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HomeMy WebLinkAboutDUKE & DUCHESS BLK 1 LT 1Onsite File DukefT Aft� Aft D.,chess oc k t · IdUnlclpaltt? bi Altchotage .age bEPAI:iTMENT oF HEALTH AND HUMAN SERVICES E~JVIRO~IMEI',JTAL SERVIcEs DIVISION P.O. IBox '1966~50 ~ AhChorage, Ala§ka 995J9-6650 ~ Telephone: 343-4744 OH-Stt~ Waslewale~ Ub~osal 9ysle~ and/or Well Inspection Report Petrol{ ~umbe?: 5~000 ~ PlO Number: "-': ~nn ~ IA~9~5 Waslewaler System: ~New D Upgrade Add~ess: Po gox ~1 qTI E~l~:v~ 5AK ~77 ABSORPTION FIELD Phone: No. el Bed~ms:~ ~ beep Trench ~Shallow Trench ~ Bed ~ Mound ~ Other LEGAL ~EsChlhTION-,,..,..~- ..,,. ~5,,. ti. ~ GPMiupS.'.,: ri. ri. TANK SEPARATION DISTANCES ~s...~ a,o~,,.~ a s.~.~... *."~1~' I~'-- --~S~""""": HbPE .~m~..o, co.,.,,..,.~ 8url~ce w,,., I~ lO0; - ~ LI~ STATION Curlaht Remarks: BENCH MARK .:::;c OF ~,.~.. Ih~ebtl~nS ~etfotmed ~y:~.~. m.....~..~. ~ DateS: lsl I .evlewed and ~pptbved by: /~Z bale:. PERMIT NO. SW000494 PAGE 2 OF 5 Municip. o[1t: oF Anchor'gg.e. DEPARTivlENT OF HEAl. TH AND HUFIAN SERVICES ENVIRONMENTAL SERVICES DIVISION · P.a. Box 196630 ~_Ancho~o, ge, Aloska 99519-6650 · Teleoho~e: 343-4744 ON-SITE WASTEWATER UISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 1~ BLOCK 1~ DUKE & DUTCHESS S/D P.I.D. NO. 051--221--19 UNSUBDI VIDED '" A Area dedicated /' , / / -- .-----~F to Munlc;pality /' ,N-4,~,(/. ~ / 10' X 20' L.e.~.~~' of Anchorage /, ~)N-.~,' ~ ~ ANCHOR PP L__ (M.O.A.) for /' O~~ /~ EASEMENT 2 L ~ I I ~ ~'~;~, · ..':~ ~ PERMIT NO. SW000494 PAGE Municipa[it: oF' .A.n_c h.o.r- 9 D e' DEPARTMENT OF HEA~THAND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.H. Box 196650 eAnchoecge, A,!osk~ 99519-6650eTeJephone: 343-4744 ON-SITE .WASTEWATER DISPOSAL ~SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 1, BLOCK 1, DUKE & DUTCHESS S/D P.I.D. NO. 051--221--19 FINAL ST1 ST2 /- 97.9' 8,~ NEW 1000 OALLON 95. POLYETHYLENEx_ 9,5.5' SEPTIC TANK C01 C02 /~C01 = 95.7' C02 = 96.2' _ ,~,,-'-FINAL GRADE ........... .,/2" INSULATION [~-J~C01 = 92.1' , C02 = 92.1' %"-MT1 -- 89.0' · WATER FOUND © 81.0' B.O.H. A B IFCO 2.0' 26.0' ST1 12.0' ,30.0' ST2 15.0' ,.31.5' DBL1 17.0' ,32.5' DBL2 18.0' 3.5.0' C01 59.5' 66.0' MT1 100.0' 102.5' C02 10,3.0' 105.5' 82.5' 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 PERMIT Initial Date Issued: Nov 30, 2000 Expiration Date: Nov 30, 2001 Permit Number: SW000494 Legal Description: T15N RIW SEC 17 NE4SE4SE4 Design Engineer:. 0003 S & S Engineering Owner Name: Dan Claugus Owner Address: PO Box 771971 Eagle River, AK 99577- J~)1,(.C/1~55 Parcel ID: 051-221-19 'Site Address: 018232 BENDING BIRCH DR Lot Size: 435600 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] PdvateWell [] Water Storage Ail 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 ( 18MC80 ). 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. Received By: Issued By: Date: Date: il° 30"O O ROBERT C. COWAN, P.E. September 14, 2000 CMLENGINEERS (907) 694-2979 FAX (907) 694-121 MUNICIPALITY OF ANCHORAGE DeparUncnt of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot l, Block 1, Duke & Duchess S/D It is requested that you issue a permit to install a proposed septic system to serve the three bedroom dwelling on the referenced property. Three tests holes were excavated and pcmolation tests were performed. The approximate location of the test holes are located on the attached site plan. At the time of excavation 8/2 Il00 water was not found. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The conslmction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/jhm Enclosure 17034 NORTH EAGLE RNER LOOP * SUITE 204 · EAGLE RIVER, ALASKA 00577 Area dedicated to Municipality of Anchorage (M.O.A.) for snow storage ";" LOT 1, BLOCK 1, J.II.M. [ R.C.C. DESIGN CRITERIA: 3 BDRM = 450 CPD SOILS = 1.2 CPD/SQFT. 450/1.2 = 3'75 SqFT. REQ'D. TRENCH CRITERIA: 6' DEEP 3' EFFECTIVE 5' WIDE 44' LONG ; 'f; DUKE & DUCIIESS S/D 10-3-00 1 OF 1 STRUCTURES. EASEME~. OR ENCROACHMENTS SHOWN ON THIS SIT--, PEAN ARE AB SHOWN ON AN AS-BUILT SURVEY DRAWN BY: WILLIAM D. FLEMING IT IS THE RE~PONSIBILTY OF THE CONTRACTOR TO VERIFY EASEMENTS, REQUIRED SEPARATION DISTANCES. AND PROPERTY LINES PRIOR TO CONSTRUCTION. NEW 1000 GALLON NE SEPTIC TANK 10' X 20' ANCHOR EASEMENT PP-L P A TH#2 CONTRACTOR IS REQUIRED TO OBTAIN UTIliTY LOCATES PRIOR TO ANY EXCAVATION WORK. ;O TRENCH"'~ ALL PORTIONS OF SYSTEM WITH LESS THAN 3.5' OF COVER REQUIRE INSULATION, t IRCH DtP, IVp 7 8 9. II 12 13 14 16 16 17 18 19 20 COMMEIIIS ~,,,,,..,,, o~ ~,,~,o,.,. I~:~;-> .~ ~'.~!.!~.,. [)EPAI'ITMENT OF IIEALlll & IIUUAIt SERVICES J ~"~/' ~ e.t_ ~ ~', '%."~. ~ 825 "L" Slteel, A,chorage, Alaska 99502-tfl650 I ~,.. L,y../~__~............ I · ~. ?,'. (_.~.~r~Os ~' .. , .., · SLOPE WAS G~OUNI)WA1ER ENCOUNTERED? IF YES. AT WI|AT E)EPTII~ SITE PLAN _-ZZF, ...... /$ ,* I'EIICOLATIO/I tlAIE ~ Immules/mchI I'EflO | IOL E DIAIdE I El! __ 1ESt I1UN I~ET~VEEtJ ~/ Fl AND '~ FI tEGAt. UESCmrlmr~: /-/Z~ / 825 'L" Slreel, Altchoragd, Alaska 99502-0650 SOILS LOG -- ~EflCOLATION TEST o~ 4 5 7 8 9 to II 12- 13--- 14- 16. 17' 19-¸ DQ/~ ~.~ ./~'//~J& Township. Ilange. Secllon: SLOPE ENCOUNTEnED? SITE PLAN I'EI~COLA/IOtl I~A1E __ ImmuleS~mch) I'ERCIIOLE DIANIEIEI! __ · 1ES! rtut,lO?WEtll __ FI AND FI ' DB ' ~ I CERIlFYIlIAI IlII~TES~WASPEIIFOIIMEUlll 17~ C~Ie Klver ~ K~d NO, 2~ ~ , ~/ '/ . ACCO~DAhCE ~F~ ~PAL OUIDELIIIES lit EFFECt 0H 11 lis DALE. DATE; 't//~/O 0 12 008 (Rev. 4/B5) Mmdclpalily OI Ai$chotaoe DEPARTMENT OF IIEALlll & IIUMAN SERVICES 825 'L" Sheel, Ahchoragd, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST P~?.',~ ~ c:, LEGAl. DESCrlIP I ION: I 2 3 6 6- 7' 8- 9- 10- II 13- 14 15 16. 17. 18. 20. SLOPE WAS OROUNI,~ WA! ER ENCOUN1ERSD1 / Deplh Io Waler Afl., ~' SITE PLAN ::izz::-t:: .... · 17034E leRlv. L Ro.d o ACCORDAhCE WIII~._AJJ. q l~kl~ Aho IdtJ,ilg°~P~ OUI~E~LI~I~j Ill EFFEct Old tills DAIE. ~2 IX)8 Cev. 4/85l · J znq 804LTEST ROBERT C. COWAN, P.E. CML ENGINEEP,~ (907) 694-2979 FAX (907) 694-1211 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 1, Block 1, Duke & Duchess Subdivision September 14, 2000 GENERAL: The scope of this project includes the installation of a 1000 gallon Premier polyethylene septic tank and a new trench to serve the three bedroom residence located on the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. Contractors installing wastcwater disposal systems must be certified by the Municipal Health Deparmaent for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifiing of the tank. 17034 NORTH EAGLE RNER LOOP ' SUITE 204 "EAGLE RNER, ALASKA 99577 Page 2 Lot ¶~ Block t~ Duke & Duch®ss September 14, 2000 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet bom the building foundation. In the line between the tank and the leachfield them shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom ofthe excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (rafted-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced doxvnward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion ofthe monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. · Page 3 Lot 1, Block 1, Duke & Duchess $/D September t4, 2000 MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials arc approved for usc in septic system installations in thc Municipality of Anchorage: .Type of Pipe Cast Iron ASTM D3034 (PVC) ASTM FSI0 0tDPE) ASTM D2662 (ABS) perforated Solid Yes Yes Yes Yes Yes No Yes Yes Use ora type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). A permeable nontoxic silt barrier {Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: · °P;ge 4 Lot 1, Block 1, Duke & Duchess 8/D September 14, 2000 The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading ofthe property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance ofthe contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to can'y out the work in accordance with these construction documents. S & S Engineefing's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR / INSTALLER MUNICIPALITY.OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 051-221-52 ANCHORAGE Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: _ (e — t J Complete legal description Duke & Duchess, Block 1, Lot 1 Location (site address) 18251 Bending Birch Drive Chugiak, AK Current property owner(s) Kristiana Rogers Day phone Mailing address P.O. Box 672143 Chugiak, Alaska 99567 Real estate agent Mary Hutchins Day phone 907-775-1711 2. TYPE OF DWELLING: ❑■ 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: Private Well Q 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 $ Waiver Fee $ Date of Payment Date of Payment i Receipt Number COSA # Osc Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone 907-522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 3/5/2020 6. DSD SIGNATURE System #1 Approved for —2— bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: 10 IYO e,� By: 1 tl� d-4—aut-i Original Certificate Date: — tiZ~ZC�l--'— 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 COSA Checklist blue sheet Legal Description: Duke & Duchess, Block 1, Lot 1 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Unknown Total depth 300* ft Cased to 35* ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 37' in. Date of flow test for COSA 3/2/20 Static water level at beginning of test 41.9 ft. Comments *Information from Well Test Data 11/17/2000 B. TANK DATA Age of tank(s) 20 years Tank type/material SEPTIC/PLASTIC Measured operating fluid level in septic tank 42 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 2/24/20 - JRs Pumping Parcel ID: 051-221-52 Structure served by this system Well production at time of test •5 gpm Water storage tank volume 500 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 9.75 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 2/17/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA 5' Wide Trench Which system tested (date installed) 12/11/00 Adequacy test date 2/20/20 ❑ ALL standpipes present per record drawing Results 0 Pass For 3 bedrooms Total measured depth from grade 9 ft (max) Fluid depth prior to test 13 in Measured depth to pipe invert from grade 6 ft (min) Water added 476 gal ❑ N/A — pressurized field New depth 19 in ❑ Monitor tubes go to bottom of effective. If not, state 1440 depth into effective Elapsed time min ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Final fluid depth 12 in Absorption rate '450 gpd Any rejuvenation treatment (past 12 months) None If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0✓ Yes Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft ❑✓ Yes if No Neighboring Tank > 100' F Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No Absorption Field on Lot > 100' 0✓ Yes if No ft Holding Tank > 100' ❑✓ Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Yes if No 0✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0✓ Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ft ft ft ft ft E Yes if No ft Property Line > 5' 0✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0✓ Yes if No ft Private Wells > 100' Yes if No Water Main > 10' ✓0 Yes if No ft Community Wells > 200'✓❑ Yes if No. Water Service Line > 10' 0✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' E✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' 7 Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' 0✓ Yes if No ft Community Wells > 200' 0 Yes if No Surface Water > 100'✓0 Yes if No ft F FN(.INFFR'S rnMMFNTS G. ENGINEER'S CERTIFICATION 1 certify that 1 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. COSA Checklist yellow sheet ® 49th ........................................ MICHAEL E. ANDERSON : CU /1 �AV No. CE -4381 1 �� 1 J' ` 3/6/20 .•`� • �§O; e® +����aesse����•s ft ft ft ri \ z z Lot 9 z PUBLIC USE EASEMENT \ (BK. 2352, PG. 315) \ \ — — — — — — — S 89-57'544\212.39'- -H 9'57'54"E 212.39'+I I o��.. • • ��s4p o 00 0 Tract A0 �I LO OQ: ' Q too N 01 rn 0 I–I N cn a 1 Q10'x20' ANCHOR EASEMENT O 4�p06,�5 :REQv`� � ------ z m ��04000�a V � Y m ON 30' ELECTRIC (L C m o s a EASEMENT Q o x 0 � \ rl C coif 3 mm� m �m E. Bo. (o L 3— .0 70'x11.8' LEAN TO �I m N > r` N T H r y n C CD 8.3'x12.2' SHED \ of Q (D � C i. m C m Q min 16.3'x20.2' SHED Zi p N N U) 1� O m O C v tK- / \ 1 0 ul LO a I� fl p- O a S.2CA " NT o mQ m p o o .. 00 a / SEPTIC PIPES / 2� rn rn ® Lo 0 0. N m m o m `a l 0"a 127.1± 1 r....x•--o . mzmocc �I 'mv WELL I . . F o a m= H m / O- m0 -0 m° m I m s 00 -II C T 0 o s ;E E .0 j m o 2 0. co �I Q) `;N �ccm 1 cL ® UJI p• O OZ V V C i m o ���: , .. '•' m Lot 2 a � "" m U a c m o /n�,, io yv O 1 RE0. TAINING WALLS G o N / U W m to /yI xl U Z0.2'O�0 tl O 3r / 7 m C m T OCL V J V) J co p s3 co m aw:. o aoto �_ 1v0 v N S LD in p 'C 'F: i p I O O TU O 0—yj y —� C Q GATE Lot I rn Emw0_£Co uai0 81,560 S.F. 5' SNOW STORAGE EASEMENT g rnr m'o H m m — — p ', m0 0 i 421:oCL , s m m CD R=225. o m 59 o129.o o N J – Q Ca m n p / W 109.94• cQ '9"�••.• / S 6�. � BENDING BI RSH 00' DRIVE / I I I Nitrate Advisory Certificate of On -Site Systems Approval # OSC2010076 Subdivision: Duke & Duchess, Block: 1, Lot: 1 A water sample revealed a nitrate concentration of 9.75 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. ° € � � Mailing Address P� O Bok 196650 *Anchorage, Alaska 99519 6650 *www mum org From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Well Water Advisory Certificate of On -Site Systems Approval # OSC201076 Subdivision: Duke & Duchess, Block: 1 , Lot: 1 This well's productivity was determined to be .6 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 3 -bedroom residence is . 31 gallons per minute or 150 gallons per day per bedroom. 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 Certificate of On -Site Systems Approval. A x ZOK-s Ma�f�ng Address �P O Box 196650 * anc}iorage, Alaska 99519 6650 *, - muni org Parcel i.D.' 051-221-19; 1. GENERAL INFORMATION Complete legal description Lo t Location (site address or directions) Municipality 9f AncJ orag,e. · DevelopmentServlc~'S Dep~[m~t ". ' .. · 'BudngSafe~D~son' :' '' · , ' "~; ' ,: ~ On-S te Water and Wastewater Program .. " : : ':"(907)~3-79~4'~ "~'" ",'":' '~: '. :~ ~' '~ "' ':~ :',' · CERT FICATE OF H~LTH'AUTHORI~PPROVAL '" - FOR A SING LE FAMILY '": ~ .DWELLING [xpkation Date: Block 1. Duke & Duchess Current Property owner(s) NHN Bendin~ Birch Drive Mailing address Lending agency Dan Claugus Dayphone 694-4540 PO Box 771971, :Eagle.Riv~, AK'99577: Day phor{e - i, ,"! .. . Mailing address Real Estate Agent · Mailing Address Unless othen~ise requested, HAA will be held'by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 Day phone 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding tank Community On-site [] Public Sewer The Municipality of Anchorage Deve!opment Services Department (DSD) 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 AJaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date et 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 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 pr.?fessional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER · As certified by my seal affixed hereto and as of the validation date shown be ow. I verify that my investigation, based on procedures outlined in the Health Auth0rit~,?pprSval GUidelines for this application, shoWs that the on-site water supply and/or wastewater disP~)Sal system Is(ai-e) ~afe. 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 r~y,lnvestlgation and inspection, the on-site water supply and/or wastewater disposals~.~a~j~l~b_r ifi~t~l,'~'?~mpliancel . with'all applicable Municipal and State codes, ordinances, and regulations In effe¢ e,, at[on Eagle Rive% A?aska 9~$77 Name of Firm. Phone ~o fl ¥- ~. Address Engineer's Printed Name Robert C. Cowan~ P.E. Date ,,"-/~ /o I .-c ' · .~.'.;ENGINEER'.~.,~ %~' .'.~' · '::'.:'~ ":' .'- i'.'"-.: -,": ';- '- ' :.. · ,~- ."' ' :/~c2,--~,/'':''' ",~,"~, · - ...................... ;.... ~.. .[ ~ · ,~ ....... · ~ , ,.. . ., ..... ~ .......t.'3~;...c--.~-.-?.~ .. · . - ...... ., ... -, .. a~, ~ t. ~O=.',~! C. COWA ; . . .. . .. ...... o ; · · .... , ... .:- ....... : ~,~,',% ".. ...';.:~, "t,,'~= ' Approved for ' - ~ .... bedrooms.· ...... ' ....... , ~'~','~;;.~;..--..;~:;;;.,,, · . Disapproved. ..,... .... · .. Co;3d'i~i~na, a'ppr~,a, ,o;': ': ' bedrooms, with the following ............. . . · . ......................... ._ . W^$TEW^TER . Add t ona Comme.ts . Note. Thc well [or th~s property meets existing, State and MumcJpa! Codes. There are present. It i~ su_~csted that periodi~ te~tln~o h~, ?orfnrrno~t tn In~t~rO th~ ~.X'_ol_!_~ Cq~t!~!!r, tt Current nitrate concentration is 6.59 mg/l. EPA maximum concentration is 10.0 mgfl. More · in fori~a;.ioi~ oii ,ih a;.r~ i~ a,,,ilablc i'~ om ibc On-$1~c Services i'-rogram, at 343-7904. Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other ,~ ~'r~Ttc. ,,,f./'~/;-~- Original Certificate Date: '~'-' ,~ - ,,O / Municipality of Anchorage Development Services Department Building ,Safety Division On-Site Water & Wastewater Program 4700 Sou~ Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) ~,3-?~04 HEALTH AUTHORITY APPROVAL CHECKLIST Leg'"Desc~ptton:LO~'- / .0'LOCK / ~d~',~ ,~ /)~Tc,V~.~J' ParcellO:O.Y'/~~.~./-/9 WELL DATA weft type P~f/v~rL Date completed ~'/K Total depth 3 00 ft. ff A, D, er C provide PWSID # Sanltery seal (~fN) Cased to ~.=~'.~_ft. FROM WELL LOG Date of test / s, ,c w.terlev,, ., ft. Well production ~,'~/ g.p.m. B4 WATER SAMPLE RESULTS: Coliform @ colonies/100 mi. Nitrate 6,~/ mg./I. Date of sample: ~/~.3 /01 Collected by: SEPTIC/HOLDING TANK DATA Tank Type/Material ~'~ ,~T'~ 4. / H, i). P. ~ Tank size ) 0 o 0 gal. Number of Compartments Foundation cleanout (~rN) ¥ 4 J Depression over tank (Y(~J Date of pumping /v/~t.-' ~,4~ Pumper -- Other bacteria o colonies/100 mi. S l S 1NOINEIRIHO 17034 E~gb Rh~. Loop Resd No. ~ Date ~led I ~/~ / 0 o Claanouts (~/N) Y~- J' High w~ter alarm (Y4~ ~ o ABSORPTION FIELD DATA Date installed ~/~./eo Soil rating~ ~or ~/bdrm) /.~ System type T~4,,, Length I.~ .~' ft. W'~lth ~ ft. Gravel below pipe ~ ft. Total depth ~o ft. Eft. absorption area ~ g'~' · Monitoring tube ~r,.5' Depression over field Date of adequacy test N,JR- - ~J g ~' Results (Pass/Fail) Fluid depth in absorption field before test ~ gal. Elapsed Time: m~..~.....,~h-','~-~plh in. Absorption rata >= Any regiment (past 12 mo.) (Y/N & type) If yes, give date For '~ bedrooms New depth in. g.p.d. D. LIFT STATION Date installed 'Pump on' level at Datum Size in gallons Manhole/Access (Y/N) in. 'Pump~ at ~tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES in. SEPARATION DISTANCES FROM WELL ON LOT TO: Absorption field on lot Public sewer main Septic tank/lift station on lot Sewer/septic sewlce line On adjacent lots On adjacent lots Public sewer manhole/oleanout Holding tank ~//,4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation. ~ Property line "/I Absorption field # Water main ' )~/A Water sewice line / o ~ Wells on adjacent lots. ) 0 0 /-~- SEP,~TION DISTANCE FROM ABSORI:rI'ION FIELD ON LOT TO: Property line ~ 5 · Building foundation .,c' ~ ' Water sewice line ]o ~- Surface water ,/o0 ·4.- Curtain drain /vo~,(, ~g~a,~ .~Wellsol~;edJacentlots J oO ~ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and rev/ew of Municipal records that the above systems am in conformance ~ MOA HAA guidelines in effect on this date. Engineer's Printed Name ]'~ 0 Date ~'/, / 0 I & HAA Fee $ Date of Payment Receipt Number (Rev. 12~oo) Waiver Fee $ Date of Payment Receipt Number Surface water Water main w' ./,O Driveway. parking/vehicle storage MUNICIPALITY OF ANCHORAGE MEMORANDUM WATER WELL ADVISORY HEAL AU ORI=Y APPROV .O. During a recent Health Authority Approval on-site inspection and test of t]~e potable water supply well on Lot . /' Block I . of~g~f ~- ~C/~k'~SSubdivision, the well's productivity was ~etermined to be O.~ gallgns per minute. The minimum well productivity require~ by this Depart~eht (~lC 15.55) for a ~ bedroom residence is ~ 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 ~f the subject Health Authority Approval. 1211 P.OI/Ol I~DEnI*C. COW~II. P.E. r~OOER 1' A, ~11AF'~I~ ~E. Civil ~go7) ~ ~.~9~g WELL RECOVERY TEST DATA CUE.T: ~ WELL LOCATION IIeE=I): ~ I ~ ~ ~J~ TEST DATE: [~- 1~ -o~ ~ESTED EY: '~ W;LL DEPTH: ~ oD ' ~ DRILLER: TEST PROCEDURE: MISt DATA: 1) ~ wMlr dowfl (~ pump. C.l~ Ilerght: qKofd lime Whe8 In Condull~ ~otd meter ;e=dh~ Or~l~ O.K.? 3) Turn pumpe~. Dr~down. Pump dj 8hut ~mpolf. Slmpl.sTmken? . ~ 8TARTTIME: , ~oo ~ STATIC WATER LEVEL: TRIAL l~ PUMP 'Il. ' ~IME METER OALJMIN. 2 on ~ ~ q, ~p 6 OPt '6 ~ ~ ROe~ C COWAN -8801 ~ WELLCURREf/TLYPRODUCES: '~.-O ~l~t..O~ ~ FLOW RATE NOT GUARANTEED-SUBSEQUENT VARtATIo,s CA, OCCUR. I ~0.14 NOrlTI I RAG1E h~'Efl I OOP · 9~ I~i E 2'~4 · EN~.~ riP, rt. N.A~KA TOTP~.P.O1