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HomeMy WebLinkAboutDUKE & DUCHESS BLK 1 LT 2I uk & Dutch lock I Lo1' 2 - 051-221 -53 O Municipality of Anchorage ~-,,,:,, Development Services Depadment :~ Building Safety Division '~ .~ On-Site Water and Wastewaler Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page } of~ ~.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 5~ OlO ~ PIDNumber: O~l--~l-- ~ " .... ~r ~¢ WastewaterSystem: ~ New U Upgrade ,~ ..... }~~rb~ ~.2 ~/~ ~,~¢~ ~q~77 -~¢¢ ABSORPTION FIELD Phone: Number of ~edrooms: ~ ~Deep Tren~ ~ Shallow Tren~ ~ Bed ~ Mound ~ Other: Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION } ' ~ Block:I Lo,:~ Subdivision: ~,~ Ft. Township: Range: Section: Fill added above original grade: ~ ~ Ft. Ft. Well: ~ New ~ Upgrade Gravelwidth: ~FI. Number of lines:~ IDistancebe~eenlines:~ Ft. Cl.,,ifi~lio. (Private, A. B. C,: Total Depth: Ca,ed Io1 ,~1~, Tolal ,bsorpti .... Ca: 50& Pipe .aleri.,: 3e/F Driller: Date Drilled~ Static Waler Level: Installer: ~ Dme Installed: Pump Set at: Casing Height Above Grou~: TAN K SEPARATION DISTANCES ~ Septic D Holding D S.T.E.P. D Other: T~ Septic Absorption Lift Holding PublidPrivat[ Manufacturer: Capacity: Tank Field Station Tank Sewer Line A ~ O I~ a, ~ i~ 6~ ( 'T~ ~v~ [ ~ ~0 Gal.  Size: Manufacturer:~ Curtain Drain /~O"e ~hO~ ~ / Pump~ak~l " .... *': BENCH MARK Lo.ti .... d Description: ~OffO~ O¢ ~ ~Z~' ~;- ~'ti Inspections performed by:12034EagleRiverL°°pR°a 'No'2 1 I -I -OI ;' ' ~--'-" .... "~'"u' aCE72 Dates: j~.,..?., ............ Development Services Depadment Approval ~j,:~/)% CE-8301 PERMIT NO. SW010464 PACE 2 OF ,3 Flunicip. aki~¥ oF AnchoPaQe DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,B, Sox 196650 ·Anchor-age, Akaska 99519-6650 ·Tetephone, 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 2, BLOCK 1, DUKE & DUCHESS S/D ?.I.D. NO. 051--221-53 ~ 30' M.E.A. EASEMENT "~_~ &TH 11' MIN.~ ; .-..----.--% ~4 ~ C02~ ~DBL1 ~ DBL2 ~~ / ~ ST2~ NEW 1250 GALLON PERMIT NO. SW010464 PAGE 3 OF 3 Munici~Li~c¥ oF Anc½onaQe DEPARTMENT OF HEALTH AND HUIVFAN SERVICES ENVIRONMENTAL SERVICES DIVISION P,{3, ]Box 196650 eAnchoPage, Ataska 99519-6650eTe[ephone, 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 2, BLOCK 1, DUKE & DUCHESS S/D P.I.D. NO. 051-221-53 FINAL FINAL ~' NEW 1250 Ub. ~ I GALLON SEPTIC TAN ORADE/ C01 =88.8' C02=88.5' t_~-'~ % C0;t_=84.9' C02=84.7' MTl:79.2'~ MT2=79.1' NO · WATER FOUND 73.1' B.0.H. A B FCO 16,5' 12.0' ST1 36.5' 32.5' ST2 44.0' 40.0' DBL1 49.0' 45.0' DBL2 51.5' 47.5' C01 64.5' 51.5' MT1 63.5' 50.5' C02 55.5' 61.5' MT2 56.5' 62.0' N. T. S. ~'./x r: .....Z"'.. %/- ~11 ~ k ROB,~RT t. COWAN ,~',~' MAR--l~--2002 I 1 : lS AM STEPPERS. CONST. 90? 746 26?0 P. 02 (907) 373-7987 (907) 357-7987 fax ,4 CE WA TER P.O. Box 877149 8124 W. Tia Ten'acc Wasilla, Ak. 99687 aceh2o~mtaonline, ne~ WELL DRILLING (907) 376-7987 354-1398 Cell Well Owner: Steppers Construction Use of Welh Domestic Location: Lot 2 Block 1 D~e n Duchess Subdivtsfon, Eagle River Date of Completion: 11-21-01 Job # 01-53 Size of Casln8: 6" Depth of hole: 165 feet Cased to: 32 feet Static Water Level: 57 feet below/ebo~e land suffice. Finish of Well (X) Open End ( ) Grout/Seal Describe screen, seal, or perforation: None ( ) Screen ( ) Perforated Well Pumping Test at 6 Gallons per ( ) hour ( X ) minute for I hours with 100% draw down from static level. of Depth in feet from casing ._tOP _ 0 to 2 feet 2 to 28 feet 28 to 133 feet 133 to 136 feet 136 to 152 feet 152 to 155 feet 155 to 165 feet DriLler Signature, Details of'Formations/size/color/etc ._C.~ing stick up Silty gravel Bedro_ck- green -~r~-dark lathes Fracted bedrock _3_ gpm ,,G, ray bedrock Fra,cted bedrock 2 ~,prn 6'ray bedrock Date: April 2, 2002 ROBERT C. COWAN, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPA[J'I"Y ()F ANCHORAGE Depm'tment of I lealth and I tuman Services P.(). Box 196650 Anchorage, AK 99519 EFEREN(,E: Lot 2; Block 1; Duke and Duchess Snbdivision This letter is to inform you that the onsite septic system was installed outside of the 30' radius of the existing test hole. This was due to the excavator removing the test hole monitoring tube prior to the first inspection. Itowever, tile soils remained consistent throughout tile excavation of the leachfield. lfyou require additional information, please contact us at 694-2979. Sincerely, 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 694 1211 .RO~..,RT C- COWAN, P.E~. April CN~L~R~ FAX (907) 694-1 'b'~'~ R &-WATC-~ MAIN $~'WE~ & WATER $O~L r~T W,~TEWATER Mr. bucas Parker 18832 Darby Rd Eagle River~ AK 99577 REFERETVCE: Lot 2: B'lock t- Duke & Duchess Subd¢.isiop Dear Mr. Parker. This letter is to inform you dim t'he septic system (m the re-f~ren, ccd pro.per, ty w~as .... +;vo~ , designed by S & S Engineering. The septic system was ~tb~an .... ~ installed as designed in accordance with ons~te soil conditions and the 'n~ of-~drm~ms (4)for the onsite structure. The septic system was appropriately inspected during the course of installation in November 2001, in accordance with current Municipality ol? Anchorage code. Tt~e onsire ~,elI was developed on I~ "~ml and produces 6 ,~allons per minu~c with a ~ =~ of q7 feet. · 1.0.0% drawdown fi'om the. static water ~,~:, Water sma, pi-es were token on 3/26/02 with satisfac'tory results. Ifx~e may be of furd~er service 1~o you~ please contact Si,cerely, Robert C. Cowan, P.E. RCt_./t~tv, ct &scl> '~s~, Enclosures: Final Septic Inspection Well ' Water Analysis R~su!ts I70:34 NORTH F_A~LE RIVER LOOP - SUITE 204 ° EAGLE RIVER, ALASKA 99S77 MAR-2~-~004 11:50 $~S ENGINEERING 907 694 1211 P.04/07 CT&E Environmental Services CT&E Rd.# 102 t 534001 Client PO# Client Name S & $ Eng/neer/~ e~nted Dat~i~e 03/28/2002 1 ! :01 Collected DaYTime 03f26f2~2 13:30 ~r~t N~g L~ 2. ~k 1. D~ & ~chess -C]~-~le ~ Lo~ 2, B~ 1, D~e & Duche~ Recalled Dat~Ti~ 03/~6/~00~ i4:15 Ordered By R~d ~,~~~ ~ ~ ~ t PW$ID 0 S~ple R~ks: p~ Re~t~ PQL U~ M~od Limi~ ~te Date 1.30 0.200 mg,q., EPA 300.0 (<!0) 03/26102 3~DT Microbiology Total Coliform co~/tOOraL 5M18 9222B 03126/02. KAP t t t t t t t t ! t ! t t I t t ! ! t t t ! I t I t t ! ! t 1 I t t t J~l~t ~, t t[t-~t'-~ t~t ~ ~ .~t. _ _ .... ~ ............ i t t t t t t I t t I t t t t ! t t t t i t i I t t t I t i t t t t t t t t t t 1 ! ! ! t t t t ! t ! i ! t ! I/- MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date Issued: Nov 09, 2001 Expiration Date: Nov 09, 2002 Permit Number: SW0'10464 Legal Description: DUKE & DUCHESS BLK 1 LT Design Engineer: 0003 S & S Engineering Owner Name: Lucas Parker Owner Address: 18832 Darby Rd. Eagle River, AK 99577-0000 Parcel ID: 051-221-53 Site Address: Lot Size: 50170 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [~ Disposal Field I-;Z] Septic Tank [] Holding Tank [] Privy [] Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 0 ~. TI'rE I Or 7'0 T /--( P. ~' ~ C o ,~.~,, .~ ,~ , Received By: '~/~/Z Date://-- Parcel I.D. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Permit Number SWOlO4¢4 Property owner(s) Mailing address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot S~ze %~ '-'t ~ ~ -A-er-e6~ THIS APPLICATION IS FOR: Day phone "~ D- (~ool ~, Zip Code Number of Bedrooms Sewer Only E] Well Only Sewer and Well ~ Water Storage Sewer Upgrade [] THIS PROPERTY CONTAINS: Hot Tub r-] Jacuzzi Swimming Pool [] Water Softening Unit Therapy Pool Iq. I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. 17034 Eagle River Loop Road, N~. 204 (Signature of property owner or authorized agent) Eagle River, Alaska 99577 Permit Fees: ~/' /"/(--2 ~' ~ · Waiver Fees: Date of Payment: ~ ~ / ~/ ~ / Date of Payment: Receipt Number: O i ~ ' ~ ~ ~r', Receipt Number: (Rev, 12/00) ROBERT C. COWAN, P.E. October 31, 2001 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SIc~R & WATER MAiN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 2, Block 1, Duke & Duchess S/D It is requested that you issue a permit to install a well & septic system to serve the proposed four bedroom dwelling on the referenced property. A test hole was excavated and a percolation test was performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation on 10/26/01 no water was found. After seven days of ground water monitoring the test hole was still found to be dry. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/jhm Enclosure 17034 NORTH EAGLE RIVER LOOP o SUITE 204 · EAGLE RIVER, ALASKA 99577 SI, I', Pi,AN D]IZ,$~G_I'q' l' ~ 00' SCA~[ 4 :;i (~ k G':_!:/<f,:,,: >, ©~- , xz ~ z Cou_~P'k-?L_-z~-.~ ......................................... o ~ ' , ~ / /~ / I X ~z~ ~ , ~ ~ / / I N ', / '-' /' ~ ~ , :II: I0 ~ rq / , ', ~' , / / ,' / i~ Xe~ ~ ~ / ~ ~t¢ X ~ o ,R ,, ' / / / ~ ~ ; '~ % ~ ~*~' *~ o , / , ~ ...................... ~ I J /r .................... .... .................... ,, ,{}:/. ~, _. :, , : ,', " ~/ I '~. 'mr~rin~ 17054 EAGLE RIVER LOOP ROAD EAGLE RIVER, ALASKA 99577 PHONE# (907)694-2979 FAX# (907)694-1211 CONTRACTOI~ IS IN?,QUIRE',D TO OBTAIN UTIt,ITY I,OCATES I~ltlOR TO ANY i4XCAVAT]ON WORK I_LUAI_: :LOT 2, BLOCK DRAWN BY: ~CHECKED BY: J.H.M.I R.C.C. DESIGN CRITERIA: 4 BDRM - 600 GPD SOILS = 1.2 GPD/SQ.FT. 600/1.8 500 SQ.FT. RBQ'D. T][~ENCN[ CRITERIA: ]o' DEEP 6' I,]FFE C'I'IV F', 3' WIDE 42' LONG lO:E: lO -31 ~E¥,SED: 11 07-011 3 SHOWN ON TH~8 ~['PE; PLAN ARE; A8 SHOWN 0N AN A~-SUI]2,T SURVEY DRAWN ~Y: WILLIAM D. FI,EM]NG IT 1~ TH~ R~SPONS~IL'PY 0~' THE CONT[~ACTOR TO VERIFY EASEMENTS, REQUIRED SEPARATION DISTANCES, AND PROPER'fY LINEiS PRIOR TO ALTERNATE SITE I~ r----l--lllllll'n ~ · ,lH MT/PROPOSED TR[iNCH CO 91' ALL PORTIONS OF SYSTEM WITH LESS THAN 5.5' OF COVER REQUIRE INSULATION. INSTALL DOUBLE~ CLEANOU r 1250 SEPTIC TANK ,IS'FALL _/ ' FCO ED Performed For: Legal Description: 1 2 3- 4- 6- 7- 8- 9- 20- ~H COMMENTS Municipality of Anchorage Development Se~ices Depadment Building Safe~ Division On-Site Water and Wastewater Program P.O. Box 196650 Ancho~ge, AK 99519-6650 ~.ci.~ncho~fle.ak.us (907) 343-7904 Soils Log - Percolation Test Township, Range, Section: Slope Site Plan WAS GROUND WATER ENCOUNTERED? NO s IF YES, AT WHAT DEPTH? O Depth to Water After p Monitoring? D~'~ E Reading Date Gross Time Net Time Depth to Water Net Drop ,,¢ I, z ~ f ~ Z I~" ~ ~ /~" PERCOLATION RATEL J (minutes/inch) PERC HOLE DIAMETER ~' PERFORMED BY: 1~ ~ ~ ,t f~ ~A.~ ~_ ~ CERTIFY THAT THIS TEST WAS PERFORMED iN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ¢., / ¢ ~ O i 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 FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-221-53 Expiration Date: 1. GENERAL INFORMATION Complete legal description DUKE & DUCHESS BLOCK 1, LOT 2 Location (site address) 18243 BENDING BIRCH DRIVE, CHUGIAK, AK 99567 Current Property owner(s) MIKE & JENNIFER CARD Day phone Mailing address PO BOX 671174 CI-IUGIAK, AK 99567 Lending agency Day phone Mailing address Real Estate Agent LES BAILEY & ASSOC. Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 COSA# 05E. 101~7¢, - il TYPE OF WATER SUPPLY: Individual Well , Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding Tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 10/30/2010 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to theSe various and dynamiC characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. DSD SIGNATURE L~'~''' Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ii-i/-/,) 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: DUKE & DUCHESS BLOCK 1, LOT 2 A. WELL DATA Well type PRIVATE If A, B, or C prOvide PWSID #~ Date completed 11_/21_/2001 Sanitary seal (Y/N) _ Total depth 165 ft. Cased to 32 ft. FROM WELL LOG Date of test 11/21/01 Static water level 57 Well production 6 WATER SAMPLE RESULTS: Coliform NEC colonies/100mL Nitrate g.p.m. 0.372 mg/L Arsenic: ND mg/I Date of sample: 10/20/10 B. SEPTIC/HOLDING TANK DATA Well Log (Y/N) ___ Parcel ID: 051-221-53 Wires properly protected (Y/N) ___ Casing height (above ground) 24 in. AT INSPECTION 10/20/2010 92 ft. 4.14 g.p.m. Collected by: ArcTerra Tank Type/Material Septic/Steel Date installed 11/13/01 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 Date of pumping 9/1_3/1_0 Pumper ]Rs ABSORPTION FIELD DATA Date installed 11713/01 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 System type Trench Length 46 ft. 5 ft. Gravel below pipe 5.5 ft. Total depth 8.75 ff. (Measured 10/20/10) Eft. absorption area 506 ft2 Monitoring tube Y Date of adequacy test 10/20/2010 Fluid depth in absorption field before test 0 in. Depression over field N Results (Pass/Fail) Pass For ~__ bedrooms Water added 605 gal. New depth 0 in. Elapsed Time: 0__ min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N__lf yes, give date -- LIFT STATION Date installed "Pump on" level at __in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off' level at Cycles tested Manhole/Access (Y/N) High water alarm level at __in. Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 7,5'+ Sewer/septic service line :2,5'+ Animal containment areas ,50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank I00'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ,5'+ Water main 10'+ Wells on adjacent lots 100'+ Property line 5'+ Water service line 10',+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water Service line 10'+ Surface water 100'+ Curtain drain 50'+ (None Known) COMMENTS Absorption field ,5'+ Surface water 100% Water main 10'+ Driveway, parking/vehicle storage Wells on adjacent lots 100'+ 10'+ 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 KENNETH M. DUFFUS Date 10/30~0 COSA Fee $490.00 Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SGS Ref.# 1105685001 Client Name ArcTerra Engineering and Surveying Printed Date/Time 10/29/2010 17:04 Project Name/# Duke & Duchess B1 L2 Collected Date/Time 10/20/2010 16:00 Client Sample ID Duke & Duchess B1 L2 Received Date/Time 10/20/2010 16:55 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: 4500NO3-F - Total 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 Dissolved Metals by ICP/~S Arsenic 5.00U 5.00 ug/L EP200.8 C 10/22/10 10/26/10 KDC Waters Department TotalNitrate/Nitrite-N 0.372 0.100 mg/L SM204500NO3-F B (<10) 10/21/10 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 10/20/10 DLC Total Coliform Negative 1 100mL SM20 9223B A 10/20/10 DLC Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. 051-221-53 1. GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Expiration Date: 7-- ~-.7-- t~) J'l Complete legal description DUKE Location (site address or directions) Current Property owner(s) LUCAS ~.. Mailing address P.O. Lending agency Mailing address Real Estate Agent Mailing address &: DUCHESS SUBDIVISION; LOT 2~ BLOCK 1 18243 BENDING BIRCH DRIVE * EAGLE RIVER~ AK * 99577 PARKER BOX 672484 * Day phone 688-3782 CHUGIAK, AK * 99567 Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well · Individual On-site · Individual Water Storage [~ Individual Holding tank [] Community Class Well [] Community On-site E~] Public Water System E] Public Sewer E~] 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-site 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 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 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 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone 337-6179 Date Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater leVels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal fight whatsoever. DSD SIGNATURE ':-:~ Approved for Disapproved. 'iL. bedrooms. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory = '. WASTEWATER ... ~_,,.~'/ · Manitenance Agreements Supplemental Engineer's Reort Other (Rev. 12/01) Original Certificate Date: -2.7-0q- Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 A= C= Legal Description: WELL DATA Well type PRIVATE If A, B, or C provide PWSID# Date completed 11/21/2001 Sani{ary seal (Y/N) YES Total depth 165 ft. Cased to ,32 ft. HEALTH AUTHORITY APPROVAL CHECKLIST DUKE · DUCHESS SUBDIVISION; LOT 2, BLOCK 1 Parcel ID: FROM WELL LOG 11/21/2001 57 6 g.p.m. N/A Nitrate i, ,,3.~ mg./L. Date of sample: 4-/14-/2004- Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ¢ colonies/100 mi. Arsenic: N/A mg./L. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL/SEPTIC Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Pumper. JRS I'BELOW EXISTING GRADEI 11/13/2001 Soil rating ~rft2/bdrm) 1.2 4-6 .ff. Width 5 ff. Date of pumping 4-/20/04 ABSORPTION FIELD DATA Date installed Length Total depth *8.75 ft. 051-221-53 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 4-/14/2004- 51 4-.4- Other bacteria . Collected by: Eft. absorption area 506 ft2 YES YES 18+ in. g.p.m. ~/ colonies/100 mi. GEG, Ltd. Date installed Cleanouts (Y/N) High water alarm (Y/N) PUMPING SERVICE 11/15/~1 '" YES' syste~3. 'e DEEP Gravel below pipe Monitoring tube YES. Date of adequacy, test 4-/14-/2004. Results (Pass/Fail) PASS Fluid depth in absorption field before test DRY in. Water added 629 gal. Elapsed Time: 0 min. Final fluid depth DRY in, Absorption rate >= Any rejuvenation treatment (past 12 mo.) (YiN & type) NONE KNOWN N/A TRENCH 5.5 ,ft. Depression over field. NO For 4 bedrooms New depth DRY in. 600+ g.p.d. If yes, give date - LIFT STATION Date installed Size in g~,ilons · Manhole/A~ "Pump on" level at _ in. "Pump~~ . High water alarm level at in. ~ ~ Cycles tested Meets alarm &.circuit requirements?. E. SEPARATION DISTANCES. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift stati0h on lot 100'+ On adjacent lots 100'+ 0i~ adjabent lots 100'+ Absorption field on lot 100'+ Public sewer main N/A Public sewer mat~h01e/Clean0ut N/A Sewer/septic Service line 25'+ HOlding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ property line 5'+ Absorption field 5'+ Water main N/A W~ite'r service line 10'+ Surface water. 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSO~iS~'iON FIELD ON LOT TO: Property line 1 O'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkit~g/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on ai:ljacent lots. 100'+ F. COMMENTS G. ENGINEER'S CER~i:FICATION I certify that I have determined through field inspections and review of Municipal ~ecords that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Date JEFFREY A. GARNESS HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number (Rev. 12/01)