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HomeMy WebLinkAboutBENSON #2 LT 6Benson #2 Lot 6 #051-281-72 Municipality of Anchorage On-Site Water and Wastewater Program •(907)343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP161326 PID Number: 05128172000 Dwelling: ❑■ Single Family(SF) ❑ Duplex (D) ❑ Multiple(SF and/or D) Project: ❑ New [' Upgrade Name: KRUPA, TREVOR D & MEAGAN B ABSORPTION FIELD Address 17937 PIONEER DR, EAGLE RIVER, 99577 El Deep Trench El Shallow Trench El Bed ❑ Mound El Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-694-6454 2 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. BENSON #2 6 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Tank Line Ft2 Ft. Well 1554 TANK PSeptic ❑ S.T.E.P. ❑ Holding ❑Other Manufacturer Capacity Surface Water >100 ANCHORAGE TANK 1000 Gal. Material Number of compartments Lot Line 7' NA STEEL 2 Foundation >10 LIFT STATION Manufacturer Capacity Curtain Drain >100 Gal. Remarks SEPTIC TANK REPLACEMENT ONLY. Pump on level at Pump off level at High water alarm at INSTALLED IN EXACT LOCATION AS OLD in. in. in. TANK. OLD TANK REMOVED FROM SITE. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank Tank to Installer drainfield JR SEPTIC Drainfield CO/MT 451141 .L Inspector MARY L. SHREVES, AK RIM ENG BENCH MARK (Assumed elevation) 100.00 ft T Inspection 1" 612117Location and description dates: 2 3"' 4t^ TOP OF CONCRETE FOOTER, PORCH POST. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp `,,:olt'Mli1ii1 , Conditional Approval: Date OF '4�: Sl�o ;' LH '• "JILL . — Mary Shreves / � dj 1.:i.'., CEVV9351 .'L.7 ,/i(;‹,,•... '• E Approved j,,,,Ca G- 1O Date Ii/)O1' jRpFESS 11M‘NN/p PO/ Inspection Report_9-1-12.doc 0 0 E o \\N, o O O. d2�vr fi �� tif}i),Jr2--T165 : A-U1 = 13,5 ' 0 15- -7-vl 2G.5 , .:-.. ,0' , A ' 6�„ ,- 2 0007 g i --...„. ,. RECORD DRAWING q 2 SuBD SCALE: 1"=50' capped vents cleano t foundation doubl cleanout cleanouts soil ~� absorption • Blt 100.00 system (top of concrete tooter, porch support poet) lE 9 .25 I\IE 95.42 4-inch 1000 GALLON 4—inch ANCH TANK STEEL SEPTIC TANK w/ 2” INSULATION SEPTIC SYSTEM PROFILE NTS 4�o�p%p%Q ALASKA RIM ENGINEERING, INC. �•OF• ,q� �I� 9131 E. FRONTAGE ROAD, SUITE 1 pcQ,_,.• •.��. �} PALMER, AK 99645 J.-- '•,'F,� �nn PH: (907)745-0222 : FAX: (907)746-0222 EMAIL: okrim©alaskarim.com . WEB: www.alaskarim.com o tz;•49TH iN ••;,� 'Po P • ,�0,...... •.,:...pE WO: 6-00854 P y, �j� j . .. � PAGE: 1 P d Engineers: Planners: Surveyors SCALE: AS SHOWN V 19 filar L. Shreves :<,d Q ��,�'., CE 9351• '.4� Conventional Single FamilyResidential Qdd�RUFESStoa�d`�" BENSON #2, LOT 6 %dOd l�l/�l� i ©2012 On-Site Water and/or Wastewater System Permit ,,,l,,,t • - [Arne MUNICIPALITY OF ANCHORAGE = ' - fr Development Services Department On-Site Water& Wastewater Program 4700 Elmore Road, PO Box 196650 l)cpart►ncnt Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP161326 Tax Code Number: 05128172000 Work Type: SepticTank Upgrade Permit Effective Dates: November 28, 2016 to November 28, 2017 Design Engineer: ALASKA RIM ENGINEERING Subdivision: BENSON #2 Site Legal Address: BENSON #2 LT 6 G:0753 Owner/Address: KRUPA TREVOR D & MEAGAN B 17937 PIONEER DR EAGLE RIVER AK 995779328 Site Mailing Address: 17937 PIONEER DR, Eagle River Lot Size in Sq Ft: 49136 Total Bedrooms: 2 This permit is for the construction of: N 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. Received B6-___11--12 ) - —� Date: Issued By: laC, , Ccuun Date: 11D 8/.201(0 MUNICIPALITY OF ANCHORAGE Community Development Department \: Phone: 907-343-7904 Development Services Division —_ Fax: 907-343-7997 On-Site Water& Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-281-72-000 Property owner(s) Krupa, Treavor and Meagan Day phone 907.694.6454 Mailing address 17937 Pioneer Dr. Eagle River, AK 99577 Site address see above Legal description (Sub'd., Block & Lot) Benson #2 Lot 6 Legal description (Township, Range & Section) Lot Size 49,136 Sq. Ft. Number of Bedrooms 2 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial n Single Family (SF) (w/wo ADU) Septic Tank x❑ Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal 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. } Charles A. Leet PE; Alaska Rim Engineering, In �a/�d'---6' 4 1 (Signature of property owner or authorized agent) Permit/Rush Fees: fr 02/S- CO Waiver Fees: Date of Payment: l;/Wa. Date of Payment: Receipt Number: C4�# 325-2..8 Receipt Number: Permit No. 05,76/3.26 Waiver No. Permit App_ : .c NOTES: 1. ALL CONSTRUCTION OF THE ON-SITE WASTEWATER DISPOSAL SYSTEM SHALL BE IN ACCORDANCE WITH THE MUNICIPAITY OF ANCHORAGE WATER AND WASTEWATER CODE 2. EXISTING SEPTIC TANK TO BE REMOVED AND DISPOSED OF IN ACCORDANCE WITH MOA REQUIREMENTS. FURNISH AND INSTALL �0 NEW 1000 GALLON SEPTIC TANK IN THE LOACATION OF THE OLD - TANK. \ 8 - Er- Po B[w59N a•o - ar. aw sueo 414 Rte. I QSO arc 1.100' •,••. .•• wer.0 /..i ���o�D�p� ALASKA RIM ENGINEERING, INC. 4 J .J : ' .�: :;,,L r'0,+,,, SLAT= a '\E .�F•q4,q�a�n PALMER, AK 99645 4:7 �P.°'°• '•. f U� PH: (907)745-0222 : FAX: (907)746-0222 �•49TH '� •••9 V� ,,,., MAIL: ckrim©olaskcrim.com : WEB: www.alaskarim.com P *I49: / f °o 0 pz, • °°.°�°°«► D W0: 6-00854 P. ;. ,�..... d c-------"--- PAGE: 1 %;••°• • • Engineers: Planners: Surveyors 10/26/2016 '( ‹„• Charles A. Leet . d (.0) %. CE 10480 °.�V��, Conventional Single Family Residential QQ�� ....••••°°°�, ��, , LOT 6, BENSON #2 SUBDIVISION. QII PROFESSM4 '` db 1 �ddd�0� 1 v 'C ©2018 C r r t I*fi ��rb Britting by DOC Co. dba SULLI"N � WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 f OWNER OF LAND "WC. -E SjDff 1.,C�° DEPTH OF WELL ADDRESS /-j-140 10 NIJA.} -LEX STATIC LEVEL OF WATER FT. Q LEGAL DESCRIPTION tt=a^4s'� DRAW DOWN FT. } DATE, - Started Ended ` GALS. PER HR PERMIT NUMBER �h bLJ KIND OF CASING KIND OF FORMATION: From f Ft. to Ft. �` _ ,1 ! From-- Ft. to Ft. From _Ft. to--1—Ft. Q ()Ek' Q From, Ft. to Ft. P P � ��7`. From Ft. to f" Ft. v'.1 (p �t�G From Ft. to Ft. From Ft. to Ft. 7-0 ht54. e - __ From Ft. to Ft. From Ft. toFt. L t C L el � � From , Ft. to Ft From Ft. to Ft. }From Ft. to-- Ft. FromFt. to `" f� Ft.E-!"" tl4"�""Froi�i Ft. to Ft. FromFt. toT:�_Ft. Cd jO & i From Ft. to Ft. From Ft. to.t'—Ft. �C From Ft. to Ft. From Ft. to Ft. From—Ft. I to Ft. From Ft. to Ft. Fran Ft. to Ft. From Ft. to Ft. From Ft. to R.ECEIVED From Ft. to Ft. From Ft. to FtnAT 1 From Ft. to Ft. Fr&n Ft. tomUhtc. From Ft. to Ft. From Ft. to Dept. health & Human Servia From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft MISCL. INFORMATION: DRILLER'S NAME f "" RPR -17-2007 05:22A FROM: 70:3437997 P.2/3 7.T ormo "A&*" D Pofts" dM1 ad"Y D?*fM 044N Wetw i Wmitnow pfffmq 4700 Lown ifnul P.0.1at t11f10 ANk"s. AN 19310.N30 ltto'>'f 1+11.110 Pump 1gs�3 ilor Log woo 11191 B Pau" Number, l�real Itlntiflatiea N(tta>»n „_,,: ilal! arilltl.t...: �_... (��(7���}l1�✓` tt '9)'Oc ' +' l ✓tY^��i0 #OL 6 F/o,-�VC� (V�i`�Q 0L 1-4q- �Ol�ccC" YJr hop UnAtsda Mtn lump LetLtltrT11P9 t11[Yw 2+spn�f YV10 V9, Mt lttlt0 tMS" Notwelri ttaal Hrr.� `1�n�e r- hmvuw&ATF 22115L) pump vim �br "l..AMOWas�.tboplu I�G_bn ?fd4n Attapt Mmft1lulsl-1N1m1: PiemAdt.1htw1n kVA w1n ia�ln�.a ttr.a ttaW�ios! �f yu Otto Ml�delMdaAlldlasl cwc C•anMIll CAU FOR SERVICE - Complete Wwor Bywan BaNas - AAttoW PUMP & WEIt StRvicE, LLC BRIAN W = ANCHORAGE 6AG1.6 RIVfiR (807) 946-8355 (807) 0224M Aatt d ae 1:1 l� inadlt r Mutt 11aYtA1 • attrlp 1s.1�M.tt.s tp to t31tb Y�Gh11►1Q Rq+.I ierdl.dra 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 SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920306 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:JOHNSON BRUCE A OWNER ADDRESS:19240 MONASTERY DR. EAGLE RIVER AK 99577 PARCEL ID:05128172 LEGAL DESCRIPTION: BENSON #2 LT 6 LOT SIZE: 49136 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 9/23/92 EXPIRATION DATE: 9/23/93 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: EXISTING WELL MUST SUBMITTED TO DHHS. RECEIVED BY: PROPERLY ABANDONED. WELL LOG MUST BE DATE: -�-- z --- ISSUED BY: -,c-'(-ftq &tI,r f DATE: f7li-f3 `YZ- LV N 163.8-7 ) hereby certify that a survey of Lot __ _ crl _ -Block _ — ___—__ _ Subdivision was made on _}i��c�vs%� and at the improvements situated thereon- are within the property lines 'd do riot overlap or encroach on the property lying adjacent thereto, at no improvements on property lying adjacent thereto encroach on ie premises in question and that there are no roadways, transmission nes or other visible easements on said property except as indicated :reon. L C' sled at Anchorage, Alaska, this___ a day of ____v�+ ONSTRUCTING ENGINEERS, INC. RA Box 60, Anchorage, Alaska 99507 •940817 1 / %i' Ir 0) G) N N 0 0 /e�' Q1 tr''1 r:Y MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION oe*- 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME /d) L I b Dill der PHONE ;KNEW Vv i r b e I dw_ .33y/C+ ❑ UPGRADE MAILING ADDRESS 5R. ?_ 1�ox gi,uer A K ,5-7 LEGAL DESCRIPTION e 6is o ki Ala, 2 LOCATION NO. OF BEDROOMS DISTANCE TO: WellV / J Absorption aret a7 Dwelling <6 7 +"'rPERMIT NO. _Y CL ZQ Manufacturer Material S�ir� No, of compartments wF ee r lti rn Liq. capacity in gallons 1,00 6 IF HOMEMADE: Inside length Width Liquid depth Y DISTANCE TO: Well Dwelling PERMIT NO. Jaz = Z< Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: Well FoundationNearest �Q lot line n T� PERMIT NO. J LL z No. of lines Length of each line Total length of lin s Trench width Distance between lines I= z w 169%inches Q H Top of tile to finish grade Material beneath tiles Total effective absorption area © S Fr. Length Width Depth PERMIT NO. 0 aQ a w Type of crib Crib diameter Crib depth Total effective absorption area W DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS P VC 1 9 0119 14 SOIL TEST RATING / J05 - INSTALLER tea r l w, C ra Q REMARKS e, OF At �" vu e. q y� •% • a • O 1 TM ' / ��, •: James L Thode k .• .w Se , T► APPROVED DATE LEGAL 7-23-%-3 L c; -t 6 $ s o n No, , /Z -U13 lKev. 3//M MUNICIPALITY OF ANCHORAGE Department '. Health and Environmenta" ?rotection 825 L Street, Anchorage, AK. y9501 264-4720 # # � HANDWRITTEN PERMIT Permit WELLAND/OR ON-SITE SEWER PERMIT Applicant: i1UJ{�.� �-� Mailing Address:Location: Phone Number: -s`3 f �/ Legal Description: L �� 1 �i.��,r_ Lot Size: Type of Soil Absorption System Is: Trench: _ Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br)1�-U cryo y®� The Required Size of the Soil Absorption System Is: t r DEPTH LENGTH 40 _ GRAVEL DEPTH 4- WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). 16dc) * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ GALLONS # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * # * TWO(Z) INSPECTIONS ARE REQUIRED # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. PERMIT EXPIRES DECEMBER 31, 1 9 3 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may requi e enlargement if th residence is remodeled to include more that 3 b rooms. Signed :'�: �,�.�_ Issued by : pplican .1 /r k/ f_' Date: / �" SWP/024(1/81) S• SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: &4/ jfe_ 11oH1,/J66Af DATE PERFORMED: LEGAL DESCRIPTION: L'T' (� j &456d 56d J U.• X4 6'LOPE SITE PLAN DEPTH (FEET) 2 �i '3R(J� f�IkLdFj v y. 4 C 5 � o 6 c5 iiJ 7 ; 'e4tl: rode 4,s 8 fE /4660 le') j 10 14 15 16 17 18 19 , rOH 61 R6e-c- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S L O P E 20 ( I PERCOLATION RATE 7L//� (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS _7/ J s!/J T PERFORMED BY: '6'e '666k -,-re _ CERTIFIED BY: �, �� �CJ�? k �c� F` DATE: le'—, r 72-008 (6/79) Grbss Depth to Net Reading Date Time m�� � ter Drop o•o•o.epe s IN 1111111ION012111E 1010■111■■1IM1111i �r all MONSON � • laverence C. Lok r .�` O No. •Aw O� �� o••eoo•. 20 ( I PERCOLATION RATE 7L//� (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS _7/ J s!/J T PERFORMED BY: '6'e '666k -,-re _ CERTIFIED BY: �, �� �CJ�? k �c� F` DATE: le'—, r 72-008 (6/79) Grbss Depth to Net Reading Date Time m�� � ter Drop o•o•o.epe s �r � • laverence C. Lok r .�` O No. •Aw O� �� o••eoo•. •N� o" ���il 20 ( I PERCOLATION RATE 7L//� (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS _7/ J s!/J T PERFORMED BY: '6'e '666k -,-re _ CERTIFIED BY: �, �� �CJ�? k �c� F` DATE: le'—, r 72-008 (6/79) CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION PUBLIC WATER SYSTEM APPROVAL TO CONSTRUCT Plans for the construction of public water system located in -- Alaska, submitted in accordance with 18 AAC 80.100 by ,i have been reviewed and are ❑ approved. ❑ conditionally approved (see attached conditions). BY„ TITLE DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract order no. Approved by Date or descriptive reference) The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction of the public water system was completed on I / (date). The system is hereby granted interim approval to operate for 90 days following the completion date. TITLE DATE As -built plans submitted during the interim approval period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. BY TITLE DATE i Municipality of Anchorage Development Services Department • J� Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 ti www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. nS1_?R1_72 1. GENERAL INFORMATION X0_ 4k*..V COSA # nkII Expiration Date: —7-24 _ 07 Complete legal description 8eneon #2, Lot 6 Location (site address) / `j j7 pioneerDrive FaQIP�er. K 99577 Current Property owner(s) Day phone 2-423E63 — Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Day phone Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System ISA 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 Onsite Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ❑ Individual Holding Tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified seal affixed and as of the Investigation, ba ed on procedures eoutlined In the Certificate of validationdate Systems Approval Guishown below, I delines that fo this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm- ArcTerra nein ring 8 S�)rmaying, Int phone- 868-3799 Address __211.44.7 PTARMIGAN BLVD , FAC F RIVFRe AK 99577 Engineer's Printed Name_ KENNETH M DI IFF ISDate -_ 04/ 0/07 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be Observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE Approved for -3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: t,vaH Lonewist _� Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory _� Other By'_A05�� Original Certificate Date: (Rev IM) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 995196650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Benson #2 Lot 6 Parcel ID: 051-281-ZZ A. WELL DATA to 't Well type PRNATE !C t" If A, B, or C provide PWSID 0 • Well Log (Y/N) N Date completed 10-31-83• Sanitary seal (Y/N) Y Wires properly protected (YIN) Y Total depth Llnknowft—ft. Cased to 40'+ ft. Casing height (above ground) _74 in. FROM WELL LOG AT INSPECTION 'i Date of test Unknown 3/19/07 Static water level - - ft. Sal ft. t Well production - - g.p.m. 2.0 g•p•m• WATER SAMPLE RESULTS: i Coliform _Q__colonies/100mL Nitrate 3.51 ma/L Other bacteria _0 colonies/100 mL Arsenic: _MD mg/I Date of samplq- 3/29/07 Collected by:.AreTerra Ii B. SEPTICIHOLDING TANK DATA Tank Type/Material_figotlg./ctt Date installed 7/23/83 Tank size 1000 gal. 4 Number of Compartments 2 Cleanouts (YIN).y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping 4/20/07 Pumper _1_B_6 I! C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d.ne or ftz/bdrm) 125 System type Qeen Trench Length _4_L ft. Width 2 ft. Gravel below pipe _Lft. Total depth $ ft. Eff. absorption area 410 ft Monitoring tube Y Depression over field N Date of adequacy test ;/9q/07 Results (Pass/Fail) Pa For I— bedrooms } Fluid depth in absorption field before test D in. Water added Ala gal. New depth tin. I Elapsed Time: sl min. Final fluid depth 9 in. Absorption rate >= 450+ 9 P•d• Any rejuvenation treatment (past 12 mo.) (Y/N & type) N if yes, give date ----- h 3 la D. LIFT STATION Date installed Size in gallons Manhole/Aocess (Y/N) 'Pump on" level at_in. "Pump off level at_in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1501+ Absorption field on lot 1501+ Public sewer main 75'+ Sewer /septic service line 251+ On adjacent lots 10 0 + On adjacent lots 10 0 + Public sewer manhole/cleanout Holding tank 10 0 1 + Animal containment areas 501+ Manure/animal excrete storage areas 10 0 1 + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5 ' + Absorption fields '+ Water main _101+ Water service line _J_0_'+ Surface water 10 0, + Wells on adjacent lots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation _101+ Water main 101+ Water Service line 10'+ Surface water _7 00'+ Driveway, parking/vehide storage 10'+ Curtain drain 50'+ Wells on adjacent lots 1 00'+ F. COMMENTS *The existing well rlosest._ � 1e 1 • .11 1 - ,.- 1 1• •• . y ••� T .1 •• •1.. - • ' • 1- •.• •: -• ly .. •1 •1 1- ' al" .P 1 1 • � la• •� Il• G. ENGINEER'S CERTIFICATION OF q(q��/ 1 certify that I have determined through field inspections and y •.��� review of Municipal records that the above systems are in / x conformance with MOA COSA guidelines in effect on this • = 9I� ... date. Engineer's Printed Name _KENNETH M. D IFF tc COSA Fee $4 . r L �I Date of Payment "f a J Receipt Number Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage 4 Development Services Department Building Safety Division .. --� On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 070111 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Lot 6 of Benson #2 subdivision. This inspection revealed a nitrate concentration of 5.78 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SCS Ret# 1071568001 ArcTerra Engineering and Surveying Client Name Project Name/# Benson No 2 Lot 6 Client Sample ID Benson No 2 Lot 6 Matrix Drinking Water PWSID 0 Sample Remarks: All Dates rimes are Alaska Standard Time Printed Daterrime 0423/2007 12:27 Collected Date rime 04/17/2007 13:00 Received Date/time 04/17/2007 15:05 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Metals by ICP/M3 Arsenic ND 5'00 Waters Department Total Nitrate/Nitrite-N 5.78 0.100 Microbiology Laboratory Total Coliform 0 wdt--frz u8/L EP200.8 C (<10) m8/1. SM204500NO3-F B (<10) col/100mL SM209222B A (<I) 04/18/07 04/19/07 TK 04/17/07 IDS 04/17/07 DLC SCS ReEN 1071317001 ArcTerra Engineering and Surveying Client Name Project Name/H Denson #2 Lot 6 Client Sample ID Denson #2 Lot 6 Front Spigot Matrix Drinking Water PI.N'SID 0 Sample Remarks All Dates rimes are Alaska Standard Time Printed Date Time 04/112007 12:51 Collected Date/time 03292007 16:30 Received Date/rime 03/302007 12:05 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date [nit Metals by ICP/M3 Arsenic ND 5.00 ug/L EP200.8 C (<10) 04/02/07 04/05/07 TK Waters Department Total NitmtcMitritc-N 3.51 0.100 mgfL EPA 353.2 D (<10) 04%03/07 1DS microbiology -1,21 boratory Total Coliform 0 cot/100ml- S%1209222D A (<I) 03/30/07 DPT lv£LL A 1 LOT 4 LOT 3 LOT 1A LOT 5 S89'45'21'W 164.19' 19.57'43-W REC) (163.90' REC) 589'37'25'W 164.31' v O (N89'59'33 -W REC) O (163.87' REC) PIONEER DRIVE A '1 oLLI O LLI O N SEPTIC V) " VENTS LOT 59 O I 50.00' (n 30.00' IU r U) = FND 3 1/4" ALUMINUM MONUMENT O = FND 5/8" REBAR Y I (n Q ANCHORAGE RECORDING DISTRICT ASBUILT OF: BENSON SUBDIVISION, ADDITION #2 LOT 6 PLAT 83-144 O° U 22.7' it 39.0' U eo � EXISTING c • ^' BUILDING ,� N m 12.0' 38 0• 24.9' v N o _4—N�N v I • o 0o j o m � `•. nJ lV a ..:.•.< .. WELL LOT 6 m O K W 4 N 3 n M 'p1 1� O r QO z N Z .:•ti. IRRIGATION WELL 589'37'25'W 164.31' v O (N89'59'33 -W REC) O (163.87' REC) PIONEER DRIVE oLLI O LLI O N V) LOT 59 O I 50.00' (n 30.00' U) = FND 3 1/4" ALUMINUM MONUMENT O = FND 5/8" REBAR (REC) = RECORD PER PLAT 83-144 I (n Q ANCHORAGE RECORDING DISTRICT ASBUILT OF: BENSON SUBDIVISION, ADDITION #2 LOT 6 PLAT 83-144 SURVEY CERTIFICATION: I, John L. Schuller, have �►� - -'`�\ conducted a physical survey of this property as shown on this ,: 0 F A ��>♦ drawing and that the improvements situated thereon are within the property lines and no encroachments exist other than noted. �'e 49� y l� EXCLUSION NOTES:It is the owners responsibility to determine ""..... """•� the existence of any easements, covenants, or restrictions which f / do not appear on the recorded subdivision plat. / • • :""""" •"•""""'... Under no circumstance should any information on this drawing y; -JOHN L SCHULLER: •t be used for construction of fences, structures, improvements, +, LS -10408 or for establishing boundary lines. (@ 0-- '.4 „6 WORK ORDER NUMBER: APR. 18. 2007 SCALE: 4O' E -Nub 1��`;\”` 07-018 AWN BY: CNrCKEO 8110R10 NU"e ; I e"/PAGE: JLS NW753 0701/10 LOT 1 LOT 2 0 O 6 M LOT 588 "'malawet�' .V W11 �� AIYD SOT •k 9957741j 6 APPLIC 4T FILLS OUT UPPER HAL ONLY Property Own,. Phone N..tiling Address Zip Code Time Buyer Date Address - 2C Zip Code 42 i 1? Lending Institution 7' 6e-, Phone Address Zip Code Inspector Realty Co. & Agent 1 Phone Field Notes: Address Zip Code ICIPAILITY OF ANCHORAGE EPT,OF i%'V,L11i Legal Description 5ebol, Street Location Type of Residence P-Iringle Family D Multiple Family No. of Bedrooms -3 D Other jf CI n Zivi d u E;11 divid'�al IFFFor ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. drilled to that date, well depth (attach log if available). n un y wells prior give 0 Public Utility VVV CONDITIONAL APPROVAL' Sewer Disposal ndividual Year Individual Installed: 3 El Public Utility When Connected to Public Utility: El Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 'V -4,A-10 !_� riA_(� Q Y (_0111_yT 12i Time Time Time Time Date Date Date Date Inspector Inspector Inspector Insp for s I— L-A C2 Field Notes: ICIPAILITY OF ANCHORAGE EPT,OF i%'V,L11i ENvjRoNtA1_,,,iTAL PROTEC410K -C GG 1* ell RECEIVE Q O APPROVE ROOMS +CNS -OF-APPROVAL DISAPPROVED CONDITIONAL APPROVAL' DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area S Well Log Received Septic Tank Size 0 Well to Tank 14 72023 (3(82) -4