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HomeMy WebLinkAboutMEADOW ROAD LT 2Meadow Road Lot 2 021-022 -57 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~"L,~ 9~.O,3~(¢ PIDNumber: 0~1 -~-~ N~m~: Wastewater System: ~ New 0 Upgrade Address: ~o~7 ~o~ ~o~ ~c4 ~/~ ~e~,~ABSORPTIONFIELD No. of Bedrooms: Phone: ~ ~--_ ~ ~ ~ D Deep Trench ~ Shallow Trench ~ Bed ~ Mound .~ Other LEGAL D ESCRIPTI ON so, Rating: Total Depth from original grade; J ' ~ GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom ~rom original grade: Gravel depth beneath pipe Township:j ~ I Range: Section: Fill added above original grade: Gravel length: WELL: ~5~ ~ New ~ Upgrade Gravelwidth: Uumber0flines: Distancebetweenlines: ~ 0 Ft. 3 /¢ Ft. CIsssification (Private, A,B,C): Total Depth: ~ Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: Pump ~et at: Casing Height Above Groued: ~p~ ~. ~. TANK SEPARATION DISTANCES s Septic U Holding ~S.T.E.P. To Sep[~c Absorption Lift Ho]ding ~ublic/Private Manufacturer: Capacity in gallons: From Tank Field Slation Tank S ..... Lines ~ C~Or~ ~ ~ ~ Material: Number of Compartments: Surface W~ter > I~O' ~ ~OO' ~ WO' - LIFT STATION Lot Size in gallons: Manufacturer: "Pump on" level at: "Pump off" level at: High water alarm at: Curtain Pump Make & Model Etectrical Inspections pedormed Remarks: ~h;X ~ ~ ~F~,~f BENCH MARK Location and Description: Assumed Elevation: ENGINEER'S SEAL 2nd 7/~/e~ ~~~ ~'% Department of Health, and Human Services approval '¢¢~¢~,... c~-358g Reviewed and approved by: Date: /- 2~ - ~ 72-013 (Rev. 9/91 ) MOA 25 SWING TIES .............. J~' .~ FROM: COR. A COR B COR'F' COR X ' /I ; i /I ,, TO: , , .... 54 49 , I C.O.C //~ ',. , M.H. D 62' 53' P' I , CORE 62 65 ~ COR "F" 83' TELECOMMUNICATIONS SITE , ............. (NO ON-SITE WELL OR SEPT C) ~ II · ,t.,; U I't / It)' ~0 ~ C.C. "G" 13' 33' -- M.T. "H" 14' 32' , C.C. "1" 22' 36' M.T. "J" 23' 31' C.C. "K" 31' 43' M.T. "L" 34' 38" 5' x 25' RESIDUAL DISPOSAL DRAINFIELDS '19' x 19' SAND 'FILTER (INSIDE 21' x 24' STORAGE SHED) 1250 GAL. STEP TANK ABANDONED WELL- 20 0 20 40 60 80 100 FEET LOT 2, MEADOW ROAD S/D : : INTERMfrI'ENT SAND FILTER , AS-BUILT SITE PLAN FLATTOP TECHNICAL SERVICES 1 INCH = '50 FEET 14530 ECHO STRg. g.T DRAWN'BY TFM ANCHORAGE, ALASKA 99516 OCTOBER, 1993 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. Z PERMIT NO: SW920388 PAGE 4 OF 4 PID NO:021-022-57 125O GALLON STEP TANK EFFLUENT DISTRIBUTION P~PES INV 85.79 19'x 19' INTERMI'FI'ENT SAND FILTER RESIDUAL DISPOSAL TRENCHE.c LOT 2, MEADOW ROAD S/D SEPTIC SYSTEM UPGRADE , CROSS-SECTION - AS-BUILT ~ATTO? 'I~CRNICA[, SImP, VICES NOT TO sCALE ~.4530 ]~CHO $'T~'F~."[' DRAWN BY TFM ANCHO]~J~G]~, AL.ASY. J~ ~)95].6 OCTOBER, 1993 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT NUMBER:SW920338 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:PATON WILLIAM OWNER ADDRESS:10177 MEADOW RD ANCHORAGE AK 99516 PAGE 1 OF 1 PERMIT DATE ISSUED:10/06/92 EXPIRATION DATE:10/06/93 PARCEL ID:02102257 LEGAL DESCRIPTION: MEADOW ROAD LT 2 LOT SIZE: 54058 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. THE PROPERTY OWNER AGREES TO THE ATTACHED SPECIAL PROVISIONS,. ISSUED BY: ~0~ ~-~'~ DATE: SPECIAL PROVISIONS FOR PERMIT NO. SW920338 The subject permit is for the construction and testing of an innovative intermittent sand filter wastewater disposal system. The property owners will allow the Department of Health and Human Services (DHHS) and its representatives access to the subject property as required during construction and testing of the wastewater system. If the system does not receive final operating approval from DHHS, the property owner agrees to install a holding tank or construct a conventional on-site wastewater disposal system. It is expected that the effluent discharged from the filter will meet or exceed the following parameters: BOD5 ' 10 mg/1 TSS 10 mg/1 Fecal coliform 500/100mi It is expected that, as a minimum, 12 sampling events will be required, 1 per month for 12 months· Additional or extended sampling and testing may be required should the system not perf~orm as expected during the 12 month test period. OP TECHNI:CAL .oER? TItEODORE F. MOORE, P.E. PH: (907) 345-1355 CIVIL & ENVIRONMENTAL ENGINEERING * ENERGY CONSERVATION & ANALYSIS March 9, 1992 14530 ECHO ST. ANCHORAGE, ALASKA 99516 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a -~ permit to install an intermittent sand filter system as a replacement wastewater disposal system for the existing 3 bedroom William Paton residence on the S1/2, NE1/4, NE1/4, NWl/4, SE1/4, Section 30, T12N, R3W, S.M., located at 10177 Meadow Road in Glen Alps. A site plan, design drawings," . specifications and soils logs are enclosed for your review. We think that this problem site is an excellent candidate for one of the experimental systems to be constructed with assistance from the Alaska Science and Technology Foundation grant which you recently received. Please let us know if there is a formal application process which must be complied with. The existing septic tank and soil absorption trench system is in a state of failure, and the combination of poor soils, shallow bedrock, and high groundwater render a conventional upgrade unfeasible. The topography of the lot slopes generally to the northwest at 10 - 30%. The proposed construction site is in a shallow swale which has a shallow water table, but carries no surface flow. We have specified that a curtain drain be installed to provide additional dewaterization of the site prior to the start of construction. You will note that we have patterned the sand intermittent £flter insofar as possible after the accepted design presently in use in Oregon, but have added insulation and 2' of soil cover for frost protection. We · have sized the 3 residual disposal drainfields on the basis of 1.2 gpd/sq, ft. Since they will be connected in series this will give an opportunity to determine how much area is actually required for treated sand filter effluent. Because of the variable soils encountered we have specified that the drainfields be overexcavated by 2 feet and then backfdled with 2 feet of sand prior to placement of sewer gravel and drain tile. This, we believe will enhance the ability of the effluent to percolate into the native soil. We have specified the installation of a sampling well in the line between the sand filter and the residual disposal ddrainfields, and would anticipate smnpling will take place there and at the lift station intake. We look forward to working with you to develop a meaningful sampling program, and are prepared to make provisions for additional sampling if you feel it is warranted. Please give me a call if you have any questions as you review this submittal. Sincerely, Ted Moore, P.E. Flattop Technical Serv~es 14530 Echo Street, Anchorage, AK99516 Phone (907) 345-1355 I NE¼, NE¼, NW¼, 1 Sy, SE~, Section 30, T12N, R2W, S.M. 10177 Meadow Lane, Glen Alps Intermittent Sand Filter Specifications 1.0 General: 1.1 The scope of the project consists of the installation of a curtain drain plus a 1250 gallon septic tank with an integral lift station which discharges effluent to an intemdttent sand filter. The effluent from the intemiittent sand filter is then collected and discharged into 3 parallel 5' wide by 25' long residual disposal drainfields. 1.2 Construction shall be as depicted on the approved site plan and design drawings including Isf, 2sf and residual disposal drainfield. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall 'Conform with Municipal and State requ'rrements. 1.3 All separation distances shall be in conformance with Municipal requirements, unless specifically waived. The residual drainfields shall be no closer than 2 feet from the property line. 1.4 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.5 Finish grading, including placement of 4" of topsoil and seeding is requked by the Municipality, however it is the responsibility of the owner and is not covered by the engineering inspections. 1.6 Prior to the start of construction, the property owner shall arrange for a surveyor to flag the propelXy line in the vicinity of the proposed sand filter and residual disposal drainfields. 2.0 Curtain Drain: 2.1 Prior to the start of construction of the intermittent sand filter, a curtain drain configured as shown on the site plan and design drawings shall be installed no closer than 30 feet uphill and to the sides of the proposed septic .tank, intermittent sand filter and residual disposal drainfields. 2.2 The property owner shall be responsible to obtain any necessary easement to allow installation of the portion of the curtain drain crossing the lot to the north. 2.3 The curtain drain shall be created by excavating a nm~row trench with a continuous slope to the north, extending as deep as possible into the underlying fractured bedrock. 2.4 The sides and bottom of the curtain drain french shall be lined with geotextile triter fabric and a 4" diameter perforated pipe (ASTM F-810) shall be laid in the bottom before backfill to within 12" of ground surface with standard sewer gravel. "Miradrain" may be substituted for the sewer gravel. The filter fabric shall be folded over the top of the gravel before final backfill. 2.5 The curtain drain shall daylight out at an elevation 3 feet lower than the bottom of the residual disposal drainfields. 2.6 No engineering inspections are required in the course of the installation of the cumin drain. 3.0 Septic Tank: 3.1 The septic tank shall be a Municipally approved, 2-compartment STEP tank with a capacity of 1250 gallons set level on undisturbed soil. The second compartment'shall be equipped with an "Orenco" package lift station. Each compartment of the tank shall be equipped with a 4" diameter cleanout, and physical access to the second compartment shah be provided by means of a watertight, insulated riser and manhole cover. 3.2 The tank shall be buried a minimum of 2 feet, and if the burial depth is less than 4 feet it shall be insulated with 2 inches of approved burial type, rigid insulation. 3.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The 4" wasteline from the residence shall have a minimum slope of 1/4" per foot, and a cleanout shall be installed within 5 feet of the building foundation. The discharge line from the lift station to the intermittent sand filter shall be 1.25" diameter Schedule 40 PVC. 3.4 The on, off and alatrn floats shall be set at the elevations specified by the supplier. The lift station shall he equipped with a high level audible and visible alarm located inside the residence to alert the occupants when the fluid level in the tank rises above the design elevation. 3.5 Installation of a lift station pump within the Municipality of Anchorage requires a valid eleCtrical permit. The contractor shall be responsible to obtain the necessary permit and Municipal inspection, and shall provide a copy of the inspectors report to the engineer overseeing the construction of the intermittent sand filter. 4.0 Intermittent Sand Filter: 4.1 Site preparation consists of excavation of a 20' x 20' level pad set as deep as practical up to 6 feet below ground level. Care shall be taken to hnsure that gravity discharge will be possible from the bottom of the filter to the residual disposal drainfields. The surface of the excavation shall be prepared by placing and compacting approved medium sand to achieve a carefully leveled sand surface within +/- 0.1'. 4.2 Next the 4' high sidewalls of the 19' x 19' sand filter enclosure shall be constructed of 1/2" exterior plywood, framed as necessary to hold in position during placement of the filter materials. Any portions of the enclosure that will be within 3' of the finished graded surface shall be insulated with 2" or rigid, burial type insulation. To maintain the stability of the enclosure during filling, the space between the plywood and the sidewalls of the excavated area shah be filled with sand at the same rate as the inside is filled. 4.3 A 30 mil PVC liner as supplied by "Orenco" shall be laid inside the filter box prior to placement of fdter materials. A 4" diameter underdrain of slotted ASTM D-3034 pipe shall be laid in the bottom of the filter box passing out tlu'ough a 4" diameter PVC "boot" where a sealant strip and stainless steel band is to be installed to insm'e water tightness. The 4" diameter D-3034 discharge line between the sand filter and the residual disposal drainfield shall be equipped with a cross fitting as shown providing a 2' deep capped sump and 4" riser extending 2' above final grade to allow for pumping of the sump and subsequent sampling. 4.4 A total thickness of 8" of 1/4" "Block Pea Gravel" shall be placed in the bottom of the filter box surrounding the 4" diameter underdrain. M.O.A. approved "sewer gravel" may be substituted for the material immediately surrounding the underdrain. Care shall be taken to ensure that the top surfaces of each material layer is level. 4.5 On top of the pea gravel layer a total thickness of no less than 24" of"Concrete Sand"shall be placed. The sand supplier shah be requested to test and designate that portion of their "Concrete Sand" stockpile for which less than 4% passes the #100 sieve, and only this material shall be utilized in the sand filter. The contractor shall supply a copy of the sieve analysis report to the engineer. 4.6 On top of the filter sand a total of 9" of I/4" "Block Pea Gravel" shall be placed. The distribution ' pipe network consisting of a 2" Schedule 40 PVC manifold and 1" diameter Schedule 40 PVC laterals shall be buried level in this pea gravel stratum such that the pipe inverts are no less than 6" above the top of the underlying sand filter layer. The PVC laterals shall have 1/8" diameter orifices drilled in the tops spaced on 2' centers, and shall have capped upturns at the ends configured as shown on drawing lsf. 4.7 The top of the upper pea gravel stratum shall be covered with approved filter fabric plus 2" of rigid burial type insulation, plus a minimum of 2 feet of soil cover. The top 4" of the soil cover shall be topsoil, and the soil cover shall be mounded at least 6" above the surrounding terrain and graded to drain off the top of the sand filter. Side slopes shall be no steeper than 2:1. The owner shall be responsible for final grading of the topsoil and seeding to prevent erosion. 5.0 Residual disposal drainfields: 5.1 The 3 parallel 5' wide x 25' long residual disposal drainfields shall be configured as shown on the plans, with the required absorption area being 1/2 that required for a typical septic tank effluent soil absorption trench, based on the perc test results. 5.2 The dralnfields shall be constructed by excavating 5' wide trenches to a depth of 5' below the original ground level and then backfilling with 2' of coarse pit run sand prior to placement of 1' of sewer gravel. 5.3 The bottom of the drainfield shall be level and the 4" diameter distribution pipe shall be buried level in the sewer gravel such that the invert of the pipe is no less than 6" above the bottom of the sewer gravel. The 4" diameter non-perforated pipes linking the drainfields shall be configured with a 6" high bump favoring retention of the liquid in the upper drainfields first. Monitor tubes shall be configured as shown on the design drawings. 5.4 The top of the sewer gravel shall be covered with approved filter fabric plus 2" of rigid, burial type insulation, before backfill with no less than 2' of soil cover. The top 4" of the soil cover shall be topsoil and the soil cover shall be mounded at least 6" above the elevation of the surrounding terrain and graded to drain. The owner shall be responsible for final grading and seeding of the topsoil. 6.0 Inspections: 6.1 A total of 7 engineering inspections will be required during the course of the sand filter construction: (1) initial stakeout with the contractor to establish the locations of the system components and to discuss the plans, specifications and construction procedures, (2) after the filter pad has been constructed and plywood sidewalls erected, (3) after the PVC liner and underdrain have been installed, (4) after the underdrain pea gravel has been placed, (5) after the filter"concrete sand" has been placed, (6) after the upper pea gravel has been placed and the distribution pipe network is in place but prior to placement of filter fabric or insulation, and (7) after final backfill and grading is complete. 6.2 A total of 3 additional engineering inspections will be required as follows: (1) After the septic tank/lift station has been set level and all piping connected, but prior to backf'fll, (2) after the excavation for the residual disposal drainfields is complete, but prior to placement of sand or sewer gravel, and (3) after the sewer gravel and distribution piping is in place, but prior to placement of filter fabric, insulation and final backfill. These inspections may be incorporated with any of the above inspections, if feasible. 6.3 The installer shall coordinate the timing of the inspections with the engineer sufficiently far in advance to ensure the availability of the engineer. 01{4~N 0~ ~ ~.0 3 }~ $30' T' I~.~.~ COtI~i ~N Icb T go~.~ Flattop Technical S~rvice~ 14530 Echo Street Ancho~aqe, Alaska 99518 $ / TE ~ P pRO.~t t..1A'F~, PI~A hi ~ CRo~s - S~¢7'/o6l pu.,N, B Y: Flattop Technical Service~ 14530 Echo Street Anchorc~ce, "'- ' .~.,~c,s~.a 995tR 16'- O" 19' the tad< To TOP ViEW 19' x 19' SAND FILTER GRAVITY DISCHARGE 14530 Echo Street Anchorage, Alaska 99518 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG'-- PERCOLATION TEST 'T. ~1.-~ ~ PERFORMED FOR: BILL PATOH PER F~0~ E'D:' DATE LEGAL DESCRIPTION: 5~'"")., N~ ~/~., ~ Y~/,NMY~..S£ ~/3,,~ownship, Range, Section: TmN, R~.~', ~,~¢ 30 SLOPE SITE PLAN 1 ML TAN "~ 2 ! ML GRAY ~ GRAVELLY 3 'ML TAN/J .SILT 4 tt2o SEEP5 7 ~,:z° SEEPS ~u~H OUT NoR-r~ 10 WAS GROUND WATER ENCOUNTERED? 11 B.H. BEbROCK 12 13- 14- 15L 16 17 18 19 20 COMMENTS IF YES, AT WHAT OL DEPTH? .~J[ [:::~ ~ Depth 10 Water Alter ~" Monitoring? Date: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ TEST RUN BETWEEN minutes/inch) PERC HOLE DIAMETER FT AND FT PERFORMED.y: .FzA~ror TSc~. Svc_~. , _~-.~ 9~OER"FVT"ATTH'S,ESTW^SPER,0RMEO,. STA~FE ACCORDANCE WITH ALL AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; "~,~ /~/ 72-008 (Rev. 4/85) PERFORMED FOR; BILL LEGAL DESCRIPTION: ~ 2 4 14530 Echo Street Anchorage, Alaska 99516 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG'-- PERCOLATION TEST · N/~ ~/~) NE ~/~,NIv'Ye~S£ ~/T~°wnship' Range, Section: "r'12./,~, R2. k/, ~ SLOPE SITE PLAN GRAVEL RoCK B.H, ~ARb£~ BEDRocK 9 10 11 12 13- 14 15 16 17 18 19- 2O WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT DEPTH? SEEPS ~ 3,~ pO E Depth to Waler AllerlQ e Monitoring? ,- Dole: Gross Net Depth to Net Reading Date Time Time Water Drop __ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN FT AND --FT AOOOHDANOE WITH ALL ~TA~E AND ~UNiOIPAL GU DEL NE~ NEFFEOTONTHIGDATE. DATE: 72-008 (Hev, 4/85) PERCOLATION RATE CERTIFY THAT THIS TEST WAS PERFORMED IN 7/t~/9/ 14530 Echo Street Anchorago, Alaska 99516 Municlpallt¥ o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG'-- PERCOLATION TEST T,H.~3 PERFORMED FOR: BILL PATOH LEGAL DESCRIPTION: ,~/:::Z, N~. ~/~., ~. ~,/,l~/,/.Y,.(,_~£~ownship, Range, Section: '1'12.~, R2. k/, 5£¢ 30 SLOPE SITE PLAN PT 2 3 4 5 GM /HL VERY lt~o' .S [EPs 8 9 10 11 12 13- 14- 15'- 16- 17- 18- 19 20 BEDROCK COMMENTS ~'~ ~, WAS GROUND WATER ENCOUNTERED? Y S .L IF YES, AT WHAT ~' ~ DEPTH? ~#E~ (~ pO E OeplhtoWalerAIler., ,, Dale' Monitoring? '¥ 2. . Gross Net Depth to Net Reading Date Time Time ~, I ~") Water Drop ~:oo m z3 ~/~ ale S:oq ~ ~8 PERCOLATION RATE //O (minutes/inch) PERC HOLE DIAMETER . TEST RUN BETWEEN ~.O FT AND 2 ._~ FT t, ol , PERFORMED BY: F'/AT'TO~=~ "r~c'c~-~. ~[/'c.~. i ,~"*-~-- ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STA~E AND M_UNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev, 4/85) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS FOR A SINGLE FAMILY DWELLING Parcel I.D. O~Z.l - GENERAL INFORMATION Complete legal description Location (site address) COSA# 0 . 1011° I Expiration Date: /-- i / Current Property owner(s) I.,(.,',lle~r,,, PR/z',',") Day phone "~ 30 ~- 3'~¢~¢'~ Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless 'otherwise requested, COSA will be held by DSD for pickup. NUMBER, OF BEDRooMs: '3 TYPE OF WATER SUPPLY: Individual Well ,. [~ Individual Water Storage [] Community Class Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. DSD SIGNATURE ~,/// Approved for _"~ Disapproved. Conditional approval for Name of Firm ~' I~, ('-/~/¢ ')-'~¢ ~,~; ~<f ,.( ~¢. Phone Address I ~-3~ ~<~¢, ~ 7~,~ ~J,~ ~,~ ~ Engineer's Printed Name ~ ~,d~¢ P, t~ o ~'~ Date bedrooms. .... bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11105) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other .~~Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: ~/" ~: ~ ~,,~ ,,~c,,,.c<,, A. WELL DATA Welltype I~,/' IfA, B, orC provide PWSID# '- Date completed ~ ! 2.?/85" Sanitary seal (Y/N) Total depth ~-oO~ ft. Date of test Static water level Well production Cased to ~.~'ft. FROM WELL LOG ~/~ / ~ ~.p.m. Parcel ID: Well Log (Y/N) Wires properly protected (Y/N) casing height (above ground) AT INSPECTION 7 /~-.."// ~¥ ft. I, ~ g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/lO0 mL Nitrate ~.~' ~ mg/L Arsenic: ~ ~ ug/L date of sample: 7./.2-7' ! ~ Other bacteria ~ 'colonies/100 mL Collected by: Be SEPTIC/HOLDING TANK DATA Tank Type/Material .~'r'~'r~ / ,..('/-,e ~ ! Tank size I~ gal. Number of.Compartments Foundation cleanout (Y/N) ~ Depression over tank (Y/N) Date of pumping '7/7..'7/ IO Pumper j~r-+ Date installed A'~,.~.~r/': Cleanouts (Y/N) High water alarm (Y/N) ABSORPTION FIELD DATA Date installed /q-~e~ t~q.{ Soil rating (g.p.d./~ or ft=/bdrm) ~ Length '7v4- ft. Width ~ ft. Total depth ~/ ft. Eft. absorption area'37~"ftz Monitoring tube . Date of adequacy test '7 ! ~'/~...~ ~ .Results (Pass/Fail) Fluid depth in absorption field before test O.~in. ~'o ~t' Water added 30,,~ gal. Elapsed Time: ~ q~'-min. Final fluid depth ~,~' in. Absorption rate >= Gravel below pipe 0, b"' ft. ¥ Depression over field /V For ~ bed~,o, ms New depth.~. ~:;~ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) , h/ If yes, give date LIFT STATION Date installed ~'~. "Pump on" level at ~ in. Datum ~ ~'m Size in gallons ~'n/'e~,~l "Pump off" level at .~.O in. Cycles tested ~ ManhOle/Access (Y/N) · High water alarm level at Meets alarm & circuit requirements? in. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: SePtic tank/lift station on lot Absorption field on lot Public sewer main !00 ' 1~' On adjacent lots ~ I ~.~,, ~ On adjacent lots ~, l.~,o ' Public sewer manhole/cleanout Sewer/septic service line Animal containment areas Holding tank M, A,. Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ff~' Property line ~,,(' ' Absorption field Water main ~. ~. water service line ~, tO ~ Surface water · Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line '?-' y' Building foundation ? ~ ' Water main Water Service line _'~ ~,, ~ Curtain drain ~ .3'~' ' Wells on adjacent lots '~ l~c,' F. COMMENTS ~T~ ~/~.~/0w~/.~$ew,~/~,o(~ 7/~7/10 ~ ~ep~ho~ ~,~ ~ ~o~ ~ opp~ ~ ~/-~1~ G, ENGINEER'S CERTIFICATION Surface water ~ 4 ~,,o' ~ Driveway, parking/vehicle storage I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name '"r'h a~,~_.zo ~ [=% ~vo o ~ Date ~ / "2..7' / to COSA Fee $. Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number ",~/-/~L / C ~OADWA'T'.t2L/R/::~$EZ" "ES"./Vl~ 8Ko ~¢,¢, ,'q:~. 710 N4/'¢ NW/4 3E/4 $£Co ap, T~/Z~ ,qo z w, S~o 36' o, AAEADOW . 327o..9/' LOT Z o /o Z4/ACo Lot __2 , Block e dow /Ro d AI8.9° 55' 5,_9"W LOT SURVEY CERTIFICATION I hereby certify that I hove ~erveyecI the ~ty sh~a and ~serihed her~, ~a ~t ~ ~ovement~ situeted t~re~ are within erty li~s o~ ~ not ~erlop or ~or~ooh ~' odJooent ~operty ond thQI no I~te ~ ~jo~nt ~ty wlop ~ ~eh ~ the q~tl~ o~ thor th~ o~e flo ~odwQys, utility I~, ~ Gibe.visible Easements of reoord other than those ~)wn the plat of rebord ore not 8hown here~n unlefl. otherwle® noted. . LEGEND ~ Brass or Aluminum capped monument 0 Iron pipe and/or rebar recovered. D 2 x 2 hub & reck recovered · 5/8" x 30" rebor set this survey ,, x Fence Li~e (Approx. Locofion) O8 Scele Ret. /?50' Date © 06-25-/0 EB. No. ~,~-04 Prepared by: I~. L. BUTTON t~egistered /_ond Surveyor 519 W, Eighth Ave. AnohorcTg~ AIcT$#o 99~01 Property of: W///~o m ,~)c/ f O/"'] SGS Ref.# 1103666001 Client Name Flattop Technical Srv. Printed Date/Time 08/02/2010 16:31 Project Name/# Lot2 Meadow Rd. S/D Collected Date/Time 07/27/2010 13:00 Client Sample [D Lot2 Meadow Rd. S/D Received Date/Time 07/27/2010 14:47 Matrix Drinking Water Technical Director Stel}hen C. Ede PWSID 0 Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 07/28/10 07/30/10 NRB Waters Department Total Nitmte/Nitrite-N ND 0.100 mg/L SM20 4500NO3-F B (<10) 07/29/10 AYC Microbiolog~ Laborator~ E. Coli Total Coliform Negative 1 100mL SM20 9223B A 07/27/10 DLC Negative 1 100mL SM20 9223B A 07/27/10 DLC 87/28/2818 87:14 868~770 ~LU$ PAC__~ 82 A+ Home Se .rvices,. inc. !nspect'~ons Phone Number: ............. Inspection Timer Setting 0/.~ ~d/,~a ~ ~ - Elapsed Timt: .... 2'I/ot.,tt Event Counter_ Date & Time ..... Well O~mer Eill P.O. Box 110378 · 10330 Old Seward Highway , _ t~..~' (907) 3494k535 Paton 85 -230 · /z -z-3o Use of Well Domes tic Location (address of: Township, Range, Secti~ if known; or distance main ro~d S;~ ;-;E; L'-v'~;, N,W!~.,. S~'4 S30 ?I2t~ R2W S.M. ~;d' Size of casing ~ Depth of Hol~ 2~' f~et Cased t~ '~ ' ~ , ..... f~t S~e wa~ 1~ ? ~ (a~ ~ow) ~d s~. ~ of wea (~ ~e) ~ ( ); P~~ ( X ).. · W~ p~p~ ~t a~ ~ ~ (~u~) for 48 of ~wd~ ~om ~e ~- NOT~M: 1. Depth h~ feet from ground surface open end ( ); ~ LO~ 3/8TM D. Shots between 104'-110' hOtLrS with 1 g 3 ft. l[ole was explo-fr_ac'd~with bloc Developed fracture zone between 95-12C' 5"~liner drilled down to T.D. a perf ' d. ~ ~ 6f .formations penetrated, size of material, color and hardness ~ TO____fk__ C~.stn~ s~ ickup __ ' ~/small water seaps fractures ]gWWA C,~rtifie~ ~.~i~eate No'~. 814 & 9TJ 2 -- STATE 07/28/2010 07:14 8686770 APLUS PAGE 81 A+ ,( INVOICE # $ 8 8 $ 3 CUSTOMER 7501 E. 140th Avenue Anchorage, Alaska 99516 345-1890 An~e, AK ~508 Block Lot DATE DESCRIPTION AMOUNT . ~_ , /~Gallons ~ Septic h~aOh~a ~ Holding Tank ~ NEEDS TO BE DONE AGAIN IN 6 MONTHS ~ Good Shape ~ Sludge buildup on boffom ~ Floater on top ~ Jim cap missing or ~ Cut standpipe to 1' above ground ~ Ne~s Septic~ine needs replacing September 17, 2010 William Paton 4036 Vance Drive Anchorage, Alaska 99508 (Cell: 907-230-3600) ACS ACS has no objection to the encroachment of the water well in the easement along the east boundary of Lot 2 of the Meadow Road Subdivision, (otherwise known as 10178 Meadow Road), as depicted in the submitted as-built survey dated 08-12-10 Acceptance, (your signature below), and use of this letter of non-objection by yourself, your heirs, your assigns, or your successors, will constitute agreement to the following stipulations: ACS will be held harmless, now and forever, for any damages or injury to any person or property as a result of this encroachment. Any ACS facility damaged or destroyed as a result of this encroachment will be repaired at no cost to ACS. Any costs incurred by ACS for special construction necessitated by this encroachment will be borne by the property owner. All applicable safety code regulations will be observed and maintained. This letter of non-objection will in no way preclude ACS from full use and enjoyment of its rights within any portion of its right-of-way. Please sign both copies, retain one copy for your use and return the other to ACS. Since2ly' Gerry ~now, ' - Alaska Communications Systems Outside Plant Engineering, MS#14 600 Telephone Ave. Anchorage, AK 99503 ACCEPTANCE SIGNATURE: DATE: RCWC 2943 C:\Documents and Settings\gsnow~DesktoCMeadow Road Subd Lot 2.DOC 600 Tetepi~one Avenue Anchorage, Alaska 99503-6091 tel 907.297.3000 www. acsalaska.com ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETWEEN MUNICIPALITY OF ANCHORAGE AND THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this ~ ~ iT)ay of ~ c ¢ ~ ~ r~ ~," of 20 [ L'), by and between herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Memorandum of Understanding agree as follows: 1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as 72Z , /~ _,C, ~ located at //~ ~ (fd o ~u, Definitions. Anchorage, Alaska. A. Alteration. Any change to the design or function of an AWWTS that Includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Prior to performing any alterations to an AWWTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65. B. Certificate of On-Site Systems Approval. An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with AMC 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. C. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. D. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. E. Permit (Construction) An On-Site Wastewater Disposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater Treatment System Operating Permit. An annual permit, issued by the Municipality, that allows the Owner to operate an AWWTS, upon meeting all the requirements of this agreement, the conditions of Operating Permit, the requirements of the On-Site Wastewater System Construction Permit and all relevant provisions of AMC 15.65 Owner shall pay to Municipality an annual fee of 3. Fee. ~ E. ~'~__~ ($ (.~ .00), payable on or before the issuance of the operating permit and annually thereafter. The annual fee is due on or before the anniversary date of the approval by the Municipality of installed system. 4. Term. The term of this Memorandum of Understanding shall be for the life of the AWWTS. The term begins on the date of approval by the Municipality of the installed system and shall continue while the AWWTS system is in use or operational or until the property is sold or title is transferred by owner and a new certificate of On-Site approval is issued to the new owner or transferee of the property. 5. Alterations~ Installation and Removal of Additional Equipment. Owner agrees not to make any alterations, removal of parts or additions to the AWWTS without a Construction Permit from the Municipality. 6. Maintenance and Repairs. A. Throughout the term of this Memorandum of Understanding, the Owner shall maintain AWWTS in good repair. In addition, it shall be the responsibility of the Owner during the term of this Memorandum of Understanding, and any extensions or renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. Further, Owner agrees to comply will all applicable ordinance, laws, regulations, rules and orders for the AWWTS. B. Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the terms and conditions contained in the Owner's AWWTS Operating Permit. This schedule shall be submitted to the Municipality annually upon the renewal of the permit. The schedule of maintenance and repair contained in the Owner's AWWTS Operating Permit is: C. Owner acknowledges that the fine schedule for failing to maintain and repair an AWWTS are codified in AMC 14.60. D. Owner agrees that only maintenance, repair personnel certified by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. E. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. F. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. G. Owner agrees that the relevant provisions of the standard specification guidebook for AWWTS is the governing professional guidelines for the construction, maintenance and repair of the Owner's AWWTS. 7. Nonwaiver. The failure of either party at any time to enforce a provision of this Memorandum of Understanding shall in no way constitute a waiver of the provisions, nor in any way effect the validity of the Memorandum of Understanding or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 8. Amendment. A. This Memorandum of Understanding shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality of this Memorandum of Understanding was executed and such writing shall be attached to this Memorandum of Understanding as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this contract, the only authorized representativeS of the parties are: Owner: Anchorage: Purchasin~ Officer C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of Understanding shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Memorandum of Understanding. 10. SeverabiliW. Any provisions of this Memorandum of Understanding decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Memorandum of Understanding. ,, By:i4e_~CJ~.: ~. ~e[J O,q By: Title: Date: ~ &c.'5 2010 Date: STATE OF ALASKA THIRD JUDICIAL DISTRICT MUNICIPALITY: The foregoing ~nstrument was acknowledged before me this ay of ~J&P&],7-zp ., 20/1), by ff¢~'o/i' ~--¢i A,l¢]g.c-l.t , the M~Commission expires: 7//)/Z¢