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Home My WebLink AboutMANN BLK 5 LT 5Ta 9.,.lgo7 0.1 t t #020-481-05 Mayor Municipality of Anchorage Department of Health and Human Services 825 OV Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http:/Avww.d.anehorage.ak.us Permit Number. #S W Date of Issue: 3-25.04 Date Started: 7-20-04 Date Completed: 7-21-04 Legal Description: Mann Block 5 Lot 5 Property Owner Name & Address: Diamond Bldrs. Inc. PO Box 221223 Parcel Identification Number 020-481-05 Is well located at approved permit location? ® Yes ❑ No Borehole Data: Depth (ft) Method of Drilling ® air rotary ❑ cable tool Soil Type, Thickness & Water Strata From To Casing type: ILU-1 Stick up 0 2 Wall Thickness: 2M inches gravel/ Nil 2 5 Diameter: finches Depth: 4Q feet organics and slit 5 8 IJfner Type: silt 8 12 Diameter' inches Depth: feet Casing stickup above ground: Z feet gravelly am 12 21 Static water level (from ground level): Meet bedrock 21 306 Pumping level:_Nk-feet after hours kwnking 4 giro Recovery Rate: 4 gpm Method of Testing: " Well Intake Opening Type: ❑ Open End ® Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: bentonite # 8 Volume: j Depth: Start Q feet Stopped Z feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? 0 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 J41___t _)r .. ___'L»—tt t__—a _1 ...a sti._..._..n_..__.. __JA!._!A J_____J'__». MUNICIPALITY OF ANCHORAGE 4 Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Permit Number: SWO40036 Legal Description: iuiann Block 5 Lot 5 i Design Engineer: 0088 Anderson Construction & Eng'g Owner Name: Diamond Builders, Inc. Owner Address: P.O. Box 221223 Anchorage , AK 99503 - Date Issued: Mar 25, 2004 Expiration Date: Mar 25, 2005 Parcel ID: 020-481-05 Site Address: Unknown Lot Size: 45820 SO. FT. Total Bedrooms: 4 1 Permit Bedrooms: 4 This permit is for the construction of. ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked 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 Date: g 1 $6 Date: Zj 2 So 4 Municipality of Anchorage Development Services Departmentffi`o • +� Building Safety Division On -Site Water and Wastewater Program .y 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. nZD_ W' l ` Permit Number SW Property owner(s) Diamond Builders Inc. Day phone 522.4826 Mailing address (1) P.O. Box 221223 Anchorage AK 9952 Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Lot 5 Block 5 Mann Subdivision Legal description (Section, Township & Range) Lot Size -4:N-Aeres'i Qacre Sq.Ft. Number of Bedrooms Four (4) THIS APPLICATION IS FOR: Sewer Only ❑ Well Only Sewer and Well ❑ 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: $175 `= Waiver Fees: Date of Payment: 3 — ZZ' O Date of Payment: Receipt Number: 4q5-6 3 Receipt Number: (Rev. 12/00) -a N O°as nb"W /4s. i2 t,p 1t y o M MUNICIPALITY OF ANCHORAGE O Development Services Department L Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-481-05 Expiration Date: 1. GENERAL INFORMATION Complete legal description MANN BLOCK 5, LOT 5 Location (site address) 16010 GOLDEN VIEW DRIVE, ANCHORAGE, AK 99516 Current property owner(s) LISA & JEFFREY HOUGHTON Mailing address Real estate agent Day phone 16010 GOLDEN VIEW DRIVE, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ❑X Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Private Well Private Septic Water Storage ❑ Community Well ❑ Public Water System ❑ Day phone TYPE OF WASTEWATER DISPOSAL: Private Septic ❑ Holding Tank ❑ Community ❑ Public Sewer Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee o a r o Date of Payment '511 1 0 Receipt Number 3IRI ` b COSA # Oma d 11'3-3 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 5/11/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to Or these various and dynamic characteristics and are outside the control of the evaluator of the AJ well and septic system. Therefore, any estimate of how long a system will function satisfactory r�P• • • . for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWCS *• -49 ii•I �'* 6. DSD SIGNATURE � � •••••• �••�" • • Curtis Huffman System #1 Approved for bedrooms 'A ?I �F6 •- CE 128991 __q �� fe�V11 /20?�0-'� System #2 Approved for bedrooms 11` �PROFESS10Nt Disapproved Conditional approval for bedrooms, with the following stipulations: H+% V 7A ,r WATER AND WASTL-,Y pRE3G�E� lj�/J J FNT SER�.��l�l\1 Original Certificate Date: 5-- ( `T' W The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: MANN BLOCK 5 LOT 5 Parcel ID: 020-481-05 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA dequacy test date ® Well log is filed with Onsite (or attached) Water storage tank volume 520 gallons Date drilled 7/21/2004 Well disinfected for coliform test? ❑ Yes ® No Total depth 306 ft ® Coliform bacteria is Negative Cased to *40 ft *(Into bedrock) Nitrate mg/L ® Nitrate less than MRL (ND) ® Sanitary seal is functioning correctly Arsenic ug/L ® Arsenic less than MRL (ND) ® Wires are properly protected FWES Casing height (above ground) 18+ in. Collected by Date of flow test for COSA 5/1/2020 Absorption rate gpd Static water level at beginning of test 82+ ft. Date of Sample 5/1 & 5/5/20 Well production at time of test 1.91 gpm If yes, enter date Comments Storage tanks bypassed for test. Arsenic samples pre & post treatment. No packer. 8:�.,,TANK DATA - NA Age o\f t k(s) _ years Tank type�t-nal _ Measured operatingNfl�uid level in septic tank ® Stand pipes/fou ndat o ,z cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA - NA C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Which system tested (date installed) dequacy test date ❑ ALL standpipes present per record drawing Results ❑ Pass For bedrooms Total measured depth from grade _ft (max) Fluid depth prior to test in Measured depth to pipe invert from grade (min) "ter added gal ❑ N/A — pressurized field New de- h in ❑ Monitor tubes go to bottom of e fective. If not, state depth into effective Elapsed time min ❑ Code -required soil e"r over field Final fluid depth i l ❑ System presoaked Absorption rate gpd (Required if v7,t for greater than 30 days prior to Any rejuvenation treatment (p 12 months) date of test) GalloKs introduced gallons If yes, enter date Comments/Deficiencies .11 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Building Foundation > 10' ®Yes Community Sewer Manhole/Cleanout > 100' ❑ Yes if No NA ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ❑ Yes if No NA ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Water Main > 10' Animal Containment > 50' ® Yes if No ® Yes if No ft ®Yes if No ft Community Wells > 200' Yes - � ..,,,, if No Surface r6 -ter > 100' Manure/Animal Excreta Storage > 100' if No Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Buil ig-Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes /if Property Line >`5: ® Yes if No ft Wells on Adjacent Lots: ft ft ft ft ft ft Absorption Field > 5' �® Yes if No ft Private Wells > 100' ®Yes if No ft Water Main > 10' [�_Ye-s� if No ft Community We,1,'s 200' ® Yes if No ft Water Service Line > 10' ® Yes if N7� ft If Se tic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distanc i-ir ess than required) Building Foundation > 10' ®Yes i f ft If ab �tption field is under driveway comment below Property Line > 10' ® s- if No _ ft Wells on Adl t Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' `�-,� ® Yes if No _ ft � ~ Water Service Lipe> 10' ®Yes if No ft Community Wells > 200' Yes - � ..,,,, if No Surface r6 -ter > 100' ® Yes if No ft P, F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review ,®AW rQ:. •' of Municipal records that the above systems are in conformance 0 ��• with MOA COSA guidelines in effect on this date. * • • ..': vim...-. j Curtis Huffman �f c CE 128991 .•i4`�®� �� /�`c - /.12/202Q . - f a Municipality of Anchorage I.<a On -Site Water & Wastewater Program (907)343-7904 T CERTIFICATE OF ON-SITE SYSTEMS APPROVAL I e Parcel I.D. 020-481-05 Expiration Date: y - Lr 1. GENERAL INFORMATION Complete legal description MANN S/D; BLOCK 5, LOT 5 Location (site address) 16010 GOLDENVIEW DRIVE, ANCHORAGE, AK, 99516 Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: ROALD & CARLY HELGESON Day phone 723-4940 16010 GOLDENVIEW DRIVE, ANCHORAGE, AK, 99516 PATTY HIGGINS W/ JACK WHITE Day phone ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: 360-2561 TYPE OF WASTEWATER DISPOSAL: Individual Well N Individual On-site ❑ Individual Water Storaq_e ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer 0 Waiver/Variance request for: N/A Distance: Received by: ) Date: V COSA to be release d//i the engineer,unless otherwise requestetl by the engineer. COSA Fee Date of Payment �N &5 Receipt Number 6 /�,9161 76 COSA# 0005-1!a9 Waiver Fee $ Date of Payment Receipt Number Waiver 9 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(aro) in compliance with 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 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG provided an engineering evaluation o/the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The repoded results describe the condition ofthe systems on the da(M of the evaluation. Separation distances were measured to readtlyiden6'fiabte features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational fife ofall wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwsterlevels (that may fluctuate during the year), qualify of construction (materials and workmanship), and the wafer usage of the family utilizing the sysfeMs. These con ddiona can vary, and are outside the round of GEG. Safishictory leaf results do not guarantee future performance of the sysfem/s,; therefore, GEG makes no warranty (express or implkd) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail. The content of this report is fw the sole benefit of the persoNpady who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent propertypurchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this report. 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following Phone 337-6179 Date OF Ali%Cyo ON-SITE =� WATER AND :o WASTEWATER gy: Original Certificate Date: 41',2 The icipalI or no age Develop,emt Services Division (DSO) issues Certificates of On -Site 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 Septic System Advisory Well Flow Advisory (Rev. 10112112) Nitrate Advisory Arsenic Advisory Other 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: MANN SID; BLOCK 5, LOT 5 Parcel ID: 020481-05 A. WELL DATA 'BEDROCK AT 21'. "PACKER INSTALLED AT SURFACE LEVEL. NOTE: WATER STORAGE TANKS INSIDE HOUSE WERE BYPASSED,DURING FLOW TEST. Well type PRIVATE If A, B, or C provide PWSID# NIA Well Log (Y/N) YES Date completed 7/21/2004 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 306 ft. Cased to *40 ft. Casing height (above ground) 18+ in. FROM WELL LOG Date of test 7/21/2004 Static water level 2 ft. Well production 4 g.p.m. WATER SAMPLE RESULTS: Coliform et?" colonies/100 ml. Nitrate NO mg./L. Arsenic: wO ug./L. Date of sample: 3/26/2015 B. SEPTICIHOLDING TANK DATA Tank Type/Material Tank size gal. Number of Compartments Foundation cleanout (Y/N) _ Depression over tank (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ftlor ft2/bdr System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff, absorptio a _ ft2 Monitoring tube _ Depression over field Date of adequacy test Results (Pass/Fail) For—bedrooms Fluid depth in abso n field before test _ in. Water added _gal. New depth _in. Elapsed _ min. Final fluid depth _ in. Absorption rate >= g.p.d. rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date AT INSPECTION 3/26/2015 xx W-T:n Collected by: GEG, Ltd. PUBLIC SEWER Date installed Cleanouts (YIN) High water alarm -ow D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump oft" level E. SEPARATION DISTANCES level Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/Ifft station on lot WA On adjacent lots 1W+ Absorptiogfield on lot NIA On adjacent lots 100'+ Public sewer main 751+ Sever /septic service fine Animal containment areas W+ Public sewer rrrenhole/deanout 100'+ Holding tank 75'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Absorption Water main Wells on adjacent lots Water service line Surface SEPARATION DISTANCE FROM ABSORPTION Property line Water service rFai Cun drain F. COMMENTS G. ENGINEER'S Surface water Wells on adjacent dots 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines In effect on this date. Engineers PrintedName JEFFREY A. GARNESS Date 01.11ir (Rev. 10/12M2) TSA PUBLIC SEWER Water main Driveway, parking/vehicle storage Municipality of Anchorage Development Services Department Building Safety DivisionMV w On -Site Water and Wastewater Program = 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-481-05 COSA # Ci5 L ?j <S Expiration Date: c . - 1 ,2 . 1. GENERAL INFORMATION Complete legal description Mann Subdivision, Block 5, Lot 5 Location (site address) 16010 Goldenview Drive Anchorage, AK 99516 Current Property owner(s) Robert and Suzanne Busby Day phone Mailing address 16010 Goldenview Drive Anchorage, AK 99516 Lending agency Day phone Mailing address �68f,ts6tO Agent Day phone Mailing Address ,Unless other ise,,re uested, COSA will be held by DSD for pickup. 2 '•NUMBR OF BEDROOMS: Four (4) TYPE OF -WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Indiv ducil Well 0 Individual On-site ❑ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer 0 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 5. DSD SIGNATURE Approved for Disapproved. bedrooms. Phone 522-7773 Date 10/31/2011 ® A4 S® 00 0 MICHAEL L ANDERSON J, CE -4381 Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory ZS _4 �7 - PROGRAM Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: _ Original Certificate Date: (Rev. 11/05) Municipality of Anchorage • '� Development Services Department s Building Safety Division On -Site Water & Wastewater Program s " 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 5, Block 5, Mann Subdivision Parcel ID: 020-481-05 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 7/21/04 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 306 ft. Cased to 40 ft. Casing height (above ground) >18 in. FROM WELL LOG AT INSPECTION Date of test 7/21/04 10/29/11 Static water level 2 ft. 2 ft. Well production 4 g.p.m. 4.67 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate i' (, mg/L Arsenic: `T ug/I Date of sample: 10/28/2011 Collected by: MEA B. SEPTIC/HOLDING TANK DATA Tank Type/Material AWWU Sewer System Date installed Tank size gal. Number of Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression over tank (Y/N) High water alarm (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ftZ/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area ft' Monitoring tube Depression over field Date of adequacy test Results (Pass/Fail) ' For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots >100' >100' Public sewer main >100' Public sewer manhole/cleanout >100' Sewer /septic service line >25' 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 Water main Property line Water service line Absorption field Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water Service line Surface water Driveway, parking/vehicle storage Curtain drain Wells on adjacent lots F. COMMENTS: Lot is Served by AWWU Sewer System. nC �A in. G. ENGINEER'S CERTIFICATION v�`�•M•O�••�`_l rt • •• S �;•' .,. ••.•� i certify that / have determined through field inspections and - >t¢; 4�� •: di review of Municipal records that the above systems are in 0'•" " •'• •"`� conformance with MOA COSA guidelines in effect on this date. �• ••• •• ••••••••••••r :ck so Engineer's Printed Name Michael E. Anderson, P.E. ;AI1tCyAE4- 8IL �1MW . , s ;� i ` ` g1 \4` , A AV Date 10/31/2011 +�f14,R0FfSSI0� COSA Fee $ 0), )Waiver Fee $ Date of Payment k ` —,'("l — II I Date of Payment (� C� (b() Receipt Number Receipt Number (Rev. 11/05) SGS Ref.# 1115347001 Client Name Anderson Engineering Printed Daterrime 11/04/2011 11:10 Project Name/4 — "mo i 24U, `� Collected Datefrime 10/28/2011 13:40 Client Sample ID "" htt ' ' ^" , , ��i„g �d��a�6S�p.'�� Received Date/Time 10/28/2011 14:03 Matrix Drinking Water Init Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic 5.00 U 5.00 ug/L EP200.8 C (<10) 11/01/11 11/03/11 NRB Waters Department Total Nitrate/Nitrite-N 0.116 0.100 mg/L SM20 4500NO3-F B (<10) 11/03/11 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 10/28/11 DLC Total Coliform Negative 1 100mL SM20 9223E A 10/28/11 DLC 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.org/onshe (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. 020.461.05 1. GENERAL INFORMATION Complete legal description W S. Block 5, Mann subarnsron FojeleDa4 COSA # 016011 Expiration Date: %— q-07 Location (site address) 16010 Gilden view Drive Anchorage, AK 99516 Current Property owner(s) "rd Vinson Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 16010 Gokierrview Drava Anchwage, AK 99516 Unless otherwise requested, COSA wAl be held by DSD forpickup. 2. NUMBER OF BEDROOMS: Four (4) 3. TYPE OF WATER SUPPLY: Day phone 242-0735 Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual Well ❑Q Individual On-site ❑ Individual Water Storage ❑ Individual Holding Tank ❑ Cor�munity�Iass Wel(--.--❑---------Community-Orrsite--- ------------ Public Water System ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of OnSite 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-ske 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 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 Finn Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 3Q70007 b. DSD SIGNATURE Approved for —4-1 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: „immmurrn,, � : WATER AND AM Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineers Report Nitrate Advisory Other By: 70"e-7-" Original Certificate Date: �� —07 tR«. roM D. LIFT STATION Date' Size In gallons Pump on- level at _ in. -Pump off level at _ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankNR station on let Absorption field on lot Public sewer main /� Sewer haptic service One � S� AnimalcontalmfentaNorm High water ahm level at Meets alarm 8 mutt mq *wwft9 On s4acent lob /00 On adjaoerrt lob /00 Pubtk:sewermanhoWdearxxit /QD� Hokting tank Manuro/anknal excrete sioage areas NOW SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Bulking foundation Property One _ Absorption Held Water main Water service One Surface water tar:^17=T I':'.'-iiI --I SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property One Building foundation Water main Water Service One Surface water l7rtveeray, perluplvennirJe seorape Curtain drain NQn* Ncftd Wella on adjacent kis F. COMMENTS: PM" le Served by AYINPU Samar sy3am. G. ENGINEER'S CERTIFICATION I car* that t have detem>lned VmWh field impactions and MAIM of Uw*#W romds that the above systems ars-b --- ---cordF�rrnarra 1140A ZEA putdellnes in elect on this date. - — Engi mes Printed Name Michael E. Anderson, P.E. Dab 7rzrrjw COSA Fee S [f f) Date of Payment `llD Receipt Number 9a1fe t{� atw. Moe) - - Walver Fee S Date of Payment. Receipt Number_ In. Municipality of Anchorage , • Development Services Department iety Division r On -Site Building WasteProgram • 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 995194650 www.nwni.org/welte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: lot 5, Block 5. Mon WHIVOw Parcel ID: 020481-05 A. WELL DATA Wee type2L& If A, B, or C provide PWSID 4_ Well Lag (Y/N) Y Date cwvMW A21104 Sanitary sees (YAV) Y Wkes properly protected (YIN) Y Total depth Moe R Cased 10 4o ft. Casing height (above ground) 18 In. FROM WELL LOG AT INSPECTION Date of test 7121/2004 1f21/2D08 Static water level 2 ft 2.5 ft. Well production 4 g.p.m. 4.8 g.p.m. WATER SAMPLE RESULTS: Cdifonn _L--colonies/10O mL Nitrate h4 L mg/L Other bacteria coloniesf= mL Arsenic: RID. ngA Date of sample: 20071 Cogected by: F l e I l21 X B. SEP ICWHOLDING TANK DATA Tank TypdMaterial Date metalled Tank sae gal. Number of CompaMfents _ Cleanouts (YIN) Foundation deanout (YIN) _ Depression over tank (Y" _ High water alarm (VIN) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d.At' or feJbdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth fL Eftabsorption area _1l' Monitoring tube _ Depression over field Date of adequacy We Resues (Pass/Faiq For _ bedrooms Fluid depth in absorption field before test in. Water added gal.. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >- g.p.d. Any rejuvenation treatment (pest 12 mo.) (YM & type) - M yes, give date L vli Ile, najz ee 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.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 02D481-05 1. GENERAL INFORMATION 44J COSA#yt(EA5 Expiration Date: 61"? Lob T Complete legal description Lot 5, Block 5, Mann Subdivision Location (site address) 16010 Goldenview Drive Anchorage, AK 99516 Current Property owner(s) Diamond Builders Day phone 5224826 Mailing address P.O. Box 221233 Anchorage, AK 99522 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Four (4) 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well✓❑ Individual On-site ❑ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer El 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 Onsite 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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of 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 (les 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 person Engineering Phone 522-7773 Address P.O. Box 240773 Anchorago. AK 99524 Engineers Printed Name Michael E. Anderson. P.E. Date S. DSD SIGNATURE Approved for 4__ bedrooms. Disapproved. 1/19/2006 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 Engineers Report Other By: Original Certificate Date: ( Z m.+ ++As1 Municipality of Anchorage Development Services Department Building Safety Division On -She Water & Wastewater Program 4700 Bregaw Street P.O. Box 196650 Anchorage, AK 99519.8850 www.muni.orplonsits (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 5, Block 5, Mann Subdivision Parcel ID: 020481.06 A. WELL DATA Weil type Rivals if A. B, or C provide PWSID # _ Weil Log (YM) Y Date completed 7/21/04 Sanitary seal (Y/N) Y Wires properly prolected (Y/N) Y Total depth 308 ft. Cased to 40 ft. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of lest 7/21004 1/21/06 Static water love! 2 ft. 2.5 ft. Well production 4 g.p.m. 4.8 g.p.m. WATER SAMPLE RESULTS: Coliform _D—colonies/100 mL Nitrate 0. 1 mg& Other bacteria 2 oolomes/100 mL Arsenic: _IA_. ZYW Date of sample:1-6-06 Collected by: L. H. S. SEPTICMOLDINO TANK DATA Tank TypelMaterial Munidpal Sewer System Date installed Tank size gal. Number of Compartments _ Clesnouts (YM) Foundation cleanout (YM) _ Depression over tank (YM) _ High water alarm (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed WA Soil rating (g.p.d.e or fe/bdrm) System type Length h. Width ft. Gravel below pipe ft. Total depth h. Eff. absorption area _fe Monitoring tube _ Depression over field Data of adequacy teat Results (Pas&*ail) For _ bedrooms Fluid depth in a' plan field before test in. Water added_ gal. New depth in. Elapsed Time: man. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation tneatitnent (past 12 mo.) (YM 8 type) If yes, give date Date Installed N/A Size in gallons 'Pump on' level at _ in. 'Pump odr level at _ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanVM station on lot Absorption field on lot WA Public sewer main >76 Sewer /septic service line 126' Animal conlardnent areas WA Manhole/Access (YM) High water alarm level at Meeks BIem b CkaA reWiweA1Mnts? On adjacent lots >I00' On adjacent lots >100' Public sewer manholekleanout >109 Holding tank WA Manure/armmel excrete storage areas WA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation WA Property line _ Absorption field Water main Water service line Surface water Weds on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line N/A Building foundation Water main Water Service line Curtain drain Surface water Wells on adjacent lots F. COMMENTS: Lot is served by AW WU Sewer System. O. ENGINEER'S CERTIFICATION 4 I certify thal I have determined through field inspections and ; +7cn v� review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. at 'E Engineer's Printed Name Michael E. Anderson. P.E. Date 1/19r2006 COSA Fee S It 43 V 7_ b Waiver Fee f Dale of Payment (/o�/IJ�I [lilt �y Date of Payment Receipt Number t(L�`7 Receipt Number (nev. 1IM) In. 9 1 a W I14 Ij.vz ' .ro•urit. c,.O.l.r .ro � I...crT' ♦ ..� 1 � I ►s Y �1 AA d a i fill,fit N � - t W r LL ~ap �fill� L I' Iab�At C 1 a W I14 Ij.vz ' .ro•urit. c,.O.l.r .ro � I...crT' ♦ ..� 1 � I ►s Y �1 - GOLKOV/CIV LM IVG - E N � - W r LL u ry 4 N 1 !1 ♦• V 1. 4� L Y . < a u - GOLKOV/CIV LM IVG - E N � - W r LL 1 L r 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.cl.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. OHO —1i V-0 r HAA #4� Expiration Date: 3 1. GENERAL INFORMATION Complete legal description Lot 5: Block 5, Mann S,bdiviaion Location (site address or directions) 16010 potdPnbipv pr g51(0 Current Property owner(s)Diamond Builders Day phone 522-4826 Mailing address PO Box 221233 Anchorage, AK 99522 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will behold by DSD for pickup. 1L{�.r► _� I" 1 ' -7!g j e 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer X❑C 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. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and.State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Engineering Phone' 694-2979 Address 17034 N. Eagle River Loop ste. 204 Eagle River, AIC 99577 Engineer's Printed Name Robert Q. Cowan Date ROBERT C. COWAN 5. DSD SIGNATURE i'�C! CE -8801 _ Approved for + bedrooms. y' ti Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date:/ -20 (Rev. 01N2) Municipality of Anchorage Development Services Department Building Safety Division 4 = s On-Site Water & Wastewater Program ° T r 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us r (907) 343-7904 s 4' HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: _L0 % S QLoGrc S MgJ,J'SI-D ParcellD: i A. WELk DATA i Well type )0RwgT - If A, B, or C provide PWSID # = Well Log(J9N) Ye s' Date completed?/d+/a# Sanitary seal &N) YGS Wires properly protected (9N) YE 1 F 1 Total depth 306 ft. Cased to Ho ft. Casing height (above ground) in. F FROM WELL LOG AT INSPECTION j. Date of test 7 /'�-/ /0 y Static water leveloZ ft. ( k ft. Well production g.p,m. g:p.m. WATER SAMPLE RESULTS: x P Coliform 5 colonies/100 ml. Nitrate 0 i mg./I. Other bacteria 0 colonies/100 ml. Arsenic: mg./I. Date of sample: fa �ao%H Collected by: 5 & S ENGINEERING t d Na ~I F 4 B. SEPTIC/HOLDING TANK DATA a,6 L JIL We River Alaska 99577 ' Tank Type/Material Date Installed 3' j Tank size gal. Number of Compartments Cleanouts (Y/ F Foundation cleanout (Y/N) De ression over tank (Y/N) Hter alarm (Y/N ) Date of pumping Pumper r C. ABSORPTION FIELD DATA Date installed Soil rating f g (g.p. or ft2/bdrm) System type - j' Length ft. th ft. Gravel below pipe ft. Total depth ft. - Eff. orption area ft2 Monitoring tube _ Depression over field Date of adequacy test Results (Pass/Fail) For _bedrooms Fluid depth in orption field before test __ in. Water added_ gal. New depth_ in. Elapse ime: `min. Final fluid depth in. Absorption rate >_ g.p.d: Any rejuvenation treatment (past 12 mo.) (YM & type) If yes, give date Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) "Pump off" level at _ in. rat m evel at in. ><veleST s ed Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot )v 1A Absorption field on lot N 4 Public sewer main 7s- 4 - Sewer /septic service line On adjacent lots 7,/14 On adjacent lots ".4 Public sewer manhole/cleanout /00 t Holding tank Al �A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main Wells on adjacent lots SEPARATION DISTANCE FROM Property line Water Servi e CuAWdrain F. COMMENTS G. ENGINEER'S CERTIFICATION Property line Water service Surface water .ABSORPTION FIELD ON LOT TO: Building foundation Water main Surface water Wells on adjacent lots I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name I` aQ¢ar C. wA� Date )a-%ay/oN Driveway, parking/vehicle storage NAA Fee $ _7.5 Waiver Fee $ Date of Payment /c�oDate of Payment Receipt Number 1DCCCJa Receipt Number (Rev. 12/01) C'e•0801 y r . m JC 0 0 z m y y 21 W 1 — 1 `" o a 3 d4$ M1 it mm y 7 0 o00 I--------+ 4 i' �6 m 2M.66. m JC 0 0 z m y y 21 W 1 ' �N — 1 `" ' �N — n `" I--------+ I.' Iry I a ' •leoCil.^ I , r� I v' K (U k a ZO � ;; I + C � /✓ O`U i"6✓ /4 `l• 43 u C%UGG .'V V/L1V CA'l VE 1 I� n, S cc w — n 1 I� n, S cc w