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HomeMy WebLinkAboutHIGHLAND TERRACE #4 LT 6C-2AHighland Terrace #4 Lot 6C -2A #050-311-35 Ft. I A, s arra ENGINEERING f 17034 Eagle River Loop Road, 11 sl Inspections performed by:,,, Ica 995ii— "" s' t e 2 9 ROBERT G COWAN Development Services Department Approval CE -88011 Reviewed and approved by: Date: a Ai 1'`SStie Municipality of Anchorage ° Development Services Department �r...�rw.,,.,..•,.,.u.,,..ne,wY Building Safety Division Onsite Water and Wastewater Program, 4700 S. Bragaw SL Ft. P.O. Box 196650 Anchorage, AK 995194M Page , Of 3 Township: Range: section: www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. Sr120;013,�2 PID Number: oSo- 3/I'a9 Name:- /J ct V I !7 /Nvi Gravel wi�O 'F"' ✓\ Wastewater S New tem: Ys i9 ❑ Upgrade Address: ©d ABSORPTION FIELD Phone: a � � � Numaeroreedrwms: _5R �,/ Oero TmMt p Slubr Trento O Bed D Mgnd p Other. LEGAL DESCRIPTION Sag Finding: TOW Depthh in original grade: R+pe Matelot36O J f7' y1 ar.� / A' a GPNFF Ft. Ft. I A, s arra ENGINEERING f 17034 Eagle River Loop Road, 11 sl Inspections performed by:,,, Ica 995ii— "" s' t e 2 9 ROBERT G COWAN Development Services Department Approval CE -88011 Reviewed and approved by: Date: a Ai 1'`SStie lf` TryraLP� �r...�rw.,,.,..•,.,.u.,,..ne,wY tardvd depth eerwalh pipe: Ft. FI. Township: Range: section: FAY added abonsodpnal pale:'_jJ 7/��„ Cmel Length: 0 , V FI. Ft. Well: New ❑ Upgrade Gravel wi�O 'F"' ✓\ NumaeroflileS: Distancebelween lines: — 0 Fl. Ft. Classifiraaan (Pnv te,A B, Ci: 1 VA Total Depth: Fl. Ca Fl. Total absaplian area: 1 Jnj 1OO" Flt R+pe Matelot36O J f7' y1 ar.� / A' Oat Drilled fjll Sbfic Water Levtl: FL hnYa�/1 r//� `i�o (j�J `G Date lnstalleT. j_5'o� /6 Yield: Pump at Casing Height Above Gsoun& ;t FL TANK GPM p W /1F1. SEPARATION DISTANCES ,Septic EJ Holding ❑ST.E.P. ❑Other: TO Septic Absorption Lift Holding ublicrPdvale Man Capably.A From Tank Feld Station Tank Sewer Line G7 YA � SI Vcal well i 1 5t .,.�— `15�. O(LIFT Mamral: Nu olcorroanments: surface Water `C 100.low STATION neGal. fig ie:Marpt Foundation /9\'Pure `err on' lives at: vel aC High rater alarm at: in. Grain wRemarks: Punt, Me MIXleI ecinal ats)(i ahs Wrtamad q:Curran 5 er-r re ✓ICOYK ars Me BENCH MARK 1 l to Y"/✓14 eV�0LULiT/GrO rs I.Oraaan ark DeunPuan: /�� ,,i^� � 1 E0 -Ha �l �l �il�/✓l i' Ft. I A, s arra ENGINEERING f 17034 Eagle River Loop Road, 11 sl Inspections performed by:,,, Ica 995ii— "" s' t e 2 9 ROBERT G COWAN Development Services Department Approval CE -88011 Reviewed and approved by: Date: a Ai 1'`SStie PERMIT NO. SWO201 32 PAGE 2 OF 3 MunicipaUt of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.11. Box 196650 • Anchorage, Alaska 99519-6650 0 Te'I hone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAi LOT 6C-2, HIGHLAND TERRACE #4 P.I.D. NO. ki JR4 �E< \ aRIV TRACT 6C-1 LOT 6C-2 F F9f\9`p, CTH#2 \\\ \\s T2 OBLI a BBL2 O \ \\ \ VH#I ST o I \\ \\ MTI \ 9 \ \ c01 \ \ CUTBA � o EXCEEDS 359 pf -------------------- LOT 3B 050-311-29 \ II o I o- I I �Pcy S @F�Fh� F >2 c yFLF o,� o I QFC 1500 N IC ON TANK I I _ I --- -� SCALE: 1" = 60' A AA LOT 3C gf ROBERT C. COWAN `'o% a-8801 �1�sfF•, .,. t, 3L�„r -''r[0 ��.' PERMIT NO. SWO201 32 - PAGE 3 OF 3 Municipalit of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.11. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 6C-2, HIGHLAND TERRACE ##4 P.1.D. NO. 050-311-29 ST1 ST2 98.4' FINAL GRADE 91.2' NEW 1500 91.0' GALLON SEPTIC TANK C01=83.3' CO2=82.1' FINAL GRADE C01=78.4' SR CO2=78.3' MT1=71.3' MT2=71.3' N. T. S. R f.� . �............. s_1 NO WATER FOUND V. 65.3' B.O.H. �.~,... �. J A % ROBERT C. COWAN .� y �tC�' CE -8801 A B C FC01 18.0' — 14.5' $ 41 FCO2 21.0' — 18.0' ST 1 1 4.5' — 27.0' ST2 — 35.5' 36.5' DBL1 — 36.0 44.0' DBL2 — 36.5' 46.0' C01 47.5' — 53.0' MT1 45.5' — 51.0' CO2 — 87.5 103.5' MT2 — 86.0' 10 1.5' S& January 17, 200$ ROBERTC. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX(907)694-1211 HEALTHAUTHORITV APPROVALS MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 SEWER&WATER MAIN EXTENSIONS Anchora e g , AK 99519 REFERENCE: Tract 6 C-2; Highland Terrace #4 Subdivision SEWER&WATER A test hole was excavated and percolation test performed on the above lot. INSPECTION referenced The approximate location of the test hole is located on the attached inspection report. Though the trench extended outside the area of the test hole, the soils remained consistent throughout excavation of the leachfield. ENGINEERING STUDIES AND REPORTS We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the septic system. If you require additional information, please contact us. WELL INSPECTION & FLOW TEST Sincerely, SITE PLANS i Robert C. Cowan, P.EE.. RCC/ts/soi Isi6C2. doc ROADDESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ,., ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 t� MUNICIPALITY OF ANCHORAGE 2 Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date Issued: May 28, 2002 Expiration Date: May 28, 2003 Permit Number: SW020132 Parcel ID: 050-311-29 Legal Description: HIGHLAND TERRACE #4 LT 6C2 Design Engineer: 0003 S & S Engineering Site Address: Owner Name: David Allen Lot Size: 65340 SQ. FT. Owner Address: 11151 Calaska Cir Total Bedrooms: 6 Permit Bedrooms: 6 Anchorage , AK 99515-2900 This permit is for the construction of: Disposal Field [�j Septic Tank ❑ Holding Tank ❑ 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 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. C'A —t'o Received By: Issued By: /arms. d trend Date: J -/1-Y /0 Z 12: 0Z) I /O: 001 i Date: z 8 2 Municipality of Anchorage i ; Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel 1. D. 05a > / f — 2 9 Permit Number SWOZO/3 Property owner(s) 0W__V 0 c c �l Day phone ?>'4- 3Z7_4 Mailing address (1 Mailing address LOT Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Acre Lot Size rorT� s q THIS APPLICATION IS FOR: Zip Code Number of Bedrooms S (K Co Sewer Only ® Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. S & S ENGINEERING 17034 Eagle River Loop Road, No. 204 (Signature of property owner or authorized agent) Permit Fees: sSO. D Waiver Fees: Date of Payment: ' ` ry+" Z � � Date of Payment: Receipt Number: t 00 O ; ' Receipt Number: (Rev. 12100) S& HEALTHAUTHORITY APPROVALS SEWER & WATER MAINEXTENSIONS SEWER & WATER INSPECTION ENGINEERINGSTUUIES AND REPORTS WELLINSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER. DISPOSALSYSTEM DESIGN ROBERT C. COWAN. P.E. CIVIL ENGINEERS (907)694-2979 FAX (907) 694-1211 May 1, 2002 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 6C-2, Highland Terrace S/D 44 It is requested that you issue a permit to install a septic system and well to serve the proposed six bedroom dwelling on the referenced property. Two test holes were excavated and percolation tests were performed. The approximate locations of the test holes are located on the attached site plan. At the time of excavation on 7/7/01 & 4/25/02 water was not found. After seven days of ground water monitoring, the test holes were found to be dry. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/jhm Enclosure 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER. ALASKA 99577 SITE PLAN REDESIGN D Q n �m00 �za OC.o3 m OHO yO / Z^� C -tZ Kin o D mz0 m / xr� vziy<in 9�C Hzm �z� 00[� W a /Doy d m � � o z / I � Z _0 z� ,m o crl / I" _ 7nau ,z:�x Nipym/">/o � / co m -7m —] (Dmm d ti..3 +,00I NIH11M S113M ON C'� IN /- O 0 O p 00 m b C 7 Zj f]dH-^ 9U1 V1 I� oinoH zx-3 x vziy<in 9�C Hzm �z� H b IT+ '011 ,� C Fri m CO cD L'7 0 � d 72.7 II ro o wry UmT�CMD y \ b O� o x t7 uz 0 �� m H 4 C� HW •C�[] cn ago a m�rtz) -gm,< .. ti..3 +,00I NIH11M S113M ON C'� IN m b f]dH-^ 9U1 V1 I� f]dH-^ 9U1 V1 oinoH zx-3 a vziy<in 9�C Hzm �z� ODmm -3 wry UmT�CMD 'T��z'npW, o > 0 �� m H 4 N HW •C�[] m�rtz) -gm,< .<m '.I 9 z 7::c"JEjzax dmz an �Mo 0 p 7 a 9po P oxo o�n z� OH z z� zw 30' .vi�Dm >ex �D noti z m / / o o o m ? / \ t\ N co '-� CO WW d �� iVCY, 00 � z cn m n x oo II / C�7 C, CD / - TI o C c �o d �o Corn z ��� / _ y Ate/ �,� ^n} >57 �. oiv T C'� 0 O a ON i N I Hll �y�a/ \� �� d c��1 M = mot � �CIO // _ (� ?��roC� m N� Tl r�J . fTl o •-� C tail 7/ 2Q<�� 0 ohm KMS 00 v� C� d ��-3d bz C7 �� s" `Jd o — K �a D o y F O �AD0r>z0 U] d C --I zOJ ➢XyxWmz v y d / Oma 9� ?cCD TI O z �9y o O U)a v a N O D ooQ zz y O Cf)o 7 � z� zv Il -u 0 o .�- O t� n � � tis°,v• ��,p,�? > r -Au Q >. z ri: n ~P� < D ,4d SITE PLAN DETAIL L mmC =r x�?Z f z o CtiZ KKu + / M> x�A zo nam / 30' .vi�Dm >ex �D noti z m / / o o o m ? / \ t\ N co '-� CO WW d �� iVCY, 00 � z cn m n x oo II / C�7 C, CD / - TI o C c �o d �o Corn z ��� / _ y Ate/ �,� ^n} >57 �. oiv T C'� 0 O a ON i N I Hll �y�a/ \� �� d c��1 M = mot � �CIO // _ (� ?��roC� m N� Tl r�J . fTl o •-� C tail 7/ 2Q<�� 0 ohm KMS 00 v� C� d ��-3d bz C7 �� s" `Jd o — K �a D o y F O �AD0r>z0 U] d C --I zOJ ➢XyxWmz v y d / Oma 9� ?cCD TI O z �9y o O U)a v a N O D ooQ zz y O Cf)o 7 � z� zv Il -u 0 o .�- O t� n � � tis°,v• ��,p,�? > r -Au Q >. z ri: n ~P� < D ,4d SITE PLAN DETAIL 1" = 20' SCALE nw �ipa nom RO o io� A m`V'y v fJ10 O 1> ^1• 0 > V 0 m--3 O z� > ^ \ 1 0 F- FFI Fq Z o fig, o FF' zm D �- 7 , 111111 'T 1=1 I I M -D > II II�I I = CJ) 0 1=1 1=11=1 m z FTI o =1 1=1 1=1 1=1 I c s m I-III-III=1' �Voz :0 X A ii RW ^ i� >�q �cv: 0O'. oNo 4��`l Z r.m z ,� tt ��`�, ,;•';tea Municipality of Anchorage Development Services Department Building Safety Division �. On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchoraoe.ak. us (907)343-7904 Solis Log - Percolation Test L Performed For: -7f/ -V I D .�'/L(�—/y Date Performed: Legal Description: G'• g' H1614~ownship, Range, Section: 1QSTH0Lo- UI Depth -eet)I i' 6- 7- 8- 9- 10- It- 12- 13- 14- I- - 7- 8 -9-10- 11- 12- 13- 14--I— ?�vO COMMENTS WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? L Depth to Water After y 9 V� / Monitoring? E Date: y ROBERT C. COWAN oz '% CE -8801 lt�l��..• it ane Reading Date Gross Time Net Time Depth to Water Net Drop D 1 1 PERCOLATION RATE '�P. 5 (minuieunch) PERC HOLE DIAMETER �y TEST RUN BETWEEN _SFT AND FT 5 & S ENGINEERING ��D.� J PERFORMED BY: U034 E.gin Rivoe r wwn Rmd Nn 9� '�•'�•/ CJ CERTIFY THAT THIS TEST AS PERFORMED IN ACJQJQ*j;€rWAia"� AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ?.1 /B Municipality of Anchorage Development Services Department Building Safety Division y� On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www. cLanchoraae. ak.us (907) 343-7904 Soils Log - Percolation Test Performed For: % /0 tC'j Date Park Legal Description: ��,i1; G'� Gj l�'/iisl-("1.�1'!\%� Township, Range, Section: Slope 1'f-sT NO c.C- # Z F—T T_T7 F__F_T— Depth 2- 3- 4- 5- 0/ -3-45- ©/ 7- B- e 10- 11- � 12- . 0 13- 14-- 15- 16- 17- 18- 19- COMMENTS 3-14-- 15- 16- 17- 18- 19- COMMENTS z WAS GROUND WATER ENCOUNTERED? Date Gross Time S IF YES, AT WHAT DEPTH? e D Depth to Water After n �T Monitoring?,yr E 3 Date: V A�7 S /o/n2 ;n g kOB/EE��R��T C. (COIWAN Reading Date Gross Time Net Time Depth to Water Net Drop 4._sofr,e 4 2s a © -- aJ c7 3o D O So 30 Il'' S" O O 3o, 3o 1l'' $" PERCOLATION RATE (minules/nch) PERC HOLE DIAMETER (p TEST RUN BETWEEN FT AND FT PERFORMED BY: % 1jG F -L L CLf�•+? l ��%/ilZ,,..� CERTIFY THAT THIS TEST/WAS, PERFORMED IN ACCORDANCE WITH ALL.STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: e� 70 1 0'L MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WATER SUPPLY PERMIT Initial Permit Number: SWO10425 Legal Description: TSF f > #4 LT,;;&Q2i Design Engineer: 0000 None Required Owner Name: David Allen 244-4C113 Owner Address: 11151 Calaska Cir Anchorage , AK 99515-2900 Date Issued: Oct 09, 2001 Expiration Date: Oct 09, 2002 Parcel ID: 050-311-29 Site Address: Lot Size: 65340 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑✓ Private Well ❑ Water Storage 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 DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 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. - WHEN THE WELL HAS BEEN COMPLETED AND SATISFACTORY WATER PRODUCTION HAS BEEN DETERMINED,• THE WELL DRILLER SHALL PLACE AN APPROVED SANITARY SEAL ON THE WELL HEAD AND NO PITLESS ADAPTER OR PUMP SHALL BE INSTALLED UNTIL AN APPROVED WASTEWATER DISPOSAL SYSTEM HAS BEEN CONSTRUCTED. Received By: Issued By: Date: P�/0_0( Date: /to —7-0/ Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907)343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. OSD.3lt — Z9 Property owner(s) J Mailing address (1) 1�d Mailing address (2) Legal description (Lot, Block & Sub'd.) Permit Number SWO/092,5 Day phonAL `C 4113 Zip Code vt� Legal description (Section, Township & Range) Lot Size Acres F . Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool s ` ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Sinqle Family Dwellinq anora in accordance with applicable Municipal Codes. (Signature of propert�/owner or authorized agent) Permit Fees:. 00 Waiver Fees: Date of Payment: Date of Payment: Receipt Number: S__7.� Receipt Number: (Rev. 12100) OR U a LC EO Id 'Itl101 m x �y z0.o $was C'4 Na C'4 'A z a..xww wzm.`t E.,xz c4�aoo.a z ujw a �E- &Ozo yVjMe ZC4 l�v�iay`z� �'"a3awew63 xam wtw`''F 7�OG rn>Fai N VZ1Q ,ppV Z0/Z0'd TTZT 469 2,06 / s 'Ilvb3Q 5NILMNION3 SIM I I I I I I I i I A W WWO� U x NDN F W / G. c a z rA mom W x s n' Mm (1E. aw / [� o ri U r co > 11 00 Z a1 �E; r4Uwtry r-)WwimZ � z C , Z0/Z0'd TTZT 469 2,06 / s 'Ilvb3Q 5NILMNION3 SIM I I I I I I I i I NVrld 311S 22:60 T00Z-9Z-d3S WWO� QF ¢vf� NDN W / / V043 NVrld 311S 22:60 T00Z-9Z-d3S Municipality of Anchorage U G, • Development Services Department Building Safety Division x. _ On -Site Water and 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. 050-311-35 COSA # 0S e I I10t0 Expiration Date: 3 — 3 0 1. GENERAL INFORMATION Complete legal description Highland Terrace #4, Lot 6C -2A Location Current Prope�owner(s) Allen, David Day phone 351-9180 Mailing address same Lending agency Day phone Mailing address Real Estate Agent Anne Roberts Day phone 689-6464 Mailing Address Prudential Vista, Eagle River . Unless othenvisg requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3 TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a.public water system. The Municipality of Anchorage is not responsible for errors or omissions in 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 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724. Eaele River Engineer's Printed Name Steve Eng Date 12/23/2011 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 se,,$)ems are subject to these various and dynamic characteristics and are outside the control of the D y`_ evaluator of the well and septic system.; q,.=z= aep;pyy 5. DSD SIGNATURE ' Qxz3 'f( V Approved for _ bedrooms. P" 6255 Disapproved. l ?z r - Conditional approval for bedrooms, with the following stipulations COSA Checklist X Arsenic Advisory 10)) )P) I Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: / Original Certificate Date: (R.. 11/05) Municipality of Anchorage • Development Services Department e 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: Highland Terrace #4, Lot 6C -2A Parcel ID: 050-311-35 A. WELL DATA — Public Water Well type P If A, B. or C provide PWSID # _ Well Log (Y/N) Y Date completed 10110/2001 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth 360 ft. Cased to 20.5* ft. FROM WELL LOG Date of test 10/10/2001 Static water level 175 ft. Well production 7 g.p.m. WATER SAMPLE RESULTS: Coliform Pass colonies/100mL Nitrate ND mg/L Casing height (above ground) 24 in. AT INSPECTION 12/23/11 235.2 ft. Arsenic: 1.0 . ug/I Date of sample: 12/19/11 Collected by: nr B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 615M2 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 10/11/11 Pumper IRs C. ABSORPTION FIELD DATA Date installed 615102 Soil rating (g.p.d./f:2 or ftz/bdrm) 0_8 System type Trench Length 72 ft. Width 2.5 ft. Gravel below pipe 7 ft. Total depth 14 ft. Eff. absorption area 1008 ft2 Monitoring tube Y Depression over field N Date of adequacy test 12/23/11 Results (Pass/Fail) Pass For 5 bedrooms Fluid depth in absorption field before test 30 in. Water added 750 gal. New depth 36 in. Elapsed Time: 60 min. Final fluid depth 30 in. Absorption rate > 750 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) unknown 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 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main NA Sewer /septic service line 25'+ Animal containment areas 50'+ Manhole/Access (Y/N) High water alarm level at -=in. Meets alarm & circuit requirements? - On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout NA Holding tank na Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 9'+ Property line 10'+ Absorption field 51+ Water main na Water service line 101+ Surface water 1001+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main na Water Service line 101+ Surface water. 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain n/a Wells on adjacent lots 100'+ F. COMMENTS *Well driven into bedrock. G. ENGINEER'S CERTIFICATION �,Q; **�� °°'•�0 1 � t .. i certify that 1 have determined through field inspections and 049yH " €e..: . review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 59eren W. Em: Engineer's Printed Name Steve Eng � �,aP pE 5 K Date 12/23/2011 r, COSA Fee $490.00 Date of Payment Receipt Number 0 L/5 976 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Q Municipality of Anchorage (•� Development Services Department \\ Building Safety Division On -Site Water and Wastewater Prooram 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CErt T 1FICATE OF HEALTH AUTHOni i r Arr-r:cuvhL I -OK A SINGLE—FAMILY DWELLING Parcel I.D. IDSO 311-zq HAA# } d Q Co 7 Expiration Date: o 4 1. GENERAL INFORMATION' Complete( legal description LC3%-C�a/GLi?Rl���'E Location (site address or directions), - S Current Property owner(s). °%�i9s ,4LLF�I Day phone �9 2�jtQ Mailing address 12.2 Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, NAA will be held by DSD for pickup. i2 Day phone Day phone 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: ' TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 19 Individual Water Storage ❑ Individual Holding tank [j Community Class Well ❑ Community On-site Public Water System ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 -)f 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 ornissions 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 Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functicnal 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 .jkl=Q�'T/i2/!Yi iS%G{q/lGu - Ply Address 73%� Engineer's Printed Name iF✓/���i__ Date, 3 a 6� OF .ASE 7- %P tt ✓/ q )� i• y��e Steven 5. DSD SIGNATURE ��s,�� PE 4256 �;. •��?ii V Approved for _S bedrooms. tl�� OFES Disapproved. ,Conditional approval for bedrooms, with the tollovring'stipulations' Additional Comments Attachments: HAA Checklist. X Septic System -Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date:_. 3"_L� —Q� (Re,.011m) Municipality of Anchorage f_ ' Development Services Department = Building Safety Division On -Site Water & Wastewater Program ° 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL %HECKLIST Legal Description:�f/tl-- Parcel ID: A. WELL DATA Well type T If A, B, or C provide PWSID # _ Well Log (Y/N) i Date completed /0//5 Sanitary seal (Y/N) Wires properly protected (YIN) Total depth 3�6 ft. Cased to <ZQ ft. isec C- ' Casing height (above ground) �in. FROM WELL LOG Date of test /O/(p/U / Static water level / 75 ft. Well production 7 i_ g.p.m. WATER SAMPLE RESULTS: AT INSPECTION 7 g.p.m. Coliform 6 colonies/100 ml. Nitrate 0, / mg./I. Other bacteria �_ colonies/100 ml. Arsenic: — mg./l. Date of sample:2/W/4� Collected by: !(11�1 B. SEPTICIHOLDING TANK DATA / / Tank Type/Material /#4jC *0(2RC'E TFIA(k IS E(�L Date installed �. 5- Tank size 5aa gal. Number of Compartments 2 Cleanouts (Y/N) yES Foundation cleanout (YIN) 4— Depression over tank (Y/N) it/ High water alarm (Y/N)_ Date of pumping S f911Pumper C. ABSORPTION FIELD DATA A(r,o S y1.r6A^_?'G Date installed < .S 6Z Soil rating (g.p.d./ft2 or ft2/bdrm) �- j Length 72! ft. Width 2.5 ft. System type %/zi9(✓Ch, Gravel below pipe 7 ft. Total depth/ a ft.+ Eff. absorption area/40J1ft2 Monitoring tube ___�L Depression over field A� Date of adequacy test IResults (Pass/Fail) r For S bedrooms Fluid depth in absorption field before test in. Water added= gal. New depth= in. Elapsed Time: – min. Final fluid depth – in. Absorption rate >= — g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date G(-6- AN F/QF 4�ff� T�Sr /1FQ�r✓zr� f 't510 b get.( R 6 r(f (3/17d 5e) D. LIFT STATION Date installed _ Size in gallons _ Manhole/Access (Y/N) "Pump on" level atin. "Pump off' level at _ in. High water alarm level at/?._____ in. Datum Cycles tested Meets alarm &circuit req ' ements E. SEPARAI ION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: i Septic tank/lift station on lot O r Absorption field on lot /-�11 © _ Public sewer main / Sewer /septic service line SG rf r� i:7n adjacent lots _ 1-,12 G On adjacent lots _---LO 0 fi Public sewer manhole/cleanout — A"14 Holding tank i11L4 — SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 1 f Property line 1<6r Absorption field 2� t r r Water main )V/1q Water service line rG Surface water Wells on adjacent lots X00 /Y - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: wry f Water main Property line 2 Building foundation 73 _ r Water Service line Z O +_ Surface water _� Q 6 rt Driveway, parking/vehicle storage Curtain drain AN f Wells on adjacent lots 1 2 -0 -Ll - F. G r F. COMMENTS r6F,7J /2 e-6cxe?� a/l/04 i Fcw-C,A) 0, l/14rd )err# Cd�!`Par 09 I -(C) A6�9✓ �®`.®®�®. G. ENGINEER'S CERTIFICATION qti .......4 1, ®<P; '°•. /t j CD .• 1 certify that t have determined through field inspections and Air ®* . ea jTs+ ...'• ...""io `"°"'°" review of Municipal records that the above systems are in .. conformance with MOA NAA guidelines in effect on this date. e Engineer's Printed Name �TCt/�t�G ®R z Steven v�%"" • �d ®® sl:°• PE 6256 Date 3/ 4111®0'0AiQ-4b _ e HAA Fee $3 d ( Waiver Fee $ Date of Payment 3 ' .2 -.__ Date of Payment Receipt Number Receipt Number (Rev. 12101) S cn � ' ✓ m m J' m P\-' OtiV`�a0� ly Mm N y/ !y r- 1 O r� ��tio 6� 131.T f q> I I o 0 Co I I ' !I OA -rr-------+� ---------------------------------- 03 I I � II 33' SECTION LINE RESERVATION FOR ROAD AND UTILITY PURPOSES 30 I I N 00008'00°W 238.39' m A S r = rn Q@ n Q oo v -O z 0 �.nQm �3@5EL n. 7,. oll� a Z ~@ Z� Qz n @ o 0 m m N Q@ G gip' D V♦ �@ a m o=�� m t— cp !Q Q N n ro a — N c D chi ui @ m