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HomeMy WebLinkAboutVIRGINIA RUDE LT B1Virginia Rude Lot B-1 #050-531-30 Municipality of Anchorage ;•'` '` Development Services Department Building Safety Division On -Site Water and Wastewater Program. 4700 S. Bragaw St. P.O. Box 196650 Anchorage. AK 9951 M650 Pagel of 2 www.cl.anchorage.ek.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SW050139 PID Number: 050-541-08 " IN Wastewater System: ® New ❑ Upgrade Aden., ABSORPTION FIELD pbon. Nuhn a B.troama ® D..p Tlwr O slava.. Tr.nrll O e.d O Mould O on.r LEGAL DESCRIPTION sd R" Taal Dapel Irom a" V.d. 1.2 GPDffF 9.5 Ft. Bark Lau s,*4 all DpM b pip. bolam Iran Original P.d. (30" d Wh balrMn pipe B1 VIRGINIA RUDE 3.4 FI. 6.1 F, TO.M,W RMW 3a Fi.mW.Dm. on" We* Gr"Lamdl. T14N RIE Sec. 32 0.5 F(. 45 F(. Well: ® NewUpg rade � HawMaw.. DM aH.MwF. 3 F(. 1 0 FL C4ud¢.eal (Poral•, A e, C). TOM own D...d b. Taal ab..O n "a Pp MMw,M Private 380 F(. 173 FL 500 Fel PVC Dais Dal. DrdW 91Ma W.I. L.wl. IWMW DM. MIalNd BILL SULLIVAN 5/31/2005 105 FL MARTIN CONSTRUCTION 80312005 vrd Pamsal al c..ngi H'9M kbara GrouW. TANK 20 GPM unk FI. 2 FL SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption lm Holding lNZty uk/ e From Tank Field Field Station Tank Lin rer Lln Ses ANCHORAGE TANK 1250 Gr well +100' +100' — — a2S MMM�al STEEL Hanby a co pMunal.. 2 s,.r.a.waM +100' +100' — — LIFT STATION Lau» +S +10 — — NO LIFT Oral«« +5' +10' — .— 'Pum an' Wel al -P� Orr rral M Hyn.alM M«m M. Faaaalbn In F h CutMn Non CC^^ ' +50 c^ +50' — — Pum Mru a Modal 6 1.alcal.rp.war pMam.d W RMnr.. BENCH MARK L,xmu WWD. Vtm, PINK REBARR IN GROUND A.MMw wMI 100 FL i9 Inspections performed by: CHARLES BALZARINI Dates: 1" 80212005 *cl` T,asTDPI1ouR tvooD Development Services Department App ova05 Reviewed and approved by: Date: (R... rwd) "�FSS�tJt�'yG Permit No. SW050139 Municipality of Anchorage Page 2 of 2 DEVELOPMENT SERVICES DEPARTMENT ON—SITE WATER & WASTEWATER PROGRAM 4700 SOUTH BRAGAW STREET P.O. BOX 196650, ANCHORAGE, AK 99519-6650 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: VIRGINIA RUDE LOT 81 050-541-08 141" — q - EKLUND ROAD SWING TIES C j 19.0' 45.0' D 16.0' 46.5' 1,250 GAL. SEPTIC TANK 4 -BEDROOM HOUSE 3'X45' LEACHFIELD ReSeR TH® UTILITY ESMr. t.E "Req XB4: S 89'56'33" W ELEVATION (NOT TO SCALE) 314.02' WELL¢ o SCALE V-40' 17 U7 M m D N N ma O_j 0 0 00 z 0 0 0 z 314.02' Q — CLLANQU[ $ + — WELL Ll PINK REBARR'IN FPCOD• — MOQR TUeE ASSUMED ELEVATION " tD0' NITh�1 S�%QQE ORIGINAL GROUND E LEVEL AT, 107.1 NGINEER'S SEAL _0000Opp i' FILL MT -1 TH-t n .......q..q7YPA * 3.r p, : 4 �vv........... 12TANK I GAL a 6.1' GRAVEL'. ° NO •WT• �O CHRISTOPHER R. WOOD, c °: ao °.°. 97.6 91.t OQO�J'•. CE -10387 ree 101. 103. BOTTOM OF T.H. on o• .. 97. �p�� E lvoo 06/13/2006 19:02 6882259 SLLLIVAN (certitieb ;Brirling log by 000CO. a» SULLIVAN WATER WELLS P.O. a= 67027 C OAMA . ALAIWA SO= - ..... PAGE 01/01 Israel to w atag o r I e peema kxzdma W116' a to IA *W d nr6V tra'lrmmry D cobb ool Demofamt 38o casbvTfi *jL% EL v&v7tA*,w= asfl Dinnmw 1� 1/ t�,a,a..>bptt, ins 'fee Lkwr ype: N 0 ,%l r- StaffCMf�Y+rleret �o � ie�l fi000+rerl� �� Ipsn Mdtaa a'resitt� f11 � WaDmwmopw*gT M Dopettew augrennae STaI foal s+opp�a feel o t>s sm.t . feet � feet �pR �6.,rtaa.rc -Vakvw vapor km O AWL b d � feet NisDWnbftdlpoe,CmpteftW f3*s DM JEvG B-AcgSiJ Ar Oct;--' N. o QfA-1 �3aecoo� Agne 4!keY Rr OR�Gk. IiQ � rGckJ �lalki 1�c�aJc,a Alvtio 6R•�-t• 4A,4Y a -•s lee ' ' - •� c. •. N MUNICIPALITY OF ANCHORAGE Development Services Department Onsite Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW050139 Date issued: May 25, 2005 Expiration Date: May 25, 2006 Parcel ID: 050-531-30 Legal Description: Virginia Rude Lot B-1 Design Engineer: 0024 Eagle River Engineering Services Site Address: 4316 Upper Kogru Dr Owner Name: Jim & Susan Bickman Lot Size: 46036 SQ. FT. Owner Address: 4316 Upper Kogru Dr Total Bedrooms: 4 Permit Bedrooms: 4 Eagle River , A 99577 - This permit is for the construction of: ❑� Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy Q 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. zz ".,4 Received By: fv Issued Date: •-5-"?1 " Cr Date: 2r o 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.ak.us (907)343-7904 ` ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING 070 Parcel I.D. Kip Permit Number SW Property Day phone &qq- 46 9 y Mailing address (1) N3/& Gf o?tr lri»-rrc. 'Pt Mailing address (2) E .�& ; ✓ue , A -k Zip Code 97577 Legal description (Lot, Block & Sub'd.) j!!!aV;Aza 164de L4 -A t3- / Legal description (Section, Township & Range) Lot Size A. v Ve Acres qiV THIS APPLICATION IS FOR: Number of Bedroomsg Sewer Only ❑ / Well Only ❑ Sewer and Well Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 1 certify that the above information is correct. Single FarnIIyj26velling andjs In apcordance (Signature of property owner or authorized agent) - i .'1axl further certify that this application Is being made for a h applicable Municipal Codes. Permit Fees:. a �9� �'� ��.�C 12�aiver Fees: Date of Payment: 5ten I Receipt Number. t o9,TFil c _ (Rev. 12/00) Date of Payment: Receipt Number: Eagle River Engineering Services Wood, P.E. Christopher R, togzt VFW RD. Suite tot (goy) 694-5195 tel Eagle River, AK 99577 (907) 694-3297 fax May 25, 2005 Dan Roth Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Virginia Rude Lot B-1 Narrative & Permit Application Dear Mr. Roth: Eagle River Engineering Services (ERES) was contracted to design a well and septic system at the above referenced property. The proposed well and 4 bedroom septic system will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are all relatively large, so there is ample room for wells, septic systems and alternate sites. 2. Immediate neighboring septic systems are all +30' distance, and no private (or community) wells within 100' of the proposed septic system. 3. This permit is for a well and septic system. 4. Drainage will not be affected and is not a major consideration in our design. Development of this lot will not adversely affect the wells or septic systems or reserve areas on adjacent lots. If you have any questions please call our office at 694-5195. Sincerely, EAGLE RIVER ENGINEERING SERVICES ,���� ' Christopher R. Wood, P.E. Principal \2003\05.051 SEPTICNARRATIVE 08f1S 3dOlS KNON v •••'•* ` �bi?yl� z8 101 o N N o� , l M „0C;?0.00 N Y! LLs w I \ M N S7/ a 06 / 3re ti Ic o m m O \\ ii V1 my D c`� / U 4 Dow �/ "�� M N NY U K z P, OL W N / h QL o% -► z J s m zw wO0 Zori �m O 0 O x 'eO a n Q / + N W 3 0• D x Z J<~ N 3 F-• V h O 0> U 3 S w M fA y H,La zQ ,Mp -� ��O�j> 0 00 Fa -M W �n N. •} Z'x wZ xQ a 0 w -j w00- p i" N�a uz co N /I M �Q: me a`4 co / H n w o Z m 7 OJ ay O� WU / �3M s q W 0 sn/p y& 8"�Q00 c� q aN 13 I o m �L) o w �z II +O =ts foo 3j Of �+ l8'S� L M „00,80.001 N Yz'^'� a�' o a z V1OV81 �� LE as 11111 ii i �z 08f1S SWVIIIIM �y IIID z z :Q ®*o¢ I Eagle River Engineering Services Christopher R Wood, P.E. 10421 VFW Rd. Suite 201 (907) 694-5195 tel Eagle River, AK 99577 (9o7) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Virginia Rude Lot B-1 May 25, 2005 A. GENERAL 1. The well and septic plan is for a 4 bedroom single family residence only. 2. The drawing and or site plan shall be apart of this specification. 3. All materials and workmanship shall meet the Anchorage Department of I Iealth and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. Any remaining open test holt excavations shall be filled and monitor tube removed. 9. It is the responsibility of the contractor to obtain any lot line staking or well radius staking, etc... by a licensed surveyor prior to installation of any component of the septic system. Although not required, it is highly recommended, and is purely the responsibility of the contractor if any component of the wastewater system is installed too close to any lot line, house foundation, well radius, surface water, or any other object which the MOA requires specific setback requirements. B. SEPTIC TANK 1. The sewer piping from the house shall be 4" PVC 3034 laid at 2% grade minimum, and insulated with 2" of burial foam if shallower than 3 fl., with 2 ft. minimum. A foundation cleanout shall be installed within 4' of the house foundation. 2. The septic tank shall be an Anchorage Tank 1,250 gallon 2 chambered septic tank. Contractor may submit alternate tank and for approval, as long as it meets MOA requirements. Two opposing afler- tank cleanouts shall be installed. C. TRENCH 1. The trench is to be located as shown on the site plan. 2. The total depth of the initial trench excavation is to be 10' max. relative to existing ground elevation at ground water monitor tube. The bottom of the trench shall be level, plus or minus 1.5". 3. A 6 foot layer of sewer rock is to be placed over the native sand and gravel. The 4" effluent piping is to be laid on top of the gravel layer with, with 6" additional gravel added as follows: 4" along sides of effluent pipe, and 2" of gravel cover over the piping. 4. The completed trench gravel and piping is to be covered with typar fabric material. 5. Soil or combination of soil and extruded board insulation to a depth of +3' or equivalent is to be placed over the leachfield. Soil shall be contoured over the trench to prevent runoff from ponding. Continued on next page \\Era\docs\WPD0CS\2005\05-05Iumch- spec.doc Eagle River Engineering Services Christopher R Wood, P.E. logzr VFW Rd. Suite 2oi (907) 694-5195 tel Eagle River, AK 99577 (907) 694-8207 faX Continued: RECOMMENDED LEACIIFIELD DIMENSIONS: TOTAL DEPTH = 9.5' GRAVEL DEPTH = 6' under effluent pipe, 2" over pipe TRENCH LENGTH = 45' TRENCH WIDTH = 3' SOIL RATING = 1.2 GPD/R= BEDROOM CAPACITY= 4 SEPTIC TANK= 1,250 gallons EFFLUENT PIPE= 4" diameter of Muni and Engineer approved materials and construction Twenty-four (24) hours notice required for all Inspections. \\Eres\docs\WPD0CS\2005\05-051 trench- spcc.doc EAGLE RIVER ENGINEERING SERVICES 10421 VFW RD Suite 201 Eagle River, Alaska 99577 (907) 694.5195 ERES Project No.: 05-051 Calculated By. CW Date: 5/22/2005 Legal: Virginia Rude LB1 TEST HOLE 1 Single Family 4 Bedroom Dwelling Deep Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 000 gallons Percolation rate = 1 minutes per Inch Wastewater application rate = 1.2 gallons per day per square foot Required absorption area = 500 square feet Trench width (W) = 5 feet Gravel depth (D) = 0 feet Required length = Required absorption area / 2 / D Required length = 500 / 2 / 0 Required length - 42 feel t 1 5 - c Total Excavation Depth = 9.5 feet + C L/ 05-051 trenchCalc 4:30 PM5122/2005 Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 995198650 www d anchoragea' k'i- (907) 3417904 Solis Log - Percolation TestPerformed For _—,TT14A kj�erA1.4N Dale Performed: _5 411 �n Legal Description: V'Rtit`AIrn ft u p - L Township, Range, Sectlon: T I I -IA) %Z I L SE:G 3Z Depth TUYSos L, wdi 5 iM - TA�J leve"" L4(z l✓ C- rVn - CNRAI 11- r 12- �l114- Fahy 14- (oOtA S 15- a PE:RL 18- 1 Pkst 19- �Z 20 - WAS GROUND WATER ENCOUNTERED? 11%l7 s IF YES.ATWIWT DEPTH? L Depth to Water After D Monitoring? POAJ P E Date:5_ /zH/o5 Reading I Date Gross Tirneme Nel Time Deplh to Water Net Drop PERCOLATION RATE C / I e / l-irax vch) PERC HOLE DIAMETER TEST RUN BETWEEN 4-S PT AND6 —Z FT I LC 2L 5/1'u NT C-4.1/•' •Twr .v T.. PERFORMED BY:f (5 04d(2p I l� (/' / PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT DA ErN DATE15 TEsg • Municipality of Anchorage =� On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D.— 050-531-30 1. GENERAL INFORMATION: Complete legal description _Virginia Rude; Lot 131 Location (site address) 30258 Eklund Ave. *Eagle River 99577 Expiration Date: / I - z —Z 0 0 Current Property owner(s) Travis Stoute Day phone 787-9873 Mailing address 30258 Eklund Ave. *Eagle River 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: Z 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. d COSA Fee $ C"(CUPID Waiver Fee $ Date of Payment 7- 2.y -- 2 0 Date of Payment Receipt Number d G Receipt Number. COSA # D S C Z.D) 3 6V Waiver # nP-) 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 Engineerinq 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: ?a 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 andworkmanship),and the water usage of the family utilizing the s stem/s. These conditions can vary, 9 Y 9 Y ry, 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 F— = •- 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 `..ol party (including subsequent property Purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSC} SIGNATURE `� System #1 Approved for A bedrooms T�( bedrooms �1y SOF«q�,�rjj� bedrooms, with the following ationON-SITE WATER AND System #2 Approved for Disapproved Conditional approval for 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 0 i (A _ COSA Checklist Legal Description: VIRGINIA RUDE; LOT 131 Parcel ID: 050-531-30 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 5131105 Total depth 380 ft Cased to 173 ft © Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 7/18120 Static water level at beginning of test 91.8 ft. Comments B. TANK DATA Age of tank(s) 15 years Tank type/material Well production at time of test 6.8+ Spm Water storage tank volume N/A gallons _Well disinfected for coliform test? F-1Yes❑ Nc a ❑ Coliform bacteria is Negative rlp' Nitrate mg/L Al Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD. tom_ Date of Sample 7121/20 Measured operating fluid level in septic tank 48" F0 Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA DEEP TRENCH Which system tested (date installed) 8/3/05 ® ALL standpipes present per record drawing Total measured depth from grade 10.1 ft (max) Measured depth to pipe invert from grade 3•9+ ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 5.63' ❑ 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 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: N/A Adequacy test date 7/18/20 Results [✓ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 665 gal New depth 9 in Elapsed time 30 min Final fluid depth 0 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date N/A NONE 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' [] Yes if No ft 0 Yes if No ft Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Private Wells > 100' Animal Containment > 50' Yes if No ft 0 Yes if No ft ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' Manure/Animal Excreta Storage > 100' if No Community Sewer Main > 75' 7 Yes if No ft 0 Yes if No ft From Septic/bolding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' QQ Yes if No ft Property Line > 5' Fv Yes if No ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' [] Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' Cj 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' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' [] Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft . F. ENGINEER'S COMMENTS *N/A - 30' TO MANMADE POND **N/A - 56' TO MANMADE POND ***MET CODE AT TIME OF INSTALLATION G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet NAECC884 Municipality of Anchorage ,., .., • -- Development Services Department :p�.._� u.xeI!, Building Safety Division !. On -Site Water and Wastewater Program r 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. COSA # /)&W43 Expiration Date: 1 — 15 1. GENERAL INFORMATION Complete legal description vir(al P1 1 t7.. Rude R Location (site address) �Oo'Z5g ECKLV �P. ,PcU�_ Current Property owner(s) Jim1 c y, oomn Day phone (nQ H - G1oG 4 Mailing address t-1 :� Ito Upper KQQY-t ) Dr1 v Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 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 EaglePhone leGti-S►qS .. ervlces Address 10421 VFW RrI Suite 201 Engineer's Printed Namaegle River, AK 99577 hf t?i�7bPNM (? l looDDate 6119 (7(P N t1 [; F] [I: i :14:1 NLIX4: �] 5. DSD SIGNATURE ' CE 10387 J� Approved for L_ bedrooms.° •• Disapproved. swr p Conditional approval for bedrooms, with the following stipulations: Additional Comments ON-SITE - jc Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other gy Original Certificate Date: ' f .S' 0 Co (Rev. 77N5) Municipality of Anchorage • Development Services Department Building Safety Division ' On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST t7 ^31-3b Legal Description: Vi Y' ! l6a_ RU d P, 1 tit Parcel ID: A. WELL DATA Well type L,/ tC If A. B, or C provide PWSID # _ Well Log N) �YC'S Date completed 5 13, 05 Sanitary seal &I) It Wires properly protected ®N) Yes Total depth 320—ft. Cased to 1 -B -ft. Casing height (above ground) 14 in. FROM WELL LOG Date of test Static water level I OS ft. Well production ZD 9— p.m- WATER SAMPLE RESULTS: Coliform _'N—colonies/100 mL Arsenic: _n' mgA B. SEPTICIHOLDING TANK DATA Nitrate -6,_ mg/L Date of sample: 51'24'0(0 AT INSPECTION cy, T 9— p.m- Other bacteria '_ colonies/100 mL Collected by. 0-OrIeS Balmrini TankType/Material <ePi CTSite1 Date installed 00 Tank size f 2,C� gat. Number of Compartments J-- Cleanouts Y&) VCS Foundation cleanout (9N) Depression over tank ()& kJO High water alarm (Yo No Date of pumpingNM COnOy han Pumper N l k C. ABSORPTION FIELD DATA Date installed -213.ICS Soil rating (g.p.d./ft2 or fe/bdrm) 1.2 System type +Ir C n C Length!�C_ft. Width R ft. Gravel below pipe to, ft. Total depth ga. ft. Eff. absorption area POO ft= Monitoring tube � Depression over field )JO Date of adequacy test N4'IY �i o h Results as Fail) pgS5_ For bedrooms Fluid depth in absorption field before test -)&,,- in. Water added„ gal. New depth&in. Elapsed Time: min. Final fluid depth in. Absorption rate >_ (.�Ob g.p.d. Any rejuvenation treatment (past 12 mo.) (Y& type) NM e KNOWN If yes, give date �_ D. LIFT STATION //1►/� Date installed "Pump on" level at _ in. E. SEPARATION DISTANCES Size in gallons Manhole/Access (YIN) `POg1p�' vel t _ i gh water alarm level at in. Cycles tested - Meets alarm d circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot -t 100 Absorption field on lot + IW Public sewer main -1 IW On adjacent lots + 100 On adjacent lots 4 QUO ' Public sewer manhole/cleanout k 100 Sewer /septic service line 25 Holding tank 4 IM I Animal containment areas t 160' Manure/animal excrete storage areas +QQ_ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 1 t Building foundation �- Property line �_ Absorption field t S Water main -I- 10 Water service line 10 Surface water Weiss on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line --" 10 r Building foundation + I I Water main + I Water Service line+ 1 0 Surface water • — 100 a Driveway, paMnglvehicle storage G_ Curtain drain -t SO' Wells on adjacent lots { I DO F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in 7C� conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name t:N RLssoPltt�f2 Q lnfadfl `; NWSfOrIERRtAl00D CH�T Dale (a I I L4 T C7%71. Ae .............C-% ..... COSA Fee $ :- 7. 5—' f 1 % � /S vg LWaiver Fee $ _ Date of Payment / ` O Date of Payment Receipt Number Receipt Number (Rev. 11/05) ANAI.YTICA GRot P Eagle River Engineering Atm: Christopher Wood 10421 VFW Rd. Ste. 201 Eagle River, AK 99577 907.694-5195 Fax: Client Sample ID: Client Project: Location: Sample Matrix: COC N: PWSN: Residual Chlorine: Comments: Virginia Rude Lot Bt Miscellaneous DW Testing Aqueous Analytica International, Inc. 5761 Silverado Way, Unit N Anchorage, AK 99518 Phone: 907.258-2155 Fax: 907-258-6634 Report Date: 618/2006 Receipt Date: 524/2006 Sample Date: 5242006 Sample Time: I1:OO:OOAM Collected By: CB Flag Definitions: MRL - Method Reporting Limit MCL - Maximum Contaminant Limit B - Present also in Method Blank 11 - Exceeds Regulatory Limit M - Matrix Interference 1- Estimated Value D - Lost to Dilution •• — RL higher than MCL; target not detected Lab#: A0605267-OIA Analysts Metbod Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 500-NO3E (Aqueous) - Nitrate Test was conducted by: Analyrtca - Anchorage Nitrate as N <MRL mg/L 0.10 10 6/32006 6/32006 AJ Lab#: A0605267-OIB Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst Arsenic Reported by: Kari Hagen, Laboratory Project Manager <MRL ug/L Test was 1.5 10 Page 1 of I 622006 6/62006 MCG ANALYTICA GROUP DRINKING WATER ANALYSIS REPORT FOR COLIFORM BACTERIA Attn: Chdstopher Wood Eagle River Engineering 10421 VFW Rd. Ste. 201 Eagle River, AK 99577 Phone: 907.694-5195 Fax: Method Of Analysis: SM9223B Enzyme Substrate Test - Coliforms In DW Test Perfomed at Fairbanks Lab Chlorine Residual: Comments: Public Water System ID ft: Date Received: 5/24106 Time Received 15:25 Dale Reported: 611108 Time Reporte 22:22 Comments: S a Satisfactory U a Unsatifactory POS a Positive Test Result NO a None Detected TNTC a Too Numerous to Count (>200 Colonies) CG ■ Confluent Growth HSM a Heavy Sediment Masking, Results May Not Be Reliable TLIT a Sample Age > 30 Hours, Too Long In Transit R a Resample Required NT a No Test Sampled Sample Sample Analysis Analysis Total Sample Name Sample Location By Date Time Lab # Date Time Coliform E. Coli Comments A% 1824 Virginia Ruda Lot CB 6/24/08 11:00 A060528"11A 5/25/08 11:00 B1 Kad Hagen. ProJed M ger Analytica International, Inc. -Fairbanks Falrbanks, AK NO NO l e vw ueir fc+-'i ., ASBUILT SEWARD ✓ti ASSOCIATES LAND SURVEYING I HEREBY CERTIFY -THAT I HAVE SURVEYED THE SCALE/ _ d • ��w FOLLOWING DESCRIBED PROPERTY, K� A� •a ri,Q.vr�,v,Rvac res lora .. Of •.. 4� AND THAT NO ENCROACHMENTS EXIST EXCEPT AS DATLi ,y s`� S,F INDICATED. IT IS THE RESPONSIBILITY OF THE s���� �: r_H OWNER TO DETERMINE THE EXISTENCE OF ANY GRID �••• •• •' EASEMENTS, COVENANTS, OR RESTRICTIONS �• r` WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' o••�• Mvk S•wrA ANY DATA HEREON BE USED FOR CONSTRUCTION //Ss� f"a t5-6918 OFFENCE LINES, OR FOR ESTABLISHING BOUND-c�' ARY LINES. DRAWNi �'t,_;�V4-e'