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WOOLEVER BLK 2 LT 3
0 0 #017-411-15 Municipality of Anchorage e Development Services Department ' Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 Page I of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: Stu .r�%g PID Number. 017-4///-/S SW Name: Cha ""'a e!q OWt /l Wastewater System: [3 New ® Upgrade A°°`° !6 I Srs n; one d eAlo a ABSORPTION FIELD pbeaa:� gab Number of Bedmoma: 0 O Trench 0Shallow Tench OBed ❑Mount other: 05 Sal Rating: aeO Toad Depth tram original grade: Z4 LEGAL DESCRIPTION P �r Ft. Block. tol:^7 Subdivision: Owleyer Depth to pipe bottom from original grade: 10 Gravel depth beneath pipe: '3 l IV Twmship: Range: Section: FA added above original grede: Gravel Length: FI: Ft. Well: ❑ New ❑ Upgrade Gravel art $ Ft. Number of lines 3 Distance between line°: FL CI aKcat,W (Private, AJI q): Total Depth: Coved ro: Total absorption res /+O 6 F� P Matelot STA Ft. r Onller D ed: Slake Watr Level: Inhaler: ^ �O Date hulalletl: I D Ft. IU Yield:pump sr aL Heght AbOOe Gioiilk TANK GPMl Ft. FL SEPARATION DISTANCES lid septic []Holding ❑ S.T.E.P. ❑ Other. To I From Septic Tank Absorption Field Lift Station Holding Tank Public/lbrivate Sewer tine Mrrlacturer c t q 5 S Capectty. Gal. lib' 1 Material:Number of Canpartmonb: well )OG, )Oa' Surface ware, /00t 1064 100 �1- LIFT STATION / 4 Size: Manufacturer / Prem Ie% `ash/c5 Lot LineIlj Gal. f v '' 'Pump on' level (eC 'Pump oft' level at: '38 High water alrm at. —J In. Foundation 7Y -73 3 ?3" 7 7 in. M. D n DPump Make & Madel Elecmi l Inspection° padomled by Curtain Dram ^� as I e �%e (�A E o Remaft: BENCH MARK Lacaeon and Description: slab o con�ief� Aaaumed Elevation: raoM Ft. OF -Ltix! f i S ENGINEERI 17034 Eagle RivwWept ap Rad. NO -Pates: 8-1 M 8-041 7110 , r-• �.-...:.... , 0 Inspections performed by: ate 1 Alalka; two River, z"° 10--) _6q Development Services Department Approval .oto p �>r w t CE B�So.(1 Reviewed and approved by: Date: y0 ,per'^ " }�X otry. tv00) %Mi;;{S�Ol51nt� PERMrr No. SW040278 PAGE 2 OF 3 DEPARTMENT ANDhHUM-AN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 3, BLOCK 2, WOOLEVER S/D P.I.D. No, 017-411-15 i I O s NEW INTERMITTANT DOSING FAT ALBERT SAND FILTER QDSF) o MH. 1300 GALLON HDPE &l '.. SEPTIC TANK SEPTIC I BL1, AREA i 100, Wg $ 11 1,L �DIU FCO \I TeM j LOT 1 .� WELL 00Q E ! � W � I - I r M O - ,I ! SCALE: I' 40' s N� ROBERT C. COWAN b CE -88013 r PERMIT N0. SW040278 PAGE 3 OF 3 MunicipaUt of Anchora e DEPARTMENT OF HEALTH AND HUKAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone+ 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 3, BLOCK 2, WOOLEVER S/D P.I.D. NO. 017-411-15 FINAL GRADE ST1 //-FINAL //— 92.5' /-MH (MANHOLE) INSULATION NEW 1300 GAL. I `—IJV DISCHARGE PIPE 90.0' POLY. TANK MTI =87.8' 89.7' 550 GALLON FAT ALBERT WITH PUMP ASSEMBLY FLUSH VALVES MT1 FINAL GRADE ` rORIGINAL GRADE RPU ORGY J' •.RN.s uiEPXS -1/2' NR UNE MTI =84.0 DIST. LINE -84.9' BOTTOM OF SAND=79.8' . FC0 9.5 22.0 NO GROUNDWATER,.��1��'� 77.1' B.O.H. DELI DBL2 T— 83.0 84.5 70.5E 72.0 1 yC I.D.S.F. (INTERMITTENT �'W�RMMT STI 87.0" 74.5" _ DOSING SAND FILTER) ST2 90.0' 78.0' 00TMT 92.7` 80.5'UW QR_A' R3_n' C.; 09/04/2004 20:32 9072438528 J&K NELSON PAGE 01 Ria'htFLx 10/19/2004 11:14 pAOE 001/001 Fax Server Page 1 of I Inspection Report mniclpallty of Anchorage, Building Saftty Division 4700 South Sragaw 3NSPZCTZONn VOIC! &434700 INSPWMN: PAX (907)249-7777 =NPO: 747-7962 Name Address Legal Subdivision Comments sr Directions LARRY NAYDOCK i2515 TOILSOME MIL;.'OR OK2LT3 WOOLEVER Permit 04-9268 Ptrena 248-9925 Inspection Data 10/20/2004 AM Inspect underground to septk system to allow backfill/grading to continue. Contractor not on site inspection Undergmund Electrical Reinspection N NO NONCOMPLIANCE OBSERVED ❑ CORRECTIONS ESSENTIALAS EXPLAINED BELOW ❑ WILLRE-EXAMINE AT NEXT ❑ DO NOT CONCEAL UNTIL REINSPECTION INSPECTION CtJMM4f9ITS.—VW4 r9fAcWrare only) G 6��rRf�+� SIAL 'Alf, ct,� 44 Vel 0.r Inspector (late: jz- u - � fllc:/C,:%Frogra=V,,2OFila\RightFax\OntRoing\M000634F-.000 10f19t2004 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 Initial Permit Number: SWO40278 Legal Description: LT -73" I Design Engineer. 0003 S & S Engineering Owner Name: CHARLES & PAMELA TOW ILL Owner Address: 12515 TOILSOME HILL DRIVE ANCHORAGE, AK 99516 - c4 g 156-6 op 61W Date Issued: Jul 21, 2004 Expiration Date: Jul 21, 2005 Parcel ID: 017-411-15 Site Address: 012515 TOILSOME HILL DR Lot Size: 38554 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit Is for the construction of: F/ Disposal Field Z 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 calling (907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Z Date: -?/I L lc y Issued By:'fr�y Date: 21 QtjSN Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 w'ww.ci.anchorage.ek.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. (91 7 — 1? 1I – l S– Permit Number SW Property owner(s) 06 P VM Day phone Mailing address (1) e a (3 o,c '2 Z \ Z'a pkx N Zip Code 'tTS7=9q Legal description (Lot, Block & Sub'd.) Lo -f 3 . Block -Z , Vd �kW _c I r Legal description (Section, Township & Range) Lot Size_. 3-14--s 54-Aeres/Sq.Ft. Number of Bedrooms –T THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage O Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. 1 fUtther certify that this application Is being made for a Single Family Dwelling and is In accordance with applicable Municipal Codes. v • b4 w'�— 5 & 5 SNGINEERING (Signature of property owner or authorized agent) 70149iji; Itive—r1upW4 ERyls River, Alaska !9577 Permit Fees: --ht (7 0 . e' Date of Payment: 7 1 f 4[ o i ANeiver Fees: i c C&V S Date of Payment: -7/) al /O y/ Receipt Number: 0Receipt Number: O 3-S' `fS-� - (Rev.12100) July 20, 2004 ROBERT C. COWgN, P.E. CML ENGINEERS (907)694-2979 FAX(907)694-1211 NEALTNAUTNORITY MUNICIPALITY OF ANCHORAGE APPRovALa Development Services Department P.O. Box 196650 Anchorage, AK. 99519 SEWER&WATER NVNEYTENSIONS REFERENCE: Lot 3, Block 2, Woolever Subdivision SEWE"'WATER MPEG„a,Y It is requested that ou issue a permit to u septic y g p upgrade a se hes stem to serve the existing four bedroom dwelling on the referenced property. According to the memo dated 4/7/04 from Jim Cross, the I.D.S.F. septic system is to be ENGINEERINGSTUDIES ANDREPORTS installed in the same location as the existing trench. The proposed system will be less than 35' from the existing 25% slope, as was the original trench. There is no evidence of any surfacing effluent in this slope. We do not recommend adding any additional fill on the above mentioned slope, as this would kill the trees and destroy the heavy vegetation that WEU WTES ION currently prevents an erosiorwoblem. rH4At 1 ^Oo cr*4,t $.,,r, de OL &o u7'ioN tlF Tfler 14.kcHF1s Aa 0 , Tp rNt C-4& . Lo C -+T-06” ^1 a rK# $?."A IL0A01; One test hole was excavated and a percolation test was performed on 6/29/04. The approximate location of the test hole is located on the attached site plan. At the time of SITEPwM excavation ground water was not encountered, and after monitoring the test hole for seven days the test hole was found to be dry, as shown on the attached soils logs. ROAD DESIGN We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. SORTEST If you require additional information, please contact us. PERCOLATION Sincerely, TEST / STFR=UR&a Robert LECNANCAL "CTIota RCC/jhm Enclosure ONSITE WASTEWATER DISPGSALSYSTEN DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER. ALASKA 99577 • DATE: April 7, 2004 a MUNICIPALITY OF ANCHORAGE Building Safety Division MEMORANDUM TO: On - Site Services Program FRs foss, P.E. ger, On Water Wastewater Program SUBJ: Slope setbacks from >25% In situations where slope conditions will not allow a wastewater disposal field to be k)cated 50 feet horizontally up gradient from a change in slope to greater than 25%, as •required in AMC 15.65.060.A.1.b the following requirements apply. (As allowed by AMC 15.65.030.G) 1. A point shall be determined two and one half feet above the invert of the distribution -piping of the-septicc field-at-the4♦eid'"osest point#o4he.slape greater than 25%. 2. A line shall be drawn from this point and perpendicular to the distribution piping at a down slope of 25% In the direction towards the slope greater than 25%. 3. The Intersection of this hypothetical line and the actual slope shall be a minimum of 35 feet horizontally from the point established in #1. 4. This 35 foot horizontal separation shall be the minimum allowed between a disposal field and a slope of greater than 25%. If a property has a wastewater disposal system that was constructed prior to 1986 and the absorption field encroaches a change In slope greater than 25%, an upgrade of the failed system may be approved in the same location if the following applies: 1. No other location exists on the property to construct an upgrade drain field with proper separations. 2. The engineer field verifies that no effluent ever surfaced on the slope surface. 3. The engineer maximizes the separation from the field to the slope as much a. • possible. SITE PLAN DESIGN O:E > o-ir > O9O"z' _ 1 1\00"'C l7 AfOO�P N 0 D `0 st=M4 4*9�w.�]] tlC l \\Mxx�y a 'vri y N d 0�-[^M mom CnZigjx yy O �NKAd�ZN W, 'N - 9 toJ O m N� II m H QUO C 2z S;r- I ovs10 C iHi ZI°i'a M m ?N II y� z -IZ Atm mio b.R omo>CyE O O rr 0 C x Oz�'nF O 2 0 H r -r 1-] O o vmz <wm �H t. .x o �>n� sa m P7 LTJ O O •p CJ r� cN j mmc9 y ,.,3 O W0 i? ii \^ir t9 ',a, m o p m z -�Om m c�sz C. m >z ix : .-. Z zu4WNR r >nvll j 9 vCCmllmn r>az .�,3 o9oy ma ps MUM =0Z. N Z� ONZ TOILSOME til - _ 4 000 �uu9 JNVa Vj O 7H o „ W m ^ ^ O Z > c i c n x DR%klX r O9>y m ✓�I m 'GA EL WICK- 00 / t DECK yos�c �yfu loo' WELL O F RAD, O �. ___ _ — 10' Util Esm} — — _ — — _ _ — _ _ — o = c _ _ _ _ _ — — — — _ 10' Util Esmf w - C _ — — _ — _ — — — _ L"m�oZMX OZ xn O 'r•la Zom'sc .A _� S< zr0 Z. mz mo d sr c m r R "Z mNZ mw o so0ezo o = io oixo� H � m r-. .. T �0 ZA \ \ .]'D mi 0A H Q he s•-7 ad0. xm .� \� > o ll3M w 0 0 o C. \ol 0 a ism Vr �: • >� C 0 It� N. T. S. DESIGN PLAN SCALE tom'' m AOOOA "ti�� f C r�N ap p� m Zomm H� m NNby .y mvi N. T. S. DESIGN PROFILE SCALE 0 nu A OO, - wpm• N r f o OOm lmn •� o,oppAtiuke! Ilk � z m m m �n mm�a� // \ 71�/fie`<_.Joro \/\// k o "7 / /%///`/�/` v a o o W 71 / pml 0'O Osv y tz < DD' HL�VI Q 1xoZ rAl c y �VlyW2 ' cn D n• mozp. LA mom ,71 1 / 40 coo 4;. :x 1, a Municipality of Anchorage wGiNEER . Development Services Department:?: Building Safety Division 1... t♦ On -Site Water and Wastewater Program. I _ 4700 South Bragaw SL R06ERT G COWAN Oz P.O. Box 196650 Anchorage, AK 995146650 �eF Ww ymci.anchoraae.sk.us cJ CE -8801 2. (907)343-M 11 ,p. .................�`��*�� kk Soils Log - Percolation Test Performed For: LAA. c-ff LA-.nQ _. --Date Performed: Legal Description: LOT 3 Q.Lec e i WOOL-tvtet+O Township. Range, Section: Depth 3- 4- 5- 6 - 4-5 6- � g' ,t 7- 8- 1 - 1 13- 14- 15- 16- 17- 19- zD- 0 R LAA. f c- j V10-0 f4w.0 WAS GROUND WATER Kt7 ENCOUNTERED? s l /IF YES. AT WHAT DEPTH? L O Depth to Water After DAY P Monitoring? E Date: *7 7 O Reading Dale Gross Time Net Time Depth to Water Net Drop Iti 10 perN 11'/%" 3 Yy ap %U0 3'/i„ 30 11 14.61 3 y2, it 0 � ./z« 3 '/V- /1..So S-0 11 (/Ifw 3 v6 .. 60 n '/�. 3 Xx" PERCOLATION RATE vi .'7 (r.'r.vles5r,2:1 PERC HOLE DIAMETER (j r TEST RUN 6cr NEEN FT AND 3 FT COMMENTS q 00 PERFORMED BY & S ENGINEERING I . CERTIFY THAT THIS TEST WAS PERFORMED IN O t CJ11�i<W*§IffTE AND ti W ICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7 / -7 /0 y S& ROBERT C. COWAN, P.E. CML ENGINEERS (907)694-2979 FAX(907)694-1211 INTERMITTANT DOSING SAND FILTER SPECIFICATIONS Lot 3, Block 2, Woolever Subdivision NEALTNanrawn APPROVALS July 20, 2004 GENERAL STATEMENT OF WORK WAERSWATER LOA ExTEPSICIIS The work and plans covered by ,these specifications consist of furnishing all labor, materials, tools, transportation, and equipment necessary to complete an Intermittent Dosing Sand Filter system as described herein and on the attached drawings. rrav CTICN All work under this project shall comply with current Municipality of Anchorage (MOA) Regulations. ENcRNEERINGSTMES The scope of this project includes the installation of a 1250 gallon septic tank, excavation of ANDREPORTS the existing trench, verification of the bedrock depth, the addition of pit run sand as necessary and required, and installation of a new I.D.S.F. septic system over the location of the existing trench to serve the existing proposed four bedroom residence located on the referenced property. WEU INSPECTION a PLowTEaT SITE INVESTIGATION WTEn.NS The Contractor must carefully examine the project documents, have full knowledge thereof, have investigated the site, and be satisfied with the conditions affecting the work. Conditions include, but are not limited to those bearing upon transportation, disposal, handling and storage of materials, availability of labor, water, electric power, roads, and ROAD DESIGN uncertainties of weather, physical conditions at the site including all underground utilities, the conformation and condition of the ground, the character of equipment and facilities needed preliminary to and during prosecution of the work. The Contractor must be satisfied NEST with the character, quality and quantity of surface and subsurfacematerials or obstacles to be encountered. Any failure by the Contractor to become acquainted with the available information will not relieve him/her from responsibility of performing the work as stated in specifications and drawings. PERCOLATIONthese TEST Location of utilities will be the contractor's responsibility. $TRUCTUpPLA MECHANICAL "cnONS ONSITE WASTEWATER DSPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER. ALASKA 9077 'Page 2 Lot 3, Block 2, Woolever Subdivision July 20, 2004 SEPTIC TANK / LIFT STATION / AIR COMPRESSOR A. General The work under this section consists of the performance of all operations pertaining to furnishing and installing the septic tank/lift station, air compressor and piping to the sand filter. B. Materials 1. Tank a. Septic tank shall be a two compartment tank of at least the minimum size indicated on the drawings and MOA approved. b. First compartment shall have a separate 4" pump -out riser. The second compartment shall have a separate 4" pump -out riser. 2. Manhole Riser or Lift Station Tank a. An additional second compartment manhole riser shall be capable of being equipped with the following: 1. A junction (Nema 4x) box or equal, bonded or attached to the pump basin. 2. UL listed electrical cord grips, installed in the J -box. b. An additional tank (M.O.A. approved) may be provided for the effluent pumping assembly and the items in (a.) above. 3. Effluent Pumping Assembly, Controls, Alarm & Piping a. Effluent pumping assembly shall be of approved materials, including the following: 1. A 110 volt or equal U.L. Listed effluent pump. 2. High-density PVC cylinder housing the pump, with level controls and screen, serving as a baffle to prevent the screen from clogging. 'Page 3 Lot 3, Block 2, Woolever Subdivision July 20, 2004 3. All piping shall be PVC or other non -corroding material. b. Pump controls and alarm system shall be an approved system with the following options consisting of: 1. Event counter 2. Elapsed time meter 3. Program timer 4. 10 watt heater 5. Remote alarm panel option with a minimum of 80 DB sound pressure at 24", operating temperature 30AC to 65AC, continuous sound to be located in the home. 6. Oil -tight visual alarm with push -to -silence feature. Automatic audio -alarm reset. 7. 15 amp motor rated toggle switch, double pole, double throw with three positions; manual (man), automatic (auto) and center (off) (H.O.A.). 8. Nema 4x -rated, fiberglass, or equal, enclosure with hinged cover. 9. All controls to be installed as per manufacturer's recommendations. 10. Control panel to be installed on outside wall of home within sight of septic tank/lift station. c. Piping from the septic tank to the sand filter is to be 1 1/4" PVC schedule 40 solvent weld piping properly bedded as described in Materials Specifications and sloped to drain back to the lift station. Insulation board 2" thick and T wide centered over pipe is to be placed where soil cover is less than 4' depth over pipe. d. The airline from the house to the filter is to be HDPE arctic insulated pipe 3/4"-2" SDR - 11. The compressor will have a gauge (0-10 psi) and be extended into the living area or garage for easy monitoring by home occupants. 4. Air Compressor 'Page 4 Lot 3, Block 2, Woolever Subdivision July 20, 2004 a. Air compressor shall be a THOMAS LINEAR SERIES model number 5060-A or 5070V -A or M.O.A. approved equal. CONSTRUCTION SEQUENCE In order to insure proper installation, the system is recommended to be installed in the following order: I. Sewer line from house to tank H. Septic tank/lift station M. Sand filter IV. Leachfield bed (if required) V. Final grading CONSTRUCTION 1. Construction Instruments Contractor shall provide instruments such as transits, or levels, for establishing proper elevations and levelness of pipe or materials. 2. Pipe Laying All pipe shall be laid with material free of large or sharp rocks and organic matter. Each section of pipe shall be handled carefully and placed accurately. The spigot end shall be fully inserted pointing in the direction of flow and glued in place to make a water tight seal. Each section of pipe shall be properly supported to insure true alignment and an invert which is smooth and free from roughness or irregularity. At all times, when work is not in progress, open ends of pipe and fittings shall be closed so that no undesirable substance will enter the end of the pipe or fittings. 3. Bedding of Pipe for Sewer Lines 'Page 6 Lot 9, Block 2, Woolever Subdivision July 20, 2004 The pipe should be bedded with materials free of large or sharp rocks and organic matter, compacted. Native materials may be used as back fill material above the pipe, provided it is free of large rocks and organic matter. All lift stations shall be installed in accordance with the manufacturer's recommendations and standards. Electrical installation is to be in accordance with the National Electric Code (latest adopted edition) by a licensed electrical contractor, with M.O.A. inspection where required. If MOA inspection is not required, a licensed electrician is to provide a letter to the Engineer stating that the system meets or exceeds all applicable codes. 4. Excavation Excavate to proper depth to allow gravity flow, install tank level, tolerance 0.05 foot, on undisturbed or compacted classified sand fill material. Create a level sand surface over the tank and add 2" burial foam +35 PSI directly over tank. Mound unclassified soil over tank with a minimum of 2 feet of cover and anti -flotation weights that may be required in areas of shallow ground water. 5. Connections All connections to be as per MOA requirements, PVC 3034 piping with Caulder or equivalent couplings for inlet riser pipes. All tank connections are to be completely water tight. *Page 6 Lot 3, Block 2, Woolever Subdivision July 20, 2004 SAND FILTER The work under this section consists of the performance of all operations pertaining to furnishing and installing the sand filter. A. Materials 1. Sand Filter a. Liner (if required - not required for bottomless sand filter) - OSI Model LI or equivalent. 30 mil PVC cut and fabricated to provide water tight enclosure of filter sand volume. Seams to be permanent as per Manufacturer's recommendations. All connections, such as boot flanges, through sand filter to be permanently bonded to the liner. b. The Contractor shall provide a washed sand to meet ASTM C-33 Concrete Sand Specifications with the additional requirement that all but 1% of the materials passing the #100 sieve be removed. All Band shall be approved for use by the Municipality of Anchorage (M.O.A.). If the sample does not meet specifications, all sand will be removed and replaced. c. The Contractor shall be responsible for providing pea gravel that shall be a washed material containing no fines (0% passing the #100 sieve) and a maximum size of 1/4" diameter. d. The Contractor shall provide the manifold assembly. The manifold assembly shall be of approved materials with orifice shields and flushing assembly. All drilled holes to be cleaned of burrs and pipes flushed, prior' to assembly. Flushing valve to include riser to finish grade. Lateral distribution piping is to be laid level (@ t 0.05'). e. Sidewalls and top of the filter box to be insulated with 2" direct burial polystyrene insulation. f. The Contractor shall be responsible for providing filter fabric. g. Air coil in sand filter to be geoflow WF16-4-24 150 LF placed 6" above bottom of sand. -Page 7 Lot 3, Block 2, Woolever Subdivision July 20, 2004 Construction of Sand Filter The sand filter construction is to follow procedures as outlined below, as applicable to this design. Pea gravel and filter sand are to be hand leveled to proper depth (tolerance within 0.05 feet) in filter, taking care not to allow mud or fine soil material into the filter or gravel layer. This would include any soil material picked up by excavation machinery buckets while loading specified material. The Contractor should estimate filter material volumes such that allowance is made for wastage of material in contact with the ground at site. The area over the sand filter to be finish graded with a minimum of 2 feet of cover and to prevent ponding of surface water run off. Side slopes shall not exceed 3:1. The Engineer will reject any sand or pea gravel that does not meet specifications or is contaminated in transit or while handling. If such material is placed in the filter, all soil material may be required to be removed and replaced with new material. CONTRACTOR/ INSTALLER MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL_ INSPECTION REPORT v NAME PHONE _ D NEW UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION ) NO.OF B€gROOf� U y m Q — Well — Absorption area Dwelling DISTANCE TO: '1 /�—sor/ Manufacturer at a PERMIT NO—(9— d bo,{- - No, of�mpartments wF rn _ Li4. eavackty in gallons length Width_ IF HOMEMADE:DIST Liquid demacO!�- O z Q *Inside TO: �ing �_—__ . ;f T, �� Mst na PERMIT NO. - Li ui patiTy in gafl� q x— - wZx w Z — Well DISTANCE TO: No. lines Length of each line Foundation t Nearest lot line. s Total length of line Trench widtl, PERMIT NO.�o Distance b tween lines Z w of , / c inches �Q/ p. O 1p Top of tale to finish grade — r __3�j Material beneath tile !� T � iUehes Total effective a s r do area - Length Width Depth PERMIT NO. w m F Type of crib �- C -sib diameter Crib depth —Total effective absorption area Lu DISTANCE TO: elle Bulldia ou ndation - Nea reHirr� J w DISTANCE TO: Depth Building foundation — Driller Sewer line Distance to lot line PERMIT NO. Septic tank Absorption area(s) A — OTHER 5 PIPE MATERIALS D SOILI"ESTRATING r q ( f INSTALLER Q 8 Dip, REMARKS _ LEGAL 0 APPROVED — DA/T�E zi� 72-01 Vev. 3/78) /1 1 1 �7 1'""1LJ P-4 l.' 1_' T W=• Ff L_ 1: '-r "-e" 1. �0 F' 1=1 PA 1_-" VA i :1 [R.' F=1 s :_d FE DEPARTMENT OF WE=ALTH AND ENVIRONMENTAL.. F ATF..C':T'ION 825 L. -RE'ET, ANCHORAGE, AK. 995 264-4720 01'-"1 , n T -T" FE EE; L.-1 E=-- F-.? F= R.... F,., r i 7 "'l. _ PERMIT NO. 1: 8005.:1.1 rail APPLICANT CHARLES TOWIL.L SRA BX 2094-L ANC:H sm''Tj �1i1=A111 LOCATION TOIL'OM DR. u_2I'Lk�(S� LEGAL L75"A BLK2 WOOLLEVER S/D LOT SIZE 43560 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM I'S: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 'SOIL RATING (SO FT/BR)== 7.00 THE: REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: A -CD lL_t .E'ro11.3-rH== -�t4 I:a F i� 'E E. _ C°E= E'" 8 E'R= THE LENGTH DIMENSION IS THE LENGTH CIN FEET; OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE: BOTTOM OF THE EXCAVATION (IN FEET). THERE: IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL F'IF'E AND THE. BOTTOM OF THE EXCAr'ATION (IN FEET). F, FE 1`91._1 :I F".1 - f_ ° Er F=" I- :l: 1"- -r 1=11 ^4 S-= _ "_' .' I :a, F-_- — 3. 121 f.3 F`1 E__ 1.....1.`11'^4 =7 PERMIT APPLICANT HAS, THE: RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION IN'SP'ECTION_; OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. all.a, `• r 1'-•11H. F_" IEE r T- TL ID 114 3 C-1 Fes: II . F-: ET 9-D L_1 I Fes=". IF= C. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL. BY THIS DEPARTMENT WILL BE SUBJECT TO P'ROSEC'UTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSA_. SYSTEM I: 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. / OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS. ARE: AVAILABLE TO INSURE PROPER INSTALLATION. 1"=' f'W F<:^. t•'1 x T EE :� ; �"" r � E��:, L=^ E= 1= C 1'•'1 E� IES �^ '�'::�_ ,• I CERTIFY THAT K I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE. SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON—SITE SEWER SYSTEM MAY REQUIRE RESIDENCE IS REMODELED TO INCLUDE MORE THAN a BEDROOMS. SIGNI-D: x. =.'!fir C s: __, _'_ E_ � 1 =-! APPLICANT CHARLES TOWILL � - --.__EATE-------------- ISSUEDP Br J FIND WELLS AS SET ENLARGEMENT IF THE V4. 0 L7 SOILS LOG. l- MUNUPALITY OF ANCHORAGE Q--�' . CI PERCOLATION - „ o} s {; , DEPARTMFNIT OF HEALTH AND ENVIRONMENTAL_ PROTECT PON TEST Pouch (3,650, Anehcrago, Alaska £5502 2713-2221 SOILS LOG - PERCOLATION TEST zevorl - PERFORMED FUR: /!Q�/�✓_ 729w)l/1�O/p''�//fJrJ-/-rGeGklh�)T DAE PE R F 0R M E D:__ LEGAL DESCRIPTION:._ ?Of13, 9/0c.� Z -'4s"-- SLOPE SITE PLAN LP ra CETJ`�-�yIRE ML 2 - �an s///y anya/ar yrrAve/ is Aa/s_;.o1'_IyZ4j/8 -- s GMBele' pK�j/8� n M� -- {6n clayey ariil-� _ angular gravel (,fop o� fa± -�I deco+yd:d hedroa/c 7 __a -- 1 iJel.BrI9G-'ri° n oec - r 10 .-ain7oe>�riy E�elow b/u�f h� WAS GROUND WATER S ENCOUNTERED? •_ Yl� L TT O i P 12 IF YES, AT WHAT /.I E .I. DEPTH? 13--- i- - 1C?�Li9N� 15 -, 16 17 18 19 20 ' PcF'•FOR;hE6 0Y: L�/ _ AA. 4 72•E03 (//76) I:3 - Reading Date Gross Time Net Time Depth to Water Net Drop and L �r PERCOLATION RATE___-___ ,'z (minutes/inch) TEST I3UN BETWEEN FT AND FT ^ _,OfFt�iF I EU l SOILS LOG muNICIPAI.rry OF ANCHORAGE. !r� PEI4(:OL Al ION �ry - DEI PARTMENT OF HEALTH AND ENVIRONMFNTA- PRO TFC TION ,�`� ,r I`uudl f.000, Andicra9s, Al �;ka 9950?. Z/6222? z' SOILS LOG -- PCRCOLAI-1011 TEST PenroE{r.+En Fon LEGnLDFSCRIPTION LOP I. :.IIP. PLAN (FI- E TI ! � _ - Dc^_•cay�� �r�cfrfi< 2• dnc� - . , ._ _ , . 04- 14 G M G ;, 741, Kelm M! L/f>l'cira'S yrnva//y . t }cr .s ! .. Till _,5i/�� an��//�a✓ I - / , • . .. - mei/ ��`� , %pn st _ � --• �%°Ce�rr�Ic>:s �'. c/ fic:ririnc-.� I' A S GROUND VIA 'F(=R I Mcur: it IR Ir YES. Al WHAI- 1, >f� J", !r'iuyc' 3r I X .q 'C °'.'`r . 9 - -- r% — 2=/frrr'�;' ✓Se Gr'fJ � /..� p'�GO�LI• / .r � e • 7 2 009 '7 161 1 tl r�(4 ��1�e`•+:i� �ia •:� 1 �rs3 I ZR ti,r IV �.. �'•i� PLRCo LArION RAI +y l'. Oma._ ! Innnulrsh nc!,1 TI 51 „LRk EI Rl1YJLFN COMMENTS_.. f/C. C✓2( i/__�%r, f�1 ,r r'�%�CT �s'��Y r i rf _ ._! _..- ___ .6L.._.__/ pq� —. /���_. J—'N.6�{rV if�L�(_�.____-�f/ �a4i.�(� _-. y��{, _ / .4/!._- /•I% / �. _r // [[ / /' a PERFORMED 13Y .C'.. t�rdi ea �,r r;(/i CJ/ /"SG�. (:L ___' �C G•fcy t=:: !/ 111II'ItDLv _.- _ .:: G%r•/%'d` . Un TE 7 2 009 '7 161 d U S 5��\N'::kerShattt v� �,;e e ar t__ent 00 0 MunicinUity ouch 6-6y NSON LEVAKE RENSHAW, JR., r Ccmu"mg Er. gmeer _lull Geo:ncnn:cal, Geo.9ical and Min ing Engineering Phone: (907)344-1814 Anchorage, Alaska 99507 September 18, 1900 o1 QvIth and Environmental. Protection of AnchoraEc Anchorate, Alaska . entlemen: 99002 re i .l ot j, Block 2, Molever :.i U.Gd v. I')CaS.e refer i0 the attached jOlis 1.-0g PercolationTBs" ...or the referenced property dated Sept, 18, 19f0.,'atRvhn,l I t is respLctfally rc juested that a waiver be Erzytui _-. this case to the iTnulrud sonaration between bottom of pa&� ire's' and ton o1 ledroct. the ,;ustiflca.tloDs are an ._. On Lne =oil ^ 1VE it will a. oe seen that a ,: rch 7,vd .- C`rms the actual bedrock surface, No seepage, ." cvi,enwe off seen:gP, w2s Sven at the too of Wis IaNev, 1Orsgt.h that horizon wzF rourd <= physically eco o e a birPlyfrRalurco, serrentine/greenntone Crctanornfured mnrfre lava). _Krollnrkl is l permenblu and ;.:; vOls claFs1ficatlun vc.u_ c c ..,, dbSignated as a aucily scrued E ,.,a e l0,'1 :: is disc le in Fti.idrni `rom the rpirlive eaEe with which it wac u! i-s"w04 W incknoe, ''he exi-Orne of this rVerM .s rot con . e, ,u he unique to the test tole and it is seen also outcrow-pirt U nhe house foundation out to the East and along the road c _ o 0ilsom- isl.1ls !rive to the •. Desi. it Q therefor ccnoluded to le Ke general bedrock Hype for at least :;he immediate area. The Regulations were undoubtedly dr<_:f-ted- \77. Lh .� !Jer'. :'tile .k surface r mind. T. instance a=r' „ s r - bearoc., e i.� nd, n this _n,.'ba:i.;e �..ch is not the case and there is no practical reason why a leach field within this rac t,ir•ed bodrock will not -wry we) l ,r:.9 yef .nerve the _n.tr,nt oi, the regulations. Additionally, because of the relatively steep topography, it is rocommcnded that the water ;yell to leach field distance restric- tion he waived In thin instance, Your careful consideration requested regulation ation na.i.vers is hues;tions please call me at the encl., cc Charles To'a'ill and favorable action upon: thece requested. Should there we any above phone number. MUNICIPALITY OF ANCHORAGE . SON LEVAKE RENSHAW, JR., P.E.. DEPT. OF I!EALTH & Consulting Engineer ENVIRONMENTAL PROTECTION Civil Geotechnical, Geological and Mining Engineering SLP 19 1980 1850 Wickersham Drive Phone: (907) 344-1814 ARE Cat rVsp[y9507 September 18, 1980 Department of Health and Environmental Protection Municipality of Anchorage Pouch 6•-650 Anchorage, Alaska 99502 ret Lot 3, Block 2, Woolever Subdi.v. Gentlement Please refer to the attached "Soils Log - Percolation Test" for the referenced property dated Sept. 18, 1980.1(attached) It is respectfully requested that a. waiver be granted in this case to the required separation between bottom of leach trench and -top of bedrock. The jus't'ifications are as :followst On the soils log it will be seen 'that a. 6 -inch band of clayey silt forms the actual bedrock surface. No seepage, or evidence of ground --water seepage, was seen at the top of -this layer. Beneath that horizon was found a physically decomposed and highly :rractured serpentine/greens tone (metamorphosed marine lava). This material. is highly permeable and by soils classification would have to be desi-gnated as a poorly sorted gravel (GP). Its decomposed state is evident from the relative ease with which it was excavated by backhoe. The existance of this material. is not considered to be unique to -the test hole and it is seen also outcropping in the house foundation cut to the East and along the road cut of Toilsom Hills Drive to the West, It is -therefor concluded to be the general bedrock type for at least the immediate area. The Regulations were undoubtedly drafted with an impermeable bedrock surface in mind. In this instance such is not the case and there is no practical reason why a leach field within this fractured bedrock will not work well and yet serve the intent of the regulations. Additionally, because of the relatively steep topography, it is recommended that the water well to leach field distance restric- tion be waived in -this instance. Your careful consideration requested regulation waivers is questions please call. me at the encl.. cc Charles Towill and favorable action upon -these requested. Should there be any above phone number. Sine A. L. R} s aw, ,1r. URN Municipality of Anchorage • -�1 Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsfe (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-411-15 1. GENERAL INFORMATION Complete legal description LOT 3; BLOCK 2; WOOLEVER S/D COSA# I DDD7-� Expiration Date: (0 O Location (site address) 12515 TOILSOME HILL DRIVE, ANCHORAGE AK 99516 Current Property owners) STEPHEN d LINDSIE JANSEN Day phone 617.1922 Mailing address SAME Lending agency Day phone Mailing address Real Estate Agent BILL BABYLON W/ PRUDENTIAL J.W. Day phone 3514762 Mailing Address 3601 CENTERPOINT DR. SUITE 200, ANCHORAGE AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well 0 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 seat 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 erred at the time of installation. Name of Firm S N S ENGINEERING Address 15861 S. BIRCHWOOD LOOP RD., CHUGLAK AK 99567 Engineer's Printed Name ROBERTA. SHAFER 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone 907.694.2979 Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report _X Other By: Original Certificate Date: '3 —2 6— U (Rb 11X5) 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 AP PR VAL CHECKLIST Legal Description: � 3+ /3ec5 c�0 Parcel ID: 0 A. WELL DATA Well typeIVATC If A. B, or C provide PWSID #= Well Log (Y! l� �\ 6 _ 71-V-1;rc Date completed flltyeO Sanitary seal '1 J)�`S Wires properly protected®/ J) Total depth t ft. Cased to P a K Casing height (above ground) la + in. FROM WELL LOG AT INSPECTION Date of test 3 Ib ►(� Static water level Well production 9.p -m. %ii g.p.m. wrcc Fcmcu WATER SAMPLE RESULTS: R( wove qq Coliform D colonies/100 mL Nitrate 1mg/L Other bacteria colonies/100 mL Arsenic: ug/L date of sample: II 10 Collected by: � 4S &7iK.�C'm&vZ B. SEPTIC/HOLDING TANK DATA Tank Type/Material _1_XT7 1 IG /f/wr Date installed /D 12 D Tank size 15CO gal.Number of Compartments Cleanouts(S3N) E`5 11 Foundation cleanouN) Y� Depression over tank (Y/6? AQHigh water alarm (1 0 Date of pumping -9g Pumper + 1I6W'Ar_ C. ABSORPTION FIELD ATA Date installed 8 1g b� Soil rating 6d./ft2 r fetbdrm) .2.0 System type I.b.S• F, r Length. 4S ft. Width ft. 'Gravel below pipe 'y"�s r ft. Total depth 5 ft. Eff. absorption area qQft' Monitoring tube Depression ove field Date of adequacy test /b /D Result Pa Fail T<l`'-S For bedrooms to n Fluid depth in absorption field before test a in. Water addedgal. New depth in. Elapsed Time: 15 min. Final fluid depth _(�)L in. Absorption rate >= fxrD Fd 9 P• Any rejuvenation treatment (past 12 mo.) (Y49 type) l�o If yes, give date — D. LIFT STATION Date installed n 'Pump on' level at in. Datum�7%0r7 of lY , E. SEPARATION DISTANCES Size in gallons :550 Manhole/Accessg)N) qr4'i,'— n 'Pump oft level at ' in. High water alarm level at A in. Cycles tested c2 Meets alarm a circuit requirements? E`> SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot �� + Absorption field on lot Public sewer main N / R Sewer /septic service line as r4- r Animal containment areas � " I On adjacent lots /Do a r On adjacent lots /oc 4 Public sewer manhole/cleanout _ Holding tank N /Fl r Manure/animal excrete storage areas /00 f SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 Property line S Absorption field / r Water main Water service line /D / Surface water / cc f r Wells on adjacent lots /CO i SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line �� + Building foundation Water main � r i Water Service line LO f Surface water /� l Driveway, parkingNehide storage r• Curtain drain NtVE /909ZY-�Wells on adjacent lots F. COMMENTS�- &%ec F=we-j e ,1T- P Mb F3Y �urnP ptrrmi3lnX�, FWw NO7 gvrTt'Ak1rrE%-SLTnFr&o MM70k2S CAti acr-ve , F}l¢ CCynPJU'-C P— auA47l11J4 0J aTs>r 0 -PmE of rt -q-fe 00 ZZT At ' G. ENGINEER'S CERTIFICATION • ( ..•... I certify that I have determine ugh field inspections and review of Municipal records that a above s ms in 9721• conformance with MOA CO gui line In ft t o this a e. :. + 1fNN •••••N•N••� Engineers Printed Name " / A. �w ti b!w 14�d Date ZJ SFv •.: '`4' COSA Fee $ Zy q0 Waiver Fee $ Dale of Payment Z/ 9y �v Date of Payment Receipt Number C� Soy Receipt Number (Rev. 1 V05) Municipality of Anchorage • Development Services Department Building Safety Division On -Site water and wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsitc (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 100070 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 3, Lot I 1 of Conifer Heights subdivision. This inspection revealed a nitrate concentration of 5.22 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SCS Ree# 1101054001 Client Name S & S Engineering Project Name/# L3,112,W'oolcverSID Client Sample ID L3,B2,Woolever SID Matrix Drinking Water Sample Remarks: Parameter Results LOQ Metals by ICP/MS Arsenic 5.00 U 5.00 Waters Department Total Nitrate/Nitritc-N 9.93 0.100 Microbiology Laboratory Colony Count 0 Total Coliform 0 Fecal Coliform 0 Printed Daterl'ime Collected Date/Time Received Datefrime Technical Director 03/19/2010 11:57 03/11/2010 11:30 03/11/2010 14:27 Stephen C. Ede AIIouublc Prep Analysis Units Mcthod Container ID Limits Date Date [nil ug/L EP200.8 C (<10) 03/15/10 03/18/10 SCL mg/L SM204500NO3-F D (<10) 03/17/10 AYC col/100nd. SM209222B col/100mL SM2092220 col/100ml. SM20922211 A (<200) A (<I) A (<I) 03/11/10 DLC 03/11/10 DLC 03/11/10 DLC t I' SAY�59r¢e"E /fP.GY 1 M Q Nr4 w.) I 2:I 'LIC � 1^ 3 v � ' � 4w✓rr I M ` m -��i Vr �•1•�rOICK {,Y Lam:( U 1 _Z d • I a '' i'4 ��`� I o � CI 6 Y n ca' I h I i I I I 'S'1 I __ +GALE ' I N29'69r40"G 16,6,4c .yuAw_ AS -BUILT NO CORNENS SET THIS DATE • . • • �h �p �•� A(, I hereby cartlry that I haw perbrmed a Mort s Inspection d"Idbwetpoewteaproparry:. LOT 4'.6 SLe CK, 2l_W4,:"yrR SyOOwis A/_ 7! •� ArKnonge Ae Cginp praclnct, Alagka. and mat the "Novemeras Masted '! Ihereon ara WIINn Iha property Yrw& aW a� r:•�y1`� 3Tsas ° do rot overlap a arlRoach on tnapop" "It aoacvd 1p/awlaynla on prepayy" adfaeant dweto '_+n 6. ./�� aneroach at mea ._.• ..—_ ..__._Prem"& in 000eadn and owl ewe are no ADVANCED WASITAVATER I'll EATAIENT SI'STISM MAINTENANCE AND Rr:PAIR A(:IUu.Nu mr MEMORANDUM OI' UNDERSTANDING IIETWEEN MUNI , 'At ITYPItANCII011AGE, AND L% Gl 4�n 1 GL TI IIS MEMORANDUM OF UNDERSTANDING made and cnlcred into as of this •��Da of N )' � of20-- by and bct%vccn LJ;7da.� w_, hcrcin the "OWNER." and the Municipality of Anchorage, hcrcin the "MUNICIPALITY." In consideration of the mutual covenants contained hcrcin, the parties to this Memorandum of Understanding agree as follows: I. ADVANCED WAsrrAVATERTRE ATMENTSYSITNIS. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment Syslcm (AWWFS), described as J2 516 ]ej at Anchorage. Alaska. 2. DcRnllians. A. Alteration. Any change to the design or function ofan AN'NkrI:S Iiat Includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Prior to performing any alterations to an AWNVfS the owner must obtain n Wastewater Disposal System Construction Permit from the Municipalily pursuant to Anchorage Municipal Code (hercinallcr, "AMC") 15.65. Il. Cerlificale orOo-Site Systems Approval. An approval by the Municipality ofcxisting waler and Wastcwalcr disixisal systems given al the time of property sale and title transfer in accordance with AMC 15.65. Thcsc approvals certify Thal file systems arc ndexfuatc for life homes that they support will meet the talcs that were in place at the time ofsyslcm construction. C. Damage. Any man-made or natural change in a system Ilial would inhibil the Syslcm from performing as designed. D. 111ainlcna"cc and Repair. The schcduicd and as needed replacement of existing parts, eontponcals and pieces ofan ANkIk'I'S that were included b, the original design which would nllow the A W WTS to continue to perform as designed. C. Permit (Conslruclio) An On -Site Wastewater Disposal System Construction Permit an dermcd by AAIC I5.C,5. i'. Pel"I'il (Operating) An Advanced Waslcwatcr'Ircatmcnt Syslcm Operating Permit. An annual permit, issued by the AIll, icipwlily, Ib:tl allows the Owner to operate an AWwfS, upon Inceling all IIIc requirements of (his agrecntcM, life cotdilions of Ot,crating Permit, the requirements of the On -Sift Wastewater Syslcm Construction Permit and all rcicvam provisions of AMC 15.65 3. rcc. Owncr shalt pay to Municipality an annual fcc or.. CIO D (MO ,00), payable on or Wore the issunnce of lite operaling permit and annually thereafter. The annual fee is due oil or before the anniversary date of the approval by Ilhc Municipality of installed sysicmt. 4. Term. The term ofthis Memorandum of Understanding shall be ror the life of tic A W RTS. 1lic term begins on file date of approval by Ilie Municipality of the installed system anti shall continue while the AWWI'S syslcm is in lose or operational or until the property is sold or title is transferred by owner and a new certificate Of On -Site approval is issued lu the new owner or transferee of the properly. 5. Allerations. Inslallalion and Removal of Additionat run inmcut. Owner agrees not to make any alterations, removal of parts or additions to the A W WfS withoul n Construction Permit from the Municipality. 6. 111aintcnanccand ltemirs. A. Throughout file Icnn of this Memorandum of understanding, the Owner shall maintain A1k'R7'S in good repair. in addition. It shall be the responsibility of the Owner during Iinc term of Ihis Memorandum of understanding, and aay cxlensiuns or renewals (hereof, at tale owner's sole expense, to pay fou any and all: (1) rcpaia(s). (2) maintenance, (3) adjushnem(s). (4) replacement costs, and (5) inspection costs. Further. Owner agrees to comply will all applicable ordinance, laws, regulations. rules and orders for the AWMI -S. B. Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the terms and conditions contained in the Owner's AW WTS Oleraling Permit. This schedule shall be submitted to the Municipality annually upxm the renewal of the pclnnil. 'I'hc schcdulc ofnnainlcnancc and repair contained in the Owacr'S A WR"I :S Operating Permit is: C. Owner acknowledges Thal the fine schedule for failing to maintain and repair all A1t'WfS arc codified in AMC 14.60. 1). Owvcr ngrecs dial only mainlcnancc, rcpair personnel certified by (hc Municipality will inspect and make any necessary Ilia Ill lcnancc, repairs or permitted allerations to ilio system. U. Owner agrees W grant fire Municipality reasonable access to lest and inslcct the AWWFS upon 24 hours written notice. 17. Owner agrees Ilcrt any sale or transfer orlille of the property will not occur without a new cerliGcatc ofon-Site Systems Approval. G. Owner agrees (fiat file relevant provisions of (hc standard specificalioo guidebook for A WWrS is file governing professional guidelines for the construction, maintenance and repair of ll,c Owner's A W WTS. 7.NIP" rraiv r. lire failure orciIher early at any lime to enforce a provision ol'Ihis Memorandum of Undcrsfanding shall in nn way constitute a waiver orlhc provisions, nor in any way cffccf file validity of the Memorandum of Understanding or any part (hereof or the right ofsuch party thereafter to cororcc each and every provision hereof. R. Anrcndrncnf. A. Phis Memorandum orUnderstanding sl,nII only be amended, modified or changed by a writing, executed by authorized representatives Ortho parties, will, file same formality orlhis Memorandum or Understanding teas executed and such writing shall be ntfachcd to this Memorandum of Understanding as an anicodnicnt. ll. For the purposes orally amendment modification or change it) file ter nis and conditions of This conlracl, ilio only authorized representatives of the garlics nre: Owner: hAgx.e i-"� Anchorage: ' rr 1migg OlTi , r C. Any attempt to amend, mocliry, or change this contract by citlicr all unanlhoritcd representative or unaulhoriied means shall be void. 9. ,lurisdicliun: Choice of I n\v. Any civil action arising from (his Memorandum 01 Understanding shall be brought in live Superior Court ror Ihe'I'hirtl Judicial District or lite State orAlaskn al A11choragc. l Ilc laws oriile Slate orAlaska sllall govcnl the rights and obligations or tile parties under Ill is Mcnlor ncium or thidcrstanding. 10. ScvcrnUULI-. Any provisions orlhis Mcnlorandum orUndcrstanding decreed invalid by n court orcompelcnt juriscliction shall 1101 invalid:de live remaining provisions odic Memorandum ol'Underslan(Iing. 011' I?It: pl(IYIC��•. BY: Dale: I isle: .2 /O Mile: S'I'ATL Op ALASKA l'I11RD JUDICIAL DISTRICT' ) ss I he r+'l rUrCgnll g IIISIr III1CIll WaS lic\VICdgC bCrnre IIIc 11115daV 20�,by_nda „i,, OrJ��!- _ _ -._- N0'I7k hUt1LIC fOR A ASK r MY COT111"lission expires: ��1� �^ Vl� STATE OLn STAT: �'i NOTgR Krlste' ` I'!;_ 3 ,A' '•'/ Cor11.'niasi i •" r I.'j ►'-_ : `A; 012 t.4'1 M:.ii r: i .'..,..'t:;, i:::t 11,2012 L ter% cl, Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON—SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Of -7 - 111 - rs7 1. GENERAL INFORMATION COSA # D=td Expiration Date: 1,2 - 1!:t —n7 Complete legal description _LoF 3, f3IacL 2, ticu Ievee S in Location (site address) 12..s-rs7 Tolrsone Hill Dr,vr . f}. oa A-4 9Q,5- ri Current Property owners) _C rrGr31 Union 0,7e Day phone 339 -9 yB S— Mailing address 1911 A I.6ohk fie- AAell oLoge 99s-& 7 1 priding agency s 4 ra c Day phone Mailing address Real Estate Agent Ot�r:�, Pfak. PeV4AAk11/ Dayphone 762-6-67h Mailing Address 360/ Crnl r�po;n f DL. Anctioc _ k4 99to? Unless otherwise requested, COSA will behold by DSD for pickup. FlLa/C e+x I/ to/9u F/44 el - 2. t2. NUMBER OF BEDROOMS: y 7GZ -587`4 or YY,.,),- iv -77 4A^, , Cof/t if Leafy OG- /Prc% u/,. 3. TYPE OF WATER SUPPLY: Individual Well El Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site El 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 Onsite 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. NameofFirm FfaFl�r Tecl+n,�a/ Str✓,w Phone 3'Yr-F3SS' Address 11S3u EcSo la^+,eA rid• . A -•+ch 99s1� Engineer's Printed Name ?7)0o dDate Sep/ 17 2-ao7 Y 'i • .�y�k. "IY• �9T�, l+m •., 5. DSD SIGNATURE ! 1/ �"ODORE F. 7i10pRE � Approved for bedrooms. •io.�4;� CE -35G9 Disapproved. ��� ti,•.�/ ��••`� h'�M- Conditional approval for bedrooms, with the following stip�BtioAs:,G.?�. Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory_ Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By:ZJZ Original Certificate Date:9—W-07 (Rm. 77,05) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lr f 3� 8 lei k 2, iyao /t✓ #� S /D Parcel ID: O ( 7 - Y I I - IS A. WELL DATA Well type _P P If A, B, or C provide PWSID # Date completed'x l96 t Sanitary seal (Y/N) i Total depth _L•Lft. Cased to u„ 4c ft. 8'W(7.0 k FROM WELL LOG Date of test Static water level Well production ft. WATER SAMPLE RESULTS: Coliform 0_colonies/100 mL Nitrate .Z9 mg/L Arsenic: ZS'- ppb date of sample: 73 �22/G7 B. SEPTICIHOLDING TANK DATA Tank Type/Material Sad. �; c / Po I,,a Ao%X /o n� Tank size 1'3c' gal. Number of Compartments 2 Well Log (Y/N) P Wires properly protected (YIN) Y Casing height (above ground) _I _in. AT INSPECTION S/ 29 /,0 7 So ft. /.7 g.p.m. Other bacteria 0 colonies/100 mL Collected by: F /a E%n T.,4 Sc c Date installed lu r 2z. / a y Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) LJ_ High water alarm (Y/N) V-4 Date of pumping to / 00 /4*'7 Pumper A + fk" M a ce ee 1,1 C. ABSORPTION FIELD DATA Date installed 10/2-Z/ Y Soil rating (g.p.d.1112 or ft2/bdrm) 2�L System type 9-F/0- !tu S"S F Length ys ft. Width F, ft. �F Gravel below pipe O. 24- ft. Total depth ?.7_ ft. Eff. absorption area36© ft2 Monitoring tube `r Depression over field _r� Date of adequacy test 419 / 29 10 7 Results (Pass/Fail) Pd For Y_ bedrooms Fluid depth in absorption field before test Q_ in. Water added 7-Y gal. New depth e, in. Elapsed Time: U min. Final fluid depth G in. Absorption rate >= 64>G g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N& type) 14&-e 6cAo w - If yes, give date IV• D. LIFT STATION 10 / z Z I o Y Date installed Iy /2-2 /aY Size in gallons SSU Manhole/Access (Y/N) Y 'Pump on' level at 3 9 in. 'Pump off" level at 3S in. High water alarm level at 1Y5 in. Datum 60 /{s m Cycles tested S t Meets alarm ti circuit requirements? Y E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot I o G ' On adjacent lots > I e -,r, I Absorption field on lot 1 a V On adjacent lots > (C+o - Public sewer main N. A. Public sewer manhole/cleanout N. .4 - Sewer Sewer /septic service line > 2S' Holding tank N• A. Animal containment areas N• A. Manurelanimal excrete storage areas N. A. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 7'i' Property line I A' Absorption field S' Water main N• A. Water service line > IO' Surface water > 160 Wells on adjacent lots > Ielgf, ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line is" Building foundation 7 2' Water main N. A, Water Service line > I at Surface water _ > luaDriveway, parking/vehicle storage _> 5'6 Curtain drain Pone SNS Wells on adjacent lots _ > leao - F. COMMENTS =-tom 91 1'z1417. a5r/Y�cho- ;,) crl'- line re*,o��'(� 1)IMA/ eU,m12r+.Ge�- aid 1r1XA01/!2fV�02L4tA4 aG& rr tti and 1YM.a1N.n� .ne f•�N • ��. IV tore -tole a 'fAd � NI!V I�fP/`/ni%1�P/7� p�Gti!M � Q*.'a' �•... •.. •�°:1 l.ti. G. EWGINEER'S CERTIFIRATION JJ •`rte..; ' L °e . I certify that I have determined through field inspections and TI -1 v......................:...t,, review of Municipal records that the above systems are in aa// conformance with MOA COSA guidelines in effect on this date.t/........ S r.+Icoc Engineer's Printed Name ThpcPv2 F. / teo.e 1',�' •.,' CF Date / /Z / O 7 e? ��F •' -''.�" COSA Fee $ g3e> `�`- RWaiver Fee $ Date of Payment 9 / / Z / 07 Date of Payment Receipt Number 9990 Receipt Number (Rev. 11105) Municipality of Anchorage • Development Services Department / Building Safety Division ' On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsitc (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 070368 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 3 of Woolever subdivision. This inspection revealed a nitrate concentration of 9.29 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SCS Ret# 1074247001 Client Name Flattop Technical Srv. Project Name/N 1-3 132 Woolever SD Client Sample 11) 1-3 D2 Woolever SD Nlatris Drinking Water PWSID 0 Sample Remarks: All Dates/Times are Alaska Standard Time Printed Date/rime 08/3112007 13:24 Collected Date/time 0822/2007 11:50 Rtceived Datdrime 08222007 13:53 Technical Director Stephen C. fade Atlomahle Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Ink Metals by ICP/MS Arsenic ND 5.00 Waters Department Total Nitmtc/Nitrite•N 9.29 0.100 Microbiology Laboratory Total Colirorm 0 ug/L EI'200.8 C (<10) 0828107 0829.07 TK mg((- SN1204500NO3-F 13 (<10) 08,28,'07 1DS col/100ml. S\1209222(3 A I<1) 0822107 SDI' wYm war 2 aaY. ur.,.al r" N 8939'10• W 118.69' iar TtwCf I I rAr w -.w t I i(B.AM .1Wt I I naaue mal 1 ® 0. 4 I r, ' I I I I N I I� I 1 I I zas .q ? S>o9 � �LHWSESE y NEIL 1 N6 I e I �ITas• . ti°•L _ IR C ••. I� to I J L I at I IN Io I I ' N 8959'00" E IO8.00• Pre Prepared by SURVEY CERTIFICATION PILOT PLAN•• •••�............. •• ••• Professional Land Surveyors rya. -r r.r a.�r rl(�,• 812 E. 12 AVE. ANCHORAGE. ALASKA 99701 • me 4E 2 RK Lot S.F. K. Plat FI. Na. ,y(9t y / ■ Scale: R c 1 FOIlNOATKAi AS -BUST L A.ar E ata a. r.w _Wr r I —r,.�-.r.w rr .h.. ....� / 'V! / / :: y..�/7L .......r ■ SarwUwt 8-30-07 Urorrl OY FEZ ��b 0 Y r.... w r r r r� r r' `����� ���DaU ___ OBERTj'C� ,>oi+�: a ■ 1� •' Dole Drorll: talo: 2841 W.O. 7222 4121-5 •' .�a� — — Lpd D.•alPtba: FINAL STRUCTURE AS-BUST•1 ,. a.+.rwrl '�0^''••.,, ,,.••''t�J�•� • •............• L ...racer , A • ••yp'a/•o,bndE:.�• Lot 3 Block 2 Nbolever 13 Im awteY SURVEY TYPE SYMBOLS ❑ 010lA0ATK11 AS -BUILT a SET REBAR DRAINAGE ASPHALT ❑ rim t FRIuCTwE Ail FOUND RESAR o�.e. **W FENCE ..:L CONCRETE OOMY ❑ P -OT R/J1 ... AS-ew ... LOT SAaRY ... IOPIM !O TT OOa ASSUMED ELEV. .R-7L—{� METAL FENCE WOOD DECK /PLOT PLANS t LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER. PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE NULL BE CONSTRUCTION. TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE SHOWH. FENCES. WELL& SEPTIC CLEANOUTS. SIDEWALKS DRIVEWAYS. ETC.. ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS. COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH 00 NOT APPEAR ON THE R CORD SV DIVISION PLAT. A DISTANCIE5 UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O 17 - H It -1 S HAA #t�K Expiration Date: :2 - 1:. - O Jr 1. GENERAL INFORMATION Complete legal description Lot nk- t woelevPr:• subtliviRion Location (site address or directions) 12515.-, Toilsome Hill Dr. G961(.O Current Propertyowner(s) Charles 8` -Pamela Towill Day phone Mailing address., ' PO Box 221233 Anchorage, AK 99522 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: ' TYPE OF WASTEWATER DISPOSAL: Individual WellIndividual On-site ®C Individual Water Storage ❑ Individual Holding tank ❑ Community Class -' Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well. and may be reissued with new water sample results. (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 Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and.State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S Engineering Phone' 694-2979 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date 7/Irby 5. DSD SIGNATURE _fL/ Approved for ___4__ bedrooms. Disapproved. Conditional approval for Additional Comments stipulations: Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration is 5.1 mg/L EPA maximum concentration is 10.0 mg/L More information on nitrates is available from the On -Site Services Program, at 343-7904. Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: R/. �o yr Original Certificate Date: (Rev. 01102) Municipality of Anchorage • '' Development Services Department Building Safety Division " On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST i F Legal Description: j,oT 3 13 L.ococ a W001.4 -v44 SID Parcel ID: 0/ 7 —ylt-IS- A. VY"L, DATA Well type PR"470- If A. B, or C provide PWSID # — Well Log (Ya N 0 j( Date completed q% Bo Sanitary seal (9N) �Lf S Wires properly protected ON) Y4 T !R« ;1D' ra B.Q. ( Total depth #O ft. Cased to ft. Casing height (above ground) / a f in. I FROM WELL LOG AT INSPECTION Date of test l of, 4%0y Static water level V ft. a 9 ft. Well production g.p.m. a- 6 g.p.m. WATER SAMPLE RESULTS: S w t y /9Nc14, a 4c& 41 amA Coliform colonies/100 mL Nitrate mg./I. Other bacteria 0 colonies/100 mL Arsenic: mg./I. Date of sample:/� �/ /o H Collected b . 8 5 ENGINEERING 17u34 ragie x1yer Loop RoadNo. 304 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Tank Type/Material Date installed 1O ;.;L /0'Y Tank size 13 0 O gal. Number of Compartments a Cleanouts (EN) it 1 I Foundation cleanouG4O/N) Y Depression over tank (' ,Qw 0 High water alarm (Y/N) / Date of pumping /J to N.5 w Pumper s C. ABSORPTION FIELD DATA Date installed 1$/oy Soil rating g.p.d./ftz orfe/bdrm) a_0 System type i. ID- S• F. Length Ys— ft. Width $ ft. Gravel below pipe 0•>,S ft. ro Total depth '7 ft. Eff. absorption area 360 ftx Monitoring tubeY&l Depression over field 0v O I; Date of adequacy test Alt0l Results (Pass/Fail) _ _ For _ bedrooms Fluid depth in absorption field:before test in. er added gaL New depth_ in. Elapsed Time: _min. Final flu' pth in. Absorption rate >_g.p.d. Any rejuvenation treatment (pmo.) (YIN & type) If yes, give date i P Date installed 1010-a40Y Size in gallons 5S'0 "Pump on" level at Y �— in. "Pump off' level at 331K in. Datum oft- 'rAaK Cycles tested a E. SEPARATION DISTANCES Manhole/Accesss�j6�N) Y4 r High water alarm level at H g in. Meets alarm & circuit requirements? Y'EJ SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot IO 6 r On adjacent lots Absorption field on lot Public sewer main N 14 On adjacent lots of /00 + /00 �4- Public sewer manhole/cleanout All Sewer /septic service line a S + Holding tank N 14 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 7 k Property line / g Absorption field S` Water main N 14 Water service line / 0 f4- Surface water / 0 o + Wells on adjacent lots / 00 4 - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Is— Building foundation -7 3 Water main r419 Water Service line I D f' Surface water /00 f Driveway, parking/vehicle storage /00 r"F Curtain drain P014 K7/Ow,d Wells on adjacent lots /00 { F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and �^ review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. eoeeRT C. ,cpWAN R,d a CA C_ C O wy„/ �ur*ti GE 8801 , Engineer's Printed Name 0�d-/oY •.,\i Date HAA Fee 7LL 30 ' Waiver Fee $ Date of Payment /t O F104 Date of Payment Receipt Number 60 75 Receipt Number (Rev. 12/01) 11- 2-04;17:38 ;CT end E S 8 8 Engineering ;6616301 • 2i 2 SGS/CUE ENVIRONMENTAL ERVICES Drinking Water Analysis Re9jQ.].T\�(�f�l-LBacteria �OGTWO SAMPLE IIFJID tIgTRUCTOae oN REVERSE am BEFORE . MUST BE COMPLETED BY WATER SUPPLIER . p Fuqua WATER SYSTEM IX �RNA18 ATR SYSTEM �Oeu1tl RaaWh ., � W W lawlm 0 sew Raaw 200 W. POTTER DRIVE ANCHORAGE, ALASKA 09518 TN: 007.8823343 Fwc007deb6301 109]262 -In '08nia6elee SAMPLE COLLECTION: SAMPLE TYPE: Arlrl �r+a sr.r eew. t / 11 ) ❑ Routine ❑ Troated Water Saw aq we.' Z t DO rKRepeat Sample �Unbeatad Water Lacallac 3 B1-ouc�; WDoL. ot r1.6 (mfertolab .no,,,%O''+I. aolt.� 084.t T C_ cot2a , . - O Special Purpose mluvaad r Lan Sy Same sa codecbor Other. TO BE COMPLETED BY LABORATORY Sample ReeelNna: Date: _�_' ❑ 6■n* Sar Se teas aM: :[3 RUSH SAMPLE Time: a � Ream 171"aal s naWM. Temqr p 4e Hmwvv&kw LImme P DelheryMethod:Far .lanuoc6: ALON Received By: ..................................................011.........................................................:................. 0.............. FCi�iIS 7 rT13i'IS 7 _rn,.7I73Iir� AMWsks.qw. ll f a f'tA0 Amyaa Aeay&al ri hea ® Membrane Fkw ❑ MMO-MUG (PIA) Sanfto MPEG: MMO-RUG I"M) RESULTS: ANC PSK NN Tow Cdbme ID11tenval E Cat ' o Come MEMBRANE FILTER RESULTS: ed .Q ` Faxed Q . cold Coag � CdwdnhoomL . L vMhtbn: eltl;: LTB: lvew {soe: � Sat[sfactory 1.re... { EC: ❑ Unsatisfactory I.-1 � Tem.n.le..e.rwa Reported /y: �� Datalykns: l ( i.te7ifr go •oeaaw.r Fane S FNR 0053 17/17103 Npetra*0cN=UMENTfORMSW1a0lCgr Form 121703.de NOV-08-2004 1234 S&S ENGINEERING 907 694 1211 P.02/02 +armrk % ilds4mam V. mom • Matsu Test Lab of Alaska Water Quality Testing t' Fuk u Palmer ullia Hwy. !•.a 80: A49 audcewn Cameum Gush e" Pur% Patmar, Aic 09a1S Phone: 0" 7454M lmatk abaragmttmaimm Fac: (2M 7454M Ma Client SGS EnWromen W Dade AcrWed: 11004 Report Dale: 11/4/04 AM.: ForestUylor Sample Data:11/1/04 Caerd 10: Let 9 Block 2 Wol&mr 60-1047262001 Sample TkM 1400 PWSID#. CD11ectw By: Source: M.S.T L!: 20041062 Semple Mama Comments: SM 4500-NO3-E Nbate-N ma/L 6.10 0.50 11/4104 11/4104 10.0 Lapegt MRI. a Method Repots Levo) MCL a Max, Cwb mhwe Level B a Preaerd In Metrred clank H -Emmaw Above MCLa D .Lestto Ok4jan * rued By Jon Paul Campbell Lab Supervisor TOTAL P.02 ReGBV>L /a J 0 4 A/I A$ -BUILT NO CORNERS SET THIS DATE •- • `tia%1 hereby certify that 1 have performed a Mortgagee's Inspection of the following described property: ��T� ��! gLUC/C 2� WooLr<VLr; 54OO1V15ro,4 Anchorage Recording Precinct, Alaska, and that the jtl_. I Improvements situated thereon ale within the property linea and 4 do not overlap or encroach on the property lying adjacent °t"3 �r�t+a.ci thereto, that no improvements on property lying adjacent thereto encroach on the premises In question and that there are no roadways, transmission Tines or other visible easements on said 44ua.'r property except as indicated hereon. - : * Dated at Anchorage, Alaska EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED E 6 U 4• Z PLAT ARE NOT SHOWN HEREON. this / day of N"''/ —2004 FRED WALATKA & ASSOCIATES Q f (907)248-1666 Engineers and Surveyors .. 82664 C 33 O I� 1111 - I ~ J _ Z o u, utAnrcu� I o � � � (' V lvE� to '-•�c I \1 I v� W Obi uta G' VI h •. I I I I 33 SCALE ' N89�s9'cb"E /o&,ov /�53ot -7Ngw- ReGBV>L /a J 0 4 A/I A$ -BUILT NO CORNERS SET THIS DATE •- • `tia%1 hereby certify that 1 have performed a Mortgagee's Inspection of the following described property: ��T� ��! gLUC/C 2� WooLr<VLr; 54OO1V15ro,4 Anchorage Recording Precinct, Alaska, and that the jtl_. I Improvements situated thereon ale within the property linea and 4 do not overlap or encroach on the property lying adjacent °t"3 �r�t+a.ci thereto, that no improvements on property lying adjacent thereto encroach on the premises In question and that there are no roadways, transmission Tines or other visible easements on said 44ua.'r property except as indicated hereon. - : * Dated at Anchorage, Alaska EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED E 6 U 4• Z PLAT ARE NOT SHOWN HEREON. this / day of N"''/ —2004 FRED WALATKA & ASSOCIATES Q f (907)248-1666 Engineers and Surveyors