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Home My WebLink AboutJEM LT 3Jem Lot 3 #015-242-66 �I\GV VJ/VL/ IUB Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 221064 PID Number: 015 242 66 Dwelling: X Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade Name Marshall ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound .. Site Address 12161 GALENA ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot JEM LOT 3 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well +100 - _ _ _ TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water +100 _ _ Material Number of compartments Lot Line +5 - - NA POLY 2 Foundation +10 _ _ LIFT STATION Manufacturer Capacity Remarks TANK ONLY - _ Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank 3034Tank to 3034 drainfield A PLUS Drainfield CO/MT 3034 Inspector CHARLES BALZARINI BENCH MARK (Assumed elevation) 100 ft Inspdection 15` 3/28/22 2nd 3/28/22 Location and description 3rd 4th GARAGE SLAB ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp 4/1/22 �OFA/�II Conditional Approval: Date '� • :qs l�� • Septic System i HARLES G BALZARINI j rr ,s Approved Date L ' Z z �0 . CE -13854 Note: this approval does not include well permit requirements. • 1lilF�PRO4 FESSlONP �I\GV VJ/VL/ IUB .MTH -� •, CHARLES G BALZARIM ��`c/•. CE 1385411112 2 ,•��® i / / 100' WELL / / RADIUS / DRIVEWAY EXISTING 500 GAL PUMP STATION EXISTING DRAIWffLD / / NEW 1000GAL POLY TANK k / G NEW DOUBLE CO'S 3 -BEDROOM C BOTH SIDES OF TANK HOME / / O / LEGEND o CLEANOUT 10' UTILITY EASEMENT o MONITOR TUBE ® TEST HOLE PLAN -SCALE: 1" = 30' BM:+100.0' BOTTOM SIDING AT HOUSE 8.2' COVER SEPTIC TANK SCHEMATIC PROFILE NEW SHOWS ELEVATIONS OF INSPECTED ELEMENTS BUT DOES NOT DEPICT SYSTEM IN ITS ENTIRETY. INSPECTION FOR GENERAL CONFORMANCE TO DESIGN AND MOA REQUIREMENTS ONLY. SCHEMATIC ELEVATION - SCALE: NTS LEGAL DESCRIPTION: JFM LOT 3 C&M ENGINEERING SERVICES OWNER: MARSHALL DATE: 4/1/22 1 REV: I DRAWN: CBJ REF: 907-854-5558 SEPTIC RECORD DRAWING X00 .MTH -� •, CHARLES G BALZARIM ��`c/•. CE 1385411112 2 ,•��® i / / 100' WELL / / RADIUS / DRIVEWAY EXISTING 500 GAL PUMP STATION EXISTING DRAIWffLD / / NEW 1000GAL POLY TANK k / G NEW DOUBLE CO'S 3 -BEDROOM C BOTH SIDES OF TANK HOME / / O / LEGEND o CLEANOUT 10' UTILITY EASEMENT o MONITOR TUBE ® TEST HOLE PLAN -SCALE: 1" = 30' BM:+100.0' BOTTOM SIDING AT HOUSE 8.2' COVER SEPTIC TANK SCHEMATIC PROFILE NEW SHOWS ELEVATIONS OF INSPECTED ELEMENTS BUT DOES NOT DEPICT SYSTEM IN ITS ENTIRETY. INSPECTION FOR GENERAL CONFORMANCE TO DESIGN AND MOA REQUIREMENTS ONLY. SCHEMATIC ELEVATION - SCALE: NTS LEGAL DESCRIPTION: JFM LOT 3 C&M ENGINEERING SERVICES OWNER: MARSHALL DATE: 4/1/22 1 REV: I DRAWN: CBJ REF: 907-854-5558 SEPTIC RECORD DRAWING GALENA CIRCLE w I EXISTING DRAIt�tPIELD / c�a w ( / N / N w z / (� { I EXISTING DRAINFIELD 100' WELL RADIUS DRIVEWAY nNG 500 PUMP STATION a�NEW DOUBLE CO'S BOTH SIDES OF TANK I 49 TH N• . CHARLES G BALZARII CE -13854 .•��`��® ROFESSI�NP� 3—BEDROOM HOME I \ EXISTING WELL �- REPLACE EXISTING TANK �J _ WITH NEW 1000 GAL (MIN) 10' UTILITY EASEMENT —HDPE GREER TANK SEE SITEPLAN FOR DETAILS SCALE: 1" = 50' C&M ENGINEERING SERVICES 907-854-5558 LEGAL DESCRIPTION: JEM LOT 3 OWNER: MARSHALL I DATE: 3/20/221 REV: I DRAWN: C131 REF: AREA PLAN 00'006 M..00IPO.00S O c O 1N3W3St/3 '711/1 a `SS32�J3 `SS3LIJ/ \\\ E c � £ o F• -i f ., --------------------------------— — ----------- f ----- -- -----------I \ a) » c �01 a) a o rxl QO\ niuZ0 E fl c Q O 6t a)In0a a) mLOw 03 @ x �c» iz :5 = a Z,. 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O) . a z .• I I W N a0 F 1 v N N N E s•' •fy �N3lry,3'I b' w w v) a) t x — — `'�O��o� 0301A1(7GnSN�) v <W ��, w a a •�� (V ch V' MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221064 Work Type: SepticTank Upgrade Tax Code Number: 01524266000 Site Legal Address: JEM LT 3 G:2740 Site Mailing Address: 12161 GALENA CIR, Anchorage Owner: MARSHALL ROBYN A Design Engineer: C&M ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: ��»crlt t)eputmu�r 3/25/2022 3/25/2023 51457 ❑ Disposal Field 0 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: Date: Issued By: � � ,�'� Date: 3 a5o�� 3 MUHMP „ WTV OF HU--JORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section --f Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel 1. D. 015 242 66 Property owner(s) MARSHALL Day phone Mailing address 12161 GALENA Site address 12161 GALENA Legal description (Sub'd., Block & Lot) JEM LOT 3 Legal description (Township, Range & Section) Lot Size 51,457 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑ (w/wo ADU) Septic Tank X ❑ Upgrade x ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C&M ENGINEERING (Signature of property owner or authorized agent) Permit/Rush Fees: it 36 of Waiver Fees: Date of Payment: 3/2 Date of Payment: Receipt Number: 0 1 22 7 J Receipt Number: Permit No. O's Pa a 10 (o C� Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System for JEM Lot 3 Dear Reviewer, The above referenced property is currently served by an older septic system with a leaking tank that needs to be replaced. The owner wishes to replace the tank at once. Our review of available documentation and field investigation show that this project will not adversely impact any nearby Wells, Wastewater disposal systems, replacement disposal sites, or drainage flowing onto and off of the subject property. As shown on the plan, the tank will be greater than 10’ from the house foundation. The tank shall be covered with a minimum of 2” moa approved insulation and 3’ of cover or a minimum of 4’ of cover without insulation. The repair must be performed by a moa certified installer in accordance with MOA requirements. Repair of the proposed system will not negatively impact adjacent lots. Upon completion of the installation, a record drawing will be submitted showing the location of the new tank, leach field, well, and other applicable features. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini@gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE 3/20/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221064, Rebecca Carroll, 03/25/22 CHARLES G BALZARINI CE-13854R EGISTEREDPROFE S S IO N ALENGINEER3/20/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221064, Rebecca Carroll, 03/25/22 CHARLES G BALZARINI CE-13854R EGISTEREDPROFE S S IO N ALENGINEER3/20/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221064, Rebecca Carroll, 03/25/22 C)IvI-10Pment Services oepartj..j. 0 Building Safety bivisioll On -Site Water A WQSftwater Pro gram 7 4700 Elmore Rood P.O. Box 196650 Mark Begich < Mayor Anchorage, AK 99507 S A E 7 www-muni.org/onsitp (907) 343-7904 Well Drilling Permit Numbej% SW PUMP �nzftfla%on Log Date of Issue., Parcel Identiricati., Legal Description /,0 7 3 Property C)wner Name & Addr , S! , �j Ure fft� L L 3 12V�l C7 "e,,_ Ce e e Pump Installation Date: < �16 Pump Intake Depth Below Top of Well Casing: Z VO feet Pump Manufacturer's Name: Pump Model: Las U_p Pump size S/Le bp Pitless Adapter Burial Depth: i/Z— feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: Well Disinfected Upon Completion? Method of Disinfection, esONO COMMents: evl - Pump Installer Name:'ANCHORAGE WELL & PUMP SERV. AN TH 00* 330 EAST 76 AVENUE ANCHORAGE, AK 99518 PHONE: 907-243-0740 AWPS Com Attention: The Pump installer shall provide a pump installation log to the DSD within 30 days of pump installation'- 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://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131425 PID Number: 015-242-66 ❑ New Upgrade Name: Michael and Cynthia Bradley ABSORPTION FIELD ❑ Deep Trench ❑✓ Shallow Trench❑ Bed Address 12161 Galena Circle Anchorage, AK 99507 ;E]Mound E]Other Phone Number of Bedrooms Soil Rating Total depthfrom origina 3 1.2GPD/SF 5Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe 4.OFt. Subdivision Block Lot JEM 3 Fill added above original grade 2.5 Ft. Gravel length 40 Ft. Township Range Section Gravel width 5Ft. Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 400 Ftp One Ft. Well >100' >100' NIA N/A >25, TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Existing Capacity Gal. Surface Water >100' >100' N/A N/A Material Number of compartments Lot Line >5' >10' N/A N/A NA Foundation >5' >10' N/A N/A LIFT STATION Manufacturer city Curtain Drain None Noted Anchorage Tank/Orenco 500 Gal. Remarks Existing Septic Tank Verified Suitable for Pump on level at 38 in, Pump off level at 4High water alarm at 45in. Continued Use. Existing Absorption Trench Decommissioned in Accordance with Municipal Code Pumpake and model OSI P2005-11 Electrctions performed by Munof Anchorage Installer PIPEMATERIAL Housetotank D3034 Tankto drainfield D3034 John's Excavating Drainfield HDPE Co/MT D3034 Inspector A. Harala BENCH MARK (Assumed elevation) 100.Oft Inspection dates: 11/20/13 pia 11/20/13 Location and description p 3r°11/21/13 4'" Garage Slab. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL • OF gC�S�® Conditional Approval: Date 1 r�'P�� jAww *: 49 TH J'. CE -4381 'www Approved®�®TSPD•sr G[%, Date -A3/ :y ••L�q`V 9�;` "�`:�' Inmcrfinn Rcn 1_i» n.... RC1 -imp a m z � y � CJ o :. O N y Q O O 0 O 0 0 0 4 W mc 0 y O N 234.09' N00° 00' 50•E A � o ! \\ 15' INGRESS, EGRESS & UTIL ESMT ..... ............................................ a 'I t \+ o ao 0 Fry O O T ~ N •\ ''i 3xno➢ P om m � ' i\ y '•.i 4E s A 00 �o al_. Du I n S3' \4 yytlL N< 9 z .i w 9 O y tO r I +i+ ^ n N O N I ii+ m N W m m ``� VJ O o W o y w D , fit 3m M zCi y d N _ N C N+ W N C m w M (n m Co pnp � K m cmo 8 0 o oo o�j o O o 0<< � m no's m OD'. C(O ftp 3 o pp CD N y CP M m �wm o ti A Z ®n__'" O tip A T 'O 0 ................................................................ 151 INGRESS, EGRESS & UTIL ESMT O S00° 04' 00"W 100.00' Z o � om :?jI . � �• / aim. Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South 6ragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: OSP131425 N F— F-11-351 Page 3 of 3 PID No. 015-242-66 � 93:8 90.8 N UU Tank Drainfield Rock Groundwater@78.1 ��— 77.1 11-19-13 40'(Trench Length) PROFILE AS -BUILT No Scole a� 1 83.1 .'• 49th MICHAEL E. ANDERSON No. :E si 87.1 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: OSP131425 Tax Code Number: 01524266000 Work Type: Septic Permit Effective Dates: November 08, 2013 to November 08, 2014 Design Engineer: ANDERSON ENGINEERING Subdivision: JEM Site Legal Address: JEM LT 3 G:2740 Owner/Address: BRADLEY MICHAEL B & CYNTHIA E 12161 GALENA CIRCLE ANCHORAGE AK 995078042 Site Mailing Address: 12161 GALENA CIR, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank 111-4 0// --,!7 Lot Size in Sq Ft: 51457 Total Bedrooms: 3 N Privy N Private Well N Water Storage 2 /V^ 7 ern 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. The existing trench submitted. as a reserve site without a I f n o leco�6�tion — NIP - 'Too Qee� � 2. The Engineer needs to do an additional test hole prior to the construction of the septic field. Construction may proceed at your own risk before the 7 day water 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. Received Issued By Id�9�3 GO f (roan wAttr hryh, 06vtjcA )?+k of-'renc.� obeeti. /1cw peel r Fi MUNICIPALITY OF Community Development Department Development Services Division 4 On -Site Water & Wastewater Program ANCHORAGE ON-SITE SEWER/WELL PERMIT APPLICA Parcel I.D. 015-242-66 Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s) Michael & Cynthia Bradley Day phone Mailing address 12161 Galena Circle Anchorage, AK 99507 Site address Same Legal description (Sub'd., Block & Lot) SEM, Lot 3 Legal description (Township, Range & Section) Lot Size 51,457 Sq. Ft. Number of Bedrooms Three (3) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (EI all that apply) Absorption Field 0 Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade 0 Duplex (D) ❑ Holding Tank F1Renewal F]Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Permit/Rush Fees: Date of Payment: Receipt Number: Oilb-1 C\ Permit No. O 5 pl ? 1 N Permit App_9-1-12.doc Fees: Date of Payment: Receipt Number: Waiver No. November 7, 2013 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Subject: Lot 3, JEM Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing absorption trench on the subject lot has failed and must be replaced .prior to the issuance of a Certificate of On Site System Approval (COSA). We are therefore requesting a permit be issued for the upgrade of the septic system to accommodate the three-bedroom home on the lot. The_ attached Site Plan and backup documentation identify the location and configuration of the existing and proposed septic system. The existing Septic Tank will be uncovered, inspected and verified suitable for continued use. The existing absorption trench will be left intact and tied to the new system with a flow diverter valve. Also identified on the plans are the locations of the existing well on this and adjacent lots and adjacent septic systems. No conflicts exist between the proposed septic system and the wells on this or adjacent lots. Protective radii are shown to the adjacent wells. Drainage arrows are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The test hole placed on the lot during the initial installation indicated Silty Sand to well graded sand (SM/SW) to a depth of 18'. No groundwater was encountered and none developed during the monitoring period. The percolation rate in the SM soil lense was determined to be 4.4 and 2.2 minutes per inch in the SW lense. We have designed the new trench with an application rate of 1.2 gallons per day per square foot. We are proposing to place a 40' long by 5' wide absorption trench with a 4' effective depth. The total depth of the system will be 7' with the distribution line at 3' below the existing surface. A flow diverter valve will be placed to connect the existing trench to the system for future use. The existing system appears to be in the electrical easement. We are requesting the permit be issued for construction of the new trench while the encroachment permit for the existing trench is ongoing. If we are unable to acquire the Lot 3, JEM August 18, 2013 Page Two encroachment permit in a timely manner the existing trench will be abandoned in place in accordance with Municipal Code. The ground surface on the lot slopes to the northwest in the area of the absorption trench. The trench will be placed parallel to the contours of the ground as much as possible and in conformance with design criteria. A minimum of 100' will be maintained between all components of the septic system and the proposed well and from any surface water 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, %y�,��-, Michael E. Anderson, P.E. Attachments 49th MICHAEL E. ANDERSON Municipality of Anchorage Page of� DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: -IVY/ 4ti7o23Z PID Number: 016-0-41— tab Name: C-Y (2&rqST0_0GT%0tA Wastewater System: ElNew 1:1Upgrade Address: ABSORPTION FIELD Phone: 3 - �d No. of Bedrooms: 3 p Deep Trench i Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Racing: Total Depth from original grade: a C� GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom from ori coal grade: Gravel depth beneath pipe ' Ft. Ft. Township:Range: g ��/� Section:./� 1� Fill added above original grade: /0 Gravel length: i 2 3 lXi v / Ft. Ft. WELL: New El Upgrade Gravel depth^ Lii+'a%/�j Nu mber ofp9lines: I Distance between lines: ' Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. 3 Ft. nry / SQ. Ft. 3�'S Z r /-: k 10 Driller:J/�� Date Drilled: Static Water Level: Installer: Date instal ed: _ A L-P iL Ft. � b ''i q Yield: I Pump Set at: I Casing Height Above Ground: TANK GPM -2 & Ft. a Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: �,aL �? E Capacity in gallons: I From Tank Field Station Tank Sewer Lines ".)'-0 J Material: v j �J �(� Number of Compartments: Well t 37 ` 6 —( 1 c/XI, SurfaceN�A Water LIFT STATION Lot i' Size in gallons: Manufacturer: Line Y5 "Pump on" level at:"Pump off' level at: High water alarm at: Foundation 7A Curtain�j fT J Pump Make & Model Electrical Inspections performed by: Drain BENCH MARK Remarks: Location and Description: p V Lt Assumed Elevation: 116-1 Ft. ENGINEER'S SEAL 1 Dates: 4► Inspections performed by: 8131 2nd a Department of Healtb and Human Services approval Reviewed and approved by: Date: 2 - Z9- / 72-013 (1/91) MOA 25 N C) D r M N 0 O r: ES �i at 0 p00�O / is u o; c m �a of n� / O \ / N 00'00'50"E 234.09' — 15' INGRESS, EGRESS, \\ ------ & UTIL_ESMT_--- D — — — — — — — — — — — — n n Z r —�--[--- n$�o m \ r Z �o-� II D or - mo r \ L O Ln --1 \\ a00 n o g �o N. .Z7 n mn °oo. D O G):�E A� \ \\ A \\ 4` 5 2 \ \ o h 0 '§ 52 I✓ 70- � o \ ^w' I n \ \ N r (n LA 00 V O� N�CA T G N 0 SoA \ O D \ \\ m Sx o \\ Z zI non a m 0 � Na 11. � a9 o n II I I I .�nw p'S Z I ! � 111 I 111 / o c I I / INGRESS, EGRESS, \\ I & UTIL. ESMf. \\ N 0904'00"E 100. 0' i i C) -,2,t- LOT 3, JEM SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom Home 5' Wide Trench System Perc. Rate: 1 - 5 Min./Inch Verify Existing 1,000 Gallon Septic Tank Application Rate: 1.2 GPD/SF 4' Drainfield Rock 500 Gallon Add On Lift Station 3 Bedrooms * 150 GPD/Bedroom = 450 SF Absor tion Area 450 SF/1.2 GPD/SF/5 SF (Width) *.5 (Red. Factor= 37.5 LF Trench Length THEREFORE: Construct a 40' Long x 5' Wide x 4' Effective Depth Absorption Trench. Flow Line Elevation in Trench to be 1' Below Original Ground Surface. Total Depth to be 5' Below Existing Ground. Provide 3' Cover Over Absorption Trench and 4' Cover Over Septic Tank. Natural Backfill 61 1 \O 4' 5' Geotextile Fabric 1" Perforated PVC (Holes Down) 30-5/16" Diameter Holes @ 1.3' Spacing Drainfield Rock TYPICAL 5' WIDE TRENCH SECTION �,,.•oF"'o (NO SCALE) .............. q, NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. ........ 49th Minimum 4' Separation From Groundwater. 011 Minimum 100' Separation From Private Wells in the Area. MICHAEL E. ANDERSON Minimum 100' Separation From Surface Water or Streams. �� ; No. CE.4381 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 DEPTH (feet) 1 - 2 3 4- 5- 6- 7- 8- 9- 10- 11 15 16 17 18 19 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: LOT 3, JEM SUBDIVISION PERFORMED FOR: NATHAN SMITH DATE: 11/14/2013 PROJECT No.: PARCEL ID#: TECHNICIAN: M. ANDERSON TEST HOLE A JUM OB/OG d SILTY SAND a WITH GRAVEL a SM d SLOPE WAS GROUND WATER ENCOUNTERED? YES IF YES @ 0' DEPTH OF WATER AFTER MO BOH @ II' DATEOFMO 49th.•°: MICHAEL E. ANDERSON Pm&wi... I SITE PLAN SEE SITE PLAN 2 s WHAT DEPTH? -- NITORING: 10' 0 DATE READING MTORWG: IV 19/2013 p 'Cr GROSS TIME NET TIME -DEPTH TO NET DROP (MINUTES) (MINUTES) WATER _(INCHES) (INCHES) PERCOLATION RATE (MIN/INCH) PERC. HOLE DIA.T(INCHES) TEST RUN BETWEEN: FT. and FT. COMMENTS: TEST HOLE PRE HOLE TO DETERMINE GROUNDWATER LEVEL. ORGANIC MATERIAL TO 1'. GRADING HAS BEEN COMPLETED ON THE LOT SINCE THE SPUR_KLAND_TEST HOLE WAS PLACED REDUCING THE DEPTH OF THE. ORGANIC LAYER. TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 11/19/2013 PERCOLATION RATE (MIN/INCH) PERC. HOLE DIA.T(INCHES) TEST RUN BETWEEN: FT. and FT. COMMENTS: TEST HOLE PRE HOLE TO DETERMINE GROUNDWATER LEVEL. ORGANIC MATERIAL TO 1'. GRADING HAS BEEN COMPLETED ON THE LOT SINCE THE SPUR_KLAND_TEST HOLE WAS PLACED REDUCING THE DEPTH OF THE. ORGANIC LAYER. TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 11/19/2013 Clean Out .s 1 Wide Trench: 5' Wide 80' L ong 4' Deep O GWM 2' Sewer rock 3' Cover I Mirafi 140 2 Feet of Septic Double Clean Outs 1000 gal Septic tank Foundation Clean out ,+- 9 71. 99.3 TOBBEN SPURKLAND P.E. LOT 3 JEW SUBDIVISION SEPTIC SYSTEM ASBUILT 203 W15th Ave SECTION 24 T12N R36/ DATE- DEC, 1Q 1991 Anchorage Ak 99501 CAMEL CONSTRUCTION SHEET: 313 GRID, 2740 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW910237 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:GAMEL CONSTRUCTION OWNER ADDRESS:P. 0. BOX 2965 ANCHORAGE, ALASKA PARCEL ID:01524266 LEGAL DESCRIPTION: JEM LT 3 LOT SIZE: 51457 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 8/14/91 EXPIRATION DATE: 8/14/92 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. 2. PROVIDE SOIL TEST DURING CONSTRUCTION WHICH VERIFIES SOIL CONDITIONS AT SOUTH END OF ORIGINAL AND REPLACE- MENT TRENCHES. TOTAL DEPTH OF SYSTEM MAY NOT EXCEED 4.0 FEET. RECEIVED BY: ISSUED BY 4t cu� (yam-[ _t_ DATE:. f DATE: `� v 20N151h.AvoueSude206 ANCH8AGE�ALASKA��N (9�D279~39�6 SEP T I C SY STEM DES I GN REVISIED 0/13/91 -4�� - B D ,� �t� � � GAMEL CONSTRUCTION uBujnHg 166~`^�� v^� Re;uired Area per Bedroom: 15O/.8 � 187.5 sq.ft.. Number of Bedrooms of this �� Ground Water at 9 ft, Soil test July 24/� ,~� ^�� Use Wide Trench Reduce Area by Using 24" of Rocks Reduction Soil Rating. From test July 9, 1991 Length of 4.4 min/in � 1.2 gal/min .7/5 = 78.75 Use .8 gal/min lots Re;uired Area per Bedroom: 15O/.8 � 187.5 sq.ft.. Number of Bedrooms of this well 3 Required Absorption Area: 562.5 sq.ft, Reduce Area by Using 24" of Rocks Reduction Factor: .7 the area� and Length of Trench 562.5 x .7/5 = 78.75 USE 80 FT. these lots c-, replacing the existing SYSTI=M comVisuRA710M 5 FT . IWI DE TRENCH TOTAL LENGTH TOTAL WIDT" TOTAL DEPTH ROCK DEPTH COVER/ F !Ll— SEPTIC TANK 80 FT 1000 SAL. The installation of this well and tic system will not impact adjacont lots. The well location conforms to the sit�ng of the existing wells in the area� and will not prevent the adjacent lot owners from developing these lots c-, replacing the existing septJc systems. The installation of this septic system will not prevent wells from be installed on the adjacent lots. Septic System Design Lot 3 JEM pg.1 �ourses on this or the adjacent lots. , The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. Septic System Design Lot 3 JEM pg.2 TO BE PERFORMED DURING CONSTRUCTION p5 0 PS 50 75 100 IPS 150 SCALE. 1'' = 50 FT, TOBBEN SPURKLAND P.E. L17T 3 JEM SSD SEPTIC SYSTEM DESIGN 203 W 15th, Avenue SECTION P4 T1PN R3W DATE' JULY 30, 1991 Anch, Ak. 99501 11 cnucr rnetcFOrlrTTnM TMC SHEET, 1/3 GRID- 2740 516�p Clean Out Wide Trench - Monitor Clean Ou S' Wide S 80' L ong 4' Deep 2' Sewer rock 3' Cover RECEIVED War; 140 2 feet o / Sep tic I. Double Clean Outs AUG 13 1991 Municipality of Anchprage Dept. Health S Human Services 1000 gal Septic tank Foundation Clean out rl,,,. .-, ,+, 3und TUBBEN SPURKLAND P.E,I I L17T 3 JEM SUBDIVISION I I SEPTIC SYSTEM DESIGN I 203 W15th Ave SECTION 24 WN RWDATE- AUG, 7, 1991 Anchorage Ak 99501 CAMEL CONSTRUCTION SHEET, 3/3 GRID: 2740 6a7) ALA TNA A VE, I S T car 1 zl ,`. LOT 2 \7 %\ LDT 3 (V \ -0- Vall o �7 V 50 0 50 100 150 1I200 250 300 SCALE` 1' = 100 Fi �'2 LfE; fIJAVGB-3Vfwe4f P'� 06s�C .BCCw G •OG31! 9 ;ham•.nir oral y�,, •b , CE•_2zb �_ LDT I LOT 2 LOT 3 Q LDT 4 TOBBEN SPURKLAND P.E. LOT 3 JEM SSDII SEPTIC SYSTEM DESIGN 203 W 15th. Avenue DATE, JULY 30, 1991 Anch. 99501 SECTION P4 T1PN R3W enuei rneicrelirrmu Feu^ SHEET. //,Q GRIDS 2740 a 25 0 25 50 75 100 125 150 SCALE., I' = 50 FT. TOBBEN SPURKLAND P.E.SEPTIC SYSTEM DESIGN 203 W 15th. Avenue LOT 3 JEM SIT Anch, Ak. 99501 SECTION 24 T12N R3W DATE: JULY 30, 1991 ramri cnucrailmnAl nvr SHEET3 GRID, 2740 J' �G rya � Tr -'a c arse C.E-'% J1.J TOBBEN SPURKLAND P.E.SEPTIC SYSTEM DESIGN 203 W 15th. Avenue LOT 3 JEM SIT Anch, Ak. 99501 SECTION 24 T12N R3W DATE: JULY 30, 1991 ramri cnucrailmnAl nvr SHEET3 GRID, 2740 Clean Out Stanclo Mira fl 140 5 Feet o F Septic Rock Cleanouts Monitor 4' Topsoil 4' Co ver Exist, Ground 4' Min ank I IUbbLN JYUKKLHND F',t. II LOT 3 JEM SUBDIVISION II SEPTIC SYSTEM DESIGN I Anchorage Ak 99501 Ave SECTION 24 T12N R3W DATE: AUG, 7, 1991 Anc ?7q_gqlr CAMEL CONSTRUCTION SHEET, 313 GRID, 2740 (ENGINEER'S SEAL) Municipality of Anchorage j DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST .o PERFORMED FOR: A L OM S T120 c.Ti i D tom} DATE PERFORMED: _748li 1_` L COM LEGAL DESCRIPTION: LOT '6 Township, Range, Section: -Cla r,1 ,Z LVL pe!P , SLOPE SITE PLAN (F ET Or�awies £ - 1 / I.00.vt4f avpurvf N 2 3 alp Si l-� Sa.K 4-. � L•GvkS�S •eu,..� 5-' ` • S�-�.�cQ 6 COMMENTS Net Drop ENCOUNTERED? 7 , s 8 .' DEPTH? 9- E 10 10- 7 Monitoring? D:" Date: 11 11 CJ 12 3 13- 14- 14151617 15- 16- 17 . 8 18- 1920 19- 20- COMMENTS WAS GROUND WATER Net Drop ENCOUNTERED? s IF YES, AT WHAT L O DEPTH? P E Depth to Water After 7 Monitoring? D:" Date: U Reading Date Gross Net Depth to Time Time Water Net Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) T -T r I_. V�' t.- . Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES + 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST _� A H G �,,., (0 0 ST ►`V C 1 0 q DATE PERFORMED: �+ q �-1`I Jf PERFORMED FOR: ,�, . LEGAL DESCRIPTION: Lo T 3 F M Township, Range, Section: -'( At -1 { 2 7J w/ s G c a q -f SLOPE SITE PLAN 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? Date: S L O P E Reading Date Gross Time Net Time Depth to Water Net Drop 43 : I 10 1 t4 '18 10z' 3:2 q 10 Iq Vil 19'ls 3t Bel o 14 74/19' c qq 10 Iq It a 5 ro y/ I rd'y :a q In ivy& ' 20 PERCOLATION RATE �• � (minutes/inch) PERC HOLE DIAMETER �✓ TEST RUN BETWEEN FT AND FT COMMENTS PERFORMED BY: • S 1 CERTIFY HAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: tt i� -` R/ 72-008 (Rev. 4/85) 1 (ENGINEER'S SEAL)` Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: G/' HEL CON st 22UCXt0tN DATE PERFORMED: -7/9�aL;-'i LEGAL DESCRIPTION: L.o 1 3 M Township, Range, Section: �-��, Nr 12.3 Uij �w'�• C.c2y DEPTH SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? P E Depth to Water After Monitoring? Date: Reading Date Gross Time Net Time Depth to Water Net Drop q 9 S; 12. -- o20'i 3: 27. 1 O Isys - 8 2 10 a1 361Z 10 cai 6.4. IO r �L 'b s. lv Is % •goNJ/ •'l,2 I t7 ' � PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER 6 TEST RUN BETWEEN FT AND 2-L FT COMMENTS C )�+ PERFORMED BY: ✓ I Y CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Ir ii IF 1. 1 l:7. I J� JL I . .. ..... 2 03 '1151 L v Rin tt e -.u4 I - 9 0 L , , L� , . PINCHIRA'61c kh,'Sfl,� 5150!. i _7T7 27 3 - -ID 14. SEPTIC SYSTEM DESIGN 9 M. 12pw a 0 -m- - SUBDT_Vls�om GAMEL CONSTRUCTION h:'- N-� 'I .... . ... . .. f _1 v a CA e F:;, o c.: 'L:: r ZI c)"i: DI.N-li (R ---!f'--:.; Sli Y z-31 e E M C 0- M F I C– P, tp —a T 0 STANDARD TRENCH TOTAL LENGTH TOTAL WIDTH TOTAL DEPTH ROCK DEPTH COVER SEPTIC TANK v s.' :�n I. c' 60 FT. 1000GAL_ The installation of this well and septic impact system will not adjacent lots. The well location conforms to the siting of the existing wells in the area; and will not prevent the adjacent lot owners from developing these lots or replacing the existing septic systems. Thnstallation of this septic system will not prevent wells from be installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. Septic System Design Lot 3 JEM V ~ oil Ww. RHATA V,. W�~ 2C3N15th.Avenuo:Suit»2H 4NCH0KAGE`ALASKA995N 27Y -3Y|6 SPECIFICATIONS FOR SEPTIC ;SYSI-Ell INSTALLATION 1.0 GENERAL 1.1 Owner- is Gamel Construction, P^O^ Box 2965 Anchorage; Alaska 99523, Phone 349~4920 1.2 Engineer is the person or entity hired by the Owner to inspect this project, The EnQUneer must be recognized by the Municipality of Anchorage, Department of Health and Human Services. 1.3 Contractor is the person or entity hired by t1 Qwner to install this project. The Comtractor must be recognized by the Municipality of Anchore" Department of Health and Human Services. 1.4 The Drawi11gs9 sheets 1 through 3� shall be part of this specification. 1.5 All materials and workmanship shall meet the require� ments of tho Municipality of Anchorage, Department of Health and Human Services` the conditions of the permit, and all applicable rules and regulations currently in effect. 1.6 All excavation depths are advisory�I and are to be verified and may be modified in the field by the Engimeer- 1 lu he responsibility of the Owner or the Contractor to adhere to the approved design, to verify that the s!.-;eci- fied separation distances are met, and that the required inspections are performed" 1.8 The Contractor or the Qwmer shall report to the Engi` Flee]- any observed condition which would put the septic system in violation of State or Municipal regulations. 2.0 SEPTIC TANK 2.1 If there is an existing septic tank, J.t may be used if �t meets the capacity reguirement for the residence. The tank shall be inspected by the Enq i rwerand its water tightness and structural integrity shall be vorifinod . 2.2 A tank shall be one fabricated by either Spycificat ions for septic system installation Lot 3 JEM Subdivision The septic tank shall be a UPC�approved two~compartment absorption field shall tank.; constructed of 12 gauge; or better; steel with bitu mastic coating, The tank shall be set level on undisturbed screened soil.The tank shall be covored with the equivalent of four the No. 200 feet of soil. to a solid section of pipe. 2.3 The septic tank shall be installed a minimum of five 3.6 GeotFox tile feet from the house foundation and a minimum of five Is from the absorption area. irig or for filtering; 2.4The septir tank shall be a minimum of J. feet from any well serving OR single residencz; 100 feet from any body of water, creeks or drainage ditches with flowing water; 150 feetfrom Class "C" wells, and 200 feet from Class A or Class B wells. 3.3 4~inch perforated 2.5 All pipe connections to watertight calder couplings. as designated ;And capped with outs shall extend a minimum of elevation. ProvisionV; shall importation if topsoil. the tank shall be mechanical Cleanouts shall be installed air—tight rain caps. Clean - 12 inches above final ground be made for landscaping and 3.1 Gravel in the absorption field shall be 0.5 to 2.5 pipe penetrating used shall be fluorfo-, rated, either by dr:illing inch screened rock, with less than M. passing the No. 200 p�le to a solid section of pipe. sieve. 3.6 GeotFox tile shall be Mirafi 140, 3.2 Sand, used for lcovey! irig or for filtering; shall have an effective grain size between No. 40 sieve and No. 18 sieve. Uniformity coefficient shall be less than it. Not more th;in 5% by weight shall pass the No. 20O sieve. 3.3 4~inch perforated pipe shall be ASTM F810. For IDV- es~ sure distribution, pipe shall be Schedule 111) PVC or ABS. 3.4 Sulid 4 -inch pipe shall be Cast Iron or ASTM D3034. 3.5 Monitor standpipes shall be installed as shown. That section of the pipe penetrating the shall be fluorfo-, rated, either by dr:illing 0.5/' holes on 6~i1 1ch centers or by joining a section of F810 perforated p�le to a solid section of pipe. 3.6 GeotFox tile shall be Mirafi 140, 3.7 Insulation shall be extruded direct burial polystyrene. Dow Chemical Styrufoam HI W. 3.8 Topsoil shall 6e a fir 1xture of 40-60% organic matter� 20~3O% sand and more that 20% silt. All quantitics are moasured by volume. ` Specifications for septic system installation Lot 3 AM Subdivision pg"2 3.9 Grass seed shall be Kentucky bluegrass" 4.0 INSTALLATIQW 4.1 Locate all underground utilities, property lines, level and scarificod ^ If sidewalls smears, they shall also be scarified. Record elevation of beginnin�, middle and end of Record elevation of each corner future driveways, existing or proposed operate on water wells, water ways; surface and sub surface drainage replaced with uncompacted materials. facilities, lakes, nate rock with native materials or spoils from the excava- tion' Level the rock surface (+- 1o> before installing the perforated pi�e. ponds� and all other facilities requiring separation di w. tances from the pr system. Notify Oener or Engireer of any observeJ possible conflict. end of tronch. Record the finish ground eleva~ tion at each 4.2 Stake alignment of system with markers showing the protective distances from wells and water bodies. 4.3 EstabliIh an elevation benchmark. This BM shall be easily identifiable. stable and Permanent. An arEli trary elevation of 100 can he assigned 4.4 Install the tank as shown on the drawings. Record the inlet and outlet elevations of the tank. Tank shall be placed on undisturbed native mil— c:: a Vol E-- e oil. cavate the absorption field. Bottom of excavation shall be level and scarificod ^ If sidewalls smears, they shall also be scarified. Record elevation of beginnin�, middle and end of Record elevation of each corner and cenI-er point of bed. Construction equipment shall not operate on the floor of the excavation. Any material com~ pacted by the operation of the construction equi�ment shall removed and replaced with uncompacted materials. 4.6 Place the rock to the depth specified. Do not contami� nate rock with native materials or spoils from the excava- tion' Level the rock surface (+- 1o> before installing the perforated pi�e. 4.7 Install the distribution pipe. Record the elevat�o: of each joint. For pressure system solvent weld the joints. 4.8 Cover the distribution pipe with rock, and cover the excavation with geotextile before backfilling and placing insulation, if required. 4.9 Record the f�nis�eJ ground elevatio: at the beginning` middle and end of tronch. Record the finish ground eleva~ tion at each corner and at the midpoint of the bed. 4.10 Furnish to copy of all survey notes to the Engineer. 5.0 INSPECTIONS 5.1 A minimum of three inspections are required. The Specifications for septic system installation Lot 3 JEM Subdivision pg.3 ^ first inspection will be of t11e open excavation. At this time the soil conditions will be observed and compared to the or presence of bedrock will be verified. The second inspection will be after placement of qrav(nl, standpipes, distribution piping; tank(s} and other compo~ nents as specified. The third inspection will be after completion of the work. Any deficiencies will be noted and the Ciot-rattor notified. Such deficiencies shall be corrected within ten days' 5.2 All electrical work requiros either an MOA electrical inspection or cerLification by an licensed electrician. Submit proof of inspection or certification to the Engineer. Submit catalog data of all mechanical equipment. 5.4 Notify Engineer at least 24 hours in advance of begin- ning any work. ~ Specifications for septic system installation Lot 3 JEM Subdivision �j C' "v -5-p" vv /Vo le rov 1-31e /W2 AE,!12 oil fL I ------- �' ip'A 'p, �5 9 60' A=r4- T-A� 4r? le Iry - r -T- 16 0-/ 3 J�7 SH T. Z OF ¢ 1 OG OF SOIL TEST', DATE; Flu c. T 13t�' 13Y:�`-' vrtl,8-t i iJi s i Off! TYPE 80RINAl-OIFIr LOCATION: �EE /�L.4-T' U. U. J wJ O a. a. SOIL DESCRIPTION w (n `) 0 ^11 /O {^y 7- 5 4a 15 25 35 RFACE. ELEV. - 0 - 51L _ S,�Nay Lr e,4 vE� Glut/ /-i/r G 4a zovvp :.4gs}N oo ni E r� - MAR ATES --203 WEST 15TH AVE.--ANCH Sh 1.cZ_Vr=_ LOG OF SOIL TESTNQ 3-7— DATES =clv,� v z� i 9 B � . --BY- TYPE BORING: d H2O Plv- LOCATION:.t� U. J W : O a.J � g � SOIL DESCRIPTION a } �¢ m r SURFACE: ELEV.- / D,2GA-NiC� ^ O.4M 5 10 r r RNARD-MARTH 9 ASSOCIATES --203 WEST 15TH AVE.--ANCWORAG DATE LOG OF SOIL TEST- %h - ' BY:. p� - _ ---�f J '= J 8171Y1S7aRl' TYPE BORING: g� D DN Nob+�+��1L LOCATION: 4-5A--p'�-A!' z m SOIL DESCRIPTION w w a SURFACE: ELEV. i 1-5 S/LTS� 5�4n/pS" Gizmo dEL GNI 10 '' y f�a G'�dE.� ; 11 T -,e 7,+(3.iz-= MAY 6E LoyvEe 6w 15 ��•� , �D 20 -30- 35-1 D-MARTH 9 ASSOCIATES/ X2103EAST 15TH AVE. --AN LOCATION OF WELL BOROUGH I SUBDIVISION I I+OT BLOCK R9644- j �M DIRECTIONS: (✓ MRASURING POYNT: top of casinq ground surface rthex:_T... BOREHOLE DATA: Depth Materia tvr)e -;ind color Frrnr, I re, 41 I 1 elo I RECEIVED I I 1991 Municipality REMARK 7 - A } nvLt -c ) iF Av w CONTRACTOR INFO, TION: /-% A � 1! 1 ,, A / / Redi(iYtered Business Signatuxe of Authorized Reoesentative n Date`T • nXPARTMEN'T Or NRTURAI, ItF 90MC99 01VISION of GEOLOGICAL AND GEOPHYSICAL SURVEYS WATER WELL RECORD �� ' OTRS I 1.2-H S 1 3 G 6W I MERIDIAN N WELL OWNER: A-V /ge'o-m-e— WELIr SEPTA:/ DATi; OF COMPLETION; Depth uI ljuJ.e: 026 2S ft Depth of casing:-243—ft 6 -- STATIC WATER t. Data Sn•� METHOD OF DRILL) NG: ®ai,r, rotary []cable tool []other:.--_ USE OF WLLL; ffaomem i,c ❑ xii,yation 0monito5: public supply other-................._......... CASING: Sti.ck-up.'?•.,ft. Diam. in WELL INTAKE: open end 17screened (] perforated Dopen hole Depths of openings:- to _ T ft SCREEN TYPE: Diam: in Slot/Mesh Sire: _. Length: ft Set Hetween and �ft GRAVEL PACK 'PYPE:: Volurne used:_ — Dapth to Cop: GROUT TYPE; vo3urne: Deptn: horn ft to DEVELOPMENT METIOD: JYtl Duration:, PUMPING LEVEL AND YIELD; C24-p—ftafter—y—hrs pumping(*—gpm PUMP INTAKE DEPTH: ft Horsepower:_. Date Pump Installed v_- WAT%R CHEMISTRY SAMPLE TAKEN? U yes WQ11, di PinfRntRri anon ommrilotinn 7 44,u'ia PLEASE MA21, Wli= COPY OF' LOG W.M.FN 45 DAYS 7'O: DGGS PO 1.3OX 77-2116 EAGLI•; RTVERf AK. 99577 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 1. D. 015 242 66 1. GENERAL INFORMATION Complete legal description JEM LOT 3 Location (site address) 12161 GALENA Current property owner(s) MARSHALL Mailing address Expiration Date: J - ) - 2 0 Z-�__ Day phone Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private SepticX❑ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request tor: N O N E q Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5 5 O Waiver Fee $ Date of Payment a 1 a O 22 Date of Payment Receipt Number Uq 5 b Receipt Number COSA # 05 C 1 1100 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 C&M ENGINEERING Phone 8545558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Date 3/12/22 OF Al 4 Aw i `�49 TH �J :�• .. . _ : , r r.HARLES G BALZARIKI . ��'��• CE -13854 .•'c�`v�� li`F�PROFESSIONP .� AW bedrooms, with the following stipulations: a WAST'_-V`IATER o J �� SER\', � f BY (� 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 Legal Description: JEM LOT 3 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 8/20/91 Total depth 268 ft Cased to 33 ft OR Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) +24 in. Date of flow test for COSA 33/8/22 Static water level at beginning of test 33 ft. Comments Pump Set at 240' per pump install log B. TANK DATA Age of tank(s) 0 years Tank type/material septic PLASTIC Measured operating fluid level in septic tank na ❑ Standpipes/foundation cleanout per record drawing Date of pumping na - D. ABSORPTION FIELD DATA Shallow Trench Which system tested (date installed) 2014 OR ALL standpipes present per record drawing Total measured depth from grade 7.5 ft (max) Measured depth to pipe invert from grade 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 na gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 015 242 66 Structure served by this system 1 Well production at time of test 1.1 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 1.39 mg/L IF, Nitrate less than MRL (ND) Arsenic ND ug/L ❑ Arsenic less than MRL (ND) Collected by C.BALZARINI Date of Sample 3/9/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station 8 years Lift station material steel Comments: Adequacy test date 3/8/22 Results LDPass For 3 bedrooms Fluid depth prior to test 15 in Water added 450 gal New depth 20 in Elapsed time 1440 min Final fluid depth 12 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) na If yes, enter date na E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' r Yes if No ft M Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' Q✓ Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' M✓ Yes if No ft E✓ Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' �✓ Yes if No ft P1 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' M✓ Yes if No ft Surface Water > 100' Q✓ Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5'C]✓ Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10' _ Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' 0 Yes if No ft Community Wells > 200' 0✓ Yes if No Surface Water > 100'✓Q 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. 3/24/22 COSA Checklist yellow sheet :-%.N 49 TM '• .. .... r�... jj C HARLES G BALZARINI r� Fc CE -13854 • �� A PROFEWCP ft 10 Owner MARSHALL Septic Tank: Lift Station/Pump Vault Street Address 12161 GALENA Sludge level 0 inches -Pumping: required es no •Pumping completed yes no Lift station: -Pump basket cleaned kes no -Effluent filter cleaned es no -Control floats cleaned yes I no -Proper float settings confirmed es no -Operation satisfactory 5L no Alarm System: -Dedicated electrical alarm circuit es no -Audible and visual alarm inside dwelling e no -Alarm system operation atisfactor not satisfactory Manhole Riser -Ground water intrusion at riser to tank connection es no d -Grounwater intrusion around pipe penetrations es no es -Manhole lid: Functional no Insulated es n Other -Weep hole functional es no Properly Secured es no -All manufacturer required inspections and maintenance completed Comments: Qualified Maintenance Provider: Technician C.BALZARINI Company C&M ENGINEERING Signature es no Date of maint,-nanr-a 3/8/22 Date 3/28/22 ,E P D � • Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval Parcel 1, D. 015-242-66 Expiration Date: 3 ' L 1. GENERAL INFORMATION Complete legal description JEM, Lot 3 Location (site address) 12161 Galena Circle Anchorage, AK 99507 Current Property owner(s) Michael & Cynthia Bradley Day phone Mailing address 12161 Galena Circle Anchorage, AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) �� 9All ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) MAY 14 2014 3. NUMBER OF BEDROOMS: Three 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual IID Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ W.fAr F-1 Public Sewer ❑ WaiverNariance request for: r Received by: ° _ �' ' ti_ 4 Date. t COSA to be released.6 the.engineer, unless otherwise requested by the engineer. COSA Fee $2-Gt �� Date of Payment Sf 1!!5Ll Receipt Number OCA g2=4 COSA# 0-,>Clq IIV? 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 Anderson Engineering Phone 522-7773 Address P.O. B:Dx 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 5/14/2014 6 i Iz 6. DSD SIGNATURE r '"�`� System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved PCFFgS10�U= e Conditional approval for bedrooms, with the following stipu action V: Original Certificate Date: "� 3' 7 Th nicip ity,' Anorage Development Services Division (DSD) issues Certifcates 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 ! - . c 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: JEM, Lot 3 A. WELL DATA Well type Private Date completed 8/20/91 Total depth 268 ft. If A. B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 33 ft. FROM WELL LOG Date of test 8/20/91 Static water level 19 Well production 'n ft. Parcel ID: 015-242-66 Well Log (YIN) Y Wires properly protected (Y/N) Y Casing height (above ground) >12 in. AT INSPECTION 11/21/13 22.5 ft. g.p.m. 1.2 g.p.m. WATER SAMPLE RESULTS:�� Coliform 0 colonies/100 mL Nitrate mg/L ^ ? N/D 1 +',- Arsenic ug/L Date of sample: Collected by: Anderson Eng. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 8/31/91 Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N {{ High /water ralarm (Y/N) N Date of pumping 1 °� ,� �� Pumper. C. ABSORPTION FIELD DATA Date installed 11/21/13 Soil rating (g.p.d./ftz or ftz/bdrm) 1.2 GPD/SF System type 5' Wide Trench Length 40 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 8 ft. Eff. absorption area 400 ftz Monitoring tube Y Depression over field N Date of adequacy test New Const. ResultsPass/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.) (Y/N & type) If yes, give date D. LIFT STATION Date installed 11121/13 Size in gallons 500 Manhole/Access (Y/N) Y "Pump on" level at 40 in. "Pump off- level at 40 in. High water alarm level at 45 Datum Bottom of Tank Cycles tested New Const. Meets alarm & circuit requirements? Y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on tot > 100' On adjacent lots > 100' Absorption field on lot > 100' On adjacent lots > 100' Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25' Holding tank N/A Animal containment areas Manure./animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5r Property line >5r Absorption field >5 Water main N/A Water service line > 10' Surface water > 100' Wells on adjacent lots> — �l C� ABSORPTION FIELD ON LOT TO: Property line 0 Building foundation > 10 Water main N/A Water Service line >10, Surface water > 100' Driveway, parking/vehicle storage >10, Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that t 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 Michael E. Anderson, P.E. Date 5/14/2014 COSA brown sheet 10-10-12.doc OF A4 P4 < .i -..x ...............ao..., =MICHAB_ E. P-7—KON CE - 43331 Vi ES90 G\qG G 00 yo• ?1 L-104.72•, I N I I 2 I � � 1 o E I �d I NI 180.00' m S83° 00' 00"E ( LUI F- ff CAR I ':.': GA7.• 6 ::. I PORT I W Z I J O 29.0' SHED F, n. ....... I � O ...',',' 4 EXISTING' I -. .. ... HOUSE WELL W ' ' 20.0' ° 0: i a o I W CD UJ SANS 0 Z o 10' UTIL ESMT ,— __ N N89° 39' saw 329.16` UNDER NO CIRCUMSTANCES SHOULD AN AS-BUILT BE USED FOR CONSTRUCTION OR FOR ESTABUSHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT=SURVEY TYPE SYMBOLS FOUNOAndi AS-BUILT ❑ FINAL slRucnRE A5-ButtT mp•• SET REBAR � � DRNkAGE �"�`�'��' ASPHALT ❑ PLOT PLAN ... TOPOGRAPHY LOT SSEczR O FOUND REBAR g_g_g WOOD FENCE'`°'`"' CONCRETE OOp ASSUMED ELEV. � O CORNER... 5-BUI 7 ... NO CORNERS T (fECERnFlGAn $-BUttT ... NO CCtiNBiS SET rTc '>f-X—)EMETAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED, WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION ��rartq� OF„• Prepared by Robert E. Johns, Jr, & Assoc. PLOT PLAN "'Dyor "°l'"°w °'y• 1 4 tra.n mG t I E nr” eN A I ♦♦.•.�E �� Professional Land Surveyors nvn Iwnd « alaR,nM a a 9. let . •p 4D 1 •1' 1700 Brink Onus. 1700 m a,. °tm as t° lnr nut 0 mY F1wM.da. and aea.A a emntlern nm. Ma ♦ �• , H ANCHORAGE, ALASKA 99504 Scale: n , 1 = 50 Rec. lot S.F. Rec. Plot File Na f th :, / �^ FOUNDATION AS-BUILT I, R°nrl E blm4 °'. Iwtly aNy q°I I na.. AtM14..a aa. bl aM tlal a'B» �•^• •. / / /.. , , „w • Dote Surve d Ye' 12/12/13 Drown b REJ }� Chocked bJMK annYa. °,a nrrm°aa a Imm� Am�„.tel wa. «ln;•n ;,�: ROSERT E. NS, J : 9 Date Drawn: Grid: b;.>a ;` ; ��0 4121—S 12/13/13 2740 w.o. 13-638 FINAL STRUCTURE AS-BUILT •. ,eS: Legal DesaEPtfon: Lot 3 L Robed c .ynnt r., n«ar arey 9°l 1 alrvshr. m 9h bl ad Uwl a . �♦ 1e^•••.,• ••••,.•••yam:♦1 �� ,� �0t1R0wM�mht.�itl°«.^1 �^ p�oTe9elanal �a°�♦• r , y Municipality of Anchorage . *AE Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore 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... O15- 247-- (*�p COSA # c4) Cr 0' O Expiration Date: 1. GENERAL INFORMATION Complete legal description Tern LJ 3 Location (site address) 12.%61 GG41r ,g Cir. , Av%Aoraae AK 9951(0 Current Property owner(t) Margref M44n MAV) Day phone 3V5- ZO2 -2. Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone y SkeY15 Day phone 273- '}7-o(. Unless otherwise requested;. COSA will be held by DSD for pickup. o f< 5;,r uhf Pv 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site (�C] 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 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 theprofessional 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 Fn4,n ,ri„4 1 Address 203 W 1541% Av@ Sfc 202 �1�GhOra42 A K 71501 Engineer's Printed Name Laps Sp a k1 ♦,_,A 5. DSD SIGNATURE ...�'`� Approved for bedrooms. Disapproved. Phone 2 7f -_Wy Date Vzs% zo I / Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory WASTE NAIER PROGRAM ^• �.� I Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other --�AtOOriginal�_ BY: -' Certificate Date. (Rev. 11/05) Municipality of Anchorage • ''� Development Services Department u � z Building Safety Division ` On -Site Water & Wastewater Program r-11 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Tem Lof 3 Parcel ID: 015- ZVZ- (o(o A. WELL DATA Well type Friyw}e If A, B, or C provide PWSID # Date completed $ ZO 1991 Sanitary seal (Y/N)� Total depth 269 ft. Cased to -33—ft. FROM WELL LOG Date of test 61201 In Static water level 1i ft. Well production y g.p.m. WATER SAMPLE RESULTS: Coliformcolonies/100 mLNitrate 1.0 mg/L Arsenic: ND ug/L date of sample: Jl2011 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Greer Sf eat Tank size l 000 gal. Number of Compartments 2 - Well Log (Y/N) 'Y Wires properly protected (Y/N) Y Casing height (above ground) Zy in. AT INSPECTION 1 9— p.m- Collected by: La•!s SAy,2lZ.�ahc1 Date installed 91311 wo l94 ! Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) _ V High water alarm (Y/N) /t/ Date of pumping '31,11Z011 Pumper At Norge Servs Leo C. ABSORPTION FIELD DATA Date installed $ 3/ Z°ll Soil rating qaia6or ftp/bdrm) 0.9 System type S; OW IrMCk Length 90 ft. Width .5 ft. Gravel below pipe �o _ ft. Total depth W+ ft. Eff. absorption area 5Jft2 Monitoring tube Depression over field Date of adequacy test _11211 2011 _ Results (Pass/Fail) P465 For -3 bedrooms Fluid depth in absorption field before test 10 in. Water added 00 gal. New depth F� in. Elapsed Time: Y O min. Final fluid depth 10 in. Absorption rate >= qSO 9-p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Vogt kNown If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level atin. "Pump off" level at in. High water alarm. level at in. Datum Cycles tested Meets &circuit uirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'4- Absorption 00'+ Absorption field on lot .. Public sewer main Sewer /septic service line 25 1+ Animal containment areas 5D I+ On adjacent lots too'+ On adjacent lots 100,+ Public sewer manhole/cleanout N Holding tank __ /✓�/{ Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5�+ Property line 51+ Absorption field 5 + Water main IVIA Water service line 1014- Surface water too I+ Al 0. Wells on adjacent lots 100 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation A 0 4- Water main /y Water Service line 10 Surface water 100+ (N-0.) Driveway, parking/vehicle storage S1 r Curtain drain 50 + N.O. Wells on adjacent lots /00 � t F. COMMENTS G. ENGINEER'S CERTIFICATION — .�F..0 F `A�'9 I certify that I have determined through field inspections and % �` review of Municipal records that the above systems are in ,, . , ; ...9 conformance with MOA COSA guidelines in effect on this date. �. J' Engineer's Printed Name Lars 115 Q .SF Date 4281lot1 �FO Zoll . , N�-�" 11�PF� FE_ S1G.,.. COSA Fee $_ O �" 1 Date of Payment Receipt Number lJv� `l 53 (Rev. 4/10) Waiver Fee $ Date of Payment Receipt Number I MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services F$' On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # D )S ' 2YZ — 6C HAA # 1. GENERAL INFORMATION Complete legal description Tem S'l/) Location (site address or directions) 2161 Galena C1�c << Property owner Pne1";r't 1-C'4¢ar, Day phone 2S7 -Y21 2 Mailing address P.O. 13oxyt31 6/ Anchorc3Qp Lending agency Pa c1A'c 1`tor f qca�� Day phone Mailing address Agent 1\164 e- - Fa- S�1e 64 Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Is Community well Public water NOTE: if community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: if community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. l/91) Front MOA P21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. 6. ®HWS SIGNATURE i/ Approved for Disapproved. M )E bedrooms. Conditional approval for Additional Comments in Pe bedrooms, with the following stipulations: Date !2r— %_-�_� The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ,72-025 (Rev, 1/91) Back MOA #21 Municipality of Anchorage / DEPARTMENT OF HEALTH & HUMAN SERVICES AUG Environmental Services Division MUNICIPALITY OF AN 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343�4714 AL SERVICES DIVISION' Health Authority Approval Checklist Legal Description: L v h 3 Tem S16 Parcel I. D.: 6 rs - 2 `/ Z - 6'C J A. WELL DATA Well type /'v If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y e -r Date completed v9/ ZU / 9 " Total depth 2G B ` Cased to 13eG vck-.3j ' Casing height (above ground) 1'5 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION Date of test &f 20 /Y / Static water level /91 Well production WATER SAMPLE RESULTS: MW Coliform Dcoloniu Ito0m4' Nitrate H•7/ Otherbacteria 1)o4e Ce�o�f�� Date of sample: 8/.31319 Collected by: 7'• F. Maa s B. SEPTIC/HOLDING TANK DATA Date installed &/3J /9/ Tank size/ Number of Compartments -a Cleanouts (Y/N) t Foundation cleanout (Y/N) Y Depression (Y/N) A/ High water alarm (Y/N) Al.4 Date of Pumping &I'S- /Y7 Pumper A* C. ABSORPTION FIELD DATA Date installed 81311911 Soil rating (g.p.d./W or ft2/bdrm)0. 9 %4d System type Length U00 ` Width S Gravel thickness below pipe 2 ' Total depth 3 - ( ` Effective absorption area S -7/ 0` Monitoring Tube present (Y/N) Y Depression over field (Y/N) N Date of adequacy test 8/3120 Results (Pass/Fail) For 3 bedrooms Fluid depth in absorption field before test (in.); Immediately after-6gal. water added (in.): I I S/8 Fluid depth 10 f16 (ins) Minutes later: 129 Absorption rate = > Y.SG g.p.d. Peroxide treatment (past 12 months) (Y/N) /Vane known If yes, give date Al -14 72-026 (Rev. 3/96)` D. LIFT STATION V A Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /'/d' Absorption field on lot z 16o' Public sewer main A/. On adjacent lots On adjacent lots "Pump off" level at* n' Z.5 I Is - Public sewer manhole/cleanout N. Sewer /septic service line -> '2 r' Lift station Al. A• SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Ts Property line 3S" Absorption field "Id Water main/service line > t o' Surface water/drainage > too, Wells on adjacent lots > too ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 Building foundation 7S' Water main/service line > 10' Surface water > 100' Driveway, parking/vehicle storage area S Curtain drain None seen Wells on adjacent lots tUU F. ENGINEER'S CERTIFICATION I certify that l have determined thru field inspections and review of Municipal records that, the above systems are in conformance with MOA HAA guidelines in effect on this date. Signature f 9«iTGs.s4vf Wtlka i+RNj4 Engineer's Name %heV45&re- Date Y;. HAA Fee $ Waiver Fee $ Date of Payment /� Date of Payment Receipt Number Ci 1 �/ Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE L� • '� DEPARTMENT OF HEALTH & HUMAN SERVICES M},� Division of Environmental Services — On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # Q I — aV2 —1'a 6 HAA# 1. GENERAL INFORMATION Complete legal description -cry( 3 �`'� S Ill Location (site address or directions) Property owner 6104 e_,L'0�9 670,WS4"a4v" Day phone 3` q— Yf A0 Mailing address P jooX A &, Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOA#21 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 of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ��>�' �j r A i r [,C_ (,k � I V Phone. X27 g` 3 i 6 6 Address Engineer's signature 6. DHHS SIGNATURE o2L� ..�/ IT Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Date )2110/`1 bedrooms, with the following stipulations: Date/2"2C%- /1 CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA 421 ,fr -Ks I - Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: It 69' f't Parcel I.D. 0 A. WELL DATA Well type R_ If A, B, or C, attach ADEC letter. ADECwater system number NIA Log present (Y/N) �Z % Date completed 9/6 ` q( Driller Al pi ty Total depth Cased to - Casing height ; � Sanitary seal (Y/N) Wires properly protected (Y/N) Date of test Static water level Well flow FROM WELL LOG a�gl AT INSPECTION WATER SAMPLE RESULTS: Coliform to Nitrate oga �2 Other bacteria Date of sample: �c 1 q `Z ( Collected by: M Z a ``0 w O PLIMP level O � SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ; On adjacent lots — a � Absorption field on lot g. On adjacent lots Llnl1 PLiblic sewer main I�1A Public sewer manhole/cleanout _ Sewer service line U Petroleum tank N WATER SAMPLE RESULTS: Coliform to Nitrate oga �2 Other bacteria Date of sample: �c 1 q `Z ( Collected by: M Z w O O � a z u LLI a � g. ~ Llnl1 P - 1 C] d W Z L<? B. SEPTIC/HOLDING TANK DATA Date installed -Tank size Compartments Cleanouts (Y/N) rtenn—Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) �� Alarm tested (Y/N) N Date of pumping k Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: 1Z KI Well(s) on lot /37 On adjacent lots % Imo' Foundation &, l To property line ® I Absorption field 14Z Water main/service line i -5 0 Surface water/drainage N//-\ 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION I`/A Date installed Size in gallons Vent(Y/N) High water alarm level — "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed 1 Length g"y Width Total absorption area Depression over field (Y/N) Results (pass/fail) On adjacent lots 25 1 57 Peroxide treatment (past 12 months) (Y/N) "Pump off" level at Cycles tested Surface water _ Soil rating - System type 1 —Gravel thickness C2 Total depth Cleanouts present(Y/N) a _ Date of adequacy test N _4 for i3Gt_4_c>e' iLr,S bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: If yes, give date Well on lot On adjacent lots > /rte Property line To building foundationf 7 �5 1 To existing or abandoned system on lot On adjacent lots i % Cutbank i`///% Water main/service line i s U Surface water Driveway, parking/vehicle storage area 15 Curtain drain YZLA E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect,on the,date of this inspection. Signature Engineer's Name I � �+ Pu'r(detcup j> Date ` `0 1 Cl V ✓' r ) HAA Fee $ Date of Payment % L-- —V Receipt Number 8 3 ;;� `Y7 LAI -7.5 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number GALENA CIR.. �a V JC74 SUBDIVISION LOT 3 w �N LOT 3 -5sPrc FIEta .-- PX(sTJNC, GRAVEL Dptve 5-0 s 83' ao t6n •• 11�. 184. qd Plbpl sri4� DRIVEWAY UNDEI�GROUNO �rlQ oW;a—rvt fol UTIL. rw$MT- N 8qv �a9'So" �►! a EXISTJ NC, BUIL.GING F.P. CANT• Tqa I hereby certify that I have surveyed AS BUILT the property depicted above and that GASTALDI ASURVEYING no enc LNA roactunents exist except as indi-- Jeff; A. Gastaldi,R.L.S. Cated.. It is the responsibility of the 3034 (settles Bay Loop owner to determine the existence of an Anchorage, Alaska 59515 -ease[nents,covenants or restrictions Tel. 907-344-4272 which do.not appear on the recorded suLxlivision plat. Under no circumstan- ces should any data hereon be used for GRID DATL construction or for establishing boun- dary or fence .lines. �. JOB 1,K). AN010RAGE REOORDING DIS'TRIC r, ALASKA 0 W ear_ Oggo, U.W.caur-