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MAXWELL LT 2
xw 11 Lot 2 #018-281-26 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: OSP111304 PID Number: 018-281-26 Name: James Seccombe Wastewater System: ❑ New © Upgrade Address: 14841 Loc Loman Lane Anchorage, AK 99516 ABSORPTION FIELD Phone: Number of Bedrooms: 748-2886 4 17 Deep Trench El Shallow Trench ❑Bed [I Mound ❑Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade .8 GPD/Ft' 12-13 Ft. Block: Lot:2 Subdivision: Maxwell Depth to pipe bottom from original grade: Gravel depth beneath pipe: 4-5 Ft. 8 Ft. Township: Range: Section: Fill added above original grade: Gravel Length: 0-1 Ft. 47 Ft. Well: ❑ New ❑ Upgrade Gravel width: Number of lines: Distance between lines: 3 Ft 1 - Ft. Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: Existing Ft Ft 752 Ft' ASTM D3034 PVC Driller: Date Drilled: Static Water Level: Installer: Date Installed: Ft. Wilco 10/27-28/2011 Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ublidPrivate Manufacturer: Capacity: From Tank Field Station Tank Sewer Line Anchorage Tank 1,250 Gal. Well >100, >100' N/A N/A >25' Material: Steel Number of Compartments: Two Surface Water >100' >100' N/A N/A LIFT STATION Size: Manufacturer: Lot Line >51 >10' N/AIN/A Gal. "Pump on" level at: "Pump off' level at: High water alarm at: Foundation >5' >10' N/A in. in. in. Curtain Drain None Noted Pump Make & Model Electrical Inspections performed by: Remarks: Flow Diverter Valve Placed. Existing Trench Connected For BENCH MARK Location and Description: Future Use. Existing Septic Tank Decommissioned in Garage Slab Assumed Elevation: Accordance with Municipal Code. 100.00 Ft. eoF Inspections performed by: M. Anderson Dates: 1st 10/28/2011 ��.•^p�, 'm.` fir••' `' � � 2nd 10/28/2011 AW Development Services Department Approval � *; 49� *; Conditional Approval Date: ys'rrr• q•• �• •y•�• ••r••.•a 00 s1�.>�s~ ®� �•NUCUa 8 ANDMSON •,94K CE -4381 •.'��`6 Reviewed and approved by: f�� !.J.� Date: /,;2 _ S 'l ROF ®sgP I:SSyd�q (Rev. 04/06) i Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: OSP111304 LO U � 98.8 fl 93.8 L 85.8 99.5 > N n U) ch � U U li U Original & Finished Grade 1,250 Gallon Septic Tank X4.2 94.0 /99.5 Finished Grade .( Page 3 of 3 PID No. 018-281-26 ind---------------- Geotextile Fabric Drainfield Rock 47'(Trench Length) PROFILE AS -BUILT - No Scale CN 2 U 97 85.8 93.8 2 H 79.5 " No Groundwater 10/28/11 W11111; 14 all 41P X�- ■ 49th �...... ..... L..I... p.......... ..... ... 1......�`�......R. ,............. . . ..... m . 1 MICHAEL E. ANDERSON j —1 MICHAEL No. CE -4381 ���% �Illij.fROFESS\Ct' 400 AV Off° z OM:(>r m: O M An ��c ; X •• QEF .4(0� N C) D M n O z 07 CTI (,.i r Ln n 0 m V C.n 00 N LO D N 7 D n I OUI r- -P, -P, M O C) z � (D 0 0 rt o Q=o � o_ 0 O < c ^ (D0 CD O CD 0 x — — o r C: 0 Ul O W a 10' CEA Easement N00'06'40"W 100.00 LOC LOMAN LANE N00'05'55"W 230.04 TT M 3 Z CT CD O v W O -A W N00'02'00"E 130.00 r- 0 0 r- 0 • W V 1 O Z cc O m O N 0 W D N co N C) (A W w W N N N cn cn w o cow 1. y m y is io o cn i� q —{ O W W A V A W O w O W CO w CO (P O O r- 0 0 r- 0 • W V 1 O Z cc O m O N 0 W ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 FAX December 7, 2011 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Lot 2, Maxwell Subdivision Separation Distance Waiver Absorption Trench to Lot Line Dear On Site Services Engineer: A second absorption system was recently placed on Lot 2, Maxwell Subdivision. It was not possible to maintain 16' separation from the existing absorption trench and still have the required 10' separation from a short section of the lot line. The trench is less than 10' from the lot line for a distance of X The trench does not impact the property to the northwest as the absorption trench on this lot is more than 75' away from the new trench allowing sufficient room for an upgrade. We recommend a waiver be issued allowing the trench to remain 5' from the northwest property line. Sincerely, "'" i Michael E. Anderson, P.E. ��� •�1 ••• P�E OF .............. 49th _ n ;•MICHAEL E• ANDERSON � •• NO. CE -4381 •' 41 ,♦♦�444. R0F ESS\ NPi��•• Mun-icipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW Waiver#: osp11349 PID#: 018-281-26 COSA#: osc111473 Permit#: osp111304 Legal Description: Maxell Lot 2 Engineer: Anderson Engineering Applicant: James Seccombe �1ent �O `Sr A r t)epar tIII ent Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ® Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ❑ Adjacent properties are not affected by this waiver. ............................................... ■ ............................. ■ ■ Waiver is Granted: X Date: Waiver is not Granted: Approved by: Name of Reviewer ............................................................................... Rec#: 08327G Amount: $200.00 Date Paid: 12/7/11 **** VARIAN C E/WAIVER REVIEW **** Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCEIWAIVER REVIEW Waiver#: osp11349 PID#: 018-281-26 COSA#: osc111473 Permit#: osp111304 Legal Description: Maxell Lot 2 Engineer: Anderson Engineering Applicant: James Seccombe n,enr S' a � Department Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ® Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ❑ Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X Date: Waiver is not Granted: Approved by: Name of Reviewer ............................................................................... Rec#: 08327G Amount: $200.00 Date Paid: 12/7/11 **** VARIAN C E/WAIVER REVIEW **** To: Joseph Pennebaker, Affected Property Owner Adjacent to Lot 2, Maxwell Subdivision Subject: Waiver Notification To Whom It May Concern: The Municipality of Anchorage On-site Water & Wastewater Program (On-site) regulates private drinking water wells and septic systems for single family residences in accordance with Anchorage Municipal Code (AMC) Chapters 15.55 and 15.65. The Chapters include minimum separation distance requirements for private drinking water wells and septic systems. The requirements represent a conservative approach to protecting public health. Occasionally, the construction or upgrade of a property's well or septic system cannot be accomplished without reducing the code required separation distances. In these situations, a waiver to the required separation distance may be approved if an Alaska licensed civil engineer can successfully show that the public health will be maintained. The code requires an absorption trench to be located a minimum of 10 feet from any lot line. The subject property owner's engineer has formally requested a waiver be granted to allow the absorption trench to be 5 feet from the lot line located on Lot 1, Maxwell Subdivision. On-site has reviewed the engineer's request and supporting documents, and is satisfied that the public health will be maintained with the reduced separation distance. A waiver approving the requested separation distance will be issued in accordance with the code. AMC 15.65.140 requires all adjacent property owners be notified seven (7) days prior to issuing a separation distance waiver. This letter and a copy of the have been sent to you in accordance with this requirement. I have read the above and have no objection to granting the waiver allowing the absorption trench to be within 5' of my property line. NOTARY .� :. pugLlC r , Date: ao— Notary Certification: ash l . �e L1v� e LCA55' vim- i �1 r vv - e� On -Site Wastewater Disposal System Permit :S' MUNICIPALITY OF ANCHORAGE Development Services Department' On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP111304 Tax Code Number: 01828126000 Work Type: Septic Upgrade Permit Effective Dates: October 25, 2011 to October 24, 2012 Design Engineer: ANDERSON ENGINEERING Subdivision: MAXWELL Site Legal Address: MAXWELL LT 2 G:3135 Owner/Address: SECCOMBE JAMES C III & PAMELA S 14841 LOC LOMAN LN ANCHORAGE AK 995164030 Site Mailing Address: 14841 LOC LOMAN LN, Anchorage Lot Size in Sq Ft: 47507 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: Prior To Construction: The test hole shall be deepened to 18 feet to verify the absence of bedrock. Submit results with the final inspection report. Received By: I 2_-i_ - -"l1 Issued B L jDate: : By i f MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D.: 018-281-26 Property owner(s): James & Pamela Seccombe Day phone: 748-2886 Mailing address: 14841 Loc Loman Lane Anchorage, AK 99516 Site address: Same Legal description (Sub'd., Block & Lot): Maxwell Subdivision, Lot 2 Legal description (Township, Range & Section) Lot Size: 47,507 Sq. Ft. Number of Bedrooms: Four (4) THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (® all that apply) Initial E]Absorption Field X Septic Tank X Upgrade X Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: yy�(f ctc'� 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. (Signature of property owner or authorized agent) rmi ush Fees: 7 a e of Payment: iv Receipt Number: v��1 Cry Permit No. Waiver Fees: Date of Payment: Receipt Number: Waiver No. C:\Users\And Eng\Desktop\Mike\Maxwell\Permit Application.docC:\Users\AndEng\Desktop\Mike\Maxwell\Permit Application.doc ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) October 19, 2011 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Subject: Lot 2, Maxwell Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing absorption system on the subject lot has failed and must be upgraded. We are therefore requesting a permit be issued for the upgrade of the septic system to accommodate the four-bedroom home on the lot. The attached Site Plan and backup documentation identify the location and configuration of the existing and proposed septic system. The existing 1,250 Gallon Septic Tank will decommissioned in accordance with Municipal Code and replaced with a new tank. The existing absorption trench will be left intact and tied to the new system with a flow diverter valve. Also identified on the plans are the locations of the existing well on this and adjacent lots and adjacent septic systems. No conflicts exist between the proposed septic system and the wells on this or adjacent lots. Protective radii are shown to the adjacent wells. Drainage arrows are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The test hole placed on the lot indicated silty gravel (GM) to the bottom of the test hole. The percolation rate was determined to be less than 15 minutes per inch. We have designed the new trench with an application rate of .8 gallons per date per square foot. We are proposing to place a 47' long trench by 3' wide with a 8' effective depth. The total depth of the system will be 12' with the distribution line at 4' below the existing surface. The test hole will be deepened to 18' to verify the absence of bedrock. The well on the lot was drilled to 150' with no bedrock present. If conditions are found to be different than anticipated a change order will be submitted with a new design for the trench. The ground surface on the lot slopes slightly to the southwest in the area of the Lot 2, Maxwell October 19, 2011 Page Two absorption trench. The trench will be placed parallel to the contours of the ground as much as possible and in conformance with design criteria. A minimum of 100' will be maintained between all components of the septic system and the proposed well and from any surface water in the area. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments PROFESS\ON=��. W z Q J z Q O J U U J 2006-171 /�-----�\ MAXWELL SUBDIVISION ,�' LOT 2 47,507 S.F. N 90'00'00"E 135.00' v 0 : O Existing Well O M CN O Li F. N � N 0 z ur Bedr / Home NOTE w 0 0 N O O z f Existing Well g I 1 x \ x \ LOT 1 O\ h^O 47' Long x 3' Wide x 8' Effective Depth Absorption Trench yr ® r Np?ion ExistiAbso Trench N 89'59'35"E 299.72' No Areas of Excessive Slope or Surface Water are Within 100' of Any Part of the New Septic System. of SCOPE OF WORK Decommission Existing Septic Tank in Accordance with Municipal Code. Place New 1,250 Gallon Septic Tank. ry/ Place Two Post Tank Cleanouts and ! Flow Diverter Valve. Construct 47' Long x 3' Wide x 8' Effective Depth Absorption Trench. Tie in Existing Trench for Future Use. SITE PLAN SCALE 1" = 50' LEGEND SV — Septic Vent CO — Clean Out MT — Monitor Tube TH — Test Hole FDV — Flow Diverter Valve LOT 2, MAXWELL SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home Deep Trench System Perc. Rate: 6-15 Min./Inch 1,250 Gallon Septic Tank - Replace Existing Application Rate: .8 GPD/SF 8' Drainfield Rock 4 Bedrooms * 150 GPD/Bedroom = 600 GPD Design Volume 600 GPD/.8 GPD/SF/16 SF/LF = 46.875 LF Trench Length THEREFORE: Construct a 47' Long x 3' Wide x 8' Effective Depth Absorption Trench. Flow Line Elevation in Trench to be 4' Below Original Ground Surface. Total Depth to be 12' Below Existing Ground. Provide 3' Cover Over Absorption Trench and 4' Cover Over Septic Tank. Place Flow Diverter Valve and Connect Existing Absorption Trench for Future Use. 3' TYPICAL DEEP TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 4' Separation From Groundwater. Minimum 100' Separation From Private Wells in the Area. Minimum 100' Separation From Surface Water or Streams. 49th .........................�...�..� MICHAEL E. ANDERSON �j : S O No CE -4381 ,•••����. �FESS��Pi MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 BRAGAW STREET ANCHORAGE, AK 99519-6650 DEPTH (feet) 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11 12- 13- 14- 15- 16- 17- 18- 19 - SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: LOT 2, MAXWELL PERFORMED FOR: JAMES SECCOMBE DATE: 10/15/2011 PROJECT No.: PARCEL ID#: TECHNICIAN: M. ANDERSON TEST HOLE A lj f a SILTY GRAVEL d WITH SAND GM a 0 SLOPE N o° a 49th ...................... MICHAEL E. ANDERSON : IQ ff' NO. CE -4381 ,•��ti. ROFESS�••i SITE PLAN SEE SITE PLAN x U a WAS GROUND WATER ENCOUNTERED? NO IF YES @ WHAT DEPTH? S DEPTH OF WATER AFTER MONITORING: NONE O 2% a DATE OF MONITORING: 10/19/2011 P E a a DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH To WATER (INCHES) NET DROP (INCHES) TEST HOLE PRESOAKED PRIOR TO TESTING: 10/1 1 1:24 2.00" 2 1:54 30 4.25" 2.25" 3 1:55 2.13" 4 2:25 30 4.25" 2.12" 5 2:26 2.25" 6 2:56 30 4.38" 2.13" PERCOLATION RATE: 14 (MIN/INCH) PERC. HOLE DIA. 811 (INCHES) TEST RUN BETWEEN: 4.5 FT. and 5.5 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. SOILS VERIFICATION SAME AS GARNESS TEST HOLE. TEST PERFORMED BY ANDERSON ENGINEERING. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE: 1011712011 {° \ SO( OG • VbNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION � PERCOLATION • $25 L. Sire". Anehorago. Alaska 99501 264.4720 TEST SOILS LOG - PERCOLATION TEST mw 5x85 -0V �0 PERFORMED FOR: DATE PERFORMED:_SJL� �. LEGAL DESCRIPTION: MA. 1 . . z • s C -4p -5P 3 •_+0 jWs$;4.1 broom i 4 5 •. 6- 7 7 .. .= n 8 9 10 11 WAS GROUND WATER ENCOUNTERED? l7 IF YES. AT WHAT DEPTH? 13 PERCOLATION RATE .:• •••:a;.(jnlwiwit/inch) 14 - - 15 OF AX11 •a.•i•A.• �Y K •... •• 17 mmmmm� ..... •D roy Roid, Jr. 4.S is •, 2251 •E20- �:i •i mmmm�� Z PROFESS) COMM d� SITE .■■■■.■■■■ ! m.-m..■m•, ■ONES-mmum■ ■ ■ ■■ ■ ■■ ■ ■ ■ ==mm PERCOLATION RATE .:• •••:a;.(jnlwiwit/inch) - - •FT••� mmmm •a.•i•A.• mmmmm� mmmmm� mmmm�� mmmmm .•� �; • I•• .0.: . PERCOLATION RATE .:• •••:a;.(jnlwiwit/inch) TEST RUN BETWEEN fT ANq— •FT••� L • t- Lam' �� •a.•i•A.• PERFORMED BY:l� ' f �Jj�]OJy CERTIFIED BY.: •DATE: ' 72-008 !,+ or: Y' r LOCATION OF WELL (Please complete either laj lb or IC.) �. WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Permit No. A.D.L. No. 1/44tr•• Section No. 70.4•hipN13 pool* Ecl Meridian la. eafough -Subdivision Lot Block F.f—of—of- Anch kltaxvel2I 1 3 13 WE] DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS E-31 S. OWNER OF WELLS )tail Rcese Address: SRA Box S49nL 81+01/ LoJc---- Lane Street Address and Area of well Location A^(tAs! Fast Bator z. WELL Los eel 0 1 4. WENEPT,!(finall ((jj S.�ATE Of COMPLETIINN7 Q� Material Type Top Bottom gravel -hard rocky 0 25 6. C] Cable tool 'win Rotary O Driven C] Dug ❑ Auger Qdetled p eared p other: sandy -hard little gravel rocl y 2 silty sant:-cobble: 45 85 7.USEX5 Domestic 0 Public Supply ❑ todu•Ity C) (rrigarlon 0 Reeherge p commerical D Taut Wali O Other= gravely hard ,and 85 98 tight gravel seepage 98 118 1001 seepage B. CASING: 0 Threaded YG Welded did., 6 1.. to150 tt. Depth weight 1_�_ �_% Ibsps. diom. In. la ff. Depth Sllckup It. 11.5— 1 1 4 _gpm hard silty clay deriented gra el 11Z 134 gravel Mandy 11gpm 1120 134 137 9. FINISH OF WELL: gra & boulders T3 1 pan Type: Diameter+ Slot/Meeh SI:e: L•nglh: Sat between ft. and ft. Backfilling Gravel pock role harC W.11 ionsusii?—Uifti, 1120 7 C111`1 ArG1i0e•4G CE4T. OF'R,. 10. STATIC WATER LEVEL: / / fl. 7 12 Above or R Seto. land surface Dote Equipment used: n [�i N 11 . PUMPING LEVEL below land surface end YIELD ft. efter hrs. pumping 9 ` � g.p,+n• It at-*, kit puwp:og t 0 0 tr.sleouTlr.a 10.11 glevito Q ves n%* Materiel: o Nttt 6em.nt O Other: • I • I 1.3. PUMP: (it available) HP Length of Drop Pipe It. copocity D subm. 0401 0 centrifical O Other 14. REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: IS. Water Temperature a OF 0 C This well was drilled under my jurisdiction and this report Is time 10 Inc best of my knowledge and belief; tlacka Note-1'lell-Verne c Drilling & Tit �3�2?N Registered Business Nome Conlr Lle ns• `7 Ad4re►s:1 2241 1lvion, SRA Box 1560 Anchorage, ��YaM�tu l y ` signed, l Dots: 7- Z3 - k 3 Authorized Representative Form 02-WWR (11/e1) Copy Ditlribution: WHITE -State DOGS. PINK -Driller. CANARY-Cusfemsr C 4 C s ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 2, MAXWELL SUBDIVISION GENERAL: The scope of this project includes the decommissioning of the existing 1,250 -gallon septic tank on the lot in accordance with Municipal Code and replacement with a new 1,250 -gallon steel septic tank. Work also includes the construction of a new 47' long X 3' wide X 8' effective depth absorption trench at the location also shown on the Site Plan. The distribution line in the trench will be placed at 4' below the existing ground surface. Total depth of the trench will be 12' below the existing ground surface. The new absorption trench and septic tank must be placed a minimum of 100' from all private wells and any surface water in the area and 10' from the water service line on the lot. A minimum of 3' of cover is required over the absorption trench and 4' of cover over the septic tank. A flow diverter valve must be placed and the existing absorption trench tied in for possible future use. 2. Construction shall be in accordance with the approved site plan, 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 all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. The Contractor must also verify the location of wells in the area and assure that the separation distances are met. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater Municipal Building Safety Division for system installations. Owners prior approval from the On -Site beginning system installation. SEPTIC TANK INSTALLATION disposal systems must be certified by the On -Site Water and Wastewater Program installing their own systems must receive Water and Wastewater Program. before A new 1,250 -gallon septic tank must be procured from an approved source and installed at the location shown. Lot 2, Maxwell October 19, 2011 Page 2 of 3 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below the distribution line must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. All pockets of unacceptable materials must be removed and replaced. Lot 2, Maxwell October 19, 2011 Page 3 of 3 MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. 1 n MUNICIPALITY OF ANCHORAGE ("N DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 264-4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE W NEW r PIi ✓I tefe 271x27/ ❑UPGRADE MAILING ADDRESS d -06-4 r LEGAL DESCRIPTION tot 2 fllocA' LL 61 I'10)1tyell u lJL�iv7'l %On LOCATION loc lom d„ Or NO. OF BEDROOMS DISTANCE TO: Well nO%L ih Absorpbonarea 0 6 Dwelling 6.T PERMIT NO6302'77Ole Manufacturer Material MaterialS�PP/ No. of compartments 2 LLiq,cap cityiallons IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO:Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons a -0 DISTANCE TO: WellL Foundation 2 2 S Nearest lot line n 7 PERMIT NO / h C! h 7 02 J LL Z No. of lines l Length of each line Total length of lines A Trench widt JO Distance between linpy F: Z W Z inches CC a Top of tile to finish gradeTotal if,— V Material beneath tile 72inche, effective absor tion area 674 02 Length Width Depth PERMIT NO. W <I— Type of crib Crib diameter Crib depth Total effective absorption area wd to DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J W i DISTANCE TO: Building foundation Sewer line Septic tank Absorption area (s) OTHER Lrf PIPE MATERIALS c C � N V SOIL TEST RATING 15-0 ft z r r INSTALLER r 11 [ Q Ex P63-072 Q e veLos REMARKS Lehi,le Icc ai7'oh reguired n J I ; VAE i If Ilev One/ rrh A r APPROVED DATE LEGAL -10-83 Lai 2 block $ &1 ke 72-013 1Rev. 3/78) MUr4I C I FAL I TY OF= ArdCHC1Fz�RGE DEPARTMENT 0F. HEALTH AND ENVIRONMENTAL �FOTECTION _ 825 '( `STREET. ANCHORAGE. AK. 95 1 ► 264-4720 44ELL Ar4E> Oro—SITE SEWEFZ F='EFRM I T PERMIT NO. C 830297 > APPLICANT J.NEIL REESE SPA BOX 1508-A ANCH. 271-5276 LOCATION LEGAL LOT 2 MAXWELL SUB LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING CSO FT/BP,)= 283 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E>E:FsTH= 11. 5 LErJGTH= S1 C3FRnVE1L ©EF}TH= -7. 5 THE LENGTH DIMENSION THE DEPTH OF A TRENCH GROUND AND THE BOTTOM THERE IS NO SET WIDTH THE GRAVEL DEPTH IS TI AND THE BOTTOM OF THE IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE OF THE EXCAVATION CIN FEET). FOR TRENCHES. AE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE EXCAVATION CIN FEET). FZE:QU I FRES SEF}T I C TF hINK SIZE= 1250 GALL-(D"S; PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TWO C 2] I r-JSF}EGT I C31r-4S AFZE FZEGEU I FZED> BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F}EFRM I T EZXF} I FRES ©EC3Er1ES'EFZ :3:1.. 1Eo82: I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 1: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNE[ ISSUE[ V4. 0 SOI( OG MbNICIPALITY OF ANCHORAGE I DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION O PERCOLATION 825 L. Sires. Anchor"., Alnka 99501 2643720 TEST SOILS LOG — PERCOLATION TEST 4mw 5r 83-00-1 PERFORMED FOR: f tlm] U!Z ri[[ -[� A�n DATE PERFORMED: (O.`7 fg$ LEGAL DESCRIPTION: ,/'T�► s�,t ��IS>� l.Q,}'p� S1[ 72PN x ( 1 r� SLOPE SITE PLAN —t— 11 1 1 1 1 - 1 2 � or P -5P s ed oe n 4-' ; 3 10 -.06 6 7 8 C71�1 9 10 i l WAS GROUND WATER ENCOUNTERED) 12 IF YES, AT WHAT 13 DEPTH? 14 is r OF Akq�1I P, ,..•......., S,� �I 16 co e Ir_fY H i� Roid, l roy , s•• - . 2251•E 19 i PROFESS\.! � in ==mmm�i -_____ ______i m_____ -_____ m__m__ .•i C' i �i.r � l' PERCOLATION RATE /.•,•••'a�.(InInill Rfinch) TEST RUN BETWEEN ' •�fT AN •'F7••• COMMENTS i_L ;�!1'. c_ / •,,,•t•• V•� PERFORMED BY:-�Potnaf 1[LIIFir1oA CERTIFIED BV•.' DATE: _ 72-006 (6/79) �•f,i�:JJi�•'\'�'� n n 6 SOILS LOG ; MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PK PERCOLATION (I TEST � 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: 1 ' zi I -SP. 1 DATE PERFORMED: L41 �1 3 1 IIAf/�`, LEGAL DESCRIPTION: �� II 5uhdiyi-siov� 1 t Lo� F— eP H OL 1 L. 2 brou3n=Uh�ra}ed pluShc, stl� 3 4 Date Gross TimeTime Net Depth to Water 5 +HZO N�21Ik3 io ML rey Silt �eLo 716 r 10 vets s No 10.43 10 .(0 , oy 8- 0:43 l02 9- s1011 lo' 43 10 Ioe5 10- 1u�53 11 1 i-f7 12- 21314 �5 2o 13- .1111 +Hzt] 14- I1'. o3 : t'S t 0 Ito11 .I2 . oy 15 15 16 17- 71819 18- 19 20 SITE PLAN WAS GROUND WATER ^1 L ENCOUNTERED? IV O P IF YES, AT WHAT — E DEPTH? (nth, d VIAa Reading Date Gross TimeTime Net Depth to Water Net Drop +HZO N�21Ik3 io 1� 716 r 10 33 No 10.43 10 .(0 , oy 0:43 l02 +1ln2() lo' 43 10 Ioe5 03S 1u�53 1 i-f7 '\ Il) �5 2o 11:03 .1111 +Hzt] I1'. o3 : t'S t 0 Ito11 .I2 . oy +HZO 5*6. i3 43 IU 133 . oy PERCOLATION RATE '� (minuteslincfil TEST RUN BETWEEN . — 6 FT AND FT PERFORMED BY: C YiQ ii iI e -!;I 6Y -\50t1 CERTIFIED 72008 (6/79) DATE: � — � �' n WATER WELL RECORD STATE OF ALASKA .- DEPARTMENT OF NATURAL RESOURES I Division of Geological a Geophysical Surveys Drilling permit No. LOCATION OF WELL (Plea.* complete either Is, Ib 0r Ic.) A.D.L. No. Io. Borough Subdivides LotBI*Ck In. y4 afte. Section No. To.nsnipNO Range E❑ Meridian 1 Ai faxwell 2—af—of—ef— a w❑ 1c. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: • Pfeil Rcesc Address: SRA Box SY10L fYeq/ Let.10 t ^ L4"c- Street Address end Area .f Well Location A/a L14 eY 4 2. WELL LOG Fest B•Iow Set Sae• 4. WE; }6EPT" (final) 77u 3.•..QATE OF COMPLETIgf� ( Material Type Top Bottom gravel -hard rocky 0 25 1 6, ❑cable tool dinflotary ❑Driven C] Dug ❑Auger ❑Jolted ❑Bared ❑other: candy -hard little rravel rocly 2 silty sand -cobbles 45 85 7.USE`(] Domestic ❑ Public Supply ❑ Induslry ❑ litigation ❑ Recharge ❑ commerical ❑ Test Wait ❑ other: grave 1y hard sand 85 98 tight gravel seepage 98 118 1001 seepage s. CASING: ❑ Th1r�ea/d�ed Ya Welded did., 6 n. to ft. Depth Weight —42me./ft, diom, In. to_ ft. Depth SNckep It. 11 —11 4_gpm hard silty clay demented gral el 1 T9 134 sandy 1+gpM 1120 134 137 gravel 9. FINISH OF WELL: y' Type:[' Diameter: /// Slot/Mesh sl:•: Length: set between ft. and It. Backfilling Graaf pats and pan & boulders 13 1 ro):n ar i chews + ( > I120 9 GYI'1 AKCHO"ko h CEPT. Of Olk 10. STATIC WATER LEVEL: /h/ fl. 7 12 gz ENVIRON " ❑ Above or R Belo. land surface Oct* L }yG J Equipment used: t/,L.1 {� [ 11 . PUMPING LEVEL below fond surface god YIELD n. ever pumping 9 9 I m. _n... it ane. _ft's eump:wp_tpm IE.6ROUTINa 0.11 ars.ba ❑Yo ref. Mesial: Onset Cement C]Olher: . 1' _ I l Is. PUMP: (if available) HP Length of Drop Pipe ft. capacity 0. p. m. ❑ Subm. ❑ Jet ❑ centrifieal O Other 14.REMARKS: 16. WATER WELL CONTRACTOR'S CERTIFICATION: 15. Wafer Temperature _a ❑ F ❑ C This call was drilled Under my )uilsglcllon and this report It true to toe best of my knowledge and ballet; Alaska Nor:-C/oll-Vern's Drilling & Ent nn3 7 Registered Business Nom•Contr LIc n1. Addrae:12241 Avion, SRA Box 1560 Anchorage, RYasfca j signed:% Date' Authortr'.. pr*sentallre Form 02•WWR(11/8I) Copy Dielri0ution: WHITE'Btate DGGS. PINK-0r1IIer. CANARY'Catgmu n MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES 0 � 4f CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 0-0. % F 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) !_ n 7- 2 /fax 11 .s/-( -C.0 _r 3'f. Ted Location (address or directions) lLlS `II I- Cc,Lcwre,rt (b) Property Owner r►^J!4"-n � X9[ C Telephone: Home I ;- �� Si z Business Mailing Address Y� (c) Lending Institution Mailing Telephone (d) Real Estate Company and Agent 'rn t UL'M Address S'4 010 0CLA3 Z1 0-r 2910-7 0 -7 (e) Telephone Mail the HAA to the following address: or: Check here if hold for pick up. List contact person and day phone number below. 2.7 4 -31 L2 2. TYPE OF RESIDENCE Single -Family, Number of Bedrooms 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank [7 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 Ina, e -e61 Flom roue rsere •+ar sco-te i )o Z abed •NLom siaaul6ua leuolssa)ad ayi ul suolsslwo Lo sioua zol elglsuodsal lou sl 86e%0yauy )o Apledlolunyy ay1 panssl sl aleolllUao a a%olaq elep azAleue jo suoiloadsul,onpuoo lou op SHHO )o saaAoldw3 •sivawaimbai alels pue leLapal uieuao Alslles of iapjo ul suollnl 1sul 6ulpual ilayl pue sawo14)o sLaseyoLnd of Asaynoo a se siyl saop SHHO 8141 •e�lsely to alelS 8141 ul paialsl6al La3ul6ua leuolssalad luapuadapul up Aq anoge S ydeAcied ul uaAi6 suopeluasa%da1 8141 uodn Aluo paseq saleoy!Uao lenaddy Al!joyiny yyeaH sanss! (SHHO) saolAiaS uewnH pue ylleaFl )o luawUedaO e6eLo14ouy )o Al!ledlolunyy ey1 NOunVo lenaddy Ieuo!l!PuoO )o swial leuolilpuo0 panwddnici --�— panaddy �_ ale0ZPV 1 7P7Aq swoapaq Jo) panaddy 1VAOtlddV SHHO '9 r"- TL61 'S'31' 3 SZZZ ' r leas s,i9aul6u3 \. ` ale0 kosl"Cl f7I p ssaLppV ' b auoydalal wily )o aweN • u0113a Sul slyi )o alep ayi uo loal)a ul suolleln6al pue •saoueulpLo'sapoo olelS pue ledlolunyy lie Llpm eouelldwoo ul sl walsAs lesodslp jalemalsem jo/pue Alddns %alem ails-uo ayi 'uolioadsul pue uope6psanul Aw wal pue sal!) o6eLoyouV )o Ailledlolunyy ayi wo11 paulelgo uollewjolul ayi uo paseq leyl Apm jayvn) I •ulaja14 paleolpul oinloruls )o adAl pue swoapaq )o iagwnu eyi iol alenbape pue leuoliounl'ales Si walsAs lesodslp lalemaisem Lo/pue Alddns La1em ells-uo ayi ie141 SM04S lenaddy Aluoyiny 41leaH s!yl to u01ie6lts9nul Aw leyi A)IIaA I'molaq UMOyS alep uollepgeA 8,41 10 se pue olaiay poxllle leas Aw Aq paipliao sy NOIIVWHOyNi CNV V1VC'HOtlV3S 3liy'S1S31'SN01103dSNi ONIOIAOtld WHid E)Nltl33NIJN3 'S • Municipality of Anchorage V �PG a fo On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 018-281-26 1. GENERAL INFORMATION Complete legal description Maxwell Lot 2 Expiration Date: 3- 1-7- Zd 22— Location (site address) 14841 Loc Loman Ln, Anchorage. AK 99516 __ Current Property owner(s) Michael Jolin & Marie Kathiio ___. Day phone Mailing address Real Estate Agent 14841 Loc Loman Ln, Anchorage AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well N Individual Water Storage ❑ Community Class _ Well ❑ Public Water System ❑ WaiverNariance request for: Received by: 4 Day phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 5 5 O Waiver Fee $ _ Date of Payment Date of Payment Receipt Number 0 9 '?5 8 Receipt Number COSA # OS C a 11'7 1 Y Waiver # istance: 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 ARCTERRA CONSULTING, INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date % 1 - Engineers 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 septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen OF 14 \ encroachments, deficiencies or discrepancies exist. 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. KENNETH �: J�iI�FUS 0( % 711In— —` \� ,s Conditional approval for _ bedrooms, with the following stipulations: 0 J J NLITY p_'76i__ i By: Original Certificate Date: 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc COSA Checklist Legal Description: Maxwell Lot 2 Parcel ID: 018-281-26 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 7/23/83 Total depth 150 ft Cased to 150 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 30 in. Date of flow test for COSA 12/15/21 Static water level at beginning of test 104 ft. Comments B. TANK DATA Age of tank(s) 10 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 49" Standpipes/foundation cleanout per record drawing Date of pumping 11/8/21 D. ABSORPTION FIELD DATA Well production at time of test 4.5 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes Nc Coliform bacteria is Negative Nitrate 3.52 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Areterra Consulting Date of Sample 12/7/21 C. LIFT STATION ired maintenance completed Age of lift std years Lift station material` Comments: Which system tested (date installed) 10/28/11 Adequacy test date 12/15/21 ALL standpipes present per record drawing Results ❑✓ Pass For 4 bedrooms Total measured depth from grade 12-13 ft (max) Fluid depth prior to test 61 in Measured depth to pipe invert from grade 4-5 ft (min) Water added 600 gal ❑ N/A — pressurized field New depth 69 in Monitor tubes go to bottom of effective. If not, state Elapsed time 300 min depth into effective Code -required soil cover over field Final fluid depth 61 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet 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 if No 5+* Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25'5Z Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ft ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® 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 5+* ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' 'Yes if No ft Water Service Line > 10' ® 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 5** ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® 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' ® Yes if No ft F. ENGINEER'S COMMENTS *Tank 5'+ from foundation meet code at time of install. ** Waiver OSP11349 granted 12/7/11 G. ENGINEER'S CERTIFICATION I certify that l 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 OF PhCH W'%0VA ; Mut.11G1PE� P,,SERVlOES MUNICIPALITY OF ANCHORAGE (MOA) E�lRO HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984. 2644744 Legal Description: Le> T 4Z r )I A y W O LL RGI. SEG 3� . T_ , aL.1 jz3Ur/ A. WELL DATA Well Classification ' 1Z ES It A. B, C, D.E.C. Approved (Y/N) N�iAr Well Log Present (Y/N) y - Date Completed 7'4 3 • R'3 Yield 1 per. Total Depth f 50 Cased to Depth of Grouting NON C Static Water Level (13 Pump Set At •FSoTTo H • Casing Height Above Ground sv0 Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) Separation Distances from Well To Septic/Holding Tank on Lot (C Q ; On Adjoining Lots ) 10 f To Nearest Edge of Absorption Field on Lot 110 * ; On Adjoining Lots f no t To Nearest Public Sewer Line N oNE To Nearest Public Sewer Cleanout/Manhole No rvE To Nearest Sewer Service Line on Lot % �C Water Sample Collected by 7-S ; Date %ZZ Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed w r 3 Size _1.2' O No. of Compartments T 1& o Standpipes (Y/N) T It/o Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) N Depression over Tank (Y/N) N Date Last Pumped 1 L/l f 7 /64acS Pumping/Maintenance Contract on File (Y/N) N/A ; for fY1A Holding Tank High -Water Alarm (Y/N) WA Temporary Holding Tank Permit (Y/N) NZA Separation Distances from Septic/Holding Tank To Water -Supply Well ( O 2 To Building Foundation h To Property Line 96 f To Disposal Field S To Water Main/Service Line > iV To Stream, Pond, Lake, or Major Drainage Course KoN4 Comments Pagel of 2 77-M fRov 8 861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 0 Type of System Design 'Le EW# Date Installed g 3 Length of Field 15.S Width o1 Field 30 Depth of Field -- Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present (Y/N)N - IAC Depression over Field (Y/N) N Date of Last Adequacy Test —111h 7 Results of Last Adequacy Test _ "-s tz-e �y✓ > /rOerflS Separation Distance from Absorption Field: To Water -Supply Well f To Property Line 93 To Building Foundation To Existing or Abandoned System on Lot No N L ; On Adjoining Lots 1 To Water Main/Service Line / o To Cutbank (if present) NO NE" To Stream/Pond/Lake%or Major Drainage Course -- No NL ' To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION • NO n/C' Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test Meets MOA Electrical Codes (Y/N) Comments •' Check Permitted Bedroom Rating Against HAA Request •' Icertify that Ihave conformed to all MOAand HAA guidelines in effect on the date of this inspection. �c+hecked•verified,o Signed Date Date Company MOA No. Receipt No. o%0 O - O O S^ �F �tX�1 Date of Payment d i .� •y r Amount: $ xd d x"; 4c,_7r+Engineer's Seal 11 f 2225-E ...Q Page 2 of 2 i.' nE 25. 1971 •:4�/ 72.026 (Rev 81161 Bark E ti • n n n �N �' o n n 203 W. 15th AVE "C SUITE 203 y G LLQAD9 [PQF ANCHORAGE, ALASKA 99501 CONSULTING ENGINEER TELEPHONE: 19071 279-3916 RESIDENTIAL WELL INSPECTION LEGAL: Lot 2, Maxwell LOCATION: . 14841 LocLoman Lane OWNER: ChemExce. Relocation TYPE OF WELL: Residential, Single Family WELL LOG AVAILABLE: Yes INSTALLATION REQUIREMENTS MET:Yes WELL YIELD FROM WELL LOG: PUMP YIELD FROM TEST: DATE OF INSPECTION: _ ��� _tea •,o �t.T .......... r 9 Gallons Per Minute 6 Gallons Per Minute December 14, 1987 TEST PROCEDURE: Well was pumped at a constant rate while the draw down was monitored with an acoustic probe. At the beginning of the test water level was found at 113 feet below top of casing. At a pumping rate of 6 gallons per minute the water level dropped to 120 feet after 30 minutes of pumping and remained at that level for the remainder of the test, 70 minutes. A total of 1000 gallons were pumped. The well recovery was instantaneous. TEST FOR E.COLI AND TOTAL NITROGEN: Water was tested for E.Coli and total nitrates on December 15, 1987. E.Coli 0. Total Nitrates 0.53 mg/1. .Max. allowable Total Nitrates 10 mg/1. TEST RESULTS: This well meets the requirements of the Municipality of Anchorage. THIS WELL WILL PRODUCE MORE THAN 3 GALLONS PER MINUTE FOR MORE THAN FOUR HOURS The Municipal requirement for well flow is 150 gallons of water per bedroom per day. This well exceed this requirement. The assessment of the condition of the well applies only to the conditions as of the day tested. The flow rate may change due to sub surface conditions that may not be observed from the surface, and changes in the land use and other factors that may impact the aquifer feeding the well. 40 203 W 15th AVE "C" SUITE 3 ANCHORAGE. ALASKA 99501 CONSULTING ENGINEER TELEPHONE: 19071 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: Lot 2, Maxwell .'�„�;.••"� �:;�;� i� LOCATION: 14841 LOCLoman Lane * 49TH^ ••• OWNER: ChemExec. Relocation rr :•)UNE ZS 25- RESIDENCE: Single Family, Four Bedrooms P') WELL: On Site `lila'^ SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK:Greer Steel, 1250 Gal. Two Comp. ABSORPTION SYSTEM: Trench ABSORPTION AREA: 624 sq. ft. SOIL RATING: 150 INSTALLATION DATE: October 1983 DATE OF LAST PUMPING: December 14, 1987. Isaacs Pumping DATE OF TEST: December 16, 1987 TEST PROCEDURE: System was inspected and measured on Dec. 11, 1987. Tank was found with two feet of'cover and 48 inches of liquid. Trench sump was 11 feet deep and had 6 inches of liquid. 150 gallons of water was added to the trench. At this time hose and meter silted up and test was discontinued. On December 14, 1000 gallons were added to the sump. When water depth was checked it was discovered that the sump had been filled with gravel and no water depth could be measured. On December 16, the sump was excavated and replaced. A clean out was also installed. Then 650 gallons was added—This caused a 12 inch rise in the water depth. 15 hours later the water depth had returned to the level prior to the test. TEST RESULT: This system meets the code requirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE The operational life of all septic systems depends on the local soil conditions, ground water levels that mayfluctuate 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 septic system. We can therefore not give any estimate of how long this system will function satisfactory for current or future occupants. APPLI(-`NT FILLS OUT UPPER HA^ ONLY Prope(ty Owear Time Phone Time %%/ Mailing Address fY Zip Code y — Buyer CXAQfLrS�{t r Address Zip Code Lending Institution 5 �_ /A + Phone y Inspector Address Zip Code Realty Co. A Allem Phone Address Zip Code n Legal Description (y[WL.eY S Z Street Location Type of Residence ' Single Family LIN;; _I ❑ Multiple Family No. of Bedrooms_ ❑ Other W ater Supply Individual H WELL LOG. A well lop Is required for all wells drilled Since June 1975. [Falls ❑ Community drilled prior to that date, give well depth (attach lop If available(. ❑ Public Utility RECEIVED. Sewer Disposal {r_Indlvidual Year Individual Installed: !� ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank ( APPROVED BEDROOMS NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time II CXAQfLrS�{t r Date Date Date Date,, Inspector Inspector Inspector Inspector Field Notes: Z N LIN;; _I dK ` RECEIVED. 1,% 1-- C .o . 6.4zo ( APPROVED BEDROOMS -CONDITIONS OF APPROVAL ( ) DISAPPROVED "-1 ( ) CONDIT NAL PPROVAL' DATE D BY:04 Solis Rating Date Sewer Installed Well To Absorption Area. /d Well Lop Received Q Cdr G �1 O — 83 Well to Tank Septic Tank Size I -, Sp rxaxz even A E C 5 ALASKA RUIROWnTAL COnTROL SCRUICCS, InC. Engineerinq S Enuironmental Studics PERCOLATION TEST DATA SHEET CLIENT Neil DATE Ll1 X83 ADDRESS ZIP CODE Clg66 l LEGAL LOCATION MflXwPlk 60bdlVl5iOn Tl_0+ Z TOTAL DEPTH OF HOLE ft. ZONE TESTED ft TO ft READING P CLOCK TIME NET TIME DEPTH TO DATUM NET DROP RATE (min/in) +H2.0 qi1 9:31 10 rn,r1. ;:�,0 oy + I+,O 4;32 10 min. 1, 1V .00 41147- 9'.52 V0 YY1i e1. o52. 10vy1l11. x;.-13 �2 + R20 loos. 10:13 10 mi n ins .,)3 1 .00 Ill: ty IU rn I n. FINAL PERCOLATION RATE O (min/in) PERFORMED BY e-jay'1SbYI 1200 West 33rd Auenue. Suha'.F• AP&Mge. Aioska 99503 • (907) 276.1361 Municipality of Anchorage Development Services Department - Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road IYY P.O. Box 196650 Anchorage, AK 99519.66 www.ci.anchorage.akus (907) 343-7904 Pi —ICJ s CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I. D. 018-281-26 COSA# -fes 1. GENERAL INFORMATION Expiration Date: Complete legal description MAXWELL LOT 2 Location (site address) 14841 LOC LOMAN LANE *ANCHORAGE, AK 99516 Current Property owner(s) WEICHERT RELOCATION RESOURCES. INC.Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent NIEL THOMAS W/COLDWELL BANKER Day phone 868-2750 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: kfdividual Well Individual On-site Individual Water Storage ElIndividual 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 samples. (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, 1 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. t further verify that based on the information obtained from the Municipality of Anchorage fifes 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. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 4141 Engineer's Comments: In conducting this evaluation, GEG, Lit). attempted to provide a thorough, ADEC MOA aoOF �0��0 conscientious engineering analysis of the system in accordance with and The described the of the - O -- - - - DSD Guidelines -&-Regulations, reported results performance the time of the test, and separation P' S�4Qi - system under the conditions encountered at features. The life wells and p 9 H '•.i'* distances measured to readily identifiable operational of all O septic systems depend on the local soils condition, groundwater levels that may (7• ... .. • . • • • • • • .. • . • . • ... • • 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 the system. Satisfactory test • • • • • . . . . • • . •: . • . results do not guarantee future performance of the system, nor do they guarantee that Q •. ff ey Gar ess: there are no hidden defects or encroachments. GEG, LTD. can therefore not provide i-7 m i QQ" ' . CE any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for 00"dprlofessio�°a 0004000�� the sof& 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. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory By: Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other NJ ON-SITE WATER AND WASTEWATER Original Certificate Date: -) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF ON—SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MAXWELL LOT 2 Parcel ID: 018-281-25 A. WELL DATA *WELL TEST PERFORMED BY MICHAEL E. ANDERSON, P.E. Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 7/23/83 Sanitary seal (Y/N) YES Total depth 150 ft. Cased to 150 ft. FROM WELL LOG Date of test 7/23/83 Static water level 1 u 1 ft. Well production 9 —9 P.M. WATER SAMPLE RESULTS: Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) >18 in. AT INSPECTION *10/31/2011 *95.8 ft. *4.6 g.p.m. Coliform n colonies/100 ml. Nitraten 958 _mg./L. Collected by: GEG, Ltd. Arsenic: Nn ug./L. Dateofsample: 4/6/12 PULLED BY GEG *NEW SEPTIC INSTALLED BY WILCO CONTRACTOR'S & B. SEPTIC/HOLDING TANK DATA INSPECTED BY MICHAEL E. ANDERSON, P.E. Tank Type/Material SEPTIC/STEEL Date installed 10/27/2011 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping NEW C. ABSORPTION FIELD DATA Pumper. Date installed 10/28/2011 Soil rating (g.p.d./Wor � 0.8 System type DEEP TRENCH Length 47 ft. Width 3 ft. Gravel below pipe 8 ft. Total depth 12-13 ft. Eff. absorption area 752 ft' Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fail) NEW For 4 bedrooms Fluid depth in absorption field before test in. Water added =gal. New depth in. Elapsed Time: = min. Final fluid depth in. Absorption rate >= Sno+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NnNF If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off" level High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas NONE Manure/animal excrete storage areas NONE SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ***5'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 25'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS YeCA4uJF— 01= SNc-'J ***SEE LOT LINE WAIVER Loc-��5�cr— G. ENGINEER'S CERTIFICATION G OF.. certify that t have determined through field inspections and^- Y �� review of Municipal records that the above systems am in """' "' . .. "" """"" conformance with MOA COSA guidelines in effect on this date. Qa � ��.J ff A. me sr Engineer's Printed Ime JEFFREY A. GARNESS 9 79 3 dp Date, I2 Odd P,e ' Lr,Cr7�.F2'�caoo �� aprof e SSIOM1°o ��40000�a COSA Fee Date of Pa, Waiver Fee $ Date of Paym Receipt Number Receipt Number (Rev. 1 1105) M = Zw zoN L Lac Loman Lane ola O O a N00°05'55"W 230.04 � _ ` m M00S^:' PSC: Mx v 'O Z 29. ou r W 22.5 M UleC a COV@f@d N slOre @ W CA M N e shad o, 7.: 00 6 34.5 0 CO G �mr N00002'00"E 130.00 " a I 8r r 0 ms ami rF 0 O w Cl 010 tCEAEasement I ,—___------ I N00006'40"W 100.00 cn � i m,4 .� Q $y o i3p�,�y�9 D &� Viz: �i u' LRyI,p�ry ,TI 00 Tj� 1 D Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Progra 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. 018-261-26 COSA # C_ ( � Expiration Date: _3 1. GENERAL INFORMATION Complete legal description Lot 2, Maxwell Subdivision Location (site address) 14841 Loc Loman Lane Anchorage, AK 99516 Current Property owner(s) James Seccombe Day phone Mailing address 14841 Loc Loman Lane Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone �,Mailiag Address . °Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Four (4) 3. TYPE bF 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, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 5. DSD SIGNATURE —G1 Approved for bedrooms. Disapproved. Phone 522-7773 Date 12/8/2011 AV AW• MI4JAEL E. pHpStSON. ♦ �'J, ;� CE -4381 �- v Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory • ' = PRQGRAM -,,off,. . "0'PENT SE�6��� '. Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: 61"XI 91" (Rev. 11105) Municipality of Anchorage �• Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 2, Maxwell Subdivision A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 7/23/83 Sanitary seal (Y/N) Y Total depth 150 ft. Cased to 150 ft. Date of test FROM WELL LOG 7/23/83 Static water level 101 Well production 9 WATER SAMPLE RESULTS: ft. Parcel ID: 018-281-26 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) >18 in. AT INSPECTION 10/31/2011 95.8 ft. g.p.m. 4.6 g.p.m. Coliform 0 colonies/100 mL Nitrate 1.56 mg/L Arsenic: N/D ug/I Date of sample: 10/27/11 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Number of Compartments Two Foundation cleanout (Y/N) Y Depression over tank (Y/N) Date of pumping New Construction Pumper C. ABSORPTION FIELD DATA Collected by: MEA Date installed 10/27/2011 Cleanouts(Y/N) Y N High water alarm (Y/N) N Date installed 10/28/2011 Soil rating (g.p.d./f:2 or ftz/bdrm) •8 GPD/SF System type Deep Trench Length 47 ft. Width 3 ft. Gravel below pipe 8 ft. Total depth 12-13 ft. Eff. absorption area 752 ft2 Monitoring tube Y Depression over field N Date of adequacy test New construction Results (Pass/Fail) 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 >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Size in gallons "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 N/A Sewer /septic service line >25' Animal containment areas None Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots >100' On adjacent lots >100' Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas None SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Absorption field >5' Water main N/A Water service line >10' Surface water >100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 5"•" Building foundation >10' Water main >10' Water Service line >10 Surface water >100 Driveway, parking/vehicle storage >25' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS: ""' See Lot Line Waiver, ftl G. ENGINEER'S CERTIFICATION A2�0 •�• .•••J'T��o I certthat I have determined through field inspections and �• • 49sd*ify � •• • ••,,• ;... review of Municipal records that the above systems are in s•� i conformance with MOA COSA guidelines in effect on this date. �'• '•• Engineer's Printed Name Michael E. Anderson, P.E. �� J+�••• ifs"»x{381 •••���`"! Date 12/8/2011 4W COSA COSA Fee $ — tA�alrc�O_ Waiver Fee $ Date of Payment 1 al I I Date of Payment Receipt Number. G Receipt Number (Rev. 11 /05) -o-�m =D D-��m mmz Z oU) —iz0 m 0 =O z m zm0 _;u' � m moo Ohm m o� D Z im m 00 CO Ul CD r ra; O M Ul 00 fV Loc Loman Lane O N00005'55"W 230.04 '0090 O N N (D o co 0CD G a�� o' ° N � 5� 0 N co m CD L c� N G7 zr CDCL 10' CEA Easement N00006'40"W 100.00 m v C) ►l O O U) D r m i CA) 0 O N 22.5 Covered N Storage b) shed co 7•, 34.5 O N00002'00"E 130.00 W O W U) 1 O p•ZZ f �oa0 6, V p' f� 09 boas � w aye�� D N asoo\N '0090 O N N (D o co 0CD G a�� o' ° N � 5� 0 N co m CD L c� N G7 zr CDCL 10' CEA Easement N00006'40"W 100.00 m v C) ►l O O U) D r m i CA) 0 O N 22.5 Covered N Storage b) shed co 7•, 34.5 O N00002'00"E 130.00 W O W U) 1 O