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THAYERMOORE HEIGHTS BLK 2 LT 1
Thayermoore Heights Block 2 Lot 1 #015-081-19 Municipality of Anchorage; Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 u Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: �w �c�3�' PID Number: aJ1� Name: A�,__f _' 1 T�A�/l�D R:N'�'1��'�l Wastewater S k stem: �� AIew -❑ U Y lam" Pgrade -- Address: 'F-0-"'E30x 91_316>2_11 Aj ldr -995 __ ABSORPTION FIELD Phone: No. of Bedrooms: $ HIO-- Cl Deep Trench Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Sail Rating: Total Depth from original grade: Lot: ' Block: Subdivision:�y OOYG. 7r 1 Depth to pipe bottom from original grade: a Ft. Gravel depth beneath pipe 4, 2••• Ft. _-rkhl Township: Range: I Sect=on: ____ Fill added above original grade: Gravel length: I t�© _I 1_D.5' ^�S� _ Ft. Ft. WELL: `'New El Upgrade Gravel width: 5 Numberotllnes: I Distance between lines: 2 Ip Classification (Private, A,B,C): Total Depth: Cased To: ke FL Total absorption area: Ft. Pipe material: scwo Ft. Ft. 1� So. Ft. F: Driller. Date Drilled; Static Water Level: Ft. Installer. Jk� Date installed: 97 IL r �' _ Yield: Pump Set at: Casing Height Above Ground: TANK FL Ft. SEPARATION DISTANCE ES septic ❑ Holding ❑ S:T.E.P. To Septic Absorption Litt Holding PublIcIPrivate Manufacturer _ M Capacity in gallons: �I ��p From Tank Field Station Tank Sewer Lines Welt IO�•r IZyf S�/ Material: �ry Number of Compartments: Surface Water6 ' �.,_ LIFT STATION Lotn /�D� tM11 Size in gallons: Men rar: Line hi Foundation l �.{•� O'Pump on" level at: "Pump oH" le High water alarm at: Curtain�— Pump Make & M electrical Inspections pertormed by: Drain�— BENCH MARK Remarks: --�—�-- _ e_— Location and Description: Yvv, or `.��2 UJesT SlV� � ida�(�6E Assumed Elevation: i Ft ENGINEER'S SEAL OF A �: 9S4p0 Inspections performed by: 2Z6131'`f_,� Dates: 1st�� 0 4 Hy*..00 LAST: .2A&. -3-� Department of Health and Hiaman Services approval O �'., BRE rr- 1260N O Reviewed and approved by: Date. C=/�_ Date: Z �O�/P1oROFESS�O��� _ �� 72-013 (Rev. 9/91) MOA 25 _ S V\l °f 0 361 60.9 WELL House B 27.9 30.6 33.9 36.5 37.4 53.3 66.2 90.8 99.7 68.5 78.5 ® TEST HOLE 1 B 0 NEW STAND PIPE PAGE 2 OF 3 S 89.58-E 180.00 (REC) IN SEPTIC PLAN ASB U LOT 2 SEPTIC WELL TO N +100' TO PROP. LINE 89'59'50"W 179.71' (M) a00000pp4 _o OF A � 4pQ 10 FF. UTILITY EASEMENT LEGAL: L.1 32 THAYERMOORE HTS. SUB. w 5 -- --------------------- i / BRENT P. EATON, P.E. ATO�Q QQO�J�., CE -9126 11835 SPYGLASS5PIR ��04�oo�QQoNP6��d ANCHORAGE, AK1 229-3777 LOT- 2 SEPTIC M y 1 Ln N / 9 O N NEW 1,250 GALLON SEPTIC TANK N'oo o m ® \ O 0 N CO1 ST2 o W N S CO 0 EXISilryO 0 Ld C04 FIOUSE \ 2 FCO oo F03 SPLITTER) \ f + MT2 I \ 3 C o _ MT1 A WELL -¢- 49.7 0 2. WELL LOT J 50.3' o 39 (R) PPRO%IMA �'�� 86 (M) ® TEST HOLE NO. 2 iT P' p500' A � ao �9 C06 C05 rR% N 89.57'W 108.83 (MEAS) �81� N 89'57'58"E 108.53' (M) R= 0 THAYER CIRCLE NOTES: — - NO NEIGHBORING WELLS +100' NO SURFACE WATER +100' NO KNOWN CURTAIN DRAINS Distances (feet) FCO ST1 ST2 C01 CO2 CO3 C04 C05 C06 MT1 MT2 House A 22.0 30.9 37.1 39.4 39.5 47.4 61.0 52.7 66.8 40.2 60.9 WELL House B 27.9 30.6 33.9 36.5 37.4 53.3 66.2 90.8 99.7 68.5 78.5 ® TEST HOLE 0 NEW STAND PIPE PAGE 2 OF 3 "ANEW TRENCH DRAINFIELD SEPTIC PLAN ASB U L DESIGN ONLY a00000pp4 _o OF A � 4pQ LEGAL: L.1 32 THAYERMOORE HTS. SUB. o� goo Q° 9T ....o °QBRENT OWNER: DAVID ANDERSON DATE: 0930/97 SCALE: 1 = 30 BRENT P. EATON, P.E. ATO�Q QQO�J�., CE -9126 11835 SPYGLASS5PIR ��04�oo�QQoNP6��d ANCHORAGE, AK1 229-3777 1plr'? ©IS503(19 BOTTOM OF SIDING ® C (SEE PLAN VIEW ASBUILT) ASSUME ELEVATION = 100' NOTE: TRENCHES ARE IN PARALLEL (VIA SPLITTER) (SHOWN IN SERIES FOR SIMPLICITY) •4 DOUBLE CLEANOUT .9 98.9 92.5 1980/94.7 95.0 ' /95.0 NEW GROutin ,93.6 X93.5 1,250 GAL. 88,5 7 SEPTIC TANK 5 ° o °o 92.4 p^ 0°0 2 .4 o o G`i=• o o °o 90.8 p ° O p0°O o° °° ° o' 0 o ^p ° _SEPTIC PROFILE ASBUILT_ LEGAL: L_1 132_THAYERMOOR_E HTS. SUB. OWNER: DAVID ANDERSON DATE: 9/30/97 NOT TO SCALE BRENT P. EATON, P.E. 11835 SPYGLASS CIRCLE ANCHORAGE, AK 99515 PH, 229-3777 E 7 PAGE 3 OF 31 ASBUIL I OF.A BRENI . ATO�Y T, CE -9126 •�\ SPF'' •........•�'' ��� ��� �'ROFESS10NPo' w'l ��036 Plti> ©i5��llq oFA�'N4 o� �. .......... 93 T 0 *I u ,e Municipality of Anchorage ... ........ DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650....... � '• BR T P. EATON Qr SOILS LOG — PERCOLATION TEST OQ 3 CE -9126 4�G ����'Fp'••........,•'• Flo PERFORMED FOR: Tv t1� pc+a i�ERSar^.I FE pd�� DATE PERF ORML'D: LEGAL DESCRIPTION:_ 13 FFEIC-IH-rS SUOO • Township, Range, Section: SLOPE SITE PLAN Or�fti%y�l I G.S' 2 4- ° u W1�i �B S 0 5 ^' • O - 6 g,0.irk - 7 8 9 10 11 12 13 14 151 I -�K R-VkDl1.� nlo. I Tk--Z lO 7;06 16 17 18 19 WAS GROUND WATER 1 ,rt ENCOUNTERED? N A IF YES, AT WHAT _ L DEPTH? 0 P E Depth to Water Alter Monitoring? N A Date: Reading Date Gross P�„ L Time Net Time --7: o 0 '7 3 Pw -- �% JIDePth 7;7YKK -7: � F 201 1 ti/ I PERCOLATION RATE )minutes/mch) PERC HOLE DIAMETER _ TEST RUN BETWEEN FT AND _� _ FT COMMENTS SX�JA"rla�l R,� [✓i .,-L �[.G{�i�f-'(� may.-., •iET �1TIl4t�t O� Go+.l514�11c"f 1 C9rl � �7C-1E1`lU I-lw� � of ��`y�/i (No Morl tTo�Ir.IG�� PERFORMED BY: t"/�1�—�('C7� — _ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. _ 1201 199-7 72-008 (Rev. 4/85) LOCATION OF WELL LOCATION/SKETCH: DEPTHS MEASURED FROM:F']casing top r'lground sudace BOREHOL~ DATA: Depth Material Type end Color From To CONTRACTOR INFORMATION: STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES Dt¥1SION OF MINING & WATER MGMT WATER WELL RECORD WEU.'O',.,mER: ~'" ~ :~ :~ 16;,t WELt DEPTH: DATE OF COMPt,ETION Depth of hole:~ft Depth of c.s ng: //--';" ,t DEPTH TO STATIC WATER LEVEL: ~, ~; ft be~ow/g~op of casing Date: ~ METHOD OF DR~LL~IG: rota~ ~ o~e~ i-I ground surface I-~ cable tool USE OF WELL:,~..domestic I-I Irrigation I-I monitor I-~ public Supply J'-] other CASING STIC~P.~,......~ft. Diam: __ Casing ~Ype: ~ WELL INTAKE OPENING TYPE: ['1 open end I-1 screened perforated /~ open hole Depths of openings: to It SCREEN TYPE: In. SIoVMesh Size: ft GRAVEL PACK TYPE: Volume used: Depth to top: ~ GROUT TYPE: Depth: from ft to ft DEVELOPMENT METHOD: Duration: PUMPING LEVEL AND YIELD: ~ ft after ~, PUMP INTAKE DEPTH: __ ft Horsepower:, ~ WELL DISINFECTED UPON COMPLETION? ~] YES ~-} N REMARKS: PLEASE MAIL WHITE COPY OF LOG TO: DNA/DIVISION OF M~ING & WATER MGMT 3601 C St, Suite 800 ANCHORAGE AK 99503-5935 Phone (90~]269-8639, F~x (907)562o1384 Ma/+ CtfY PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960361 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME::DAVE ANDERSON OWNER ADDRESS:3310 TRAVIS LANE ANCHORAGE, AK. 99507 PARCEL ID:01508119 LEGAL DESCRIPTION: THAYERMOORE HEIGHTS BLK 2 LT 1 LOT SIZE: 24000 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED:11/01/96 EXPIRATION DATE:11/01/97 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED B ISSUED BY: DATE: /j lclllq DATE:// o 0 BRENT P. EATON, P.E. C I V I L E N G I N E E R 11835 Spyglass Circle + Anchorage, Alaska 99515 + Phone 229-3777 September 25, 1997 Municipality of Anchorage On -Site Services Attn: Jim Cross, P.E., Manager P.O. Box 196650 Anchorage, AK 99519 Subject: Lot 1, Block 2, Thayermoore Heights Subdivision Dear Mr. Cross: "03 W000 3RENTtP 4 EATON � 5., CE -9126 Z� This letter is in reference to the active permit (number SW960361, copy attached) for the subject property. The property owner, David Anderson, has requested my assistance to perform construction inspections and to submit as -built information following construction of the septic system. Upon my initial investigation, with the assistance of Carl's Excavating, the ground water level in the vicinity of the test hole was found to be ten feet below the surface and not "dry" as reported in October, 1996 by the original design engineer. This situation necessitates some changes to the original design. Please see the attached new design calculation. The systern will be installed in the same area as shown on the site plan by S&S Engineers dated October 26, 1996 (copy attached). It will utilize the radius offered by the original test hole as referenced, but will be installed in two legs minding all required separation distances. If site conditions at the time of construction require installation outside the original test hole's radius, additional percolation test(s) will be performed. In this instance, I will forward these results to you along with required as -built information immediately following construction. Please note that my professional seal on this letter and attached design calculation are by no means to be taken as certification or approval of work by others. We intend to begin construction of this system under the permit referenced above as soon as possible. I will notify your office of my inspections. Thank you for your attention to this matter. If you have any questions please call me by phone at the number given above. BRENT P. EATON, P.E. C I V I L E N G I N E E R 11835 Spyglass Circle • Anchorage, Alaska 99515 • Phone 229-3777 13PE Project No: 97-01 Calculated By: BE Date: September 25, 1997 Legal: Lot 1, Block 2, Thayermoore Heights Subdivision "rest Hole 8/21/95 by S&S Engineering, Robert Cowan (attached) Single Family, 4 Bedroom Dwelling Wide Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 600 gallons Percolation Rate = 17 minutes per inch Wastewater application rate = 0.6 gallons per day per square foot Required absorption area = 1,000 square feet Trench Width (W) = 5 feet Gravel Depth (D) = 4 feet Total Excavation Depth = 6 feet Required Length =; Shallow Trench Factor x Required Absorption area/W Shallow Trench Factor= (W+2)/(W+1+2D) Shallow Trench Factor= 0.5 Required Length = 900 feet A� 4 .'a.�.l ok"I � BRENT P• EATON CE -9126 :• C WO DOOUMEWANDERSOM ALC.DOC —I" = 50' SITE PLAN_ DESIGN p<> — p�r 07N -4 to r >c� r al r. o r - trJ rri p s_ rr7 7c, d r0 ITt O en rrl r z � v _i o e7 fp cn rrl j O"l O~� m z GROVER DRIVE �d \•, � o W > - -- - — - — ma=y—• ---- - -- - - —\ tris o i/2 z r -----a N -^,\ r o ;a� 1 m ••.\ rn II r— u II O II r -Oi __ __ oc)O 'm ► �. �i W 0 0 _� O 1\'O r— ,y ;_____.________ o ,t I pN0 r O "'� \ \^ -i p � I y -vi r =\ QrL70 1 9 O 4 m `\ n Q 1;5 m . y C7 r 0 m .O O \ yt \/1 rr, (% o ci 71 O-o i AS �;d1 I /� x u, ? �\ HpUs Rel ep� �� n O O �_. 0-g<� >:ECcrrl D 0- Z> NZ, Y ry 7-CTII mo( r Cm+tm m� O Cn D C t-•'D C 1 o mmr—ryrn D ,D � an z Zvi - S co 1 ort�rCN> O r w �0>w> � baloti I o�m�tmm N �b o v-4 FC) zy p a v�� KmK nO n�n co Oti �hh E: of-z zA al Z -ir l� n lsa rzi a m NrI_K n0 N 'vOci NO > Z p Z N➢ r AZH O p In Zm [�+�l• z ,y p T N ��, r •rt �1 w 022o Ao'i ➢� xaia O \ gug4 rCtr 0 ••J��r1l Oco ➢n �o PERFORMED LEGAL DESCRIPTI DEPTH (FEET) 1 - Z -C L 2- 3• 4 5 l v 6 7 8 9 10 t �V 11 12 13 14 15 c� 16- 17- is- 19 - 20 617181920 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST f OF/AJ j=J,4T Ne r:_ 1-0 7— 1 (3 L K Z '1'U Av i.AM o.4of •% SILTY CN -Vi L C- cc i sto,� a .may I lO V L Township, Ran SLOPE DATE Section: -T-K Time =77 Net Drop GROUND WATER N 0 ENCOUNTERED? IF YES, AT WHAT — DEPTH? _— I- Depth to Water After O1 A5 7%fin Montloring7Ort'!_ Oale: I-'ZAu6L W f �M/ IfAad SIL.r ML R, wS 13.0, r1. COMMENTS _UL' 09 Y 7-w (ENGINEEH S SIAL) .J0d-W-Ak%Nb- PROF SITE PLAN NA PERCOLATION RATE / 77— (minutewinch) PERC HOLE DIAMETER G— TEST RUN BETWEEN 4 FT AND 5- //x FT PERFORMED BY: _-S-&S S FNGINII�' -�----•R � CERTIFY THAT THIS TEST WAS PERFORMED IN 17034��, piolRt�IWY1 (��y���pp�RCi�6111INE N EFFECT ON THIS DATE. DATE: _ / �� / r S ACCORDANCE WITH TKtVatl' 1151a1lR� 99577 72-008 (Rev. 4/85) Time Net Depth to Time Water Net Drop 11:31 I- s/yo 7%fin [RteadmgD.teGross 0 .—G PERCOLATION RATE / 77— (minutewinch) PERC HOLE DIAMETER G— TEST RUN BETWEEN 4 FT AND 5- //x FT PERFORMED BY: _-S-&S S FNGINII�' -�----•R � CERTIFY THAT THIS TEST WAS PERFORMED IN 17034��, piolRt�IWY1 (��y���pp�RCi�6111INE N EFFECT ON THIS DATE. DATE: _ / �� / r S ACCORDANCE WITH TKtVatl' 1151a1lR� 99577 72-008 (Rev. 4/85) LEALTHAUTHORITY APPROVALS SEWER& WATER MAIN EXTENSIONS SEWER& WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN s&S� �-tneepunq October 14, 1996 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX(907)694-1211 REFERENCE: Lot 1, Block 2, Thayermoore Heights Subdivision Request you issue a permit to drill a well and install a septic system to serve the proposed four bedroom house on the referenced property. A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered in the test hole and after seven day ground water monitoring, the monitoring tube was found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincerely, &�Z Robert: C. RCC/gk Enclosure 4 %-r Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 50' SITE PLAN DESIGN SCALE _ o - r a m N v c0 I.� •' A X,o'd A�� m GIZOVFR DRIVE �� \' o � D '' N \ t" O :;u r•e-1 ri U r - G II O II r CD 10 -- —_ _. ....... vl N o py r I � m �luV i3 n FrI u, � I /yo eDR SFO m� _im 0 o tiw h � j CSO pyo ZS -i 9 I ry \ IN r Osis zy LM 10 ------ I r -o m zDz K tba, o~ j o rl wzMqK N ^ V O 10 L'/ rrJ{mZ �� �i A H• O'O -i ti h, o o�t� z o 01 Z lj ♦ rC"rZ s j mmi�mmm N AmnZ NA oOG7 O Ana O s 0o0 zz O z0 ON TI p `p A X A \ G'ai I� O (n, Am- C EngzneeizinG ROBERT.COWAN, RE. ROBERTASHAFE. SHAPER, P.E. R'Gie CIVILENGINEERS aE ON-SITE WASTEWATER DISPOSAL SYSTEM (807)694-2979 CONSTRUCTION PRACTICES FAX(907)694-1211 \\ and — MATERIAL SPECIFICATIONS HEALTHAEIORITY T T Y REFERENCE: Lot 1 Block 2 Tha ermoore Heights Subdivision APPROVALSLS October 14, 1996 SEWER&WATER GENERAL: MAIN EXTENSIONS 1. The scope of this project includes the installation of a 1250 gallon septic tank and a leachfield trench to serve the proposed four bedroom residence located on SEWER&WATER the referenced property. INSPECTION 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all ENGINEERING STUDIES applicable State and Municipal Wastewater Disposal ANO REPORTS Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. WELLINSPECTION & FLOW TEST 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. SITE FLANS 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the ROADDPSIGN Municipal Health Department. SEPTIC TANK INSTALLATION: SOILTEST 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. PERCOLATION TEST 2. 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 STRUCTURAL& MECHANICAL minimum of 12 inches above final grade. INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 1, Block 2, Thayermoore Heights Subdivision October 14, 1996 Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cl.eanouts (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. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed --up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. 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. 4. 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 of the 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. Page Three Lot 1, Block 2, Thayermoore Heights Subdivision October 14, 1996 5. 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. MINIMUM MATERIAI, SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPh) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mi.rafi140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. 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. Page Four Lot 1, Block 2, Thayermoore Heights Subdivision October 14, 1996 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: 1. 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. 2. 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 of the 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 of the contractors work rests with the owner and the M.O.A. Page Five Lot 1, Block 2, Thaye.rmoore Heights Subdivision October 14, 1996 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 carry out the work in accordance with these construction documents. S & S Engineering'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 PGE B, •F �� Municipality of Anchorage - // On-Site Water and Wastewater Program // (907) 343-7904 SA ETY n CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-081-19 Expiration Date: 10—q-1 1. GENERAL INFORMATION Complete legal description THAYERMOORE HEIGHTS BLOCK 2,LOT 1 Location (site address) 7201 THAYER CIRCLE,ANCHORAGE,AK 99507 Current Property owner(s) CARRIE &JASON JANOWSKI Day phone Mailing address 7201 THAYER CIRCLE,ANCHORAGE,AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex • Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage Holding Tank ❑ Community Class ,Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: frikk- Date: 4(/L` COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 52-L()-°° Waiver Fee $ Date of Payment 7 [5`U)tg Date of Payment Receipt Number d69' Loq 4 Receipt Number COSA# i V 131° 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 ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377 Address 4640 SHOSHONI DRIVE.ANCHORAGE.AK 99516 Engineer's Printed Name MICHAEL N.ANDERSON,PE Date 07/03/2018 :.‘ e® dyAaOF ,t • 'r y•' A. ••`;'r' 9, ...v*•.z A...• •• 1 *..:k:.* 6. DSD SIGNATURE l�, • MICHAEL N. ANDERSON ;:i ; • System#1 Approved for Le bedrooms. if� f• System#2 Approved for bedrooms. ��pRQ �S�ifltL���` Disapproved. .:. . Conditional approval for bedrooms, with the followif,%.,a ipul tions: r� r v oN_S1.�E �<;` p1/4N .,)� Nl QROG� PO Gc A IT Q'..."‘.. y: V`"–�— / Original Certificate Date: 7-ci —17 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 blue sheet 10-10-12.doc 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: THAYERMOORE HEIGHTS BLOCK 2.LOT 1 Parcel ID: 015-081-19 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 4/811997 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y Total depth 115 ft. Cased to 115 ft. Casing height(above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 4/8/1997 6/29/2018 Static water level 63 ft. 62 ft. Well production 100 g.p.m. 4.6+ g.p.m. WATER SAMPLE RESULTS: Coliform ND colonies/100 mL Nitrate 7. L( 2-mg/L Arsenic: ND ug/L Date of sample: 6129/2018 Collected by: FIRST WATER C.S. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 9/3/1997 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping ?' 3 --1� Pumper C. ABSORPTION FIELD DATA — *TESTED EAST TRENCH Date installed 10/311997 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 System type WIDE TRENCHES Length (2 X 50') 100 TOTAL ft. Width 5 ft. Gravel below pipe 4.2 ft. Total depth 6.8+ ft. (Measured 6/29/18) Eff. absorption area 1000 ft2 Monitoring tube Y Depression over field N Date of adequacy test 6/29/2018 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test W 30/0 E in. Water added *660 gal. New depth 30/5 in. Elapsed Time: 1010 min. Final fluid depth 30/0 in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) N _ If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) _ "Pump on" level at in. "Pump off' level at in.High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? ._ E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1004. On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 10'+ Absorption field 5'+ Water main 10'+ Water service line 104- Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10' Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(None Known)_ Wells on adjacent lots 100'+ F. COMMENTS Similar testing results/state as previous 2015 COSA with lower or western trench having 24-30"of fluid and the eastern 0". G. ENGINEER'S CERTIFICATION .7F I certify that I have determined through field inspections and •:,•14).• •• • °.:C-7‘117 review of Municipal records that the above systems are in * :4 9 T conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name MICHAEL N.ANDERSON,PE %":• •••• ••• "f •• MICHAEL N. ANDERSCN Date 07/03/2018 ;• CF-94 9 , • COSA canary sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • � t'`�i 907-343-7904 On-Site Water and Wastewater Section \ tt, / Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On-Site Systems Approval # OSC181319 Subdivision: Thayermoore Heights, Block: 2, Lot: 1 A water sample revealed a nitrate concentration of 6.42 milligrams per liter (mg/L). 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. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org Nitrate Fact Sheet 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. Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org Parcel I.D. 015-081-19 11 Municipality of Anchorage � . a On -Site Water and Wastewater Program MAY I (907) 343-7904 rete ten s �t r Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: g ^ a 2 - / S Complete legal description Thayermoore Heights, Block 2, Lot 1 Location (site address) 7201 Thayer Cit' Current Property owner(s) Andrew Mamrol Day phone Mailing address 7201 Thayer Cir. Anchorage, AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well El Individual F Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer '❑ WaiverNariance request for: Received by: Lam//1 Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 51:Q to - Waiver Fee $ Date of Payment 5Ll R 15 Date of Payment Receipt Number Receipt Number _ COSA# OJClSratom 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 flies 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MCA 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 ran 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, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE _ z System #1 Approved for —4 bedrooms System #2 Approved for bedrooms Disapproved Date 04/21/2015 Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: The 6uni:;614af orage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represen tions 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 blue sheet .. If more than 1 septic system is on the lot: COSA Checklist # of 1 Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Thayermoore Heights, Block 2, Lot 1Parcel ID: 015-081-19 A. WELL DATA Well type PrlVmte If A, B, or C provide PWSID # Well Log (YIN) -Y Date com feted 64/08/1997 Sanitary Y/N Y Y P ry seal ( ) _ Wires properly protected (YIN) Total depth 1 15 ft. Cased to 115 ft Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 04/08/1997 04/20/2015 Static water level 63 Well production 100 ft 58 ft. g.p.m. 5.6+ 9— p.m- WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate S>75 mg/L Arsenic AJ 6 ug/L Date of sample: 5/11 lotG I S Collected by: Pl5 B. . SEPTICIHOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 10/03/1997 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Date of pumping 8/8/2014 C. ABSORPTION. FIELD DATA Depression over tank (Y/N) N High water alarm (Y/N) _ Pumper A+ Homes Services 10/03/1997 0.6g.p.dJsgft Shallow Trench Date installed Soil rating (g.p.d./ftz or ftz/bdrm) System type Length 50/50 ft. Width 5/5 _ ft. Gravel below pipe 4.2/4.2 ft 6.ai�4 1000 z Y/Y - N/N Total depth ft. Eff. absorption area ft Monitoring tube — Depression over field Date of adequacy test 04/20/2015 Resuits (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 24/0. in. Water added 613 gal New depth 29/0 in. Elapsed Time: 130 min. Final fluid depth 24/0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested - Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 50+ 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 line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+_ Wells on adjacent lots 100+ 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 Steven R. Pannone Date 041n2015 COSA canary sheet 2-6-15.doc FrA Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ Municipality of Anchorage o 4E Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 151228 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 1 of Thayermoore Heights subdivision. This inspection revealed a nitrate concentration of 5.75 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. � 4 p V4�� �O� • F .'n LL O�FI � W N Q • zJ Q e ,•o a z -_ w i W�J NVILL U' W' Q, ,c.e as L -I,UO,z000 S i — - — - — - — - — - GROVER STREET_ 0 y m R J 0 M LLQ) woi om moa Municipality of Anchorage" ' Development Services Department Building Safety Division . On -Site Water & Wastewater Program:' 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519.6650 ..,•. • www.d.androrage.ak.us ......, . .... •' .. (907) 343-7904' CERTIFICATE OFHEALTH AUTHORITY: APPROVAL FORA SINGLE, FAHIL'•Y DWELLING Parcel 11.1) 015-061-19 HAA# Ph . O I D 0 S y} - 1. , GENERAL INFORMATION Expiration Date: - .K'- 7- 01 Complete legal description . THAYERMOORE HEIGHTSSUBDMSION;LOT 1, BLOCK 2 Location (site address or directions) 7201 THAYER CIRCLE _ ANCHORAGE, AK, 99516 Current Propertyowner(s) DAVE & PATTY'ANDERSON Day phone 346-3344.. Mailing address P.O. BOX 231021 ANCHORAGE, AK -99523 Lending agency, Day phone Mailing address Real Estate Agent TERRY PISA w/ 'PRUDENMI. JACK WHITE Day phone 762-3157 Mailing address 3201 'C' STREET SUITE 200 ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ■ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 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) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results 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 professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,000.00 at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined In the Health AuthorityApproval Guidelines for Misapplication, 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 Munldpalfty of Anchorage riles and from my Investigation and Inspection, the on-site water supplyand/or wastewa tar 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 ALASKA WATER k WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD, SURE 2B • ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A GARNESS, P.E. Date Z 0 Engineer's Comments: In conducting this evaluation, AlVWC, ina attempted 10 provide a thorough, 400d�Op4p4 conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the pedonnance of the �v ,.• DO system under fie conditions encountered at me time of the test and separation 0 distancos measured to readily Identifiable features. The operational life of all wells and septic systems depend on the kxglsollscondition, groundwaterlevels Mat may ..•••• •• • • •• •••••• • ... fluctuate during the year, and the water usage of the famllybeing 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 DO f fr A. rn ss.t i there are no hidden defects or encroachments. AK%V, Ina can therefore not provide O —7953 e p any warranty or future estimate of how ling the system will continue to meet theQ4'e q`Fvv opera tionaIrequirementsofthe ADECorMOA DSD. The con fent ofthis repoRlsfor 0�'Q'Protesstio01 the solo benefit of the ownerlfsled above. Army reliance upon or use of this report by any ��OOoo�oo other person or party Is not authortzed, nor wail it confer any legal right whatsoever. f r t 5. DSD SIGNATURE���\\\?G\�,• ....... Approved for _� bedrooms. ON-SITE • • ,C WATER AND • n Disapproved. : WASTEWATER Conditional approval for bedrooms, with the Blowing stipulatmantiPROGRAM JJJJ �Q .••• •�\11 Attachments: HAA Checklist Manitenance Agreements Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other By. Original Certificate Date: a 0 (RW. 1iao) Municipality of Anchorage • Development Services Department Sunding Safely Division On -Site water ft Wastewater Program 4700 South Bragew SL P.O. Bax 198850 Anchorage, AK 9951946850 W ww.d.enchorage.ekus (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: THAYERMOORE HEIGHTS S/D: LOT 1. BLOCK 2. ParcellD: 015-081-14 A. WELL DATA Wen type PRNATE If A. B, or C provide PWSID# N A Date completed 4/8/97 Senitary seal (Y/N) YES Total depth 115 R Cased to 115 fL FROM WELL LOG Data of tow 4/8/97 Static water level 63 fL Well produc9on 100 g,p,m, WATER SAMPLE RESULTS: Wen Log (YM) YES Wires properly protected (YM) YES Casing height (above ground) 12'+ in. AT INSPECTION 2/16/01 61 1t, 6.37 g.pm. Conform 0 colonies/100 ml. Nitrate 3.12 mgA.. Other bacteria 0 colonles/100 ml. Date of sample: 2/16/01 Collected by: AWWC. INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Meterlai STEEL Date installed 9/30/97 Tank sirs 1250 gel. Number of Compartments 2 Cleanouts (YM) YES Foundation cleanout (YM) YES Depression over tank (Y/N)No tngh water alarm (Y/N) N/A Date of pumping 2/14/01 Pumper DENALI SEWER AND DRAIN C. ABSORPTION FIELD DATA Date Irwtailed 10/3/97 Son rating Qd>leftrin) 0_6 Length 100' ft. Width 5 R System type TRENCH Gravel below pipe 4.2 R Total depth as -7.5 ft. Eff. absorption area 1000 fe Monitoring tube YES Depression over Held NO Data of adequacy test 2/16/01 Results (Pass/Fan) PASS For 4 bedrooms Fluid depth in absorption field before test 15 In, Water added 657 gal. New depth 27 in. Elapsed Time: 30 min. Final Iluld depth26 in. Absorption rate >= 450+ g.p.d. Any re)uvenetion treatment (past 12 mo.) (Y/N & type) NONE KNOWN if yes, give data - D. LIFT STATION Date installed Size in gallons 'Pump ore level at n. I- SEPARATION DISTANCES High water alarm level at rn. Cycles Meets alarm 6 circuit requirements? - SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanknift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service One 25'+ On adjacent lots 100'+ On adjacent kits 100'+ Public sewer manhole/cleanout N/A Holding tank N/A SEPARATION DISTANCES FROM SEPTIGHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption geld 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent kits 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property One 10'+ Building foundation 10'+ Water main 10'+ Water service One 10'+ Surface water 100'+ Driveway, parking/vehide storege 50'+ Curtain drain NONE KNOWN Welts on adjacent kns 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through held Inspections and *! 4 r* revlew of Mun/dpal records that the above systems are In conformance with MOA HAA guidelines in effed on this date. • e re A Ga eae;' sneer's Ptl N me JEFFREY A GARNESS 7953 .` a Datet ..... � �o ss HAA Fee$ i3 0 0,O c Date of Payment 2 - ;Z 6-0/ Receipt Number 7 7 A, (wv.12Aq Waiver Fee $ Date of Payment Receipt Number 02-20-01 17:05 FROM -CTE ENVIRONMENTAL CT&E Environmental Services Inc. L L. 5615301 T-020 P.02/03 F-508 CT& E Ref.N 1010787001 Client PON Client Name AK Water & Wastewater Consultants Inc. Printed Date/Tlme 0220/2001 16:06 Project NamelN Thavemoore Heights S/D Ll B2 Collected Date/Plme 02/162001 13:45 Client Sample ID Thayemoore Heights S/D Ll 132 Received Dale/Time 02/162001 15:15 hlatria Drinking Water Technical Director Stephen C. Ede Ordered By PWSre p Released By ynJ Sample Remarks: Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Waters Department Nitrate -N 3.12 0.500 mg/L EPA 300.0 10 max 02/16/01 SCL Microbiology Laboratory Total Coliform 0 coV100mL SM1892220 02/16/01 SKW