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Home My WebLink AboutGREAT LAND ESTATES #3 BLK 7 LT 3Great Land Estates #3 Block 7 Lot 3 #051-133-48 .� Municipality of Anchora'e :. °,: _' .•. Development Services Department Building Safety Division r On -Site Water and Wastewater Program, 4700 Bragaw St. P.O. Boz 196650 Anchorage, AK 99519-6650 Page I Of www ci.anchorage.ak. us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 5bX60,^C63 PIDNumber:� _[ 33-4/8 Nam. (J; IYIekow Wastewater System: W New ❑ Upgrade ej t e/ ABSORPTION FIELD P""6%�f- Nu of11.n s 3 0 Deep TrerRn Ks"110 Tl« 0 Bea p MpAW 0 Omer LEGAL DESCRIPTION B°"Rat ... ° �_J1 R con/Ft' Tda Deem ham wgNl araaa /. �FI. Bloch La siyaiwtudl Crl ' Depm tp pW Ddlam ham a�Q��`.�aae Gravel dean Uarw.m ol» J's FI. FI Townamp Rargs Sealan Fu aeric aoownal aa. ♦y_ FI. Gnva Lerptn Q 3V Ft. Well• [:1 New El Upgrade c"° "0h Nunroa alma I DiAanu »n een luras FI' FI CI 5 k Pnv. A, B C ( - 1 Noe- Td1 Dapm 50 FI. Cassa to �(�� Ft Total soadawn area 3 Flt P Malanal � Fg/ s IIK �� / /v4ell (/jam 1 au D.1W steed waur L.va FI Ml~ j `l.ra - X4(7 Dau msulua —�6-0 YWO I Pumpsslst , 1��vFl. CavrglbgMAO CsaegFt TANK GPM . SEPARATION DISTANCES ❑ septic ❑ Holding ❑ S.T.E P. ❑ Other. ToSeptic From Tank Absorption Field Litt Station Holding Tank lutilorPrivate Sewer Line P�em1e aS�/G �OGaI wen U I I MISL ��I Maldw Nu , d Campanmema svnaaaw.ler•• ,',�- LIFT STATION ld Lax 101 a. a;.IJH Fougeign � APT 1 'Pure on' NvN al a a/ rru Hign wnsr alrm at {1 '^ n n Cunrn Dan h nv P MOaw Elacmcal msaed�ana Psrtdmea M R.msrk. BENCHMARK Lo [l wa D.aaiptw L Ir fl wmea evalgn 00 Ft 5 i 5 ENGINE �Ot Inspections performed by: 17014 Eagle River LOOP Road, NO -18" 1" ay—0 �V ". Eagle River, Alaska 2n0 i"Development K Services Department Approval 1, t Conditional Approval Date: _ 5" G COWAN fr210E�� r Reviewed and approved by: tRr W oel \a PERMIT NO. SW060263 PACE 2 OF 3 Municipality of Anchora e DEPARTMENT OF HEALTH AND HUAN 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 LOT 3, BLOCK 7, GREAT LAND ESTATES #3 P.I.D. NO. 051-133-48 � / I I I I I I � / � Iz I I JS tAJI i apo\ uj 4 �a I w I I 16 >_ I t I LOT 20 W„a I / � I TCO 3 J eNFk. y0,6 ooB NEW 1000�GALLON HDPE SEP SIC TANK Y ' FM I TMT A • T MT I BM ST2 • OI �� 3S O,•f 7C� ":.. .. DBL1 Z I I 4 THI I N • ALT. SITE • IC02 + I I _tL_j —MT2i I 20' UTILITY, TELECOM & ELECTRIC EASEMEN_ SCALE. V - 40' ENG}l4Ft3T1'��{k� ' _s�,' LOT 2A :-".. p, ROBERT C COWAM 'Y r�� I C`-8801 I Il �RGiESS1:'•��4 PERMIT No. SW060263 PACE 3 of 3 DEPARTMENT OF AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Te hone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LECAL LOT 3, BLOCK 7, GREATLAND ESTATES #3 P.I.U. N0. 051-133-48 ST1 ST2 X97.7' FINAL GRADE-/ II II i-2" INSULATION NEW 93.3'-/ 11000 GALLON POLYETHYLENE 93.0' SEPTIC TANK CO1 MT2 CO2MT1 Co' = 97.7' CO2 = 98.9' FINAL GRADE MT2 = 88.9' INSULATION *SRI 1 • MT1 = 88.9' A NO WATER FOUND 82.9' B.O.H. N. T. S. A B C FCO I — 21.0 10.0 ST1 1 27.0 23.0'— ST2 26.0 26.0'- 5BL1 25.0 28.0 — 5BL2 25.0 29.0 — MT 23.5 22.5 — 001 38.0 26.5 — MT1 36.024.5 — CO2 48.0 59.0 — MT2 49.5 60.5 — INSULATION *SRI 1 • MT1 = 88.9' A NO WATER FOUND 82.9' B.O.H. N. T. S. Municipality of Anchorage Development Services Department Duildhg Sorely Division +..! On -Silo Water wd Wastewater Program 4700 Soulh Dngow S1. P.O. Dox 196650 Anchorage, AN 995196650 wv'wAlmr"LQM9 t1k Y3 19011343-7904 T So li s L - Percolation Test Pestonped rot:v'is1 B14krn)Q1V Data Pedc Legal Descrhrllory -T 3�$ ' �r f�'r � r � � 65rT wn iM, Rango, Saclion- COMMENTS Wn9CWAIEn ENCOUNT OUNIERE07 C s IF YES. AT WHAT DEP1117 •^ I. Depth to Water Aller D Moullodual F E Dale: y}. elriri�+ts., . 41•. err.; •..p- r -¢ . e...... .......1. y. r4o N . $Male. F' i 143741 e r a med: Site Plait 1 Reading Dale Groff Tlrne No174ne Deplh to Walar Nel Uwp •'-"""`^"`.^1.n1c Imxasohxl'1 FERC IIOIE RIAMEIER 1EsrnUN9E1wEEN ET AND rT PERrORML'D DY: I cmurY THAT 11115IEST WAS PERroRMED Its ACCORDANCE WIT II ALLSTATE AND MUNICIPAL GUIDELINES IN Err CCT ON 7I its DAIS. DAIS: Deplh eel e — 012f7ANlC5 1 2- A- 6-;_ :. 7- . a COMMENTS Wn9CWAIEn ENCOUNT OUNIERE07 C s IF YES. AT WHAT DEP1117 •^ I. Depth to Water Aller D Moullodual F E Dale: y}. elriri�+ts., . 41•. err.; •..p- r -¢ . e...... .......1. y. r4o N . $Male. F' i 143741 e r a med: Site Plait 1 Reading Dale Groff Tlrne No174ne Deplh to Walar Nel Uwp •'-"""`^"`.^1.n1c Imxasohxl'1 FERC IIOIE RIAMEIER 1EsrnUN9E1wEEN ET AND rT PERrORML'D DY: I cmurY THAT 11115IEST WAS PERroRMED Its ACCORDANCE WIT II ALLSTATE AND MUNICIPAL GUIDELINES IN Err CCT ON 7I its DAIS. DAIS: 09/06/2007 20:14 6882259 SLLLIVAN PAGE 01/01 Certf f f eb Orilling Log by DOC CO. d W SULLIVAN WATER WELLS P.O. BOX 670272, CHLIGIAK, ALASKA 99567 *TELEPHONE 688-2759 OWNER OF LAND: \,) IM IfltN ADDRESS: lir •b� LEGAL DESCRIPT,()N-Xr±6uc� eJ %,4> DATE:1V � PERMIT NUMBER: D&M(o-5-Date ofIssue. _ TAX IDENTIFICATION NUMBER: i� _ �� _ .--1 IS well located atapprovedpermit location? )'es O No Method of Drilling: r rotary O cable tool Depth of well: ( 01 Casing TypJ% Wall Thickness • 9 Inches Diameter � inches, depth _ai feet Liner Type: , Casing Stickup Above Ground., - feet Static Water Level: '6 7 feet Recover Rate.1g Method of Testing: tr Well Intake Opening Type: D open end q(ppen holo O Screened; Start I !' feet S/to_ppeq ��11 fit Perforations Start ll� feet Stopped aa_ feet Grout Type: ) �r votume � Lr$ Depth: from (L_ feet, to feet Well Disinfected Upon Completion? O No Method of Disinfection: (}lilt O pM Comments: ATTENTION: It Is the responsibility of the property owner to submit a Copy of the well tog to the proper.authority. Municipal ty Of anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu Borough: Department of Environmental Conservation. Legal Description: Great Land Property Owner Name &Address: EST#3 Jim Bickman Lot:3 B7 4316 Upper Kogru of -A.- FaOIp Rivor 09577 Pump Installation Date: 8!27!2007 Pump Intake Depth Below Top of Well CasingA88 Feet Pump Manufacturer's Name: Dempster Pump Mode1:L-75 Pump Size:1.5 hp Pitless Adapter Burial Depth:10 feet Pitless Adapter Manufacturer's NameMartinson Pitless Adapter Installer: Arctic Pump & Well, Inc. Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: Pump Installer Name: Arctic Pump & Well, Inc. No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.5.484 / Virus Database: 269.12.9/975 - Release Date: 826/2007 9:34 PM 8/27/2007 Page 2 of 2 MUNICIPALITY OF ANCHORAGE Development Services Department �\ On -Site Water & Wastewater Program 1 4700 South Bragaw Street �� P.O. Box 196650, Anchorage, AK 99519-6650 p (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Aug 16, 2006 Expiration Date: Aug 16, 2007 Permit Number: SW060263 Parcel ID: 051-133-48 Legal Description: GREAT LAND ESTATES #3 BLOCK 7 LOT 3 Design Engineer: 0003 S & S Engineering Owner Name: JIM BICKMAN Owner Address: 4316 UPPER KOGRU DRIVE EAGLE RIVER, AK 99577 - Site Address: NHN CHUGACH PARK DRIVE Lot Size: 44120 SO. FT. Total Bedrooms: 3 Permit Bedrooms: 3 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 catling (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. 5. The following special provisions. -Engineer needs to do an additional percolation test during construction of septic field. The percolation test procedure is to follow Table 3-8 of the EPA Design Manual. Please submit stamped and signed results with the As -built Inspection Report. If the results require a design change, construction of the system will stop pending On -Site review and approval. Received By: Date: q -/17/0G Issued By: �r� Date: 6)11 IC4 Municipality of Anchorage Development Services Department Building Safety Division • i On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 ON-SITE SEPTICMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. n�� I- " Dt`Gk�Ah Day phone Propertyowner(s)_�i f ' -_ 11L Mailing Site address LIJU.Ls 1"d-ttr •"�`"' ` Legal description (Sub'd, Block JJ& Lot) Lfff-5, Legal description (Township, Section & Range) Lot Size ZK/I 96 _Sq. Ft. THIS APPLICATION IS FOR (®all that apply): Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage Code Number of Bedrooms 3 lip Code THIS APPLICATION IS AN: Initial Upgrade Renewal certify that the above informationis c ect. I further certify that this application is Single Family Dwelling and is in accornce with applicable Municipal Codes. (Signature of PermiVRush Fees:—q—&—o" Date of Payment: g agent) Receipt Number: (Rev. 7 V05) Waiver Fees: Date of Payment: Receipt Number: I■ made for a IEALTHALTTHORITY APPROVALS SEWER&WATER MHNEXTEMIONS SEWER& WATER P&SPECTION ENMWV**STDIES ANO REPORTS wELLmPECTION & FLOW TEST SITE PLANS SOILTEST PERCOLATION TEST STRLCruVL& ►ECWNICAL WSPECTION5 ONSITE WASTEWATER DISPOSALSYSTEM DESIGN August 10, 2006 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 3, Block 7, Greatland Estates Subdivision 43 CMLENGINEERS (907)694-2979 FAX(907)694-1211 It is requested that you issue a permit to install a new well and a new septic �ystem to serve the proposed three bedroom dwelling on the referenced property. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation 5/18/01, ground water was not found. After monitoring, no ground water was found. 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 Enclosure information, please contact us. P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577 «iol 0 00< N uvu s0x 0 "-i=>LN3Y43SV3 J.lnin ,Ol Wz 0 J ` — — — — — — — �iaY J r 0.&0QO � �� w r-07 IC m H 4r ovai`` IL V, o o O 0.O O00 O N N N Ir m J mo OO -.-t.V) to x a4 j \ ` ` (Y( d Vol) a\W > ` �r d W W z W W O Z ow3i �noo0 q iui �n s v NV -3115 I NOIS30 I ;0£ _ r pp Y Gso� U O Z O W Op_Y F ESQ f- D W NZ OOU WO JZ N O 0-J~mQ d ——OJd-Dw-0- — a-00 OU a- x a4 j \ ` ` (Y( d Vol) a\W > ` �r d W W z W W O Z ow3i �noo0 q iui �n s v NV -3115 I NOIS30 I ;0£ _ Performed For. Legal Description 0 t Municipality of Anchorage Development Services Department Building Safety DIA510n On -Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www d awa`Kanc (907) 343.7904 Soils Log - Perc lation Test �W, I)wlz, /7 ' I Township, Range, Section: r � � v 3- r ° 1 4- s- - (621,q)Cvi th 7- 8- ro 9- } '10- 0 -3-e 12- 3 e .. 6•o. ii 1 X WAS GROUND WATER if /o ENCOUNTERED? �V 8 L IF YES, AT WHAT DEPTH? F D Depth Monl Monitoring? he / �'�'+��- /E Date: / Reading Dale Gross Time Net Time Depth b Water Net Drop M,A, i Alld I,YnA1 PERCOLATION RATE _PERC HOLE DIAMETER TEST RUN BETWEEN _?,6FT ANO Afdt5 FT G-�ee.7 CERTIFY THAT THIS TEST WAS PERFORMED BY: A e, / PERFORMED IN A ORDANCE WITH ALL STAT D MUN�C WD5 - IN EFFECT ON THIS DATE. DATE: TfALTHAITHORRY APPROVALS SEWER 6 WATER L1NN E%TE SIOFS SEWERS WATER INSPECTION ENGINEERWGSTUOIES AND REPORTS WELL INSPECTION S FLOW TEST SITE PLANS SOILTEST PERCOLATION TEST STRUCTURAL& WCIVNICAL INSPECTIONS CN SITE WASTEWATER DISPCSALSYSTELL DESIGN ROBERT C. COWAN. P.E. cmLENGINEERS (907)894.2979 FAX(907)694-1211 ON-SITE NVASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 3, Block 7, Greatland Estates Subdivision #3 August 10, 2006 GENERAL: 1. The scope of this project includes the installation of a new 1000 gallon HDPE septic tank a septic trench to serve the proposed three bedroomi residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Development Services Department or ADEC if required, for system installations. Owners installing their own systems must also receive prior approval from the respective agency. SEPTIC TANK INSTALLATION: 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling of shifting of the tank. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577 Psgs 2 Lot 3, Block 7, Grsstlsnd Estates Subdivision 03 August10,2006 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. 5. 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 TRENCIIIDRAINFIELD INSTALLATION: 1. 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 leve 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. 3. A silt barrier must be installed between the final gravel layer and the native s i it backfillbarrierEnsure the silt barrier covers the entire gravel surface before placing backfill. 4. 5. 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. 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 i depression after settling. Page 3 Lot 3, Block 7, Greatlend Estates subdivision 03 August 10, 2008 1%11NIDiUl1i MATERIAL SPECIFICATIONS: 1. 0 3. 4. 9 11 7. Any septic tank proposed for installation must be constructed by a Municipal septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Tvpeofpipe 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. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dowl Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). A permeable nontoxic silt barrier (Typar 3401, Miraft 140N, or equal) must le installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must i conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. Page 4 Lot 3, Block 7, Greatland Estates Subdivision 113 August10,2006 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: 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 omis lions 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 ° 1'.. kis 1Ji(i(1Anchorage, Alaska !Y9519 -(X&) 51J�fRi1 • Tclq)honc (!X)7) ) 3;3�&S)1 fu (!N)i) 1t1-%lNl O;7(N)Ilrug:twStrccl•.\nchomgc.tin>ka!M).Sg7 s • F r mm.n unknrg Mayor Hark Begicl( Building Safety Division July 12, 2005 Darrell Kenneth P.O. Box 670947 Chugiak, AK 99567 Subject: On -Site Water and/or Wastewater Permit. Permit Number: SW040313 Legal Description: Great Land Estates #3 Block 7 Lot 3 Dear Mr. Kenneth: An On -Site Water/Wastewater Permit, number SW040313, issued by this office for a single-family system, will expire on August 03, 2004. The permit is valid for 365 calendar days. If this was a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to this office for review, approval and documentation. This as -built inspection report must be signed by the licensed Professional Engineer who inspected the installation of the system. As -built inspection reports are required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, a new permit must be obtained from this office. A new permit for a second year may be issued for a fee of $115.00 if the renewal application is received on or before the expiration date of the original permit. When applying for a new permit, the fees are: $460.00 for a wastewater permit and $175.00 for a well permit. If you have any questions, please call this office at 343-7904. Sincerely, Daniel J. Roth Program Manager On -Site Water and Wastewater Program Enc: Copy of permit Community, Security, Prosperity 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 - nitiaf ?4flf u-�-1 Date Issued: Aug 03, 2004 Expiration Date: Aug 03, 2005 Permit Number: SW040313 Parcel ID: 051-133-48 Legal Description: DREATLAND ESTATES #3 -BLOCK 7.10T.31 Design Engineer: 0003 S & S Engineering Site Address: NHN CHUGACH PARK DRIVE Owner Name: DARREL KENNETH & LOYDALE C. Mcl Lot Size: 44120 SO. FT. Owner Address: P.O. BOX 670947 Total Bedrooms: 3 Permit Bedrooms: 3 CHUGIAK . A 99567-0947 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 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 By: Date: 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 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. DS/- /33 - y y Permit Number SW Property owne Mailing addres Mailing addres Legal descripti phone /of �_ c2ggq Legal description (Section, Township & Range) Lot Size 441 l Acres/Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms mit`' .3 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: /15 -LZ Waiver Fees: Date of Payment: �/ a� oq Date of Payment: Receipt Number: 6_5& 1.5 Receipt Number: (Rev. 12/00) 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 Date Issued: Jul 29, 2003 Expiration Date: Jul 28, 2004 Permit Number: SW030276 Parcel ID: 051-13348 Legal Description: JGREATLAND ESTATES #3 BLOCK 7 -LOT 3 Design Engineer: 0003 S & S Engineering Site Address: NHN CHUGACH PARK DRIVE Owner Name: DARREL KENNETH & LOYDALE C. Me[ Lot Size: 44120 SQ. FT. Owner Address: P.O. BOX 670947 Total Bedrooms: 3 Permit Bedrooms: 3 CHUGIAK . A 99567-0947 This permit is for the construction of: 0 Disposal Field Q 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: i l 1a/o3 w �/" Date: 2 d3 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.ek.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. QV -133 -AE Permit Number SW030Z76 1 (#88- Z144 Property owner(s) D ARRE LL- ° LoV DALE K4 D 6 N AL -b Day phone Z60 -14'15 Mailing address (1) Mailing address (2) r I&Y, Zip Code ' iOLS V + Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) I Lot Size �-'A=m 44j.Ft THIS APPLICATION IS F / �� Number of Bedrooms rr0UR 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 Single Family Dwelling and Is in accordance with applicable Municipal Codes. S & S ENGINEERING _dd�t� /'r1./�— Eaal& Eagle River Loop Road No. 204 aale River. Alaska 99577 (Signature of property owner or authorized agent) Permit Fees: a N 00. e' '1- Ire. "' Waiver Fees: _ Date of Payment: S–/j r /° i Date of Payment: Receipt Number: U 13- H Tel Receipt Number: (Rev. 12/00) being made for a RV April 29,2003 ROBERT C. COWAN, P.E. CMLENGINEERS (907)694-2979 FAX(907)694.1211 WALTHAWH NTV MUNICIPALITY OF ANCHORAGE APPR(NALS Development Services Department P.O. Box 196650 Anchorage, AK.•�9519 SEWER & WATER IWN E%TENSIO S REFERENCE: Lot 3, Block 7, Greatland Estates S/D SEWER& WATER 06KCTION It is requested that you issue a permit to install a septic system to serve the proposed four bedroom dwelling on the referenced property. A test hole was excavated and a percolation test was performed. The approximate location ANoREPPORTS S of the test hole is located on the attached site plan. At the time of excavation on 5/18/01 no water was found. After seven days of ground water monitoring the test hole was still found to be dry. WEUNSPECTION &TEST 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 SNE PLANS properties. If you require additional information, please contact us. ROADDESIGN SO&TEST Sincerely, /( 2 GJZ",— Robert C. Cowan, P.E. RCC/jhm PERCOLATION TEST Enclosure STRUCr RAL.A WCKAN CAL INSPECTIONS ONSITE WASTEWATER bIS110SALSYSTEIA DESIGN 17034 NORTH EAGLE RIVER LOO + SURE 204 • EAGLE RIVER, ALAS KA 99S77 SITE PLAN I DETAIL 0* D / ti r O=r �r0 m � N cnz 6 mw0 H Ln / N O y / " F z c �o Ql oQ / 4 / / V / PROPOSED 1300 GALLON ' / HDPE SEPTIC / TANK — DOUBLE 'Jb, CLEANOUT PROPOSED WELL x INSTO�OQJ��... FCO 1All 1_' 4 m w I} J I� I0 ask „?a� P{ . `'► oC., �y� CO MT ? TH1 I I 2A I I I I 0 t•J / A I N y 10 A Cz''DZ li 2C W SEPTIC Ci vm �m�mzrA AREA ZK 0, A 2 10 10mm r - OcVCH X00IS,ynF`p z—m f.12 t, O M,m �m NOm -.. n a�mZ Pn ppn 0^�0 iF 0a8 04 *MOO Z A O N Z `�\ \t�� 4 aonMwo Z T m ? C�,�a • 1�C `I Q` mn Io yc Il �.i 2* i b a a �0 O 'I :is Municipality of Anchorage Development Services Department Building Safety Division onsite Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www clanchoraoe.ak.us (907) 343.7904 Soils Log - Performed For: Legal Descriptio Ole 2- 3- 2-3- ° 1 4- 5- 1,?.0 6- �o �G��) tv� f1� at"-® 10- r� 11- 12- t �. 13- tsy 14. (3r0.i{ 15- 17- is- 20- 1-1 Qi i•_ -'L 41 - .• . t . � N.pfNWH.• • ............. } ..N•• -shale 10 : t e A - u. 1417-Z . r�: !�'•• •'• .EN d V ation Test a°�`�Q`E Date Performed: S / V I Township, Range, Section: WAS GROUND WATER 4/0 ENCOUNTERED? S IF YES. AT WHAT DEPTH? LO Depth to Water Allo' P Monitoring? / �M E Date:" ! / Reading Date Gross Time Net Time Depth to Water Net Drop 8!r MM I aAdl !r �nNA1 �G17 �.Srr. PERCOLATION RATE 'LL(ninuteaanch) PERC HOLE DIAMETER TESTRUNBETWfEN 3,6- FT AND 414—_FT ,,., j _ PERFORMED BY: 7A to--% f 1' y ///`�,/� t� �� CERTIFY THAT THIS TEST WAS PERFORh1ED IN A ORDANCE WITH' ITH ALL STAT D MUN C LADE IN EFFECT ON THIS DATE. DATE: EPLRNS MUNICIPALITY OF ANCHORAGE Ar Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-133-48 1. GENERAL INFORMATION Expiration Date: Complete legal description Great Land Estates #3, Block 7, Lot 3 Location (site address) 19841 Chugach Park Drive, ChugiakI, AK Current property owner(s) Charles Stewart Day phone 907-230-8760 Mailing address Real estate agent 20754 Mountainside Drive, Anchorage, AK 99577 Jay Osborne 2. TYPE OF DWELLING: F1 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 345-4663 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic R Water Storage ❑ Holding Tank . ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer, ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ SSD Date of Payment R l z `lel Receipt Number 0 G 3q, U b COSA # 4 5C Ig It/6-5 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 Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 9/24/19 �'it fill OF 49th ®� 6. DSD SIGNATURE 0###1tNUYit#tiNYti#iYiN System #1 Approved for bedrooms+fin'. MICHAEL E ANDERSON f qa.t No. CE -4381 t? System #2 Approved for bedrooms t� 9/24/19 t#i.,..` Disapproved By: Conditional approval for bedrooms, with the following stipulations: 5rj s Original Certificate Date: 16-7 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 COSA Checklist blue sheet Legal Description: Great Land Estates #3 Block 7 Lot 3 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 10/04/06 Total depth 500 ft Cased to 233 ft OR Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) '24 in. Date of flow test for COSA 9/16/19 Static water level at beginning of test 191 ft. Comments B. TANK DATA Age of tank(s) 12 years Tank type/material Septic/Plastic Measured operating fluid level in septic tank 41 ❑ Standpipes/foundation cleanout per record drawing Date of pumping JR's Pumping - 9/18/19 D. ABSORPTION FIELD DATA 5' Wide Trench Which system tested (date installed) 6/26/07 ❑ ALL standpipes present per record drawing Total measured depth from grade 9.3/10.0 ft (max) Measured depth to pipe invert from grade 5.3/6.0 ft (min) ❑ NIA — pressurized field ❑ Monitor tubes go to bottom of. effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 051-133-48 Structure served by this system Well production at time of test 4.5 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate 2.11 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date of Sample 9/12/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 9/16/19 Results F/ Pass For 3 bedrooms Fluid depth prior to test 0„10„ in Water added 450 gal New depth 8„/5" in Elapsed time 1440 min Final fluid depth 0"/0" in Absorption rate >450 gpd Any rejuvenation treatment (past 12 months) NONE If yes, enter date 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' El Yes Community Sewer Manhole/Cleanout > 100' 7✓ Yes if No ft Q Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' F,71 Yes if No ft Holding Tank > 100' El Yes if No ft Neighboring Absorption Fields > 100' ✓❑ Yes if No ft Water Main > 10' Animal Containment > 50' F(� Yes if No ft Q Yes if No ft ® Yes if No ft Water Service Line > 10' ❑✓ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' 0 Yes if No ft 2] Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' El Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: 0 Absorption Field > 5' 0 Yes if No ft Private Wells > 100' ✓❑ Yes if No ft Water Main > 10' F-71 Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 2✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓M Yes if No ft Private Wells > 100' Water Service Line > 10' 0 Yes if No ft Community Wells > 200' Surface Water > 100'✓� Yes if No ft F. ENGINEER'S COMMENTS ®✓ Yes if No ft [✓ Yes if No ft G. ENGINEER'S CERTIFICATION ��C OF ,C(� f certify that l have determined through field inspections and review �P;#R•`'"'R R 8, of Municipal records that the above systems are in conformance with'$ .fit &' 'o,z MOA COSA guidelines in effect on this date. 491th lR�1�F!!!!fR ,RRA lRR! !„i RISl .Wtl� RRRif1+i��AAjjt##,RRiIR,GR4R`i�,KRR1Rf/'iRiFR;RRll9i,R[R MICHAEL E. ANDERSON t No. CE -4381 ”} 9/24/19 COSA Checklist yellow sheet /'R{�F..... � Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL I Parcel I.D. 050-133-48 1. GENERAL INFORMATION Expiration Date: l I- I l'/ 3 Completelegaldescription GREATLAND ESTATES #3 BLK 7 LT 3 Location (site address) 19841 CHUGACH PARK DR Eagle River, AK Current Property owner(s) DONOHO ERIC Day phone 240-0385 Mailing address same Real Estate Agent Susan Bickman Day phone 240-0385 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class C Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by _ Date COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 1�qO Date of Payment g v-- o Receipt Number 037al i' Date of Receipt Number. COSA 4 oSL' � J M Do 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 _NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 8/13/2013 6. DSD SIGNATURE 1IGSystem #1 Approved for 2 bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following By: o d� + Original Certificate Date: —! j —�3 The umcp y o Anchorage Devlopment Services Divisi6n (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 COSA blue sheet 9-1-12.doc 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: r®, f � 0 '-'x gfe3 #3 B7 3 Parcel ID: A. WELL DATA Well type / If A, B, or C provide PWSID # Well Log (YIN) Date completed d 6 Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth$ 0e ft. Cased to 2 3 3 ft T Casing height (above ground) / 0* in. FROM WELL LOG Date of test D 4 6 Static water level 8 9 ft. Well production WATER SAMPLE RESULTS: Coliform _colonies/100 mL Nitrate SSmg/L Arsenic -Q ug/L Date of sample: 2? 1? B. SEPTIC/HOLDING TANK DATA AT INSPECTION Z. 5 g.p.m. Collected by: Tank Type/Material7VtT lc S 6� Date installed 42_6/07 Tank size Ps gal. Number of Compartments Z Cleanouts (YIN) _ !1 Foundation cleanout (Y/N) __Y_ Depression over tank (Y/N) Al High water alarm (Y/N) Al Date of pumping IV13 Pumper S(2 S C. ABSORPTION FIELD DATA Date installed a; 2 d 7 Length .38 ft. Soil rating (g.p.d./ft2 or fe/bdrm) l 2 Width S System type94), Ivc„ Ft" ft. Gravel below pipe 4_ ft. Total depth / 0 ft. Eff. absorption area 3_0'0 fe Monitoring tube T Depression over field Al Date of adequacy test .1 3 Results (Pass/Fail) Aril' For 3 bedrooms Fluid depth in absorption field before test--7—in. Water added 50 gal. . New depth -LZ in. Elapsed Time: i Q min. Final fluid depth _Z in. Absorption rate >= a g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) ✓a 9 If yes, give date D. LIFT STATION N/4 Date installed "Pump on" level at Datum Size in gallons Manhole/Access (YIN) in. "Pump off" level at in. High water alarm level at E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Meets alarm & circuit requirements? Septic tank/lift station on lot / 60 �t Absorption field on lot G `t Public sewer main Sewer /septic service line 2— Animal Animal containment areas So , F SEPTIC/HOLDING TANK ON LOT TO: On adjacent lots O° On adjacent lots /OQ i;c Public sewer manhole/cleanout N/l Holding tank Manurelanimal excrete storage areas /00 �t Building foundation S'f Property line /Q 'P Absorption field s 'I- Water tWater main N/t Water service line / 0 f Surface water /6 0 �+f Wells on adjacent lots / Do `1 - ABSORPTION FIELD ON LOT TO: Property line 46't Building foundation Id -,f Water main it44 Water Service line 10 e fi Surface water 4400 'f- Driveway, parking/vehicle storage �i r Curtain drainy'Uu' Wells on adjacent lots /00 �t F. COMMENTS G. ENGINEER'S CERTIFICATION l 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 Date or /I /2 COSA brown sheet 10-10-12.doc Municipality of Anchorage « Development Services Department Building Safety Division x On -Site Water and Wastewater Program a *' 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. ;�`1- j�> �� / COSA # Expiration Date: / (0 d 1. GENERAL INFORMATION Complete legal description Lot 3; Block 7; Greatland Estates Subdivision #3 Location (site address) 19841 Chugach Park Dr. Current Property owner(s) Eric Donaho Day phone 980-1500 Mailing address PO Box 672122 Chugiak, AK 99567 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: 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 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 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 S & S Engineering Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567 Engineer's Printed Name Robert A. Shafer 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. Phone 694-2979 bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory t WASTEWATER PROGRAM NT Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Rev. 11/05) a Municipality of Anchorage ¢�GS • '� Development Services Department Building Safety Division On -Site Water & Wastewater Program s " E T r 4700 Elmore 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: �v3 ; t '-I �rer,,AAI-4 rSA4cS A---3 Parcel ID: A. WELL DATA Well type' ��`� If A, B, or C provide PWSID # Well Log (Y/N) Date completed�D �// 6 Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth $-00 ft. Cased to 23 -3 -ft. Casing height (above ground) / in. FROM WELL LOG Date of test CAl G 6 Static water level 8 �/ ft. Well production 9.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate /7�7)t 66 g/L Arsenic: &L>ug/L date of sample:0 B. SEPTIC/HOLDING TANK DATA AT INSPEC ION 7 /U g.p.m. Other bacteria 0 colonies/100 mL Collected by: 5 9 5.,N 6V N LFA/n0 G Tank Type/Material S Vic_ e h\ �- Date installed _ /Z6 Z o-7 Tank size I tv 0 gal. N tuber of Compartments Z Cleanouts (Y/N) `! Foundation cleanout (Y/N) 4._ Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 1V 30 O�1 Pumper ��. `5 `t'ImP"gg C. ABSORPTION FIELD DATA Date installed 6 26 0 Soil rating (g.pA_/ft2 r ft2/bdrm) � Z Length 3 S ft. Wid S ft. System type 5 ►1c. OL4 4Y-tAc Gravel below pipe I/ ft. Total depth I0 ft. Eff. a sorption area3SW ft2 Monitoring tube 4— Depression over field AJ Date of adequacy test 07710 Result(Pass ) SS For 3 bedrooms Fluid depth in absorption field before test % in. Water added gal. New depth 13 in. Elapsed Time: `Lo min. Final fluid depth 'I in. Absorption rate >= y5_ 0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) A /�i- If yes, give date D. LIFT STATION Date installed A% /Pr— "Pump on" level a in. E. SEPARATION DISTANCES Size in gallons off' level at in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot %00 �t Absorption field on lot 166 it Public sewer main AJ l Sewer /septic service line 25- �4 Animal containment areas 15'0'* (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots / UV Y - On adjacent lots 144) It Public sewer manhole/cleanout N 18 - Holding tank qtr I'r- Manure/animal excrete storage areas l 00 1-t SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation �1t Property line c r{ Absorption field S'f Water main A) �'t Water service line 10,{ Surface water !Do, f Wells on adjacent lots '-f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10,4 Building foundation f o 1t Water main to 1f Water Service line to 14 Surface water / 03 1f Driveway, parking/vehicle storage 10 If Curtain drainywn2 11,v-,owv+ Wells on adjacent lots /pd 4 F. COMMENTS S1A hnCA 14D cc r G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. h. , wr00 rr. Engineer's Printed Name •S !fit 4 Mat f1ft UVi Date i— �� 0 COSA Fee $ `v Date of Payment Receipt Number o 8516 1 `:> (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number in. I Iddook I -SG,b' SGS Ref.# 1102548001 Client Name S & S Engineering Project Name/# L3;B7; Great Land Est 43 Client Sample ID L3;B7; Great Land Est #3 Matrix Drinking Water Sample Remarks: Printed Date/Time 06/14/2010 8:48 Collected Date/Time 06/07/2010 12:00 Received Date/Time 06/07/2010 16:25 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results LOQ Units Method Container 1D Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 Waters Department Total Nitrate/Nitrite-N 1.66 0.100 Microbiology Laboratory E. Coli Negative 1 Total Coliform Negative 1 ug/L EP200.8 C (<10) 06/08/10 06/10/10 KDC mg/L SM20 450ONO3-F B (<10) 06/08/10 AYC 100mL SM20 9223B A 100mL SM20 9223B A 06/07/10 DLC 06/07/10 DLC Municipality of Anchorage • Development Services Department Building Safety Division _ 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 FORA SINGLE FAMILY DWELLING r Parcel I.D. LAS/ -0 - (/p �TCOSA# l'�10`4to Expiration Date: G - 2 R -OR 1. GENERAL INFORMATION Complete legal description Location (site address) Lot 3; Block 7; Greatland Estates Subdivision #3 19841 Chugach Park Dr. Chuglak, AK 99567 Current Property owner(s) Jim Bickman Day phone 694-9694 Mailing address 4316 Upper Kogru Dr.Eagle River, AK 99577 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Untess otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Q Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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 Firm S 3 S Engineering Address 15861S. Birchwood Loos Engineer's Printed Name AK 5. DSD SIGNATURE JC Approved for 3 bedrooms. Disapproved. Phone 694-2979 Date �� Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory VKUGRgM ,))ml Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: uz Original Certificate Date: 2 �O (Rw. 71Ns) Municipality of Anchorage Development Services Department i 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 CERTIFIICANE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: _ ►-ai 3� (LXX 7 (�k_'E!}TZi�1(J� $7 Parcel ID: A. WELL DATA Well typeVf%%�If A, B, or C provide PWSID # _ Well Lo Y/ ) Date completed*6jq Sanitary seat{ 1) Wires properly protected!) Y�� Total depth 22 ft. Cased to !L5 ft./ I r Casing height (above ground) � -f in. ..a l Date of test Static water level Well production M nRA IAICI 1 1 !1R WATER SAMPLE RESULTS: A) .Coliform D colonies/100 mL Nitrate 1 -%? i gJL Arsenic: N� ug/L date of sample: �/DQj AT INSPECTION ' 9— p.m- Other bacteria n Qcolonies/100 mL .Collected by: `jv-g B. SEPTIC/HOLDING TANK DATA F Tank T elMateriat J'6is(1G l� a YP 'Date installed Tank size two gel. Number of Compartments .2— Cleanout Foundation'cleanout&%) jt75 Depression over tank ,L6)j_Q0 High water alarm (I) IVO Date of pumping '&)/I+ Pumper C. ABSORPTION FIELD ATA Date installed 6 oZ�O D� Soil rating g.p.d./ft r rProdrm) a? - System type �tffiLcav Length ' ✓t✓J ft. Width .� ft. Gravel below pipe ft. pp pp1 Total deptli�3-,ft. Eff. absorption area Uft2 Monitoring tube \IVS Depression over field 7pLUCfIO/l� Date of adequacy test. F C w"F'tesults(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. Any rejuvenation treatment (past 12 mo.) (Y/N & type) 1 Absorption rate >_ g.p.d. If yes, give date sus f dray b CY,� CC) Ort 65 C c 1 U, 1 laa c. z ` U L 0 _ Ld :-J) 2 F- aFZ-'zcnSR O Z LJ to i � x 0n��08xz l x >- 0w a ".! 1- p U E- - F- -jU !�- Q Z tan F r,\2 zu:U1-OJ w 2 .X- LIJ ww (ll 0m Q Ld l��`uiZtncrixO Xit Fa - 2 Cr ~OWC=i�� — a \Z ) f-- i �w�t.: ZU War =wt= - fes- o iw OZ=o �U s z U- F- f 0 2zzwujmo (� a Z LLI_ p a 1 w G U F-- Z M :L.i f-'- a w F- i- Z �f_UOF -ZJ WAC w3 v`stw-� Wno�IQ--m_z to LLJ w Jp—Z U_ LL