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HomeMy WebLinkAboutSUE TAWN ESTATE #2 BLK 3 LT 2Town Estates Block 3 Lot 2 #051-501-28 Municipality of Anchorage Page 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: ,~'/,~ <~L~ O/L~_~ PID Number: Name:./.=~/~;W~,y' Wastewater System: ~New ~ Upgrade Addre~ ~ ~ ?~, ~/~ ABSORPTION FIELD Phone~_~ ~No. of B~rooms: ~ Deep Trench ~ Shallow Trench ~Bed ~Mound ~Other Total Depth from original grade: LEGAL DESCRIPTION SoilRating: ~, ~ GPD/Sq. Ft. ~, ~ ' Lot~ ~BI°ck: ~~'~/Subdiv~i°n:~ ~ Depth to pipe bo~om from~,original~ grade: Ft. Gravel depth beneath~'P~e ~ Ft. ~ ~ Pill added above original grade: Gravel length: Township: /5~]] Range: /~~Secti°n: /~ 0--~ Cb ~1 Ft. Distance ~ lin~: WELL: ~ew D Upgrade Gravelwidth: ~ Ft. NumbeDlines: [ ~ Ft. Pi e material: Classiflcation (Private, A,B,C):~ / ~>~ Tota~ Depth:/~ ~ Ft. Cased To:l ~ I Ft. Total absorption area:~_ Driger: ~///~ Date Drilled:~/~ StaticWater Level:~ Ft. Installer: ~ Date i~/~~-( - ~ Yield: Pump Set at: Casing Height Above Ground: SEPARATION DISTANCES ~Septic D Holding D S.T.E.P. From Ta~k Field Station Tan~ Sewer Lines ~ WelP l~l 170 ~]A ~l~ /~, ~,.ri~,: ~ Sudace Water ¢/~/ t ~ W/~ LIFT STATION Lot / / [ Line ~ ~2 ~/ Size in gagons:I Manufacture~ Foundation /Z' Z~/ ~/~ "Pump on" level at: ~ater alarm at: / Cu~ain ~ t~ ~ Pu~l~tri~l Inspections pedormed by: Drain Remarks: ~LI~ ,~)/~ ~L ~ BENCH MARK Inspections performed by: ~ ~ Dates: 1st Depadment of Healt~nd Human Se~ices approval Reviewed and approved by: ate:/2 / 72-013 (Rev. 9/91) MOA 25 Permit No. -- SW960165 Page 1 of I Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 543-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: SUE TAWN .2 LOT 2 BLK 3 PlO No.: -- 051-501-28 SWING TIES A-C = 17,0' B-C = 30.4' A-B = 40.3' B-D = 3%8' DRIVE WAY 1250 GAL [] TEST HOLE · MONITOR TUBE o SEWER CLEANOUT - WELL EASEMENT ~- EXISTING LEACHFIELD ELEVATIONS (NOT TO SCALE) by SULLIVAN WATER WELLS P.O. BOX6?O2Z2, OHUQIAK, ALASKAgg$$r * TELEPHONE6~2759 ADDR~S ~0 ~n ~ ~ ~ ~& ~g~ STATIC LEVEL OF WATER FT. ~ ff o~scmmso~d~M ~ I o~w oow~ ~T. NUMBER KIND Off CASING ~~ KIND OF FORMATION: Fram__Ft. to__Fi. F{om.~Ft. fo.__Ft. ~ From~ FI. to .~Ft -- From From Ft. to. Ft.. Fton] Ft. lO~Ft-- From~Ft, to Ft.~ Frem~Fl, t~__Ft. Ftom___Ft-to Ft,~, FronL.__~Ft. to_. Fr. MISCL INFORMATION; Fram Ft. to Ft. From, FI. to From, Ft. ttx Ft From · Fl, to Ft.~ ..~ l:r0m__Ft, to Ft. From__Ft. to Ft. From~.F t. I~_ FL Ft. lo__Ft., FI. to__Ft. Fr~ Ft, Io Ft, From~FL to~. Ft._ From~Ft. to Ft. From Fl, t~ Mu[))c)pali[y Ot Anchorage Oept, Health & Human Services MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 2 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960165 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:DREWRY JAY V & TERRI A OWNER ADDRESS:PO BOX 672372 CHUGIAK, AK 99567 PARCEL ID:05150128 LEGAL DESCRIPTION: SUETAWN ESTATE #2 BLK 3 LT 2 LOT SIZE: 73367 (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: DATE ISSUED: 7/02/96 EXPIRATION DATE: 7/02/97 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: ~iTwo~iFO©T: sAND F~TER LAYER MUST :BE USED. THE sAND USED ~ZN THEFtLTER~LAYER MTJST BE CLEAN SAND WITH 4% OR +LESS PASS- ZiNG THE #100 SIEVE AND 2% OR LESS PASSING THE #200 SIEVE. A SIEVE ANALYSIS MUST BE PROUIDED. iTHERE.SHOULD BE 5'sPACING BETWEEN THE INTERNAL DISTRIBUTION MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ~EST~ 2 1/2' spAciNG ON THE OUTER LINES. THE LENGTH OF THE BED ~ST NOT BE LESS THAN 57.5 FEET; PAGE 2 OF 2 Jul-e9-§6 O9:17 JAS For-warding Anchorage 907 562 1646 P.O2 Tuesday, July 09, 1996 Municipality of Anchorage P_O. Box 96650 Anchorage, Alaska 99509 To whom it may concern, t am writing Ihis letter to you to inform you that the septic system being installed on my property on Sue Tawn Estate, Addn. No. 2, Lot 2, Block 3, is being installed by the owner (myself). I have experience in excavation work, as well as, I have installed of septic systems in the past. If you should have any questions concerning this installation, please do not hesilate to call me or relay any questions or concerns through the Eagle River Engineering Services to whom i have retained to design the septic system for me t~ install. Of which, I will instatl the system exactly to their specifications. In addition, I have had my lot surveyed by a professional Land Surveyor of Seward & Associates Land Surveying firm in Eagle River, so that I am certain as to where the lot lines are located. Sincerely, Owner of Said Property 907-223-9053 RECEIVED JUL 1 1 1996 Municipality of Anchorage Dept. Health & Human Services Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694[-5195 tol Eagle River, AK 99577-3294 (907) 694-3297 hx June 27, 1996, 1996 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Sue Tgwn//2 Lot 2, Block 3 Narrative & Permit Application Dear Mr. Cross: The well and septic system will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity. 4. Drainage will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \ 1996\96-050A-NAR.DOC ? SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM ~EGAL:' Sue Tawn//2 Lot 2, Block 3 06/26/96 2. 3. 4. 5. 6. 7. 8. 9. 10. BED 1. 2. 3. 3. 4. 5. 6. 7. 8. GENERAL The well & septic plan is for a single family residence only. The drawing and or site plan shall be a part of this specification. All materials and workmanship shall meet the Anchorage Department of Health requirements. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. Any remaining open test hole excavations shall be filled. The bed is to be oriented to follow the natural land contour to maintain uniform total depth of the bed bottom. The bottom of the bed excavation shall be level, plus or minus 1.5". A 2' filter sand layer shall be required at a total depth of 5'. Material shall be an ADEC approved filter sand. A one foot gravel layer is to be placed over the sand. The 4" effluent line in the bed shall be laid level within 0.03', at mid-depth in the gravel layer. The bed gravel is to be covered with typar fabric material. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the bed. Mounded side slopes not to exceed 3:1. The area over the bed is to be finish graded to prevent ponding of surface water runoff. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: BOTTOM OF FILTER SAND LAYER, = S' '! ~dp['( BOTTOM OF GRAVEL LAYER =, 3'/.~,k....---~ F'0'qf ~ SAND FILTER THICKNESS = 2 ,o~/SD~approved ma~,e, rial SEPTIC GRAVEL THICKNESS = 1 ~ 6" under pipe, 2' over pipe BED LENGTH = 57' BED WIDTH = 15' SOIL RATING = 0.7 GPD/ft2 BEDROOM CAPACITY = 4 SEPTIC TANK -- 1,250 gallons minimum Twenty-four (24) hours notice required for all inspections. \1996\96-050^-S?C.DOC · SEPTIC N EI GH Bi~?,~ ~-~~ ~ ~ / ~/ VACANT ~SEMENT NO SURFACE WATER ~- PROPOSED L~CHFIELD NO KNOWN CURTAIN DRAINS ~ EXISTING L~CHFIELD WELL/SEPTIC S~TE PLAN LEGAL: SUE TAWN fi2 LOT 2, BLK 5 ~L~.. .... OWNER: DREWRY .. JO~ff ~-OSOA/~AT~: O~/~/~q SCAL~ ~"= ~0, EAGLE RIVER ENGINEERING SERVICES ~ '.LOUIS A. BUTERA** P.O. Box 773~94 ,,;~ .... .... ... EAGLE RIVER, AK. 99577 'i~?~o~ss~o~ (907) 694-5195 FAX: (907) 694 3297 ~:.~?,~ 'EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 96-050 Calculated By: LB Date: 6/26/96 Legal: SUE TAWN #2 LOT 2 BLK 3 Single Family 4 Bedroom Dwelling TEST HOLE 1 & 2 Bed Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 600 gallons Percolation rate = <1 minutes per inch Wastewater application rate = 0.7 gallons per day per square foot Required absorption area = 857 square feet Bed width ON) = 15 feet Gravel depth (D) = 1 feet Required length = Required absorption area / Bed width Required length = 857 / 15 Required length = 57 feet 2' Sand Filter required To be placed under sewer rock · SINGLE'FAMILY ON-SITE WORKSHEET ERRS PROJECT NUMBER: 96-050 CALCULATED BY: LEGAL DESCRIPTION: SUE TAWN #2 LOT 2 BLK3 LB NUMBER OF BEDROOMS: 4 WATER USE PER BEDROOM: 150 GALLONS PERCOLATION RATE: <1 MINUTES PER INCH DEPTH TO GROUNDWATER: 8 FEET DEPTH TO IMPERMEABLE LAYER: 10 FEET USABLE SOIL STRATA ANTICIPATED DEPTH OF COVER: 3 FEET TOTAL USABLE DEPTH: MOUND OR BED SYSTEM USABLE SOil STRATA DEPTH: 0.7 GAL/SQ.FT 857 SQ.FT WASTEWATER APPLICATION RATE: ABSORPTION AREA REQUIREMENT: MINIMUM BED LENGTH 12 FEETWIDE BED 15 FEETWIDE BED TRENCH SYSTEM WASTEWATER APPLICATION RATE: ABSORPTION AREA REQUIREMENT: SHALLOW TRENCH OPTIONS 5 FEET WIDE TRENCH 71 FEET 57 FEET N/S GAL/SQ.FT #VALU E! SQ.FT DEEP TRENCH OPTIONS 3 FEET WIDE TRENCH EFFECTIVE REQUIRED TRENCH EFFECTIVE REQUIRED TRENCH DEPTH(FT) ENGTH(FT) DEPTH(FT) ENGTH(FT) 1 #VALUE! 4 NA 2 NA 4.5 NA 2.5 NA 5 NA 3 NA 5.5 NA 3.5 NA 6 NA 4 NA 7 NA 8 NA 9 NA DESIGN SPECIFICS FIELD SYSTEM: GRAVEL DEPTH: TRENCH OR BED WIDTH: LENGTH: B (B=BED, S=SHALLOWTRENCH & D=DEEP TRENCH) FEET 15 FEET 57 FEET Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: P/"~-~,/f'~' OATE PERFORMED: LEGAL DESCRIPTION: '~¢- ~',~ ~-¢r; ~,,~ L ;~ ~.~ Township, Range, Section: 7;,4! 2 3 4 5 6 7 8 9 10 11 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~/ O~ DEPTH? p E Oeplll Ia Water After Monitoring? ~ Dale: ,~'-..2 8 ,.~,~ PERCOLATION RATE __ TEST RUN EETWEEN ~ J (mmutes~mch) PERC HOLE DIAMETER __ ) PT AND Y FT ACCORDANCE WITH ALL. STATE AND MUNICIPAL GUIDELINES IN ~FFECT ON THIS DATE. DATE- z~'~ '--')' 6'' ' ~ <;' -- Municipality e! Anchorage DEPARTMENT (DF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~>f' ~- '~' r' .~' LEGAL DESCRIPTION: OATE PERFORMED: Township, Range, Section: 2 3 4 5 6 7 8 9 10 11 12 13 14 t5 16 17 18 19 20 COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? OEPTH? Oeptft IQ Waler After M~nit~ing? ~'. 5'- I I ! PERCOLATION RATE /-~ I (mJnu[es~=nch) PERC HOLE DIAMETER ~ '" TEST RUN BETWEEN '~ FT ANO ~/ FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, CERTIFY THAT THIS TEST WAS PERFORMED iN DATE, ~>' 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 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DVVELLING Parcel I.D. 051-501-28 GENERAL INFORMATION Complete legal description Location (site address) COSA # 0'50 Expiration Date: SUE TAWN ESTATES #2, BLOCK 3, LOT 2 18940 SUE TAWN DRIVE, CHUGIAK, AK 99567 Current Property owner(s) DANIEL SOLODON & LYNNE SCHLUMPF Day phone Mailing address 18940 SUE TAWN DRIVE, CHUGIAK, AK 99567 Lending agency Day phone Mailing address Real Estate Agent Mailing Address EDWARD DAVISON - PRU Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMB~!O~:BE,DROOMS: 4 3., aPE OF:.WATER-~UPPLY: ,i.::.'lndividualW, e!l' ' '¢~' '. [] Individ~ja'l Wai~'~: Storage [] Cor~'muhity 'Cl~s~ r Well [] Public Water'System [] 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 pedod 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. ! 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, Al( 99577 Engineer's Printed Name KENNE~r~I M. DUFF-US Date 05]30/11 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 dudng 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 "" occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. DSD SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: · Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory /o5 X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Cedificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite ' (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SUE TAWN ESTATES #2, BLOCK 3, LOT 2 A. WELL DATA Well type PRIVAT£ If A, B, or C provide PWSID # __ Well Log (Y/N) Y Date completed 7/1996 Sanitary seal (Y/N) Y__ Total depth 102 lt. Cased to 101 lt. FROM WELL LOG Parcel ID: 051-501-28 Wires properly protected (Y/N) Y Casing height (above ground) 36+ in. AT INSPECTION Date of test 7/1996 5/20/2011 ff. 22 g.p.m. 8+ Nitrate 2.85 mg/L Collected by:. ArcTerra Static water level 6 Well production 30 WATER SAMPLE RESULTS: Coliform NEC colonies/100mL Arsenic: ND .mg/I Date of sample: 5/20/11 B. SEPTIC/HOLDING TANK DATA Tank TypeS01aterial Septic/Steel Date installed 9/7/1996 Tank size 1250 Number of Compartments _2 High water alarm (Y/N) N C. ABSORPTION FIELD DATA Date installed 9/7/1996 Soil rating (g.p.d./ft2 or ff2/bdrm) 0.7 Length 57 f. Width 15 ff. Gravel below pipe 0.5 ft. Eft. absorption area 857 fi2 Monitoring tube Y Depression over field N gal. Cleanouts (Y/N) Y Foundation cleanout (Y/N) _Y Depression over tank (Y/N) __N Date of pumping 10/15/10 Pumper ]Rs Results (Pass/Fail) Pass For 4 bedrooms in. Water added 680 gal. New depth 0 in. __ in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N__lf yes, give date --_= System type BED Total depth _3 lt. Date of adequacy test 5/20tll Fluid depth in absorption field before test 0 Elapsed Time: 0__ min. Final fluid depth 0 LIFT STATION Date installed "Pump on' level at. Datum in. E. SEPARATION DISTANCES Size in gallons "Pump off' level at ... Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer/se~ service line Animal containment areas 50'+ in. Manhole/Access (Y/N). High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots IO0'+ Public sewer menholo/cleanout 100'+ Ho~ tank lee'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main 10'+ Water service line 10'+ Wells on adjacent lots 160'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field 5'+ Surface water 100'+ Property line 10'+ Building foundation Water Service line 10'+ Surface water Curtain drain 50'+ (Noise COMMENTS Water main 10'+ Driveway, parking/vehicle storage 10'+ Wells on adjacent lots 100'+ G. ENGINEER'SCERTIFICATIO. ......~~ '' re~, of Municipal records filet the above systems are in .'~~:~' comotmance with MOA COSA guidelines in effect on this date ..""*:~" Engineer s Printed Name K~NN~'FH 1~. D~S ...'~r~.:~?~~! COSA Fee $490.00 Waiver Fee $ Date of Payment Receipt Number (Rev. 11/05) Date of Payment Receipt Number ....... SGS SGS Ref.# 1112011001 Client Name ArcTerra Engineering and Surveying Printed Date/Time 05/27/2011 8:09 Project Name/# SUE TAWN #2 B3 L2 Collected Date/Time 05/20/2011 13:10 Client Sample ID SUE TAWN #2 B3 L2 Received Date/Time 05/20/2011 15:45 Matrix Drinking Water Technical Director Stephen C. Ede PWSID 0 Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 05/24/11 05/26/11 NRB Waters Department Total Nitrate/Nitrite-N 2.85 0.100 mg/L SM204500NO3-F B (<10) 05/25/11 AYC Microbiolog~ Laboratory E. Colt Total Coliform Negative 1 100mL SM20 9223B A 05/20/11 SDP Negative 1 100mL SM20 9223B A 05/20/11 SDP RUSH! Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. muni.org/onsite (907) 343-7904 j CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING ParcelI.D. 051- ~DJ-~ 1. GENERAL INFORMATION Complete:legal d~scription cos^# Expiration Date: Lot 2; rqoc~ 3; Sue Tawn Estates # 2 Location'(site address) 18940 Sue Tawn -. 'Current Property owner(s) JayDre~ry Mailing address PO Box 672372 Chugiak. AK 99567 Lending agency Day phone 694-2979 Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3, TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class Well [] Public Water System [] 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 (CO,SA) 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 pedod 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 vedfy that my investigation, based on procedures outlined in the CerlJficate of On-Site Systems Approval Guidelines for this application, shows I~at the on-site water supply and/or wastewater disposal system is (ara) safe, functional and adequate for the number of bedrooms and type of structure indicated herain. 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 supp.,~e~(:~l~stewater disposal system is(ara) in compliance with all applicable Municipal and State codes, X~"'~OHame' of~atid'fegulati°nSFirm s & S Engineedngn effect at the t/me of installation. ~!~" ~ ,~ . Address 158615. BirchwoodLoopChugiak,~99567 ~. ~ Engineer's Printed Name ~'~'~..,.//7/~.. ('~//.,.~,~.-' Date ~/~'~' / 5. DSD SIGNATURE ~.s,./~ ~ ~., ~.~ ,rove ,or. Conditional approval for bedrooms, with the following stipul'a~ions: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: ~Original Certificate Date:~~' 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 A. WELL D~, WelltyP,e /"Z¢/I~,- IfA, B, orCprovidePWSlD# ~' Date co;.Pieted Sanita, sea, Total depth ID~ ft. Cased to JO I ff. FROM WELL LOG Date of test Static water'level Well p~oduction ~::z~.. O g.p.m. i WATER SAMPLE RESULTS: Coliform ! O coloniesll00 mL Nitrate ArsenicI ug/L date of sampl B. SEPTIC/HOLDING TANK DATA Tank T!pe/Material ~*I:'TiC Wires properly protected) Ca~in~ height {a~ove ~round) AT INSPECTION Other ~acteria ~ colonies/~O0 mC Date installed Tank size ~C'uO gal. Number of Compartments c~ Clean0uts~Jq) Foundation cleanoul(~N) ~' Depression over tank (Y~ ~h water alarm' (Y~ ~0 Date°f~p~mPing ~ 7/~ Pumper ~a m~E~: -; ~ i C. ABSORPTION FIELD DATA Data installed ~'/'7/~,,~' ' Soil rating (g.p.d./ft2 or ft'/bdrm) __ Length! ;'i ~".~ ' Total d;pth :'31 fl. ff. Width j..~ ~ ft. Gravel below pipe ~), ~' ~ ff. Eft. absorption area ¢5?ft' Monitoring tube k/l?, : Depress on over field I,,I, Date oftadequacy test -ir ~ ~Resu ail) ~"/"~ ,:' I For bedrooms , , ,, Fluid depth in absorption field before test ~) in. Water added al. i New depth ~ in. Elapse~Tim.e: O..min. Final fluid depth O in. Absorption rat; >= ,~l~'t~' g.p.d. Any rejuvenation treatment (past 12 mo.) (Y(~I type) j~O If ¢es, give date / D. LIFT STATION t~)/~ Date installed Size in gallons Manhole/Access (Y/N)~ 'Pump on' level at in.~water alarm level at in. Datum ~ Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES Public sewer main Sewer/septic service line Animal containment areas SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot {DE) On adjacent lots On adjacent lots /~:~ ~- Public sewer manhole/cleanout ,'O/,~ Holding tank /0/~* Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~' ~ Property line ,~' Water main water service line Wells on adjacent lots /,~ '/ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ('~) ~ Building foundation. /'~ Water Service line /g~) ~'' Surface water ~g:~) / Curtain drain ~01~ P~I~),~,.J Wells on adjacent lots [~:~> 4.- Absorption field ~-'~- Surface water /~ *~ Water main /L)//f Driveway, parkingNehicle storage F. COMMENTS review of Municipal records tha~he above sy_stems are in confo~ance with MOA COSA uid Engineer s Printed Name t I / I Date ~ ~ ~ ' COSAFee $ ~ . /~¢ Wa,verFee$__ Date of Payment ~ Date of Payment Receipt Number~', ~C~O'/~7~ Receipt Number (Rev. 11~5) 07/24/2008 15:52 9876941211 SNSENGIN%_E~ING PAGE 01/03 10833~001 L2~3 ~ue Ta~m L2~33 Sue Tawn ~L#2 I'W$1D 0 ~ted DatiVe ~8 ~4:~ C~ct~ D~t~ime ~ 1~008 lO:~ R~d DatiVe ~ 1~8 14:15 T~h~cal D~or Stephen ~ ~e PQL Un~ Dab Date ~ EP200.8 C (<10) 0WISt0g 0'7/18/08 To~ Nitmt~Nit~t~N 2.60 ~ SM20 4500NO3-F B (<10) ~7/12/0 $ JDZ ~/i c:ob~.oloc~y Laboga toL-~' T0u] C0 tLrorm ~o~100mL SM20 9:,~t A (<200) m]/100mL $M~0 ~'~a A (<1) c~I/100mL SM20 ~'~n A (<1) 07/11/08 DLC 07/I 1,~8 DLC 07/11/08 DLC ASBUILT I HEREBY CERTIFY .THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY.' AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSII31LITY OF THE OWNE~ TO DETERMINE THE ~(ISTENCE OF ANY EASEMENTS, COVENANTS~ OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOUU ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTARLISHING B~JND- ARY LINES. SE~,IARD & ASSOCIATES LAND SURVEYING 694-082~ ,... :..~..7..~.. :,. -.;i.*..~ DEPARTMENT OF HEALTH&HUMAN SERvIcEs ~'~ ' ' Divisi~_e~tEensV;r~nstea~tiS~vices' , ' ~ P.O. Box 196650 Anchorage, Alaska: 99519-6650 343-4744 - CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLINg3 Parcel ,.D. # 051-501-28 '-'i~"~'!4~y-O~" '~ 1. GENERAL INFORMATION Complete legal description 5ct 2, Block 3, Sue ?awn 82 Locatio~,.(site,.¢,~.., .,-~ address or directions ~ '~'P, roperty owner'~ ,"prcwrv, \4',~ , \ .-,,-,,-~Mal ng'address ........P.O. Box 672372, Chuqiak, AK 99567 '~- Mmhng ..... "~¢ 2605 ...... address: ;. Denali, Suite 100, ; . AgeQ.t Victori8 DeLorla Address NHN Sue Tawn Drive . '. Day phone 688-4171 or 2685107 Day phone Anchoraqe, AK 99503 · Day phone 277-40R] Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well Community well Public water XXX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site ×xx Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~)25 [Rev. 1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on~site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING Name of Firm 17034 Eagle River Loop Road No, 204 Phone 6 c~ ~_/, ...% ~ -7 ~ Eagle River~ Alastca 99577 Engineer's signature ' Date 7/~ -7 /~/¢ DHHS SIGNATURE l~' Approved for / Disapproved. Conditional approval for bedrooms. bedrooms, with the followir': stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued, The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work, 72~)25(Rev. 1/91} Back MOA~21 Municipality of Anchorage DEPARTMENTOF HEALTH & HUMAN SERVI~ 2 7 'i998 Environmental Services Division MUNICIPALITY OF ANCHOI~AG[: 825 L Street, Room 502 ·Anohorage, Alaska g950~N~~vTq~4 01V~S~ON Health Authority Approval Checklist LegaIDescription:LO'r A B[-ock' 3 ~v£ '7~ ~ 7-- Parcel i.D.: A. WELL DATA Well type P/~ Log present ~'/N) Y ¢ ~ Total depth I 0 '~- Sanitary seal (~N) 'V f 5 If A, S, or C, attach ADEC letter. ADEC water system number Date completed r~ / ~ ~ Cased to ~/0 't- Casing height (above ground) Wires properly protected ~'N) S FROM WELL LOG Date of test "/ '/ ~ ~' Static water level r° / Well production ~ o g.p.m. AT INSPECTION g.p.m. WATER SAMPLE RESULTS: Coliform O Nitrate 1o ~ ';L. Other bacteria Date of sample: '"7 / ~' ~' SEPTIC/HOLDING TANK DATA Collected by: S & S ENGINEERING · 17034 Eagle River Loop Road No, 204 Eagle River, Alaska 99577 Date installed ~/'~ Ir'IL Tanksize I'~"~O Number of Compartments ~- cleanouts~/N)__ High water alarm (Y/~ A, o Foundation cleanqu.,t.,(;~YN).,, ~/~ 3- Depression (Y/~ ~ o Date of Purpp[n~ ~ 'i.~ {--: '~; %Pumper ~ ~ s ABSORPP 0N FIELD DATA.. '" ' Date instal.led ,~ ~[~ /'~ 6 .. S~il.. rating ~r ff~/bdrm) O. ~ System type ~,* o Length :. $~ ~ Width : I ~ Gravel thickness below pipe O. ~ ' Total depth ~ fiffo~tive a~s~rption aroa ~ S ~ ~, Monitodn~ lubo pros~nt ~) ~ ~opmssion ovor fiold (Y~ Data of adoquae~ Ios~ ~ ~ - ~ ~ ~ Bosul/s (Pass/Fa~) For ~- B~drooms Fluid ~ ~t~: ~sorpflon rato ~ fi.p.d. ~orox~m~M~st 12 months) (W~) II gos, ~ivo dat~ · 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles t~sted.~'~''~- Size in gallons "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / O 0 -/~ Absorption field on lot Public sewer main /q / 4- "~ : -' Sewer/septic service line / O 0 On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station f SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation "[' -/' Property line ~~ ~ Absorption field Water main/service line /O ~/- ~ Surface water/drainage ? ~ ~ ~P Wells on adjacent lots /o SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: / /..~ Property line I 0 + Building foundation ~ o Water main/service line Surface water /0 (~ ['~- Driveway, parking/vehicle storage area Curtain drain N~ ,~,~ ~. ~ o ~ ,v Wells on adjacent lots / o ,3 -~ ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal re--stems are in c°nf°rmance:>70~_ 2A guidelines in effect on this date' Signature 5,%:.,. HAAFee $. ~(~)~OO Date of Payment 7/2 7/¢~ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* JUL-~I-gS 1~:00 FROM-CTE ENVIRONMENTAL zt~___~ C T,E Environmental,Services lac, T-012 P.04/lO F-O15 CT&E Ref.# 983855004 Client Name $ & S £ngin~rmg pl'o~ eet N~e/Y N/A Client Sample ~ Lt 2 BI~ 3 SVE Tawn g2 Mat~x D~ing Wa~er Ord~ed By PWS~ 0 Sample Remarks: Client I~ Printed Da~elTime 07f31/98 12:20 Collected Date/Time 07/22/98 17;00 Received Date/Ti"ae 07/23/98 16:00 Tecl~eal Director: Stephen C, Ede 0 0,100 ma/L EPR 300.0 10 m~x OTIZ6/98 07/Z6/98 GCP