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SUNSET HILLS BLK C LT 17 P-228
Sunset Hills Block C Lot 17 P-228 #018-201-15 Municipality of Anchorage '; . er" Development Services Department 467 [Irv: Building Safety Division On -Site Water and Wastewater Program, 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.cl.anchorage.sk.us (907) 3417904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: _SW 050_202 PID Number: CIB- 201 - 15 Nam. F Wastewater System: ❑ New IL Upgrade Address 1- IA -101 ABSORPTION FIELD PhoneN.l of Brrdpoms KDwp Tw ch O Shallow Trench ❑ BOE 0 M.W O OfhK. LEGAL DESCRIPTION Salfiabng 9.o GPDIFt° TOW Dove, if W91"!grraa d FI. lora d Sum"'J 1" I D•pn b on pp. bomom eOng," grad. G'" depth o•Matn pppa: .54n 1I'S Ff. 5, FI Tmnsnlp Range se*on Fe added Wow anginal gnmu, o—I Ff. Grawi Longm. 15 Ft. I ❑Upg Well: £ 15� n [:3 New rade WavN vnEn: 2.5 14~1of Ines Dwfancl Duwwn Ines - Ft. Ff Clasvnuoon (Pnvow, . B. C) TOW Dept],Casal w ToW abwrpuon •raa Pp• moon al (]� FI. FI (53 Ft, 5Gh140 T v� DNler Dow DNW Swbc well, Llv Mueller 1` A'r Swic Dew alelellld j Ff nom 11 z3 It zy oq held Pump SII at Clung Nephi Atx v Ground TANK GPM Fl. Ft SEPARATION DISTANCES ❑ septic ❑ Holding ❑ S.T.E.P. Qj Other. To From Septic Absorption Field Litt Station Holding Tank ublicMilvatesa" Sewer Line AncVorn Lard( capeaty Gel Isno IN"65+ Tank GSF41' 65 /V A 25 `+ W1.01 M,.,4.. Shj NunD•r of Conganmenw 2 $odea•wale, 100tti- tO0(+ ltd + N A Z LIFT STATION Lot Ln1T l.0 ` r 1.0 5 + )VIA q • 500 �w auurer Ancl,ortL Gal q%k Fwndaean 1 5 + F ID t L S + A( A 'Pump on' Idl, al I in •Pump df I•vel n 20 el Ntpn caul, Yarm N 11.5 in. Conan Dian N A N A N A n N A Pump Maw & MO l 02Qr1Cp Elact nal ulpw. , p•rlorm•d by Alun 1 Re *iuVr lrz on c BENCH MARK in PID loo4an ruq D•sanp4an �oi10.•. $;p�;+ Corne, .S rtf�on eA AVE R 4irG /� w1Md IIw4d1 Gw re, e- 1017 Ft 11� Inspections performed by: APS &%ArfL\o v1r\ Dates: 1N (0-23109r\ Engi��I:g�44ry� '<..OF At,, 11,l 2nd < Development Services Department Approval Conditional Approval Date: 1�%- LP.RS E. _e.^:Rxl A":x,41; `U11tjRa�� 9 / Reviewed and approved by: Date: -�' E3 1500 ADVANTEX TANK, AX20 POD, W/ DEEP TRENCH ABSORPTION FIELD LENGTH 15 FEET WIDTH 2.5 FEET TOTAL DEPTH 8 FEET SEWER ROCK 5.1 FEET INSULATION 2 INCH III C,Areoi 0T 16 ^. IR6L5L7'To 17 C \ R100.00 $e c� BE QtI NCH MARK® "A" Area SLOPE � WING TIES Moir.• THIS IS NOT A SURVEYED FLAT. WELL a SEPTIC LOCATIONS TAKEN TROY ON -$a WATER AND WASTE WATER WARWNT DOCUkWAY M. ALL LOCATIONS SWWM ARE' APPROXIWTE. ' 49th, SPURKLAND 01 SCALE, I' = 30 FT. •��������� SPURKLAND ENGINEERINGSUNSET HILLS BLOCK C LOT 17 I I SEPTIC SYSTEM ASBUILT 203 W 157H. AVENUE FANNIF MAE DATE: JAN. 12, 2010 ANCH. AK. 99501 907 279-3916 11201 SPECKING AVE:, ANCHORAGE, AK 99507 SHEET. 2 3 GRID- 3033 PERMIT # SW090202 PID # 018-201-15 SUNS£THILLSBCL17D2.DVG A B C D E 4.5' 25.5' F 16.3' 37.3' G 21.0' 39.5' H 14.5' 34.0' / 13.5 24.0 Moir.• THIS IS NOT A SURVEYED FLAT. WELL a SEPTIC LOCATIONS TAKEN TROY ON -$a WATER AND WASTE WATER WARWNT DOCUkWAY M. ALL LOCATIONS SWWM ARE' APPROXIWTE. ' 49th, SPURKLAND 01 SCALE, I' = 30 FT. •��������� SPURKLAND ENGINEERINGSUNSET HILLS BLOCK C LOT 17 I I SEPTIC SYSTEM ASBUILT 203 W 157H. AVENUE FANNIF MAE DATE: JAN. 12, 2010 ANCH. AK. 99501 907 279-3916 11201 SPECKING AVE:, ANCHORAGE, AK 99507 SHEET. 2 3 GRID- 3033 PERMIT # SW090202 PID # 018-201-15 SUNS£THILLSBCL17D2.DVG D"`' AOJANTEx AX20 PDD \ INSULATED RISER ELEV.= 6' PUMP -OUT 91.8' .luff.>,fill SLIDE SECTION OF 6' PIPE OVER THIS CONNECTION TO PROVIDE SHEER PROTECTION - EXTEND TO BRIDGE EXCAVATION ELEV = 91.76' .•• E � '�� �•.�P(................. ' 49th /.....i ............. ......1 . ;..... �................. LARS S URKLAND i 1500 GALLON ADVANTEX TANK REN,CH MARK BOTTOM SIDING Nt CORNER CANa ASSUMED [LEYARON loop SPURKLAND ENGINEERING SUNSET HW BLOCK C LOT 17 SEPTIC SYSTEM ASBUILT 203 W15th Ave fANN/E A/Af DATE JAIL 12, 20I0 Anchorage Ak 99501 14201 SPCCAW ROAD Cf. AK SHEET 3/I GRID- 2739 I PERMIT / SWO90202 PARCEL 1D / 018-201-15 SUNSETHILLS8CL170.DW0 I To Advantex Unit 1 1/4' Schedule 40 PVC 3/16' Holes at 20 Inches Monitor Deep Trench, 2.5' Vide 15' Long 8' Deep 5.1' Sewer rock 2' Insulation 2+' Cover 49th �+, LARr SPURKLAMD NV SCALE � c_ : .. __ Monitor 2' Cover �- aEV.= 95.0' To Advantex Unit Silt Barrier 5.1 Ft oF Septic Rock NV SCALE amcm mARK sonom.9p1w Nr comERr AZWO ELEVAnoma SPURKLAND ENGINEERING SUNSET HIIJS BLOCK C LOT 17 SEPTIC SYSTEM ASBUILT Anchorage Ak 99501 1,LVI VrCnMG RW. ANCHOMiX AK SHEET, 4/4 GRID,3033 I PER ..- PERAI/T f SWO90202 PARCEL ID / 018-201-15 SUNSETHILLS8CL17D4.DW0 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 PERMIT Upgrade Date Issued: Oct 06, 2009 Expiration Date: Oct 06, 2010 Permit Number: SWO90202 Parcel ID: 018-201-15 Legal Description: SUNSET HILLS BLK C LT 17 P-228 Design Engineer: 0007 SPURKLAND ENGINEERING Site Address: 014201 SPECKING AVE Owner Name: FANNIE MAE Lot Size: 8605 SO. FT. Owner Address: 14201 SPECKING AVENUE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99515-4124 This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by tailing (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 healed to prevent freezing. 5. The following special provisions. Received By: Issued By: Date: !D } O Date: i4 % 8 Municipality of Anchorage Development Services Department on -Site Water and Wastewater Program p.cnr Ucparumen r **** VARIANCE/WAIVER REVIEW **** WR#:90 0058 HA#: _ Permit#: 090202 PID#:018-20 -15 Legal Description: Sunset Hills Block C Lot 17 Engineer: Saurkland Enaineerinn Applicant: Fannie Mae Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 1.0 foot. In addition, a waiver of the 100 feet from the well to tank or field has been waived. The approved distance is 65 feet. This waiver approvals apply to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: 10M2009 Approved by: 14ame of Reviewer ' Rec#: 13405 Amount: $1.050-00 Date Paid: 9130109 **** VARIANCE/WAIVER REVIEW **** Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99507 www.muni.org/onsite (907)343-7904 ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Otis -aol- IS Propertyowner(s) FAnn;E MAC Day phone Mailing address PO Dox 650043 DALLAS r TX Zip Code Site address IN201 SPecAL goad Zip Code Legal description (Sub'd., Block & Lot) Sw%s T 1115 61k C L.1 11 Legal description (Township, Range & Section) Lot Size gi 6057 Sq. Ft. THIS APPLICATION IS FOR (® all that apply) Absorption Field ❑ Septic Tank 91 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage Number of Bedrooms 4 452(45 THIS APPLICATION IS AN. Initial ❑ Upgrade B Renewal ❑ 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 authorized agent) Permit/Rush Fees: -5>0 + Waiver Fees: /05-0 Date of Payment: % QDate of Payment: Receipt Number. 01.3y D 5 Receipt Number. (Rev. 11/05) �parr���r�d ��go�c�c�r�or�g Environmental Consulting and Design 77� SEPTIC SYSTEM DESIGN Sunset Hills Block C Lot 17 Municipality of Anchorage September 25, 2009 Development Services Department On Site Water and Wastewater Program 4700 Elmore Road Anchorage, Alaska 99519 Subject: Septic System Installation Permit 14201 Specking Road Ladies and Gentlemen: 1 am writing to request a permit for the upgrade of the septic system for the above referenced property. The proposed system will serve a 4 -bedroom single-family residence. The lot was developed in the early 1970's and the existing drain field extends over the property line. A soils log, site plan, design drawings and construction specifications are enclosed for your review. Design Calcs: No Groundwater to a depth of 18 feet (8/7/2009) Use 1500 gallon Advantex tank, AX20 treatment unit Soil Rating. From Testholc 7/31/2009 <1 min/in = 6 gal per sq. ft/day @ depth of 4 feet 26.7 min/in = 4 gal per sq.ft/day @ depth of 8 feet No. of Bedrooms 4 Required Area per Bedroom: 150/ 4 =37.5 sq.ft. Total arca required: 37.5 x 4 = 150 sgft System: We arc proposing a 1500 gallon Advantex tank, AX 20 treatment Unit and deep trench absorption field. The absorption field will be 15 feet long and contain 5 feet (150 sq. ft. effective) of sewer rock. Soils: A test hole was excavated on July 31, 2009. See the attached soil logs. Ground water was monitored for through August 7, 2009. No Ground water was observed. The percolation rate of less than I minute per inch was observed from a depth of 3 feet to 8 feet. Sandy silts below a depth of 8 feet should act as a sand filter, negating the need to import 2 feet of filter sand. 203 West 15i° Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net Environmental Consulting and Design Surface Nater: No surface waters were observed within 100 feet of the proposed septic system Topography: The lot generally level. There are no down gradient cut banks or slopes greater than 25 % with in 50 feet of the proposed septic system. R'aivers: Do to the location of the well, no site exists on property out side of the 100 foot well to septic system set back. A well to septic tank and drain field waiver application is included. In order to maximize the well to septic system distance we are requesting a V lot line waiver. There would be no adverse impacts with the granting of this waiver. The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. The proposed septic system will not change the general slope of the arca. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or concerns, please contact me at 279-3916. Sincerely, Levo S il Lars Spurkland, P.E. Spurkland Engineering 203 Rest 15'h Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, LspurklandCagei.net Environmental Consulting and Design September 25, 2009 Municipality of Anchorage Development Services Department Building Safety Division On Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519 Subject: WAVIER REQUEST Sunset I lills Block C Lot 17 14201 Specking Road Ladies and Gentlemen: With this submittal we arc applying fora waiver of the 100 foot separation distance required between the septic system and a private well. The existing septic system is being upgraded and due to the location of the well and the size of the property no area exists outside the 100 foot separation distance for the proposed septic system. A well log for the existing well could not be located. On May 191h, 2009 the static water level was observed at 97 feet below the top of the well casing. Steady pumping of 1000 gallons of water from the well at a maximum out put of 4 gpm caused a maximum draw down of 17 feet. Water samples collected from a utlity room faucet on May 13'h, 2009. Water quality analysis for bacteria, nitrate and arsenic showed 0 total coliform bacteria and below detection limits for nitrate -nitrogen and Arsenic. The proposal septic system consists of a 1500 gallon advantex tank, an AX 20 treatment pod, a pump discharge vault, and a deep trench sub surface absorption field. Soil logs indicate the following site conditions: a layer of organics; sandy gravelly silt, organics, gravel and sand and sandy silt. The total depth of the test hole was 18 feet. Ground water was not observed during the excavation, nor during the monitoring period. A percolation test was conducted in the sandy silt and a percolation rate of 26.7 minutes was observed. Well logs from several neighboring properties record the follow soil strata's: silty gravel, sand, silty sand, and silty sandy gravel. Layers of hardpan and clay are also noted. The water bearing strata appears to be approximately 142- 164 feet deep. 203 West 15'h Avenue Suite 203, Anchorage, AIC 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng@gci.net _,►�- �par��0�a�d C��go�c�c�r�or�g Environmental Consulting and Design Mitigating Factors: The referenced lot is fairly flat. The house is between the well and the septic tank. If the septic tank were to overflow, it would drain away from the well head, making surface flow contamination from the septic system impossible. The proposed Advantex system produces a highly clarified effluent meeting secondary wastewater treatment standards. A maintenance agreement is required to ensure that the system is operating properly. An malfunction should be detected quickly, and then fixed. Layers of silt, hardpan and clay should serve to inhibit subsurface migration of septic system effluent. The existing system has been in place for over 30 years with no observed degradation of water quality. Water quality analysis conducted this summer did not detect nitrate -nitrogen or total coliform (indicators of possible contamination due to septic systems). Waiver Request: 65 feet from septic tank & drain field to well. Included for your review is a the permit application for the septic system upgrade, soils logs conducted in 2009, well logs for Sunset I fills Blk C lot 16, 15 & Blk B lot 4 & 5, and water quality result from water samples collected on May 13'h, 2009. If you have any questions or arc in need of additional information, please contact me at 279-3916. Sincerely, Lao S� Lars Spurkland 203 Nest 15'h Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng@gci.net LOT 14 � \ d� LOT 7 S�\ \ LOT 6 \ \ \ LOT 15 r \ �y LOT 5 \\ LOT 4 `+ \ LOT 3 \ NOTE• TTRS IS NOT A SURVEYED PLAT. WELL & $1NWAIrR LOCATIONS TAKEN FROM ON -SAE WATER AND WASTDEPART&W DOWkWAIM AL1 LOGTTONS SHO APPROXIMATE. 50 0 50 100 150 200 250 300 SCALE] 1' = 100 FT. SPURKLAND ENGINEERING SUNSET HILLS BLK C LOT 17 SEPTIC SYSTEM DESIGN 103 W 157H. AVENUE FANNIE MAE DATE: Sept. 15, 1009 ANKH. AKTl ' 99501 14201 SPECKING AVE., ANCHORAGE, AK 99507 SHEET. 1/4 GRID: 3033 I PERMIT #SV090XXX PID # 018-201-15 SunsetHlllsBCL17Dldwg T" \ �Ye f f INSTALL 4 -BEDROOM SEPTIC SYSTEM 1500 ADVANTEX TANK, AX20 POD, W/ DEEP TRENCH ABSORPTION FIELD LENGTH 15 FEET WIDTH 2 FEET TOTAL DEPTH 8 FEET SEWER ROCK 5 FEET INSULATION 2 INCH v Area OT 16 0" w LOT a�7 R100,00 �Sre- NOTE.• YAKS IS NOT A SURVEYED PLAT. *TU* SEPTIC LOCATANd TAKEN F" ON -SAC M R AND WASTE WAnw DEPARTMENT DOCLWWAMN. ALL LOCATKINS SHOWN ARE APPROXIAL:Tr 9 4.: 49th /^1 -%.* N SCALE, 1' = 30 FT. '•��t������� SPURKLAND ENGINEERINGSUNSET HILLS BLOCK C LOT 17 SEPTIC SYSTEM DESIGN ?03 W 157H. AVENUE 11 DATE: SEPT. 15, 1009 ANCH. AK. 99501 PANNI£ MAf SHffT 21 GR/D: 3033 907 179-3916 14201 SPECKING AVE., ANCHORAGE, AK 99507 PERMIT # SV090XX PID # 018-201-15 SUNSETHILLSBCLI7D2.DVG 8 CAP ADVANTEX24. AItYO PO 1 INSULATED RISER 1 8' PUMP -OUT OPTIONAL — Li SLIDE SECTION OF G" PIPE •� OVER THIS CONNECTION TO PROVIDE SHEER PROTECTION - EXTEND TO BRIDGE EXCAVATION 1500 GALLON ADVANTEX TANK .' 49th_ ; �} L I � LARS SPURKLAND ENGINEERING SUNSET HILLS BLOCK C LOT 17 SEPTIC SYSTEM SCHEMATIC 203 W15th Ave FANNIE MAE DATE, AUGUST 5, 2009 Anchorage Ak 9 — —.1 9501 14701 SPCCA7NG ROAD, ANCHORAGE, AK SHEETS 3/4 GRID- 2739 I PERMIT / SW090OXX PARCEL ID f 018-101-15 SUNSETH/LL0C07DJDWG I Beep Trench, I To Advantex Unit 1 1/4' Schedule 40 PVC 3/16' Holes a t 20 Inches Mon/tor 2' Wide 15' Long 8' Beep 5' Sewer rock 2' Insula tion 2+' Cover 2' In: Sit t NO SCALE 4 SPURKLAND 5 Ft of Septic Rock NO SCALE SPURKLAND LNUINLLKINU SUNSET HILLS BLOCK C LOT 17 SEPTIC SYSTEM DESIGN 203 W15th Ave FANNI£ MAE DATE, SEPT. 25, 2009 Anchorage Ak 99501 14201 SPCCCINC ROAD ANCHORAGE. AK SHEET, 4/4 GRID, 3033 PERMIT/ SW090XXX PARCEL ID / 018-101-15 SUNSETHILLSBCL17D4.DW0 Municipality of Anchorage Depth Development Services Department (Feet) i �P ' `r•F +� Building Safety Division ll-!Iljf i C; yt On•S9e Water and Wastewater Program , : 49TH 4700 South Bragaw St. P.O. Box 196650 Anchomge, AK 99519-6650 www.muni.orgronsile ' • f�"a �� (907) 340a9D4 09GJ1 Its r�,'.IARS E. 5 URKLANO. Soils Log - Percolation Test o� m �9 Performed For: tbb roc R- Date Performed: Legal Description: S..nir� F/;115 g)K C (.oi IT Township, Range, Section:_ :7LLii 15- 16- n- 18- 19 - Saye SA 13P.N WAS GROUNDWATER • �O ENCOUNTERED? /V S IF YES. AT WHAT DEPTH?L _ O Depth to tor AaAfterP Monitoring? E Dee: g Ocj Reading I Dale I Gross Time I Net Time I Depth to Water I Net Drop PERCOLATION RATE 41 (nye ) PERC HOLE DIAMETER TEST RUN BETWEEN A Acpit-. ei g c(� 11 • PERFORMED BY: f onn J;t UrF.AA/•Cl I _ PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL FT AND FT U.iyL'1� CERTIFY THAT THIS TEST WAS IN EFFECT ON THIS DATE. DATE: 'i/3� Depth (Feet) ll-!Iljf Occra.Du,S % 2- mWL, Gn) 09GJ1 Its 3- o� m �9 4- 5 4 9 I } GravbG Y 6- Q ' 9 Sa., c` 7- t pl (GP, SP) 15- 16- n- 18- 19 - Saye SA 13P.N WAS GROUNDWATER • �O ENCOUNTERED? /V S IF YES. AT WHAT DEPTH?L _ O Depth to tor AaAfterP Monitoring? E Dee: g Ocj Reading I Dale I Gross Time I Net Time I Depth to Water I Net Drop PERCOLATION RATE 41 (nye ) PERC HOLE DIAMETER TEST RUN BETWEEN A Acpit-. ei g c(� 11 • PERFORMED BY: f onn J;t UrF.AA/•Cl I _ PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL FT AND FT U.iyL'1� CERTIFY THAT THIS TEST WAS IN EFFECT ON THIS DATE. DATE: 'i/3� yr ei Municipality of Anchorage /tib' INEE s s Development Services Department Building Safety Division 9TH ye On -Site Water and Wastewater Program 4700 South Bragaw Sl. . • • • • , ,, P.O. Box 196650 Anchorage, AK 99519-6650 • r;•. LABS E. S RKLA40: w .munl.orglonsRe (907) 343.7904 �I t,� . II�Fo.�}�,o .� Soils Log - Percolation Test 1 Performed For. fir, , gr � Date Performed: Legal Description: 5....SJ 4011 KIK C. LF 13L Township, Range, Section: 5- 6- 15- 16- 17- Site Plan WAS GROUND WATER ENCOUNTERED? a IF YES. AT WENT DEPTH? L Depth to Water After 0 P Monitoring? E Date: Reading Date Gross Time Net Time Depth to Water Net Drop 3e e9 II 45 0 In.-, 11,114 if 3 " Ir 11:15 3o f,:n ll 1/ t. I Irl1 " Il.y5 m. lo'/,z " 1 1h N 93�r' h ')15 10fiin IiSol PERCOLATION RATE fib, + (�ww.) PERC HOLE DIAMETER lidno_ SDah,a TEST RUN BETWEEN f) Fir AND C_FT P« PERFORMED BY: `q( -901AM C v AI i� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE ftTH ALINEt IN EFFECT ON THIS DATE. DATE: 3J D Environmental Consulting and Design Single Family On-site Wastewater Disposal System Construction and Material Specifications Subject Property: Sunset Hills Block C Lot 17 Date: September 25, 2009 General: 1. The owner shall contract with a contractor to perform the work outlined in these specifications and plans in accordance with the attached MOA permit. There Is not contractual arrangement between the contractor and the Engineer. The Engineer shall be the owner's representative and will Inspect the work to document the contractors activities. Final acceptance of the contractors work rests with the owner and the MOA. 2. The scope of the project includes the procurement and Installation of a 4 -bedroom on-site wastewater disposal system at the location depicted on the attached site plan drawings. The scope of the work also includes the installation of an Advantex 1500 gallon tank, an AX -20 treatment pod, a lift station, and a deep trench absorption bed, 15 -feet long, with 5 feet of septic rock below the distribution piping. All components of the proposed septic system must be constructed a minimum of 100 feet from any surface water or water wells In the area. A minimum of 4 feet of earthen cover Is required over the septic tank and a minimum of two feet of cover Is required over the drainfield. In addition to the required earthen cover, 2 -inch thick, 40 psi, direct bury board foam shall be installed directly over all Installed piping. 3. Construction shall be In accordance with the approved site plan and design drawings and any special provisions noted on the Municipal well and/or septic permit. All materials, components, workmanship and construction practices shall comply with the Municipality of Anchorage's latest ordinances regarding wells and septic systems, as well as MOA, Development Services Department, On-site Water and Wastewater Program (DSD) policies. 4. The contractor Is responsible for obtaining all underground utility locates, layout of the proposed system, and verifying and maintaining all required separation distances to lot lines, surface water, wells, steep slopes, etc. 5. The property owner shall be responsible for final grading any depressions formed from settlement of ball material. The property owner is also responsible for vegetation of all areas disturbed by septic system installation activities. 6. Contractors installing wastewater disposal systems must be certified to do so by the MOA DSD, On-site Water Wastewater Program. Property owners installing their own systems must receive advanced approval from MOA DSD prior to system installation activities. 7. The contractor shall ensure that ALL materials being used are in compliance with the most current guidelines established by the Municipality of Anchorage. Refer to "Standards and Specifications for Component Parts and Materials Used in the Construction of On-site Wastewater Disposal Systems", Dated December 2000, as provided by MOA DSD, On-site Water and Wastewater Program. 203 West 15'" Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, LspurklandCgci.net Spurt and EagoneaT051Mg Environmental Consulting and Design Septic Tank Installation: 1. A new septic tank, of the size speed in the design drawings, shall be procured from a quailed manufacture/supplier If the existing septic tank Is found to be defective. . 2. The burial rating of the tank shall be adequate for the actual burial depth encountered. 3. The tank shall be level and sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the tank shall extend a minimum of 12inches above the final grade. S. Tanks installed with less than 4 feet of cover shall be insulated. 6. The sewer service line from the house to the tank shall have a minimum slope of 2% unless prior approval is obtained from the engineer. 7. The inlet and outlet lines from the tank shall be bedded in drain rock or the soil shall be sufficiently compacted to prevent future settlement of the soil. S. Septic tank inlets, outlets and cleanouts shall be fitted with water tight couplings. 9. A cleanout shall be installed 1 to 4 feet from the foundation. 10. Post tank cleanouts shall be installed per MOA requirements. Does not apply to pressurized lines. 11. In areas with high ground water, the septic tank shall be sufficiently anchored to resist buoyancy forces when there is not adequate soil cover to resist uplift force. The contractor shall refer to the engineer for direction regarding this matter. 12. The tank backfill shall be graded sufficiently to ensure positive drainage away from the tank. 13. All holding tank and lift stations shall have an audible and visible alarm inside the residence being served. 14. All lift stations shall be wired in compliance with all MOA guidelines and the Uniform Electrical Code. A municipal electrical permit and inspections must be obtained where required by the MOA. 15. The contractor shall verify that the septictank/lift station is a minimum of 100 feet from any residential water well, 150' from any class'C' well and 200 feet from any community water wells. Additional separation distances must also be maintained. 16. The contractor shall remove or abandon the existing tank in compliance with the Unform Plumbing Code. Drain field Construction: 1. The drain field shall be excavated to the dimensions outlined in the design drawings. If any discrepancies are noted, contact the engineer immediatey for clarification. 2. The drain field shall be installed parallel to slope contours. 3. The bottom of the drain field shall be within 2" of level. If the sidewalls or bottom of the excavation become smeared, they must be raked or scared prior to the placement of filter sand or drain rock. 4. The drain field must be a minimum of 5 feet from the test hole excavation. S. Distribution pipe Is to be Installed level with perforations facing downward, atop a level bed of drain field rock. Septic rock shall then be placed atop the distribution piping to provide a minimum of 2" of cover, level across the entire width and length of the trench, above the piping. 203 Nest 15'h Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net Environmental Consulting and Design 6. A sift barrier must be Installed at between the final drain rode and the native soil backfill. The silt barrier shall cover the entire drain rods surface. 7. Monitor tubes must be 4" in diameter, installed in the locations depicted on the design drawings, and extend a minimum of 12" above final grade. The portion of the monitoring tube below the septic rods must be perforated and the portion above the drain rods shall be solid. 8. Backfill over the final gravel layer must not be less than 2 feet. Insulation must be Installed when the backfill depth Is less that 3 feet. 9. Drain field back fill shall be mounded to prevent depressions from forming due to subsequent settlement of backfill material. 10. The contractor shall verify that the drain field is a minimum of 100 feet from any residential water well, 150' from any class'C' well and 200 feet from any community water wells. Additional separation distances must also be maintained. Inspections: 1. A minimum of two inspections are required by the Munidpaiity of Anchorage. These Inspections must be conducted under the supervision of a Professional Engineer licensed to practice in the State of Alaska. 2. The first inspection must be conducted after the excavation of the drain field and before the placement of any gravel. The septic tank may be set in place, but may not be backfilled. 3. The second Inspection must be conducted after the placement of the sift barrier, gravel, distribution lines, stand pipes, cleanouts, and insulation, but before the placement of any backfill. 4. The contractor shall provide a legible copy of all field notes relating to system layout and construction to the engineer for the use in preparing the record drawings. S. The contractor shall coordinate all inspections with the Engineer. A minimum of 24 hours notice Is required prior to the start of construction. If necessary, a preconstruction meeting will be held on-site. 203 Nest 15'h Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net Sunset Hills Subdivision Block C Lot 17 Parcel ID: 018-201-15 Waiver for 65 feet from well to tank and field Issued October 5, 2009 General 1. From the water sample, total coliform was 0, and total nitrates was 0 mg/L. 2. Any overflowing sewage would have to travel around the house to get to the well head. 3. Overflowing sewage would flow away from the well head. 4. The location of the system is in a visible area and any surfacing effluent will be seen and corrected. 5. The proposed system is the Advantex, Category III, nitrate reducing. Effluent meets secndary wastewater treatment standards and is constantly monitored with remote telemetry by Anchorage Tank and Welding. 6. No well log available. Well log from Lot 16 used. ADEC Criteria Water Table Depth of water bearing zone in well 138 feet Assumed bottom of tank and field 8 feet 130 feet Soil Sorption Soil descriptions from neighboring well log Points 7.2 Water Table Gradient - Water table slopes away from the water source 5.3 Assume 7.8% slope Horizontal Separation 65 feet between septic tank and well x = -10/25 + 2.0 Total Points 16.5 A separation distance of 65' has points calculated at 16.5. Almost sure to be free from any form of contamination from household sewage. 1.6 DEC PTS Depth From Depth To Thickness Calc. Pts Gravel 0 8 73 65 0.00 Sand 1.5 73 78 5 0.06 Clay and gravel 4 78 85 7 0.22 sand 1.5 85 88 3 0.03 Gravel 0 88 95 7 0.00 Clay and gravel 4 95 110 15 0.46 Sand 1.5 110 112 2 0.02 Clay and gravel 4 112 138 26 0.80 0 0.00 130 1.59 1.6 Permeability Soil descriptions from neighboring well log DEC PTS Depth From Depth To Thickness Calc. Pts Gravel 0 8 73 65 0.00 Sand 1.5 73 78 5 0.06 Clay and gravel 2 78 85 7 0.11 sand 1.5 85 88 3 0.03 Gravel 0 88 95 7 0.00 Clay and gravel 2 95 110 15 0.23 Sand 1.5 110 112 2 0.02 Clay and gravel 2 112 138 26 0.40 0 0.00 130 0.85 0.9 Water Table Gradient - Water table slopes away from the water source 5.3 Assume 7.8% slope Horizontal Separation 65 feet between septic tank and well x = -10/25 + 2.0 Total Points 16.5 A separation distance of 65' has points calculated at 16.5. Almost sure to be free from any form of contamination from household sewage. 1.6 SW090202 Sunset Hills BC L' f 138 Water Table Gradient Calculation Sunset Hills Subdivision Block C Lot 17 Appr. 64' 10/5/09 Hills 15 143' / LOTs15. BLOCK C. DISTANCE SHOT FROM CENTER OF WELL TO CENTER F—TANX LEANOUT .. 100.10 \ ♦ \ -� Oc LLNC +s ..•.�. \� L Fn �\�r2 9L F uo Weil 17 . JJ, Its on / usecIII 4o cA(cLLI / sAG��nsfi. / suNSES Huls s/D: vM6V LOT 17. BLOCK C. L q r pn�ld Ae wA+t v. 11/1/2004 �o I.D.WY M. i/-1 Y\ N.•• GARNESS ENGINEERING GROUP, Ltd. sem: vy CONSULTANTS t GENEML CONTMCTORS PMI TMI MA'1 9ATI YM . AY[ AG1 A/ AONf . MI fMllgl.MTA . wax mnqu.PtA 1 " 306 PREPARED IOW: PHONE NUMBER: PACE NUMBER: RHONDA BOUND (907) 223-5912 1 OF 1 SUNSET HILLS SUBDIVISION; LOT 16. BLOCK C. OF WORK: 4Q gyp/ SITE PLAN FOR WAIVER PACKAGE �4 MUNICIPALITY OF ANCHORAGE OF ITMENT OF HEALTH AND HUMAN SERI .iS Environmental Health Division 825 ••L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE; DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT DISTANCES -- FROM SEPTIC TANK ABSORPTION FIELD WELL Address _Tri_ .A C;i IL_0LV C U1rL su--> WELL — -- 7�f » ��u - Phone(s) PCPC, nat No. it> 00 15 No. of Bedrr000ms LOT LINE --- / G .22 LEGALOESCflIPTION Lot _ block ubd,,smn :_==l r 1-111-1=` FOUNDATION _ -- n '%L •h -� — �j Ci Township. Range, Section TANKS___ — AS -BUILT DIAGRAM IShuw location of well. septic system. Properly lines. loundalion. dnveway, wear budges, etc.) --- - — — SEPTIC ❑ HOLDING Mauulanc lAu'Wr GaPanly fm g1allons Malenal / �— No. of Gmnpadmenls — — -- TYPE OF SYSTEM ❑ TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Ueplh to Pgpe bollnm Irom ontpn Cl grade Fill ad0ed above orggmal yratle Gravelleng@— FT Intal depth Isom onymal grade Gravel depth benealfg prye FT FT ' if _ Total absorption area SQ FT Distance belvreen lines Fl. -- l� -- V C— — - _ — — � —_ ,y � •. l- — — — _ — Nunibcr ul ho Sort rating [ SO FT Pgpe material — Installer — Dale installed _— --- WELLS e � .• CI PRIVATE ❑ OTHER (Identi(v) Q t• - CIa, _,hcation (A,9,C) '- --_---- Total Depth Cased to —FT�— FT Instal leg Date Installed'. - I{ i V C — — — -------- -- RE/MARKS: A"tc�v't•� 'lLrj ryec "ex(ec . 0 ticJ _Kej�-ul Scale. I �- `J��7`— - InsPectti ns( Performed by:'C - ENGINEF�flg SEAL yL$ I IrY .. ...a P1 '.. r. rrr F....... �. •rru r. rl,neGVr •.. i', 7 ``Cf GLLclLL r L . p, 2225–E ,•o, f g 1�; JUNE 2.5. 1971• ,_,. e f •h y Cl !1 �"LC�.✓t��L. avi toC (L GC:sS�7e C,Len q / I —.-�`�"� �ix'uC — cenily that this Municipal and Slate guidelines in eltect an This date: e2yL Health Department Approval: —_—_—_ inspection was petleroad accort in0 to all s�—TY Date._,__ 72-013 (3/85) ' . I r� D[FARTMfl: NT OF MEA[!H AND ENVIROmM[-NTAL PROTECTION C25 L CTItEET, ANCHORe GE, AK 995O1 2�4-472O PERMIT NO: 860051 HAND NRITTEN DATE IS��UED: �2/19/86 AP�LlCANT: 8O8 8AINES ADDRE�S: 2522 ARCTIC SUllE 200 ANCHORA:E, AK �9503 [�ONTAC[ PHONE; 27�-1231 LE8AL I`ESC�IP: nUBDIVISIDN: SUNSET HILLS~'- LOT: 17 BLOCK: C GECTION1.11 P;; 12N RANGE: 3W 14000 !3Q.FT0R AC�ES) [ certi�y Lhai: 1. ] am �amiliar with the re1"i1 ments , on-site sew4. f/s and wells as seL <or1� |�y Lhe Mun1cipality o[ Anchorage (MOA) and the S�ate o� Alaska. install the sysLem ix accordance with all MOA codes and regulatinns, and in cnmpliance with the design criteria n� ti�is p�rmiL" 3 ] wil1 a�here t�� a11 MOA and State o1 01as1 1 iack distanoom any existing well, wastewaLe, disposal system or public sewerage syst,em on 1 i s or any adjacent or nearhy 1ot^ wa�^c2 1 '�� �-v 'af"t-1 61-- ^ ° -y7 ������� ���� ����0/l ^��� a� �� .o"����`',�' ° u / v wa�^c2 1 '�� �-v 'af"t-1 61-- ^ ° -y7 ������� ���� ����0/l ^��� a� �� .o"����`',�' ° u SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST PERFORMED FOR . K� BCu I vi e ^_ DATE PERFORMED. LEGAL DESCRIPTION- —� o L—/ �.� Y, c_. 'T SLOPE SITE PLAN f EPfll sly, -y — z C3 12-A Vt�E 1— I flVI O 10 - C'a "-'6V f- L- Ly 17. - 13 14 C U W <il c/CY 5 _ I Y of .c C7 6 (] 10 - C'a "-'6V f- L- Ly 17. - 13 14 WAS GROUND WAT ERI S ENCOUNTERED? -- — o P �j— IF YES, AT WHAT E I DEPTH? Reading Dale Gross Net Depth to hL t i Tlme Time, Walor Duop C I 1 WAS GROUND WAT ERI S ENCOUNTERED? -- — o P �j— IF YES, AT WHAT E I DEPTH? Reading Dale Gross Net Depth to hL t i Tlme Time, Walor Duop 20 LJ PERCOLATION RATE _ Imimgc5/inch) TEST m N BETWEEN r FT AND ,I °T COMMENTS_ _1_t= il oMJ _u / ✓I. L�.�I�L� L,s.�Li-(/�..c_ V+ -E- L_.l _ �'st�4�. Gt, 1 i rM ham_-c.n ,1 ,nom �(/ Iry �isL PERFORMED BY: r / _ZY S CERTIFIED BY: 72-008 (6/79) DAT E:_/ Y /), I 1 20 LJ PERCOLATION RATE _ Imimgc5/inch) TEST m N BETWEEN r FT AND ,I °T COMMENTS_ _1_t= il oMJ _u / ✓I. L�.�I�L� L,s.�Li-(/�..c_ V+ -E- L_.l _ �'st�4�. Gt, 1 i rM ham_-c.n ,1 ,nom �(/ Iry �isL PERFORMED BY: r / _ZY S CERTIFIED BY: 72-008 (6/79) DAT E:_/ Y /), G ITER ANCHORAGE AREA BORO' _ iH HEALTH DEPARTMENT No 758 327 EAGLE ST. ANCHOrAGE,.ALASKA 99501 279.2511 ` INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME ✓ ADDRESS _PHONE --' s�.I--ZJi�Gi//� f7�s�, rc•. cam= LOCATION�F^'/�.is%�O�iJ/O.%� LEGAL DESCRIPTIONlO%/��/�C,"_fr//(/!�'T/1/G,✓✓`.,S't�,: SEPTIC TANK: DISTANCE FROM WELL�✓��G�' '>;z—MATERIAL l�/T��/1//��''�N MBER OF COMPARTMENTS OU L/i�%liyOG�d /i�//� / DEEPTH LIQUID CAPACITY GALLONS. INSIDE LENGTH < _INSIDE WIDTH oe SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS OUTSIDE DIAMETER. �� OR WIDTH h/1 LENGTH _Z�Z/ , DEPTH LINING MATERIAL --'G4- Gift/lI r/�'.I;�i��/ DISTANCE FROM WELL�G� ,BUILDING FOUNDATION•-Z`r / NEAREST LOT LINE /% TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) =� -30 SQ. FT. TILE DRAIN FIELD: /,/1119 DISTANCE FROM NUMBER OF LINES / � ABSORPTJ.OTV AREA STANCE BETWEEN LINES FT. LENGTH OF EACH LINE NEAREST LOT TRENCH WIDTH TOTAL LENGTH OF LINES_ IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE: IN. ABOVE TILE WCLL: WATER TYPEd�CG�I' DEPTH BUILDING FOUNDATION. -5 SAMPLE- E_ v42 NEAREST NEAREST SEPTIC SEEPAGE ✓ OTHER LOT LINE _ -=? SEWER LINE Z,2 f , TANK- / SYSTEM CESSPOOL /✓G' Gam, SOURCES'��.n'1y DISTANCES: >o" - s - DATEut " DIAGRAM OF SYSTEM K� eIL� SAi eU M C� WA LO N O (N co N co a� cu C O cu Q X W 0 0 0 i r C) N 00 CD m U (u d F— F— LU — HW J Q U) Z W F- U) O N C O Q O Q U U O O a N bm 0 .o N O Q Q cu L cu Ln 0 a c O O L X A E 0 Lan N O N CY) N G) cu 0 0 cu U O U cu .s O M L) O`` =O O CL aa) Q- L O 3 t _a •V N -5 U) t •c co ~ co O ~ 'a N L (D O O v 0 C •� U) N O 0 C CL •V a > -0 �, o 0 .� O Q cn > -O > Q N EN N 3 O < U �-' dLL N p a d a .N z Q U E ,r A > C Q 'o O 0 w N i O. L . CL Q Q U) N v v C O •j> d X O u +' cn = fC L O N +a o m o N r_ E rLim Q -0 0 .� O L v ) U) n N > O O Gni Q. L 0 U � LL"O c Q \ c6 N U) C O V) U Q Q v F- WO Q L cu m U)L E 2 = U Q t— O v o N o Q U) Q L Q N O d' rl- O O') 07 ti 1 _ 00 m 0') t I CL A a� (1) LL a� ca c 0 i E EF} a) � LL a *k 0 O M O U o U U ) VI W•• ^J^'' V/ Imo^ OCLW a) V O U 'E_>, N Q LO o a •� Q1 O)U N Yc E N c E in O a) 3 O U U N U) a) �+ 0o Q m N Un c �_ o CV W U)j E O O LlN Q O cn � O U to c ~ = O ❑ ❑ a) c .O N V Z a) O U Y IL V Q co + c- ❑ a .0 V W L O O cn IL � a) c' o N .a N > H 00 u; a o(N 'a _ 2 cu 0 El U m ami o CL Z LLJ (1) U) ElL CIO '"' m Co ❑ CL 0L � W w �I > > N �' Z a °_ m co a o r E C U W J El N c� C 'tea' E d •0 VI V/ VJ _j a) d � O ® CU W cr N 70 c°v~j W W ~ H U a) LL cv Y a Z o N o N Z O HLOa Q W LL LL G7 N CD cn E 0 a a a. aD CO = Q. Co M U U O H Fes- N Q Q > n x >% N M N cD >� > w o m r+ a� (1) LL a� ca c 0 i E EF} a) � LL a *k 0 O M O U o U COSA Checklist.docx COSA Checklist Legal Description: SUNSET HILLS BLOCK C LOT 17 P-228 Parcel ID: 018-201-15 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled CIRCA 1953 Total depth *99+ ft Cased to UNKNOWN ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 8/26/24 Static water level at beginning of test 91 ft. Well production at time of test 2** gpm Water storage tank volume None gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 8/26/24 Comments *PER ACOUSTIC SOUNDER AT INSPECTION – (PAST COSA/HAA SHOWED 113-163’ TOTAL DEPTH) **LOW FLOW WATER PRESSURE – PERHAPS RESTRAINED BY PLUMBING. B. TANK DATA Measured operating fluid level in septic tank *NA Date of pumping AX MAINT – 9/20/24 Required maintenance completed, if AWWTS Comments: *FLOATS/TIMER – SEE AX MAINT C. LIFT STATION Required maintenance completed Age of lift station 15 years Lift station material STEEL Comments: ARM PERFORMED MAINTENANCE D. ABSORPTION FIELD DATA Which system tested (date installed) 11/24/09 ALL standpipes present per record drawing Total measured depth from grade 8.3 ft (max) Measured depth to pipe invert from grade NA ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective (ED). If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 8/26/24 Results Pass Fluid depth prior to test 0 in Water added 600 gal New fluid depth 15 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 61 in (MOA 5.1’ ED) Effective depth used 0 in (Final Fluid Depth) Effective depth (ED) remaining 61 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots, visual observations, MOA records & appears approximate. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No *50+ ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No *50+ ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No **1 ft Field to Property Line > 10’ Yes if No **1 ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No *50+ ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No *50+ ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *MAY MEET CONVENTIONAL SEPARATIONS, BUT SYSTEM MEETS CATII/III SEPARATION DISTANCE REQUIREMENTS. **WR#090058, MOA APPROVED INSPECTION REPORT & PREVIOUS COSAs. G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 9/20/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 09/20/24 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this 14 Day of 5s-9-m-NAZs9- of 20 aj , by and between VW%-& upLOSz , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. t In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as AN ADVANTEX SYSTEM located at (legal description) SUNSET HILLS BLOCK C LOT 17P-228 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Py Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. Pv It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Pv Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. P' Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Pagel of 3 PV Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. 'Qy Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. VIy Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Py Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. pv Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. P� Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 ca - I N y H U �, i M w O M N c co Q 00 0 00 0 • (• (c. Municipality of Anchorage O PGE Q On-Site Water and Wastewater Program (907) 343-7904 �, ff Certificate of On-Site Systems Approval Parcel I.D. 018-201-15 Expiration Date: 3-- `I-)49# 1. GENERAL INFORMATION: Complete legal description SUNSET HILLS; BLOCK C, LOT 17 P-228 Location (site address) 14201 Specking Ave. *Anchorage,AK 99516 Current Property owner(s) Esther Jurasek Day phone 227-0206 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® 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: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 52p Waiver Fee $ Date of Payment (o(_-'i Q Date of Payment Receipt Number O t{ G?3 Cj Receipt Number COSA# Q Iga S- J 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road,Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 7'1 )1cr �a000_opq� In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system o C�' A; �Qe in accordance with the guidelines and regulations established by the Municipality of Anchorage and d� .••."'••1.-4, j industry practices. The reported results describe the condition of the system/s on the date/s of the Q P.•' •.• ,r�n evaluation. Separation distances were measured to readily identifiable features. Hidden defects orV encroachments may exist that were not identified during the evaluation. The operational life of all wells DG�; 1 , -7*O0 and septic systems depend upon a variety of variables, including but not limited to, soil conditions, l ...... •••• groundwater levels (that may fluctuate during the year), quality of construction (materials and � vA workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and �_`� are outside the control of GEG. Satisfactory test results do not guarantee future performance of the Q ••J f Gam-ss," 0 system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of Go m C —79 3 �QD the well or septic system. GEG makes no representation whether an alternative well or septic system Un9 '• •' .c�0 can be installed on the property in the event either of the current systems fail to perform adequately in u� P� ' a I f the future. The content of this report is for the sole benefit of the person/party that retained GEG to '/ Pr0fesSlo^°4� perform the evaluation. Reliance upon the information provided in this report by any other person or �OO000�,_ party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms . , �l rb,wk4y Disapproved < ON-SITE Qm Conditional approval for bedrooms, with the followit st*i` VND WASTEWATER oz r9� PROGKAM o$ r sER�c<`' By: �-- Original Certificate Date: c (1-1q 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 j` Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10-10-12.doc COSA Checklist Legal Description: SUNSET HILLS; BLOCK C, LOT 17 P-228 Parcel ID: 018-201-15 If more than 1 septic system on lot: COSA Checklist# 1 of 1 Structure served by this system 1 A. WELL DATA 0 Well log is filed with Onsite (or attached) Well production at time of test 3.6+ gpm Date drilled 1953(2) Water storage tank volume N/A gallons Total depth *112.9+ft Well disinfected for coliform test? ❑ Yes EU No Cased to UNK ft Q Coliform bacteria is Negative ❑■ Sanitary seal is functioning correctly Nitrate mg/L Q Nitrate less than MRL (ND) 0 Wires are properly protected Arsenic ug/L EU Arsenic less than MRL(ND) Casing height (above ground) 12+ in. Collected by GEG, LTD Date of flow test for COSA 9/20/18 Date of Sample 1/21/19 Static water level at beginning of test 96.2 ft. Comments *PER GEG INSPECTION B. TANK DATA C. LIFT STATION Age of tank(s) 9 years ❑U Required maintenance completed Tank type/material t PE t. Age of lift station 9 years ■❑ Standpipes/foundation cleanout per record drawing Lift station material .5 E r t_ Date of pumping SEE MAINTENANCE REPORT Comments: MAINTENANCE BY ANCHORAGE TANK D. ABSORPTION FIELD DATA Which system tested (date installed) 11/09 Adequacy test date 9/20/18 El ALL standpipes present per record drawing Results ✓❑Pass For 4 bedrooms Total measured depth from grade 8.4+ ft(max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade N/A ft(min) Water added 685 gal 0 N/A— pressurized field New depth '18 in t❑ Monitor tubes go to bottom of drainfield. If not, state Elapsed time 1095 min depth into effective E] Code-required soil cover over field Final fluid depth 0 in Absorption rate 600+ gpd ❑ System presoaked NO (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) date of test) Gallons introduced N/A gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' S0'+ Community Sewer Manhole/Cleanout> 100' 0 Yes if No ft 0 Yes if No ft Neighboring Tank> 100' 0 Yes if No ft Private Sewer/Septic Line> 25' 0 Yes if No ft Absorption Field on Lot> 100' ❑Yes if No 50'+ft Holding Tank> 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Animal Containment> 50' 0 Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft ✓EYes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water> 100' 0 Yes if No ft Property Line > 5' DYes if No *1 ft Driveway/Parking > 0' 0Yes if No, comment Absorption Field > 5' 0✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' E Yes if No ft Private Wells > 100' 0 Yes if No 50'+ft Water Service Line> 10' 0 Yes if No ft Community Wells> 200' 0 Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation> 10' 0 Yes if No ft Driveway/Parking > 0' 0 Yes if No, comment Property Line > 10' 0 Yes if No *1'+ ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells> 100' 0 Yes if No 50'+ft Water Service Line> 10' 0 Yes if No ft Community Wells>200' 0 Yes if No ft Surface Water> 100' ✓0 Yes if No ft F. ENGINEER'S COMMENTS *WR#090058 TANK TO FOUNDATION 5' MET CODE AT TIME OF INSTALLATION og600‘N�4 G. ENGINEER'S CERTIFICATION ,,,--%c Or i; C,9s�� e:" • . Jr I certify that I have determined through field inspections and review if _. T/.J .... --()OA of Municipal records that the above systems are in conformance with i * * 0 MOA COSA guidelines in effect on this date. k.,,,,--- VA (/ .•.J-f, y A. C�arn ss: QQ° 'et,.. CE-7953 .0 09 (I's' •l1 .•)•J 10lc o0 COSA Checklist yellow sheet 0'"‘‘ ' ,p0' =----" ro ress� oQ #AECC884 / J MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE ` REPAIR A GREEMli I TT THIS MAINTENANCE AND REPAIR AGREEMENT,herein the`AGREEMENT'made and enter d into as of this .29 Day of I- L i of 20 ,by and between -li.'Y 14 Al/A. u"..--' ,herein the #i WNER"and the Municipality of Anchorage,herein the"MUNICIPALITY",in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein,the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System(AWWTS), described as %1)VA Ji/j g y located at(legal description) 2. Maintenance.Rear'rs and Alterations. (Owner is required to read, understand and initial each section) T{„),!,,,, Throughout the term of this Agreement,the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all CC// repair(s),maintenance,adjustment(s),replacement costs, and inspection costs. This includes an annual maintenance fee(typically$400 to$600). CY,f i‘,tv Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. C-4N ) Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system,which could include.sewage backup and costly repairs or drainfeld replacement. (rev. 05/1812018) Page 1 of 3 A, Owner acknowled,.:s that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. �'UA, Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Vel Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. (11(t,\‘`•N Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. qW\ Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction,maintenance and repair of the Owner's AWWTS. • titin' Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to op-late the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to'enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall he brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severabilit-v. Any provisions of this Agreement decreed invalid by a cotof competent Jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of OWNER: J G By: Ss%,c19b(12, —, (signature) j Date: -2 -( ! $1 &iQ)t1 tUg. it-A&/ (print name) STATE OF ALASKA ) ) ss. TF-LRD JUDICIAL DISTRICT ) The foregoing instr . eat was acknowledged before me this te day a , 20 L,by t;1' ' Cl I. .� L it!i: :!:/_ l�Ic ry Puh1Ec -..°•�r4 TA• P41 :" FORA SKA °. SERA fthN1L3A y Cu ssion expires:( �3 State of Alaska ivey Corrrnie.;ion Expires Feb.3,2021 M ?N1iCrP•�LITY: -.011"--- \, �` � '(signature) Date: eZ (print name) Title: (rev. 0511S/2018) Page 3 or 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 CERTIFICATE OF HEALTH AUTHORITY - APPROVAL FOR A SINGLE FAMILY DWELLING c� Parcel I.D. # nloti -moi —_ HAA # 9 LL L-- 1. GENERAL INFORMATION Complete legal description _ Loi `17; Stab. "C Sunaet HZUs Subd.Lvi6ion Location (site address or directions) 14201 Speaki Avenue Anchwtage, AK Property owner H.U.D. C/0 ASSOCIATED BROKERS _ Day phone 258=8888 Mailing address _ 2509 E.fde StAeet Suite 4 Anchon.age, AK 99503 Lending agency--. Day phone _— Mailing add Agent Sandy Hjetm6.tad/ A66oe.fated B)token6`_. Day phone _ 258-888 Address 2509 Eide S.tAeel; Suite 4; AnchoAa e, AK 99503 ' Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well _ X_ Community well _ Public water 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: Individual on-site XXX Holding tank Community on-site Public sewer NOTE:. > If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system.'" 72-025(RBV.1191) Front MOAN21 \� 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 furtherverify 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 5 & 5 [NGi(JL:URING Address 17nze c,nle Eagle River, Engineer's signature Phone Z X79 — Date o y - /�r aTq etc �• AC a )oil A. 4hair tom, taa� s �a�_�•.x 6. DHHS SIGNATURE _L Approved for �_ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Date – 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 lending institutions in orderto 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. 72-025 (flee. 1/81) Back MOA #21 ® Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL. CHECKLIST Legal Description:L YF 9 akG" Parcel I.D. fk(s SW A. Well Data Well type —f2 r (/U 72L_ If A, B, or C, attach ADEC letter. ADEC water system number Ai -L Log present (Y&.2,2 _,_Date completed , G�!/ %moi _Driller VGA— _ Total depth 1(03 "_Cased to Casing height 1 f Sanitary seal 0) Wires properly protectecON) FROM WELL LOG Date of test Nb Lv� �(//�c r�✓�{[Cf Static water level Well flow g.p.m. Pump levell _ SEPARATION DISTANCES FROM WELL TO: AT INSPECTION 1 m Z oz . n M n ; r a C) ——r1n n _ /—9•P•Tt s AT �e.r CO N M � Septic/holding tank on lot ; On adjacent lots _ ���/� o Absorption field on lot q0 -X- ; On adjacent lots r� r Public sewer main /S 4- _Public sewer manhole/cleanout_/U U %r Sewer service line ZS (f Petroleum tank � WATER SAMPLE RESULTS: Coliform /�� Nitrate _ O C) _Other bacteria Date of sample:_ � /`� Collected by:— rLs_� B. SEPTIC/HGk04NGa-TANK DATA Date installed ZS A ____Tank size / ZrU 64L Compartments_ 2_ Cleanouts (Y/) -KL�— _Foundation cleanout (Y V � _Depression (Y/0 _ High water alarm (Y© /Jo Alarm tested (Y/N) �TPumper Date of pumping _ � Pumper v7 fi SEPARATION DISTANCES FROM SEPTIC/140LENN13 TANK TO: Well(s) on lot /tr�� � r On adjacent lots lm��_ —Foundation _ �U r f To property line _/d ' _Absorption field S �_ Surface water/drainager� �P�Vbr� 2-2'I-Slp 72.026 (3/93)• Frmt Water main/service line /0 r/— CONTINUED ON BACK PAGE C. LIFT STATION / ,b� Date installed Manufacturer _ Size in gallons Manhole/Access Vent(Y/N) High water alarm level Meets MOA electrical codes "Pump on" level Cycles tested mp off" Level at SEPARATION DI CE FROM LIFT STATION TO: uVel on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 2/2 / Soil rating (GPD/Ft) 9`S / System type Length j% / Width 3 Gravel thickness Total n! Total depth /0 Total absorption area 0r6 Cleanout presen(Y/) ((ff S Depression over tie (Y/I@ LJ Date of adequacy test�� �S� 9 Result pass/ ail) % S J for l � Bedrooms Water level in absorption field before test 0 After test Peroxide treatment (past 12 months) (Y/N) AALLJF %�_LcJ'J If yes, give date N SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lotkfi m_ On adjacent lots ( 0_:� /7- Property line To building foundation ��� �/ To existing or abandoned system on lot N On adjacent lots Z U r� Cutbank /"/`',rL_ Water main/service line /U ¢ Surface water ( Driveway, parking/vehicle storage area /0 Curtain drain E. ENGINEER'S CERTIFICATION 44 tJA, 1 certify that l have checked, Signature Engineer's Date River, Alaska 99577 HAAFee$�-� Date of Payment Receipt Number L 72026 (3193)' Back t to all MOA and HAA guidelines in effect on the date of this inspection Waiver Fee $ Date of Payment Receipt Number �M 204 t Waiver Fee $ Date of Payment Receipt Number 2. 3. 4. ANCHOFIAGE MUNICIPALITY OI DEPARTmENT OF HEALTH AND ENVIRONMENTAL;I'r,OTECTION J ''`DIVISION OF ENVIRONMENTAL HEALTH:` CERTIFICATE OFINSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY l " 264-A720 � e Application Date GENERAL INFORMATION (a) Legal Description i(include lot, block, subdMslon, section, township range) , Loy 71 StJ`N�� �1tI�L�' Sf�G3,�, 7IaN�2is Location (address or directions) (b) Applicant Name' ''�f1� �S =Telephone, Home -- Business ApplicantAddr'ess :•5�.� AVS tw�C.'SrE�'�On�QJO:S (c) Applicant is (check one): Lending Institution d ; Owner6l44WwX ; Buyer Q Other ❑ (explain); _ (d) Lending InstitutionI��— + _ Telephone Address (e) Real Estate Company and Agent — No N L - Address Telephone (f) Mail the FIAA to the following address: Page 1 of 2 """ 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 1. 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 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, "'W44 -State aRGI w9644us•i{a-attsct N" -dc" ipiie-iwsraaciicw� /J - •�J Name of Firm f o 64'e ►t �p V r k11 d,Nr�( Telephone — _A7 k? b Address AaG!i_1��� /5 Date arb SL o' / R k6 w,�•.;.• • •fid [4 STH a � • •• �• Engineer's Seal /P o. 2225 ,? • JUNE 25. 1971 •,:144 • ,1tido'c�ria,t� ����;� 6. DHEP APPROVAL Approved for -fur 6'¢ bedrooms by 'Q °i a Date Annrnved w--- f)isannrnved (� Cnnditinnal Terms of Conditional Approval I fob CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to.satisfy certain federal and state requirements, Employees of DHEP 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. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALIry OF ANCHORAGE t.NVIRONMEOr HEALTH & NrAL PROTECTION CHECKLIST - FEBRUARY 1984 R ^ �' 264-4721) - - Legal Description: _40T17, ) (— SONS 7-D A. WELL DATA Well Classification Tst If A, B, C, D.E.C. Approved (Y/N) — fi/A Well Log Present (Y/N) Date Completed Tv -0— 19 6 9 Yield Total Depth�i¢_..5 — Cased to «@ Depth of Grouting __�iQ1�:+ Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) J Electrical Wiring in Conduit (Y/N) _ Depression Around Wellhead (Y/N) —N Separation Distances from Well: To Se tic/ S p Fadfaing Tank on Lot e-7— _ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot — RD _; On Adjoining Lots — 7ja-c> To Nearest Public Sewer Line h ID rJM To Nearest Public Sewer Cleanout/Manhole _ NONE_ To Nearest Sewer Service Line on Lot Water Sample Collected by �-? - _ ;.Date —' t,/8(0 Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed YA,&_ Size 1,250 No. of Compartments Z Standpipes (Y/N) _rV00 — Air -tight Caps (Y/N) — Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped bite, JG. Pumping/Maintenance Contract on File (Y/N) IV144 _ ; for -_ WA Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well �— To Building Foundation - 2 To Property Line lC) To Disposal Field To Water Main/Service Line —_�>fC> To Stream, Pond, Lake, or Major Drainage Course _ "ONE, Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �5 Type of System Design "06 6410 Date Installed If 6-7 Length of Field _ Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area 3 30 * Standpipes Present(Y/N) Depression over Field (Y/N) N / Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well `!O To Property Line O To Building Foundation 33 To Existing or Abandoned System on Lot hIONLE To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Ko N k Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments On Adjoining Lots 7>U To Cutbank (if present) 0 Ne Dimensions Manhole/Access (Y/N) "Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, ver ie �r conformed to allMOA and HAA guidelines in effect on the date of this inspection. Signed S Date / r :',6 Company Receipt No. 315-/ Date of Payment Amount: $ Page 2 of 2 72-028 111/94) u6_ M. op 49 . �.... `r .2225-E JUN)' 25. 1911 Yt` Jn Engineer's Seal TO [ M ��MILA11 20 3 W 1 5th AVE 'C" SUITE 203 ®3 D CONSULTING ENGINEER Ity V `PQI�u ANCHORAGE, ALASKA 99501 TELEPHONE. (907) 279-3916 ;iE P T I C S Y S T E M A D E Q U A C Y T E S T LEGAL: LOCATION: OWNER: RESIDENCE: WATER SYSTEM: SEPTIC SYSTEM: DATE OF PUMPING: DATE OF TEST: LOT 17, BLOCK C, SUNSET HILLS 14201 SPECKING BOB BAINE;S SINGLE FAMILY, FOUR BEDROOMS ON SITE WELL NV�iCiP. <, Ttc /U,\/ iyyb. Re (61 FROM MUNICIPAL RECORD:): U TANK: ANCHORAGE TANK, STEEL, L250 GAL ABSORPTION SYSTEM: LOG CRIB ABSORPTION AREA: 330 + SOIL RATING: 85 INSTALLATION DATE: 1971 TANK INSTALLED FEB. 1986 JAN. 29, 1986 TEST PROCEDURE': SYSTEM WAS INSPECTED AND MEASURED. THERE, WAS NO EVIDENCE OF TANK. A BACKHOE WAS USED TO EXCAVATE AREA WHERE TANK WAS SUPPOSED TO BE. NO TANK WAS FOUND. A 1250 GALLON TANK WAS LATER INSTALLED. WELL WAS FOUND TO BE A PIT WELL WITH WELL TOP AND PRESSURE TANK INSTALLED IN CONCRETE PIT. WELL PIT WAS ABANDONED, WELL CASING EXTENDED TO ABOVE GROUND AND SANITARY SEAL, INSTALLED. LOG CRIB WAS FOUND TO BE 9.5 FEET DEEP WITH 44 INCHES OF LIQUID. CRIB DEPTH 'IS 60 INCHES. APPROXIMATELY 750 GALLONS OF WATER WAS ADDED TO THE CRIB. THIS CAUSED THE WATER LEVEL TO RISE TO 61 INCHES. 24 HOURS LATER THE WATER LEVEL WAS DOWN TO 44 INCHES. TEST RESULT: THIS SYSTEM MEETS THE OPERATIONAL CODE REQUI:- REMENTS OP' THE MUNICIPALITY OP' ANCHORAGE. THE SEPARATION DISTANCE BETWEEN THE WELL AND THE SEPTIC SYSTEM I:S LESS THAN THAT REQUIRED. A WAIVER FOR THESE SEPARATION DISTANCES HAS BEEN GRANTED BY THE MUNICIPALITY. The operational life of all septic systems depends on the local soil conditions, groundwater 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't his,,ysegtic system. We can therefore not give any estimate of hod,•lang:;the'system will continue to meet the operational requi- ^;,r.emen•�s' Of'. d Municipality and State. 0..2225 5? + lU N`c 2�. 071 d 3 W 15th AVE "C" SUITE 203 r B rA � �g p 20ANCHORAGE. ALASKA 99501 CONSULTING ENGINEER TELEPHONE (907) 279_3919 R E S :E D E N T I A L W E L L I N S P E C T 1 0 N 2,. c;. LEGAL: LOT 17, BLOCK C;, SUNSET HILLS LOCATION: 14201 SPECKING AVENUEfit o, C, y yF, y 1 OWNER: BOB BAINESft �o C ic. mY ' TYPE OF WELL: SINGLE FAMILY WELh LOG AVAILABLE: NO INSTALLATION REQUIREMENTS MET: NO, WELL IS LESS THAN 100 FEET FROM SEPTIC TANK AND LOG CRIB. A WAIVER HAD BEEN GRANTED BY THE MUNICIPALITY. WELL YIELD FROM WELL LOG: PUMP YIELD: DATE OF INSPECTION: JAN. 29, 1986 TEST PROCEDURE: WELL WAS NOT TESTED. A WELL PUMP INTALLATION REPORT SHOWS WELL TO BE 163 FEET DEEP. STATIC WATER EVEL AT 114 FEET AND A WELL YIELD OF ti GP WITH 1.0 FEET OF DRAWDOWN. PUMP IS �I-N-S'M LED AT 140 FEET. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON JANUARY 29,1985. TEST WAS NEGATIVE. TEST RESULT: THIS WELL MEETS THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE, EXCEPT FOR THE SEPARATION DISTANCES. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. Municipality of Anchorage February 27, 1986 P.U. BUA 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES. MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES Tobben Spurkland, P.E. 203 West 15 Avenue, C Suite 203 Anchorage, Alaska 99501 Subject: Lot 17 Block C Sunset Hills Subdivision Waiver Request, WR86-017 Dear Mr. Spurkland: Waiver requests for the subject property have been approved as a result of a completed upgrade of the well and verification of the well casing depth. Waivers of thewell to septic tank and well to absorption field separation distance requirements have been granted to 76 feet and 90 feet respectively. These waivers are valid for the existing four bedroom single family dwelling only. Sincerely, . Stephen S. Morris Civil Engineer On-site Services SSM/ljw Municipality of Anchorage February 14, 1986 P.O. BOX 6650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 7"ONY KNO WLES. MAYOR DEPARTMENT 01: HEALTH & HUMAN SERVICES Tobben Spurkland, P.E. 203 West 15th Avenue, C Suite Anchorage, Alaska 99501 Subject: Lot 17 Block C Sunset Hills Subdivision Waiver Request, WR86-017 Dear Mr. Spurkland: This letter is in response to our recent telephone conversation regarding the well on the subject lot. A waiver of the separation distance requirements cannot be written unless the following improvements and inspections are made to the well: 1. The casing of the well must be extended at least one foot above ground level. The existing well pit must be backfilled with silt or other relatively impervious material. Backfill material must be suitably compacted. Other features of the well (i.e. sanitary seals, etc.) should also be brought up to Municipal code. All upgrade construction must be inspected by you or another professional engineer. 2. The casing depth should be verified to a minimum of 40 feet. Waivers of the required separation distances to the proposed septic tank (60 feet) and existing absorption field (80 feet) will be forthcoming contingent upon the well upgrade and casing depth verification. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/ljw �liVll�Ylf�l��liti9UVDg LP'a�® MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 6-6650 ANCHORAGE, ALASKA 99501 SUBJECT: REQUEST FOR WAIVER OF SEPARATION PRIVATE WELL. LOT 1.7, BLOCK C, SUNSET HILLS 203 W. 15th AVE "C SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3915 FEBRUARY 5, 1986 FV�p/PFf (7j), oV V4t- O F tips rNcy R 06 DIS&,4F,ORPFn lFCfj0A GF Gentlemen; We are resubmitting a request for waivers from the separation distances stated in Title 18, Alaska Administrative Code Chapter 80.020 This submittal follows the format outlined in a Memorandum dated January 3, 1985 on the subject of "Separation Distance Waiver Guidelines for SCRO", prepared by Mr. Bruce Erickson, District Office Coordinator. State of Alaska, Department of Environmental Conservation. This Memorandum outlines a procedure to be used in the evaluation of waiver requests by assigning number values to geological features addressed in the waiver request. In this request I have followed this procedure and assigned values to the pertinent: features as shown. This residence was constructed in the early 1960's or earlier. A well and septic system was installed at that time. Sometimes in the late 1960's a portion of the lot was acquired by the State as Right of Way for the Seward Highway, and the septic system had to be replaced. A permit was issued by the Health Department and an installation report prepared and filed. This installation report shows a log crib installed 80 feet from the well. It also shows an "area of existing septic tank" located 42 feet from the well. On January 29, 1986 I performed a Health Authority Inspection on this property. I located the log crib and tested its absorption rate. Since I saw no evidence of the septic tank I hired an excavator to exposed the tank. The excavator exposed the cast, iron house sewer in the ares of the tank but were not able to locate the tank itself. The sewer pipe was followed to within 15 feet of the logcrib. It was concluded that the septic tank had been abandoned and that presently no septic tank is part of the septic system serving this residence. A fifteen foot gest hole was dug in the vicinity of the log crib. No ground water was observed. A septic tank can be installed within 50 to 60 feet of the well and we are asking for up to a 50 feet variance for the tank and a Tobben Spurkland P.E. Waiver Request Lot 17, Block C Feb. 5, 1986 Pg•2 Sunset Hills 20 foot variance for the log crib. The following risk analysis is submitted. 1. Vertical D:Lstance Between Sewage System and Ground Water. Well logs for lot 15 and lot 16 show water bearing soil at 75 feet. r" Point value assigned 5.8 2. Soil Absorption. Well logs shows silty gravel and hardpan down to the perched water at 75 feet. [ [�.•} ;��„�.�,�7 Point value assigned 2.5 3. Permability: The testhole shows a gravelly silt from 9 to 15 feet. Point value assigned 2.0 4. Water Table Gradient. This is a confined aquifer with 50 feet of pressure head. At maximum drawdown the gradient of the water table will be 0%. At less than maximum drawdown the gradient will be positive. cz.e._ew"-t, "!5 Point value assigned 3f0 f 5. Horizontal Separation From well to septic tank 50 ft. From well to leach field 80 ft. Point values assigned For septic tank 1.0 For drain field 2.2 TOTAL POINTS _ /,/„ S For septic tank k4`.3� For drain field 15=:g /�=' Both of these totals shows that no bacteriological contamination is possible and that chemical contamination is unlikely Cast iron will be used in the construction and water tight couplings will be used. I request that a waiver be issued for this property. Yours tiC.C.Irk Tobb n Spurkland P.E. June 12, 1969 HP, Phillip Lobrced Box 10020 Klatt Rd, St. AnchorraF;e, Ak, 99502 SUBJECT: Sewer and water Re- quirements, Lot 170 block C, sunset :sills Subdivision L'aot Dear tor. Lobred: This letter is to inform you that permit 0182 issued to you for relocation of your sewer and wager :system In not valid. Further investigation by this Department hau shown that due to the loss of land at the rear of your property, there is not sufficient distance to install an adequate sower and water system to serve your duplex. We regret that thy per - At had to be channed. You have now been Issued permit #184 which 15 for the instal- lation of an £ndividuni newer and water system. The house and haocemnnt rental will have; to be converted to :a single family residence. Please remember the .ewer system will have to be inspected prior to backfill, the old well casing .in to be completely filled with cement and the old sewerage system is to be collapsed and filled with earth. Sincerely, UAVZU R. L, DUNCA`t, M. D. Medical Director BY. Rolfr A ItAckland, R. S. Sanitarian RkRStrn • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval / a Parcel l.D.018-201-15 Expiration Date: 1. GENERAL INFORMATION: Complete legal description SUNSET HILLS; BLOCK C LOT 17 P-228 Location (site address) 14201 Specking Ave `Anchorage AK 99516 Current Property owner(s) Esther Jurasek Day phone 227-0206 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System WeiverNariance Received by: 11� COSA to be released to the COSA Fee $ 521, Date of Payment 161[7-111 Receipt Number 60&,43 COSA# 85Cis15(4,5 TYPE -OF WASTEWATER DISPOSAL ® Individual ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ Date: y0 a !p requested by the engineer. 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: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101 -Anchorage. Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: l In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party, that retained GEG to perform the evaluation. Reliance upon the Information provided to this report by any other person or party, (including subsequent property purchasers) is not authorized, nor will It confer any legal right whatsoever. _. #AECC884. 6. DSD SIGNATURE - - - - _ Systern #1 Approved for bedrooms System #2 Approved for _ bedrooms - Qp N Or :+lVC Disapproved J2 ON-SITE tP Conditional approval for bedrooms, with the foliou�rig L11�jiptl¢.1D :: o WAS o.= By � t�^-� 1---�i� Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civilengineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors, or omissions the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory - Other Cosa blue a.ah04 0-12.mc 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: SUNSET HILLS: BLOCK C, LOT 17 P-228 A. WELL DATA 'PER GEG INSPECTION Well type PRIVATE If A, B, or C provide PWSID#NSA Date completed 1953 (7) Sanitary seal (YIN) YES Total depth "112.8+ ft. Cased to UNK ft. Parcel ID: 018-201-15 Well Log (YIN) NO Wires properly protected (YIN) YES Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 9/20/2016 Static water level ft. 98.2 ft. Well production g.p.m. 3d6+ g.p.m. WATER SAMPLE RESULTS: `` ��✓✓����� Coliform k)r colonies/100 ml. Nitrate &)!0ng./L. Collected by: GEG, Ltd. A senic: N�4r,g./L. S.O «mate of sample: 9/21/18 '•(1 B. SEPTIC/HOLDING TANK DATA Tank Type/Material ADVANTE%/STEEL Date installed 11/23-24/2009 Tank size 1500 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) 'YES Date of pumping 5/18/18 Pumper MAINTENANCE WITH ANCHORAGE TANK C. ABSORPTION FIELD DATA BELOW E%ISITNG GRADE Date installed 11/23-24/2009 Soil rating .p.d./ rft'/bdrm) 4_0 System type DEEP TRENCH Length 15 t. Width 2.5 ft. Gravel below pipe 5.1 ft. Total depth 8.4+ ft. Eff. absorption area 153 ft' Monitoring tube YES Depression over field NO Date of adequacy test 9/20/2018 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 8 in. Water added 685 gal. New depth 18 in. Elapsed Time: 1095 min. Final fluid depth 0 in. Absorption rate >= 600+ g_p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NO If yes, give date - 'SEE ATTACHED 2018 MAINTENANCE LOG PERFORMED BY A+ HOME SERVICES "SEE 11/25/09 ELECTRICAL INSPECTION ON FILE WITH MOA D. LIFT STATION "'2ND COMPARTMENT OF 1500 GALLON S.T.E.P. TANK Date installed 11/23-24/2009 Size in gallons —500 Manhole/Access (Y/N) YES "Pump on" level at —*in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO Septic tank/lift station on lot 50r+ On adjacent lots 100'+ Absorption field on lot 501+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 1001+ Sewer /septic service line 251+ Holding tank 100'+ Animal containment areas 50'+ Manurelanimal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation '54 Property line **V Absorption field 5'+ (ASSUMED) Water main 101+ Water service line 101+ Surface water 10(Y+ Wells on adjacent lots 501+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line -11, Building foundation 1o'+ Water main 10'+ Water service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 501+ F. COMMENTS 'MET CODE AT TIME INSTALLATION "WR#090058 G. ENGINEER'S CERTIFICATION l certify that / 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 JEFFREY A. GARNESS Date 101,041 94 (Rev. 10/12/12) p..o..eee. L •5. Municipality of Anchorage Development Services Department �� ' Building Safety Division �" `=' On -Site Water and Wastewater Program ` , 1 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 019-101-15 COSA # ! /)01)10 Expiration Date: T — 7 — �� 1. GENERAL INFORMATION Complete legal description &4. _, } "MS QIocIZ C Lok Location (site address) 147-01 SpecU,,, Ayentie Current Property owner(s) M a E Day phone Mailing address Lending agency 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: L_ 3. TYPE OF WATER SUPPLY: Individual Well E, 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 (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional 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 SparizLKA Ln ineer; „4 Address Zo3 W. 15+t' Ave. 5h. Zoe AnQAOr Vo Ak 7757o) Engineer's Printed Name Lars SD NrFLIu..r� 5. DSD SIGNATURE _AZ Approved for —#L bedrooms. Disapproved. Phone ?M -37/(o Date IIz/ Zo1O -r ��.oF A(gs111 %A, JJ A 'TtV v / / LFis E. S?!J:ik-,AN7: / '10 Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: 11�' e&� Original Certificate Dater r a (Rev tUDS) Municipality of Anchorage �• Development Services Department Building Safety Division ' On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: 54�saA Parcel ID: 01R - 201— 15 A. WELL DATA Well type P�;v. ke- If A, B, or C provide PWSID # = Well Log (YIN) N Date completed -:j_11169 Sanitary seal (Y/N) Wires properly protected (Y/N) i Total depth —0—ft. Cased to ,140 ft Casing height (above ground) +12 1n. FROM WELL LOG AT INSPECTION Date of test Prc. 1W9 51191 $D% Ze 01 Static water level 4nkneen ft. Well production un Kwew n g.p.m, WATER SAMPLE RESULTS: Coliform -0—Colonies/100 mL Nitrate OAQ mg/L Arsenic: NQ ugll date of sample: i151Zolo +f 51 r9�oy T B. SEPTICIHOLDING TANK DATA Tank Type/Material /5f'-1 Tank size 16500 gal. Number of Compartments 1Z Foundation cleanout (Y/N) it Depression over tank (YIN) A/ Date of pumping Naw C. ABSORPTION FIELD DATA Pumper_ 4 T ft. 4 g.p.m. Other bacteria _colonie1s/I100 mL Collected by: L,lR $�Gr A Date installed Il 23 01 Cleanouts (Y/N) Y High water alarm (YM) Y Date installed It 4K o Soil rating g.p.d./f r f6bdrm) System type 'Tient), Length 115 ft. Width Z 5 ft. Gravel below pipe 5.1 ft. Total depth 9 ft. Eff. absorption area hLitt Monitoring tube Depression over field /✓ Date of adequacy test Ntw Results (Pass/Fail) — For —bedrooms Fluid depth in absorption field before test= in. Water added= gal. New depth —in. Elapsed Time:=min. Final fluid depth — in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date —' D. LIFT STATION Date installed 163101 o 'Pump on' level at lD in. Datum &n Ao`L 8.8.E E. SEPARATION DISTANCES Size in gallons 1500 15 'Pump off" level at 2W in. Cycles tested N4 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 65 !>`' A Absorption field on lot 657 42 Public sewer main too r+ Sewer/septic service line -2F r+ Animal containment areas $0 I+ Manhole/Access (YM) S High water alarm level at tai I*5 in. Meets alar & circuit requirements? y On adjacent lots IOU + On adjacent lots I00 + Public sewer manhole/cleanout 100,+ Holding tank N/A Manure/animal excrete storage areas 1 DO 1+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: r � Building foundation 10t1p Property line 1 Absorption field 5 + r Water main to 1 + t Water service line l0 t Surface water 100 + Wells on adjacent lots 100 r+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I t A Building foundation I0 •51 Water main I Dt+ 1 Water Service line 101 + Surface water t too + Driveway, parking/vehicle storage 10 t r Curtain drain IVIA Wells on adjacent lots 100 k F. COMMENTS See, ✓arlaNct 061 tr Ie- ���\\L! G. ENGINEER'S CERTIFICATION i P�E.pFAC!� I certify that I have determined through field inspections and h.��TFi review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. '0 `" - Engineers Printed Name r5 r rte anrI // LARS Fc� -/ ���'•;�,� tSzQ �O Date 1117.1Z010FES COSA Fee $ Date of Payment Receipt Number (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number RA. ....,�.� 16 > S 56 0.0ti GRAVEL DRIVE � ^ `` ' \Z— 00 \ A 00. SURVEY CERTIMATION 7T RAM 4 AS -BUST '10412 S AS-K&T �j 1�0 _ Z Fa�oATOH /.S-IR1T ®AR ,o --a-•► woo 1a ..'. `•.. �a FE o FoFOUNDD R OD Fa : N PLOT PLANS do LOT SURVEYS CA A VERIFY PROPOSED LDIMO GRADE RRrLATVE TOVE SMO FENCM VAn L8. SQTTO ONLY =DEWAUI�. pSHRrI1YR M THEIR APPRORIMATC LOCATION. ONLY. it/a Tjr� O Til[ [XISTIIICE Ort ANY EASEMENTS. COVENANTS GA RC3MGT10NS NOT APPEAR ON THE RECORDED SLgMMSION PLAT. MAY I ALL DISTANCE'S ARE RECORD UNLESS OTHER NOTm. t, ou V' EIDSTING u' HOUSE S 66 ��•Lh Prepared by Robert E. Johns, Jr. & Assoc. Seal.: 11I n 301 IAm PM F4 110, Dot. 3 n y.G 1 7—wi—(19 D-- er• RE:T CR.a:d W JIB Lut 17 Block C sunset frills IDT HFM'LT SURVEY TYPE STMtSULZ '.:•.:...-• ASPIMLT AGE • SETWO Fa�oATOH /.S-IR1T ®AR ,o --a-•► woo 1a ..'. `•.. �a FE o FoFOUNDD R OD Fa rN.L n..:RAc Asaar Mn tU.KT ... Tara.1.FNT (g�> ASAMED EIEV. 9I� METAL M24CC mom DOOR PLOT PLANS do LOT SURVEYS NOTE:GROUND AND _ _ VE THOSE *APROVKWD4n IC OGLEANOUTA A VERIFY PROPOSED LDIMO GRADE RRrLATVE TOVE SMO FENCM VAn L8. SQTTO ONLY =DEWAUI�. pSHRrI1YR M THEIR APPRORIMATC LOCATION. ONLY. it/a CONSTRUCTION. To nNIwIHm OiADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC.. ARE SMOTYN PRCVENT SONi HMPROVEMFJITS FROM BONG SERI AMD LOCAL. Til[ [XISTIIICE Ort ANY EASEMENTS. COVENANTS GA RC3MGT10NS NOT APPEAR ON THE RECORDED SLgMMSION PLAT. MAY I ALL DISTANCE'S ARE RECORD UNLESS OTHER NOTm. HA.IICN DO AN AS -GMT BE USED FOR CONSTRICTION OR FOR ESTABUSMID WUbGARY Qt ra" L"M UNDER NO ORCWSTAAICES SHOULD INITIAL TRANSACTONLY AND ASSUMES FINANCIAL UA6EITY ONLY FOR THE CM OP TR SUR1IEY. ION THE SURVEYOR TAKES MMPCM�UTY FOR THE UST= DMTAIOE$ PREVAIL OVER 9CAIIIIQ R2nR .tET MAY CAUS£ ERRORS N SOME