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HomeMy WebLinkAboutSTONEBECK LT 11BOnsite File �: r  O ! Municipality of Anchorage Development Services Department :~i~ Building Safety Division On-Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 0sP101025 PID Number: 05120219000 Name: JAMES STONE Wastewater System: [] New [] Upgrade Address: 18332 SUE TAWN DR., CHUGIAK ABSORPTION FIELD Phone; Number of Bedrooms: 4 [] Deep Trench [] Shallow Trench ~ Bed [] Mound [] Other: Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION 0.7 GPD/FF 4.5 Ft. Block: 3 Lot: 1 1 Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: SUE TAWN ESTATE #2 2.5 Ft, 0.5 Et. Township: Range: Section: Fill added above original grade: Gravel Length: 1.5 Ft. 58 Ft. Gravel width: Number of fines: Distance between lines: Well: [] New [] Upgrade 15 Ft. 5 3 Ft. Classification (Private, A, B, C); Total Depth: Cased to: Total absorption area: Pipe MatedaI: PRIVATE 400 Ft. 144 Ft. 870 Ft~ PVC Driller: Date Drilled: Static Water Level: Installer: Date Installed: SULLIVAN 6/7/10 156 Ft. CMM GENERAL CONTRACTORS 10/13/10-10/16/10 Yield: Pump Set at: Casing Height Above Ground: 1 GPM 388 Ft.2 Pt. TANK SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other: T~ TO Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity: From~ Tank Field Station Tank Sewer Line GREER TANK 1,250 GaL Material: Number of Compartments; we, +100' +100' NA NA NA POLYETHYLENE 2 SurfacaWater +100' +100' NA NA ~ LIFT STATION Size: Manufacturer: Lot Line +5' + 10' NA NA Gal. , "Pump on" [evel at: "Pump off" level at: in High water alarm at: Foundation +5' + 10' NA NA in. in. Pump Make & Model Electrical Inspections performed by: Curtain Drain +100' +100' NA NA Remarks: INSPECTED BOTTOM OF EXCAVATION ON 10/14/10. BENCH MARK Location and Description: INSPECTED DRAINFIELD PIPES IN PLACE ON 10/15/10. FOUNDATION CLEANOUT INVERT Assumed Elevation: 100.0 Ft. Engineer's Stamp Inspections performed by: COLIN MEEHAN, P.E. Dates: 1st 10/14/10 DeveloP't~ent S~ces'Oepartment Approval , Conditional ApprovalS,,' :,7, :7? .?£??'~:Z/4.~.~:.-~ , Date:~.: f/4.//j i / q " (Re,', 04~06) ' ~ '[--' /-- SUE TAWN ESTATE, ADDITION 2 BLOCK 3, LOT 11 AS BUILT SITE PLAN FEB. 23, 2011 FIGURE 1 ~x o> o~ S~ _ ~ ~ ~ °~ 0 m' ~o~ o~ -' ~om >oz ~ o m~ x~ ~m ~m o~ o SUE TAWN ESTATE, ADDITION 2 I SEP~C SYS~M AS BUILT PLAN BLOCK 3, LOT 11 MARCH 3, 2011 I FIGURE 2 ? .~ I I I I P m 0 0 7 (..Om ....~ ;::U >- m--q m z I I II I SUE TAWN ESTATE' ADDITION 2IBLocK 5, LOT 11 UARcHSEP11¢ SYSTEU AS BUILT i24 Well Log Permit Number:~101025 Date of Issue e1412010 Date Started: 61712010 Date Completed: 61812010 Property Description SUE TAWN ESTATES #2 Lot 11 Block 3 Property Owner Name & Address: Borehole Data: Soil Type, Thickness & Water Strata Casing Sfickup Silt Sand Gravel W/Boulders Silt Gravel Clay W/Cobbles Hardpan Yellow Bedrock Gray & White Bedrock Gray Bedrock Gray & White Bedrock Gray Bedrock Parcel Identification NUmber: Is ,*'ell located at approved permit location? Section: Town: CMM GENERAL PO BOX 774042 EAGLE RIVER, AK 99577' Depth From To 0 2 45 61 61 134 134- 165 165 207 207 289 289 384 384 4O0 Water Sample Results: Arsenic: Nitrates Total Coliform Bacteria Other bacteria: 05120219000 '~-- [__ ~No ~Ycs Range: Attention: MethodofDrilling ~1 airrotary [-~ cabletool Casing type: Wall thickness 0.28 inches Diameter 6 inches Total: 14n feet Liner type: Diameter inches Depth: feet Casing stick-up above ground: 2 feet Static Water Level(from top of casing) Pumping Level: feet after I hours pumping gpm Recovery Rate t gpm Method of Testing: Air feet Well Intake Opening Type [~ Open End [~] Open Hole ~] Screened Start .... feet Stopped feet [-[ Perforations Start feet Stopped feet Grout Type: Ben~ni~ drygranular Volume: t50 Pounds Depth 44 Start 0 feet Stopped ~ feet P~mp Intake Depth: feet Pump size: HP brand name Well disinfected upon Completion? ~ Yes L_~ No Method of disinfection CHLORINE 50 PPM Comments: ug/] Well Driller: Cole Sullivan mWl Sullivan Water Wells · ...... !P.O. Box 670272 colonies/100mL Chugiak, AK 99567* col/100mL 1907) 568-z7*Ss The property owner shall provide this log to DSD (onsite) and DNR within 30 days of completion. Arctic Pump & Well, Inc. PO Box 770197 Ea_qle River, AK 99577 CMM PO BX 774042 Eagle River, AK 99577 Jim Sullivan 688-2510 or 258-2510 745-2510 Fax:688-2543 Email: apw(~gci.net Alaska Distributor Invoice # 866 PO: Date of Completion Phone: (907) 694-8758 Email Address: Cell Phone: (907) 317-0231 Fax Number: 9076968758 '~Prol~ertv Information: Legal: SueTawn B3 Lll Street: sue tawn Static Level: 156 Well Depth: 400 1 Gallons per Minute Pitless Depth: 10 Excavator: cram Well Ddller: sww Pitless Model: B-10 Description Price per Unit Price AmOUnt 1 378 390 3 1 1 7JS1 S4-2W230 $1,348.00 $1,348.00 $1,348.00 GALVENIZED PIPE $3.75 $3.50 $1,323,00 10-2 WG SUBMERSIBLE PUMP WIRE DOUBLE JACKET $1.80 $1.80 $702.00 CHECK VALVE 1" BRASS SPRING $30.00 $30.00 $90.00 WATER SPLICE $28.00 $0.00 $0.00 INSTALLATION $600.00 $600.00 $600.00 Received in Satisfactory Condition Payment due on receipt of invoice unless prior arrangements made. All account Past Due will be charged 1 112% per month. $25 second billing charge. THANK YOU Performed For: Legal Description: 5- 6- 7- 8- 9- 10- 13- 20- James Stone Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.cLanchora,qe.ak, us (907) 343-7904 Soils Log - Percolation Test Sue Tawn Estate #2, Block 3, Lot 11 Slope WAS GROUND WATER ENCOUNTERED? Yes IF YES, AT WHAT DEPTH? 6.5 Feet Depth to Water After Monitoring? Date: Date Performed: November 1, 2009 Township, Range, Section: T15N, RIW, Section 15 Site Plan Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS Percolation test not completed at TP-2, monitoring tube not installed. PERFORMED BY: Colin Meehan, P.E. I Colin Meehan, P.E. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 11/1/09 Permit Number: Tax Code Number: Work Type: On-Site Water & Wastewater System Permit OSP101025 05120219000 WellSeptic MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Initial Permit Effective Dates: June 04, 2010 to June 04, 2011 Design Engineer: MEEHAN COLIN & JONTIE Subdivision: SUE TAWN ESTATE #2 Site Legal Address: SUE TAWN ESTATE #2 BLK 3 LT 11 G:1060 Owner/Address: STONE JAMES R & MARY S 1221 TOMAHAWK DR FT RICHARDSON AK 995051015 Site Mailing Address: 18332 SUE TAWN DR, Chugiak Lot Size in Sq Ft: 92229 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y SepticTank N Holding Tank N Privy Y Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: 1. Minimum 7 day water monitoring for test hole 2 must be provided. Construction may proceed at your own risk before the 7 day monitoring is complete. Please submit stamped and signed results with the as-built inspection report. If the results require a design change, construction of the system will stop pending on-site review and approval. AMC 15.65.060.B.4 .~_ ,( ::.-- .¢~.~¢: .~.¢ Received By: Issued By: 'l(~-~/~¢-r~~,c_,c.,y,.~ Date: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program · 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99507 www.muni.orglonsite (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-202-19-000 Property owner(s) James & Mary Stone Mailing address t2213'omahawk Drive. Fort Richardson, AK Site address 18332 Sue Tawn Drive, Chugtak, AK Legal description (Sub'd., Block & Lot) Sue 1'awn Es[ate #2, Block 3. lot 11 Legal description (Township, Range & Section) Lot S~ze 92,229 Sq. Ft. Day phone, .Zip Code 99505 .Zip Code 99567 Number of Bedrooms 4 THIS APPLICATION IS FOR ([] all that apply): THIS APPLICATION IS AN: Absorption Field [] Initial [] Septic Tank ITl Upgrade [] Holding Tank [] Renewal [] Prw 1:3 , Water Storage I-i C.~,~t,.~,-. ,~mt,~' I certify that the above Information is conect. I further cert~ that this application is being made for a (~-'~ of property owner or authorized agent) ~. ~ Permit/Rush Date of Payment: (Rev, 11/05) Waiver Fees: · 'Date of Payment: Receipt Numbe~. May 12, 2010 Municipality of Anchorage On-Site Water and Wastewater Program 4700 EImore Road Anchorage, Alaska 99519 Attention: Onsite System Reviewer Subject: Onsite Well & Wastewater System Sue Tawn Estate #2, Block 3, Lot 11 Dear Reviewer: · ~. The subject property is currently undeveloped and is the proposed site ora llu'eebedroom single family residence. The site plan shows the proposed locations of the home, water well and septic system components on the property. Attached to this letter is the following: Site Plan Septic System Plan Specifications Soils Log - Percolation Test On-site Sewer/Well Permit Application Thc adjacent properties consist of single family homes with onsite systems which are shown on Figure I. The surrounding properties should no the affected by the location of the proposed well and septic because all required separation distances have been met. Little Peters Creek is located on the western boundary of the property. Please fell free to contact me if you have any questions or comments at 317-4806. Sincerely, Colin Meehan, P.E. ~< © ~ m~- >m ~ > O0 -- ITl ITl Z -r-I m )> o m~ m r'n 0 m ~> mz--0 ITl Z---IT ---I 03:0-0 -<Ox mmO '-n ~on r- Z(/) 'mT go m.--t · Fr-i ~ dk o >~ ~ > ~ m ~ m ~ ~ z ~ ~ ~ > mz~ ~ ~ F~ · ~ v Z ~ z I m >~ o ~ 0 ~ z ~ m 0 ~ ~ ~ Z Z~O ~ 0 ~ -- Z ~ O Z~ -- ~ Z~ o - ~m~ ~ m ~ m ~ O~F ~ ~ ~ ~ -- ~ 0 .--I 0 m ._~ m O ~00 m ~.-~ SUE TAWN ESTATE, ADDITION 2 BLOCK ,3, LOT 11 OCT. SITE 13, 2010 PLAN FIGURE 1 om X~ SUE TAWN ESTATE, ADDITION 2 SEPTIC SYSTEM PLAN } l BLOOK 3, LOT 11 OCT. 13, 20101 FIGURE 2 m Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.ci.anchorage.ak, us (907) 343-7904 Soils Log - Percolation Test Performed For: James Stone Date Performed: November 1, 2009 Legal Description: Sue Tawn Estates fl2, Block 3, Lot 11 Township, Range, Section: T15N, RlW, Section 15 9- 10- 12- 13- 15- 16- 17- 20- Slope Site Plan WAS GROUND WATER ENCOUNTERED? Yes IF YES, AT WHAT DEPTH? 6.5 feet Depth to Water After Monitoring? 5.5 feet Date: 6/22/2010 Reading Date Gross Time Net Time Depth to Water Net Drop 1 11/1/09 0:05 5 sec. 1" 1" 2 11/1/09 0:20 15 sec. 2" 1" 3 11/1/09 0:36 16 sec. 3" 1" 4 11/1/09 0:52 16 sec. 4" 1" PERCOLATIOI~ RATE 0.25 (minutes/inch) PERC HOLE DIAMETER 12 inches TEST RUN BETWEEN 1 FT AND 2 FT COMMENTS Monitoring tube installed on 11/1/09 to a depth of 7 feet below ground surfface. PERFORMED BY: Colin Meehan, P.E. I Colin Meehan, P.E. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 11/1/09 Per/ormed For: Legal De&criptton: Municipality of Anchorage Development Services Department Building ~afoly Oivl$iort On-Site Water and Wasteweter Program 4700 Elmcxe Road P.O. Box t96650 Anchorage. AK 99507 www,ci,anchora~e ak.us (607) 34:)-7~04 Soils Log - Percolation Test 4- 5- 6- 7-' 8- 9- 16- 17- 18- 19- 20- James Stone Date Performed: November 1.2009 Sue Tawn Estate #2, Block 3. Lot 11 ~ Township. Range, Sec~on: T15N. RIW. Section t,5 $1o1~e Site Plan ENCOUNTERED? Yes · IF YES. AT WHAT DEPTH? 6.5 Feet Depth {o Water AfTer Monitoring? Dale: Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (mmmeean~) PERC HOLE DIAMETER TEST RUN I~ETWEEN FT AND FT COMMENTS Percolation test not completed at TP-2, monitonng tube not InstaIled. PERFORMED BY: Colin Meehan, P.E. I Colin Meehan. P.E. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 11/1/09 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.ci.anchora,qe.ak.us (907) 343-7904 Soils Log - Percolation Test Performed For: James Stone Date Performed: 10/6/10 Legal Description: Sue Tawn Estate #2, Block 3, Lot 11 Township, Range, Section: T15N, RlW, Section 15 2- 3- 4- 5- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- Slope Site Plan WAS GROUND WATER ENCOUNTERED? Yes s IF YES, AT WHAT DEPTH? 8.0 ft L O Depth to Water After p Monitoring? ~'. (~ ~ E Date: 10113/10 Reading Date Gross Time Net Time Depth to Water Net Drop 1 10/6/10 0:00 0 sec. 5" 0" 2 10/6/10 0:15 15 sec. 6.5 1.5" 3 10/6/10 0:30 15 sec. 7.5" 1.0" 4 10/6/10 0:45 15 sec. 9.0" 1.5" 5 10/6/10 1:10 25 sec. 12.0" 3.0" PERCOLATION RATE 0.15 (minutes/inch) PERC HOLE DIAMETER 8" TEST RUN BETWEEN 2 FT AND 3 FT COMMENTS Monitoring tube installed on 10/6/10 to a depth of 8.5 feet below the ground surface. PERFORMED BY: Colin Meehan, P.E. I Colin Meehan, P.E. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 10/6/10 ON-SITE WASTEWATER DISPOSAL SYSTEM GENERAL The scope of this project includes the installation of a new on-site wastewater system serving a proposed 4 bedroom residence. The new on-site system will include a 1,250 gallon septic tank as shown on the Site Plan. The system will a~so tnclude installation of a 58' long by 15' wide drainfield bed as shown on the site plan. The new drain field shall be placed a minimum of 100' from atl wells in the area and 100' from any surface water in the area. The septic system must also be a minimum of 10' from the water sen/ice line on the lot. A minimum of 3' of cover is required over the drain field and 4' of cover over the septic tank. The septic tank must be constructed of 10 gauge steel if it is to have more than 4' of cover. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions and all applicable State and Municipal Wastewater Regulations. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verifications of the locations of all lot lines. The Contractor must also verify the location of wells in the area and assure the separation distances are met. The Contractor must provide field survey notes to verify the layout of the septic system and to ensure no encroachment into easements or lot line setbacks. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Building Safety On-Site Water and Wastewater Program for system installations, Owners installing their own systems must receive prior approval from the On-Site Water and Wastewater Program before beginning system installation. SEPTIC TANK INSTALLATION 1. A new 1,250 gallon septic tank must be procured from an approved source and installed at the location shown on the site plan. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4' cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above the final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2' of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive s~ope exists away from the septic tank. DRAINFIELD CONSTRUCTION 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the bed shaI! be level throughout. 2, Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Sue Tawn Estate #2, Block 3, Lot 11 5/12/2010 1 of 2 Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4' in diameter and installed at the locations shown on the design. The portion below the distribution line must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum of 100' away from any private water weI~s in the area. 150' from a Class C well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the drainfield to drain away. 8. A minimum 2' of native accepting soil stratum below the bed bottom. MATERIAL SPECIFICATIONS 1. Septic tanks must be constructed by a Municipality of Anchorage approved septic tank manufacturer. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage. Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated but not solid) and ASTM D2662 or A.B.S. (perforated or solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank Inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be 0.5' to 2.5" in diameter with less than 3 percent passing the #200 sieve. INSPECTIONS Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field sun/ey layout and construction notes for use in preparing the certified as-built of the completed system. In addition, the property owner must furnish an as built of the lot showing the location of the house, septic system and other above ground features for use in preparation of the septic system as built. Sue Tawn Estate #2, Block 3, Lot 11 5/12/2010 2 of 2 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 GE~ERAL~INFORMA:TION Cecnplet~,~egal d~scdPti°n Location (site address) Current Properly Owner(s) ~ Mailing address / ~1 Lending agency Expiration Date: ~/d//// Day phone Day phone Mailing address Real Estate Agent Day phone Mailing Address / Un/ess otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class __ Public Water System Well TYPE OF WASTEWATER DISPOSAL: ~ Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer The Municipality of Anchorage 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 ~ ~/L~ ~/ ~'~ Phone Address /qS~ ,~r,~t~ Cf ~ ~,..4b Engineer's Printed Name C. oz_,~ 5. DSD SIGNATURE Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisor? X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other OriginalCertificateDate: ~/C~///, (Rev. ll/05) 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 Parcel ID: ~'1 - WELL DATA Well type'Cr; Date completed Total depth ~DD ft. Date of test Static water level Well production If A, B, or C provide PWSID # __ Sanitary seal (Y/N) ~/ Cased to lq~ ft. FROM WELL LOG I~/ I ?-/tO / ft. g.p.m. Well Log (Y/N) / Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION ft. g.p.m. WATER SAMPLE RESULTS: Coliform z. t colonies/100 mL Nitrate ~,~ mg/L Arsenic: ~..°~ ppb date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material ~,-~.~r- ~'~e~1 Tank size 1~ gal. : ~, Number of Compartments Foundatie~ clean~ (Y/N) ,/~ ,,Depression over tank (Y/N) Date of pumping ',~ Pumper C. ABSORPTION'FIEI~D DATA Date installed ,1::¢!~'/1! ..Soitta~in~rft2/bdrm)0,'"7 Length Z~cf ft..,: ' Width '7__O ft. Total depth q,~ ft. Eff. absorption area%'''rD ft2 Monitoring tube __ Date of adequacy test ~, .~5~¢-J¢k Results (Pass/Fail) Fluid depth in absorption field before test __ in. Water added Elapsed Time: __ min. Final fluid depth __ in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Other bacteria '~ t colonies/100 mL Collected by: Date installed t~/i~'/~t Cleanouts (Y/N) ~/ High water alarm (Y/N) /~) System type Gravel below pipe ¥ Depression over field ~ gal. Absorption rate >= If yes, give date ~J 'For ~ bedrooms New depth in. g.p.d. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at __ in. "Pump off" level at __ in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line Animal containment areas On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank ~J~ Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation +' ~'' Water main Wells on adjacent lots + leo Property line * '~ Water service line +leO Absorption field Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: I Property line + Water Service line Curtain drain ~- ~' Building foundation Surface water + Wells on adjacent lots .~ lC''~ Water main ~ ~ Driveway, parking/vehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect.on this date. Engineer's Printed Name Date ,~,(~--Waiver Fee Date of Payment Date of Payment Receipt Number (Rev. 11/05) Receipt Number (;ROt P Colin Meehan Attn: Mr. Colin Meehan 18717 I st Street Eagle River, AK 99577 907-317-4806 Fax: Client Sample ID: Sampling Location: Client Project: Sample Matrix: COC #: PWS#: Residual Chlorine: Comments: James Stone Well Colin Meehan Drinking Water SP-Analytica, Inc.-Anchorage 4307 Arctic Blvd. Anchorage, AK 99503 Phone: 907-258-2155 Fax: 907-258-6634 Report Date: 3/3/2011 Receipt Date: 2/23/2011 Sample Date: 2/23/2011 Smnple Time: 2:35:00PM Collected By: Unknown Flag Definitions: MRL = Method Reporting Limit MCL = Maximum Contaminant Limit B = Present also in Method Blank H = Exceeds Regulatory Limit M = Matrix Interference J = Estimated Value D = Lost to Dilution ** = RL higher than MCL; target not detected TNC = Too Numerous to Count - result rejected CF = Confluent Growth - result rejected TCNG = Turbid Culture No Growth - rejected Lab#: Al 102259-01A Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 4500-NO3E (Aqueous) - Nitrate+Nitrite pres Test was conducted by: Analytica - Anchorage Nitrate-Nitrite as Nitrogen 1.40 mg/L 0.50 10 3/1/2011 3/1/2011 MC Lab#: A1102259-01B Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 9223B-PA (Aqueous) - Coliforms in DW E. Coli Pass PASS/FAlL 1.0 Total Coliform Pass PASS/FAIL 1.0 Lab#: A1102259-01C Test was conducted by: Analytica - Anchorage 1 2/23/201 l 2/23/2011 KM 1 2/23/2011 2/23/2011 KM Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 200.8/200.8 (Aqueous) - Family Well Water I Arsenic 2.04 ug/L 0.15 Test was conducted by: Analytica - Thornton 10 200.8 3/2/2011 3/2/2011 RM Page 3 of 3