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Home My WebLink AboutSTONY BROOK BLK 1 LT 1B sr , ' Municipality of Anchorage Page l of'Z--' 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.a ~-~)~ PID Number: ~ [d~'ll ~, Wastewater System: ~ew ~ Upgrade t[[~ ~%¢~ ~ ~,~6~ ABSORPTION FIELD Phone:I~lN°'°~r°°ms: ~eepTrench ~ Shallow Trench ~Bed ~Mound ~Other LEGAL DESCRIPTION s°i~ ~b"~: ~. &~../sq. ~, /~/ Lot: t~ Block:[~dSubdivisi°n:~ Depthto pipe bottom ,rom odginalgrad~ Ft, Gravel depth beneatl, pipe ~/ Ft. ~ Fill added above original grade- Gravel lengll~: I WELL: ~ New ~ Upgrade Gravel width: ~/Ft. ~ ~ Ft. Classification (Private1 A.B,C): Total Depth: Cased TO: Total absorption area~ Pipe material: ~ ~/~ Casing Height Abov~ Ground: .,.~ /~ .,. TANK SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P. From Tank Field S~ation Tank Sewer Lines ~ ~ ~ ~ /~ [ Material: Number of Compartments: Surface w~t~ [~'~ t~ ~ ~ ~ LIFT STATION Line J~ t~ {~ t~ ~ ~ ~I ' Foundation t~~ ~ ~ "Pump on" level al~evol at: I High water alarm at: ~¢ ~ [~ ~ P~n~ [ Electrical lnspections performed by: Curtain Drain Remarks:: 'BENCH MARK Assumed ENG~EAL Inspections performed b~a~j` ~tver, ~aska ~S~7 Dates: 1st ~ -~ ~ >~_ Department of Healt~d S~rvices apprgval ~ ~",, Reviewed and approved b Date: ~ ~. ~,~-~- 72-013 ( Rev. 9/91 ) MOA 25 Pbrmit No. SW930089 Page g of g Municipality of Anchorage 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 STONY BROOK SUBDIVISION, BLOCK 1, LOT lB 01551106 Legal Description: PID No.: CO1 C02 96.5' 96.? FINAL GRADFr~C04 MT./- C03 MT2,/ 92.7~ 86.7'~' · 79.7' NO WATER FOUND NEW 5 BDRM HOUSE FOUNDATION 500 GAL SEPTIC TANK A B FCO 18.5 7.6 [ C01 18.2 21.2 C02 26.0 32.9 C03 44.2 49.9 C04 40.8 53.~ ~?t 98.31 107.51 C05 98.8 107.9[ MT2 96.2 102.3 C06 97.5 103.6 CO4 /NEW TRENCHES C06 ENGIN S SEAL 72-013 A (Rev. 9/91 ) MOA 25 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER ' WATER 'WELL RECORD WELL OWNER; WELL DEPTH; DAT~ OF Depth Of hole~ ~ ~ ~ ft Depth 0f Casing; ~ O ~ ~t _ ~ . ,.I DEPTH TO STATIC WATER LEVE,L: . . . Date: '~ /~ I ~Z .. M~HOD OF DRILLING~ ~eit rotary ~ cable tool ~ other USE OF WELL~ ~ domestic ~ irrigation ~ monitor ~ publ;c supp~ ~ other. CASING STICK-UP; ~, ft, Diam: · ~ jn, to ft Ceslng type:~'L~_ - in, to WELL INTAKE OPENING TYPE,S. open end ~ screened ~ perforated ~ open hole Depths of openings: to ....... ft SCREEN TYPE: Dism: in. Slot/Mesh Size: .__ . Length: .... ft GRAVEL PACK TYPE: ..... Volume used: Depth, ,to top: ...... GROUT TYPE: Volume~ __ Depth: {rom ft to _ ~ ':'_--- fl DEVELOPMENT METHOD: ~, ........ Duratiom PUMPING LEVEL AND YIELD; .~._~ ~ ft after / hfs pumping.~'.¢'~, gpm PUMP INTAKE DEPTH: ,~ ft H~)~opower: __~ DISINFECTED UPON.COMPLE~ION? [ $ ,.1~ NO PLEASE MA L WH TE COP,Y~0F LO,G:, TO: DNRIDIV SION OF~WATE~ - '~i"" ~ PO BOX 772116 EAGLE RIVER AK 99577.~-116 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930089 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:STEVENS JAMES L OWNER ADDRESS:ill38 STONY BROOK DR ANCHORAGE, ALASKA 99516 DATE ISSUED: 5/07/93 EXPIRATION DATE: 5/07/94 PARCEL ID:01551106 LEGAL DESCRIPTION: STONY BROOK BLK 1 LT lB LOT SIZE: 41914 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / 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 343-4329 OR 343-4681 AFTER BUSINESS HOURS 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: 1. SYSTEM BE INSTALLED AROUND TH #1. CARE MUST BE TAKEN TO KEEP SYSTEM IN GM MATERIAL. 2. ENGINEER WILL CERTIFY THE ABSENCE OF ANY GROUNDWATER AT INSTALLATION SITE. RECEIVED BY: ISSUED BY: DATE: DATE: April 15, 1993 ROBERTSHAFER, PE ROGERSHAFER. PE CIVIL ENGINEERS (907) 694-2979 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDtES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. Box 196650 Anchorage, Alaska 99509-6650 REFERENCE: Lot lB, Block 1, Stony Brook Subdivision Request you issue a permit to install a well and septic system to serve the proposed 5 bedroom home on the referenced property. Two soil tests were performed on the property as shown on the attached design/site plan. Both test holes were monitored on April 15, 1993 and found to be dry to a depth of 17 ft. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed well and septic system. If you have any questions or require additional information for your review, please contact us. Sincerely, ROGER J. SHAFER, P.E. ON SITE WASTE WATER OISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 407 RECEIVED Niu.~'~ ,.~, .: ,: :~nGhorag~ Dept. ~l;~-I{h ~ HLIr~an Sen/ice~ 3ARJO \ \ 5'1 ¥07 ~00~8 W Z / ¥o? Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ' ~ -~/~ s~oPE SiTE P,AN 1 2 3 4 7 8 9 10 WAS GROUND WATER ENCOUNTERED? Gross Net Depth to Net Reading Date Time Time Water Drop 11 s IF YES, AT WHAT OL DEPTH? p 12 E Depth to Waler ADer Dale: ~]~ 13 ~ Monitorin9? 14 15 16- 17 - 18- 19- 20 - PERCOLATION RATE ~) (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~:~ FT AND ~'~ ET PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMEO LEGAL DESCRIPTION: 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 20- ['"~ ~ ~,~r DATE PERFORMED: ~"'~'~[~..~.~ Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? pO E Depth to Wetor AEar / Monitoring? ~ Date: '~'"~ ~ Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~[x::~ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN J¢~ FT AND 7 FT PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNIC~PAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot lB, Block 1, Stony Brook Subdivision GENERAL: 1. The scope of this project includes the installation of a 1500 gallon septic tank and a deep absorption trench to serve the five bedroom residence proposed for the referenced property. 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. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 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. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. Ail standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. page 2 Lot lB, Block 1, Stony Brook 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. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENOH/DRAINFIELD INSTALLATION: 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. 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. 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. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. 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. 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. page 3 Lot lB, Block 1, Stony Brook 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: 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. 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. 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. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank constructed by a manufacturer. proposed for installation must be Municipally approved septic tank The following septic system Anchorage: pipe materials are approved for use in installations in the Municipality of Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM FS10 (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. page 4 Lot lB, Block 1, Stony Brook 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. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, it's gradation specifications must conform to AMC 15.65.060D. / uni¢ila litYo 0 Anchorage P.O. BOX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 343-4200 x~D~ Tom Fink MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES January 12, 1988 Bob Runkel 4811 Bishop Way Anchorage, Alaska 99508 Subject: Lot lB Block 1 Stoneybrook Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1987. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as-built inspection report (three-part form) must be sent to this office for review and approval, and for documentation. Effective January 1, 1988, a new fee schedule is in effect. When re-applying for a new permit, the new fees are; $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. Program Manager On-site Services RWR/ljw enc: Copy of Permit [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19. 20 SITE PLAN / / / / WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Cross Net Depth to Net Reading Date Time Time Water Drop / ~-~7 0 0 I0,('~0" 0 ~ ~-~- ?? £ Z_ q, oo" /" H PERCOLATION RATE ~T~L/'L~ (minutes/inch) TEST RUN BETWEEN ~// FT AND ,~"~ FT 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] SOILS LOG //~ PERCOLATION TEST PERFORMED FOR: /~/ j/-~,~.L~-~j',~' 2 3- 4- 5- 7 8 9- 10- 11 WAS GROUND WATER ENCOUNTERED? 13- DATE PERFORMED: J/~'J~' ~/! /~7~7 E IF YES, AT WHAT DEPTH? 14- 15- 16- 17- 18- 19- 20- Gross Net Depth to Net Reading Date Time Time Water Drop 4 Michael E. Anderson 4381 -E PERCOLATION RATE ~ / ~'/'~//7-" (minutes/inch) TEST RUN BETWEEN '~ , FT AND ~'~FT 72-008 (6/79) / / ' / / ~ / ~tay 5, 1978 R&M No. 851114 Mr. Ralph Weeks P.O. Box 6305 Anchorage, Alaska 99502 Subject: Soil Investigation for Sanitary Sewer System, Lot lB, Block 1, Stoneybrook Subdivision, Anchorage, Alaska Dear Mr. Weeks: At your request of April 26, 1978 we conducted a subsurface soils investi- gation at the proposed location of the sanitary sewer system on the suject lot. This investigation, which was accomplished on May 4, 1978, consisted of a test hole drilled to a depth of 10 feet below the existing ground surface. Several attempts were made to drill to greater depths but each one encountered boulders at shallow depths with subsequent auger refusal. A road cut adjacent to the subject lot and consisting of similar material was logged to a depth of 15! to give a more complete picture of the material encountered. It is believed to be a representative example of material at the site. The test hole was sited according to your instruc- tions and its location is shown in attached Drawing A-01. Drilling was accomplished with a rotary drill rig using continuous flight solid-stem auger with an outside diameter of six inches. A sample was taken at the depth shown on the soils log in Drawing A-01. The sample will be held in storage at our lab for approximately 6 months. In addition, all material brought to the surface by the augers was continuously monitored by an experienced engineering geologist. The topography at the drilling site is generally hilly and sloping to the west. At the time of the investigation the site had original vegeta- tion consisting of spruce, alder, and mosses. The top of the hole was located at original ground surface. The soils encountered in the test hole and road cut are shown in Drawing A-O1. Groundwater was not encountered to a depth of 10 feet. Due to the lack of moisture in the soils encountered in the test hole, as well as those observed in the road cut, it is believed that no water table would be encountered within a depth that would affect the normal instal- lation of a sanitary sewer system. Bedrock was not encountered. Seasonal frost was absent and permafrost was not encountered. A percolation test was performed within the bore hole at the depth shown in the attached Table I. All depths were measured from the top of the May 5, 1978 Mr. Ralph Weeks Page -2- hole. The data in Table 1 show average infiltration from the depths indicated to the bottom of the hole. The measured perc rate was 12.5 minutes per inch. We appreciate this opportunity to be of service to you. Please contact us if you have any questions concerning this letter or if we can be of additional service. Very truly yours, R&M CONSULTANTS, INC. $ta££ ~e~l~g±~t GAS:LK/kah Project Manager BORING NUMBER 1 Date Completed: 5-4-78 SOil DESCRIPTION PEAT Dark Brown, Soft SILT W/SO~ GRAVEL (GM-ML) Brown, Moist, Medium Dense 4.5w 1 SILT W/SOME GRAVEL (GM) TRACE SAND Scattered Boulders and Cobbles Brown, Dry, Dense 10.0' Total Depth Of Bore Hole GRAVELLY SILT W/MANY (GM) COBBLES AND SCATTERED BOULDER~ Gray, Dry, Dense '15.0' No Water Table Encountered/Total Depth Of Road Cut LOCATION SKETCH No Scale LOT iA 120' ~T.H. 1 LOT lB Road Cut Mountain Lake Terrace NOTE: DISTANCES SHOWN ARE APPROXIMATE AND HAVE NOT BEEN MEASURED BY SURVEYING METHODS. EXPLANATION ORGANIC MATERIAL Little Visible Ice OqO'Vx .. (~Ss, 72, 5~ iO/o,85,9 pcf TYPICAL SOILS LOG I SAMPLER TYPE SYMBOLS SOIL SYMBOLSI OKD. ~t~ I ]I~.,5~.C__O.~.U.'I~.~TS.,~ ,-c. ll ~,0T lB, B~C~ l D~T~. 5-4-78 / II ............. Il STONEYn~OOK SUBDIVISION e abov3/l S0,LS LOG jJ ~c~oRA~E, ~sRA GRID. PROJ. N0.851t14 PERCOLATION TEST Louise Weeks R&M NO. 851114 TIME ELAPSED TIME INCHES DROP IN INCHES 12:00 12:01 12:02 12:03 12:04 12:05 12:06 12:07 12:08 12:09 12:10 12:15 12:20 12:25 12:30 12:40 12:50 1:00 1 2 3 4 5 6 7 8 9 10 15 2O 25 5o 40 50 60 9 9.6 9.6 9.6 10.2 10.2 10.2 10.2 10.8 10.8 10.8 10.8 11.4 11.4 12.0 12.6 13.2 13.8 .6 .0 .0 .6 .0 .0 .0 .6 .0 .0 .0 .6 .0 .6 .6 .6 .6 4.8 # Total Drop 12.5 Minutes per inch C=, 1 8 9 10 u � p 7 `\,10 ►�7k. F Municipality of Anchorage 0- MAY` �::I s * On-Site Water and Wastewater Program t i 0 (907) 343-7904 E T t co za 68 Lg�� Certificate of On-Site Systems Approval Parcel I.D. 015-511-06 Expiration Date: 0-A-16 18, Q018 1. GENERAL INFORMATION Complete legal description Stony Brook Block 1 Lot 1 B Location (site address) 11138 Stony Brook Drive Current Property owner(s) Ronald Bates Day phone Mailing address 11138 Stony Brook Drive Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: Q Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 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: 4Received b : •t`1, i Date: COSA to be released to t ngineer,unless otherwise reqbilli by the engineer. COSA Fee $ 5 Waiver Fee $ Date of Payment G71 0/1Fs Date of Payment Receipt Number Og,gb5fi Receipt Number COSA# 4.)-(-"C. I912-G1 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. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 5/9/2018 OF Ac.,��l!_N 6. DSD SIGNATURE f System #1 Approved for -5bedrooms 1 •.S{even R. ian€14--- ....... one:''j rr+�g. CE-8149••. �� System #2 Approved for bedrooms s •. Disapproved ski\�OFESS1d��+ Conditional approval for bedrooms, with the following stipulations: \1Y /IN :' ON-SITE 'Q WATFR AND "' WASTEWATER H- OG AM ,040 72\i\( • By: �q bf, P¼ C11Ji f Ek Ikrl d Original Certificate Date: Inv 18, .201' The Municipality of Anchorage 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 sheeti' c • If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Stony Brook Block 1 Lot 1B Parcel ID: 015-511-06 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 7/20/1993 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 209 ft. Cased to 209 ft. Casing height(above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test 7/20/1993 5/8/2018 Static water level 110 ft113.1 ft. Well production 30 g.p.m. 4.5 g.p.m. WATER SAMPI,'j= RESULTS: Colif. li.�1- colonies/100 mL Nitrate NI� mg/L :1", 5/3/2018 PES Arse is qtr ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 5/24/1993 Tank size 1500 gal. Number of Compartments 2 Cleanouts(Y/N) Y Y NFoundation cleanout(Y/N) Depression over tank (Y/N) High water alarm (Y/ N/A/A Date of pumping !L till Pumper fWUL Cil �14 C. ABSORPTION FIELD DATA Date installed 5/24/1993 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 GPD/SF System type Deep Trench Length 111 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 10 ft. Eff. absorption area 1332 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5/8/2018 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test 0/40 in. Water added 750 gal. New depth 0/53 in. Elapsed Time: 240 min. Final fluid depth 0/40 in. Absorption rate >= 750+ g.p.d. N Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION .+` I certify that I have determined through field inspections and ,,rip' .• �4` •ty#, review of Municipal records that the above systems are in 0*: L -I\ •.*,� conformance with MOA COSA guidelines in effect on this date. % 4V) Engineer's Printed Name Steven Pannone ',•':Seven•1t Pannone• e Date 5/9/2018 I.:-.. CE-8149 " �� r k‘4ZES.Sieit.,„..‘"-... COSA canary sheet_2-6-15.doc ___S.G t. SGS Ret# 1181939001 Client Name Pannone Eng.Srv. Printed Date/Time 05/16/2018 16:12 Project Name/4 11138 Stony Brook Drive Collected Date/Time Client Sample ID 11138 StonyBrook Drive 05/03/2018 15:15 Received Date/Time 05/03/2018 15:48 Matrix Drinking Water Technical Director Stephen C.Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date [nit Total Dissolved Solids 221 10.0 mg/L SM2I 2540C A (<500) 05/04/18 EWW Metals by ICP/MS Hardness as CaCO3 ND 5.00 mg/L SM21 2340B D 05/09/18 05/15/18 VDL Waters Department Total Nitrate/Nitrite-N ND 0.100 mg/L SM21 4500NO3-F C (<10) 05/03/18 AYC Microbiology Laboratory • E.Coli Negative 1 100mL SM21 9223B B 05/03/18 DSH Total Coliform Negative 1 100mL SM21 9223B B 05/03/18 DSH Private Individual Analysis Chloride 8.22 0.200 mg/L EPA 300.0 A (<250) 05/07/18 05/07/18 AYC Conductivity 376 1.00 umhos/cm SM21 2510B A 05/03/18 AYC Fluoride ND 0.200 mg/L EPA 300.0 A (<2) 05/07/18 05/07/18 AYC Sulfate 16.6 0.200 mg/L EPA 300.0 A (<250) 05/07/18 05/07/18 AYC Alkalinity 166 10.0 mg/L SM21 2320B A 05/03/18 AYC Aluminum ND 20.0 ug/L EP200.8 D 05/09/18 05/10/18 VDL Antimony ND 1.00 ug/L EP200.8 D (<6) 05/09/18 05/10/18 VDL • Arsenic 5.34 5.00 ug/L EP200.8 D (<10) 05/09/18 05/10/18 VDL Barium ND 3.00 ug/L EP200.8 D (<2000) 05/09/18 05/10/18 VDL Cadmium ND 0.500 ug/L EP200.8 D (<5) 05/09/18 05/10/18 VDL Calcium ND 500 ug/L EP200.8 D 05/09/18 05/15/18 VDL Chromium ND 2.00 ug/L EP200.8 D (<100) 05/09/18 05/10/18 VDL LOT 1A N89°55'10"E 300.00' -- - I I GREEN HOUSE 1 0o�4pO�0o44 4 C 3 C _ .... I v��•.•••rr...HA.... 95�4 'ir 25.0' M I 0,l'o)/"?..." ..4.9 TH* '•.'f-(110 ;E: • •••••••••••••• q seN o 0'... / O 25.4' " 1$b • g •' ��% EXISTING m LOT 2 . STEVEN CALLA/HAN; ��O 5 CO �'•- 4 N HOUSE 200 I o z0 Q444°^#0. a •• ¢L//gg�-1122034 'n . . 4Q^#0.17 % t� �0 b2.0 2.0' jll� �� ......':'.'.'.'..'.':.'..'.'.'..':.'::.•. ® b Ni N in iv 00°fe3Sionot .‘5("4... M b o ‘OOOOOo� 30.4' j :: :::........... ..... ...............• ...............•...... • • 0 ••••••••••• •••••• ••••• ••• z LOT 1B :: 'z: .................. ................. zo I 30' 0 - - - - --- - - - - 10' UTILITY EASEMENT v �O S89°55'10'W 280.01' R=20 `r) gNOTE: 112TH AVE. THIS DRAWING SHALL NOT BE MOUNTAIN LAKE DRIVE MODIFIED FOR USE AS A PLOT PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH. zso H Street LEGAL AS-BUILT e I ('�� Anchorage,Alaska 99501 DESCRIPTION: ADDRESS: 11138 STONY BROOK AVE. PARCEL#: 015-511-06 a„J s... . •-1.I-SJ -�.I LOT 1B, BLOCK 1, SURVEY CERTIFICATION LCO THIS O i.INC HAS CONDUCTED A PHYSICAL SURVEY OF Survey DepartmentTHE PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE Phone Street 562-5291 STONY BROOK SUBDIVISION IMPROVEMENTS SITUATED THEREONANOTEDWITHIN THE PROPERTY LRIE3AND N0 Malnlux LEGEND ENCROACIUENTS EXIST OTHER THAN NOTED. Inc..-,....-, DRAWN DATE: 4!252018 WORK ORDER 18025 Aaphelt Phone 243-8985 #CO II '• EXCLUSIONARY NOTE:R IS THE OWNERS'RESPONSSILITY TO DETERMINE THE aiLtliitedAne• ert9Tneeki^q'ouitveying. DRAWN BY: AP PLAT: 78-191 .. Concrete...._ EXISTENCE OF ANY EASEMENTS,COVENANTS.RESTRICTIONS OR FUGHT.OI-WAY CHECKED BY: SC GRID: SW2839 WATER WELL TSV Dung f�i1(�: TAXINGS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT UNDER NO FENCE —X—X— " ! CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION•FOR ORDERED BY' BETHANY STAMPER --Wbod Deck ESTABLISHING PROPERTY LINES.OR FORPLOT•PUW PURPOSES. SCALE: V=30' FBIPfi:808/60 REF:991413B - - - MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 015-511-06V HAA# g {~0~ (,~ .~.~/-~ 1. GENERAL INFORMATION Complete legal description Lot lB; Stonybrook Subdivision Location (site address or directions) 11138 Stonybrook Drive Anchorage, AK Propedy owner James Stevens . Day phone Mailing address C/O Prudential Vista Real Estate 4241 "B" St. Anchorage, Lending agency Mailin. g address Agent Ralph Nobreqa/Prudential Vista Address Day phone Day phone 727-6903 AK 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. 5 NOTE: Individual well Community well Public water If community well system, provide written confirmation from lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site xx NOTE: State ADEC attest- 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. 72~5 (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 fil~aa~la'rl~fil~,F/~nvestigation and inspection, the on-site water supply and/or wastewat;~cr~l~t~c:~aof~l:~l~ce with all Municipal and State codes, ordinances, and regulations ~,0elff~) ~,a~ ~f:~is inspection. Name of Firm Anch0~ge, AKa9 Phone Address ' Engineer's signature _/ .---¢~' ~'-~ '---- Date ~'"- Alaska Water 8. Wastewater Consultants, Inc. '~hall be PAID .$ /600, ~ ~ ~r to, closing for the Engineering Se~ices Provl~ DHH~ SIGNATURE ~' Approved for ~/~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval C, ertificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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, , tCEIVI:L, Municipality of Anchorage JUL 2 1 1999 DEPARTMENT OF HEALTH & HUMAN SERVICES ........ ~UNI(.IPALITY 0[- ~-nwronmenza ~erv ces u~v~s~on ~NViRONMENTALSERViCESJJ~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval ·Checklist Legal Description: STONYBROOK S/D: LOT lB Parcel I.D.: 015-511-06 A. WELL DATA Well type PRIVATE Log present (Y/N) Total depth 209' Sanitary seal (Y/N) Date of test Static water level YES Date completed Cased to 209' YES FROM WELL LOG E:~ 7/20/.~3 ~ 110' If A, B, or C, attach ADEC letter. ADEC water system number N/A 7./20/93 Casing height (above ground). 2'+ Wires properly protected (Y/N) YES AT INSPECTION 7/15/99 114' Well production 30 g.p.m. 5.6+ g.p.m. WATER SAMPkE RESULTS: Coliform ~ Nitrate * ~' r~'/~- Other bacteria (~ ' Date of sample: 7/15/99 Collected by: AWWP.: INC. B. SEPTIC/HOLDING TANK DATA ~ Date installed 5/94, ,.~?'~ Tank size l~nC) Number of Compartments 2 Cleanouts (Y/N) YES Depression (Y/N) NO High water alarm (Y/N) NC) Foundation cleanout (Y/N) YES Date of Pumping 7/15/99 Pumper ISMCS C. ABSORPTION FIELD DATA Date installed 5/24/95 Length 111' Width Soil rating ~or ft2/bdrm) .6 System type r~FEP TRC. H 3' Gravel thickness below pipe 6' Total depth 9.75' Effective absorption area 1352 ROFT Monitoring Tube present (Y/N)~ Depression over field (Y/N) NO Date of adequacy test 7/15/99 Resu_l~{s (Pass/Fail) PASS For 5 bedrooms ' ' ; I'~, - 710 ' Fluid depth in absorption field before testJ~n, o" ' ~' ~gal. water added (in.).~'~ ); Immediately affert~ = ~¢" Fluid dept~ ~' O'~ (ins) Minutes later: $5 j~- ~"J~' Absorption rate = 7~o+ g.p.d. Peroxide treatment (past 12 months) (Y/N) ~ If yes, give date - 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (WN) High water alarm level at* E. SEPARATION DISTANCES N/A Size in gallons "Pump~ .~~*Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 100'+ "Pump off" level at* Absorption field on lot 100'+ Public sewer main NONE Sewer/septic service line 25'+ On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Water main/service line 10'+ Surface water/drainage 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 10% Building foundation 10'+ Absorption field Wells on adjacent lots Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots NONE 100'+ Sur[ace water 100'+ Curtain drain NONE KNOWN 10'+ F. ENGINEER'S CERTIFICATION ,. con,orm~ln(~ with~:~//~g~ ~li~_nes in effect on this date. Signature_ Engineer's N~ ~ ~ / JEFF GARNESS Date HAA Fee $___ ,~). Date of Payment '~//~ ~ Receipt Number 50'+ 100'+ 100'+ 100'+ 72-026 (Rev. 3/96)* 5'+ NONE Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519,6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot IB; Block .1,i Stony~Broo. k~.,s~6divi~ion Location (site address or directions) 11138 Stony Brook Dr~ve Property owner Mailing address Lending agency Mailing address J~.es L. Stevens Day phone 11138 Stony Brook Drive Anchorage, AK 99516 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well NOTE: Community well. Public water 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: XXX Individual on-site 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. 72-025 (Rev. 1/91) Front MOA #21 Be Se 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. Name of Firm -~"~ Phone ~2~'- 2. ~7~ S & 5 ENGINEERING 17034 Eagle River Address Eagle River, Alaska 9~ Engineers s~gnature DHHS SIGNATURE ~ Approved for / Disapproved. bedrooms. Conditional approval for bedrooms, with the following 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 DH HS does this as a courtesy to purchasers of homes and their [ending 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. ~ 7~2_~'ZS~(R~v. 1/91) Back MOA~21 .......... ~. ........................... Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~/-~c~_~/~._ / ; Z..-,o-.r'~ /.,"'~ Parcel I,D. A. Well Data Log presenO/N) ~ Total depth ~//~ / Sanitary se~N) Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number /~.//~. Date completed "~/~/~"~"? Driller /~/~/"-~- Cased to ~--~'~ / Casing height /~ Wires properly protecte(~N)/ FROM WELL LOG AT INSPECTION / //~ / / -,-~ g.p.m. / g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/hu!~g tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots /~3'~) '--~- ; On adjacent tots Public sewer manhole/cleanout Petroleum tank /---f ./~-- WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate /~,./'Z~ Other bacteria ~ Collected by: ~ ~ --~ ~-~/~-'- B. SEPTIC/.EIDM3~IG TANK DATA Date installed Cleanouts ~N) High water alarm Date of pumping Tank size /~---gr~) ~,/~/-Compartments '~ Foundation cleanout,_~N) "7,/ Depression (Y~ ~ / Alarm tested (Y/N) /..~//Z~.. Pu ,rnp~e~,, : :. .... : .. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot / ~ ',~z_ On adjacent lots To property line /~) '-'/- Absorption field Surface wateddrainage /4~ /--F 72-026 (3/93)* Front Foundation ,/ Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SwEe;~ION DlST~~~n~¢:ts D. ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y/N) ~~ J ~P mpu~off" Level at ~clos tested Surface water Date installed Length /// / Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y~ :~ 2'~-~-~_:~ Soil rating (GPD/Ft2) ~'~. ~ Systemtype ~-,~t ' Width Gravel thickness ~ / Total depth / ~-~ 2-'~ Cleanout presen~(~N) '"'7// Depression over field (Y~ /'-D/4~ · Results (pass/fail) .-5 ,-¢'_--~;~'? for ~ Bedrooms /UP/,& After test /-.//CA. - [%/ If yes, give date/._)/?A, . SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Sudace water Curtain drain / E;%Z:) '¢ On adjacent lots / 4;~ ' -~ Property line ~ ~ To existing or abandoned system on lot ~-'~ ~-7- Cutbank /,~¢-~¢~- Water main/service line /~ '_/L- Driveway, parking/vehicle storage area E. ENGINEER'-.c; CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA gu/defines in effect on the date of this inspection. Signature_ Engineer'z~lArP/~34~ .e .e .e .e .e .e .e .e .e~. __p_~ea~{~QO~. Date £~iver, AI~ 99577 HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)' BAck Waiver Fee $ *' Date of Payment Receipt Number