Loading...
HomeMy WebLinkAboutBRUIN PARK BLK 4 LT 15Bruin Park Block 4 Lot 15 #016-111-41 r Municipality Anchorage rr'rr,,, of ,;. t l- Development Services Department . `"` z ��'.`, �' ' Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page www.cL anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: So(/ O-AD 13 l PID Number. 0 /10— 111— 91 of Name: B RAD E 12.0 V lt_1C Wastewater System: ■ New ❑ Upgrade Address: 1 5 I Williti.c.cv- lbr;v'e. ABSORPTION FIELD Phone: Number of . corns: �{ I6rDeep Trench 0 Shallow Trench 0 Bed 0 Mould 0 Other LEGAL DESCRIPTION SoA Rating: 0.8 GPDrFP Total Depth from original grade: I D Ft, Block: tot Subdivision: 4 15 8RVtN ?AR-v,_ Depth to pre bottom from original grads: 4 Fl. Gravel depth beneath pipe: 6 Ft. Township Range: Section: FM added above original geode: Gravel tenpin: FI. 65 FI. Well: L 'New Upgrade Gravel width: d ane': I Distance between lines: 3 FI. I ---• FL Classification (Private. A. e. Cl: Total Depth: 1.2.1 Ft. Cased to: 1..n1 Fl Total absorption area p 780 Fe Pipe Material: 1 1= Sloe `3oy Driller. A t.., p t N K 1 I rrT'I Date Drilled: 6 -7-0 3 Static Water Levet 37 FL Installer. I< vial; Date Metaled: k frq!— tL x- )g, Yield. r;LD GPM Pump Set at: 2.o7Tbt- Ft Casing Height Above Grant a, Ft TANK SEPARATION DISTANCES 'Septic 0 Holding • S.T.E.P. 0 Other. ''''---..b From Septic Tank Absorption Field Lift Station Holding Tank PubndPrlvate Sewer line ManulscMer tf ><I�d (.{�1,�—['gN1t capaaty %2 DGat. Well I i B 132 l/' mate": ST i— C L Number of Compartments: Surface Water 1./.- 1./". L/ ✓� LIFT STATIO Lot Line 47 IT) / Sae: Gal. Manufacturer. Foundation /1 0 40 i / 'Pump on' level at in. 'Pump off level at in. High water alarm at: In. Curtain Drain V 1/ V (/ Pump Make & Model Electrical Yupect ons performed by Remarks: BENCH MARK Location and Description Be 1lc, tNI SIOlt HV Assumed Elevation: /0_0O9! FL Engir a `�'�tmp Inspections performed by: 1. S Dates: 1'I 4)144."‘�....sfitmc•T.••ee«•« • Fa 2nd �!('u /03 ; ..`L �i Development Services Department Approval Reviewed and approved by: Date: /2'3 i 03` �g'�"�t Tebbe., • �� 'C� tf.�`9' _�"•1pp''0��45 Fa (Arr. 12100) pRpfEs's1� 12 17 / 11 / / t STANDARD 4-BEDROOM1250 3YSIF11 / STANDARD ,AR�STPITC TANK � i4 65 TT LONGv 10 TT DEEP 4P. �,�/i �6 n UTE Rocx • 4' SWRIC 36 1T AC BC 4D5 AD 56 50 30.5 / BE 79.5 AF / BE / 69 46 16 iboos vas 49th 1%V i Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Rick Mystrom http:/lwww.ci.anchorage.ak.us Mayor Permit Number: #SW 030131 Date of Issue: 5-15-03 Parcel Identification Number: 016-111-41 Date Started: 8-7-03 Date Completed: 8-7-03 Is well located at approved permit location? ® Yes ❑ No Legal Description: Bruin Park Block 4 Lot 15 Property Owner Name & Address: Brad Erovich 751 Highview Drive Anchorage, Alaska 99515 Borehole Data: Depth (ft) Method of Drilling ® air rotary ❑ cable tool --- Soil Type, Thickness & Water Strata From To Casing type: steel stick-up 0 2 Wall Thickness: .250 inches organics & silt 2 5 Diameter: 6 inches Depth: 121 feet gravelly silt 5 15 Liner Type: silt gravelly silt silty sand 15 23 41 Y3 41 55 Diameter: inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): 37 feet Pumping level: 121 feet after gravelly silt 55 60 2 hours pumping 20 gpm silt 60 92 Recovery Rate: 20 gpm gravelly silt 92 117 Method of Testing: airlift Well Intake Opening Type: silty water sand & gravel 117 120 gravelly silt 120 121 ® Open End ❑ Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: bentonite # 8 Volume: I k Depth: Start 0 feet Stopped ?feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? ® Yes ❑ No Method of Disinfection: Comments: Well Driller: Alpine Drilling & Enterprises PO Box 110496 Anchorage Alaska 99511 Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property _. .1. _11 _I. •11 .1. _Il _ ___'1_ ____Vl l.. �_ �I. T..�-LTT__1�1. O TT__.._ (1_. _'.__ .•.1.'.. IIV..1 _L ..1_ .. \c 1-- Cod z,3 Il avv,.. MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM 1 WATER SUPPLY PERMIT Initial Permit Number: SW030131 Legal Description: 4Bruin Park Block 4 Lot 15 r Design Engineer: 0007 Tobben Spurkland, PE Owner Name: Brad Erovich Owner Address: 751 Highview Dr. Anchorage , AK 99515 - Date Issued: May 15, 2003 Expiration Date: May 14, 2004 Parcel ID: 016-111-41 Site Address: 11310 Polar Dr. Lot Size: 19000 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: El Disposal Field 0✓ Septic Tank ❑ Holding Tank ❑ Privy 0✓ 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 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. 8/6 /03 WELL pieitLEg »/Tena 4 Is M 5 i T` 70 THE AVE CORar R OP• !PRaf RTy ACCR055 ®/?1vr-w11Y OF <it1QflCi-7 "0-E-. Received By: Issued By: Date' Olt1/0-5 Date: 31/5/63 Municipality of Anchorage • Development Services. Department ;! Building Safety Division t . }.11 On -Site Water and Wastewater Program D lit y EJ 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FORA SINGLE FAMILY DWELLING Parcel I.D. DI (0-8 /- /41 Permit NumberSW030/3] Property owner(s) t3 -rex el l rO ll i G iT Day phone Mailing address (1) 75 1 }4 ;51.4 v;- -c,u D,,, -t -'— Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) L.4- 1 5l Ilk B.>QUtim -PA (7_< Legal description (Section, Township & Range) Lot Size /IMO. Acres/.q.Ft. Number of Bedrooms L! THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade 0 THIS PROPERTY CONTAINS: Hot Tub 0 Swimming Pool ❑ Therapy Pool ❑ ❑ Well Only. [t�}� Water. Storage Jacuzzi Water Softening Unit 0 0 I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorize agent) Permit Fees: 4751-0•0 °I' Date of Payment: -51 Waiver Fees: Date of Payment: Receipt Number: Receipt Number: (Rev. 12/00) T.SPUIRKLAND P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 15 BLOCK 4 BRUIN PARK S/D Brad Erovlck Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street Anchorage, Alaska 99519-6650 May 7, 2003 We are submitting an application for the installation of a well and septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the well and septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following : No Ground Water or Impervious Layer to 16 ft. Use Standard Trench Soil Rating. From Testhole 01/28/03 10 min/in = 0.8 gal per sq.ft/day No. of Bedrooms 4 Required Area per Bedroom: 150/ 0.8 = 187.5 sq.ft. Total area required: 187.5 x 4 = 750 sqft Testhole depth 16 feet Bottom Rock At 10 feet Top Rock At 4 feet Rock Depth 6 feet Minimum Trench Length 750 / 12 = 62.5 ft. SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 65 FT TOTAL WIDTH 2 FT TOTAL DEPTH 10 FT ROCK DEPTH 6 FT COVER 4 FT SEPTIC ANK 1250 GAL The installation of this well and septic system will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. C •• 49th •••••',*• • • r �. r 0t: TDBJEN SPURKLAND _ r No. CE -2225 ................... rrwSSI ■ 100 150 200 250 300 ALE: 1' = 100 FT. B I-4- Well B 12 K 5 // VACANT 1/ // N// 14 ' / / N'N TOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCH. AK. 99501 (907) 279-3916 LOT 15, BLOCK 4, BRUIN PARK S/D JACKIE AND BRAD EROVICK 11310 POLAR DRIVE SEPTIC SYSTEM DESIGN DATE: JAN. 23, 2003 SHEET: 1/3 GRID: 2633 PERMIT #SV030XXX PID # 016 -111 -XX BRU04151.DVG / 17 11 STANDARD 4 -BEDROOM • ". , / 1250 GAL SEPTIC TANK / STANDARD TRENCH / tfv a 17' LONG 10O TT DEEP 0 \I zc Rock' / / / 12/ / 16 / / . C'),•• P 49th • i i TiVN TOB 01f ' No. Ct-22 ff ff,1;f,F E iii N25 N IOD ., SCALD 1' ,50 FT. 125 150 / / / TOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCH. AK. 99501 (907) 279-3916 LOT 15, BLOCK 4, BRUIN PARK S/D JACKIE AND BRAD EROVICK 11310 POLAR DRIVE 14 PERMIT # SV030XXX PID # 016 -111 -XX SEPTIC SYSTEM DESIGN DATE: MAY 7, 2003 SHEET: 2/3 GRID: 2633 BRU04152.DVG Standard Trench: 2' Vide 65' Long 10' .Deep 60' Sewer rock 4' Cover Silt Barrier NO SCALE Monitor Cleanouts 4' Cover Double Clean Outs • 1 : =11-11=11=11=11=11=11=11=111==11=n11==111=1=11=111=1=11=11=1:1 n—U-11 g° a=n -u=: -'i=n_il=a=��_.. =11=11=11=11=11=11===11= =11=11=I-1=11=II=1=1h: I=u�. •. 1=11 =11=11=11=11=11=11=11=11=11=11=1=:11=11=11=1'= 1:p 11=1.11=1 . -"- 1=11=11=11=11==Ii=i111=11=11=11=11=11= 11=11=11=11=I-111-" =I I�p ll�ll=11=11=11=11-11=11=11=11=61=61-IIll? 11-"' r�rl�r •:•:::•:•:•:•:•:•:•:::4••••:••••%":•••••••:••••••• •••••••••••••••••••••••••:•:•:44.11:•:•:•:•:•:•:•:: 1250 gal Septic tank 4„.<7.7.....,„.............. ''''' • Ai 49th • • • :� TOB ' S▪ PURKLAND .1: al •• No. CE -2225 •'� N Arie ,, ;; �ili- 6.0 Pt or Septic Rock Effective NO SCALE Foundation Clean out 1250 gal. septic tank TDBBEN SPURKLAND P.E. 203 W15th Ave Anchorage Ak 99501 279 291A LOT 15, BLOCK 4, BRUIN PARK 11310 POUR DRIVE BRAD EROVICK SEPTIC SYSTEM SCHEMATIC DATE' MAY 7, 2003 SHEET' 3/3 GRID 2633 PERMIT SW0300XX PARCEL ID / XX W0100013.DWG Performed For: Legal Description: 0 Dept (Feet) /1/1/ 1 2- 3- 4- 5- 6- 7- 8- 10- 11- 12- 13- 14- 15- 16 17- 1G- 19- 20 - Municipality of Anchorage Development Services Department Building Safely Division On -Site Water and Wastewater Prcgram 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 YAW/ Ci anchorace.ak.us (907) 343-7904 Soils Log - Percolation Test < l! d!I 11 6 4AV; a� .•'fes .. d �%ErrGwee .w 0), . Io'itr; 49L .9... 19 R` i T- •ben Spurkt°nd O� �% CE -2243 6W �iepao' EssioN4�4 1-28-03 Date Performed: LOT 15s SW_ 44 SRA, t1.4 ?Aa , Township, Range. Section: Slope Site Plan OQ4ANLC. Scx-Kct•l S;l-t. L. COMMENTS 13ersro Lt.{ of Holt WAS GROUND WATER E?:CCL: AERED? No IF YES, ATWW'TDEPTH? Depth to Water After P Monitoring? T�/ E Date: 5/7103 Fga2 Date Gross Time,�jI Net Time ?/4•ESOELv_•tic•SVt. Depth to Water Net Drop l',Z_ 8.03 toe.‘ Co VT laa.tLwk 4Ys 1 0 L9/li Lo a 7 lly 6'/y 1: 0 s• t0 I 6% 1° 6 try 1 6 to y try 1° 6,1/4i $- 5 t t:7 6 1/41 10 35 tO 6 V to PERCOLATION RATE 1 D (mmtestnc1) FERC I'.CLE 0 A}.IETER TEST RUNBETNEEH ij FT AND fd FT PERFORMED BY: l , �j 1 1 . s CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNCIPAL GUIDELINES IN EFFECT ON THS DATE. DATE: IA f/0 3 /5- ./4-411 ABM Escrow MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 0CT 2 81977 RECEIVED Octdber 25, 1977 Reference: Earnest Money dated August 24, 1977 Environmental Quality Letter October 24, 1977 Verbal agreements between buyers/sellers/agents 1. Seller will escrow $600.00 for estimated material costs to improve septic system located at subject property. Estimates available at Polar Realty upon request. Seller will escrow $50.00 for repair or replacement of intercom system. Seller will pay, from closing funds, $125.00 to R &.M Consultants for septic system test. 2. Bowden and Polar Realty will escrow $50.00 each towards repair or replacement of intercom system. 3. Buyer will release seller from future liability as con- tracted for on subject agreement to purchase. .c) Buyer/ ��:•; i C 7 iG I Polar I alty rg Bowden Realty Gf Seller Gc_..('1r;��J' ��.,v • L.,t= Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 016-111-41-000 Expiration Date: / / ' . " / 3 1. GENERAL INFORMATION Complete legal description Bruin Park Blk 4 Lt 15 Location (site address) 11310 Polar Drive, Anchorage, AK 99516 Current Property owner(s) Stephen & Heidi Tait Day phone Mailing address 11310 Polar Drive, Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: Z Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance, Received by: da COSA to be released to the engineer, unless otrequested by the engineer. Date: COSA Fee $ 490.00 Date of Payment 7-/a 91/3 c -LC Receipt Number /4532? CosA# C-1313"1 Waiver Fee $ Date of Payment Receipt Number Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 7J&7/,3 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. 6. DSD SIGNATURE ?..------' System #1 Approved for i' bedrooms. i �E� % oZ 7 (- VSs Air System #2 Approved for bedrooms. Disapproved. \P�F`is0N;I Conditional approval for bedrooms, with the following stipulations: By: KENNETH M. DUFF 7115 . \, Ol((U((F((((oe, csi ON-SITE WATE N AND WASTEWATER oZ, PROGRAM , Original Certificate Date: — 3-- /3 Th uniGlity An .rage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: Bruin Park Blk 4 Lt 15 Parcel ID: 016-111-41-000 A. WELL DATA Well type Pvt If A, 6, or C provide PWSID # Well Log (Y/N) Y Date completed 8-7-2003 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth 121 ft. Cased to 121 ft. Casing height (above ground) 2.0 /Fr FROM WELL LOG AT INSPECTION Date of test 8/7/2003 71512013 Static water level 37 ft. 63 ft. Well production 20 g.p.m. 7.7 g.p.m. WATER SAMPLE RESULTS: Coliform Neq colonies/100 mL Nitrate 0.184 mg/L Arsenic: 5.29 ug/L Date of sample: 7/5/2013 Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA Tank Type/Material Steel Date installed 6/25/2003 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 7/8/2013 Pumper A+ C. ABSORPTION FIELD DATA Date installed 612512003 Soil rating 0.8 (g.p.d./ft2 or ft2/bdrm)_ System type Deep Trench Length 65 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 9 ft. (Measured) Eff. absorption are 780 ft2 Monitoring tube Y Depression over field N Date of adequacy test 71512013 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 37 in. Water added 1158 gal. New depth 59 in. Elapsed Time: min. 1440 Final fluid depth 44.4 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N if yes, give date D. LIFT STATION Date installed NA Size in gallons NA Manhole/Access (WN) NA "Pump on" level at NA in. "Pump off' level at NA in. High water alarm level at NA in. Datum NA Cycles tested NA Meets alarm & circuit requirements? NA E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 1004 Public sewer main 75'+ Public sewer manhole/cleanout 1001+ Sewer /septic service line 25'+ Holding tank 100'+ Animal containment areas 501+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Water main 10'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Water Service line 10'+ Property line 51+ Absorption field 5'+ Water service line 10'+ Surface water 100'+ Building foundation 10'+ Water main 10'+ Surface water 100'+ Driveway, parkingNehicle storage 10'+ Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that t have determined through field inspections and review of Municipal records that the above systems aro in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 7/2912013 COSA brown sheet_10.10.12.doc 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 Parcel I.D. 0:6- //t - '// 1. COSA # O(O n (-� Expiration Date: 12 - 7' - t7 Gi GENERAL INFORMATION Complete legal description Lob or, eiock Y, i3rr:.n Park Sid Location (site address) 113:0 rear D r. -e Current Property owner(s) Renee an. a c k Day phone 36o - 86s, Mailing address ltpro Po/sur Dr'.te, lnetiorop A -'c 99s11 1 Lending agency 'Daly phone Mailing address Real Estate Agent (rr. E.-►e,;y j a-na.l R rot& Day phone 230 -7 voe Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. please lu.1/ o cone r1 Sn,d Stowck ?6o -6656 w4en Ca(A rrae' fv- p..c 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank 0 ❑ Community On-site 0 ❑ Public Sewer 0 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 registeredirr heState-of Alaska -Certificates -of On:SiteSystems Approval area equlred for-the-ransferaf title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may; be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm FfaPh? 'Tech n/COI Svrvr+Av Address / 'is- 3 et Echo canyon Rom Rrc6 99s -!C Engineer's Printed Name i heodo,70 T. ino-r Phone ? 4Cr- 17 s, - Date s, Steri..) 2006 ' 4 OF vitt„, , et.v ?' Ott(A • X43 r• ,"<a Imo 5. DSD SIGNATURE .� a. Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: LL • TF:EODORE F. IEOOAE d 0 { i7 CE -3509 , E • •• .11.Q j'J 4441( /DFrg y?� SY; �� �P cy• Additional Comments• ON-SITE • • 0-;:4 WATER AND M. WAS I tWA1 ER PROGRAM BY Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate -Advisory Gcl1`l,�lun 110 Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other (Rev. 11/05) Original Certificate Date: (1— 7-o6 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.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: L. f Ib; t3 /oc k y/ en. ,fit Pork S Parcel ID: o/ 6 – / I / - di/ A. WELL DATA Well type P t If A, B, or C provide PWSID # — Well Log (Y/N) Y Date completed 8/7 /03 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Total depth /It ft. Cased to /2r ft. Casing height (above ground) FROM WELL LOG AT INSPECTION Date of test 8/7/03 eILi/o! Static water level 77 ft. 6` ft. Well production ?O g.p.m. 7.i +- g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate <0.1 mg/L Arsenic: L.71 ppb date of sample: 8/ t.v/o B. SEPTICIHOLDING TANK DATA Tank Type/Material Sa. He / flat, / in. Other bacteria 1 colonies/100 mL Collected by: F//Her nth C' -r Date installed 6 r 24" / 0 3 Tank size its* gal. Number of Compartments Z Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) ta High water alarm (Y/N) Date of pumping 8%6 / 0/ Pumper tcaact C. ABSORPTION FIELD DATA 1" A. Date installed 6 / 2.s"/o3 Soil rating (g.p.d./ft2 or ft2/bdrm) O. b System type Trent Length LS ft. Width 2 ft. Gravel below pipe L ft. I Total depth 9 ft. Eff. absorption area Iso ft2 Monitoring tube Y Depression over field M Dale of adequacy test 8 / 28 /OK' Results (Pass/Fail) Pact For °j bedrooms Fluid depth in absorption field before test 23 in. Water added TSI gal. New depthjr.3 in. Elapsed Time: f72 min. Final fluid depth 2*0 in. Absorption rate >= 5_42/2I g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) None K n..✓n If yes, give date D. LIFT STATION N. A. Date installed 'Pump on" level at _ in. Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1 2o' Absorption field on lot 1 3S' Public sewer main N• 4. Size in gallons Manhole/Access (Y/N) 'Pump off" level at _ in. High water alarm level at Cycles tested Meets alarm & circuit requirements? Sewer /septic service line •> Zc'• Animal containment areas No 1f in. On adjacent lots > 10c' On adjacent Tots > too • Public sewer manhole/cleanout M• A. Holding tank 1". A. Manure/animal excrete storage areas me^C SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 7 10 ' Water main M. A. Property line V-71 Water service line Absorption field .t ' > to' Surface water > ram• Wells on adjacent lots > t oo SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I0' Building foundation Yo' Water Service line -> to' Surface water > too. Curtain drain Meet seen Wells on adjacent lots > '00' F. COMMENTS Water main W. A. Driveway, parking/vehicle storage > So G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name TA eo done Date Sent S. tots 6 F. ?tee -t �.,t''•u; :nap:: r. MOORE f '• CE -3L04 t c COSA Fee $ H3o !e Date of Payment 9/570� Receipt Number (Rev. 11/05) 8508a - .6.5./04.6 c`g: fir. Waiver Fee $ Date of Payment Receipt Number SCS Refit Client Name Project Name/N Client Sample 1D Matrix PW SID 1064969001 Flattop Technical Srv. L15 Blk 4 Bruin Park SD L15 Blk 4 Bruin Park SD Drinking Water 0 All Dates/Times are Alaska Standard Time Printed Date/time Collected Date/lime Receised Date/time Technical Director 09/05/2006 9:26 08242006 15:15 08/24/2006 15:58 Stephen C. Ede Sample Remarks: Parameter Results PQL Units Method Allowable Prep Analysis Container ID Limits Date Date Ink Metals by ICF/MS Arsenic Waters Department N1lmll N Microbiology Laboratory Total Coliform 6.76 ND 1 OB. No Coli 5.00 ug/L EP200.8 0.100 mg/L EPA 353.2 colJl00m1. SM209222B C (<10) 0828/06 09/01/06 WAW B (<10) 0824/06 ALR A (<1) 08/24;06 TLF LOT // o��,i 06' 19 5 GNI v DATE LOT (6 N LOT /4 6.56) Lot /5 , Block 4 Bruin Park ,Subdivision Anchorage Recording District, Alaska LOT SURVEY CERTIFICATION 1 honey orllty that I have swveyed the property shawl and described hereon, ond that the I.prere.ente eltaated thereon ore within Me prop• rosy lines and de set overlap or encroach on ed$eoenl property and that ha urorovrwde on odlaoent property overlay or encroach w the premien N question and Mal then are co roodeo e, utility linos, r ens visible 'consenter sold property poser se Indicated Mr,se. i=E�O....s�f • -vf1 ' .. / )9 .Wrdulton s.•. 111193 t�ay"i 3/414, AorfssioNAt - wlese , [aeee.r,te 01 roosted *Mr than Mose shown w Me Net of reseed re pot acne Mr00e Ise motel. LEGEND 0 Brass or Aluminum capped monument recovered O Iron pipe and/or rebar recovered. O 2 x2 hub & tack recovered • 5/8"x30" attar set this survey BAS/S OF VERT/�^,a,L DATUM = 1927 N.G.S. /972 ACAvuST. Scale e40 r IRef. 763,3 Date © 06-Z3-03 F.B. No. 46-74 Prepared by: R. L. BUTTON Registered Land Surveyor (907/279-6200 5/9 W Eighth Ave. Anchorage A,4t9950/ Property °f: Brod 1' c.kck%e Ero vick