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GREAT LAND ESTATES #1 BLK 2 LT 1
Gr ntl nd Estates # 1 Block 2 Lot 1 #051- 131-05 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page / Of-? ON-SITE WASTEWATER INSPECTION REPORT Permit Number: O S P j 51,3 & PID Number: 0 51/31 e'i s' Dwelling: Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New PUpgrade Name: cd ABSORPTION FIELD E9C/S711V'19 ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 2020f 13001v. El Other Phone Z 52— Number of Bedrooms Soil Rating Total depth from original grade Q2 5 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade � - Ft. Gravel depth beneath pipe Ft. Subdivision n Block Lot R7-1—AA F.i */ Z / Fill added above original grade Ft. Gravel length Ft. J Township Range Section Gravel widthBeds: Ft. Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area - Number of trenches Dist. between trenches From Tank Field Tank Line Ftiz FL Welloyy f �OG. TANK Septic ❑ S.T.E.P. E] Holding [I Other Manuffectu r 7 � Capacity SoOGal.Q [/ Surface Water fGO( /o Material Number of compartments Lot Lineo f a `f �V / —' NAFoundation 0 {,� (a LIFT LIFT STATION Manufacturer Capacity Curtain Drain ,_ Gal. Remarks A /6 t 7� a ,V !/� /� 414 y f Pump on level at in. Pump off level at In. High water alar at in. F_COViYb1/LI�/ SSS / d G�� 7t;!9:AJK. Art z [/P� r Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL Housetotank nk o drain e � � r Drainfield Q,? CO/MT 30.r Inspector /V dr (Gttt! �Np BENCHMARK (Assumed elevation) /zlott Inspection s 14he 2 Z dates: 3m 4 ' r Location and description _ %/0 /2Eqg_ 4 6c*, COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL En sneers Stamp �e z Conditional Approval: Date �A g I2/3n/s Approved I tg Date1 inspection Report a-i-iz.aoc AS -BUILT MEASUREMENTS A B STI 49 41 ST2 59 52 DCO 65 59 Greatland Circle Flat Slope ewer Service Under Irivewa Insulated w/ 6" nsulation Board 10' Utility Easement 10' Utility Easement 7% slope--— — NORTHRIM . ENGINEERING * •49m PO Box 770724 Eagle R/ver, Alaska 99577 907.694. 7028 Flat Slope Garage Well,s% Slope Lot 13 Over 106—/ GREATLAND ESTATES 1' = 50' #1 BLOCK 2 LOT 1 RECORD WASTEWATER RECORD LAYOUT REPLACE SEPTIC TANK 12/30/16 12 of 3 / Existing Well Well Barn Over 100' New 1500 Gallon Septic Tank w/DCO's Decommissioned Old Flat Slope Ij� / Septic Tank I- P/YQ PER UPC d 'SL Existing Flat Slope 'y Trench 01, A Sr, Sid Existing SDO Gallon r,6 Lift Station 5 Bdrm nco 10' Utility Easement 10' Utility Easement 7% slope--— — NORTHRIM . ENGINEERING * •49m PO Box 770724 Eagle R/ver, Alaska 99577 907.694. 7028 Flat Slope Garage Well,s% Slope Lot 13 Over 106—/ GREATLAND ESTATES 1' = 50' #1 BLOCK 2 LOT 1 RECORD WASTEWATER RECORD LAYOUT REPLACE SEPTIC TANK 12/30/16 12 of 3 �3n o p "ro mZ Z Ili mcn-P�Cl) rvr c-) < A O ty�DNp rn�0C 0 N A h oCD 0 2 n� ro +ro * c -o Q� o s� 3 o v R1= 3 ri 3 iro 0 n Aoch ro ID N A Z op A p -h O- 3 o 3 `F O n c+ -- - )(D ro N Z S�q nA ro a- Q Qo 3 0 o r(D 0 z o m 'q,�• • "9( II Q 3 � � 1 ep�iI �1 0 rD 3 - g � < -0 m \ � -h h ro x n p 3 bd F ,+ 3 A 3f7 - - - --- p C z p Cl) 3 - (O 3 CD OD 3 n A X- ro ro Q No p m D z -u v -3 r ro Cl)33 H C7 D Rom �p r —I D n w n m C D Z o n Q h (� 7C o N n 3 M 3 t it7 ro m Z mD (� N OD O co F-1 3 � v Q N �{J d A rp Q ro _ Y F GN Nr ` JF— 7 F-1 M Lq n D c 1Q 3; m 3 x A ai ! Iv D O ? F h Z3 3- ro (O Q O j r d �M o +— —i F9 h S' (� go A `+ .. i D r0 .+ A ro N h O N I frl O 3 i �i '3 GS' '_' n n � S �3n o p 0 pr0 Aoch ro O p A h O 3 n fo P 3 O c h rDro m < ro A p0 U 0 0 0 U fm � 3 p (O Op C!1 C7 � ro A 3 O c e+ N w ro h F ro ro 3 N ro 1 n --1 A 3 z- Ro 7 z ro 3 n S On -Site Water and/or Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP151384 Tax Code Number: 05113105000 Work Type: SepticTank Upgrade Permit Effective Dates: December 10, 2015 to December 09, 2016 Design Engineer: NORTH RIM ENGINEERING Subdivision: GREAT LAND ESTATES #1 Site Legal Address: GREAT LAND ESTATES #1 BLK 2 LT 1 G:1260 Owner/Address: KOHUTEK SHERI R 20209 CHAPEL DR CHUGIAK AK 995676305 Site Mailing Address: 20209 CHAPEL DR, Chugiak Lot Size in Sq Ft: 89734 Total Bedrooms: 5 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: la// o//S Issued By: /Vim/ e:5�1�� Date: IZ lO l MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERIWFF=LL PERMIT APPLICATION Parcel I.D. 0 5/- /31— Cd 5 Property owner(s) leOHa%EK Day phone Mailing address c/ Site address 0,4,m� Legal description (Sub'd., Block & Lot) J Legal description (Township, Range & Section) Lot Size _9 73Sq. Ft. - - APPLICATION IS FOR: -- (® all that apply) Number of Bedrooms S APPLICATION IS AN: - - - TYPE OF DWELLING: Absorption Field ❑ Initial ❑ Single Family (SF) Septic Tank F (w/wo ADU) Upgrade Duplex (D). ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Permit/Rush Fees: 15 Date of Payment: Receipt Number: 0'1o13O Permit No. oe2?i5 i ;�gy Permit App_9-1-12.doa Waiver Fees: Date of Payment: Receipt Number: Waiver No. t TH IR M NGINEERIN6 MEMO Steve Eng, PE, PH (907) 694-7028 tel northrimeng@aol.com Date: 11/30/15 Number of Pages: 4 To: MOA On -Site Services Subject: Greatland Estates #1, Block 2 Lot 1 Septic Tank Failure The subject property has a COSA application in process. The tank was pumped and found to contain rocks, requiring replacement. Please expedite a permit so the tank can be replaced. The 500- gallon lift station and existing trench will remain. Please review as soon as possible. If there is need for additional information or clarification please give me a call. Thanks -Steve 'ATF- IZ M ENGINEERING Greatland Estates #1, Block 2 Lot 1 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is an existing 5 -bedroom, single family home. Most of the neighboring lots are developed. The current septic tank has failed- the Trench & 500 - Gallon Lift Station still function. These lots are large and are served by private water wells. No adverse impacts are expected from tank replacement. The easement is depicted on the lot. The sewer service line has a history of periodic freezing under the driveway; Replace and/or insulate as required. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • New 2- compartment, 1500 gallon septic tank. Watertight couplings on inlet & outlet. • 5' minimum between the tank and bed. 10' to property lines. • 4' of cover or insulation is required for tank; an equivalent of 1" insulation for 1' foot soil cover. Minimum of 2' soil with insulation. Tank & solid pipe must be set on well compacted, stable soil. • 4" diameter cleanouts with airtight caps are required F to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2% slope. Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) s 3' DESIGN NOTES: 1. Existing Trench Remains In Place. 2. Sewer Service Line minimum 2% slope. 3. Replace Septic Tank/Decommission Old Tank Per UPC. Connect New Tank To Existing Lift Station. 4. Lots Served by Private Water Wells. 5. No Conflicts Within 200'. 6. Check Condition Of Sewer Service Line— Replace If Necessary. Greatland Circle Flat Slope Check Condition Of Sewer Service Under Driveway, Replace And/Or Insulate As Required. Existing Well/ Well Barn Over 100' New 1500 Gallon Septic Tank w/DCO's Decommission Old Flat Slope Septic Tank Z"/� PER UPC Pk4 d 7 Existing Flat Slope y �� / Trench Existing00 Gallon Lift Station 5 Bdrm �_ A ^ Flat Slope SO' Utility Easement —, we �u�������� ll p —�S% Slo�� L Slo e — Lot 13 Over �106T —7 ■ M /2 C54 6 /° ai @� u )g C\ eE z M /2 @� \\ 7® \/ / ® LA f Ln q u % 2 z K f % \ 2 } \ /. < \ t § G $ ( j ( ! o -C , \ \ 0 2 a- �k \g a §�L\ \-`` e . ƒ-- ;p -Q)E ucL 00E Q®5® !!m( 2eL Kai® \t«2! \\ /2E\tG J)� 25!ƒ±~) 2®G�G/ca= e0aluadl5\ °eGoaC» A/7\{eeeE®f Ldalmw22 E®o b®�0) a- E �)/]6!®\\§3 . )mE03£!-`Q± ��° [�(1) 0Dt Pie m*uiz >a / r::) Q 2 « w w « b 2 g 2 2 � O 2 L u w L 2 g »:; G.: c ;R , m / Municipality of Anchorage Page 1 or 3 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 SW970407 PID Number: 051-1-31-os Name: Wastewater System: 0 New Upgrade Cla Address: ABSORPTION FIELD 20209 Cha el Dr. Chu iak AK 99567 Phone. - _ No. of Bedrooms: C1 Deep Trench X1 Shallow Trench ❑ Bed ❑ Mound ❑ Other 688-6118 Five 5 LEGAL DESCRIPTION Soil Rating: Total Depth fromoriginal grade: GPD/So- Ft. Lot: Block: Subdivision: Depth to pipe botlpm IMM original grade: Gravel depth beneath pipe 1 2 Great Land Est. 0 FL 4 t Ft. Township: e: Ran9 Section: Fill added above original grade: Gravel length: 63' ' _ ' Ft. Ft. Gravel width:, 5 Number of lines: Diwnes mveet fin WELL: Existing Ft. 1 —ce Ft. C7assificauon (Private. A.B.C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. I Ft. 63n so. Ft. ASTM D303.4 PVC Driller. Date Drilled: Static Water Level: Installer. Date installed: ' Ft_ CCC Construction lr/17/98 yield.Pump Set at ` Casing Height Above Ground: - TANK GPM Ft. Ft. SEPARATION DISTANCES ❑septic Existing Verified Sound. To septi A rpdon Litt Holmnq pumictprivtne Manufacturer. Capacity in gallons: From Tank FroW station Tank Seer Lines >100' >100' >100' N/A N/A Material: Number of Compartments: well Surface >100' >100' >100' N/A N/A LIFT STATION Water Lot >51 > 1 o t >10' N/A N/A Size in gallons: 500 Manufacturer. Anch. Tank Orenco Line Foundation > 5' > 1 0' > 1 0' N/A N/A "Pump on- level at "Pump off" level aC High water alarm at 28" 28" 4" Curtain None Noe on Lot Pump Make 3 Model Electrical Inspections performed by. Drain 200SI05HHFI Heavenly T.iahf-- Electrical BENCH MARK Remarks: Existing Septio 91ank Verified Suitable For Continued - _ Location and Description: Garage Slab Use. Lift Station and Absorption Trench Placed Under This Permit. Assumed Elevation. 100.0 Ic"r(� ' RR y>c- Ar `�" `;?> ,; � °4 '� Inspections performed by: c Gilbert Dates: 1Stl/17/9s r 2nd1/17/eftF�� ° . m ° C �� Department of Health and Human Services approval s� .°° Reviewed and approved by: w• P Date: Municipality of Anchorage Page 2 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On -Site Wastewater Disposal System or Well Inspection Report Permit Number SW970407 PID No. 051-131-05 GREAT LAND CIRCLE W�11 I 1 BarLul 4J 0 a 0.i m fro H4J roEI) a c� .iJ ow TH .ri. O-ri 2 N Ni y L04 xro W Ei. _. Five Bedroom A he Home Garage he RNL PLAN AS -BUILT SCALE 1" = 40' A B LS 66.5 69.2 M1 77.8 79.6 M2 135.5 140.5 W�11 I 1 BarLul 4J 0 a 0.i m fro H4J roEI) a c� .iJ ow TH .ri. O-ri 2 N Ni y L04 xro W Ei. _. Five Bedroom A he Home Garage he RNL PLAN AS -BUILT SCALE 1" = 40' Municipality of Anchorage Page 3 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On -Site Wastewater Disposal System or Well Inspection Report Permit Number SW970407 PID No. 051-131-05 100_2 £ 105.5 H M To Existin�/ Drainfield Rock Septic Tank 95.4 4 97.5 63' 50 Gallgn 87.5 Li t Station 10' i NOTE: Existing Septic Tank Inspected and Verified Sound For Continued Use. Only the Lift Station and Absorption Bed Were Placed Under This Permit. PROFILE AS -BUILT HORIZONTAL SCALE 1" = 10' NO VERTICAL SCALE 1 11 06/20/1999 11:35 6947112 -JYiN-22-•99 0E [ 10 AM SGTECHNICAL 491 Villow Street • Wasilla, Alaska 99654 Phone* (907) 373-3893 • Fax# 373-3894 PAGE 01 P.02 �DOK up b� 4, 1-1iSGVASt ��-f �Ic- i ave OGV Tf o�oes CeAKOV%� t -o CuvVevtrNEL ao C6w,tiryn, �oti.� ���.d�bwS� CO, eta\ Wj7 C'.4-bh7tS �r k Z's C,w45c N o 0 65_ �\ g '1089 e P G of NO Seryices M���Oea� hy°�Numa� Ook- Received Time Jun -20, 10:19AM $µle 4,\j 6 rcatla••ol Es�+p`c� Pe�cVS L' N edK i�l� 171a S bCRll/ �DOK up b� 4, 1-1iSGVASt ��-f �Ic- i ave OGV Tf o�oes CeAKOV%� t -o CuvVevtrNEL ao C6w,tiryn, �oti.� ���.d�bwS� CO, eta\ Wj7 C'.4-bh7tS �r k Z's C,w45c N o 0 65_ �\ g '1089 e P G of NO Seryices M���Oea� hy°�Numa� Ook- Received Time Jun -20, 10:19AM "So pvq PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970407 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:LEVY DONALD E & CHERI OWNER ADDRESS:20209 CHAPEL DR CHUGIAK, ALASKA 99567 PARCEL ID:05113105 LEGAL DESCRIPTION: GREAT LAND ESTATES #1 BLK 2 LT 1 LOT SIZE: 89734 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED:12/03/97 EXPIRATION DATE:12/03/98 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: ISSUED BY: c DATE: 14S L[ 7 DATE: 2 ��7 November 20, 1997 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 1, Block 2, Greatland Estates Subdivision Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: The absorption trench on Lot 1, Block 2, Greatland Estates Subdivision has failed and must be replaced before a Certificate of Health Authority Approval can be issued. We are therefore applying for a permit to upgrade the septic system on the lot including the placement of a new lift station. The attached Site Plan shows the area where the new lift station and absorption trench are to be placed. The existing septic tank will be uncovered, inspected and verified for continued use. The existing absorption trenches will be left in place for possible future use. The testholes placed in the area of the proposed absorption trench revealed clean well graded gravel with a percolation rate of exceeding 1 minute per inch. No groundwater was encountered nor was any measured during the monitoring period. We are therefore proposing placement of a 63' long by 5' wide by 4' effective depth absorption trench for disposal of septic effluent. The distribution piping will be placed at the original ground surface as a tighter silty gravel material was encountered at 6' below the surface and extended to the bottom of the testhole. Effluent will be absorbed into the looser gravel material. The ground surface of the lot is mostly flat with only a minor drop from west to east. The surface slopes at a 0 to 1% grade from north to south. The lots in the area are between 2 and 3 acres and no conflicts were noted between the new septic system and wells in the area. Lot 1, Block 2, Greatland Est. Subdivision November 20, 1997 Page Two If the system is constructed as designed the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments OF 4,'j 1 j l C2 +� TH 5911-E AREA MAP SCALE 1" 100' 49TH r� T'. MICHAEL E. ANDERSON . % VIA% 4381-E Nlow • TAS NOTE; No wells are located within 100' of new septic system. NOTE: VERIFY INTEGRITY OF EXISTING SEPTIC TANK. x ! LU x. U Well 3 C W Barn is > z C\/\ x 0 t'J LU LL. IL O OJWO F Z Z nl N LU O Q Y Z '� N Z Fa - N c LL X N J a U -� O �-r . • <,qc, 1. i * • 49TH MICHAEL E. ANDEFiSQN 4381:1l'NP�.����%r OFESS ®. Existing Absorp. Five Bedroom he Trenc Home Garage SITE PLAN SCALE 1" = 40' LOT 1, BLOCK 2, GREATLAND ESTATES SUBDIVISION DESIGN FACTORS: Five Bedroom Home Perc. Rate: LT 1 Min./inch Application Rate: 1.2 GPD/SF SYSTEM REQUIREMENTS: 5' Wide Trench System 500 Gallon Lift Station Existing 1,500 Gallon Tank Pressure Distribution System 5 Bedrooms X 150 GPD = 750 Gallons Per Day 750 GPD/1.2 GPD/SF X .5 (Red. Factor) = 63 LF Total Length of Trench Therefore: Construct a 5' Wide Trench Length. Distribution Piping to be Placed Bury Insulation and a Minimum of 2' Trench. System with One Lateral 63' in at Original Ground Level. Direct of Fill Placed Atop Absorption b rzaul=115LD •Rout TYPICAL 5' WIDE TRENCH SECTION,�,�,���\ (NO SCALE) OF A< Lj NOTE: Grade Area to Drain Away. •;4 • 49TH t� •..: .A.•d 1r,A• ��A.•. MICHAEL, E. ANDERSQN 5EAW Municipality of Anchorage owl DEPARTMENT OF HEALTH &HUMAN SERVICES 1.10 .. 41�9y�•�� 825 "L" Street, Anchorage, Alaska M02-006500 SOILS LOG — PERCOLATION TEST HAEL E.*ANDERSON ; Gr PERFORMED FOR: Don Levy DATE LEGAL DESCRIPTION: Lot. 1., Block 2 Township, Range. Section: oI E1 Greatland Estates SLOPE. 1 2 �3 �{ 4 5 8 7 9 9 10 11 12 13 14 15 15 17 18 19 I'mnC.. "J0.I AA ••off [vL'C- WAS GROUND WATER ENCOUNTERED? . IF YES, AT WHAT DEPTH? No EI DOM to No a pqt 11 2 § 11 Rduq Dm - a Gree NK Time Tlm� Dep to War Not Drop AI; I N. 21V &L # %57 dt4 /:SB I 75- 2#5, /*S9l • Ou :ou IL'' 95' zo-tZ 4 1 PERCOLATION RATE " (mmws>rinrJl) PERC HOLE DIAMETER 1 TEST RUN BETWEEN Z 1 L- FT AND 3 ' FT - COMMENTS Testhole Presoaked Prinr t0 mPG}_ Mnro +,hnn Sn% of material. in the GW layer. -passes the No. 4'Seive. PER BY:5 • � i LBcfrr� I � - a— / ` RTIFY THAT /TJry�L�S TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE.. ��• `"/9 7 72-M (Rev. MBS) . T OF + Ahs @AL) e Municipality of Anchorage A. �� jr DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street• Anchorage, Alaska 99502-0650 . . SOILS LOG — PERCOLATION TEST ? A �< -, R"ICNAEI E. kt�pE9S01V :., pJJ,r2,,4381-Ee PERFORMED FOR: Don Levy DATE PFjiFOgl�lEq£ • 1.1 / 1.4•' � LEGAL DESCRIPTION: Lot 1. , Block 2 Township, Range. Section: nI ErrI Greatland Estates SLOPE ' SITE PLAN 1 3 4 5 06 a 8 9 10 11 12 13 14 15 16 17 is 19 penze., 40, Z WAS GROUND WATER NO ENCOUNTERED? IF YES, AT WHAT - DEPTH? 06P to Wdw� e &w 11120/9 11 ji PERCOLATION RATE - s3 (minutes/inch) PERC HOLE DIAMETER / TEST RUN BETWEEN 4P FT AND 7 FT COMMENTS Testhole Presoaked Prior to Teat_ Mnrn than Fn* of material, in the GW laver'oasses the Nn_ 4 wive_ PERFORMED BY: S. & IZE27 1 LId"""� bac— - CERTIFY THAT THIS/TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINESINEFFECT ON THIS DATE DATE 72 -ODS (Rev. MBS) _ . Elevation @ Highest Discharge Point Pressure @ Highest Discharge Point Liquid Level in Tank (Elevation) Diameter of Holes in Distribution Line Diameter of Distribution Line Hole Spacing in Distribution Line Length of Transport Line Diameter of Transport Line 4o ' IZ.q cAZ \ h- _ /z-4 C.19)L f -S s9 GPM S`� GPM 1 D2iF,c� @ S 14l, -P2G$Surl._ -rb H 105 — 9z) + D19Z (29.5 >z. 4 !3 + 11,.E + ZD 05= 05 i49 F -5 5 D /-6 res / r► Laa—ei� oo09is (40) Cz9. 5)"Ss Pump won,4c.S / 5 M� ORENCO SYSTEMS, INC C�20LO�NIAL ROAD ROSEBURG, OR 97470 1 (503) 673-0165 350.00- 1 b6 6' !6p ! TFU 41`5 1 EFFLUENT 1 /2 Hp to 11/2 Hp SINGLE PHASE, 60HZ ------ -- • ...... 1... 17- 4 .. . . ... ... .. 115/230 VOLT 20 OSI 15 HHF - 9 stage:..:...;..: . ....... PC#2 Tap 300.00 - �-9 (D 5/ 2 JJ .. ... L ... ... ... .. Tj ...... ........... ... ... J.. 2Z ..... ... .... ... ............ ... .. ...4 .. ... LLL. ........ ....... .. . .. .. ... ..... L 20 OSI 10 HHF stage' .. ... ... .. .. .. ... 250.00- J- .4 .. ....... ... ... .. . . ... . ... .. .. ...... .... . ... ... .. . .... . . . . 4.4" 200.00 . ............ V 20 OSI 05 HH -5 150.0c)- !7 I �z T"!... T' 1 .. ....... ... .... .. ... ... .. .. ... .. ... ... .. .. t 1 100.00 - L .. ........... ..I...:......... . -44-4- J .1., 40 CIS OS HH 2 s tage* 50.00 - .. . ....... .. . .. .. ........ . A �aiubp ri C tL 05 HHF- 5 stage .. flow controller 0,00 - 11 0.00 5.00 10.00 15.00 20.00 25.00 30.00 35.00 40-00 45-00 50-00 NET DISCHARGE, GP? 4 M� ORENCO SYSTEMS, INC C�20LO�NIAL ROAD ROSEBURG, OR 97470 1 (503) 673-0165 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 1, BLOCK 2, GREATLAND ESTATES SUB. GENERAL: 1. The scope of this project includes the construction of new 63' long x 5' wide x 4' effective depth absorption trench at the location shown on the plans. It also includes procuring and placing a new 500 gallon lift station and construction of a pressure distribution system. The existing septic tank must be uncovered, inspected and verified for continued use. If damaged and unsuitable, the tank must be replaced. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. The property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK/LIFT STATION INSTALLATION 1. The lift station is to be constructed by a certified tank manufacturer. Construction shall include an 18" manhole for access to the lift station. Lot 1 Block 2, Greatland Estates November 20, 1997 Page Two 2. The septic tank/lift station shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes shall extend a minimum of 12 inches above final grade. 4. Septic tank/lift stations installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 5. A foundation cleanout shall be installed one to four feet from the building foundation. No cleanouts are required between the lift station and the drainfield in a pressure distribution system. 6. Final grading over the septic tank/lift station shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH CONSTRUCTION: 1. The absorption bed shall be constructed to the dimensions shown on the design. The bottom of the bed shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion in the drainfield rock must be perforated. 5. Direct bury insulation must be placed over the distribution system when less than 3' of backfill depth is available. Lot 1 Block 2, Greatland Estates November 20, 1997 Page Three Finish grade over the bed must be mounded to prevent settlement or depressions. MATERIAL SPECIFICATIONS: 1. The lift station must be constructed by a Municipally approved septic tank manufacturer. An Orenco 20 OSI 05 HHF - 5 is recommended. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast iron (perforated and solid), ASTM D3034 or PVC (Perforated and solid), ASTM F810 or HDPE (perforated, but not solid) and ASTM D2662 or ABS (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: A minimum of two inspections are required by Municipal Ordinance. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation Lot 1 Block 2, Greatland Estates November 20, 1997 Page Four of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of the second inspection. The contractor is responsible during the layout of the system to assure that all separation distances from adjacent wells in the area are met. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES f9�1 _ 13 Environmental Health Division V 825 "L Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name /�. DISTANCES ' I e �lGr �G� SEPTIC ABSORPTION Address NG 7 7, /-5o '%Lo5' FROM TO TANK FIELD WELL •I- Phone(s) Permit No. No. of Bedrooms WELL}- G�F�'Z�ro9 sW90-ola�. 5- LEGAL DESCRIPTION Lot Block Subdivision Township, Range, Section /7 / lQ. �/Q/C A/ /1A6 D4TRENCH ❑ BED TANKS SEPTIC ❑ HOLDING Manufacturer Awa44 �A'/i K— Total depth from original grade Capacity in gallons t5-00 Material 9 FT No. of Compartments TYPE OF SYSTEM D4TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from original grade original grade S FT 9 FT Fill added above original grade Gravel depth beneath pipe FT ¢ FT Gravel length Gravel width 9 4. FT Z FT Total absorption area Distance between lines 7!5 Z SO FT 2 / FT Number of lines Soil rating Pipe material 2 /$"O SOFT PVG 7�A D3o3 Installer 14)(,W G�ox/TiSGX✓lLS Date Installed S V CiF\ U --it 6-A /.Va WELLS PRIVATE ❑ OTHER (Identifv) Classification (A,B,C) Total Depth Cased to 177 FT i77 FT Installer Date Installed: ? 15 -7 z ? REMARKS: LOT LINE FOUNDATION AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, driveway. water bodies. etc.) Scale: 2-9 - Inspecticon� P`aAr�-/rme y: Date: I ID 'd�� 6! ccerl that this ipe ion was pew rmed according to all Municipal and State guidelines in effect on this date: ✓�%� Y / Health Department Approval: Date: to Dsrvid R. VD iyroit NO. 2203-E L !'�OfESS1d��t' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES PO BOX 196650 ANCHORAGE, ALASKA 99519 343-4744 HAND WRITTEN PERMIT Permit Number: SW90(DX[�(n Permit Type: Date Issued: S1l71gl? Expiration Date: /2113// 90 Design Engineer: y�n1 Owner Name: /fir-jhuf �Y 'rte/ Day Phone: 6 g8? --;Z/6 g Owner Address: 6 30 4S60 -k Ald- Acir Qn�S, Ck bo f1/C Parcel ID: 05/- 131-0,6'- �/ Lot Legal: Subdivision: 6.ie,1 vnc1 Z-1sr 341 Lot: % Block: ,7j, Section: /D Townshi !SW Range: i v✓ Lot Size: �'773� sq.ft or acres) Max Bedrooms: This Permit: Total Capacity:.5- SEPTIC TANK: Minimum septic tank capacity: la�O gallons. Each septic tank must have at least 2 compartments, insulation is required if depth to top of septic tank(s) is less than 4.0'. Lift stations require an appropriate electrical inspection. WELL LOG: A copy of the well log must be sent to DHHS within 30 days of the well's completion. 161-10 - 74V a,7swincee,4a.9 . I CERTIFY THAT: , 1. I will install the on-site sewer system and/or well in accordance with all codes and regulations of the Municipality of Anchorage (MOA) and State of Alaska , and in compliance with the design criteria of this permit. 2. I will adhere to all MOA and State of Alaska requirements for separation distances from any existing well, septic system, or surface water on this or any adjacent or nearby lot. 3. I understand that this permit is valid for a single family dwelling with a maximum of,"S bedrooms. I also understand that any enlargement will require an additional permit. 4. 1 understand this permit is issued for the calendar year and expires on December 31 of the year issued. 5. I will notify DHHS prior to all inspections by the engineer or well driller. SIGNED: ISSUED db/115 DATE: l� (owne de ignee) BY: DATE • 7- '1,00 SIGNED REDIFORM® 4S468 n NCS REPLY NECESSARY F-1 REPLY REQUESTED - USE REVERSE SIDE David R. Dayton PIALS. SR I Box 1026 Chugiak, AK 99561 I ll� ef Z07— A0 C X 'Z A 7 f7- n A nai-O el'', 4'f C.fPc- 0 Nlrie roe_ ins IrcZF. Lellalz Al N �u' 'ZI t' 1J/,J69 7 /6-/7 T 220 /5) /,-Z� e574,0 Z5l 1104615,F— PI'NFESSO'� -f� 0 ('? -/- ............ .... e Municipality of Anchorage � ' e °„. DEPARTMENT OF HEALTH & HUMAN SERVICESQ.� 825 "L” Street, Anchorage, Alaska 99502-0650 aeenc eaa2aoeo oeee®ao eu SOILS LOG — PERCOLATION TEST e Darvid 2. Dnyton f7 lre°o 2205-E J6 PERFORM /D&/— /4459' J S�a.e�� DATE PERFORMED:' LEGAL DESCRIPTION: 4 15L 'L e5 74,*10 C�,r Township, Range, Section: n�T1 (lN 1T Alo SLOPE �L C'oPi9 cas WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? N Depth to Water After - / -105-/119 Monitoring? Date. S L O P E SITE PLAN Reading Date Gross Net Depth to Time Time Water Net Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER ��f/ �'� /� TEST RUN BETWEEN FT AND FT COMMENTS /i�D0.t7TU/L "r'QIIS /�'�oAlITa2 �div �FfG-GlGGLiJ S�.i/�lU /((/� GUf}r2r�L �/Lc^�G�V% PERFORMED BY: 1Z ��4)2)�j 1 220"2 W'4ely*", CERTIFY THAI THIS W S ERF RMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: i'/7 � �I �V I I W � f I � I Q h V Od m An %�Q d cd A y i. I i I N...,,"„ .._ v ' Od m An %�Q d cd A y i. I i I N...,,"„ .._ GR JR ANCHORAGE AREA BOROU" ", Dn...,STMENT OF ENVIRONMENTAL QUALII . 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ��=l i z1 / jj_ /N �i � /0 1A MAILING ADDRESS,"%� � (�'J liCl i/Cr /� _ _._PHONE/ _ s FROM WELL ? BUILDING FOUNDATION_!!�, I NEAREST LOT LINE Z Cl TOTAL EFFECTIVE Z- <J ems, SQ. FT. ABSORPTION AREA (WALL AREA) TILE DRAIN FIELD: LOCATION % ( --- LEGAL DESCRIPTION SEPTIC TANK: bi L ,414, ( oG� /,C�9 JCC' f' NUMBER OF DISTANCE FROM WELL MATERIAL COMPARTMENTS LIQUID CAPACITY GALLONS. INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH - SEEPAGE SYSTEM: SEEPAGE PIT: /1_ NUMBER OF PITS / OUTSIDE DIAMETER / 1 OR WIDTH LENGTH_L74 , DEPTH C� LINING MATERIAL %l DISTANCE _ s FROM WELL ? BUILDING FOUNDATION_!!�, I NEAREST LOT LINE Z Cl TOTAL EFFECTIVE Z- <J ems, SQ. FT. ABSORPTION AREA (WALL AREA) TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL FOUNDATION , NEAREST LOT LINE , OF LINES , DISTANCE BETWEEN LINE— _-TRENCH WIDTH ^---- TOTAL EFFECTIVE NUMBER OF LINES -�"J� .IN. ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE f % �t % � WELL: TYPE = I 4 DEPTH -/,BUILDING ` DISTANCE FROM / �� WATER ,BUILDING FOUNDATION._ Z SAMPLE , NEAREST r� NEAREST SEPTIC LOT LINE SEWER LINE TANK �! SEEPAGE OTHER o SYSTEM U CESSPOOL SOURCES_ DIAGRAM OF SYSTEM DISTANCES:. _ Z0r f,{{ l CL 0_ f c A> GREA, ER ANCHORAGE AREA BORVUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 279-8686 NAME OF APPLICANT INSTALLATION LOCAT LEGAL DESCRIPTION SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT PERMIT NO. O/ Jam,MAILING ADDRESS/ -�` �� � /`/� PHONE INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH X SEEPAGE PIT DRAIN FIELD TO BE INSTALLED BY OTHER SOIL TEST RESULTS�� NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE `- C` "C TYPE_��`' ` `6JK/,?" -l-�l SEEPAGE AREA SIZE X26 -C' TYPE MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM `> FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT u `-� DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK J SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD let WATER MAIN TO SEPTIC TANK DRAIN FIELD 11 SEEPAGE PIT / e�(n . ALSO CONSIDER AREA WELLS. SEEPAGE PIT SEPTIC TANK, ,, - , SEEPAGE PIT /�� L.� DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IROU-I-KTO Ai9D.-OUT OFSEPT4G--TANK-AND_.1i XC CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT Ff7TED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. �--"�4-1--Z OR LICENSED DESIGNER I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER A HORAGE AREA BOROUGH ORDINANCE NO. 28-6 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. �/ • /%� DATE JT APPLICANT'S SIGNATURE MUNICIPALITY OF ANCHORAGE lh / 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. 051-131-05 Expiration Date: 1. GENERAL INFORMATION -- Complete=legal-description GREAT LAND ESTATES #1 BLK 2_LT 1_ Location (site address) 20209 Chapel Dr Current property.owner(s) GILBERT JAMES Mailing address Real estate agent mm Day phone 770-654-3667 Day phone 770-654-3667 Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ SSo• 00 Waiver Fee $ Date of Payment M J'24(19 Date of Payment Receipt Number 02.43aJ Receipt Number COSA # O-CQ11908 Waiver # X67 8 9 10 2. TYPE OF DWELLING: Fx� Single Family (w/wo ADU) ti A ❑ Duplex a OCT 18 2019 ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 �<< 0168L9o' 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ED Private Septic Z Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ SSo• 00 Waiver Fee $ Date of Payment M J'24(19 Date of Payment Receipt Number 02.43aJ Receipt Number COSA # O-CQ11908 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm NorthRim Eng. Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 10/23/19 6. DSD SIGNATUREr 5CY `:: J2 •• 03 System #1 Approved for 5 bedrooms nJi@YC;1Eng System #2 Approved for bedrooms J�F Pc Disapproved �pR�FEss\0`� Conditional approval for bedrooms, with the following stipulations: Oz.. 1 ?goGR O OA i By: Original Certificate 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 Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisory Arsenic Advisory Other S Legal Description: GREAT LAND ESTATES #1 BLK 2 LT 1 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA Parcel ID: 051-131-05 Structure served by this system ❑ Well log is filed with Onsite (or attached) Well production at time of test 6+ qpm Date drilled 1972 Water storage tank volume 0 gallons Total depth 177 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to 177 ft _ ❑ Coliform bacteria is Negative F Sanitary seal is functioning correctly Nitrate 3.4 mg/L ❑ Nitrate less than MRL (ND) ---FE❑-Wires-are-properly-protectedArsenic ug/L—❑ Arsenic-less-than-MRL–(ND) — Casing height (above ground) 18 in. Collected by NRimEng Date of flow test for COSA 10nl19 Date of Sample 10m19 Static water level at beginning of test 147 ft. Comments B. TANK DATA Age of tank(s) " "5 years Tank type/material Steel Measured operating fluid level in septic tank 47 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 1 0 2-1 ^ 1q D. ABSORPTION FIELD DATA 1/17/98 Which system tested (date installed) 1/17/98 ❑ ALL standpipes present per record drawing Total measured depth from "grade 6 ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A –pressurized field,., , ❑ Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION ❑ Required maintenance completed Age of lift station 1/17/98 years Lift station material steel Comments: Adequacy test date 10/7119 Results M Pass For 5 bedrooms Fluid depth prior to test 0 in Water added 750 gal New depth 5 in Elapsed time 60 min ❑ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 750 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) E✓ Yes Septic Tank/Lift Station on Lot > 100' ft If absorption field is under driveway comment below Community Sewer Manhole/Cleanout > 100' F1 Q Yes if No ft M Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' F71 Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' Q✓ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ✓� Yes if No ft M Yes if No ft --Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' E✓ Yes if No ft Fv(l Yes if No ft From_Septic/Holding_ Tank on Lotto: (Please enter distances if less than required) Building Foundations > 10' Q✓ Yes if No ft Surface Water > 100' 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'✓Q Yes if No ft Water Main > 10' ✓❑ Yes if No ft Community Wells > 200'✓❑ Yes if No ft Water Service Line > 10' 0✓ 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' E✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' F1 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' U Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 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. COSA Checklist yellow sheet Lift Station/Pump Vault Owner 3�Vvte_5; Street Address 2-0�Oq. C Septic Tank: -Sludge leveinches -Pumping: required ygs L no -Pumping completed( es no Lift station: x -Pump basket cleaned <0 no -Control floats cleaned (ge L no *Operation satisfactory es no Alarm §ystern. -Dedicated electrical alarm circui -Alarm system operatiop---satisfact o- a Manhole Riser *Ground water intrusion at riser to tank eGround water intrusion around pipe p( *Manhole lid: Functional es no Other -Effluent filter cleaned /es no -Proper float settings confirmed 0 no no, *Audible and visual alarm inside dwellin<es�_o . -'_x- - connection es no netrations KesCnoD -Weep hole functional es no Insulated es no Properly Secured e no 11 _I_\ -All manufacturer required inspections and maintenance completed (,Iy'no Comments: Technician Date of maintenance i 3/1 q Company Signature* Date (101,411q- . Municipality of AnchorageGL• t c ,� On-Site Water and Wastewater Program o4' _ (907) 343-7904 s r [_, CERTIFICATE OF ON—SITE SYSTEMS APPROVAL Parcel I.D. 051-131-05 Expiration Date: 9'2 6 R 1. GENERAL INFORMATION Complete legal description Great Land Estates #1 Block 2 Lot 1 Location (site address) 20209 Chapel Drive,Chugial,AK Current Property owner(s) Richardson Day phone 268-4329 Mailing address same Real Estate Agent Brandy Day phone 268-4329 2. TYPE OF DWELLING: 5 9 8 9 10 77 ® Single Family (w/wo ADU) ti i.!.,:;:.1.1;7-';�'' I �'- ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) JUN 14 2.01B Cyd �' w 3. NUMBER OF BEDROOMS: 5 it a 6 8 9 c� 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: _ ~ , _ Date:,c4-> c/�J COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Jr' ZC' Date: Date of Payment total AS Date of Payment Receipt Number OtvaD Receipt Number COSA# (36Ul t c2 toq 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 Phone 694-7028 Address PO Box 770724,Eagle River Engineer's Printed Name Steve Eng Date . 6/14/1S:• 6. DSD SIGNATURE System #1 Approved for S bedrooms. ,�: L„�, System #2 Approved for bedrooms. e�i%j�t:, .'TV Disapproved. '" ' •• Conditional approval for bedrooms, with the following stipulations: Awc, \\tri= U PROGRP By: Original Certificate Date: l7^ 2C) ^1 ? 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 Ad,viscay .tiN! Septic System Advisory Arsenic Advi ory Well Flow Advisory Oth r s COSA blue sheet 9-1-12.doc + • a. }.s.. 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: (ec. LS Esi-- 76( 15'2 L/ Parcel ID:as/ /s/Os A. WELL DATA Well type P If A, B, or C provide PWSID# Well Log (Y/N) /v Date completed /77z ? Sanitary seal (Y/N) y Wires properly protected (Y/N) 7 d' Total depth /7 7 ft. Cased to / 7 ft. Casing height (above ground) / in. FROM WELL LOG AT INSPECTION Date of test. 5130 /A' Static water level ft. //7/5 ft. Well production g.p.m. 3.5 g.p.m. WATER SAMPLE RESULTS: Coliform 1 colonies/100 mL Nitrate 3.05mg/L Arsenic N f' ug/L Date of sample: ,d/3 /1 d' Collected by: //'i,h. B. SEPTIC/HOLDING TANK DATA ,/ Tank Type/Material 6 6/Tl / l L L Date installed /4/ 21/ Tank size /5°4 gal. Number of Compartments 2 Cleanouts (Y/N) Foundation cleanout(Y/N) Y Depression over tank(Y/N) /V High water alarm (Y/N) I y Date of pumping f/2‘fi 7 Pumper 44r ./l o /ch C. ABSORPTION FIELD DATA SAC l(ow Date installed ///7/7 e Soil rating (g.p.d./ft2 or ft2/bdrm) / 2 System type '7 ,ic.., Length ‘3 ft. Width -s ft. Gravel below pipe c-1 ft. Total depth C ft. Eff. absorption area ‘30 ft2 Monitoring tube y Depression over fieldA Date of adequacy test S/3t (A' Results (Pass/Fail) D / For, S bedrooms Fluid depth in absorption field before test ei in. Water added 750 gal. New depth Y in. Elapsed Time: 26) min. Final fluid depth Q in. Absorption rate >= 750 g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) tn.11'` If yes, give date D. LIFT STATION Date installed //(7/f8 Size in gallons 56'0 Manhole/Access (Y/N) y "Pump on" level at�t.. i is. "Pump off' level at t if,. High water alarm level at /O. riot Datum Z.6f'fovi." Cycles tested 3 Meets alarm&circuit requirements? ' E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot / '5 rf On adjacent lots /6rO 7- Absorption Absorption field on lot /QG '1 On adjacent lots /O G �f- Public sewer main l 6' G `'t' Public sewer manhole/cleanout -140.fi Sewer/septic service line 2 5 'f Holding tank /Ga -e- ( Animal containment areas S. 0 r Manure/animal excrete storage areas /DO 74SEPTIC/HOLDING r`SEPTIC/HOLDING TANK ON LOT TO: Building foundation / 6 r-f- Property line l <1L Absorption field .S Water main cr. Water service line /D 'r Surface water /6/O r Wells on adjacent lots /O' 'N ABSORPTION FIELD ON LOT TO:• r Property line /6 i Building foundation /D .4- Water main /6-►'� r Water Service line /O '1' Surface water /D6 if Driveway, parking/vehicle storage /Q f Curtain drain 5 "� Wells on adjacent lots /Q& 'F F. COMMENTS G. ENGINEER'S CERTIFICATION • I certify that / have determined through field inspections and • - . '°44xi01 review of Municipal records that the above systems are in '1 !)itconformance with MOA COSA guidelines in effect on this date. : .pr fio • Engineer's Printed Name • Date COSA yellow sheet 2-6-15.doc MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Lift Station/Pump Vault Maintenance Log Owner 3- ,40e5 Street Address .god a 9 /Or%u Septic Tank: -Sludge level xeo-inches •Pumping: required es Alra -Pumping completed yes no Lift station: -Pump basket cleaned no •Effluent filter cleaned Nei no -Control floats cleaned no Proper float settings confirmed .+in no -Operation satisfactory no Alarm System: -Dedicated electrical alarm circuit yes no •Audible and visual alarm inside dwelling(yes-) no 1 Alarm system operation satisfactory not satisfactory Manhole Riser -Ground water intrusion at riser to tank connection es •Ground water intrusion around pipe penetrations yes •Weep hole functional re no -Manhole lid: Functiona07A no Insulated(' no Properly Secure es no Other -All manufacturer required inspections and maintenance completed yes no IComments: Qualified Maintenance Provider: Technician AC?,A AC?, ''/ �E4� Date of maintenance I Company ,1L1,4,1 Signature Date -1419 Mailing Address: P. 0. Box 196650 Anchorage,Alaska 99519-6650 ' www.muni.org Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-131-05 1. GENERAL INFORMATION Expiration Date: 14—S-162 Complete legal description Great Land Estates #1 Block 2 Lot 1 Location (site address) 20209 Chapel Drive, Chugial, AK Current Property owner(s) Kohutek Day phone 252-0254 Mailing address same Real Estate Agent Buyers Real Estate Day phone 252-0254 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class C Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: Date: f/�6 COSA to be released to the engineer, unless therwise requested by the engineer. COSA Fee $45;-(10 Date of Payment Receipt Number 0155 � COSA#_ 0�0S_l5'l2 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 Phone 694-7028 Address PO Box 770724 Eagle River Engineer's Printed Name Steve Eng Date 10/26/2015 6. DSD SIGNATURE System #1 Approved for �_ bedrooms.; System #2 Approved for bedrooms. Disapproved.�p�� Conditional approval for bedrooms, with the following stl taI li, n5 - By: '-Ct Original Certificate Date: f v 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 9-1-12.doc 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:Ci a, i� Gq,d ;i5j f -&_j '0/ $2 el Parcel ID: 0 5"/ /3/ Q T A. WELL DATA Well type If A, B, or C provide PWSID # Well Log (Y/N) Al Date completed / Z Sanitary seal (Y/N) Wires properly protected (Y/N) ki Total depth / % % ft. Cased to / %ft. Casing height (above ground) 1�� in. ,FROM.WELL LOG AT INSPECTION Date of fest. §tatic water level ft. rft. Well production 9.p -m: WATER SAMV ,LE.WULTS: Coliform Q colonies/100 mL Nitrate Arsenic Mb ug/L Date of sample: Collected by: Allelpq6�t B. SEPTIC/HOLDING TANK DATA I• 2�l// j TankType/Material SEPr(54 ST/_W,EG `' Date installed' Tom" Tank size l BO gal. Number of Compartments gzw FL&-- Cleanouts (YIN) Foundation cleanout (Y/N) Depression over tank (YIN) /t High water alarm (YIN) Date of pumping 1 J k Pumper C. ABSORPTION FIELD DATA Date installed ///2/ Q 8 Soil rating (g.p.d./ft2 or ftz/bdrm) System type Length 4-� 3 ft. - Width 5 ft. Gravel below pipe ft. Total depth ft. Eff. absorption area &Q0 fe Monitoring tube 1- Depression over field At Date of adequacy testTLS Results.(Pass/Fail) For .5 bedrooms o r. FluitJ depth in absorption field before test _Q in. Water added 7S0 gal. New depth /Z in. :. . Elapsed Time: min. Final fluid depth (� in. Absorption rate >_ SQ g.p.d. Any rejuvenation treattMVpast 12 mo.) (Y/N & type) A)O If yes, give date D. LIFT STATION Date installed 111- / Size in gallons S C a Manhole/Access (YIN) "Pump on" level at O. f `n. "Pump off'level at in. High water alarm level ata C f in. Datum Bn f f ry�� Cycles tested 3 Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Zcd On adjacent lots /o O "-f- Absorption tAbsorption field on Jot 166 f -r On adjacent lots /a c) `4 - Public sewer main P6G rt Public sewer manhole/cleanout Sewer /septic service line z S r'r' Holding tank Animal containment areas Manure/animal excrete storage areas /a Q If- SEPTIC/HOLDING TANK ON LOT TO: Building foundation `�` Property line /J!57 �;K- Absorption field Sof Water main r/,0 s.Y. Water service line Surface water X00 rt Wells on adjacent lots Ica ABSORPTION FIELD ON LOT TO: Property line /6 F Building foundation /0 'f Watermain 6`44 Water ServAse line 16 `- r Surface water /GO 'F Driveway,.parking/vehicle storage Curtain drainCSS r f Wells on adjacent lots /60 t F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name --Z:7zF /fes o/J G Date COSA yellow sheet 2-6-15.doc i OF 4t '11k Eno 0 ASBUILT L I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE-' FOLLOWING DESCRIBED PROPERTY: �-6 AND THAT NO FNCROACHMENTS EXIST EXCEPT AS DATE: INDICATED. IT IS THE RESPONSIBILITY OF THE SWNER TO DETERMINE THE EXISTENCE OF ANY GRID: EASEMENTS, COVENANTS, OR RESTRICTIONS NHICH DO NOT APPEAR ON THE RECORDED SUBDI- JISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' 4NY'DATA HEREON BE USED FOR CONSTRUCTION 6� x DF FIANCE LINES, OR FOR ESTABLISHING BOUND- kRY LINES. DRAWN: o owwo 4��aF A S�.P . soft Dven. Mork S.WO'd a A LS,- 69)B `ra Municipality of Anchorage i®r; Development Services DepartmentBuilding Safety DivisionOn-Site Water and Wastewater Program S AE T Y 3' 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. #051-131-05 COSA # O 5C l k l C3(n g Expiration Date: % - .3 / 4;L 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Lot 1, Block 2, Greatiand Estates #1 20209 Chapel Drive, Chugiak, Alaska 99567 Steve & Jeannie Keith Day phone (781 ) 738-1164 Mailing address 13550 Royal Fifth Ct., Corpus Christy, TX 78418 Lending agency Day phone Mailing address Real Estate Agent Brooke Stiltner/RE/MAX Day phone ( 907) 244-6742 Mailing Address 11525 Old Glenn Hwy, Eagle River, AK 9%77 Unless otherwise requested, COSA will be held by DSD for pickup 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Pq Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of 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, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-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 Pinard Engineering Phone (907)357-3647 Address PO Box 871347 Wasilia, AK 99687 Engineer's Printed Name Paul E. Pinard, SR P.E. Date V.9`/111 5. DSD SIGNATURE _Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: WATER ANDrn= ppievzOAKA w. hfT GE\ff Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other 1 -- BY: � Original Certificate Date: � G (Rev. 11105) Municipality of Anchorage • ''-� Development Services Department 4 { Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 1 , Block 2, Greatiand Estates #1 Parcel ID: #051-131-05 A. WELL DATA Well type Pvt Date completed _a72 ? Total depth 177 ft. Date of test Static water level Well production If A, B, or C provide PWS ID # Sanitary seal (Y/N) Y Cased to 177 ft. FROM WELL LOG WATER SAMPLE RESULTS: ft. Coliform _D_colonies/100 mL Nitrate 2.71 mg/L Arsenic: ND ug/L date of sample: 3/1 /11 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1500 gal. Number of Compartments 2 Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 3/3/11 147 ft. 5.3 9.p -m. Collected by: Pinard Engineering Date installed 5/26/90 Cleanouts (YM) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping l OItt ( Pumper �1F\5Ir �^�. ,� C. ABSORPTION FIELD DATA Date installed 1/17/9 Soil rating (g.p.d.e &UM) 1 •2 System type 5 Wide Trench Length 63 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth �l _ ft. Eff. absorption area 630 ft2 Monitoring tube Y Depression over field N Date of adequacy test 3/3/11 Results (Pass/Fail) Pass For 5 bedrooms Fluid depth in absorption field before test 0 in. Water added 800 al. New depth 0 in. Elapsed Time: 1;L min. Final fluid depth _0 in. Absorption rate >= 750+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Known If yes, give date D. LIFT STATION Date installed 1117198 Size in gallons 500 Manhole/Access (Y/N) Y "Pump on" level at j_Q_,ffl. "Pump off" level A 0 s lin. High water alarm level at 9.9' �itx Datum Top of Riser MT Cydes tested _ 3 Meets alarm & circuit requirements? Y E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 1001+ Public sewer main NA Sewer /septic service line 251+ Animal containment areas 1001+ On adjacent lots 100' + On adjacent lots 1001+ Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas 1001+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 1 + Property line _JL+ Absorption field 51+ Water main NA Water service line 10' + Surface water 100'+ Wells on adjacent lots 100' + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 5Building foundation 10' + Water main 101+ Water Service line 10f+ Surface water 1001+ Driveway, parking/vehicle storage 25' + Curtain drain NA Wells on adjacent lots 100' + F. COMMENTS 1 G. ENGINEER'S CERTIFICATION ' ;&Ip'' I certify that I have determined through field inspections and ties 't • >s �� review of Municipal records that the above systems are in ini r. *"� e s • ^ s. conformance with MOA COSA guidelines in effect on this date."TA} sowft Engineer's Printed Name Paul E. Pinard, Sr. P. E. � Date 3/9/11 COSA Fee Date of Payment 3//1 /11 Receipt Number No 1 -7 (Rev. 4/10) Waiver Fee $ Date of Payment Receipt Number ARCTIC PUMP & WELL INC. Jim Sullivan PO Box 770197 nm I us mlod41 " cuEagle River, AK 99577 q V, MIS S SM (907) 688-2510 (907) 258-2510 (907) 745-2510 Mirrz tci.ne� Pump Installation Log Well Drilling Permit Number: SW Parcel Identification Number: Date of Issue, Arctic Pump & Well, Inc. Page I of I Legal D escript ion: Great land Est #1 Property Owner Name & Address: Lot: I Remax Brooke Block -2 Pump Installation Date: 10/18/2011 Purnp Intake Depth Below Top of Well Casing: Feet Pump Manufacturer's Name: Pump Model: Pump Size: hp Pitless Adapter Burial Depth: feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: casing 40'+ with no preforations Pump Installer Name: Arctic Purnp & Well, Inc. Arctic Pump & Well, Inc. Page I of I Municipality of Anchorage - • Development Services Department *A1 Building Safety DivisionOn-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-131-05 HAA#f A �/d 717 _� Expiration Date: Z 8 — a Z 1. GENERAL INFORMATION Complete legal description Lot 1, Block 2, Greatland Estates Subdivision NoX i Location (site address or directions) 20209 Chapel Drive Current Property owner(s) Eric C. and Barbara J. Beck Day phone 688-6118 Mailing address Lending agency Mailing address Real Estate Agent 20209 Chapel Drive Chugiak, AK 99567 Day phone Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Five 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (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 Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Achael E. Anderson, P.E. Date 1111101 5. DSD SIGNATURE _ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: .,(W(6'076 s ; ON-SITE Additional Comments WASTEWATERFKUURAM o Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: 8 " 0/ (Rev. 12100) Municipality of Anchorage ,,.• • Development Services Department _ Building Safety Division ` On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 995196650 www.ci.anchorage.ak.us (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 1, Block 2. Gmattand Estates No. 2 Parcel ID: 051-131-05 A. WELL DATA Well type Private N A, B, or C provide PWSID # _ Date completed 1972 Sanitary seal (YIN) Y Total depth_Cased to 177 ft. FROM WELL LOG Date of test Static water level ft. .., Well Log (Y/N) N Wires property protected (YIN) Y Casing height (above ground) 24 in. AT INSPECTION 10f26/2001 140 ft. g.p.m. 5.6 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 1_6 mg.A. Other bacteria 0 colonies/100 mi. Irate of sample: 10126f2001 Collected by: MEA B. SEPTICIHOLDING TANK DATA Tank Type/Material SeoOdSteel Tank size x.500_ gal. Number of Compartments 2 Date installed 512611990 CAeanouts (YIN) Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) Y Date of pumping 11212001 Pumper Sanitary Pumpers C. ABSORPTION FIELD DATA Date installed 111711999 Soo rating (g.p.dAt' or ft2/1)dnn)11 GPDISF System type S VVide Trench Length 63 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 7 ft. Eft. absorption area 630 ft Monitoring tube Y Depression over field N Date of adequacy test 1012612001 Results (Pass/Fail) Pass For 5 bedrooms Fluid depth in absorption field before test 6 in. Water added620 gal. New depth6 in. Elapsed Time: 60 min. Final fluid depth 6 in. Absorption rate >= 750 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N N yes, give date D. LIFT STATION Date installed 111711998 Size in gallons 500 ManholefAccess (YIN) Y •Pump on' level at 28 in. 'Pump off" level at 28 in. High water alarm level at 34 in. Datum Bottom of Tank Cycles tested 5 Meets alarm 8 circuit requirements? Y E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllift station on kri 211110 Absorption field on lot >100' Public sewer main WA Sewer /septic service line >2S On adjacent lots MW On adjacent lots AW Public sewer manhole/cleanout WA Holding tank WA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >S Property line 4 Absorption field >T Water main WA Water service line Air Surface water >100' Wells on adjacent lots AW SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 5 Building foundation >10' Water main >1V Water Service line >IV Surface water 2100' Ddveway, parking/vehicle storage >25' Curtain drain None Noted Wells on adjacent lots MW F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and ; t• : G z T `t Y ', review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. B• ••;i��frR'E►`>� n .��• TAtvl� : �:: ; Engineer's Printed Name Michael E Anderson. P.E. �� !r,•.• �� - �-- , Date 1111101 ♦4+�^ • rrr•, , HAA Fee E -2;t'Q . Date of Payment Receipt Number / 7 �t - (Rev.12100) Walver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL - OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date/�"� i 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) �ZDS �iG�t/TJG/J-rv/� (b) Property Owner �2TrfN/L �5 ��y Telephone: Home Business Mailing Address A/G 71 `��K 2 Z05_ S��/Ge i%a/�j /G e�gsiG (c) (d) Lending Institution Mailing Address Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the followina address: or: Check here ❑, if hold for pick up. List contact person and day phone number below. 7/ p- �d'kL�f2O� 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY Individual Well( 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 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. Pagel of 2 72-025 (Rev 8/861 Front NOe8 (99/8 Aad) 960 -LL Z to Z abed �laoM s,aaaul6ua leuolssaloid ay; ul suolsslwo jo sioaaa aol alglsuodsai;ou sl a6eaoyouy to AllledlolunW ayl 'panssl sl a;eoipoao e aaolaq elep azAleue ao suol;oadsul;onpuoo;ou op SHHO 10 Se9Aoldw3 •s;uawaalnbai ale;s pue leaapal ulelaao Alslles o; aapio ul suol;n;l;sui bulpuai alay;pue savoy to saaseyoand of I(saunoo a se sly; saop SHHG aL41 T�ISeIV 10 aIL ay; ul paaa;sl6aj aaaui6ua leuolssaload ;uapuadopul ue (q anoge 9 ydeiBuied ul uan16 suolle;uasaadaa ay; uodn Fluo poseq sa;eollpao ienaddy /;ljoy;ny y;leaH sanssl(SHHO) saolnaaS uewnH pue y;leaH to ;uawpudap a6eaoyouy to (;lledlolunyq ayl N011(1V0 lenoiddy leuolllpuo0 to swaa I Ieuol;l—pU00�— panoiddesla Q panoaddy Aq swooapaq � aol panoaddy 10 lVAOliddV SHHO '9 X70 X�� moi`/ ssaappV euoydelal 7�1 (val`tY/ pi Wald;oaweN •uolloadsul sly; 10 alep ayl uo loa;la ul suolleinbai pue 'saoueuipio'sapoo ale;S pue iedlolunW lie 14pm aouelldwoo ul sl walsls lesodslp jejumalseM ao/pue AlddnS aa;ean a;ls-uo ay; 'uolloadsul pue uol;e6l;sanul Aw woal pue sal!1 a6eaoyouy to AI!ledioiunN ay; woal pauielgo uol;ewiolul ay; uo poseq leyl Aluan aaylanl I •ulaaay pa;eolpul aan;ona;s to ad (l pue swooapaq to aagwnu ay; aol olenbape pue leuollounl'ales sl walsAs lesodslp aalemalsem ao/pue Aiddns aa;em alls-uo ayl;eyl sMoys ienoaddy /t;uoylny ylleaH S1141 10 uo1;e61;sanul Aw ;eyl Al!Jan I 'Moiaq.uMoys alep uol;eplien ayl to se pue olaaay paxllle leas Aw Aq paylliao sy N0UVWHOANl (INV V1VO `HOUV3S 3-11d `S1S31 `SN01103dSNl `JNIOIAOFld WHIq ONI1:133NION3 -9 MUNICIPALITY OFFANtMGAR6( ITY OF ANCHORAGE (MOA) EIgpt WIENTAL SE CHECKLIST APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 JUN 71990 RECEIVED A. WELL DATA Legal Description: Well Classification r ����y�� If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Al Date Completed 1972-- ? Yield 5-1c, Total Depth 177 Cased to /77 Depth of Grouting — Static Water Level 134 -e'� " Pump Set At Casing Height Above Ground /& 7/ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot / 7© " ; On Adjoining Lots ���' 24 - To To Nearest Edge of Absorption Field on Lots' ; On Adjoining Lots T Nt P blic Sewer Line � A' cg- Nearest Public Sewer 2®ca T` o Bares u Cleanout/Manhole /T/oiv43- To Nearest Sewer Service Line on Lot Water Sample Collected by � �"`� ; Date rf dy,/g0 Water Sample Test Results Comments�6* ip /i/✓cc=2p Asp f /liar '51oP/>6W a177 421 667 tit 'ee- //Z 127,1's t Uc�t_c_ v2_ 1;67w.7w B. SEPTIC/HOLDING TANK DATA Date Installed S ZG gD Size �Z'�� No. of Compartments Z Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) /' Depression over Tank (Y/N) // Date Last Pumped A60i T4 A)4 Pumping/Maintenance Contract on File (Y/N) for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well 170' f To Property Line $O To Water Main/Service Line /00-'s- Course 0"rCourse Zov t To Building Foundation To Disposal Field Al To Stream, Pond, Lake, or Major Drainage Comments s -%/1!e �; c /,wl i Page 1 of 2 72-026 (Rev. 8/861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �u�-O �iiL Type of System Design �2G-6ctf Date Installed �/z �'��� Length of Field Z' Width of Field Depth of Field � i Gravel Bed Thickness Square Feet of Absorption Area >S '� Standpipes Present (Y/N) Y Depression over Field (Y/N) /V Date of Last Adequacy Test lve�_-w �7s�sTG �J Results of Last Adequacy Test S>`57r_rJ_J Separation Distance from Absorption Field: To Water -Supply Well zoo -� To Property Line To Building Foundation 414- To Existing or Abandoned System on i Lot Ie;l �- 5-e¢ C'-, On Adjoining Lots yeE--U -, To Water Main/Service Line la C.,) To Cutbank (if present)tiQ To Stream/Pond/Lake/or Major Drainage Course ;off r To Driveway, Parking Area, or Vehicle Storage Area Comments D( -D `�6�r/�/iiit3 /e7- L%u5l,46a' ��/2icr� i.,) pb)c� D. LIFT STATION , VC)/ � Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify tha ave c cckkked, erified or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed G�GC�j. ` Date 5 / Company P/i'40O /�•I404/TyN P/h MOA No. Receipt No Date of Payment l 7O OI Amount: $ � g' i ` / `, ;'. Engineer's Seal Page 2 of 2 72-026 (Rev 8/86) Back °aWao nea«ne�oau .-a e.. ry: David R. dCYj/LGiI "; --� oenti" a PO`ES,It)tLP_�DY