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HomeMy WebLinkAboutCONTOUR ACRES #3 BLK 3 LT 4Contour Acres #3 Block 3 Lot 4 #017-451-13 Municipality of Anchorage Page of 71 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: S W `ISO H O -7 PID Number: of 7 - L451 - 13 �' Name: Boa ()OP*4P, Wastewater System: El New ❑ Upgrade Ngo ta>C- Address: * -I-Isis 20 ` BAST o► o �Lv>7, 1,5o Ark FJ N k ABSORPTION FIELD Eal! S`t ," Phone:No. L}L} -385 of Bedrooms: 11 Deep Trench E3 Shallow Trench ❑Bed El Mound ❑Other LEGAL DESCRIPTION Soil Ra' g: Total Depth from original grade: GPD/Sq. Ft. Lot: Block: Subdivision- A000 3 Depth to pipe bo tto m original grade: Gravel depth beneath pi G04ToLOA GtLFS Ft. Ft. Township: Range: Section: Fill added above original gra Gravel len Ft. WELL: ❑ New ❑ Upgrade Gravel width: u er of lines: Distance between lines: EXIST/nf Ft. Ft. Classification (Private, A,B,C): Total Dep • Cased To: Total absorption area: Pipe material: I?K%,JP%-r�G Ft. Ft. SQ. Ft. Driller: Date Drilled: Static Water Level: Installer: Date installed: Ft. ovJ reit- V�S'rA r✓�- Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES XSeptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding ublic/Private Manufacturer: TRT Capacity in gallons: From Tank Field Station Tank Sewer Lines A wekv►oRkg- Isoo Well- f to 0'+ — z5 �t- Material: STFF_L_ Number of Compartments: 7- Surface/ooI bolt ---- -- -- LIFT STATION WaterLot 10 l'f" Size in gallons: Manufacturer: Line / O't Foundation t "Pump on" level at: mp off" level High water alarm at: CurtainPump N° ar k °"�/� Make Electrical Inspections perform Drain Remarks: JNW 0,5u&LE -00 T BENCH MARK Location and Description: 14Ta LL So poki 0 R To Al,40 F-ree, -r& rA- U e < Neo —pit,i tic.. >=► l4L_ GRA oft 6 0 s'? Ccm,-& !o Btr De*1E 1►.i TN-E-SPRIrIG �F moi, Assumed Elevation: CItJGI_�O�s ToP So f✓ Rab SOD EN I�N"E�k%S S`EA , ,�,,� �IF AJV 1, Inspections performed by: WA',5'r&WKT" CadsuarA-4 Dates: is lO lya ®° °' ° °®°"" `"' • llnl�. Io 1,. ®. ...... ........ 2nd . f A. Garness Department of Health and Human Services approvals `- ' , E-7953 •. ����� IROFESSION�� Reviewed and approved by: Date: 1160 , 72-013 (Rev. 9/91) MOA 25 /2 PERMIT NUMBER: SW980407 AS -BUILT DRAWING PARCEL NUMBER: 017-44 51-13 NEW 1500 GALLON SEPTIC TANK---- BARN EXISTING TRENC wTOPSOIL AND SOD TO BE PLACED OVER TANK IN THE SPRING OF 1999. INVM or am a Imxf - 92,98 CO *PIN& (.m 96,70 t 51 5T2 TOPSf"/ 44 NSW 1500 GAI,I.ON %FfIC TANK I T °o' W I IC) I � WELL EXISTING DRIVEWAY ---__--._---__-- �� W \ oulfl f VINMf oP DIM OLnef - 92.68 ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 7320 E. CHESTER HEIGHTS CIRCLE. ANCHORAGE. AK 99504 PHONE: (907) 337-6179/FAX: (907) 338-3246 4L DESCRIPTION: CONTOUR ACRES SUBDIVISION ADDITION #3, LOT 4. BLOCK 3, OF WORK: AS -BUILT OF SEPTIC TANK UPGRADE PARED FOR: PHONE NUMBER: BOB FINK 441-6385/345-0840 DRAWN BY: bt;w.t: rn�c: 10/23/98 J.L.M. 1 = 40' 2 OF 2 0F.A_ 'J;'• H •'. alt WIT ... .. .. e rey A.�. n .s: s�'•, C 7953 -, c 'l\ti�'ro f essi00—t v -ia 12 MUNICIPALITY OF ANCHORAGE VDepartment of Health and Human Services On -Site Services Program 825 L Street, Room 502 O P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW980407 Legal Description: CONTOUR ACRES #3 BLK 3 LT 4 Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: Bob Fink Date Issued: Oct 14, 1998 Expiration Date: Oct 14, 1999 Parcel ID: 017-451-13 Site Address: 012746 REATA DR Lot Size: 87770 SQ. FT. Owner Address: 206 E. Dimond #150 Total Bedrooms: 3 Permit Bedrooms: 3 Anchorage , AK 99518 - This permit is for the construction of: ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. Received BY Date: / Issued By: u��," "U Date: • V Alaska Water & Wastewater Consultants, Inc. 7320 East Chester Heights Circle — Anchorage — Alaska 99504 Phone (907) 337-6179 — Fax (907) 338-3246 Consulting Engineers October 13, 1998 Municipality of Anchorage Department of Health and Human Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic Tank Upgrade for Lot 4, Block 3, Contour Acres Subdivision Addition #3 To whom it may concern: The existing 3 bedroom house is served by a private well and a septic system that consists of a 1500 gallon septic tank and a trench type drainfield. The septic tank has collapsed and needs to be upgraded as soon as possible due to the health hazard. We propose to excavate, pump, crush, and abandon the existing septic tank by burying on-site; and replace it with a new 1500 gallon septic tank in the same area of the old tank. Double cleanouts are to be installed prior to and after the new tank. We request that you issue a expedited permit due to the health hazard. The excavation will be a owner install. Attached is a letter stating the experience level of our client. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. P. r.-_ M.S. LOT 1, BLOCK 3, CONTOUR ACRES ADDN #3 LOT 2, BLOCK 3, CONTOUR ACRES ADDN #3 / \ COUNTRY CLUB LANE \ ' 100' WELL RADIUS ' WELL I G � \ / I LOT 5, BLOCK 3, \ — CONTOUR ACRES ADDN #3 I EXISTING SEPTIC TANK (SEE DESIGN, PAGE 1 OF 2) Z �� LJI Gam;k (, _EXISTING DRIVEwar --WEL Q \ W \ Iry EXISTING TRENCH \ / I G 4161 LOT 3. BLOCK 3, \ \ CONTOUR ACRES ADDN #3 \ 100' WELL RADIUS I I WELL ALASKA WATER AND WAS'T'EWATER CONSULTANTS, INC. 7320 E. CHESTER HEIGHTS CIRCLE, ANCHORAGE, AK 99504 PHONE: (907) 337-6179/FAX: (907) 338-3246 LEGAL DESCRIPTION: CONTOUR ACRES SUBDIVISION ADDITION #3, LOT 4, BLOCK 3, TYPE OF WORK: SITE PLAN PREPARED FOR: PHONE NUMBER: BOB FINK 441-6385/345-0840 10/13/98 I- - J.L.M. I 1 = 100' I 1 OF 2 ..... .... .... • • . Je r y A. • arness; IOm C —7953ly v �O�ffikpro i essi0� INSTALL DOUBLE CLEANOUTS PRIOR TO AND AFTER THE NEW SEPTIC TANK. ---h BARN EXISTING I I I EXISTING DRIVEWAY EXISTING 1500 GALLON SEPTIC TANK. TANK HAS COLLAPSED. REPLACE WITH NEW 1500 GALLON SEPTIC TANK. OLD TANK IS TO BE PUMPED, CRUSHED, AND ABANDONED BY BURYING ON—SITE. WELL ALASKA WATER AND WAS'T'EWATER CONSULTANTS, INC. 7320 E. CHESTER HEIGHTS CIRCLE, ANCHORAGE, AK 99504 PHONE: (907) 337-6179/FAX: (907) 338-3246 iL DESCRIPTION: CONTOUR ACRES SUBDIVISION ADDITION #3, LOT 4, BLOCK 3, OF WORK: DESIGN OF SEPTIC TANK UPGRADE PARED FOR: PHONE NUMBER: BOB FINK 441-6385/345-0840 10/13/98 I J.L.M. I 1= 40' I 2 OF 2 Te a Aarness,C 7953 %Oa d �v'Pr0faasio� �'� i 1 I i i i i i i I I I EXISTING DRIVEWAY EXISTING 1500 GALLON SEPTIC TANK. TANK HAS COLLAPSED. REPLACE WITH NEW 1500 GALLON SEPTIC TANK. OLD TANK IS TO BE PUMPED, CRUSHED, AND ABANDONED BY BURYING ON—SITE. WELL ALASKA WATER AND WAS'T'EWATER CONSULTANTS, INC. 7320 E. CHESTER HEIGHTS CIRCLE, ANCHORAGE, AK 99504 PHONE: (907) 337-6179/FAX: (907) 338-3246 iL DESCRIPTION: CONTOUR ACRES SUBDIVISION ADDITION #3, LOT 4, BLOCK 3, OF WORK: DESIGN OF SEPTIC TANK UPGRADE PARED FOR: PHONE NUMBER: BOB FINK 441-6385/345-0840 10/13/98 I J.L.M. I 1= 40' I 2 OF 2 Te a Aarness,C 7953 %Oa d �v'Pr0faasio� �'� i Oi_:'r- 1 2-'Boe rioN 243 : a 1 E V'ERGREEM 205 E, Dimond Blvd., 0150 Anchoroge, Alaska 94515 (907) 344.2588 ()ctobcr 12, 1998 Complete Londscope Service Fox (407) 522.2500 Evergreen Landscaping, Inc. ,Jeff Garness Alaska 'Water & Wastewater Consultants Pear Mr. Garnessi Fvvrgreun Landscaping will be installing a now 1,500 gal rank at 12746 Rata ro replace an existing tank that has rusted and is failing. This is for n homawowner installation at my residences The new tank and connections to existing inflow and outflow lines will be in- --pected and approved by your firm this weeks Evergreen has had extensive under -- ground excavation, subgrede preperation and drainage experience over the Dart M years and looks forward to working with you on this project. if you have any questions, please contact ne as soon as possible at the above phone nualbor. Thanks, fvozgrc¢ L ndscapirng, r itobert A. Pink, Pres ant '2UNICIPALITY OF ANCHORAGE Hear_ i and nvironmental Protec on FoXrth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME_�52� _�IQI/�Yl_—___-- MAILING ADDRESS ; on ng CI`—C-Q-- PHONE Z1 -3Y quS'U LA LOCATION �� ---- LEGAL DESCRIPTION SEPTIC TANK - DISTANCE yyak, FROM WELL MAI'4UFACTURER � � – MATERIAL INSIDE LENGTH_ ---INSIDE WIDTH T SAee-1 NUMBER OF COMPARTMENTS _ LIQUID DEPTH LIQUID CAPACITY B0"'GALLONS. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL- I')-- �.__-NEAREST LOT LINE___ -D -- OF LINE # of Lines _.�____ DISTANCE BETWEEN LINES —Ny—A—TRENCH WIDTH 3L IN. TOTAL EFFECTIVE ABSORPTION AREA _--- ® SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE � ® MATERIAL_ BENEATH TILE __._ IN. ABOVE TILE Z IN. SEEPAGE. PIT: DIAMETER OR WIDTH _—., LENGTH_, DEPTH- Log EPTH-Log Crib Rings Crib Size: DIAMETER --_DEPTH DISTANCE FROM: WELL - TOTAL EFFECTIVE BUILDING FOUNDATION NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. Well Class: Depth: Well Distance To: Lot Line _ Bldg: Sewer Line: Pipe Materials: W1�, p", # of Bedrooms: lu Installer: Remarks: G,��S I- t 'I d DATE �LLI. )-1�-IAPPROVED —� � i I _ © - - - I. S1 I !-i- �,Lj - 5- --1 - -- - - DATE �LLI. )-1�-IAPPROVED —� � ' I F- F4 L_ I -r V ��F= n N IZ�_ FZ F4 0 I=- k. DEPARTMENT [ HEALTH AND ENVIRONMENTAL r'9TECTION 825 'L' STREET, ANCHORAGE, HK. 99�_-"1 " r� 279-2511 ' L4 E: L_ L_ Fj p -A I-,.* iZi P -A - - I !�E- EE t4 FEE FR �FEE ��r-1 3: _[ PERMIT NO. ( 77622 APPLICANT DON GLEtt 2834 BONNIFHCE 3334050 LOCATION REHTH DR LEGAL L4 83 CONTOUR ACRES 3 LOT SIZE 84000 SQUARE FEET TYPE OF SOIL HB5ORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 5 SOIL RATING (5Q FT/BR)= 135 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ::L:IL l3FRF4VEEL_ E>E:F�:`r"= � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRE ,QR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (%N 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). �������� ������� �F�NK �I��= ����� OF�����N� H PACKAGE PLANT MAY BE INSTALLED AT THE PERMITTEES OPTION SUBJECT TO THE FOLLOWING CONDITIONS: 1. EITHER H CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. 2. R CONTINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF H MAINTENANCE AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL ABSORPTION 5y5TFM AND/QR YOU MAY BE SUBJECT TO PROSECUTION. ---------------------------------------- ___ -T-wci <;2 > I " 4_3 F=I, [-= C-"- -F I C3 "' E3 F=1 F;?_ E: ���0 U I Fl;z EE r.,A BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELLAND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. Fl" FEE FR. M I _F �X F=' I Fq" E::E5 �I-E r-- e M 0 e F;� 3- jL° ���w I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2' I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3' I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 5 BEDROOMS. SIGNED------------------------ HPP NT DON GLE ���__r�-\ /1-�- / \ ISSUED BY___ ____ ____DHTE__��____________ V].0 t 7 1 "Gr, :rsi is or a :t.cna._nd r t ini +ss" 2204 Cleveland Anchorage, Alasha 99503 Performed For Don Glenn ,Date Performed 8--1-77_ L e n a I r)escri n t i on:— Lot 4 B1 oct:3 Subrii vi s i ones This Vorm Renorts Soils Lon Yes `Percolation Tenth reet _ Soil Characteristics 2 1' Peat 1' Reddish Silt 4 Sandy Gravel 6 Elm 10 — Silty Sandy Gravel 12-- 14- 3-6 2.-- 141-6 18 -- -- Bottom of test hole 20— Was (round Water Encountered?- No If yes, At what Denth? Read i nq Date I Grnss Time Net Time .i Depth to H2O tet Cron! ------ - _�l __ - -----.--__ __-----_.__..--- �- -- --- A Percolation RateMinute Prnposed Installation: Senr�aoe Pit _Drain Field Depth of Inlet Deoth To Bottom Of Pit Or Trench _ - _ -- C nm!,ENTS: 125 square feet required -mer-bedr-e4u_-1rom.._minus._.2!__-to__b_!..__ _- --- -- --150 square -et zequirQdv_nP�dro�m- morons 6 -to -1 s.... -------- Test' Performed By Data Certified PY Ci __ _ E-1 --- i r � i .i Depth to H2O tet Cron! ------ - _�l __ - -----.--__ __-----_.__..--- �- -- --- A Percolation RateMinute Prnposed Installation: Senr�aoe Pit _Drain Field Depth of Inlet Deoth To Bottom Of Pit Or Trench _ - _ -- C nm!,ENTS: 125 square feet required -mer-bedr-e4u_-1rom.._minus._.2!__-to__b_!..__ _- --- -- --150 square -et zequirQdv_nP�dro�m- morons 6 -to -1 s.... -------- Test' Performed By Data Certified PY Ci __ _ ����������gal ���my w FT to PA Lo w4»l Fy K C3 EE: DEPHH[MENT [ HEALTH AND ENVIRONMENTAL 1TECTION 825 'L STREET, ANCHORAGE, HK 994.1 279-2511 PERMIT NO. ( 77832 ) APPLICANT DON GLENN 2834 8UNIFHCE 3134050 LOCATION RIHTH DRIVE LEGAL LUT 4 BL ] CON[UUR ACRES #-"'-* LUT SIZE 85000 SQUARE FEET MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM I5 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F�, k-_ 17-1 k--- k -L _:i�: 1L" I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR UN -SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF HNCHORHGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. �IGNED�_ -------------------- APPLICANT __________________HPPLICHNT DON GLENN ISSUED BY- -- ------ DATE _ _) M -W DRILLING, INC. -) DRILLING LOG Well Owner Dn".) Glenyx Use of Well Location (address of: Township, Range, Section, if known; or distance main road -1:.ot re ` to k :3 Contour. Acres, Anchorage Size of casing {' { Depth of Hole 2.50 feet Cased to 213°6__ feet Static water level t. Niffbelow land surface. Finish of well check one open end Screen ( ) ; Perforated ( xx ) . on_ 1.5 Mills Knife, Perforations ;a Z09 `--4� Describe screen or perforati0 6' Well pumping test at 1 gallons per Uf) (minute) for 1 hours with 10024' ft. of drawdown from static level. Date of completion 10 / 11 / 7 7 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness t. TO Casing stickup TO 4 Organics TO 15 Silty, gravcl .35 Clean sand TO 1_ `a TO 519 TO TO 1_ 1 TO .1 F, TO TO -- O { 1 1.;3;1TO ?.`10 180 TO 20 TO i7 TO--I;t2 TO Silty cobbles Sandy loose gravel Boulder Sand Sand Silty gravel All Silty cobbles anT ly grovel, e } .7 y� CCI'��IC.iit) No's. �J-( & W13'. ! �e L . sandy Lei. �i ply '•... l � J Y-ieck'rock, water scrips i!3 sporadic fraotL:res 2 — STATE Municipality of Anchorage Development Services Department Building Safety Division � r i Onsite Water and 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 FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-451-13 1. GENERAL INFORMATION ST COSA # 0 t)b5 q8 Expiration Date: 3�/07 Complete legal description Contour Acres #3 Blk 3 Lot 4 Location (site address) 12746 Reata Drive, Anchorage, AK 99516 Current Property owner(S) Robert & Donna Fink Day phone Mailing address 12746 Reata Drive, Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Mary Tutterow / Kris Abegg Day phone 240-7682 / 349-1200 Mailing Address 3111 C Street, Anchorage, AK 99503 Unless otherwise requested, COSA will be held by DSD forpickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well ✓❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site El Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite 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 Onsite Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY -ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Watkins Engineering, Inc Phone 907-349-1851 Address P.O. BOX 110443, Anchorage, AK 99511-0443 Engineer's Printed Name CINDY W. ELUS Date 12/5/2006 49LH' 6. DSD SIGNATURE mac; : c:Ir'UY W. Ellis X' Approved for bedrooms. CE.1osn Disapproved. Ess,u c Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory C Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: Z a O (rsw.11M) Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 Bregaw Street P.O. Box 190850 Anchorage, AK 995196650 www.muni.orglonske (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Contour Acres i3 Slk 3 Lot 4 Pa ID: 017-451-13 A. WELL DATA Well type PRI If A, B, or C provide PWSID t= Date completed 10111/77 Sanitary seal (Y/N) YES Total depth 350 ft. Cased to 313.6 ft. FROM WELL LOG Data of test 1011111977 Static water level 190 Well production 1 9.p -m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 1.96 mg1L Arsenic: <•005 mgA Date of sample: 11/27/06 B. SEPTIC/HOLDING TANK DATA Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 25 in. AT INSPECTION 6/19/2006 189 1.8 by recoverylest g.p.m. Other bacteria 0 colonies/1 W mL Collected by: Cindy W. Ellis, P.E. Tank Type/Materiel Steel Septic Tank Data installed 10/14198 Tank size 1500 gal. Number of Compartments 2 Cleanouts (YM) YES Foundation cleanout (YAC DOO Depression over tank (YIN) NO High water alarm (YIN) WA Date of pumping 8/19/2008 Pumper Northland Pumping C. ABSORPTION FIELD DATA Date installed 9112/77 Soil rating (g.p.d.Ae or fe/bdrm)135 System type deep trench Length 50 ft. Width 3 fL Gravel below pipe 7.0 ft. Total depth 11.2 R. Fff. absorption area 700 ft= Monitoring We YES Depression over field NO Date of adequacy teat 8/19/2008 Results (Pass/Fall) Pass For 3 bedrooms Fluid depth in absorption field before test 75.8• in. Water added492.8 gal. New dept87.25 in. Elapsed Time: 1449 min. Final fluid dept 74.5 lr. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN b type) none known If yes, give date D. LIFT STATION Data installed NA Size in gallons "Pump on" level at _ in. 'Pump ofr level at _ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access (YIN) High water alarm level at Meets alarm 8 drain requirement? Septic tankAift station on lot 148' On adjacent lots 100'+ Absorption field on lot 149+ On adjacent lots 100'+ Public sewer main 109+ Public sewer manhote/deanout 100'+ Sewer /septic service fine 140' Holding tank 100• Animal containment areas 100'+ Manurelanimal excrete storage areas 1001+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 1S' Property fine70_+ Absorption field 5'+ Water main 100'+ Water service one 2&+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property fine 14' Building foundation 29' Water main 100'+ Water Service line 25'+ Surface water 100'+ Driveway. park V"hK* storage 18' Curtain drain N/A Wells on adjacent lots 100'+ F. COMMENTS: 'Sump is 7 Itches too deep. Filled the field to the top of the lateral at 87.25 inches from bottom of field (94.25 inches from bottom of sump). Recovery well flow test was conducted. G. ENGINEER'S CERTIFICATION h,•f 49TH 1 certify that 1 have determined through field inspections and ;* review of Muninpal records that the above systems are Jn --- conformance with MOA COSA guidelines in effect on this data Engineer's Printed Name CINDY W. ELLIS Cin Y W Ellis CE•tosrr Data 12105/2008 ................. COSA Fee $ 7U / Waiver Fee S Data of Payment /GL Date of Payment Receipt Number Receipt Number (Rev. I Imm in. 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.ci.anchorage.ak.us (907)343-7904 Septic System Advisory Yom•. t!L•dl f T Health Authority Approval # 060578 During a recent adequacy test on the septic system for Block 3, Lot 4 of Contour Acres 43 subdivision, 75.5 inches of standing water was observed in the absorption field. This indicates that approximately 90% of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Health Authority Approval. SCS Ref.# 1066909001 All Dates/Times are Alaska Standard Time Client Name Watkins Engineering Printed Date/fime 12/05/2006 7:59 Project Name/# Contour Acres #3 Block 3 Lot 4 Collected Date/Time 11/27/2006 15:15 Client Sample ID Contour Acres #3 Block 3 Lot 4 Received Date fime 11/27/2006 16:25 hlatria Drinking Water Technical Director Stepheo C. Ede Sample Remarks: Allowable Prep Analysis Paramaer Results POL Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 11128/061129/06 Mil Waters Department Nitrate -N Microbiology Laboratory Total Coliform 1.96 0.100 mg/L EPA 300.0 0 coV100mL SM209222D B (<10) 11/17/061127/06 ALR A (<I) 1127/06 DPT a r / / e S 0o «' ' w 225.00' « #u 7SEMC 4- — — — — — — — — — — Sz \ o` Pb a' � ,��• e �/ \ w §: ( CDco \k(j § \ w 4 **62 ��a# to � . CA ISV 0.40� g ��¢ } @ Soo@'"w REATA 2 D RIVE \ % § s R \ / / / . / , 8 Z\� & [ o M d R Ef) u V \ 2 G M > § X k ec� ! �q%\ ( | .. |Ii§&m ; �■._ !� E .§!|W o��K? Z |� > (,;/ `@ Q■ m |G3 ,,� > £ a r / / e S 0o «' ' w 225.00' « #u 7SEMC 4- — — — — — — — — — — Sz \ o` Pb a' � ,��• e �/ \ w §: ( CDco \k(j § \ w 4 **62 ��a# to � . CA ISV 0.40� g ��¢ } @ Soo@'"w REATA 2 D RIVE \ % § s R \ / / 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 I.D. # 11 — Lj 1 — 12) HAA # 1. GENERAL INFORMATION '0 Complete legal description A L\.a-ao Location (site address or directions) 17-77q42 1 br. 2",5 Mtle's vv 2 Property owner _71ek m I:Tun! 132ss xw Day phone _'N 5 3212-- . Mailing address Lending agency Pr Day phone Mailingaddress MIA,n.ea,42 �l3,"'Sen D. 1D?025 T510 Agent `obn Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 � 3. TYPE OF WATER SUPPLY: Individual well y Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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 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 rAl r < Phone JU ? " alk Address e `'' %< Engineer's signature 6. DHHS SIGNATURE Approved for 0 Disapproved. Conditional approval for d/vim Additional Comments bedrooms. _ Date v� �'� .• A • lS�1A • _..�,.— , m. ry 1 IMAM • # �. CE 7892 • ' bedrooms, with the following stipulations: 111TIr 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. 72-025 (Rev. 1/91) Back MOA #21 11 . b" Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: t"o7 4 Zl,gr,K 1 G. l or 955- Parcel I.D. A. WELL DATA Well type a If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 0/l/i7-7 Driller __f11 of Total depth Z- 5th Cased to X 13 • ra Casing height 2 - Sanitary seal (Y/N) Y Wires properly protected (Y/N) y c FROM WELL LOG AT INSPECTION Ir--1ro Date test fp // 17-I lJft l "LZ3 �q 11"r► c z of D Static water level d !C� �)'� t , ! Well flow g.p.m.' g.p o Pump level C& 4,U/AJI& 0 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 1 'fid/ '� ; On adjacent lots ZCtl -� Absorption field on lot LX10 On adjacent lots !Zoo Public sewer main ? Public sewer manhole/cleanout A Sewer service line Petroleum tank] WATER SAMPLE RESULTS: Coliform Nitrate LAIA JL1 Other bacteria Date of sample: — 12-A-611 1. Collected by: i5-4A..'4rr r B. SEPTIC/HOLDING TANK DATA Date installed 1177 Tank size 159,9 ag Compartments 2.. Cleanouts (Y/N) Y Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) Alarm tested (Y/N) 14, A' Date of pumping 1g3 Pumper )5 -am P- --- �a► SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well (s) on lot is�l - On adjacent lots 200_" Foundation 30'/4 r l To property line Absorption field Sp Water main/service line— f14A Surface water/drainage 1h 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed t41a. Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 477 Soil rating . System typeT,_VZa-�, Length Width 3! Gravel thickness Total depth 6. -ff" Total absorption area 740 4 Se 1 -Cleanouts present (Y/N) r Depression over fieldY/N u 6"k'`Date of adequacyJ'nl y�i W Rr(0_iZ 4-r� .=> i3 F� �� •T --r es -r- , A Tie- ° .1¢ �, c; 4• Results (pass/fail) 7-A5 , for 3 bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ,1 On adjacent lots Mok Property Fine ?, 1 To building foundation To existing or abandoned system on lot �IA On adjacent lots 2-004 Cutbank tj r IY4 Water main/service line,. Surface water rye Driveway, parking/vehicle storage area �A{ Curtain drain" E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect �o®nboj of this inspection. Signature, 9 • '.r Engineer' ame 45��k A(C • 1W. ,J'�a7WA)Iv-\. " '"• ••"'•: •� Date � GREG RY SM PUTNAM.: �— ������,. CE , 7892 OFESSIO���� HAA Fee $ 3 00 ` C)?' Date of Payment Receipt Number °2�✓�� %a�� 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. r LABORATORY 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 I.D. # ;04RIVATE WATER SYSTEM �e,,s��� �45� 3z1Z Nar�ne \ Phone No. � Z-Ret 1y2 Mailing Address /\.r SAMPLE DATE: 7T Mo. Day SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. ❑ Special Purpose Year ❑ Treated Water ❑ Untreated Water SAMPLE Time Collected No. LOCATION Collected By K 3 1 I 4 L 5 A.D.E.C. READ INSTRUCTIONS 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 } Z Time Received Analytical Method: Membrane Filter * No. of colonies/100 ml. Lab Ref. No. Result' Analy —z 935-6660 m m m BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verification: LSB BEFORE Fecal Coliform Confirmation BGB O Coliform/100 ml COLLECTING SAMPLE Final Membrane Filter R�efsul Coliform/100 ml Reported By °� "1 Date / - - 4" /5-- TNTC = Too Numerous To Count OB = Other Bacteria PART ONE OF TWO: REMAINDER TO FOLLOW SINCE 1909 COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES REPORT of ANALYSIS Chemlab Ref.# :93.6660-1 Client Sample ID :WATER SAMPLE/BASHAW Matrix :WATER 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561.5301 Client Name :BASHAW, JOHN WORK Order :74095 Ordered By :JOHN BASHAW Report Completed :12/16/93 Project Name Collected :12/13/93 @ 15:00 hrs. Project# Received :12/13/93 @ 15:30 hrs. PWSID :UA Technical Director:7��7k--Released By : Sample Remarks: SAMPLE COLLECTED BY: UA Parameter Nitrate -N QC Allowable Ext. Anal Results Qual Units Method Limits Date Date Init, 1.2 mg/L EPA 353.2/300.0 10 12/15 CMR - - -- - --------------------------------------------------------------------------- * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than A190 NN SGS Member of the SGS Group (SociAte G6n6rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA y DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DA E DATE INSPECTOR INSP7771INSPECTO� .!�A MUN IPALITY OF ANCHORAGE MUNICIPALITY OF A H DEPT. QP HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC WRONMENTAL PFOTECTION 826 LStreet - Anchorage, Alaska 99501 i ENVIRONMENTAL SANITATION DIVISION OCT 3 0 1980 Telephone 264-4720 EE EE r D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. T. PROPERTY OWNER -77PHONE do r JOACWA 3Yy -7/�-! MAILING; ADDRESS PQ i4 lag P V 7 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION .' A� PHONE 5. LEGAL DESCRIPTION 7 !G Ofg STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOM SINGLE FAMILY ❑ One ❑ Four ❑ Other Two ❑ Five MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY �. INDIVIDUAL* * ATTACH WELL LOG, A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL,SYSTEM INDIVIDUAL/ON-SITE** Iq.`1"1 YEAR ON-SITE SYSTEM WAS INSTALLED. PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79)- . THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO Q FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGEDISPOSAL. SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: 16bO If Tank is homemade give dimensions: SOILS RATING (� j TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR, BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE X. f BY J 72-010 (Rev. 6/79) CHEMICAL & G&fLOGICAL LABORATORIES ii.W ALASKA, INC. TELEPHONE (907)-2794014 ANCHORAGE INDUSTRIAL CENTER 274-3364 5633 8 Street LA CRATOR:eb Drinking Water Analysis. Report. for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY WATER SYSTEM: Analysis shows this Water SAMPLE to be: I.D. NO. . .... El Satisfactory n Water System Name I% Phone No. Mailing Address City State SAMPLE DATE: _t Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. ❑ Special Purpose SAMPLE NO. 1 2 3 4 5 Zip Code ❑ Treated Water ❑ Untreated Water Time Collected LOCATION {{ Collected By t l Unsatisfactory ❑ Sample too long in transit; sample should not be over 48 hours old at examination to' indicate reliable results. Please send new sample. Date Received Time Received Analytical Method: O Fermentation Tube tg Membrane Filter Lab Ref. No. Result' Analyst 4 i J t.F `i?i I � � m � m *No. of colonies/ 100 ml. or No. of Positive portions. 66-1120 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1978 Date Collected READ INSTRUCTIONS Date Received BEFORE Hours 24 Hours Source a.m. _Time Received p.m. Lab. No. loml I loml 1 10.1 1 loml I 1 1.0ml I 0.Iml EMB Broth 24 hours: Broth 48 hours: COLLECTING SAMPLE Multiple Tube Report: 10ml Tubes Positive/Total 10mI Portions Membrane Filter: Direct Count Collform/looml Verification: LTB BGB Final Membrane Filter Results Coliform/100m1 Reported BY Date Time - p.m.