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SCIMITAR #3 BLK 2 LT 1
Scimitar #3 Block 2 Lot 1 #051-134-01 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201454 PID Number: 051 134 01 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade Name TATU M ABSORPTION FIELD F-1 Deep Trench El Wide Trench El Bed ❑Mound Site Address 19933 SEIKA ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 3 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SCIMITAR#3 BLOCK 2 LOT 1 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding I Sewer Total absorption area Number of trenches Dist. between trenches From I Tank Field Lift Station Tank Line Ftz Ft. Well 1 oo _ _ _ +25 TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER TANK Capacity 1000 Gal. Surface Water +100 _ _ — Material HDPE Number of compartments 2 Lot Line +10 - - - NA Foundation +10 _ _ _ LIFT STATION Manufacturer NONE Capacity Gal. Remarks TANK REPLACEMENT ONLY OLD TANK DECOMISSIONED PER MOA REQUIREMENTS Alarm location Electrical installed by PIPE MATERIAL House to tank ASTMF628 Tank to 3034 drainfield Installer HOMEOWNER Drainfield exist CO/MT 3034 Inspector C. BALZARI N I BENCH MARK (Assumed elevation)100 ft Inspection vt 11/1/20 Lid 11/2/20 Location and description BOTTOM STEP AT DECK STAIRS 3d 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Of= A/,, Conditional Approval: Date 41 • ,f- l ' TH 49 .. ...., ...... �� . • . CHARLES G BALZARIM ��� �'F�,s,.• CE-13854 .,.��� ANW Septic System Approved �n�r Date a 2 U pp ft b ��l�F�pROFESSIONP�'...� Note: this approval does not include well permit requirements./15/20 (Rev 05/02/18) SWING TIES LEGAL DESCRIPTION: SCIMITAR#3 BLOCK 2 LOT 1 A B C 35 56 D 40 61.1 E 42.4 63.5 F 43.8 64.7 G 45.3 66.1 �llz- J O Q- 4p 1h \ \DIVERTER 38' 3.5'--/ EXIST. SYSTEMS 4.29 x93.66 3.7' COVER 89.45 SEPTIC TANK SCHEMATIC PROFILE VIEW SHOWS ELEVATIONS OF INSPECTED ELEMENTS BUT DOES NOT DEPICT SYSTEM IN ITS ENTIRETY. INSPEC11ON FOR GENERAL CONFORMANCE TO DESIGN AND MOA REQUIREMENTS ONLY. DRIVEWAY ' d-" nX- N ' ' v s�G> TH t �4 ... r� • • CHARLES G BALZARINI ����'F�j•. CE -13854 .•����/ SOLLERET ���>\ PROfESS1�NP� 3 -BEDROOM HOME \o/ DECK SCIMITAR #3 BLOCK 2 LOT 1 'Y \\\\-NEW 1000 GAL MIN POLY TANK WITH INSULATED RISER AT FIRST COMPARTMENT SYSTEM FULL 10/2020 NEIGHBORING 100' WELL RADIUS BM: BOTTOM STEP AT DECK INSULATION OVER TANK. 18 SCHEMATIC SETCION NTS SCALE: 1" = 30' / SCIMITAI C&M ENGINEERING SERVICES 907-854-5558 LEGAL DESCRIPTION: SCIMITAR#3 BLOCK 2 LOT 1 OWNER:TATUM DATE: 11/2020 1 REV: RAWN: CB REF: INSPECTION DRAWING MUNICIPALITY OF ANCHORAGE Development Services Department Right of Way Section ENCROACHMENT PERMIT R202665 THIS AGREEMENT, made this 11th day of December, 2020, by and between AMARIS R. HAUKAAS TATUM & DAVID S. TATUM and their heirs, administrators, and assigns, hereinafter called “PERMITTEE”, and the Municipality of Anchorage, a municipal corporation organized and existing under its Charter and the laws of the State of Alaska, hereinafter called the “PERMITTER”. WITNESSETH: WHEREAS, PERMITTEE is the owner of the following described real property: SCIMITAR #3, BLOCK 2, LOT 1, according to the official records thereof, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTER owns and/or maintains the real property more particularly described as follows: The FIFTEEN FOOT UTILITY EASEMENT, immediately along the northwest boundary of PERMITTEES property as shown on Plat No. 80-51, on file in the office of the District Recorder, Anchorage Recording District, Alaska, and; WHEREAS, PERMITTEE has placed a septic system upon the referenced real property which encroaches 3.5 feet upon the PERMITTER’S 15.0-foot Utility Easement. NOW, THEREFORE, it is mutually agreed between the parties hereto that: 1. The PERMITTER, acting through the Director of Development Services Department, hereby grants to the PERMITTEE the privilege of allowing septic system to encroach 3.5 feet upon the PERMITTER’S 15.0 Utility Easement, as shown on “Attachment A,” included herewith. 2. The PERMITTEE agrees forever to indemnify, defend, save and hold harmless, the Municipality, its officers and employees, from any and all lawsuits, claims or actions brought to any person for or on account of damage to property or injury, disease, illness or death of persons, including all costs and expenses incident thereto, arising wholly or in part from or in connection with the existence of, alterations, maintenance, repair, renewal, reconstruction, operation, use or removal of the encroaching septic system, as placed upon the PERMITTER’S 15.0-foot Utility Easement. 3. The PERMITTEE shall not assign or transfer any of the rights granted herein to another individual or company without first notifying and securing the approval of the Director of Development Services Department. 4. This Agreement and Permit grants PERMITTEE no interest in PERMITTER’S real property whatsoever, except only the encroachment rights described herein. 5. The PERMITTER reserves the right to revoke this permit upon twenty (20) days written notice to the PERMITTEE. The PERMITTEE agrees upon such notice of revocation, to move said encroachment(s) from the 15.0-foot Utility Easement in which it is placed. Should the PERMITTEE refuse or fail to comply with said written notice, the PERMITTER may, without further notice to the PERMITTEE, remove or cause to be removed the encroachment(s), and the PERMITTEE hereby agrees to reimburse the PERMITTER for all costs incidental to the removal thereof. In addition to the mutual promises heretofore made, the PERMITTEE has paid the PERMITTER a one-time permit application fee of $120.00. The PERMITTER hereby waives the annual fee of $315.00. IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seal the day and year first hereinabove written. GRANTEE: GRANTOR: MUNICIPALITY OF ANCHORAGE Amaris R. Haukaas Tatum Jack L. Frost, Jr. Owner Right of Way Supervisor David S. Tatum Owner December 10, 2020 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201454 Work Type: SepticTank Upgrade Tax Code Number: 05113401000 Site Legal Address: SCIMITAR #3 BLK 2 LT 1 G:1261 Site Mailing Address: 19933 SEIKA DR, Chugiak Owner: TATUM AMARIS R HAUKAAS & Design Engineer: C&M ENGINEERING SERVICES This permit is for the construction of: Effective Date Expiration Date: s0 -S De.partn,etit Lot Size in Sq Ft: Total Bedrooms: 10/28/2020 10/28/2021 41305 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: Prior to COSA approval, 1. a letter of non -objection is required from ROW and 2. the original bed may need a property line waiver Received By: Date: Issued By: Date: O zg Zd 3 MUNIMPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 051 134 01 Property owner(s) Tatum Mailing address Site address 19933 Seika ON-SITE SEPTIC/WELL PERMIT APPLICATION Day phone Legal description (Sub'd., Block & Lot) Scimitar#3 Block 2 Lot 1 Legal description (Township, Range & Section) Lot Size 41,305 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ADU) Septic Tank 0 Upgrade ED(w/wo (D) ❑ Holding Tank ❑ Renewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: none Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C&M ENGINEERING (Signature of property owner or authorized agent) Permit/Rush Fees: 160,75 COvin Date of Payment: If(9- Z3' 10 Receipt Number: 6 5'Z � 2 Q Permit No. OS P ZO it 5 9 Waiver Fees: Date of Payment: Receipt Number: Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System Modification for Scimitar#3 Block 2 Lot 1 Dear Reviewer, The above referenced property is currently served by a 3 bedroom septic system upgraded in 1996. The Tank, installed in 1985, has failed and is need of immediate replacement. We are proposing that the existing tank be replaced with a new 1000 gallon (min) moa approved septic tank. As shown on the plan, the tank will be greater than 10’ from the house foundation. The tank shall be covered with a minimum of 2” moa approved insulation and 3’ of cover or a minimum of 4’ of cover without insulation. The repair shall be performed by a moa certified installer or qualified homeowner in accordance with MOA requirements. Repair of the proposed system will not negatively impact adjacent lots. The 1996 drain field was found to be mostly full. The diverter valve will be switched to the 1985 bed system which is dry. Upon completion of the installation, a record drawing will be submitted showing the location of the new tank, leach field, well, and other applicable features. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini@gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE 10/20/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201454, Deb Wockenfuss, 10/28/20 CHARLES G BALZARINI CE-13854R EGISTEREDPROFES S IO N ALENGINEER 10/20/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201454, Deb Wockenfuss, 10/28/20 MUNICIPALITY OF ANCHORAGE 0 911)7 "A' Developn-tent Services [.)epartnn,�,n! Pi or)& 3-7904 011 -site Water & )4"',:'istevlaer F 8.K. 91-. - 313, - _7 9 9 The On-site Water and Wastewater Se,;tion (On-site) may is.5ue an approval for a homeowner to perform work on Pn on-site wastewater disposal systern to serve that individual's owner- occupled, single-family or duplex home if the homeowner meats and agrees to the following requirements: 1, The property owner and excavation eqLppment operator may perfornn work on no more than one owner -installation project in a 12 -month period, 2. Owner's projected act,I'Ve involvement with the Ins taflatiorr. � 11 3. The name of the excavation equip, mi� �f ,ent operator: VK 4, 1 agree that there will be no monetary compensation for installation servi,-es rendered. 5. I'he name of the inspecting engineer. 6agree to discus the tollowing items with the inspecting engineer: a. Permit design criteria and specifi-cations. b. Inspection requirements set forth, in AMC 15,65 70, C. Advance i notice given to to the On5 6-sit,_3 *VqW ater & astewater Seection for all required nnunicipainsix-15 0-70AI 7. 1 agree to have the project-spec'-fic On-site Wastewater Disposal System Permit available at the construction site for the duration of all relax work - 8, 1 agree that if the system is an advanced wastewater treatment system (AWWTS), I will obtain additional Installation instructions and approve; from the equipment distnibUtOr, As owner of (legal description) KI -A , I -T /7 I agree that the information above is true ano, accurate, 17_�, — Owner's printed name. I.,A,/ZD I�E L 0V:�I_I________ Owner's signature: Date: 72-013 (Rev. 9/91) MOA 25 Municipality of Anchorage Page of 2 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 11SLj © �Z6 PID Number: Name: .�{ Wastewater System: ❑ New if Upgrade Pti fl L L - �i Address: CTI S-7 CPV6LWr Qtve ABSORPTION FIELD 1i'33 : ZZwy& < Phone: A-rrel,. SH0k9"J No. of Bedrooms: (¢9y -yaoo Mtr+sc.F4 - A ❑ Deep Trench gShallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Z Total Depth from original grade: -31 (- GPD/Sq. Ft. Lot: Block: Subdivision: 2 Depth to pipe bottom from original grade: Gravel depth beneath pipe .7— `,a rAfL"t3 0,51 Ft. : Ft. Township: Range: { Section: Fill added above original grade Gravel length: _ WELL: O Upgrade ' Gravel width: Number of lines: j Distance between lines: TD �W Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: AST A D 303uf FL Ft. .3% 1 SC. Ft. I F8I 0 Driller: D rt Static Water Level: Installer: ✓ A tr Date installed: 10.-, t4—y4-, Ft. t =1 Yield: Pump Set at: Casing Height Above Ground: - TANK GPM Ft. Ft. SEPARATION DISTANCES `Septic tS,���Holding ❑ S.T.E.P. E)LTo Septic Absorption Lift Holding Public/Private Manufacturer: _ Capacity in gallons: From Tank Field Station Tank Sewer Lines INA iL NG c-- f j6C4 it 1000 Well- Ii t _ �5 t Material: - :� I,- Number of Compartments: job 11766+ `� _ — — LIFT STATION Water (Op6"t lOnt+ LotSize 50 _ in gallons: Manufacturer: Line 5D Foundation 3� It JD± — _ "Pump on" level at: "Pum vel at: High water alarm at: Curtain t Pump Ma el I Electrical Inspections performed by: DrainE7J' BENCH MARK Remarks: Location and Description: `1'FM = Tor eF 6- Ne, ill, Lc �7.�4i �i.uS� TQ �[if�•t ifn\i `i Assumed Elevation: Ft %. /J/Jjj','�:S[j{J{' {S d7/{'�{{ ••//////��(('' !(i' iff {SfKISSMf•t Inspections performed by: 5 9 ONGINFORINQ D��js: 1st la - dG- ib IA.. p •• �•.•••••_ ............. _ " :..,,.,,.. 17034 Paple RIver LOOP Roo f 6: 2nd ? ROBERT C. COWAN Q , cl -ssot CO.tt s E2ivtsv, Alaska 9577 ,,`��` . r. Aa?lr Department of Hea th and H ervices approval .... Reviewed and approved by: �v,� Date: 72-013 (Rev. 9/91) MOA 25 SW960326 Permit No Municipality of Anchorage 2 2 Page of — DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Leoal Description: LOT 1, BLOCK 2, SCIMITAR S/D #3 PID No.: 051-134-01 72-013 A (Rev. 9191) MOA 25 0111n SOLLERET / DRP IE A B ST1 40. D, 63.0' 5' UTIL. ESMT. IWELL ST2 45.Y 68.5' , 6h'iL�F� DBL2 48. ' 71.5' 49. ' 72.5' Jvi BFD CO1 52. 75.5' / F�/ o CO2 101 5' 125.0' �+ MT1 99. 122.5' / ayO0SFMC cC ST2 \S EXISTING 1000 GAL.n Col SE TIC TANK d / INEGRIIY LI \ (T VERIFIED 10-16-96 K ELEVATED) Ar T / DBL lY I DIVESTALLEER (D FFLD)OVY RT EXISTING BE ABANDONED / AY USD INDTHE FU URE. / MT1 CO2 COI = 93.0 NEW TRENC CO2 = 92.3 INAL GRADE INSULATIDN ORIGINAL GRADE yU L® 1 SR C01 89.6 \ MTI = 87.1' ♦ 82.6' ATER FOUND 80.1' B.O.H. SCALE L" = 40' STI ST2 `G '•0 1 n � IN ULATION \ / xi n fv i-( ---�— E STING — "} 89.8' 1000 GAL. C" n ROBERT C. COWAN 4 `c1 T NK1' N.T.S. }. J CE -8801 9�F PP 72-013 A (Rev. 9191) MOA 25 0111n MUNICIPALITY OF ANCHORAGE PAGE 1 OF 1 I1 10 N DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 82S "L" STREET, ROOM 502 C� 1UJ ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960326 DATE ISSUED:10/01/96 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE:10/01/97 OWNER NAME:YACKLEY DAVID J & BARBARA J OWNER ADDRESS:19933 SEIKA DR EAGLE RIVER, AK 99577 PARCEL ID:05113401 LEGAL DESCRIPTION: SCIMITAR #3 BLK 2 LT 1 LOT SIZE: 40305 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: DATE: /o�i. /q (' ISSUED BY: % _ �' l,L - - - DATE: /__-� 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 DISPOSALSYSTEM DESIGN September 12, 1996 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 1, Block 2, Scimitar Subdivision Unit #3 Request you issue a permit to upgrade the septic system serving the existing three bedroom house on the referenced property. A test hole was excavated and percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. At theime of excavation water was encountered at 9 feet, and aft�e_ seven day ground water monitoring, water was found to be at 7.5 feet. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, W4/ 7v X, Robert C. Cowan, P.E. RCC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 6() SITE' nLANa 0)c3iGN SCALE .- � Ai� i.P Cn N W � (n O r \ )ryl ca 7'rriI�y �� o n/ C) m vC) W r cr z�➢— (n -t rim�0-1 t� m mcm \ h /71 Ci —i u \n \ v,A cco Un p f NO WELL/SEPTI\ ,� \ j N -s\�o�wTHia iuo•� �i \\ �7 / z i m frlz'o O Cmm A =y w pmo= f O \o mou�i G)m O z O =� mAcrniti X cn / D / o-zimz f m x<F�x�m \\ N➢ro ��DOm➢-i-zim_ (4O LI I VI mmnG � � m�OZA—CJ GJ I N 0.�9 O Cpr'IAID(7 V I L J xr �ooa Z 0Lv ➢ncxmi_�� I �i I � O n "COD�O➢0D0 It Cyzm oz ooh t (n o �xUl oco 0 ao� D (�O-iy Din to \ mmZ�j�y--''9Nr•i mzqK OMWO AAKN��1�/r -ii A omn i Km �DZ �Zn �Y G` q0 L` O D O � W � L� ��m`-im rC"1 ZDA �i O-CI'� 1'-h .• m oz nAm oa mmti�mAm _"i ➢t-A ff i`i; 1'n -a t jr vziz m "Do D {N i� .i Fn ozo _A r�i Cl� NO mr �a1 s.-� O On n i O�oz A ➢DO /J :: �/� mOaK �-➢iD Zr3•i yMA �t3 F?C Orn0 • � �+�•- �' Z � �'I 'MN ••' z A Z 0 a• y ii _f ''''•yJ� Municipality of Anchorage 0*DEPARTMENT OF HEALTH & HUMAN SERVICES „�` ' 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST ROBERT C. COWAN 1.`c...- CE -8801 e" PERFORMED FOR:�7b'-�r'�'�.s-rys�b_- L_D�j-1G-L�-...1 DATE PERFORMED':''1;} LEGAL DESCRIPTION: �'r % J61.P— Z S,_i,4i7-,01,,-#ownship, Range, Section: FT- �� SLOPE SITE PLAN COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? K°1 S 1 L " O P q E Date: S ReadingDate Gross Time Net Time Depth to Water Net Drop �.� c• iZ-��tta I� 2 3 " ,h 11 4- I 5 5` �. N 3 N 1 2 N - S' U tot �` s 7 9 7,1 i l � 10 c 11 12 13 14- 15 16- 6171819 17- 18- "I 20 COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? K°1 S 1 L " O P q E Date: S ReadingDate Gross Time Net Time Depth to Water Net Drop �.� c• iZ-��tta I� ,h 11 253Aµ I �. N 3 N 1 2 N - S' U tot �` •• PERCOLATION RATE mss_ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND 3 FT J Cr 5 ENGIIVEERIIVG/.// PERFORMED BY: I [LL6t CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE W14SRLgigW#'AAbi� f OPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: / 72-008 (Rev. 4/85) s&S� �rneentnG ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS ROBERTC. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 1, Block 2, Scimitar Subdivision Unit #3 AAPPPROVASHORITY September 12, 1996 GENERAL: 1. The scope of this project includes the installation of a leachfeild trench to serve the three bedroom SEWER&WATER residence located on the referenced property. The MAIN EXTENSIONS existing septic tank is to be excavated to verify integrity. If of poor inegrity than the tank is to be pumped, crushed, and abandoned in place; and a new 1000 gallon septic tank is to be installed. The SEWER&WATER existing bed is to be abandoned as such that it may be INSPECTION used in the future. The monitoring tube and cleanout of the existing bed that are located in the easement are to be relocated outside of the easement. ENGINEERING STUDIES 2. Construction shall be in accordance with the approved ANDREPORTS site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. WELL INSPECTION & FLOW TEST 3. The contractor shall be responsible for obtaining any necessary underground utility locates. SITE PLANS 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. ROADDESIGN 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SOIL TEST EPTIC TANK INSTALLATION: PERCOLATION TEST 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. STRUCTURAL& 2 • The septic tank shall be sufficiently bedded to MECHANICAL prevent settling or shifting of the tank. INSPECTIONS 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 1, Block 2, Scimitar Subdivision Unit #3 September 12, 1996 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH%DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 1, Block 2, Scimitar Subdivision Unit #3 September 12, 1996 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation 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: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a .filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever applies. Page Four Lot 1, Block 2, Scimitar Subdivisiom Unit #3 September 12, 1996 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page hive Lot 1, Block 2, Scimitar Subdivision Unit #3 September 12, 1996 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER I / �_ `✓ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME - PHONE ANEW I" ❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION VI 2 L1 tib( 2 �7 LOCATION NO. OF 13EDROOMS Well( Absorption area Dwelling PERMIT NO. v x DISTANCE TO: Zf Z>� 1 4c,> 85021 3 w2 Manufacturer Material ts No. of compartmeie- e- Yt R U) Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth I [7 Y DISTANCE TO: Well welling PERMIT NO. Z = z Manufacturer - Material Liquid capacity in gallons O Well Foundation Nearest lot line PERMIT NO. w= DISTANCE TO: FL Z No. of lines Length of each lineotal length of lines Trench width Distance between lines P:Zw inches F. Top of tile to finish grade Material beneath tile Total effective absorption area O inches W Length 50" Width 1 S, �. De3hf w �� 5 � f c1 P�P� PERMIT NO. 4SSvz'►3 w Type of crib Crib diameter Crib depth Total effective absorption area84 c . f W WellBuilding DISTANCE TO: �J�?, ,�/- foundytIon (00> ? Nearest lot line f I J Class Depth Driller Distance to lot line PERMIT NO. J W 3:DISTANCE T0: Building foundation Sewer line Septic tank Absorption area(s) - OTHER PIPE MATERIALS ' V'C-- DEa D a o SOIL TEST RATING INSTALLER / '�LS� btiT+l REMARKS /C 4- P^rf A,:.Sh x. r W � K APPROVED t� DATE (p1-1 L GAL 'iJ l it i. .i11i�I�to C"ifaiiMf�% 4Jy47d £` �J' LOCATION OF WELL (Please complete either la, Ib or Ic.) la. Boro��((u ghJJ Subdivision Lot Biock Top Bottom 1/a gtrs. 6, ❑ Cable tool Q ❑Auger ❑ Rotary ❑ Driven Jetted ❑Bored OD u ❑Other: 3 Fb. aiilVtsi1 aczrv.tar� 92 1oQ _ ❑ Irrigation E] Recharge f_Of_Of— Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS Other: Street Address and Area of Well Location - 2. WELL LOG - Material Type: zoil Sand gt civ ! rocs gray rock green wr grey WATER WELL RECORD STATE OF ALASKA DEPARTMENTOF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Permit No. A.D.L. No. Section No. Township NE] Range EE] Meridian s❑ W� 3. OWNER OF 7ELL: i�.r_Address: C^T_a. r Feet Below Surface 4. WELL DEPTH: (final) � ft' 5. DATE OF COMPLETION 7 i. Top Bottom V ! 6, ❑ Cable tool Q ❑Auger ❑ Rotary ❑ Driven Jetted ❑Bored OD u ❑Other: 3 7. USE: Q Domestic ❑ Public Supply ❑ Industry 92 1oQ _ ❑ Irrigation E] Recharge Commerical ❑ Test Well Other: S. CASING ❑ Threaded Q Welded diam. - In. to ft. Depth Weight 17 lbs./ft. diam. in. to ft. Depth Stickup ft. 9. FINISH OF WELL: Type: Diameter: C) - Slot/Mesh Size: Length: Set between ft. and ft Backfilling Grovel pack i DEpr O RAGCHO 10. STATIC WATER LEVEL: ry, O j S TEC ❑ Above or O Below land surface Date AL p Equipment used: I I .PUMPING LEVEL below land surface and YIELD ft. after -- hrs. pumping g. p. m. ft. after hrs. pumping g. p. m. 12.GROUTING Well Grouted: ❑ Yes ❑ No Material: ❑ Neat Cement 0 Other: 13, PUMP: (if available) HP N Length of Drop Pipe I. capacity g, p,m_ r ❑ Su bm, Jet ❑ Cenirifical ❑Other 0 14. REMARKS: I Z 0 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature _a ❑ F ❑ C This well was drilled under my jurisdiction and this report is true to the best of_, my knowledge and belief; Registered Business Nome - Cdn%rbt('License Number '-;7...? -L,2; "4ii`Th,,ter z 1�'T.?6? ._ a Signed : Form 02-WWR (11/81) %-f %!-/"Ert..Jf' >'Q Dale: Authorized Re presentofive =r Copy Distribution: WHITE - State DGGS, PINK -Driller, CANARY - Customer ',r / ** DEPTH TO PIPEBOTT3M < 3^5 FT, REQUIRES INS�/LATIO� ** DEPTH TO PIPE BOTTOM < 4.0 FT. MAY RE�UIRE � LIFT STATIO� ** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS(NOT EXCEEDING 75 FT. �ACH> ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS fi'uif�iAcipacwt Fo %i s 650 j Gr 4- ANCHORAGE, ALASKA 99502-0650 ,es (90-7) 2_64-4111 Anchorage TONY KNONJI FS. MA YOH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit 4: 840239 January 31, 1985 5 TO: Permit Applicant SUBJI:(=T: Lot 1 Block 2 Scimitar Subdivision A permit issued by this Department for an individual well and/or_ on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of municipal Ordinance. A new permit must be obtained from this r)cpartment for any well and/or on-site sewer system not instE)ll.ed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, E Bandt Sup Keith eYvisor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 ���X C.- 11 . 3: W- IT" ClIF"��������� DEP1711TIEM' OF" HEF[TH WE:, PRoTECTTON 825 L STREET/ HNCHORHGE/ HK 99501 264�4720 Who --- 511 -T-K ���§"-*--*.'! �P .������ PERMIT NO: DHTE ISSUED HPPLICHNT HDDRESS� CONTHCT PHONE LEGHL DESCRIP LOT SIZE� MHX BEDROOMS 84G2]9 04/2]/84 MYERS CONST. %S&S ENGINEERING ENGLE RIVER/ HK 99577 694�2979 SUBDIVISION� SECTION: 10 40157 (SQFT ] SCIMITHR TOWNSHIP� 15N OR HCRES) LOT: 1 2 RHNGE: IN LISTED BELOW HRE THE OPTIONS HVHILHBLE TO YOU IN DESIGNING YOUR SEPTIC SYS -TEAL CHQOSE THE OPTION THHT BEST FITS YOLF. SITE ... ..... .... .... .... �..... ��..... �..... ������������������� -T- Fit K 10 Q V ii 1117-» 8^8Fi-- F:::fl][P-d DEPTH TO PIPE BOTTOM (FY ) 60 65 6.0 GRHVEL DEPTH (FY 0 0. 5 2. 0 'TO TA, L DEPTH 9.0 7.0 8.0 f GRHVEL WIDTH 5 14.0 50 GRHVEL L 0 ]60 GRHVEL VOLUME (CU. 9 14i5 166 THNK SIZE (GHLS) 1/000. 0 ** 1/000. 0 ** 1,000. 0 ** SOIL FT./BR) 85 85 85 �* THNK MUST HAVE HT LEHST TWO COMPHRTMENTS ..... ... �..... �..... ..... .... ....����������������� I CEUIFY THAT 1 I HM FRMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE (MOH) AND THE STHTE OF HLHSKH. 2 I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH HLL MOH CODES HND REGULATIONS/ HND I1"I COMPLIHNCE WITH THE DESIQN CRITERIA OF PERMIT. A I WILL'ADHERE TO HILL MOH HND STATE OF HLHSKH REQUIREMENTS FOR THE SET I.BHCK DISTHNCES FROM HNY EXISTING WELL/ WHSTEWHTER DISPOSAL SYSTEM OR PUBLIC SEWERHGE SYSTEM ON THIS OR HWY HDJHCENT OR NEARBY LOT. 4. I UNDERSTHND THAT THIS PERMIT IS VHLID FOR H MAXIMUM OF ] BEDROOMS HND H�Y ENLHRGEM�NT WILL REQUIRE HN ADDITIONAL PERMIT IF H LIFT STHTION IS INSTHLLED IN HN HREH COVERED BY MOH BUILDING CODES"/ THEN (1) HN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED/ (2) HS-BUILTS WILL 140-F BE HPPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT/ AND (]) THE ELECTRICHL WORK MUST BE DONE BY H ELECTRICIAN. ommam HPPLICANT' nommmmm V—x TE:-r��-------- DHTE� g�. � If SOILS LOG Date MUNICIPALITY OF ANCHORAGE • +.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: �' ILI���h�1 Q�)Ci'�IE�'�� DATE PERFORMED: LEGAL DESCRIPTION: L—c,; 1 16 �FPT SLOPE SITE PLAN eeoa a 18 ° pobart A, She r o` a Q� ao No. 1457-5 ° a � mss.• �,'`. � 20 1 2+ 3 e, 4 - (,1 ei tsT Gc�y 5 6 f 7�r 7 o N r 9 �/ L7 / WATER k� 11 4/,{IL 1 WAS GROUND L 7y ENCOUNTERED? 12 P �✓t�T Y..\ �r 1-b,.1 ilF YES, AT WHAT E tO DEPTH? 13- 14- Date Gross Time 15— Depth to Water Net Drop aoaa.ae eagaa 16 17 eeoa a 18 ° pobart A, She r o` a Q� ao No. 1457-5 ° a � mss.• �,'`. � 20 COMMENTS Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE —(minutes/inch) it TEST RUN BETWEEN FT AND FT PERFORMED BY: � 411 �' CERTIFIED �' DATE NtyVEqB, ALASKAl. rjM-n7o 72-008 (6/79) .. --_- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: / -' LEGAL DESCRIPTION: (FEPF1 6 /t O/2G/q a,/ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 C- vv- es 3�1R.40( ��1r. �� a=•fi �..m COMMENTS PERFORMED BYI, 4, 72-008 (6/79) /< SOILS LOG ❑ PERCOLATION TEST DATE PERFORMED: :: �z / gcF Sc. ~1 z,oq-.z 003 SITE PLAN MEMO NONE M■■O MEMO IMERM NONE E■E■ MMEM MONO M■■O WAS GROUND WATER S ENCOUNTERED? 6 L O P IF YES, AT WHAT E L DEPTH? r Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN FT AND CERTIFIED (minutes/inch) FT DATE: Zn " y COSA Checklist Legal Description: Scimitar#3 Block 2 Lot 1 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL D ❑■ Well log is filed with Onsite (or attached) Date drilled 1986 Total depth 213 ft Cased to 28 ft ❑■ Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) +18 in. Date of flow test for COSA 10/12/20 Static water level at beginning of test 32 ft. Comments B. TANK D Age of tank(s) 0 years Tank type/material Plastic Measured operating fluid level in septic tank 0 ❑■ Standpipes/foundation cleanout per record drawing Date of pumping na D. ABSORPTION FIELD D bed Which system tested (date installed) 1985 ❑■ ALL standpipes present per record drawing Total measured depth from grade 3.5 ft (max) Measured depth to pipe invert from grade 2.5 ft (min) ❑ N/A — pressurized field ❑■ Monitor tubes go to bottom of effective. If not, state depth into effective ❑■ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: 1996 system was mostly full diverter switched to 1985 bed COSA Checklist yellow sheet Parcel ID: 051 134 01 Structure served by this system 1 Well production at time of test +3.2 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ❑■ No ❑■ Coliform bacteria is Negative Nitrate mg/L ❑■ Nitrate less than MRL (ND) Arsenic 22.04 ug/L ❑ Arsenic less than MRL (ND) Collected by C.Balzarini Date of Sample 10/15/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: I_1 IF_1 ATA Adequacy test date 10/12/20 Results Q Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 0 in Elapsed time `1440 min Final fluid depth 0 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) NO If yes, enter date NA 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 Wells on Adjacent Lots: 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' Animal Containment > 50' Q Yes if No Q 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 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 two standpipes removed from bed system under 1996 permit diverter valve may be used to switch back to 1996 drainfield. G. ENGINEER'S CERTIFICATION I certify that / 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. 10/15/20 COSA Checklist yellow sheet ��C�- *:49TH ..1. CHARLES G BALZARINT CE -13854 .,• f� ft ft ft ft MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Arsenic Advisory Certificate of On‐Site Systems Approval # OSC201633 Subdivision: Scimitar #3, Block: 2, Lot: 1 A water sample revealed an arsenic concentration of 22.047 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On‐Site Water and Wastewater Program website (www.muni.org/onsite) or at 343‐7904. This advisory must be attached to all copies of the subject Certificate of On‐Site Systems Approval. Municipality of Anchorage ® On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-134-01 1. GENERAL INFORMATION Expiration Date: Complete legal description Scimitar #3 Block 2 Lot 1 Location (site address) 19933 Seika Drive, Chugiak, AK Current Property owner(s) Lindsay Day phone 894-5780 Mailing address Same Real Estate Agent Latosha Williams Day phone 894-5780 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer . ❑ Received by:�:� �(i �% Date: r3 711,ir COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ J ?_(o �_ Date of Payment �'��(o Receipt Number D5;p COSA# �CI�10(P� 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 NorthRim Engineering eering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date, 2/26/2016 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: 7 By: \� i wt�: r��''L[- Original Certificate Date: The Municipality of Anchorage Devlopment 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 bl.e.heel 9-1-12.doc 4 If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: A. WELL DATA Parcel I Well type /" - If A, B, or C provide PWSID # Well Log (Y/N) T Date completed 6/fS Sanitary seal (Y/N) V Wi'res,properly protected (Y/N) Total dept h2 (3 ft. Cased to �' g ft. Casing. height (above ground) /5 in. FROM. WELL LOG AT INSPECTION Date of test . 7ZC AT Static water level ft. Z ft. Well production Z U.M. ; _ 9 P•m. WATER SAMPLE RESULTS: ColiformAft—colonies/100 mL Nitrate �mg/L Arsenic_ ug/L Date of sample: fb Collected by: B. SEPTIC/HOLDING'TANK DATA Tank Type/Material OPTIC �ST L Date installed 00/2- 2APS Tank size %466 gal. Number of Compartments Cleanouts (YIN)' Foundation cleanout (Y/N) Depression over tank (Y/N) _,,AZ High water alarm (Y/N) IV Date of pumping J— C ©a, Pumper C. ABSORPTION FIELD DATA v S a/lo Date installed 4 �O6 Soil rating (g.p.d./e or fe/bdrm) X System type Length ft. Width 5 ft. Gravel below pipe Total depth ft. Eft. absor /tion area 3 q ftz Monitoring tube Depression over field Date of adequacy test / (� Results (Pass/Fail) /, For _ bedrooms Fluid depth in absorption field before test D in. Water added U5a gal. New depth /D in. Elapsed Time: u min. Final fluid depth d in. Absorption rate >= Sa g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) A/J If yes, give date r D. LIFT STATION /,%%j' Date installed "Pump on" level at in. Datum E. SEPARATIONDISTANCES Size in gallons Manhole/Access (Y/N) "Pump off" level at in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? WELL ON LOT TO: Septic tank/lift station on lot /d r f On adjacent lots Absorption field on lot X00 �-f On adjacent lots /4v/1 �7 __ Public sewer main //�l Public sewer manhole/cleanout 1a �f r Sewer /septic service line z_ 5 "t Holding tank 0 f Animal containment areas ` $ O ° Manure/animal excrete storage areas /42:;P �f SEPTIC/HOLDING TANK ON .LOT TO: Building foundation Property line A0 Absorption field S f Water main _�/ n Water service line Id 'f Surface water Wells on adjacent lots X66 i� ABSORPTION FIELD ON LOT TO: Property line A6 `I'- Building foundation Water main /d' Water Service line : - lO !f Surface water / / C�0 If`' .Driveway, parkingNehicle storage /a .rte Curtain drain ;' /D f = Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that / 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 N e S% /.65U% �Nlo Steven V1 'z9 PE Date COSA yellow sheet_2-6-15.doc • Municipality of Anchorage On -Site Water and Wastewater Program <' (907)343-7904 s: Er. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-134-01 Expiration Date: / 1. GENERAL INFORMATION Complete legal description SCIMITAR #3 BLOCK 2 LOT 1 Location (site address) 19933 SEIKA DRIVE CHUGIAK AK 99567 Current Property owner(s) JAMES & EMILYN PENFIELD Day phone Mailing address Real Estate Agent PO BOX 672514 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: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by: - Date:24,11-9 COSA to be released to V ngineer, unless otherwise requested by the engineer. COSA Fee $ �Qb Date of Payment $�/3 Receipt Number Waiver Fee $ Date of Payment Receipt Number COSA # d 5C/3 `4036 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 ARCTERRA CONSULTING, INC. Phone 868.3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 2/4/2013 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 6. DSD SIGNATURE System #1 Approved for, bedrooms. T#�` System #2 Approved for bedrooms. V4� Disapproved. Conditional approval for bedrooms, with the following stipul �W(Q �t OF Original Certificate Date: Theunicipality f An rage 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 Septic System Advisory Well Flow Advisory COSA blue sh el 9-1-12.do, X Nitrate. Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: SCIMITAR #3 BLOCK 2, LOT 1 Parcel ID: 051-134.01 A. WELL DATA Well type PRVT If A, B, or provide PWSID # Date completed 71611985 Sanitary seal (YIN) Y Total depth 213 ft. Cased to 28 ft. (Into Bedrock) FROM WELL LOG Date of test 71611985 Static water level 14 ft. Well production 2 9 - p.m - WATER SAMPLE RESULTS to b Coliform NEG colonies/100 mL Nitrate -GW mg/L 4'i� 9 Arsenic: ib ug/L Date of sample: 1122113 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTICISTEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (YIN) Y Depression over tank (YIN) N Date of pumping 914112 Pumper Sanitary C. ABSORPTION FIELD DATA Well Log (YIN) Wires properly protected (YIN) Y Casing height (above ground) 12+ in. AT INSPECTION 112212013 ft. g.p.m. Collected by: ARCTERRA Date installed 912711985 Cleanouts (YIN) Y High water alarm (YIN) N Date installed 1011611996 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 System type Shallow Trench Length 50 ft. Width 5 ft, Gravel below pipe 2.5 ft. Total depth 4.5 ft. (Measured 1/23113) Eff. absorption area 391 ft2 Monitoring tube Y Depression over field N Date of adequacy test 1123113 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 4.8 in. Water added 600 gal. New depth 15.6 in. Elapsed Time: 1440 min. Final fluid depth 3.6 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed "Pump ori" level at —in. Datum Size in gallons "Pump off' level at _ in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 1001+ Public sewer main 754 Sewer/septic service line 25'+ Manhole/Access (YIN) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 101+ Surface water 100'+ Wells on adjacent lots 1004 ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water main 10'+ Water Service line 101+ Surface water. 1004 Driveway, parking/vehicle storage 10'+ Curtain drain 504 (NONE KNOWN) Wells on adjacent lots 1004 F. COMMENTS *Vacant system presoaked prior to testing. G. ENGINEER'S CERTIFICATION 1 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 COSA brown sheet 9-1-12.doc in. Municipality of Anchorage eL Community Development Department p Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 131030 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 1 of Scimitar #3 Subdivision. This inspection revealed an arsenic concentration of 44.9 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.or /og nsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SGS Ref.# 1130260001 Client Name AreTerra Engineering and Surveying Project Name/# Scimitars 3 B2, Ll Client Sample ID Spigot Matrix Drinking Water Sample Remarks: Printed Date/Time 01/31/2013 13:41 Collected Date/Time 01/22/2013 16:00 Received Date/Time 01/22/2013 16:50 Technical Director Stephen C. Ede Parameter Results LOQ Units Method Container ID Allowable Limits Prep Analysis Date Date Init Metals by ICP/MS Arsenic 44.9 * 5.00 ug/L EP200.8 C (<10) 01/23/13 01/24/13 ACF Waters Department Total Nitrate/Nitrite-N ND 0.100 mg/L SM214500NO3-F B (<10) 01/30/13 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM21 9223B A 01/22/13 SDP Total Coliform Negative I 100mL SM21 9223B A 01/22/13 SDP Page 2 of 4 Parcell.D. 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 051-134-01 1. GENERAL INFORMATION Complete legal description COSA # D CD0(12 Expiration Date: 7— y7L — 0 Lot 1; Block 2; Scimitar #3 Location (site address) 19933 Seika Dr. Chugiak Current Propertyowner(s) Paul Deaner Day phone 698-0951 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Urdess otherwise requested, COSA will be held by DSD /or pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Q Individual On-site a ❑ Individual Holding Tank ❑ ❑ Community On-site ❑ ❑ 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 engineers work. A. 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 Onsite 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. NameofFirm S d S Engineering Phone 694-2979 Address17034 N. F.avle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name PO&A i C. C„ a✓4,11 Date 3 / a X /o G 5. DSD S�NATURE T� �e ROBERT G COWAN o� • CE-88oI Approved for _3 bedrooms. 4 it'�q o... �� •. ••` Disapproved. k%It� SIA, ` Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Well Flow Advisory Nitrate Advisory Maintenance Agreements Supplemental Engineer's Report Other By: 10 o Original Certificate Date: �/— ' 7 (Rev. 1185) 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/onsfte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: `_6 r I '3 a: -s- IMI -Mi? 452l Parcel ID: 6) A. WELL DA�TA� Well type 0-tYF{it- Date completed 4b's Total depth 21 r ft. If A. B, or C provide PWSID # — Well Log&) �� S Sanitary seal &I) Wires properly protected (9N) 6n? Cased to uK�r � �) Casing height (above ground) _12 r in. FROM WELL LOG Date of test -71& S /' r Static water level 14, ft. Well production :2e 0 g.p.m. AT INSPEC ION 2 7, t' '2''S // r ft. ^Told g.p.m. WATER SAMPLE RESULTS: Coliform __y—colonies/100 mL Nitrate0,Z�SmgJL Other bacteria �_6_ colonies/100 mL Arsenic: 'D mgA Date of sample: 4/d(, Collected by: 5°"S ['t-''iT1 7MeK761 B. SEPTICfHOLDINO TANK DATA Tank Type/Material 5Z; f. sty -r/ L Date installed \ / a7 5 Tank size 1 LL 6 gal. Number of Compartments Cleanoutsom) Foundation cleanout &) if -5 Depression over tank (Y& 0 High water alarm (Y/LID FOO Dateofpumping2 OS Pumper SM`' �t EMP1122 C. ABSORPTION FIELD DATA C _ Date installed b b 9 Soil rating g.p.d./ft= r 8e/bdrm) System type �Hi LQ LO A-" r Length r rte ft. Width 51 ft. Gravel below pipe ?v 5 ft. Total depthg0r'__ (0 W Eff. absorption area !ELJe Mondorintube t: Depression over field ND Date of adequacy test 3 �� "Resu (Pas ail) 473 For bedrooms 'r Fluid depth in absorption field before test Q in. Water added gal. New depth 5 in. '�Un n Elapsed Time: LL min. Final fluid depth � in. Absorption rate >_ 4 501 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y&type) 00 If yes, give date D. LIFT STATION �} Date installed 'Pump on' level at _ in. E. SEPARATION DISTANCES Size in gallons level at _ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: I Septic tankAift station on lot /00 / Absorption field on lot /0 /- "- Public sewer main "9 1 Sewer /septic service line a6 + f Animal containment areas .5r->4 (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots /GY') r4 - Public sewer manhole/cleanout f")14 - 0 Holding tank u t'k- 1 Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: f Building foundation } Properly line S � -j-- Absorption field S 1� r Water main Water service line /0 Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 r Building foundation /O /•/- Water main r r / Water Service line / D Surface water f� a Driveway, parking/vehicle storage 1 Curtain drain IVO/ KA -Wells on adjacent lots /� 4- F. COMMENTS �-OF ..0 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 COSH r,..�,.. guidelines in effect on this date. r - c-cnwAN o- g �fj i�+�RQ99 ' CE, BE01 Engineer's Printed Name _l&UA7C. CL' r./,I d + tt <' , ••.........•• 3 Date I a z �o llziai�a�;+'" COSA Fee $ `l .[� `� Waiver Fee $ Date of Payment 3/3/ ob Date of Payment Receipt Number 1 25-13. , Receipt Number (Rev. I Deli) 02-22-2006 15:52 THE DEGNERS 9076880951 PRGE2 KP?9619x629 1KeatsAUff OF ANCHORAGE MTfm AurHOWTY pesoUrnON NO. 911-54 lmDtltno4t Appoova+o 712 VACATION or one 111 or iH (IQ !VOP LrrM= ►ASEMgXr 014 712 NORM BOUNDARY OF 9 M1PAR SUBDriMM. NO. S. WHERE T11E WELL ENCROACHES WO E U uzrr EASUaMr AS SHOWN ON THE AT7ACHEo A54INCT PREPARED BY DUANE MARK MRARD. DA= NOVEMBER 10. 1991• NVMYwi •V 1 wNZREA& a ye1RY1 has lm W tMCI Asw Devld and Barbara Yat to vase lalhom aae4. cove 111 bot N tltt len 1101 foot utWry sasaornt en the.; TA boundwy NCM 1. Nock 2. Seta~ SubdwtoWL Ma S. yr w the aauctum tnerusch * ena the UMW aandtdA. r stw•m on the anached as'btuk prpa rd Ou Mark fid. *Aw Nswwbw 10. 1991. Rested h Ow SE 114 N Smdoe 10. T15N. RIW. Bew d Metltrt. Alaska. end WHIRF.A& IW1 etrlke ws p bAM and the oeyuest was hotel by the Im A.tkaAty. am WHEREAS. ate P1aBwtt Audwrwy hww the U" avatpuuca Mud leder N amsOjeetoee leis ate tneevaehomtt into the utility tmimteet 9MIMUMAS, the PMoovt AMIwrWy Sued the Ww bcUW vacated b Wrdual Sed W ICCREAS. the Pla" AuthorW btad A perum N aw eesewtmt b bt . Nr atthat s" what to ate Manedpak0r. • NOM. 7HEI=oRe• BE tP RESSOLVED by the Amhors a PA my Au ndW "the vacom N tM abort desertbd eneereatl be appro.ad subject to reowdog Otto nooballon at the State District Reavdds 00kt PASSED ANDAMW4ED y Ow AetbwW Nwtnt Autherey this 22nd � NJuy. 1996 .. •. T. Maurer. Jr. AuthentY '' Daperdeet of CAM Mist. a D". :=:•• P99650�% . ?�:`. Atsdserate. Al(99619lt190 ' . •t 34OW t it ivav � /y9! ipl�•rT/�.9i/nit/ 'Sy --- - - -- �^ �• btWARD & ASSOCIATES LAND SURVEYING 694-0829 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALEt , FOLLOWING DESCRIBED PROPERTY y� OF q�'�� DATES S s�.7�<ar/va4 rvirvv, laT� B4�! 2 AND THAT NO ENCROACHMEWTS EXIST EXCEPT AS '9S RO �: INDICATED. IT IS THE RESPONSIBILITY OF THE H 1' • GRID OWNER TO DETERMINE THE EXISTENCE OF ANY s..'.:.. ....:. ' EASEMENTS, COVENANTS, OR RESTRICTIONS HW�r.f / WHICH DO NOT APPEAR ON THE RECORDED SUBDI- •. 1).*,* Me.k sw.re VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' 1� •. LS-eois• �t ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR SB' �9 ;Zy A� FOR ESTABLISHING BOUND- vv .- ARY LINES. DRAWN: \As T„• SCS ReLN Client Name Project Name/p Client Sample ID 11latris PINSID 1061361001 S & S Engineering LI 132 Scimitar No 3 LI D2 Scimitar No 3 Drinking Nater All Dates/rimes are Alaska Standard Time Printed Date/Time 03/302006 7:41 Collected Date/time 03212006 15:50 Received Datetrime 03222006 9:49 Technical Director Stephen C. tale Sample Remarks: 353.2 - The MS for NO2 failed to meet QC criteria. The batch LCS is within QC limits. Allowable Prcp Analysis Parameter Results PQL Units Method Container ID Limits Date Date [nit Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<-10) 0324/06 0327/06 SCL Waters Department Nitrate -N 0.275 0.100 Microbiology Laboratory Total Colifomt 0 mg/L EPA 353.2 D (o— 10) 0322/06 AZS col/100ml. SN1209222B A (<-1) 0322/06 J17M Y MUNICIPALITY OF ANCHORAGE • - DEPARTMENT OF HEALTH & HUMAN SERVICES - - Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # fir ! - 1 3y -c� I HAA # APfAL C `-II-,A 1. GENERAL INFORMATION Complete legal description Lot 1; Bleck 2; Scimitar Location (site address or directions) 19933 Seika Drive Eagle River, AK Property owner David & Barbara Yackley Day phone Mailing address C/O Remax of Eagle River 16600 Centerfield Dr. Eagle River, AK 99577 Lending agency Day phone Mailing address Agent Sharon Minsch/ Remax of Eagle River Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XXX 694-4200 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank, Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING Name of Firm v ( nn gnarl No. 204 Phone C c' y - c' -7 9 17834 5aglo River p Address Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE , S _ Approved for �" bedrooms. Disapproved. Conditional approval for Additional Comments Date /0/� -) / o 6 'ROBERT C. COWAN �c CE - 8801 bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 72-025 (Rev. 1/91) Back MOA 421 ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage OCT DEPARTMENT OF HEALTH & HUMAN SERVICES t Environmental Services Division I 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: 1-0- i {��i aY `Sci1Y`i.•'NVZ- Parcel I.D.: ob- i i34 —6i ,5/o i+3 A. WELL DATA Well type Ftitw A-+ u" If A, B, or C, attach ADEC letter. ADEC water system number /A Log present &N) Date completed Total depth Z1 Cased to Zq Casing height (above ground) I� Sanitary seal (DN) Wires properly protected (Sw FROM WELL LOG AT INSPECTION Date of test L S cs I -Z. A 5 ! _i Static water level 14 Well production Z 9-p m. 9— p.m-WATER SAMPLE RESULTS: Coliform O Nitrate Other bacteria Date of sample: 10 /1'7 `t f. Collected by: :5 f i I t4 E&a f1 is B. SEPTIC/HOLDING TANK DATA Date installed cl -2'7 _ 15 Tank size i000 Number of Compartments Cleanouts(&/N) Foundation cleanout&N) Depression (Y& t� High water alarm (YQ Date of Pumping ��' Pumper C. ABSORPTION FIELD DATA /System Date installed 10 i C I Soil rating (g.p.d./ft2 or ft2/bdrm) 12— - / S tem type Length Width Gravel thickness below pipe 2 _� Total depth "C Effective absorption area -;.I i I Monitoring Tube present (ITN) �'( Depression over field (Y/& !J Date of adequacy test IV avJ Results (Pass/Fail) For �3 bedrooms Fluid depth in absorption field before test (in.); Immediately after=gal. water added (in.): Fluid depth ' (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level E. SEPARATION DISTANCES "Pu *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 10o U Size in gallons "Pump off" level at* i On adjacent lots 1 u ® t Absorption field on lot Ino,' On adjacent lots tool Public sewer main N �/� Public sewer manhole/cleanout ! P, Sewer /septic service line Lift station t� lac SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: i Foundation f 0 % i Property line 50, ± Absorption field l Y Water main/service line It) f Surface water/drainage 100 f Wells on adjacent lots l©f3I SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Sa Building foundation '50 'r Water main/service line 101-i' water 100 l t Driveway, parking/vehicle storage area 71 - Surface l ± Curtain drain N /A Wells on adjacent lots I 001 F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records that the above systems are in conformance with M� OOA%HAA 9 'd lines in effect on this date. � \'c`�OF�%A � �� �� E Ak Signature �r'G l r, " y e� J. it k+ Engineer's Name Cr wN,.i :` e%'✓t?� ���� Date HAA Fee $ 3 8h " e Date of Payment / azle��� Receipt Number "Z%4 (3G 4 i 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number ROBERT C. COWAN CE - 8801 i aa° CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID Parameter Nitrate -N Total Coliform CT&E Environmental Services Inc. Laboratory Division Laboratory Analysis Report 965632002 S & S Engineering N/A Ll B2 Scimitar #3 Outsd Fauc. Drinking Water Client PO# Printed Date/Time 10/21/96 20:29 Collected Date/Time 10/17/96 12:00 Received Date/Time 10/18/96 11:45 Technical Director: Stephen C. Ede Released By Allowable Prep Results POL Units Method Limits Date 0.100 U 0.100 mg/L SM18 4500-NO3F 10 max 0 0 col/100mL SM18 92228 200 W. Potter Drive, Anchorage, AK 99518-1605 — Tel: (907) 562-2343 Fax: (907) 561-5301 3180 Peger Road, Fairbanks, AK 99709-5471 — Tel: (907) 474-8656 Fax: (907) 474-9685 Analysis Date Init 10/19/96 EMB 10/18/96 TAV ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA 5 '�,'MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date I d G 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range; Location (address or directions) (b) Applicant Name ��u�r�� rnu"'" � Telephone: Home ��� yS b� Business _ �h- Applicant Address &Z" (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Buyer ❑ ;Other ❑ (explain); (d) Lending Institution wl - �t��z�"r-J Telephone Address (e) Real Estate Company and Agent Address Telephone (f) ai+-the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family p< Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well o Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite p Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 11 1Y84) Page 1 of 2 mob. ''ENGINEERING FIRM PROVIDilvi:iINSPECTIONS, TESTS, FILE SEARCH, DSA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S R. S GP.II_INEEERIN Telephone Address SR B 196X Date EAGLE RIVER, LAK 99577 OF Al A. SWOP IR 6. DHEP APPROVAL��� Approved for E?� c� bedrooms by G / / 1�` L t ti Date , Approved Disapproved Conditi nal Terms of Conditional Approval cihep CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNI IPALITY OF ANCFi•": ,,;;;� DEPT. OF HEALTH " MUNICIPALITY OF ANCHORAGE (MO r ( ENVIRONMENTAL PP.OTEC:;j,w HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 1VIAi C/ 7 1986 264-4720 Legal Description: L 17 Z R ECE11J F n A. WELL DATA Well Classification ?A «/ P� If A, B, C, D.E.C. Approved (Y/N) Well Log Present/Nj Date Completed – "� Yield `4 Total Depth Z l 3 Cased to 7– 66 De th of Groutin Static Water Level 1A I Casing Height Above Ground — Electrical Wiring in Conduit 6`wy p g — Pump Set At Z ` r— Sanitary Seal on Casing (OTdj Depression Around Wellhead Separation Distances from Well: To Septic/Holding Tank on Lot 0 Z On Adjoining Lots To Nearest Edge of ,Absorption Field on Lot 1 2S?j ` ; On Adjoining Lots t O To Nearest Public Sewer Line ~( `� To Nearest Public Sewer ZS I } Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by r( S. e/co I J ; Date Water Sample7est Results�l— Comments B. SEPTIC/HOLDING TANK DATA Date Installed '5 --Si" No. of Compartments Z Standpipes t Y-d'f Air -tight Caps0_N)Foundation Cleanout/K Depression over Tank Date Last Pumped Pumping/Maintenance Contract on File (Y/N) /""/x_ ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well �o Z r To Building Foundation To Property Line To Water-4viaiWService Line Course Comments Page 1 of 2 72-026(11/84) To Disposal Field (_10 I *- 1 I To Stream, Pond, Lake, or Major Drainage 1„ C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata SSU `-�3 P_ Type of System Design Date Installed G Z — S Length of Field 3� Width of Field Depth of Field 31 �u Gravel Bed Thickness Square Feet of Absorption Area ��� Standpipes Present (91W Depression over Field erg) Date of Last Adequacy Testy� ,,ll// Results of Last Adequacy Test Separation Distance from Absorption Field: r To Water -Supply Well (QO1 4 - To Building Foundation Lot To Water-Main/Service Line 3o`y To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION To Property Line 10 To Existing or Abandoned System on On Adjoining Lots To Cutbank (if present) (I �t 1� 00kA- Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all ,tylAt andel AAAAduidelinos in effect on the date of this inspection. Signed S & S ENGINEERING Date I tt77 CompanSR B 196X MOA No. EAGLE RIVER, AK 99577 Receipt No. Date of Payment Amount: $ �rJ Page 2 of 2 72-026 (11/84) Of At tt Jrl K.r„sk c........as...e. a.bw+ x, at,wft;r . t `r •+• .�.•� t2Ul �4� •+. a • {fr tt �1�t �OFEBSnL�