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HomeMy WebLinkAboutBEAM LT 1Beam Lot 1 #051-102-20 ARCTIC PUMP & WELL INC. k t. Jim Sullivan PO Box 770197 �n Eagle River, AK 99577 wa s w at - (907) 688-2510 (907) 258-2510 (907) 745-2510 abw@gci.net Pump Installation Log Well Drilling Permit Number: SW Parcel Identification Number: Date of Issue: �S ( 16 a- a -O Arctic Pump & Well, Inc. Page I of I Legal Description: Beam Property Owner Name & Address: Lot:I Patricia Gangestad Block: PO BX 671201 Chnaialr AK 095(.7 Pump Installation Date: 12-27-12 Pump Intake Depth Below Top of Well Casing: Feet 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: casing 40' + with no perforations ground slopes away from well Pump Installer Name: Arctic Pump & Well, Inc. Arctic Pump & Well, Inc. Page I of I G��Q GREA',R ANCHORAGE AREA BWIGH t� Department of Environmental Quality 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME /�7t y�fLYl� MAILING ADDRESS,4 Q" ' __531 �r/1'114Z1 PHONE 6,09'aile-, LOCATION%4f: {i/%i/n?' r` el.e LEGAL DESCRIPTION l (l>l j ,�YL•>/!'.�/�. SrY' 4/, T/VV, G''/CJ SEPTIC TANK: DISTANCE QNUMBER OF FROM WELLMANUFACTURER MATERIAL COMPARTMENTS INSIDE LENGTH % vii INSIDEWIDTH �yLIQUID DEPTH LIQUID CAPACITY /V 000 GALLONS. SEEPAGE PIT: NUMBER OF PITS L . DIAMETER _—OR WIDTH2 �p' LLENGTH.Z1, ' DEPTH LINING MATERIAL Ln, CRIB SIZE: DIAMETER84 6EPTH?2 ' DISTANCE FROM: WELL / .3 TOTAL EFFECTIVE BUILDING FOUNDATION q,2, NEAREST LOT LINE x22�. . ABSORPTION AREA (WALL AREA) . -7q6 SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE gni I lad CONSTRUCTION BUILDING NEAREST FOUNDATION, LOT LINE , CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DISTANCES:,4A-A INSTALLED BY: -N2 PIPE MATERIAL: PQ•7f /%'n/) LOT SLOPE: REMARKS: Form PW026 DEPTH DISTANCE FROM: NEAREST SEPTICSEEPAGE i SEWER LINE- , TANK S.LZ_, SYSTEM / REMARKS DIAGRAM OF SYSTEM A gall ?c>7 m _'or NUUSQ ��IL6 S14 - i,000yal icp+�c'Wne � g 5 Y DATE � I/7A APPROVEJ�4 �� A.A.B. GREA -R ANCHORAGE AREA BOR' 'GH ►���� Department of Environmental Quality u 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME/ ' Z3�-2,17 MAILING ADDRESSsS` 3PHONE LOCATION��"! d{ /612-5 ( 'OCG LEGAL DESCRIPTION /-"q// �/�' �.. ' % %/ G'-1/cJ SEPTIC TANK: DISTANCE ff����//%% FROM WELL —L— MANUFACTURER MATERIAL NUMBER OF COMPARTMENTS INSIDE LENGTH—7�ii INSIDE WIDTH LIQUID DEPTH -/-/LIQUID CAPACITY 4g &20 GALLONS. SEEPAGE PIT: NUMBER OF PITS _ 1 . DIAMETER _ OR WIDTH¢22', LENGTH" DEPTH LINING MATERIAL L CRIB SIZE: DIAMETERDEPTH Cc9 / DISTANCE FROM: WELL TOTAL EFFECTIVE BUILDING FOUNDATION , NEAREST LOT LINE cam/ ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: j TYPE �,i�l I I�C� CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION, LOT LINE SEWER LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DISTANCES: 410A INSTALLED BY: PIPE MATERIAL: ��� �� //0/-) LOT SLOPE: REMARKS: Form PW -026 REMAR DATE DEPTH DISTANCE FROM: SEPTIC f� SEEPAGE i TANK , SYSTEM % 3 , . DIAGRAM OF SYSTEM n cv f APPROVED L-4511- Form -4Sr GREA .._R ANCHORAGE AREA BOR.- JGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH fi-6150 ANCHORAGE. ALASKA 99502 rELF.:PHONE 279-6606 PERMIT NO SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCATION//// 16 LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK -ea rl A•' ck • r t �� E TYPE AND SIZE OF FACILITY TO BE SERVED MAILING ADDRESS C✓' ��'X L� GE PIT PHONE V DRAIN FIE D , OTHER 2 l X -y, , 0 i A44 m TO BE INSTALLED BY / SOIL TEST RESULTS /1/ Q ✓ � U �°- NOTEi THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED PERMIT VAI Th (INF YFAR FINAL INSPECTION, 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE LC-'&/G�.,TYPEStP-12^ Or CQnCrPt SEEPAGE AREA SIZE /11 MINIMUM DISTANCES, REQUIREMENTS 5 ft. FOUNDATION TO SEPTIC TANK 99 FOUNDATION TO SEEPAGE PIT 20 ft* , DRAIN FIELD 10 ft, SEPTIC TANK TO SEEPAGE PIT WALL 15 ft SEPTIC TANK 5 ft* , SEEPAGE PIT 20 ft. , DRAIN FIELD 10 ft. TO NEAREST LOT LINE. 10 WELL TO SEPTIC TANK 90 , SEEPAGE PIT i T DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK 10 ft* , SEEPAGE PIT 10 ft.• , DRAIN FIELD 10 ft. , SEPTIC TANK, 25 ft*, SEEPAGE PIT 100 ft. , DRAIN FIELD 50 fte TO RIVER, LAKE, STREAM. TYPE DIAGRAM OF SYSTEM 4" CAST IRON SIPHON SEPTIC PIPE WHO AIRTIGHT CRIB TAN): ,/ CAPS CAST Levee CAST IRON INTO BNDISTL'RBEO 111L 45 N I <--I 5 ?tl Ill RUF tilfi1MUt'l C I required whenever line crosses under driveway. anelc:�tt laFl.l. i)I�_I FSCFS CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF 1t'I'. 1410 L'A 1. EXCAVATION S FEET INTO UNDISTURBED SOIL. 10 w,;J;- (io' 10 PIT- 100' GO SE0:11 LINE- 10' 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. 10 TANK- 00" TO I'll- 120' IXfi11:EP LI;7�- 40' GRAVEL BACKFILL nH'-r.o' MILT LAST IRON SEVER UNE. CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. PUP•l IC .:� 1'0 iArtv,- 200' TO PIT - 200' 100'-2n0' ONLY is?r:N SEWER li W-itq SDIIPCE OF HEALTH THORITY "IInF;'li/'TIDO I OR LICENSED DESIGNER GRAVEL FAJ011. A$DU:10 CR 8. ' TABLE )4' MININUM ABOVE WATER: 4 Inr.H s:NER ur,E. CC14- I:IR ARCA WELLS. SEEPAGE PIT EXCAVATION BASED ON SOIL TEST. LAST ]PON, -7 I'V,[ 5' I?:TO ON. Dr STI!PCCD SoIL EPTIC ANY, M':LL "�I • Grade: 2'.per 100` or 1/4" p r foo: except 10' precreding tank 6 tha. should I not exceed 2,. 6' per NO on flat terrains. —J 4 1NCH ,CAST IRON SIPHON PIPE �SEEPAGE PIT CRIB GRAVEL BACKFILL 20' MINIMUM LOT 1111F. r I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.88 AND THAT THE ABOVE DESCRIBED SYSTEM, IS IN ACCORDANCE WITH SAID CODE. DAT "'/ APPLICANT'S SIGNATURE �' L0 1 GREATER ANCHORAGE AREA BOROUGH DEPA''MENT OF ENVIRONMENTAL QUA' Y 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 CASE # 1 Performed For Raymond Beam Date Performed 7/10/72 Legal Description: Lot —1B 10 C k SubdiV1sion Beam This Form Reports Soils Log x Percolation Test Sec. 9, T 15N, R 1W Depth Feet Soil Characteristics 2 Brown Silty Sand (SM) ~� 4 Gray Sand (SW) with Silty Sand Seams 6 (SM) with few fine gravel s Was Ground Water Encountered? No 0 If Yes, At What Depth? rroposea Installation: Seepage Pit X Drain Field Depth Of Inlet Depth To Bottom Of Pit Or Trench COMMENTS : 185 square feet of drainage area is required per bedroom est Per1 orme a By Carlisle d d erL 1 T 1e a BY: National Testing Date: DATE RECEIVED -_ INSPECTION APPOINTMENTS TIM ' TIME TIME STREET LOCATION DATE DATE DATE ,A( -.Ar V (.r t INSPECTOR INSPECTOR INSPECTO SINGLE FAMILY Y MI fly OF 717-FIEWPUL MUNICIPALITY OF ANCHORAGE DEPT. OF I :' ;',!.T I c< DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT16WVIRONMENIAL i ..:*I -_CTION 825 L Street - Anchorage, Alaska 99501 DEC0* 2 3 1980 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED ECc'VE REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. P PERTY,OWNER Moll, PH NE e=a/ �n � I j depth (attach log if available.) A r„* aod' MAI CraAD ESS /J o Q a t 11 r A -c f7 S/0 PROPERTY RESIDENT (If different from above) PHONE 2. P7R —T /PHONE d 3.�SC� p 4 v' rr) I iQ co d MAI LIN A DRESS ►I uoiolt, 4� 3. LENDING INSTITUTION I PHONE AC-PAC-11PI� L MAILING ADDRESS 4. REALTOR/AGENT PHONE No Q MAILING ADDRESS 5. LEGAL DESCRIPTION e Lj.. U i JQc 9 is N tW STREET LOCATION O L ,A( -.Ar V (.r t 6. TYPE OF RESIDENCE l NUMBER OF,BED S SINGLE FAMILY 0541pp 1A cS1� ❑ One Four ❑ Other ❑ Carl ❑ wo Five '? MULTIPLE FAMILY Three hree E3Six 7. WATER SUPPLY ;K1 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 Wv"i " ❑ PUBLIC UTILITY depth (attach log if available.) A r„* aod' S. SEWAGE DISPOSAL SYSTEM Q � INDIVIDUAL/ON-SITE** (� 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) • np q � ✓ n� I/ n,�. f�• 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENO-E U SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ---97 ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER FOUR ❑ SIX 2. WATER SUPPLY = —'© INDIVIDUAL ❑ COMMUNITY '_ = ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAUSYSTEM INDIVIDUAL/ON -S! TE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED _ INSTALLER �//� r "-09 .1. -7 Septic Tank %/ Holding Tank Size: Y r) )OKIf Talk is homemade give dimensions: SOILS RATING TYPE OF TA K MANUFACT RER [-,) t_Q51) J1 ^J �1�I.I!L'Qll`Yl)LLL�`Y TOTAL ABSORPTION AREA MATERIAL n 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line i 5. COMMENTS r c F O l�( nLA tAPPROVED FOR BEDRO f�COND�ITIONAL APPROVAL (letter acc pany certificate) ❑ DISAOPROVED DATE e 1_ g BY 72-010 (Rev. 6/79) oo DAVID A. SLENKAMP A/�, u MECHANICAL ENGINEER t7e 694-9055 A January 6, 1881 /MUNICIPALITY OF ANCHORAGE �AC'Ef RAVER, At'P'6 DEPT. OF o.-PI-111 �a ENVIRONMENTAL OTE-CT'ON Mr. Dennis Robson Box 3034 Anchorage, Alaska 99 510 • RECEIVED Dear Mr. .Robson, Reference: Lot 1; Beam Subdivision A sewer system adequacy test was performed on the system located on the referenced property, per your request. The septic tank was pumped and verified to have's capacity in excess of 1250 gallons. The seepage pit was charged with approximately 1000 gallons of fresh water and after a period of 24 hours it was determined that approximately 667 gallons had percolated out of the crib. It can be concluded from this test that the septic system is currently functioning adequately for the four bedroom residence located on this property. If we may be of further assistance, please do not hesitate to call. Sinc cc: Municipality of Anchorage Department of Health and Enviornmental Protection Alaska Pacific Bank SRB 196X EAGLE RIVER, ALASKA ROBERT A. SHAFER CIVIL ENGINEER 694-2979 Municipality of Anchorage A4 -� 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 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING �& - /C56U>- Parcel I.D. 051-102-20 COSA # Q e IQ>' ^941 Expiration Date: 1. GENERAL INFORMATION Complete legal description BEAM LOT 1 Location (site address) _22917 DALLON COURT, CHUGIAK, AK 99567 Current Property owner(s) CLIFFORD GANGESTAD Day phone Mailing address PO BOX 671201, CHUGIAK, AK 99567 Lending agency Day phone Mailing address Real Estate Agent LES BAILEY & ASSOC. Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® 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 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 ARCTERRA CONSULTING. INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER. AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 4/18/13 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 septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a �, , system will function satisfactory for current or future "k` -k1 occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist.t�a 5. DSD SIGNATURE ne$ /W, 4 Approved for bedrooms. rnx . Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By Y Original Certificate Date: Lls (R 1vH Municipality of Anchorage s • '� 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 CHECKLIST Legal Description: BEAM LOT 1 Parcel ID: 051-102-20 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # _ Date completed Pre 1972 Sanitary seal (Y/N) Y Total depth 200 est. ft. Cased to 40'+ ft. FROM WELL LOG Date of test Static water level ft. Well production 9-P M. WATER SAMPLE RESULTS: Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) 36 in. AT INSPECTION 6/13/11 184 ft. 0.99 9.p -m. Coliform NEG colonies/100mL Nitrate 3.83 mg/L Arsenic: ND mg/I Date of sample: 4/8/13 & 12/3112 Collected by: ArcTerra B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic Date installed 1972 Tank size 1000 gal. Number of Compartments 1 Cleanouts (YIN) Y Found tion cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping la �) la umper Rs � C. ABSORPTION FIELD DATA V'Ve Date installed 1972 Soil rating (g.p.d./ft2 or ft2/bdrm) 185 System type Crib Length 8 ft. Width 8 It. Gravel below pipe 6 ft. Total depth 9.2 ft. (Measured 6/13/11) Eff. absorption area 540 ft2 Monitoring tube Y Date of adequacy test 6/13111 Depression over field N Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 33.6 in. Water added 670 gal. New depth 45.6 in. Elapsed Time: 85 min. Final fluid depth 34.2 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date -_ D. LIFT STATION 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 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 841+ Absorption field on lot 1001+ Public sewer main 751+ Sewer /septic service line 251+ Animal containment areas 501+ On adjacent lots 1001+ On adjacent lots 1001+ Public sewer manhole/cleanout 1001+ Holding tank 1001+ Manure/animal excrete storage areas 1001+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 51+ Water main 101+ Water service line 101+ Surface water 1001+ Wells on adjacent lots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 101+ Water main 101+ Water Service line 101+ Surface water 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (None Known) Wells on adjacent lots 100'+ F. COMMENTS Casing scoped to 40'+ FCO located inside foundation May consider adding water storage due to well storage (Static water level 184' / bottom of well est at 200') and lower producing well G. ENGINEER'S CERTIFICATION` I certify that / have determined through field inspections and ,W / V review of Municipal records that the above systems are in !* ' conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS_ + Date 4118/2013 COSA Fee $490.00 — PAID PREVIOUSLY Waiver Fee $ _ Date of Payment Id t 1, Date of Payment Receipt Number CJ5 d'7 Receipt Number, (Rev. 11/05) 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 /V CERTIFICATE pP y O 1 SA ETY CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLIN cPC,i 0*0a5c)oy Parcel I.D. 051-102-20 COSA # Expiration Date: —1Y —/3 GENERAL INFORMATION Complete legal description BEAM LOT 1 Location (site address) 22917 DALLON COURT, CHUGIAK, AK 99567 Current Property owner(s) CLIFFORD GANGESTAD Day Mailing address Lending agency Mailing address Real Estate Agent Mailing Address PO BOX 671201, CHUGIAK, AK 99567 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day 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 ARCTERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS - Date 12126/12 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 septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future -dw E' A�� occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. r 5. DSD SIGNATURE �tk.l0 Approved for bedrooms.sa. Disapproved. Conditional approval for bedrooms, with the following stipulations: ��ncunuaL y Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: ✓ Original Certificate Date. if _' 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 CHECKLIST Legal Description: BEAM LOT 1 Parcel ID: 051-102-20 LA1014, 0 r7_A 0 Well type PRIVATE If A, B, or C provide PWSID # Well Log (YIN) N Date completed Pre 1972 Sanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth 200 est. ft. Cased to 401+ ft. FROM WELL LOG Date of test Static water level Well production ft. 9 -p.m - Casing height (above ground) 36 in. AT INSPECTION 6113111 184 ft. WATER SAMPLE RESULTS: Coliform NEG colonies/100mL Nitrate 3.47 mg/L Arsenic: ND mg/l Date of sample: 12/3/2012 Collected by: ArcTerra B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic Date installed 1972 Tank size 1000 gal. ..- Number of Compartments 1 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping,2 2 ! Pumper IRs CV C. ABSORPTION FIELD DATA Date installed 1972 Soil rating (g.p.d./ftz or ftz/bdrm)185 System type Crib Length 8 ft. Width 8 ft. Gravel below pipe 6 ft. Total depth 9_2 ft. (Measured 6/13/11) Eff. absorption area 540 ft2 Monitoring tube Y Depression over field N Date of adequacy test _6113111 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 33.6 in. Water added 670 gal. New depth 45.6 in. Elapsed Time: 85 min. Final fluid depth 34.2 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date_ D. LIFT STATION 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 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 841+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 251+ Animal containment areas 50'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank 1001+ 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 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 101+ Water Service line 101+ Surface water 100'+ _ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (None Known) Wells on adjacent lots 100'+ F. COMMENTS Casing scoped to 40'+. FCO located inside foundation. May consider adding water storage due to well storage (Static water level 184' / bottom of well est. at 200') and lower producing well. G. ENGINEER'S CERTIFICATION i certify that f have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS AV Date 12/26/12 , /� COSA Fee $490.00 Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 11/05)