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HomeMy WebLinkAboutGREAT LAND ESTATES #3 BLK 4 LT 2Greatiand Estates #3 Block 4 Lot 2 #051-133-16 MW Municipality of AnchorageFF Sage 91 2013 of31 On -Site Water and Wastewater Program • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131275 PID Number: 051-133-16 Dwelling: W Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New Wta Upgrade Name: ADAM HAYS ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 19730 UPPER GREATLAND DR CHUGIAK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original gradeGravel Ft. depth beneath pipe FL Subdivision Block Lot GREAT LAND ESTATES #3 4 2 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES TO Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Fly Ft. Well 100'+ 25'+ TANK M Septic ElS.T.E.P. [I Holding [I Other Manufacturer ANCHORAGE TANK Capacity 1250 Gal. Surface water100'+ Material Number of compartments Lot Line 5'+ STEEL 2 NA Foundation5'+ LIFT STATION Manufacturer Capacity Gal. Curtain Drain N.C. Remarks EXISTING SEPTIC TANK Pump on level at in. Pump off level at in. High water alarm at in. ABANDONED PER MOA REQUIREMENTS Pump make and model Electrical Inspections performed by PIPE MATERIAL Housetotank 3034 raankto drainfield 3034 Installer DEAN CONSTRUCTION Drainfield CO/MT Inspector ANSON MOXNESS BENCH MARK (Assumed elevation) 100 ft Inspection 1r 8/20/13 Location and description 2�a 3'" 4.h BOTTOM SIDING NORTH CORNER COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date �� O .. A...40 111 i A,�" • . �� 1r spURKLAND;t�w, � 11 00 ADDroved �• ° Date Inspection Report9-1-12.doc GREA T LAND ES TA TES #:,3,� BLOCK 4 \ / cor z � LY \ / \ \ / ABANDONED IXIST/NC �i \\/ � \ SEPTIC TANK PER MOA \ \ CODE RfOUIR£MENTS \ � \ 1 \ x \ 100' STREAM \ \ \ OFFSET —► a SW/NG TIES A 8 \ f:C.O. C 9' 25' S.T. C.O. D 21.5' 40.5' \ \ Sr C.O. E 29' 45' DBL C.O. F 31.5' 45' R5 0 25 50 75 100 125 150 SCALE., I' = 50 FT NOTE. THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. DOUBLE CLEAM 100' WELL RADW 0 CONNECTED r0 1250 GALLON SEPTIC TANK EXIST BRAINFI£LD BENCH MARK BOTTOM SIDING NORTH CO ASSUMED ELEVAOON 100 FEET FOUNDATION CLEANOUT SPURKLAND ENGINEERING I I GREAT LAND ESTATES 13 BLK 4 LT 2 SEPTIC SYSTEM ASBUILT 203 W 151H. AVENUE ANCH. AK. 99501 ADAM NAYS DATE OCT 11 2013 (907) 279-3916 11 19730 UPPER GREATIAND OR, CHUG/MK AK 99567 SHEET. VI GRID. NW1260 PERMIT # OSP 131275 PID # 050-501-29 GRE4TL4NDESTATES#3B4L2-ASB.DWG On -Site Wastewater Disposal System Permit Permit Number: OSP131275 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Tax Code Number: 05113316000 Work Type: Septic Permit Effective Dates: August 14, 2013 to August 14, 2014 Design Engineer: SPURKLAND ENGINEERIt Subdivision: GREAT LAND ESTATES #3 Site Legal Address: GREAT LAND ESTATES #3 BLK 4 LT 2 G:1260 s-iot-I3 ( 2. oo Owner/Address: HAYS ADAM MICHAEL & RAYMOND KIMBERLY 19730 UPPER GREATLAND DR CHUGIAKAK 995676324 Site Mailing Address: 19730 UPPER GREATLAND DR, Chugiak This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy Lot Size in Sq Ft: 72310 Total Bedrooms: 4 N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received B Issued By: MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Waer & Wastewater Program � .lav ON-SITE SEWER/WELL PERMIT APPLICATION �_aroe l 1.D 9 OcJ — ✓ 1 Y� Property owner(s) ADAM HAYS Day phone 223-2406 Mailing address Site address 19730 UPPER GREAT LAND DR., CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) GREAT LAND ESTATES #3 BLK 4 LT 2 Legal description (Township, Range & Section) Lot Size Sq. Ft. APPLICATION IS FOR: (® all that apply) Absorption Field Septic Tank velty Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 4 APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) 0 (w/wo ADU) Upgrade 0 Duplex (D) E]Renewal ❑ Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: NONE Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. &V owner or Permit/Rush Fees: c9-00— 1dD'L_ h Date of Payment: ( 11{ l l 3 G� Receipt Number: Oq1� 3 Permit No. OS71'J 1a`15� Permit App_9-1-12.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. i &_Ak Spa Haimd Ergo as ong Environmental Consulting and Design August 13, 2013 Municipality of Anchorage Development Services Department Building Services Division On-site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Subject: SEPTIC TANK PERMIT APPLICATION Great Land Estates #3 B4 L2 Ladies and Gentlemen: We are submitting an application to upgrade the septic tank for this lot. The existing septic tank serving the above referenced has been compromised and the owner would like to replace it. The submittal consists of one (1) drawing showing the present improvements on the lot and the proposed improvements of the lot, of which only the septic tank is subject to this permit application. The installation of this septic tank will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses within 100 feet of the proposed septic tank location. The proposed septic tank will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or are in need of additional information please contact me at 279-3916. Sincerely, L��pS' urkiand, P.E. 203 West 15`h Avenue Suite 202, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (467) 276-6013, SpurklandEng@gci.net GREAT LAND ESTATES #� I BLOCK 4 / INSTALL N£W 1250 GALLON STEL SEPTIC 1 �T \ LOT 2 CONNECT TO DRMN PTLD 1 \ / ABANDON PER MOA \V \ SEPTIC TANK PER MOA 1 MOVE TANK OUSIVE 0 1 \ CODE REOUIR£MENTS 1 100' WELL RADIUS & \ v \ \ 100' FROM STREAM v \ c� \\ x \ lO, � STREAM _ 1 INSULATE LLN£ UNDER DRIVEWAY 1 \ \ \ \� 25 0 25 50 75 100 125 150 SCALE., 1' = 50 FT. NOTE: THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC LOCATIONS TAKEN fROM ON—SITE WATER AND WASTE WATER DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE APPROXIMATE. DLN/axE 4 FEET COVER CLEANOUTS FOLMIDATION CLEANOUT CIINNECT£D TO 1250 6ALLIIN SEPTIC TANK EXIST GRAINFIELD I31-UMALANU L:INUMMIlN(i( GREAT LAND ESTATES 13 BU 4 LT 2 (I SEPTIC SYSTEM 203 W 15TH. AV£NU£ ANCH. AK. 99501 ADAM HAYS DATE' AUGUST 13 2013 (907) 279-3916 19730 UPPER GREATLAND DR. CHUO/AK AK 99567 SHEET: 7/1 UK/d: NWI-760 PERMIT # USP 111XXXX Pilo # 050-501-29 6REATLANDESTATES#3B4L2,DV6 ` MUNICIPALITY OF ANCHORAGE f' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ® ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME_M d ,(/�,�� (//J� d�iA �I`ax� CX< PHONE ��i"��45� Lf4(EW ❑UPGRADE MAILING ADDRESS �f _ LEGAL DESCRIPTION i L LOCATION NO. OF BEDROOMS Uy DISTANCE TO: Well > Absorption area Dwelling PERMIT NO. PZ Z LU Manufacturer Material No. of compartments I.- y Lie. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. - _jaZ = Z < Manufacturer Material Liquid capacity in gallons a j= Lu DISTANCE TO: Wel�of Foundation Nearest lot line PERMIT NO. Jw Z — Z w No. of lines Lenline Total length of lines Trench wh i t 0 inches Distance between lines ~ H a Top of tile to finish grade j DIL Material beneath tile 1 des Total effective absorption area Lu Length Width Depth PERMIT NO. C9 6 F Lu Type of crib Crib diameter Crib depth Total effective absorption area Lu rn DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER q i PIPE MATERIALS U3®-34- SOIL TEST RATING r too ~- ism i -`f INSTALLER REMARKS I APPROVED ATE LEGAL 72-013 (Rev. 3/78) M -W DRILLING, Inc. P.O. Box 10.378 • 10300 Old Seward Highway (907) 349.8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner l'c'7C i,., Use of We11C`i' Location (address of: Township, Range, Section, if known; or distance main road 7_c�t 2 B'[odk 4. [;lxa t: iUmad T'Ar'aLr�ls 1 feet Cased to ) ° I feet Size of casing () Depth of Hole "'I Static water level 6 + ft. (abode) (below) land surface. Finish of well (check one) open end Screen ( ); Perforated Describe screen or perforation Nrinn Well pumping test at— 10 gallons per (htlut). (minute) for 1 hours with of drawdown from static level Date of completion 7v'.17� kip 19,33- WELL 9dsWELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness TO 4 mn _11 11 TO28 „--„ 2 TO /_14 Silty p `ma S ldy Mave 74 TO TO- TO- TO- 0- --TO- TO- TOTOOTOTO TO- TO @Ft°le N_. .:. Certi4idat@ i3d§. 5344 &i §72 3—CONTRACTOR 3—CONTRACTOR E•' r DEPART[IENdT OF HEALTH AND E'r-l•.J IRC iNdl''IENdTFiL F'I ..C-iTEi 7'IOpd 25 L.,' STREET, ANCHORAGE, AK 99501 , 264-4 720 PERMIT NO. 8_3'057.-L, APPLICANT HARP LOU STORLE = -= LOCATION GREATLAN D d _ _ LEGAL L 2 B 4 GREATLAN D EST. LOT SIZE 6}i._il�ii� 0 SQUARE FEET TYPE OF SOIL ABSORPTION) _YSTEN'1 IS: DRAINaFIELD MAXIMUM NUMBER OF BEDROOMS _ 4 SOIL RATING (SQ F T/BR) = 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM I S : THE LENGTH D I N'IEN•dS• I ONd IS THE LENGTH (IN FEET) OF THE TRENCH OR C: -RA I NdF I ELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEENd 'THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THE GRAVEL DEPTH IS THE IlINdIllUVl DEPTH OF GRAVEL BETWEEN THE OUTFALL F'IF'E AND THE BOTTOM OF THE EXCAVATION•d (IN FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO IN•aFORfl THIS DEPARTMENT DURING .THE INSTALLATION IN SPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY ANdCI THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. — — — e I sYe a== __a I I"-1 F" � C _I I e=e P -.I � lam= � F._ I✓. e_! U I F° � a — — BACKFILLING OF ANY SYSTEM WITHOUT FINAL INdSPEi_TIONd AND AF'F'1=?OVAL B THI_• DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DI_,TAN CE BETWEEN A WELL ANE, ANY ON -d --ITE SEWAGE DISPOSAL SYSTEM I' . 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. N'1 I Nd I MUM DISTANCE FR011 H PRIVATE WELL TO A PRIVATE SEWER LINE I S LC FEET AND TO A COMMUNITY SEWER LINE I S 75 FEET. WELL LOGS ARE REQUIRED FIND N'iusT BE RETURNEE, TO THE DEPARTMENT WITHIN 230 DAYS OF THE WELL COMPLE.T I i_IN•J. OTHER REQUIREHENdTS 11AY APPL'r'. SPEC:IFIi=ATIONS AND CONSTRUCTION DIAGRAI'lS ARE AVAILABLE TO INSURE PRC+PER INSTALLATION. F" E=— F1'l 1E T' EE . ---C F=" 1E F--! EE'—=. Ue I= C- E: I -°l E. �' Imo: _. --L -'`Fl . _- I i=ERTIFY THAT i: I Alii FAM I t_ I AR WITH 'THE REC!U I REN'IENdT_• FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. RAGE. _: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. _: I UNDERSTAND THAT THE L --SITE SEWER SY TENT MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELEC , TO INCLUDE MORE THAN 4 BEDROOMS. SiGNdED : ADPL I CAN1T hl F:4' L}r—iLE — TORLE `_— ISSUED BY___ toi � ac ;•`4. 0 g.t_ is'va; ccs<'_ {t -'s' , iLT"ri RNIC .3 9 y i d f f�� i J I�i!'ii✓-(�il.•Y- r!!.�r, 19K. ? 3 O _t 33C 3 flfl% 111014 if fqp--;;:y s_ i;,k� •�; FCDRLE ' 3 3--3 s s„ � ¢ ''__ L FD r; S;m:-,aT!:.;•it`'T!-' �.ui. LY SIZE49000 4�iy;{5.,�, s'; TYPE— _I1-}Y'F_`l m Ci a€�!}±e 1C. f'ir 1IYF 030}'/e��1'.t?= -=='l ±,. 17jopkjIfyip StIvul OF T14E SGft- ±i=°a+ 'i s'raY.�FFO. j I'5. R-1;= LENGTH E7 t P'I``W51 t)'N i'� j,H—: L.�' N61fi-# ( i i'i FFE r> !`Ir= 144-,- j r'�-,'ieilCH OR. Df'�'i`f I�'tt � O -O. Csir HOF e,! T Pc?'#t_ H rjR, p t r i -a M 7— D I `i 3tiii!_:i BETIVEN THO 1j1:'p��CE OF THE _� 9 -$ � = f ` ... YA £ F—I W 1 CI 16 ! y . two go) Of f a ES � rs ,, �a pp j��1 = .I y 1a 7.+ C 7 7 -IF �€ 'Ra 'i t-, E1 11��� 04 TPC CUMALL ALL P Ii E 1. -tom. G + V i L DEPTH a `., THE! F esE! p= i_ x ,,• : i ,1 i 1 .7 t: YJ W' ; , s , i ift, , EI)rj k?f'qu ,!ppp! )vpL e€a ! PI a }•f _ i -'l -lf�! j NRL. !. r y 1 i #t t -- -•.0 t 'j_ _`�`% t t WELL AND i'tI 3 3C -44-51N �'' '��`?!~' � F_'- i a !� a R J I!s S rC 1 [ `5 •i F_kt l L i� i i'S7 j!� i 21 L €'�.^_+s. i A WE- r a.Y.SJ .r'e�t i -OR A a'`hIVATE: H LL 13FZ, 'l 1,91 V31 ..1191 ��±� i ROM A 3'ti!i5L C )=,�'i_L DEPEt'3f.>1��t� TYPE PE O f'i_Ib L i i= WaLL . i n PRIVATE SEWER LINE � 5 Of FEET AND '^t{' ER !__ (Nb 4:5 :=fir Fz=,1_€ t� !_3 xF i"� MUST :7' �:t RE`3', RNEC� i € s I'�i ru Ci : �,"-moi'. ft•± I4I i•I I i 1 : N ?1_s frx-I , S :=;T,-,•L;� s�t�i:{1II;�t _il�,t � :'1:xr =i, -�i�_!_�II L•_,,ii•�%�`.2 FIt•fC) CONSTRUCTEON DIi-t..iRAi'1S AME: #`"€.= Ia'3'�:. n?t_ `r'' iJr fN-: ?;4LLa'<iT1i3JN,. TO ENFOc l i TH -15EPPIR I'MIE T CUR i Nef HE ART '. F1-= S; } 's i�rr ; 3's- `,' t tr US ii �..f�i i_t"': r - ., }J F i I'=, i�7�}�}''t RTY RHO�i'Fi� E± i;: R iC"yENCE'� r; Fif !%H� t'4�±_}_ ii ILL 'SEf-,VE. I;7i"N 11 �JCVDR ii NS• YJ W' ; , s , i ift, , EI)rj k?f'qu ,!ppp! )vpL e€a ! PI a }•f _ i -'l -lf�! j NRL. !. r y 1 i #t t -- -•.0 t 'j_ _`�`% t t WELL AND i'tI 3 3C -44-51N �'' '��`?!~' � F_'- i a !� a R J I!s S rC 1 [ `5 •i F_kt l L i� i i'S7 j!� i 21 L €'�.^_+s. i A WE- r a.Y.SJ .r'e�t i -OR A a'`hIVATE: H LL 13FZ, 'l 1,91 V31 ..1191 ��±� i ROM A 3'ti!i5L C )=,�'i_L DEPEt'3f.>1��t� TYPE PE O f'i_Ib L i i= WaLL . i n PRIVATE SEWER LINE � 5 Of FEET AND '^t{' ER !__ (Nb 4:5 :=fir Fz=,1_€ t� !_3 xF i"� MUST :7' �:t RE`3', RNEC� i € s I'�i ru Ci : �,"-moi'. ft•± I4I i•I I i 1 : N ?1_s frx-I , S :=;T,-,•L;� s�t�i:{1II;�t _il�,t � :'1:xr =i, -�i�_!_�II L•_,,ii•�%�`.2 FIt•fC) CONSTRUCTEON DIi-t..iRAi'1S AME: #`"€.= Ia'3'�:. n?t_ `r'' iJr fN-: ?;4LLa'<iT1i3JN,. ?. . L fii'i 1`} i`•k a.. { ! F i to r., , 1 iAe Ra!! ! { Id CeIY1EN 9 ..i FOR CM -SITE SCIWER3 ! TNO WELLS RS ART H t HE = t JN <C s,-, t._ I . Y J: FORTH ' H!�E_'S fflk {'= IN i4i . _i : F3DERST-f INO MIT HE ON--' 1•� r u;F e ;'�Sr±�Ii It ` k O��r� _ 5't_i.a:=NP,-'E Ise R �'i3v{i.z'LGO TIO L �a�!.t' 110E -- I;7i"N 11 �JCVDR ii NS• A2- ------------- Sim 1 = { MUNICIPALITY OF ANCHORAGE f DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 'YJ PERCOLATION ��. •�' TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 • SOILS LOG — PERCOLATION TEST 'PERFORMED FOR:' Imo?- r� '�•"�e �.i _ DATE PERFORMED: 4' / LEGAL DESCRIPTION: / r ----d SLOPE S l f.�,,p A N 1• 2 3• 4- 5 . -5. 6- 7 8 9- 10- 11 . 12• 13- 14- iJ - 16- TE 20 - I I I I COMMENTS - PERFORMED BY 72-008 (6/79) /dv .0/,J4. WAS GROUND WATER ENCOUNTERED? Y L O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop and A;d hat rSe T1tu�.yA -fl-e hd�. �..us - le(- PERCOLATION RATE 6/22/83 hole was pu�S walk o- bacWtoP- year tkcS tY and A;d hat rSe T1tu�.yA -fl-e hd�. �..us - le(- ... (minutes/inch) ItoTe-"1/a ' waS ento hler�a a} j2- FeLl n_�� n t,. ALASKA IMIRMRTAL COnTROL SNU OS, Inc. Engineering & 6nuironmental Studies June 8, 1983 Mr. Bob Pratt Department of Health & Environmental Protection 825 L. Street Anchorage, Alaska 99501 Dear Bob: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH 2, ENVIRONMENTAL PROTECTION RECEIVED I have reviewed the August 1981 soils test on Lot 2, Block 4, Greatland Estates. The soils test was done with a backhoe and would reflect the normal high water level of 9 feet. Peter's Creek located 135 feet away would be running at it's near peak flow at this time and may have influenced the groundwater level. I believe a septic set at 5 feet below ground level would maintain the 4 foot separation. I recommend a bed or a shallow 5 foot wide drainfield for this lot. Recommended sizes for a 3 or 4 bedroom home are shown below. Bedrooms Bed � � 15' x 30' 17' x 35' 5 wide (6 inches gravel) 60 ft. 80 ft. If you have any questions please let me know. Sincerely, Leroy C. R id Jr., P , PE President 1200 West 33rd Auenue, Suite B • Anchorage, Alaska 99503 • (907) 276-1361 N Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-133-16 1. GENERAL INFORMATION Complete legal descripti Location (site address) I Expiration Date:/ D v 1-5- / 4 J Current Property owner(s) Mailing address Real Estate Agent Day phone 223-2406 Hope Russo Day phone 301-0701 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class C Well Public Water System 8 UE U TTA N IL 09 9014 TYPE OF WASTEWATER DISPOSAL: ® Individual ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ Received by c ._ ' "y �y� Date: r COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ JAZ% Date of Payment -7 lei lo Receipt Number 0155 Date of Payment Receipt Number. COSA# 05C.MI3V) Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 7/9120146- /9 20146. 6.DSD SIGNATURE eee a •e System #1 Approved for bedrooms. ' System #2 Approved for bedrooms- Disapproved. Conditional approval for bedrooms, with the following stipulations: By: �i%J. Original Certificate Date: The Municipality o nchorage Devlopment 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 Well Flow Advisory COSA blue sheet 9-1-12.d.c Arsenic Advisory Other If more than 1 septic system is on the lot: . COSA Checklist # _of _ Structure served by this system Certificate of on -Site Systems Approval Checklist Legal Description: Parcel ID: f)5/- /33— /e A. WELL DATA Well type �_ If A, B, or C provide PWSID # Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N)_ Total depth �/ ft. Cased to tcj ?ft. Casing height (above ground) /a in. FROM WELL LOG AT INSPECTION Date of test �3 7 Static water level 153 ft Well production Q g.p.m. S g.p.m. WATER SAMPLE RESULTS: Coliform —0--colonies/1 00 mL Nitrate mg/L Arsenic Q, ? 38 ug/L Date of sample: Collected by: v, B. SEPTIC/HOLDING TANK DATA Tank Type/Material--S E 111d 3 T EEL Date installed 2a Tank size /0'F0 gal. Number of Compartments Z Cleanouts (Y/N) y Foundation cleanout (Y/N)T Y Depression over tank (Y/N) /V High water alarm (Y/N) N Date of pumping 1P Pumper xr 7-JdK 4eSS THAW /_r e rx-fj C. ABSORPTION FIELD DATA Date installed;ZFI.? Soil rating (g.p.d./ft'. or 0bdrm) /Od—/SO System type S 01 ! REAJC' ff Length 3 ft, Width 5 ft. Gravel below pipe ft. Total depth 5 ft. Eff. absorption area2d 5fe Monitoring tube�/ Depression over field Al Date of adequacy test 7 i Results (Pass/Fail) $J T For bedrooms Fluid depth in absorption field before test —_ in. Water added 4 tQO gal. New depth 3 in. Elapsed Time: min. Final fluid depth Z3 in. Absorption rate >= 46_ g.p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) gA114 If yes, give date D. LIFT STATION /�-4 Date installed Size in gallons Manhole/Access (YIN) _ "Pump on" level at in. "Pump ofr level at in. High water alarm level at Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: / Septic tank/lift station on lot Absorption field on lot / 0 0 Public sewer main Nfi' Sewer /septic service line 05 /t Animal containment areas 50 rt i On adjacent lots On adjacent lots / 00 � f Public sewer manhole/cleanout AIA in. Holding tank 1J,' Manure/animal excrete storage areas U o f SEPTIC/HOLDING TANK ON LOT TO: Building foundation s r'f Property line _Ce,lf Absorption field J� r Water main AZ4 Water service line //J f Surface water /OD (— Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line 161-1-- Building foundation /D f Water main Water Service line O ';0' Surface water .4- Driveway, parking/vehicle storage Curtain drain &4VK Wells on adjacent lots � �y 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 COSA guidelines in effect on this date. Engineer's Printed Name S % �� /51V6 Date % 141 COSA brown sheet_10-10-12.doc Via; ,a o��. E _•,., . 0A .B§ S ACV♦ 4y Steven � � 6 PE .5 n ppp ,nr �� Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. /33- //r COSA# 1053i( Expiration Date: '� - a a - 0 1. GENERAL INFORMATION Complete legal description Lot 2; Block 4; Greatland Esttes Subdivision 03 Location (site address) 19730 Upper Greatland or, Current Property owner(s) Ted a Mary Stode Day phone e88-2276 Mailing address PO Box 672122 Chuglak. AK 99567 Lending agency Day phone Mailing address Real Estate Agent Nancy Stahley/ King's Real Estate Day phone 686-2276 Mailing Address 22700 Lakehill Dr. Chugiak, AK 99567 Unless otherwise requested, COSA will be held by DSD forpickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site El Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System Q Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system Is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. Name of Firm S a s Eng(neeimg Address 15861 S. Birchwood Lp. Ch giak AI 9 67 Engineer's Printed Name / 5. DSD SIGNATURE _eff� Approved for _L7L bedrooms. Disapproved. Phone 6942979 Date Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist _X_ Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: {� Original Certificate Date: — .2 — 0 7 (Rw 11)05) d{. Municipality of Anchorage Development Services Department Building Safety Division -- - __,©n-Stte+Alatar & WBsCeiNate,`i'rogram 4700 Bragaw Street P.O. Box 190550 Anchorage, AK 99519550 www.muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST 1l�' � _____ #�3 Legal Description: Lo 2j3u>L'>L_ i ln�F+¢7" mz &V fg Pend ID:CAr/— / 3 3-L& A. WELnLWell IUIE Date completed A Total depth±� ft. If A, B, or C provide PWSID # = Sanitary sea((g I) Cased to , �ft. FROM WELL LOG Date of test #2 1 16 S-3 r Stats water level (04 ft. Well production 11) g.p.m. WATER SAM_PE RESULTS: Colifo.... C colonies/100mL Nitrate 111 mgll Arsenic: _NLD mgn Date of sample: �lb 7 Well Loi;�(O�`�Nl)� Wires Properly wotete,( h) qVS Casing height (above ground) 1 Z in. AT INSPECTION J©O(p td '� I ft. x4*3 g.p.m. Other bacteria 0 colonies/100 mL Corrected by: '54- S C"fil 7�Q1K1f+ B. SEPTICIHOLDING TANK DATA Tank Type/Material f C z g"('mc Date installed -7/7, Eli?) 3 Tank size 1.4 gat. `, Number of Compartments Clearwuta0t) ` VS iE6 Depression over tank High water alarm 0 Founda0on deanout ),_ P iY� �9 (Y�� Date of pumptng �� PumpertS �U►rtpl ►Ufs C. ABSORPTION ATA Date installed ?j Son rating (g.p.dJfe rod System type S - to I DE Length 8-b ft. Width ft. Gravel below pipe 3 ft. Total depth 5 ft. Eff. absorption area &q fe Monitoring tube f r_�� Depression over field Ab Date of adequacy test � Res (Pas ad; For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. r Elapsed Time: q min. Final fluid depth Q in. 1 t Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (-0 type) N O If yes, give date D. LIFT STATION U/I, Date installed -- - - Size in gallons 'Pump on' level at _ in. 'Pump off" lel DatumCycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic lank/lift station on lot-98, ot-98 -g I " Absorption field on lot IM -t- Public Public sewer main Rif Sewer /septic service line OS I+ Animal containment areas '50 + •.. ; ManholefAeoess (WN) at Masts alarm & circuit requirements? I On adjacent lots On adjacent lots foo f Public sewer mantwle/deanout A Holding tank 411 1 Mamlrefanimal excrete storage areas foC7 rt SEPARATION DISTANCES FROM SEPTIC/MOLDING TANK ON LOT TO: Building foundation Property lined Absorption field QS f Water main Water service line 0 ft Surface water Wells on adjacent lots in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line l0 t F Building foundation tD +_ Water main _ i la Water Service line Surface water Driveway, parkirgfvshicle storage f0 fit' 1 Curtain drain EJC'P* Wells on adjacent lots 100 + F. COMMENTS ;�Weu;42iJStu 520tyJ4 Lu ltitr<�ti G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and FIs nU�WA review of Municipal records above syste s are inconformance with MOA CO gu' fine in Ile this 117 Engineers Printed Name Date o COSA Fee $ L Date of Payment ?C! 0 T Receipt Number. (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SCS ReLN 1073942001 Client Name S & S Engineering Project Name/a L2 D4 Greatland Est 03 Client Sample ID L2 E4 Grealland Est #3 Matrix Drinking Water PWSID 0 Sample Remarks: All Dates/Times are Alaska Standard Time Printed Date/time 08/15/2007 16:26 Collected Date/I7me 08/06/2007 13:10 Received Dale/time 08/06/2007 16:40 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date lnil metals by SCP/MS Amcnic ND 5.00 ug/L EP200.8 C (<10) 08/13/07 08/15/07 Mil Haters Department Total Nitratc/Nitrite-N 1.39 0.100 Microbiology Laboratory Total Colirorm 0 mg/L SM2045DONO3-F D WO) col/IOOmL SM209222B A (<I) 08/09/07 JDS 08/06/07 SDP Time APPLIG, IT FILLS OUT UPPER HAC ONLY Pro - rty Oainer Time —� Phone r ., Date Date Mailing Address�.r i� - Zip Code Buyer Inspector Address L. l r / / Zip Code Field Notes: (C C..se.nn"pp - Phone Lending Institution , - � s - h1 a o• �����Y���^^^^� ` DEPT. OF HEF,LTti & L^ Address - ' Zip Code - ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVA -- A -- ' ( ) DISAPPROVED Phone Realty Co. & Agent ( ) CONDITIONAL APPROVAL' Address Zip Code LAD TZN BY: Soils Rating Legal Description �= 'zj ; ,( i` 211 Well Log Received _ Street Location p /c�a -) ^ Z. 2 —0 -3 Well to Tank CJ S I Type of Residence Single Family .: Multiple Family No. of Bedrooms ❑ Other Water Supply ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. P Individual 6 Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal Individual Year Individual Installed: Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time —� Date Date Date Date Inspector Inspector Inspector Inspector ' Field Notes: (C C..se.nn"pp MUNICIPALITY OF ANCHORAGE h1 a o• �����Y���^^^^� ` DEPT. OF HEF,LTti & L^ ENVIRONM.'NTAL PROTECTION ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVA -- A -- ' ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE ' `-83 LAD TZN BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received _ Septic Tank Size p /c�a -) ^ Z. 2 —0 -3 Well to Tank CJ S I 72-023(3182) PC P