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HomeMy WebLinkAboutTHERESA MAE LT 2ATheresa Mae Lot 2A #015-081-40 Municipality of Anchorage • ; Development Services Department `"ti* ' Building Safety Division On-Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page of www.d.anchorage ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SW070231 PID Number. 015-08140 Nra Colony Builders Wastewater System: RINew ❑ Upgrade Aarw 9420 Vanguard Drive, Unit A Anchorage, AK 99507 ABSORPTION FIELD F+ao. 345-0371 N~ of e.aaame 5 O Dep T.O d 0 shame Tlrrll O Bee 011 O Oew a Tdro"NftVm LEGAL DESCRIPTION AS Gpcot" s 10ea F,_ emcx LK s 2A uenw.wlp D'0"' °p Ppe Mndn nom erq^ei oMs Gma aepm oM..m pW Theresa Mae 5-6 FI. 4 FI Tow mV Rave sei m Fig Mae Mme OngP i VMe Gmw unOm 0-1 FI. 168 FI. Well: New ❑ Upgrade GreMl eiorl 5 wlme.d Iae 2 O--aiw.rl we >t0 F Fi Cuwr'ollal (Pnvae A B. CI Tpui Wpm.Cuee m T"eeMrpucn ars, P" www Private 176 Fr. 176 Ft 1,680 Fr, ASTM D3034 PVC DNw Dole omw Supc War l." mar, Wu InwuM Alpine Drilling 6/4108 73 FT Red Dog Excavating 815-12/08 Ywe Pwep sa a Camp NrpM N Gnlne TANK 20 Gpy 165 Ft. >t.s FT SEPARATION DISTANCES 0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption LM Holding lublitulFirvale °p1•` iY From Tank Field Station Tank Sewer Line Anchorage Tank 1,500 Gr Morena Nleror Of Cdryrmlenu well >100' >100' N/A N/A >26 Steel Two (2) sl+rMewao >too' >100' N/A N/A LIFT STATION Latt.e`e >6 >10' N/A N/A Gr 'Plenp a' le r a 'Pnp dr levM K Myl welt rrm K Folemenon >5' >10' N/A N/A h ti h Puna Mrd a Moor Ewzrw ImpecOone panxmM er C~ OW, None Noted BENCH MARK wawn Me DeKJmUCv1, Lower House Level Concrete Slab. qYM 100.0 Fl. t Inspections performed by: A. Harala Dates: 10 8/5/09 +�F........ 2nd 8/6-7/08 i l��p;• A��•••;5.��e1 Development Services Department Approval .re* 491ti�� •9�lr � Conditional Approval Date: 0. "e" MICHAEL E ANDERSON + 0� J�fq•• CE-4381 . O it 49nAW n Reviewed and approved by / Date: dvi ill« Dual ��■ ¥ \� ~ : V) L) n� _aa. •. §/% 0 LO kQ 0 LLJ , » ƒ- S; / / B i � � V � & . k c tj , LLJ �) z \ PQ [§ cc', V) )§/ \\\ % �{ Q = /§ k :20 4 k , �k & _ i� - Z § fe_ ; � ,-; CH 2 {§�� ��{|{_! S K E ■_ §| (/It E OM §� ° `Ec q e| § a a, Lo ; G2■;■ k f ƒ-ƒ-------------------------------� , �S3,-,m .�.m=. Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-0655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number. SW070231 PID No. 015-081110 BI4IOB e T 8/4/08 - - - - 90.2 88.8 49th .� PROFILE AS -BUILT . BR=� '. ._�._ No Scale Sep 02 2009 7:36RM Colony 907-345-6934 p.2 ALPINE DRILLING & ENTERPRISES Permit Number. kSW 7Q 0231 Date of Issue: 8-6-07 Parcel Identification Number: 015-081-40 Date Started: 6-4-06 Date Completed: 6-5-08 Is well located at approved permit location? ® Yes ❑ No Legal Description: Theresa Mae Lot 2A Property Owner Name & Address: Colony Builders 9420 Vanguard UnttA Anchorage, Alaska 99507 Borehole Data: Depth (ft) Method of Drilling ® air rotary ❑ cable tool Soil Type, Thickness d: Water Strata From To Casing type: 8jggj Wall Thickness: .025, inches Diametet:•6inches . Depth:l78feet Liner Type: Diameter: inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): Z3 feet Pumping level:jafoet after 2 hours pumping 2200 gpm Recovery Rate: 20 gpm Method of Testing: a/rtift Weil Intake Opening Type: ❑ Open End ® Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: benrordte granules Volume: 2 Depth: Start!Q feet Stopped 2 feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? ® Yes ❑ No Method of Disinfection: Ch/onne tablets Comments: Well Driller: Alpine Drilling & Enterprises P.O. Box 110496 Anchorage, AK 99511-0496 stick-up 0 2 gravellysllt .2 71 Slit 71 87 gmvellysllt 87 89 sandy silty H2O 89 93 sandy silt 93 101 gravelly sandy silt H2O 101 105 gravelly slit wet 105 108 gravelly silt 108 120 silt grey 120 169 silty water send & gravel 169 176 Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property owner or the well driller shall provide it well log to the Development Services Department within 60 days of completion. Development Services Department Building Safety Division ® �.r On -Site Water & Wastewater Program 'r 4700 Elmore Street +: P.O. Box 196650 ° Mark Begich Anchorage, AK 99519-6650 Mayor w .muni.oro/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SNV 70 0231 Date of Issue: 10113108 Parcel Identification Number: 015-081-40 Replacement Only: YES NO Description Lot 2A Teresa Mae p Installation Date: 07-1-2008 p Intake Depth Below Top of Well Casing: 166 feet p Manufacturer's Name: Grundjos p Model: 15SQE07-180 Size 314 hp Adapter Burial Depth: 12 feet Adapter Manufacturer's Name: Campbell B-10 Adapter Installer: N/A Disinfected Upon Completion" ❑ Yes ❑ No ad of Disinfection: Recirc Owner Name & Address: Colony Builders Installer Name: Aarow Pump & 1Vell Service LLC PO Box 110496 Anchorage AK 99516 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. 7-.29-09 MUNICIPALITY OF ANCHORAGE Development Services Department 7� On -Site Water 8 Wastewater Program _ _ 0$cD 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial 6 /z: 0a Date Issued: Sep 06, 2007 Expiration Date: Sep 05, 2008 Permit Number: SW070231 Parcel ID: 015-08140 Legal Description: TERESA MAE LOT 2A Design Engineer: 0014 ANDERSON ENGINEERING Site Address: 7102 THERESA MAE CIRCLE Owner Name: NORTHERN HOME BUILDERS Lot Size: 52525 SQ. FT. Owner Address: 3425 MURPHY CIRCLE Total Bedrooms: 5 Permit Bedrooms: 5 ANCHORAGE. AK 99502 - This permit Is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. THE ENTIRE SUBSURFACE DISPOSAL FIELD AND ALTERNATE IS NOT WITHIN A 30 FOOT RADIUS OF A PERCOLATION TEST. THE ENGINEER NEEDS TO DO AN ADDITIONAL PERCOLATION TEST PRIOR TO THE CONSTRUCTION OF THE SEPTIC FIELD. PLEASE SUBMIT STAMPED AND SIGNED RESULTS WITH THE AS -BUILT INSPECTION REPORT. IF THE RESULTS REQUIRE A DESIGN CHANGE, CONSTRUCTION OF THE SYSTEM WILL STOP PENDING ONSITE REVIEW AND APPROVAL. 3 " 5�-'p ((� Received By: Issued By. AtV1sP0r. afrroVt,(, y;P Date: 741d Date: PS Municipality of Anchorage Development Services Department Building Safety Division _ On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWERIWELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-081-40 Property owner(s) Northern Home Builders Day phone 830-2052 Mailing address 3425 Murphy Circle Anchorage, AK Zip Code 99502 Site address 7102 Theresa Mae Circle Anchorage, AK Zip Code 99516 Legal description (Sub'd., Block & Lot) Lot 2A, Theresa Mae Subdivision Legal description (Township, Range & Section) Lot Size 52,525 Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field El Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well 0 Water Storage 101 Number of Bedrooms Five (5) THIS APPLICATION IS AN: Initial Upgrade ❑ Renewal ❑ 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. E. (Signature of property owner or authorized agent) Permit/Rush Fees: L160 t 175 Waiver Fees: Date of Payment: 0/20L07 Date of Payment: Receipt Number. L4 25 43 Receipt Number. (Rev. 11/05) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 FAX August 19, 2007 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 2A, Theresa Mae Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 2A, Theresa Mae Subdivision intends to construct a new five - bedroom home on the lot. A shop will also be constructed with a bathroom and a connection to the septic tank. The system will be designed and constructed for five bedrooms. We are therefore requesting a permit be issued for the construction of a new well and septic system to accommodate the home and shop. The attached Site Plan and backup documentation identify the location and configuration of the proposed well and septic system along with the alternate site. Drainage arrows are shown on the site plan showing the grade and direction of flow on the lot. The drainage pattern will not be changed as a result of this project. The test holes placed on the lot in the area of the absorption trench and alternate site indicated silt with sand and gravel. The percolation rate of the soil was determined to be between 31 and 60 minutes per inch. No groundwater was found during the placement of the test holes and none was noted during the monitoring period. An application rate of .45 gallons per day per square foot was used in the design of the absorption system. We are proposing to place a new 1,500 -gallon septic tank and 2- 46' long by 3' wide by 9' effective depth absorption trenches to treat and dispose of the effluent generated in the house. The elevation of the distribution line in the absorption trenches will be 3.0' below the surface and the total depth will be 12.0'. A minimum of 3' of fill or 2" of insulation and 2' of fill will be placed over the absorption trench and 4' over the septic tank. A flow splitter valve will be placed to insure even flow to each trench. The ground surface on the lot in the area of the absorption trench slopes to the west at constant grade approximating 5%. The new trench will be constructed parallel with the Lot 2A, Theresa Mae Subdivision August 19, 2007 Page Two slope as much as possible in conformance with Municipal requirements. The new septic system will be constructed a minimum of 100' from all wells and any surface water and 10' the proposed and existing water services in the area. If the system is constructed in accordance with our design the following statements apply: 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, '7/4-,c" EJcc-.o Michael E. Anderson, P.E. Attachments 1 A AeCA Fin � � 2- . � § . ` | ¥ � ` |« k | iI � A,,,, E � ' § - k & D E I , � § m $ ■ -f- c 2 0 ` GROVE` E u :} o-� }\0 -v.,_ oo,q* ; . \ •� . %. . � ��, 0 mH m I I N I 1 I N 00'02'191V 165.23' 10' T. k E. ESNT. I ---------------------'� I I � I I i� 8 I �x(A> I YO i I vm*or � I I m 01 ju D In OO v M I'rq I �wtAi�oo I �i D C I co I I SO r -1 �� N® 9.xN o Oam e o m+ ow 0 I �T I I m I � I I m Cn D In OO v M I'rq i cl) � I o D C I co I � I I o ONO i _Z ID o r • • " • •'9�••� I •tri 17� •S •�� Id N D m Id LOT 2A, THERESA MAE SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Five Bedroom Home Deep Trench System Perc. Rate: 31 to 60 Min./Inch 1,500 Gallon Septic Tank Application Rate: .45 GPD/SF 9' Drainfield Rock 5 Bedrooms X 150 GPD/.45 GPD/SF (Application Rate) = 1,666.7 SF Absorption Area 1,667 SF/5 SF/LF-.5 (Red. Factor) = 166.7 LF Trench Length THEREFORE: Construct 2-84' Long x 5' Wide x 4' Effective Depth Absorption Trench at the Location Shown. Flow Line Elevation in Trench to be 6' Below Original Ground Surface. Total Depth to be 10' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption Trench. Maintain 100' Separation from Wells in the Area. Natural Backfill 5'6" Geotextile Fabric 6.. O 4" Perforated PVC (Holes Down) 4'0" 5' Fri Drainfield Rock TYPICAL 5' WIDE TRENCH SECTION.,•��••..�♦♦♦ (NO SCALE) = �P' ......... ♦♦i NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. ,••-•'•. .»49m..._.. _..».». Minimum 4' Separation From Groundwater. o ,'tl . . Minimum 100' Separation From Wells in the Area. � '. MK VELE DeR o Minimum 100' Separation From Surface Water or Streams.' ♦i,%A,{ ;;�., MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT/BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM 4700 BRAGAW STREET ANCHORAGE, AK 99519 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: THERESA MAE SID PERFORMED FOR: SHAWN COOLEY DATE: 4/7/2006 PROJECT No.: M0608 PARCEL ID#: TEC UQCIAN: A. HARALA TEMP: 45° DIiPTII TEST HOLE 2A-2 (&i) � COMMENTS: OB/OG WELL COMPACTED DAMP SILTY SANDS W/GRAVELS SM -GM WAS GROUNDWATER ENCOUNTERED? IF YES, WHAT DEPTH? DEPTH OF WATER AFTER MONITORING: DATE: SLOPE 0% No .�.,• 49th MICHAEL L ANDERSIN No. CE -4361 SITE PLAN LOT 2A TO None A- 0% 5/20/06 DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) WATERF (INCHES) NFT DROP (INCHES) 4/7/06 TEST HOLE PRESOAKED PRIOR TO TESTING: 1 1150 11.0 CHARGE 2 1220 30 9.375 1.625 3 1220 12.0 CIIARGE 4 1250 30 10.5 1.5 5 1250 11.375 CHARGE 6 1320 30 9.75 1.625 PERCOLATION RATE• 18_5 (MIN/INCII) PERC. HOLE DIA,_§_jINCIIES) TEST RUN BETWEEN:: 4_5 FT. and 5_5 Fr. TEST PERFORMED BY: AH I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 5/20/06 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT/BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM 4700 BRAGAW STREET ANCHORAGE, AK 99519 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: THERESA MAE S/D PERFORMED FOR: NORTHERN HOME BUILDERS DATE: 7/22/2007 PROJECT No.: PARCEL ID#: TECIINICIAN: A. HARALA TEMP: 45° Dr:Pnl TEST HOLE 1 (&m) 1ZZ4OB/OG SLOPE SITE PLAN • LOT 2A 2 TH2 •l 3 O TI 5 0% I 6 WELL COMPACTED DAMP 7 SILTY SANDS W/GRAVELS SM -GM 8 w:: q.•• 9 "• WAS GROUNDWATER • : ENCOUNTERED? NO 10 •; IF YES, WHAT DEPTH2 0% I I DEPTH OF WATER None AFTER MONITORING: OIA TP- 8/I8/2007 12- 13- 14- - 2 1314 •'.. 15 16 18 19 4s COMMENTS: E. ANDERSON CE -4380 •JO•C7.•'0< DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) Dy C,TERD (INCHES) NFT DROP (INCHES) 8/14 TEST HOLE PRESOAKED PRIOR TO TESTING: 1 2:04 2.38" CIIARGE 2 2:34 30 3.00" .62" 3 2:36 2.75" CHARGE 4 3:06 30 3.25" .50" 5 3:07 2.50" CHARGE 6 3:37 30 3.00" .50" PERCOLATION RATE 60 (MIN/INCI I) FERC. HOLE DIA. 6 (INCHES; TEST RUN BETWEEN:: 5_0 FT. and 5_5 FT. TEST PERFORMED BY: AH I, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 8/20/06 Municipality of Anchorage Development Services Department Building Safety Division yt On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchoraoe ak.us (907) 343.7904 A _ 'ISoil}sLog - Percolation. Test Performed For. l�L.vr1Y 3(.j r4. ,, A Date Performed: -L Legal Description: Mje�Sn M A L/� Township, Range, Section:, '© 0 3-1 o IAt� o v l ►1 4- L • 1 6- ' 7- 10- 11-,Z.. -10-11- • Sr/5M 12-:i ICF1st5 13- 14- 7 j 15- G� 16- (r! 17 - COMMENTS Vy" WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? NArclt L Depth to Water After 0 Monitoring? N 0,49t*. E" Date: 1 1(v 1717 PERCOLATION RATE tm.wtf~w PtRO HQLt VUVALJ to TEST RUN BETWEEN FT 'AND FT PERFORMED BY: . I CERTIFY THATTHIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPALGUIDELINES IN EFFECT ON THIS DATE. DATE: MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT/BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM 4700 BRAGAW STREET ANCHORAGE, AK 99519 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: THERESA MAE S/D PERFORMED FOR: NORTHERN HOME BUILDERS DATE: 7/22/2007 PROJECT No.: PARCEL ID#: TECIMCIAN: A. HARALA TEMP: 45° Dr•.Pnl TEST HOLE 2 (rml) 1 OB/OG 2 3 4 5 �• 6 WELL COMPACTED DAMP 7 a SILTY SANDS W/GRAVELS 8 w SM -GM y •• 9• WAS GROUNDWATER SITE PLAN LOT 2A TH2 O THIO • : ENCOUNTERED? No 10 .•• IF YES, WHAT DEPTH? I I DEPTH OF WATER None 0% AFTER MONITORING: 12 DATE: 8/18/2007 ., a• 13 .: . 14 •:'•'.a 15 •: 16 17 18 °' BOH 19 COMMENTS: DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) Dy PTERD (INCHES) N€T DROP \INCHES) 8/14 TEST HOLE PRESOAKED PRIOR TO TESTING: 1 2:12 4.63" CIIARGE 2 2:42 30 5.38" .75" 3 2:44 4.25' CHARGE 4 3:14 30 5.38" .63" 5 3:16 4.38" CHARGE 6 3:46 30 5.00" 62" PERCOLATION RATE•• 48 (MINANCII) PERC. HOLE DIA. 6 (INCITES) TEST RUN BETWEEN: 5,_0 FT. and 5_5 FT. TEST PERFORMED BY: AH 1, MICHAEL E. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 8/20/06 'P3_15 Municipality of A�chorage Development Services Department 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 N,4CERTIFICATE OF ON-SITE SYSTEms APPROVAL (907) 343-7904 Pip FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-06140 COSA# C i�iy3 6 Expiration Date: j(`1jD4 1. GENERAL INFORMATION Complete legal description Lot 2A. Theresa Mae Subdivislon Location (site address) 7102 Theresa Mae Circle Anchorage, AK 99516 Current Property owner(s) ColonyBuilders Day phone 345-0371 Mailing address 9420 Vanguard Drive Anchorage, AK 99507 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: Five (5) 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site❑ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certifieates of Onsite 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 numberppf bedrooms and type of structure indicated herein. I further verify that based on the Information obtained jrom the Municipality of Anchorage files and from my investigation and inspection, the on-site water supplX and/orwastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinanfes, and regulations in effect at the time of installation. : I Nan)e of Firm Anderson Engineering Phone 522.7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 10112no08 6. DSD SIGNATURE 6 :� MAIM ate' CE -4381 ; y" Approved for S bedrooms.rj �fp'fd'/f--o4; Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Well Flow Advisory Nitrate Advisory By. (Rw. 5L05) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: D Municipality of Anchorage ., • "' Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsfe (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 2A. Theresa Mae Subdivision - Parcel ID: 015-081.40 A. WELL'DATA Well type R to Date completed 8/4108 Total depth 178 ft. Date of test , Static water level If A. B, or C provide PWS ID N _ Well log (YM) Y Sanitary seal (YM) Y Wires property protected (YIN) Y Casedto 778 ft. FROM WELL LOG Well production WATER SAMPLE RESULTS: 8/42008 73 ft. 20 Coliform 0 colonies/100 mL Nitrate N/D mg/L Arsenic: ND mg/I Date of sample: 102M8 B. SEPTICIHOLDING TANK DATA Tank Type/Material SepudSteei Tank size 1.500 gal. Number of Compartments Two Foundation cleanout (YM) Y Date of pumping New Construction Casing height (above ground) >24 in. AT INSPECTION ft. g.p.m. Otherbacteria 0 colonies/100mL Collected by: J. Daws Date Installed 8152008 Cleanouts (Y/N) Y Depression over tank (YM) N High water alarm (YM) N Pumper C. ABSORPTION FIELD DATA Date Installed 8/6-12/oe Soil rating (g.p.d.M2 or ft /bdnn) A5 GPDISF System type s Voda Trend, Length 168 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 1x11 fL Eft. absorption area 1.68-0 ft2 Monitoring tube Y Depression over fleld N Date of adequacy test New Const Results (Pass/Faif) For bedrooms Fluid depth In absorption field before test in. Water added gal. : New depth in. Elapsed Time: min. Final fluid depth in. Any rejuvenation treatment (past 12 mo.) (YM & type) N Absorption rate >= -g-p.d. If yes, give date D. LIFT STATION Date Installed Size in gallons Manhole/Access(YIN) 'Pump on' level at_ in. 'Pump air level at_ in. High water alar level at in. Datum Cycles tested Meets alar 8 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 >29 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 >S Property line>S Absorption field >S 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 170' Building foundation >10' Water main >1a Water Service tine >10' Surface water >100' Driveway, parking/vehicle storage >zs Curtain drain None Noted Wells on adjacent lots >100• F. COMMENTS: a'f��' • �yr�o .•��.* G. ENGINEER'S CERTIFICATION *; 49D o I certify that I have determined through field inspections ande'•' "'•' "'n"• '�'• '0 review of Municipal records that the above systems are in �...�. i conformance with MOA COSA guidelines in effect on this date. p YTCHAEL. &-MDERSON: Engineer's Printed Name Michael E. Anderson, P.E. +� yrs+:;0-%J-tl•'t��y Date 10/1312009 UWaiver COSA Fee 3 Fee $ j49 Date of Payment I a Date of Payment Receipt Number. �T 1C1 �1'� Receipt Number (Rev. 11/05) T 0o 40 N N 44kt N 10'T. do E. ESWr. r— — — — I I I I I — — — — — — — — — — — — — — — — — — — —I—. i I I I � I 1 I I I I • � I I I I I I , I o • I I� q'I � I o , 37.9' o'o� I rtp1 A,� u Yn I , At _J r 20.0' I 46.3' I I I � I I I I ,o m I I FD W O v 00.02'34" 1H 115.21' 52� N Fa m VY V 9