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HomeMy WebLinkAboutJB CRUZ LT 3J6 CRUZ Lot 3 #017-101-54 u mpcu, oq ncpvn_ - i-, c.aoc Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http:/ANww.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP111061 PID Number: 017-101-54 New ❑ El Upgrade Name: Nathan and Khrysten Smith ABSORPTION FIELD El Deep Trench ❑✓ Shallow Trench ❑Bed ❑ Mound Address 8501 Hidden View Anchorage, AK 99504 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 748-5938 4 1.2 GPD/SF 5.7 Fl. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.7 Ft. Gravel depth beneath pipe 3.OFt. Subdivision Block Lot JB Cruz 3 Fill added above original grade 1-2 Ft. Gravel length 59.0 Ft. Township Range Section Gravel width 5.0Ft, Beds: Number of Lines Distance between lines I FL SEPARATION DISTANCES TO Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 517.5 Fe 1 1 N/A Ft. Well >100' >100' NIA N/A >25' TANK 71 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity I 1,25OGal. Surface Water >100' >100' N/A N/A Material Number of compartments Lodine >5' >10' N/A N/A Steel Two (2) NA Foundation >5' >10' N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain None Noted Gal. Remarks Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 PCN, Inc. Drainfield F810 CO/MT D3034 Inspector M Anderson BENCHMARK (Assumed elevation) 100.Oft Inspection„ dates: 1 7/21/11 2- 7/21/11 Location and description Garage Slab COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Conditional Approval: Date ' 49n3�, ,. Neo NY Y#a s •,.• • 0 ,. •.. .lY.NMN. NYH. e•o, u,• YC 0 �MICHAIM B ANDERSON % Q O d no Approv c� Date u mpcu, oq ncpvn_ - i-, c.aoc A"4 V O F— Tract 10C s M zM m oN d: . MMS !wM .wM QUm `o w¢ wm aN a Z L �w� tea¢ w� w � m `E w w S 0 a 0 0 z E d a I 1 I o I > I I I I a. O N I D O p 0) Co2 / I N E 99'ti£L M„Sb,90.ON \ 10' Utility Easement --------------------- F I I ,99'b£ L 3„6Z%20.OS M _ }aaa}S olojjn8 M'/Y93N/Y/S N0.SY.ppNY ,0£ W N r'7 rn 00 Z ,0£ I o I > I I I I a. O N I D O p / I Co2 / I I I u, I I I IN I �C I O I J m D I a�'S alowallV I a U I _ C E I N < y O Iw O I a --- ----I L I o 20' CEA Easement F—I ,99'b£ L 3„6Z%20.OS M _ }aaa}S olojjn8 M'/Y93N/Y/S N0.SY.ppNY ,0£ W N r'7 rn 00 Z ,0£ Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 Elmore Road Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: OSP111061 PID NO.: 017-101-54 M 5.6 100.1 �N UU 1,250 Gallon Septic Tank Bedrock 49th PROFILE AS -BUILT �� S BENJNO CE-12592LER No Scale ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) February 2, 2011 Adrian Jaime c/o Prudential Jack White Vista 3801 Centerpointe Drive, Suite 200 Anchorage, AK 99502 Subject: Lot 3, JB Cruz Subdivision Well Inspection and Flow Test Water Quality Analysis Dear Adrian: A flow test was performed on the well currently located on Lot 3, JB Cruz Subdivision on January 28, 2010. The lot is vacant and no power is currently available to the well. A generator was used to provide power to the pump in the well to complete the test. The static water level in the well was found to be 115' below the top of the casing prior to beginning of the test. The water was then allowed to flow freely for a period of 4 hours and the well production measured on a regular basis during that period. The average flow monitored during the test period was more than 5.5 gallons per minute and the static water level dropped slightly to 121' and recovered rapidly once the test ended. The total depth of the well was determined to be 147' and the pump was set at 140'. A camera was used to inspect the interior of the casing. No perforations were noted to depths of 40'. The water production from the well is excellent and easily meets the requirements for a four bedroom home. A new sanitary seal was placed on the well to replace the existing casing cover. The casing at the ground level was found to be bent and must be replaced when the new water service is run from the well to the new house to be constructed on the lot. The casing can be cut at approximately 10' below the surface and a new section welded in place during placement of the new pitless adapter and water service line. The casing has apparently been hit by a vehicle at some time in the past causing the minor bending of the casing. In addition the wiring from the well head must be encased in conduit to below ground once the power is run to the well from the new house. In summary, the well is in good condition and can be repaired to meet all requirements of the City and State for a private well. The water production is excellent and far exceeds all minimum volume requirements of either the City or the State. Lot 3, JB Cruz Subdiviaion Well Inspection and Flow Test February 2, 2011 Water samples were taken from the well and tested for coliform, bacteria, arsenic and nitrate content. Results indicate that none of the aforementioned contaminants are found in the water and it is safe for human consumption. A copy of the results are attached for your use. Please let me know if you have any questions or comments. Sincerely, g� Michael IYAnderson, P.E. Attachments F� 4918 m - Ilenj�lir in 1 Schiller, �� N �•., CE -1 92 `' tW FESS1� 0�- On -Site Wastewater Disposal System Permit 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 Permit Number: OSP111061 Tax Code Number: 01710154000 Work Type: Septic Upgrade Permit Effective Dates: May 19, 2011 to May 18, 2012 7-�2_ f - J( z° `©v 7-x.1-1/ c- 7 Design Engineer: —GARNESS E WEER RQWP-6T4D j} " cktJ:�;d tn t- vy Subdivision: JB CRUZ 0' Site Legal Address: JB CRUZ LT 3 G:3037 Owner/Address: SMITH NATHAN & KHRYSTEN 8501 HIDDEN VIEW ANCHORAGE AK 995042945 Site Mailing Address: 5055 E 142ND AVE, Anchorage Lot Size in Sq Ft: 40317 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N 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: The existing well shall be documented prior to construction of the septic system. Documentation shall include well yield test results, water quality test results, and confirmation of required separation distances. If the well is found to be out of compliance with the code, construction of the septic system shall stop pending approval of a new proposed well location. Recei Issue( Col. �, �: �Qer� OtLAJ -`Le Wa;vfr vv) Cvtyfr Aeeata a.vxd ;.r vv -d wi A desw, co i MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. '59, Property owner(s) NATHAN SMITH Day phone 748-5938 Mailing address BUFFALO STREET *ANCHORAGE, AK 99516 Private Well V it' Site address BUFFALO STREET *ANCHORAGE, AK 99516 rl)- Ptd Legal description (Sub'd, Block & Lot ) JB CRUZ LOT Legal description (Township, Section & Range) Lot Size Sq. Ft. Number of Bedrooms 4 THIS APPLICATION IS FOR: ( ® all that apply) Absorption Field Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: 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. (Signature of property owner or authorized agent) Perm ush Fees: _ � Fees: C it Date of Payment:Date of Payment: =7 ( 1-2 i ) Receipt Number: Receipt Number: C- Permit No, Waiver No. C'�S'F (Rev. 01/11) re ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) July 20, 2011 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 3, JB Cruz Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of the subject lot intends to construct a new four-bedroom home on the property. We are therefore requesting a permit be issued for the construction of a new septic system to accommodate the home. The well is currently in place and will be used if it meets Municipal requirements. The attached Site Plan and backup documentation identify the location and configuration of the existing well and proposed septic system along with the alternate site. No existing wells or septic systems are closer than 100' from the existing well or proposed septic system. Drainage arrows are shown on the site plan showing the grade and direction of flow on the lot. The drainage pattern will not be changed as a result of this project. The test holes placed on the lot in the area of the absorption trench and alternate site indicated silty sand (SM). The percolation rate of the soil was determined to be 5 minutes per inch. Groundwater was found during the placement of the test hole at 10.5' below the surface and dropped during the monitoring period. An application rate of 1.2 gallons per day per square foot was used in the design of the absorption system. We are proposing to place a new 1,250 -gallon septic tank and a 57' long by 5' wide by 3' effective depth absorption trench to treat and dispose of the effluent generated in the house. The elevation of the distribution line in the absorption trench will be 3.0' below the surface and the total depth will be 6'. A minimum of 3' of fill or 2" of insulation and 2' of fill will be placed over the absorption trench and 4' over the septic tank. The ground surface on the lot in the area of the absorption trench is basically flat with a downhill slope from the east at a grade approximating 25%. The new trench will be constructed parallel with the contours of the slope as much as possible and 50' from any breaks in grade greater than 25% in conformance with Municipal requirements. C61 Lot 3, JB Cruz Subdivision July 20, 2011 Page Two The new septic system will be constructed a minimum of 100' from all wells and any surface water and 10' from the proposed and existing water services in the area. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments .••••� OF ��� �b °•• 49th ••° ,..r. .. .. ..h.. r ; MICHAE7777777 P ��J ••.•• N.0. CE -4381 0•�S ���.pROFESSI�N� �� Ll f 49th F s -1r DROP DOWN TO ROAD H W W CDS.. *NOTE: EXISTING WELL ErIUST BE DOCUMENTED, PRODUCTION TESTED, WATER OUALITY TESTED. AND SEPARATION DISTANCES CONHWED PRIOR TO CONSTRUCTION OF THE PROPOSED SEPTIC SYSTEM- 1 NUMOR OF OMROOMS: 4 6M LM PER CLAY (Gap). 5C PROPOSED !t AICAlm itAsE..-„O 'AD® 9G.FT� 120 hfllk Y DEFTFt 6' MIom 5' LE W t 15' MAA 5, SAPID FUM N^ REDUCTION F7Imm 0.58 ACMAL S0.fT-- 129.3 SHALL HAVE TETE NORTH LOT •uw' WEST EASEMENT, AND ALL WELL RAN FI,AMM BY A REGISTERED LAND SURVEYOR PRIOR TO ..A... ........ ... .................... 7g'; MICHAEL E. ANDERSON - �,J,� .•.•No. CE -4381 ��• ::ROFESS���:��� I�v 14 5-25X t � PROPOSED 1250 G4LLfM1 SEPTIC TANK 06TALL FCO a. • r SITE PLAN SCALE 1" = 40' 0DOSMA MIEELL cSEE NOTE ON TIIIS PAM y•i° � r •2�•�'�•:ti Pok • � • �•• •~ Is' 4 LOT 3, JB CRUZ SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom House 5' Wide Trench System Perc. Rate: 1-5 Min./Inch 1,250 Gallon Septic Tank Application Rate: 1.2 GPD/SF 3' Drainfield Rock 4 Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate) = 500 SF Absorption Area 500 SF/5 SF/LF*.57 (Red. Factor) = 57 LF Trench Length THEREFORE: Construct an Absorption Trench 57' Long x 5' Wide x 3' Effective Depth. Flow Line Elevation in Trench to be 3' Below Original Ground Surface. Total Depth to be 6' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. 3' Natural Backfill 2'6" 6" 1 1 0 5' Geotextile Fabric 4" Perforated PVC (Holes Down) Drainfield Rock TYPICAL 5' WIDE TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 4' Separation From Groundwater. Minimum 100' Separation From Wells in the Area. Minimum 100' Separation From Surface Water or Streams. Minimum 10' Separation From Water Services in the Area. - •.•�E OF ..... ♦� 49th '� ♦I ' .......................................... m-. MICHAEL E. ANDERSON �' NO. CE -4381 Apt ♦♦♦.�FESS��i•• GARNNESS ENGINEERING GROUP, Ltd.. CONSULTANTS & GENERAL CONTRACTORS 3701 E. TUDOR ROAD, SUITE 101 + ANCHORAGE, AK. 99507 + PHONE: (907)337-6179 + FAX: (907)338-3246 + WEBSRE gomeesengineering.eom SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: ILIAMNA ACRES; TRACT 9, N2, S2 PERFORMED FOR: ADRIAN JAIME DATE: 8/28/2006 DEPTH ORGANICS (feet) = TEST HOLE #3 1 7 -jljITlfll SM 8 9 10 11 12 13 14 15 16 17 18 19 DEPTH TO GROUNDWATER PLOAM 10.5' (SM) SOIL CLASSIFICATIONS 10.5' 9/8/2006 11.5' 5/9/11 2 3:30 30 0" 6" • ' 3:30 — 6" — 4 4:00 IIIIIIIIIML 0" 6" 5 4:00 — 6" 11111W I GM /CL 30 0" 6" • DOD%/%GCNRII IIIIIIIIIMH • SC 7 -jljITlfll SM 8 9 10 11 12 13 14 15 16 17 18 19 DEPTH TO GROUNDWATER DATE 10.5' 8/31/2006 10.5' 9/5/2006 10.5' 9/8/2006 11.5' 5/9/11 SEE ATTACHED SITE PLAN DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 9/5/2006 1 3:00 — 6" — 2 3:30 30 0" 6" 3 3:30 — 6" — 4 4:00 30 0" 6" 5 4:00 — 6" — 6 4:30 30 0" 6" PERCOLATION RATE 5 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4.5 FT. AND 5.0 FT. 20 ' A FOUR HOUR PRESOAK WAS PERFORMED: E YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: BENNY MAUS COMMENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PRF RIVED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: CV1 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 3, JB Cruz Subdivision GENERAL: The scope of this project includes the procurement and placement of a new 1,250 -gallon septic tank at the location shown on the Site Plan. Work also includes the construction of a new 57' long X 5' wide X 3' effective depth absorption trench at the location also shown on the Site Plan. The distribution line in the trench will be placed at 3' below the existing ground surface. Total depth of the trench will be 6' below the existing ground surface. The new absorption trench and septic tank must be placed a minimum of 100' from all private wells and any surface water in the area and 10' from the water service line on the lot. A minimum of 3' of cover is required over the absorption trench and 4' of cover over the septic tank. A cleanout must be placed every 50' minimum between the septic tank and the absorption trench. 2. 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 Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. The Contractor must also verify the location of wells in the area and assure that the separation distances are met. 4. 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. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Development Services Department Building Safety Division 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. The cover over the tank shall not exceed 4' unless approved by the tank manufacturer. Col Lot 3, JB Cruz Subdivision July 20, 2011 Page 2 of 3 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 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 slope 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 trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. 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 100' away from any private water wells 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 absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. C6.1 Lot 3, JB Cruz Subdivision July 20, 2011 Page 3of3 MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: 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 and 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 .5" to 2.5" in diameter with less than 3% 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 survey layout and construction notes for use in preparing the certified as -built of the completed system. 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 f , (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL • FOR A SINGLE FAMILY DWELLING Parcel l.D "-' 017101w?4 COSA #l455 - Expiration Date: h' GENERAL INFORMATION Complete legal description Lot 3, JB Cruz Subdivision Lotion (Slte:addreSS),' 85055 E. 142nd Avenue Anchorage, AK 99516 Current Property ovvner(s) Nathan and Khrysten Smith Matlmg'adtlress 8501 Hidden View Anchorage, AK 99504 Day phone Lending agency Day phone Mailing address Real Estate Agent, Day phone Mailing Address- Unless,othetwfSe.requesteU, COSA will be held by DSD for pickup. 2. NUMBEROF'BI✓DROOMS: Four (4) . 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well '✓❑ Individual On-site ❑✓ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of 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 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 anti State codes, ordinances, and regulations in effect at the time of installation. Name of Pt Anderson Engineering Phone 522-7773 z Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Benjamin Schiller, P.E. 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. .bate 311/2012 OF A4 44 ;o.% -.Benj eIn.1 Schiller, sCE- f�592 •: bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report )ther (Rev. 11ro5) 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: Lot 3B, JB Cruz subdivision A. WELL DATA Well type Private Date completed unknown Total depth >80 ft. If A, B, or C provide PWSID # Sanitary seal (YIN) Y Cased to >40 ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform c colonies/100 mL Nitrate .494 mg/L Arsenic: N/� ug/l Date of sample: 2/23/2012 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Number of Compartments 2 Foundation cleanout (YIN) Y Depression over tank (YIN) N Date of pumping N/A Pumper New construction C. ABSORPTION FIELD DATA Parcel ID: 017-101-54 Well Log (YIN) N Wires properly protected (YIN) Y Casing height (above ground) >24 in. AT INSPECTION 1/2812011 115 ft. 5.5 g.p.m. Other bacteria 0 colonies/100 mL Collected by: B. Schiller Date installed _ Cleanouts(Y/N) 7/21/11 Y High water alarm (YIN) N Date installed 7121/11 Soil rating (g.p.d./ft2 or ft2/bdrm)1.2 GPD/SF System type 5' wide Trench Length 59 ft. Width 5 ft. Gravel below pipe 3 ft. Total depth 7-8 ft. Eff. absorption area 517.5 ft2 Monitoring tube Y Depression over field N Date of adequacy test New Const. Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at _ in. "Pump off' level at —in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot >100 Absorption field on lot >100' Public sewer main N/A Sewer /septic service line Animal containment areas >25' >50 Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots >100' >100' Public sewer manhole/cleanout NIA Holding tank N/A Manure/animal excrete storage areas 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 >10' >100 Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >25' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS: Well Casing straightened and extended T above grade. Casing is currently protected with large snow berm. Bollards will be placed in the spring and the driveway realigned to further protect the well. G. ENGINEER'S CERTIFICATION 1 certify that / have determined through field inspections and ��: �•� review of Municipal records that the above systems are in ��t • 49TH conformance with MOA COSH guidelines in effect on this date. ® „ t �... Engineer's Printed Name Benjamin Schiller, P.E. �.0 C .Beni /Jn 1 SChlller,'�e Date 3/2012 ``LF9..'CE- •. 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