Loading...
HomeMy WebLinkAboutRAMSEY TR ARamsey Tr A #051-821-01 Municipality of Anchorage Community Development Department On -Site Water & Wastewater Program 4700 Elmore 5t. ■ P.O. Box 196650 ■ Anchorage, AK 99507-6650 ■ www.muni.or_gjonsite • (907) 343-7904 Well Decommissioning Log Legal Address' Subdivision T Ramsey Subd. Tract A R Section Lot Block Lot On-site Water & Wastewater Program certified contractor performing the well decommissioning: Name: Bill Sullivan Signature Company: Sullivan Water Wells Well decommissioning date: 8/6/14 Method of decommissioning: AMC 15:55.060L1 a. ❑ b. ❑ c. Location: Use the space below to provide a drawing of the property showing the following items; • North Arrow • Decommissioned well, • Other water wells on the property, • Two separate swing -tie distances for each well shown in the drawing, Note: The swing -tie distances shall be measured from either permanent stru ures of property corners. &All +c '- L,�FCat22 ,l% )i4 4 td4r • MUNICIPALITY OF ANCHORAGE�tsr- C:),. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 4-25-4lsrAff 94 t 1 ENVIRONMENTAL ENGINEERING DIVISION , „\\ ` 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 QRZ. (Q ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME 7n,8�<6012.44.-f PHONE .0 ., 98�0 LI NEW li�'L/PGRADE MAILING A D D R E e `I®'Og 9036 1...A.kihd.gafe- 41_,d QCQ 99'67402 LEGAL DESCRIPTION fid- A C 6,44 ...te K,fo✓ LOCATION div I BEDROOMS NO. F OS— SEPTIC TANK DISTANCE T0: Well/ 2® o Absorptiion ria Dwelling ,? i PER�'N�O.aa/ Manufacturer C Materia l�r No. of cor.Tfitments Liq. capacity in gallons f25� IF HOMEMADE: Inside length Width Liquid depth 0 x Z DISTANCE TO: Well Dwelling PERMIT NO. 0 z a 2—F Manufacturer Material Liquid capacity in gallons TILE DRAINFIELD TRENCH TO: Welly /r Foundation/ , frJj Nearest a4 -in' 2/ PER No. of lines 2 Length of eac line Z4, 6.-, Total len th of lines Trench width `30 inches Distance between lines �— Toor}oof tile to finish grade r 1.144—'14-.-W — Z ' a/�1�`T Material beneath tile 474, inches Total effective absorption area /457,0 5.40 /�'r— SEEPAGE PIT Length Width Depth PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. 1.1 DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER IIIIIIIII SOIL TEST RATING .543 -AINSTALLER..++ ii , .2.90 RN E—eie-KzN Jt�1 REMARKS ,-,f • ,• Li S -t &./►i W41,- /Ow•Oi ./ i .5/i if 1 ie -C91.,,„-...- 7,. .4.7--,4,,,,,,„„, rc lin I��������� 4? -440;41r14.- Mil 17411 Effil GLV J:,O✓ 11/11 I [.' Q Gni G` '- :-� C G t b tj, � � 7 I I��������� C:),..,"' 286E e ci d No. - v ® eq8 (-�,� F� .■■■■11118�■■■■■■■ APPROV DATE LEGAL /%�/�//� ///J� �,} ,.,� `A ��p� .'-'1:e-:2) icy 6a 1n/A Ns” . /IC / �e-:2)e"�A�c't- 4�1f -4, -.!�/ Fir -401-10 DEPARTMENT r -\HEALTH AND ENVIRONMENTAL79TECTION 825 'L STREET, ANCHORAGE, AK. 264-4720 0Fq-s:Iya Flal:Rmrir PERMIT NO. ( 800221 ) APPLICANT MR. RAMSAY LOCATION PETERS CREEK LEGAL TRACT A RAMSEY 5. R. BOX 9030 99567 6889280 LOT SIZE- 440000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS 3 SOIL RATING (SQ FT/BR)= 280 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: IDEEF'71-1== 1,....EZNOTIA== ed41- THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). FQLf IR IE C EFT r F4 F4 FeZ I d_L_0FJ'53 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. 1 -WO IC:2> IN".E.F'EECTION:E. tRFE REEIDAJIED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. FlaFtmiir ax1=.1Fza c›eicamE:a1R., I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE 11UNICIPALITY OF ANCHORAGE. 2: I WILL IN gALL THE SYSTEM N ACCORDANCE WITH THE CODES. 3: I UNDERST D TH HE 0 T SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IC REMOD LED TO E MORE THAN 3 BEDROOMS. SIGNED AP LICANT MR :AMSAY ISSUED BY__....).f....A0 DATE 62 "-A--1$ 4) V4.0 Russell Oyster 694-2774 0 & E ENG.NEERING & DEVELOP MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 • • SOIL LOG • 4 41 Performed for: Name. '///" 4,47,57 >'" Tel. No Earl Ellis 688-2280 Mailing Address. Legal Description: / .4/4 A/A4S f c" Depth (feet) Soil Characteristics 0 1 441 6;41 Kt- c"-- , 2 7/"./Se:. /do ; 3 4 5 6 7 8 9 10 11 12 /11 7 e.17."!.-!,7 4), ),:.7» .X Ae, 13 _____ r f6-1 14 15 16 PLOT PLAN 4/4 PERC. TEST 3/4 " /0,,f Ground Water Encountered: Yes No If yes, what depth Proposed Installation: Seepage Pit_ Drain Field Comments. 4446,604411.11/N, 4irc't• OF * 44. 2."‘•t * 49 T 00 •• 410 00•• Ear P, z bz.03 NO. 1745-E 46 I P114 0‘. ROFESSIO Performed by: Date. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970163 DESIGN ENGINEER: OWNER NAME:BRADLEY DWIGHT C & LAUREN M OWNER ADDRESS:22008 VOYLES BLVD CHUGIAK, AK. 99567 PARCEL ID:05182101 LEGAL DESCRIPTION: RAMSEY TR A LOT SIZE: 435600 (SQ. FT.) NUMBER OF BEDROOMS: 2 THIS PERMIT: 2 THIS PE;y_T IS FOR THE CONSTRUCTION OF: O`MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 7/07/97 EXPIRATION DATE: 7/07/98 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: DATE: DATE: Vo/ /7?- \ ' . , •• r44#'6f if,11•14. 4% . totrhIl..i, i , . ;. : . 3k . :.- t•VI V,. .;': A . .. _, . . ' ,„ ' - • ` . • - *sg*.ist'. ' .i..,„: ., I4, „ , ..“4.4i..4...., - .• , ., . .i.,., ..:- yr e...............,i,,,g. • i '::.':::::',' ' :, ' .,,- - ' ,5..4.• ,,N -1:...1,=;:i., .,... - -,,. .,-;!-::-.- ---',' -F--- , 4f.'77--,:. - L1112.... ) ;.':. ';'•;:',::,,..-,,..-.,;', 1 hereby R,vjthe e: '5.7"1-J—/3-irc1.11;i4 k1. 5 ATIChOrage Recording Precinct; Alaska, ridthat the inlp:9ve ments situated thereon are,w,ithin thOropertY,finep and d not overlap or encroach on ,tti.ProPertY IYIng.atilOce/it thereto, that no improvements on pJoperty Lying adjacent Ibereto encrqach on the premises irrilueStion'and that there:are.no rOad*AYS transmission lines or -other,i,isible easements -on said proprty except as fed hereon. Dated at "4. 1.1d jeC°''' 0 5 6Eagle urveyor Np. 880-1S jiver AIaska 9977 ••tong (907)694.2S43 this ROBERT C. JO-1NSON , • d Land$ RECEIVED (lJrrtifjrb Oriiliiq Eng by SEP 41997 DOC Co. dba OS n l l Municipality of Anchorage SULLIVAN WATER WELLS .� L��1��� Dept. Health & Human Services P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 OWNER OF LAND .) t t 44 it=rrrr1 d DEPTH OF WELL/y ADDRESS c2�ooe kiiCi�t's /C 04 us' rik" IC LEVEL OF WATER FF LEGAL DESCRIPTIO DATE - Started PERMIT NUMBER ' — ^ "ids DOWN FT t GALS. PER HR rr KIND OF CASING Aga KIND OF FORMATION: From €~.i Ft. to ,) Ft. From :;d Ft. to_l_Ft. From 4.Ft. to1 �2, Ft J t a <:;rt� x s,. From / ti> Ft. to ,`} Ft. From 3 Ft. to Ft. From t ,. Ft. to , s:'J Ft. From {a 3 Ft. to _Ft. ' 'tuj 6 -- From rFrom ,`a Ft. to,;,eq. Ft. From ii Ft to /} `} Ft. 11.E E,= From J Ft to / a Ft. ; 4 r_ From it ' t Ft to / . �' 6 P From f ) to I"�'J Ft,� From f€,) Ft. tot . Ft From ,:) Ft to . ,1 Ft. From Ft. to Ft. From Ft. to Ft. From Ft to Ft. From Ft to Ft From Ft to Ft. From Ft. to Ft From Ft. to Ft From Ft to Ft From Ft. to Ft. From Ft. to Ft. _ From Ft. to Ft. From _Ft. to Ft. F"ro( Ft to Ft From Ft to Ft From Ft to Ft From Ft to Ft From Ft to Ft From Ft. to Ft. From Ft. to Ft. From Ft to Ft MISCL. INFORMATION: DRILLER'S NAME�i- MUNICIPALITY OF ANCHORAGE os DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY H _ 264-4744 Application Date December 29, 1987 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Tract A; Ramsey Subdivision Location (address or directions) Section 3 & 4; T15N; R1W; SM Property Owner Key Bank of Alaska Telephone: Home Business Mailing Address Lending Institution Telephone Mailing Address RE/MAX OF EAGLE RIVER - Virginia Kohfield Real Estate Company and Agent Address 16600 Centerfield Drive, Suite 201, Eagle River, Alaska 99577 Telephone 694-4200 (e) Mail the HAA to the following address: or: Check here IN, if hold for pick up. List contact person and day phone number below. S & S ENGINEERING/694-2979 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family ER Number of Bedrooms 3. WATER SUPPLY 4 Individual Well I 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 0 Community 0 Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/861 Front I 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Telephone 6 944-2-92 9 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Address Date 6. DHHS APPROVAL Approved for /gas-- (7 bedrooms by Approved Disapproved Conditional //7/f Date �/��/ti • /</ /76 Terms of Conditional Approval 4.111fb dhhS CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (Rev. 8/861 Back MUNICIPALITY OFNI kP4LITV OF ANCHORAGE (MOA) ENVIRONMENTAL SERIA E SORITYT - APPROVAL FEBRUARY 1984 (HAA) Ci 189 264-4744 Legal Description A RECEIVED A. WELL DATA Well Classification j r471J 1 D J If A, 6, C, D.E.C. Approved (Y/N) Well Log Present (Y l) Date Completed F'�tg2- 191 Total Depth v1-•• Cased to '411::) 4"5-epth of Grouting Static Water Level \ mor Pump Set At Casing Height Above Ground 1 Yield •� (.31rh-1-t• L)r Sanitary Seal on CasingcN) ✓ Electrical Wiring in Conduit?N) ,--- Depression Around Wellhead (Wit) Separation Distances from Well: i j To Septic/Neil-FH3 Tank on Lot Zn ; On Adjoining Lots � �� To Nearest Edge of Absorption Field on Lot 12ro I ; On Adjoining Lots k (. AN 1-../A To Nearest Public Sewer Line Cleanout/Manhole To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by t r ; Date \ - k -Ss Water Sample Test Results� ' C--' 1 Comments 1 1i1� - - -02-09 Jet, d''- M 1 rJ. c L1 7 B. SEPTIC/HOLDIN&TANK DATA Date Installed (— 7 Size l26"b No. of Compartments Standpipes 09N) Air -tight Caps(i,N) Foundation Cleanout (WED Depression over Tank (Y0 ` Date Last Pumped 1 "'S 88 Pumping/Maintenance Contract on File (Y/N) r' ; for -- — Holding Tank High -Water Alarm (Y/N) P/as Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/ Tank: To Water -Supply Well —w To Building Foundation 11 1 S!. To Property Line I D "'1— To Disposal Field 1 To Water Main/Service Line j ( o - To Stream, Pond, Lake, or Major Drainage Course 1 ©C7 "1-- Comments 12'1' of ?vf—lf' :�81—oZZ- Page 1 of 2 72-026 (Rev. 8/86) Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed (.'2-k-80 Width of Field Type of System Design `1C) t Length of Field Depth of Field Square Feet of Absorption Area �Gr�vel Bed Thickness �r k 4'S to w61 Standpipes Present ON) Depression over Field (Y' Date of Last Adequacy Test (-1 - P,3' Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Lot To Property Line o To Water Main/Service Line c;) � ; On Adjoining Lots To Stream/Pond/Lake/or Major Drainage Course To Existing or Abandoned System on gyp/-_ /A To Cutbank (if present) \ c� O / 'I To Driveway, Parking Area, or Vehicle Storage Area SPC" -- Comments Comments /".-f it `fit i- l� gvX/f /'' zto I /z/a* D. LIFT STATION / i1 Date Insta Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at 'Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Electrical Codes (Y/N) Comments ing Cycles during Adequacy Test Meets MOA ** Check Permitted Bedroom Rating Against HAA Request •* I certify t a I verified, or conformed to all M A andAA guidelines in effect on the date of this inspection. Signed17034 Eagle River Loop Road No. 214te // Company- River, Alaska 99577 '1 9 any G7 MOA No. O Receipt No. Date of Payment Amount: $ % U o Page 2 of 2 72-026 (Rev 8/861 Back CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM LD.# PRIVATE WATER SYSTEM Name 5 & S ENGINEERING Mailing 170Xi Eagio River LOOT ifb.'2U ROYd 4 AOOT Eag a River, Alaska 99577 City Phone No. State SAMPLE DATE:i t i I4 l `I_1 Mo. Day e SAMPLE TYPE: o Routine Li Check Sample (for routine sample with lab ref. no. ❑ Special Purpose Year Zip Code ❑ Treated Water Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 1 H moist, f 2Issy _ _ 2 1 3 41 51 J TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received / — S — S g Time Received /?, a Analytical Method: Membrane Filter * No. of colonies/100 ml. Lab Ref. No. Result* Analyst /ly U READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verification: LTB Final Membrane F Reported By TNTC = Too Numberous To Count OB = Other Bacteria Coilform/100mI BGB Re Its yt/i_- if /=✓tM'i/,' Date Coilform/100m1 Time: t PART 1 OF 2 REMAINDER TO FOLLOW a.m. .+ m, CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 LABORATORIES Client P0# : VERBAL Req #: Client Smpl ID: TRACT A RAMSEY S/D Sample Rec'd : JAN 5 88 Ordered By Send Reports To: S & S ENGINEERING R SCHAEFER 17034 EAGLE RIVER LOOP RD., #204 EAGLE RIVER, AK. 99577 Special COLLECTED 1-4-88 Instruct: Chemlab Ref #: 8752 Lab 55npl ID: 1 Parameter Tested ANALYSIS REPORT BY SAMPLE Matrix: Water Result/Units Work Order No. Client Account Date Report Printed: Released By Reports Address #2 Method 4588 SNSENGP JAN 7 88 3 12:01 2/ C' Allowable Limits NITRATE -N 0.51 mg/1 Sample ROUTINE SAMPLE Remarks: ANALYSIS COMPLETED: 1-6-88 LABORATORY SUPERVISOR: STEPHEN C. EDE 34 10 1 Tests Performed * See Special Instructions Above ND= None Detected ** See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than Parcel I.D. 015-821-04 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description RAMSEY TR A Location (site address) 22008 VOYLES BLVD Expiration Date: ! a - 3 - Current Property owner(s) LAUREN AND DWIGHT BRADLEY Day phone Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual [] Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Puhllo Water System ❑ Public Sewer ❑ WaiverlVariance request for: NONE Distance: -- Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number COSA # 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 SPURKLAND ENGINEERING Address 203 W. 15TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for By: Phone 279-3916 Date 6/7/2014 �QFAL `! ,d gyp. f - bedrooms, with the following t SPURKLAND. t l 115 0 r! 0 0` t44Cy`yi `* oN SITE �;� \ATER AND �o WAStEWATFR oZ RpGR�: 1 P A Original Certificate Date: Th um: •�i,9rfchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represtions 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 Septic System Advisory Well Flow Advisory COSA blue sheet E i c Nitrate Advisory Arsenic Advisory Other Parcel I.D. S� o�i QIX8-821,04 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Expiration Date: 1 Q - 1. GENERAL INFORMATION Complete legal description RAMSEY TR A Location (site address) 22008 VOYLES BLVD Current Property owner(s) LAUREN AND DWIGHT BRADLEY Day phone Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) 0 Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Pi ihlic Water System ix 2 TYPE OF fli//ZST 1)V iEli ibiSFOSAL: Individual Holding Tank Community Pi thlir Sewer WaiverNariance request fo : NONE Distance: Received by: COSA to be released io the engineer, unless otherwise requested by the engineer. Date: W-1(! i COSA Fee $ 524 Waiver Fee $ Date of Payment 8!(a.ltil Date of Payment Receipt Number �S 0Q5336 Receipt Number COSA # 40 6C N«Q / 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 SPURKLAND ENGINEERING Address 203 W. 15TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND 6. DSD SIGNATURE By: System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Phone 279-3916 Date 8/7/2914.N.\‘‘. c"L.AlA SPURKLAND.I I • t ''., 1.15 0 ..k.;-., 1 CPR. SOAP -a:7 bedrooms, with the following stipulations: do - =�o=7WW$OASTNTrEE3SRWFITAENT`GD;Is) ) Original Certificate Date: q - The unici.ti ' ofi•ri:horage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheet_b Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: RAMSEY TRA Parcel ID: 051-821-01 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # Date completed 7/97 Sanitary seal (Y/N) Total depth 202 ft. Cased to 202 ft. Date of test Static water level Well production FROM WELL LOG 7/97 122 20 ft. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 0'723 mg/L Arsenic ND ug/L Date of sample: 7/9/14 B. SEPTICIHOLDING TANK DATA Tank Type/Material STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) Date of pumping 7/9/14 Pumper JRS PUMPING Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 24+ in. AT INSPECTION 7/9/14 112 5.4 ft. g.p.m. Collected by: ANSON MOXNESS Date installed 6/24/80 Cleanouts (Y/N) Y High water alarm (Y/N) N C. ABSORPTION FIELD DATA Date installed 6/24/80 Soil rating (g.p.d./ft2 or ft2/bdrm) 280 System type TRENCH Length 90 ft. Width 3 ft. Gravel below pipe 8'0 ft. Total depth 11 ft. Eff. absorption area 1456 ft2 Monitoring tube Y Depression over field N Date of adequacy test 7/9/14 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 77 in. Water added Elapsed Time: 30 min. Final fluid depth 79'5 600 gal. New depth 81'5 in. in. Absorption rate >= 600 Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date --- g.p.d. D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at -- Datum Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 1001+ in. On adjacent lots 100'+ Public sewer main NA Public sewer manhole/cleanout NA Sewer /septic service line 25'-'- Holding tank NA Animal containment areas 50+ Manure/animal excrete storage areas 1001+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5'+ Water main NA Water service line 10+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 101+ Absorption field 5'+ Surface water 100+ Water main NA Water Service line 10+ Surface water 100'+(N.O.) Driveway, parking/vehicle storage 10' Curtain drain 501+ (N.O.) Wells on adjacent lots 1001+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name LARS SPURKLAND Date 8/7/2014 COSA brown sheet_10-10-12.doc 1320.00' N90° 00' 00"E NOTE: PLAT 72-53 USED FOR THIS SURVEY 1 O O O so a7 s b 0 0 cn M Lu O p (II 502.0' 20.8' o N CV V M N 6,0 6.p EXISTING HOUSE ;I- /00.. s ° b O in .......' O O ce ........ O .'•� $4gry 4 o WELL of 1320.00' N90° 00' 00"E UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LJNES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL. TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR DIE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE, ULOT SURVEY SURVEY TYPE SYMBOLS • SET REBAR 1 DRAINAGE o f1N AS-BUILT FINAL NAL SSTRRUCTURE AS-BUILT ❑ PLOT PLAN ... AS-BUILT ... LD; $IIR�EY ... IOPOCRAPHY 17 AS-PACT ... NO CONNERS SET RECDinRCAlla AS-BUILT ... NO CORNERS SET 0 FOUND REBAR k.. 'w.::p.1 CONCRETE G-9—Ek WOOD FENCE (00) ASSUMED ELEV. 17../M0 •K--K—X- METAL FENCE WOOD DEO< PLOT PLANS & LOT SURVEYS NOTE: ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROMBEINGSEEN AND LOCATED. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER. PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILCING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. SURVEY CERTIFICATION Prepared by Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 1700 Brink Drive. ANCHORAGE, ALASKA 99504 PLOT PUN Met I Mw ��,������, 41,2 ,....1..1....-... OF A !++ """'•••. I Iway rely Mlw•dr F.alee awe.a neon, ewll •••••. M. kt rc.e ea aid Mill IFae a a No Ne �r'�P'.•••"" -J r eetaY,d cone. am thee, an e. plan w a M• eat a my bond. as aaea a ane,aaw nae le mound °"' as newt. FOUNDATION AS-BUILT 4 Raet E bN,a ,1.. fray ABM, Met I non em^- of UP ir ..• , 4 `: - - ` R '� `•( -` ••a�l• . '4 ..•••0 " • /' ... / Scale: = , 1" 60 Rec. Lot S.F. Rec. Plot File No. Dote Surveyed: 07/30/14 Drawn b . ' REJ Checked D,yM K a IM •• baton US NA and Na amnion as na^ad!m shown nw>L � �, a "� "w ! . ROBERT E" OH JR. i ase 0..�u Date Drawn: 08/01/14 Grid: 1560 W.O. 14-353 FINAL STRUCTURE AS-BUILT I. Adel E .u.,., a, hominy (artily Ma MN pend m be-4 Flay el n• as d Me A•). - ... s ;',e`°: �. !e .••'•.... .. •''.• ypa �1 p ...,,,,.. + + ♦ Legal Description: TRACT RAMSEY avow AS *t oaVW Inlasynatbri ea Ilan haven a no.ndrants W viae ...,•nwaeF + Pyelfessionat t' .111 ; :: - +n....••