HomeMy WebLinkAboutDOROTHY MARIE ESTATES LT 1Dorothy Marie Estates Lot 1 #015-273-64 Municipality of Anchorage Page t of _2__ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 6crl 860012 PID Number: 015 -- Z73 -.V!� 1a!A Name: gAi 40AA04'16 14A1VY-or4,s Wastewater System: I(New ❑ Upgrade A00 Address: 99SO-4 A43SORPTION FIELD 3 565 A t-A M GSA 00-. A JI-A . AI_ Phone: Zt3 — 3 $ oL No. of Bedrooms: 4❑Deep Trench JN Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: / • 2 GPD/S2. Ft. Total Depth from original grade: 8 Lot: ' Block: __..- Subdivision: �A Depth to pipe bottom from original grade: Gravel depth beneath pipe ' 0e,o'r"Y r�lA1r. r GST. q Ft. 'I Ft. Township: Range: Section: z CL011.� Fill added above original grade: Gravel length: 1 T12f, GJ O -QS Ft. 50 Ft. WELL: I� New ❑Upgrade Gravel width: 5 Number of lines: i Distance between lines: Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: p,5-rte O 3034 P6 w A--E Z I Z Ft. 2 I Z Ft. 5 00 S. Ft, 1 0 Driller:Date y� �A.AFAfLT VItILL)14 Drilled: 57 &-IL Static Water Level: 90 Ft. Installer: GGI.OST'Ar,, Date installed: °I% Yield: Pump Set at: -Z05 Casing Height Above Ground: I TANK /0 GPM Ft. I + Ft. SEPARATION DISTANCES j&Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines 1250 Weltyl /oo.I- too f + '-� ._--_ _ Material: sTi:Et- Number of Compartments: Z Surface a 100 i + foo f t -- -- — LIFT STATION Lot t Ifo ± t 30 — -- Size in gallons: Manufacturer: Line Foundation • 7 i t 7 t . -- __. "Pump on" level at: "Pum evel at: High water alarm at: Curtain Grp KEG Pump Make 8 Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description: TB M - 7o P o F" n N F0JA410AiY1 00 BY Po1nlr A Assumed Elevation: ,'` • IAC � //ff M` ��•E Inspections performed by:S & S ENGINEERING Dates: l st 6-3`14 17034 Eagle River Loop Road, No. 204 2nd mac"` ROBERT C. COWAN NAN ," , - Ea Eagle Rivar, Alaska 99577 9 r 3rd L``t-9b �G�J�i�ygCE-$'�1 w Department of Hea h and H rvices approval" ;' ��,� , •... ,`` ,y Reviewed and approved b ate: 0 • - `� 72-013 (Rev. 9/91) MOA 25 f Permit No. SW960012 Page 2 of 2 REVISED 7-3-96 Municipality of Anchorage 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 Legal Description: LOT 1, DOROTHY MARIE ESTATES S/D PID No.: 015-273-03 A B C FCO 18' 11' - ST 1 16' 12' - ST2 21' 16' - STI ST2 . FINAL GRADE D131_2 2 4' 20' — j C01 37' 32' - MT 1 38' 33' - --� N CO2 58' - 31' I 96.11 1250 GAL 95. ' MT2 59' - 33' I I I I LOT I I FINAL GRADE7 ALT. SITE MT CO I . I I INSUL TION �^ SR 10' MIN. CQ1 Ar CO2 _ M c 02&_TH#2A 7 i \ �#1 T _ _ -- ���7 4°01 M �F 1 = 92' M12 = 91.9' I o0 B ST1 NO GROU 85.9' D WATER B.O.H. � ;111� 4 BDRM FCO AE S\-NEW ISTNKLHO ETCA n WN �, ti I "9 I I WELL a�„� ROBERT C. COWAN �y� CE - 8801 <w - - - - - - ------- -- —- - - - - - - - - - UTIL. E 'ALE i" 40 ,,...........•����� �10 �t,'� p�RafESS1C�k�` iVE.1�►► EAT 112 h 72-013 A (Rev. 9/91) MOA 25 IF3�I�iP��' ��Iy%IIRC§} �Y��33I6i� 1201 Ramona S t . 99 515 ANCH01EtA0Rv ALASKA 344-7'714 SIX INCH WATER WELL DRILLED ----------OUT TO THE DEPTH OF 21 P feet. DRILLED AT THE RATE OF $24.00 PER FOOT. Steel casing seated out to 212 ft. PROPERTY OWNER Mr. George Moore Bruin Builders, Inc. 562-3640 LOCATION OF WELL SITE Lot 1 Dorothy Marie Estates. DRILLER Bernie Claus o f . Ra.mnart Drilling Works. WEL.I, LOG - 0 - 18' Sandy gravel with 40% brown clay. 18 - 67' Coarse gravel with 15% clay. 67 - 134' Hardra.n. A cemented gravel material with several small boulders. 134 - 190' Sandy gravel & small boulders. 35% clay. 190 - 2.06' Hardra.n. A blue clay tyre cemented gravel. 206 - 212' 'v`Jater bearing fine gravel going into a good coarse water bearing gravel at 212 feet. 'Nater recovery back ur to 90 feet of surface. This water well making •:a. full ten grm. One horser3ower submersible -cum should be install five to seven feet off bottom. X1,500.00 aid on this well 5-8-96. Total cost of drilling: 9b24.00 rer ft. x 212 ft.: $5,088.00. Muni arrroved well carr: $30.00 ;v VTl.Lte check to Ra.rri �rU.rt Drilling 'Works for: 3, 618.00. No set-ur cost. No mob or demob cost. RECEIVED JUN 20 1996 Municipality of Anchorage Dept. Health & Human Services COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF 3 a 618. 00 THANK YOU VERY MUCH.7-� -, --'� _ BERNIE CLAUS OF RAMPART DRILLING WORKS DATE may 16, 1996 Th,n.nk you Geo You've mot class! SERVICE CHUG31i O F It/=% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. 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 Co_�-�CA ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT -- PERMIT NUMBER:SW960012 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:MATUKONIS RALPH J SR OWNER ADDRESS:3565 ALAMOSA DRIVE ANCHORAGE, ALASKA 99502 PARCEL s�u DATE ISSUED: 1/23/9610-2,-'l EXPIRATION DATE: 1/23/97 LEGAL DESCRIPTION: plcc)gnqj T12N R3W SEC 21 LT 30 fffJii l LOT SIZE: 217800 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: L1= �tSS 'ow (9 J com,- DATE• / -mss"-,y'6 DATE: — 24 — 7 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN s&S� ,-in eRinq December 12, 1995 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: (Proposed) Lot 1, Dorothy Marie Estates ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Request you issue a permit to drill a well and install a septic system to serve the proposed four bedroom house on the referenced property. Two test holes were excavated and percolation tests performed. The approximate location of the test holes are located on the attached site plan. At the time of excavation no water was encountered in the test holes and after seven day ground water monitoring, the monitoring tubes were found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. There are no points of contamination within the proposed well radius which can be seen on the attached site plan. If you require additional information, please contact us. Sincerely, &/Z+�,_ Robert C. Cowan, P.E. RCC/gk Enclosure 17034 NORTH EAGLE RIVER LOOP • SUITE 204 0 EAGLE RIVER, ALASKA 99577 50' SITE PLAN DESIGN SCALE ,^-hJ� rnc�� Ilii "`3�C"G 00 U) t-N m;am �y �,tn5 m U) O -, m e �i(j) Zmp-OC��-I-vD II m zpn� NII I� � �o c� ��o��a �m< II IIS c `z7�,nn ON�Z< *1V� m U1N m - pm rt7 a 0C)0 -f O �c G ZJ_OM t7J 0 I•-3 _ v r *1 Tl '{gym tt Ln m :c m .. f*I -j" C 7_ m AD z D > Umi O I N om o to=m -0 c0 �OyI-,-�CcnD O o m Zw7' to m Cf)O-ZiF,m z r M - m��1-1 mz D 0 D D rC-gt>ZD Zx 0 n o mrmi=00r�*Im T. T, Z i V) O r, -< Z v "C\ ^ -uW �.. D�M _ Mmo 0-- I p>Z (AD i N <z z oho z�z o 0Z -{ O r, 01 z SIIIC( s� S U) rh � -D p.r N03 O O c, /� r D- h-+ m N 1 / O FTI IU 03Otid m �� � —IO m m i 3M8(3 o3s o ���� -(A I M I N C O O m m rrj � cn I �? (A ZO\- Or (7 r I Ll)O X ma71 _ 00 Z I(A n Oc) O;u co 0 �O�Z D-';,\;uD� n Z NZ �.�+�,wac' v1•��� r p dO XONrnN L2 9�,� Q D DCO f Om R, , �< r OF .4 WL) e Municipality of Anchorage �C'`' ,''•.3'<? Y DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 ,�•.••' :... •y.., `: 'x+ SOILS LOG — PERCOLATION TEST • ROBERT C. COWAN n f .� PERFORMED FOR: I�o x #w mi ANO 1i4 y M }% 1 V ICON f S �f� ^�^^ ,� (y���y\� DATE PERFOR • ` r'e 't., LJ J..•' ..r LEGAL DESCRIPTION: 407 3a Township, Range, Section: Yf C7/o,v a / `jf5l;w " Je 31✓ DEPTH T J i f{ v( - r jw- I SLOPE SITE PLAN (FEET) 1 ��. 0 ✓t. 13 14- 15- 16- 17- 18- 19- In 4151617181920 G- 4 /4- v i L Iv % C-013gL_f j S, Lr 1-14Y4f4 Los 5 j C--24%tf, L, C 4%4 1'V C- WAS GROUND WATER N ENCOUNTERED? IF YES, AT WHAT t DEPTH? F F E Depth to Water After Monitoring) Date: ■■■■..■"■■ ■■■■■■■"�h� 1-0, ■■EMNO-1 MINN 0Mri��l MINN MMM110'1111 MEN EMENE MR I 11111111910 ■EwNINE MINN ■MMAI MI Raw MENUMS Al 910H WENMES 1Ii001NMmmw w Reading Date Gross Time Net Depth to Time Water Net Drop 2 3- '7 .. 4 4 — 7 7S* r, -, 5- 6- 67 7 j/ M L 8 �.v• 9- 10- 10 11 11 Q C� e �•� x 12 13 14- 15- 16- 17- 18- 19- In 4151617181920 G- 4 /4- v i L Iv % C-013gL_f j S, Lr 1-14Y4f4 Los 5 j C--24%tf, L, C 4%4 1'V C- WAS GROUND WATER N ENCOUNTERED? IF YES, AT WHAT t DEPTH? F F E Depth to Water After Monitoring) Date: ■■■■..■"■■ ■■■■■■■"�h� 1-0, ■■EMNO-1 MINN 0Mri��l MINN MMM110'1111 MEN EMENE MR I 11111111910 ■EwNINE MINN ■MMAI MI Raw MENUMS Al 910H WENMES 1Ii001NMmmw w Reading Date Gross Time Net Depth to Time Water Net Drop ri.Su�K '7 .. 3 — 7 7S* r, -, PERCOLATION RATE / (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND S FT COMMENTS f XCfV.4 )r/di✓ Q j/ 7 -W -Cf - 4 E X. PERFORMED BY: S & S ENGINEERING I CERTIFY THAT THIS TEST WAS PERFORMED IN 17094 Eagia Riwr Loop Road No. NX y / pl r ACCORDANCE WI t TEX"64 IWAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:�0ICAMNt 4NQ RAY M/jTVKOA/1 s DATEPERFORME���;?�A"I••�J��7' LEGAL DESCRIPTION: 1'O 1 30 Township, Range, Section: s'f Gd 7io.� / T'f' "�✓ f 3ti✓ DEPTH T9 -S7— #01 1 a, SLOPE SITE PLAN (FEET) 1 z 7 06?G.4'V r C_ S 2 � 1 G 2 �� d? I 64 411 C L w / 3 P. 5 FiNw 4 a O C-cAS40,, A L y vu° 5 e 6 ti E, _. 7 8 9 s4It 6 10- 11 0 11 12 d 13 tr•g� 14 r0 a � 0 4" 16 17 18 19 R, 0. #. SANn AkN SE MEMO MENEM NNEENNERIN NINE MENof ■Io■ iiM1N M1§1 ■I'SN.. ONE ■w Minn ■iirii�i it Mica NONE N1 NINE MENOW N! Norma G 2RV k L WAS GROUND WATER N a �/ Ir"i S ENCOUNTERED? S IF YES, AT WHAT -- L DEPTH? 0 r` i 70 0-t P E Depth to Water Afterbb__,, {{ ^ Monitoring? � Date: Reading Date Gross Time Net Depth to Time Water Net Drop SAS t) o Q .� Y.3?J- 1 0 q. 0 1 • xs" '" 20 PERCOLATION RATE � (minutes/inch) PERC HOLE DIAMETER (' TEST RUN BETWEEN FT AND 6 FT COMMENTS ExcAVAr/O"/ QY 'Tw£EA "_X' s )T'r. Sv t7-19QL#— G©/Z- -S tPP SEPi r c SY S_roto Df, S rS e PERFORMED BY: S & S ENGINEERING. 41LCERTIFY THAT T IS TESTAS PERFORMED IN 17004 Eagle River Loop Road No. 404 8- �cl ACCORDANCE WI I E h4y#WAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) s&S� ,in epunq ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS HEALTH AUTHORITY APPROVALS REFERENCE: (Proposed) Lot 1, Dorothy Marie Estates December 12, 1995 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 SEWER&WATER `�"+•i'•`'i'• MAIN EXTENSIONS 1. The scope of this project includes the installation of a 1250 gallon septic tank and leachfield trench to serve the proposed four bedroom residence located on SEWER&WATER the referenced property. INSPECTION 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all ENGINEERING STUDIES applicable State and Municipal Wastewater Disposal AND REPORTS Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. WELL INSPECTION & FLOW TEST 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. SITE PLANS 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own ROADDESIGN systems must also receive prior approval from the Municipal Health Department. SOILTEST SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. PERCOLATION TEST 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. STRUCTURAL& 3. All standpipes on the septic tank shall extend a MECHANICAL minimum of 12 inches above final grade. INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two (Proposed) Lot 1, Dorothy Marie Estates December 12, 1995 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three (Proposed) Lot 1, Dorothy Marie Estates December 12, 1995 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four (Proposed) Lot 1, Dorothy Marie Estates December 12, 1995 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five (Proposed) Lot 1, Dorothy Marie Estates December 12, 1995 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER Municipality of Anchorag • j Development Services Depart Building Safety Division On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsito (907) 343-7904 e ment CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 0/5%255-i! COSA# 0L00� 1. GENERAL INFORMATION Expiration Date: / — 2 S" 7 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address DOROTHY MARIE EST! LOT 1 3901 E. 112th * ANCHORAGE AK 99516 MICHELLE BARR Day phone 240-3748 3901 E. 112th * ANCHORAGE AK 99516 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage riles 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 GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Engineers Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwaterlevels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ___Z Approved for 14 bedrooms. Disapproved. 337-6179 Date 10h, 0 Conditional approval for bedrooms, with the Illowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineers Reort Other ey: � (Rev. 11A5) Pro (f((fI /r I O F ANC''% JR.••' '••.,4p'��� ON-SITE • G+= WATER AND WASTEWATER '. PROGRAM OPA, Original Certificate Date: / O —.2— 5�' O G Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water d Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.orglonsite (907) 3437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: DOROTHY MARIE EST: LOT 1 Parcel ID: D 15'-2734tf A. WELL DATA Well type PRIVAIE If A. B, or C provide PWSID# N/A Well Log (YM) YES Date completed 5/16/1996 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 212 ft. Cased to 212 ft. Casing height (above ground) 18' in. FROM WELL LOG AT INSPECTION Date of test 5/16/1996 10/18/2006 Static water level 90 ft. 143 ft. Well production 10 g.p.m. 6.95 g.p.m. WATER SAMPLE RESULTS: Coliform _Q _ colonies/100 ml. Nitrate JJ25-mgJL. Other bacteria 0 colonies/100 ml. Arsenic:-h&—ugJL. Data of sample: 10/5/2006 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 6/4/1996 Tank size 1250 gal, Number of Compartments E Cleanouts (Y/N) YES Foundation deanout (YM) YES Depression over tank (YM) NO High water alarm (YM) N/A Date of pumping 10/18/2006 Pumper McDONALDS PUMPING C. ABSORPTION FIELD DATA Date installed 6/4/1996 Soil rating .p.d. ft9bdrm) 1_2 System type SWALLOW TRENCH Length 50 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 07J ft. Eff. absorption area 500 ft' Monitoring tube YES Depression over field NO Date of adequacy test 10/18/2006 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 In. Water added 632 gal. New depth 0_5 In. Elapsed Tane: 2 min. Final fluid depth 0 in. Absorption rate >- 600+ g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 3 type) NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Acoess (YM "Pump on" level at _in. "Pump otr leHigh water alarm level at Cycles tested Meets alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100,+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 500+ Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5' Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 102+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parkingfvehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent kits 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through fleld inspections and review of Municipal records that the above systems are in conformance with MOA COSA guideNnes In effect on this date. Engineer's Printed Name JEFFREY A GARNESS Date IQ/I,>A( COSA Fee S 1%3o. C)C7 Date of Payment Receipt Number (Pw 1IMS) Waiver Fee $ Date of Payment Receipt Number SCS ReLN 1066043001 Client Name Gamess Engineering Group, Ltd. Project Name/N Lot I Dorothy Marie Est Client Sample ID Lot 1 Dorothy Marie Est Matrix Drinking Water Sample Remarks: All Dates/times are Alaska Standard Time Printed Date/time 10/17/2006 9:24 Collected Date/rime 10/052006 17:24 Received Date/time 10/06/2006 14:34 Technical Director Stephen C. Ede Parameter Results PQL Units Method Metals by SCP/14S Arsenic ND 5.00 ug/L EP200.8 Waters Department Nitratc•N 1.09 0.100 mg/L EPA 353.2 Allowable Prep Analysis Container ID Limits Dale Date Init C (<10) 10/11/06 10/12/06 TK D (<10) 10/06/06 XZ Microbioloay Laboratory Total Coliform 0 col/100mL SM209222B A (<I) 10/06/06 DPT Municipality of Anchorage • Development Services Department u Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-273-64 HAA #_ QQ tNgS Expiration Date: 720' nH 1. GENERAL INFORMATION Complete legal description Dorothy Marie Estates, Lot 1 Location (site address or directions) 3901 E. 112th Ave., Anchorage Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address & Roxanne Matukonis Day phone 522-9439 3901 E. 112th Ave. Anchorage, AK 99516 Day phone Lori Hackenburger Day phone 727-4444 3111 C Street, Suite 100, Anchorage, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q 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 4 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. (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 Watkins Engineering, Inc. Phone 349-1851 Address P.O. Box 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis 5. DSD NATURE Approved for _ Disapproved. bedrooms. Date Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other BYt_� (Rev. 01102) ))W 1; Original Certificate Date: S o -4 U Develo 1PUIRy of anchorage °t ent Services'Deparfinent °x 3uild'mg SafetyDivrswn V1�ater &Wastewater Program s ^ ITY n or 7onsife HORITYAPPROVAL CHECKLIST' - 1' y;ParcellD 015 273-6d proVide' PW §Tb # " 1Nell Loa'(Y%Kl Y ` rr we ft g.p.m. 9 -P.M. k . 7t1. " I rafe mg O er ac ena coiomes/100 ml. Date. f sample:'s,-ts-on Collected by Cindv Eltis' 'rv. ,0.W'.. �xx.w^h5�,♦,4w+Fs�L�%'°w+T'k"pv^+.f�.��L�� 'C?i�m'at4+.m. ew� Date installed 6-4-96 Vumber of Compartments 2 Cleanouts (Y!N) Y' epresslon o 7 tank n Ig wa er alarm' Pumper Northland Pumping t/6it rating (g p d/ft feme) System type s a ow trent Width 5.0 ft. Gravel below pipe 4.0 '' ft sorp ion area ° Monitoring tube Y Depression over field n O'Q Results (Pal's/Fail) PASS Fora bedrooms ore test m Water added gal New depth 0 in rrra ur ep irr: corp ion ra e > g p d Pe :n known �" If ve5 dive date oN Pr 49TH (YIN) * Size in gallons Manhole/Access 3/ records that the abovesystemsare in •••.., MOA HAA guidelines in effect on this date.CI' y W. Ellis "Pump in. High water alarm level at �n 0"e7-_ "' °^ '� w'. �'•�' °`"Meets alarm & circw '? g. k Cydles tested oN Pr 49TH RI�ICA * de"Cermmed through field inspbctions�and 3/ records that the abovesystemsare in •••.., MOA HAA guidelines in effect on this date.CI' y W. Ellis �: _ .• „K.• Name Cmdy W Ellls CE 1057 I >� :Fo;:••Q-3 Waiver Fee $ nix "A Date of Payment 14 - Receipt Number SGS Ref.# 1045313001 Client Name Watkins Engineering ProjectName/# Dorothy Marie Est Lot I Client Sample ID Dorothy Marie Est Lot I Matrix Drinking Water PWSID 0 Sample Remarks: All Dates/Times are Alaska Standard Time Printed Date/Time 08/24/2004 6:56 Collected Date/time 08/19/2004 13:00 Received Date/Time 08/19/2004 14:34 Technical Director!'�/ Stephen C de Released Parameter Results P L Units Method Container ID Allowable Prep Analysis Q Limits Date Date Init Waters Department Nitrate -N 1.06 0.100 mg/L EPA 300.0 B (<=10) 08/20/04 JIB Microbiology Laboratory Total Coliform 0 coU100mL SM209222B A (<=1) 08/19/04 DKC t' _09h02/2004 1E:33 9072432091 f �1 I\^ t, Scale; =30' FRED WALATKA & ASSO r 6G ZS L 16-.00 OL /L. ' I i s: � na IlS' Sef1;c vC,is_-,, y,eJ '2' 0. K. ¢0=e o ---z- -Sty. ", t_Z9O10 .H4o� N MFrt" Hse. 16= O c N 3Z� N 4o° kr ' lio lo' Tele. Elect: Es.nt.— N89`58'2&"E' 165 Co M M E, I1Zra Ave. A"UILT HO CORNERS SET THIS DATE 1 M j certify that I have peflormod a Matt PAGE 01 C Anchorage Recording PMCIr1CI, Alaska, and matma im,ro.emanta ahueted thereon are w"Min the Property fines and do na wenap or encroach on the property IYing adjacent ret,, that re, Improvements on Property tying adjacent !helot, '-,d '�'"""c'}°1*•x encroach an the prembes In question and that there are no .YY, roadways, narasmtselon Ilnas a ,mer vlslWe ea9emerrts on said yh�a'`•.. o,,,,°, :'� �d Property e>Cept as Indleeea hereon. �?'i ° .::9x9:aN_`•` ea .' Dated M Anchorage. Aleake EASEMENTS OF RECORD, OTHER THAN t+:s - I f f day ,t se 8004 THOSE SHOWN ON THE RECORDED FRED W tATKA 8 ASSOCIATES PUT ARE NOT SHOWN HEREON. L0/7 (907) 208-1886 Engineers and Surveyors MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. # 5" - ? 3 -ME; Lc�c� HAA # �aLE L:.?1� 1. GENERAL INFORMATION Complete legal description Loi: 1; Vorcothy (t,antie. E.6tates Location (site address or directions) E. 1124"h Avenue. - Ar;.chokaoe. AK Property owner Rays 9 Roxanne. hIatukonis Day phone 248-3802 Mailing address 3565 A2cuCosa Dkive Anchokage., A:' --z Lending agency Mailing address Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well .Inn Community well Public water NOTE: if community we!! system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site '"XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING9 ,ver Loop Phone Road No. 204 (� c( tf — 2 �f 76 Name of Firm 17034 Eagle � Address Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE Approved ,for Disapproved. -661 -M bedrooms. Date Ln ROBERT C. COWAN /,:,k- CE ,Q �,, • CE - 8801 +`- FESSION Conditional approval for bedrooms, with the following stipulations: Additional Comments 4UTIC The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA 821 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISIO Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICESJUL 19 1996 U* Environmental Services Division r' Ft���� 825 L Street, Room 502 • Anchorage, Alaska 99501 * (907)UG E D Health Authority Approval Checklist Legal Description: Lo -r I , 0.,t.rH-t tMA,c,r Esr: Parcel I.D.: -C)IS - 273 -03- A. -a3A. WELL DATA Well type ell, "J E If A, B, or C, attach ADEC letter. ADEC water system number Log present&N) Y Date completed 5 "i -91: Total depth I Z Cased to 2/Z Casing height (above ground) 14' Sanitary seal CTN) y Wires properly protected AVN) y FROM WELL LOG AT INSPECTION Date of test Static water level Well production O g.p.m. g.p.m: WATER SAMPLE RESULTS: Coliform Nitrate tOhl Other bacteria Date of sample:ZIZ21 Collected by: Ea�,N EEcint c , B. giffaHOLDING TANK DATA Date installed r? - `� - 9 �` Tank size 1 zSb Number of Compartments Z Cleanouts ON) Y Foundation cleanout (VN) Y Depression (Y.Q N High water alarm (Y6) hi Date of.Pumpitg <. Pumper b C. ABSORRTION FIELD DATIi!►R, Date installed ,.(o' 4=`q"6'` Soil rating (g.p.dJft2 or ft2/btlrm) 1.2- .System type 72G He 4 Lengthy Width `f Gravel thickness below pipe y Total depth 8 Effective absorption area o Monitoring Tube present ON) Y Depression over field (Y/M AJ Date of, adequacy test fJ F-0 Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test (in,); Immediately after gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) — If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES *Datum Size in gallons "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Se tic holding tank on lot 10014- On adjacent lots .100 ► + Absorption field on lot 1 00 + On adjacent lots / o ► t Public sewer main tJ %A Public sewer manhole/cleanout t4 / A Sewer /septic service line 25 + Lift station SEPARATION DISTANCES FROM SEPTIC HOLDING TANK ON LOT TO: Foundation 7 Property line 1-t0 Absorption field 10 Water main/service line ► 0 14- Surface water/drainage 10014 Wells on adjacent lots /00 # f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: V. Property line SO' f Building foundation ) 7 Water main/service line Z5 + Surface water 100 1 F- Driveway, parking/vehicle storage area Soy+ Curtain drain /00 + Wells on adjacent lots 100 f F ENGINEER'S CERTIFICATION 1 certify that I have determined thru field inspections and review of Municipal records "Af. s are in conformance with MOA ideline in effect on this date. y�P•"""'•'' 9 Signature Engineer's Name ' R / 6 �F ftOBEtr C ryCSWAN ! Date ( �3 •� CE 8801 HAA Fee $ '✓08 �� Waiver Fee $ Date of Payment ` Lz�Date of Payment Receipt Number Receipt Number 72-026 (Rev. 3/96)* +E, 17:11 ME ESI ANCHORAGE 4 9076941211 CT&E Environmental Services Inc, Laboratory Division i Laboratory Analysis Report NO. 018 003 962700.962700001 Collected Date 07/02/96 10 Lot 1 Dorothy Marie Est. Drinking Water Technical Director: Stephen C. Ede �> Released Results QC PQL Units method allowable Prep analysis Init Qual Limits Date Date - 1.04 0.100 mg/L EPA 353.2 _ 07/03/96 ESC 0.100 U 0.700 mg/L EPA 353.2 07/03/96 ESC col/100mL Sm18 92226 07/06/96 TAV TNTC 08 W/O COLI V Undetected LT - less than GT Greater than D Secondary Dilution J Below the calibration range 200 w. Poller drive, Anchorage, AK 88618-1605 — Tel. (907) 562-2343 Fax; (907) 561-5301 3180 F'eger Road, Fairbanks. AK 98709-6471 — Tel: (907) 474.8656 Fax: (907) 474-9685 FAI.. FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY. OHIO. WEST VIRGINIA