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HomeMy WebLinkAboutSUE TAWN ESTATE #2 BLK 2 LT 1Sue Tawn Estates #2 Block 2 Lot 1 #051-471-17 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program. 4700 S. Bragaw SL P.O. Box 196650 Anchorage. AK 99519-6650 Page Gf3 • www.d.anchorage.sk.us (907) 943.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PermitNumber 5 4 s 0 a a i PID Number. /-- 47/ -17 Wma I F�'� -5fover New Wastewaters stem: Y W❑Upgrade akkt4o 6%0� DI Ll1N iA A s ABSORPTION FIELD P nn. Mof o[ KMw T,Nw• 0 5411« TmKh O Bw O Ma,d O Moor. LEGAL DESCRIPTION SWRa" Fes) T°"tDom sromvtig"wg� ,({ Bbek: La SueEiMla� r{/ ,µ D.p4bPw emom kom erlDl+1 P'b^ Cr.w•Ibp40w.m pp.. Hte7awn 1. •1� Towmlvp Ra•aaBsdbrc Ft. Fill added saN.a ayNr wed, ` ` it gih 6wM LN Well: ❑ New ❑ Upgrade Ft. ha «wbac FI. Naomtr w»s: Dist s lnss: D"sleutan (PMN...A{-B. Ck TOM 13"ft U CwO b: i.� r1� • / •1 1 FI. T" Alboorptlm arae � � � `bet Ft P" MN FI. i/Ft dir . s D«a DrYbO' St«k W«^w LM' r 5141 Gln lA) U0 Ft F� ""o": 0wrler- Q30 F 10 DN. km~ S 9-� -5-5- YiNC, Para BN « c.kva tt..atJ Aber. Ga.N 14 7 GPM 14 r1ewJ� Ft. a t+ n TANK SEPARATION bISTANCES IN Septic t] Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lit From Tank Field Station Holding Publklprtvat Tank Sewer Line s`s`os A,r G p tr G ek4 l�st wtl 1 11`31 �� �� 7 QS4' MMa•« 5-fee N� a compannNMs' Bance wale, )001f Q()1+ LIFT STATION tali. 47' aD �. iar,NNm 151 _7 1 ` (CJJ�I 1 'Pamm "v««. 'Faro aNp4-"w to ma In K CvMin d.kr ---- Nm,, e rQ / %(�t�IT `— �"� MM. a E�N.trital hrp.cOpu pNrt m t try Rerrwks BENCH MARK r Jin kl Asw E"v1•on -0 po�aT i 0 0 FL E y �1 \/�!•••••••,••.•• 4 _1V '7 5 d S ENGINEERING I `• 4'A Inspections performed by: 17034 Eagle, River Loop Ro77_ed, Nobftume e, es: i« �] �6- q5 �' {y °�' '� _ It ver, *Iaska "53 0,0 Development Services bepartmerit Appboval T kot;ar C. e i�r•� CE -6801 Reviewed and approved by: Date: '����� PERMIT NO.§W950221 PACE 2 OF 3 UIPgDEPARTMENTOFHEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEMS 19-6650 AND/ORT WELLINSPECTIONREPORT LEGAL LOT 1, BLOCK 2 SUE TAWN ESTATES #2 P.I.D. NO. 051-471-17 PERMIT NO. SW950221 PACE 3 OF 3 Municipalit of Anchorage DEPARTMENT OF HEATH AND HUMAN SERVICES P.G. Box 196650ENVIRONMENTAL SERVICES D��''IppVISION hon: 343-4744 ON—SITE WASTEWATER*DISPOAnChorQSAL SYSTEMI9-6650 AND/ORe1WELLeINSPECTION REPORT LECAL LOT 1, BLOCK 21 SUE TAWN ESTATES #2 FINAL GRADE FINAL GRA. kA 93.6'/ I NEW 1250 GALLON SEPTIC TANK ml =99.8' =100.2' P.I.D. NO. 051-471-17 98.9' 2" INSULATION 93.4' 2" INSULATION )i =92.1' )2=92.2' NO WATER FOUND 79.2' B.O.H. N. T. S. rA -A ROBERT C. COWAN CE -8801 r/a•; 1 rs ��x#i �e�► Witting ir�� by Doc co. aoa SULLIVAN WATER WELLS �t P.O. BOX 670272, CHUMAK, ALASKA 99667 • TELEPHONE 688.2769 OWNER OF LAND/�r¢(Y� Lta Jam, - DEPTH OF WDLL f -- ADDRESS �� IJG45A i 1��^16Z ST TIC LEVEL OF WATER ft. LEGAL DESCRIPTIO O t I ,d � 4:r _ V j � f 4' " I DRAW DOWN • Started FT_ DAT `` _fid `0 F. rred Ended r GALS. PER HR / C PERMIT NUMBER _ KIND OF CASING 6 4;�o KIND OF FORMATION* From Q—Ft. toA—Ft. C'Alt,`te C 7'/f )I1 From —Ft. ro Ft. Fromoz Ft. to-/ �Ft. La a G From Ft, to Ft. % t~ From.l � Ft. to A—& " :' Ft. �'� �r From Ft- to Ft. From a& Ft. t� a� S Ft.From Fr. to—Ft From-l�-FL to7lFt.. Ad -e-4 r ' From, Ft. to Ft From �� �.Ft. to lc+�fl Ft. �,"+4'�,�- ��-J{ Fruwn� Fr. to—Ft, From_ c1 d 3 Ft. to_L3_�_Ff' et ,4'r S ty 4 Rj �e7y � Fro t / Ft. to Ft. Frotr _Ft. to_ 44j '4 _Ft. -COW 0 6R gJ �c t From Ft. to Ft. From Ft. to Ft. From Ft, (a—Fr, From Ft. to Ft. -From Ft. to—Ft- Prom—Ft. oFt.Pratt Ft, to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft, to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From FL to Ft, From Ft. to Fc From Ft. to Ft. From Ft. to Ft. I:rom Ft. to Ft -__ WWOilkILI1060T,r ilriT1 SEP 17 1997 Municipality of Anchorage Dept. Health & Human Services DRILLER'S NAME lJ.a-i-y cl - T0'd 4444 b4bbbb446 StZ 889 S113M N3.LUM NVAI11r1S Wd 6Z:,'-0 r1H1 96-ZT-d3S SUe, -02 o -i-o b -Q S&S nG Date: 2 - 7 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX(907)694-1211 RECEIVED HEALTHAUTHORITY APPROVALS �i7n r,`^ 9 1896 Municipality of Anchorage Municipality ot Anchorage SEWER&WATER DEPARTMENT OF HEALTH AND HUMAN SERVICES Dept. Health &Human Services MAIN EXTENSIONS 825 L Street ' P.O. Box 196650 Anchorage, Alaska 99519-6650 SEWER&WATER INSPECTION REFERENCE: Lo -r T ENGINEERING STUDIES ANDREPORTS The septic inspections for the referenced property were performed on `1 -2.(o SS and 9 -:27-9 S . Prior to submitting the On-site Wastewater Disposal System and/or Well Inspection Report we are waiting for the f'-00 r�JrJ to be WELL INSPECTION WTESTEST BFLOW comp feted. If we may be of further service please contact us. SITE PLANS Sincerely, o _� ` ROADDESIGN ,-- Robert C. Cowan, P.E. SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 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 PAGE 1 OF 1 1 C %CL- qL a7L "- IJ \© `.ci `a� q I ) PERMIT NUMBER:SW950221 DATE ISSUED: 8/16/95 DESIGN ENGINEERS & S ENGINEERING EXPIRATION DATE: 8/16/96 OWNER NAME:STOVER,RALPH BLAINE & LYNN K OWNER ADDRESS:P.O. BOX672401 CHUGIAK, AK 99567 PARCEL ID:05147117 LEGAL DESCRIPTION: SUETAWN ESTATE #2 BLK 2 LT 1 LOT SIZE: 70410 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING S. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED ISSUED BY: BY: DATE: �---� DATE • S} ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. ueeking August 10, 1995 CIVIL ENGINEERS (907)694.2979 FAX (907) 694-1211 HEALTHAUTHORITY MUNICIPALITY OF ANCHORAGE APPROVALS - Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 SEWER & WATER MAINEXTENSIONS REFERENCE: Lot 1, Block 2, Sue Tawn Estates Request you issue a permit to drill a well and install a SEWER&WATER septic system to serve the proposed four bedroom house on INSPECTION the referenced property. Also request you issue a waiver for the cutbank to the east of the proposed system of 45 feet. Please make note of the waiver on the permit under special provisions. ENGINEERINGSTUDIES ANDREPORTS A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. WELLINSPECTION At the time of excavation no water was encountered in the & FLOW TEST test hole and after seven day ground water monitoring, the monitoring tube was found to be dry. SITEPLANS This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring ROADOESIGN wells, septic systems or drainage patterns by the installation of the proposed septic system. There are no points of contamination within the proposed SOIL TEST well radius which can be seen on the attached site plan. If you require additional information, please contact us. Sincerely, PERCOLATION TEST V_'Izz G '^ Robert C. Cowan, P.E. STRUCTURAL& RCC/gk MECHANICAL INSPECTIONS Enclosure ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1" = 50' 1 SITE PLAN DESIGN / PROPOSED 0 / 4 BDRM 0 1 HOUSE r of O M Z-1�f�10 W NO2�y �!n?� N I� 00 m � 0F07cn \ L/) 0 , o� 0� mc) Z: mm m Nij0�2 m � tl0� �� / p0-I� DVIN 2 1 �p�' \ \ / O �301��� D W 301 \\ �j Z> m O p �D G� ➢�cm Z Z T.O 3p1 701 F F- 00 O n(mil--mem~SOA O r �y ZZ�v'~n=m * om0r�C ND � m Z N mz, m-qK: C7 DNrL/ Z � m- j�\ ��� Anon _---------d��+d \ � jp pri�ZO L hT mm rl� ➢ O //im m Yin•%.mac !�%c �J (7/�L-�_jl` �� / i , pDZ� tn➢ - Z OO N om Z I N o m O O 0 a m 0 I A p D Z z D ,n D r p om�K^ m r- I' X, pm gzm Dy0 r,: mm ; aMp o C zooi �,Z w F- 0 C) C mfr pro cn y 3 .o U 0 apt - - -� _ -dol o -� z1— eo1_� \ JASMINE RO\IAD _ [� 301 ---301 301 z-�- - 3011 / PROPOSED 0 / 4 BDRM 0 1 HOUSE r of O M Z-1�f�10 W NO2�y �!n?� N I� 00 m � 0F07cn \ L/) 0 , o� 0� mc) Z: mm m Nij0�2 m � tl0� �� / p0-I� DVIN 2 1 �p�' \ \ / O �301��� D W 301 \\ �j Z> m O p �D G� ➢�cm Z Z T.O 3p1 701 F F- 00 O n(mil--mem~SOA O r �y ZZ�v'~n=m * om0r�C ND � m Z N mz, m-qK: C7 DNrL/ Z � m- j�\ ��� Anon _---------d��+d \ � jp pri�ZO L hT mm rl� ➢ O //im m Yin•%.mac !�%c �J (7/�L-�_jl` �� / i , pDZ� tn➢ - Z OO N om Z I N o m O O 0 a m 0 I A p D Z z D ,n D r p om�K^ m r- I' X, pm gzm Dy0 r,: mm ; aMp o C zooi �,Z w F- 0 C) C C PERFC LEGAI 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 TEST RUN BETWEEN FT AND b FT COMMENTS S & S ENGINEERING 2Q4 r7 PERFORMED BY:raw.x,,,96 77 t� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH AE8qJ0/RIff MlA4APIN�C' MMUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) HEALTHAUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERINGSTUDIES ANDREPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN ROBERT C. COWAN, RE. ROBERTA. SHAFER, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CIVIL ENGINEERS (sm) 694-2979 CONSTRUCTION PRACTICES FAX(907)694-1211 and MATERIAL SPECIFICATIONS Lot 1, Block 2, Sue Tawn Estates August 10, 1995 GENERAL: 1. The scope of this project includes the installation of a 1250 gallon septic tank and leachfield trench to serve the four bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP -SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 1, Block 2, Sue Tawn Estates August 10, 1995 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Page Three Lot 1, Block 2, Sue Tawn Estates August 10, 1995 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Page Four Lot 1, Block 2, Sue Tawn Estates August 10, 1995 INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. Page Five Lot 1, Block 2, Sue Tawn Estates August 10, 1995 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER SEACOAST CONSTRUCTION CO., INC -, i lI ; I I t 1 1 i ! 1 ' ! I I PHONE No. 907 345 7249 Sep.il 1995 12:00PM P03 Ar, epic tiA 14 1 -Aa If (IIN -;%c 410- L MUNICIPALITY OF ANCHORAGE o Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-471-17-000 Expiration Date: 1/31/2024 Legal description SUE TAWN ESTATE #2 BLK 2 LT 1 Site address 19311 JASMINE RD Chugiak AK 99567 Current property owner(s) SMITH CRAIG S X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 10/31/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department 3 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-471-17 Complete legal description SUE TAWN ESTATES #2 BLOCK 2, LOT 1 Location (site address) 19311 JASMINE ROAD, CHUIGIAK, AK 99567 Current property owner(s) CRAIG S SMITH Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 28 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ _G_SU Date of Payment /VI,- 3 COSH Waiver Fee $ Date of Payment Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: SUE TAWN ESTATE #2 BLOCK 2, LOT 1 Parcel ID: 051-471-17 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 9/1995 Total depth 141 ft Cased to 141 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 10/13/2023 Static water level at beginning of test 125 ft. Well production at time of test 4.6 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 1.93 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 10/12/23 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 50” Date of pumping 10/04/2023 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 9/27/1995 ALL standpipes present per record drawing Total measured depth from grade 17.3 ft (max) Measured depth to pipe invert from grade 10.2 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective 5.8’ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000 gallons 10/12/23 date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 10/13/2023 Results Pass Fluid depth prior to test 9 in Water added 450 gal New fluid depth 19 in Elapsed time 1360 min Final fluid depth 6 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 84 in (MOA 7’ ED) Effective depth used 20 in (Missing ED + Final Fluid Depth) Effective depth (ED) remaining 64 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximately 1.2’ or 14” of ED is missing. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 10/28/2023 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. 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, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 10/28/23 UNICT UTV OF AHCIHORAGE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC231404 Subdivision: SUE TAWN ESTATE #2 Block:2, Lot: 1 907-343-7904 Fax: 343-7997 The septic tank for this property is 28 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. 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.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. VJ(I —14-7 —I'7 COSA# 9�La(_ 1. GENERAL INFORMATION Expiration Date: Complete legal description Lot 1; Block 2; Sue Tawn Estates Subdivision #2 Location (site address) 19311 Jasmine Current Property owner(s) Louis Lancaster Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent Bonnie King Day phone 2447176 Mailing Address 22700 Lekehiit Dr. Chuglak, AK 99567 Unless otherwise requested. COSA will be held by DSD /or pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well (] Individual On-site 0 Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of fide (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 S s s Engineering Phone 694-2979 Address 15861 S. Birchwood Loop Chugiak, AK 99567 Engineer's Printed Name P 449 fA i C. COc✓rf ti Date /�rA7 5. DSD SIGNATURE -moi Approved for 3_ bedrooms. Disapproved. Conditional approval for bedrooms, with the following per, ROBERT C. COWAN c \ CE -8801 s � Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Well Flow Advisory Nitrate Advisory Maintenance Agreements Supplemental Engineers Report Other By: Original Certificate Date: O '.ZLz— 0 % (R. rrM) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wasiewater Program 4700 Bragaw Street P.O. Box 1965W Anchorage, AK 99519-6650 www.muni.org/onstts (907)343-7914 CERTIFICATE OF CIN -SITE SYSTEMS APPROVAL CHECKLIST Legal Descliptlon: �� ST 2 Parcel ID: O r I 4 7 / - f 7 A. WELL DATA Well type R11/01 E Date completed.5 Total depth NO. If A, B, or C provide PWSID # "— Sanitary seal(oo Cased to j: ' ft. FROM WELI. LOG Date of test Static water level Well production •[ g.p.m. WATER SAMPLE RESULTS: Well Log(!Ikl) __Jea_ Wires properly protected) '-/M Casing height (above ground) %e nfin. AT INSPECTION 0 b la3' ft. X/• o.p.m. Coliform __V__colonies/100 mL Nitrate . , 5 &gIL Other bacteria Q colonies/100 mL Arsenic: moll Date of sample: *0;? Collected by. S v t - .V. B. SEPTICIHOLDING TANK DATA Tank TypalM%If"1- �-rle-.1<s;T ,r( Date installed 26 Tank size_ oaf. Number of Compartments _2_ Cleanou�l) (6g Foundation claanoLI& Depression over tank (Y®�_.A2> High water alarm Date of pumping _---T- Pumper 7VE 5 T�Mrlllc76 C. ABSORPTION FIFLn nere Date installed gtjSoil rating(o.p.d er fe/bdrn) _b System type _/ Amue.N Length — ft. Width 0106, ft. Gravel below pipe !f 1 ft. Totai deg Eff. a orptlon area �p Mondori tube � Depression over field I Date of adequacy test 151 Resin as Fall For a bedrooms �,,r Fluid depth In absorption field before test A in. Water added " �%gai. New depth, in. n Elapsed Time: � min. Final fluid depth in. Absorption rate >=-q O+ g.p.d. Any rejuvenation treatment (past 12 mo.) (ype) 00 If yes, give date D. LIFT STATION A)/M Data iostalled - - Size in gallons "Pump on' level at _in. 'Pump ofr f� Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: D Septic tank/Ilft station on tot jig i Absorption field on lot lit Public sewer main l in Sewer /septic service line otrJ I Animal containment areas �+ High water alarm level at in. Masts alarm & circuit requirements? I On adjacent lots goe f On adjacent lots /0404 Public sewer manhole/cleanout p Holding tank p I Manureianimal excrete storage areas AO© f SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: I I' Building foundationj s Properly line 4T Absorption field S t Water main Water service line /O + Surface water 1040 4 I Wells on adjacent lots 4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line �al Building foundation Water main Ai 1p Water Service line Surface water I D® t 1 Driveway, parking/vehicle storage O r r AOT UUCra- D21U6"-14Y Curtain drain k)0M mil) Wells on adjacent lots It) i F. COMMENTS G. ENGINEER'S CERTIFICATION 141 vaa Ifv _ \* I certify that I have determined ttuough field inspections and " review of Municipal records that the above Systems are in RRr conformance with MOA COSH guidelines in effect on this date. Engineers Printed Name R ......,.... Date Si I rT JO 7 COSA Fee $ 3t✓ — Waiver Fee S Date of Payment 0� Date of Payment Receipt Number o 5553h Receipt Number (Rev. 1 VD5) NI SCS ReE# 1073829001 Client Name S & S Engineering Project Name/# LI B2 Sue Tawn Est, #2 Client Sample ID LI B2 Sue Tawn Est #2 Matrix Drinking Water PWSID 0 Sample Remarks: All Dalettrnmes ere Alaska Standard Time Printed DateMme 08/152007 16:22 Collected Dale/rime 08/022007 11:20 Received Datdrime 08/022007 16:17 Technical Director Stephen C. Ede Parameter Results PQL Units Me0w Container ID Allowable Limits Date su Analysis Init Metals by ICP/MS Arsenic P1D 5.00 Waters Department Total Nitratc/Nitritc-N 2.55 0.100 Microbiology Laboratory Total Coliform 0 ug/L . EP200.8 C (<10) mg/L SM204500NO3-F B (<10) coU100mL SM209222B A (<1) 08/0&07 08/15107 MII 08/07/07 1DS 08/02/07 SDP r s ►.� t;.�ty Robot C.!!.14 '-C tic. 6. •a r' r µ•1 u� -"1 411 117 Xi v 6�. M2tf �i wa-r lTock --+-2---- k"' t, .r / AS -BUILT 1 hereby certify that 1 have surveyed the following described propertyy'- L e l l] i%r i' 2- F srn Fshn -fw r 1,1 , 140, i�_ Pre<lnct, Alaska, and that the Anchorage is situated thereon are within the Property lines and deo not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska this I -lay of '4E 2007 ROBERT C. JOHNSON x,-•• y-.� SCALE: Registered Land Surveyor No. 8A0 -LS 1 i G Box 71-0456, Eagle River, Alaska 99577 Phone (907) 694-2543 Municipality of Anchorage Development Setvlces Deodtiment e 4•` �� f Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box i9665o Anchorage, AIC 99519-6650 rvww.ci.anchorage.ak.Us (907) 34J4904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parceli.D. 051-471-17 HAA# (f' Expiration Dale: -7— 19 _ O 1. GENERAL INFORMATION Complete legal description Lot 1 • Block 71 Sue Tawn Estates #2 Location (site address or directions) 1 q11 1 .TA am; n P R d - Current Propertyowner(s) Ralph' Stover Day phone Mailing address Lending agency Day phone Mailing address •: Real Estate Agent Steve W'snie'vski @ 'Great Iprl7Myphone 694-9125 Mailing Address 11411 old niPn;,apTP��RivPr, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. ,W4 � �r g /0 3 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well El Individual On-site {� Individual Water Storage ❑ IndividUal Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certilicales may be reissued for a period of up to one year with valid water samples.) CertificIles are valid tot 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, l verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal syMerrl is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. l 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 lime of installation. Name of Firm S & S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name RnhPrr r r'nwnn Date __gLiO 103 E OF 5. DSD SIGNATURE r ; aoatRT C COWAN }jar � ,CE•8a01 ���� Approved for bedrooms. pt r cp Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory ll�tt��Y OF `\\\`IN.'. .'. 0��� S = ON-SITE • �i WATER AND r m WASTEWATER • nn none . JJJJ/O 1111 Maintenance Agreements Supplemental Engineer's Report Other By Original Certificate Date: 8" 0 3 (Rev. 12100) 0 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program . 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal DescriptionyL4r/ : ej!ge C Z' 47YC—;2LW— J5Sr ff 2- Parcel ID:_ Q61r . A. WELL DATA Well type Date completed. Total depth L12 ft. If A, B, or C provide PWSID # =' Well Log (Y/N) 7 Sanitary seal (YIN)) Wires property protected (YIN) _ Cased to —49—ft Casing height (above ground) +in. FROM WELL LOG Date of test . . 0 5 - Static water level J9,t% ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate 1 o5m_g.41/03 /I. Arsenic: Date of sample: 3 B. SEPTIC/HOLDING TANK DATA Tank Type/Material C�I 'S Tar", Tank size /74*V gal. Number of Compartments 2 Foundation deanoutY/N) _Y Depression over tank (Y/N) N Date of pumping N;4 — N4C� Pumper —" AT INSPECTION 31 3 4' 3 g.p.m. Other bacteria 0 colonies/100 ml. Collected by: S •f S &46.1 NWA4,4 4— Date installed s-_ Cleanouts (YIN) High water alarm (Y/N) C. ABSORPTION FIELD DATA '��� Date installed#40noil rating ;�ftz/bdrm) ► •�. System type T14604G H Length ft. Width Z • J� ft. Gravel below pipe ft. Total depth Iv' 'f Eff. absorption area4ffift Monitoring tube Depression over field /j Date of adequacy test _a Results (Pass/Fail) -4&:% For ;* bedrooms Fluid depth in absorption field before test 0 in. Water added — gal. New depth 0 in. Elapsed Time: � min. Final fluid depth 0 in. Absorption rate >=4 !F0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) /y If yes, give date - Syyr fps nro r iJ /u 564LV I G&- �/Z, 2 Y � . (pLac.*.o /.4 s4.AJI Gt 1N eooa ). D. LIFT STATION Date installed /V `Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off" level at _ in. Cycles tested Manhole/Access (Y/N) High water alarm level at in. Meets alar & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lISA,attbn on lot 4- On adjacent lots Absorption field on lot IDS 14 - Public sewer main N /septic service line /Do I t" On adjacent lots Public sewer manhole/cleanout Holding tank Al �A- SEPARATION DISTANCES FROM SEP1ICIHO.12<G TANK ON LOT TO: / It S / !- Building foundation S 41" Property line �f - Absorption field Water main _ N Water service line Surface water too,r Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: � Property line /+Dr t Building foundation ID + Water main /A I r / / Water Service line + / Surface water F Driveway. parking/vehicle storage Curtain drain u/N Wells on adjacent lots F. COMMENTS - .,V, -n •.. G. ENGINEER'S CERTIFICATION •''�y�,'h I certify that I have determined through field inspections and `' '`;'.; review of Municipal records that the above systems are in "' ' '"'• ^� ^° conformance with MOA HAA guidelines in effect on this date. ? �Er r; r?, ROB�C WAN Q Engineer's Printed Name if 6,96 C CO �'->�l ��=t f W Y . /003 ;'�,_,, :•'_ ,. Date t i HAA Fee $ 3 '7S' - + V Waiver Fee $ Date of Payment If) r oh 3 Date of Payment Receipt Number O 336-7->, Receipt Number (Rev. 1210 t ) 4- 8-03; 4:12PM; SCS Rcf.# 1031697002 Client Name S & S Engineering Project Name/# NA Client Sample ID Ll B2 Sue Tawn Est. Matrix Drinking Water PWS1D 0 ;907 5815301 u 3/ 5 All DatcslTimes are Alaska Standard Time Printed Date/TIme 04/08/2003 15:29 Collected Date/flme 03/31/2003 15:00 Recelved Datelfime 04/01/2003 12:33 Technical Director Stephen E Released By(/� Sample Remarks' Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Waters Department Total Nitrate/Nitrite Microbiology Laboratory Total Coliform 1.95 1.00 mg/L EPA 300.0 0 col/l00tnL SM18 9222D c (<=1) 04/06/03 JS 04/01/03 BAG 33 TRACT 8 N 89057'24'E 176.29' N c- ti � : y D Lo / Q. �14 40 �\ m \\ O\ o N \\ W N I .Xb • / O J / e. /8 N i^I rn i r� r y CO / m n ZD 24.6' N / �Yi Sq 9),6.1 I 1 y O 1 ® �A I N wm 1 ' O'" m Vn 1 m 1 OD 1 po 1 p 1 ? 1 1 N 89.53'57'W 171.98' CO �YY nm vN p� ^ 000 � T W y N �� •� nN oa ��n m m CD 8 p\\ m Z O • , N u u? m N W n �• n C �A O 4 N Bti S� o Q ^? n n o= E jAr .♦fie *\,,' PC,:• :z :W n N (^p u�IUV1 +O� i•Ti% 2 ct m A v7r Do o�Wo osn �� foG�.'.v / w ''7 OI SAI ^' A > > n n p �_ o � � �'• i� • .• r m q m 111 for _ o vr0� ' 000�v ,�\�1 Z D lk Cf ff=v(O Nonm pu r w (T 0032 v ? m O IE co) D N 2;