Loading...
HomeMy WebLinkAboutHILLSIDE NORTH #4 LT 2Hillside North #4 Lot 2 #041-031-88 r Municipality of Anchorage Page I of 3 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: ��,y9�aJ%5� PIDNumber: OLO-OSI -&& Name: 0 t TTt-=12 n 13>= YLT Wastewater System: New El Upgrade Address: P. ABSORPTION FIELD Q. p 7 � � Phone: No. of Bed oms: Deep Trench ❑Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Op 8 Total Depth from original grade: Q :� GPD Lot: Block: Subdivision: IVkt-In Depth to pipe bottom from original grade: Gravel depth beneath pipe 4 S r D >_ N 11 t2 r Ft. Ft. Township: Range: Section: Fill added above original grade:Gravel length: Ft. j50 Ft. WELL: [ .New ❑Upgrade Gravel width: Number of lines: Distance between lines: Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area:: Pipe material: 11434ig Ft. 1 14 S Ft. &0'10 SQ. Ft. `. 0., != Driller: so l.ut Daae l9 -Druled: Static Water Level: k, Ft. Installer: _ -e — 67 Date installed: % 7 /zro9 fm Yield:�r� Pump Set at: Casing Height Above Ground: I TANK % t9 GPM 8d 7� Ft. t Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines I0_6- Well r�o( t�� >a5 Material: Number of Com artments: .. Surface Water N 1. LIFT STATION Lot0 Line 13 O Size in gallons: Manufacturer: Foundation - _ �� "Pump on" level at: "Pump off' level at: High water alarm at: Curtain Pump Make & Model Electrical Inspections performed by: Drain t7(`l� Remarks: BENCH MARK ,ry Location and Description: 4rS a V n m i u i e.Ot GA A a A -(r jt5 ,L Ar es Assumed Elevation: ie�v Fr ENGINEER'S SEAL .. *4 4 .. Inspections performed by: —Dates: 1st�� 'y"hii 2nd V,7 ... . Department of Health and Human Services approval c: Reviewed and approved by: �'�--- Date: 72-G i3 (Rev. 9/91) MOA 25 u 1. . ' I F- - - - - _ - __ - - - I II I I I , PRIMARY TRENCH I I TOTAL DEPTH 9 FT LENGTH 50 FT ^� �+++.+++%+++++ ` .. ROCK 6 FT I Iq I I # 8 I I I BENCH MARK REPLACEMENT TRENCH 1 � I I I SWING TIES: AC 48.5 FT D BC XXX I AD 87.5 C A BD 88.5 AE 94 \ BE 75.5 T I, AF 88.5 1�YI I 8F 74 i I I I I i I I 25 0 2 50 75 100 125 150 50 FT. ♦ I Well ''4 49th TOBBI/N SPURKLAND • 1. ✓•'t NO, CE -2225 �1� �F''• ............•••'••�F i Nir f%FFSSt�N'�44 I TOBBEN SPURKLAND P.E. I I LOT 2 HILLSIDE NORTH #4 I I SEPTIC SYSTEM AS BUILT I 203 W 15TH. AVENUE DATE: AUG. 31, 1997 ANCH. AK. 99501 ROBERT JUETTNER BASHER ROAD SHEET: 213 GRID: 2142 I PERMIT # SW960175 PID # 041-031-88 HSN00022,D WG PRIMARY TRENCH Clean Sut Standard Trenches 2' Wide 50' L ong 9' Deep 6,0' Sewer rock 3' Co ver REPLACEMENT TRENCH NV SCALE 1E 88.13 —\ Im Mira fi 140 82.1 — 6,0 Ft of Septic Rock Foundation Clean out O 1000 gal Septic tank O Double Clean Outs Clean Jut 12+ FT. Cleanouts Monitor 3' Cover ND SCALE OF .� P::• ............:..: S •� . Ai►.....4 9 t h ..................: j n4- TNBTD, SPURKLAND CE -2225 p•�Z ♦� FESS10N�i��� - Exist. Ground 4' Min Cover over r Tank 88.13 1E 88.43 /E 88.81 82.1 1000 gal, septic tank BENCH MARK, GARAGE SLAB ASSUMED ELEV 88,5 T❑DDEN SPURKLAND P.E, LOT 2 HILLSIDE NORTH 114 SEPTIC SYSTEM AS BUILT 203 w15th Ave ROBERT JUETTNER DATE: AUG. 31, 1997 Anchorage Ak 99501 11 SHEET,. 3/3 GRID: 2142 I PERMIT NO SW960175 PID NO. 041-031-88 HSN00023.DWG LILT -16`--1996 19:13 MULD00H ELPIEHTARY Tnt cav ifirb 43ritting lCog by DOC; Co. d0a SULLIVAN WATER WELLS /,:5 p.O. Bax 67o272, CHUGIAK, ALASKA 99567 v TELEPHONE SU -2759 P.01 I- 41 E. I OWNER OF LAND -DEPTH OF WELL 7 I s _k� A 4f/,J ' L ADDRESS LEGAL. DESCRIPTIO DATE - Started Ended STATIC LEVEL OF WATER FT DRAW DOWN Fl. GALS. PER HR 6� 0� PERMIT NUMBER KIND OF CASING KIND OF FORMATION: From—D—Ft tin 2? —Ft.From — Ft- to— Ft - From Ft. to -A Ft. v L) 01 From.—Ft. to_�Ft_ From_1 Ft - tot _2k_ft. __-lL_' 8_A4J4F4_, From Ft. to—Ft. From_,j _.Ft. to Ft, --- From—Ft, lo_Ft From Ft. to Ft. ll&, From -------- Ft. to FI �jJ4� FromFI.to Ft. From 7r4AJEL Frojn_Ft. to—Ft. FL to— Ft. A) Ft. to—Ft. From Ft. to_L� Ft. �rw A rik__ Froml___Ft. to-9-1—Ft- From�Ej- it— Ft 6j /� 7L— From Ft. tej_2�'_Z Ft. 57 r3 4'c" Frm—Ft. toFt.__ Frorrl From ---Ft. to_.. _Ft From la)_!��_ Ft. tolllft �r" �J'O�J-:4e From _.._Ft, to—Ft— , b From - FI. to Ft. From__Fl. From _----Ft- to___Ft. From-- __Ft. to ---Ft. MISCL- INFORMATION, fc), CA R EC El. VED'' SEP 151997 Dept. Human 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:SW960175 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:JUETTNER ROBERT & VIRGINIA OWNER ADDRESS:P.O.BOX 671390 ANCHORAGE, ALASKA 99567-1390 PARCEL ID:04103188 LEGAL DESCRIPTION: HILLSIDE NORTH #4 LT 2 LOT SIZE: 138956 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 P cy\ ".4 ' +_�rj DATE ISSUED: 7/09/96 EXPIRATION DATE: 7/09/97 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).. 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DURING CONSTRUCTION, PERFORM ADDITIONAL SOILS p m• TEST TO A DEPTH OF 15 FT. MIN. AT OR NEAR TEST �bobo HOLE 42 AND SUBMIT SOILS LOG WITH ASBUILT. I RECEIVED P ISSUED BY: DATE: 141 DATE: 046111hls T.SPURKLAND P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 2 HILLSIDE NORTH ROBERT JUETTNER No Ground Water or Impervious Layer to 15 ft. Use Standard Trench Soil Rating. Test Hole #12.5 min/in Test Hole #2 5.5 min/in Use 0.8 gal/sq ft No. of Bedrooms 3 Required Area per Bedroom: 15010.8 = 187.5 sq.ft.. Total area required: 3 x 187.5 = 562.5 sq. ft. Finish Floor Elevation 88.5 Ground Elevation at Absorption Field 75+ - Top of rock 3 feet below ground Testhole Total Depth 15 feet Rock depth 6 ft. Length of trench 562.5 / 12 = 46.8 ft. SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 50 FT TOTAL WIDTH 2 FT TOTAL DEPTH 9 FT ROCK DEPTH 6 FT COVER 3 FT SEPTIC TANK 1000 GAL 6*1R ;ZIP O -SER AI �OkA ✓UN V'�Fsors�� R 7819g6 fQr/ Vel) The installation 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.-Po4ding and/or concentration of surface runoff will not result from this installation. re iNt ftil �OaoG Dr, r ex Fn l� c, e +„ y » , / P e' Lar 1 � car 2 car 1 i i I Lor z C \ i / Lir 1 I 0 \V ,. ♦ TOB N•SPURKLAND == ♦ • • U CiP ♦♦✓��:. NO. CE -2225 ��•�'�,r ♦� �� ••�••'............. '�•••���♦• FES 50 0 50 100 110 300 250 300 // SCALE- 1' = 100 F r, TOBBEN SPURKLAND P. F- LOT 2 HILLSIDE NORTH 114 SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE DATE: MAY 30, 1996 ANCH. AK. 99501 ROBERT JUETTNER ___ __._ BASHER ROAD SHEET: 1/3 GRID: 2142 . 1 _ __. ■ ■ i+i {a I ! i a !'a aaa' ' F- — — — — — — — — — — , I a+. a' I I a a a a PRIMARY TRENCH I TOTAL DEPTH 9 FT LENGTH 50 FT W . ^^ ROCK 6 FT++++,+ I I I S = 20 - 2sz i I I C a::: REPLACEMENT TRENCH �h 12 4 � I I 1000 GAL TANK ' I ' INSULATE UNDER DRIVE AY I � \ I I 1 Y I , I i .♦♦♦♦rrr��14 I ♦♦OPE, ��...q� 9 ��� aI 49th � r.S......... ...................... . ....� .. .....................F.... 25 0 50 75 100 125 150 �. C ��. TOBB SPURKLAND F. SLIt4,, P/ = 50 FT, I��sT� No, cE-zzz'..•����.AV P,; •• ............. •• �1 ftFESSI���♦♦♦ TOBBEN SPURKLAND P.E.SEPTIC SYSTEM DESIGN zoa W 15TH. AVENUE LOT 2 HILLSIDE NORTH #4 203 AK. ROBERT JUETTNER DATE: MAY 30, 1996 ANC(Qn7) 97a_aaia BASHER ROAD _ SHEET: 2/3 GRID: Z14Z PRIMARY TRENCH Monitor Clean Out Standard Trenches 2' Wide 50' L ong 9' Deep 6,0' Sewer rock 3' Co ver REPLACEMENT TRENCH NO SCALE Mira Fi 140 6,0 Ft of Septic Rock Clean Out I2+ FT. Cleo nouts Monitor �— 3' Co ver NO SCALE Foundation Clean out 1000 gal Septic tank ouble Clean Outs OF 49th : .� TNBBEI SPURKLAND J ✓�, �.� No.. CE -2225 •�. pRaEEssio��:'�� - Exist, Ground 4' Min Cover over Tank INSULATION 1000 gal, septic tank BENCH MARK, ASSUMED EL EV, 88,5 TOBBEN SPURKLAND P.E. LOT 2 HILLSIDE NORTH #4 SEPTIC SYSTEM DESIGN 203 W15th Ave ROBERT JUETTNER DATE' MAY 30, 1996 Anchorage Ak 99501 SHEETi 3/3 GRID 2142 ak. Municipality of Anchorage iy n®®9aeeo3eau¢oa®igonnartoea DEPARTMENT OF HEALTH & HUMAN SERVICES }rg ,7 soy as G. •onno nw4opa v' 825 "L" Street, Anchorage, Alaska 99502-0650 % so bon 9 !urkfand SOILS LOG — PERCOLATION TEST I (P� CE -2225 e, q PERFORMED FOR: �Yl -,P-r DATE PERFOFMEDm..._.." LEGAL DESCRIPTION:_ 1-0 1 0 , 1'`7'1 l-, -Q, I 1 I"' TownshiD. Rance. Section: D ETI L�4,O T 1 2 qt� 3 �I { S I�� ) 'P 4 ,. � -e ms Cfm a r 6- 7 7 a! 8- 9- g my r. 10 11 12 13- 14- 15- 31415 '� o C i aq" ct 71819 17- 18- 191 20 COMMENTS WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? P E Depth to Water After M N IJ Monitoring? � Date: � SITE PLAN mmm c.. . p c- �� c�, f✓ u PERCOLATION RATE - (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND 4 FT PERFORMED BY: 1 CERTIFY THAT " THIS® TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7qq to c.. . p c- �� c�, f✓ u PERCOLATION RATE - (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND 4 FT PERFORMED BY: 1 CERTIFY THAT " THIS® TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7qq to (ENGINEERS SEA 0141vj t ' Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES I t 825 "L" Street, Anchorage, Alaska 99502-0650 c: SOILS LOG — PERCOLATION TEST - PERFORMED FOR: 1 R.f. �P% 1/Ii 'e r R-119 61e Y`+ DATE PERFORMED: qO LEGAL DESCRIPTION:_ o i 94 1 ,1 i.g._;d-e Township, Range, Section: El T 10 SLOPE SITE PLAN ,I ;EE r`. r t � S f / /' �� rot V-t� 2 � a d � r"th Ll.stii 3 i� 4 5 6 7 8- 91 10 WAS GROUND WATER y�tD ENCOUNTERED? tv 11 IF YES, AT WHAT 12 DEPTH? 13 Depth'o Water After Monitoring? Date: 14- 15- 16- 17 4151617 18- 19- 20- COMMENTS 81920 COMMENTS ■ ■�■iiii PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND 7 FT PERFORMED BY: _ 11 _ S __ I S CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.. DATE: >�,I t I ® Municipality of Anchorage < o On -Site Water and Wastewater Program a` _ (907) 343-7904 S E T Y Certificate of On -Site Systems Approval Parcel I.D. 041-031-88 Expiration Date: Oa � 1 ofd � U 1. GENERAL INFORMATION: Complete legal description HILLSIDE NORTH #4; LOT 2 Location (site address) 9550 Basher Drive *Anchorage 99507 Current Property owner(s) Joan Bittner Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 . ., Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Community Class—Well ❑ °Public Water System ❑ Waiver/Variance request for: Received by: Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA# 0 S Citi 13 U I 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor'will it confer any legal right whatsoever. - 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, o� OF A 41;L�- 4 o T .:.\.. ................... . ., a........... • .. . 6N m J ess.: ✓ CE 795 ` fes51011 #AECC884 0tttr`(,� �r � ON-SITEm with the following stip�l %w ATER AND J9 WASTEv'ATER o^ PROGRAM By: U(11lig Original Certificate Date: '7 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 Fo.x� 0 0_ ,5 X i 1 , v i , ✓i%. r�r� rv�'r _ .: ry L.. z vtgeD COSA Checklist Legal Description: HILLSIDE NORTH #4; LOT 2 Parcel ID: 041-031-88 If more than 1 septic system on lot: COSA Checklist # 1 of Structure served by this system 1 A. WELL DATA ❑- Well log is filed with Onsite (or attached) Date drilled 7/96 Total depth 143 ft Cased to UNKNOWN ft 0 Sanitary seal is functioning correctly W Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 5/28/20 Static water level at beginning of test 58.8 ft. Comments B. TANK DATA Age of tank(s) 24 years Tank type/material SEPTIGSTEE Measured operating fluid level in septic tank 50" 0 Standpipes/foundation cleanout per record drawing Date of pumping 7/10/2020 der SEG. -1�xnC A1I'ab2v DEEP D. ABSORPTION FIELD DATA 1L TRENCH Which system tested (date installed) 7/29/96 Adequacy test date 7/23/20 ❑I ALL standpipes present per record drawing Results Q Pass For 3 bedrooms Total measured depth from grade 9.5 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 4.8+ ft (min) Water added 556 gal ❑ N/A - pressurized field New depth 23 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 230 min depth into effective 5.91' WCode-required soil cover over field Final fluid depth 4.5 in Absorption rate 450+ gpd W System presoaked (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) `NO date of test) **2107 If yes, enter date NIA Gallons introduced gallons Comments/Deficiencies: 'ASSUMED "DRAINFIELD PRESOAKED ON 7/22/20 Well production at time of test 6.3+ 9 p Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes N Nc © Coliform bacteria is Negative Nitrate 2.10 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 5/28/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: NIA COSA Checklist yellow sheet 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' P/1 Yes Community Sewer Manhole/Cleanout > 100' [J✓ Yes if No ft Q Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' 71 Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' 121 Yes if No ft Neighboring Absorption Fields > 100' Fv� Yes if No ft Water Main > 10' Animal Containment > 50' Fv� Yes if No ft Yes if No ft Fv� Yes if No ft Water Service Line > 10' F71 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' FVJ Yes if No ft F/� Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' P/1 Yes if No ft Surface Water > 100' El Yes if No ft Property Line > 5' P/1 Yes if No ft Wells on Adjacent Lots: Q Absorption Field > 5'✓21 if No Yes if No ft Private Wells > 100' Fv� Yes if No ft Water Main > 10' F71 Yes if No ft Community Wells > 200' Fv� Yes if No ft Water Service Line > 10' F71 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' 0 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' Q Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' F/� Yes if No ft Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS 24 YEAR OLD STEEL SEPTIC TANK MAY BE APPROACHING THE END OF IT'S USEFUL LIFE. SEE ATTACHED MOA ADVISORY. FOUNDATION CLEANOUT IS PRESENT, BUT NOT SHOWN ON AS -BUILT G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet O F , 4- g f H '-.-7 ••,��r r y-<��uo ness: JJ/ CE 7953 4pW'ProfessWo _ #AECC884 C!)i1 J �, MUNICIPALITY OF ANCHORAGE    DEVELOPMENT SERVICES DEPARTMENT    907‐343‐7904  On‐Site Water and Wastewater Section                                                                                           Fax: 343‐7997  www.muni.org/onsite         Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org      Septic Tank Advisory   Certificate of On‐Site Systems Approval # OSC201327  Subdivision:  Hillside North #4, Lot: 2  The septic tank for this property is 24 years old.  The average life for a steel septic  tank is 20 years. Typical replacement costs range from $7,000 to $11,000.   This advisory must be attached to all copies of the subject Certificate of On‐Site  Systems Approval.               This is an example of what the metal of a 30 year old steel tank MAY look like.      Municipality of Anchorage Development Services Department Building Safety Division On -Site Water S Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING/(, !` Parcel I.D. 041-031-88 COSA# QS C, l �i� 0 9 1. GENERAL INFORMATION Expiration Date: z> m.2— L ' Complete legal description HILLSIDE NORTH #4 S/D: LOT 2 Location (site address) 9550 BASHER ROAD • ANCHORAGE. AK • 99507 Current Property owner(s) ROBERT do VIRGINIA JUETTNER Day phone 338-5392 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 9550 BASHER ROAD * ANCHORAGE. AK • 99507 Day phone DARRELL FRIESS W/ REMAX Day phone 240-9225 110 W. 38TH AVE, #100 • ANCHORAGE, AK • 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site N Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal af,7xed hereto and as of the validation date shown below, 1 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 Finn GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG. LID. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 6 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readilyldentifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benerit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will If confer any legal right whatsoever. S. DSD SIGNATURE Approved for bedrooms. Disapproved. Date � 10 h O OF ..W�2r. '.r........,*. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory (/ Arsenic Advisory Maintenance Agreements Supplemental Engineers Report Nitrate Advisory Other By: (Rw. M05) fffdk A G�mess : ONSITE WATER AND WASTEWATER PROGRAMc' I M 111 Original Certificate Date: " 2. IN O Municipality of Anchorage , Development Services Department ° Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: HILLSIDE NORTH #4 S/D; LOT 2 Parcel ID: O LI /- 0 3 1 - g S A. WELL DATA Well type PRNATE If A, B, or C provide PWSID# N A Well Log (Y/N) YES Date completed 7/1996 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES Total depth 145.4 ft. Cased to 145 ft. Casing height (above ground) 12+ In. FROM WELL LOG AT INSPECTION Date of test 7/1996 5/10/2010 Static water level 60 ft. 64 ft. Well production 10 9.p -m. 5.6 g.p.m. WATER SAMPLE RESULTS: Coliform // 7 colonies/100 ml. NitrateQ.mg./L. Other bacteria colonies/100 ml. Arsenic`s S•y ug./L. Date of sample: 5/10/2010 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 7/26-29/1996 Tank size 1000 gal, Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping js' 1 ? -/ O Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA [-BELOW EXISTING GRADE Date installed 7/26-29/1996 Soil rating .p.d./ r ft'/bdrm)0_B System type TRENCH Length 50 ft. Width 2 ft. Gravel below pipe 6 ft. Total depth "9.6 ft. Eff. absorption area 600 ft' Monitoring tube YES Depression over field NO Date of adequacy test 5/10/2010 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 30 in. Water added 450 gal New depth37 in. Elapsed Time: 120 min. Final fluid depth30 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 me.) (Y/N & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons Manhole/Access "Pump off" level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main NSA Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage '10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field Inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date S11 S JI D COSA Fee S L %a -!�?— Date of Payment 5 f I Ci t Zo 10 Receipt Number 0 c1Z 6 8$ (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number • u►wraa a,u .0 m�aa Beau / �� run tpma a rw/-•m 14 -a` y(a l FS J4� •s • w ' i r � (A I'D -z- I flu o� � 4 azjl• 40'• o` n- • e n IN i•o .z ' � R � N 0 ;ZZ I t / I ' N ��'•� t I rYnr.lbo / •�ccn N 16•LBi 3?�v/,[5.69/V •4091)5 AbYd INC9Yn-L y"Ak W/J a N • I.(•'Fii•��•YY. «yy. • j •ol•+•1e e•• u••1A wl Swett (me) �S o S rrL6Yj �lA 53blOOM t YM1Y(M103UA pw—=—WBsm npop o ,/ "�S~~•.....».•� • d,'8 . vn•1•Y v� a wwos iiea o • ���+`_yM coma •ob. eYµ 40•ne w w1.1Y•w my w ■ o . a�•Put Wy41b.ey11 N+Y•.e •few Va•aYenMelwawoD YY4•mo &Maww'W Ad apYbuweYouo+•Yuy • � •ta e1111 OY• YUerry 'IOY1M4 eYlOwo•M .•ean4wy l os •noi � 41, A0 dJ7 NjV7 •gn•dwpYuugreII�got Ilew 1V•1•YI d10NVW N/Y9V7f7YLL5 t11f)aou l3a Cf13NM000N •.L71Rt7-SY I:: .. 1 ' Y.Lw/O SCS ReLN Client Name Project Name/N Client Sample ID Matrix Sample Remarks: 1102055001 Gamcss Engineering Group, Ltd I Iillsidc North N4 L2 I Iillsidc North N4 L2 Drinking Water Printed Date/time Collected Datelrime Received Datelrime Technical Director 05/17/1010 16:02 05/10/2010 9:55 05/10/2010 12:30 Stephen C. Ede Allowable Prep Analysis parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic SAOU 5.00 ug/L EP200.9 C (<10) 05/11/10 05/14/10 KDC Waters Department Total Nivate/Nitrite-N Microbiology Laboratory E. Coli Total Coliform 2.42 0.100 Negative 1 NCgalive 1 mg/L SM204500NO3-F D (<IO) 05/11/10 AYC IOOmL SN1209223O A 05/10/10 DLC IOOmL SM209223B A 05/10/10 DLC