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Home My WebLink AboutGREAT LAND ESTATES #3 BLK 7 LT 2AGreatland Estates Block 7 Lot 2A #051 - 133 - 47 Municipality of Anchorage ...,~ ~:, .' Development Services Department - · '~". Building Sa[ely Division "~ ~1~ · O~Site Water and Wastew.ater program. 4700 S. ~ragaw SL P.O. Box 196650 Anct~'age. AK 99519-6650 Page www.d.and~orage.ak.us (907) 343-7904 ON-SITE WASTE'WATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT -: ~-~11 ~ Oo,,~g WastewaterSystem: l-lNew Jg}Upgrade ~'~r~:~ ~707q7 4'h~c~b,//~ ~/q~ 7-~//~ ABSORPTION FIELD Well: [] New r'i Upgrade ~"1 ~ ~. TANK SEPARATION DISTANCES Tank F~,ld Btal~onTank I Sew~- Une · ...w.,. IC0¥ I00; ~ / UFTSTATION V ""~'~': BENCH MARK _ Development Services Department Approval ~.%,~.- C£-8801 ..,/...~.'~_,~ PER).IIT NO, SW030275 PACE 2 oF' 5 MunicipoU"c oF .A.n_=c h.o..r' o g ?. DEPARTMENT OF' HEA~_TH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 O Ar~cho~(~ge, Alosko 99519-6650 · Telephor~e 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT iZCAL LOT 2, BLOCK 7, GREAT LAND ESTATES #$ P.I.D. I,;o. 051-133-30 r" ~ LOT 20 ~ LOT 21 :'--- I [ I I I ' , ~ ~" LOT 22 , ,,-;,',~.-." ^'..L,t~.~ I PERMIT NO. SW050275 PACE 3 OF 3 Mur~icip. cfli'l:~:¥_. ~oF Anchor'ctQe DEPARTMENT OF HFALTHAND HUM'AN SERVICES ENVlRONr"IFNTAL SERVICES DIVISION P.O. Box 196650 IA~cho~ge, At~sk~ 99519-66501 TelepP~one: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LECAI. LOT 2, BLOCK 7, GREAT LAND ESTATES #5 P.I.D. NO. 051--13,.3--30 ST1 ST2 /9.3.2' FINAL ~ ~'J I NEW 1000 I"~ .,.. -.~"- ~'::) ' I GALLON ITM FINAL GRA~E A B FCO 25.5' 17.0' ST1 67.0' 46.5' ST2 73.5' 51.5' DBL1 78.5' 55.5' DBL2 79.5' 56.5' DV 86.0' 65.5' C01 95.5' 78,0' MT1 87.0' 89.5' C02 86.5' 92.5' MT2 71,0' 67.0' C05 78.0' 63.0' C04 69.5' 70.0' MT1 =80.5'j · NO WATER FOUND 74.0' B.O.[I. CO1 =91.9' 02=91.9' '. 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 Upgrade Date Issued: Jul 29, 2003 Expiration Date: Jul 28, 2004 Permtt Number: SW030275 Legal Description:~GREATLAND ESTATES ~3 BLK' 7 LT:'2 Design Engineer: 0003 S & S Engineering Owner Name: Darrell McDonald Owner Address: PO BOX 670947 CHUGIAK, AK 99567-0947 ParcellD: 051-133-30 Site Address: 019727 CHUGACH PARK DR Lot Size: 89734 SQ. 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 consb'uction must be in accordance with: 1. The attached approved design. 2. Ail requirements specified in Anchorage Municipal Cede 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. ROBERT C. COWAN, P.E. CML ENGINEER~ (9O7) 894-2979 FAX (907) 694-121 ~CW,NC~ Suly 2~2003 MUNICIPALITY OF ANCHOR. AGE Developmem Services Department P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 2, Block 7, Greatland Estates Subdivision It is requested that you Issue a permit to upgrade a septic system to serve the existing three bedroom dwelling on the referenced property. One test hole was excavated and a percolation test was performed on 6/12/03. The approximate location of the test hole is located on the attached site plan. Ground water was monitored and after seven days the hole was dry as shown on the attached soils logs. 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. Ifyou require additional information, please contact us. Sincerely, RCC/jnm Enclosure 17034 NORTH F_~GL£ RM[R LOOP ,t SUITE 204 ~ EAGLE RIVER, ALASKA 99577 SITE PLAN DETAIL / / ........... I / NS~ALL ~/ s~ ~mc l* ~ ~ GALLON EDP[ F,.~L ?'ff.'.../ ~B2 ~ Perfon~ed For: Legal Description: Municipality o! Anchorage Developmenl Services Departmenl Building Safe~y 17~sloa On-Slte Wa~ a~ Wasl~et Pr~ram P,O. Box 1966~ ~ge, ~ 9951 ~ d ~n~e a~.us Soils Log - Percolation Test t. 2- 3- 4- 5- 6- 10- 13. '14- '15- 18. 19- 20- COM,",I/HT S Reacting Date G~'os$ Time Hel Time Depth lo Water Net D~'cp o o V4' /z,' ~TEST ROBERT C. COWAN, P.E. C~/1L E~GINEER~ {907) 604-2970 FAX (007) 694-12t 1 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 2, Block 7, Gmat Land Estates S/D July 2, 2003 GENERAL: The scope of this prgject includes the installation of a 1000 gallon HDPE septm ta~fl~ff a new ~?[~ch to serve the existing three bedroom residence located on the referenced property. 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. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed other~vise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval 'from the Municipal Health Department. SEPTIC TANK INSTALLATION: 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 or shifting of the tank. 1703,4 NORTH EAGLE RIVER LOOP & SUffE 204 a EAGLE RNER, N. ASKA 99577 Page 2 Lot 2, Block 7, Great Land Estates $/D July 2, 2003 All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Septic tanks installed with less than 4 ft. ofcover shall be insulated. 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. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCII/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom ofthe excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (rafted-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level 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. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 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 a depression after settling. Page 3 Lot 2, Block 7, Greet Land Eatetea $~D July 2, 2003 MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use ora 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 (Dow 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, Mirafi 140N, or equal) must be 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 conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. 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: Page 4 Lot 2, Block ?~ Great Land Estates $/D July 2, 2003 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. 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 ofthe 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 omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineefing'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 z~'~x MUNICIPALITY OF ANCHORAGE ( .. a~..~\',~ . DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street. Anchorage, Alaska 99501 Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE MAILING~ LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ~q~n gallons IF HOME.DE: nside lengt~ Widm Liquid de~h Dwelling PERMIT NO. ~ O ~ DISTANCE TO: W"" ~ DiS~C~O:/ ~, f~n~t~, ~ Se~r li.~ Septic tank Absorplion i'1;_11-4 I mS I PAL I [.,EPARTMEHT OF HEALTH AND ENVIRONf'IEHTBL PROTECTION 825 L STREET~ RHCHORRGE, RK ~501 264-4720 6~4--S i Ti SEI4ER ~:, i.4ibb F'ERI4 I T PERMIT HO: 840240 DATE ISSLIED: 04?22:/84 RF'PLICAHT: ADDRESS: CONTACT PHOtIE: KEITH BAKER X S&S ENGINEERIHG' EAGLE RIVER, 6~42979 .- LEGAL DESCRIP: SUBDIVISION: GREBTLBND EST. LOT: SECTION: LOT SIZE: 2. SA (SQ. FT. OR ACRES) MAX BEDROOMS; BLOCK: ? LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOg IH DESIGNING YOUR SEPTIC SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOUR SITE. T~:Ef4CH E:ED 14. D;:RIr4 DEPTH TO PIPE BOTTOM (FT.) 4. 0 6. 5 4. 0 GRAVEL DEPTH <FT. ) ' 7. 0 - 0. 5 ~. 5 TOTAL DEPTH (FT.) &~. 0' ?. 0 7. 5 GRAVEL WIDTH (FT.) 2. 5 14. 0 5. O GRAVEL LENGTH (FT.) 22. D 28. O 41. 0 6R¢¢./EL VOLUME (CU. YDS. ) 15. 2 'i4. 5 i2. 5 TANK SIZE (GALS) l, 000. 0 ~,~, i, 00Ct 0 ~,~, l, 080. 0 .~.~ SOIL RATING <SQ. FT. ?B.R) . i02 B5 125 ,+:~: TANK MUST HAVE BT LEAST TI,lO COHPARTMEHTS I CERTIFV THAT: i. I Ri'.1 FAMILI8R WITH THE REQUIREMENTS FOR OH-SITE SEWERS AHD WELLS RS SET FORTH B'¢ THE HUHICIPBLITY OF R~ICHORBGE (MOB) AND THE STATE OF ALASKA. 2. I WILL IHSTBLL THE SYSTEH IN ACCORDANCE WITH ALL MOB CODES AND REGULRTIOHS, At~D IH COMPLIANCE WITH THE DESIGN CRITERIR OF THIS PERMIT. 2. I WILL ADHERE TO ALL. HCA RHD STATE OF ALASKA REQUIREMEHTS FOR THE SET BACK DISTANCES FROM AHY EXISTING WELL, WRSTEI.IBTER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM OH THIS OR BHY ADJACENT OR HERRBY LOT. 4. I UNDERSTAHD THAT THIS PERHIT IS VALID FOR B MR)4IMI_IM OF ~ BEDROOblS RHD ANY ENLRRGEIdEHT WILL REQUIRE AH.ADDITIONAL PER£.IIT. IF B LIFT STATION IS IHSTRLLED Iii RN BREFI COVERED BY MOA BUILDIHG CODES, ]'HEH (i) AH ELECTRICAL PERI'lIT AHD INSPECTIOH HUST BE OBTAINED; (2) RS-BUILTS WILL NOT BE APPROVED WITHOUT BH ELECTRICAL IHSPECTIOH REPORT; AND (~) THE ELECTRICAL Wm]RK MUST BE DOHE BV R LICEHSED ELECTRICIAN. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PER FORMED FOR: /~ ~'~"J~ ~ ~¢'~ 9 , , 10 ,.----- 11 12 13 14 15 16 17 18 19 2O SOILS LOG I'-I PERCOLATION TEST ENCOUNTERED? COMMENTS 72-008 (6/79) IF YES, AT WHAT DEPTH? DATE PERFORMED: SLOPE SITE Dross Net Depth to Net Reading Date Time Time Water Drop COLATION RATE ~/~ (minutes/inch] RUN BETWEEN FT AND FT CERTIFIED BY: DATE: WATER WELl CONTRACTOR'S CERTIFICATION: · , '.: .... '>',' :"..WATER WELL RECORD "'.. ~,-~.. ~'-?' *;~'; ? ..... · -. STATE OF .... -' ~ RESOURE$ ,-::., · ~, Division of G~olo~;icol 8 GE h¥$1COI Survey~ Tll~l~hll~ RrJ !Er] .... : .,. ,. "~" ,al -of "*-'.':*'J-~ '" '" ~. OWNER Ot WEU.: ,'~a'. 13a~rel~' McDonald -?.<: 4. WEI. L DEPTH: (fi.el) S. OATE OF COMPLETION OCob,,,oo, NOR°'°. Dc,'.,, D'-" V;O"".' Ooo,.d ' '0 ";','"" 0"*";%' 0 ' O t.,,W.,~ O 0,,.,:' ' ' ,O. STATIC WATER LE~E~' 100 .-' ,,.* ~. /6/ IS.GROUTING Perforations at 95-105..f; liner 94J206 . -:'. I~oduc~ion ~of 5. GPM "'.:'-~!aL~.uson Prllltn~ ,:. ,:. /u% 5.~85 . ~- -, . . ,- - Iiq.-'; A.,.,,: P.O. Box 770504 Encle Rivert ,".lC. 9~,1577 '--~ '~ :'""' '- * ~ .... ._.:,-. : - . ~ · .:, .. .. ~. ~'. Parcel I.D. o5~-~33-47 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FORA SINGLE FAMILY DWELLING ,~_~..:Z_.~.~,~.. COSA# Expiration Date: 1. GENERAL INFORMATION Complete legal description Great Land Estates #3, BIk 7, Lot 2A Location (site address) z9727Chugach Park Drive Current Property owner(s) Mark 8, Shannon Brand Mailing address Day phone Lending agency Mailing address Day phone Real Estate Agent Cheryl Campbell / Prudential Mailing Address Unless otherWise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Day phone 35~-~-43o Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding Tank r-'] [] Community On-site [] Public Sewer r--] 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/oa~astewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinan~~egulations in effect at the time of installation. Fi Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box 100217, Anchorage, AK 995zo Engineer's Printed Name Steven R. Pannone, P.E. Date Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe 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 soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 5. DSD SIGNATURE [YApproved for ~> bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: ~' 0N-SITE ,~. ~ : WASTEWATER .- JJ),-j'¢JY/b¢~ .,' Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other 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 OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type Private Date completed ~1',61=.q8,. Total depth 206 .ft. Gmat Land Estates #~ ~BIk 7~ Lot 2A IfA, B, or C provide PWSID #~ Sanitary seal (Y/N) Y Cased to =o8 ft. Parcel ID; Date of test Static water level =.oo Well production 5 WATER SAMPLE RESULTS: Coliform Ne§ colonies/100mL Arsenic: ~', Df,~ug/I B, SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size ~.eeo gal. Foundation cleanout (Y/N) Y_ Date of pumping ~h. q120~e C, ABSORPTION FIELD DATA FROM WELL LOG g.p.m. Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) ~.8+ AT INSPECTION 41~612oz0 3.66 ft. ~ g.p.m. in. Nitrate 0.968 mg/L Date of sample: ~12c~1~o~o Other bacteda Neg colonies/100 mL Collected by: Pannone. Engineering Date installed lO~'~ol2oo3 Number of Compartments_~ , Depression over tank (Y/N) N Pumper J.R's Cleanouts (Y/N) Y High water alarm (Y/N) N Date installed ',ol2',12oo~_ Soil rating (g:.p.d./ft2 or ~/bdrm) o.89_Ddlft2 Length ~6 ft. Width ~l ft. Total depth =.=. ft. Eft. absorption area 6,*~ ft2 Monitoring tube Y Date of adequacy test ,.I.,61:zo.,o ResUlts (Pass/Fail) Pass Fluid depth in absorption field before test g in. Elapsed Time: ~o min. Final fluid depth o_ in. Any rejuvenation treatment (past 12 mo.) (YiN & type) N System type Deep Trench Gravel below pipe 7 Depression over field N F°r3 bedrooms .Water addedzrso gal.. New depthz in. AbsOrption rate >= ~rSo g.p.d. If yes, give date LIFT STATION Date installed "Pump on" level at~ Datum Size in gallons in. "Pump off" level at~ in. Cycles tested E. SEPARATION DISTANCES Em Gm Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot zoo+ Absorption field on lot zoo+ Public sewer main N/A Sewer/septic service line 25+ Animal containment areas 50+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 54 Property line 5+ Water main ~.o+ Water service line Wells on adjacent lots zoo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line zo+ Building foundation ' zo+ Water Service line ~.o+ Surface water zoo+ Curtain drain none known Wells on adjacent lots zoo+ COMMENTS 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 .. Steven R. Pannone~ P.E. ~ol~12ozo Date On adjacent lots zoo+ On adjacent lots zoo+ Public sewer manhole/cleanout NIA Holding tank NIA Manure/animal excrete storage areas Absorption field 15+ Surface water zoo+ Water main lO+ loo+ Driveway, parking/vehicle storage Waiver Fee $ Date of 'Payment Receipt Number COSA Fee $ ]-/Z Date of Payment Receipt Number (Rev. 11/05} in. ......................... SG,,$ ............. SGS Ref.# 1105237001 Client Name Pannone Eng. Srv. Printed Date/Time 10/04/2010 11:50 Project Name/# 19727 Chugach Park Dr Collected Date/Time 09/29/2010 t4:00 Client Sample ID 19727 Chugach Park Dr Received Date/Time 09/29/2010 14:45 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: 4500NO3-F - Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements. Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Waters De,ar tment Total Nitrate/Nitrite-N 0.968 0.100 mg/L SM20 4500NO3-F B (<10) 09/29/10 AYC Microbiology Laboratory E. Coli Total Coliform Negative I 100mL SM20 9223B A 09/29/10 DLC Negative ! 100mL SM20 9223B A 09/29/10 DLC Municipality of Anchorage Development Services Department .',"' '~'' Building Safety Division On-Site Water and Wastewater Program 4700 Elrnore 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. OS'I-1 'bt COSA Expiration Date: '7,/~-"~ ,//D GENERAL INFORMATION Complete legal description Lot 2A; B~:~k 7; Greafland Estates Subdivision #3 Location (site address) 19727Chugach ParkDr. Current Property owner(s) Mark & Sharo~ Brand Day phone 263-4323 Mailing address 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 3, 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 [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the reprasenta§ons 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. DaD 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 pdvate or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a pedod 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 tn 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 vedfy 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 vedfy that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm s & s Engineering Phone 694-2979 Address 15861 s. eirohwood Loop Rd. Chugiak, AK 99567 ,1! Engineer's Printed Name Robe~ A. Sharer Datej~~ 5. DSD SIGNATURE f Approved for ~;~ bedrooms. Disapproved. Conditional approval for b d e rooms, with the tallowing stipulations. ....,,..r,j · · ,o ~.-' WATER AND ~ ~ ',h'ASTEWATER : : Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date: ~/~-~//~ Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & 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 CHECKLIST Legal Description:. ~oJc ?--PVi '~tc_'-I ',, (oCr,,.~.~.o.~*~ ~'5~.J-~"~ Parcel ID: ~)_~ ! - 13'5-q7 IfA, B, or C provide PWSID # Sanitary seal (Y/N). ~ Cased to IO8 ft. A. WELL DATA Well type ~J~. Date completed t~[tt. I~q Total depth "~:)(o ff. FROM WELL LOG Date oftest q~ ~'/~ Static water level I~,~ ~'~,$ ft. Well production ~ gp.m. WATER SAMPLE RESULTS: .Coliform ~ coloniesll00 mL Nitrate ,I,~'_~ ;mg/L Arsenic: ~,D ~ uglL date of sample: B. SEPTIC/HOLDING TANK DATA Tank size t~c~O gal. NumberefC0mpartments Foundation cleanout (Y/N). ~ Depression over tank (Y/N) Date0'pumpi.g.,' /' [ Pumper ABSORPTION FIELD DATA Date installed ;~/~/Z1/O~ Soilratin~orft~lbdrm) Length Z~o ft. Width "~ ft. Total depth ~ I: ft. Eft. absorption area ~q~ ft~ Well Log (Y/N) ~ Wires properly protected (Y/N) Casing height (above ground) AT INSP/ECT,~)N ft. Y /~3 ~n. Other bacteria ~) colonies/100 mL Collected by: Date installed /0/~. ~/0 ~ Cleanouts (Y/N) y High water alarm (Y/N) /%/ Date of adequacy test l///' (:,/[ o Results (Pass/Fail) __~,~,~ Fluid depth in absorption field before test (~) in. Water added q'5"O gal. Elapsed Time: I ?-~ min. Final fluid depth {~ in. Absorption rate >= System type ~ Gravel below pipe ~ ft. Monitoring tube~ Depression over field. ~ Any rejuvenation treatment (past 12 mo.) (YIN & type) For ~* bedrooms New depth "~ in. '~O g.p.d. If yes, give date ---..-- D. LIFT STATION Date installed Size in gallons 'Pump on' level at in. 'Pump o~ater alarm level at in. Datum ~ Meets Cycles tested alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /O o '~y' Animal containment areas ~"*'~/'~ Absorption field on lot Public sewer main Sewer/septic s~rvice line On adjacent lots /~ O/'1' On adjacent lots ! Public sewer manholelcleanout F--,/,~.- Holding tank Manure/animal excrete storage a~eas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundaiion '~;'"~( Property line ~ Water main /4) ~¢ Water service line Wells on adjacent lots ~'~ o SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /~ "~: Building foundation Water Service line tO f4 Surface water Curtain drain r~c~¢ ~.o,.~n Wells on adjacent lots F. COMMENTS Absorption field Surface water Water main /o~ Driveway, parking/vehicle storage Date of Payment /~ - ~ ~-- / O Date of Payment Receipt Number ~) 3 ,.~'"..~ ~ O Receipt Number (Rev. 11/05) SGS Rcf.# 1101606001 Client Name S & S Englnecrlng Printed Daie/'Fime 04/21/2010 15:16 Project Name/# Lot 2A; B7: Greatland Est #3 Collected Date~rime 04/16/2010 I 0:15 Client Sample ID Lot 2A; BT: Grcatland Est #3 Received Date/Time 04/I 6/2010 13:50 Matriz Drinking %'atcr Technical Director Slenhen C. Ede P%VSID 0 Samolc Rcmarks: AItov,~ble Prep Analysis Param~ Results LOO Units Mg'thod Container ID L/mits Date Date Init Me~als bZ ICP/MS Arsenic $.00U 500 ugq. EP200.8 C (<10) 04/19/10 04/20/10 SCL Waters Department Total Nilrate/Nitrite.N 1.22 0.100 mg/L SM204500NO3-F B (<10) 04/16/10 AYC Microbioloc~f Labora to:-~, Colony Count 0 Total Coliform 0 Fecal Coliform 0 col/I OOmL SM20 9222B A (<200) col/l OOmL SM20 9222B A (<1) col/100mL SM20 9222B A (<1) 04/16/10 KAR 04/16/10 KAR 04/16/10 KAR 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 RUSH wv~v.muni.org/onsito J (907) 343-7904 Parcel I.D. 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address CERTIFICATE OF ON-SITE SYSTEHS APPROVAL FOR ,b, SINGLE FAMILY DWELLING cosA o5/7o Expiration Date: ~ ~'/'/7 CREATLAND ESTATES SUBDIVISION #5; LOT 2A~ BLOCK 7 19727 CHUCACH PARK DRIVE * CHUGIAK AK~ 99567 WILLIAM &: JANIS SMOKE Day phone PO BOX 671954 * CHUGIAK~ AK 99567 688-8515 Day phone LYNFTTF w./ RFMA× PROPFRTIFS Dayphone §94-4804 16600 CENTERNELD DR. * EAGL~ R~ER. AK 99577 Unlessothetwise mqueste~ COSA w~bohe~byDSD~rpick~. 2. NUMBER OFBEDROOMS: 3 3. 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 Public Sewer E] The Municipality of Anchbrage 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. Cedificates 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 pdvate or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year {Nith 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 investigQ~tionj based on procedures outlined in the Ce~'ficate of On-Site Systems Approval Guidelines for this application, s~w~ J~e o~-~r~Water supply and/orwastewater disposal system is (am) safe, functional and adequate fo~ the number of bedrooms and type of structure indicated heroin. I further verffy that based on the i. : '~ ~ . information oblained from the Municipality of Anchorage files and from my investigation and inspection, the" on-site water supply and/or wastewater disposal system is(am) in compliance with all applicable Municipal . and State codes, ordinances, and regulations in effect at the time oflnstallafion. Name of Firm GARNESS ENGINEERING CROUP. Ltd. Address 3701 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 analys~s 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, end separation distances measured to readily identifiable features. The operational life of all wells end septic systems depend on the local soils condition, greundwater levels that may fluctuate dudng the year, and the water usage of the family being served by the system. These conditions ere outside the contrel 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 prevfde any warranty or future estimate of how long the system will continue to meet the operational mquirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit cf the owner listed above. Any reliance upon or use of this repot by any other person or party Is not authorfzed, nor w/lilt confer any legal right whatsoever. Phone 337-6179 Date 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for ~ bedrooms. bedrooms, with the fllowing stipulations: .... :-.-~ .- ON-SITE :.-.c: WATER AND ~ ~" [ '.. WASTEWATER .. :' .,,,%., .,. Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory By: Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other Odginal Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw S~est P.O. Box lg6650 Anchorage, AK 99519-665O www.muni.org/onslte (9o?) ~4a-Tg04 CERTIFICATE OF 0N-SITE SYSTEMS APPROVAL CHECKLIST Legal Desc=tptton: GREAT LAND ESTATES SUBDIVISION ~3; LOT 2A, BLOCK 7, Parcel ID: A. WELL DATA Well type pmVATli: If A, B, or C provide PWSID~ N/A Date completed 4/16/1984 Sanitary seal (Y/N) YES Total depth 206 ft. Cased to 108 ft. FROM WELL LOG Date of test 4/16/1984 Static water level 100 ,ft. Well production 5.0 g.p,m. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12 + in. AT INSPECTION 9/11/2oos 165 g.p.m. 4 WATER SAMPLE RESULTS: Coliform O colonies/100 mi. Arsenic: /d_D ugJL. SEPTIC/NOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank siz~ 1000 gal, Number of Campertmenta Foundation deanout (Y/N) YES Date of sample: 9/11/2006 2 Depression over tank (Y/N) NO Other bacteria O colonies/100 mi. Collected by: $[(;, Ltd. Date installed 10/20/2003 C~eanoute (Y/N) YES High water alarum (Y/N) N/A Date of pumping ABSORPTION FIELD DATA Date installed lo/21/2oo~ Length 46 ff. Pumper *~ ~.wlrt p{ V~.~ Soil rating ~ ft~x:lrm) 0.8 System type TRENCH Width 3 .ft. Gravel below pipe 7.0 Total depth Il,7 ff. Eft. absorption area 644 fi2 Monib3ring tube YES Date of adequacy tast 9/11/2006 Results (Pass/Fail), PASS Fluid depth in abeoq3flon field before test DRY in. Water added 500 gal. Elapead Tirne: 0 min. Final fluid depth DRY in. At:~:~3tion rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN Depression over field NO For 3 bedrooms Now depth DRY in. 450+ g.p.d. If yes, give date - D. UFT STATION Date installed Size in ~alfons Man~ "Pump on" level at in. "Pump off" . High water alarm level at __ in. ~ Cycles tested. Meets alarm & circuit requirements?. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lilt station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic sewice line 25'+ Animal containment areas 50'+ 100'+ On adjacent lots 100'+ On adjacent lots, 100'+ Public sewer manl~ole/deenout N/A Holding tank N/A Manure/animal excrete storage ames 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Walls on adjacent lots 100'+ Absorption field 5'+ Surface water 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation. 10'+ Water sewice line 10'+ Sudace water. 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ Water main N/A , Driveway, parking/vehicle storage 10'+ COMMENTS HORSE CORRAL I$ 50'+ FROM WELL AND WASTE 15 STORED ,(~rVER ,'r:HE SEPTIC SYSTEM G. ENGINEER'S CERTIFICATION I cerefy that I have determined through fieldinspec~ons end review of Municipal records that the above systems are in conformance with MOA COSA gulclellnes in effect on this date. Engineer's Printed Name JEPPKEY A. GARNESS Date Waiver Fee $ Date of Payment Receipt Number illmU-O-L4 18:18 From: 10/04/2006 0~:d2 d~La~ Pumping PO Box 9';3~1.~ (9O7) Janls Smoke Po Box 6711~4 Chugiak, AK 0~557.1954 (9o7) 58a-8515 .d.~form~oq Jenls 19727 Cht~gach Park Drive Chug;ak, AK 99567 (007) 688-8515 SEPTIC PAGE Service Agreement Jm ~,a~p~,.: 10o0g P.o. Numeee: Tern-a: Net30 T~, 0 ~' Koflig ~T~ Re~ c~ S~: O~ Glenn H~ ~: ~S~ ~3 8000 ' ITank fu~ of Sofi~ = BF ~ Acld[tlona~ Location Commems c~.g,.~: are on E~rown Cedar tide~ home Fi~t House o1'1 left aft~ Poniard Dr Se~c ~2 51de of home Number:. 021352 Order Dote: 28-Sep-2000 Service Dale: 03-Oct-200O 12:00 Technician: Dave G alln n.,~ Planned: 1000 GaL Actual: Hose Length: P.1/1 Double Tank: [] Pump Oyste m; Batfle~ Inlet: I'-} Baffler Outlet:. [] ._..__. Service Type Qb/ Price Each Tax7 $e~ic Service 15K I $0.00 NO Ezl~.SJon Actual $0.oo E~amated C;ha,~a~ S0.1X) ~OO0 TI, x Totd Grand $~.~ $o.0o $ .bl,~urm md TRio ~ Cuetam~' Repm~n~ AUG-~-E9304 ~GI~iY"M From: 9(~,~4498~1 ID: Paee:001 1~=96~ SGS Rt f.l~ CUent Name prolect l~am e/'d Client Sample ID Matrix 1065427001 Gamess Enginecrlng Group, Ltd. Greatland ESL #3 B7 L2 Greatland EsL #31371.2 Drinkinll Wirer Ail Dates/Times ire Alaska Standard Time Printed Dire/Time 10/05/2006 16:30 Collert ed Date/l'lme 09/11/2006 17:30 Received DateFHme 09/11/2006 14:05 Technical Director Stephen CL F.,de Sample P,~natk.s: · p~tr~m~e~ Rcsul~ I'QL Uni~ Medaod Container ID Limits Dat~ Dsm Inlt Nitrate-N 0.952 0.100 mg/L EI~A 353.2 B 09/12/06 ALP, Nih"itc-N ND 0300 mt/l. EPA 353.2 B 09/12/06 ALR Net. als Dep&~immnt · . !5~ ............ 5.00 mg/L SM202340B C 09/15/06 10/02/06 Mit Private Individual Aluminum ~ 20.0 ' ug/L EP200.$ C 09/15/06 10/02/06 MH Antimony lqD l.O0 ug/L EP200.8 C (<6) 09/15/06 10/02/06 Mil Axswiic liD $.00 'ag/L I~P200.8 C (<I0) 09/1 ~06 10/02/06 Barium .10.5 3.00 ug/L I~P200.8 C '(<2000) 09/15/06 10/02~6 Mil Cadmium lCD 0.500 ug/L EP200.8 C (41) 09/1~06 10/02/06 Mit Calcium 43400 500 ugtL EP200.$ C 09115/06 10/02/06 Chromium ND 1.00 ugtL ' EP200.$ C (<100) 09115/06 10/04/06 MH Coppex 3].5 1.00 ug~L EP200.8 C (<1300) 09/I 5/06 10/92/06 IVIH Iron lid 2~0 ugrL EP200.8 C (<300'~ 09/15/06 10/02/06 MH Ltad 0.605 0.200 ug/L EI'200.8 C (<15) 09/15/06 10/02/06 MH Magnesium 10700 50.0 ug/L EP200.g C 09/15/06 10/02~6 Mil Manganese ItD 1.00 ug/L EP200.8 C (<50~ 09/1~/06 10/02/06 Mil ]~hosphoms lCD 200 ug/L EP200.8 C 09115/06 10/02/06 MH Chloride 2.12 0.100 mg/L EPA300.0 B (<250) 09115/06 0~/121/06 DSH Fluoride I~'D 0.100 mg/L EPA300.0 B (<2) 09113/06 09/13/06 DSH Potesslum 649 500 ug/L EP200.S C 09115/06 10102106 Selenium I4D 5.00 ug/L EP200.8 C (<50) 09/11/06 10/02106 MH Sodium 4720 500 Ui/L ~'200.8 C (~250000) 09/15/06 10/02/06 Mit Silicon 4870 200 ug/L EP200.8 C 09/15/06 10/02/06 Mil Silver ND " 1.00 ttg/L E1~200.8 C (<100) 09/15/06 10/02/06 ThalUum ND 1.00 ' u~I, EP200.S C (<2) 09/15/06 10/02/06 Mil Sulfate 33.5 0.100 mg/L EPA 300.0 B (<250) 09/13/06 09/13/06 SGS Reft/ Client Name project ~ame/O Client Sample ID 1065427001 Gara~ss Engineering G~oup, Ltd. Gr~atlaad .Est. #3 B7 L2 Gr~atlaad E~t. #3 B7 L2 Drinking Water All Dates/Times are Alaska Standard Time l'rinted Date/Time 10/05/'2006 16:30 Collected Datefl'ime 09/I1.r2(~06 17'.30 Received Date/Time 09/12/2006 14:05 Ttchnlcal Director Sttphen C. private Individual l~nal~sis Total D~solvcd Solids 169 10.0 mg/L . SM20 2540C D {<500) 09118/06 Zinc 49.1 $.00 ug/L E1'200.8 C (<1000) 09/15/06 1~/02/06 Mil lqickel ND 2.00 ug/L .EP200.8 C (<100~ 09/15/06 10/02/06 HCO3 A~kal~nity 122 20.0 mg/L S~0 2320B D 09/14/06 PLW CO3 Alkaliniiy ND 20.0 mgrt. SM20 2320B D 09/14/~ PLW O11Alkallnlty ND 20.0' mg/L S?,~20 2320B D 09/14/06 1)LW pH '7.65 0.100 l~Hunits EPAIS0.1 D (6.5-8.11 09/12/06 CRY Alkalialty 122 20.0 mgrb SM20 2320B D 09/14/06 I~LW Total Coliform 0 col/100mL SM20 9222B .A (<11 09/12/06 I~F FRO,%I : Fl,:mtn9 Sur%,t:~Jtn9 Ser~.~tces FP~ HO. : ~JO?-24B-4~3~O I',~. 0~ 2003 02:1GP1'I Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program · 4700 South Bregaw St. P,O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorege.ak, us (9O7) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE PAMILY L)WELLIN~ ParcelI.D. 06'"1 -- 133-30 GENERAL INFORMATION Complete legaldescdption Lot: 2: Block Location (site a~dress or directions) Expiration Date: ~ - ,~- O Lit- 7: Greatland Estates ~[D ~ NHN Chugach Park Dr.~ Chugiak, AK Current Property owner(s) Darrell McDonald Day phone 688-2944 Mailing address . · PO Box 670947, ChugJ. ak, AK 99567 Lending agency Day phone Mailing address Real Estate Agent .' Mailing Address Un/ess otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: ;} Day phone 3. TYPE OF WATER SUPPLY: · Individual Well Individual Water Storage Community Class ~ Public Water System Well [] [] [] D TYPE OF WASTEWATER DISPOSAL: IndMdual On-site [] IndMdual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-sit~ wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells er 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 ved~y that my investigation. based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe. functional and adequate for the number of bedrooms and type of structure indicated herein. I further vedfy 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 wastawater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NamccfFirmS & S Engineering Address 17034 N. Eagle River LP RD~ Engineer's Printed Name Robert C. Cowan DSD SIGNATURE ~ Approved for 3 Disapproved. Conditional approval for bedrooms. - Filu.e. 694-2979 .... Eagle River~ AK 99577 Date .,7J5.;; ....... "..: ,_, __ bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisor7 Well Flow Adv!sory X Maintenance Agreements Supplemental Engineer's Report Other Odginal Certificate Date:. // - ~- ~)_~ Mnnicipallty of Anchorage Development Services Department BuiU~g S~e~y Division On-Site VVater & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Ancherage, AK 99519-6650 www.cLanctmroge.ak.us (907) 343-7g04 HEALTH AUTHORITY APPROVAL CHECKLIST Well type c~' If A, B, or C provide PVVSID # ~ Date completed ~'/~- Sanita~/seal (Y/N) V FROM W~LL LOG Date of test ~ Static water level /¢:P~:) fL Wall production ~--. D g.p.m. Well Log (Y/N) Wires propedy protected (Y/N) Casing height (above ground) AT INSPECTION 1¢4 fL ~'° ~ g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/lO0 IN. Nitrate 0.'1 mg./I. Arsenic: -- mg,/L Date of sample: B. SEPTIC/HOLDING TANK DATA TenkType/Material .5~.p*r, r.. / Tank size [~00 gal. Number of Compartments Foundation ctaanout (Y/N) Y Dap _re~n over tank (Y/N) Date of pUmping ~IA"- Na.~,/ Pumper Other bacteria 0 colonies/lO0 mi. Collected by: _-~.? Date in=tepid Cleanouta (Y/N) High water alarm ABSORPTION FIELD DATA Date installed /0/~.,-/0 ~,., 'Soil rating ~..d./l~' ft2/t:)drm) Length ~ ~ Total depth ~ I °/3- ft. Date of adequacy test Fluid depth In absorption field ~)e/fom test in. / Elapsed Time: min. / Irmal fluid depth Any rejuvenation treatment (past 12 mo.) (Y/N & type) System type T,<t/,, cH ff. Width 3 ft. Gravel below pipe -7 ft. Eff. ab~q:rdonarea(o~ ~ Monitodngtubs '~.J' Depression over field ,/V/g-~ Results (Pass/Fail) P/~ ~S For 3 bedrooms Water added, gal. / New depth in. / in. Absorption ra~ >= g.p.d. /V/ If yes, give date D. UFT STATION Date installed/,/fY/- ,~[ Size in gallons 'Pump on' lovel at ...~in. 'Pump off' lovel at Datum / Cycles tested. E. SEPARATION DISTANCES in. Manhole/Access (Y/N) High wa~er ~ level at Meet~ alarm & ~,~utt mqtdmments? Jrl. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankaift,sta~n on lot. /{:~O if. On adjacent lots Absorption field on lot / C~ C) f~/-- On adjacent lots Public sewer main /L///~[ Public sewer manhole/deanout S~epfic sewice SEPARATION DISTANCES FROM SEPTlClHQL4~G TANK ON LOT TO: Building foundation ~ '4- Properly line. ~ 4- Absorption field Watermain /~// ,A~ Water service llne //~) L $uffacewate, Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line [ (~ ;4- Building foundation I Ot¢ Water main Water Service line surface water / OC) ' Curtain drain~V/O,v~- /~'~/~tt/4,/Wells on adjacent lots / O0 /O0 D~m~vay, padrJng/vehicle storage 4- /O F. COMMENTS G. ENGINEER'S CERTIFICATION l certify that lhave determined through field inspections and review of Municipal records that the above systems are in Engineer's . ........ I ! / .s*- / O ] Date of Payment HAA Fee $ Date of Payment Receipt Number (Rev. 12/01) Receipt Number RtL# Cllmt S'amp[t ID I017123001 s & s ]!n~t~i~g Lot 2 BI~7 Gr~tl~nd ,V~ D~,Irtn~ Wa~r 0.100 ms/L, I~PA ]00.0 B ¢"~101 1 l~)t~03 JJB ~iczobtolog'l, Lmbo~atory To~l Coil fo~'n col/l~ ~18 ~22213 A 10/31/o3 DKC FROM : Fl~mtn9 Su~in9 Se,~,.,ic~$ FAX HO. : 907-2zl3-4890 N~. hgJNICIPALIT~ OF ANCHORAGE ° DIVISION OF ENVIRO~SMENTAL R~LTH DEP~THEh'T OF HF~ALTH AND ENVIRO~fl~NTAL PROTECTION APPLICATION FOR V~.ALTH Ab'~HORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal .Description ~nclude lr~ot, bloc~k,,.subdivision, sect~lon,__township, Location (address or directions) (b) Applicants Name ~.,~/~'£~. /~C~v',~la Applicants Address_ (c) Applicant is (check one) Lending Institution Buyer~ ; Other~ (explain); (d) Lending Institution range) Telephone - tlome Business Owner/butlder~; Telephone Address (e) (f) Real Es:ate Co. & Agent Address Telephone. Mail the HAA to the following address: 2. Type of Residence Single-Family~ Number of Bedrooms 3. Water Supply' Individual Multi-Family~-~ Other (describe) Community~--~ Publiel'-'--] Note: If community well system, must have written cortfirmation from the State Department of Environmental Conservation attesting to the legality and status. Sewage Disposal Onsite ~ Public ~--~ Community ~--~ Holding Tank ~ Note: If community well system, must have written cor~lrmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] En~ineerin~ Firm Providin~ Inspections~ Tests~ File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is 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 f~nicipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all M~nicipal and State codes, ordinances, and regula- tions in effect on the date of this inspection, Name of Firm Telephone Address Date DtIEP Approval ~-~ Approved for Approved Terms of Conditional Appr~oval~ bedrooms Disapproved Conditional CAUTION THE MU~IICIPALITY OF ~NCItORAGE DEPARTHENT OF HEALTH ~ND ENVIROL,~EN~AL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE P, EPRESEN~- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY ~ INDEPENDENT PROFESSIOnaL ENGI}ffiER REGISTEKED IN THE STATE OF ALASKA. TH]~ DHEP DOES THIS AS A COL~TESY TO PURCHASERS OF HOMES A~I~ THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- M~N~S. ~MPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~NALYZE DATA BEFORE A CERTIFICATE IS ISSUED, THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (D~EP SEAL) RR4/eJ/D18 [Page 2 of 2] 7-19-84 Ae MUNICIPALITY (F KNCHO~AGE (MOA) HEALT~ AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 i, AUNICI~AtITY OF ANCHORAG~- DEPL OF HEALTH & ENvt~ONN',sNTAL RECEIVED Well I~g I~esent ~N.) Total Depth ~ ~ Cased to Static Water Leal Casing Hsight Abo~ Ground Electrical Wirin~ in Conduit ~N) Separatio~ Distances f~cm Well: If A, B, cr C, D.E.C. App~o%~d(Y/N) Pump Set At ~" ; on rejoining Lots ./00 '{~ ~ on Adjoining Lots To Neamest Edge of Abso=ption Field on Lot To Nearest Public Sewer Line /c)/~-- To Nearest Public Sewer Cleanout/Manho To Nearest Se~r Service Line on Lot Water Sample Test ~esults De[xession over Tank (Y_~ Pa~e Last ~ed PumpinG/Maintanance ConLract cn File (Y/N)~//~- ; Holding Tank High-Water Alarm (Y/N) ~/,~- Tempo~az"y Holding Tank Permit (Y/N) NO~ of Oa,¥a~tmsnts Foundation Cleancut (~N) fc~ / To'Building Foundaticn To Disposal Field F/~ / To Stream, Pond, Lake, ~ Major Drainage [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD E~TA · Soils ~atin~ in Abs~-pt, ion~trata /D~/~Z ~. ~ of ~tem ~si~ ~ I~tal~d ~/q/&~ ~ of Field 7~ -- Wi~ of Field [ ~O' '~ Depth of Field Gravel Bed Thickness ~ ~st ~a~ ~st To D~iveway, Parkin~ Area, c~ Vehicle Stc~aGe Area D. LIFT STATION Size in Gallons Manhole/Access (Y/N) "Pump On" Le~sl at ~%~/Off" Level at High Water Alai~a [emi at ~ / / Vent (Y/N) I certify that I have checked, ~rified, c~ o0nfc~med to all MOA HAA Guidelines in effect on the date of this inspection. Si~ed · & ? E~0~iN0 Dete Co.~an¥ ~ ~.,~ ~;VaS. Au, s~% ~o-~ MOA ~. / KB1/d5/$ [Page 2 of 2] 2-15-84