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Home My WebLink AboutLEACH LT 6 Municipality of Anchorage Page 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: ~[,'--~ ~ "Z. ~ ~'~'~¢- PID Number:_ ~ I~ I I'Z--~ Na.~e:._.[ 1 ~ ~ I:~ Wastewater System: o New ~pgrade Address: '~. ~ 1 [I ~ ~ ~ q~d' IG~ ~_ ABSORPTION FIELD LEGAL DESCRIPTION ~o~,..,i.~: ~,~GPD/Sq. Ft. ~otal Depth from original grade: Lot: Block: Subdivision: Depth to pipe bottom from original grade:/ Gravel depth beneath pipe 'rownship: Range: J Section: F~II added above original grade:~/ Ft. Gravel length: ~Ft.' WELL: ~ New ~ Upgrade e~a~.~ ~i~ / Number of lines: Distance between lines: ~ification (Private, A,B,C): Total Depth: eased To: Total absorption area: ~ipe materia~[O ~. Driller: Date Drilled: Stolid Water Level: I~taller: Date installed' Yield: Pump ~et at: Oasing Height Above Ground: ~.~ .,. .,. TANK SEPARATION DISTANCES ~ptic u Holding ~ S.T.E.P. To Septic Absorption Lift Holding Public/Private .Manufacturer: ,Capacily in gallons: From Tank Field Station Tank SewerLines ~~~ '~(~ [~ MsterJa[: Number of Compartments: Surface w~t.~ ~ I~'e ~ _ ~ LIFT STATION Lot ~ I Size in gallons~c~re Line ~1 ~- _ ,_ ~ r: Fou,dation I ~ ~ ~ --. ~ "Pump o~'~vel]~ .....[1~--7~1~i7 High water alarm Curtain ~M,~ [~)OM, J PumpMakeA~°del lElectricallnspectionsperformedby~ Drain ~ Remarks: BENCH MARK Location an~ Description: Inspections performed by: ~~.~a~ lst~~ , Eagle River, Alaska 99~ 2nd_~~ ~ ~A,, ROeE, Department of Hea~ and Human~Services approval , ~;~%~0FESS~;~ Reviewed and approved by' ~~~- Date. Z-2?-?Z 72-013 (1/91) MOA 25 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · 'l"elephone: 343-4744 On-Site Wastewater Disposal System and/or We~l Inspection Report 72-013 A (2/91)MOA25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT NUMBER:SW920074 DATE ISSUED: 5/07/92 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 5/07/93 OWNER NAME:HVID JAMES P & EACH (50%) OWNER ADDRESS:P. O. BOX 1].1682 ANCHORAGE, ALASKA 99511-1682 PARCEL ID:01511234 LEGAL DESCRIPTION: LEACH LT 6 LOT SIZE: 22216 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAl, PROVISIONS: EASEMENT GRANTED FOR SEWER SYSTEM. RECEIVED BY: WAIVER TO CUTBANK GRANTED FOR FIELD TO BE 30 FEET FROM DRIVEWAY. LOTS 5 AND 6 IN COMMON OWNERSHIP; USE AND MAINTENANCE DATE: DATE: March 2, 1992 ROBERT SHAFER, P.E. ROGER SHAFER, P E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTNORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lots 5 & 6; Leach Subdivision; Request you issue a permit to upgrade the sep~c system serving the referenced property. The existing crib is currently in a state of failure with periodic surfacing. The proposed trench is to parallel the driveway at 100 ft. away from the we~. Unfortunately, th~ is only approximately 30 ft. away from a cutbank. However, the "cutbank" co~ist~ of a change in grade in excess of 25%. It is not a man-made cut exposing soil, instead, the bank is covered with organics and vegetation. Therefore, we do not anticipate the surfacing of effluent through the cutbank. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. Sincerely, ROGER J. SHAFER, P.E. RJS/gm 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 ./ MAY 7 ~99R D ~l.m)icipality of Ancho~afle ept. Health & Human Services d}.,4..-': ',' :'., '? L ?' SCALE Municipality oi Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 0~ownship, Range, Section: 3 4 5 6 ~;_A~ 7 9 10 ~2 14- 15 16 17 18 19 2O I I~ ')~ ~'_¢~_.WAS G R O U N D WAT ER ENCOUNTERED? SLOPE SITE PLAN COMMENTS ~ (~--~'%"~. >('7'p¢~ 4~:;':(7:" . $ & S ENGINEERING S L IF YES, AT WHAT O DEPTH? p Depth ID Waler Alter Monitoring? '-',~:-. 2::" E Reading Date Gross Net Depth to Net PERCOLATION RATE '~'~' ~-"-.~'~'fninutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEI"~--'~).) ~\ FTAND [(,b --FT 17034 Eagle River Loop RoadNe, PERFORMED BY: ~_R~I,;~~~'~-..:,. ,/~,/~'~.,//] --CERTIFY ~TEST WAS PERFORMED IN ~ V~ THAT THIS ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON ~-HiS DATE, DATE: 72-008 (Rev. 4/85) GPCATER ANCHORAGE AREA BORO"~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-251 N? 792 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: MAILING ~:~./~.,.~ ~, ADDRESS ~ ~/~. / LEGAL DESCRIPTION ~::~,r*~ ~~/ ~, DISTANCE FROM WELL ,//~-:~ LIQUID CAPACITY /,~',~ ~'-~'. NUMBER OF MATERIAL ~"~.~'~Z"'~ COMPARTMENTS GALLONS. INSIDE LENGTH ~ INSIDE WIDTH ,:--~ LIQUID DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS ~/ OUTSIDE DIAMETER LINING MATERIAL~ ¢~J~~J~ . DISTANCE FROM WELL NEAREST LOT LINE ~ z '~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ SQ. FT. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WEE[ FOUNDATION , NEAREST LOT LINE , OF LINES. /'"'~---~ETWEEN LINES TRENCH WIDTH /"""--~- IN. TOTA-~L FFECTIVE NUMBER OF LINES/_0~'"~ ABSORPTI/ SQ. FT. EACH DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE_ DISTANCE FROM WATER WELL: TYPE ,~:~,.~-~J~'.~.,~:~' DEPTH ~",,"J/',,'~, , BUILDING FOUNDATION ~" / , _SAMPLE_-/'t/-/~ , NEAREST NEAREST SEPTIC / SEEPAGE .. ~, .~ / OTHER/¢'~)''''~-:/- LOT LINE /4 /7~' , SEWER LINE ..................~zg F,;/ , TANK //~.~7.~'~ , SYSTEM /¢"¢~- , CESSPOOL~--)~ , DISTANCES: DIAGRAM OF SYSTEM '~'-~.~,.. .. ' . . · .1"".' ')~'~ ,'~: I , o . GRE~,'ER ANCHORAGE AREA BOhOUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-660 ANCHORAGE, ALASKA 99502 TELEPHONE 279-8686 PERM,T NO, / ~"~' 0 SEWAGE DISPOSAL SYSTEM APPLICATION AND PERMIT INSTALLATION LOCATION ,:/ ~'; /~' ":/,~[: ¢~ / NeTE: THIS PERMIT IS NOT VALID WITHOUT 80lb TEST COMPLETION DATE ANTICIPATED ~7%'~.~ FINAL INSPECTION~ 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION lilY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. / SEPTIC TANK SIZE ~-~--O TYPE. . ~SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~r' FOUNDATION TO SEEPAGE Pit , DRAIN FIELD SEPTIC TANK TO SEE~EP._ e PIT WALL SEPTIC TANK ~ , SEEPAGE PIt '~--~ TO NEAREST LOT LINE, / WELLTO SEPTIC TANK ~5) DRAIN FIELD DRAIN FIELD /~/ · , DRAIN FIELD 72, · SEEPAGE PIT ALSO CONSIDER AREA WELLS. SEEPAGE PIT septic TANK, . SEEPAGE PIt TO RIVER, LAKE, STREAM. , DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED With AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. . ALtH ,o:HORitY LICENSED DESIGNER DIAGRAM OF SYSTEM CERTIFY that I AM FAMILIAR WITH THE REQUIREMENTS OF G~TE,~ ANCHORAt~AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DAT/~ '~'~ PPLICANT'S SIGNATURE ~- / GRE,~.,'ER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE. ALASKA 99502 TELEPHONE 279-861B§ DISPOSAL SYSTEM APPLICATION AND PERMIT NAMe_ OF App,,OANT L MA'L'NG ADDRESS INSTALLATION OF: SEPTIC TANK ~ SEEPAGE PIT ~ , DRAIN FIELD COMPLETION DATE ANTICIPATED PHONE , OTHEr NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF' ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. DIAGRAM OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPT,C TANK TO SEEFA E P,T WALL SEPTIC TANK TO NEAREST LOT LINE. , DRAIN FIELD . SEEPAGE PIT , DRAIN FIELD WELL TO SEPT]C TANK DRAIN FIELD · SEEPAGE PIT ALSO CONSIDEr ARea WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, . SEEPAGe PIT TO RIVER, LAKE, STREAM. · SEEPAGE PIT DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING G/~TM OF EXCAVATION S FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEP_T~tE;_'FAHI~_AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH~EGULATIONS REGARDING INSTALLATION. I CERTIE .THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT Tide ABOVE DA'i~//// / I g APPLICANT'S S GNATURE .... ~ CRE~TE~ ANCHOR:%sE A}~t:A B. HEALTH D~'PAYT ~",~ 327 EAGLE ffI'~EET ANCHORAGE~ ' ~'- A,.,A, ;NA 99501 PePfor, med For /%, / /- . Location c:o/~ /(.q t, Was Ground ~/ate~, Encounte~,ed If Yes, At Hhat Depth },lead ina G~oss Ti me Time Dept:h To H20 Net Dnop l'roposed Ins.allatzon: ,~eepage !':it / Der3th Of 'fnt,~l ./' -, ' ...... ~" ~O~'T,i?'~. -~ ...~ ..... ,)%.th Po bottom Of Pit 0 Test Performed B3,:..~i~C~ ~ o~,:., c~i~i~d By:~c~ _ ./~ ~.__,. / 6. TYPE OF RESIDENCE [] SINGLE FAMILY MULTIPLE FAMILY 7. WATER SUPPLY [~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY SEWAGE DISPOSAL SYSTEM [;~ INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date / ? 7 / · If system is over two (2) years old an adequacy test is required [] PUBLIC UTI LITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. r 72-010(3/78} NUMBER [] One ....'1~'-I~ [] Other [] Two ~ Five ,2~,.,,-~ _,~., .. · [] Three [] Six ' ATTACH WELL LOG. Awel Icg ~s requu'ed for all wells drdled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available,) MUNICIPALITY OF ANCHORAGE i' ~ ~' , ~-. DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECT O[~-.-. -.~. , '~' - ' ' ~ Telephone 264-4720 j~ ~ ~ ~ , . , REQUEST FOR A PROVAL OF INDIVIDUAL WATER AND SEWER FACI/61T~E~' DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processea. Please allow ten (10)days for processing. PROPERTY RESIDENT (If different fzom abo~e~ ~ . PHONE 2. BUYER ~ ~ ~~ & ~ ,ri ~ PHONE MAILING ~ESS~ ~ ~ ~ ~, TOI ~ ~ MAI LING ADDRESS - THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED " INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [~' SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER ~2. WATER SUPPLY I~/ INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -8lTL DATE INSTALLED []PUBLIC UTILITY "~ Connection Verified ~NSTALLER [~Septic Tank.or [] Holding Tank Size: I''l"'~'z~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTUR~__~ ~._~(~ TOTAL ABSORPTION AREA MATERIAL ~ ~'~ ~m~ 4, DISTANCES Septic/Holding Tank Absorption Are Sewer Line 1 Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line [] CONDITIONAL APPROVA~ (letter must accompany certificat~¢)'~''''~' ~____~2 [~'"~DISAPPROV EO DATE BY (Title) ///r~ LEGAL DESCRIPTION 72-010 (Rev. 3/78) JML John M. Lambe, P.E. 4303 North Star Street Anchorage, Alaska, 99503 907-279-8056 NEW PHONE NUMBER 276-4113 SOIL ABSORPTION SYSTEM TEST PERF0~4ED FOR: TELEPH 0 NE :_;~ ~;~"Z~,~B LEGAL DESCRIPTION:~L--~ _<~--J~ L~~ No. OF BEDROOMS:~ RECORDS ON GRIB~. DRAINFIELD O~H~ TEST PERF0~ED IN ACCORDANCE WITH JML STANDARD PROCEDURE ACCEPTED BY MUNICIPALITY OF ANCHORAGE, DEPT. OF ENVIRO~ENTAL QUALITY 0N WITH THE ~LLOWING MODIFICATIONS:" ' SURGE CAPACITY: SOIL ABSORPTION SYSTEM (SAS)c~~. y-~/~,~/ ~~~~ SEPTIC TA~ PLUS SAS ABSORPTION RATE ~, y / v ' OBSERVATIONS: NOTES: SUPERVISED BY John M. Lambe, P.E. 4303 North Star St~e~ Anchorage, Alaska, 99503 907-2794~056 EXISTING DRAIN FIELD TEST r. PE~COLATION ADEQUACY REFERENCE: /-~ o~ DATE ~//~/ 7~ ' PERFORMED BY: -/ ! · LEGAL DESCRIPTION. · -,c~"nc CDt//"J' DEPT~ BELO~ ..... METER READING GALLONS PUMPED TIME .... ~.~-~" ~'~ ~(" ~~ I' ,~ /~>, , .,//,'~ ~ "7" ~ '-//" , ,~ 2 s~ ~ / //.'~ 7Lx'' 7 -~" ~o~ ~o ~ , /~.'2~..~ , ,, .... r~ ~_ ..... ~.'5~ John M. Lambe, P.E. 4303 North Star Stre~ Anchorage, Alaska, 99503 907.279-8056 EXISTING DRAIN FIELD TEST ~ PERCOLATION ADEQUACY DATE4~//,~'./~* PERFOI:D',_ED BY: /_?c,~ /__~..-.,./,, ~ LEGAL DESCRIPTION: Z~r~ ~-~ / ~,~c,~ J-~z?,-3 DEPTH BELOW METER READING GALLONS PUMPED . TIME REFERENCE (, GALLONS ) ( NET ) GREATER Be~CHOP~GE AREA BOROUGE 104 West ~orthern Lights Boulevard Anchorage, Alaska 99503 S- 1854 Plat Status: Final BOROUGH: Engineer }~ealth Department Public Works Department Sand Lake Fire Department School District Street INames Tax Assessor Alaska Department of Alaska Railroad ~l~h~.~ays Anchorage Natural Gas Corp. Central Alaska Utilities Chugach Electric Association Date~ June 16, 1970 CITY OF ~GiORAGE: Fire Harshal Hunicipal Light & Power Departmen~ Property Management Officer Public Works Department Telephone Utility Traffic Engineer Water Utility GAB Telecommunications~ Inc. Matanuska Electric Association ~iatanuska Telephone Association Assistant Superintendent of Hails Re: Subdivision / X~×-JaX, yj~ty~iy Description ~f Property: See attached plat ~mer: Donald M. Leach Gentlemen: Petition has been received by the Greater Anchorage Area Borough Planning and Zoning Commission for the proposed__ Su___bd. ._. of subject property~ Attached is a copy of~e proposed plat. Will you please submit your comments in writing, specifying any easements cr other requlr~mentr that your department or agency may need, If we do not hear from you bY- _Ju__jlx 3~. 1970 , we will assmae that you do not wish to submit any comments. ~ '~ If you have no further use for the attaci]ed print~ please return it with your com~en ts. Enclosure Planning Department Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program., ~. 4700 Elmore Road Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-112-34 GENERAL INFORMATION Complete legal description Location (site address) COSA# O~(-'~A--~ \\\ 'c~t ~e Expiration Date: / / - ,~. ,,~ - / / Lot 6, Leach Subdivision 4201 O'Malley Road Anchorage, AK 99516 Current Property owner(s) Don and Judie Scofield 4201 O'Malley Road Anchorage, AK 99516 Mailing address Lending agency Day phone Day phone Mailing address ¥ Reai'Es~'ate.'/~gent., Mailing Address ?; Unless othervCi~e requested, COSA will be held by DSD for pickup. Day phone NUMBER OF BEDROOMS: TYI~E OF wATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class Well [] Public Water System [] Four (4) TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site wateEsupply and/or wastewater disposal'system is (are) safe, functional and adequate for the number of bedmom{~ci type of structure indicated herein. I further ve'H~ that based on the information obtained from the Mun]ci~ality of Anchorage files and from my investigation anaiiin~Pe~tiOn?~he on-site water supply and/or.w.a~t~W.i~te~"~lisposal system is(are) in compliance with all applicable M~nicipal and State codes, ordnances, and reg'ulat ons n effect at the bme of ~nstallabon. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. bedrooms. DSD SIGNATURE L/''//Approved for J~ Disapproved. Conditional approval for Phone 522-7773 bedrooms, with the following stipulations: .... .. ON-SITE : Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: R - ~--'~.-// 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: A. WELL DATA Well type Private Date completed Unk. Total depth ft. Lot 6, Leach Subdivision If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to >40 ft. FROM WELL LOG Pamel ID: 015-112-34 Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Arsenic: N/D mg/I B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,500 gal. Foundation cleanout (Y/N) Y Date of pumping 7/25/11 C. ABSORPTION FIELD DATA Date installed 6/5/92 Length 55.5 ft. Total depth 12.5 ft. g.p.m. Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) >18 AT INSPECTION 7/28/11 197 ft. 3.6 g.p.m. Nitrate 5.1 mg/L Date of sample: 7/28./! 1 Collected by: B. Hippe Date installed Number of Compartments Two Cleanouts (y/N) Depression over tank (Y/N) N High water alarm (Y/N) Pumper A Plus Home Services 6/5/92 Y N Soil rating (g.p.d./ff~ or ft2/bdrm).8 GPD/SF System type Deep Trench Width 3 ft. Gravel below pipe 9 Eft. absorption area 999 ft2 Monitoring tube Y Depression over field N Date of adequacy test 7/28/11 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 61.2 in. Water added 761 gal. New depth 75.6 Elapsed Time: 1,440 min. Final fluid depth 61 in. Absorption rate >= 600 Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date in. in. g.p.d. LIFT STATION Date installed "Pump on" level at Datum in. E. SEPARATION DISTANCES Size in gallons "Pump off" level at ~ Cycles tested in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot* Absorption field on lot Public sewer main N/A Sewer/septic service line >25' Animal containment areas >50' >100' >100' Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. On adjacent lots >100' On adjacent lots >100' Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas >100' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Water main > 10' Water service line Wells on adjacent lots >100' >10' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field Surface water >5' >100' Property line >10' Building foundation >10' Water Service line >10' 'Surface water >100' Curtain drain None Noted Wells on adjacent lots >100' COMMENTS: Water main >10' Driveway, parking/vehicle storage >25' 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 Michael E. Anderson, P.E. Date 8/19/2011 COSA Fee $ 4'~C~ ,'"' ;~ ~I~._O~ ~ "' ~~~aJver Fee $ Date of Payment ?~ [~ Date o, Payment Receipt Number ~~ ~ ~ ~ Re~ipt Number (Rev. 11105) Mnnicipality of Anchorage Community Development Department Development Services 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 Nitrate Advisory Certificate of On-Site Systems Approval # 1 11316 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 6 of Leach subdivision. This inspection revealed a nitrate concentration of 5.1 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. SGS ReL# 1113441001 Client Name Anderson Engineering PrintedDate/Time 08/02/2011 8:03 Pro.iect Name/# Lot 6 Leach Subdivision Collected Date/Time 07/28/2011 8:55 Client Sample ID Lot 6 Leach Subdivision Received Date/Time 07/28/20l 1 9:15 Matrix Drinking Water Technical Director Stel~hen C. Ede Saml~le Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date hilt Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 07/28/11 07/29/I1 NRB Waters Department Total Nitrate/Nitrite-N 5.10 0.100 mg/L SM20 4500NO3-F B (<10) 07/29/11 AYC Microbioloq¥ Laboratory E. Coli Total Coliform Negative 1 100mL SM20 9223B A 07/28/11 DLC Positive 1 100mL SM20 9223B A 07/28/1I DLC SGS Ref.# 1113696001 Client Name Anderson Engineering PrintedDate/Time 08/12/2011 8:04 Project Name/# Lot 6 Leach Collected Date/Time 08/09/2011 9:37 Client Sample ID Lot 6 Leach Received Date/Time 08/09/2011 10:01 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Microbiolo~r Laboratory E. Coli Total Coliform Negative 1 100mL SM20 9223B A 08/09/11 DLC Negative 1 100mL SM20 9223B A 08/09/11 DLC Aarow Pump & Well Service LLC (907)346-9355 Inspection Report I ran a camera 55~ down the well at 4201 O'Maltey Rd and did not find any holes/cracks in the casing or leaking around the pitle:ss. 0 z 75.00 ELMORE ROAD P x ~ NOO°O7'OO"VV 100.00 20' Elec. ransmilslon Line 30' UTILITY EASEMENT (~el dr[yaw, ay ~ -, 7,:5,00 100.00 ~' NOO°O5'OO"W g I SHELL SUBD. 75.00 Z