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HomeMy WebLinkAboutDOUGLAS TR B REM Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page / of,,~ www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 0 5P///',~ .~'Llf PID Number: Name: ~~ ~]~r~S WastewaterSystem: ~New ~pgrade Address: 2~ ~ ~~ O~ ~ ~ ABSORPTION FIELD Phone: ~__/~ Z Number ~ Bedrooms~ ~eep Trench ~ Shallow Trench D Bed ~ Mound ~ Other: LEGAL DESCRIPTION so, Rating: ~ ~ GPD/Ft~ Ft. Block: ~~ ~ ~¢~ S Depth to pipe botto~ fro~ original grade: Gravel depth be~eath pipe: ¢ : Gravel LenCh: Townshi Range: Section: Fill added above original gr?. . %~Ft. ~ Ft. ~e ~ Number of lines: I Distance belden lines: Well: ~f ~ New ~ Upgrade Grave, width: ~ Ft. / -- Ft. Classifi~,i0, <Private, A. B, C): / ,th: Ft. Cased~// Ft. Total abso~tion area: ~ ~O Fi2: Pipe Materi~ Driller: ~S Date Drilled: ~c .a.r L~el: ,natalie Date Installed:/ Yield: Brat: C~Heigh, Above Ground;" ~g SEPARATION DISTANCES B Septic ~ Holding~.T.E.P. ~ Oth~  Manufa~urer: Capacity: To Septic Absorption Li~ Holding ~ubliCPrivate Tank Field Station Tank Sewer Line ~ Gal, ~,, /¢a'¢ Materia ~be, of CompaAments: Size: / ,a~la%~,:STATI6N I  "Pump on* le~ in. "Pump o~ level at: ~High water ala~ at: Cudain Drain ~ ~ . Pump~Model m. Ele~d~l Insp~ions ped~ by: Remarks: ~~.~ V~/~~ BENCHMARK Inspections pe,ormed by:.1_~_ (~ Dates: 1st ¢Y 37/[ - Development ad.ices Depadment Approv&( ' Conditional Approval Date: , / Reviewed and approved by: ! U ~~¢' Date: / 0 ¢'// I--IF'Il-- f-) f.D ~- N C 0 _Q (- t-- Z vD C U ~ C Z W J Z p- L~ Z X W (- c U U U (- C C O~ Z +~ 0 0 ¢ O_ U (- bO 0 0 0 (- U c v Z <[ CF-- 0 OZ 0 (- C 0 ._ 0 ¢~ .> C U II II C 0 C II W Z I, W ED Z T m ~ n/ Z F- W S Permit Number: Tax Code Number: Work Type: On-Site Wastewater Disposal System Permit OSPl11254 05020101000 Septic MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 EImore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade ° /1'oo Permit Effective Dates: September 21, 2011 to September 20, 2012 Design Engineer: NORTH RIM ENGINEERING Subdivision: DOUGLAS Site Legal Address: DOUGLAS TR B REM G:0058 Owner/Address: CORP OF ST ANDREWS PARISH OF THE ARCHDIOCESE OF ANCHORAGE 225 CORDOVA STREET ANCHORAGE AK 995012409 Lot Size in Sq Ft: 93828 Site Mailing Address: 21738 PRICE DR, Eagle River Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field N SepticTank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: The permit includes waiver OSP111258 allowing the drainfield to be 37 feet from a slope _> 25%. Received By: , Issued By: Date: Date: Municipality of Anchorage P.O. Box 196650 · 4700 Elmore Road Anchoraqe, Alaska 99519-6650 · (907) 343-7904 · Fax (907) 343-7997 http:l/www.mu ni.or.qlOnsite Development Services Department On-Site Water and Wastewater Program ~ent ,R · Department VARIANCE/WAIVER REVIEW WR#: OSPl11258 HA#: PID#: 050-201-01 Legal Description: Douglas Tract B Rem Engineer: North Rim En.qineerin.q Permit: OSPl11254 Applicant: St. Andrew's Parish Your request for a waiver of the required 50 feet horizontal separation from the absorption field to a slope greater than or equal to 25 percent has been approved. The approved separation distance is 37 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: 9/21/11. Approved by'z~ -~ C../ Name of Reviewer Rec~: 01599C Amount: $200.00 Date Paid: 9121/11 **** VARIANCE/WAIVER REVIEW **** Community Development Department Development Services Division On-Site Water & Wastewater Program UNICIPALITY OF ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 Mayor Dan Sullivan ON-SITE SEWERANELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. O .~C~-- Z ~/- 0 [ Property owner(s) %'T:'. ,,,¢~,.t_t j~,,~-,~fJ~. Day phone Mailing address /~'¢'.5='.~' ~_.e..~'TL¢~.I~'"c:j~ ~/t~__.., ,~¢,, ftc. Site address ~----~/'-~.~'~¢P' /~f¢~ ~)~1~'~... / Legal description (Sub'd.. Block & Lot) ~0~ ~,_~ ~'~"':~' ~ Legal description (Township, Range & Section) Lot Size---~'-I. 0~2. oe Sq. Ft. Number of Bedrooms Z7/ THIS APPLICATION IS FOR: ([~] all that apply) . Absorption Field /,~ Septic Tank ' [] Holding Tank [] Privy [] Private Well [] THIS APPLICATION IS AN: Initial [] Upgrade ~ Renewal [] Water Storage [] THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: 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. aut r, (Signature of property owner or ~ush Fees: Date of Payment: Receipt Number: Permit No. Waiver Fees: Date of Payment: Receipt Number: Waiver No. C)_¢'~ i ! I ~. G:\Building\On Site\Forms\Client Forms\Permit App_010411 .doc (Rev. 1/11 ) EERING MEMO Steve Eng, PE, PH P.O. Box 770724, Eagle River AK 99577 (907) 694-7028 tel northrimeng@aol.com Date: 9/15/11 Number of Pages: To: MOA On-Site Services Subject: Douglas, Tract B New Trench Design An existing house has a failed trench. A new wastewater trench has been designed. The old trench will be connected via valve. The existing septic tank and piping will be used. The test hole revealed fine sand w/cobbles and no groundwater. No conflicts exist to neighboring lots. An existing water well is already drilled and location shown on drawing. Please review the wastewater system design for the single family home. I have included design plans & specs, design guidelines, & soil tests. If there is need for additional information or clarification please give me a call. Thanks-Steve Douglas, Tract B SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is an existing 4-bedroom, single family home. The existing trench failed an adequacy test. A replacement trench will be constructed and the old trench connected via a valve. Most of the neighboring lots are developed. This is a large lot with no separation conflicts. The easements are located on the drawing and are not encroached upon. Soil tests revealed sandy soil with cobbles. An application rate of 1.2 GPD/FT2 with 0.5 reduction factor for utilizing a 5' wide trench. Trench Length = 500 FT2/5'x .5 reduction factor = 50'; 1 line ~ 50'. Monitoring revealed no groundwater. The existing septic tank will be used. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. · Use the existing 1500 gallon septic tank. · Install a "Bull-Run" valve or equal at the head of the trench. Connect to new trench and old trench. "On" to new trench. · 3' of cover or insulation is required for trench; an equivalent of 1" insulation for 1' foot soil cover. 2' minimum soil cover with insulation. Minimum insulation sheet thickness is 2". · Tank & solid pipe must be set on well compacted, stable soil. · 4 inch diameter cleanouts with airtight caps are required 1' to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. · All cleanouts must extend to at least ground level. · In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. · Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain- rock. · Drain rock to be ½" to 2 ½" screened. Drain rock to be distributed uniformly throughout the trench. · Perforated pipe to be installed level with perforations down. · Silt barrier (filter fabric) to be installed above the drain rock. · Smeared trench sides must be raked or scarified before drain rock placement. · The finish grade must be mounded to promote drainage over the trench. · Insulation must be placed over any pipe installed under driveways or parking areas. · Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, · Sewer Service Line is minimum 2% slope. · Septic Tank to be pumped every two years or when required. · Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) Z -4 V × r-l~ "~'D COZ 0 ~ 0 FOZ n ~ rr-1 0 ® 0 ©~ ~- ® © D D ---I © (I) © D © MEMO Steve Eng, PE, PH P.O. Box 770724, Eagle River AK 99577 (907) 694-7028 tel northrimeng@aol.com Date: 9/21/11 To: MOA On-Site Services Subject: Douglas, Tract B Number of Pages: 3 New Trench Design- Slope Measurements Slope Measurements were made in order to determine if the existing slope would qualify for the April 7, 2004 Slope Setback Memo by James Cross. The attached drawing shows that at a downhill distance of 35 feet, the 25% is not crossed. The edge of the trench will be located adjacent to the existing lower driveway. Please review the slope waiver measurements. I have included drawings. If there is need for additional information or clarification please give me a call. Thanks-Steve H- O Z <[ W Z H- Z X W I +~ 0 C 0 0 Z X I,I _C _C U U U c C C ~ ~ 0 r~ Z .p 0 ~- U U -~ C C C C W 0 6.) 0 0 ~0o 0 C 0 0 0 Z <[ C~ 0 ~__,LD OZ cD(/) _> O) 0 U C O 'O tn ('- 0 o.U U ~.-F> U Oq'~ SFIILS LOG - PERCOLATION TEST Date Performed: 9/7/11 Performed For: Barbara Crittenden Legal Description: DougLas, Tract B p - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10 - 11 - 13 - 14 - 15 - 16 - 17 - 18 - 19 - 20 - DEPTH (FEET) ::O:':-.~..'~ ¢. i,.'i:', .'.: :! ':¥":~:<0": Organic Overburden SP Sand w/ CobbLes T,H, Location: See Attached Design ~ Date Gross Time Net Time Depth Net Drop 1 9/7 0 -- 7, -- 8 9/7 10 10 min, 10,5' 3,5' 3 9/7 12 -- 7, -- 4 9/7 82 10 rain, 10,5' 3,5" 5 9/7 85 -- 7, -- 6 9/7 35 10 rain, 10,5' 3,5' 7 9/7 37 -- 7' __ 8 9/7 47 10 mir, 10,5" 3,5' 9 9/7 50 -- 7' __ 10 9/7 60 10 rain, 10,5' 3,5' Comments: Presoaked, Measured to Performed ByNorthRim Eng, I PerFormed in Accordance with ON THIS DATE, DATE: 9/15/11 Groundwater? No Depth -- Water Depth AFter Monitorinq,None Date: 9/15/11 PercoLation Rate 3 min,/inch Perc HoLe Diameter 6~ Test Run Between 3' and 4' nearest ]/16th inch, ~~' CERTIFY THAT THIS TEST WAS ALL State/MunicipaL GuideLines in EFFect N OR THRIM EN ~INEERIN G; PO Box 770724 Eagle River, Alaska 99577 907. 694. 7028 TESTHE]LE LOG T, H, 1 G E O T E C H N I C A L ~ h CRT RIM ' Ex.~N~INEERING SBILS LOG - PERCOLATION TEST Dote Performed: 9/7/11 PerFormed For: Bcrbcr~ Crittenden Le9ct Description~ DougLas, Troct B p - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10 - 11 - 12 - 13 - 14 - 15 - 16 - 17 - 18 - 19 - 20 - P1 - DEPTH (FEET) ...::0:':-.0:..'~ Orgcnic Overburden SP Send w/ CobbLes T,H, Locction: See Attcched Design Groundwoter? No Depth Woter Depth AFter Monitorinq,None Dote: 9/15/11 v ~ Dance Gross Tirae Net Tirae Dep~ch Ne~c Drop 1 9/7 0 -- 7,, -- 2 9/7 10 10 rain, 12' 3 9/7 12 -- 7. -- 4 9/7 22 10 rain, 12" 5 9/7 25 -- 7, -- 6 9/7 35 10 rain, 12" 5" 7 9/7 37 7" __ 8 9/7 47 10 rain, 12' 5" 9 9/7 50 -- 7,, __ 10 9/7 60 10 rain, 12" 5~ Perco~ction Rote ~min,/inch Perc HoLe Diometer Test Run Between 3' ond 4' Comments: Presoaked. Measured ±o near~%~t 1/16~ch innh. Performed By Nor~hRim En9, I ~~ CERTIFY THAT THIS TEST WAS Performed in Accordcnce with A~ Stcte/Municipo~ Guidelines in EFFect ON THIS DATE, DATE: 9/15/11 OR THRIM gN GINEgRIN (3 PO Box 770724 River, AIosko 99577 907. 694. 7028 TESTHDLE LOG GEOTECHNICAL T, H, 2 , Municipality of Anchorage Page / of ,2. DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: .-5'/,t/~?~),~,~- PID Number: Name: a,,~¢o Am ~~ ~ "~~ Wastewater System:~ New ~Upgrade Address: ~%~ /DZ~ ~~ ~ ABSORPTION FIELD Phone: No.~f B corns: ~ Deep Trench D Shallow Trench ~ Bed ~ Other LE GAL DESCRI PTIO N sci, Rating: Total De~m original grade: GPD/Sm Ft. Block: Subdiv~ion: Depth to pipe bottom from original grade: ~vel depth beneath pipe '~;w.,,,,:i....e: Ise ,,o.: Fill added above original~~ Gravel length: Ft, ~ Ft. Ft. WELL: D New ~ Upg~ Gravel wid~ Number of lines: } Distance between lines: Ft. Ft. C'lassification (Private, A,B,C): ~ Cased To: ~orption area: Pipe material: ~ Ft. Ft. SQ. Ft. Driller: ~ Date Drilled: Stati~ Water Level: Installer: ~ / Date installed: ~ SEPARATI ON D ISTAN CES ~Septic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding Public/Private M~ufacturer' ~[~ Capacity in gallons:/ From.., Tank Field Station Tank Sewer Lines ~ / Material: Number of Compadments: Sudace /~ LIFT STATION Line / ~ * I ~t & ~ -- ' ,0' "Pump on" level at:~evel at: I High water alarm at: Foundation /0 + ~ ~ ~ Cu~ainDrain /~ i~ /0~ l+ __ -- -- :Pu~ I Electrical Inspections pedormed by: ~emarks: ~Xf~//~ 5~t~ ~ YellOW. BENCH MARK , Location and Description: ~ ~ ~ ~ ~ ~ [ Assumed Elevation: ENGINEER'S SEAL Department of Healt~ and Human Services appro~a~ Reviewed and approved by: Date: 72-013 (Rev. 9/91) MOA 25 PREVIOUS A-C=24,0' B-C=15,6' A-D=31,2' C-D=P4,0 AS-BUILT SEEPAGE SYSTEM DOUGLAS ply B7' STATE SETBACK ESMT, EXIS DETAILS/SITE PLAN S/]], TRACT B L500 GAL S,T, weLL SCALE: 1' = 50' MILE-HI RI]AD IBM PREPARED FDR~ CBRPBRATIDN DF ST, ANDREWS PARISH P,D, BOX 10B839 ANCHORAGE, ALASKA 99510 KND ENGINEERING 20441 PTARMIGAN 3LVD EAGLE RIVER, AK, 99577 (907)696-6111/Fox (907)696-8111 DATE: 4/28/97 DRAWING # SCALE: AS NOTED 97o88-$1 PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970082 DESIGN ENGINEER:KND ENGINEERING OWNER NAME:CORP OF ST ANDREWS PARISH OWNER ADDRESS:21739 MILE HI AVE EAGLE RIVER, ALASKA 99567 DATE ISSUED: 5/05/97 EXPIRATION DATE: 5/05/98 PARCEL ID:05020101 LEGAL DESCRIPTION: DOUGLAS TR B REM LOT SIZE: 93828 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: SEPTIC TANK 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 (iSAAC80). 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: ISSUED BY: ~]~ ! 6' ~- ~ND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 April 30, 1997 Municipality of Anchorage Dept. of Health & Human Services On-Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Remove & Replace Existing Septic Tank - Douglas S/D, Tract B Gentlemen: On Saturday, April 12, 1997, we received a request from a contractor to provide services in conjunction with a collapsed septic tank. The tank had completely collapsed to the point that the system was not operational causing sewage to backup into the house. I contacted Mr. Cross and received a verbal authorization to replace the tank in the same location subject to applying for a permit and insuring separation distances were met with all wells. We also were to leave the tank open for inspection as required. The tank was replaced on Saturday and we conducted an inspection of Monday April 14th. In addition to the tank we had the contractor install two (2) post tank cleanouts and a foundation cleanout. Due to constraints with the location of the house and porch we were unable to install the foundation cleanout any closer than approximately 10' away from the house instead of the standard 5'. The existing septic system was permitted and installed in 1989, however, no inspection of the tank was performed or cleanouts installed at that time. The existing tank was removed and disposed of on site. The new tank was placed in the same hole as the previous tank and separation distances were verified to be compliant with DHHS criteria. There are no public or private wells within 200' of our proposed system location except as noted. There is neither surface water within 100' nor any curtain drain within 50'. The surrounding lots are developed and we do not expect that there will be! a~y adveLse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, .!1~ D Engineering attachments: On-Site Well and Sewer Application Wastewater Absorption System Details/Site Plan WASTEWATER SYSTEM DnUGLAS S/D, DETAILS/SITE TRACT ]} PLAN PRICE DRIVE ND PUBLIC WELLS WITHIN 200' BF PROPOSED SYSTEM, ND PRIVATE WELLS WITHIN 200' DF PRDPOSE~ SYSTEM EXCEPT AS NOTED. :NSTALL POST TANK C,O,'s >REVIOUS SEEPAGE 27' STATE SETBACK ESMT. ~o,oo & REPLACE EXIST, 12~ GAL, S.T. MILE-HI ROAD NOTES: 3, 41 5, 6, EXISTING TANK HAS FAILED, REMOVE AND REPLACE WITH NE~/ TANK, USE 1250 GALLON SEPTIC TANK, INSULATE TANK IF <4' COVER, CONTRACTOR WILL ENSURE MAXIMUM 2% SLOPE INTO SEPTIC TANK, CONNECT TO EXISTING OUTFALL PIPE AND INSTALL POST TANK CLEANOUTS. INSTALL FOUNDATION CLEANOUT, ALL OTHER SYSTEM COMPONENTS TO REMAIN THE SAME, PREPARED FOR, CORPORATION OF ST. ANDREWS PARISH P.O, BOX 102239 ANCHORAGE, ALASKA 99510 KND ENGINEERING 20441 PTARMIGAN BLVD EAGLE RIVER, AK, 99577 (907)696-6111/Fax (907)696-8111 DATE, 4128/97 IDRAWING # SCALE: 1~ = 100' ~ 97oa8-s1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES Phone(s)~_ ~ /~O ]1 PermitE ? ~ ~N°' ilN°' ~°f Bedrooms WELL 1 3 5- / / / ~ ~ Lot T~¢~ ~ Block lSubdivision Township, Range, Section AS-BUILT DIAGRAM (Show location of well, septic system, prope~y lines, foundation, TANKS N ~ SEPTICEr,~.~/ ~ HOLDING ~anufacturer Capacity in gallons Material No. of Compa~ments ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER / Depth to pipe bottom from Total depth from originat grade ~ , Fill added above original grade Gravel depth beneath pipe ~, ~ ~N Gravel length Gravel width ~ Total absorption area Distance between lines ~ ~ ~ Number of lines Soil rating Pipe material ~, t~ X ~ ~ ~ WELLS "~. ,X REMARKS: d~zH p,.. - ~ - I ~~ ce,fly ,,at t,is ,nspe,10n was ped0rme, according ,0.11 $ ~' Louis A. Municipal and State guidelines In effect on this date: ///~/~ va'a ~..%~ CE-d73&? Health Oepa.ment Approval: Date: /~0/~ ~ '~'fPP 72-013 (3/85) i]wr'~er' Name:: C['.'.'RPOI::;.'ATIr'' ..,]lq 01::' SA I N'T' AIxlDI::;'.EWS I:::'AI:";'. I SH Owr"~ e: r Ad d r ess i~ I:::' ,, 0,, BI] ,X '., .,.n'""'"'":r~;~,-,,. ::......,. A N C H 0 F:;.: A G E, A K 9 9 5 1. () ;(:) a'y F:' h c:, n e: 6 9 4-2 1 '70 I,,..o t I_ e g a 1 :: S u I::)c:l :i, v i s .i, o n ~: DOUGLAS SUBD ! V I S I ON Se,r,;:t ;l (;ill ~ 9 'L[ C)t4r'l~,~h :i.p ~ 141',1 Range l,,.,u,,, S:i,;,ze 9'7680 (sq,, f'L c)r' ac:t"es) Max Deci r' ,::::,c:)rns ~: 'T'l"l :i, s I:::'e r' m i '1'.,: 4 'l"ot a ]. Cai:',) ac :i, t, y L,,otl - Block: B 1W d:.r' I ,,, [; 'i"ANI< M in :i. mum 'Lot a t sep't',, :i, c 'Lant-:: c:apac :i.'Ly: 1, ,,t,,..t.. ga :1, 1 otis. Each sept :i, c f · , ,, () '1:, an I,:: must h ave a'L ',1. east,:::,"'"' c: oml::)a r' t men t s. Dep'l:..h '1',,o top o f s~ep'[:, :i, c: t,,,,,:~l I.:: . s ~ ,::', 4 '~-' 6) e 'L r' ~<s) c:lt.,~ :i, r' (.:::) ~!~ :i. r"~ ~ L,( ]. a '[,, :i. C)r'~ (::) v ~:~) r' 't',. a ri k ( !5 ) ,, :1: t',tI:::'[)F;H"I D. H ,, H ,, S ,, F:'R I OR 'T'() ',1: I',ISF':'tECT I []IxlS B'Y CNG I NEER ~,, :[ t:::' Af::"f'EF:;~ Oi"::'I:::'ICIE HOURS, CALl .... :343-468:1, AND LEAVE A MIES,SAGIE. CONSTI::;;LK:;T PER IENG];NEtiEF:;;S A'T"/"ACHIED AI:::'PF~',OVED DI!~:SI[+.~N,, ]'HIS PEF;HdIT EXF::'];F;',IES :1.2t/::51/89 AND VAL, ID F:OI::;~ A SINGLE; F::'AM]:LY H()ME. ANY IEXCAVATION MUST BE OPEN AND CL,[)SED 'T'HE SAME DAY OF;.', I"'IEAT['LL" IF L, EF'T OPEl',! OVER IxlIGHT'. C lie R'T' I F:' Y 'T' H A 'T: :I., t am fam:i, liar. w'it'..l"~ tl'~m requipements For' on-site sewer's and wells as set. f'or','Lh !',:)y the I"lur'l:i,c.:i,f~a].:i. ty of' Anc::hor'age (MOA) and the S'Late of Alaska. 2. ;t: w:i,],], :i.r'ls'Lall the system :i.n a(:::(:::c:)r'danc:e w:i.'Lh a],l MOA c:c)des ar'id r'egu],a'L:i,(::H"~s~ and :i.n c:omp],iance w:i. th the design c:l'i'Ler':i.a of this I]ercn:i,'l:.,. ::~;,, ]: wi].l adher'e 'Lo alt MOA and ER. ate (::)f Alaska r'E~qt,,~;i,r'eflter'1t, s for' 't;,,he set back d :i, star'lc:(.:.Ys ~' r'om any ex ~.st;i.r]g we]. sewer'.a(;;le ~!~ys'f,.em (;)r'l 't',.h :i.s (;;)p ar"~y adj ac::e~it of' r'teai"by ~o't',,. 4,, ]; ur~c:lerstar'id tha'L 'Lhis permit a ].s(:;) Ltrid((,'.,~r ~Ft',. aR (::l that the capac:i, ty ot' the to'Lal sys'Lsl~ is 4 bedr'ooms ar'~d ....... .......... .cc.;,. ................................................... C,[tI~LAT :1', [)N 01:;:' SA ]', NT 7,~NI',)RI!iEWS i:::'Al::;~ :[ SH Municipality of Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 November 3, 1989 Father Moore Corporation of Saint Andrews Parish P.O. Box 102239 Anchorage, Alaska 99510 Re: Permit Number SW890256, Tract B Douglas Subdivision, P.I.N. 050-201-01 Dear Father Moore: It is our understanding the referenced property belonging.to Saint Andrews Parish is being sold to the current tenant, Paul Delachroche. The sewer permit issued to the parish was, issued in anticipation of the new owner(Mr. Delachroche) converting the structure currently being used as a duplex to a single family home. This office does not have authority to issue sewer permits for multifamily structures. Therefore the conversion from duplex to single family must be completed prior to the transaction between the Corporation of Saint Andrews Parish and Mr. Delachroche. If the structure is not converted or if Mr. Delachroche intends to continue using the structure as a duplex, the subject permit will be voided and the jurisdiction over the sewer system transferred to the Alaska Department of Environmental Conservation (ADEC). If you have questions, please contact me at 343-4744. Program Manager, On-Site Services cc: Paul Delachroche(perspective buyer) Louis Butera, P.E., Project Engineer MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS L~)G PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 - ToP 5o~- t. ,: .' O ~g WASGF O '.' ENCOU .... '~ '~ DEPTH~ JND WATER ED? AT WHAT Date V, SLOPE Gross Time .~,: ;lo,' ,",--, DATE PERFORMED: lC)/ /"7 / (~fi ,, SITE PLAN I S L O P E Net Time Depth to Water Net Drop MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOl LS LOG PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: I0/ LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O SLOPE SITE PLAN WAS GROUND WATER S ENCOUNTERED? /V£i L O 1 ~' ' ~'~,/~ ~/~ P E If YES, AT WHAT/~'-- i /0/. t1.~. DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE 5' ~o (minutes/inch) TEST RUN BETWEEN ~', 5- FT AND 7 I' FT COMMENTS PERFORMED BY: 72-OO8 (6/79) Eagle River Engineering Services Eagle River, AK 9957* 694--5195 CERTIFIED BY: ~-'~'~~- ' DATE: 550.1 O' NO WELL." +1 O0 EXISTING PIT TH3 [ ~// TH1 27' STATE SETBACK EASEMENT 329,90' Mile High Rd. 100' SEPTIC SITE PLAN LEGAL: D_ou§las Subdv. Tract B OWNER: Paul Delcrose CONTRACTOR: N/A JOB # 89-120j DATE: 10/18/89J SCALE 1" = 50' EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 I~ - TEST HOLE · - MONITOR TUBE o - SEWER CLEANOUT" + - WELL :;~;;;;~;,';- PROPOSED ~CHFIELD EASEMENT ~ EAGLE RIVER ENGINEERING SERVICES P. O. Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 SHEET NO. CALCULATED BY CHECKED BY SCALE ,,,"~O 7' ~ S~-,~ Z..~' OF DATE DATE - SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL= DOUGLAS SUB., TRACT C A o GENERAL I. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department Of Environmental Conservation require- ments. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified or modified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. ?. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. B. It is always recommended that a surveyor locate the nearest lot lfne position and the location of any easements. DRAINFIELD 1. The drainffeld is to follow the natural land contour to malntafn uniform total depth of the trench bottom. 2. The bottom of the drafnfield shall be level, plus or minus 1.5". 3. The total depth of the drainfleld excavation is not to exceed g' at any point. 4. The sewer line is to replace the existing sewer line that leads F~- tank. 5. The dratnffeld gravel is to be covered with typar or fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 4' or equivalent is to be placed over the drfanffeld. ?. The area over the drainfield is to be finish graded to prevent pondlng of surface water runoff. 8. The septlc tank and leachffeld must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS TOTAL DEPTH = 9' DRAINFIELD LENGTH GRAVEL DEPTH = 2.5' DRAINFIELD WIDTH = 5' Soil Rating = 163 Bedroom Capacity : 4 Septic Tank Size = 1250 ***NOTE: ***NOTE: INSULATE FLOW LINES UNDER DRIVING SURFACES. SLOPE WITH 45° CONNECTIONS. ~ PROPERLY ABANDON EXISTING TANK. STEP SEWER LINE DOWN \ 330.10' NO #ELLS ~100' EXISTING PIT I ! I I I I NOTE: TIE SI~/ER UNE TO W. TRENCH AT OR CLOSE TO MID POINT. TH3[ rH 1 I 27' STATE SETBACK EASEMENT 329.90' 33' SEPTIC Mile High Rd. SITE PLAN LEGAL: Douglas Subdv. Tract B OWNER: Paul Delcrose CONTRACTOR: N/A JOB # 89-120 DATE: 10/51/89J SCALE 1" 50' EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 694-3297 100' [] - TEST HOLE · -- MONITOR TUBE o SEWER CLEANOUT 4h ~: WELL :i:::i::::: ,~, I~ROPOSED LEACHFIELD ------,~ ~EMENT SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: DOUGLAS SUB., TRACT C GENERAL 1. The well and septic plan are for a single family residence only. 2. 'The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department Of Environmental Conservation require- ments. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. A'll excavations and depths are advisory and are to be verified or modffied in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibfflity of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. ?. The excavation is to be exactly in the area shown on the site plan, any deviation requires engtneer approva'l. 8. It is always recommended that a surveyor locate the nearest 'lot line position and the location of any easements. DRAINFIELD 1. The drainfield is to follow the natural 'land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the drainfield shall be level, plus or minus 1.5" 3. The total depth of the drainfield excavation is not to exceed 8' at any point. 4. The effluent line is to replace the existing sewer 'line that 'leads from the exising tank. 5. The drainfield gravel is to be covered with typar or fabric material. 6. Soil or combination of soil and extruded board insulation 'to a depth of 4' or equivalent is to be placed over the drianfield. 7. 'The area over the dratnfield is to be ffnfsh graded to prevent pondtng of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private we'll, 150' to any Class "C" well, or 200 feet to any community welt. RECOMMENDED LEACHFIELD DIMENSIONS TOTAL DEPTH = 8' DRAINFIELD LENGTH = 102' Soil Rating = 163 Bedroom Capacity = 4 Septic Tank Size = 1250 ***NOTE: ***NOTE: GRAVEL DEPTH = 1.5' DRAINFIELD WIDTH = 5' INSULATE FLOW LINES UNDER DRIVING SLOPE WITH 45° CONNECTIONS. PROPERLY ABANDON EXISTING TANK. SU RFACES~P SEWER LINE DOWN GRE ANCHORAGE AREA BO,..,I.' Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME Do.ug Jones MAILING ADDRESS River ROa~EGAL DESCRIPTION LB ~ LOCATION 4".5 Miles Eagle PHONE SEPTIC TANK: UL~184942 DISTANCE FROM WELL 139 ' MANUFACTURER Stack Steel MATERIAL Steel INSIDE LENGTH. INSIDE WIDTH LIQUID DEPTH_ NUMBER Of 2 COMPARTMENTS LIQUID CAPACITY 1'250 GALLONS. SEEPAGE PIT: ~ DIAMETER 66 ' 12 ' 21,' 6 ' NUMBER OF PITS · .,, OR WIDTH ........ LENGTH , DEPTH LINING MATERIAL Concrete CRIB 51ZE: DIAMETERwallace DEPTH DISTANCE FROM: TOTAL EFFECTIVE BUILDING FOUNDATION ~ ADDITIONAL ABSORPTION , NEAREST LOT LINE (125 WELLApprox 200' ABSORPTION AREA (WALL AREA) 396 ! SQ. FT. sq.'/bedroom required - good for three(3) bedrooms) WELL; TYPE Drilled Approved CONSTRUCT ION DEPTH BUILDING 86 ' NEAREST NEAREST 100 '+ SEPTIC 139 ' FOUNDATION __, LOT LINE , SEWER LINE , TANK_ CESSPOOL , OTHER SOURCES. APPROVED JRL -DISAPPROVED REMARKS DISTANCE FROM: SEEPAGE Approx 200 ' SYSTEM DISTANCES: INSTALLED BY: Richard Berg PIPE MATERIAL: Cast Iron LOTSLOPE: Very steep REMARKs:Excavator had problems with water runoff from mountainside. Form No. EQ-031 DIAGRAM OF SYSTEM DATE June 20, 1 9 7 '~PPROV ED G.A.A,B. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Performed For ~a~ ,~7~~ Legal Description:/ Lot ~' Block This Form Reports Soils Log ~_ Case # Date d P e.r f orme d ~/9/~'~ Subdivision_ ~o~?//~$- ~: Percolation Test - Soil Test Must Be Logged To 4' Below Proposed Seepage System - Depth Feet Soil Characteristics Was Ground Water Encountered? If Yes, At What Depth? I 1, lO- ll- 12-- 13-- 14-- i't _] 1... Reading Date Gross Time Net Time Depth to H20 Net Drop Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet . Depth to Botto~ of Pit or Trench COMMENTS: /~..9-'F,2z?/ b-,~l,-o .,--~ - ~.- ?';'11 ~ ,'~ ~X,' s Date: Municipality of Anchorage • �,• << On-Site Water and Wastewater Program o •,t _ (907) 343-7904 :. IAA 1I G f Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-201-01 Expiration Date: q' 12-` t,S2 1. GENERAL INFORMATION Complete legal description DOUGLAS TR B REM Location (site address) 21738 Price Dr, Eagle River, AK Current Property owner(s) George Day phone 240-1369 Mailing address same Real Estate Agent Elena Novitsky-Mabeus Day phone 240-1369 2. TYPE OF DWELLING: 5 6 y 8 a ;i•,,� ® Single Family (w/wo ADU) '13\* c ,rT- :.,\,,❑ Duplex `,!, ,/,,. ❑ Multiple Dwellings (Single Family and/or Duplex) Q JUN 0 , l j if. :1 3. NUMBER OF BEDROOMS: 4 , 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by: - /h _ Date: .//2/r' P- COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 52.-(f, "" Date: Date of Payment to-(c"(g Date of Payment Receipt Number OQ1g i L Receipt Number COSA# O5C,tt I Z�j�o Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 6/6/2018 _`• is °e ` 47 6. DSD SIGNATURE '�z ~�° v' y r; • r '- yr ra• System #1 Approved for VI •_ bedrooms. '`, System #2 Approved for bedrooms. ;a.. v,. r £ �I� Disapproved. ,/� ‘c' . Conditional approval for bedrooms, with the following stipuiattqfs .z-- 0i- HiG, ON—SITE • WATER AND c� WASTEWATER c, rROGRAM By: � Original Certificate Date: `2 The Municipality of Anchorage Devlopment Services Division(DSD)Issues Certificates of On-Site Systems Approval(COSA)based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory . Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheer 9.1-12.doc If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate icate of On Site Systems Approval Checklist Legal Description: 4D CU GL,4_s %1e 13 AFM Parcel ID: QSQ ZO (O•( A. WELL DATA Well type P If A, B, or C provide PWSID# Well Log (YIN) A/ Date completed / ?73 Sanitary seal (Y/N) y Wires properly protected (YIN) y Total depth V)/f<ft. Cased to (//1/k ft. Casing height(above ground) Zd in. FROM WELL LOG AT INSPECTION Date of test. 0A/1, 5/23/,¢ Static water level LJ/kit< ft. !/( ft. Well production CJNk- g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate Al 6 mg/L Arsenic A/ b ug/L Date of sample: S(/4118 Collected by: / e,frp, En B. SEPTIC/HOLDING TANK DATA Tank Type/Material 5 SPT/C/ STI L Date installed 61�i/'7? 7 Tank size /500 gal. Number of Compartments Z Cleanouts (Y/N) Foundation cleanout(YIN) y Depression over tank (Y/N) A/ High water alarm (YIN) ( A/ Date of pumping `(6/l8 Pumper IYrR`f ?uvtitPE,2_' C. ABSORPTION FIELD DATAo 9,�3 i( Soil rating7—P , Date installed . (g d./ft2 or ft2/bdrm) !, o� System type-7—PE�Ie_* Length 55 ft. Width S ft. Gravel below pipe y ft. Total depth ci ft. Eff. absorption/ area 5-50 ft2 Monitoring tube y Depression over field Ai Date of adequacy test S/Z3// 8 Results (Pass/Fail) P For 47/ bedrooms Fluid depth in absorption field before test 33 in. Water added (00 gal. New depth , 7 in. Elapsed Time: , CO min. Final fluid depth 33 in. Absorption rate >= g' YO g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION /4A Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot /00 1'f' On adjacent lots /a 0 Absorption field on lot MIS lS !'f' On adjacent lots / f Public sewer main /CO f Public sewer manhole/cleanout . /G C f Sewer/septic service line 2 S. f Holding tank (d d -F- Animal containment areas 5 "f Manure/animal excrete storage areas /Da +- SEPTIC/HOLDING TANK ON LOT TO: Building foundation /614- Property line /O 11- Absorption field /6 i# Water main (0 Water service line / 0 f Surface water /OO �f Wells on adjacent lots /06114 ABSORPTION FIELD ON LOT TO: Property line /0 -F Building foundation / Water main Water Service line /0 (1- Surface water /06 Driveway, parking/vehicle storage l Curtain drain (/A/1( Wells on adjacent lots /OD /4- F. -F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and - review of Municipal records that the above systems are in 'eh,. conformance with MOA COSA guidelines in effect on this date. ERViiE. ; =X1 : * Engineer's Printed Name 3 7"FV6 �/✓ Date ‘-/ /t 0/14.'"4-.1; �•�i►i1d���r COSA yellow sheet_2-6-15.doc Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 Parcel I.D. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 050 ;] t -01 1. GENERAL INFORMATION Complete legal description Douglas Tract B REM Expiration Date: /- Location (site address) 21738 Price Drive, Eagle River, AK 99577 Current Property owner(s) St. Andrews Mailing address same Day phone 689-1802 Lending agency Mailing address Day phone Real Estate Agent Barbara Crittenden . Mail'ing Address Prudential Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: 4 Day phone 689-1802 TYPE OF WATER SUPPLY: Individual Well IndiVidual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding Tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 9/29/2011 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and se, E~A~ are subject to these various and dynamic characteristics and are outside the control of the ~OF evaluator of the well and septic system. ~ Approved for ~ bedrooms, t, ~,'.. uisapprovea. Cond~bonal approval for bedrooms, with the following sbpulabons: 0N-SITE · ~: ~ATERAN~ Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X -~ .. PROGRAM .. ?,y.~ .. .' Arsenic Advisow Maintenance Agreements Supplemental Engineer's Repod Other Original Certificate Date: Municipality of Anchorage Development SerVices Department Building Safety, Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHEC.KLIST Legal Description: Douglas Tract B REM A. WELL DATA- Public'Water Well type P If A, B, or C provide PWSID # ~ Dare-completed 19737 Sanitary seal (Y/N) Y Cased to Unk FROM WELL LOG na ft. na g.p.m. Nitrate <MRL Total depth Unk ft, Date of test Static water level ,Well production WATER SAMPLE RESULTS: Coliform Pass colonies/100mL Arsenic: 1.18 ugd :mg/I Date of sample: 8/2~11_ B. SEPTIC/HOLDING TANK DATA Tank Type/Material Sept~q'Stee! Date installed 6/4/97 Parcel ID: 050-210-01 Well Log (Y/N) N Wires properly protected (Y/N) Y_. Casing height (above ground) 20 in. AT INSPECTION 4118/11 42 ft. 3.5 g.p.m. .mg/L Collected by: NorthRim Eng. Tank size 1500 gal. Number of Compartments 2_ Cleanouts (Y/N) Y_. Foundation cleanout (Y/N) Y_ Depression over tank (Y/N) N_. High water alarm (Y/N) N Date of pumping 9/28~1 Pumper lR's C. ABSORPTION FIELD DATA Date installed 9/23/1_I Soil,rating (g.p:d.lff2 or ft21bdrm) 1.2 System type Trench '-' Length 55 ft. Width'_5 ft. Gravel below pipe 4__ft. Total depth _9 ft. Eft. absorption area 550 ft2 Monitoring tube Y Depression over field _N_ Date of adequacy test NEW Fluid depth in absorption .field before test Elapsed Time: na min. Final fluid depth __ Results (Pass/Fail) Pass For 4__ bedrooms na in. Water added na gal. New depth na na in, Absorption rate >= na g.p.d. in. Any rejuVenation treatment (past 12 mo.) (Y/N & type) N__If yes, give'date --- D. LIFT STATION Date installed na "Pump on" level at na in. Datum na E. SEPARATION DISTANCES Size in gallons na "Pump off" level at na in. Cycles tested na Manhole/Access (Y/N) na High water alarm level at na in. Meets alarm & circuit requirements? na SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main NA Sewer/septic service line 25+ Animal contaihment areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 10'+ Water main NA Water service line Wells on adjacent lots 100'+ On adjacent lots 1_00+ On adjacent lots 100+ Public sewer manhole/cleanout NA Holding tank na Manure/animal excrete storage areas Absorption field 100'+ Surface water 100'+ NA Driveway, parking/vehicle storage 10'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 10'+ Water main Surface water 100'+ Wells on adjacent lots 100'+ Property line 10'+ Water Service line 25% Curtain drain (None Kaown) COMMENTS Zabel Valve To Old Trench. "On" to New Trench, 0'+ G. ENGINEER'S CERTIFICATION I certify that I have determined 'through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steve Date 9/29/2011 COSA Fee ~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 4 ~'~. Steven~W. Eng (Rev. 11/05) ANALYTICA GROUI~ NorthRim Eng Attn: Steve Eng 17237 Bear Paw Circle Eagle River, AK 99577 907-694-7028 Fax: 907-694-7026 Client Sample ID: Sampling Location: Client Project: Sample Matrix: COC #: PWS#: Residual Chlorine: Comments: ER 8 ER 8 Drinking Water SP-Analytica, Inc.-Anchorage 4307 Arctic Blvd. Anchorage, AK 99503 Phone: 907-258-2155 Fax: 907-258-6634 Report Date: 9/7/2011 Receipt Date: 8/24/2011 Sample Date: 8/24/2011 Sample Time: 10:00:00AM Collected By: SE Flag Definitions: MRL = Method Reporting Limit MCL = Maximum Contaminant Limit B = Present also in Method Blank H = Exceeds Regulatory Limit M = Matrix Interference J = Estimated Value D = Lost to Dilution ** = RL higher than MCL; target not detected TNC = Too Numerous to Count - result rejected CF = Confluent Growth - result rejected TCNG = Turbid Culture No Growth - rejected Lab#: A1108364-01A Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 4500-NO3E (Aqueous) - Nitrate+Nitrite pres Test was conducted by: Analytica - Anchorage Nitrate-Nitrite as Nitrogen <MRL mg/L 0.10 10 8/31/2011 8/31/2011 MC Lab#: A1108364-01B Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 9223B-PA (Aqueous) - Coliforms in DW E. Coli Pass PASS/FAIL 1.0 Total Coliform Pass PASS/FAIL 1.0 Lab#: A1108364-01C Test was conducted by: Analytica - Anchorage 1 8/24/2011 8/24/2011 KM 1 8/24/2011 8/24/2011 KM Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 200.8/200.8 (Aqueous) - Family Well Water I Arsenic 1.18 ug/L 0.15 Test was conducted by: Analytica - Thornton 10 200.8 9/1/2011 9/1/2011 RM Page 3 of 3 ARCTIC PUMP & WELL INC. Jim PO Box 770197 Eagle River, AK 99577 (907) 688-2510 (907) 258-2510 (907) 745-2510 apw([i;¢ci.net Pump Installation Log Well Drilling Permit Number: SW Parcel identification Number: Date of Issue: Legal Description:Douglas TcB Rem Lot: Property Owner Name & Address: St Andrews Parish 225 Cordova St Pump Installation Date: 10/6/2011 Pump Intake Depth Below Top of Well Casing: Pump Manufacturer's Name: Dempster Pump Model: Pump Size: hp Pitless Adapter Burial Depth: feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: U/K. Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: Well casing 40+ with no perforations Feet Pump Installer Name: Arctic Pump & Well, Inc. Arctic Pump & Well, Inc. Page 1 of 1 _j AS-BUILT Anchorage Recording Precinct, Alaska, and that the imp_rove: men_ts situated thereon are within t_he l~rol:~ty .lines and ao not ov .e~lap or ericro.ach on the prol~~ ly~..8-adjic_ent thereto, that ~ ~ver~.erits. on pr~.~rty 1 .~ir~_~ acI.j~nt thereto encroach e.p~m~..es m quest]on a~d that them a~ no roadways, _tra~s~o. ~?~.es,o? othe~ visible easements on said pt°pe~y except as mdicatecl ne~eon. Dated at ..Eagle ]Uve~, ~[aska ROBERT C. JOHNSON '~ ~, SCALE: Resistered Land S _mTeyor No. gS0-LS 1', = ~n~ p.nt~:~,on~t'0~r~,~o_~.~River, Alaska ~577 TIME 'DATE INSPECTOR DIRECTIONS: I NSPECTI ON APPOINTMENTS TIME DATE INSPECTOR 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] .MULTIPLE FAMILY T , r 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC' UTI LITY Connection Verified 3. S WA E D SPOS; L SYSTEM [] INDIVI DUAL/ON -SITE F-IPUBLIC UTI LITY Connection Verified r'~lSepticTank or [] Holding Tank Size: If Tank is homemade give dimensions: "+YPE OF TANK TOTAL ABSORPTION AREA i4. DISTA~I~ES WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED TIME DATE - INSPECTOR NUMBER OF BEDROOMS [] ONE [] THREE [] TWO [] FOUR PERMIT NUMBER , , DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER FIVE .[] OTHER SIX SOl LS RATING MANUFACTURER VIATERIAL ion Area Sewer Line [Z~APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must acco_~m@an¥ [] DISAPPROVED ///! DATE I' BY (Title) / ~'~ L'EGAL DESCRIPTION certificate) 72-010 (Rev. 3/78)