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HomeMy WebLinkAboutHOMESTEAD HILLS BLK 2 LT 5Homesteod Hill Block Lot 5 #015- ! 73- 20 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 Page of www.ci anchorage.ak.us (907) 343-7904 ON-SITE WAST~/A?ER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. $~,.lo5o~(,,5 PID Number: "'" Jot.~ T,,cV.~y WastewaterSystem: I~New I--IUpgrade 13~$1 SpmJlo,,~ b.iv~ ABSORPTION FIELD LEGAL DESCRIPTION s~.~,~ O,(~ 0-! SEPARATION DISTANCES ~sepfic ~ Holding ~ S.T.E.P. ~ ~hen ~ Septic ~so~tlO~ L~ Holding )u~nvate ~ Tank Field Station Tank :-,... ~:~.~ %.k ff, O. N.J, ~ LIFT STATION ~-~:o', ,o' ~ ~l~ ...-.- '~ -I "'~' BENCH MARK Development Se~ices Depa~ent Approval i ~..~.~.~ ...--..~ Conditional Approval Dato: ,.~Reviewed~, and approved by: ~ ~ Date:, il" Jo., , L/_ _%%5 _~. · ....... --::---: ~:---::-r-_~- '- ...... ,__~ ......... % :~ ,, , 1 ........ ~ .............. I / M"¢ ...... ~"-'Y";'"'"~'-'~"'"'~ ~ ~r~rT;~'~a;"7~~ 20~ · 15~. AVENUE ANCE. 4K. 99501 4~I ~PUNE flR~E fl~' 4U~UST 22, 2006 (907) 279-3916 JOHN TUCKEE SXE~: 2/~ GRID:26J~ PERMIT ~ $V050365 PI~ 8 015-173-20 H~HO2052~E~VG 10.5 - 10.5 45.I 10.0 ~0 2' I/ldo 68' Long lO' Beep 7' Sewer rock 3' Cover Nll SCALE , Honlton , /~ Cleanout$ ~ ~ 4' Cover / .= . ' -- ZI £t o£ Septic Rock / Effect/ye NO SCALE SPURKLAND ENGINEERING 203 Vl5th Ave Anchorage Ak 99501 ] PE£~IT ~ SWO$OJ6$ ]0 ~ I000 gal Septic tank I000 got septic tonk ] HOYESTEAD HltrX BLOCK 2 LOT 5 JOHN YUCKEE PARCEL I~ / 015-I75-20 El-rY.= 80.9' BENCH JIA£E BO~TOI~ S/D/NC A$SUI~ED EI_rFATION I00 IISEPTIC SYSTEH DATE, ~U~. 22, 2006 HSHBS~J. BWG MUNICIPALITY' OF ANCHORAGE Development Services Deparlment 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 Date Issued: Sep 22, 2005 Expiration Date: Sep 22, 2006 Permit Number: SW050365 Parcel ID: 015-173-20 Legal Description: HOMESTEAD HILLS SUBDIVISION BLOCK 2 LOT 5 Design Engineer: 0007 Tobben Spurkland, PE Site Address: NHN BIRCHBARK AVENUE Owner Name: BEN SWENSON Lot Size: 23440 SQ. FT. Owner Address: NHN BIRCHBARK AVENUE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99516- This permit is for the construction of; [] Disposa Field [] SepticTank [] Holding'rank [] 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. 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.cLanchorage.ak.us (907) 343-7904 ON-SiTE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Permit Number SW Property owner(s) Mailing address (1) Mailing address (2) Day phone Zip Code qq 5 I~ Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size _,.05.?~-~_ Acres/Sq. Ft. THIS APPLICATION IS FOR: Sewer Only ~ Sewer and Well [] Sewer Upgrade [] THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Number of Bedrooms Well Only [] Water Storage [] Jacuzzi [] Water Softening Unit [] 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 Muni~Codes. (Signature of property owner or authorized agent) {~ Permit Fees: ..t~' q& ~ Waiver Fees: ,,.,,,.,,, '., ,.,, ~..7/ (Rev. 12/00) T. P.E. 203 W I Sth. Avenue. Suite 203 ANCIIORAGE, ALASKA 99501 (9O7) 279-3916 Fax (907)-2?6-6013 SEPTIC SYSTEM DESIGN LOT S BLK 2 llOMESTEAD HILLS S/D Municipality of Anchorage Development Services Department On Site Water and Wastewater Program 4700 South Bmgaw Street Anchomge, Alaska 99519 December 29, 2004 We are submitting an application for the installation ora well and septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the well and septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: No Ground Water Encountered. Use Standard Bed with BioC~cle Soil Rating. From Testhole 12/23/04. I el < mln/in -- 2 gal per sq. Wday No. of Bedrooms 4 Requlred Area per Bedroom: 150/2 =75.0 sq.fi. Total area required: 75.0 x 4 ~ 300 sq. fi. Bottom Rock At 10 feet Top Rock At 3 feet Rock Depth 7 feet Total Bed Length 300 /14=21 USE 25 FT SYSTEM CONFIGURATION BIOCYCLE STANDARD BED TOTAL LENGTH 25 FT TOTAL WIDTll 3 FT TOTAL DEPTtl l0 FT ROCK DEPTti 7 FT COVER 3 FT The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. There nre no developed or natural surface / sub surface drainage courses on this or the adjacent Iot~. The proposed septic system will not change the general slope of the nrea. Ponding and/or concentration of surface runoffwill not result from this installation. I 3 6 ~IRCHBA£K N JO $CAL£~ 1' = 100 F~ I ~-'~ ........ "~'-"t ...... ~'"~ ~EPTIC S~TE~ DESIG~ SHE~: I/3 GRID: 2636 HSHO~O4I. DVG IOBBEN SPURK~AND P.E. 203 · I5TH. AVENUE AHCH. AK. 99501 (~0~) 2~-3~ PERHIT # SVO50XXX LOT PIB # 4431 TRAPUN£ DRIVE BEN SWENSON XX ~~ ~ ........ ~ . ...',~,':~.~'.5.: ~ ...... ~ ~IRCH~ARK A VEN~ ~ roeem SPUN~Mm P.a LOT 5 BK 2 HOMESTEAD HI~ smr/c srsrm ~Es/an 20J W 15~. A~HUE (907) 279-39~ BEN S~HSON SHE~' 2/J C~IO: 2636 PEEH/T 8 SVO5OXXX PZ~ 8 XX HSHOPO5ZgVG ] $~NDA£D TRENCH ] F'O~VD~TJON~E~JT-~ LEVELING ~TU~S~, ~ACTE~ TOBBEN SPURKLAND P.E. 205 W 15TO. AVENUE ANCM. AK. 99501 ] LOT 5 BLK 2 HOMESTEAD HILLS T£APUNE D~91VE 44310EN SWENSON ] SEPIIC SYSTEM DES/GO DATE: DEC. $0, 2004 SHEET: 3/$ GRID: 2656 PERMIT PI~ # xxx HSHO2§53.DVG 13. 14- 15- '.,5. 17. Municipality of Anchorage Development Services Departmenl Building Safely Division On-Sile Water and Waslev,'aler Program 4700 Sou~h Bragaw SL P.O. Box lgE6.~0 Anchorage, AK gg§19-~,650 (9O7) 343-70O4 Soils Log - Percolation Test SIo~3e 6o~ Site Plan I I I Reading Da:e Gross Time I 13- Te~t F/oI~ 'aZ. Municipality of Anchorage Developmenl Services Department Building Sa~ely Division On-$ile Water and Wastewa~er P,'ogram 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www ~;i a,~ cho,'aqe (907) 343-7904 Soils Log - Percolation Test Slooe Site Plan III III IGfossTime' I Fl.. D .. Net Time De~',h Io Wate- ~o'/~" I ~o,~;. I Io~/~" ~s=.~aR:.,~--o iN ACCOROANC=- V;n~ A'.~ STAT: A,~O ~U,~:C~AI. GU~O.%~,4ES I~ EFFECT O~ TN~S OAT~. OATB: Il/Z? ZOo~ ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETWEEN MUNICIPALITY OF ANCIIORAGE THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this ~L '2- day of ~er~r-~ '"]'e,q ~-~of200.~, by and between~M t'~u~O~ '~L~t[ herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Memorandum of Understanding agree as follows: I. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as 2. Definitions. located )--~, Anchorage, Alaska. A. Alteration. Any change to the design or function of an AWWTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Prior to performing any alterations to an AWWTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65. B. Certificate of On-Site Systems Approval An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with AMC 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. : C. Damage. Any man-made or natural change in a system that would inhibit the system from perfonning as designed. D. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. E. Permit (Construction) An On-Site Wastewater Disposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater Treatment System Operating Permit. An annual permit, issued by the Municipality, that allows the Ox~er to operate an AWWTS, upon meeting all the requirements of this agreement, the conditions of Operating Permit, the requirements of the On-Site Wastewater System Construction Permit and all relevant provisions of AMC 15.65 3. Fee. Owner shall pay to Municipality an annual fee of ($ /~).00), payable on or before the issuance of the operating permit and annually thereafter. The annual fee is due on or before the anniversary date of the approval by the Municipality of installed system. 4..Term. The term of this Memorandum of Understanding shall be for the life of the A%VWTS. The term begins on the date of approval by the Municipality of the installed system and shall continue while the AWWTS system is in use or operational or until the property is sold or title is transferred by owner and a new certificate of On-Site approval is issued to the new owner or transferee of the property. 5. Alterations, Installation and Removal of Additional Equipment. Owner agrees not to make any alterations, removal of parts or additions to the AWWTS without a Construction Permit from the Municipality. 6. Maintenance and Repairs. A. Throughout the term of this Memorandum of Understanding, the Owner shall maintain AWWTS in good repair. In addition, it shall be the responsibility of the Owner during the term of this Memorandum of Understanding, and any extensions or renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. Further, Owner a~ees to comply will all applicable ordinance, laws, regulations, rules and orders for the AWWTS. B. Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the terms and conditions contained in the Owner's AWWTS Operating Permit. This schedule shall be submitted to the Municipality annually upon the renewal of the permit. The schedule of maintenance and repair contained in the Owner's AWWTS Operating Permit is: (~ o~ t/ ~/~ /. C. Owner acknowledges that the fine schedule for failing to maintain and repair an AWWTS are codified in AMC 14.60. D. Owner agrees that only maintenance, repair personnel certified by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. E. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. F. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. G. Owner agrees that the relevant provisions of the standard specification guidebook for AWWTS is the governing professional guidelines for the construction, maintenance and repair of the Owner's AWWTS. 7. Nonwaiver. The failure of either party at any time to enforce a provision of this Memorandum of Understanding shall in no way constitute a waiver of the provisions, nor in any way effect the validity of the Memorandum of Understanding or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 8. Amendment. A. This Memorandum of Understanding shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality of this Memorandum of Understanding was executed and such x~xiting shall be attached to this Memorandum of Llnderstanding as an amendment. B. For the purposes ofany amendment modification or change to the terms and conditions of this contract, the only authorized representatives of the parties are: Anchorage: Purchasine Officer C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 9. Jurisdiction: Cholee of I,aw. Any civil action arising from this Memorandum of Understanding shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Memorandum of Understanding. 10. Severabilitv. Any provisions of this Memorandum of Understanding decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Memorandum of Understanding. OWNER: Title: Date: ~- ~L.'9_ ~ t9 ~'- Date: STATE OF ALASKA THIRD JUDICIAL DISTRICT MUNICIPALITY: The foregoin_e.~stmment was acknowledged before me this,fl~ day of~ 20 ~5, by ~ ,_~-~Cex~ , the, /m,~ r~ 2 oe , on behalf olde M~icipali~ of A~ch~ra~. My Co~ission expiresK q/~/D~/~2-' ~: ~ 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 SEWERJWELL SUBMITTAL COMMENT SHEET To: TOBBEN SPURKLAND Legal description: HOMESTEAD HILLS BLOCK 2 LOT 5 The attached paperwork has been reviewed and is being returned for the following reasons: Odginal signature or stamp missing on Calculation error in design. Additional soils information needed. Water monitoring results inadequate. Discrepancy in information submitted. Topographic information missing or inadequate. Incomplete; missing Incomplete; missing Additional adequacy test information needed. Water sample unacceptable. Measured/proposed d~stances/dlmens'ons m'ss'ng. Locations of all soils, percolation and water monitoring tests not shown. Proposed system too deep for soils information submitted. Well log required. Omission in narrative. Insufficient fill over tank or field. [] Other. THE PROPOSED SEPTIC SYSTEM FOE SERVING LOT 4 NEEDS TO BE PERMITED & CERTIFIED INSTALLED BY D.E.C. PRIOR TO RECEIVING A PERMIT FOR LOT 5 SEPTIC SYSTEM FROM THE ON-SITE PROGRAM. Name of reviewer:. JOE GOODALL Date: 1/12/2005 P/ease supply the necessary information and re.submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK STATE OF ALASKA DEPAP. TIVIENT OF ENVIRON~{ENTAL CONSERVATION CONSTRUCTION AlNq) OPERATION CERTIFICATE FOR DOMESTIC WASTEWATER DISPOSAL SYSTEMS Plans.for the cons~'uction or modification of ~00 ~~~ ~ ~ dome= was,ewater [] approved. [] conditionaUyapproved (see attached condidons). , Alaska, submitted in accordance with 18 AAC 72.210 have been reviewed End are If construction has not started wi~in two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. B. APPROVED CIIA~GE ORDERS Change (contract order number or descriptive reference) Approved by Date C. APPROVALTO OPERATE The "APPROVAL TO OPERATE" section must be completed and signed by the Department before this system is made available for use. The construction of the domestic wastewater disposal system was completed on (date). The system is hereby granted interimapproval to operate for 90 days following the completion date. BY TITLE DATE As-buib,'record drawings, submitted to the Department, or an inspection by the Department, has confu-med that the domestic wastewater disposal system was constructed in substantial conformance with the approved plans. The system is hereby granted final approval to operate. 'Y TITLE ~'~ DATEv (Rev Distribution: 1. Retain original t'or project file 2, Make copies for distribution STATE OF ALASKA D£PARTMXNT OF ENVI~ONb~ENTAL CONSERVATION A~PLICATION FOR ON-SITE WATER AND SEWER SYSTEM APPROVAL OR DOCUMENTATION OF SYSTEM INSTALVATION [. G~NERAL INFORM~,TION ,[~ Appli~n~ I--I ~ IGIwNam~&Addr~.t~) Ty~ of W~' SupCy $pt,~ Tretu~.nt of Wa~ef (Chock ~II ~ A~ly) n No~e n cl~o~a~on ~ Fil~on I-I Mineral Remov~l W*U I~ h ~ I~'il~ of~ ',~11 ming m~e~ b dr~ge dhre~ed away ~m ae ~ the (mshg within · i'~d~us of I 0 feet of the well wing? [~ No O No [] No IYicld fl£ ava~.~bl~)~.~s I~.mp~,~ 5ampl~ i~: kv~m. Sure, lc R.ulu: Nora: gl~t ba ttgn~d by a C~mfl~d InstalIar, Pearl.tonal £ngln~r, D~ ~taff. or Owner/Butldar ~,,~_,,rr. '. / ~ 3 ' At= 122, EE= 124. ~ ...... ~ ............ ~ ........ ~ ~ ~ s~.-~ ~,~ ~ C~SS i WELL ' - C~ X ~~ ~ P~:~? , ,, , _~ , ~ ~ ~~~ timI 4~ 3IPCH3APK A roBBER SPURK~NO P.E. LOT 4 BK 2 HO}IESTEAD HILLS SEPDC SYStEm 203 · ~5TH. AVENUE ARCH. ~K. 9950~ ~I YRAPLINE DRIVE DA~E: JUNE ~5, 2005 (907) 279-J9~6 BEN SWENSON $HEE~: 2/~ GRID: 26J6 PERMIT ~ RID ~ HSHO204$.BV6 ~ F~RA££ ~'0 ~I~AIN ~ I ~$LOPE FINISI~I~ ~AD[ A~AY NT$ LEVELI,~ C~SE, C~PACrE~ INS ~AL L A rION I. EXCAVArE A C~PACr AS ~ P~rECt ~Or~OH ~ FlY. ASS ~ T~E EXrRA C~ ~ ASS~E ~HAr INS~ArI~ C~SE IS LEVEL 4. ~ACgFIL~ A~D ~ ~ tO IN~t ~ 4' I~NT ~D 1-1/4' EFFL~Nt LINES VITH FREE-FLOVI~ NSF X~O/GRA VEL ~ACKFILL Nd~:w~sr E~DNG, ASSUWED E~A~ON l~' rOSBfN $PURK~RD P.L LOT 4 B~ 2 HOMESTEAD HILLS SEPTIC srsrcu ~SSUILr 20~ W ]5TH. AVENUE DARE: dUNE 2~, 2005 ARCH. AK. 99501 4431 TRAPLINE DRIVE (907~ 279-~916 BEN SWENSON SHEEE' 3/4 CHID: 2~6 ADEC P~OJECT ~ 4607 4-INCH MOI'ITOR PIPE © ~ 4/--- ,~-INCH INSUldTION ~ ~ O O E5 ~ A~o~sso~ -- ELE~ = 85.2' 4-1N~ gON/TOR riPE o o, o o o o o OD o o o ~=82.2' > o o o o o o o o o o o ~ °°°°°°°°° ~ ~ ¢~u~ / nc~= zf4' ~ / BIOCYCLE 6000 ELE~= 8L9 ~a.~>... ~ ~-~". No. cr-~ * ~ I. PRIMARY TREAT~EN[ SEPTIC TANK 5. SOlL ABSORPBON BENCH ~ARK ~OP NW FOOBNG, DECK ASSUMED EtEVA~ION too' TOBBEN SPURK~NO P.L LOT 4 BK 2 HOMESTEAD HI~ SEPTIC SYSTEU ASBUILT 20~ Wl6th Ave Anchoroae Ak 99~01 4431 TRAPUNE DATE; JUNE 21, 2005 279-J9~6 BEN SWENSON SHEEL' 4/4 GRID: 26J6 ADEC PROJECT ~ 4607 HSHOSO44.D~G State of Alaska DEPARTMENT OF ENVIRONMENTAL CONSERVATION DOMESTIC WASTEWATER SYSTEM OWNERS'S STATEME.~T Thi~ Informatio~ ts required by 18/ut C 15.030. Please type or prlnt all non-,signature Items In Init: Project Name: Project 14o: Date received: I submit the enclosed items concerning the above-refer:riced proposed project for rewew. By my signature I certify that the project is (check one): ~pfivately or'ned and that I am the owner. [ ] owned by a sole proprietorship and that I am the proprietor. owned by partnership of which I am a general parmer. owned by a corporation of which I am a principal executive officer of at least the level of vice president, or a duly authorized representative responsible for the overall management of this project. owned by a municipal, state, federal or public agency, of which I am a principal executive officer, ranking elected q4~icf~l, or other duly authorized employee. · / 'Sl~ture (~,'e~ase sign in ink) Name and Official Title Date Company or Agency (if applicable) 18 AAC 15.030. SIGNING OF APPLICATIONS. All permits or approval applications must be signed as follows: (I) in casa of corporations, by the principal executive officer of at least the level of Vice-president or his duly authorized representative, if the representative is responsible for the overall management of the project or operation; (2) in {he caze ora parmership, by a general pa'trier, (:t) in the case ora sole proprietorship, by the proprietor, and (4) in the case of municipal, state, or other public facility, by either a principal executive officer, ranking elected official, or other duly authorized employee. (eft. 11/256F/7, Register (::4). Authority: AS 46.03.020(10), AS46.03,090, AS .46.0'1.100, AS 46.03.110, AS 46.03.160, AS 46.030.330, AS 46.03.720. State of Alaska Department of Environmental Conservation CERTIFICATION OF CONSTRUCTION FOR DOMESTIC WASTEWATER SYSTEMS Instructions: Within 30 days aRer the con~ructlon, installation, or modification of a project i~ completed, the owner, the contractor(s) responsible for constructing the project, and a registered engineer respons~le for construction inspection, must.complete and sign this foi'm declaring that the project was consl~'ucted in accordance with the most recent Deparm~ent-approved plans, or in accordance with the attached as-built drawings. Ifa project is being completed in phased construction, a map shall be attached showing that portion of the project being declared completed on the date stated inthe Ch, reef's Section. Completion of each phase of a project must be declared as it is completed. Additional Certification of Construction forms are available from any Department of Environmental Conservation office. Please type or print, except for signature: SECTION A- Owher'a Section Nameandbfiefdescriptionofproject: LOT" ~/, ~ll.~g: ~-/$s~-.~,~ff' ~'~;11~ AD£CProjectNo. "~ q~t~ 7 Date Project C~mpleted: ~ I gg~/~>.-.,~- I certify that I em the owner of the above-referenced project. I further certify that this project was constructed ~u accordance ' with the latest plans submitted to and appro,,;ed by the Al~ka Department of Environmental Conse~ation (ADEC), or in accordance with the attached as-built drawings. I understand that I may be required to take remedial measm'es to correct any coas~'uction which was completed without prior ADEC approval, which depal'u from the approved plans, and which is found to be inconsistent with the applicable i'equirements ofADEC wastewater disposal regulations (18 A. AC 72). $~gnatur{,.~OC/~r (Please Sign in Ink) Date 24 SECTIOI'~ B- Contractor's Section certify that 1 (or nn individual under my d~rect supervision) have conducted ~n inspection of the project referenced in Section A, cr portions of the project which I had the responsibility for constructing, and that to the best of my knowledge and information, the project, or those portions, w", or were constructed in accordance with the latest plans submitted to and approved by the Alaska Department of Environment21 Conservation, cr in accordmce with the at~ched .,-built drawings. Name of Contractor Signature of Co~tractor (please sign in ink) Date For multiple contractors, if applicable: ICa me of Contractor - Signature of Contractor (ple.,e s~.gn in ink) Date Icame of Contractor Signature of Contractor (ple.,e sign in ink) Date SECTION C- Engineer's Section I certify that I (or any individual under my d~'ect supervision) have conducted an inspection of the above referenced project, and that to the best of my knowledge, and information, the project w., constructed in accordance with: (check one of the following) [~e latest plans submitted to and approved by the Alaska Department of Environmental Conservation or [] in accordance with the attached es-built drawings. Signature of ProfeJsionel Eng'meer Responsible for C~nstruction Inspection . ('Please Sign in Ink) State of Alaska Professional Engineer Kegistration Number Date 2~ Municipality of Anchorage Development Ser¥ices DePartment Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw. Street P.O. Box 196650 Anchorage, AK 99519-6650 vcww.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEIVlS FOR A SINGLE FAHILY Parcel I.D. 015-173-20 1. GENERAL INFORMATION APPROVAL DWELLING cos^ , o5c Expiration Date: '~ Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address. Real Estate Agent Mailing address HOMESTEAD HILL; BLOCK 2, LOT 5 4333 BIRCHBARK AVENUE *ANCHORAGE, AK 99516 THADDEUS & AMY OWENS Day phone 4333 BIRCHBARK AVENUE *ANCHORAGE, AK 99516 602-6950 Day phone CHARLIE WHITLOCK W/ COLDWELL BANKER Day phone 3000 "C" STREET *ANCHORAGE, AK 9950,3 250-5556 Unless otherWise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] Individual On-site · Individual Water Storage [] Individual Holding tank [] Community Class A 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of AnchOrage is not responsible for errors or omissions in the professional engineer's work. STATEMENT OF INSPECTION BY ENGINEER o As certified by my seal affixed hereto and as of the vafidation 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, t,~e on-site water supply and/or wastewater disposal system is(are) in compliance with afl applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address ,5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal fight whatsoever. DSD SIGNATURE ~/// Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Phone 557-6179 Date' ~Jtachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory, (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report /~---~/~ Original certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE Legal Description: WELL DATA OF ON-SITE HOMESTEAD HILL; SYSTEHS APPROVAL CHECKLIST BLOCK 2, LOT 5 Parcel ID: 015-173-20 COMMUNITY WATER Well type COMMUNITY "A" IfA, B, or C 'provide PWSID# 211669 Well Log (Y/N) Date completed ~ Sanitary seal (Y/N) Wires properly protected (Y/N) J Total depth m .ft. Cased to___ft. Casing he~ in. FROM WELL LOG ~.~CTION Date of test . ~_ ~ ~ WATER SAMPLE~ Coliform ~ colonies/100 mi. Nitrate mg./L. Other bacteria colonies/100 mi. ~ ug./L. Date of sample: Collected by: SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tanksize 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumpin_cl~,/~ ~ J I I Pumper ABSORPTION FIELD DATA I'BELOW EXISTING GRADE] Date installed 6/15/06 Soil rating (g.p.d./ft2or~ 0.8 Length 60 ft. Width 3 ,ft. Totaldepth '15.25 ft. Eff. absorption area 852 ft2 Monitoring tube YES Date of adequacy test 2/11/11 Results (Pass/Fail) PASS Fluid depth in absorption field before test 63 in. Water added 620 gal. Elapsed Time: 1.39 min. Final fluid depth 75 Any rejuvenation treatment (past 12 mo.) (Y/N & type) KNOWN Date installed 6/15/06 Cleanouts (Y/N) YES High water alarm (Y/N) N/A in. Absorption rate >= NONE TRENCH System type DEEP Gravel below pipe 7.1 ,ft. Depression over field NO For 3 bedrooms New depth 77 in. 450+ g.p.d. If yes, give date - LIFT STATION Date installed "Pump on" level at in. Size in gallons Manhole/Access ~ ~ "Pump off" leve~ High water alarm level at in. ~ ~ Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Meets alarm & circuit requirements? COMMUNITY WATER Septic tank/lift station on lot Absorption field on lot. Public sewer main Sewer/septic service line On adjacent lots On adjacent lots  nout ----~ Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation *5' Water main N/A Wells on adjacent lots 200'+ Property line 5'+ Absorption field Water service liri~~ Surface water. 5'-I- 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line'~'~ Surface water 100',1, Driveway, parking/vehicle storage 1 0'+ Curtain drain NONE KNOWN Wells on adjacent lots. 200'.1. *5' PER ORIGINAL 1/10/07 INSPECTION REPORT. DISTANCE FROM ST1 TO F. COMMENTS AT CLOSEST POINT IS 7.3'. . G. ENGINEER'S CERTIFICATION ~'x~,,_ L:).?....~./~ ,~ ~ S and ~ ~ I certifythatlhave determined through field inspection /~.'-~T.~j~...., ~ review of Municipal records that the above systems are in {~, ...... '~ "!'/ !'[ r..,~ ! ......... ~ conformance with MOA COSA guidelines in effect on this ~,K~J/..~.. ~; .... ] ........ .~ date. '~A ~ '~.~Y A. ~ess.-' ~ Engineer's Printed Name JEFFR~ A. GARNESS v~,. I1 vcE-7953 ." ,&~ /. ........- Date ~/~ ~ ~~x~ COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment, Receipt Number Environmental Consulting and Design WATER LINE CONSTRUCTION LOT 5 BLK 2 HOMESTEAD HILLS S/D October 5, 2006 John Tuckey 13551 Spendlove Drive Anchorage, AK 99516 CC: Ref: Steve Mackey Water line Upgrade for Lot 5 & 6 Block 2 Homestead Hills To Whom It May Concern: Installation of the water line was conducted between the 12t~ and I5t~ of September, 2006. Construction inspections were conducted by Spuddand Engineering. Changes to the engineering plans are noted on the As-built. If you have any questions, please contact me at 279-3916. Sincerely, Lars Spurkland, P.E~ Spurkland Engineering 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurldandEng~gcLnet Z W Z ]A IUU ]NI T]U VUI TR~PELINE DRIVE 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. munl.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. OI5' cos # Expiration Date: GENERAL INFORMATION Complete lagal description Location (~te address) Mailing ~dr~s Lending agency Day phone Day phone Mailing address Real Estate Agent , Day phone e Mailing Address Unless othenvise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~, ,, Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual. Holding Tank ~ Community On-site ~E] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only Fpon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. C, ertificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties sewed 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 sen/ed 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 ara valid for one year for properties sensed by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for enors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER ' ': ' " As cerlified by my seal affixed hereto and as of the validation date shown below, I verify that my Invesiigalion, 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 disposa~ 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 oMained from the Municipality of Andxxage files and from my investigatk~ and inspection, the on-site water supply and/~ wastewater disposai system is(are) in compf~ce with all applicable Municipal and State codes, ordinances, and regulations in effect at ~ lime of installation. Name of Firm _ Sj3~//'~.I~ '.~r)~neec~rF?,~..,. ~, .. iPhone ~'~o3~1~ Address ~0~ t,J, 15f~ ~v¢,:, ~/e,-2O?): /~nc~or~q~,~ ~75o1! ' J Engineer's Printed Name. 5. DSD SIGNATURE ~ Approved for ~ bedrooms. Disapproved. Conditional approval for . Date ~/2~/07- bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory ~nic Advi .sory ....... Maintenance Agreements Supplemental Engineer's Report Other. Original Certificate Date:~7 Municipality of Anchorage Development Services Department Bui~ng Safety Dh~sk~n OmSIte Water & Wastewater Program 4700 Bragaw 61met P.O. BOx 196650 Anchorage, AK 99519-665O v~w~.muni.o~onSlte (~,) ~43-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST ~W~.LDATA AT INSPECTION g.p.m. High w.~- alarm ~ mimenaUm a~a~ (past 12 m~) (Y~ & ~/Pe) g.p.d. O. UFT STATION Water m~n IOI +' E. SEPARATION OISTANCES SEPARATION OI~TANCL=~ FROM WELL ON LOT TO: Sel~c tank/~ ~a~on ~3n lot -- Al~mq3aon ~eld on M -- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Pml~ty rme, IO'~. /~eo~i~ aela 5"+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Pml~lyar~ Io'~- Buil~r~g~ ~o'+ Wa~'mam ;"later So,'M~e line Curio dram ,~,]A. COMMENTS: Surface wata- Ioo ' ~- Dm,m.~, ~ ~ . 10'+ LOT ~ Anchora~ Re~rding District~ Alaska ~OT SURV~ CERTIFICATION Date © o~-o4-o~ s~e /,,: N 85" 57'/0'.' W .._ AVEo ............... ' ~flmntI Of ~d O~ff ~ ~o~ LEGEN~ Ir~ pl~ ¢~ rebar recovered, ~ 2x2 hub &tack I. 5/8"x~" rebar set this ~ · Fence LiEe (Ap~o[. L~tion} I~ ADJU~ ~ ~ ~~ = 19~7N~. P~r~ by: E~/~.~ ~ _