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HomeMy WebLinkAboutMCCABE EAST LT 5McCabe East Lot 5 #017-341-14 Municipality of Anchorage Development Services Department (4 " Building Safety Division - On -Site Water and Wastewater Program, 4700 S. Bragaw Sl. P.O. Boz 196650 Anchorage, AK 99519-6650 Page' Df3 vyci.anchorage.sk.us (907) 343-7904 Ww. ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: %0 -7 PID Number: _ _ 01 % -1341 Name. DAA Wastewater System: dgNew ❑Upgrade fI j, AOdr«a 5030 L kWOC,44ABSORPTION • FIELD Qin r:,4A'i .4111 Pnane. 8 _ / Nwild, or Beds o 4 Ikoeap TrenN O Shaeow Tench D BM O mmm D opw. . LEGAL DESCRIPTION Sca Rae"°It D Tola'Dpmhomongmalgrada: GPD/Ft* t. Black: Lets su""Ob"i: ` D•Pm to pope bottom holy,Original a'aa•' C✓avN depth berm' ppe: FI. fl Township: RwVe sato m FA'eche above ppnY grade: <` / I or"LWVth: Fl. FI. Well: ❑ New ❑ Upgrade Grata wmn: NVmWr Ilewe Dlaunp Den»enlme Ft Fl Claahe eon (Pnvate. A. S. C): TOW Dopm' Cased to / /F{ Total abso palm was ate' ml a larw 45 r d t• of T FP 7,47 8! Dr t (j�J , , Dau Dialed. n Soho Water LevM. hataa-la" Data olmmiw Ft CQ 044 o"Ple) Ymd. 3 Pump ut. Cawng 9exght Above : ANK GPM y1 q . FL FL SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption rP Lift Holding 9 ubbUPrivate hu+awer. Plodle aoaoty I From Tank Field Station Tank 6ewerllne / M �/l�Gr Well 1p3( ^Q, ^ r 1 Malanr. D r NumberN tompanmanu. Swrapa Willa, I + I I + LIFT STATION Lot U" �, �, n. rx, sower. Gr Found~ �S, 59 , 'Pwry W. IevN at Wgh water Maim at N. Pump take a Elednca' hapeceona pedt d by.. Cwaln Drrn 0� n0 v� R~a: BENCH MARK Locabon and DeamPban, s r 0 5 / �/{'' yr ea leouon. 1©O FL 1 1 ' ' Enginea(�a,�$(amp M 7 S r" S ENGINtci.ln 17tH: PERMIT No. SW970287 PAGE 2 OF 3 MunicipaUt of Anchorage DEPARTMENT OF HEATH 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 LEGAL LOT 5, McCABE EAST S/D P.I.D. N0. 018-341-14 Id LOT 1 I c I � 02 5' ,. 12..x`--- E'SCMfN�� F+� I TEN W I w v I LL 0 NO z I NEW 1300 GALLON PC L HDPE SEPTIC TANK .< Z I Co 12' MIN. MTI QQ •sTj1 LOT 4 i u l GI I F DELI d DELI r3 u i `I I i 100' WCLL 940105 Li " I CO2 W 1 I � 1 O A� SCALE. I' SO' o l R lJ ENGINEER STAMP /' � . ' • ben A. 61,4er /' �' • No. lIJ7t � 7o i PERMIT No. SW970287 PACE 3 OF 3 Municipalit of Anchorage DEPARTMENT OF HEATH 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 LEGAL LOT 5, McCABE EAST S/D P.I.D. No. 018-341-14 ST1 ST2 90.9' FINAL GRADE 7il 2" INSULATION NEW 86 1' GALLON!1300 OLYETHYLENE 86.4' SEPTIC TANK C01=90.2' CO2=88.5' FINAL GRADE C01=85.2' SR CO2=85.2' rlTl =79.2' N T. S. ENGINFF..RZTAMP A B FCO 37.5 13.5 NO WATER FOUND '° .-•�• :�'J :' ST1 _2 61.0 51.0 72.2' B.O.11. 0% t ST _BL 65.0 54.0 D1 67.5 56.5 «. .:.. ••.p DBL2 68.5 57.5 CO1 69.0 67.5 ' .�.•A rlhaNr MT1 69.5 67.0 aM;•''��•�;,�s~ c02 104.0 81.0 Mar 29 05 10t55a Daniel J Wi LOCATION OF WEL W 970 O7 907-258-1346 P.1 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF MINING 8 WATER MGMT WATER WELL RECORD aeeeuoa &USOMPION LOT BLOCK AACTWN OTM UcTgm To'" turas ypapyN ❑N ❑E I I Cad e �• ❑s ❑w LOCATIONISKETCH: WELL OWNER: �� $ -134 7`!101 DEPTHS MEASURED FROMIOcadng top ❑wound surface WELL DEPTH; DATE OF COaE►LETiON Depth of hole. it BOREHOLE DATA: Depth Depth of Material Type and Cola From To DEPTH TO ATIC WATER LEVEL - ft below wlY top ❑ grour surface pof�casino Data: _LIQ IIIc METHOD OF DRILLING: )6 sir rotary ❑ table tool G ❑ other 10, /t -7 USE OF WELL:M domesvic ❑ irrigation ❑ monitor L4Z ❑ oriwe supply ❑ D"t STICK • P: tt Diem:. min. tpk/t •1 (j� yCASING t 2 Casino type: __In . n �- WELL INTAKE OPENING TYPE: ❑ open end ❑ screened ie ❑perforated )1 open hole ..2G Depths of Worrings: to 1t 't SCREEN TYPE. Diam: IrL 6 Slot/Mesh Size: ' Length: It GRAVEL PACK TYPE: b Volume used: Depth Top: GROUT TYPE: Ivo :L Depth: from IT to it . 1� DEVELOPMENT METHOO• Cl— ' og -- _ Duratiom - • PUMPING LEVEL AND YIELD; It after hm oumpino am • PUMP INTAKE DEPTH: It Horsepower. r WELL DISIIVECTED UPON COMPLETION? 'S.LYES 13 No CONTRACTOR INFORMATION: REMARK - .EASE MAIL WHITE COPY OF LOO TO: DNRR)NISION OF MINING i WATER MGM 7501 C at. suite 800 ANCHORAGE AR 85503-5935 S& 1@ALTHAUTHOR ITY APPRONA S SEWER 6 WATER LWN EXTENSIONS SEWER 6 WATER INSPECTION ENGINEERING STUDIES ANDREPORTS WELL04PECTION A FLOW TEST SITEPLANS If -rd -i7Gn1 SOIL TEST PERCOLATION TEST STRL CRXIAL B KCRANMAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEIA DESIGN Eh August 28, 1998 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 5, McCabe East Subdivision ROBERT C. COWAN, P.E. ROBERTA. SHAFER PE. CIVIL ENGINEERS (907)694-2979 FAX(907)694.1211 RECEIVED AUG 31 1998 Municipality of Anchorage Dept. Health & Human Services This is to provide a status for permit # SNV970287 for the referenced property. The septic inspections for the septic system on the referenced property were performed on 8/24/98 and 8/25/98. Prior to submitting the On-site Wastewater Disposal System and/or Well Inspection Report we are waiting for the installation of the well and construction of resident foundation. If you require Enclosure Cowan, P.E. information, please contact us. 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 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:SW970287 DESIGN ENGINEER:S 6 S ENGINEERING OWNER NAME:BETHARD, FRANK OWNER ADDRESS:12801 REATA ANCHORAGE, ALASKA 99516 PARCEL ID:63'674T= LEGAL DESCRIPTION: 0 1-1 - 344 ' - rl y MCCABE EAST LOT 5 LOT SIZE: 53373 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: LA 0 n, PAGE 1 OF 1 DATE ISSUED: 8/29/97 EXPIRATION DATE: 8/29/98 E.n6 &'o w �ZJM6 ld LIYI ab's CC�-YI ' a h,J Lo nn 4hr, K) LNU ML, (fa ki to 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: RECEIVED BY: `. 4l __ DATE: ,'AqA % ISSUED BY: 3 a'L';�" - DATE: a --l9-'? 7 NEkTHAUTHORRV APPROVALS SEWER& WATER MAN EXTENSIONS SEWER & WATER INSPECTION ENDINEERING STUDIES ANDREPORTS WELLNSPECTION & NAW TEST SITE PIANS SO4LTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER CISPOSALSKTEM DESIGN S& ROBERT C. COWAN, P.E. CML ENGINEERS (907)694-2979 August 8, 1997 FAX(907)694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 5, McCabe Subdivision Request you issue a permit to drill a well and install a septic system to serve the proposed four bedroom house on the referenced property. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. The monitoring tube within the test hole has been checked and found to by dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. NYe do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system If you require additional information, please contact us. Sincerely, 11&(74L Robert C. Cowan, P.E. RCC/mg Enclosure 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER ALASKA 99577 I 0 Y V t o 0 o N ✓ice+e� K N p. N --a J ` f? u t! s VW, < 7 Q y Com+ O , r�Ow ''mx wz Css 1 l s 2 h.+ W Q W n2 U) W A 7 G •I tY r d J O Z CS O J r Cr W A / o N N ia N ` f? u MMMT UnQI'IJQI�IIVII 0 N 4 (L -"V) O O O O d O 000 O N llama M 11 N W F o N N 4{ ` f? u t! It Z inU ag FUVCL y Com+ UW4 Z MMMT UnQI'IJQI�IIVII 0 N 4 (L -"V) O O O O d O 000 O N llama M 11 N W F o N N 4{ u t! W FUU w ag FUVCL y Com+ UW4 ►_ ''mx wz Css OO $ g � Gzz7 �w3J $ il'i O . . N ! �► is H —cD M IW NJIS30 NVId-3115 .09 = j h e ' Municipality of Anchorage * 9t _ DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TESTn tO°e^ < COWAN r� CE -[3801 F2A,.K 13� TNAR� • !! - PERFORMED FOR: DATE PERFORMED: y-''T'G•/q.Z- J LEGAL DESCRIPTION: LO Y S DEPTH (FEET) I 1 �• C'4; bt6RrrLS 18- 19- 20- COMMENTS s1920COMMENTS NT e—C-A9C Range. Section: PLAN 1 sq,�n B "rA.l�.t su.T WAS GROUND WATER /y 0 ENCOUNTERED? S IF YES, AT WHAT — L DEPTH? O P E Depth to Water Atter /r `/Q Monitoring? —� D+Ie: 7 Reading Date Grou Time t 6soiga 2 �o •a N:Z� j t it ;1 3- io.. .30 4 4- 5 5- 6 r; 6 o•�e o. •1 e a at 1. 6 g to- o it 11 �• • r D 2 12- 13- 13 14- 14 15 15 �q ` a `e 16 �t• 17 i '• R. O. H. 18- 19- 20- COMMENTS s1920COMMENTS NT e—C-A9C Range. Section: PLAN 1 sq,�n B "rA.l�.t su.T WAS GROUND WATER /y 0 ENCOUNTERED? S IF YES, AT WHAT — L DEPTH? O P E Depth to Water Atter /r `/Q Monitoring? —� D+Ie: 7 Reading Date Grou Time Net Depth to Net Time Water Drop 6soiga a 7 N:Z� it ;1 io.. .30 I G" PERCOLATION RATE (mmutevinth) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND 7 FT S d S ENGINEERING PERFORMED BY: CERTIFY THAT THIS1EST WAS PERFORMED IN 7 / 1 C r ACCORDANCE WITS44 R1YsS AIpk%1F9=1. GUIDELINES IN EFFECT ON THIS DATE. DATE R 7 72-M (Rev. 4/65) W-ALTHAUTHORP/ APPROVALS SEWER& WATER MAIN DGENSIONS SEWER& WATER INSPECTION ENGINEERINGSTUDIES ANDREPORTS WELL INSPECTION & FLAW TEST ROADDESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECNANCAL IAPEC770Ns ONSITE WASTEWATER DISPOSALSYSTEM DESIGN S& nG ROBERT C. COWAN, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 5, McCabe Subdivision August 8, 1997 GENERAL: CIVILENGINEERS (907)694.2979 FAX(907)694-1211 The scope of this project includes the installation of a 1250 gallon septic tank and a leachfield trench to serve the proposed four bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 R. of cover shall be insulated. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 5, McCabe Subdivision August 8, 1997 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-sm (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Page Three Lot 5, McCabe Subdivision August 8, 1997 Type of Pike Perforated Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam 19 or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi NON, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. page Four Lot 5, McCabe Subdivision August 8, 1997 Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. FM acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER MUNICIPALITY OF ANCHORAGE Development Services Department 7 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 017-341-14 Certificate of On -Site Systems Approval Expiration Date: O 1 �. '20 Z 3 Legal description MCCABE EAST LT 5 Site address 5030 BAINBRIDGE CIR Anchorage AK 99516 Current property owner(s) NATHAN & HALLEY HULSMAN X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: 0 Original Certificate Date: 5/15/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNICIPALITY OF ANCHORAGE " Development Services Departments Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 017-341-14 Complete legal description McCabe East Lot 5 Location (Site address) 5030 Bainbridge Circle, Anchorage, AK 99516 Current property owner(s) Nathan & Halley HUlsman Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑■ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel R Plastic ❑ Concrete ❑ Fiberglass Age 24 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Date of Payment C/ 5 /?")z COSA# (` SC- 7-3/t Z 16 Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 McCabe East Lot 5 017-341-14 2.2 8/28/98 367 241 4.01 24+ 5/1/23 Forge Engineering 246 4/17/23 49" 8/22/98 N/A N/A N/A 5/1/23 40 56 1440 25 >600 72 25 47 Benjamin Schiller, P.E.5/4/23 (907) 522-7773 GE �V Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I. D.017-341-14 1. GENERAL INFORMATION: Complete legal description McCabe East; Lot 5 Expiration Date: 6-' - Z — z Location (site address) 5030 Bainbridge Circle *Anchorage AK Current Property owner(s) Dawn Brown Day phone 907-441-4826 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: 15� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4.. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Date of Payment a 3 a 0 1 Receipt Number _ 022 / 7� COSA # OSC211060 Waiver Fee $ Date of Payment Receipt Number Waiver # 14 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: 2,/ Zz/2-/ 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 IGNATURE System #1 Approved for __�_ bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the fo ASU°� p........:... 6firey A. Gayness: �9�'• � =753 .•'� � � 4 �4 4� aProtessio"oao #AECC884 (OF((' C'rt, J2 ON-SITE WATER AND m" ��igW4&fiA hTER o �,� PROGf,AM Original Certificate Date:_3— The Z 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 Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other___S4,,e�1Txv4z JiStD `N COSA Checklist Legal Description: McCabe East; Lot 5 Parcel ID: 017-341-14 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ffi� Well log is filed with Onsite (or attached) Date drilled 8128198 Total depth 367 ft Cased to 241 ft FEC Sanitary seal is functioning correctly FR Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 2/12/21 Static water level at beginning of test 259.3 ft. Comments B. TANK DATA Age of tank(s) 23 years Tank type/material SEP„GH°P' Measured operating fluid level in septic tank 49„ 0 Standpipes/foundation cleanout per record drawing Date of pumping ? 2_J D. ABSORPTION FIELD DATA Which system tested (date installed),- 1 �-Z(-a� FIC ALL standpipes present per record drawing Total measured depth from grade 11.1 ft (max) Measured depth to pipe invert from grade 3.91 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 5.91 WE Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 2.5+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No oliform bacteria is Negative Nitratel q—_�ng/L ❑ Nitrate less than MRL (ND) Arsenic ug/L [JArsenic less than MRL (ND) Collected by Date of Sample 2/12/21 C: LIFT STATION E:1 Required maintenance comp] Age of lift station s Lift station mater' Comme Adequacy test date 2/12/21 Results [DPass For 4 bedrooms Fluid depth prior to test 34 in Water added 661 gal New depth 44 in Elapsed time 130 min Final fluid depth 38 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) NO If yes, enter date N/A Q� 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' ❑✓ Yes Community Sewer Manhole/Cleanout > 100' M Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' [71 Yes if No ft Private Sewer/Septic Line > 25' 7 Yes if No ft Absorption Field on Lot > 100' F✓ Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' ® Yes if No ft Water Main > 10' Animal Containment > 50' 0 Yes if No ft ❑✓ Yes if No ft ® Yes if No ft Water Service Line > 10' El Yes if No Manure/Animal Excreta Storage > 100' —✓❑ If septic tank is under driveway Community Sewer Main > 75' FV� Yes if No ft Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ❑ Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: 0 Absorption Field > 5' []✓ Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' F/I Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' El 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' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' Fv1 Yes if No ft Community Wells > 200'✓[] Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS INTEGRITY OF FCO COULD NOT BE CONFIRMED FCO LOCATED UNDER PATIO G. ENGINEER'S CERTIFICATION I certify that / 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 OFA o o��� ......' U ��.. .: ...................� �O ,J ff ey�,G_ar�gess. 9• CE -7953 D d0fess*kOoo #AECC884 i - - Municipality of Anchorage �!r • �- Development Services Department •`' Building Safety Division On -Site Water and Wastewater Program - 4700 South Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 ` •� www.ci.anchorage.ak.us "1 (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL �.� FOR A SINGLE FAMILY DWELLING Parcel I.D. 017.341-14 HAA # tx n I Expiration Date: % - / ' O 5 1. GENERAL INFORMATION Complete legal description -Lot 5 McCabe East Location (site address or directions) _5030 Bainbridge Circle Anchorage AK qq51(0 Current Property owner(s) _Dan & Tina Wilkins Day phone __8-1346 Mailing address X030 Bainbridge Circle Anchorage AK 99516 Lending agency Day phone Mailing address Real Estate Agent _Jennifer Toomer/Dynamic Prop Day phone 727-0227 Mailing Address _3111 C Street, Anchorage AK 99503 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by., 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ID Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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) 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 by 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 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 Health Authority Approval Guidelines for this Health Authority Approval application shows 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 Pannone Eno. Svc. Phone 272 -MB Address P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date DS'oti ( U Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DIIIIS Guidelines & Regulations.7he reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hiddct defects or encroachments. PES can therefore not provide any warranty for future performance not give any estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DIMS. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 5. DHHS SIGNATURE .Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: R. 0 j : • ON-SITE �Gt Additional Comments t 1A./AUR A.ND m: WASTEWATER . Av Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: 0, —�+� �• Original Certificate Date: Expiration Date: Reissue Date: tnw.1 uaat Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorageAk.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 5 McCabe East Parcel I.D.: 017-341-14 A. WELL DATA Well type (' It A, B, or C provide PWSID M _ Well Log Y Date completed IN2811 Sanitary seal Y Total depth —330—ft Cased m 241 ft FROM WELL LOO Date of test IL28/1998 Static water level 245 It Well production 3 9,p,rn WATER SAMPLE RESULTS: Coliform —a—colonies/100 ml Nitrate 1'31 mgr Wires property protected Y Casing height (above ground) 12+ in. AT INSPECTION 4/6/2005 255 It 2.7 9 -p.m Other bacteria 0 colonies/100 ml Date of sample: 4/6/2005 Collected by: Steve Pannone Arsenic N/A mg/I B. SEPTIC/HOLDING TANK DATA Tank Type/Material Premier Plastics HDPE Data installed a121H$98 Tank size —A300 gal Number of Compartments g Cleanouts Y Foundation deanout Y Depression over tank )y High water alarm N/A .:.. .rfi.r �.�.- . • .� h C. ABSORPTION FIELD DATA Date installed 8121/18;8 Soil rating (g.p.d./W or fe/bdrm)12 . System type Deep Trench Length AZ—ft Width -3_ It Gravel below pipe 6 ft Total depth UA ft Effective absorption area iKft° Monitoring tube Y Depression over sea N_ Date of adequacy test 4/62M Results (Pass/Faiq Paas For 4 bedrooms Fluid depth in absorption field before test s in Water addedfo gal. New depthg in. Elapsed Time: 65 min Final fluid depth 2 In Absorption rate >= 899± g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) No If yes, give date (Rev. 11/99) 0. LIFT STATION Date installed Site in gallon: "Pump on" level at _ in"Pump off' level at Datum E. SEPARATION DISTANCES LrJ:71 ' SEPARATION DISTANCES FROM WELL ON LOT TO: 1114 IIr., High water alar level at _ in Meets alarm & dreud requirements? Septic tank1 iflstation on lot 100+ On adjacentlots 190+ Absorption field on lot 120 On adjacent kits 100+ Public sewer main 100+ Public sewer manhole/cleanout 100+ Sewer /septic service line 40+ Holding tank 100+ SEPARATION DISTANCES FROM SEPTICMOLDING TANK ON LOT TO: Building foundation 25+ Property One -fi_Q± AbsorpUon field 10+ Water main 100+ Water service line 25+ Surface water 100+ Drainage Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property One 2V Building foundation 5W Water main 100+ Water Service line 50+ Surface water 100+ Driveway, parkingNeticle storage 50+ Curtain drain None Observed Wells on adjacent kris 100+_ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field Inspections y and review of Municipal records that the above systems aro In conformance with MOA HAA guidelines In effect on • • this date. j Steven . Po -RAX Engineer's Printed Name Steven R. Pannone. P.E. •••� E at� Date ©S& t{ (U •e�e�h _.`'�'�• Receipt Number 616-7a a Lr+ (Rev. 11AM Date of Payment Receipt Number L=42.93' R=125.00' R=20.00' 49 B 10' T&E EASEMENT 25' DRAINAGE / EASEMENT / v11 i .I /.6'x1 6.6' SHED Lot 5 53,373 S.F. SEPTIC C.E.A. EASEMENT (Doc. No. 1991- NOTE: DUE TO SNOW & ICE COVER, THE DRIVEWAY IS APPROXIMATE C/RCLC N� oh=o �G I100' PROTECTIVE RAD L-�"A,64.06 82'x9.7' 260 0' L MOVN ROAD OSP �S 75'05'41"E 18.40' 0 S%o / \Lo 52.3' 3 U) Lot 3A USMj O WELL — I 1n SHED 1.2'x3.2' CANT HOUSE DETAIL Scale: 1" = 30' 1' PORCH PLOT PLAN ___ AS BUILT _X_ SCALE _1" =_60__ GRID _ SW 2937__ Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, in c . (907) 522-6476 Phone 000000p0� (907) 522-4625 Fax Professional Land Surveyors ken®longsurvey.com jonothan®langsurvey.com I hereby certify that I have surveyed the following described property: LOT 5, McCABE SUBDIVISION EAST (PLAT No. 83-344) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. Dated this the __LL--- Day of - at Anchorage, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49TH'�� ................................ KENNETH �G. vLAN� .. o 11L(e21 PFo ' .. S— 202. ' yJOG 4 a R� O O 0n��SSIONA� o� Ld IDT 6 IIAS 67.979 SQ.FI. of AREA c* \fi I1q�N��IOCE C C�y —� The location olthe slructure(s)as shown on this record drawing hasbuild con,phes Title 21. AMC. le 17 / 75 OnL,vrt 130.8 AUNICIPALIT 'A nnt.n•�.wGf. -- v n �TRAFFIC 1�•''--6'F.�i7TA:c1'11' �H77R-ArED rs sl Ka19 n13 o At�Ixlov@n wr.., +]Y.ED Cl APPROVED AS XiTtr`� D NOT AI•PROILD. 112-, YRdIT\ p1lve W,y ilope not 10 xe teed010 ,Ir iii• .. �9nNG I K-1 of N C) O 0 e, \\ LOT 5 HAS 53,373 SQ.FT. OF AREA Ccs \ e�e Cy vu.. BAINBRIDcE \ C3 CIhcLE h � it I M --1, Inly M Irl] <!M J `L OPpWPGE E.�Mt. i . OH p,/ESMt .; N<rrtano�"T t7 S C2 / 130. M E. sL Daniel Wilkins CURVE TABLE BEARING I LENGTH CURVE DELTA RADIUS LENGTH C1 64'21'14' 50.00' 56.16' C2 60'00'00• 50.00' 52.36' C3 22'30'00• 375.00' 147.26' C4 430'27' 125.00' 9.83' C5 12259'33' 20.00' 58.90' C6 5756'43• 264.06' 267.05' Engineering k Surveying. Inc. 9330 Vanguard Drive, Suite 203 Anchorage, Alaska 90507 12/1 P GON C7 LOCATE SNOW AND ICE, 52, IN O O O LINE TABLE LINE BEARING I LENGTH Lt N 75-05'41• W 1 18.40' GRAPHIC SCALE: 1 Inch = 30 Feet I is 30 60 I" = 30' Lot 5 Block 5—Built 2401161 McCABE EAST eld Bonk SUBDIVISION (907) 562-6050 1 DLlli 1 210 1 hereby certify that the property described hereon has been surveyed by me, or at my direction, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto unless otherwise shown. That no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other easements on said property except as shown. It is the responsibility or the owner or builder, prior to construction, to verify proposed building grade relative to finish grade and utility connections and to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Listed distances prevail over scaling. Reproduction may cause distortion. J��•OF A49 , • 49L 71 •••, CHARLES E. FORBES 00 LS -7326 ,• ��_� ei •. •.• SJ��