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HomeMy WebLinkAboutPOLLARD LT 1Pollard Lot 1 #051-261-40 Municipality of Anchorage Development Services Department �i►ti7 Building Safety Division On-Site Water and Wastewater Program, 4700 Bragaw St. 3 P.O. Box 196650 Anchorage, AK 99519-6650 Page of www ci.anchorage.ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. Stith 0506X045- PID Number: H.me 1 ef4 W /nl F2 Wastewater System: PTNew ❑ Upgrade 9'9577 ABSORPTION FIELD umhx d asaoame P°"2 30-7K62 o D.ap Tw h O snen" Trent O aea 0 Dinar LEGAL DESCRIPTION Sal Ramp � GPD/Flt TCIaI Depen ho. M"I 71410, Z FI. 6lOnk Lot svnElelPpn S Q Dapin to 4170 ponom han agnel 41.00 ♦ FI. GravN aagn narosln 7704 / S FI Taannry Range swron Fu aaaaa apme mpnel praee } Gr"Lenpm '77 FI. G Ft. ❑ New ❑ Upgrade GravN enOln lhit; d IeNs D,Mance Dsreeen Inas — FI Well:JC)USrfAC Ft, classdl ww (Pmata. A a C) Taal DWin Cafes to Taal eosorpW Yea SO � Flt SI..L I F L)LX—C o Am FI. Ft Drub, D.N Dn11e<1Slea ler Laws In".1w Dna....�II E Z2/0 5 Fl TANK nm. Pump sale Gs .gyp. Aeove Grww GPM FI. Ft SEPARATION DISTANCES []Septic ❑ Holding .T.E.P. ❑ Other. To Septic Absorption Litt Holding ubllUPnvate ""'"'I•'""` !' is E apauly lSQ� From Tank Field Station Tank Sewer Line Q Lldefy Hu.wr d Companlnenls w.L rt 0014- 'f- — S0 f STEEL Z s✓lacewelar O't 0 1- /a0'"- LIFT STATION La Lne t Q'f / �•f' Sao /Sao Gal /7/` of O�/Tw� /v�'�.• FarMMron 5- (o'f '.F _ •Parry ai Iev.lal 'Fu drb at H.gnwVW Mer. at al 3S in 45-in Pump Matra a MooN ENarK# .+In�penotmeG Com', - �077a/ C_ Cunrn Dian � � ReraAs BENCH MARK L«•Yal ana l>e 0 Q Ra- ASWrINO Ww-t 1 /QQ FL Inspections performed by: �ni f� K rayl /C� Dates: 1" 111241ar ee:�E OF A(QS 2ndkh S OC ;.••.•....eej•� A .•' •''e Development Services Department Approva * 49L ' Soo ... ....... ...:... `� Conditional Approval Date: J •• •fit........ 9cc, j Stevan n9: 1� jj fe••• PE 6256.'Vate �/I Date:O� ev Reviewed and approved by: IR.v 04961 \ TERNATE NOR THMM j ENGINEERING 17237 Bear Paw glrcle Eagle River, Alosko 9577 907.694.7028 _ DESIGN NOTES: 1. Total Depth of Trench Is 2'. Terrain relatively flat in vicinity of septic 2. Sewer Service Line minimum 2% slope. 3. Lots Served by Public do Private Water V TEST HIGH SLOPE HO LES LAT TERRAIN 1500 GALLON ABSORPTION S.T.E.P. TANK ZLgENCH Tank C.O. 1 Tank C.O. 2 Manhole Monitor Tube 1 Monitor Tube 2 Foundation C.O. CREEK Septic System Construction Does Not Preclude Adjoining Lots From Sanitation Improvements. A B 15.5 31 23 30.5 49.5 27 5 97 100 7 29 POLLARD S/D LOT 1 REDESIGN 1" = 60 WELL AS -BUILT LAYOUT of 3 ui UI L L O ei {+ a d j U O 4 W U £ a L O y W L > li U NtA 0 L' u W O � 4 t d Ny f 3 £ O' +d C a) +� U ^ d fn L S £ O O N UWS Q1 1 d d > U d L CLOG L +; O U L S C5 U (1) C L 0 df N 4 � �NQ O 1 U UCIL O £ > dyO — i. :p c NSN� CL a £ N G O0£- L• C^+i0 _a o,+ Nn - VI NOIs£ Ula dCOL OC CLLc4- Cy0-0 JU OU W °a V d U FL- iS4.F- dmU 0 OF- WY O y I CLL a: LLOO CLF d d W= A VI y3ya .4 co ri v vi�6 Lq LO ON II £ O ip d d L W N S U C L L F- O F- 3 O c d Ol U c O +' d 3 - II 0 0 P Zr :D S U Z W cy Z Z x ¢ �_ d d . c 41 3 3 O Ci F-10 y L £+ N 4- Ll in �i m a) +o, 0 U CL L d L �? U 0 C o nat V CD £ Ln � N N 3 O c d Ol U c O +' d 3 - II 0 0 P Zr :D S U Z W cy Z Z x ¢ �Z xy ua N 4- Ll in �i 3e d o O FQ)A �W �? m to a nat N w � �W � 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 PERMIT Initial Permit Number: SW050265 Legal Description: POLLARD SUBDIVISION LOT 1 Design Engineer: 0838 North Rim Engineering Owner Name: KIRK & DENNITA WINTER Owner Address: P.O. BOX 772468 EAGLE RIVER. AK 99577 - Date Issued: Aug 05, 2005 Expiration Date: Aug 05, 2006 Parcel ID: 051-261-40 Site Address: 20501 LAUGHLIN ROAD Lot Size: 143312 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ PrivyPrivate 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 Issued I Date: 4 S O S Municipality of Anchorage Development Services Department ' } Building Safety Division On -Site Water and Wastewater Program ■ 4700 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. l /–/r/- �,l Permit Number SW Property Mail Site phone 35'0-c�lzsQ4 Code 953-2 "> Code Legal description (Lot, Block & Sub'd.) 1 fee- d S! ^ /_ p'T Legal description (Section, Township & Range) Lot Size_ q4 3�Acre q.Ft. THIS APPLICATION IS FOR: Number of Bedrooms Sewer Only Well Only El and Well / ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 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. of property owner or agent) Permit/Rush Fees:1�10 Waiver Fees: Date of Payment: S Date of Payment: Receipt Number.1) qi ) (Rev. 09/04) —r�f� Receipt Number: y.. SIM �N �INEERING NorthRim Engineering 17237 Bear Paw Circle Eagle River, AK 99577 907.694.7028 July 29, 2005 MOA On -Site Water & Wastewater Program 4700 Bragaw St Anchorage, AK 99519 RE: Septic System Design, Pollard S/D, Lot I The existing property is under development. The property has been partially developed in the past with a water well that requires rehabiltation. A creek crosses the southern part of the property and crosses over to the west. Proper separation has been maintained to the creek. Some gravel has been extracted from the site on the east and a high slope is present with a gravel face. The area of the septic system is relatively flat. Most of the neighboring lots are developed. This site should not negatively impact any of the other area lots. To the north and east is undeveloped. Please review the wastewater system design for the 4 bedroom single farm'ly home with shop and home office. I have included design plans & specs, design guidelines, & soil tests. If there is need for additional information or clarification please give me a call. Sincerly,, Fteve��,ng, PE, P ii Design Enclosures ' I NEERING Pollard S/D, Lot 1 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing - This lot is being developed. The plan is a single family home @ 4 bedrooms and a shop with home office. A new 1250 gallon septic tank will be followed by a 50 -foot absorption trench. The property is in excess of 3 acres in size. Neighbor lots are developed to the west and south. The lots are served by water wells and septic systems. One Class C well is located on Tract A. No adverse impacts are expected from septic system replacement. The neighboring wastewater systems are located on the drawing. The property is relatively flat in the vicinity of the septic system; a steep slope exists to the east at a gravel extraction site. The general slope is toward the creek. No conflicts to any neighbor lots is anticipated. The test hole revealed a sandy soil with a percolation rate below 1 min.lmch; over 50% of the soil is sand. An application rate of 1.2 GPD/FT2 with 0.5 reduction factor for utilizing a 5' wide trench was utilized. The old system will be properly abandoned. An existing water well is present and noted on the plan; this well will require rehabilitation to become operational. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastcwtiater Regulations. • Two compartment, 1250 gallon septic tank. • Watertight couplings on inlet & outlet. • 5 foot minimum between the tank and bed. 10 foot to property lines. • 3 feet of cover or insulation is required for trench; an equivalent of 1" insulation for each foot soil cover. Tank & solid pipe must be set on %vcll compacted, stable soil. • 4 inch diameter cleanouts with airtight caps are required 1 to 4 feet from foundation wall, prior to arty 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10 feet from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs, ASTM D-3034 may be used in hcu of cast iron. • Trench to be placed level, minimum of 4 feet to groundwater, 6 feet to bedrock from drain -rock. • Drain rock to be %a inch to 2 %a inch screened. Drain rock to be distributed uniformly throughout the trench. • Perforated pipe to be installed level with perforations down. • Silt barrier (filter fabric) to be installed above the drain rock. • Smeared trench sides must be raked or scarified before drain rock placement. • Backfill over drain rock must not be less than 36". • The finish grade must be mounded to promote drainage over the trench. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ADS ASTM D2661, • Scwcr Service Line is minimum 2% slope. • Septic Tank to be pumped every tvo years or when required. • Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI or equal) \ 1�1 -7 DESIGN NOTES: — — 1. Total Depth of Trench is 7.5. LIJ Terrain relatively flat in vicinity of septic 2. Sewer Service Line minimum 2% slope. 3. Lots Served by Public & Private Water K W/Of Double C.o.'s 1250 GALLON SEPTIC TANK 4 BDRM—HOUS TEST HOLE LAT TERRAIN ORPTION CREEK HIGH SLOPE Septic System Construction Does Not Preclude Adjoining Lots From Sanitation Improvements. MGR 7l ;'r''I /�+ ?,-. POLLARD S/D - I/�.�`� ElIGI% F -'l; I ( , r� L 0 T 1 . ' 17237 Bear. Pow 4rrclev /L��, Fogle River, Alaska 99577 907.694.7028 H 1 " = 60' WELL SYSTEM LAYOUT ate: 8/4/05 :IEEE i IoF4 j NOR, THRIM ENGINEERING 17237 Boor Pow Circle Cagle River, Alaska 99377 °��'t, c*`�.• 907694.7028 POLLARD S/D LOT 1 ISUBDIVISI❑N --1� LAYOUT 100 j 8/4/05 12 of 4 u / $ { 0 f CL c ( / 0 L� u } u / 0 cl m } z \ -Y $ cl [ /r 0 CD L } w{ t 0 0 aL < u 2 &3 t < W /o \ ± £��� « � �`%` »•t %%�] �r:3 os,� §±t �]_)/ �% Ln /§M )41 C r 2 2 C]) .a�.63h/ap k�§�/)+a ;e41u-3tnf ©±;f/o£-Y ®c®L wO�- �_,£u o0 °°°_©�» z��$L!/bLua § tt tfa> &/$ _ l mnm>�<��� Ncu w¥wa w Q � � Lu 2 � ¢ w Q 2 uk3 �¢2 0�z _jLd wR - $ ? } N N O 4' S N u v u~ D 'a C; d a~ u a .p 0 n C a Oi N N 3 th w in� 41 L S PQ N O d . 3 O (U;zs +1 w 4'cl ; SOILS LOG - PERCOLATION TEST Date Performed; 7/12/05 Performed Fort Kirk & Dennita Winter Legal Description Pollard S/D, Lot 1 DEPTH (FEET) Organic SP Sand w/ Gravel T.H. Location: See Drawing Groundwater? No Depth Water Depth After Monitorino.Nonp nntPt 7iigins # Date Gross Time Net Time Depth Net Drop 1 7/19 3 -- 4 - �: 2 ,;•; 5 1 min. 14' 1.5' 6 7/19 3 -- 13' -- 4 :.; 4 1 min. 14.5' 1.5' 9 7/19 10 -- 13' -- 6 " P' 11 - 1 min. 14.5' LT p :. 12 - •• • :f•. •4'• 13 14 - 15 - 16 - 17 - 18 - 19 - 20 - 21 - Organic SP Sand w/ Gravel T.H. Location: See Drawing Groundwater? No Depth Water Depth After Monitorino.Nonp nntPt 7iigins # Date Gross Time Net Time Depth Net Drop 1 7/19 0 -- 12.5' -- 2 7/19 1 1 min. 14' 1.5' 3 7/19 3 -- 13' -- 4 7/19 4 1 min. 14.5' 1.5' 5 7/19 6 -- 13' -- 6 7/19 7 1 min. 14.5' 1.5' Percolation Rate <1 min,/Inch Perc Hole Test Run Between -3' and 4' Comments GrPntPr thnn 90% snnrl Performed By NorthRim Fng, I" Performed in Accordance with E ❑N THIS DATE. DATE, 7/28/05 Diameter 6' �- 1-11 CERTIFY THAT THIS TEST WAS l State/Municipal Guidelines in Effect -ZE.C. A " NOR THRIM y�P' TESTHOLE LOG ENGINEERING[. ' 4 T. H. 1 17237 Bsor Pow Ckvfo Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 SgeEt'v CERTIFICATE OF ON-SITE SYSTEMS APPROVAL / Parcel I.D. 051-261-40 e Expiration Date: - 1. GENERAL INFORMATION Complete legal description Pollard Lot 1 Location (site address) 20501 Laughlin Ste Eagle River AK Current Property owner(s) Adler, Ronald Day phone 242-1030 Mailing address same Real Estate Agent Amy Davenport Day phone 242-1030 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: D 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ . Received by: 0, - Date: COSA to be released to the engineer, unless otherwise requested by the engineer COSA Fee $ L1 q O odqq K- Date:_ Date of Payment (D [ap(i 3 C4 Date of F Receipt Number O 15Gd-o Receipt IN COSA#- 015C_131acs 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 ;-6/.-29f2018., w e a.t R 6. DSD SIGNATURE _System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: The Municipality of Anchorage Devlopment 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 Septic System Advisory Well Flow Advisory COSA blue sheet 9-1-12.tloc Nitrate Advis,' 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: I6l/R r oQ of l Parcel ID:Q S /— Z -C'/-Gf 0 A. WELL DATA Well type If A, B, or C provide PWSID #_ Well Log (YIN) Date completed % Sanitary seal (Y/N) - Wires property protected (YIN) Total depthiZL ft. Cased to -Z�-ft. Casing height (above ground) n. FROM. WELL LOG Date of test Static. water level Well production 20 WATER SAMPLE RESULTS: AT INSPECTION 3 3S ft. g.p.m. '�'f g.p.m. Coliform colonies/100 mL Nitrate /F? mglL Arsenic:ug/L date of sample:, a Other bacteria D colonies/100 mL Collected by B. SEPTICIHOLDING TANK DATA Tank Type/Materialn C— " STF% Date installed Tank size%500 gal. 'Number of Compartments 2 Cleanouts (YM) Y Foundation cleanout (Y/N) —*- Depression over tank (YM) Al High water alarm (YIN) Date of pumping /D /Z Pumper T. (Z. S C. A13SORPTION FIELD DATA Date installed -G>�2zL& s .Soil rating (g.p.dM or ft2/bdrm) l Z System type /14t) clot #/ Length 71ft. Width s ft. Gravel below pipe S ft. Total depth 3_S ft. Eff. absorption area S ft2 Monitoring tube —�-- Depression over field Ail Date of adequacy test 9143 Results (Pass/Fail) M SS For _q_ bedrooms Fluid depth in absorption field before test 6 in. Water addedK� gal. New depth 13 in. Elapsed Timer 20 min. Final fluid depth in. Absorption rate >= `f Gd g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type)t4 6 If yes, give date D. LIFT STATION Date installed "Pump on" level at _#/ in. Size in gallons / S O O 'Pump of level at- in. Datum R),> f t6#-, Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot /do 'f' Absorption field on lot /D 6 `-f - Manhole/Access (Y/N)_ High water alarm level at yS in. Meets alarm & circuit requirements? On adjacent lots On adjacent lots 6d '4- a a `P Public sewer main ,yig Public sewer manhole/deanout NA Sewer /septic service line Z$ Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 4- Property line Absorption field 5- �f Water main Alh Water service line /D 'f Surface water JGa �r Wells on adjacent lots 0 �t ABSORPTION FIELD ON LOT TO: Property line 'W r� Building foundation /Q'- Water main /VA Water Service line Surface water Driveway, parking/vehicle storage / Curtain drain S� fi Wells on adjacent lots /,0G 'r F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name�7 r ✓F F—ai c Date 6LaQ% ( 3 COSA brown sheet 9-1-12.doc fS_ Parcel I.D. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 051-261-40 COSA # f -S L I U 12' CQ Expiration Date: _ �/- 1. GENERAL INFORMATION Complete legal description Pollard, Lot 1 Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 20501 Laughlin Street Winter 20501 Laughlin Street Laura Hamilton RE/MAX— Eagle River Unless otherwise requested, COSA will be held by DSD for pickup. Day phone 696-0357 Day phone Day phone 244-0357 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 ❑ 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 NorthRim Engineering Phone 694-7028 Address P,O, Box 770724 Engineer's Printed Name Steve Eng 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Date 10/14/10 �yi ��jj�+7 wwr iJ �• `� ••4a •iii "Q.�1�Y� 1t6� �q •r• a• 4.l ,fir t• � O..a avas.ieic•c �+ • ft a.Y. .i.Y.4e••o0c �. trz.x• a r.. r:. cc_,�Slaves N.V. &Ig r ;tl<", r� Za. r Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory N J�: ON-SITE • �= WASTEWATERPRU16 RAM .: Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other �0))J)))); I'' s By: Original Certificate Date: CT / (Rev. 11105) Municipality of Anchorage *AE Development Services Department Building Safety DivisionOn-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Pollard, Lot 1 Parcel ID: 0.51— 2 61— 4 0 A. WELL DATA Well type P Date completed 11/1/69 Total depth 328 ft. If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased toff 3 ft. FROM WELL LOG Date of test 11/1/69 Static water level 34 ft. Well production 20 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 2,5 mg/L Arsenic: 0,250 mg/I Date of9d 10 B. SEPTIC/HOLDING TANK DATA Tank Type/Material " Anchorage Tank SJER Tank size 1500 gal. Number of Compartments 2 Foundation cleanout (WN) Y Depression over tank (WN� Date of pumping 9/2/10 Pumper J.R,'s C. ABSORPTION FIELD DATA Date installed 11/22/05 Soil rating (g.p.d./ft2 or ftz/bdrm) 1,2 Length 79 ft. Width 5 ft. 3.5 506 Total depth ft. Eff. absorption area W Monitoring tube 10/12/10 Pass Date of adequacy test Well Log (Y/N) Y Wires properly protected (Y/N)Y Casing height (above ground) 12"+ in. AT INSPECTION 10/12/10 41.6 ft 6 9— p.m- Other bacteria 0 colonies/100 mL Collected by: N R i m E n g Date installed 11/22/05 Cleanouts (Y/N) Y High water alarm (Y/NT System type mound Gravel below pipe 1.5 Y N Depression over field . 4 ft. Results (Pass/Fail) For bedrooms 0 Fluid depth in absorption field before test in. 60 0 Elapsed Time: min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (Y/N & type) 600+ Water added gal. New dep4 in. 600+ in. Absorption rate >= g.p.d. n If yes, give date D. LIFT STATION Date installed 11/22/05 "Pump on" level at 4t in. Datum bottom E. SEPARATION DISTANCES Size in gallons 1500 "Pump off" level atm_ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ,,,i Absorption field on lot 1 no, + Public sewer main NA Sewer /septic service line Manhole/Access (Y/N) High water alarm level at 45 —in. Meets alarm & circuit requirements? �f-- On adjacent lots 100' + On adjacent lots 100' + Public sewer manhole/cleanout NA Holding tank Animal containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5' + Property line 1 n, + Absorption field_ 5' + Water main ,A Water service line 100+ Surface water Wells on adjacent lots,4W + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1n,+ Building foundation 101+ Water main NA Water Service line 10' + Surface water 100' + Curtain drain 501+ F. COMMENTS Wells on adjacent Iot400' + Driveway, parking/vehicle storagV/ + G. ENGINEER'S CERTIFICATION` 0 4'11t I that I certify have determined through field inspections and review Municipal J0 e•��•.�,®B of records that the above systems are in:49TH*��•���.����•.• conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steve Eng ` :' `-Steven W. Eng Date 10/14/101•'�FD°• PE -6256 / �'.�.t'� fa COSA Fee $7 9 O Date of Payment 16 — % y _ Receipt Number Q ✓�� S G (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SP-Analytica, Inc. -Anchorage 4307 Arctic Blvd. Anchorage, AK 99503 Phone: 907-258-2155 Fax: 907-258-6634 1NAL 1 IC A GKOI. I" Northrim Eng Report Date: 9/9/2010 Attn: Steve Eng Receipt Date: 8/25/2010 17237 Bear Paw Circle Sample Date: 8/25/2010 Eagle River, AK 99577 Sample Time: 10:OO:OOAM 907-694-7028 Collected By: SE Fax: 907-694-7026 Flag Definitions: MRL = Method Reporting Limit Client Sample Io Pollard L1 MCL = Maximum Contaminant Limit Sampling Location: B = Present also in Method Blank Client Project: Various H =Exceeds Regulatory Limit Sample Matrix: Drinking Water M = Matrix Interference COC #: J = Estimated Value PWS#: D = Lost to Dilution Residual Chlorine: ** = RL higher than MCL; target not detected Comments: TNC = Too Numerous to Count - result rejected CF = Confluent Growth - result rejected TCNG = Turbid Culture No Growth - rejected Lab#: A1008343 -02A Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Amihst 4500-NO3E (Aqueous) - Nitrate+Nitrite pres Test was conducted by: Analytica - Anchorage Nitrate -Nitrite as Nitrogen <MRL mg/L 2.5 10 9/2/2010 9/2/2010 MC Lab#: A1008343 -02B Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 922313 -PA (Aqueous) - Coliforms in DW Test was conducted by: Analytica - Anchorage E. Coli Pass PASS/FAIL 1.0 1 8/25/2010 8/25/2010 CW Total Coliform Pass PASS/FAIL 1.0 Lab#: A1008343 -02C 8/25/2010 8/25/2010 CW Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Ana" 200.8/200.8 (Aqueous) - Family Well Water I Test was conducted by: Analytica - Thornton Arsenic 0.250 ug/L B 0.15 10 200.8 9/7/2010 9/7/2010 RM ASBUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENC §OACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS., OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI— VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SEWARD & ASSOCIATES LAND SURVEYING 694-082 SCALE: 0' !QtAP '�; DATE: ,,�� H •' $ GRIDS a�.* .�r.,* '• Duane Mark Seward Ar ��!}J FS: 6 '. LS -16918 AY DRAWN: ,,..