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Home My WebLink AboutMOUNTAIN TERRACE ESTATES #2 LT 2Mountain Terrace Estates #2 Lot 2 #020- 121- 15 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: OSP101152 PID Number: 020-121-15 Name. Sallye Werner Wastewater System: ✓❑ New ❑ Upgrade Address: P.O. Box 111318 Anchorage, AK 99511 ABSORPTION FIELD Phone: Number of Bedrooms: 2 ❑Deep Trench A Shallow Trench ❑Bed ❑Mound El Other. LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: 7.2-7.4 .8 GPD/Ft? Ft. Block: Lot. Subdivision: 2 Depth to pipe bottom from original grade: Gravel depth beneath pipe: Mtn. Terrace Est. No. 2 3.7-3.9 Ft. 3.5 Ft. Township: Range: Section: Fill added above original grade: Gravel Length: 1-1.5 Ft. 41 Ft Well: ✓❑ New ❑Upgrade Gravel width: Number of lines:Ti� 1,126 lines. 5 Pt. Pt. Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area. Pipe Material: Private 80 Ft. 44 Ft. 379 Ft' ASTM D3034 PVC Driller: Date Drilled, Static Water Level: Installer: Date Installed: Sullivan Water Wells 9/15/2010 15 Ft Whitters Excavating 9/2-4/2010 Yield: Pump Set at: Casing Height Above Ground: TANK 4 GPM 183 Ft. >1.5 Ft. SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ublic/Private Manufacturer: Capacity: From Tank Field Station Tank Sewer Line Anchorage Tank 1,000 Gal. Material: Number of Compartments: Well >100' >100' N/A N/A >25' Steel Two Surface Water >100' >100' N/A N/A LIFT STATION Size: Manufacturer: Lot Line >5' >10' N/A N/A Gal. "Pump on" level at: "Pump off' level at: High water alarm at: Foundation >5' >10' N/A N/A in. in. in. Pump Make & Model Electrical Inspections performed by: Curtain Drain None Noted Remarks: BENCH MARK Location and Description: Garage Slab Assumed Elevation: 100.00 Pt. Ur%�,�,��."„•",�:C.�4®e '�►� Dates: 1st 9/2/2010 Inspections performed by: A. ates: 1 2nd 9/3,4/2010 s �e v •e'°��00 Development Services Department Approval ,�.� 4918 Conditional Approval Date: ... •••ss•••••••o••o•••••e•••••e•• I sMIC HAa L 14PiMMN r ,� . CE - 4381 .• �`�.. Reviewed and approved b : C Date: ' % 1, ir '" "R4rrSS10Va� pp y ,� (Rev. 04/06) 'f, Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT PID No.: 020-121-15 4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904 MOUNTAIN TER RACE ESTATES SUBDIVISION NO. 2, LOT 2 49,270 S.F. PLAN SCALE 1" = 40' 81.03 Permit Number: OSP101152 Page 2 of 3 LEGEND S1 — Septic Vent C4 — Clean Out M1 — Monitor Tube TH — Test Hole Permit Number: OSP101152 Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report 98.5 97.5 UU Finished Grade Ori final Ground 3.97 1,000 Gallon Septic Tank 93.7 _ Q U Page 3 of 3 PID No. 020-121-15 10/12/10 No Groundwater PROFILE AS -BUILT No Scale 3.5 �••�E OF441 49th ............................................... �..,��.. MICHAEL E. ANDERSON No. CE -4381 ��I Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street J"�a P.O. Box 196650 d Mark Begich Anchorage, AK 99519-6650 S A E T Y Mayor www.muni.org/onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SWOSP101152 Date of Issue: 10/13/2010 Parcel Identification Number: 020-121-15 Replacement Only: YES NO Legal Description Lot 2, Mountain Terrace Estates #2 Pump Installation Date: 10/13/2010 Pump Intake Depth Below Top of Well Casing: 78 feet Pump Manufacturer's Name: Goulds Pump Model: 10 GPM Pump Size 1/2 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Manufacturer's Name: Campbell Pitless Adapter Installer: N/A Well Disinfected Upon Completion? ® Yes ❑ No Method of Disinfection: Recirc Comments: Property Owner Name & Address: Sallye Werner Pump Installer Name: Aarow Pump & Well Service LLC PO Box 110496,Anchorage, AK. 99511 (907) 346- 9355 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. - - - -- - - -- —. 160 I T� T T� T� s Juuv WATE.R WE-11,"LLS Domestic - commercial - Geothermal Phone 907-688-2759 www.sullivanwaterwells.com Well Log Permit Number: OSP 101152 Date of Issue 8/25/2010 Parcel Identification Number: 02012115000 Date Started: 9115/2010 Date Completed: 9115/2010 Is well located at approved permit location? X ]Yes I INo Property Description MOUNTAIN TERRACE EST. #2 Lot 2 Section: Town: Range: Block NONE Property Owner Name & Address: SALLYE WERNER PO BOX 111318 ANCHORAGE, AK 99511 Borehole Data: Depth Method of Drilling �X I air rotary FI cable too] Soil Type, Thickness & Water Strata From To Casing type: Casing Stickup 0 2 Wall thickness 0.25 inches Brown Bedrock 2 46 Diameter 6 inches Total: 44 feet Gray Bedrock 46 80 Liner type: Diameter inches Depth: feet Casing stick-up above ground: 2 feet Static Water Level (from top of casing) 15 feet Pumping Level: feet after 1 hours pumping gpm Recovery Rate 4 gpm Method of Testing: Air Well Intake Opening Type I I Open End IX I Open Hole I Screened Start feet Stopped feet I Perforations Start feet Stopped feet Grout Type: Bentonite dry granular Volume: 500 Pounds Depth 44 Start o feet Stopped 44 feet Pump Intake Depth: feet Pump size: HP brand name Well disinfected upon Completion? X Yes _ No Method of disinfection CHLORINE 50 PPM Comments: 8" OVERSIZE HOLE DRILLED FROM GROUND SURFACE TO 40'. 44' OF 6" WELL CASING INSTALLED AND ANULUS GROUTED TO SURFACE. WELL CONFORMS TO SHALLOW BEDROCK MOA CODE Water Sample Results: Arsenic: ug/I Well Driller: Nitrates mg/1 Cole Sullivan Sullivan Water Wells Total Coliform Bacteria colonies/100mL P.O. Box 670272 Chugiak, AK 99567 Other bacteria: col/100mL (907) 688-2759 Attention: The property owner shall provide this log to DSD (onsite) and DNR within 30 days of completion. En SGS Ref.# 11 10853001 Allowable Method Container ID Limits Prep Analysis Date Date Init Client Name Anderson Engineering Printed Date/Time 03/18/2011 15:49 Project Name/# Mountain Terrace Ests. U2 L2 Collected Date/Time 03/09/2011 16:10 Client Sample I Private WW drawn from Hose Bib Received Date/Time 03/10/2011 10:10 Matrix Drinking Water Technical Director Stephen C. Ede PWSID 0 Sample Remarks: 4500NO3-F - Total Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to f,CS for accuracy requirements. Parameter Results LOQ Units Allowable Method Container ID Limits Prep Analysis Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/l, EP200.8 C (<10) 03/14/11 03/17/11 NRB Waters Department Total Nitrate/Nitrite-N 2.48 0.100 mg/L SM20450ONO3-F B (<10 03/11/11 AYC Microbiology Laboratory E. Coli Negative l 100ml- SM20 9223B A 03/10/11 DLC Total Colifonn Negative 1 100mL SM20 9223B A 03/10/11 DLC MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 I SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: LOT 2, MOUNTAIN TERRACE ESTATES No. 2 PERFORMED FOR: SALLYE WERNER DATE: 9/2/2010 PROJECT No.: PARCEL ID#: TECHNICIAN: A. HARALA DEPTH TEST HOLE A (feet) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 OB/OG a .Q .d a. a SILTY GRAVEL WITH SAND GM 'a d ' SLOPE c WAS GROUND WATER ENCOUNTERED? NO IF YES @ WHAT DEPTH? S DEPTH OF WATER AFTER MONITORING: NONE LO d DATE OF MONITORING: 10112110 a'. A BEDROCK @ 14' SITE PLAN SEE SITE PLAN 11, DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH To WATER (INCHES) NET DROP (INCHES) TEST HOLE PRESOAKED PRIOR TO TESTING: 9/2 1 9:44 3.75" 2 10:14 30 6.25" 2.50" 3 10:15 3.63" 4 10:45 30 6.13" 2.50" 5 10:46 3.50" 6 11:16 30 5.94" 2.44" PERCOLATION RATE: 12.3 (MIN/INCH) PERC. HOLE DIA. 6" (INCHES) TEST RUN BETWEEN: 3.5 FT. and 4.5 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 3/23/2011 /02 TEL Eo � aECe E51MT, DECK LOT 2 49 270 S• F, ° 48' 4Z" E 8/0 03' ®WELL i � \ m 3o- -/—" VIVA -A � m MO) 0 P ST RSC-NRE e c.0. \ 32° 9 SEPTIC S.P. S \ L0/ t ~�� tic �, �. ��2 �' t� 5 J Lot Z ,Block MOUNTAIN TERRACE ESTATES UNIT NO 2 Anchorage Recording District, Alaska LOT SURVEY CERTIFICATION 1 hereby certify that I hove surveyed the property shown and described hereon, and that the improvements situated thereon ars within the prop- erty lines and do not overlap or encroach on ad jacent property and that no improvements on adjacent property overlap or encroach on the premises in questlon and that there are no roadways, utility lines, or other visible easements on sold property except as indicated hereon. '� �a• aoe•o•oa '® R. L. B, on o Easements of record other than those shown on �d�F �•r LS-1192OW ••• ��`�m the plot of record ars not shorn hereon unless + 9Fp •®e® ®r°'°�` .0 otherwise noted. �� 'OR LEGENDOFEssioNPA- 0 Bross or Aluminum, capped monument recovered 03--;O—ll O Iron pipe and/or rebar recovered. O 2 x 2 hub & tack recovered 0 5/8" x 30" rebar set this survey —* Fence Line (Approx. Location) Scale �� ('�� Date R _ _ Prepared by: R. L. BUTTON l ° �v © OV �O �O Registered Lond Surveyor (907)279-6200 519 W. Eighth Ave. Anchorage Alaska 95150/ Ref.3 �� F B. No. �✓ _ 0 0 Property of: Slye Wel-rrer On -Site Water & 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: OSP101152 Tax Code Number: 02012115000 Work Type: WellSeptic Initial Permit Effective Dates: August 25, 2010 to August 25, 2011 Design Engineer: ANDERSON ENGINEERING Subdivision: MOUNTAIN TERRACE ESTATES #2 Site Legal Address: MOUNTAIN TERRACE ESTATES #2 LT 2 G:3342 Owner/Address: WERNER SALLYE L PO BOX 111318 ANCHORAGE AK 995111318 Site Mailing Address: This permit is for the construction of: Lot Size in Sq Ft: Total Bedrooms: 49270 6 Y Disposal Field Y Septic Tank N Holding Tank N Privy Y 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: Issued By: Date: Z 5 ^ /0 Dater �Al Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-121-15 Property owner(s) Sally L. Werner Day phone Mailing address P.O. Box 111318 Anchorage, AK Zip Code 99511 Site address 16844 Kenai Terrace Road Anchorage, AK Code 99516 Legal description (Sub'd., Block & Lot) Lot 2, Mountain Terrace Estates Subdivision No. 2 Legal description (Township, Range & Section) Lot Size 49,270 Sq. Ft. Number of Bedrooms Two (2) THIS APPLICATION IS FOR (® all that apply): Absorption Field 0 Septic Tank 0 Holding Tank ❑ Privy ❑ Private Well 0 Water Storage ❑ THIS APPLICATION IS AN: Initial 0 Upgrade ❑ Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 7 ce Waiver Fees: Date of Payment: ��F,% C /� a Date of Payment: A'�%) lr/ Receipt Number: �' I �l `/ Receipt Number: (Rev. 11/05) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) August 11, 2010 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 2, Mountain Terrace Estates Subdivision No. 2 Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 2, Mountain Terrace Estates Subdivision No. 2 intends to construct a new two-bedroom home on the lot. We are therefore requesting a permit be issued for the construction of a new well and septic system to accommodate the home. The sytem was originally permitted in 2002 and has since expired. The attached Site Plan and backup documentation identify the location and configuration of the proposed well and septic system along with the alternate site. No existing wells or septic systems are closer than 100' from the proposed well or septic system. Drainage arrows are shown on the site plan showing the grade and direction of flow on the lot. The drainage pattern will not be changed as a result of this project. The test holes placed on the lot in the area of the absorption trench and alternate site indicated gravel with sand and silt (GM). The percolation rate of the soil was determined to be 8 minutes per inch. No groundwater was found during the placement of the test holes and none was noted during the monitoring period. Bedrock was found at 13' below the surface An application rate of .8 gallons per day per square foot was used in the design of the absorption system. We are proposing to place a new 1,000 - gallon septic tank and a 41' long by 5' wide by 3.5' effective depth absorption trench to treat and dispose of the effluent generated in the house. The elevation of the distribution line in the absorption trench will be 3.5' below the surface and the total depth will be 7.0'. A minimum of 3' of fill or 2" of insulation and 2' of fill will be placed over the absorption trench and 4' over the septic tank. The ground surface on the lot in the area of the absorption trench slopes to the southwest at grades between 25% and 40%. The new trench will be constructed parallel with the slope as much as possible in conformance with Municipal Lot 2, Mountain Terrace Estates No. 2 August 11, 2010 Page Two requirements. Slope flattening will be required downslope from the alternate site to insure a minimum of 50' to a slope greater than 25%. A cross section showing the extent of the slope flattening is attached. The new septic system will be constructed a minimum of 100' from all wells and any surface water and 10' from the proposed and existing water services in the area. If the system is constructed in accordance with our design 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 reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments N 49th••••••• •MICHAEL E. ANDERSON ��'•.• NO. CE -4381 •• �_AV Existing Well VACANT LAND 1 4 2, o \ \, ii pR ccCtO�P: AREA MAP SCALE 1' = 100' Existing well 7 5 AsI MOUNTAIN TERRACE ESTATES SUBDIVISION NO. 21 LOT 2 49,270 S.F. 81.03 LEGEND SV — Septic Vent CO — Clean Out MT — Monitor Tube TH — Test Hole PLAN LOT 2, MOUNTAIN TERRACE ESTATES SUBDIVISION, UNIT NO. 2 DESIGN FACTORS: SYSTEM REQUIREMENTS: Two Bedroom Home 5' Wide Trench System Perc. Rate: 8 Min./Inch 1,000 Gallon Septic Tank Application Rate: .8 GPD/SF 3.5' Drainfield Rock 2 Bedrooms X 150 GPD/.8 GPD/SF (Application Rate) = 375 SF Absorption Area 375 SF/5 SF/LF*.54 (Red. Factor) = 40.5 LF Trench Length THEREFORE: Construct a 41' Long x 5' Wide x 3.5' Effective Depth Absorption Trench at the Location Shown. Flow Line Elevation in Trench to be 3.5' Below Original Ground Surface. Total Depth to be 7.0' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. Maintain 100' Separation from Wells in the Area. Natural Backfill 3'0" 6" 1 I \ O 3'5" 5' Geotextile Fabric 4" Perforated PVC (Holes Down) Drainfield Rock TYPICAL 5' WIDE TRENCH SECTION ...,.oF..��• '•. (NO SCALE) ��P�E.............. • + NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. � 49th W Minimum 4' Separation From Groundwater. i � L 1E. io.................... ............... u Minimum 100' Separation From Wells in the Area. 0 � = nnicHaE�E.aNOERsoN ♦c�: Minimum 100' Separation From Surface Water or Streams.- �i�'% No. CE -4381 'WIN 4bF SS\P.��i Municipality of Anchorage Development Services Department/On-Site Water & Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519 SOILS LOG - PERCOLATION TEST Performed For: Joe Burnham Legal Description: Int 2, Mountain Terrace Estates No. 2 SLOPE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 OG/OL TEST HOLE NO, 1 Rust 10% Silt GM Date Gross Time Olive Depth To Water 15% Silt 1 Was Groundwater Encountered? No If Yes, What Depth? 18:34 Depth to Water 8.56" After Monitoring None Date: 5/26/02 6.5" Bottom of Hole Bedrock Date Performed: SITE PLAN � `l OF :...........: I CAV S` •i ' • AV �. 49th - 1 7. 9 M ANDERSON •••�S '. NO. CE -4381 5/19/02 •♦, ��iOFESS� �•� See Site Plan S L O P Reading Date Gross Time Net Time Depth To Water Net Drop 1 19 -May 18:14 6.38" 2 18:34 20 8.56" 2.18" 3 18:35 6.5" 4 18:55 20 9" 2.5' 5 19:11 6.5" 6 19:31 20 8.88 2.38" Perc. Rate: 8.5 Min./Inch Perc. Hole Diameter: 8" 22 Test Run Between 5 Ft. and 6 Ft. Comments: Test Hole Pre Soaked Prior to Testing. Performed By: Alan Harala. I, Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 6/10/02 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 DEPTH (feet) 1- 2- 3- 4- 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: LOT 2, MOUNTAIN TERRACE ESTATES No. 2 PERFORMED FOR: JOE BURNHAM DATE: 5/19/02 PROJECT No.: PARCEL ID#: TECHNICIAN: A. HARALA TEST HOLE 2 SILTY GRAVEL a WITH SAND a GM a- - a. 15% SILT -a d SLOPE a WAS GROUND WATER ENCOUNTERED? No IF YES @ WHAT DEPTH? DEPTH OF WATER AFTER MONITORING: NONE a DATE OF MONITORING: 2/26/02 a-. -I BEDROCK @ 12.5' —I SITE PLAN SEE SITE PLAN DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH TO WATER (INCHES) NET DROP (INCHES) TEST HOLE PRESOAKED PRIOR TO TESTING: 5/19 1 4:13 1.38" 2 4:43 30 4.13" 2.75" 3 4:45 1.50" 4 5:15 30 4.00" 2.50" 5 5:16 1.25" 6 5:46 30 3.69" 2.44" PERCOLATION RATE: 12.3 (NIIN/INCH) PERC. HOLE DIA. 6 to (INCHES) TEST RUN BETWEEN: 4.5 FT. and 5.5 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. TEST.PERFORMEDBY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 9/26/2007 91 trr/,''L I dJ a r 0 � �1J fl mom• t� 0 � i ¢� o LL .° iu O � � I 0 �i .' .. .J�. Z ••~•P••. . �:% 4 lo • ■ d _ -5' s n ` Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. D10-1 Z I— I S Permit Number SW Property owner(s) O Q-- I l i i V) Ji /VIA– Day phone Mailing address (1 Me Mailing address (2) & ,_n CAA . &� , Zip Code Legal description (Lot, Block & Sub'd.) Mno ln��/��a Y (6 Legal description (Section, Township & Range) Lot Size (- V Acres Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms 'wf ZD Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling andrig in accordance with applicable Municipal Codes. (Signature of property owner or aythorized agent) Permit Fees: Waiver Fees: Date of Payment: 1 I Ll ` t Date of Payment: Receipt Number: �r 1 Receipt Number: (Rev. 12/00) George P. Where/, Mayor May 12, 2003 T/� Lr �'�] Anchorage Municipality of Ancho _ "7e All -Am erica City Building Stifety Dixision ' I I111 2002 Joe Burnham 1120 E Huffman Rd. RMB 453 Anchorage AK 99515 Subject: On -Site Water and/or Wastewater Permit. Permit Number: SW020181 Legal Description: Mountain Terrace Estates #2 Lot 2 Dear Joe Burnham: An On -Site Water/Wastewater Permit, number SW020181, issued by this office for a single-family system, will expire on June 19, 2003. This permit was valid for 365 calendar days. If this was a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to this office for review, approval and documentation. This as -built inspection report must be signed by the licensed Professional Engineer who inspected the installation of the system. As -built inspection reports are required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, a new permit must be obtained from this office. A new permit for a second year may. - be issued for a fee of $100.00 if the renewal application is received on or before the expiration date of the original permit. When applying for anew permit, the fees are: $400.00 for a wastewater permit and $150.00 for a well permit. If you have any questions, please call this office at 343-7904. Sincere Ja cs Cross, P.E. Manager On -Site Water and Wastewater Program Enc: Copy of permit P.O. Box 100050 • Anchorage, Alaska 99519-6650 • Telephone: (907) 343-8301 • Pae: (007) 343-8`_'00 4700 South Bragaw Strcct • Anchorage, Alaska 99507 h t t p://w�t�c.ci.nnchorngc.nk.us MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM /WATER SUPPLY PERMIT Initial Permit Number: SW020181 Date Issued: Jun 19, 2002 Expiration Date: Jun 19, 2003 Parcel ID: 020-121-15 Legal Description: MOUNTAIN TERRACE ESTATES #2 LT 2 Design Engineer: 0014 Anderson Engineering Site Address: Owner Name: Joe Burnham Lot Size: 49270 SO. FT. Owner Address: 1120 E. Huffman Rd. PMB 453 Total Bedrooms: Permit Bedrooms:,; Anchorage . AK 99515- C*�i This permit Is for the construction of: [71 Disposal Field 0✓ Septic Tank E] Holding Tank ❑ Privy Private Well Water Storage All construction must be In accordance with: 1. The attached approved design. 2. All requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 7/2-T/OZ SEE ENG/tiEE1Q1l AkE4117E0 00S.#64 Cf/NA.,Gjab P*4 PROPoJ6G sY5reA' OjeSi&N FROA 3 BEJo/QOO.wJ rc ¢ BFq/PGortS. Received By: Issued By: Date: Coo, 0 � Date: �o 160?_ ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) MEMORANDUM DATE: September 24, 2002 TO: Dan Roth FROM: Mike Anderson, P.E. SUBJECT: Lot 2, Mountain Terrace Estates Subdivision, Unit No. 2 Septic System Construction Permit No. SW020181 Revised System Design The owner of the subject lot intends to construct a four-bedroom home on the lot rather than the previously permitted three-bedroom home. The septic system will be upgraded to accommodate the four-bedroom home. The attached site plan shows the location of the 1,250 -gallon septic tank and the absorption trench along with the alternate site. The design parameters are the same as those shown in the original permit application package and system design. Please review the attached information and, if acceptable, modify the existing septic system and well permit to allow a four-bedroom septic system. Let me know if you have any questions. Lot 2, Mountain Terrace Estates, Unit No. 2 "4WAr ROS Pro" A. FourHouse y `Bedr III O O jD 1,2 Gallo S J��_.. terna e S to MrrP o '! �}✓ g 1 o 'r 81'—Long z ' .slide/ r—_ -----0 10 �x 3.5' Eff. Pth �tn Abs rption Trb c CIO .......................... ---- 1 OF PLAN VIEW N. _ ..... 11 Com•'• No CC-+191 � �'� - LOT 2, MOUNTAIN TERRACE ESTATES SUBDIVISION, UNIT NO.2 DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home 5' Wide Trench System Pere. Rate: 10-12 Min./inch 1,250 Gallon Septic Tank Application Rate: .8 GPD/SF 3.5' Drainfield Rock 4 Bedrooms X 150 GPD 1.8 GPD/SF = 750 SF of Absorption Area 750 SF/5 LF (Width)'.54 (Red. Factor) = 81 LF Trench Length Therefore: Construct an 81' Long X 5' Wide X 3.5' Effective Depth Absorption Trench. Flowline Elevation in Trench to be 3.5' Below Original Ground Surface. Total Depth to be 7' Below Existing Ground. All Components of the Septic System to be Outside the 100' Protective Well Radius. Maintain 6' Separation From Bedrock. I I Natural 3' Backfill Geotextile Fabric 6" 4" Perforated PVC 3'6" Schedule 40 Drainfield Rock 5' I TYPICAL WIDE TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 10' Separation From Lot Line. Minimum 4' Separation From Groundwater. Minimum 100' Separation From Wells in the Area. Municipality of Anchorage Development Services Department Building Safety Division i On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. hr�() ^ la I - / 6� Permit Number SWOZO/8/ Property owner(s) Joe Burnham Day phone 223.7228 Mailing address (1)1120 E Huffman Road PMB 453 Anch., AK 99515 Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Lot 2 Mountain Terrace Estates Subdivision, Unit No. 2 Legal description (Section, Township & Range) Lot Size 1191 0-70 Acre Sq.Ft THIS APPLICATION IS FOR: Number of Bedrooms Three (3) Sewer Only ❑ Well Only ❑ Sewer and Well ® Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. L. (Signature of property owner or authorized agent) Permit Fees: is�S d • V c�> Waiver Fees: Date of Payment: y/AGZp� / Date of Payment: Receipt Number: o� lb [ 0 CJi Receipt Number: (Rev. 12100) 'ANDERSON>ENGINEERING 'P.O.BOX 240773 .ANCHORAGE, AK 9M24 522-7773. 522-6779 (FAX) June 11, 2002 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 2, Mountain Terrace Estates Subdivision, Unit No. 2 Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 2, Mountain Terrace Estates Subdivision, Unit No. 2 intends to construct a three-bedroom home on the lot. We are therefore requesting a permit be issued for the construction of a new well and septic system to serve the home. The attached Site Plan and backup documentation identify the location and configuration of the new septic system and alternate site and the parameters used in the design. Also identified on the plans are the locations of the proposed well on the lot, test hole locations and the locations of the wells and septic systems in the area. Drainage contours are also shown and current drainage patterns will be maintained after construction. Some slope flattening will be required down hill from the new septic system to provide the 50' separation from the system to a 25% slope. The existing slope on the property is nearly 35%. The test holes placed near the location of the proposed absorption trench indicated gravel with varying amounts of silt and percolation rates of between 10 and 12 minutes per inch. No groundwater was found during the placement of the test holes and none was noted during the monitoring period. Bedrock was encountered at 13.5' below the ground. We are therefore proposing to place a 5' wide by 61' long by 3.5' effective depth absorption trench on the property. The total depth of the trench will be 7' to allow sufficient separation from bedrock. The distribution pipe will be placed at 3.5' below the ground surface. The ground surface on the lot slopes as shown on the attached Site Plan with fairly steep slopes from northwest to southeast. The new absorption trench will be constructed in conformance with Municipal requirements and parallel to ground contours where possible. The slope fronting the septic system will be flattened to provide the necessary separation distance. All components of the new septic system will be constructed a minimum of 10' from the water service line on the lot. Lot 2, Mountain Terrace Estates No. 2 June 4, 2002 Page Two If the system is constructed in accordance with our design the following statements apply: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, a�, Michael E. Anderson, P.E. Attachments 1 N •a 1 Ingle / 31 ped\I i Ina [InI. , i � `1` �, P. :\�\ yo \,, �\\. 4'__ . �_� 1' �• ,�.�T' ^ \ . , J ^^ a QdIIC •„. ,.� \ g� • c�jys%(fp \\t� PROP \�� `:,� �\ ��4\...1 I•. CD I : d 192.1. 459 ss o I I..I� '9JJ VJ\ A \ I c\\ VACANT I • \ D L JO. \ • A n I I O b I: Z Hr. 8 \ :°�� °•Ise I \ 11 II �tTJ�J' \ •�/l\Vl O it M1 l J. 1 �v a `A•'p: 9 h \ AREA SYSTEM PLAN - / ' - - �r # 1 -��.. �7 491h 00 1 I' SCALE 1" =1001 0, --� Q : , -. Y,CHAEL E. ANDERSON s ^ NOTE: No Conflicts With Wells or Septic e'r�+ NO. CC=4381 \��L \ Systems on Neighboring Lots. �9�_ ✓: Lot 2, Mountain Terrace Estates, Unit No. 2 /RAX /b L TES 1 ZW Pr Vel A. �4 by Three c/- Bedroom . House fa A"4 gnu` Sm.' - Se0 i GTanknkn . Mn 4 Alterna e S to I tl 1 �ta0-},-� 401 n61' Long X 5' Wide / 3.5'. Effective Deepi�h%'�- � '�.`Ab` o ption Trench / -/y—�•1 ac 4 4 A.L E. A%nERSO4 No. CE -4381 PLAN VIEW Tli R' -' o + c 0 u •�N G W LOT 2, MOUNTAIN TERRACE ESTATES SUBDIVISION, UNIT NO.2 DESIGN FACTORS: 3 Bedroom House Perc. Rate: 10-12 MinAnch Application Rate: .8 GPD/SF SYSTEM REQUIREMENTS: 5' Wide Trench System 1,000 Gallon Septic Tank 3.5' Drainfield Rock 3 Bedrooms X 150 GPD/.8 GPD/SF (Application Rate) = 562.5 SF of Absorption Area 562.5 SF/5 LF (Width)•.54 (Red. Factor) = 60.75 LF Trench Length Therefore: Construct an Absorption Trench 61' Long X 5' Wide X 3.5' Effective Depth. Flowline Elevation in Trench to be 3.5' Below Original Ground Surface. Total Depth to be 7' Below Existing Ground. Maintain 6' Separation From Bottom of Trench and Bedrock Surface. 3.5' Ceotextile Fabric -4" Perforated, I'VC Schedule 40 Drainfield Rock TYPICAL WIDE TRENCH SECTION F 49th ON . (NO SCALE) �0 � . MICHAEL E. ANDERSON NOTE: Grade Area Over Trench to Drain Away. 0 C, ` No cE-43e Minimum 6' Separation From Bedrock. islf � Minimum 100' omMinimum t�Groundwater. Wells in the AreaW Minimum 10' Separation From Water Service Line. Municipality of Anchorage Development Services Department/On-Site Water d Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519 SOILS LOG - PERCOLATION TEST Performed For. Joe Burnham Dale Performed: 5/19102 Legal Description: Lot . Mountain Terrace state No. SLOPE SITE PLAN 1 3 4 5 6 7 11 OG/OL TEST HOLE NO, 1 Rust 10%R Silt GM Olive H 15%R Silt 1 Was Groundwater Encountered? No If Yes, What Depth? Depth to Water 20 After Monitoring None Date: 5!26/02 Bottom of Hole Bedrock See Site Plan S L O P 49th F\ Y-CYAEL E. ANDER! %, No. CE -4181 Reading Date Gross Time Net Time Depth To Water Net Drop 1 19 -May 18:14 6.38' 2 18:34 20 8.56' 2.18' 3 18:35 6.5' 4 18:55 20 9' 2.5' 5 19:11 6.5' 6 19:31 20 8.88 2.38' Perc. Rale: 8.5 Min./Inch Perc. Hole Diameter. Test Run Between 5 Ft. and 6 Ft. Comments: Test Hole Pre Soaked Prior to Testing. Performed By: Alan Harala. I, Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 6110/02 8' Municipality of Anchorage Development Services Department/On-Site Water & Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519 SOILS LOG - PERCOLATION TEST Performed For. Joe Burnham Date Performed: Legal Description: Lot 2. Mountain Terrace stat s Nm 1 10 11 12 13 14 OG10L TEST HOLE NO. 2 Rust 10% Silt GM Olive 15°/s Silt Bottom of Hole Bedrock Was Groundwater Encountered? No If Yes, What Depth? Depth to Water After Monitoring None Date: 5/26102 EL SITE PLAN i 49th ; 4 04 i^ t 4WO.AE. E. ANYYSON/ �1 c�siN No. CE -4391 5119/02•♦♦•�� E55\ :� • See Site Plan Reading Date Gross Time Net Time Depth To Water Net Drop 1 19 -May 18:14 6.38' 2 18:34 20 8.56' 2.18' 3 18:35 6.5' 4 18:55 20 9' 2.5' 5 19:11 6.5' 6 19:31 20 8.88 2.38' Perc. Rate: 8.5 Min./Inch Perc. Hole Diameter. 8' Test Run Between 5 FL and 6 FL Comments: Test Hole Pre Soaked Prior to Testing. Performed By: Alan Harala. I, Michael E. Anderson Certify That This Test Was Performed In Accordance With All Stale and Municipal Guidelines In Effect On This Date: 6110102 • Municipality of Anchors On -Site Water and Wastewater Prograr (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS Parcel I.D. 020-121-15 Expiration Date: C9 1. GENERAL INFORMATION Complete legal description MOUNTAIN TERRACE ESTATES #2 LOT 2 Location (site address) 16844 KENAI TERRACE ROAD ANCHORAGE, AK 99516 Current Property owner(s) BRENT WILLIAMS Day phone Mailing address Real Estate Agent 16844 KENAI TERRACE ROAD, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 2 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 ❑ WaiverNariance request for: Distance: Received by: COSA to be released to the a neerss otherwise requested by the engineer. COSA Fee $ `li,Q r'a6 ::SC4�. Date Gf-Payn-ant Receipt Number Date: Waiver Fee $ Date of Payment Receipt Number COSA # i FLIM 1 11� 1 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 5/16/2016 Engineers 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 / OF AZ X, encroachments, deficiencies or discrepancies exist. 6. DSD SIGNATURE System #1 Approved for e;11— bedrooms. 'g EENNE 7,16 System #2 Approved for bedrooms. r'roFE351pt`�'1, Disapproved. Conditional approval for bedrooms, with the following stipulations: W By:,e - S a�/ l� Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Onsite 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 engineers work. - ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_1a10.12.dw If more than 1 septic system is on the tot: COSA Checklist # _of _ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: MOUNTAIN TERRACE ESTATES #2 LOT 2 Parcel ID: 020.121.15 A. WELL DATA Well type PRVT Date completed 9/1512010 Total depth 80 ft. If A, B, or C provide PWSID # _ Well Log (Y/N) Y Sanitary seal (YIN) Y Cased to 44 ft. FROM WELL LOG Date of test 9115/2010 Static water level 15 ft. Well production 4 9 - p.m - WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 1.94 mg/L Arsenic: ND ug/L Date of sample: 012016 B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Tank size 1000 gal, Number of Compartments 2 Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 6130114 24 ft. g.p.m. Collected by: ARCTERRA Date installed 914/2010 Cleanouts (Y/N) Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 5121201(1 Pumper A+ C. ABSORPTION FIELD DATA Date installed 91412010 Soil rating (g.p.d./fe or fe/bdrm) 0.8 Length 41 ft. Width 5 ft. Total depth 8.75 ft. (Measured 6r2116) Eff. absorption area 379 f? System type SHALLOW TRENCH Gravel below pipe 3.5 ft. Monitoring tube Y Depression over field N pate of,adequacy test 613012014 Results (Pass/Fail) PASS For 2 bedrooms Fluid depth in absorption field before test 0 in. Water added 301 gal. New depth 0 in. Elapsed Timer!F5 min. Final fluid depth 0 in. Absorption rate >= 300+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES WELL ON LOT TO Size in gallons Manhole/Access (Y/N) "Pump off level at _ in. High water alar level at in. Cycles tested Meets alarm & circuit requirements? Septic tank/lift station on jot 100'+ On adjacent lots 1001+ Absorption field on lot 100'+ On adjacent lots 1001+ Public sewer main 751+ Public sewer manhole/cleanout 1001+ Sewer /septic service line 25'+ Holding tank 100'+ Animal containment areas 501+ Manuretanimal excrete storage areas 1001+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 51+ Absorption field 51+ Water main 104 Water service line 101+ Surface water 1001+ Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 101+ Water main 10'+ Water Service line 101+ Surface water. 1001+ Driveway, parkingivehicle storage 104 Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 1001+ F. COMMENTS 5!212016 site inspection found the monitoring tube dry. Well flow & septic adequacy test performed by Pannone Eng in June 2014 G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 5116/2016 COSA canary sheet2-6-15.doc /", 1001 is Ar gssloHo-W .W Parcel I.D, 020-121-15 Municipality of Anchoragew rRy � Q w�, _, On -Site Water and Wastewater Program (907) 343-7904 5 A E , Y JUL 0 � L. Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: Complete legal description Mountain Terrace Est. #2, Lot 2 Location (site address) 16844 Kenai Terrace Rd. Current Property owner(s) Sallye Werner Mailing address Real Estate Agent Day phone 16844 Kenai Terrace Rd. Anchorage, AK 99516 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 2 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well it Individual Fx� Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance v' t Received b� �'� ;w y� `�t � ` � Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number COSA# f1iS�i14�Ji�l Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE L-SISystem #1 Approved for 2 bedrooms System #2 Approved for bedrooms Disapproved Phone (907)272-8218 Date 7/1/2014 Owl $Ieven W. panrione • / %�-- CE -8149 Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: 0 Th uni �jt 4; 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 bf Alaska. The Municipality of Anchorage is not responsible for errors or dmissions in the professional engineers work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet( :� c If more than I septic system is on the lot: COSA Checklist # + of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Mountain Terrace Est. #2, Lot 2 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 9/15/2010 Sanitary seal (Y/N) Y Total depth 80 ft. Cased to 44 ft. FROM WELL LOG Date of test 9/15/2010 Static water level 15 Well production 4 WATER SAMPLE RESULTS: ft. Parcel ID: 020-121-15 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 6/30/2014 24 ft. g.p.m. 6.0+ 9 - p.m - Coliform P:��colonies/100 mL Nitrate • �� mg/L Arsenic 10 D_ ug/L Date of sample: 6/30/2014 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Collected by: PES Date installed 9/4/2010 Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm _(Y/N) N Date of pumping 012,014 Pumper A t )—iz�(� . �(if 1� C� , O JCS C. ABSORPTION FIELD DATA Date installed 9/4/2010 Soil rating (g.p.d./ft2 or ftz/bdrm) 0.8 GPD/SF System type Shallow Trench Length 41 ft. Width 5 ft. Gravel below pipe 3.5 ft Total depth 7.2 ft. Eff. absorption area 379 ftZ Monitoring tube Y Depression over Feld N Date of adequacy test 6/30/2014 Results (Pass/Fail) PASS For 2 bedrooms Fluid depth in absorption field before test 0 in. Water added 301 gal. New depth 0 in. Elapsed Time: 45 min. Final fluid depth 0 in. Absorption rate >= 300+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at _ Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS As -Built on File G. ENGINEER'S CERTIFICATION i certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 7/1/2014 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ in.