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HomeMy WebLinkAboutDENALY BLK 1 LT 12Abenaly Block 1 Lot 12A #067 - 041-30 • Municipality Anchorage ° }} 3tt �_ of Development Services Department "' , ^ Building Safety Divisions On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: _ 5w0300.1373 PID Number: 06 7--®''l •-30 / of..? Name: !k 6YY1 . Wastewater System: :• New • Upgrade Address: 1 �/�j i703!{/� E456RfleeLJ.?Op + t%ve441K99 ?7 ABSORPTION FIELD Phone: 15,2 5.55 ✓— Number of Bedrooms: 9. gi(Daep Trentlt 0 Shallow Trench CI Bed ❑Mound ❑ Other: LEGAL DESCRIPTION Soil Rating: ©, /1 PD/Ft° 'IG Total Depth from original grade: 1 / ') Ft. (J Block: Lot: �,/( Subdivision F�! s pe 144 y Depth to pipe bottom from original gre e: Ft. Gravel depth beneath pipe: CJ Ft. Township: Range: Section: Fill added above original grade: I C i e FL Gravel Length: 5D Ft. Well: Ft, New ❑ Upgrade Gravel width: Ft. Numberof lines: Distance between lines: Ft. Classificatjerrei tae, a C): [U V i( Total Depth,.--) i Ft oCl Cased to's-�04 fil41 /�3 Total absorption area: . I .y '/ Ft' CJ✓ p A G %�M p33y/Fsro Driller: /'i.—W Ori/l trdgToe- Delo O'lled: 6`010-03 t}}'�� Watteerr/Leve`l: 1 r're5�1p)t. Installer. -0201 £Xe4va��r�C Date (Installed: 5----"D-03Q Yield: 1 GPM Pump �S t at: b(ri t el iv yl Ft. Casing Height Above Ground: Ft. / TANK SEPARATION DISTANCES • Septic 0 Holding ■ S.T.E.P. • Other: To From Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Line M ufacturer. ^ r 'rem Ie( Plaitl C S Capaclt : (3vu Gal. Well J 5 115' Ii l{a% J j /I \ '�'� �^ 5,..f.„ Material: FiO p r.,� ,(,/i^ Number of Compartments: O^'(1 Surface Water 1001, /00%.4. LIFT STATION Lot Line �5 ( 33' Size: Manufacturer Foundation ®� p iI 'Pump on' level et in. 'Pump off' Imo. • High water alarm at: M. Curtain Drain 4„ . -' �QPump '/ Y'.�ur+" 0/ yl k.✓ Make & Model Electrical Inspections performed by: in Remarks: BENCH MARK Location and Description: ,r^ fop of c000det-ti°04 a Assumed Elevation: rrr��� poi,' i f, ('T� 100 FI. jiiiiiiiiirrilikrak ,go -cSOF-4i. 1,i-',1. s :'tiw1. „r ,,,,?,'a ^' ' � 4 '%, ROBERT C. COWAN / 'how; cE - 8601 :.ti:ct- ie .� ie,,, p" •••..�.• ";; ` °' �r ''�% i}..l; :,‘i `•tii .� S & S ENGINEERING 17034 Eagle River Loop Road, No 204 at Inspections performed by: bales: 1 5 "®� Nagle kiver, Alaska 99377 nd 2 ��^�� Developmen Reviewed and approved by: ervices Department Approval Date: .13l95' (Rev. 12(00) PERMIT NO SW030083 PAGE 2 OF 3 Nuniciaalit of Anchora e DEPARTMENT OF HEATH AND HUMAN9SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 12A, BLOCK 1, DENALY S/D P.I.D. NO. 067-041-30 NEW 1300 GALLON HOPE SEPTIC TANK SCALE: 1" = 50' PERMIT NO SW030083 PAGE 3 OF 3 Municipalityof Anchona e DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES D��IppVISION 343-4744 ON-SITE WASTEWATERP O. Box 196650�DISPOSAnchoraAL SYSTEM e, Alaska LAND/OR 9-6650 • eWELLe INSPECTION REPORT LEGAL LOT 12A, BLOCK 1, DENALY S/D P.I.D. NO. 067-041-30 FINAL GRADE 95.3' ST1 ST2 ,-- 99.7' NEW 1300 GALLON POLYETHYLENE SEPTIC TANK 2" INSULATION 95.1' C01=98.6' CO2=98.1' FINAL GRADE MT1=87.0' MT2=87.3' • C01=95.0' CO2=95.0' NO WATER FOUND 81.0' B.O.H. .. ...,. 5..:.r..:..-- ..y i ROBERT G COWAN ,iQ `"c�•ti CE -88O 4`x„9 .' 'Nh, FFEESS1 ". N. T, S. FR4or � �e ........., It A B C FCO - 8.0' 32.0' ST1 35.0' 14.0' 49.5' ST2 37.5' 17.0' 52.5' TMT 41.0' 20.0' 54.0' DBL1 39.5' 19.5' 55.0' DBL2 40.5' 20.5' 56.0' C01 31.0' 14.5' 54.0' MT1 32.0' 17.5' 57.0' CO2 78.0' 66.0' 104.0' MT2 78.0' 66.0 104.0' • C01=95.0' CO2=95.0' NO WATER FOUND 81.0' B.O.H. .. ...,. 5..:.r..:..-- ..y i ROBERT G COWAN ,iQ `"c�•ti CE -88O 4`x„9 .' 'Nh, FFEESS1 ". N. T, S. FR4or � �e ........., It M -W Drilling, Inc. *P.O. Box 110378•Anchorage, AK 99511• Job No.: 03-133 •907-345-4000 • 907-345-3287 Fax♦ Project No.: N/A Permit No. SW030083 Groundwater Well As -Built & LoR Deepening JUL 0 7 REC'd • Well Owner: Kappen Homes • Use of Well: Domestic •Legal Description: Denaly Subdivision, Block I, Lot 12 Eagle River, Alaska Construction •Hole Depth: 221' *Casing Size: 6" *Cased To: 220.1' *Material: A 53 Steel *Drill Method: Air Rotary Perf ♦Well Completion- Open end X Screen Perforated Method: *Screen/ Perforation description: None •Grout Notes: (5) Sacks- No. 8 bentonite granules • Notes: • Well Development: Method: Air surge Notes: *Static water level (SWL) flowing (above) (below) top of casing (TOC). • Well yield test at 15 gallons per minute (GPM)/ ) for 1 hours with 100% of drawdown (DD) from static level (SWL). Air lift *Method: *Date of completion: *Deepening completed: 14 May 2003 20 June 2003 Well Lo *Pump Install: Depth in feet from top of casing. Details of formations penetrated, size of material, color and hardness. 0 TO 3 Casing sticku a 3 TO 8 Fill and organics 8 TO 23 37 Cobbley gravel: dry Cobbley gravel: damp 23 TO 37 TO 41 Gravel: wet 41 TO 62 Gravel: with silty clay 62 TO 82 Gravel: with thin silty clayey beds 82 TO 157 Clay: dense 157 TO 161 Water gravel TO Deepening Water gravel: dirty 1 161 TO 171 171 TO 207 Clay: gray, dense Sandy gravel: water -bearing 207 TO 221 TOL r TO TO TO ._ W Certificate No's. 814 & tot 973 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW030083 Legal Description: Denaly Block 1 Lot 12A Design Engineer: 0003 S & S Engineering Owner Name: Kappen Homes Owner Address: 17034 N Eagle River Rd Eagle River , AK 99577 - This permit is for the construction of: f✓ Disposal Field 1 Septic Tank Holding Tank ,"c\L eYY-\ Date Issued: Apr 15, 2003 Expiration Date: Apr 14, 2004 Parcel ID: 067-041-30 Site Address: NHN Denanina Dr. Lot Size: 42235 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 Privy Private Well 1 Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (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: �� �- Date: 17` //6 /o j Issued By: Date: 41 (5103 Parcel I.D. Municipality or A>hlvitotage Develophieht Services bepartnmeht Building Safety Division On -Site Water and WasteWater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, Ak 99519-6650 www.clanthorage.ak.us (907) 343-7904 ON-SITE SEWERIWELL PERMIT APPLICATION rOR A SINGLE FAMILY tWELLING 0 b7—bN/ Permit Number SW Property owner(s) ka p p ,, i Ho, vie 5 bay phone 6 —5-585 85 Mailing address (1) 17& ,1) jle- k; gr. Leop Road 5u; -[e a31 Mailing address (2) get9 ie £ ;v er / AK- D j) /� Zip Code 9(i 577 Legal description (Lot, Block & Sub'd.) Lb± iaig 106k i) Oeri ly S/D Legal description (Section, Township & Range) Lot Size N4< Acres THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool therapy Pool 0 Number of Bedrooms Well Only Water Storage [] Jacuzzi O Water Softening Unit ❑ 1 certify that the above information is correct. 1 further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Fag'e River, Ol.ska49.477 (Signature of property owner or aUthorized agent) Permit Fees: S S-0 • e Y Waiver Fees: bate of Payment: Receipt Number: bate of Payment: 'Receipt Number: (Rev. 12/00) nginee2Rinq HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & PLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL a MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. ROBERT A. SHAFER, P.E. April 3, 2003 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 12aBlock 1, Denaly Subdivision CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 It is requested that you issue a permit to install a well and septic system to serve the proposed four bedroom dwelling on the referenced property. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation 3/24/03 no water was found. After monitoring, ground 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 construction 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/bjj Enclosure 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 1" = 40' SCALE DESIGN SITE—PLAN 20' PRIVATE ROAD ACCESS EASEMENT Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.d.anchoraoe.ak.us (907) 343-7904 � Soils )Log - Percolation Test Performed For: �''A _ �.1 12ni}'i L1� l Legal Description: 2- 3- 4 - Depth (Feet) p!L(r 1 CS 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16 17- 18- 19- 6 a 0 .® O Cl 20 - COMMENTS MENTS Slope WAS GROUND WATER ENCOUNTERED? O it W YES, AT WHAT DEPTH? Depth to Water Aker Monitoring? Date: s 0 P Dale Performed: g LD Site Plan Reading Dale Gross Time Net Time Depth to Water Net Drop 0 iti ',/u1� I 0 o 0 u w 10 0 w5/r t*-bN O 0 — 2 y1) 3 " ZW1 O .,, 0 / r, 1 __.. 30 3i) 9 Vile l PERCOLATION RATE'�J�r TEST RUN SE 1 rrEEN (rinutesinch( FERC HOLE AMETEK FT AND PT PERFORMED BY: ' (t [i�r �If�✓ �`""""�r✓v' 2 CERTIFY THAT THIS TES/ WAS PERFORMED INACCORDANCE SMITH A.LI STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: TJ'12+7d,- S&S ngineenrnq HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WEU. INSPECTION S FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURALS MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEV DESIGN ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 12#13lock 1, Denaly Subdivision April 3, 2003 GENERAL: CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 1. The scope of this project includes the installation of a 1300 gallon HDPE septic tank with a pump basin, and a pressurized drainfield to serve the proposed four bedroom residence located on the referenced property. 2. 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. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 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 Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 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 minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page 2 Lot 12i8Iock 1, Denaly Subdivision April 3, 2003 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCII/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. 2. Once the gravel is installed, the distribution pipe is to be installed level with the holes faced downward. The distribution piping is to be of PVC (ASTM D3034 or equal). All joints are to be solvent cemented. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. 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. 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 fmish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: Page 3 Lot 1203Iock 1, Denaly Subdivision April3, 2003 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 (HDPE) 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, Femco, or equal). 5. 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. 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 specifications applies. Page 4 Lot 120BIock 1, Denary Subdivision April 3, 2003 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. 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 • '~ Municipality of Anchorage U On -Site Water and Wastewater Program a (907) 343-7904 S a E T Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 067-041-30 1. GENERAL INFORMATION Expiration Date: Complete legal description Denaly Block 1 Lot 12A Location (site address) 7015_Kulchay Cir. Eagle River, AK Current Property owner(s) Robert Tasso Day phone Mailing address Real Estate Agent 7015 Kulchay Cir. Eagle River,_ AK 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 _ Well ❑ Public Water System ❑ Waiver/Variance request for: 4 Day phone _ �Q -202 Z TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: _ _ Date: ___ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ .J�Sd _ Waiver Fee $ Date of Payment Receipt Number _06 37aC COSA # _D5 G 2 21060 Date of Payment Receipt Number Waiver # Distance: 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 ARCTERRA CONSULTING, INC. _. Phone 696-6111 Address -2_0441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUSDate .2/.z -- Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future ��� \ occupants or can ArcTerra guarantee that no unseen n% encroachments, deficiencies or discrepancies exist. �l" OF `1z 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved. Conditional approval for L * z� 'a. KENNETH I. Its . D' Sbedrooms. / c bedrooms. 1 �\F� sa r SS L0 �-01 bedrooms, with the following stipulations: �WY O -/ o WATER ro A G) V Np ,AT _ PRO .Z SIV/ \vim ���iJl SERVICES ����1� BY' V_ Original Certificate Date))))ll 1�2QZZ 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.dw Legal Description: Denaly Block 1 Lot 12A Parcel ID: 067-041-30 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 5/14/2003 Total depth 221 ft Cased to 220.1 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 41 in. Date of flow test for COSA 2/15/22 Static water level at beginning of test Comments *Artesian B. TANK DATA Age of tank(s) 19 years Tank type/material Septic/Plastic Measured operating fluid level in septic tank 49" Standpipes/foundation cleanout per record drawing Date of pumping 2/14/22 D. ABSORPTION FIELD DATA Structure served by this system Well production at time of test 5.4 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes 0 Nc Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 2/11122 FT STATION ❑ Requl aintenance completed Age of lift station years Lift station material Comments: Which system tested (date installed) 5!22/03 Adequacy test date 2/15/22 ALL standpipes present per record drawing Results V Pass For 4 bedrooms Total measured depth from grade 11 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 3 ft (min) Water added 600 gal ❑ N/A — pressurized field COSA Checklist yellow sheet New depth 0 in Monitor tubes go to bottom of effective. If not, state depth into effective Elapsed time 0 min IN Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date Com ments/Deficiencies: COSA Checklist yellow sheet 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' Yes if No Community Sewer Manhole/Cleanout > 100' If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that / 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 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AI< 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Qt.P'4 - DLit- 3) 1. GENERAL INFORMATION Complete legal description Lot 12A; Bioac 1; Donay subdivision COSA# t)q-'nattW Expiration Date: / O — — 07 • Location (site address) 7015 Kulthey Dr. Current Property owner(s) Doug & Mila scripture Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address same Day phone 696-7571 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: . 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: o 0 ❑ 0 ❑ 0 ❑ 0 Individual On-site Individual Holding Tank Community On-site 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 $ Engineering Address 15861 S. Birchwood Loop Rd. Chugiak, AK 99567 Engineer's Printed Name /2 8 d &.4-7- 6 . Co G✓R-r✓ 5. DSD SIGNATURE 17-' Approved for Disapproved. Conditional approval for bedrooms. Phone 6942979 Date 7 /10 /0 7 OF '41Z1'tS�\ V % `*ori ROBERT CAN 11.1. CE -6801 ••. .. Vit' �t uP^iiva +�'•ti— bedrooms, with the following stipulations: `G \$tY/OFrq�'�.�� r .•.Cyr •ONSITE WATER AND m" : WASTEWATER - JO�J • n Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory By: 14,02, mw11105) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 7— / 2-- 0 7 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & 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 CHECKLIST Legal Description: �-\ZA ILbLK' S DENALy S/1) Parcel ID: 01,5 - OMI -30 A. WELL DATA Well type WI Vitrr If A, B, or C provide PWSID # Date completed 6/20/3 Sanitary seal lJ/N) Total depth 221 ft. Cased to 220•Ift. FROM WELL LOG 6/ao/b 3 Date of test Static water level ART ES \ A to ft. Well production 1 S g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate OD mg/L Arsenic: N ug/L date of sample: 4/2(p/0} B. SEPTIC/HOLDING TANK DATA Tank Type/Material S E e -n LI N D P r Tank size I-21 0 D gal. Number of Compartments Foundation cleanoutl&N)yES Depression over tank (YO) NQ Dale of pumping (f 7o /07 Pumper TeS 2 Well Log ®/N) yES Wires properly protected (5IN) yES I Casing height (above ground) %I-- in. AT INSPECTION 6/22 /o7 qet-csiAu ft. g.p.m. C. ABSORPTION FIELD DATA Date installed x/22103 Soil ratingg.p.d./ft2 r ft2/bdrm) O•g Length 50 ft. Width 3 ft. Other bacteria colonies/100 mL Collected by: SSS EA) GIN ECt'ttJ Ca Date installed Cleanouts (9/N) S/22/03 YE s High water alarm (Y6 1\10 System type t€CP 1iit ks Lrj Gravel below pipe g ft. Total depth 'I I.5ft. Eff. absorption area %0O ft2 Monitoring tube YES Depression over field A IS Date of adequacy test 4/2-g /07 Results Fail) For 9 bedrooms Fluid depth in absorption field before test 0 in. Water addedg41 gal. New depth10 in. Elapsed Time: 1 0 min. Final fluid depth 14 in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) I\10 1000 + g.p.d. If yes, give date D. LIFT STATION Date installed /YTI Size in gallons "Pump on" level at _ in. • - • • level at _ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 11 5 On adjacent lots Absorption field on lot On adjacent lots Public sewer main N/<% • Sewer /septic service line 2 S } anhole/Access (Y/N) High water alarm level at Meets alarm 8 circuit requirements? Animal containment areas G6 '4 - IOD' 4- in. 4- in. 106 ;-- Public sewer manhole/cleanout N/A Holding tank N/4 Manure/animal excrete storage areas 10 0 4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation i 0 ' Property line 55 • Water main N�f water service line 10 4 Wells on adjacent lots IDO A - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: i Property line 33 Building foundation 1 rJ Water Service line 16 k Surface water 106 � 1. Curtain drain INN r hi.,(4N Wells on adjacent lots 1 00 F. COMMENTS G. ENGINEER'S CERTIFICATION 1 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. goa4.C7 C. Co 4.41,-, 7 /10/07 Engineer's Printed Name Date Absorption field 5 r Surface water 10014 Water main N/4 Driveway. parkingNehicle storage 10 4 Romer( It towAN e . CE=EBU1 /4-•-40J *tater+ COSA Fee $ 410 e Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number AS BUI 1.7 SEWARD I ASSOCIATES LAND SURVEYING 694-0829 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: zar:-cY era.€ torn) dr./ AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE TH° EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SCALE:/c y� DATE: GRID: ter. 767 FB: // C- DRAWN oryJ Municipality of Anchorage Development Services Department Building Safety Division . On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.clanchorage.ak.us •(907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL* fOR A 51NGLE FAMILY DWELLING Parcel I.D. 067-041-30 •Expiration Date: / — -- D if 1. GENERAL INFORMATION Complete legal description Lot 12A; . Block 1 : Denaly Subdivision Location (site address or directions) • _ ; j S iCo1(,k y Ka Homes 622-5585 •:` Current Property owner(s) pp an Day phone Mailing address 17034 N. Eagle River Loop Eagle River, AK 99577 Lending agency Day phone Mailing address Real Estate Agent Mailing Address . Day phone Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: ' Individual Well Individual Water Storage Community Class Well Public Water System 4 2.. � , el/ c � ' 3 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of 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. (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 •i.'::^r'?1.,r' r. • date sf�owrj below, I verify that my investigation:, ovai Guidelines for this application, shows that the on-;•• As certified by my seal affixed hereto and as of the validation based on procedures outlined in the Health Authority Appr site water supply and/or wastewater •disposal system is(are)• safe,=,fupctional and adequate for the pumber of • bedrooms and type of structure indicated herein. I further verify fiat based on the information obtained from the Municipality of Anchorage files and from •my investigatioi3; and,irispection,• the on-site water supply and/or wastewater disposal system is(are) in compliance with all •a plicable' Municipal and •State codes, ordinances, and regulations in effect at the time of installation.. �' t '' •a: , • . • • :± ... 1 • Name of -Firm S•-& •S. 'Engine era•ng•694.=297' —• Address 17034 N. Ea leRiver'; .4.dPS;2bW�WRiVr :AK 99577 Engineer's Printed Name Robert' `C _•' `�nraan :, 4 d•33'x:., r . _ 5. DSD SIGNATURE • Approved for Disapproved. ' • Conditional approval for Additional Comments' • • 4 f: t' -• 04t(tttr•rrrrrrif' ►; j:• ON -SIT WATCR AND m WASTEWATER; : •• • o. GROGRAM ..••• Attachments: HAA Checklist • X Septic System Advisory' Well Flow Advisory ` Maintenance Agreements Supplemental Engineer's Report Other (Rev. 01102) Original Certificate Date: / 0 — 9 - 0 3 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.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L0 T 13 A A. WELL DATA Well type PRly4 ti - Date completed 6 (3'0/oj Sanitary seal Q/N)Yt Total depth a- -1 ft. Cased to O -v ft. FROM WELL LOG 6I2.0103 j3 LOc�c p'..Ny "Yb Parcel ID:0 O9/-30 If A, B, or C provide PWS}D # Date of test Static water level ART ft. Well production 1 3— g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mI. Nitrate O. 1 mg /I. Arsenic: mg./I. Date of sample: 10/, X03 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SLf° 7 r c/ HOPE Tank size J3.00 gal. Number of Compartments P. - Foundation cleanout ON)1C2 Depression over tank (Y49) ^' ° WeII Log 0\1) YE S Wires properly protected 0N) YA f Casing height (above ground) 1 8 t in. AT INSPECTION ft. g.p.m. Other bacteria 0 colonies/100 ml. Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Date installed S / - Zoo 3 Cleanouts1) yf 1 High water alarm (Y0 i.' O Date of pumping j•' ^' E... Pumper C. ABSORPTION FIELD DATA Date installed 3-1d4h) 3 Length S 0 ft. Total depth 11 ft. Eff. absorption area y ft2 Monitoring tube Date of adequacy test N/# "- a/ Results (Pass/Fail) Soil rating Jq.p.d./ft2jr ft2/bdrm) 0- Width 3 ft. Fluid depth in absorption field before test Elapsed Time: min. Any rejuvenation System type -I f,j c -M Gravel below pipe ft. Ye j in Water added gal. fluid depth in. ment (past 12 mo.) (Y/N & type) Depression over field For bedrooms New depth in. Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump oft' level at Datum yc es tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot lir' Absorption field on lot 1/ G Public sewer main N / Sewer /septic service line a- 4" Manhole/Acc High water alarm level at in. Meets alarm & circuit requirements? i On adjacent Tots / O 0 4 On adjacent lots f 0 J '-4 N/A Public sewer manhole/cleanout Holding tank Al /A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation /0 Property Zine ' Water main N / f} Water service line /0 Wells on adjacent Tots / D d f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: , Property line 3 3 Building foundation LC- Water SWater Service line / ° -t-• ' Surface water 1 0 b -t- Wells on adjacent Tots / °I) " . Curtain drain r' °''t % Ado la F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name /ep0.O R r C. COreq", Date /0 /6 /0 3 Absorption field Surface water 1 O Water main iv /A Driveway, parking/vehicle storage 4 o f HAA Fee $ 37s_ -o Date of Payment Receipt Number (Rev. 12/01) /0/70) 0 Ala 8-01 Waiver Fee $ Date of Payment Receipt Number