HomeMy WebLinkAboutTHAYERMOORE HEIGHTS BLK 1 LT 4hayermore Heightss, Block 1 Lot 4 #015-081-06 Name: Qa Ve.U Addr� ox y 1-3 � 1-3 Phone: Municipality of Anchorage Development Services Departments Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page j of www.ci.anchorage.ak.us (907) 343.7904 l ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PID Number: 5- 5-0,17 SOv1 Wastewater System: IR'New ❑ Upgrade eha°>�3ABSORPTION FIELD 7aNumber of Becraoms: _.. Deep Trench t]shaum Trench 13 sed (]Mound E3 Other LEGAL DESCRIPTION Block. I Lot. � rlivision: 4,,ermore 1l Township. Range: section: Well: MNew ❑ Upgrade Classifcation�(Pnva�ll%Q,C'; Tolal peptn:FCOsedWDnller. 1YlrDale onll^tln •, ., Above Soil Ratirg: 01, Depth to Pipe bottom from ai iral C J LS 9 �( Filladdedabove odor one d.: Gravel I peal absorption area: --/-) Pi e JFL / C� FF _ Ins Ile,. Date �AdIr�B/J� TANK t(Septic ❑ Holding ❑ S.T.E.P. Sewer Line ;�5,4- UFT STATION BENCHMARK 5 i 5 ENGINEERING Inspections performed by: 17034 Eagle River Loop Road NOCTpr;: II eagle Rlv w, Alaska 99577 2nd Developm t Services Department Approval Reviewed and approved by: Date: (Rcvl Ja0) grade:: A ice between lines: —� Ft. I] Other: Ca��pacyity:/m� /f'LA/ Gal. Ft. OF T t ROBERT C. COWA14 f r CiJ, :� CE -8801 .±a in. SEPARATION DISTANCES To From Septic Tannkk Absorption Lift Holding Station Tank Well (FFii�ie�l/lddJ Surfacewater -YL- Lot Line 7) i L/73 Foundation L—F ` t III V y/� t Curtain Drain �/o yn Remarks: Above Soil Ratirg: 01, Depth to Pipe bottom from ai iral C J LS 9 �( Filladdedabove odor one d.: Gravel I peal absorption area: --/-) Pi e JFL / C� FF _ Ins Ile,. Date �AdIr�B/J� TANK t(Septic ❑ Holding ❑ S.T.E.P. Sewer Line ;�5,4- UFT STATION BENCHMARK 5 i 5 ENGINEERING Inspections performed by: 17034 Eagle River Loop Road NOCTpr;: II eagle Rlv w, Alaska 99577 2nd Developm t Services Department Approval Reviewed and approved by: Date: (Rcvl Ja0) grade:: A ice between lines: —� Ft. I] Other: Ca��pacyity:/m� /f'LA/ Gal. Ft. OF T t ROBERT C. COWA14 f r CiJ, :� CE -8801 .±a in. PERMIT NO. SWO30293 PAGE 2 OF 3 Municipalit of Anchora e DEPARTMENT OF HEALTH AND HUI`AN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D Box 196650343-4744 ON—SITE WASTEWATER�DISPOSArchorcAL SYSTEM AND/OReWELLe INSPECTION REPORT LEGAL LOT 4, BLOCK 1, THAYERMOORE HEIGHTS P.1 D. NO. 015-081-06 2 I I I I 3 o SryEO I I I n Z 17' MIN. CO2 W N N// MT1 a / TH roZ U 3 FCO M Q o 2 TBM p....a DBL1 & DBL2 C01 SEPTIC AREA S ST1 NEW 1000 GALLON GRAVEL DRIVE SEPTIC TANK A N P��uS �p0 5 oS �� RP SCALE: 1" = 40' IUFR�1 ROBERT C. COWAN i•'vw CE • 8801 4 f ---- PERMIT No, SWO30293 PAGE 3 OF 3 MunicipaUt of Anchor z e DEPARTMENT OF HEATH AND HiJRXN SERVICES ENVIRONMENTAL SERVICES Dle IVISION P.D. Box 196650 *Anchorage, A�ctskcL 995: 343-4744 ON—SITE WASTEWATER DISPOSAL SYSTEM1AND/OR eWELLeINSPECTION REPORT LEGAL LOT 4, BLOCK 1, THAYERMOORE HEIGHTS P.I.D. No. 015-081-06 FINAL GRADE 77.7'/ FINAL GRAD E MTI =68.0' ST1 ST2 PNEW COI=84.0' 82.8' C01=77.1' C01=77.1' SR CO2=76.7' NO WATER FOUND 60.5' B.O.H. 84.5' 77.5' A B FCO 50.0' 43.0' STI 64.0' 96.5' ST2 65.0' 92.5' DBL1 67.5' 88.5' DBL2 68.5 86.5' C01 69.0 85.5 MT1 92.0 64.0' CO2 94.0' 59.5' NOTE: COMBO FITTINGS ROD CAN'T REACH INVERT N, T. S. rP ? 1 ROBERT C. COWAN f� f .% CE - 8801 r' It It M-W Drilling, 'mc. eP.O. Box Z~O378*Ancho~ge, AK 99§1~· *907-345-4000 · 907o345-3~'87 Faxe Job No,: 03-177 Project No,: Permit No. SW030293 Groundwater F/eli/is-Built & Log · P/ell Owner: Anderson, Dave & Palxicia · ~lse o/P/ell: · LegalDescrlptlon: ,,,,Thayennoore l'lei~hts Subdivision~ Block It Lo! 4 , 9800 Hillside Drive- Anchorage. Alaska Domes[lc ,,Construction · lioleDeptA: 196' eCaslngSl:e: 6" eCnsedTo: 195.41' · DrlllMetAod: Air Rolar~/ · P/ell Completion- Open end X Screen Pecl'oroted · Screen/Petforotlon descr~tlon: None · Grout Notes: (3) Sacks- No. 8 bentonite granules cArat·rial: A ~3 Steel Per/:. Afethod: · Notes: · Well Development: Method: Air surge Notes: e Statlc water level (SW£) 168' (c~c:'c) (below) top of casing (TOC). · Wellyleld test at 20 Gallons per minute (GPM)/ge~nef~ke4~C,P~) for __ with 100% of drowdown (DD) from static level (SWL). · MetAod: Air lilt I itou~ · Dot·of completion: 22 September 2003 ePumplnstall: Well Log Depth in feet from top of casing. Details of formations penetrated~ size of materialt color and hardness. 0 TO 2 Casin~stickup 2 TO 4 Fill 4 TO 10 Cobbles: gravelly 10 TO 17 Gravel: silty clay 17 TO 28 Sand: dry 28 TO 115 Cobbles: gravelly, sandy 115 TO 136, Silt}' sand: gravelly, clayey 136 TO 142! Sand: wet 142 TO 170 Siltyclay: dry 170 TO 185 Gravel: silty~elayey 185 TO 196 Water bearing gravel TO TO TO TO r MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Renewal Date Issued: Aug 04, 2003 Expiration Date: Aug 03, 2004 Permit Number: SW030293 Parcel ID: 015-081-06 Legal Descri tion: 1AYERMOORE BEtGjJTS BLYC Design Engineer: 0003 S & S Engineering Site Address: 009800 HILLSIDE DR Owner Name: Dave & PatriciaAnderson Lot Size: 24725 SQ. FT. Owner Address: PO Box 231021 Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE, AK 99523-1021 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: Date: o' 0-3 Municipality of Anchorage • Development Services Department s ip � Building Safety Division On -Site Water and Wastewater Program 'slpf,. 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 0-,S!TE SEWERIWELL PERMIT APPt_!CAT!On! FOR A SINGLE FAMILY DWELLING Parcel I.D. I t rAi cfL►Ma02� 1i,1� lS ll� IT 4r Permit Number SW03aZ?3 Property owner(s) ��$ �� � Day phone B';;n -10-4 Mailing address (1)'CIO.�53Y. G560L1 F�NCat. 7+1L R fig-address(2) 1<� Co Qf2 -I�V, Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size 2-qOaS Acres/Sq.Ft. THIS APPLICATION IS FOR: Zip Code %523 Number of Bedrooms ?S Sewer Only ❑ Well Only ❑ Sewer and Well Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ that the above information is correct. I further certify that this application is being made for a Single t II' d is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: X00 Cl O Waiver Fees: Date of Payment: 7 I2 'f lc)-? Date of Payment: Receipt Number: 3 / 0 73 Receipt Number: (Rev. 12/00) Rruc- Ld 7131103 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Jul 31, 2002 Expiration Date: Jul 31, 2003 Permit Number: SW020258 Parcel ID: 015-081-06 Legal Description: THAYERMOORE HEIGHTS BLK 1 LT 4 Design Engineer: 0003 S & S Engineering Site Address: 009800 HILLSIDE DR Owner Name: Dave Anderson Lot Size: 24725 SQ. FT. Owner Address: PO Box 231021 Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE, AK 99523-1021 This permit is for the construction of: Z Disposal Field 7 Septic Tank Holding Tank ❑ Privy Private Well Water Storage 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued Issued By: Date: -7/ 1?1 G -Z- zl� �q� Date:.i/ O 2 li uffielpality of Atithot agte ., beVelophiet t Seivices bcpetimeht Building Safely bivision =o e n On -Site Water and Wastewater Program SA ETY 4700 South l3ragaw St. P.O. box 196650 Anchorage, Alk 99519-6650 www.cl.anchotage.ak.us (907)$43-7904 ON-SITE SEWERMELL PERMIT APPLICATION rOR A SINGLE rAMILY DWELLING Parcel 1.0. 0/5—O9 ! —OCo Permit Number SWO20238 Property owner(s) k\ E1 A n A'_R S o n bay phone Z Z--"' I l'- Z - Mailing address (1) ?,.,b 2 31 o Z Mailing address (2) k ac ti Al•Pcltr Zip Code a9 SZ3 Legal description (Lot, block & Sub'd.) LOA 'q 610 1{ J1 Legal description (Section, Towhshlp & Range) -- Lot Size Acre q.P Number of Bedrooms 3 THIS APPLICATION is POR: Sewer Only ❑ Well Only ❑ Sewer and Well Water Storage ❑ Sewer Upgrade ❑ THIS PROPIERTY CONTAINS: Not Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application Is being made for a Single Family bwelling and is In accordance with applicable Municipal Codes. 44yl �5 & 5 ENGINEERING (Signature of property owner or authorized agent) Permit Fees 4 5-5-0, Waiver Pees: bate of Payment: '7 / a- e lo z bate of Payment: - heceipt Number: 0 ;L 3 a I`6 Receipt Number: _ (Rev. 12100) 17034 Eagle River LOOP M Eagle River, Alaska 99577 HEALTHAUTHORITY APPROVALS SEWER&WATER MAIN D(TENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES PNDREPORTS WELLINSPECTION & FLOW TEST SITE FLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN UnG ROBERT C. COWAN, P.E. 7 CIVIL ENGINEERS (907)694-2979 FAX(907)694-1211 July 23, 2002 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 4, Block 1, Thayermoore Heights S/D It is requested that you issue a permit to install a well & septic system to serve the proposed three bedroom dwelling on the referenced property. A test hole was excavated and a percolation test was performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation 7/2/02 water was not found. After seven days of ground water monitoring the test hole was found to be dry. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, �-)WZ4� Robert C. Cowan, P.E. RCC/jbm Enclosure 17034 NORTH EAGLE RIVER LOOP : SUITE 204 • EAGLE RIVER, ALASKA 99577 ' SITE PLAN DESIGN W ---------------- Anchor Esmt 1" = 60' I I sew XZmm ¢ !v F s HOp o �RoOk y rk a � _ sg r c o 9 G % 9 �O m �m o I HILLSIDE DRIVE PDo v w +.10 b A Nc foo I � Q mo `Y 1 mo ; � I0 imn Ik O ys na om o s o i m n 44TFR �Fzo� Z JVD CMM VATF`S/J'f �Ztib]m�g F -.y 1" = 60' I I sew XZmm ¢ !v F s HOp o �RoOk y rk a � _ sg r c o 9 G % 9 �O m �m o I HILLSIDE DRIVE �PTIC AREA PDo v w +.10 b I � no -a- atnw zo � I0 m Zr,M<W ti � n O z'vI z� --3 opted o i m n Samm qjN tx'! Z JVD CMM �Ztib]m�g F -.y m- rpyp9y m m Ono r C•na zaz ZV �' 'owna rani '� � �m Otn 0 wa o>ZH xn ZZ a y � a z� zr�n �- O O z �PTIC AREA -------- - - oC0 ✓ Lr' tnK� ���•. Wn cxjorn °'i Op anp U w n l7v no -a- atnw zo - I0 m Zr,M<W ti � n O z'vI z� Q yrii Km Czm Samm qjN tx'! Z JVD CMM �Ztib]m�g F -.y m- rpyp9y m _--I <mo C>zo r C•na zaz ZV �' 'owna rani '� � �m Otn 0 wa o>ZH xn ZZ z� zr�n d -------- - - oC0 ✓ Lr' tnK� ���•. Wn cxjorn °'i Op anp U SITE PLAN n < D L r0 m m ., m N y O N O C Z Z N Azo Z r N W N C N < r 'tn D H � !1 z a m 0 Z O D C 0 DESIGN Anchor Esmt � N Q O o�o � z O (.n (n O Z Cr Irl Q O ull O m D M n O D D D � = Dr o v z0� v m 0 Z O D C 0 DESIGN Anchor Esmt � N O o�o b�m;..�� fTl Q z rn' %-0 o\o Q m fn o tD LTJ z o ooZ m oC7 m z gCTE v O m n proof � �J Cz7 K V n O 0 ' r O PROP 3 BED ov SED uSi Q) 50 < 0 a �z O HILLSIDE I DRIVE 30 o\o /100, WELL b�m;..�� rn' %-0 i�7 o tD LTJ z ooZ m oC7 m z �bx ii oil Z d O m n proof � ado AD Cz7 K V mom 0 r m O o x Q a PTI(T 1 `T/� no -3— atn u, I vzi j 1 1 1 C' M s,eA / SW(T-e �J (rR/�vcc wtTly Recce S � c9cc»s�c,vac j3DJ q X62 WAS GROUND WATER ENCOUNTERED? At 0 S IF YES, AT WHAT DEPTH?� L Depth to Water After 5511 O Monitoring? IDPy PE Date:% 21-0 2— itL7 ItV'l SAND N1L I'i L c.w3 Site Plan E z�_c Reading Municipality of Anchorage Development Services Department 11 R'S Al f r t Net Time Building 4700n SafetyDivision On -Site Water and Wastewater Program 4700 South Bra aw St. 7�% I �.. Ml •• P.O. Box 196650 Anchorage, AK 99519-6650 .,� � •••......� ROBERT C. COWAN www.ci.anchorace.ak.us (907) 343-7904� A ` CE - 8801 9999 '� Soils Log - Percolation Test Ilk Performed For: JAV f hA/106A S'0 Date Performed: 7�a��� R.oT iP r -a csc Legal Description: 714A yL+2 MOs; A4– ke IC•-aF>'j Township, Range, Section: 1 1 1 C' M s,eA / SW(T-e �J (rR/�vcc wtTly Recce S � c9cc»s�c,vac j3DJ q X62 WAS GROUND WATER ENCOUNTERED? At 0 S IF YES, AT WHAT DEPTH?� L Depth to Water After 5511 O Monitoring? IDPy PE Date:% 21-0 2— itL7 ItV'l SAND N1L I'i L c.w3 Site Plan E z�_c Reading Date Gross Time Net Time Depth to Water Net Drop 30 - G" 150 3o C o YtHUUL tJUN HAIL (mmutesAmh) PERC HOLE DIAMETER 6 TEST RUN BETWEEN Fr ANDFT COMMENTS PERFORMED BY: S R, g ENGINEERING I CERTIFY THAT THIS TES WA PERFORMED IN ACO ifgWlR fAtIL&VI 9*4bfftr2( IPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: we River, Alaska 99577 r'ny1neeRtnG ROBERT C. COWAN, P.E. We "1A4fA CML ENGINEERS (907)694-2979 FAX(907)694-1211 HEALTH AUTHORITY APPROVALS ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICE$ and MATERIAL SPECIFICATIONS SEWEgBWATER MAIN EXTENSIONS REFERENCE: Lot 4, Block 1, Thayermoore Heights Subdivision July 23, 2002 SEWEfl 8 WATER INSPECTION GENERAL: 1 The scope of this project includes the installation of a 1000 gallon Premier ENGINEERINGSTUDIES AND REPORTS polyethylene septic tank and a new trench to serve the proposed three bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design a LOW TEs;71ON drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. SITE PLANS 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible ROADDESIGN for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the SOIL TEST Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. PERCOLATION SEPTIC TANK INSTALLATION: TEST 1. A septic tank is to be constructed by a certified septic tank manufacturer. MECHANICCAL$ Construction shall include two 4" cleanouts for pumping access. INSPECTIONS 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. ON SITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 Page 2 Lot 4, Block 1, Thayermoore Heights SID July 23, 2002 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. Page 3 Lot 4, Block 1, Thayermoore Heights S/D July 23, 2002 MINIMUM MATERIAL SPECIFICATIONS: I Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pine Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: Page 4 Lot 4, Stock 1, Thayermoore Heights 3/D July 23, 2002 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to cant' out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Municipality of Anchorage e, On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-081-06 Expiration Date: Z / 1. GENERAL INFORMATION Complete legal description THAYERMOORE HEIGHTS S/D; BLOCK 1, LOT 4 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 9800 HILLSIDE DRIVE ANCHORAGE, AK, 99516 COLEMAN & DELLA CUTCHINS Day phone 9800 HILLSIDE DRIVE, ANCHORAGE, AK, 99516 2. TYPE OF DWELLING: N Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Day phone 538-1360 TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site ■ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by: ��wC._ ,goLlet— Date: r X13 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number COSA # 0 S L I I l •;), 2 Waiver Fee $ Date of Paymen 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. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 " ANCHORAGE, AK, 99507 Engineer's Printed Name Engineers Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluator, GEG, LH). attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines B 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 solls 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 authonzed, nor will it confer any legal tight whatsoever. 6. DSSIGN TURE DSD #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. 337-6179 Date 7 /10 [13 bedrooms, with the following stipulations: OF O�y_SiT� SAT FWA DR VVHJ' ?AA 0 Original Certificate Date: _ The Mimlci)fality or Anchorage Develop, emit Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. 11105) If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: THAYERMOORE HEIGHTS S/D; BLOCK 1, LOT 4 Parcel ID: 015-081-06 A. WELL DATA Well type PRIVATE If A, B, or provide PWSID# N/A Date completed 9/22/2003 Sanitary seal (Y/N) YES Total depth 196 ft. Cased to 195 ft. FROM WELL LOG Date of test 9/22/2003 Static water level 168 ft. Well Log (Y/N) Wires properly protected (YIN) YES Casing height (above ground) 18+ in. AT INSPECTION 7/18/2011 159 ft, Well production 20 g.p.m. 5.4+ g.p.m. WATER SAMPLE RESULTS: Coliform�� colonies/100 ml. Nitrate G.9 3 mg./L. Collected by: GEG, Ltd. Arsenic: / pu o ug./L. Date of sample: 7/3/2013 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 8/11/2003 Tank size 1000 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 7/5/2013 Pumper ONE STOP PUMPING C. ABSORPTION FIELD DATA Date installed 8/11Z2003 Soil rating OZEd.l r ft2/bdrm) 0_6 System type TRENCH Length 46 ft. Width 3 ft. Gravel below pipe 8.5 ft. Total depth *13.9 ft. Eft. absorption area 782 ft' Monitoring tube YES Depression over field NO Date of adequacy test 7/18/2011 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 8 in. Elapsed Time: = min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump off' level E. SEPARATION DISTANCES level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot loo ,+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption Feld 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 pP`� "' • '. I certify that l 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. Q e A. Engineer's Printed Name JEFFREY A. GARNESS Q��QC9j 7 g15.33 Date `11143 professo• a\ F',o•o`Ao o o (Rev. 11105) Municipality of Anchorage p, Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 111276 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 4 of Thayermoore Heights subdivision. This inspection revealed a nitrate concentration of 6.93 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-081-06 COSA# Expiration Date: 1. GENERAL INFORMATION Ex p Complete legal description THAYERMOORE HEIGHTS S/D; BLOCK 1, LOT 4 Location (site address) 9800 HILLSIDE DRIVE * ANCHORAGE, AK * 99507 Current Property owner(s) DWANYE & LISA DORAU Day phone 720-7651 Mailing address Lending agency Mailing address Real Estate Agent -- Mailing address 9800 HILLSIDE DRIVE * ANCHORAGE, AK * 99507 Day phone D'ETTE OWENS W/ KELLER WILLIAMS Day phone 440-2313 101 W. BENSON BLVD, #503 * ANCHORAGE, AK * 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Municipality of Anchorage. �— �� Development Services € epartment - 0 Building Safety Division tT Individual Holding tank On -Site `Nater & Wastewater Program ❑ 4700 Elmore Road ❑ P.O. Dox 196650 Public Sewer Anchorage, AK 99519-6650 www.r.-i unt.org/onsitte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-081-06 COSA# Expiration Date: 1. GENERAL INFORMATION Ex p Complete legal description THAYERMOORE HEIGHTS S/D; BLOCK 1, LOT 4 Location (site address) 9800 HILLSIDE DRIVE * ANCHORAGE, AK * 99507 Current Property owner(s) DWANYE & LISA DORAU Day phone 720-7651 Mailing address Lending agency Mailing address Real Estate Agent -- Mailing address 9800 HILLSIDE DRIVE * ANCHORAGE, AK * 99507 Day phone D'ETTE OWENS W/ KELLER WILLIAMS Day phone 440-2313 101 W. BENSON BLVD, #503 * ANCHORAGE, AK * 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 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. 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 engineer's work. 4. STATEMENT OF INSPECT!ON BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, / 'verily that nttly investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply ardfvr wastewater disposal system is (are.) safe, functional and adeMuate for the number of bedrooms and type of structure indicated herein. I further verify that based on the r i ,✓ r_ c n s„ s n -,# r f,'1 f n my in�ieJ.ation and :^spectior' the it ill7rl, ation obtained b ort, the ifunicipali, o, 11n-orage ;lees and ,rom +; ., . 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 Address GARNESS ENGINEERING GROUP, Ltd. 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Enaineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being 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 _Z Approved for bedrooms. Disapproved. Phone 337-6179 Conditional approval for bedrooms, with the following stipulations: Attachments: COS^ Checklist Septic System Advisory Well Flow Advisory Nitrate r.uViSo;y V tars_ .if �i'3V`i�fl \! e -n..- ..- - Maintenance Agreements Supplemental Engineer's Report Outer By:— ��` ; Original Certificate Date: ............... aA. rness.. rofess�o��o If OFri, C er \�� •.,..,• yet ON-SITE WATER AND : rn WASTEWATER PROGRAM ia:*, rc Yrs (Rev. 11105) Municipality of Anchorage ,t ,:5� Development Services Department "' Building Safety Division ,',. T On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: THAYERMOORE HEIGHTS S/D; BLOCK 1, LOT 4 Parcel ID: 015-081-06 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N A Well Log (Y/N) YES Date completed 9/22/2003 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 196 ft. Cased to 195 ft. Casing height (above ground) 18+ in. Date of test Static water level Well production FROM WELL LOG AT INSPECTION 9/22/2003 7/18/2011 168 ft. 159 ft. 20 g.p.m. 5.4+ WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrates. &3mg./L. Collected by: GEG, Ltd. Arsenic: _�g./L. Date of sample: 7/18/2011 B. SEPTIC/HOLDING TANK DATA Coli }or rr% —4 P cI 1 Tank Type/Material SEPTIC/STEEL Date installed 8/11/2003 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping Pumper ONE STOP SERVICES C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 8/11/2003 Soil rating p.d./ orft2/bdrm) 0.6 System type DEEP TRENCH Length 46 ft. Width 3 ft. Gravel below pipe 8.5 ft. Total depth *13.9 ft. Eff. absorption area 782 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 7/18/2011 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 0 in. Elapsed Time: — min. Final fluid depth 0 in. Absorption rate >= 450+ g,p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (eveY/N "Pump on" level at in. "Pump off' level High water alarm ll at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ 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, Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ 100'+ 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 / certify that / 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 N me JEFFREY A. GARNESS Date Z 8J f COSA Fee $ Ifq d Date of Payment srh Receipt Number G3 I q 0-0 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SGS_ SGS Ref.# 1113371001 Client Name Aarow Pump & Well Service Printed Date/Time 07/28/2011 15:14 Project Name/# 9800 Hillside Drive Collected Date/Time 07/26/2011 9:00 Client Sample ID 9800 Hillside Drive Received Date/Time 07/26/2011 9:40 Matrix Drinking Water Technical Director Stephen C. Ede PW SID 0 Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 07/26/11 CR Total Coliform Negative 1 100mL SM20 9223B A 07/26/11 CR Municipality of Anchorage Gt 8 Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 01508106 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 4 of Thayermoore Heights subdivision. This inspection revealed a nitrate concentration of 5.83 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SGS Ref.# 1113220001 Client Name Garness Engineering Group, Ltd Project Name/# Thayer Moone Hts Bl, L4 Client Sample ID Thayer Moone Hts Bl, L4 Matrix Drinking Water Printed Date/Time 07/21/2011 16:34 Collected Date/Time 07/18/2011 11:25 Received Date/Time 07/18/2011 12:05 Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date snit Metals by ICP/MS Arsenic I Waters Department Total Nitrate/Nitrite-N Microbiology Laboratory E. Coli Total Coliform ND 5.00 5.83 0.100 Negative 1 Positive 1 ug/L EP200.8 C (<10) 07/19/11 07/20/11 NRB mg/L SM20 450ONO3-F B (<10) 07/18/11 AYC 100mL SM20 9223B A 100mL SM20 9223B A 07/18/11 DLC 07/18/11 DLC 15-' 11 16; 31 FFC'PI-kellerldi11iamsFealt;,, 9073656565 T-356 P0002/0002 F-059 � prepared by SURVEY c •nFlCATIOK a ° Robert E. Johns, Jr. & Assoc. A r� Proltss'8lonal Land Survp-yoru W=tw�fMr» . •ra,.. aK sa •r t+� , a RAo Lot 5•F. Roe. Plot F• No. th 9 n o 40' ►OUW13AA1AA�iC7 Dot* i''""p CfiOCk�Q D 0' � IM X14 A}A' Ml M �► J ."rw. T JGi 14. 2 Ci FMAI BTAtscYtAe6 A9r�LT r � L,fO� �rlAVnn: •�." ��1 W,.•.1...�ri a.�tr� •v p�df time. L ,� 4 Block "arw w ®���end r�`OYE ;IAi 11t5 ■r a.. od n� .fir ti1��a '9 .....wars., ►at tlnlvCr SUR1'�Y TYPE SYMBOLS ft11wDAU 11 MAwRT • SET p$8Aq `�° w DRANK E A5PHALT rpm BTWLFCMK haat o #1000 WMAA .o-.�o w000 rrNIX cor•aaCrC Rrr /Vw • .. �a va�7 ... Lar bu�cr ... P� �bpa A Urn ELEV. N- �— MC7K MMM M[40D QED PC.C3T PLANS br I.ONOT IT In TNF =PCNSIA TY OF j"r CKJIVC t°Cii bN O'fl!`I£R, PRIOR TO ONLY Tt1 FV tMPRo +tE sv nc oC the W3s,vW0C.AND "► Kgs OOMWWAY"% ca+sMVG-npi° TO vMFy pRopoWo 131.11 W'S rjRADC R'�kAi�< gtrowrv. FSNCF.F. wE';4e. _ TO PNl4'I�EP VKADE M Q v1>U N�NECn rW A" M M' C 17a++N5 ►gcw � rnip�Hi ouCNtl�plttivCM�w-M Mo%d IMNO elo-Q = AND Y6=ATW. •� E30Shti,= or MY �Mt• lUEJR1v1S'i0N DO"'S ALL D{STAN zo ARC 1vrmE#4 C1NLE33 DTFt Wi&� NOTED. M -PCH Do NOV APPEAR ON THS RECCR O ,r�,r.� ran nRaN�STAMt�9 bZiOulA rp ^S pU4r BE u3CD FV�Q G�1sRiuonon OR FOR C51AWW10 M -NU tY Qt PEtfCC Utl"- .. r Am Iry MLY Fat Tim cosi of THE SURVEY. 3 N 68'STOa' K' ____,,,„_, 187.1.8' �"�+;• f l 24.6' V 1 1 Of i ? m rn ry m r I � y • I ire CL WELL s40 o I S 89'5 10011 v h I � prepared by SURVEY c •nFlCATIOK a ° Robert E. Johns, Jr. & Assoc. A r� Proltss'8lonal Land Survp-yoru W=tw�fMr» . •ra,.. aK sa •r t+� , a RAo Lot 5•F. Roe. Plot F• No. th 9 n o 40' ►OUW13AA1AA�iC7 Dot* i''""p CfiOCk�Q D 0' � IM X14 A}A' Ml M �► J ."rw. T JGi 14. 2 Ci FMAI BTAtscYtAe6 A9r�LT r � L,fO� �rlAVnn: •�." ��1 W,.•.1...�ri a.�tr� •v p�df time. L ,� 4 Block "arw w ®���end r�`OYE ;IAi 11t5 ■r a.. od n� .fir ti1��a '9 .....wars., ►at tlnlvCr SUR1'�Y TYPE SYMBOLS ft11wDAU 11 MAwRT • SET p$8Aq `�° w DRANK E A5PHALT rpm BTWLFCMK haat o #1000 WMAA .o-.�o w000 rrNIX cor•aaCrC Rrr /Vw • .. �a va�7 ... Lar bu�cr ... P� �bpa A Urn ELEV. N- �— MC7K MMM M[40D QED PC.C3T PLANS br I.ONOT IT In TNF =PCNSIA TY OF j"r CKJIVC t°Cii bN O'fl!`I£R, PRIOR TO ONLY Tt1 FV tMPRo +tE sv nc oC the W3s,vW0C.AND "► Kgs OOMWWAY"% ca+sMVG-npi° TO vMFy pRopoWo 131.11 W'S rjRADC R'�kAi�< gtrowrv. FSNCF.F. wE';4e. _ TO PNl4'I�EP VKADE M Q v1>U N�NECn rW A" M M' C 17a++N5 ►gcw � rnip�Hi ouCNtl�plttivCM�w-M Mo%d IMNO elo-Q = AND Y6=ATW. •� E30Shti,= or MY �Mt• lUEJR1v1S'i0N DO"'S ALL D{STAN zo ARC 1vrmE#4 C1NLE33 DTFt Wi&� NOTED. M -PCH Do NOV APPEAR ON THS RECCR O ,r�,r.� ran nRaN�STAMt�9 bZiOulA rp ^S pU4r BE u3CD FV�Q G�1sRiuonon OR FOR C51AWW10 M -NU tY Qt PEtfCC Utl"- .. r Am Iry MLY Fat Tim cosi of THE SURVEY. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING r� R�-15Sv`re Parcel I.D. ois-o8i-o6 COSA# Expiration Date: 1. GENERAL INFORMATION Complete legal description Thayermore Heights Block z Lot 4 Location (site address) a800 Hillside Drive Anchorage, AK g95o7 Current Property owner(s) David Anderson Day phone (480) 2i6-o5L_ Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 121; S Alma School Rd #ss26 Chandler AZ 85224 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 _ 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone 317-f_75�a TYPE OF WASTEWATER DISPOSAL: Individual On-site 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 sample results. (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 verify that my investigation, based on prdcedures 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 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 _Pannone Engineering Services LLC Phone 272-8218 Address P.O. Box 102og4. Anchorage AK agsio Engineer's Printed Name Steven R. Pannone. P.E. Date_ (795P) (Zi/ Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with h10A DSD Guidelines & Regulations. The reported results describe 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 soil condition, ground water 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 this system. All systems eventually fail an satisfactory lest results do not guarantee future performance of the system, nor do they guarantee that there arc no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory _ Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date:_ (Rav 11leS) 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 SYSTEMS APPROVAL CHECKLIST Legal Description: Thavermore Heights Block a Lot y Parcel ID: o2s-oei-o6 A. WELL DATA Well type P Date completed 91221200 Total depthX06 ft. Date of test Static water levet If A. B, or C provide PWSID # _ Sanitary seat (YIN)Y Cased to 205.42 tt. FROM WELL LOG 012212003 468 ft. Well Log (Y/N) Y Wires properly protected (YIN) Y Casing height (above ground) 12+ in. AT INSPECTION 7/22/2008 z5S ft. ZD Well production 20 g.p.m. s.z g.p.m. WATER SAMPLE RESULTS: 9.57 Coliform colonies/100 mL Nitrate mg1L Other bacteria colonies/100 mL Arsenic: bW— mgll Date of sample:14Z&3 Collected by: Laura Pannone B. SEPTICIHOLDING TANK DATA 1710/0 Fi Tank Type/Material Anchorage Tank Steel Date installed 812s12ooa Tank size s000 gal. Number of Compartments a Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YM) NIA Date of pumping 7fta12oo8 Pumper Isaacs Pumping C. ABSORPTION FIELD DATA Date installed 8/2s/2oo3 Soil rating (g.p.d./ft2 or ft2/bdrm) 25o System type Deep Trench Length 46 ft. Width a ft. Gravel below pipe 8 ft. Total depth 21.75 ft. Elf. absorption area Lft2 Monitoring tube Y Depression over field N_ Date of adequacy test 7/2,4/2oo8 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth In absorption field before test o In. Water addedS2o gal. New deptho in. Elapsed Time: o min. Final fluid depth o in. Absorption rate >= &So+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) N If yes, give date F. COMMENTS G. ENGINEER'S CERTIFICATION ��:���. ,,,����0 I certify that I have determined through field inspections and 4 •., s r} review of Municipal records that the above systems are in , ...I .. .. .... conformance with MOA COSA guidelines in effect on this date. � Engineer's Printed Name Steven R. Pannone. P.E. # C sle+en f.' Pannone! • t:'• No CE 814�ri Date C r2_11 ,;:. .......... . .......••'c;: COSA Fee $_ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ _ Date of Payment Receipt Number, D. LIFT STATION J� % Date installed Size in lions Manhole/Access (Y/N) 'Pump on' levet at —in. 'Pump off" el at —in. High water alarm level at in. Datum Cycl t (Y \\ Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot loo+ On adjacent lots aoo+ Absorption field on lot soo+ On adjacent lots aoo+ Public sewer main m, joo-I itU Public sewer manhole/cleanout Sewer /septic service line u+ Holding tank loo+ Animal containment areas soo+ Manure/animal excrete storage areas soo+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation so+ Property line so+ Absorption field c+ Water main 7c+ Water service line xc+ Surface water aoo+ Wells on adjacent lots soo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ao+ Building foundation _ao+ Water main 75+ Water Service line zc+ Surface water aoo+ Driveway, parking/vehicle storage ao+ Curtain drain Wells on adjacent lots aoo+ F. COMMENTS G. ENGINEER'S CERTIFICATION ��:���. ,,,����0 I certify that I have determined through field inspections and 4 •., s r} review of Municipal records that the above systems are in , ...I .. .. .... conformance with MOA COSA guidelines in effect on this date. � Engineer's Printed Name Steven R. Pannone. P.E. # C sle+en f.' Pannone! • t:'• No CE 814�ri Date C r2_11 ,;:. .......... . .......••'c;: COSA Fee $_ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ _ Date of Payment Receipt Number, Municipality of Anchorage • '� Development Services Department Building Safety Division ` s• arr On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 080264 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 4 of Thayermore Heights subdivision. This inspection revealed a nitrate concentration of 6.57 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. 14 WIE U�J SCS Retia Client Name Project Name/N Client Sample ID \latria Sample Remarks: 1086627001 Pannone Eng. Srv. 9800 1 lillsidc 9800 1 lillside Drinking Water Printed Date lime Collected Date rime Received Dale/rime Technical Director 12/18/2008 13:13 12/10/2008 11:05 12/10/2008 17:05 Stephen C. Ede Parameter Rcsults POI. Units Method Container ID Allossablc Limits Prep Analysis Date Date Init Waters Department Total Nitrate/Nitrite-N 6.57 0.100 mg/L SX1204500NO3-F B (<10) 12/16/08 JDZ Microbiology Laboratory Colony Count 0 cot/100ml. SM20 92228 A (c200) 12/10/08 DLC Total Coliform 0 col/100ml- SN1209222B A (<I) 12/10/08 DLC Fecal Coliform 0 col/100mi. SM209222B A (<1) 12/10/08 DLC Municipality of Anchorage Development Services Department 4, -, Building Safety DivisionOn-Site Water and Wastewater Program4700 Bragaw StreetP.O. Box 196650G' Anchorage, AK 99519-6650 0l/ 111% � www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING o Parcel I.D. o15-o8i-o6 COSA # Expiration Date: 1. GENERAL INFORMATION Complete legal description Thayermore Heights Block i Lot 4 Location (site address) 9800 Hillside Drive Anchorage AK gg5o7 Current Property owner(s) David Anderson Day phone 1-480) 236-og6 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 129 S Alma School Rd #1126 Chandler. AZ 85224 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 'A 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site ED 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 sample results. (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 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Phone 272.82-18 Address P.O. BOX 2029S4. Anchorage. AK g9rio Engineer's Printed Name Steven R. Pannone. P.E. Date Engineers Comments: In conducting an adequacy lest, l attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe 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 soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. Tlese conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the 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. S. DSD SIGNATURE _( 11104 Approved for _ e2bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory x - Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 0 3;0, (nom tfa5 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 SYSTEMS APPROVAL CHECKLIST Legal Description: Thavermore Heights Block s Lot Parcel ID -oaS-obi-o6 A. WELL DATA Well type P If A. B, or C provide PWSID # _ Well Log (Y/N) Y Date completed 9L221200-4 Sanitary seal (Y/N)y Wiresed ro p p y protected (YM) Y Total depth 196 ft. Cased to 1GS.L3 ft. Casing height (above ground) sz+ in. FROM WELL LOG AT INSPECTION Date of test hga000 7/21/2008 Static water level _ 268 ft, Well production zo g.p.m. WATER SAMPLE RESULTS: — �— 1 _:_ g•p.m. Coliformcolonies/100 mL Nitrate (s. 0-2 mg/L Other bacteria colonies/100 Arsenic: 4& mg/I Date of sample: 71211os mL Collected by: Laura Pannone B. SEPTIC/HOLDING TANK DATA Tank Type/Material _Anchorage Tank Steel Date Installed 8/iihooa Tank size _%000 gal, Number of Compartments a Cleanouts (Y/N) Y Foundation cleanout (Y/N).y Depression over tank (Y/N) ),I High water alarm (Y/N) NIA Date of pumping _24518 oB Pumper Isaa s PUMDinO C. ABSORPTION FIELD DATA Date installed 8/11/2oo2 Soil rating (g.p.d./ft2 or i Length 66 ft. Width a Total depth 13jS ft. Eff. absorption area Lft2 Date of adequacy test Zh1/2oo8 Results Fluid depth in absorption field before test c in. Elapsed Time: o min. Final fluid depth o In. Any rejuvenation treatment (past 12 mo.) (Y/N & type) t2/bdrm) zco System type Deep Trench ft. Gravel below pipe _8.S ft Monitoring tube Y Depression over field LI (Pass/Fail) Pass For 3 bedrooms Water added5oo gal. i New deptho in. Absorption rate >= bSo+ g.p.d, N If yes, give date D. LIFT STATION Date Installed 'Pump on" level at_ In. Datum Manhole/Access (YIN) 'Pump ollf�' vel at _In. High water alarm level at in. Cycles).6Pb,d�.,_ Meets alarm & circuit requirements? E. SEPARATION DISTANCES / � SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankflift station on lot aoo+ Absorption field on lot %oo+ Public sewer main 15+ Sewer /septic service line ac+ On adjacent lots ioo+ On adjacent lots ioo+ Public sewer manhole/cleanout .acO l f f Holding tank ioo+ Animal containment areas zoo+ Manure/animal excrete storage areas aoo+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation io+ Property line %o+ Absorption field ;+ Water main 7s+ Water service line ZS+ Surface water loo+ Wells on adjacent lots zoo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line zo+ Building foundation zo+ Water main 7s+ Water Service line z5+ Surface water ioo+ Driveway, parking/vehicle storage so+ Curtain drain P'Y? *f' Wells on adjacent lots aoo+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field Inspections and review of Municipal records that the above systems are In conformance with MOA COSA guidelines In effect on this date. Engineer's Printed Name Steven R. Pannone. P.E. Date 0�-7 COSA Fee $ ✓v �po Waiver Fee $ _ Date of Payment g �d0 Date of Payment Receipt Number 5'ZPW-% Receipt Number (Rev. 11105) 'en R Ponni No CE 8149 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 080264 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 4 of Thayermore Heights subdivision. This inspection revealed a nitrate concentration of 6.07 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SGS RCU 1083569001 Client Name Pannone Eng. Srv. Project Name/N L4,B1 Thayermore Iits Client Sample ID L4,B1 Thayermorc fits Dlatric Drinking Water PN'SID 0 S.vnplc Remarks: All Dales/Times are Alaska Standard Time Printed Date/rime 08/052008 8:32 Collected Date/Time 07212008 13:30 Received Date/Time 07212008 13:55 Technical Director Stephen C. Ede ParametttAllowable Prep Analysis Results PQL Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 500 Waters Department Total Nitratc/Nitritc-N 6.07 0.100 ug/L EP200.8 C (<IO) 0725/08 07/31/08 NRB m8/L SM20450ONO3-F B (<IO) Microbiolow Laboratory Colony Count 0 col/IOOmL SM209222B Total Coliform 0 col/100mL SM209222B Fecal Coliform 0 col/IOOmL SM209222B A (<200) A (<I) A (<I) 08/01/08 JDZ 0721/08 DLC 0721108 DLC 0721/08 DLC 31O]GS-1mH k osv�lk®N it 4■ * % \0 .�\ it§ ■ . J ♦ ».,_.. ��a.:•��■ . ■ k2§@§k�k§% 0Z��o§ e o / § 2B[ \o SQ I LLJk$ko�§§ Lo- 2V)0): § ?§S°U[§qk°2 n §« §§ w R E b§�§b��kS\U \ m�0u \ am 00§(2 2 z �kz §z0 § R §§0°§ CL 2m ■ z ACMDX: 2� 2w§§ ) §/§�$ a )§ 5_��� r\ V) CIO a- k §§§k / 2 C¥E Q 2&U\ § § Municipality of Anchorage 1'1'•� PAGE eU/ •';(' Development Services Department , Building Safety Division o On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 0CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 015-081-06 HAA# LJLi DUB Expiration Date: j,)&2/U4 1. GENERAL INFORMATION T Complete legal description Lot 4; Block 1: Thayermore Heights Subdivision Location (site address or directions) 9800 Hillside Dr. Gai5a7 Current Property owner(s),;Dave & Patricia Anderson Day phone 227-1172 Mailing address Lending agency Mailing address Real Estate Agent PO Box 231021 Anchorage, AK 99523 Day phone Day phone Mailing Address 7 Unless otherwise requested, HAA will be held by DSD for pickup. /o 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well MK Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site X❑{ Individual Holding tank . ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (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 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Engineering Phone _ 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK //99577 Engineer's Printed Name Robert C. Cowan Date^ `7,//(O� 5. DSD SIGNATURE _ Approved for bedrooms. Disapproved. ROBERT C. COWAN CE -8801 Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: k . Q - Original Certificate Date: (Rev. 01/02) lvtu Deveto On- ��" If A B, or C rdutde PWSID # Well l o YE:S / xz'o3 Sanitary weal /N) �s Wires properly protected &N) Y&5 Y"°t#'a" ft Cased to r9 ft Cd''surg"Iieight (above ground) MOM >W' N_" R0 9Pm. q 6 J" 9Pm R�S'tUL`r. ' L�ns�riA WY colomes/900 ml Nitrate mg A. Other bacteria o colonies/100 mf }aY%a� r�°'�.# u#. � z'.t, c ,w�, �'w�✓�'-:^b°`,^�"`?�4R '`,e°�'x+" z±�.d��Fr+�e>w: L.r:+ ar ar � a�� ✓ s w : m / a e o semi e. �/ 2R u S & SENGINEERING _, . a a" a u 7 ap • ver Loop Wad No 204 '�agteiver, rro .. .. Fun,4+m�FS�`m?�✓""s�'si�a.a�`w...� a tx f"+dFce'k.4 ,.�Z+,,:a. �a,�n�f�•ata• strs�, � ' 03 �, v .. ... �`". ..a �4 4��¢Y�ffi`'dzi� .. r H �"� ue�' F:'�,^}� iv}2�✓x.54. .�h� ..,.'�.; 'S a 'gal. � f;i"um,6er of'Compartments` �� Cleanouts �) `i£ S ou N) YES _pepression oger tank High-water alarm"(Yf� /V ` N A NEw Pumper 1449 _7 4we� �:= f'eyKYEa x«r haw gcm4.�+ Y3TM+ Nv � v} P "/ �� Soil rating / z or ftZ/bdrm) © 6,. System type bE trti y7Rjr v cN ft." : Width '�� ft Gravel below prpe � $ �.<e„ahft _ ft � Eff abs�orpYibn areae a- ftp Monitdring ube YDS Depression over fieltl _ c est NEw' Results (Pass/Fail) For bedrooms orption Ia a ore'tes in at added_ gal. New depth to = Mn., :: ' al fluid depth _ In: Absorption rate"5 -� gp.d. atment'(past 12 mo.) (Y/N &'type) If yes, give date n u records that off level at igh water alarm level at in. tested Meets alarm & circuit requirements? fir.. .. C3 )Ove systems are in s in effecfon this date. �. ' p�� ROBERT L COWAN W C0("ig ���� -8801 ..4+/ar7er-Fee $ 17 Date of Payment i w `�^s ?n 5+."' ar .gr CWF �a ✓'' �� . _'.r,: a�+.�i . _ !� Receipt Number 9- 1-04; 4:25PM; CT&E Ref. #: 1045556001 Client Name: S & S Engineering Project Name: Thayermoore Hts, Lt 4, Bik 1 Client Sample ID: Thayermoore Hts, Lt 4, Bik 1 Matrix: Drinking Water PWSID n/a Sample ;907 5615301 ME Environmental Services 200 W. Potter Drive Anchorage, AK 99518 Tel: (907) 562-2343 Fax: (907) 561-5301 All dates/times are Alaska Standard Time Printed Date/Time: 09/01/04 16.30 Collected Datefrime: 06/29/04 19:00 Received Date/Time: 08/30/04� //�12:21 Technical Director: Stepher).,�fe Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Total Coliform (MF) 0 COV100 ml SM92228 09/01/04 DC Nitrate 4.23 1,00 mg/L EPA 300 10.0 09/01/04 JJB 08/03/04 1Q:18 FAX 1 907 563 6139 SIEMENS BLDG TECH-LANDIS N O N O HILLSIDE DRIVE D 1�2j0o1 414 N O HILLSIDE DRIVE D 1�2j0o1