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HomeMy WebLinkAboutKASILOF HILLS BLK 3 LT 1AKasilof Hills Lot 1A Block 3 #015-161-93 Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O_ Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permjt Number. SW000084 PID Number 015-161-93 Naa Wastewater System: $KNew ❑ Upgrade S inell Homes Address: .9210-Vanguard Dr. An ABSORPTION FIELD. Phone: - No. of Bedrooms- 344--5678 ) -O Deep Trench E)Shallow Trench ❑ Bed ❑ Mound_ Other Soil Rating: - Total Depth from original grade: LEGAL DESCRIPTION ' 2 GPDrSo.Ft. 3.5'. Lot: --.- Block: ,Subdvision: Depth to pipe-bottom from original lade- Gravel depth beneath pipe- 1A 3 Kasilof Hills 1.5' Ft .5' Ft. Township:: (_ Range_ ech0n: - Fill added above original grade. ' Gravel. length:. Ft- Ft. WELL 11 New ❑Upgrade Gravel witlth' Number of lines: Da ante he weenlre :. .. - 1�:2 FL - 4 Ft Classification (Private. A.8,Q Total Depth: Cased To Total absorption area - Pipe material: Private 327 F. 5Ft. 360 so: Ft. Anch. Tank Kit ... Dnller :Date Drilled:- Static Water Levet Installer.":. `- - Date installed:- .__. -'•' Alpine Dri11in 6 20 00 t. 5/2.6-30/00 Yield Pump Set at. .(ring Height Above Ground--- - 1 .5 GPM FL : 2 Ft TANK SEPARATION DISTANCES oseptic. 0Holdin9 =TeP To .-Sent l--ADsoryjion lift Holding' uUt1�twat¢ Manufacturer.. Capacity ingalldns From, Tank. _ .Rem ..' station Tank -. se tines Anchbrage Tank {'.1 25.0 Material: Number of Compartments well- >1100I 5100 >100 N/A .>25' Steel Three (3)- Surface 3 Surface > 10.0...' > 1 OW >100 N/A N/A ,LIFT STATION. Lot.- _ > 5) :> 1O t. >5' 5 t - Size mgallons:- - Man Lineufacturer / .` N/A N/A 250 An r r..: t - "Pump on"level at "Pumpofflevelat High water at arm at Foundation >5. >10 - >5 N/A N/A 421 42.". 44" Curtain r j j. Pump Make &Model Electrical Inspections performed by_. - ' >25->:50. >25 N/A c NfA Drainrenco 1 Muni.' of-. Remarks: System is an Intermittent BENCHMARK Location and Description. Bottomless Sand'Filter Manufactured Gara e Slab by Oreeco Systems,:and Anehorage_::Tarfk - metl Elevation.. 100 `0 777 etc�u s1 ;e Inspections performed by: MRA bates: lst 5/?Inn st ;s 2nd 5/ 3 0/ 0_(L y b 1 ✓ Department of Health and Human Services approval 'f0.9 Reviewed and approved by lam. Date:®b➢���� T 13 (flee. 9/91) MOA25 .. .. - . � 113q%v Permit Number SW000084 N 1`L°� PID No. 015-161-93 X ZO' Page 2 of 3 A B S1 71.0 24.2 S2 72.9 29.3 MH 73.3 30.7 M1 55.5 16.8 M2 35.7 38.7 - Ln < L — 0 20' U11L. ESMT. I n G n 10' X 20' g i ANCHOR ESMT. Z rtro W ¢� - - - - i rA 0 F14 n� t;. x GRAVEL DRIVE w I N -cpm. m to n�a_ :. m J UJ I u uw E•. m a n . I I I rrrt m;m ct tr GInm �I w.: I i o �. rr: 01 m rt t7 o n - WELLEn I � � to i ' L 6. IA _N —ANCCHOR � ` EMT.. _ Sub Drain 5&4—/ . th S 89°58'18" E 170.00' 1 ' SHEBANOF DRIVE - Municipality of Anchorage Page 3 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On -Site Wastewater Disposal System or Well Inspection Report Permit NumberSW000084 PID No. 015-161-93 ® Oct, 16 00 08:45a Spinell Homes i 0 907-344-1946 p.1 RECEIVED OCT 18 2000 Municipality of Anchorage Dept. Health & Human Services Municipality of Amchorage DEPARTMENT OF HEALTH & HUN AN SERVICES 825 "L" Street,. Anchorage, Alaska 99502-0550: PROPERTY OWNER MA.INbT NANCY,.AGREEMENT ON-SITE WASTEWATER DISPOSAL SYSTEM. This agreeme' nt, dated �. /' 260_; is made between tJze.Mw u cipality _ . of Anchorage•Departrnent of Health acid Human Services (DIMS) and the property Own er(s)'of: {I'ID.k�rloF �IUd: Address . mus agreement is made for the purpose o£raauxtauung an onsite wastewater disposal System on -the subject property_ 17xe property .o"er(s) agree to the foAowing: The property owner(s) will have an annual inspection of the system performed by .. % . a registeredprofessional en0aeer This inspection shall verify that all eflluerrt'and air Pnmps, timers,'aitd -alarms are f mWoning as designed.. Any adj' ierz Ae's shall be• Corrected and the.en&eer's statement that the system is functioning as designed shall . Sa Hied annually with DHHS_ . PropertyN/anie . .. Property Owner Name. ... tarized Here) � �mrnzisx��� X/2W OFMIALsa k. AL . STATE OFALASKA PAMELA A7 STATE NOTARY PUBLIC 19i� Comm. EX.^.lfes: Augist 21, 2001 y. Z�ZReceived Time Oct -l6• 7:46AM P16 :01 000b '91'P0 Oct 16 00 03:09p Spinell Homes 907-344-1946 p.l Received Time 00.16, 2:10PM 11 -OCT -00 08:4B FROM.BPINELL HOMES INC ID:9073441976 Municipality of Anchorage Department of Health and Human Services 825 "L" Street P,O, Box 196650 Anchorage, Alaska 99519650 Pock Mystrom http:/AY6w.c1.anchorage.-ak.us Mayor PAGE 1/1 Permit Number: #,$W-OW084 .Date-of7&suee.5 3,00 .Parcel Identifiication Number. 015-161-93 Date Started: 6-10-00 Date Completed: 6-20-00 is well located at approved permit location? ® Yes ❑ No Legal Descrlipdioq: XaSdDff.HX BJk31t.1A Property Owner Name & Address: Spinnell Homes Inc. 9210 Vanguard Dr, Anchotage, Ak4J95&7 Borehole Data: Depth (ft) Method of Drilling M air rotary ❑Cable too} Soil Type, Thidmess & Water Strata From To Casing type: steel stick-up 0 2 Wall Thickness: _025 inches fill material 2 4 Diameter: 6 inches Depth: 65 feet organic & s#t 4 9 Liner Type: gravelly silt 9 21 Diameter: inches Depth: feet Casing stickup above ground: 2 feet silt 21 32 Static water level (from ground level): 59 feet silty sandy gravel 32 38 Pumping level: 327 feet after gravelly silt -wet 38 60 12 hours pumping 1_5 gpm bedrock 60 327 Recovery Rate, 1_5 gpm Method of Testing:air lift H2O seepage'_5gpm 60 310 Well Intake Opening Type: H2O 1 gpm 310 327 ❑ Open End M Open Hole ❑ Screened Start feet Stopped fret RECEIVED [] Perforations Start feet Stopped feet Grout Type: Bentonite # 8 Volume: I be OCT 8 2000 Depth' Start 0 feet Stopped + feet Pump. Intake Depth feet of rHea D t. p thl& Human Services Pamp size hp Brand Name Well Disinfected Upon Completion? ®'Yes ❑ No Method of Disinfection: Clorine Tablets Comments: Well Driller: Alpine Drilling & Enterprises -P O Box 110496' . Anchorage AK 99511 Attention: The well driffer shall provide a well log to the property owner within 30 days of completion and the property n�rmar nr flip ��inll rM:F�rr-clrriAaa �a.�lf 7nn-M'-fin i'ivnt r-{`X•tv�{}}, ;Q,'.�.j�� ,.�.�m,.��.1iin T•Yi'itovo of nmm�toYinn Received Time Oct -11. 7:49AM ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Permit Number: SW000084 Legal Description: KASILOF HILLS BLK 3 LT 1A Design Engineer: 0014 Anderson Engineering Owner Name: Spinell Homes, Inc. Owner Address: 9210 Vanguard Dr. Anchorage , AK 99507- Date Issued: May 03, 2000 Expiration Date: May 03, 2001 ParcelID: 015-161-93 Site Address: 011100 KASILOF BLVD Lot Size: 48855 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: Disposal Field 1 Septic Tank L—] Holding Tank 1 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 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. 5. The following special provisions. tHIS PERMIT ISSUED FOR THE CONSTRUCTION OF AN ALTERNATIVE INTERMITTENT DOSING SAND FILTER (IDSF) WASTEWATER DISPOSAL SYSTEM. THE ATTACHED PROPERTY OWNER AGREEMENT SHALL BECOME A PART OF THIS PERMIT PACKAGE. Received By: Issued By: Date: Date: ¢ —OQ c. MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Permit Number: SW000084 Legal Description: KASILOF HILLS BLK 3 LT 1A Design Engineer: 0014 Anderson Engineering Owner Name: Spinell Homes, Inc. Owner Address: 9210 Vanguard Dr. Anchorage , AK 99507- Date Issued: May 03, 2000 Expiration Date: May 03, 2001 ParcelID: 015-161-93 Site Address: 011100 KASILOF BLVD Lot Size: 48855 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: Disposal Field 1 Septic Tank L—] Holding Tank 1 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 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. 5. The following special provisions. tHIS PERMIT ISSUED FOR THE CONSTRUCTION OF AN ALTERNATIVE INTERMITTENT DOSING SAND FILTER (IDSF) WASTEWATER DISPOSAL SYSTEM. THE ATTACHED PROPERTY OWNER AGREEMENT SHALL BECOME A PART OF THIS PERMIT PACKAGE. Received By: Issued By: Date: Date: ¢ —OQ April 21, 2000 Municipality of Anchorage Department of Health and Human Services I 825 "L' Street Anchorage, AK 99502-0650 Subject: Lot 1A'Block 3, Kasilof Hills Subdivision p Y 9 I Septic System tem Desi n and Pp Permit Application cation Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 1A, Block 3, Kasilof Hills Subdivision intends to construct a three bedroom home on the lot. We are hereby requesting a permit be issued to construct a new well and septic system to serve the house proposed for the lot. The attached Site Plan and backup documentation shows the location and configuration of the new septic system and the location of the well The 100' protective radius for the well and neighboring wells is also shown on the Site Plan. In addition, a subsurface drain placed on the lot over a month ago is also shown. Several testholes were placed on the lot in early spring last year. All holes revealed groundwater at shallow levels and indicated the lot could not be developed in that condition. A subsurface drain was constructed along the eastern and southern lot lines to intercept the flow of water and transportit around the area designated for the absorption bed. A monitor tube was placed in the area designated for the bed after the drain was completed. No water has been noted in the tube over the past month indicating the drain is effective. We have therefore designed a,bottomless sand filter for placement on this lot to treat and dispose of the effluent generated in the septic tank. The filter will be placed at the interface leve( between the organic layer and the silty gravel below. The distribution piping will be approximately 2' below the original ground surface. The percolation rate of the underlying silty gravel has been established at 60 minutes per inch. The lot surface slopes from south to north at rates varying from I% to 2% with a 4% to 8% grade from east to west. The sand filter will be placed perpendicular to the slope as required by the Municipal Ordinance. The existing drainage pattern on the lot will be maintained through final development: The outlet of the subsurface drain will be a minimum of 100' from all components of the septic system. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. w N O \ 1 O' N w �..- PRO.JECT TH►S N +i - • 1 NVw �I HEBANOF STRE T AREA MAP �q. a ° cn SCALE 1" 100' NOTE: Outlet of Drain Must Be 10 From Septic Tank Absorption.Bed. ANDERSON ENGINEERING l Jos Lot 1A, Block 3, Kasilof Hills SHEET NO. OF CALCULATED BY MEA DATE 4119100 CHECKED BY DATE _. 20 LOT 1A, BLOCK 3, KASILOF HILLS SUBDIVISION DESIGN FACTORS: 3 Bedroom Home Pere. Rate: 60 Min./Inch Application Rate: 2 GPD/SF SYSTEM REQUIREMENTS: Bottomless Inter. Sand Filter 1,250 Gallon STEP Tank 2' Coarse Sand (See Spec.) Air Supply Line (Anch. Tank) 6" of 3/8 Pea Gravel 3 Bedrooms X 150 GPD = 450 Gallons Per Day 450 GPD/2 GPD/SF /12 LF (Width of Bed) = 21 LF Length of Bed Therefore: Construct a Bottomless Intermittent Sand Filter System 12' Wide X 30' Long. Distribution = Piping to be. Placed at 1.5' Below Original Ground Surface. A Minimum of 2' of Cover Required Over Bed. I •• I.r , I ,I :I I Ic. I I � i• :� I � I :I I Y' 17iA. MOMfOKPL'i'IIEF At FPLN CCM nffa w MFFNTOf iiNN0019 MP�FK MF;VPI VFS I I/ 4" VA 50140 P/C OF %V AIV <JIS %WON I'm Aww ewm" S1FP M17MAtobat&U LK WM17 - NWKf.0 11LI/4NCA VIAHOLE5). (Wfffl 7rpPcfn� ) IiAa UP ON MONOM AW MU ?50(MNJI/4" )IF5 PLAN VIEW BOTTOMLESS SAND FILTER DETAIL (NO SCALE) NOTE: Grade Area to Drain Away. Maintain 6' Separation From Bedrock. Provide 4' of Cover or 2" Insulation and 2' Cover. Grade Surrounding Area to Drain Away. LOT 1A, BLOCK 3, KASILOF HILLS SUBDIVISION DESIGN FACTORS: 3 Bedroom Home Pere. Rate: 60 Min./Inch Application Rate: 2 GPD/SF SYSTEM REQUIREMENTS: Bottomless Inter. Sand Filter 1,250 Gallon STEP Tank 2' Coarse Sand (See Spec.) Air Supply Line (Anch. Tank) 6" of 3/8" Pea Gravel 3 Bedrooms X 150 GPD = 450 Gallons Per Day 450 GPD/2 GPD/SF /12 LF (Width of Bed) = 21 LF Length of Bed Therefore: Construct a Bottomless Intermittent Sand Filter System 12' Wide X 30' Long. Distribution Piping to be Placed at 1.5' Below Original Ground Surface. A Minimum of 2' of Cover Required Over Bed. -7 QJPLafim 21 1 MN. OF FLIM SM17` PROFILE VIEW BOTTOMLESS SAND FILTER DETAIL (NO SCALE) NOTE: Grade Area to Drain Away. Maintain 6' Separation From Bedrock. Provide 4' of Cover or 2" Insulation and 2' Cover. Grade Surrounding Area to Drain Away. 2" 'Direct Bury FL1Ej,'FA= Insula OVET FEAa'kW- FI.YW" PAA'irR _ AKGw EtUlif;" Z N ' y�v�yyjo,J /aGSC%.% f t4`%jC( tl 4 � Municipality of Anchorage,;: Department of Health & Human Services 4 825 L Street, Anchorage, AK 99502-0650 6 s SOILS LOG - PERCOLATION TEST Performed For: Soinell Homes Date Performed:? -'11— Legal Description: Lot 1A, Block 3 Kasilof Hills Subdivision SLOPE SITE PLAN 1 13 14 15 16 17 1 OG/01- 10 G/OL GM 15%-20% Silt Bottom of Hole Was Groundwater Encountered? If Yes, What Depth? Depth to Water After Monitoring Date: South Yes S 7' L O 5' P 5/15/99 _ E See Site Plan 4% - 8% Pere. Rate: 60 Min./Inch Perc. Hole Diameter: 8" 21H Test Run Between 4 Ft. and 5 Ft. Comments: Testhole Presoaked Prior to Percolation Test. Testhole Dry After Placement of French Drain. Performed By: Mike Anderson. I, Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 4/21/00 1 8 9 10 11 12 13 14 15 16 Iff OG/OL GM 15%-20% Silt Bottom of Hole Was Groundwater oa N 6P South Encountered? Yes If Yes, What Depth? 7' Depth to Water After Monitoring 5' Date: A Municipality of Anchorage Department of Health & Human Services 825 L Street, Anchorage, AK 99502-0650 fklew L SOILS LOG - PERCOLATION TEST h mak\ +W 4 Performed For: knell Homes Date Performed / in 3 Legal Description: Lot 1A. Block 3. Kasilof Hills Subdivision SLOPE SITE PLAN 1 8 9 10 11 12 13 14 15 16 Iff OG/OL GM 15%-20% Silt Bottom of Hole Was Groundwater oa N 6P South Encountered? Yes If Yes, What Depth? 7' Depth to Water After Monitoring 5' Date: 5/15/99 6*10 See Site Plan Perc. Rate: 60 Min./Inch Perc. Hole Diameter: 8" 21 Test Run Between 4 Ft. and 5 Ft. Comments: Testhole Presoaked Prior to Percolation Test. Testhole Dry After Placement of French Drain. Performed By: Mike Anderson I, Michael E Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 4/21/00 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 1A, BLOCK 3, KASILOF HILLS SUBDIVISION GENERAL: The scope of this project includes the procurement and placement of a new 1,250 gallon combination septic tank and lift station and pressure distribution system. Work also includes the construction of a new 30' long x 12' Bottomless Intermittent Sand Filter at the location shown on the attached Site Plan. All existing organic material must be excavated to the silty gravel layer below which is expected to be at least 2' below the original ground surface. A minimum of 2' of coarse sand meeting the attached specification must then be imported and placed in the filter area. The filter must then be constructed atop the imported material in conformance with specifications furnished by the supplier. A minimum of 2" of direct bury insulation must be placed atop the filter and 2' of natural backfill atop the insulation. In lieu of insulation 3' of cover may be placed atop geotextile fabric over the new filter. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK/LIFT STATION INSTALLATION The 1,250 gallon septic tank/lift station must be constructed by certified tank manufacturer. Construction shall include an 18" manhole to provide access to the lift station. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. Lot 1A, Block 3, Kasilof Hills April 20, 2000 Page 2 of 3 5. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 6. Final grading over the tank/lift station shall be such that a positive slope exists away from the septic tank. ABSORPTION BED CONSTRUCTION: 1. The absorption bed shall be constructed to the dimensions shown on the design. The bottom of the bed shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. The lift station must be constructed by a Municipally approved septic tank manufacturer. An Orenco 20 OSI 05 HHF-5 pump is recommended. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A. B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). Lot 1A, Block 3, Kasilof Hills April 20, 2000 Page 3 of 3 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. EQUIPMENT SPECIFICATIONS: 1. Air Supply Line shall be a Wasteflow Emittedine, %" inside diameter from Anchorage Tank. Line shall be insulated with Y2" foam pipe wrap inside a 2" Schedule 40 PVC Jacket buried a minimum 3' below the surface. 2. Air Compressor shall be a Thomas Industries Model 5070 as supplied by Anchorage Tank. Compressor shall be located in the garage or crawlspace. 3. A pressure gauge calibrated from 0 to 10 PSI shall be furnished and installed in line with the air line. The gauge shall be mounted in an area which provides easy viewing access such as the garage. INSPECTIONS: A minimum of two inspections are required by Municipal Ordinance. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. FILTER SAND SPECIFICATION Coarse Well Graded Sand Maximum 2% Passing No. 100 Seive Maximum 1% Passing No. 200 Seive -MAY PROPERTY OWN -Fig MAINTENANCE A,GREEAENT ONSITE WASTEWATER DISPOSAL SYSTEM This agreement, dated AY Z Zo is made between the Municipality of Anchorage ]department of Health and Hunan Services (DB' -'S) and the property owne(s) o£fGoT to ` 3tx�L�t�fFLLS Std .. . This agreement is made for the pvspose of maintaining an on-site wastewater disposal system on the subject property. The property owner(s) agree to the following. The property owner(s) will have an annual inspection of the system performed by a registered professional engineer. This inspection shall verify that all effluent and air pumps, timers, and alarms are functioning as designed. Any deficiencies shall be corrected and the engineer's statement that the system is functioning as designed shall be fated annually with the DHH5 Property -@caner Name property Owner Name (��N/ot��arize Here)� j,,� A� 0 6e, OMCIALSEAL $TATEOFALASKA PAME►A M. WOOnKE NOTARY PUBLIC rnm Fvilms AU0=21.2001 6/6Reaeiv MY'u� May, 2• 1:31 PM NV99:8 0006 '6 .yew MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-161-93 1. GENERAL INFORMATION Expiration Date:/) - 2.S - 2 Z Complete legal description KASILOF HILLS BLOCK 3, LOT 1A Location (site address) 11140 KASILOF BLVD. ANCHORAGE, AK 99507 Current property owner(s) NICHOLAS & SOPHIA HUFF Day phone Mailing address Real estate agent 11140 KASILOF BLVD. ANCHORAGE, AK 99507 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Waiver Fee $ Date of Payment 8/3/20,U Date of Payment Receipt Number 8-0 3 Dl-� Receipt Number COSA # Q S C I2 M � Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 7129122 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FkS 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved *: 49TH ....•:* r • ' . Curtis Huffman : CE 128991 .•��`�i kv .7/29122 R F ss o P�``�:xw, Conditional approval for bedrooms, with the following sti t����t�r6t�xrr// P�,UTY pFq,t���� < wgSTFRAIbn "_ o PRO q TFR RvicE l� ,\` Original Certificate Date: 9 -2.S -2 -2 - The -23-22 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory%% Well Flow Advisory Other S .I i>iX Ur/ COSA Checklist Legal Description: KASILOF HILLS BLOCK 3 LOT 1A Parcel ID: 015-161-93 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Water storage tank volume NA gallons Date drilled 6/20/2000 Total depth 327 ft Well disinfected for coliform test? ❑ Yes ® No Cased to 65 ft ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate 0.426 mg/L ❑ Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) 24+ in. FWrs Date of flow test for COSA 7/28/22 Collected by Static water level at beginning of test 20 ft. Date 7/28/22 Well production at time of test 2.5+ gpm Comments PER OWNER — NO WATER STORAGE & THE WELL HAS BEEN HYDROFRACTED. B. TANK DATA C. LIFT STATION Measured operating fluid level in septic tank * ® Required maintenance completed Date of pumping 7/28/22 Age of lift station 22 years ® Required maintenance completed, if AWWTS Lift station material STEEL Comments: *PER FLOATS / MAINT. REPORT Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 5/30/2000 ® ALL standpipes present per record drawing Total measured depth from grade 4_3 ft (max) Measured depth to pipe invert from grade NA ft (min) N/A — pressurized field. ® Per record drawings, field is insulated. ® Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 7/28/22 Results M Pass Fluid depth prior to test 3 in Water added 450 gal New fluid depth 4 in Elapsed time 1440 min Final fluid depth 3 in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) lin Effective depth used 3 in Effective depth remaining 3 in Comments/Deficiencies: THIS IS AN IDSF 2000 SYSTEM & APPEARS TO BE OPERATING WITH SOME STANDING WATER & SYSTEM SHOULD BE PROPERYLY MAINTAINED. SHOWING SIGNS OF AGE. COSA Checklist—July 2022 copy.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft — ®Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Tank to Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer's Printed Name CURTIS HUFFMAN, PE Date 8/5/22 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, tr• . • • • • • . • `l local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the �Q�•• system and maintenance. The operational life of all well and septic systems are subject to TM ••* j these various and dynamic characteristics and are outside the control of the evaluator of the • • • • - well and septic system. Therefore, any estimate of how long a system will function satisfactory • • • Vic- for current or future occupants or guarantee that no unseen encroachments, deficiencies or • • • • • • • - discrepancies exist can be given by First Water Consulting & fel f5 Curtis Huffman ����ci�l • . CE 8% 28991 . •&Aiw,// •PROFESSION �? COSA Checklist—July 2022 copy.docx ��\�\�� www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 221392 Subdivision: Kasilof Hills Block 3 lot 1A Starting at 20 years of age the MOA issues Advisory's for steel septic tanks The septic tank for this COSA / property is 22 years old. A leaking septic tank may be a source of contamination to the aquifer. Typical replacement costs range from $10,000 to $15,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank in failure and should be replaced. Mailing address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org v MUNICIPALI'T'Y Oh ANCHORAGE, ADVANCED WAS'E'EWA'I'EIt'i'lZEA`I'MEN'I' SYSTEM MA1NTh.NANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND 111 1"AIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this -Z!—A Day of aS4- of 20 2j,,., by and between calci Lay040"d N°"e III , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as ISDF - SAND FITER SEPTIC SYSTEM located at (legal description) KASILOF HILLS BLOCK 3, LOT 1A 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Z! Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. IM Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. 1-- nsnomnio% Dn-.1 .,f2 Owner acknotiviedges that the Municipality may request records ol'maintenance and repairs li-om the manufacturer's representative or maintenance provider. W— Owner acknowledges that (lie fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. am_ Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. kOwner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. OWN40. 81 A 11 �' t 11' ALASKA )--s. III ORD JUDKINL DISTRICT I The . MMI'Llment ICLnowledud Wore:me this 4p1 day kll'Au-tts 20111.4 by �(7C-)ALASKA I J 11 -IC FOR ALASKA STA7f E' OF At, ASK A NOTARY PUDLIC /'Jbort Km M,/ CommInIon Uplrw) M.,*.V 24, 202-51 IN I I I N I CI IIA 1. FIX - By: (print name) (rev. 05/18/2019) Date: �-17-2? Title: Page 3 of 3 �ste wter er i%lt!NIClf)A(.ITYOFANC110fA"iL�n('onitilt'llityV)ive](�I)IIIeritt)cparttDCIll-On- Silr-�Witcr&Wa Pro.,"7rarn P: 907-343-7904 - F: 907-343-7997 - IW, Box 196650 AnchorageAY , -1 , 99519-6650 Int6rmittent Dosing Sand Filter Maintenance Log Owner Street Address f 1 LCA Li lid Phone Legal Desc. PID___ --- .Sludge level inches -Pumping: required y��s no -Purnping completed (��es�,no AbsorPtion Field: r u� Liquid level inches -Flushing valves per approved design(Ce�-,no -All flushing valves opened, distribution lines flushed, and flushing valves closed no Lift station: -Pump, basket cleaned�esno -Biotube effluent filter cleaned �,n o f) -Timer float setting 77 inches -High level float setting L 'Linches -Reference point r�,p -Pump onseconds -Pump off-42D—Minutes 0 -Cumulative lifetime cycles -Cumulative run time hours -Operation satisfactory (L no Air System: -Air pump filter cleaned NeA no -Air pressure psi -Date of latest install or rebuild -Air system operation satisfactorv) not satisfactory Alarm Svstem: -Dedicated electrical circuit (g�Lno Audible and visual alarm inside dwelling Xe­s_� no -Float setting inches -Alarm system operation (satisfactorv) not satisfactory Comments: ... __ ........................ .............. — ........ ____ ....... I.- ........ -.1 ............... .......... ........... Maintenance Provider: Technician Uj Date of maintenance'sAo_�_� 'C & Company Signature DateLL;__� f �b 6789 • Municipality of Anchorage On -Site Water and Wastewater Program ti (907)343-7904 I g N U w Parcel I.D. 015-161-93 Certificate of On -Site Systems Expiration Date: 1. GENERAL INFORMATION . Complete legal description Kasilof Hills, Block 3, Lot 1A Location (site address) 11140 Kasilof Blvd. Current Property owner(s) Dwight Stuller Day phone Mailing address 11140 Kasilof Blvd. Anchorage, AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: R Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well F Individual E 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 $ 62 % Date of Payment %f 9115 Receipt Number nllcia% COSA # Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the info ajiv ny tained. from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastev ftp., is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. iy In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, An Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for 3;. bedrooms System #2 Approved for bedrooms Disapproved Date 6/1/2015 Conditional approval for bedrooms, with the following stipulations: Original Certificate 7Th Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage. is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSAbluesheel Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # i of Structure served by this system 1 Certificate of On -Site Systems Approval, Checklist Legal Description: Kasilof Hills, Block 3, Lot 1A Parcel ID:015-161-93 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 6/20/2000 Sanitary seal (Y/N) Y Total depth 327 ft. Cased to 65 ft Date of test Static water- level Well production FROM WELL LOG 6/20/2000 59 ft. 1.5 g.p.m. Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 5/19/2015 23 ft. 2.3+ 9 - p.m - WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate ND mg/L Arsenic ND ug/L Date of sample: 5/19/2015 Collected by: PES B. SEPTICIHOLDING TANK DATA Tank Type/Material S.T.E.P./Steel bate installed 5/30/2000 Tank size 1,250 gal. Number of Compartments 3 Gleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N. High water alarm (Y/N) Y Date of pumping 11/3/2014 Pumper A+ Home Services ` C. ABSORPTION FIELD DATA Date installed 5/30/2015 Soil rating (g.p.d./ft2 or ft2/bdrm) 2 GPD/SF System type IDSF Length 30 ft. Width 12 ft, Gravel below pipe 0.5 ft. Total depth 4.7 ft. Eff. absorption area 360. fe Monitoring tube Y— Depression over field N Date of adequacy test 5/19/2015,. Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 1 /2 in. Water added 479 gal. New depth 115 in. Elapsed Time: 140 min. Final fluid depth 1/2 in. Absorption rate >= 450+ g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date D. LIFT STATION Date installed 5/30/2000 "Pump on" level at 42 in. Datum Bottom of Tank E. SEPARATION DISTANCES WELL ON LOT TO: Size in gallons 250 "Pump off"level at 42 Cycles tested 3 Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ Manhole/Access(Y/N) Y in. High water alarm level at 44 Meets alarm & circuit requirements? Yes On adjacent lots 100+ On adjacent lots 70 Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property]ine T Q+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10 -i - F. COMMENTS 9 *Waiver on File WR#OSP111234 Survey As -Built on File. Air pump at 3 PSI during test. 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 COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone ' Date 6/1/2015 COSA canary sheet 2-6-15.doc $�e�ri )?.f�annone. CE -8149 in. 00/1u!Lino uY.LU 0000!!u Hruo r sIlk �-1A 7P;907-345-7904 c[5ALZ OF . NCRORAQE * Commanity Devetopmeat Dapartmoat • On -Site water do Wwtmwater Prpg= • F; 907.343.7997 • P.O. Box I%650 Anchorage AIC 99S I9-6650 • http:/ vw.muni.oxg/buildiog Intermittent Dosing Sand Filter Maintenance Log Owners 1;-�+ e-, L_. ! 1 Street Address_ %I/ yt- Phone„-B_22.614e ' Legal Desc, PID SeDtit: Tank: Sludge level_inches •Pumping: required es o •Pumping completed es o Absorption Field• 1 f • 3.1 ~a •Liquid leveiinches •Flushingvalves per approved design -All flushing valves operic:d, distribution lines flushed, and flushing valves closed os no Lt station: •Pump basket cleaned es no •Biotube offluent filter cleaned es o •Timer float setting inches •High level float setting -4.L -Inches -Reference point a �f 72f to -Pump on -/0 seconds -Pump off (00 minutes -Cumulative lifetime cycles y J . _ _ 'Cumulative run time —L�hours *Operation satisfactory es no Air System; -Air pump filter cleanedes o_ •Air pressure •Date of latest install or rebuild �2 ?-- •Air system operation Alarm Svs em. -Dedicated;(v electrical circuit el no -Float setting / e2. inches Comments- �> si s o no sans o o -Audible and visual alarm inside dwelling es • o *Alarm system operation sans o �t satisfactnw .............. ................................. I .......... .. ................................. ................ ....... ..... .................. ..................................... ....... I., ... I............... ............... ........................... .................. I ................ ...,..... ............................................................................................................................ .................................................................................:........................................................... ..................................... ........................................................................................... Maairdenance Provider: Technician , Le �� u k� 5 �� Date of maintenanoe 1_A)he /s Company A )v rw 2 5pyvtc Signature v✓ - Dela .7✓ht lS� Log_040313Aoc Municipality of Anchorage F w. • Development Services Department °_ Q. Building Safety Division s r V On -Site Water & Wastewater Program 4700 Elmore Road 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. 015-161-93 COSA# 1. GENERAL INFORMATION Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address KASILOF HILL; BLOCK 3, LOT 1A 11140 KASILOF BOULEVARD *ANCHORAGE AK 99516 SILVIA YOAKUM Day phone 11140 KASILOF BOULEVARD *ANCHORAGE, AK 99516 Day phone BRANDI CROOM W/ KELLER WILLIAMS Day phone 101 W BENSON BLVD *ANCHORAGE, AK 99503 Unless, otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: 345-5542 XXX TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 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 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 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 Address GARNESS ENGINEERING GROUP, Ltd. 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. 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 of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test 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 Phone 337-6179 Date _ h.3 fr OF !!�� 4 g*I ff eG ness: E— �v • •mac O ,D�x,pro f e s sio"to`� other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE \\�`�`4���;.••••,•• �y4r' Approved for bedrooms. , ON-SITE 'Gy _ DATER AND ; m= Disapproved. WAASTEWA SERPROGR•; Conditional approval for bedrooms, with the following stipulations: O••.� •.• A.` Attachments: COSA Checklist (/ Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory ,/ Other / By: "� ! Original Certificate Date: (Rev. 11/05) Municipality of Anchorage • Development Services Department Building Safety Division " On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: KASILOF HILL; BLOCK 3, LOT 1A A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 6/20/00 Sanitary seal (Y/N) YES Total depth 327 ft. Cased to 65 ft. FROM WELL LOG Date of test 6/20/00 Static water level 59 ft Well production 1.5 g.p m WATER SAMPLE RESULTS: Parcel ID: 015-161-93 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 24+ in. AT INSPECTION 8/25/11 4 ft. *2.9 g.p.m. *WELL HAD BEEN HYDRO -FRACTURED PER OWNER. Coliform _ 0 colonies/100 ml. Nitrate ND mg./L. Collected by: GEG, Ltd. Arsenic: VLA ug./L. Date of sample: 8/25/11 B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP/STEEL Date installed 5/26-30/00 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES Date of pumping B a s Pumper % r-» e CrS,; c C's C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 5/26-30/00 z z BOTTOMLESS Soil rating (g.p.d./ft or /bdrm 2 System type SAND FILTER Length 30 ft. Width 12 ft. Gravel below pipe 0.5 ft. Total depth *4.58 ft. Eff. absorption area 360 ft2 Monitoring tube YES Depression over field NO Date of adequacy test _ 8/25/11 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 480 gal. New depth 0.5 in. Elapsed Time: 50 min. Final fluid depth 0 in. Absorption rate >= 450+ d 9.p. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - * D. LIFT STATION�,,��,� Date installed 5/26-30/00 Size in gallons 1500 Manhole/Access (Y/N) YES "Pump on" level at TIMER in. 'Pump off" level at TIMER in. High water alarm level at 46 in. Datum BOTTOM OF TANK Cycles tested_' X Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots *70' Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main 5'+ Property line 5'+ Absorption field 5'+ N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 1 Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *SEE ATTACHED WAIVER LETTER & DRAWING. 4.0 PSI ON GAUGE PER GEG TECH ANDREW GRAY. G. ENGINEER'S CERTIFICATION o� OF• A I certify that I have determined through field inspections and p * 9 H �* review of Municipal records that the above systems are in .. • • • • • .. • .. • . .......... • conformance with MOA COSA guidelines in effect on this date. J ffr Garn ss.. Engineer's PT'tedNName JEFFREY A. GARNESS _ 5Date �� O�p�f re RSIC, �ro f e s sio�oo COSA Fee $ C Waiver Fee $ Date of Payment 6A I 1 �-i I 1 Date of Payment Receipt Number l7 c� o Icl Receipt Number (Rev. 11/05) 0 SGS Ref.# 1114086001 Client Name Gamess Engineering Group, Ltd Project Name/# KasilofHills B3L1A Client Sample ID Kasilof Hills B3 L I A Matrix Drinking Water Printed Date/Time 08/31/2011 8:02 Collected Date/Time 08/25/2011 14:30 Received Date/Time 08/25/2011 17:33 Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 Waters Department Total Nitrate/Nitrite-N ND 0.100 Microbiology Laboratory E. Coli Negative 1 Total Coliform Negative 1 ug/L EP200.8 C (<10) 08/26/11 08/30/11 NRB mg/L SM20 450ONO3-F B (<10) 08/26/11 AYC 100mL SM20 9223B A 100mL SM20 9223B A 08/25/11 DLC 08/25/11 DLC I)om I eam, Keller VV mamS Kealry 10:1114U KaSIIOT WIVO. (1tIUf,5-5b0Z40) 14:zts uts/Y8/ 1 Ilam I-uu rg uL-uz 73-136 KASILOF HILLS SUBDIVISION LOT 1-A, BLOCK 3 46,855 S.F. N FIN CtURE -B AS —B U I L T J PROPFRTII DEWft ABOVE Mb THAT No I ENCIM40WENI8 EXIST EXCEPT AS INDICATED. JEFF A CASTALM R.LS. 1 I �I 4720 wESr 86TH AVENUE DETERION£ THE (X6tMCE OF ANY EkstkENTS; CJI COVENWM Ca :1 "CH DO NOT PHONE 245-5454 JI . CHID DATE HEREON BE USED FOR CONmRuanON OR FOR 01 6/30/20M ESTABUSHM BOUNDARY OR MICE UNES. I 1 ° ANCHORAGE RECORDING 0141RICf, ALAS101 I JOB NO_ NOTE: NO CORNERS SET THIS DATE. 00-05 XMIAT NL - — — — — ——--———————— ———— — — — — —— '� ��� 0 W " l to 0 20' UTIL ESWF. '. O I 10' X 20' 1 $ 8 I ANCHOR ESAR. I GruVM DFWE , b = BWLMM{ 70 Vr�7r W, 2►ar JI law q ■°r wo• NMI li.r O 1 Ca �e.ml m•1c srsRU ' h 1 of co Obi Clio 1 L --� 10'X20' --ANCHOR ESW. 55 5� ♦• po 5 89'58'13'E 170.00' gftio o n SHEBANOF DRIVE FIN CtURE -B AS —B U I L T I HERESY C94M MT 1 NAVE SURVEYEC THE PROPFRTII DEWft ABOVE Mb THAT No GASfALDI LAND SURVEYING ENCIM40WENI8 EXIST EXCEPT AS INDICATED. JEFF A CASTALM R.LS. R 19 THE ROWONSfBIIJ1Y OF THE OWNER TO 4720 wESr 86TH AVENUE DETERION£ THE (X6tMCE OF ANY EkstkENTS; ANCHORAGE, ALASKA 99502 COVENWM Ca :1 "CH DO NOT PHONE 245-5454 APPEAR ON THE RECORDED SUMNIStON PLAT. UNDER NO CIRCWI W CM SHOULD ANY DATA CHID DATE HEREON BE USED FOR CONmRuanON OR FOR 6/30/20M ESTABUSHM BOUNDARY OR MICE UNES. 2641 ANCHORAGE RECORDING 0141RICf, ALAS101 F.B. JOB NO_ NOTE: NO CORNERS SET THIS DATE. 00-05 XMIAT OF q� a•4v Pt .....a, . rs-eoa, .� � a► � `OhiAaewll°I�.�� Municipality of Anchorage P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 , (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Program cent �� P G fi� il C ro epartment **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP111234 COSA#:OSC111342 Permit#: PID#: 015-161-93 Legal Description: Kasilof Hills Subdivision, Block 3. Lot 1A Engineer: Garness Engineering Group Applicant: Silvia Yoakum Your request for a waiver of the required 100 feet horizontal separation from the absorption field on Lot 7 to the private well has been approved. The approved separation distance is 70.0 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: !l✓- // Approved by: Name of Revie r ......................................................... .................... Rec#: 097252 Amount: $1,050.00 Date Paid: 9/1/11 **** VARIANCEMAIVER REVIEW **** Kasilof Hills Subdivision, Block 3, Lot 1A Parcel ID: 015-161-93 Waiver for 70 feet from well to field located on Lot 7 9/13/2011 General 1. The drainfiels is downhill from the well. Overflowing effluent will not travel toward the well 2. The well log lists all soils between 4' and 60' as being silty soil mixtures and is cased to 65'. 3. Current nitrate levels are non-detectable. The encroachment has existed for over 11 years and has not adversely impacted the water quality. 4. If the well met the 100' separation, the total points would be 13.7, within the same range established by the ADEC. ADEC Criteria Water Table Points Depth of water bearing zone in well Depth To 60 feet Assumed bottom of field 21 11 10 feet 32 11 0.44 50 feet 5.2 Soil Sorption 0.18 gravelly silt 1.5 38 60 22 Soil descriptions 0 0.00 DEC PTS Depth From Depth To Thickness Calc. Pts Gravelly silt 2.5 10 21 11 0.55 silt 3.5 21 32 11 0.77 silty sandy gravel 2 32 38 6 0.24 gravelly silt 2.5 38 60 22 1.10 1.8 0 0.00 0 0.00 50 2.66 2.7 Permeability Soil descriptions DEC PTS Depth From Depth To Thickness Calc. Pts Gravelly silt 1.5 10 21 11 0.33 silt 2 21 32 11 0.44 silty sandy gravel 1.5 32 38 6 0.18 gravelly silt 1.5 38 60 22 0.66 0 0.00 0 0.00 50 1.61 1.6 Water Table Gradient - Water table slopes toward the water source, 19' drop over 200' horizontal Assume -10% slope 1.2 Horizontal Separation 70 feet between septic field and well 1.8 Total Points 12.5 As per ADEC waiver guidelines, with a minimum point value of 12.5, no bacterial polution possible but chemical pollution possible but unlikely from household chemicals. � )�4 iii -93 05 P 111 J -3q P4 L°1 Ian GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS ....... August 31, 2011 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 REFERENCE: Kasilof Hills Subdivision, Block 3, Lot IA; 11140 Kasilof Blvd, To whom it may concern, The subject property is served by a private well and a septic system. The well and septic system were designed and inspected by Michael E. Anderson RE in 2000. Michael Anderson submitted a C.O.S.A. for the property in 2000. GEG, Ltd. then submitted a C.O.S.A. for the property in 2004. On our last C.O.S.A. we listed the distance from the well to adjacent septic systems as 100'+ based upon Anderson's documents. We recently were retained to do the C.O.S.A. inspection for the current owner. During the course of our inspections, the distance between the well and the drainfield on Kasilof Hills Block 3, Lot 7 was found to be 70.07' (shot with a Topcon total station). The septic system encroached upon was installed in 1980. In short, the septic system was installed prior to the well. We are requesting that you waive the distance from the well to the drainfield to 70+ feet. The following items are justification of this waiver: • The drainfield is downhill from the well. Overflowing effluent would never travel toward the well. • The well is cased to 65 feet and the well log lists all soils between the 4' and 60' as being silty soil mixtures. These silty soils clearly have served to impede migration of contaminants toward the water table. • The well has had water samples taken 3 times during its lifespan: The nitrates levels have been 0.513 mg/L (10/11/2000), 0.25 mg/L (7/25/2004), and Non -Detectable (8/25/2011). • This encroachment has existed for over 11 years and has not adversely impacted the water quality. Based upon the aforementioned facts, we believe there is minimal risk associated with granting this waiver. _ If you have any,questi 41, please contact me at 337-6179. .E., M.S. 3701 E. Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com M (Rev. 01/05) KASILOF HILLS S/D; / \ KASILOF HILLS S/D; BLOCK 3, LOT 7 / \ \ BLOCK 3, LOT to EXISTING DRAINFIELD )RADIUS EXISTING.yHOUSE /APPROXIMATE 100' WELL �`UNT100' WELL RADIUS I o / STANK / N / SCALE: ---- \\\ SHEBANOF AVENUE 1• = ao' . 0 GARNESS ENGINEERING GROUP, Ltd. p *:-'4 CONSULTANTS & GENERAL CONTRACTORS �•" "' .. ......""• "'... 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 • PHONE (907)337-8179 • FAX (907)338-3248 • WEBSITE: www.gamoseenginmring.com R ; PREPARED FOR: PHONE NUMBER: PAGE NUMBER: : SILVIA YOAKUM 907-345-5542 1 OF 1 e A. G rness LEGAL DESCRIPTION: DRAWN BY: A.J.G. KASILOF HILLS S/D; BLOCK 3, LOT 1A e �o TYPE OF WORK: DATE: 40odprofessI— (Rev. �o\ o SITE PLAN FOR WAIVER REQUEST 8/26/2011 01/05) Municipality of Anchorage Department of Health and Human Services 825 °L" Street P.O. Box 19WSO Anchorage, Alaska 99519-6650 Rick Mystrom http:/Mww.cr.anchorage.ek.us Mayor Permit Number: ASW -000024 Mate-ofx - Xaxeei.Identification Number: 015-161-93 Date Started: 6-19-00 Date Completed: 6-20-00 Is well located at approved permit location? ® Yes ❑ No Leo Descdpdo . Kasiloffl�i1181k31t.1A Property O raerName & Address: Spinnell Homes Inc. •9210Yan.guard Dr. • • AttEfrora�co- Ak995t�Y7 . Borehole Data: Soil Type, Thidmess & Water-Stmta Depth (ft) From To Method of Drilling ® air rotary [] cable took Casing type: steel stick-up 0 2 Wall Thickness: _025 inches fill material 2 .4 Diameter: 6 inches Depth: 65 feet organic & s&f .4 g Liner Type: . gravelly slit g Z1 Diameter: � _ inches Depth: feet -•••• =P •O'Box•110436 Anchorage AK 9'9511 Casing stickup abo'v'e ground: 2 feet silt 21 32 -Static•water level (from ground level): 59 feet silty sandy grave! 32 38 Tawpirog level: 327 feet after gravelly silt -wet 38 6012 hotus P P. 7_5 gPm bedrock -60 327 Recovery )(tate: 1`5 gprn Method of Testing:'airlift H2O seepage'_5gpm 60 310 Well intake Opening Type: H2O 7 gpm 310 327 ❑ Open End ® Open Hole RECEIVED ❑ Screened Start feet Stopped feet 0 -.Perforations Start feet Stopped feet Grout Type. Bentonite # 8 Volume_ 1 b� OCT 18 2000 Depth: Start 0 feet Stopped ± feet -pump: intake Depth feet Pump size hp Brand Name Municipality Dept. Hea thy& Humaof nhServiiices Well Disinfected Upon Completion? ®ices ❑ No Method of Disinfection: Clorine Tablets Comments: Well Drifter. Alpine Drilling & Enterprises ' -•••• =P •O'Box•110436 Anchorage AK 9'9511 Attention: The well dniffer shall provide a well log to the property owner within 30 days of completion and the property r.�x>nor nr t]rs� wA11 r]ri � sx.�]f �rnt to Fizp ipr�t rcf`i%i?}� �g �i�rr�m• (� t Aft -hocro of nsrw�ntPti Received Time Oct -11. 7:0AM Municipality of Anchorage ' Development Services Department "! Building Safety Division On -Site Water 8 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 015-161-93 HAA# bA O�S� 1. GENERAL INFORMATION Expiration Date: / L — 0 71 Complete legal description KASILOF HILLS SUBDIVISION; LOT 1A BLOCK 3 ❑ Public Water System ❑ Location (site address or directions) 11140 KASILOF BLVD * ANCHORAGE. AK 99507 Current Property owner(s) DAVID & BONNIE PALMER Day phone 929-4806 `Mailing address Lending agency Mailing address Real Estate Agent Mailing address P.O. BOX 112975 * ANCHORAGE. AK 99511-2975 Day phone VANESSA GEHRING W/ PRUDENTIAL J.W. Day phone 3201 C ST. SUITE 200 * ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 240-3336 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 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 HeSoh-Authority Approval are valid for 90 days from the date of issue for properties served by a private o�,Qa"ss C well and may be reissued with new water samples. (Certificates may be reissued for a period of up -6 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, 1 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. 1 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. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's 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 repo,,ed results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test 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 Disapproved. bedrooms. Phone 337-6179 Date Z`d O I--," Conditional approval for 3 bedrooms, with the flowing stipulations: At the time of title transfer, the new property owner shall sign the attached maintenance agreement which shall be returned to this office before an unconditional approval is issued. Attachments:y HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other By. .�� Original Certificate Date: (Rev. 12101) wIun1%;iP; Developmen Bu H Ancnorage - Fices Deparnt K Sty DiJision _tme . , .._:. y istewaterProgram- ragawry 5e =9 i ge alc us �PPR`(17%/Sl(�{-IF('KIfCT //ZU/ZUU4. y MOMM 0.43 g.p.m. c tt. Gravel, below pipe U•5 ft. ft Monitoring tube YES Depression over field NO lts (PasslFail� PASS " For bedrooms Water added 453 gala New depth 0.5 in T,2 in. Absorption rate>= 450+ 9.p -.d* at On adjacent lots U+ weus on aalacent iocs T F ( cc WG WATER IN IT 3 .S ®S� ��' � �E i n r ,+ .a ,,.�, is SrsJ OS L✓� �o0Es000 C> h.w......a ed nd ......... ..*. Q that the above systems are in a guidelines in effect on this, date ....... ffr or r �i JEFFREY' A. GARNESsS Q�� E 795 �z O a�Oo�O Waiver Fee $ Date of Payment \� Receipt Number 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.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Health Authority Approval # 040376 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 3, Lot IA of Kasilof Hills subdivision, the well's productivity was determined to be 0.43 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. Jul 27 04 01:44p Vanessa Gehring 907-333-6030 73-138 KASILOF HILLS SUBMISION LOT. 1 -At- BLOCK 3 i Received 07-15-2004 11 :33w From- To-ATCA TITLE DEPT- Pace 002 p.2 SHEBANOF ORAE 1 mumn.bHc mpv -*,Ar I mvr- sur4im THE AS.- U I L T PROPEAT I+ DEpli'f1ED A6WE AND THAT NO GL4rALDl LAAO au No JEFF A Gg{AHLD41, H.LS. Q/OROACIh1E" EXIST EXCEP. AS INOICALTEO. IT R THE T OP THE OWNER TO 4724, WEST STH AVIIiUE pEHFRMINt THE bMnVNCE OP ANY EAMUEMM WCHOft F_ ALASKA 99502 COVE AWS dk RQ'RSIer9*4 *)*w co NOT PHONE 248-Z464 AFRFM ON -RILL 1tECOMED zUeOt l M pLAT_ UNDER NO COWLIUSTAMOM SHOLLM ANY DATA ORta aAYc ED FOR HEREON SE USM COMWMICflON OR FOR zesH e/30/20W ESTASLM400 BOUNDARY -OR FENCE UNM F.a. doe �Ho. ANCHORAGE REOORDHNO MS. jar. ALASKA __ oo-Toe I[HSfN NOTE: ,NO CORNERS SET THIS DATE. i Received 07-15-2004 11 :33w From- To-ATCA TITLE DEPT- Pace 002 p.2 ��" Municipality of Anchorage • 41 Department of Health and Human Services Division of Environmental Services ��9 On -Site Services Section 825 "L" Street Room 502 f�� P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.ancho rage. ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I.D. 01 5-1 61 -93 HAA#�GGSa Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 1A, Block 3, Kasilof Hills Location (site address or directions) 11140 Kasilof Boulevard Current Property owner(s) Spinell Homes Day phone 344-5678 Mailing address 9210 Vanguard Drive Anchorage, AK 99507 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: Three (3 ) 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well U Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 less than 30 days old. 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. 72 025 � Rev. 01/00)' 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 Health Authority Approval Guidelines for the Health Authority Approval application show that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, tl•,c- on- site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering _ Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 10/17/00 F ; '''ENGINEER'S 6 ° STAMP DHHS SIGNATURE I/ Approved for bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations. Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: �� cy Original Certificate Date: / O _ / � _. O O Expiration Date: f — /3 0 0 75-025 iRev. 01:001' Reissue Date: Municipality of Anchorage • '� Department of Health and Human Services Division of Environmental Services R E C E I V On -Site Services Section 825 "L" Street Room 50 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us OCT 17 2000 (907)343-4744 MUN ALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL CHECISNST)NM NTALSERVICESDIVISION Legal Description: Lot 1A, Block 3, Kasilof Hills Parcel I.D.: 015-161-93 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log Y Date completed 6 20 00 Sanitary seal Y Wires properly protected Y Total depth 327 ft Cased to 65 ft Casing height (above ground)> 24 in. FROM WELL LOG AT INSPECTION Date of test 6/20/00 Static water level 65 ft Well production 1 .5 g.p.m WATER SAMPLE RESULTS: fii g.p.m Coliform 0 colonies/100 ml Nitrate • 513 mg/I Other bacteria 5 colonies/100 ml Date of sample: 10/11/00 Collected by: MEA B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP/Steel Date installed 5/30/00 Tank size 1 , 250 gal Number of Compartments 3 Cleanouts Y Foundation cleanout Y Depression over tank N High water alarm Y Date of pumping New Construction Pumper N/A C. ABSORPTION FIELD DATA Date installed 5/26/00 Soil rating (g.p.d./ft2 orft2/bdrm) 2 System type Bottomless Sand Filter Length 30 ft Width 12 ft Gravel below pipe .5 ft Total depth _1-5 5 ft Effective absorption area 3 6 0 ft2 Monitoring tube_y Depression over field N Date of adequacy test New Const. Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in Water added gal New depth in. Elapsed Time: min Final fluid depth in Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date N/A 72-026 (Rev. 01/00)' D. LIFT STATION Date installed 5/30/00 Size in gallons 250 Manhole/Access Y "Pump on" level at 42" in "Pump off" level at 42 in High water alarm level at 44 in Datum Bottom Tank Cycles tested New Const. Meets alarm & circuit requirements_'_. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot >100' On adjacent lots >100' Absorption field on lot >100' On adjacent lots >100' Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >251 Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >51 Property line > 5, Absorption field >5' Water main N/A Water service line > 10 Surface water > 10 0, Drainage >100' Wells on adjacent lots > 10 0' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line > 10 1 Building foundation >10' Water main N/A Water Service line >10' Surface water >100' Driveway, parking/vehicle storage_ )' Curtain drain >20' Wells on adjacent lots >1001 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.` r Engineer's Printed Name Michael E. Anderson, P. E. Date 10/17/00 HAA Fee $ 3Q"0 ' �-y Date of Payment Receipt Number 1nY2 72-026 (Rev. 01/00)' Waiver Fee $ Date of Payment Receipt Number