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GREAT DANE PARK LT 1
at Dan Pork Lot l #015-273-46 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6660 Phone: (907) 343-7904 Fax: (907) 343-7997 http://w .muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201254 Work Type: SepticTank Upgrade Tax Code Number: 01527346000 Site Legal Address: GREAT DANE PARK LT 1 G:2635 Site Mailing Address: 3541 E 112TH AVE, Anchorage Owner: BORST CHRISTOPHER I & ERICA L Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sci Ft: Total Bedrooms: Uchuruncnl 7/21/2020 7/21/2021 48841 ❑ Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: /L (r[ { 10.4K Date: _ Date: �� C= Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201254, Rebecca Carroll, 07/21/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201254, Rebecca Carroll, 07/21/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201254, Rebecca Carroll, 07/21/20 Municipality of Anchorage Development Services Department ` ; Building Safety Division On-Site Water & Wastewater Program, 4700 South Bragaw St. A P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW020066 PID Number: 015-273-46 Name: JUDD RAYMOND PETERSON Wastewater System: ❑ New ■ Upgrade Y Address: 3541 El 12TH AVE. ANCH. AK. 99516 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 269-7622 3 ❑Deep Trench ■Shallow Trench ❑Bed []Mound ❑OTHER LEGAL DESCRIPTION Soil Rating: <1 Total Depth from original grade: 9.12 MAX GPD/Sq. Ft. Ft. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: — 1 GREAT DANE PARK 5.09 MAX Ft 4.03 F, Township: Range: Section: Fill added above original grade: Gravel length: — — — SEE DWG. Ft. 37.5 FL WELL: Gravel width: 5 Number of lines: Distance between lines: — ❑ New ❑ Upgrade Ft. 1 Ft. Classification (Private, A B,C): Total De Cased To: Total absorption area: Pipe material: D 3034/ F-810 Ft. Ft. 375 SQ. Ft. Driller. Date Drilled: Static Water Level: Installer. OWNER Date installed: 7/10/02 FL Yield: Pump Set At Casing Height Above Ground: TANK GPM Ft Ft. SEPARATION DISTANCES ■ Septic ❑ Holding ❑ S.T.E.P. ❑ Other To Septic Absorption Lift Holding Public/Private Manufacturer. PREMIER Capacity in gallons: 1000 From Tank Field Station Tank Sewer Lines Well 100'+ 100'+ — — 25'+ Material: PLASTIC Number of compartments: 2 Surface Water 100'+ 100'+ - - - LIFT STATION Lot Line 5'+ 10'+ — — — Size In gallons: Manufacturer. "Pump on" level at: 'Pump off" at High water alarm at: Foundation 5'+ 10'+ — — — Pump Make odel: Electrical Inspections performed by: Curtain Drain NO KNOWN BENCH MARK Remarks: Location and Description: OLD SEPTIC TANK WAS REMOVED TO LANDFILL. TOP OF WINDOW SILL ON WEST SIDE OF HOUSE Di r • bloe� ;raA, • Assumed Elevation: 104.9 Ft. ENGINEER'S SEAL ��\� • / / • • v 44� l / l<_A i � lGl. = ��e,1��„— , r'! ,�) i. P� Inspections performed by: AKWWC, INC. Dates: 1st 7/8/02 ©�4. ,' THS ••.�*�� p • • • • • • •II• • �• ............ • • �O 2nd 7/10/02+ 3rd 7/10/02 ef' ey A. Gar/ ess. do —79 3/ ADO Development Services Department Approval �9-s 0 4404d�'r Reviewed and approved by: % Date: o /a7 ��- of%1 (Rev. 12/01) t essio 0��00�06 ' l IMF PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: SW020066 015-273-46 / 1 ci �1 �N" I\PLAsnc I 1 / �v -"PST1I , 0oV CONCRETE SEEPAGE PIT \ST2 CLEANOUT. �� / DBL1 IV Jtt MIn DGI\tGG1Y r ------ OLD SEEPAGE PIT L- — — — - AND NEW DRAINFIELD TH#1+ — MT1 C01L \\\\MT2 CO2 NEW DRAINFIELD SEE PAGE 3 OF 3 FOR DETAILS. C F - w in w A 3 yOFUt SFo"' )UND H2O I o dT FOR B STIC TANK �I NE CO I TERNATE SITE = B C MT 31.48 — 47.79 ST1 34.45 50.51 ST2 38.23 — 53.94 DBL1 40.18 55.29 DBL2 41.15 — 55.90 BR 42.35 56.75 C01 73.29 = 99.76 07/23/02 DRAWN BY: ALASKA WATER & WASTEWATER B.S.G. - CONSULTANTS, INC. SCALE: 6901 DEBARR ROAD, SUITE 26 •ANCHORAGE. AK 99504 •PHONE (907)337-6179 `FAX (907)338-3246 1" = 40' PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JUDD RAYMOND PETERSON (907) 269-7622 2 OF 3 LEGAL DESCRIPTION: LOT 1; GREAT DANE PARK SUBDIVISION TYPE OF WORK: AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE MT1 70.88 1105.87197.48 CO2 59.58 76.5 88.4 MT2 61.23 78.44 90.2 UNE CO 34.57 66.4 163.24 i'&;vnes �3* ... 0 9/ I I3 f e s sionGoo PERMIT NUMBER: AS—BUILT D RAM N G PARCEL ID NUMBER: SW020066 015-273-46 3' OF BOARD INSULATION WAS PLACED OVER TANK TO FINAL GRADE = 103.46 — 103.85 DISPLACE SOIL WEIGHT. 41 TOP OF TANK AT INLET = 97.64 —\ i— TOP OF TANK AT OUTLET = 97.7 .. ............................. ... ............................ sM�� * o 0 0 ��, R�ht GALLON NEW 1000 INVERT OF BUNG SEPTIC TANK AT INLET = 96.82 PREMIER PLASTIC WITH 4' BURIAL RATING INVERT T BUNG AT OUTLET = 96.64 ORIGINAL GRADE = 97.02 — 98.10 FINAL GRADE = 97.50 — 97.98 INSULATION r—FILTER FABRIC 1- 5' INVERT OF PIPE = 93.01 DATE: 07/26/02 DRAWN BY: ALASKA WATER & WASTEWATER B.S.G. < CONSULTANTS, INC. = SCALE: 6901 DEBARR ROAD, SUITE 2B . ANCHORAGE, AK 99504 . PHONE (907)337-6179 ' FAX (907)338-3246 NTS PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JUDD RAYMOND PETERSON (907) 269-7622 3 OF 3 LEGAL DESCRIPTION: LOT 1; GREAT DANE PARK SUBDIVISION TYPE OF WORK: PROFILE AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE OF TRENCH = 88.98 0 ............... J � J ff G•rne s.* 7953 m pp O sM�� * o 0 0 ��, R�ht �.•� -- •.•.•.❖.�. •.•.•a 1- 5' INVERT OF PIPE = 93.01 DATE: 07/26/02 DRAWN BY: ALASKA WATER & WASTEWATER B.S.G. < CONSULTANTS, INC. = SCALE: 6901 DEBARR ROAD, SUITE 2B . ANCHORAGE, AK 99504 . PHONE (907)337-6179 ' FAX (907)338-3246 NTS PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JUDD RAYMOND PETERSON (907) 269-7622 3 OF 3 LEGAL DESCRIPTION: LOT 1; GREAT DANE PARK SUBDIVISION TYPE OF WORK: PROFILE AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE OF TRENCH = 88.98 0 ............... J � J ff G•rne s.* 7953 m pp O 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 PERMIT Initial Permit Number: SW020066 Legal Description: GREAT DANE PARK LT 1 Design Engineer: 0041 AK Water & Wastewater Consultan, Owner Name: Judd Raymond Peterson Owner Address: 3541 E 112TH AVENUE ANCHORAGE, AK 99516-1431 `2vJ Date Issued: Apr 17, 2002 Expiration Date: Apr 17, 2003 Parcel ID: 015-273-46 Site Address: 003541 112TH AVE E Lot Size: 48841 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 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: Issued By: Date: '4/_ZZ70112 Date: 4h710 Municipality of Anchorage Development Services Department Building Safety Division SAFETY 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 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-273-46 Permit Number �lvp20066 Property owner(s) JUDD RAYMOND PETERSON Day phone 269-7622 Mailing address (1) 3541 EAST 112TH AVENUE * ANCHORAGE. AK Mailing address (2) Zip Code 99516 Legal description (Lot, Block & Sub'd.) LOT 1: GREAT DANE PARK SUBDIVISION Legal description (Section, Township & Range) N/A Lot Size i1g; a / Acres Sq.F Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. ALASKA WATER & WASTEWATER CONSULTANTS, INC. Permit Fees: <S 700, Waiver Fees: Date of Payment: % —eoo' Date of Payment: Receipt Number: /f4a1/0 y Receipt Number:, ALASKA WATER & WASTEWATER CONSULTANTS, INC. April 11, 2002 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragraw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Proposed Septic System Upgrade for Lot 1, Great Dane Park Subdivision To whom it may concern: The existing house is served by an undocumented private well and septic system. A new three bedroom house is being constructed dictating that a new septic system be installed with a reserve site. A test hole was excavated south of the septic system. The new septic system will be designed around the 30 foot radius of this test hole. We are proposing that a 1000 gallon septic tank and a five foot wide drainfield be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that an application rate of 1.2 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch b. Allowable Application Rate: 1.2 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 375 ft2 f. Total Depth: 10 feet (max.) g. Effective Depth: 4 feet h. Width: 5 feet i. Reduction Factor: 0.50 j. Minimum Length: 37.5 feet long k Effective absorption area= 375 ft2 6901 Debarr Road, Suite 2B * Anchorage, AI{ 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.corn 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: The area for the proposed septic system is mostly flat; in short, there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your M.S. NOTE: Attached is a site plan drawing, a design drawing, two soils log, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com I I I I LOT 27A; SECTION 21, T12N, R3W I 0z �l z \\CSEPTIC j ti \� ARS I I _ LOT 25; SECTION 21,I / --- T12N, R3W i i��' �%�0 I �y —_J (INSTALL I / F.C.O 1 / EXISTING 3 1 LLJ BEDROOM HOUSE <v / \\ EXISTING SEPTIC 1 3 U pp SYSTEM I / I ~ Z I LL.I o _ __ I N F I Q I Y _ __ #1 I O U N I I a - -- I c�i z I 0 I N a I N lT 0 I i ow I I 1- I -� Q I ii N Q I I N LL.I o r7 J I D—'1 I J N oLu I CD J0 I I I J CSEPIIC PROPOSED SEPTIC SYSTEM I ARES (SEE DESIGN PAGE 2 OF 2)1 - — — — — — — — — — ---I 11 1 E. _ 112th AVENUE_ 1 --------------------------------------- ------------------- I--' N Lul N N LLL SIEFKER S/D #2; ai ¢ En H 0: (A LOT ABA, ow ow o� J N N zl o DATE: 4/11/2002 DRAWN BY: �sr . ......... C.J.G. AL A'V1'ATER & WASTEWATER SCALE: 3 CONSULTANTS, INC. 1,. _ 100' 6901 DEBARR ROAD, SUITE 2B ' ANCHORAGE, AK 9950& ` PHONE (907)337-6179 • FAX (907)338-32L6 I PREPARED FOR PHONE NUMBER: PAGE NUMBER: vn ,40 JUDD RAYMOND PETERSON (907) 269-7622 1 OF 2of A. rner • s ss: LEGAL DESCRIPTION: JI�r1 E-7953 LOT 1; GREAT DANE PARK SUBDIVISION TYPE OF WORK: �1��`aeaprofessioro��' SITE PLAN FOR SEPTIC SYSTEM UPGRADE EXISTING CONCRETE SEEPAGE PITS TO REMAIN IN PLACE FOR POSSIBLE FUTURE USE PROPOSED 1000 GALLON "PREMIER" PLASTIC SEPTIC TANK iTH#1 z / I w / w 3pRppp I � H FARO F� o�SF py I � 0 -'CO \— INSTALL DOUBLE I CLEANOUTS (DBL) 4' +/- ALTERNATE SITE PROPOSED DRAINFIELD. EXCAVATE A TRENCH THAT IS 10 FEET DEEP MAXIMUM BY 5 FEET WIDE BY 37.5 FEET LONG. ADD 4 FEET OF CLEAN, WASHED SEWER DRAINROCK. INSTALL TRENCH PARALLEL TO SLOPE CONTOURS. WEST LOT LINE SHALL BE FLAGGED I I BY A REGISTERED LAND SURVEYOR. DATE: Q�p6oO�O 4/11/2002 o OF 0� q9 DRAWN BY: C.J.G. ALASKA WATER & WASTEWATER SCALE:,, CONSULTANTS, INC. -- _ _ • • • • • • . 6901 DEBARR ROAD, SUITE 2B • ANCHORAGE, AK 9950& ' PHONE (907)337-6179 ' FAX (907)338-32&6 1 40 ...........� ..... PREPARED FOR: PHONE NUMBER: PAGE NUMBER: I JUDD RAYMOND PETERSON 269-7622 2 OF 2� . QO � •.J ffr A. me s. - LEGAL DESCRIPTION: Q —7953 LOT 1; GREAT DANE PARK SUBDIVISION TYPE OF WORK: ��oaP DESIGN OF PROPOSED SEPTIC SYSTEM UPGRADE OO fessio � NG SEWERTILINE' �9 Qg EXISTING UNDOCUMENTED / SEPTIC TANK TO BE V / EXISTING CLEANOUT s,� � ABANDONED PER UPC \ \ / /f / / TALL FCO EXISTING CONCRETE SEEPAGE PITS TO REMAIN IN PLACE FOR POSSIBLE FUTURE USE PROPOSED 1000 GALLON "PREMIER" PLASTIC SEPTIC TANK iTH#1 z / I w / w 3pRppp I � H FARO F� o�SF py I � 0 -'CO \— INSTALL DOUBLE I CLEANOUTS (DBL) 4' +/- ALTERNATE SITE PROPOSED DRAINFIELD. EXCAVATE A TRENCH THAT IS 10 FEET DEEP MAXIMUM BY 5 FEET WIDE BY 37.5 FEET LONG. ADD 4 FEET OF CLEAN, WASHED SEWER DRAINROCK. INSTALL TRENCH PARALLEL TO SLOPE CONTOURS. WEST LOT LINE SHALL BE FLAGGED I I BY A REGISTERED LAND SURVEYOR. DATE: Q�p6oO�O 4/11/2002 o OF 0� q9 DRAWN BY: C.J.G. ALASKA WATER & WASTEWATER SCALE:,, CONSULTANTS, INC. -- _ _ • • • • • • . 6901 DEBARR ROAD, SUITE 2B • ANCHORAGE, AK 9950& ' PHONE (907)337-6179 ' FAX (907)338-32&6 1 40 ...........� ..... PREPARED FOR: PHONE NUMBER: PAGE NUMBER: I JUDD RAYMOND PETERSON 269-7622 2 OF 2� . QO � •.J ffr A. me s. - LEGAL DESCRIPTION: Q —7953 LOT 1; GREAT DANE PARK SUBDIVISION TYPE OF WORK: ��oaP DESIGN OF PROPOSED SEPTIC SYSTEM UPGRADE OO fessio � ,o��Oppp o OFINAEASKA � WATER & WAS-i'EWATER� - CONSULTANTS, INC. sso(907)337-6179 a a,: 1 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK. 99504 + PHONE 907 337-6179 • FAX (907)33B-3246 • WEBSITE: okwwc.com D SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: GREAT DANE SUBDIVISION; LOT 1 °. fry G rness, PERFORMED FOR: VVV o4 E-7953 JUDD RAYMOND PETERSON DATE: 3/11/2002 O 's ' '•mac°Q (feet) DEPTHP rofessi%O v` ORGANICS TEST HOLE #1 pppoo 1 SOIL CLASSIFICATIONSGP ML 3 Psm GM CL I I 4 GC OL ��'�, IfiffI F� i N411/ ; v SWMH 5 SP CH 00 p � OH 6 os4 e \ t TH#1 7 ®o © o � SP cv a I o0°d0°6 I g°a°Q°�®e O Z EXISITING 3 BEDROOM 9 ®Q®s©®0 HOUSE SITE PLAN 1"=100' 10-1 11 12 SM 13 14—'��Jjjjjj 15 ecauQlow °000°00 3®0°®0 Q�O°°° c SP 90 00°00 17 `0 0®OII °9° fi BQ©p©°d 18 B.O.H. PERCOLATION RATE <1 (MI �CH) PERC OLE DIA. 6 (INCHES) 19 TEST RUN BETWEEN Z-(-'5T. ND 6s' T. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ONO SOILS LOGGED BY: CALEB GALL PERCOLATION TEST PERFORMED BY: CALEB GALL COMMENTS: THE INSITU SANDY SOILS WILL ACT AS A SAND FILTER PERFORMED BY A.W.W.C., INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS• PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: :s 11'6, 0 Z. DEPTH TO GROUNDWATER DATE DRY 3/11/2002 ��2� •� Eesti �� 3/11/2002 1 — — DATE READING CLOCK TIME NET TIME (MINUTES) WATER L VEL READI�1 NET DROP (INCHES) 3/11/2002 1 — — 6" — 2 — <1 0" 6" 3 — — 6" — 4 — <1 0" 6" 5 — — 6" — 6 — < 1 0" 6" pli 4 CC7; J-1�t/i•� m O Q LOT 27A; SECTIO T12N___W �L r e o ¢ o SERPTIC SECTION 2 ,--R3 0 J � EXIS BEDROO H \ U o NG SEP 9 SYSTEM O U � N M ~ N W Z N f� zI - z O U Q N N a O Q O Q U n N 0 \ W N Q W J = V SEPTIC PROPOSED SEPTIC SYSTE (SEE DESIGN PAGE 2 OF 2 E. 112th AVE E N N � N Q E IE.FKER S/D LOT A8A, #2; O ¢ U- J w Z O Q D 3/18/200 0� F ✓ ��� D WN BY: /�,.,P' 0 C') : r T DO SCALE: ZFAX(9078-3246 �..... 6901 DEBAR ROAD. SUITE 2B ' ANCHORAGE. AK 99504 ' PHONE (907)337-6179- 177 _ 00! . ............... D REPARED F PHONE NU ER: PAGE NU BER:Q DD RAYMOND PE 0769- 622 1 OF 2 QQ •.Ji fr y A. Giarne C -7953 44�st`e �''• s, mp p,`cp� LEGAL DESCRIPTIO LOT 1; GRE54T DANE P " < SUB ISI a0 Profess'W\ TYPE OF WORK: SITE PLAN FOR SEPTIC SYSTEM UP RX�� pp0000a m MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-273-46 Expiration Date: 1. GENERAL INFORMATION Complete legal description GREAT DANE PARK LT 1 Location (site address) 3541 E 112TH AVE ANCH AK Current property owner(s) MICHAELTYLMAN LIVING TRUST Day phone Mailing address SAME Real estate agent Day phone 2. TYPE OF DWELLING: ❑ Single Family (w/wo 10 17 ❑ Duplex ❑ Multiple Dwellin (, ; �y� a r Duplex) N . V � �- 3. NUMBER OF BEDRO S�'O �„ D.- 4. TYPE OF WATER SUP P `e� 0> a �C5 TYPE OF WASTEWATER DISPOSAL: Private Well �` 0� 6 0 Private Septic Q Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: fn74/ f-- Date: 57/7,/l COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 6-0 Waiver Fee $ Date of Payment a9_1 I g Date of Payment Receipt Number 4—Myo/ Receipt Number COSA # g5e_1 ! `1q.1;L 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 MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE. ANCH AK 99516 Engineer's Printed Name MIKE N ANDERSON, P.E. Date 5-3-19 as 0° SPY♦'Y �`� 6. DSD SIGNATURE�,� 49ra 0 0° e • • O y 0 O 00 O 0 o e °,s System #1 Approved for 3 bedrooms, • • °s% esee••°. 70 MICHAEL N. °O•�ee.e°rJ System #2 Approved for bedrooms e, •° ANDERSGN ; J �� CE 9 69 Disapproved �� ���� . 5� �'or Conditional approval for bedrooms, with the following ti `ghr 2V'11'1� �`~_✓ By: t^"�—� ^ Original Certificate Date: 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 COvA Checklist Legal Description: GREAT DANE PARK LT 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 5/29/87 Total depth 241 ft Cased to 241 ft Al Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12"+ in. Date of flow test for COSA 4/18/19 Static water level at beginning of test 92 ft. Comments B. TANK DATA Age of tank(s) 710102 years Tank type/material PLASTIC Measured operating fluid level in septic tank 44 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 4/18/19 D. ABSORPTION FIELD DATA 2002 SYSTEM TESTED Which system tested (date installed) 7/8/02 ❑ ALL standpipes present per record drawing Total measured depth from grade 8.5 ft (max) Measured depth to pipe invert from grade 4.5 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ 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 Parcel ID: 015-273-46 Structure served by this system Well production at time of test 4+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 1.02 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 4/18/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 4/18/19 Results F, -/]Pass For 3 bedrooms Fluid depth prior to test 20 in Water added 450+ gal New depth 28 in Elapsed time 1440 min Final fluid depth 20 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date UN 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' Q✓ Yes Community Sewer Manhole/Cleanout > 100' Q✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' F✓ Yes if No ft Private Sewer/Septic Line > 25' ED Yes if No ft Absorption Field on Lot > 100' F/ Yes if No ft Holding Tank > 100' 0✓ Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10'✓1 Animal Containment > 50' ✓l Yes if No ft 0 Yes if No ft Yes if No ft Water Service Line > 10'✓Q Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' Q✓ Yes if No ft Q✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q✓ Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' 0✓ Yes if No ft Wells on Adjacent Lots: [Z] Absorption Field > 5' Q✓ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10'✓1 ft Yes if No ft Community Wells > 200'✓Q Yes if No ft Water Service Line > 10'✓Q 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' Q✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' L✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓Q Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' [Z] Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l 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 C. 8 ® Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 s x r r CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-273-46 Expiration Date: 7-16 1. GENERAL INFORMATION Complete legal description GREAT DANE PARK LOT Location (site address) 3541 E 112TH AVENUE, ANCHORAGE, AK 99516 Current Property owner(s) WESLEY & ALICE VANDERMARTIN Day phone Mailing address Real Estate Agent 3541 E 112TH AVENUE, ANCHORAGE, AK 99516 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 ❑ WaiverNariance request for: 3 Day phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ istance: Received by: ����� Date: ZY- //- /'] COSA to be released to h engineer, unless otherwise requested by the engineer. COSA Fee $ ro22Cp — Date of Payment bohl Receipt Number C3 i( COSA# oJCI -I � \ k 9 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the 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 868-3791 Address _20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 4/7/2017 THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS (ENGINEERING SURVEYING CONTRACTORS ETC ASSOCIATED WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. 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 ,.ft ®•®® encroachments, deficiencies or discrepancies exist. do, OF ALS * . 9 Tei 6. DSD SIGNATURE / , M System #1 Approved for. bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, F, KENV;I,V with the following stipulations: OFA'i;_ I LZ WATER m AND rp WASTEWATER z Original Certificate Date: ' t' ''� IL 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: GREAT DANE PARK LOT 1 Parcel ID: 015.273-46 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # Date completed 512911987 (DEEPENED) Sanitary seal (Y/N) Y Total depth 241 ft. Cased to 241.2 ft. FROM WELL LOG Date of test 512911987 Static water level 158 ft. Well production WATER SAMPLE RESULTS: Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 313012017 In g.p.m. 4.7+ g.p.m. Coliform NEG colonies/100 mL Nitrate 1.0 mg/L Arsenic: ND ug/L Date of sample: 3130117 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC 1 PLASTIC Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 91112016Pumper TUFF TOWN C. ABSORPTION FIELD DATA Collected by: ARCTERRA Date installed 711012002 Cleanouts (Y/N) Y High water alarm (Y/N) N Date installed 711012002 Soil rating g.p.d./ft2 r ft2/bdrm) 1.2 System type DEEP TRENCH Length 37.5 ft. Width 5 ft. Gravel below pipe 4.03 ft. Total depth 8.75 ft. (MEASURED 3/30/17) Eff. absorption area 375 ft2 Monitoring tube Y Depression over field N Date of adequacy test 3130117 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 25 in. Water added 450 gal. New depth 31 in. Elapsed Time: 1260 min. Final fluid depth 25 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum rel Size in gallons _ "Pump off' level at Cycles tested in. Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 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 54 Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ 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 1'+ Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION / 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. Engineer's Printed Name KENNETH M. DUFFUS Date 41712017 COSA canary sheet 2-6-15.doc ..0 OF AL�� � i 4 P)) TH i KEtiN. U IS/ P ES .t ivyAIV Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 PC, - i S Sean C CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-273-46 COSA# CsC h/ L 1. GENERAL INFORMATION Expiration Date: a� Complete legal description GREAT DANE PARK S/D; LOT 1 Location (site address) 3541 E. 112TH AVENUE * ANCHORAGE, AK * 99516 Current Property owner(s) RAYMOND JUDD PETERSON Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing address 3541 E. 112TH AVENUE * ANCHORAGE, AK * 99516 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYP.E,OF.WAT'ER SUP�PLY: I rJdivid ual! 1�ell� `. Individual W8feP5tor64e _. ❑ Comrriunityl,C,lass", Well ❑ P u b I i 8 ter.System ❑. Day phone Day phone A y 1Av, J 1\ /7,3/\l 301-0729 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 On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD %SIGNATURE ✓ Approved for bedrooms. Disapproved. Phone 337-6179 Date V1 ]-ZZ III _ Conditional approval for OF bedrooms, with the following stipulations�\- � ♦ee•ose• O • ♦e ON-SITE WASTEWATERPROGINAM _ I • • _ Iii \O • • e e • • ` Attachments: ��'�,P 5 COSA Checklist Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Ni to Advis fy Other B0_ Original Certificate Date: y (Rev. 11105) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: GREAT DANE PARK S/D; LOT 1 Parcel ID: 015-273-46 A. WELL DATA *WELL DEEPENED AND DOCUMENTED ON 5/29/1987. Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) Date completed *5/29/1987 Sanitary seal (Y/N) YES Wires properly protected (Y/N) Total depth *241 ft. Cased to *241.2 ft. Casing height (above ground) YES YES 12+ in. FROM WELL LOG AT INSPECTION Date of test *5/29/1987 5/3/2011 Static water level *158 ft. 94 ft. Well production *20 g.p.m, 4.52+ 9— p.m-WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrateo .0t mg./L. Collected by: GEG, Ltd. Arsenic: NO ug./L. Date of sample: 11 /1 1 /2011 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/PLASTIC Date installed 7/8-10/2002 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 11/21/2011 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 7/$-10/2002 Soil rating ( .p.d./ft r ft2/bdrm) 1.2 System type DEEP TRENCH Length 37.5 ft. Width 5 ft. Gravel below pipe 4.03 ft. Total depth *8.5-8.6ft. Eff. absorption area 375 ft2 Monitoring tube YES Depression over field NO Date of adequacy test **5/3/2011 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 2 in. Water added 475 gal. New depth 15 in. Elapsed Time: 120 min. Final fluid depth 10 in. Absorption rate >= 450+ g,p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — **NOTE: TESTED 2002 TRENCH. OLD SEEPAGE PIT CLEANOUT COULD NOT BE LOCATED DURING INSPECTION. SEEPAGE PIT IS CONNECTED AS RESERVE SITE BY DIVERTER VALVE. 2002 TRENCH WAS IN USE AT TIME OF TEST. D. LIFT STATION Date installed "Pump on" level at in Size in gallons Manhole/Access (Y/N "Pump off"level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ On adjacent lots On adjacent lots 100'+ 100'+ Public sewer main NSA Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 1'+ Curtain drain NONE KNOWN Wells on adjacent lots -1 00'+ F. COMMENTS NOTE: SEPARATION BETWEEN WATER SERVICE LINE & SEWER SERVICE LINE IS UNKNOWN. G. ENGINEER'S CERTIFICATION / 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 JEFFREY A. GARNESS Datei r � 7 l P COSA Fee $ !�/q c . Waiver Fee $ Date of Payment S�/ / 1 ► Date of Payment Receipt Number US ����, (i Receipt Number (Rev. 11/05) € nicipality of Anchorage Development SeMces Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-273-46 COSA# =1 1. GENERAL INFORMATION Expiration Date: R "7 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address GREAT DANE PARK S/D; LOT 1 3541. E. 112TH AVENUE * ANCHORAGE AK * 99516 RAYMOND JUDD PETERSON Day phone 3541 E 112TH AVENUE * ANCHORAGE, AK * 99516 Real Estate Agent x Mailing address r.. Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER. -OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well N Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone 301-0729 TYPE OF WASTEWATER DISPOSAL: Individual On-site N 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATENIENT OF !NSaECTION BY ENGINEER As certified by my sea! affixed hereto and as of the validation date shown belovv, i verify that , ny investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-si c water Supp, v ano;%r wastewater disposa! 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 iiOriiau:On Oucaiiieul from, the Municipality vir rnCForage frc.S und fCn my investigation and inspection, he on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE i Approved for bedrooms. Disapproved. Conditional approval for Atachrrients: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Phone 337-6179 Date 5—/j 0 / l WASTEWATER bedrooms, with the following stipulations: ":Z,. PROGRAM .: ".� ` Arsenic. Advisory Maintenance Agreements Supplemental Engineer's Report Other By: - Original Certificate Date:' (Rev. 11/05) Municipality of Anchorage • Development Services Department Building Safety Division z.., 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: GREAT DANE PARK S/D; LOT 1 Parcel ID: 015-273-46 A. WELL DATA *WELL DEEPENED AND DOCUMENTED ON 5/29/1987. Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed *5/29/1987 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth *241 ft. Cased to *241.2 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test *5/29/1987 5/3/2011 Static water level *158 ft, 94 ft. Well production *20 g.p.m. 4.52+ g,p,m. WATER SAMPLE RESULTS: o.g35 Coliform colonies/100 ml. Nitrate mg./L. Collected by: GEG, Ltd. Arsenic: NO ug./L. Date of sample: 5/3/2011 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/PLASTIC Date installed 7/8-10/2002 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 5/20/2010 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 7/8-10/2002 Soil rating .p.d./ r ftZ/bdrm) 1.2 System type DEEP TRENCH Length 37.5 ft. Width 5 ft. Gravel below pipe 4.03 ft. Total depth *8.5-8.6 ft. Eff. absorption area 375 ftZ Monitoring tube YES Depression over field NO Date of adequacy test **5/3/2011 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 2 in. Water added 475 gal. New depth 15 in. Elapsed Time: 120 min. Final fluid depth 10 in. Absorption rate >= 450+ g,p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — **NOTE: TESTED 2002 TRENCH. OLD SEEPAGE PIT CLEANOUT COULD NOT BE LOCATED DURING INSPECTION. SEEPAGE PIT IS CONNECTED AS RESERVE SITE BY DIVERTER VALVE. 2002 TRENCH WAS IN USE AT TIME OF TEST. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots Absorption field on lot 100'+ On adjacent lots 100'+ 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 1'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS NOTE: SEPARATION BETWEEN WATER SERVICE LINE & SEWER SERVICE LINE IS UNKNOWN. G. ENGINEER'S CERTIFICATIONo l�. I certify that I have determined through field inspections and �* Municipal t the guidelines g above ystems are in �........... ......... review of na conformance withMOA COSA in effect on this D f date. U J fire AGarness: Engineer's Printed Name JEFFREY A. GARNESS QQ ems CE -7b3 7b3 �c�G Date/D/ red 7 `D�,_r o f e s sio,o COSA Fee $�U A Waiver Fee $ Date of Payment Date of Payment Receipt Number C� ��� �T' Receipt Number (Rev. 11/05) 6 82 37- _0_E 105 Z� DWELL I N I N ti_2... 26.5 - 0c) ! N O 14,k °y- H°USFY A EAST 112TH AVENUE SHED 0 m m m sA• m m 0 m 41 THE INFORMATION HEREON I5 FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTI1,15 STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS: AND IS NOT TO BE U5ED FOR POSITIONING ADDITIONAL 5TRVCTURE5, IMPROV—cN.ENT5, GR,'-ENCELINES• EASEMENTS OF Rc'CGRD, OTHER THAN TH05E APPEARING- CN THE RECORD PLAT. ARE NOT SHOWN HEREON (UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON T,95 DRAWING ARE NOT TO RE USED TO DETEAMKE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVIN6 SHOWN HEREON MAY 8c APPROXIMATE DUE TO EXCESSIVE= SNOW AND/OR ICE. ELEC. TRANSFORMER TELE. PED. POWER POLE 0:- LH SHANEA.HOLT ei LS -6914 G AS -BUILT SURVEY 1" = 40' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 1, GREAT DANE PAX SUB. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _47H DAY OF MAY , 2011. 8506 HOLT LAND 51AVEYINS 6060 W I5 YEW DRIVE ANCHORA6EAK MIS 345-5513 AM