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HomeMy WebLinkAboutYOSH LT 2Yosh Lot 2 #051-0634 q6 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: sw090018 PID Number: 051-063-17 Name: WILLIAMSON AND ASSOCIATES Wastewater System: [] New [] Upgrade Address: 22243 LAKE VIEW DRIVE, EAGLE RIVER AK. 99567 ABSORPTION FIELD Phone: Number of Bedrooms: 907-726-1778 3 ~' Deep Trench [] Shallow Trench [] Bed [] Mound [] Other: Soil Rating: Total Depth from odginal grade: LEGAL DESCRIPTION 1.2 gpD/ft~ 8.0' Ft. Block: Lot: E2;S2;SE4;NE;SW4; Subdivision: Depth to pipe bottom from odginal grade: Gravel depth beneath pipe: 3.0' 5.0' Ft. Ft. Township: 15U Range: 1W Section: 3 Fill added above original grade: Gravel Length: _~- 1J3'--. Ft. 40.0' Ft. "- Gravel width: Number of lines: I Distance between lines: Well: [] New [] Lpg 3.0' Ft. 1I ~'~/tt. Ft. Classification(Private, A, B, C): T/~ta~Depth: ~./ Casedto: Totalabsorptionarea: Pipe Material: ,.. ~.~ ,C...J..~.~/'"'"~ '~'- Ft. Ft. 400 Ft2 ASTM 03034/F810 Driller:~ Date Drilled: Static Water Level: Installer: Date Installed: Ft. TWEED EXCAVATION 4-23-09 SEPARATION DISTANCES [] Septic [] Holding [] S.T~E.~Pt~~'~- r-i Other: T~To Septic Absorption Lift Holding )ublic/Private Manufacturer: --""~'" ~/ I ~'~ Capacity: From ~ Tank Field Station Tank Sewer Line~ Gal. Well 102' 123' - ........................ 25'-I- 'Ma~ Number of Compartments: FoundationSurface Water 100'+ 56' 100'+ 85' _ ........................ ~'P®~ LIFT STATIO.~i Size: Manufacturer: Lot Line 66' 37' - ..................... Gal. "Pump on" level at: " ' ' I High water alarm at: .................... ~ ~ in. in. Curtain Drain ............. NONE KNOWN ............ Pum~ Electrical Inspections performed by: Remarks: EXISTING 2000 GALLON CONCRETE TANK INSTALLED BENCH MARK Location and Description: IN 1964. TOP OF GARAGE SLAB BY POINT B 104.0' Assumed Elevation: Ft. ~ Engineering Engineer's Stamp Inspections performed by: I~!~~, ~A!¢1~{3 ~71'P' I~d. Dates: let 4-23-09 2nd 4-23-09 Development Services Department Approval_.:. ~,~ Conditional Approval Date: Reviewed and approved by: ~: ' PERMIT NO. SW090018 PAGE 5 OF 4 ~unicipo, Li-ty o-F' Anchor-o, 9e DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, &700 BRAGAW STREET P,D, Box 196650 e Anchorcge, Ataska 99519-6650 e TeLephone~ (907) 343-7904 ~www,ci,cnchor-age,ak,us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL E2;S2;SE4;NE4;SW4;SEC.5;T15N;R1W;SM P.I.D. NO. 051-065-17 PERMIT NO. _SW090018 PAGE 2 OF 3 MunicipcLi-t;y o¢ Ancho:-cge DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, /~700 BRAGAW STREET P,D, ]Box 196650 ·Anchorage, AL{lsk(1 99519-6650 ·Te{ephone: (907) 343-7904 · www.ci,~ncho~ge,ak.us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL E2;S2;SE4;NE4;SW4;SEC.5;T15N;R1W;SM P.I.D, NO. 051--065--17 ROPOSED LOT .~ '/ / ~' ':%'.~~:: .~ / LINE · :"'" "~ ' a~c2 c3~ ~..~'..:: ~.: :,' . :X~...~.:..:'..~'.. · .......... :.'".,: "': .:',~:~ :'>".' F' '~: ".. ~ ~ ~ ENGINEER STAMP PERMIT NO. $W090018 PAGE 4 OF 4 Municipo, li-tsy o£ Anchoro. ge DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET P.D. Box 196650 ·Anchor'age, ALaska 99519-6650 ·TeLephone'. (907) 343-7904 ·www.ci.anchopage.ak.us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL E2;S2;SE4;NE4;SW4;SEC.3;T15N;R1W;SM P.I.D. NO. 051-063-17 ORINAL FINAL GRADE=95.5' GRADE MT1 =87.4' MT2=87.5' CO1 =96.5' C02=95.5' ~] ~ C01=92.5' C02=92.5' · WATER FOUND 81.5' B.O.H. A B FCO 10.5' 54.0' ST1 59.5' 98.0' ST2 60.0' 99.5' DBL1 67.0' 106.5' ,DBL2 68.0' 107.5' C01 86.5' 122.0' MT1 86.5' 120.5' C02 9,3.5' 106.5' MT2 9,3.5' 107.5' EN~ N.T.S. 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: Mar 06, 2009 Expiration Date: Mar 06, 2010 Permit Number: SW090018 Legal Description: T15N R1W SEC 3 S2NE4SE4 PTN Design Engineer: 0003 S & S ENGINEERING Owner Name: CHAD WILLIAMSON Owner Address: 22243 LAKE VIEW DR EAGLE RIVER, AK 99567-0000 Parcel ID: 051-063-17 Site Address: 021646 OLD GLENN HWY Lot Size: 62970 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] SepticTank [] 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. Received By: ~~_.~ Date: Issued By: Date: 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. Property owner(s) Day phone Mailing address ¢,~L¢",~ ~:{.--/¢_.~. ~//~©"~>p__, ~¢.~ZipCode Siteaddress~/~ ~ ~~ ~,~./~ ZipCode ' - ~ ' ' ~ /~' ~1~ ,~ Legal description (Sub'd., Block & Lot) 5~ ) ~~ ~~ Legal description (Township, Range & Section) Lot Size ~2,~ ¢~ ~ ~,~; Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR (~] all thatapply}ply),: Absorption Field Septic Tank Holding Tank [] Privy [] Private Well [] Water Storage [] THIS APPLICATION IS AN: Initial [] Upgrade ~ Renewal I certify that the abov~n is correct. I further certify that this application is being made for a Single Family Dwe~g and is in ~cordance~ith~p~icable Municipal Codes. (Signature of prop;dy owner or auth~g~enn~" '-'~ Permit/Rush Fees: Date of Payment: Receipt Number: (Rev. 11/05) Waiver Fees: Date of Payment: Receipt Number: ROBERT C. COWAN · CIVIL ENGINEERING March 2, 2009 PH: 907-694-2979 FAX: 907-694-1211 HE~TH AU"¢ HOR~TY APPROVALS ~;EWER & WATER MAiN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING ANO REPORTS WELL iNSPECTION & FLOW TEST ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL iNSPECTIONS ON SiTE W/~TEWAT'ER D~POSAL SYSTEM ,DESIGN MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: S2;NE4~4;~ PTN; SEC.3; T15N;R1W It is requested that you issue a permit to install a new septic system to serve the proposed three bedroom house on the referenced property. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation (2/5/2009) water was not found. After seven days of monitoring, no ground water was found. 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 re~if~ g~al information, please contact us. Sincerely, ........ ~fer,~.~E.~ ":~ hafer~ p E Enclosure 15861 S. Birchwood Loop Road - C~ hugiak, Alaska 99567 .,Ih" ~- . >~ -[' Wo~JOw .~ z i.. w mz~ · wwm~m ~ --~4o ~ z~wmz  OQW~ ~Z O~ ~_ r~ ILl z ,01;' = ..I, ILl NOIS:IQ NVld - :lJ.l$ z Performed For: Legal Descdplion: 1 2- 3- 4- 5- 7- 8- 9- lO- 11~ 12- 14--- 15- 16- 17- 18- 13- 2o- Municipality of Anchorage Development Services Department Building Safely Division On-Site Water and Waslewaler Program 4700 South Bragaw SI, P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Soils Log - Percolation Test ~ ~ ownsnip ~a~ge ~eclon' ~ r Slope ' ' '-- COMMENTS Sile Plan WAS GROUND WATER ,~ ~ ~ ENCOUNTERED? - ~'J?~'--- S IF YES, AT WHAT DEPTH? ~ L Depth to Water After ~. _---'~-~ pO Monitoring? ~1 E Dele: ~ Reading Date Gross Time Net Time Oeplh to Waler Net Drop TESTRUN BETWEEN __.__~E~FT AND ._~ ~FT PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MI~NICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: MUNICIPALITY OF ANCHORAGE apt*A6 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-063-96 1. GENERAL INFORMATION Complete legal description YOSH LOT 2 Expiration Date: _ 1-�6 12 1 a 0.2 0 Location (site address) 21646 OLD GLENN HWY., CHUGIAK AK 99567 Current property owner(s) JEREMIAH & GAYLEE NEWBOLD Day phone Mailing address Real estate agent 21646 OLD GLENN HWY., CHUGIAK, AK 99567 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic, Water Storage ❑ Holding Tank' ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment f6 �19 Receipt Number /� 05AND COSA # USCI ` l6al Date: Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377 Address 4661 NATRONA AVENUE, ANCHORAGE, AK 99516 Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 10/31/2019 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 t# due to subsurface conditions that may not be observed from the surface, changes in land use, t V local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. 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 f �i �t well and septic system. Therefore, any estimate of how long system will function satisfactory /�lk � ' l for current or future occupants or guarantee that no unseen encroachments, deficiencies or Tj discrepancies exist can be given by FU 5 and Anderson Construction & Engineering. 6. DSD SIGNATURE Approved #1 System A y pp for3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: Jp J JJ� :A ON-SITE WATER AND F1 ffER z� NM o� SCJ By: iQ i �,, F, �lun �) Original Certificated Date: The Municipality of Anchorage 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 Checklist blue sheet Legal Description: YOSH LOT 2 Parcel ID: 051-063-96 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1964 CIRCA Total depth 129 ft Cased to 40+ ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSH 10/25/2019 Static water level at beginning of test 94 ft. Well production at time of test 1.6 gpm Comments B. TANK DATA — 1964 - 2000 GAL Age of tank(s) 55 years Tank type/material SEPTIC / CONCRETE Measured operating fluid level in septic tank 47" ® Standpipes/foundation cleanout per record drawing Date of pumping 8/5/2019 D. ABSORPTION FIELD DATA Which system tested (date installed) 4/23/2009 ® ALL standpipes present per record drawing Total measured depth from grade 9.2 ft (max) Measured depth to pipe invert from grade 3.7 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 5.5' +/- Structure served by this system _ Water storage tank volume 600 gallons Well disinfected for coliform test? ❑ Yes ® Nc ® Coliform bacteria is Negative Nitrate 3.94 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Fly; Collected by_= Date of Sample 10/24/2019 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 10/25/2019 Results r;� Pass For 3 bedrooms Fluid depth prior to test 42 in Water added 600 gal New depth 61 in Elapsed time 1110 min ® Code -required soil cover over field Final fluid depth 41 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: MT appears to extend 5.5'+/- below lateral. System operating in the ED top 1/3. �E COSA Checklist copy 2.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No ft Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ft ft ft ft ft ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ®Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION Aw OF .AZ 1 certify that I have determined through field inspections and review Apr�............ of Municipal records that the above systems are in conformance cS . with MOA COSA guidelines in effect on this date. A91H* f MICHAEL N. ANDERSON.- •. No. CE 94 9 10/30/19• G COSA Checklist copy 2.docxFESSIO�� ft ft Municipality of Anchorage Development Services Department Building Safety Division On-Site Water4700andEimoreWastewaterRoad Program 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. Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 2; Yosh Subdivision (previously E2; S2; SE4; NE4; SW4; Sec 3; T15N; RlW) Location (site address) 21646 Old Glenn Hwy Current Property owner(s) Williamson & Associates Mailing address 22243 LAke View Dr. Chugiak, AK 99567 Day phone 726-1778 Lending agency Day phone Mailing address Real Estate Agent Carline Streano Day phone 350-1945 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 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 s & s Engineering Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567 Engineer's Printed Name Robert A. Shafer DSD SIGNATURE i~ Approved for 3 Disapproved. Conditional approval for bedrooms. Phone 694-2979 { --/ / bedrooms, with the following stipul~t~?f~~'- By: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/05) X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: /~ - ~- c'~ .- 0 ~' 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: J'~ ~', \/~ ~ [''[', ~/~) A. WELL DATA Well type~tlJ~ a,e com.,e, Total depth ~' tc:~ 'ft. Parcel ID: ~5//- ~oS - [~ Date of test IfA, B, or C provide PWSID # ~ Sanitary seal~l) .~__~ Cased to /~+ ft. FROM WELL LOG Well Log (Y~) Wires properly protected~N) Casing height (above ground) AT INSPECTION ql' ft. g.p.m. Static water level ~ ft. Well production .J g.p.m. WATER SAMPLE RESULTS: System type Gravel below pipe ;~ ! ft. '~E-'5 Depression over field For ~) bedrooms New depth -- in. g.p.d. C. ABSORPTION FIELD DATA Date installed /~.,~/~a~ Soil rating (g.p.d./ft2 or ft2/bdrm) _ I ft. Width ~ Length J'J~) ! ft. Total depth ~"'~ Irt. Eft. absorption area ~)ft2 Monitoring tube . Date of adequacy test M~~--3 <~~ Results (Pass/Fail) -- Fluid depth in absorption field before test -- in. Water added -- gal. Elapsed Time: "-' min. Final fluid depth ~ in. | Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y~)type) ~ 0 If yes, give date Coliform ~ colonies/100 mL Nitrate ~,~ mg/L Arsenic: ug/L date of sample: I~1 B. ~EPTICIHOLDING TANK DATA Tank Type/Materiel. ~~/~.C~~~-~ / Tank size ~ gal. Number of Compartments Foundation cleanou~l) ~-_> DepresSion- over tank (Y~ '~o High water alarm (Y(~ / x.~ , c:~t/I o~tO~ Pumper ~-~.-%" Date of pumping. Date installed I~_~ ~. -'/%~ Other bacteria O colonies/100 mL Collected by: D. LIFT STATION Date installed Size in gallons "Pump on" level at ~el at in. Datum .....-~ Cycles tested E. SEPARATION DISTANCES ~--.-.-.Mawh~E/A"~ s (Y/N) High water alarm level at Meets alarm & circuit requirements? Absorption field on lot, Public sewer main Sewer/septic service line Animal containment areas SEPARATION DISTANCES FROM WELL ON LOT TO: I SePtic tank/lift station on lot I I On adjacent lots ! ~:~ ~ On adjacent lots /~ ~ Public sewer manhole/cleanout Holding tank N/~ Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~" '/' / Water main /~J ~ /D '-/" 'Wells on adjacent lots /~ "~ Property line '~ '~ water service line Absorption field Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /~) ''/- Building foundation /~)-/- Water main Water Service line Curtain drain ! Surface water /~;)4~) ~ I Wells on adjacent lots ?tg~ --/- 'i Driveway, parking/vehicle storage F. COMMENTS I certify that I have determined through field inspections and review of Municipal records t~e above systems are in conformance with MOA COSAe~/~ff~ ~.~* es i fie o ' ate. En~lineer's Printed Name S~ ~ ~ ~ ~) COSA Fee $. Waiver Fee $ Date of Payment Receipt Number (Rev. 11/05) Date of Payment Receipt Number ITl ~m m~ m m"~ 0 m co m I 30 30 Z 0 Z m ;0 co ['13 m I-' m Z Z Z Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore 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 COSA# Expiration Date: GENERAL INFORMATION Complete legal description E 1/2; S 1/2; SE 1/4; NE 1/4; Sec. 3; T15N; R1W; SM Location (site address) 21646 OLD GLENN HWY, CHUGIAK AK. 99567 co Current Property owner(s) WILLIAMSON AND ASSOCIATES Day phone 907-726-1778 Mailing address 22243 LAKE VIEW DRIVE, EAGLE RIVER AK.99577 Lending agency Mailing address Day phone Real Estate Agent Mailing Address Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 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 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 s & s ENGINEERING Phone 907-694-2979 Address 15861 S. BIRCHWOOD LOOP, CHUGIAK AK. 99567 Engineer's Printed Name ROBERT A. SHAFER Date 4-3-09 DSD SIGNATURE Approved for Disapproved. [~ Conditional approval for bedrooms. bedrooms, with the folJowi~g stipulations:, Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: ~~"~~Original Certificate Date: (Rev. 11/05) /,-/-/3-09 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: A. WELL DATA Well type _~ ] q~ L/ Date completed __ Total depth ] 2,? ft. Well Log (,(~J2 ~ Wires properly protected~N) Casing height (above ground) IfA, B, or C provide PWSID #__ Sanitary seal (~) ._/~__ Cased to Z-/t:) ~ft.- Parcel ID: ~.~'-[- ~' '~-/7 in. Date of testFROM WELL.....LO..~. Static water level /J ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 mL Nitrate ~, ~-~'mg/k Arsenic: /J'J..) ug/L date ofsample: ~/~/(P~ B. SEPTIC/~TANK DATA Tank Type/Material CdPPT~~ AT INSPECTION g.p.m. Other bacteria Collected by: (~ colonies/100 mL Date installed Tank size ~p~O gal. Number of Compartments ~-- Cleanout (~1~1) Foundation cleanoul~l)~ Depression over tank (YF) Date of pumping P~g IL--~ Pumper ~ ,~, ~ b~l~ (~ , Date installed ~ Soil rafi~ ~.p.d./ft or ~/bdrm) ~ ~ ~stom typo ken,th ff. W~dth ~ ff. ~ ff. Total depth ~ ft. Eft. absorption area ~~be Date of adequacy test ~esults (Pass/Fail) ~ For ___ bedrooms Fluid depth inab~ before test ___ in. Water added__ gal. New depth in, Elapse ' e: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date LIFT STATION Date installed "Pump on" level at__ Datum Size in gallons ~ in. ~ "in/ ~'-'~i~sWa~2~rma2a~lrnci~lq~trements? SEPARATION DISTANCES in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lYres'ration on lot ~'~ Absorption field on lot .,/'~ -/-- Public sewer main Sewer/septic service line Animal containment areas On adjacent lots //~(~ ~'/'- On adjacent lots .,/~:~) t 7/- Public sewer manhole/cleanout /(J ~ Manure/animal excrete storage areas /V o A/~ SEPARATION DISTANCES FROM SEPTIC~ TANK ON LOT TO: Building foundation ,~"z.//.. I Property line ~- I~ Water main ~ / ~ water service line /~) ~ Wells on adjacent lots /O~ ~7L SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:---..,_ Property line /-/-7_., ~ Building foundation ~'~ / Water main Absorption field 40 ~ ! Surface water ,,/~ 7/-- Water Service line ~ ~- Surface water //~0 ' 7/-- Driveway, parking/vehicle storage Cu~ain drain ~~ ~ Wells on adjacent lots ~ ~ F. COMMENTS~//~~ ~ ~7l ~ ~ I cedi~ that lhave determined through field inspections and review of Municipal record~~e above systems are in conformance with MOA COS~ guid~ine~ in effe~ thi~ate. Engineer's Printed Name ~~~ ~~ ~~ ~"~' Date ~~0 ~ ~, ~~ COSA Fee $ q~ ~ Waiver Fee $ Date of Payment ~/~ Date of Payment Receipt Number ~[0 ~ Receipt Number (Rev. 11/05) 04/06/2009 16:45 9076941211 SNSENGINEERING PAGE 04/07 LOT SGS ReL# Client Name Project Name/# Client Sample ID ~atrtx 1090180001 '$ & S Engineeric~g/i E1/2~S I/2,,NE1/4,]~=t /4 $~;Sec3;TISN;RI Drinking Water FrOnted DaredTlme Collected Date/Time Received DatedTim~ Tgchn~cal Director 01/22/2009 13:34 01/16/2009 !1:30 01/16/2009 14:50 Stenhen C. Ede Sample Remarks: Allowabl, Prep An~,lysi~ Patamemr Results PQL UaJ.~ M~o~ Conmi~er ID Limits DaCe Da~ Init M~tals b~ ~'CP/MS Arsenic ND 5.00 EP200.$ C (<10) 01/l. 9/09 01/20/09 NRB Waters Department Total Nitrat~/Nkrite-N 4.59 0.100 mg/L SM20 4500NO3-F B ('<10) 01120/09 JDZ F~%crobiology Laboratory Colony Count 0 colll001nL SM20 92221~ A (<200) 01/16/09 DLC Total Coliform 0 col/100nlL SM20 9222B A (<1) 01/'16/09 . DLC Fecal Col/form 0 col/100mL SM20 9222B A ('<1) 01/16/09 DLC 04/13~200~ 12:01 90769412~1 SNSENGINEE~NG PA~E 05~05 W;ndows Live I-Iotrnail Print Me,sage / ! 21636 Old Glenn From: Jim SulliYan (apw@gd,net) 5ant: 'rue 2/1,7/09 4:49 PM To: '$nS_En§ Eagle RJYer {sns_eagledYer@hotmall.¢om) Yoshi Page 1 of 1 t extended casing installed Moa seal with j box and conduit, casing is 40' + with no perforations. I am billing Chad Thanks Jim Sullivan, CPI Arctic Pump & Well, Inc. PO Box 770197 , Eagle River, AK 99577 (907) (007) 25~-251o (907) 745-25~0