Loading...
HomeMy WebLinkAboutCONTOUR ACRES #2 LT 3Confou Ac es Lot 3 #017-451-25 Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page '1 of 3 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND]OR WELL INSPECTION REPORT Permit Number: sw080114 PID Number: 017-451-25 Name: Trevor Fairbanks Wastewater System: [] New [] Upgrade Address: 5500 Penny Circle, Anchorage 99516 ABSORPTION FIELD Phone: Number of Bedrooms: 4 [] Deep Trench 171 Shallow Trench [] Bed [] Mound [] Other: Soil Rating: Total Depth from odginal grade: LEGAL DESCRIPTION 0.8 GPD/Ft2 West 9.0 / East 8.97 Ft. Block: Lot: Subdivision: Depth to pipe bottom from odginal grade: Gravel depth beneath pipe: 3 Contour Acres #2 W 4.89 / E 5.46 Ft. W 4.11 / E 3.51 Ft. Township: Range: Section: Fill added above odginal grade: Gravel Length: 0.5-0.8 Ft. W 38.0 / E 42.0 Ft. Gravel width: Number of lines: Distance between lines; Well: [] New [] Upgrade 5.0 Ft. 2 10 Ft. Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: private 326 Ft. 60 Ft. 769 Ft2 ASTM D3034 Driller: Date Ddlled: Static Water Level: Installer: Date installed: Alpine 10-2-08 141 Ft. owner 8-14-08 Yield: I Pump Set at: Casing Height Above Ground: GPMI 286 Ft. 2 Ft. TANK 3 SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other: T~ To Septic Absorption Lift Holding ~ublicJPrivate Manufacturer: Capacity: Tank Field Station Tank Sewer Line Premier 1300 Gal. Material: Number of Compartments: we, 140 142 NA NA 120 HDPE 2 suaacewater 100+ 100+ NA UA ~ LIFT STATION Size: Manufacturer: Lot Line 70 50 NA NA NA Gal. Foundation 14 16 NA NA "Pump on" level at: in. "Pump off" level at: in. High water alan'n at: in. Pump Make & Model Electrical Inspections performed by: Curtain Drain NA NA NA NA Remarks: MT5 provided to monitor groundwater level at tank. Do not pump BENCH MARK Location and Description: tank if GW is more than Ift above bottom of tank. Garage Slab Assumed Elevation: 104.72 Ft. Engineer's Stamp Inspections performed by: Cindy W. Ellis, P.E. Dates: 1at 8-13-08 2nd 8-14-08 Development Services Department Approval Conditional Approval Date: Reviewed and approved by: ,~x.~/.~~/~ ,/E~) ~ ~.'~'.. E - 'J0577 .."' ,:2' ¢<,,/~ Date: jO ~..,?..,,7.- ~'~ '~,.'~"..l:.O ...... ~j.¢:.. ',~..O~.~~:.'~,'~ A B C A B C Based upon an asbuilt r ~ survey by Charles Forbes, ST1 --- 17.1 33.4 MT2 o.x9 20.9 54.4 LS-7326, dated 8-27-09. ST2 --- 19.9 38.6 CO3 --- 48.5 70.2 DCO --- 22.0 43.0 MT3 --- 49.9 72.0i I FS --- 23.7 45.9 CO4 39.0 32.7 67.8! CO1 --- 47.6 59.1 MT4 40.8 34.6 69.5 MT1 --- 49.7 61.8 MT5 --- 13.1 33.4 CO2 33.7 19.8 53.6 FCO --- 9.7 24.9 MT3 MT~ Contour Acres h2 Lot 3 Record Drawing or Septic Installation Trevor Fairbanks Watkins Engineering, Inc. Scale 1 inch = 30 ff Phone: (907) 360-3389, ~ellisak~gmail.com A B C ST1 --- 17.1 33.4 ST2 --- 19.9 38.6 DCO --- 22.0 43.0 FS ___ 23.7 45.9 CO1 ___ 47.6 59.1 MT1 --- 49.7 61.8 CO2 33.7 19.8 53.6 A B C MT2 33.9 20.9 54.4 CO3 --- 48.5 70.2 MT3 --- 49.9 72.0 CO4 39.0 32.7 67.8 MT4 40.8 34.6 69.5 MT5 --- 13.1 33.4 FCO --- 9.7 24.9 93.73 99.12 Top of ?ank 94.53 1)(~0 93.58 !,'low (;01 MT1 PIPI~: /? ~ 97.29 _C3rade98.71 .74_ l~ol Iota of Bollom of / ~ ~ ~ ~/I'[",~.~_89.84 90.04 f Of Pipe Nole: ?e:,;t }k)le lRelalive Pep/h: 83.71 No Waler. 93.25 (,0,, k/IT:~ ~/1'I'4 (704 PlPI{; ~'*II/I'Y,R ¢'ABRI(; Top of' Pipe 92.60 [[ } NOTEi ~' 96.83 - 97.14 Trench 88.14 N/IT3 88.16, AS-BUILT \ '~,lnv(~ll of Pipe rJ'o~;I l{O](-! Rehdive Deplh: Nc) Wale~ 92.25 l}o/lom of ~'1'4 88.14 Contour Acres #2 Lot 3 Record Drawing of Septic Installation .re o, ,n,,n er, n,, ,nc. Permit No. SW080114 Cindy W. Ellis, P.E. P.O. Box 22574 O~ober 14, 2009 Billings, MT 59104 No Scale Phone: (907) 360-3389, cwellisak~gmail.com ',x, :7:~' ALPINE DRILLING & ENTERPRISES Permit Number: #SW080114 Date of Issue: 7-08-08 Date Started: 10-1-08 Date Completed: 10-2-08 Legal Description: Property Owner Name & Address: Bor~hole Data': Soil Type, Thickness & Water Strata Parcel Identification Number: 017-451-25 Is well located at approved permit location? [] Yes ~[~ No Contour Acres #2 Lot 3 Treavor Fairbanks 3305 Eo 64th Ave. Anchora~le, Alaska 99507 Depth (ft) Method of Drilling [] air rotary From To stick-up 0 2 silt 2 18 silty gravel 18 39 silt 39 51 gravelly silt 51 73 cobbly gravel 73 79 gravelly silt 79 103 silt 103 115 silty gravel 115 125 silt 125 137 bedrock 137 326 [] cable tool H20 285 300 Casing type: steel Wail Thickness:. 025 inches Diameter: _6 inches Depth: 6._q feet Liner Type: ~ Diameter: _ inches Depth: ~ Casing stickup above ground: _2 feet feet Static water level (from ground level): .141 feet Pumping level:, 326 feet after _2 hours pumping _3 gpm Recovery Rate: _3 gpm Method of Testing: air lift Stopped ~ feet Stopped ~ feet Well Intake Opening Type: [] Open End [] Open Hole [] Screened Start ~ feet [] Perforations Start ~ feet Grout Type: bentonite granules Volume: 2 bgs. Depth: Start 0 feet Stopped ? feet Pump: Intake Depth ~ feet Pump size hp Brand Name Well Disinfected Upon Completion? [] Yes [~] No Method of Disinfection: Alpine Drilling & Enterprises P.O. Box 110496 Anchorage, AK 99511-0496 Comments: Well Driller: Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property owner or the well driller shall provide a well log to the Development Services Department within 60 days of completion. Mark Begich Mayor Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Street P.O. Box 1966§0 Anchorage, AK 99§1~-66§0 www.muni.orq/onsJte (907) 343-7904 Pump Installation Log © Well Drilling Permit Number: SW080114 Parcel Identification Number: O17-451-25 Date of Issue: 7-8-08 Replacement Only: YES ~ Legal Description Lot 3, Contour Acres #2 IIProperty Owner Name & Address: Trevor Fairbanks 5500 Penny Circle Anchorage, AK. 99516 Pump Installation Date: 7/24/2009 Pump Intake Depth Below Top of Well Casing: 286 feet Pump Manufacturer's Name: Grundfos Pump Model: 15 Sqe 15 290 Pump Size 1.5 hp Pitless Adapter Burial Depth: 13 feet Pitless Adapter Manufacturer's Name: MAAS Pitless Adapter Installer: Aarow Pump & Well Service Well Disinfected Upon Completion? [] Yes [] No Method of Disinfection: Recirc Comments: Pump Installer Name: Aarow Pump & Well Service LLC PO Box l10496,Anchorage, AK. 99511 (907) 346- 9355 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE Development Services Depatlment On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anch~age, AK 99519-6650 (DO?) 343-7904 ON-SiTE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Jul 08, 2008 Expiration Date: Jul 08, 2009 Permit Number: SW080114 Legal Description: CONTOUR ACRES #2 LOT 3 Design Engineer: 0844 WATKINS ENGINEERING Owner Name: TREVOR FAIRBANKS Owner Address: 3305 E. 64TH AVE ANCHORAGE, AK 99507- Parcel ID: 017-~51-25 Site Address: 5500 PENNY CIRCLE Lot Size: 111653 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] 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: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-45%25 Property owner(s) Trevor Fairbanks Mailing address 3305 E 64th Ave, Anchorage, AK Site address 5500 Penny Circle, Anchorage, AK Legal description (Sub'd., Block & Lot) Contour Acres #2 Lot 3 Legal description (Township, Range & Section) Lot Size 111,653 Sq. Ft. Number of Bedrooms 4 Day phone .Zip Code 99507 Zip Code 99516 THIS APPLICATION IS FOR (~] all that apply): Absorption Field [] Septic Tank [] Holding Tank [] Privy [] Pdvate Well [] Water Storage [] THIS APPLICATION IS AN: Initial [] Upgrade [] Renewal [] 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. (S'g ature of pr~erty owner or a~thodzed agent) Permit/Rush Fees: Date of Payment: ~ "~--"7-- 0 ~ Receipt Number: /OC~ C~ [ (Rev. 11/05) Waiver Fees: Date of Payment: Receipt Number:. Watkins Engineering, Inc. P.O Box 110443, Anchorage, AK 9951! (907)349-!851 cwellis@g¢i.net June 25,2008 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: Contour Acres #2 Lot 3 Proposed Well and Septic System Development To Whom It May Concern: Attached please find the application and supporting documentation to install a well and septic system for a proposed 4 bedroom house at the subject location. There are no slope concerns or surface waters nearby. The proposed septic system is not within 100 ff of any private well, and the proposed well is not within 100 ft of any septic system. The proposed drainfield design is based upon Test hole #2 dug on June 11, 2008 to a total depth of 15 ft. There was no groundwater influx when the hole was dug or after 7 days of monitoring. The maximum depth of the drainfleld is 9 ft. A percolation test conducted between 4.5 ft and 5.0 ft resulted in a rate of less than I minute per inch. The soils were not consistent, however, so an application rate of 0.8 gpd/ft~ is used in the design. Test hole #1 encountered similar to lower quality soils, and no perc test was conducted. Test hole #3 encountered slightly better quality soils overall, and a percolation test between 5.0 and 5.5 ft yielded a result of 10 minutes per inch. The reserve drainfleld site is around Test hole #3, based upon a design similar to the primary drainfield site. A lift station will be required for the reserve site. The soil logs are attached. Two trenches are proposed, with the same absorption area. The flow will be split equally between the 2 trenches, using a Zable flow splitter. The proposed design is as follows: Proposed Soil Absorption System: 4 Bedrooms x 150 GPD/BR = System Type: Application rate: 600 GPD 5owide 0.8 gpd/~ Well and Septic Permit Application for Contour Acres #2 Lot 3 Watklns Engineering, Inc.; June 25, 2008; page 2 600 GPD I 0.8 gpd/~ = Maximum Depth: West Trench (downhill) Effective Depth: Reduction Factor: Length: Absorption Area: East Trench (uphill) Effective Depth: Reduction Factor: Length: Absorption Area: Total Absorption Area: 750 ~ required 0.9 ft above base of organics 4.0ft 0.50 38ft 380 ft2 3.5ft 0.54 42 ft 388 ~ 768 ~ I am not aware of any adverse effect that this upgrade would have on any adjacent properties' water and wastewater treatment needs. Thank you for consideration of this permit application. If you have any questions or need further information, please call me at 349-1851. Sincerely, Cindy W. Ellis, P.E. President Jl~ 4 5 I I I I , Septic '""" ~ Area /I/ × ~" Septic I [; / /~ ~ ~aa ,I; - ~ \  WELL /1~ ~ /~,~ ,11 ~ / / / ~~ _ _ ~.~..~ c,.c~ 2 I1[ ¢~/o~ ~isang / ~X~ , i / ,t' x~ ~ ~roposeo[ ~ ~I i e~.,_Proposed ~ ~ *~ ~ ~1 /li'~House ~ ~°~e ~ / ,// ~ L, ~ ,,~ / / ~Proposed /)~T~ /~ L .... J sapac , / ! septic syst~_~ ~. [[ ~ ~Z~ Sln Area 2 Undevelo~d 3 4 Undevelo~d 5 Undevelo~d 6 ROSE3UD HILLS SUBDI /ISION Block 1 Lot 3 well ~ is I~ted to ~e south Septic Area ~ntour Acr~ ~2 Lot 3 ~ 51te Plan ~..9~.~4~. Trevor Falrban~Watkins Engineering, Inc Parcel ID:0~7~5]-25 ~" 49 ~ '"?~ Cindy W. Ellis, RE RO, Box ~]0443 June 25, 2008 Anchorag~ AK 995[~443 ~.."-.~-~- ~-~ ~al~ ~' - ~00' Phon~ (907) 349-~85~ Fa~ (907) 349-]934 ~"~,,,,.,.,~'~- Test Hole #2 Proposed 6/11/08 Trenches DESIGN DETAILS Organics _ o.s 4 BR, 600 GPD ML 0.8 gpd/ft2 -- 4.0 5.0 4" perf Requires 750 ft2 ,,h pipe (2) 5-wide Trenches West trench: __0,5 --4.0 5.0 O~O~''' _ 15.0 4.0 It sewer 4.0 ft effective; RF = 0.50 SM rock 38 ft long; 380 ft2 Proposed East trench: Well SM/ \ 9.0 .c,~ 3.5 ft effective; RF = 0.54 ~A/ \ -G'?'~. 42 ft long; 388 ft2 .~. _~ 768 ft2 total '"'- - BOH_ 15.0 C~.~O~ Max9ftdeep __ No Water --/../"//'Based/' upon · plot plan J by Charles E. Forbes, LS--7326 JJune 12, 2008 \ /J/ s ptiotank tDriveway .... Proposed trenches ~ -~ / I'~ ,~,'~'~ West: 4.0 ft eft x 38 ft Zable Flow e O~ East: 3.5 ft eft x 42 ft Splitter I ~e~ ~ O ..... ,_= _-L___ S 89°56 00' W ~ Contour Acres #2 Lot 3 Proposed Well & Septic Development Trevor Fairbanks Watkins Engineering, Inc. -- · ..+~ Parcel ID;017'451-25 ~..~~ Cindy W. Ellis, P.E p.o. Box 110443 June 26, 2008 Anchorage, Alaska 99511-0443 'o~.~'-~.c.~).~:,-.'~ Scale I inch = 30 ft Phone (907) 349-1851, Fax: (907) 349-1934 Municipality of Anchorage Development Services Department Building Safety Dt',~sJon On-Sile Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519~50 ~ ,si anchorage ak us (907) 343-7904 Soils Log - Percolation Test Performed For:. Trevor Fairbanks Legal Des~pfion: Contour Acres #2 Lot 3 Test Eole #1 Organics 1---1.0 2- 9--3.0 __7.0 Slope 5- 6- 7- 6- 9- 10- 11- 12- 13- 14- 15- 16- 17- 16- 19- 20- Date Pedo~'med: 6/11/08 Tovmship. Range. Section: Site Plan SEi A' ~TA ZHE :) WAS GROUND WATER £NCOUN'r~RED? NO IF YES. AT WHAT OEPTH? -- L 0 Mo.~w~.g? DRY E O.te: 6/1808 13.0 EE AT ['ACHEE Reading Dale Gross T~me Net Time Depth to Water Net Drop No pezcolation test cor, ducted PERCOLATION RATE (mmu~e~-~h) PERC HOLE DIAMETER TEST RUN BET~I[EN FT AND Fl' COMMENTS Soils frm'n 3 to 7 were mixed SM and ML - Inconsistent PERFORMED IN ACCORDANCE W1TH ALL STATE AND MUNICIPAL GUIDEUI~ES IN EFFECT ON THIS DATE. DATE: Municipality of Anchorage Development Services Department Building Safety Divtsioa On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK ~9519-6650 www cf anchorage ak us ·(~07) 343-79O4 Sods Log - Percolation Test Slope 5. 6. 7- 8. 9- 10- 11. 12. 13. Performed For:. Trevor Fairbanks Legal Desc~ptton: Contour Acres #2 Lot 3 Test Hole ~2 Organics 0.5 4.0 perc 4.5-5 WA~ GROUND WATER 9 · 0 ENCOUNTERED? NO $ IF YES, AT WHAT DEPTH? -- L 0 DepUt b~ Water After p ~oe~o~sng? DRY E Date Performed: 6/11/08 Township. Range. Section: Site Plan SE] A,?TA ]Hf ) ;EE AT FAC {EI 14- 15- 16- 17. 18. 19. 20, COMMENTS 15.0 Reading Date Gross T~me Net Time Depth to WaterNet D~op I 6111/08 1:47-1:50 3 6'-0' 6' 2 6/11/08 1:50-1:53 3 6'-0' 6' 3 6/11/08 1:53-1:56 3 6"-0' 6" 4 6/11/08 1:58-2:02 4 6'0' 6' 5 6/11/08 2:03-2:07 4 6'-0' 6" 6 6/11/08 2:10-2:13 3 6'-0' 6" 7 6/11/08 2:14-2:17 3 6'-0' 6' PERCOlATiON RATE <1 (..,*,u,.,~) PERC HOLE D~AMETER 6" TEST RUN BE"I%N~EN 4.5 FT AND 5.0 FT PERFORMED aY: Cindy W. Ellis/Rocky Trainor , ~/J~"~/. /~'Z~.~ CERTIFY THAT 'I]-{IS TEST WAS _ PERFORMED 1" ACCOR---~'=~E'~-'~"H~MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ -~.5 '~2)~ Municipality of Anchorage Development Se~ces Department Buitding Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorege, AK 99519-6650 wwwcl anchora(]e ek us (907) 343-7904 So,Is Log - Percolation Test Performed For: Tmvor Fairbanks Date Peri'on.ed: 6/11/08 Legal DescflptJon: Contour Acres #2 Lot 3 Township, Range, Section: Slope Site Plan Test Hole #3 Organics 0.5 2.0 perc 5-5.5 6- 7- Se_~ Aztach~d 10- 11- 12- 13- 14- 16- 17- 18- 19- 20- COMMENTS 11.0 .0 WAS GROUND WATER ENCOUNTERED? NO IF YES. AT WHAT DEPTH? 6/18/08 Se, A';ts :h( :t Reading Date Gross Time Net Time Depth to Water Net Drop 1 6/11/08 1:05-1:35 30 6'-2.75' 3.25' 2 6/11/08 1:36-2:06 30 6'-3.0' 3' 3 6/11/08 2:07-2:37 30 6'-3.0' 3' 4 6/11/08 2:38-3:08 30 6'-3.0' 3' PERCOLATION RATE 10 (nlet~,es/eeh) PERC HOLE D~ETER 6' TEST RUN BETWEEN 5.0 FT AND 5.5 FT PERFORMED BY: CindyW. Ellis ,RockyTrainor , ~/~?////~.~ CERT,FYTHATTHiSl'ESTWAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDJ~MNES IN EFFECT ON THIS DATE. DATE: ~, --'~,~ ~ ~' 68/08/2008 16:11 3491934 T~evo~ F~t~mk~ 3305 E 64~ ~r¢ .~chot~g~ A~ 99~07 (907) 77O-9924 2008 Municipal~ of Anchorage Dcvelopmcnt Scrvlccs Dcpartm~t Building SgfctT Division On-sit~ Water Wastewater program 4700 South Bragaw St P.O~ Box 196650 Anchorage, AK 99519-6650 Dear Sir o~ ]Ms&m: This lcttcr is to inform youz Dcl:~ttment that thc On-site system £o~ thc above menOoned lot will b¢ installed b7 thc h~d The On-~ite system &signed by Watldns eogh~ecx~ng ~ be installed in ~¢corchncc ~ith Construction Practices und M~t~zial Spec~ications outlined bT Wu,ldns Eng~¢*~q"~ and O.-.4t¢ WarerWastcwatet larogr~m ' Fairbanks, my. father and general contractor of 'the excavation will be done by Denms with the ADEC wastewater 15 years, md my~¢l£, · Environmeu~ Spcdalist of ? program. Both my dad md I have been grotmcl a~d iaave partidpatecl in conswaction. excavation ~ojects for many yeats. T~vor Fakhanks Ovmer]Buildcr CC: Cindy Ellis I~.E., Watkins Eng~cefing Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I,D. 017-451-25 GENERAL INFORMATION Complete legal description Location (site address) COSA # O Expiration Date: Contour Acres #2 Lot 3 5500 Penny Circle, Anchorage 99516 Current Property owner(s) Trevor Fairbanks Mailing address 3305 E. 64th Ave., Anchorage, AK 99507 Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickupo NUMBER OF BEDROOMS: 4 Day phone Day phone Day phone TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class ~ Well [] Public Water System [] 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 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 Watkins Engineering, Inc. Address PO Box 22574, Billings, MT 59104 Engineer's Printed Name Cindy W. Ellis DSD SIGNATURE ~ Approved for Disapproved. Conditional approval for Phone 907-360-3389 Date bedrooms., i bedrooms, with the f Iio Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other (Rev 11/05) Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type private Date completed 10-2-08 Total depth 326 ft. Contour Acres #2 Lot 3 Date of test Static water level 141 Well production 3 WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Arsenic: 0 ug/I B. SEPTIC/H~BING TANK DATA Parcel ID: 017-451-25 If A, B, or C provide PWSID # -- Sanitary seal (Y/N) yes Cased to 60 FROM WELL LOG 10-2-08 g.p.m. Well Log (Y/N) yes Wires properly protected (Y/N) yes Casing height (above ground) 24+ AT INSPECTION NA - new NA- new ft. g.p.m. NA - new in. Nitrate 0 mg/L Date of sample: 7/31/09 Other bacteria 0 colonies/100 mL Collected by: Rocky Trainor, Watkins Engr Tank Type/Material Premier HDPE septic tank Tank size 13oo gal. Foundation cleanout (Y/N) yes Date of pumping NA-new C. ABSORPTION FIELD DATA Number of Compartments 2 Depression over tank (Y/N) no Pumper NA-new Date installed 8/14/08 Length 38 + 42 Total depth 9.0 Date installed 8/14/08 Cleanouts (Y/N) yes High water alarm (Y/N) NA Soil rating (g.p.d./ft2 or ft2/bdrm)0.8 System type shallow trench ft. Width 5.0 ft. Gravel below pipe w 4.1/E 3.5 ft. Eft. absorption area 769 ft2 Monitoring tube Y-4 Depression over field no Date of adequacy test NA-new Results (Pass/Fail) NA-new For 4 bedrooms Fluid depth in absorption field before test in. Water added gal. New depth Elapsed Time: __ min. Final fluid depth in. Absorption rate >-- Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date in. g.p.d LIFT STATION Date installed NA Size in gallons "Pump on" level at in. "Pump off" level at Datum Cycles tested E. SEPARATION DISTANCES in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift .station on lot 140 Absorption field on lot 142 Public sewer main lOO+ Sewer/septic service line 120 Animal containment areas 100+ Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank NA Manure/animal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 16 Surface water 100+ Wells on adjacent lots lOO+ Absorption field 10 Surface water 100+ Building foundation 14 Property line 7o Water main 100+ Water service line 50+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 50 Water Service line 50+ Curtain drain NA COMMENTS: in. Water main lOO+ Driveway, parking/vehicle storage 40+ COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) ENGINEER'S CERTIFICATION ~,. '.:~.~ I certify that I have determined through field inspections and review of Municipal records that the above systems are in Engineer's Printed Name Cindy W. Ellis ~ 5 ~ ~'~} Waiver Fee $ /~~~t ~ Date of Payment Receipt Number