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HomeMy WebLinkAboutUS SURVEY 3042 LT 101USS 3042 Lot 101 #075-093-46 VPV OF Til, t U STATE OF ALASKA -j---� ya DEPARTMENT OF ENVIRONMENTAL CONSERVATION - 'P CO STRUCTION AND OPERATION CERTIFICATE F ALAS Jor PUBLIC WATER SYSTEMS A. APPROVAL TO CONSTRUCT Plans for the construction or modification of a �• �«r� i, �'�'� �.;a �t}� L.7 ; /•�`, ?,: 34, public water system located «; in ''I' `�`d""� , Alaska, submitted in accordance with 18 AAC 80.100 ` have been reviewed and are',, © approved. ❑ conditionally approved (see attached conditions). By TITLE DATE ' If construction has not started within twoears of thea y pprbval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. B. APPROVED CHANGE ORDERS Change (contract order no. or descriptive reference) Approved by Date C. APPROVAL TO OPERATE The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public. The construction of the s• 5,,,� /,z 4b� 1011' 44 11f 211 311 �� Itt C public water system was completed on ��l' (date). The system is hereby granted interim approval to operate fo, 90 days following the completion date. BY 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 ff 'Ij DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C) 2. YELLOW - WATER SYSTEM FILE (Complete Section C) 3. PINK - ENGINEER/MUNI-BOROUGH (Complete Section C) 18-0407 (Rev. 11/83) 4. GOLDENROD - MUNI -BOROUGH (Complete Section A) Y Municipality of Anchorage Page 1 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 Number: SW980320 PID Number 075-093-46 Permit Name: Michael and Suzanne Farley Wastewater System: Xi New 0 Upgrade Address: P.O. Box 1213 Girdwood, AK 99587 ABSORPTION FIELD Phone: 783-1998 No. of Bedrooms: Four XX Deep Trench 0 Shallow Trench 0 Bed 0 Mound 0 Other LEGAL DESCRIPTION soil Rating: GPD/Sq. Ft. Total Depth from original grade: Lot: Block:Subdivision: 101 US Survey 3042 Depth to pipe bottom from original grade: 1.5 Ft. Gravel depth beneath pipe 6 Ft. Township: Range: Section: Fill added above original grade: 2 - 3 Ft Gravel length: 6 Ft. WELL: 0 New 0 Upgrade Gravel width: 3 Ft. Q5 Numb of lines: Distance � 5 een li•nt Classification (Private, A,B,C): Existing Class C Total Depth: Ft. Cased To: Ft. Total absorption area: 1,027.2 so.Ft. Pipe material: ASTM D3034 PVC Driller: Date Drilled: Static Water Level: R. Installer: H.R. Redmond Date installed: 7/30,31/99 Yield: GPM Pump Set at Ft. Casing H ight Above Ground: Ft. TANK SEPARATION DISTANCES O Septic ❑ Holding ❑ S.T.E.P. To From Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Lines Manufacturer: Anchorage Tank Capacity in gallons: 1 250 weir >150 >150 N/A N/A >75' Materiae Steel Number of Compartments: TWO Surface Water >100 >100 N/A N/A N/A LIFT STATION N/A Lot Line >5 >10 N/A N/A - N/A Size in gallons: Manufacturer. Foundation >5 > 1 0 N/A N/A N/A "Pump on" level at: "Pump off' level at: High water alarm at: Curtain Drain None ,Noted on Lot Pump Make&Model Electrical Inspections performed by: - _ Remarks: BENCH MARK Location and Description: Top of Cinder Block Foundation Wall. Assumed Elevation: 100.0 Ft= F y{J 4 vh ' f y V 41?t,v r5t a" a- mac` ' " tip,, Inspections by: MEA Dates. 1st 7/30/99 performed 2nd 7/31/99 Department of Health and Human Services approval Reviewed and approved by) W / o * Date. 10 "2 7 tt PP 12013 (Rev. 9/91) MOA 25 . A Municipality of Anchorage Page 2 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, AK 99519-6650 343-4744 On -Site Wastewater Disposal System or Well Inspection Report Permit Number SW980320 PID No. 075-093-46 S1 18.0 29.0 S2 21.9 32.9 SV 25.0 37.3 C4 31.1 33.0 M2 61.6 73.2 Class C Well c Cleanout M Monitor Tube SV Zabel Flow Splitter ternate Si e AGOSTINO MINE ROAD PLAN AS -BUILT SCALE 1" = 50' C4 4p T - Municipality of Anchorage Page 3 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, AK 99519-6650 - 343-4744 On -Site Wastewater Disposal System or Well Inspection Report U Permit Number SW980320 PID No. 075-093-46 N ern rn UU OD ' U SOUTH LATERAL N II -- 96. h 96. 6 .. 92.9 Geotextile Fabric 11f, Drainfield Rock ill NORTH LATERAL 42.8' 92.9 4 SQL PROFILE AS -BUIL : HORIZONTAL SCALE 1" = 10' w w,f>fi Oa..a NO VERTICAL SCALE k 43711 r k MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SW980320 Legal Description: US SURVEY 3042 LT 101 Design Engineer: 0073 Haas & Associates Owner Name: Michael & Suzanne Farley Owner Address: PO BOX 1213 Girdwood , AK 99587-1213 This permit is for the construction of: 1 Disposal Field 111 Septic Tank Holding Tank 7-5/-91 /0:08 .� //.' 30 Date Issued: Aug 25, 1998 Expiration Date: Aug 25, 1999 Parcel ID: 075-093-46 Site Address: Lot Size: 55440 SQ. FT. Total Bedrooms: /Id Permit Bedrooms:lir / Privy ❑ Private Well 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 (24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. A minimum of 2 inspections shall be performed by a licensed Civil Engineer This is a renewal of Permit #SW940313 \I- /4)c`cb C1Aa oK a, to l V eNeck(CC. 9' I-4 a Mike- e- E, A ie('avA 7 � .A9. HH c & -- "fsivl c1\aArt e.4., WBR )\-l`12cVed fp&da 7•Z3-997 Received By: Issued By: Date: Date: 8 • Z5 .96 MEMORANDUM DATE: July 23, 1999 TO: Donna Mears FROM: Mike Anderson, P.E. SUBJECT: Lot,C US Survey 3042 Permit No. SW980320 RECEIVED JUL 23 1999 Dept. Heath municipality Human Ser 01 vicess The owner of Lot 30, US Survey 3042 in Girdwood has decided to construct a four bedroom system on his property. The permit was previously issued for a three bedroom house and must be modified to allow the larger system. The Site Plan for the lot has been modified to include a 1,250 gallon septic tank. The absorption trench has also been modified to include two laterals each 42' in length. A flow splitter valve will be installed to evenly distribute effluent flow to each lateral. The total depth of the trenches will be 7.5' with 6' of gravel beneath the laterals. Sufficient area exists on the lot to allow placement of the primary and alternate system for the septic system. Additional testholes may be required, but will be placed during construction. Results will be submitted with the as -built to verify the uniformity of soils on the property. Please modify the permit to allow construction of a four bedroom system. LOT 30, US SURVEY 3042 4-, CV/ rti u� to m Wide Trenches us c Well AGOSTINO MINE ROAD SITE PLAN SCALE 1" = 40' tosi LOT 101, US SURVEY 3042 DESIGN FACTORS: Four Bedroom System Perc. Rate: 27 Min./Inch Application Rate: .6 GPD/SF SYSTEM REQUIREMENTS: Deep Trench System 1,250 Gal. Septic Tank 6' Drainfield Rock 4 Bedrooms X 150 GPD / .6 GPD/SF = 1,000 SF of Absorption Area 1,000 SF/12 SF/ LF of Trench = 83.7 LF Trnch Length Therefore: Construct a Deep Absorption Trench System With Two Laterals Each 42' in Length with 6' of Drainfield Rock Beneath the Lateral. Zabel Z-200 Splitter Valve. Required for Even Flow. Distribution Pipe i n Trench Placed at 1.5' Below the Original .Ground Surface. Total Depth to be 7.5' From Original Ground Surface. Mound Over Trench to Provide 3 ' of Cover or 2" of Direct Burial Insulation and 2' of Cover. NOTE: 1 '. 6" 6' • 3' TYPICAL DEEP TRENCH (NO SCALE) Grade Area Over Trench to Drain A Minimum 4' From Groundwater. Maintain 10' Separation From Lot %N\/ Geotextile Fabric 4" Perforated PVC (Slots Down) Drainfield Rock SECTION ytri TM fr- /A. yti��E, MOON. `t`# way. Line. Rick Mystrom, Mayor Municipality of Anchoragel�� Department of Health and Human Services Mrd 825 "t.:' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 August 23, 1995 Henry L Chandler Sarah Lee Chandler PO Box 871 Girdwood, Alsaka 99587 0871 Subject: USS #3042 Lot 101 Permit #SW940313, PID #075-093-46 The subject permit, issued August 23, 1994 by this office for a single family well and/or on-site wastewater system, has expired as of August 23, 1995. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as -built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Si ( erely, ry 4t t S J mes Cross, .E. P ogram Manager On-site Services enc: Copy of Permit cc: Haas and Associates 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 PERMIT PERMIT NUMBER:SW940313 DESIGN ENGINEER:HAAS AND ASSOCIATES OWNER NAME:CHANDLER HENRY L & OWNER ADDRESS:P.O. BOX 871 GIRDWOOD, ALASKA 99587 PARCEL ID:07509345 LEGAL DESCRIPTION: US SURVEY 3042 LT 101 LOT SIZE: 55440 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 8/23/94 EXPIRATION DATE: 8/23/95 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) . 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 PROVISIO RECEIVED BY: ISSUED BY: DATE: /0/1 I/9f DATE: - 2 3 - %¢ 11\.HAAS & ASSOCIATES, INC. CIVIL ENGINEERING CONSULTANTS • MATERIALS TESTING • ENVIRONMENTAL SERVICES July 12, 1994 Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Attention: Dan Roth, P.E. Re: Lot 101 USS 3042 Dear Mr. Roth: The proposed septic system on the above -referenced lot will have little or no effect on adjacent systems for the following reasons: 1. The neighboring systems are over 100 feet away from the proposed drainfield. 2. The proposed drainfield and reserve area are over 50 feet from slopes greater than 25%. 3. The 150 feet separation distance from the class "C" well located on lot 102C and the 100 feet separation distance from the system to surface water are being met. 4. The reserve space is adequate based on our test holes. 5. The system will be mounded, topsoiled and seeded to provide positive drainage away from system. If you have any questions, please call us at 344-4108 or fax us at 349-8791. 229— 3933 Sincerely, Haas & Associates, Inc. jam®fitB7 Sandor Manyoky, P.E. Civil Engineer SM/slum 3900 E 112TH AVENUE • ANCHORAGE, ALASKA 99516 • TEL/FAX (907) 349-8791 HAAS & ASSOCIATES 3900 E. 112th Ave. ANCHORAGE, AK 99516 (907) 349.8791 DB he Ctiapiefier, lice/ler /7o/c/e0 SHEET NO /� OF CALCULATED BY .5 / DATE 5 — 2 �+rXe� -- 9' CHECKED BY DATE 501---a" SCALE M fro 7'62 vi /97. ct MOW, 204115+Ok St s120f'I IPc,olm.Matolail. To Order PHONE TOLL FREE 1-800-225-6380 .apt , 0„ --tds er CO x0. ®ve ° 49TH : I e Oa eaemote °caveat °e $r °tenon a ace• .ea Snndor Manyoky :� 4 N e° CE 8467 • "t� Og�0P94FESSIOy®� 7 C,0 HAAS & ASSOCIATES 3900 E. 112th Ave. ANCHORAGE, AK 99516 C,0C.0 64 (907) 349-8791 4m JOB Lee C/ Qnc%%ear 51 lieediAer Mo/o/eii SHEET NO OF y ,yrf CALCULATED BY S — DATE J e" - �J CHECKED BY DATE SCALE •"' /yw�� T3• 009 Gal TalA1e.: C, WN i!Couer 0. r2L Ca PP 0 /- 4{Oj4' evG rills P/P hc bed cni piei. A Lr%G r i" via e vJ 0 o°et°°a3a° pae° °e one5-ct 0°ea° eco ®.ii..... CE8467 •'< 0�Sandor Manoy 4; o,F PRODUCT 20-1-1 {Srpk GMpsl 15-1(P N1/AaEV/®Irc.. Groan. Mass. 014)1. To Oder P004E TOLL IEEE 1B]e1255380 PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST iL (A00 OOOep 0 5 00, Go: v t<%rio San dor nvnrcu /' ` CAano/'@Ir ,t Hecate r NO/den DATE PERFORMED: LEGAL DESCRIPTION: v 0 71 / © / (/" $ 30 L/ a Township, Range, Section: TIM 2 o kepd w/s; //- �M i44,\ 0111 SLOPE u 10 WAS GROUND WATER // �7 ` , 4 ENCOUNTERED? 11 12 13 14 54. �.15 9 16 17 18 19 20 Q s/3/l/9v Lc, / IF YES, AT WHAT 7 DEPTH? COMMENTS $o«Irc.r�( Yes I S /��^ J, S O Depth to Water After/ / ��//ft Monitoring? % Date. •1 SITE PLAN p0ti 11L viA vi A 107,6 L, U/ln N� ,zv2 5- 8 Reading Date Gross Time Ne Time Depth to Water Net Drop s 1-99 •� II y af/ li ,8169Yam G' I t /Ohlih- Jr J' e S/8fl If If A)2r 10I.nic- .538n 5/1" II ll d't 3r /o,.;,- 512'' t" ll n d)t/7 ;. j4M� 5581 34 II II % 6`',SrlJrnvw Ss'8° 3811l II 1:or Id wlipt. 5 -seri 389 PERCOLATION RATE 2 7 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN `' FT AND G ° FT • PERFORMED BY:c .ULsaiir 670 cp I ^�'f ✓ f'sr+¢o2 t% , CERTIFY TTyyTHI TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DDATE. DATE 5/ 9 72-008 (Rev. 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST Gee CAandJer Heq' it r LEGAL DESCRIPTION: TH0z 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 .nt114EaR9 ,+�qn eea+ oCO eeoeq pAv P a rb vstance oc.00 00(1001100 ISO a ®{e ,4 ; Sander Manyoky e1.11 ov CE 8467 ; c€41 DATE PERFORMED: Lot /o/ (1(5 9011 Township, Range, Section: cot. %zeet ,lG s,/f 5M y;Hy Go lid Wi 41,1 (rye C7 S/39gf/ Cfitir L l\otsv. Isle COMMENTS ?(-)f s.o4 SLOPE U 0 ctNrs, GROUND WATER COUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN N ttle i0 Sed cirgt9. Axe -1 Vodu N fc\ P 10 2 A ID - 8 We 4- � 02 E Depth to Water After /3 .6/31/q9Monitoring? Dal ' J ern 3 Reading Date Gross Time Ne Time Depth to Water Net Drop -----/-171/ 1110 p -(9- 6`/ h h': 20 ldm to 5c" 1zn 11 11 3� u F N S q 3e '1 n 140 'I 5-58 3,f 11 t( et PO it 5 -5 -Sq ?#11 PERCOLATION RATE 27 T1 RUN BETWEEN a FT AND 4 FT (minutes/inch) PERC HOLE DIAMETER PERFORMED BY' _KoLr 1-lc'/hyo icy I V"" / (,N"T�II ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES//IN EFFECT ON THIS DATE. DATE' 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN HAAS & ASSOCIATES, INC. CIVIL ENGINEERING CONSULTANTS • MATERIALS TESTING • ENVIRONMENTAL SERVICES SYSTEM DESIGN SPECIFICATIONS LOT 101 USS 3042 ON-SITE SEWER SYSTEM DESIGN 1. This design is for a three-bedroom single family residence using a cep trench with qipti feet of gravel gravity 11rstr$?ution. yw4'- 0 2. Deep trent with ttel. feet of gravel, 3. Soils loading rate is 0.6 gallons/SF/day, 3 bedrooms X 150 gpd/0.6gpd/SF = 750 SF absorption area required, 750 SF/MOP/LF – , a C5P X 0.5. —r 5 F tfreAt 2$e 4. All materials, construction methods and required inspections to follow MOA rules and State of Alaska D.E.C. regulations. The contractor is responsible for obtaining all required permits. The contractor is responsible for notifying the engineer and the MOA at least twenty-four hours in advance of all inspections needed. 5. Contractor will insure no additions or changes have been made to the well and septic systems on the adjacent lots prior to the time of construction of this system. If any changes to those systems have occurred, the engineer should be immediately notified for review and possible clranges as necessary. 6. The overburden will be removed to the underlying silty sand (SM) and silty gravel (GM) material under any portion of the trench area. 7. The lot slopes down to the north and west: The installation of the trench will have little or no effect on the surface drainage, ground water, or the adjacent systems in the area. 8. The septic system should be properly maintained including septic tank inspection and pumping on an annual basis. 9. We recommend that no garbage disposal be installed and low phosphate biodegradable detergents be used. 3900 E 112TH AVENUE • ANCHORAGE, ALASKA 99516 • TEL/FAX (907) 349-8791 Parcel I.D. 075-093-46 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Expiration Date: 1. GENERAL INFORMATION Complete legal description U.S. Survey 3042, Lot 101 Location (site address) 184 Agostino Mine Road Girdwood, AK 99587 Current Property owner(s) Michael & Suzanne Farley Day phone 227-7729 Mailing address P.O. Box 1213 Girdwood, AK 99587 Real Estate Agent Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex U Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four 4. TYPE OF WATER SUPPLY: Individual Well n Individual Water Storage ❑ Community Class C Well Public Water System [1 TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer I-1 WaiverNariance request for: Distance: Received by: C COSA to be released to the engineer, unless otherwise requested by the engineer. Date: sD— 6D —I3 COSA Fee $ -\' o Waiver Fee $ Date of Payment 11io 1\ 3 Date of Payment cc Receipt Number o 0 (oR 0 Receipt Number COSA # Ci5C \ 31`130 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 Address P.O. Box 240773 Anchorage, AK 99524 Engineers Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for By: Phone 522-7773 Date 8/15/2013 4swe: OF A/94 ® P 5 ® A. .,�®® 49TH ��, 1::57“® 4 a° 00 mMICHA 1_, Mu iYl'llDERSON cs 0 f e CE - 4381 ,' g``/® ®4 flt9 eso.B-Is--I•.r .°cc. ®®�®PROFESSIO' " 4 bedrooms, with the following stipulatiA4N" /\`PV�� OF Cti�,,�i WATER AND 7,:.-:oWASTEWAT l� PROGRAM /U. Original Certificate Date: / 0 1 ' /3 The 'Niunitpality 6Y 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 Septic System Advisory Well Flow Advisory COSA blue sheet ! '.i o Nitrate Advisory Arsenic Advisory Other 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: U.S. Survey 3042, Lot 101 Parcel ID: 075-093-46 A. WELL DATA Well type Public If A, B, or C provide PWSID # C Well Log (Y/N) Date completed Sanitary seal (Y/N)_ Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate N/D mg/L Arsenic N/D ug/L Date of sample: 8/5/13 Collected by: Anderson Eng. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 7/30/99 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N Pumper McDonald's Pumping Service Date of pumping 7/9/13 C. ABSORPTION FIELD DATA Date installed 7/31/99 Soil rating (g.p.d./ft2 orft2/bdrm) .6 GPD/SF System type Deep Trench Length 85.6 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 10 ft. Eff. absorption area l'D27 ft2 Monitoring tube Y Depression over field 2 Date of adequacy test 8/5/13 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 37 in. Water added 600 gal. New depth 38 in. Elapsed Time: 1,440 min. Final fluid depth 37 in. Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at in. Datum Cycles tested Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. E. SEPARATION DISTANCES WELL ON LOT TO: Class C Public Water System Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer/septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: >5' >5' Building foundation Property line Absorption field >5 100' Water main N/A Water service line > 0 Surface water > Wells on adjacent lots >100 ABSORPTION FIELD ON LOT TO: Property line >10 Building foundation >10 Water main N/A 10' Water Service line >25 Surface water > 1 �� Driveway, parking/vehicle storage > Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS **See Lot Line Waiver. G. ENGINEER'S CERTIFICATION I certify that f 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 8/15/2013 COSA brown sheet 10-10-12.doc 1.10/SWIPal, 10. ,..„a ,. _v •gym 00 t MICHAEL E. ANDON : e �'. CE -4381 • Z's UI/NL 0,1 J: 49 rN `' �r •• �OP� \ A Mark E. Davis : LS -7338 ....... . d� F 0 rO/e s sio n of .Z 1eAaa„en A, r T LOT 102C ORDERED BY: MICHAEL & SUZANNE FARLEY EXCLUSION NOTES: It is the owners' responsibility to determine LEGEND: SET ENE the existence of any easements, covenants, or restrictions 5/8"RB W/CAPE® 5/8" RB 0 which do not oppeor on the recorded subdivision plat. NOTE: It 3.25" AL.MON. MONUMENT 1) is the cont actor's responsibility to check top of foundation HUB & TASK p grade and building setbacks in relation to lotlines and esm'ts. SLANA SURVEYS INC. SURVEY CERTIFICATION: SLANA has conducted a physical survey of this property as shown on this drawing and to the best of our knowledge and abilities, oil dimensions hove been measured true and correct. LAND, CONSTRUCTION & MINERAL SURVEYORS 440 W. BENSON BLVD. ANCHORAGE, ALASKA 99503 (907) 562-6103 WORK ORDER NUMBER: S99-26 DATE: OCT. 27, 2000 SCALE: (fax) 561-6626 DRAWN BY: DMD. CHECKED DY t. GRID NUMBER: 4912 Boos/PACE: 250/28 A S S LJ I LT OF: LEGAL DESCRIPTION: LOT 101 U.S. SU FENCE- x— X — OVERHANG - 8000 DECKS CONCRETE- " ASPHALT - SEPTIC STANDPIPES- Q WATER WELL- ELEV.(NO DATUM)- I 100.0 VEY 3042 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 075-093-46 HAA# /0907;'C'..5157 Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 1 01 , u. S. survey 3042 Location (site address or directions) Agostino Mine Road, Girdwood, Current Property owner(s) Michael & Suzanne Farley _/ Mailing address / G {i r ( Y?f L Ctc�� Lending agency Mailing address Alaska Day phone 783-1 998 ) 997 - Day phone Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: Four (4) 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ❑ Individual Holding Tank [;3 Community On-site ❑ Public Sewer The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates c - Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independer professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval arE required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipalin of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 inev. 01.001' 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 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 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. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P. E. Date 10/30/00 6. DHHS SIGNATURE Approved for 1-f- bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations` Additional Comments Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: `.�r/ GC) Original Certificate Date: / 0 - 3 /-c o Expiration Date: I - 3 I -c ( Reissue Date: 55 025 Rev 01 °el' Legal Description: Lot Municipality of Anchorage Department of Health and Human ServiRsE C Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 OCT EIVE 3 1 2000 MUNICIPALITY OF ANCHORAGE ENVIHEALTH AUTHORITY APPROVAL CHECKLISTMENTALSERVICESDIVISION 101, U.S. Survey 3042 A. WELL DATA Well type class C If A, B, or C provide PWSID # Date completed Sanitary seal Total depth ft Cased to ft FROM WELL LOG Date of test Static water level ft Well production g.p.m WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml Nitrate Date of sample: 1 0/27/00 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 7/30/99 Tank size 1 , 250 gal Parcel I.D.: 075-093-46 Well Log Wires properly protected Casing height (above ground) in. AT INSPECTION ft g.p.m 5 mg/I Other bacteria 4 colonies/100 ml Collected by: MEA Cleanouts Y Foundation cleanout Y Date of pumping New Construction C. ABSORPTION FIELD DATA Date installed 7/31 /99 Soil rating (g.p.d./ft2 or ft2/bdrm) • 6 System type Deep Trench Number of Compartments 2 Depression over tank N High water alarm N Pumper Length 85.6 ft Width 3 ft Gravel below pipe 6 ft Total depth 1 0 ft Effective absorption area 1 , 02fVV Monitoring tube Date of adequacy test New Const. Results (Pass/Fail) Fluid depth in absorption field before test in Elapsed Time: min Final fluid depth Any rejuvenation treatment (past 12 mo.) (Y/N & type) 72-026 (Rev. 01/00)* y Depression over field For bedrooms N Water added gal. New depth in. in Absorption rate >= No If yes, give date g.p.d. N/A D. LIFT STATION - N/A Date installed Size in gallons "Pump on" level at in "Pump off" level at in Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access High water alarm level at in Meets alarm & circuit requirements Class C Well on Neighboring Lot Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation > 5Property line > 5' Absorption field > 5' Water main N/A Water service line >10 ' Surface water >100 ' Drainage >100' Wells on adjacent lots >150' 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 Noted Wells on adjacent lots >150 ' F. COMMENTS Septic System was Only Recently Placed in Service. 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 HAA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 10/30/00 HAA Fee $ 5co , ©D Date of Payment /D Receipt Number 72-026 (Rev. 01/00)' D 6 go tl Le/y6,5) 1j1 Waiver Fee $ Date of Payment Receipt Number 10-30-00 13:28 FROM -CTE ENVIRONMENTAL CT&E Kett/ Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID CT&E Environmental Services Inc. a.AIP®m®.AR.Wamrosrmsr®®vd 1006734001 Anderson Engineering LI01 Girdwood L101 Girdwood Drinking Water 0 5615301 1-082 P.01/02 F-256 Client POO Printed Date/Time Collected Date/Time Received Date/Time Technical Director Released By 10/30/2000 13:12 10/27/2000 13:00 10/27/2000 13:50 Stephen �l� Sample Remarks: Parameter Results POL units Method Allowable Prep Analysis Limits- Dote Date !nit Waters Department Nitrate -N Miorobiolgw Laboratory Total Coliform 0.500 U 4 OB NO COLI Received Time Oct•30. 1:32PM 0.50 mg/L EI'A 300.0 col/100mL SM18 9222B 10 max 10/27/00 SCL 10/27/00 MT 10-30-00 13:29 letka. CT&E Environmental S rvices Inc. Laboratory Division risarn ®star areared®®wossrarrroriiirrassesr. FROM -CTE ENVIRONMENTAL 5615301 T-082 P.02/02 F-256 Drinking Water Analysis Report for To 200 W. Potter Drive al Coliform Bacteria Anchorage, AK 99518.1605 READ INSTRUCTIONS ON REVERSE SIDE REFO ' COLLECTING SAMPLE Tel: (907)562-2343 Fax: (907 561-5301 TO BE COMPLETED BY LABORATORY is shows this Water SAMPLE to be: MUST BE COMPLETED BY WATER SUPP ❑ PUBLIC WATER SYSTEM I,D. ti ❑ PRIVATE WATER SYSTEM ❑ Send Results 0 Send invoice out in nine hging ss,� �I ii- tp Winer Syflcm NameCompmy Name _ Cmi act nave Plume Number ra Number Mailing Address. Qty Sin,e Zip Code ❑ Send Results 0 - Send Invoice -.A-�9CRSoa �'a.1Gtl.1ans_Grs( Company ,mie Pte Rom r y in out in nine hging ss,� �I ii- tp Ag–q77 — c City Siam Z,p Ccgc SAMPLE DATE: 1, G Month Day SAMPLE TYPE: )(44. Routine ❑ Repeat Sample (for routine sample with lab ref. no. ❑ Special Purpose 0 Year Satisfactory q Unsatisfactory O Sample over 30 hours old, results may be unreliable ❑ Sample too long in transit; sample should not be over3Otours old at examination to indicate reliable results. Please send new sample via special deliverymail. / 19 29 -/lam Date Received Time Received Analysis Began Analytical Method: Li/ Membrane Filter ❑ MMO-MUG Number of colonies/l 00 ml. 1006234 ❑ Treated ❑ Untreated Water Time SAMPLE LOCATION Collected 'girt /fli tarittiwunfl >'Nn Collected • By o'Y1 CA". Mose Print Result* Analyst 1 titig Nota(, ari Anch Fhks Jun Date: Time: Client notified of unsatisfactory results: ❑ ❑' Phoned Spoke with Faxed D ate: Time: Comments: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Coliform E. Coli Membrane Filter: Direct Count (� Colonies/100 ml Verification: LTB BGB COLIFIRM Fecal Coliform Confirmation /` Final Membrane 'r'er ' ,1,. l 5 Coliform/100 mi Reported By/ Time ) 63 4tA SFr ate 1,ain10� h rs INTO- Too NwneronxTo Coma OR = Other Bacterid *EGG Member of the SGS Group (Societe Generale de Surveillance) ENVIRONMENTAL FPR e C e 1 V e d T I (n e1, O C t• 3 0, IP 1; 3 2 P M, ILLIN IS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO. WEST VIRGINIA