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HomeMy WebLinkAboutSHELL #2 LT 6Shell #2 Lot 6 #015-112-23 Municipality of Anchorage © Development Services Department , Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 Page/ of _ - www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: S co cp O PID Number: Name: P/ Wastewater c r Wastewater System: New El Upgrade Address: Phone: ABSORPTION FIELD / Numder of Bedrooms: N11 Stip ;Lv (, f [.Deep Trench 0 Shallow Trench p Bad ❑ Mound Cl Other: LEGAL DESCRIPTION Boil Rating: Total Depth from originalgrade: Block: Lot:O'A47 GPD/FI° //0 Ft. `Salbdivisian: Depth to pipe bottom from original grade: Gravel depth beneath pipe: IV//11 Z 9 f Ft. 17,05- Tawnshi: r• 2 Ft. p Range: Section: Fill added some original grade: r Gravel Length: . -.I 5 Ft. / Z Ft. I - Well' XNew L. 1 UDorade Gravel v^dth: Number of lines: Distance between lines: Classification (Private, A, S. C): Total DepM: ,�;Z Cased to: �l ���y�l T " FL Total absorption area: I Ft. Pipe Material: V H FL Ft. Driller: � , Date Red: SFab<Watw Level: ,} l 33�ij, Ftp Installer. ZJ'0'Tj Date Install d: (YI C �/0 O ZZI/ Ft. Yield: Pump Set at: Casing Height Above Ground: 20 GPM 011460W TANK Ft. Z,O Ft. SEPARATION DISTANCES 5rseptic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic AbS0rpf100 t.lft Tank Field Station Holding ubliGPrivate Tank ^ufacturer. Capacity. Sewer Line Nr yn� f ?_50 Gal. Well /U,Q 4. ��(� BOO �� Material: Number of Compartments: Surface Water (vo ��0 rf LIFT STATION Lot Line 15 rl�� arta aclurer. T J T Gat. Foundation 2—o f4- 20 1 4. 'Pump on' level at: ' u at: High rater alarm at: C Wain Drain j•// , N �, in. Pump Make 8 Model n. Electrical Inspections perfomletl by: Remarks: BENCHMARK Location arta oescripuon: Assumed Elevation: r Ft. .... /(9V Engineer's Stamp `�®",xx% of !ac���llt Inspections performed by: {,t�r(sai1 Dates: 1at °% yS G� *' 4SITH 2nd y 5 9f°p Qdk • f ... , .�/.� Development Services Department Approval :MICHAEL N. ANDERSON a• ; Reviewed and approved by: fj�''p'r���`,{i'. CE 94 9 (a<.- ipoi Date:_ l,l �,L. �+, 1/P,•, • r 1 `ti®Vi;/ Permit No, SWO30470 Page 2 of 2 DATE: 10/14/04 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 6, SHELL SUBDIVISION NO. 2 PID No.: 015-112-23 SEPTIC SECTION N.T.S. 100' WELL RADIUS \ ADdI(C ENT 'EXISTING \ \ \\ HOUSE C /C05LOT I 7 WELL \ I MOUN DIRT \ LOT 6 A OUND LS \ \ \ I OR RUNO MTi Col A \\\ I \\F,pL� \I \\ ELL \���9,P! / \ \\� \ TH#1 evla EXISTING p ap HOUSE \ \ 1 \ 8 Solt GRAVEL DRIVEWAY / 2----- TCO2 — — CO2 � 10' EASEMENT 1,2 GALL N TC01 � � / SEPTIC TANK—/\ / MARK GRND. PIPE ELEV. ELEV. Col 10.0 34.0 98.5 95.3 CO2 62.0 42.0 96.5 93.5 i TCo1 64.0 44.0 98.5 TCO2 67.0 51.0 98.5\ 100' WELL RADIUS / CO3 69.3 54.5 96.6 93.8 \�'------�� C04 89.1 74.2 96.6 92.3 MT 102.5 112.1 97.7 ASBUILT COS 122.2 125.0 95.2 92.3 SCALE: 1"=40' - �D •'_SSn SV.B$ -O'MALLEY ROAD- Col CO2 To, az Co3 "110o. o= .•PSE OF q44 yg5 V, Mil .��( �........... .....�� ♦I QV. ••� MITER FABRIC / / •• •iv.uu................./ SM `AELON T. ; 1� :.MICHAEL N. ANDERSON.* -,.O 1.ln':. No. GE 9469 i SEPTIC SECTION N.T.S. FROM : ALPINE DRILLING FAX NO. : 907 345 0202 Sep. 17 2004 10:26RM P2 .,� Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Rick Mystrom http://www.c1.anchorage.ak.us Mayor Permit Number. #SW 030470 Date of Issue: 41-10-03 Parcel Identification Number: 015 -112 - Date Started: 8-9-4 Date Completed: 8-10-04 Is well located at approved permit location? ® Yes [7 No Legal Description: Shell # 2 Lot 6 Property Owner Name & Address: Spinnell Homes 1900 Northem Lights Blvd. Ste 201 Anchorage, Alaska 99517 Borehole Data: Depth (ft) Soil Type, Thickness & Water Stram From To stick-up _.. 0 2 silt 2 12 gravelly silt 12 34 silt cobbly gravel 34 68 cobbly gravel 68 gy silty sand 89 112 silty cobbly gravel 112 156 Silt 156 180 gravelly silt 180 183 silty cobbly gravel w/bldrs 183 230 gravelly sandy silt 230 254 silt 254 267 water sand & gravel 267 269 Method of Drilling 17 air rotary cable tool Casing type: steel Walt Thickness: .250 inches Diameter: 5 inches Depth: 269 feet Liner Type: Diameter: inches Depth: Casing stickup above ground: 2 fe Static water level (from ground le el): 221 feet Pumping level: 267 feet after 2 hours pumping 20 gpm Recovery Rate: 20 gpm Method of Testing: airlift Well Intake Opening Type: Open End ❑Open Hole ❑ Screened Start Feet Stopped feet [] Perforations Start feet Stopped feet Grout Type: bentonite # 8 Volume: 1 Depth: Start 0 feet Stopped 20 feet Pump: Intake Depth feet Pttm size h Brand Name Well Disinfected Upon Completion? ®Yes [] No Method of Disinfection: chlorine tablets Comments: Well Driller: Alpine Drilling & Enterprises PO Box 110496 Anchorage Alaska 99511 Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property Municipality of Anchorage P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Tcli.hhone (907) 343-&301 • Far (907) 343-8200 .� 4700 Bragaw Street • Anchortigc, Alas] a 99507 �S a E Magor Mark Begich umlt.munl'o g Building Safety Division 10/18/2004 Michael N. Anderson 4640 Shushoni Avenue Anchorage, Alaska 99516 Subject: Waiver Request for Shell#2, Lot 6 Waiver Request #WR040075 Parcel ID #015-112-23 HAA# HAO40543 Dear Engineer: Your request for a waiver of the required 100 feet horizontal separation from the animal containment area to the private well has been approved. The approved separation distance is 30.0 feet. This waiver approval applies to the existing animal containment area to private well separation only. Any future upgrade to the on-site water supply system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Julie Makela, P.E. Civil Engineer On -Site Water & Wastewater Program Community, Security, Prosperity _ A -- , "� - inicipaiity of Anc orage Ka�...w - mx1F .. pGG a4i elopment S"erV IC s epartment r" Building$afetybiyvisigrr s fin-Sit¢�Vateran�aslewakerProgram�`� 4700 B"ragaw Stieet .,.. . r y,. Box"(46`6nc`Tiorage'•_A www.ci.ancnor or orage. ak.us -.. (903437404_��,_�,�,_...w_-...,_ _.... _ .� VaiverRe; ie-*-Wo—r—izs`ieet 23 Prrr�i Ae Gra fent `` Totaf Michael N. Anderson, P.E. Civil/Structural Engineering and Excavation 4640 Shoshoni Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 October 14, 2004 i.N O2 K 343-5-221 Municipality of Anchorage Department of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Re: Lot 6 Shell No. #2 S/D, Waiver Request from "Animal Containment Area" To Whom It May Concern: This is a request for a waiver from an animal containment area. The lot directly to the east has horses and corrals within the 100 foot setback of the existing well. The following items are my rational for the granting of this waiver: 1. The well is very deep 267 feet. 2. The Animal Containment Area is located across the oiled road and down hill from this site. 3. The water test has low nitrate level typical for the area, test sheet attached. 4. The coliform and other bacteria are zero, test sheet attached. 5. The soils around the well has been mounded up for maximum drainage. If you have any question please call me at 345-3377 Sincerely �✓%�r�ic-i Michael N. Anderson, P.E. 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 Initial Permit Number: SW030470 Legal Description:1Shpjt'91Co Design Engineer: 0088 Anderson Construction & Eng'g Owner Name: S�yy,pinell Homes Owner Address: "tHIMBREL DRIVE Anchorage , AK 99507- "I-l5--zy Date Issued: Nov 10, 2003 Expiration Date: Nov 09, 2004 ParcelID: 015-112-23 Site Address: 4301 O'Malley Road Lot Size: 15653 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: 0 Disposal Field Z Septic Tank Holding Tank O 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:1AkU Date: �� 03 I -. 0 0 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us .0Q Igor (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. () k C ` I h Z 2'3 Permit Number SW030470 Property owner(s)_ S p n e ►' Ft) rrr Q S Day phone 3 41g - S-& ; Mailing address (1 Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size ,i Sq Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well (�s Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot 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 Dwelling and is in accordance with applicable Municipal Codes. . (Signature of property owner or authorized agent) Permit Fees: S Tj' O Date of Payment: ///--?/o Receipt Number: uq-3"7 (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: �© + c, -o 2u56 Michael N. Anderson, P.E. Civil/Structural Engineering and Excavation 4640 Shoshoni Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 November 7. 2003 Municipality of Anchorage Department of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Re: Lot 6 Shell No. #2 S/D To Whom It May Concern This is a request for a new septic and well permit for a new home. A test hole was excavated and found to have loose silty sand SM for the complete depth. The pere was 40 minutes per inch with no water observed for the complete 18'. The new system design consists of a deep trench with 9 feet of rock starting at elevation -2 feet for a total length of 74 feet, see the drawings. An existing well was found on the west end of the lot however it will be cut below grade and fill with concrete. Without doing this the lot is difficult to develop an alternate site for the septic system. Also a 5 foot lot line waiver is requested along the north and west property line, see the plan. This will not impact the neighboring system on the west side, which is already developed and has a large lot. Lot 7 Shell on the north side is owned by Spinell Homes, and is tieing developed at the same time. The lot slopes gently to the west at about 2 to 5 percent. The lot is bordered by two streets therefore this new system will not encroach any neighboring lots for future development along the east of north boundary. If you have any question please call me at 345-3377 SinWIN. Minderson, P.E. DESIGN CRITERIA: 4 BDRM X 150 = 600 GPD SOILS'= 600/0.45 = 1330 SQ FT REQ'D 1330/18 = 74.0' TRENCH SYSTEM 12.0' DEEP 9.0' EFFECTIVE 2.0' WIDE 74' LONG 0' M A L L E Y R 0 A D TRENCH SECTION N.T.S. > m EXIS ING 100' WELL RADI JS — TYPICAL w J 1 \V g 1 / / - w a4\ Z PROPOSED HOUSE NEW SEPTIC SYSTEM OVER BRIG Septic Design Prepared For SPINELL HOMES, INC. LOT 6 SHELL NO. 2 SUBDIVISION ®�' • l A. Prepared By . ...... . .. P ,•'. %'r � j..•01 •...� MICHAEL N. ANDERSON, P.E. %r ':. �:.�1✓Y/ L.... 4640 SHOSHONI DRIVE ;MICHAEL N. ANDERSON ; e° (907) 345-3377 / FAX (907) 345-1391 e s'. CE/9a 9Il SCALE: 1"=200' OCTOBER 30, 2003 k,�pROFESSIQ��V�= Is WELL I o\ I I \ I \ \ \ LL TO AND,' / / / / ZT / C V71111 �o -RESERVE DRAINFIELD I \ I \\ I \ I \ I \`� -LOT8- I I / i 100' EXISTING WELL \ / RADIUS - TYPICAL DRIVEWAY N D O / O_ / m / Z / 3 / I DRAINFIELD -LOT7- � I I I WELL I WELL I DRIVEWAY -LOT6- 7 — — — — — — — — — — - \,10' ILITY EASEMENT - 0' M A L L E Y R 0 A D - Septic Design Prepared For SPINELL HOMES, INC. LOT 6 SHELL NO. 2 SUBDIVISION Prepared By MICHAEL N. ANDERSON, P.E. 4640 SHOSHONI DRIVE (907) 345-3377 / FAX (907) 345-1391 SCALE: 1"=30' OCTOBER 30, 2003 ..� .• a , �a � tea.° °•7, I. c%�� . Y A -�q• MICHAEL N. Aj�NDERSpNe; y' 1,250 GALLON \ \ w \ `� SEPTIC TANK \ \ oz DOUBLE C \ \ a ` o CO ° DRIVEWAY -LOT6- 7 — — — — — — — — — — - \,10' ILITY EASEMENT - 0' M A L L E Y R 0 A D - Septic Design Prepared For SPINELL HOMES, INC. LOT 6 SHELL NO. 2 SUBDIVISION Prepared By MICHAEL N. ANDERSON, P.E. 4640 SHOSHONI DRIVE (907) 345-3377 / FAX (907) 345-1391 SCALE: 1"=30' OCTOBER 30, 2003 ..� .• a , �a � tea.° °•7, I. c%�� . Y A -�q• MICHAEL N. Aj�NDERSpNe; y' Municipality of Anchorage. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: LJ DATE PER LEGAL DESCRIPTION: L 6 I` 6 yjt%/ lit` 2 Township, Range, Section: DEPTH SLOPE 1 2 3 4 5 6 7 s 9 10 11 12 13 14 15- 16- 17- 19 20 COMMENTS 4- 1 1 00 s c //6'V WAS GROUND WATER �'' ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After MonitoringT o n5- Date: ,s ym MICHAEL N. ANDERSON CE -946,9 d PLAN Reading Date Gross Net Time Time Depth?e Water Net Drop rT 5p� Tr r5I Min' , 3u.r& " 13y ' 7, 3 VY r. PERCOLATION RATE y0 (minuteVinch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND S FT PERFORMED BY: Mt ek •T/N4. L <rb/rr I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:. 72-008 (Rev. 4/85) Municipality of Anchorage k � M. Mark Begich, Mayor: 5P c Building Safety Division iv P.O. Box 196650 • 4700 Bragaw Street Anchorage, Alaska 99519-6650 • (907) 343.8301 • Fax (907) 343.8200 http://www.m=i.org November 10, 2003 Michael N. Anderson, P.E. Anderson Construction & Engineering 4640 Shoshoni Avenue Anchorage, AK 99516 Subject: Waiver Request for Shell #2 Lot 6 Waiver Request # WR030103 PID #015-112-23 Dear Mr. Anderson: Your request for waiver of the required 10 feet horizontal separation from a property line to a wastewater absorption field has been approved. The approved separation distance is 5 foot along the north and west property line. This waiver approval applies to the existing on-site wastewater disposal system to property line separation only. Any future upgrade to the on-site wastewater disposal system will required all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343- 7904. Sincerely, Daniel J Roth Civil Engineer On -Site Water & Wastewater Section 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 FOR A SINGLE FAMILY DWELLING Parcel I.D. OI -1 a - a3 COSA# 3 S 1. GENERAL INFORMATION Expiration Date: 3 A / D Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SHELL S/D k2: LOT 6 10734 WHIMBREL DRIVE • ANCHORAGE. AK • 99507 STEPHANIE & MICHAEL CLEMENS Dayphone 561-0695 10734 WHIMBREL DRIVE • ANCHORAGE. AK • 99507 Day phone MATT DIMMICK W/ KELLER WILUAMS Day phone 665-6520 101 W. BENSON BLVD, #503 ' ANCHORAGE, AK • 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SURE 101 * ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineers 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 d Regulations. The reported results described the performance of the system under the conditions encountered at the time of the tes4 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 lost results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTO. can therefore not provido 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. S. DSD SIGNATURE _$G Approved for ! bedrooms. Disapproved. Date I z3kc, Conditional approval for bedrooms, with the illowing stipulations: Attachments: COSA Checklist yll� Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineers Report Nitrat Advisory Other f3Y: Original Certificate Date: �n (Rev. 11A5) 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: SHELL q2: LOT 6 Parcel ID: A. WELL DATA Well type PRNATE If A. B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 8/10/2004 Sanitary seal (YIN) YES Wires property protected (YIN) YES Total depth 269 ft. Cased to 269 ft. Casing height (above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test 8/10/2004 11/19/2009 Static water level 221 ft. 213_ft. Well pr ._... - .... �... :.. oduction 20 g.p.m. 6.47 g.p.m. WATER SAMPLE RESULTS: ColiformtlY� colonies/100 m1. Nitrate.-mg./L. Other bacteria mi. Arsenic: ND ug./L. Date of sampie:l 1/17/200 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SPETIC/STEEL Date installed 9/15/2004 Tank size 1250 gal. Number of Compartments 2 Cieanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 11/20/2009 Pumper DENALI SEWER AND DRAIN C. ABSORPTION FIELD DATA V13ELOW EXISTING GRAD Date installed 9/15/2004 Soil rating (g.p.d./* /bd)0.45 System type DEEP TRENCH Length 72 ft. Width 2 ft. Gravel below pipe 9.25 ft. Total depth +14.3 ft. Eff. absorption area 1332 W Monitoring tube YES Depression over field NO Date of adequacy test 11/19/09 Results (Pass/Fall) PASS For 4 bedrooms Fluid depth In absorption field before test 59 in. Water added 600 gal. New depth52 in. Elapsed Time: 150 min. Final fluid depth77 in. Absorption rate >= 600+ g,p,d• Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off" level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 'PER EXISTING WAIVER. #WR040075 Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank Animal containment areas '30'+ 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 '*3'+ 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 +•5'+ WAIVER EXISTING. DISTANCE ACCORDING TO AS—BUILT SURVEY IS 3'+. REQUEST AMMENDMENT TO EXISTING WAIVER. G. ENGINEER'S CERTIFICATION 00 ..• •.... gsrpo I certify that I have determined through held inspections and review of Municipal records that the above systems are in ""•.. .. • ""' •' • •... conformance with MOA COSA guidelines in effect on this 0 date. f Gar ess. Engineer's Printed Name JEFFREY A. GARNESS �04� CE79 3 e� [ SFO Date t1/23/p�i P'T�ba�\ �D�O�0000 COSA Fee 5 i/ 90' o Waiver Fee $ Date of Payment/? yf Date of Payment Receipt Number 8y3� q Receipt Number (Rev. >>ros) t Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http:llwww.muni.org/Onsite Development Services Department On -Site Water and Wastewater Proaram Ment `o q, Department **** VARIANCE/WAIVER REVIEW **** WR#: 090067 HAM 090435 Permit#: PID#: 015-112-23 Legal Description: Shell #2. Lot 6 Engineer. GEG Applicant: Stephanie & Michael Clemens Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 3.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ............. .............................................................. ass$ Waiver is Granted: X Waiver Is not Grant Date: 12009 Approved /Til t t r Name of Reviewer ............................................................................a Rec#: 64319 Amount: $0.00 Date Paid: 11/24109 **** VARIANCE/WAIVER REVIEW **** rim f 0 znn •i 50' f.7.g4 qqA LnF 'oN ym weal :iotwwtn mA wa pc : in ani /pnn7 /1 I /A SCS Ref.# 1096246001 Client Name Gamess Engineering Group, Ltd Project Name/Al Shell #2 L6 Client Sample ID Shell #2 L6 Matrix Drinking Water Printed Date/Time 11/20/2009 15:32 Collected DatefTime 11/17/2009 16:15 Received Date/Time 11/17/2009 16:30 Technical Director Stephen C. Ede Samplc Remarks: Allowable Prep Analysts Parameter Rnults PQL Units Method Comamtt ID Limas Date Date Inn Metals by ICP/M3 Arsenic ND 5.00 ug/L EP200.8 C (<10) 11/18/0911/19/09 NRB Waters Department Total Nitratc/Nitritc-N 3.73 0.100 mg/L SM204500NO3-F B (<10) 11/20/09 LCE Microbiology Laboratory Colony Count 0 col/100mL SM209222B A (<200) 11/17/09 DLC Total Coliform 0 col/l00mL SN1209222B A (<I) 11/17/09 DLC Fecal Coliform 0 col/100mL SM209222B A (<I) 11/17/09 DLC Municipality of Anchorage Development Services Department Building Safety Division 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 llopko CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR SINGLE FAMILY DWELLING Parcel I.D. 001;— 11'L, 2 3 HAA# t%Un Expiration Date: _/ — IA'dtprs�� 1. GENERAL INFORMATION Complete legal description Location (site address or directions) �� 3 L� J tib, oyv j� ✓1���� Current Property owner(s) S p r,) c (� !Fan �_ Day phone 39;P63 H&t ,'56 ;z 8' Mailing address _ Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 Day phone Day phone 3. TYPE OF WATER SUPPLY:, TYPE OF WASTEWATER DISPOSAL: Individual Well E Individual On-site 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 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. 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 t -%r dP� A 14AJ-eVfdr4 Phone Address 41, -4o Stiushan (/Fv/, j� k 9 9Sf(o Engineer's Printed Name Mks .el/ Ak,4j. i sorT P. F1 Date !v /y ON V. ir,• MICHAEL N. ANDERSON ;4� 5. DSD S GNATURE r i• CE -94 9.0z 100 Approved for _ !� _ bedrooms. ralliF�•N'• •Yk`t�,\� � Disapproved. Conditional approval for bedrooms, with the following stipulations: MWl 111I1Mua. HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: \J ,p. ].t . Original Certificate Date:lqh (RW. 01/02) r �D. LIFT STATION . Da e ' Size in gallons Manhole/Access (Y/N) "Pump on" level at _in. "Pump o t?vei at=_jn. High water alarm level at in. Datum Cycles tested Meets alarm & circwTem ents9 E. S'EPARATIO'N"DISTANCES"'��` ' ' � SEPARATION DISTANCES FROM WELL'ON LOTTO: Septic tank/1441 tabes on lot /00 /� On adjacent lots /r70 Absorption field on lot /U 0 t -F On adjacent lots (00-f Public sewer main 7� ��: Public sewer manhole/cleanout Sewer /septic service line T S Holding tank SEPARATION DI`STAIVCES FROM SEPTIC/H9EB4NF TAN`K"'ON"L'OT"TO. Building foundation L®/f- Property line /5 r� Absorption field /0 Water main FfA Water service line S 0 /i Surface water /U v i Wells on adjacent lots SEPARATION -DISTANCE FROM A"BSORPTION'FIELD`ONLOTI'U. Property line T14 Building foundation 2 0 114 Water main Water Service line ' /00"L Surface water / ov (.It f Driveway, parking/vehicle storage SD Curtain drain !✓/� Wells on adjacent lots /o0 (+ F. COMMENTS_... � �_„ � _ :, � ._u _._. _, .. _. _..! .. . .G. ENGINEEWS'CEZTTFICATION "' w .. �� OF A(q�gd �gip,•,. ••sus' I certify that / have detenmined through field inspections andj y' • • 9 rd review of Municipal records that the above systems are in / *:•49TH conformance with MOA NAA guidelines in effect on this date. X.......® Engineer s Printed Name M t r( p r[' %c(.4N J r04-u'� 10 MICHAEL N. ANDERSON Date /0 ------------- HAA b A HAA Fee $43 0 75-g-0 R tqf H f-2 j0 00 �ao�a aiver Fee $ Date of Payment IO o¢ Date of Payment Receipt Number 0 5-9,0- 7 _. Receipt Number .. (Rev. 1Z/01)'' 10-14-04 03:44PM FRNKT&E ES!, SES ENV SERVICES HTH15301 T-535 P.03104 --431 r Mat4u Test Lab of Alaska V iater Quality Testing Mile 3.2 Palmer•Wasilla tiwy. P.O. box 2749 Midtown Community Business Park - Palmer, Ak. 99645 Phone: (9071745-3005 Email: mat sutesttabZroaershsa com Fax: (907)749-3010 Client: SGS Envircnrnental Ann.: Forest Taylor Client ID: ID40843001 PWSID #: Source: WS.T.1-1: 2004890 £ample Matrix: Comments: Cate Arrived: 10/12/04 Report Date: 1D112I04 Sample Date: 1018104 Sample Time: 0815 Collected By: {, en=�h..a ParamPiser units Results MDL Date Prepared Date Analyzed MCL__'I{ SM 4500-NO3-E Total NO3W02 mg/L Legend: MRI.= Method Repan level MCL = Max. Contaminate Level B = Presets In Method Blank E = Estimated Value H ASove MCL p = Lust to Di'l.ution ftep�rted E y Jon Paul Campkell Lab/Supervisor <MDL 0.50 10/12/04 10/12/04 10.0 1C-i4-04 C3:44PM FROM-CT&E ESI, SGS ENV SERVICES 'SGs" - SGS Ref.# 1046643001 Client Name Mike N. Anderson, P.E. Project NameM Shell #2 Lai 6 Client SnmRle 1D Shell #2 Lot 6 Matrix Drinking Water 9075615301 T-555 P. 02/04 F-431 All Dates/Times are Alaska Standard Time Printed Date/Time 10/14/2004 16:33 Collected Date/Time 10/08/2004 8:15 Received Data/Time 10/08/2004 8:45 Technical Director /�Sttts► n C. Ede Release,l,,J Sample Remarks Total nivite/nitrate was analyzed by Mat-Sa Test Lab of Alaska. Altowable Prep .4nalym Parameter i>.eSnits PQL Units Method ContainerlD Limits _ Date Dam last Microbiology Laboratory Total Coliform. U co1J100mL SM209222A A (<=1) 10;08/04 PKC