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HomeMy WebLinkAboutMOUNTAINSIDE VILLAGE #1 BLK 6 LT 5Mountainside Village #1 Block 6 Lot 5 #020-172-33 Nl micip r ' lAr of Anchorage Department of Health and Human Services C�1`liL 825 1" Street Rick Mysrrorn. P.O. Box 196650 Ancnorage, Alaska 99519-6650 Mayor Permit NumberS'W9,,!5�0_W Date Of Issue]] - 3 2f Tax Identification Number020-172 - 7 3 Date Started j -fit --& Date Completed 1`1 - 20 -15 Is well located at approved permit location? W Yes ❑ No Legal Description ��G(�nfZtlnsr�,(G, �rllClG/�#1 Block 6 Lot S Property Owner Name & Address: � 7200 �r5i�/�G nfG�)n �i-Ive A/1 C'60 oa' `/ Borehole Data: Depth Soil Type & Thickness & Water Strata From To Method Of Drilling: ❑ air rotary cable tool Casing Type: er s_c Wall Thickness,2�o igches Diameter inches, depth feet Liner Type: Diameterinches, depthfeet Casing Stickup Above Ground: 2 feet A' r �© Static Water Level (from ground level): feet Pumping Level:�feet after ,e/P hrs. pumping gp Recovery Rate: f S gpm ;0 Method Of Testing: Pci1-f ' G C V\ Well Intake Opening Type: ❑ Open End X Open Hole ❑ Screened; Start feet Stopped_ Z-) feet ❑ Perforations Start ,J 4 feet Stoppedfeet Grout7ype: .0 re,ec) 1 Volume / r? U F T Depth; from Cc�f ,,, � feet, to feet Pump Intake Depth:_Ecn'S eet Pump Size 3 z _hp Brand Name Lin Well Disinfected Upon Completion? ❑ Yes No Method Of Disinfection: 4� �P ,��- Comments: E � E I v ED Well Driller Name S� o -e Com_ Company (t cow i? MAR 16 Mailing Address City State Zip lvlunicipal,ty of Dept. Health & viuman Servicos Attention: The well driller shall provide a well log to the property owner within 30 days of completion. •F MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WATER SUPPLY PERMIT Initial Date Issued: Sep 03, 1998 Expiration Date: Sep 03, 1999 Permit Number: SW980340 Parcel ID: 020-172-33 Legal Description: MOUNTAINSIDE VILLAGE #1 BLK 6 LT 5 Design Engineer: 0019 Flattop Technical Services Site Address: 007200 BIG MOUNTAIN DR Owner Name: JIM & LINDA THOMAS Lot Size: 167492 SQ. FT. Owner Address: 7800 CASEY CIRCLE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE , AK 99507-3082 This permit is for the construction of: ❑ Disposal Field ❑ 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. Receive Issue Date: Date: �a Municipality of Anchorage Page of _ 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: -5W 96'02 306' PID Number: D 20/ 7 2 33 Name: THomQ� Wastewater System: f l New ❑ Upgrade Address: 7600 C�Qy Crrr/P, 4ncA. Ak. 99S07 ABSORPTION FIELD Phone: �� 3 �/F/ No. of Bedrooms: - 57 y O Dee p ® Trench Shallow Trench E3 Bed El Mound ❑ Other LEGAL DESCRIPTION Soil Rating: f Z Total DepthS, 0 original grade: I GPD/Sq. Ft, Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 5 61`IGUA%CIIASI (/Q villG Q $/ L I , 9 t Ft. 3,1 Ft. Township: Range: Section: Fill added above original grade: Gravel length: 1. 0 FL GU Ft. Gravel width: Number of lines: Distance between linees` WELL: El New 11 Upgrade C J Ft. Classification (Private, A,B,C): Depth: Cased To: Total absorption area: 2 Pipe material: F-,510 (7e r -.F Ft. Ft. S 2 SC. Ft. D -,30-7 1/ Nan Driller: EDateDrilled: Static Water Level: Installer: o awn e r- Date installed: 6l y 197 Ft. Yield:Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES C9Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: At, �' Capacity in gallons: ?.i From Tank Field Station Tank Sewer Lines cJ)Q /' e / IX/7 ry� Well- — ZS Material: Sfeel Number of Compartments: 2 >l00 >t6o > Surface - LIFT STATION v. A. Water 7 (OG > 100r — Lot Size in gallons: Manufacturer: Line 25 2g" — — — t "Pump on" level at: "Pump off" level at: High water alarm at: Foundation Sp Curtain - - - Pump Make & Model Electrical Inspections performed by: Drain - - BENCH MARK Remarks: s S {-ewl /.,Sk (lei e• c, eVTX L Location and Description:: GGtt'Y'c m/ G'�Gb/' p �rllcr/ a,(- puri¢ rn1 ec3/zon re prf J'('GP�/' /rmiT" �u7Nv1%�Gr� p/¢(Gi -ecl en p�/n eY�r+i /e rlbn Assumed Elevation: / /' / O� 60C keit/ nAd Or CelTUn aT (v J- l�il�,Ft r'P ENGINEER'S SEAL // // ,S'Lt rlie 41/ S Yee-6m an e" IT I,LI01r,/YI,/ 1'e,I C(Kcnoufl ,nSi�tll�cP Qr-e' 75""� i�, wcE/ �e lrn e .J . Inspections performed by: E(Or e %rte Dates: 1st 6/ 1 97 2nd/l'f Department of Health and Human Services approval C. ' Date: (2"3(V_ Reviewed and approved by: (�— 72-013 (Rev. 9/91) MOA 25 PERMIT NO: 960306 PAGE 2 OF 3 PID NO: 02017233 A, M OU "H" - \ NT�i SWING TIES: \ FROM: COR. 7" COR. "G" COR. "H" COR. "I" \ TO: S.T. C.O. "D" 108' 96' S.T. C.O. "E" 114' 102' TR. C.O."A" 437' 171' 90'TR. (C#2� M.T. "B" 414' 157' 114' ..A..TR. C.O. "C" 390' 151' 143' / 60' LONG C.O. _ x 5' WIDE DBL (TYP) -\ DRAINFIELD C.O� / W. 3.1' GVL. E:. _-DRIVE D.. PROP. 1250 GALLON WELL �. / SEPTIC TANK SITE �O ---TBM �4 BDRM HOUSE UNDER CONST. �♦tt♦�"�`` ,i ��V -- - ------------ OF q� I .•.•... s 4 Aff TH �•.•••.••.••••.0 �..u.0 .• i�• • • •'Y'••o•,••• / 1j • THEODORE F. MOORE �. �•�� CE - 3589 • QA 1,\.Pra fa ss1a_ i�® PERMIT NO: 960306 PAGE 3 OF 3 PID NO: 02017233 INV. 81.3' - 2" RIGID INS. + 2' SOIL COVER 1250 GALLONVINV. SEPTIC TANK 1 81.T li: tOF ^� INV. 26.8 - INV. 26.8' I�,4.466*6 .9® 1' AV Ar BOTTOM EXCAVATION ELEV. 23.T / r y: 49' 60' LONG x 5' WIDE SOIL ABS. DRAINFIELD """° •" '""/`" WITH 3.1' GRAVEL BELOW PERF. DIST. PIPE + ?S •e• THEODORE F. .: V �• •o CE - 358899 �• $cam Asjr •e. .�• c# AF •, �0req •. e u • • nab ®A' \ BOTTOM T.H. #1 ELEV. 17.2' 1��\®`-+►�� M.T. DRY 9/24/96 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960306 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:THOMAS LINDA S OWNER ADDRESS:7800 CASEY CIRCLE ANCHORAGE, ALASKA 99507 PARCEL ID:02017233 LEGAL DESCRIPTION: MOUNTAINSIDE VILLAGE 41 BLK 6 LT 5 LOT SIZE: 167492 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 9/23/96 EXPIRATION DATE: 9/23/97 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. '-SPECIAL PROVISIONS: MAXIMUM DEPTH OF THE DRAINFIELD SHALL BE 5 FEET FROK PORGINAL GRADE. RECEIVED P ISSUED BY: DATE:- / 2- V DATE:- 9` 23 - ?1 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sus: The purpose of this letter is to provide the required design narrative in support of our application for a permit to construct wastewater disposal facilities on Lot 5, Block 6, Mountainside Village S/D, located on Mountain Drive. Soils logs, perc test results, a site plan, design drawings and specifications are enclosed for your review. The proposed system will be constructed in the vicinity of test hole #1. As can be seen from the soil longs, the native material between l' and 7' below ground level is a silty sandy gravel with a measured perc rate of 1-4 minutes per inch. Using the soil application rate of 1.2 gpd/sq. ft. specified in the wastewater ordinance, this proposed 4 bedroom residence requires a total absorption area of (4 x 150)/1.2 = 500 square feet. Using a length reduction factor of 7/12, the proposed 5' wide x 58.5' long drainireld design has a total effective absorption area of 501 square feet. The topography of the lot in the area of the proposed construction slopes down towards the north at 25%. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties, nor will it have any significant impact on reserved space - surface and subsurface, or on drainage. The property owner plans to do the construction work himself, and he will be responsible to provide your office with the necessary proof of his capabilities. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, f� Ted Moore, P.E. cc: Jim Thomas CONSTRUCT 58.5' LONG x 5' WIDE "All SOIL ABSORPTION DRAINFIELD W. 3.0' SEWER GVL. BELOW DIST. PIPE 58.5 C.O. M.T. C.O. Lol ------------------ ---- 4" ASTM F-810 PERF. PIP 4" ASTM D-3034 NON -PERF PIPE INSTALL 1250 GAL. SEPTIC TANK Lo 6 L 6 co UNDISTURBED GRAVEL SECTION "A - All SCALE: 1":= 5'- 0" DBL. ITOR TUBE PLAN VIEW SCALE: 1" 0 10'- 0" INIMUM 2' SOIL COVER - SLOPE 3:1 TO MEET NATURAL GRADE ORIGINAL GROUND FILTER FABRIC 3 RIGID INSULATION F-810 PERF PIPE 2 112" SEWER GRAVEL L5, B6, MTNSIDE. VILLAGE S/D PROPOSED SEPTIC SYSTEM PLAN AND CROSS-SECTION FLATTOP TECHNICAL SERVICES SCALE: AS SHOWN 14530 ECHO STREET DRAWN BY: TFM ANCHORAGE, AK, 99516 SEPTEMBER, 1996 flattop 7echnicafServices 14530 Echo Street, anchorage, AK99516 Phone (907) 345-1355 Lot S, Block 6, Mountainside Village S/d Mountain Drive Wastewater disposal system installation Specifications 1.0 General: 1.1 The scope of the project consists of installing a 1250 gallon septic tank followed by a 58.5 foot long x 5 foot wide soil absorption drainfield with 3,0 feet of sewer gravel below the horizontal distribution pipe. 1.2 Construction shall be as depicted on the approved site plan and design drawings. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform with Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The new 1250 gallon, 2 compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.2 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4"' per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. For pipe runs longer than 75 feet, additional cleanouts shall be installed every 75 feet. 3.0 Soil absorption system: 3.1 The soil absorption system shall be constructed by excavating a 5 foot wide by 58.5 foot long trench in the vicinity of test hole #1. The axis of the trench shall parallel the natural contour of the land and the depth of the excavation on the uphill side of the trench shall be 5.5 feet below original ground level. 3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow proper infiltration. Sand for leveling or serving as filter material shall comply with Municipal specifications. 3.3 A total of 3.5 feet of approved sewer gravel shall be placed in the bottom of the excavation with the perforated distribution pipes laid level such that the pipe inverts are no less than 3.0 feet above the bottom of the sewer gravel. Sewer gravel shall be 0.5" - 2.5" screened gravel, with less than 3% passing the #200 sieve. 3.4 Monitor tubes and cleanout pipes shall be of 4" diameter and installed in the locations shown on the design drawings. The portion of the monitor tube extending through the sewer gravel shall be perforated. 3.5 Approved filter fabric shall be placed over the entire top surface of the sewer gravel. A minimum of 2 feet of soil cover is to be placed over the inter fabric. If the soil cover thickness is less than 3 feet, two inches of rigid, burial type insulation is to be placed over the entire top surface of the gravel, in addition to the filter fabric. 3.6 The top surface of the cover material shall be raised a minimum of 24 inches higher than the insulation and shall be graded to smooth contours. Fill slopes shall be no steeper than 3:1. 3.7 Unless specifically agreed otherwise the homeowner shall be responsible for arranging to have the site finish graded after the backfill material has stabilized, and for placement of adequate topsoil and seed to promote rapid revegetation of all areas disturbed by the construction. 4.0 Inspections: 4.1 A minimum of 4 engineering inspections will be required during the course of the project: (1) initial stakeout with the contractor to establish the location of the system and to discuss the plans, specifications and construction procedures, (2) after the native material has been excavated to expose the infiltrative surface to ensure that it is level and at the right elevation, and conforms with the soil test information, (3) after the sewer gravel is in place and the distribution pipes have been laid and connected up to the septic tank, but prior to placement of insulation or filter fabric, and (4) after rough backfill and grading is complete. The septic tank requires one inspection after it is set level and the piping connected, but prior to backfill, This inspection may be incorporated with any of the above inspections. 4.2 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 TEST HOLE # 1 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Lot 5, Block 6, Mountainside Village S/D DATE PERFORMED: August 16, 1996 PERFORMED FOR: Jim and Linda Thomas DEPTH SLOPE (feet) Pt and reddish sandy loam 1 2 3 4 GP/GM Silty sand gravel Gray, dry 5 Variable silty content 6 7 1]:1:1:: ::1:1:1:1 SM/ML Gray silty sand Damp 10 µ.u.u.u.• B.H. Bedrock 12� 13 14 15 16 17 18 il Depth to Groundwater Date No groundwater 8/16/96 Test hole dr 8/28/96 _................................... ................. , 0% Date Reading Clock Time Net Time (minutes) Percometer Reading Net Dro (inches 8/16 12" Presoak Add water & start 1:05:30 233/8 #1 1:10:30 5 191/4 4 1/8 Add water 23 1/4 #2 1:16:20 Add water 1:17:45 23 1/2 #3 5 418 ` PERCOLATION RATE 1.25 (minutes/inch) PERC HOLE DIAMETER 6, TEST RUN BETWEEN 2.5 FT AND 3.0 FT COMMENTS: This test hole was dug on August 11 1996 and partially re -excavated another older test hole. The Pere test was conducted in a PERFORMED BY FLATTOP TECHNICAL SERVICES. I '� )A� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 9 //6 / 4/< FLATTOP TECHNICAL SERVICES 14530 ECHO ST. ANCHORAGE, ALASKA 99516 TEST HOLE # 2 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Lot 5, Block 6, Mountainside Village S/D DATE PERFORMED: August 16, 1996 PERFORMED FOR: Jim and Linda Thomas DEPTH SLOPE (feet) Pt. 1 SM Reddish sandy loam 2-9ft 6 7 8 9 10 11 12 13 14 15 16 17 GP/GM Silty sandy gravel GM/ML Very silty gravel GM Black angular silly gravel B.H. Bedrock 25% Depth to Groundwater Date No groundwater 816 6 Test hole dr 8/28 6 DateClock Reading 0% Net Time (minutes) Percometer Reading DateClock Reading Time Net Time (minutes) Percometer Reading Net Drop (inches 8/16 12" Preso, 27 3/8 Acid water & start 4:45:30 23 5 8 41 4:50:30 5 217/8 13/4 Add water 4:51 231/2 #2 4:56 5 223/16 15/16 Add water 4:56:30 23 1/2 #3 5:01:30 5 221/4 114 Add water 5:02 23 12 #4 5:07 5 2214 114 L-1 PERCOLATION RATE 4 (minutes/inch) PERC HOLE DIAMETER 6„ TEST RUN BETWEEN 2.5 FT AND 3.0 FT COMMENTS: This test hole was dug on August 11, 1996 and left open PERFORMED BY FLATTOP TECHNICAL SERVICES. I l _ ,moi /LLc._ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IINddEFFECT ON --THIS DATE. DATE: 9 / /6 /9C M.O.A. DH IS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: S F.p 2.3 1996 Municipality of Anchorage C)ept. Health & Human Services 7800 Casey Circle Anchorage, AK 99507 September 23, 1996 As per phone conversation of September ", 1996, I am writing this letter. I am the owner of Lot 5 Block 6 Mountianside Village. I am an "owner builder," and intend to do the septic work myself My experience includes working in the building trades for over 30 years. I own my own excavating and drilling equipment. All work will be preformed in accordance with all M.O.A. and DHHS regulations, under the direction of Ted Moore, P.E. Sincerely, James R. Thomas CERTIFICATE OF ON-SITE SYSTEMS APPROVAL. FOR A SINGLE FAMILY DWELLING Parcel I.D. 0 172--33 COSA# Expiration Date: O 1. GENERAL INFORMATION Complete legal description Lot Se 8I&C k G y,rlWe $t r Location (site address) -77-00 Ery huc.�Aain l�rv� Current Property owner(s) O• f• i L rn ado, 71ia.naf Day phone (90Y) V.10-0 0 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 72 S++10i.-, Trru/� Pales+ eoatl. FL T216Y-SS67_ Day phone Day phone Unless otherwise requested, COSA will be held by DSD for pickup. P l take Cul/ T. ^ 00-40"t4 1 Aclma,1 2. NUMBER OF BEDROOMS: _ y.tG-x669 L4,Afin GalA rely {vim /rick -MP 3. TYPE OF WATER SUPPLY: Individual Well 191 Municipality of Anchorage A Development Services Department Building Safety Division ❑ On -Site Water and Wastewater Program 5 4700 Elmore 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. 0 172--33 COSA# Expiration Date: O 1. GENERAL INFORMATION Complete legal description Lot Se 8I&C k G y,rlWe $t r Location (site address) -77-00 Ery huc.�Aain l�rv� Current Property owner(s) O• f• i L rn ado, 71ia.naf Day phone (90Y) V.10-0 0 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 72 S++10i.-, Trru/� Pales+ eoatl. FL T216Y-SS67_ Day phone Day phone Unless otherwise requested, COSA will be held by DSD for pickup. P l take Cul/ T. ^ 00-40"t4 1 Aclma,1 2. NUMBER OF BEDROOMS: _ y.tG-x669 L4,Afin GalA rely {vim /rick -MP 3. TYPE OF WATER SUPPLY: Individual Well 191 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 191 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 engineers 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. NameofFirm F/c.1/.1. Tec4ri ca/ $c.v:cv Phone 3NS—Irs- Address &Ayo^ R✓, .4nc4o,-aft, i4 C 99t.1K 0 Engineer's Printed Name Date 9 / 29 / 2ao9 Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Rev 11105) e< 1. 10 0 r"ne<a <ee eeeen ee oe•.n.•ev4.v.� ry 5. DSD SIGNATURE i .... 'a a YHF0,442 F. a^ORE ; �' ` Approved for C-35°9 �. bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Rev 11105) Municipality of Anchorage • '-' Development Services Department Building Safety Division ' On -Site Water & Wastewater Program 4700 Elmore 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: 1,01-S-' )3 Jr cte f�i� MoU^ /161^ sloe Wok /sl Parcel ID: 07-0 - /7 2 -33 A. WELL DATA Well type f If A. B, or C provide PWSID # Date completed X20/9 8 Sanitary seal (YIN) Y Total depth je ft. Date of test ' Static water level Well production Cased to 'L,_ft. FROM WELL LOG 1►/20/96 J6S ft. I.S. g.p.m. WATER SAMPLE RESULTS: Coliform_g2. ies/100 mL Nitrate 2.6Y mg/L Arsenic:_ ug/L date of sample: cam/ /6 /09 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Seokc Y.S kd l Tank size 17-5W gal. Number of Compartments 3_ Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 7d in. AT INSPECTION 2oS, ft. •, /.o g.p.m. Other bacteria 0_colonies/100 mL Collected by: 1=lohlvp TceA S..e ,, Date Installed 6 /Y /9 7 ,Cleanouts (Y/N) Foundation cleanout (Y/N) Y � Depression over tank (Y/N) )J High water alarm (Y/N) /J. A Dateofpumping 9/23/09 Pumper A,r 11o~ Sty✓«'moi C. ABSORPTION FIELD DATA . Date installed_!E_/97 Soil rating (g.p.d./ftZ or ft2/bdrrri) System type S'- dt als►,n Fi./� '�* a Length lib ft. Width S ft. Gravel below pipe 34 ft. Total depth -C ft. Eff. absorption area 228= Monitoring tube Y Depression over field #J Date of adequacy test 9 / 24 /09 Results (Pass/Fail) Pwl For _9 bedrooms Fluid depth in absorption field before test U In. Water added,Z31i6gal.� New depth2.d_ in. Elapsed Time: Z V& min. Final fluid depth 7 in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) 0 If yes, give date M..4. D. LIFT STATION JJ. tr, Date installed Size in gallons 'Pump on' level at_ in. •Pump off" level at _ in. Datum E. SEPARATION DISTANCES Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot hut' Absorption field on lot > tuo • Public sewer main N • A. Manhole/Access (Y/N) High water alarm level at Meets alarm 8 circuit requirements? On adjacent lots > too* On adjacent lots -o trp Public sewer manhole/cleanout N Sewer /septic service line ? 15•0 Holding tank ry A. Animal containment areas N• A. Manure/animal excrete storage areas N• / SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 160 Property line T -S Absorption field > 2Atr, Water main N• A. Water service line > to' Surface water •> trio - Welts on adjacent lots 7 trio' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO Property line 'LS'* Building foundation _> 7.av I Water main M• 04 Water Service line ? tbSurface water > ICA&' Driveway, parking/vehicle storage o' Curtain drain Akey SOOA Wells on adjacent lots F. COMMENTS•..v 0101 C,e; rnrl rllid 6s/w*e^ fstn4.e4mm hove- DgAiA r VII nn-rowkod !Jv r2a0-4- of at/a,v..sr )-Wit in. Will $44100.+111- ^0•,Crnr'9 f<r� rnrr44lV G. ENGINEER'S CERTIFICATION , '?'" r". • Pp I certify that I have determined through field inspections and review of Municipal records that the above'systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed Name i-Aiodo••e ,` r+ao.r t• •;•......•.........,�...:: •,., Date _9 / 2.9 / 2•eta9 ,-. cc 3589 COSA Fee $ &190 — Waiver Fee $ Date of Payment 9 /30/09 Date of Payment Receipt Number Q !1 S 7 Receipt Number, (Rev. 77/05) ', SCS RaLN Client Name Project Name/N Client Sample ID Matrix Sample Remarks: 1095019001 Flattop Technical Srv. L5,Bk6, Moutain Side Village L5,Bk6, Moutain Side Village Drinking Water Printed Dateffime Collected Dalcfl'ime Received Date/rime Technical Director 10j'0112009 16:05 09/162009 15:30 09/1612009 16:00 Stephen C. Ede Allowable Prcp Analysis Paramctcr Results PQL Units Method Container ID Limits Date Date Init Metals by ICP/M3 Arsenic ND 5.00 ug/L CP200.8 A (<10) 0924/09 09/30/09 NRB SCS ReEN Client Name Project NameM Client Sample ID Matrix Sample Remarks: 1095019001 Flattop Technical Srv. L5,Uk6, Moutain Side Village L5,6k6, Moutain Side Village Drinking Water Printed Date/Fime Collected Date/Fime Received Date/Time Technical Director 09232009 10:22 09/162009 15:30 09/162009 16:00 Stephen C. Fde Allowable Prep Analysis Parameter Results PQL Units Mcdw Container ID Limits Date Date Init Waters Department Total NitratclNitritc-N 2.64 0.100 mg/L SM204500NO3-F 11 (<10) 0921/09 LCE Microbiology Laboratory Colony Count 0 coVI00mL SM20922211 A (Q00) 09/16/09 DLC Total Coliform 0 cot/100ml. SM20922213 A (<I) 09/16/09 DLC Fecal Coliform 0 coV100mL SM20922211 A (<I) 09/16/09 DLC