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HomeMy WebLinkAboutPROSPECT HEIGHTS #5 BLK 2 LT 8Prospect Heights #5 Lot 8 Block 2 #015-135-16 „ ...,.., I _ Municipality of Anchorage Page of � DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report PID Nlumber: Permit Number: Name: Wastewater System: ❑ New ❑ Upgrade Address: ABSORPTION FIELD Phone: No. of Bedrpo �j tdms: Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: O U GPD/Sq. . Ft. Total Depth from original grade: I D Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe -7 P�dSP .— Ft. Ft. Township: Range: Section: Fill added above original grade: 'S Gravel length: Ft. 3— Ft. Gravel width: Numberoflines: Distancebetween lines: �f WELL: 'KNEW ❑ Upgrade /n1 v— Ft. I � Ft. Classification (Private, A.B,C):_ Total Depth: Cased To: Ft. Ft. Total absorption area: I p� _5SO. Ft. Pipe material: r (� (? I wk-Tt sZO Driller: Date Drilled: Static Water Level: Installer: Date installed: Aj~PIN� 7/2,/l Ft. Yield: Pump Set at: Casing Height Above round: TANK GPM F” TO Ft. Ft. SEPARATION DISTANCES [.Septic ❑ Holding ❑ S.T.E.P. To Septic Litt Lines Manufacturer: AA ,,`` ANC," A(L Capacity In gallons.:: P From Tank StationSewer /, Material: Number of Compartments: WSW Surface %4f/ KFeldo rldPublic/Private LIFT STATI N Lot - Size in gallons: ManWater ufacturer. Line "Pump on" level at: "Pump off' I el at: High water alarm at: FoundationJ '' 3 7 11 / Pump Make &Model Electrical Inspections performed by: Curtain Drain BENCH MARK Remarks: t Location and Description: r1 a w,, 41� /L�tit Assumed Elevation: kV ruPt� -- ENGINEEji'S SEAL 10 S�G Inspections performed by: �S Dates: 1s R q 2nd Department of Health and Human Services approval Pa --"f Date: LL'—0-0 Reviewed and approved by: 72-013 (Rev. 9/91) MOA 25 F SWING TIES: 0 AC 35.2 FT G D AD =1 ♦ ♦ BD 64 5 STANDARD TRENCH C AF 86 TC 88 FT 2000 gal S. T. BF 91 TD 10 FT � I AG 84 ERD 7 FT ♦ BG 74 �GpA :. ♦ I ♦ ♦ 150--:::: ♦ X60 = = I �. p�Eq�11� ♦ ��_.._......_��..., ,........... /... r� 49th... •i� ♦ ` :..,.;.. . .� I �♦ It TOBB N•SRURKLAND 'C�= No. CE -2225 All ♦♦•♦♦,���n�S������••• ♦ ♦ Iso I II 25 0 25 50 75 100 125 150 1% SCALE- I" = 50 FT TOBBEN SPURKLAND P.E. PROSPECT HEIGHTS #5, BY 2 LOT B SEPTIC SY M AS BUILT 203 W 15TH, AVENUE DATE: JU 19, 1999 ANCH. AK. 99501 ROBERT ARTWOLD 7on71 970-: SHEET- 2/3 GRID: 2.540 PERMIT # SV980025 PID # 015-135-16 PR00208P,DVG Standard Trench - 2' Wide 88 Long 10' Deep 7' Sewer rock 3' Cover Foundation Clean out 77. SILT BARRI 7 rt OF Septic Rock TOBBEN SPUKKLANII 1 203 W15th Ave Anchorage Ak 99501 Monitor Clean Out Clean Out Monitor Cleanout5 NO SCALE 6a ECT HEIGHTS #5, BK SEPTIC SYSTEM SCHEMATIC PERMIT NO: SW980025 P.I.N. 015-135-16 Double Clean Outs CP 2000 gat Septic tank 70.82 2000 gat, septic tank BENCH MARK, TOP FOUNDATIO ASSUMED ELEV. 100,00 LOT 8 SEPTIC SYSTEM AS BUILT DATE: JUNE 19, 1999 SHEET: 3 3 GRID: 2541 PR00208J.DWG 10-11-2000 04:34PM FROM CreativehKitchenhDesign TO 3434786 P.01 Michelsohn & Daughter Construction Inc. 750 W. Dimond Blvd. 0100 Anchorage, AH. 99515 Tele: # 9o7 522-3375 Date: October ii, 2000 RECEIVED Municipality of.Anchorage Dept. of Health and Human Services OCT 12 2000 P.O. Box. 196650,825 "L- St. Rm.502 Anchorago Anchorage,A.K. -99519-6650 00 { Health y0fmanServ- Attention Jim cross WOakh&Human�er_-1ges RE: Septic permit L 8 Blk.2 Prospect Heights #5 Dear Jim The septic system at lot 9 Block 2 Prospect Heights # 5 sub. was started on or about the first of March 1999. we started the trench and the installation of the tank knowing that the permit was due to expire. I had called you and explained what we were doing and stated that we would not be completed with the system until after the expiration date. You stated that if we were to start the work before that you would honor the permit. 1 hope that this letter helps explain the situation and you sign the final paper work so we may proceed with getting the final CO. Any questions that you may have pertaining to this matter please feel free to call me at 522-3375, TOTRL P.01 \ DEPARTMENT OF NATURALRESDURCES DIVISION OF MINING & WATER MGMT I'. WATER WELL RECORD LOCATION OF WEL////1��L BLOCK SECTION CTRS SECTION TOWNSHIP RANGE KIERIDIAN BOROUGH e pDl I0}N�^' L0JW ^LOT i P CfK] Y ❑$ LOCATIONISKETCH: WELL OWNER: DEPTHS MEASURED FROM Ucasing toP 0ground surface WELL DEPTH: DATE OF COMPLETION Depth of holecasing- f f Depth Of casing: —„� BOREHOLE DATA: Depth Material Type and Color From To DEP 0 STATIC WATER LEVEL: ' ( „: - - it below ( top of casing ❑ ground Surface Date: ..� METHOD OF DRILLING: air rotary E) cable tool 0 otherUSE OF WELL: )I. domestic 0 irrigation 0 monitor :., ' { F y t l % ❑ public supply © other r i'2 n. r,.. . ,. ,, CASING STIC • it Diem. In. to t ' Casing type: In, to Amt, WELL INTAKE OPENING TYPE: 0 open end 0 screened 0 perforated ?open hole Depths of openings: to it SCREEN TYPE: Diem: in, Slot(Mesh Size: Length: it GRAVEL PACK TYPE: Volume used: Dep h to tip: D GROUT TYPE: Depth: from It to ft 19 J9 DEVELOPMENT METHOD: MuniciTal Duration: .11 IIIIjI1jIIIjjIjj@jdIIIjjIdIL� ea th & Huma Serv'ces PVMPINIJ.EVEL AND YIELD: It after hrs pumping gpm:! PUMP INTAKE DEPTH: ft Horsepower: WELL DISINFECTED UPON COMPLETION? YES 0 NO:., CONTRACTOR INFORM4TION: REMARKS: 4:z- Rouq'Irrad Business Name / i PLEASE MAIL WHITE COPY OF LOO TO: P DNRIDIVISI N O C MINING WATER MQMT 5 eut iure of onxe es resen a Iva at15—e -800 ANCHORAGE AK 99503.6835 Phone (9071269.8639,Fax (9071562.1354 I(ITF4 h.R M,oA Cop MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW980025 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:ROBERT ARTWOHL OWNER ADDRESS: PARCEL ID:01513516 LEGAL DESCRIPTION: PROSPECT HEIGHTS *5 BLK 2 LT 8 LOT SIZE: 91155 (SQ. FT.) NUMBER OF BEDROOMS: 6 THIS PERMIT: 6 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 3/04/98 EXPIRATION DATE: 3/04/99 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE ENGINEER SHALL PERFORM AN ADDITIONAL SOILS PERCOLATION TEST AT THE WEST END OF THE TRENCH. RECEIVED BY:�-%,eLeLL.-d DATE: ISSUED BY: 4�'� 1� / u�� DATE: �' g. q T.SFUIRMi AIN) P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN PROSPECT HEIGHTS #5, BK. 2 LOT 8 Municipality of Anchorage Department of Health and Social Services 820 I Street Anchorage, Alaska 99501 ["'4VIRO NMENrAt sERvres orvrsror, KECEIVED January 30, 1998 We are submitting an application for the installation of a well and septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the well and septic system are subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following : No Ground Water or Impervious Layer to 16 ft. Use Standard Trench Soil Rating. 10 min/in = 0.8 gal per sq.ft/day No. of Bedrooms 6 Required Area per Bedroom: 150/.8 = 187.5 sq.ft.. Total area required: 187.5 X 6 = 1125 sqft Testhole depth 16 feet Bottom Rock At 10 feet Top Rock At 3 feet Rock Depth 7 feet Total Trench Length 1125 / 14 = 80.36 ft. SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 80 FT TOTAL WIDTH 2 FT TOTAL DEPTH 10 FT ROCK DEPTH 7 FT COVER 3 FT SEPTIC TANK 2000 GAL The installation of this septic system will not prevent wells from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. 16 � � � Al � ' 1 A2 ZERMA T A VE, — � 12o I TH #2 130 O TH #1 i ♦ I I r ♦ iAo i I 1 8 I I r ♦ 150 � ( ♦ l60 I � I I � I `~ ®�®®OF q ®®®® ♦ I i 150 AV ® 49th 0 .... =®®! oa � � I o...... ... .......... ...........s I I ~ �� •TZ EN SPURKLAND i I ®IC✓J� No. CE -2225` wr ............. ®®®� pRQFESSID�Po®® I i ®®�►rIL®wa®®® ,� /50 0 50 100 150 2DD 250 300 P�RKI SCALE- 1' = 100 FT, I i OBBEN sPURKLAND P.E. 203 W 15TH. AVENUE # PROSPECT HEIGHTS 5, BK 2 LOT B SEPTIC SYSTEM DESIGN 2 ANCH. AK. 99501 ROBERT ARTWOLD DATE: JAN 19, 1998 (907) 279-3916 1 1 SHEET: 113 GRID: 2540 PERMIT # SW 980XXX PID # PRM02081,D 116 n 130 z ♦ STANDARD TRENCH Tt0 FT 1 r TD 10 FT ERD 7 FT ♦ 140 2000 gal S. T. ♦ * 150DF ` e'•'• Cj�P♦ +1 ♦ `` AV azA �• 4�� I a . ....................... ... ` ` ; ..;...: 9th { Well 1 o.... ............ .....0 ♦ 1 TOB EN SPURKLAND ®1C✓J®F': 1j®�••.......o.,®®P'A®®�®`AV ®®F ® l AV ♦ Iso�_oCE-2225 ®®+psSauj ♦ I 1 25 0 25 50 75 100 125 150 SCALE. 1" = 50 FT ♦ . lUtWtIV DrUKALAivu r.t. PROSPECT HEIGHTS# 5, BK 2 LOT 8 SEPTIC SV, EM DESIGN 203 W 15TH. AVENUE DATE. JAl✓ 9, 1998 ANCH. AK. 99501 ROBERT ARTWOLD SHEET.- 21J 907 279-3916 / GRID: 2540 PERMIT # Sl✓980XXX PID # PRH02082,D416 Mont for 'lean Out Standard Trench- 2' hide 80' L ong 10' Deep 7' Sewer rock 3' Co ver NO SCALE SILT BARRI 7 f t o f Sep tic , OF 44 w �•�� 49th . , 77 ® BEN SPURKLANDT No. CE -2225 410, Doulale Clean Huts 0 2000 gal Septic tank 0 J Foundation Clean out f-1,,,, ,,,,, , -/-,- V ASSUMED ELEV. 100.00 TOBBEN SPURKLAND P.E. PROSPECT HEIGHTS 115, BIS 2 LOT 8 SEPTIC SYSTEM DESIGN Anchorage ge Ak 99501 Ave Anchorage SEPTIC SYSTEM SCHEMATIC DATE: JAN 19, 1998 79-. ROBERT ARTW✓OLD SHEET: g3 GRID: 2540 PERMIT N0: SW98OXXX P.I.N. PR002083.DWG Municipality of Anchorage .� DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG ---- PERCOLATION TEST PERFORMED FOR: C? LJ DATEPERFORMED t��'n 0 LEGAL DESCRIPTION: —PYQSa--: CCj Ct ct'q�� b Township, Range, Section: DEa n SLOPE SITE PLAN 1 � Ci i�--G 4N 2 3 " C K 4- 5- 5 5 1.4 6�` s L 7 u <' 8 9- V" 17 18 19 20 J 11 --CQ WAS GROUND WATER i ENCOUNTERED? 4�C S L PO Net',,, E J IF YES, AT WHAT DEPTH? Depth to Water Alter Monitoring? C-L'r- �A Date: e di Reading ading Date Time Net Time Depth to Water Net Drop /`` /-x, N 2- 42- 5 5 1j2 f t7 i� f0' t J IF YES, AT WHAT DEPTH? Depth to Water Alter Monitoring? C-L'r- �A Date: e di Reading ading Date Time Net Time Depth to Water Net Drop /`` /-x, 2- 42- 5 5 1j2 f t7 i� f0' t J u�( PERCOLATION RATE (minuses/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND �� �Z FT DISCLAIMER Grnund4�a+Qr c 0 n d i t i n n s indicated are for the dates hown only. Past and future presence and/or depth of groindwater can not be predicted roil these o va ions. PERFORMED BY: 1 I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DAT;.. DATE: 72-008 (Rev. 4/85) (ENGINEER'S SEAL) Municipality of Anchorage , DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST t PERFORMED FOR: J j�j C I- v,.J 6 l DATE PERFORMED: �2 7 LEGAL DESCRIPTION:_4�'JZQ5?J�-E C - L < EC6ji-C Township, Range, Section: D H (1 SLOPE SITE PLAN 2 7 i 8 l 9 10 `" 11 12 13 14 15 16 17 18 19 20 F� i) 30 U ld�� f3,0 —11 0 0-4 0 �- 14o1_z' WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L DEPTH? O P E Depth to Water Alter Monitoring? _Dale:__ Reading Date Gross Net Depth to Net Time Time Water Drop 4 yf,,g ly f PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT DISCLAIMER- Groundwater Cnnditinnc indicated are fnr the dates shown only. Past and future presence and/or depth of groundwater can not be predicted rom ese o erva tons. PERFORMED BY:I l CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ` 72-008 (Rev. 4/85) 7G eU. Municipality of Anchorage On -Site Water and Wastewater Program ar ... (907) 343-7904 s a'< Certificate of On -Site Systems Approval Parcel I.D. 015-135-16 1. GENERAL INFORMATION: Expiration Date: / - Zig —zoz( Complete legal description PROSPECT HEIGHTS #5; BLOCK 2 LOT 8 Location (site address) 10001 Schuss Drive *Anchorage 99507 Current Property owner(s) Marcie & Doug Prevost Day phone 841-7027 Mailing address Real Estate Agent 2. TYPE OF DWELLING: © Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class_Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ j a, 50 (CIN) b -19 > Waiver Fee $ Date of Payment Z Date of Payment Receipt Number ©(TZ 7q Receipt Number COSA # 0 SC ,), 0 1 S j9 Waiver # — n 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: it) /f c� 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 system/s; 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 in 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. DSQ om-- SIGNATURE System #1 Approved for 5 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: �-- _ Original Certificate Date: f © -2_C9-Z 0 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other7GP-L- �.e.� jf�l/iilU✓�/ rnrt„S€o( � Hi #t-, L -G COSA Checklist Legal Description: PROSPECT HEIGHTS #5; BLOCK 2, LOT 8 Parcel ID: 015-135-16 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA FW Well log is filed with Onsite (or attached) Date drilled 7/2/98 Total depth 205 ft Cased to 88 ft © Sanitary seal is functioning correctly FIC Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 9/15/20 Static water level at beginning of test 83.8 ft. Comments B. TANK DATA Age of tank(s) 21 years Tank type/material SEPti WEE Measured operating fluid level in septic tank 48" © Standpipes/foundation cleanout per record drawing Date of pumping �`' �_o - D. ABSORPTION FIELD DATA DEEP TRENCH Which system tested (date installed) 5/6/99 FEI ALL standpipes present per record drawing Total measured depth from grade 19.66 ft (max) Measured depth to pipe invert from grade 10.1+ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 625•.7.97 © Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 6.3+ gpm Water storage tank volume n/a gallons W I'disinfected for coliform test? E] Yes F Nc ZColiform bacteria is Negative Nitrate -35 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑'Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 9/16/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: N/A Adequacy test date 9/15/20 Results ❑✓ Pass For 5 bedrooms Fluid depth prior to test 11 in Water added 832 gal New depth 20 in Elapsed time 120 min Final fluid depth 12 in Absorption rate 750+ gpd Any rejuvenation treatment (past 12 months) %\J 0 If yes, enter date N/A 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' 0 Yes Community Sewer Manhole/Cleanout > 100' 0 Yes if No ft Q Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' R Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' Z Yes if No ft r7l Yes if No ft 0 Yes if No ft Water Service Line > 10' Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' M Yes if No ft Q Yes 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' Q Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: ✓0 Absorption Field > 5' Q Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ft Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' El Yes if No ft If absorption field is under driveway comment below Property Line > 10' F71 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓0 Yes if No ft Private Wells > 100' Q Yes if No ft Water Service Line > 10' Fv� Yes if No ft Community Wells > 200' (]✓ Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS C, m � � V ~ f 1 C -.a --v S? -A• --JD Pi P5�S A SJ F— O) D 1 P= G. ENGINEER'S CERTIFICATION 0 F Op certify that I have determined through field inspections and review .- �•� .sem° o of Municipal records that the above systems are in conformance with - C� . A �T MOA COSH guidelines in effect on this date. ......... . F . . ....... ...... . ..� Q IJ A. Gorn`ess. Q CE•53.> D 9 • `ceQ COSAChecklist yellow sheet04 O�ea�r0 'r`ono\�o� fess a #AECCH D���DOq" ,-)A Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 201569 Subdivision: Prospect Heights #5 Block 2 lot 8 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 21 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. Maden Address P O Box 196650 * Anchora e bl � � � * ' g g , aska 99519 6650 www muni org i Municipality of Ancho Development Services Dei Building Safety Division �- On -Site Water & Wastewater Prog 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTE FOR A SINGLE FAMILY D1 Parcel I.D. 1. GENERAL INFORMATION Complete legal description PROSPECT HEIGHTS SUBDIVISION q5; LOT 8. BLOCK 2 1 Location (site address) 10001 SCHUSS DRIVE • ANCHORAGE. AK 99507 Current Property owner(s) YOLANDA GARFIELD Day phone 346-7701 Mailing address 10001 SCHUSS DRIVE • ANCHORAGE, AK 99507 Lending agency Day phone Mailing address Real Estate Agent RoNNiF AA HN R w/ PRI ID NTIAI Day phone 767-3110 Mailing address 3801 CENTERPOINT • ANCHORAGE. AK 99503 I Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well N Individual Water Storage ❑ Community Class—Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site'Systems 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 samples. (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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS, P.E. Date '7OZ Engineers Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance ofthe system under the conditions encountered at the limo of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may Puctuate 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 the system. Satisfactory lost results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the flowing stipulations: Attachments: COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineers Reort Nitrate Advisory Other By: Original Certificate Date: 0 O! IHw I'M.\ Municipality of Anchorage • Development Services Department Building Safety Division OnSlte Water b Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anehorege, AK 995198850 www.murd.org/onslte (907)343.7904 A. CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Deseriptlon: PROSPECT SUBDIVISION SUBDSION i5 : LOT 8. BLOCK 2, Parcel ID: WELL DATA Well type .PRNAh If A, B, or C provide PWSID# N/A Well Log (YIN) ETES Date oompleted 7/2/1998 Sanitary seal (Y/N) YES Wires party protected (Y/N) LES Total depth 205 ft. Cased to 88 ft. Casing height (above ground) 18+ in. FROM WELL LOCI Date of test 7/2/1998 Static water level 84 ft. Well production 7 G.P.M. WATER SAMPLE RESULTS: Coliform _0 colonies/100 ml. Arsenic:-U&UgJL. 8. SEPTIC/HOLDING TANK DATA AT INSPECTION 7/18/2006 88 ft. 4.3 g.p.m. Nitrate ljh-mgJL. Other bacteria colonies/100 ml. Data of sample: 7/18/2005 Collected by; GEG.I Ltd. I Tank Type/Materiel SEPTIC/STEEL Date installed 5/6/1999 I Tank size 2000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YM) YES Depression over tank (YM) NO High water alarm (YM) N/A Date of pumping 7/18/2006 Pumper McDONALD'S PUMPING C. ABSORPTION FIELD DATA I Data installed 5/611999 Soil rating (g.p.dA 0.8 System type DEEP - TRENCH i Length 88 ft. Width 2 ft. Caravel below pipe 7.0ft. i Total depth 25.s—M ft. Eff. absorption area 1125 fe Monitoring tube YES Depression over field NO I Date of adequacy test 7/18/2006 Results (Pass/Fail) PASS For S; bedrooms Fluid depth in absorption field before test DRI' In. Water added 901 gal. New depth DRY in. Elapsed Time: U min. Final fluid depth DRY in. Absorption rate >- 750+ g.p.d. I Any rejuvenation treatment (past 12 mo.) (YM 6 type) NONE KNOWN If yes, give date - j: r D. LIFT STATION Date installed 'Pump on' level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at Cycles tested Meets alarm & circuit requirements? - SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankfilft station on lot 100'+ Absorption field on lot 1001+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lob 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTICfHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 1006+ Welts on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 100+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Drtvmmy. parkingNetdde storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS 0. ENGINEER'S CERTIFICATION I cad fy that I have determined through field bapadions and review of Municipal records that the above systems are in conformance with MOA COSH gu/detnes in effect on this date. Engineer's Printed Name JEFFREY A. CARNESS Date 13A/% COSA Fee siJ is Date of Payment -7 r to Receipt Number �J IWv. IVW Walver Fee E Date of Payment Receipt Number J JUL-19-2006 WED 12:41 PM DYNAMIC PROPERTIES FAX NO. 9072617446 30-15-2000 02t27PM FROM CrontluehKieehenhDeslgn TO 5611948 P.63 WINES 010*TANMMP� Ths bodloA M 1lTs soucwn (�) ss simm, an tetra goad etn wr+p (os•putp I" AAMC. mow. •05 / la. , a e EAS D"T LOT E. 440 WEST BENSON B ANCHORAGE; ALA -W a' ��( 0 I QCLAPPON MOTET It M ow OWAW towww"r le N1r;MN V40 40now° of 01y quacrMttc, awww h w mm"WA 7 �. M.Icrc Oo nw apyrar w We rww0.0 subd1W on N. MOT[: NM 3.751 ALW&L I% UMr n° cYM+NwCM SI Mt wy data twom wN for" t0WJM)ITI® • (^04 d 5 .. ... ....... 0 ................. t Mich • L. Jokolo + 5-7030 i• � O�p�O PROSPECT HEIGHTS -ADD. NO.5 O °7alond � n0 r I PA .. L MI0 o OELSOHN wltn MICMELSOMN Lt DAUGHTER 440 WEST BENSON B ANCHORAGE; ALA -W a' ��( 0 I QCLAPPON MOTET It M ow OWAW towww"r le N1r;MN V40 40now° of 01y quacrMttc, awww h w mm"WA .r -.r... .._ 3./5" M/cws •ItIr M 0 M.Icrc Oo nw apyrar w We rww0.0 subd1W on N. MOT[: NM 3.751 ALW&L UMr n° cYM+NwCM SI Mt wy data twom wN for" t0WJM)ITI® • (^04 d 5 OwWunlel or Mr ""AM" Maty M1•w rucF. ----a— Y — 66 LA ;t MRT11MAYM ►ANTECH Aa cm&. Etcd O ml OUMy N L* acwny °c rrwM N ao°ot M.tcd thaw Ch- •a a- D goL. n w rlw NOw w mnil. YM./ °7MK- AS—BUILT OF: LE" 00=%P=W- ,M* %DqT 5 � LOT 8, BLOCK 2, PROSPECT HEIGHTS -ADD. NO.5 r ' TOTRL P.03 P. 02