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HomeMy WebLinkAboutTHERESA MAE LT 2CTheresa Mae Lot 2C #015-081-42 Municipality of Anchorage ;�' '�•, Development Services Department" o Building Safety Division - On-Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage. AK 99507 Page of www d.andwrage.akus (907)3437904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWO60125 PID Number. 015.08142 , Brett Dufour a Laura Halverson Wastewater System: ❑� New ❑ Upgrade Add° 10529 Ridge Park Drive Anchorage, AK 99507 ABSORPTION FIELD Pim 2304891 ftb ae.amm.4 DDeq Trec! Q1sn.eo-TwO Dery Owa OO„.r LEGAL DESCRIPTION soi ` Toa opmr�me 9a�. .6 Gpose R. am La 2G sutxl a Theresa Mae 0.p„ b Pv. eaeea tmm *l ll a Gr..al eso„twmtl ppe 5 FI. 4 A Ta.•mtp Reqs asset Fe.itox1 o..0a91 (jibs Gr„a LwV t 0-1 Ft. 102 n. Well: ❑ New ❑ Upgrade CY .rept (sawsar.. 1 Osteoa MM.. 5 n. Ft DMweusel (Pt . A a. Cd Tall DepenCe.e b Ta.l .G.ep.ut.n. Pp. M Existing Ft, n 1,010 Flt ASTM D3034 PVC >aK Dao Dr alas wr L. w1Ytl Dr.IrsIYW Ft. Red ON Excavating 5r2212007 r.q Pum as a C.rq ""'" • Grourle TANK GPM F< FL SEPARATION DISTANCES 0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lit Holding tibilwnviote T From Tank Field Station Tank Sewer line Anchorage Tank 1,250 Gr Manor R,aae a Domesrr.. wa >100' >100' WA WA >25' Steel Two (2) aut.awre >100' >100' N/A NIA LIFT STATION LAX L" >s >10' NIA NIA cr �m I.wa vumrrM..l.t tall-reram.t Fa.tMbrl >s >10' NIA NIA Ptsrq Mrw a MSM El.peol Imps Pala,ne M C~ DW, None Noted R Existing Septic Tank was Pumped. Crushed and Abandoned BENCH MARK lor..oa.r D.wv.et On Site. Existing Absorption Trench was Abandoned in Place. Garage Slab Lr ,uut Fl Inspections performed by: A•Harala Dates: 10 5=007 +++ OF At4ja Qsrr� 2nd 57222007 Z Development Services Department Approval n: r'?' 4 SH *, s w Conditional Approval Date: •' 00... ���� ••� .r ............ s .... MUCNAFI V. ANDERSON;'v CE-4381 �•\?` Reviewed approved by: Date: I - 9 - o� ..... 0" al and A� •�• 1, r+ ..'`SOo i :• i � a �`�9J•�� .1 S : N 00 02'34'W 115.20' n 0%ti: i I i 0%0,at I t r • �4 «A a �� I .� c +i{ jii5 " • 3 m W I o u N I ; I I N I V I g I " m D I C I 7 I I mm r I m :Eo r' N D m z �' Cl fTl " o S rK i m ri I�7 3 I r, m �D �m— e D .� o ® I s u �o 83 8% m mcg i� O bd m m I o )a mvm C In I z ;X I -4 0 Z I ENm'= I m � X O I I ; II I — — — — — — — 10' T. k E. ESMT. -- J v O -p N 00'02'34'W 115.15'o +o CD O �- m w - GROVER DRIVE JL N Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number. SWO60125 98.0 � UU U to tq E 1.250 Gallon Septic Tank 91.55 91.35 PID No. 015-081-42 91.1 f 49th i PROFILE AS -BUILT ��A iMICH 1ELEANDERSOl1 �0, ..•• No. [creat i No Scale •�1' ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 FAX MEMORANDUM DATE: January 9, 2008 TO: Jeff Poet FROM: Mike Anderson, P.E. SUBJECT: Lot 2C, Theresa Mae Subdivision Well and Septic System As Built The test holes placed on Lot 2C, Theresa Mae Subdivision were monitored for groundwater on a regular basis. The depth or thickness of the groundwater was measured rather than the distance from the ground surface to the surface of the water. That information was then recorded on the Soils Log -Percolation Test submitted to the City. The dimension shown on the report for groundwater is the thickness of the groundwater at the bottom of the test hole and not the distance to the groundwater surface for the surface of the ground. Please advise if you have further comments regarding this permit application. 0 1 Qi' Municipality of Anchoragea `P,:�'� (ENGjIM't3,��j.) - �•90• Development Services Department �"�� T 49m IPA Building Safety DHielon ,. *; ......... ....: s y� On-S@e Water and Wastewater Program �'•. .... ••�• 47DO South BragawSt. • P.O. Box 196650 Anchorage, AK 9951.93650 Q;,..^..9s,•1/.��%or•••'^",� ' S Val.MICHAEL•E ANWSON wwwel anchorage sk.us (907) 343-79oe 0, To. Jaw x.4381 v Soils Log - Percolation Test t����iR�orcos�o�d�•` -: _ - Performed For. Date Performed: -,� 1s D - � Legal Description: .,y 1 /1 EKP5A- � , Ip'r ?�L Township, Range, Section:, ' Slope Site Plan 7H /1• IG Sj /T WAS GROUND WATER �I ENCOUNTERED? S e e IF YES. AT WHAT DEPTH? .110 0 Depth to Water Ager - P Mon � NonitorNp? E .Date: .w 14- d.�-YIsL 15- j 16- 17- zo- Reading _ Date Gross Time Net Time Depth to Water I Net Drop _ C,:14;- PERCOLATION RATE TESTRUNBETWEEN COMMENTS rffy G,a,/(*J y/�y ►.yti .�^c L: fl 114"Wt t ly (It A (mNule✓ndt).__._. PERC.HOLE DIAMETER___ . 11 - FT ..'AND s�J.O -'Fr PERFORMED BY: I G 1� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: • {►9' O� ' i i Reading _ Date Gross Time Net Time Depth to Water I Net Drop _ C,:14;- PERCOLATION RATE TESTRUNBETWEEN COMMENTS rffy G,a,/(*J y/�y ►.yti .�^c L: fl 114"Wt t ly (It A (mNule✓ndt).__._. PERC.HOLE DIAMETER___ . 11 - FT ..'AND s�J.O -'Fr PERFORMED BY: I G 1� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: • {►9' O� ' MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d 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: Jun 02, 2006 Expiration Date: Jun 02, 2007 Permit Number: SWO60125 Parcel ID: 015-081-32 Legal Description: NEWSY #1 LT 2 Design Engineer: 0014 ANDERSON ENGINEERING Site Address: 009700 GROVER DR Owner Name: SHAUN N. COOLEY Lot Size: 158680 SO. FT. Owner Address: 10000 CRAIG CREEK Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99516 - This permit is for the construction of: 0 Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by catling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, seated, and heated to prevent freezing. Received By. Date: Issued By- ( Date: 2t7 kill Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-081-32 Property owner(s) Shaun N. Cooley Day phone 5294625 Mailing address 10000 Craig Creek Circle Anchorage, AK 99516 Zip Code Site address 9700 Grover Drive Anchorage, AK Zip Code Legal description (Sub'd., Block & Lot) Lot 2, Newby Subdivision No. 1 Legal description (Township, Range & Section) Lot Size 158,680 Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field 0 Septic Tank 0 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms Four (4) THIS APPLICATION IS AN: Initial ❑ Upgrade [� Renewal ❑ 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. /' fjj Z (Signature of property owner or authorized agent) Permit/Rush Fees: _ qj/' C'' • CEJ Waiver Fees: Date of Payment: 5130 /01y Date of Payment: Receipt Number. EMD -4 94,4 Receipt Number. (Rev. 11105) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677--7766 TAM MEMORANDUM DATE: May 17, 2007 TO: Joe Goodall FROM: Mike Anderson, P.E. SUBJECT: Lot 2, Newby Subdivision No. 1 Septic System Permit No. SW060125 We have modified the septic system on the subject lot to include a 100' long by 5' wide absorption trench with a 4' effective depth. This will allow additional drop from the septic tank and the house. The location of the well on the lot requires the septic system to be placed nearly 100' from the house. The lot surface is fairly flat and the effluent entry into the trench must be at least 5' below the surface to provide gravity flow. The attached site plan and trench section detail show the modifications to the system. Additional test hole information will be supplied with the as built inspection report to verify soil conditions. ZVOff N,19.10.00N LOT 2, NEWBY SUBDIVISION NO. 1 DESIGN FACTORS: Four Bedroom House Perc. Rate: 14-30 Min./Inch (Est) Application Rate: .6 GPD/SF SYSTEM REQUIREMENTS: 5' WideTrench System 1,250 Gallon Septic Tank 4' Drainfield Rock 4 Bedrooms X 150 GPD/.6 GPD/SF (Application Rate) =1,000 SF Absorption Area 1,000 SF/5 SF/LF•.5 (Red. Factor)= 100 LF Trench Length THEREFORE: Construct an Abosrption Trench 100' Long x 5' Wide x 4' Effective Depth. Flow Line Elevation in Trench to be 5' Below Original Ground Surface. Total Depth to be 9' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. Enter Trench at Midpoint with Effluent Flow. 4'6* I Natural BackfillGeotextile 4 Fabric 6- 4'0" T 4" Perforated PVC (Holes Down) Drainfield Rock ICAL DEEP TRENCH SECTION NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock Minimum 4' Separation From Groundwater. Minimum 1 00'Separation From Wells in the Area. Minimum 100' Separation From Edge of Lake. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 FAX May 27, 2006 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 2, Newby Subdivision No. 1 Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing absorption system on the subject lot has failed and must be upgraded prior to subdivision of the property. We are therefore requesting a permit be issued for the upgrade of the septic system to accommodate the four-bedroom home on the lot. The attached Site Plan and backup documentation identify the location and configuration of the existing septic tank and proposed septic systems. Also identified on the plans are the locations of the existing well. The new system will be constructed entirely outside the 100' protective radius of the well on the lot. No conflicts exist between the proposed septic system and the wells on adjacent lots. Drainage arrows are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The test holes placed on the lot at the location of the new absorption trench indicated silty gravel and sand (GM/SM). The percolation rate was determined to be 14 to 30 minutes per inch. We are proposing to construct a 1,250 gallon septic tank and a 73' long by 3' wide absorption trench with 7' of gravel beneath the distribution pipe. The distribution pipe in the trench will be placed at 2' below the surface with the total depth at 9'. The ground surface on the lot slopes slightly to the west at a grade of 3%. The new trenches will be constructed parallel with the slope as much as possible in conformance with Municipal requirements. The new septic system will be constructed a minimum of 1 00'from the existing well and any surface water in the area. If the system is constructed in accordance with our design the following statements Lot 2, Newby Subdivision No.1 May 27, 2006 Page Two apply: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely,, ykl-'-C� Michael E. Anderson, P.E. Attachments WCNAEL E. ANDERSON 4 no. CE -438' . N PQ W J L J } J Q S � W N N 3AJN WAUD .• ,� _ Avg• III � Q 1 am 0 = R.O m � QPM w O 0 ' r O` • N N� QW W8 V 12 C91 V Lf7 In (+) u I LOT 2, NEWBY SUBDIVISION NO. 1 DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home Deep Trench System Perc. Rate: 14-30 Min./Inch 1,250 Gallon Septic Tank Application Rate: .6 GPD/SF 7' Drainfield Rock 4 Bedrooms X 150 GPD/.6 GPD/SF (Application Rate) = 1,000 SF Absorption Area 1,000 SF/14 SF/LF = 71.4 LF Trench Length THEREFORE: Construct a 72' Long x 3' Wide x 7' Effective Depth Aborption Trenche at the Location Shown. Flow Line Elevation in Trench to be 2' Below Original Ground Surface. Total Depth to be 9' Below Existing Ground. Provide 3' of Cover Over Trench and 4' Over Tank or Provide 2" of Insulation and 2' of Cover. Maintain 100' Separation From Wells in the Area. Natural Backfill 1'6" Geotextile Fabric 6" 4" Perforated PVC (Holes Down) 7'0" 3' Drainfield Rock TYPICAL DEEP TRENCH SECTION ,.•••• •�� (NO SCALE) �JPLE,.......... ' NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock :..... ... 49th_... .... Minimum 4' Separation From Groundwater. 0" Z • ...... ,..... Minimum 100' Separation From Private Wells in the Area. i �"". A�,chaef i". de Minimum 100' Separation From Surface Water or Streams.No. CE4381 Minimum 10' Separation From Water Service Line. nisi •._ -----=--7 :s MUNICIPALITY OF ANCHORAGE .��P��OF �������•♦ DEVELOPMENT SERVICES DEPARTMENT/BUILDING SAFETY DIVISION fit, �. ON-SITE WATER AND WASTEWATER PROGRAM 4700 BRAGAW STREET ANCHORAGE, AK 99519 t ...... 49th���� SOILS LOG - PERCOLATION TEST y �L� 0. .................. ;MICHAEL E ANDERSON •1 `�, No. CE 4381 LEGAL DESCRIPTION• NEWBY #1 S/D �iE ''•..,�_'� PERFORMED FOR, SHAWN COOLEY �i4lillf si�;:��• DATE: 4/6/2006 PROJECT No M0608 Illivius�•"� PARCEL ID,#• TECHNICIAN: T. L. KIMBROUGH Professional En Ieeero Stamp: :PT}I TEMP: 48° TEST HOLE 2 (fC-1 (r«1) 1 OB/OG SLOPE SITE PAN 2 SILTY SANDS W/GRAVELS 3 il I = GLACIAL TILL LENSE 4 OTTHI <5% 6 WELL COMPACTED DAMP 7 D SILTY SANDS W/GRAVELS — LOT 2C SM -GM 8 9 WAS GROUNDWATER GROVFR DR. ENCOUNTERED? Yes IO SEEPS IF YES, WHAT DEPTH? No DEPTH OF WATER 21 O% 11 AFTER MONITORING: 12 DATE: 5/20/2006 13 MINUTES) (MINUTE(INCHES) 14 1$ 1( BOH 17 18 19 20 PERCOLATION RATE• 14.1 (MINANCII) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 4_5 FT, and 5_5 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO PERCOLATION TEST. TEST PERFORMED BY: TRK I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: GI�OSS TIME NET TIME DEPTH of INFT DROP DATE(S)WATERNCHES) 4/6/06 TEST HOLE PRESOAKED PRIOR TO TESTING: 1 1231 7.12$ CHARGE 2 1301 30 4.87$ 2.2$ 3 1301 7.$ CHARGE 4 1331 30 $.37$ 2.12$ $ 1331 g.0 CHARGE 1401 30 8.87$ 2.12$ MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT/BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM 4700 BRAGAW STREET ANCHORAGE, AK 99519 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION• NEWBY #1 S/D PERFORMED FOR- SHAWN COOLEY DATE: 4/6/2006 PROJECT No • M0608 PARCEL IDX TECHNICIAN: T. L. KIMBROUGH TEMP: 48' Dr:PTH TEST 110LE 2C=-2 (red) 1 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 COMMENTS: OB/OG SILTY SANDS W/GRAVELS =1 GLACIAL TILL LENSE WELL COMPACTED DAMP SILTY SANDS W/GRAVELS SM -GM F:57: TEST PERFORMED BY: TLK WAS GROUNDWATER L ENCOUNTERED? Yes IF YES, WHAT DEPTH? NO DEPTH OF WATER 1,5, AFTER MONITORING: DATE: 5/20/2006 SITE PAN 0 TH2 LOT 2C GROVFR DR. 1'. DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH of WATER (INCHES) NET DROP (INCHES) 4/6/06 TEST HOLE PRESOAKED PRIOR TO TESTING: 1 1410 9.25 CHARGE 2 1440 30 7.75 1.5 3 1440 9.5 CHARGE 4 1510 30 8.13 1.37 5 1510 10.0 CHARGE 6 1540 30 8.63 1.37 PERCOLATION RATE• 22_(MINANCI I) PERC. f TOLE DIA. 6 fINCI IES) TEST RUN BETWEEN. 4_5 Ff. and 5_5 FI'. 1, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: jG;-la—OL ONSITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 2, NEWBY SUBDIVISION NO. 1 GENERAL: The scope of this project includes the abandonment of the existing absorption trench and the pumping, crushing and backfilling of the existing septic tank. It also includes the procurement and placement of a new 1,250 -gallon septic tank at the location shown on the Site Plan. Work also includes the construction of a new 73' long X 3' wide X 7' effective depth absorption trench at the location also shown on the Site Plan. The distribution line in the trench will be placed at 2' below the existing ground surface. Total depth of the trench will be 9' below the existing ground surface. The new absorption trench and septic tank must be placed a minimum of 100' from all private wells and any surface water in the area and 10' from the water service line proposed for the lot. A minimum of 3' of cover is required over the absorption trench and 4' of cover over the septic tank. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. The Contractor must also verify the location of wells in the area and assure that the separation distances are met. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION A new 1,250 -gallon septic tank must be procured from an approved source and installed at the location shown. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. Lot 2, Newby Subdivision No.1 May 27, 2006 Page 2 of 3 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. Lot 2, Newby Subdivision No.1 May 27, 2006 Page 3 of 3 MATERIAL SPECIFICATIONS: Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5' in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. • Municipality of Anchorage On -Site Water and Wastewater Program M (907) 343-7904 s x Parcel I.D. 015-081-42 1 Certificate of On -Site Systems Approval GENERAL INFORMATION Complete legal description Theresa Mae, Lot 2C Location (site address) 7143 Theresa Mae Circle Expiration Date: Current Property owner(s) David & Vicky BaggS Day phone Mailing address Real Estate Agent 7143 Theresa Mae Circle 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual Q Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: � - `� �, �� � 'F' Date. COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment Receipt Number COSA # Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE 1. System #1 Approved for / Y pp �=bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Date 12/10/13 bedrooms, with the following stipulations: BY: '//2y % ✓, ftp Original Certificate Date:_ j - / 3 /__7 The 1iunicii5alit -of ehorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA bluesheel r a c If more than 1 septic system is on the lot: COSA Checklist # 1 of I Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Theresa Mae, Lot 2C A. WELL DATA Well type Private Date completed UNK Total depth UNK ft Date of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to U N K ft FROM WELL LOG ft. aml WATER SAMPLE RESULTS: Coliform./,V, mL Nitrate mg/L Arsenic 2.55 ug/L Date of sample: 12/10/13 s/al X13 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/steel Parcel ID: 015-081-42 Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) 18 in. AT INSPECTION 6/17/13 66 6.5+ Collected by: PES ft. Date installed 5/22/07 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 6/25/13 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 5/22/07 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 GPD/SF System type Shallow Trench Length 102 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 10.9 ft. Eff. absorption area 1,0101f Monitoring tube Y Depression over field N Date of adequacy test 6117/13 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 44 in. Water added 608 gal. New depth 47 in. Elapsed Time: 110 min. Final fluid depth 44 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum E. SEPARATION DISTANCES WELL ON LOT TO: Size in gallons "Pump off"level at in. Cycles tested Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (YIN) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ 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 Steven R. Pannone Date 12/10/13 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parkingivehicle storage 10+ R1 is Parcel I.D. 015-081-42 Municipality of Anchorage On -Site Water and Wastewater Program fl (907)343-7904 saK Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Theresa Mae, Lot 2C Location (site address) 7143 Theresa Mae Circle Expiration Date: /0 - : 7 - / Current Property owner(s) David & Vicky Baggs Day phone Mailing address Real Estate Agent 7143 Theresa Mae Circle 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well El Individual (] Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ , PuUIIV VVatel Sy$telll ❑ PUblicSewer ❑ WaiverNariance request for: Z ZL_1 Received by: 7`wx X11 �_ Date: VVI COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 4610 Date of Payment 61 lis'1 13 ri-\"- Receipt Numberb1'_7 C'Q COSA # OSL l 31 dj ) Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGyATURE System #1 Approved for __+_ bedrooms System #2 Approved for _ bedrooms Disapproved Phone (907) 272-8218 Date 6/17/13 Conditional approval for bedrooms, with the following stipulations: BY Original Certificate Date: / 1_3 Th unia6�rv1 -pality of choratn ge Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory �� Arsenic Advisory Well Flow Advisory Other COSA blue sheet r c If more than 1 septic system is on the lot: COSAChecklist # + of + Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description Theresa Mae, Lot 2C A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed UNK Sanitary seal (Y/N) Y Total depth UNK ft. Cased to UNK ft FROM WELL LOG Date of test Static water level Well production ft. Parcel ID: 015-081-42 Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) 18 in. AT INSPECTION 6/17113 66 6.5+ WATER SAMPLE RESULTS: Coliform4J1f.4colonies/100 mL Nitrate 2.93 mg/L Arsenic 2.55 ug/L Date of sample: 5/21/13 Collected by: PES B. SEPTIC/HOLDING TANK DATA ft. Tank Type/Material Septic/Steel Date installed 5/22/07 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping War ?_/_ Pumper f kawee �P�✓+GE'C 6/as /I 3 C. ABSORPTION FIELD DATA Date installed 5/22/07 Soil rating (g.p.d./f:2 or ftZ/bdrm) 0.6 GPD/SF System type Shallow Trench Length 102 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 10.9 ft. Eff. absorption area 1,010 ft' Monitoring tube Y Depression over field N Date of adequacy test 6/17113 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 44 in. Water added 608 gal. New depth 47 in. Elapsed Time: 110 min. Final fluid depth 44 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed Size in gallons _ "Pump on" level at in. "Pump off" level at Datum Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: in. Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION / 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 Date 6/17/13 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ nil Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program a 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-7904 Septic System Advisory Certificate of On -Site Systems Approval # 131293 During a recent adequacy test on the septic system for Block , Lot 2C of Theresa Mea subdivision, 44 inches of standing water was observed in the absorption field. This indicates that approximately 92% of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval ANALY ICA GROUP Pannone Engineering Services - PES Attn: Dan Moran P.O. Box 100217 Anchorage, AK 99510 907-272-8218 Fax: Client Sample ID: Sampling Location: Client Project: Sample Matrix: COC #: PWS#: Residual Chlorine: Comments: 7143 Theresa Mae Well -Safe Program Drinking Water 085094 Lab#: A1306387 -01A Analytica Group, LLC -Anchorage 4307 Arctic Boulevard Anchorage, AK 99503 Phone: 907-258-2155 Fax: 907-258-6634 Report Date: 6/28/2013 Receipt Date: 6/24/2013 Sample Date: 6/24/2013 Sample Time: 9:20:OOAM Collected By: Nick Flag Definitions: MRL = Method Reporting Limit MCL =Maximum Contaminant Limit B = Present also in Method Blank H = Exceeds Regulatory Limit M = Matrix Interference J= Estimated Value D = Lost to Dilution ** = RL higher than MCL; target not detected TNC = Too Numerous to Count - result rejected CF = Confluent Growth - result rejected TCNG = Turbid Culture No Growth - rejected Analysis Method Prep s MRL MCL Method Prep Analysis Parameter Result Units Flags Date Date Analyst 9223B -PA (Aqueous) - Coliforms in DW Test oras conducted by: Analytica - Anchorage E. Coli Absent Present/Absent NA 6/24/2013 6/24/2013 KM Total Coliform Absent Present/Absent NA Page 3 of 3 6/24/2013 6/24/2013 KM 06126!2013 08:02 8686770 APLUS ��pp16NT FAGS P P ", . 9 SFA TS A FULL A+ HOME SERVICES , INC. 7501 E. 140th Avenue Anchorage, Alaska 99516 345-1890 CUSTOMER Aacharage, Alf 99516 Block Lot DATE DESCRIPTION ss= Please note that the pice inmwe'is da " °fa PAGE 01 INVOICE # 45233 Gallons p Septic Leach Area Holding Tank _ ❑ PROBLEM AREA — CALL FOR MORE INFORMATION ❑ WEDS TO BE DONE AGAIN IN 6 MONTHS Good Shape ❑ Sludge buildup on bottom ❑ Jim cap missing or ❑ Cut standpipe to 1' above ground needs replacing TOTAL AMOUNT ❑ Floater on top ❑ Needs Septictrine Municipality of Anchorage [development Services Department Building Safety Division On -Site Water and Wastewater Program `''" s E T Y 4700 Elmore Street / ,Aj, P.O. Box 196650,`/ Anchorage, AK 99519-6650 . www.muni.org/onsite (907) 343-7904 J CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. 65 f - 41 -7- COSA# 05(-/0/1 Expiration Date: % 0 / 3_/1D 1. GENERAL INFORMATION Complete legal description I- vi- "c. C 7-h *,recct "et e- i/1 Location (site address) '7 r AI J 7-h _* il-esek "cAe off 0-e• r t -- Current Property owner(s) 6+e 0- � l.e'cctr* 14cr A v-xv,, Day phone .cam 3 091 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone - 0;V/70M:'c I.. ec !%� f vC6 r�.�, O.w. %z�✓ z% Day phone 23 unless otherwise requested, COSA will be held by DSD for pickup. Pi* '0 �� 1� �'4-�"r J*, IV�'x�,n 2. NUMBER OF BEDROOMS: ,?v 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my. investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm F lafle,� �e rtrtrac� .Se r�rlC�f Phone 3 qg- - /.3.6; .S Address J&- .3G? C c wcr _ A -k 919S 1011, Engineer's Printed Name -1-heo elPa�E Date J-1- .:aaa900�0'9:®a®gyp,.®fiYC66ti:y' 6. DSD SIGNATURE./ Approved for bedrooms. Disapproved: 7��f Conditional approval for bedrooms, with the following stipulations Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory �^ � �AIA�Tr1AlATCC9 PROGRAM ,. • Q .� Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Rev. 11105) Municipality of Anchorage *AIE Development Services DepartmentBuilding 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: ko f 2 e' 7-A ee& x . j'-cuA S /p Parcel ID: Ors - ©8 P - y Z A. WELL DATA Well type Pv f If A, B, or C provide PWSID # Date completed Un Lc Sanitary seal (Y/N) Total depth Le -d --ft. Cased to >i'i0 ft. FROM WELL LOG Date of test Static water level --- ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform _colonies/100 mL Nitrate 3.q7 mg/L Arsenic: ug/L date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material .SPA k; c S'%P/ Well Log (Y/N) Wires properly protected (Y/N) Y Casing height (above ground) > J4in. AT INSPECTION 49'PS/Zorn Gy ft. 7./ g.p.m. Other bacteria colonies/100 mL Collected by: Date installed S/ 22 / a 7 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N. A Date of pumping _ 3"/ IY / !O Pumper X _Coates C. ABSORPTION FIELD DATA Date installed 5/ZZ/417 Soil rating (g.p.d./ft2 or ft2/bdrm) O• d d System type Sh,*110cv Trr.+c4 Length /!! 2 ft. Width S_ ft. Gravel below pipe ft. Total depth ft. Eff. absorption area /G►Gft2 Monitoring tube Y Depression over field M Date of adequacy test 6'1 10 - 19 / 24,10 Results (Pass/Fail) 1'as✓ For bedrooms Fluid depth in absorption field before test 28 in. Water addedg9Y7gal. New depthWn. Elapsed Time: 13 Z min. Final fluid depth Absorption rate >= 6410 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) A/arig l ch oc -i If yes, give date M. A. D. LIFT STATION N, A. Date installed "Pump on" level at in. Datum Size in gallons "Pump off' level at in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot -1. 10 3 Absorption field on lot 1101 Public sewer main M• A. Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots ' 1 q4, On adjacent lots '> IdW,, I Public sewer manhole/cleanout 1u • ii,. 0 Sewer /septic service line •> ZSR �r'f Holding tank NA• • o ✓ �� T. Animal containment areas N• /4•ff Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line 34,' Absorption field S' Water main M• A. Water service line 14,' Surface water 14,401 Wells on adjacent lots > 106 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line :;z 13 Building foundation Water main N A. Water Service line >> 10 ' Surface water 7 166-' Driveway, parking/vehicle storage *e 3' Curtain drain Man1 Wells on adjacent lots >' F. COMMENTS iD4t.^rn./ Ke Se,4 he- Gtofe uack�/ }�•rf flyo(rCt �� JCiP f of >rY� et �r�OC f-tr � ao�oro�ros� o.F `�29 y7�alfcrl o�u�aJ�i- SG►ow u n ga l-.Co;P " rm/z' G. ENGINEER'S CERTIFICATION o� �rea r ty, ,� *I / a&Y 1 certify that I have determined through field inspections and V 'pgyg review of Municipal records that the above systems are in ,,°i`.p° '•.�`'� conformance with MOA COSA guidelines in effect on this date. EJ; -1 H .�11 10V . •....s•ass s.rw� a,,,,�, Engineers Printed Name T`i�oc►n! %• 1'�yo•� Date M4I y 201 6 .THEODORE F. MOORE • IV., CE - 3589 •° " COSA Fee $ y90 Waiver Fee $ Date of Payment -7-6 ' Date of Payment Receipt Number Ll 6-- A- Receipt Number (Rev. 11/05) SGS Ref.# 1102805001 Client Name Flattop Technical Srv. Project Name/# Lot 2C, Theresa Mae S/D Client Sample ID Lot 2C, Theresa Mae S/D Matrix Drinking Water PWSID 0 Printed Date/Time Collected Date/Time Received Date/Time Technical Director 06/24/2010 16:42 06/18/2010 13:00 06/18/2010 13:35 Stephen C. Ede Sample Remarks: ;Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 06/21/10 06/24/10 KDC Waters Department. Total Nitrate/Nitrite-N 3.47 0.100 mg/L SM20 450ONO3-F B (<10) 06/20/10 AYC Microbiology Laboratory F. Coli Negative 1 100mL SM20 9223B A 06/18/10 DLC Total Coliform Negative 1 100mL SM20 9223B A 06/18/10 DLC _.__ _------Municipality of.An_chorage_______.___. Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-08142 ' COSA # 08 O0D r -j Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 2C, Theresa Mae Subdivision Location (site address) 7143 Theresa Mae Clyde Andwrage, AK 99516 Current Property owner(s) Brett Dufour 6 Laura Halverson Day phone 2304891 Mailing address 7143 Theresa Mae Circle Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pi kup. 2. NUMBER OF BEDROOMS: Four (4) 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well --❑ Individual On-site ❑� Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. —.--4.—STATEMENT-OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-sfte water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. - - Name of Firm - Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date trar2oos 4L j ' 49th MICHAEL E. MDER50N 6. DSD SIGNATURE ►� Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: a Attachments: -----___--- COSA_Checklist- _-, -_-. X Arsenic Advisory--- -- - Septic System Advisory Maintenance Agreements Well Flow Advisory Nitrate Advisory ✓J/ (R«.lift) Supplemental Engineers Report Other Original Certificate Date:_1 - 9 - O R -.-_.----_-__-_— Municipality_ofAnchorage.._.. . _.._...----- •e,_ • Development Services Department Building Safety Division Y Onsite 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: Lot 2C. Theresa Mae Subdivision - Parcel ID: 015-08142 A. WELL DATA Well type Pdvaie It A. B, or C provide PWSID # Well Log (YM) N Date completed 7121102 Sanitary seal (YM) Y Wires properly protected (Y/N)y Total depth 106 ft. Cased to 106 ft. Casing height (above ground) >24 in. FROM WELL LOG AT INSPECTION Date of test Static water level Well production WATER SAMPLE RESULTS: fL Coliform colonies/100 mL Nitrate 1.75 mg/L Arsenic: ND mg/I Date of sample: 11/2JI07 B. SEPTICIHOLDING TANK DATA 12/142007 68.8 fL 6.2 g.p.m.. Other bacteria colonies/100 mL Collected by: F. LeDouu Tank TypetMaterial septic/steel Date installed 522207 Tank size 1.250 gal. Number of Compartments Two Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping New Construction Pumper C. ABSORPTION FIELD DATA Date installed 52212007 Soil rating (g.p.d.M2 or fe/bdrn) •6 GPD/SF System type T wde Trench ,--Length toz ----.-R.. -- Width 5 R Gravel below pipe - 4 ft Total depth s fL Eff. absorption area 210 ft2 Monitoring tube Y Depression over field N Date of adequacy test New ConsL Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Tune: min. Final fluid depth in. Absorption rate >= g.p.d. 7 Any rejuvenation treatment (past 12 mo.) (Y/N & type) 'N ' ' If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) 'Pump on' level at _ in. 'Pump ofr level at _ in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanklid station on lot >1W On adjacent lots >100' Absorption field on lot >1W Public sewer main N/A On adjacent lots >100' Public sewer manhole/cleanout N/A Sewer/septic service line >7s Holding tank N/A Animal containment areas None Manure/animal excrete storage areas None SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation >S Property line>S Absorption field >5 Water main N/A Water service line >1d' Surface water >10( Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >1a Building foundation >1p Water main >1c' Water Service fine >ta Surface water >1W Driveway, parkingNehide storage >2' Curtain drain NOAe Noted Wells on adjacent lots >1W F. COMMENTS: G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and 12141 49th W 3° review of Municipal records that the above systems are in r— F � 0 conformance with MOA COSA guidelines in effect on this date. i .y. ±i^ S MICHAEL E. ANDERSON f L� �. Engineer's Printed Name Michael E. Anderson, P.E. J No CE -4381 f ��� Date Qr281M7 — ------ --- - --��jf0 P •.• - -- -- COSA Fee $ Waiver Fee $ Date of Payment % - 3 Date of Payment Receipt Number �t'i�5i'7 Receipt Number (Rev. 11105) - .... .. ... - SCS Ref.M 1080056001 Client Name Anderson Engineering Project Namely Theresa Mae Subd L 2C Client Sample ID Theresa Mae Subd L 2C Matrix Drinking Water PWSID 0 Sample Remarks: All Dates/fimn are Alaska Standard Time Printed Date/Time 01/08/2008 8:26 Collected Date/fime 01/03/2008 14:17 Received Date/time 01/04/2008 14:05 Technical Director Stephen C. Ede Attouable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Microbiology Laboratory Total Colirorm 0 cot/IOOmL SM209222D A (<I) 01/04/08 TRM SGS Rc[M 1076264001 Cheat Name Anderson Engineering Project Named Theresa Mae Subdivision Lot 2C Client Sample ID Theresa Mae Subdivison Lot 2C 111atriz Drinking Water PWSID 0 Sample Remarks AO Datn/17ma are Alaska Standard Time Printed Datc((kne 12/10/2007 13:57 Collected Date/rime 11/29/2007 13:57 Received DateA'Ime 11292007 14:15 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Due Date [nit Metals by ICP/M9 _ Arsenic ND 5.00 ug/L EP200.8 C (<10) 12/03/0717106/07 TK Waters Department Total Nitrate/Nitritc-N Microbiology Laboratory Total Colifonn 1.75 0.100 mg/L SM204500NO3-F D (<10) 4 OD, No Coli 5t: -V- RarT�rr coV100mL SM209222D A (<I) 12/04/07 LCP 1129/07 SDP w Lij 3niaa a3noa0 b .4t'Slt M.h£.Z0.00 N_ .S.90, H 0 i°££ En vjI ;LLL r W I m � D U �V)CV,i ~ i g< w � J w Lij 3niaa a3noa0 b .4t'Slt M.h£.Z0.00 N_ .S.90, H R i°££ vjI ;LLL r W I � I W ~ i w b r 1 S i .OZ'4tt Muf£.ZO.00 N C) Z IM b N u *40 Ar Air ;LLL ♦ I Q! L • l�AIF