MICIS 'lV%VAHd05V (]IqV dC) tIOl$lAlCI sS' o`rmos,qu rTv-anmvN ao jNmiaAivduc V-Ag%rllv 10 a(j,VLs Municipality.of Anchorage ., • Development Services Department �i •: Building Safety Division \ On -Site Water 8 Wastewater Program a 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519519.6650 �� cccCCCy www.muni.org/onsite (907)343-7904 \ \v CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Qlq-IA1-53 h COSA# f r- n 1. GENERAL INFORMATION Expiration Date: 9 � -2 0 - Q % Complete legal description SEA TURN SUBDMSION: LOT 2 _BLOCK 1 Location (site address) 5841 _AZALEA DRIVE ► ANCHORAGE. AK 99516 Current Property owner(s) SAMUEL AND KATHLEEN JOHNSON Day phone C/O AGENT Mailing address HC3 BOX 8425 • PALMER. AK 99645 Lending agency Day phone Mailing address Real Estate Agent NICHOLETTE WILSON w/ REMAX PROPERTIES Day phone 301-1441 Mailing address 110 W. 38th SURE 100 • ANCHORAGE. AK 99503 Unless otherwise requested, COSA will be held by DSD /or pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY:. TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, 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. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of Installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE _LZ Approved for _�/_ bedrooms. Disapproved. Phone 337-6179 Date �' I V- A 7 - Conditional approval for bedrooms, with the fllowing stipulations: Attachments: C/ COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other ...... ...:...°. �� • ON-SITE • ��� WATERAND ; m- : WASTEWATER : a•,. PROGRAM R .ill /Q,04ty \l\�� By: Original Certificate Date: � -' 2 � '" 0 ar (Ra. 11105) Municipality of Anchorage f ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Boz 195650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SEA TURN SUBDIVISION: LOT 2. BLOCK 1 Parcel ID: A. WELL DATA Well type PRIVATE If A. B. or C provide PWSID# N/A Date completed 8/27/1991 Sanitary seal (Y/N) YES Total depth 101 ft. Cased to 101 ft. FROM WELL LOG Date of test 8/27/1991 Static water level 52 ft, Well production 7.0 g.p.m. WATER SAMPLE RESULTS: Coliform 43l" colonies/100 ml. A►, Arsenic: � ug./L. B. SEPTIC/FIOLDING TANK DATA Nitrate AjamgJL. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION 6/5/2007 52 ft, 5.91 g.p.m. Other bacteria � colonies/100 ml. Date of sample: 6/5/2007 Collected by: GEG Ltd. Tank Type/Material SEPTIC/STEEL Date installed 9/20/1991 Tank size 1250 gal, Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YM) _ N/A Date of pumping 6/6/2007 Pumper McDONALD'S PUMPING C. ABSORPTION FIELD DATA POELOW EXISTING 0 -RA -DU Date installed 9/20/1991 Soil rating .p.d. r ft2/bdrm) 0_8 System type SHALLOW TRENCH Length 96 ft. Width 5 ft. Gravel below pipe 2.5 ft. Total depth "6.4 ft. Eff. absorption area 750 ft' Monitoring tube YES Depression over field NO Date of adequacy test - "•6/6/2007 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 6 In. Water added '•• 1208 gal. New depth "•• 16 in. Elapsed Time: 995 min. Final fluid depth 13 In. Absorption rate >= 600+ g.p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - •• SYSTEM WAS PRE-SOAKED WITH 1000 GALLONS ON 6/4/2007 ••• THE LAST 523 GALLONS ONLY CAUSED A 3 INCH RISE IN THE TRENCH D. LIFT STATION Date installed "Pump on" level at —in. Size in gallons "Pump Or Manhole/Access water alarm level at in. n r Cvdes tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 1001+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 'S0'+ On adjacent lots 100'+ Public sewer manhole/deanout 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'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I cot* that r have determined through field inspections and...... a':' y • ........... ..... . review of Municipal records that the above systems are in conformance with MOA COSA guidelines m effect on this ................ date. Je A. s: r s Printed Name JEFFREY A. GARNESS Engines ' 3 �p�•�. khw�4.���` Date 6�rw/c, ^�dprofoss COSA Fee $ 7 3U. D 0 Date of Payment A/! 4,2 7 Receipt Number �/ y L — (Rw. I Ift) Waiver Fee $ Date of Payment Receipt Number yt. f. •ao•oo.c .. 1v1 �- I/0.Op�a jseo O,uaua7 w wr" m ia' wt Ar E.t?..•.+•--�'f--� ;� J^��' i h.a S ►.w FrI+.Y � Wwj• •h � 40� v. MOYM�b W • •. • • • • 1�"n1} IM 4.p"} NAA -v.Y�� Nn. SGS Refp 1072543001 Client Name Gamess Engineering Group, Ltd. Project NameN Sca Tum LI D2 Client Sample ID Sea Tum LI D2 Matrix Drinking Watcr PN'SID 0 All Date%/Times are Alaska Standard Time Printed Daterfime 06/13/2007 16:21 Collected Date rime 06/05/2007 12:00 Recehed Date(1'ime 06/052007 14:05 Technical Director Stephen C. Ede Sample Rcmarks: 4500-NO3 - Total NitratclNitritc - The matrix spike recovered below the QC criteria. The batch LCS is within QC limits. Pammder Allowable Prep Analysis Results PQL Units Method Contamer ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 waters Department Total Nitmtc/Nitritc-N ND 0.100 Microbiolovy Eaboratory Total Colifitnn 0 ug/L EP200.8 C (<I0) mg/L SM204500NO3-F D (<10) coUl00mL SM209222D A (<I) 06/07/07 06/12/07 TK 06/09/07 JDS 06/05/07 DLC MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES klftl Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 017— /f g) - 3 2. 3. 4. GENERAL INFORMATION HAA # & Zi -1 MY Complete legal description Se� y J Location (site address or directions) Ll Property owner Teo-"(- Day phone 3 -f �c.c - � Mailing address I"?_0 1 .7 U ", Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF 13EDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site —� Holding tank Community on-site Public sewer _ NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA N21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm �6=fit r /- Phone _A W Address Engineer's signature 6. DHHS SIGNATURE. Approved for Disapproved. 0 Conditional approval for /L/vA1 % Additional Comments bedrooms. Date ` ( ;?-) bedrooms, with the following stipulations: 411Th The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo 1 '2_ � K I g v_cn i (,w 617- A. I 7-=- 9 P Parcel I.D. — A. WELL DATA Well type Pe-,!, If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed � ��` c� % _ Driller_ Total depth /0 Cased toCasing height— Sanitary eight Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION z Date of test 9-- a� 7" �t ILI Static water level _ z U cr' P > Well flow7 0 V) ..m. g.p.m. LO cv �9 ilk Pump level W v_ 20 Q__.J SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot On adjacent lots > Absorption field on lot On adjacent lots —> / Public sewer main � Public sewer manhole/cleanout Sewer service line �/ / Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed q �o! �/ Tank size /0Tg 0 Compartments Cleanouts (Y/N) -Foundation cleanout (Y/N). / Depression (Y/N) 114 High water alarm (Y/N) Alarm tested (Y/N)_ t�411S, Date of pumping N Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot r 30 { On adjacent lotsFoundation_ To property line Absorption field `U —Water main/service line Surface water/drainage/_- , 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION l\�/ Date installed Size in gallons Vent(Y/N) High water alarm level _ "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots "Pump off' level at Cycles tested Surface water _ D. ABSORPTION FIELD DATA j Date installed gl�Or �1 Soil rating ` System type a2/ ,1A 1"V6_`� Length Width Gravel thickness -Total depth "'/ y Total absorption area / sy Cleanouts present (Y/N) Depression over field (Y/N) N Date of adequacy test Results (pass/fail) I ��.-�_S for bedrooms Peroxide treatment (past 12 months) (Y/N) ' T If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: , Well on lot /60 4- On adjacent lots > / a_6�' Property line To building foundation �%� To ex``isting or abandoned system on lot On adjacent lots > Cutbank �//1Water main/service line U Surface water /A Driveway, parking/vehicle storage area >50 Curtain drain�« E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature vT Engineer's Name Date �A? ✓ HAA Fee $ Date of Payment �� 1 Receipt Numbed 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 40509 Chemlab Re£.# 91.6292 Semple # 1 Matrix: WATER Client Sample ID POTABLE WATER 2./1 SBATURN Client Name :TOBBEN SPURRLAND, P.E. PWSID UA Client Acct :TOBBENS Collected NOV 22 91 @ 13:15 hrs. BPO# POW :NONE RECEIVED Received NOV 22 91 @ 14:00 his. Req# Preserved with AS REQUIRED Ordered By Analysis Completed NOV 25 91 Laboratory Supervisor STEPHEN C. EDE Released By : m G Cj// .......,..................................... Parameter --------------------------------------------- NITRATE-N Sample ROUTINE SAMPLE COLLECTED BY: T.S. Remarks: .......................... 1. Teets Performed ND- None Detected NA- Not Analyzed Send Reports to: 1)TOBBEN SPURELAND, P.E. 2) .......................................................I............................ Results Unite Method Allowable Limits --------------------------------------------------------------------------------- ND(0.10) mg/1 EPA 353.2 10 RECEIVED NOV 2 6 1991 Municipallty of Anchorage Dept. Health & Human Services .............................................................................................. I........ ' See Special Instructions Above UA -Unavailable See Sample Remarks Above LT -Less Than, GT -Greater Than ey�� SGS Member of the SGS Group (SociM6 Generale de Surveillance)