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HomeMy WebLinkAboutRAMERT LT 5Rctmert Lot 5 #060 -342 -11 Municipality of Anchorage Page 1 01 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 o Telephone: 343-4744 On-Site WastewaterpDisposal System and/or Well Inspection Report Permit Number: ✓ w 1 ? O ! 6g1 PID Number 060"3'4 a- /1 Name: f Wastewater System: Ca New ❑ Upgrade Address: Po Box %70567 AgIeRj- �K 9(15-J% ABSORPTION FIELD Phone: 609/ v� q 3 �- / I No. of Bedrooms: f J / —IL...5 0 Deep Trench IX'Shallow Trench 0 Bed 0 Mound 0 Other LEGAL DESCRIPTION Soil Rating: la eGPD/S.. FL Total Depth from original grade:9l Lot: �' Block: Subdivision: R✓✓J I\Rei Depth to pipe bottom from original grade: � FL Gravel depth beneath pipe �\ Ft. Township: 2ange: Section: JJ. Fill added above original grade:'\ r d Ft. Gravel length: 'J s `/ Ft. WELL: g New ❑Upgrade Gravel width: Ft. Number of lines: I Distance between lines: Ft. Classification (Private, A,B,C):�/ Pri vo,-/-e Total Deptll a Ft. Date Drilled:i , Cased To: i I r/O 9 Ft. Staiic00' ft Total absorption area: to /so.F(t. Instajg0ij±L (-// /O, ry liu. 'CM K L Pipe material: iSTMD3o3�f/�-y10 Date installed: �j� 9Q D (J W S✓lDrilleri/' vav / 'Q��, We4/s Yield: GPM Pump Set at- 14 K Ft. Casing H ight AboveboGround: O( Ft. TANK V SEPARATION DISTANCES Septic ❑Holding ❑S.T.E.P. 7o From Septic Tank Absorption Field Litt Station Holding Tank Public/Private Sower Lines Manufacturer:r Pre/VIir er Capacity in gallons: Well- l o \ IQDtf- •-- ---. Material: pe) ryelIL n e Number of Compartments: WateSurfacr 100 --i" 100\+ LIFT STATION Lot Line G}� J Ct .5 SizeAin Illons: /i% %1- Manufacturer: nnnJ t Net 5 Jet 06e Foundation 6 (1 \ 1� "Pu p on" level at: , 57 'Pump off' level at: 5'3,5" High water alarm at: 10.S„ CurtainPymp Make&Model Ia5'4eicA Elec rical Ipspections performed by: E(& /'mac rc 3. Dain `re Ky10 LI -- Remarks: BENCH MARK Location and Description: .' 1 we/ / / [(Pa P (/(/ 1f Assumed Elevation: loo 'CSC': q -1t lec9 \I ✓ 4( + q th • *7 r .„ ga'.»2».... i .' ",..,.... 7 ,, . ROBERT C. COWAN / C de •0 -,,\ CE-8801 rt�i gat , •• .• , . < `'�`-wt � S & 5 ENGINI:iERNT --- 17034 Eagle 121ver Loop Road, No. Inspectionsperformed b :EC/?^'�— P Y Rlver, l�hlka 995!7 Dates• 1St o -` /— ci ate _ /� Pvi4( I 7—.9 I Department of Health and Human Services approval . ' Date• /0 "gift_ Reviewed and approved by: -,g 7 72-013 (Rev. 9/91) MOA 25 PERMIT NO. SW970249 PAGE 2 or 3 Aunicipalit of Anchora e 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 LEGAL LOT 5, RAMERT S/D P.I.D. NO. 060-342-11 1P UTILITY EASEMENT _ i CHH N1� LOT 3 \\ 1 _jj SfP11C SYSIC4 CAS[MENI _ _ \ \ 0' C/C FENCE N H C0 COA l01 5 _\ WITH GATE II z icu U o LJ in SCALE: 1" = 100' L n STATION CO3 LOT 5 G GRAVEL DRIVEWAY GALLON 1300 SEPTIC )(1ST N'-} "SEPTIC TANK F� `PX f1 C�9` � dp F� 9L 15' TELECOM a ELECTRIC EASEMENT ` BUILDING e" -T2 a' T NNA MAST ANTENNA MA e' C/L FENCE Bn Mr S a�� ..... sll (i5(n�I/JO N •••• 4T: PERMIT NO. SW970249 PAGE 3 OF 3 Municipalityof Anchora e DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 *Anchorage, Alaska 99519-6650 • Telephone: 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 5, RAMERT S/D P.I.n. NO. 060-342-11 ST1 FINAL GRADE ST2 CO3 17.••Air •e3' SAG'.••.aR•• • •'•,oYetra NEW 1300 GAL. POLY. TANK CO1 MT1 CO2 MT2 1 1 1111! INSULATION 94.5' C01 = 94.3' CO2 = 94.4' FINAL GRADE CO1 = 90.9' CO2 = 91.0' MT1 = 88.7 MT2 = 88.6' s NO WATER FOUND 82.6' 13.0.I4. MH A B FCO ST1 ST2 CO3 MH C01 MT1 CO2 MT2 31.5 24.0 92.5' 96.0' 100.5' 103.0' 457.5' 460.0' 512.0' 510.0' 92.5' 97.0 101.5' 104.0' 445.5' 448.0' 500.0 497.5' N. T S. • — Lti'dt=::0�e Sep. 10 '99 12:53 '1 SOUTH FORK CONST TEL 907-694-1122 P. 1 • . ED'S :ELECTRIC UCA NVICEFIAGE r 0103 OMMEFtbiAL WOVE •• (907) 272-11591 • 414009511(11iG,'ALASK.00901 • • Fax (907) 27244590 • ;Rt C4 44idea • g •a04, ty 7 CIP 4 e e intro, - • , 5 , tj silo/ `e 4+0 6-t 1.• , • 4 1 .,1 kJ- r,‘ • • • 4• • •`: •47-ec• m450..r. /6ice. • se:•:.4.0. a •KC • ) 3 ) •! el 1 .;-11 . 40 • • p4 449: irL.';w141,50*Olk..0.010%;4-4444E • (!. ;I:E. • .1) • , : . .; SEP -25-99 SAT 12:50 PM SULLIVAN WATER WELLS 688 2759444444444444 P.02 (ertifieb prating Eng by Doc Co. dba SULLIVANWATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 886-2769 OWNER OF LAND�)014,1 s}44..IF4a ADDRESS ➢'CU�Ox 170 569~_° tZ LEGAL DESCRIPTION.4AMeg At 5 PERMIT NUMBER of b3s(oDate of Issue_5' „•1 S - 9? TAX INDENTIFICATION NUMBER b ha - - / Is well located at approved permit location? es Q No Method of Drilling: [dell rotary otary j0 cable tool Depth of well: '200 Casing Type STE6d.- Wall Thickness r (95-10 inches Diameter_ 6/r _Inches, depth �01�� feet Liner Type: __4)..0.6.1 Casing Casing Stickup Above Ground: A feet Static Water Level (from ground level): 100 feet Pumping level: feet after hrs. pumping _gpm Recover Rate: (2 _gpm Method of Testing: 41A Well Intake Opening Type: Q Open End ica<en Hole 9 Screened; Start__ 9 Perforations Start _feet Stopped feet Grout Type: Liecu i`« tr Depth: from 0 fee,/ Stopped feet Tw a% olume l S 0 4 6 S feet, to feet Pump Intake Depth: feet Pump Size hp Brand Name BORE HOLE DATA DEPTH From _To_ „2___ 11 18' `71 lis PO 13)- 14•S-11 3).tis-t1 1201 1R6 Lc 2oa C4J,,Jc, SSr_rciGJ►P asoAct< 6fat..1 l3E(JROck Q4 air-) 13 eRoc 1 6eewnl l�EA/lce te/0Na1 ___.Q/SG rE' c ' Rt 'f IJE04b c fC 13Rtio� _„ ,,3ED.2ack 64o03"i F/r°a-r1/4064 1. jr 4- aEd,'pct I,/4/14&fEE-,j Well Disinfected Upon Completion?b)/6s Q No Method of Disinfection: it P/'n C E/zoA,e-, Comments: ire q'//r/'p? —( 7-1- )1 D MufrciT p 3 IT.F.a unurage Dept. Health & Human Services Driller's Name�- ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WATER SUPPLY PERMIT Initial Permit Number: SW980356 Legal Description: RAMERT LT 5 Design Engineer: 0003 S & S Engineering Owner Name: Dan Janke Owner Address: PO Box 770567 Eagle River , AK 99577 - This permit is for the construction of: L] Disposal Field Septic Tank Li Holding Tank Date Issued: Sep 15, 1998 Expiration Date: Sep 15, 1999 Parcel ID: 060-342-11 Site Address: Lot Size: 438790 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 (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 septic system easement agreement must be included in the As -Built package. Received By' Issued By: 1,0(40 Date Date: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON—SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970249 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:JANKE DAN OWNER ADDRESS:P.O. BOX 770567 EAGLE RIVER, AK. 99577 PARCEL ID: 00.6&34-2.Q.L O/ O — 342.--, , LEGAL DESCRIPTION: -7 J?' » ighr L-01— .S LOT SIZE: 438790 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 1c)•l`()Pn 1t ne> 13Yd - 1n LICcLrn DATE ISSUED: 8/11/97 EXPIRATION DATE: 8/11/98 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE : .- /kg'? 4. iNi.' ,� 4,od"S&S EngIneoung we &uw HEALTH AUTHORITY APPROVALS SEWER &WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERINGSTUDIES ANDnEPOnrs WELL INSPECTION &FLOWTEST MEPLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. ROBERT A. SHAFER, P.E. Date: / Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 4 REFERENCE: /07- 5 , 4 AA 6g 7 CIVIL ENGINEERS (907) 694-2979 FAX(907)694-1211 RECEIVED AUG 17 1998 Municipality ot Anchorage Dept. Health & Human Services The septic inspections for the referenced property were performed on 8-/l- 28' and 8 -//-- 9K . Prior to submitting the On-site Wastewater Disposal System and/or W 11 Inspection Report we are waiting for the f,,.,cQ47-eat,�6k.Air to be completed. If we may be of further service please contact us. Sincerely, Robert C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 hr "Pk S & S ROBERT C. COWAN, P.E. ROBERT A. SHAFER, P.E. Engineovng 1IIIIIII� — EAGIE HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN WEa CIVIL ENGINEERS (907) 694-2979 July 9, 1997 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 5, Ramert Subdivision Request you issue a permit to drill a well and install a septic system to serve the proposed three bedroom house on the referenced property. A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered in the test hole and after seven day ground water monitoring, the monitoring tube within the test hole was found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. There are no points of contamination within the proposed well radius which can be seen on the attached site plan. If you require additional information, please contact us. Sincerely, sill ‘v Robert C. Cowan, P.E. RCC/jm Enclosure 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 UNDEVELOPED 0' UTILITY EASEMENT 00-(-y ›ow0&30 zx- A z 0 0 in O?- YA--1-( ?Zoo -x z' o mDc v, 5.: 13-'w0m vCOz m" . )o'-� m"4 n5' m z rpmm z. m tmnoz�<mz .-->0 A0 Z0. -mOG7 NOL ATH 00 zi 07.0 zz O- Z O0 , TI z m -1 000 0 XI oi al p z n� za Od0 n icA rA xoa 0 nmp �m z o 0 SITE _LAN DESIGN .TJ cn cm N{? m- c - m o -1m �MntiC] C) z it m N p a � w 0E0 = dO±3V3 I- 0 •• EASEMENT i w o r Cn 0 r> – Li 0 O > `� w 6�i 7Fn 2-{ sawn -rim EAST PROPERTY LINE APPROX. 89' • 1 I n -1 PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG —• PERCOLATION TEST DKr% JaaKt< LEGAL DESCRIPTION: ❑E PT•H (PEE7-4 3- 4- 5- 7- 8- 9- 10 C • 11 - 12- 13- 14- 15- 16- 17- 18- 19- 20 - COMMENTS Loi 5, RAMERT 6P/SP W/ LAKcDE- C©6BLE 5 I3.O,M4. pkolorptvoisi /$ ,o• N. ROBERT C. COWAN he # re - DATE PERFORMED, 7 — s fl 3/, Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF VES, AT WHAT DEPTH? t40 Depth to Water Alter Monitoring? Old Date. S L 0 P E SITE PLAN t N Reading Date Gross Time Ne Tirne Depth o Water Net Drop PRESOAC PE AA o0 1 7 -OI -9T '•So -" I MrtJ• Lin 3s/y° 3'/z " .- 2 2•.51 3 2:57 4 2 : S3 3'At 6 2:59 i" PERCOLATION RATE f (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT S & S ENGINEERING L -•� CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: 1763$-Eegle River Loop Road No. 20.4 7 /? s /q 7 ACCORDANCE va gIem@tT6TitlA3'IEAtfJ95»PAI. GUIDELINES IN EFFECT ON THIS DATE. DATE - 72 -008 (Rev. 4/85) ""1"1%."....:41114,. fltk .,&1 &S 'Engineeiinq AEIL MX ALASKA HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ROBERT C. COWAN, P.E. ROBERT A. SHAFER, P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 5, Ramert Subdivision July 14, 1997 GENERAL: 1. 3. 4. 5. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 The scope of this project includes the installation of a 1000 gallon septic tank and a five foot wide drainfield to serve the proposed three bedroom residence for the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP • SUITE. 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 5, Ramert Subdivision July 14, 1997 Septic tanks installed with less than 4 ft. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRLNCH/DRA N1JIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. Page Three Lot 5, Ramert Subdivision July 14, 1997 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM PII I0 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam I1I or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typal- 3401, Mirafi 140N, or equal) must be installed between the final leach ield gravel Iayer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. The final inspection is to occur upon final grading of the property. Page Four Lot 5, Ramert Subdivision July 14, 1997 Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineerings inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/OWNER R usH MUNICIPALITY OF ANCHORAGE Development Services Department -- 2 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 060-342-11 1. GENERAL INFORMATION Complete legal description Ramert Sub, Lot 5 Expiration Date: / _ I V -'--"_e e zZ Location (site address) 7550 Hllarld Rd, Eagle River, AK 99577 Current property owner(s) Park, Terry Y & April J Day phone (907)317-5228 Mailing address Real estate agent PO Box 772464, Eagle River, AK 99577 Melissa Bell/Firebird Realty 2. TYPE OF DWELLING: ❑■ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone (907)830-3031 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic Q Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 -f J�0 Date of Payment 10 - �' 2 Receipt Number U Vtf -7,'D COSA # 0 -SC -2-1160-5 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 10/8/21 \ CIi1 TH 6. DSD IGNATURE % :. • . . System #1 Approved for 3 bedrooms r Benjamr'ySchlller System #2 Approved for bedrooms c,s•,. co/82292 Disapproved }11�pROFESSIONP�.�� Conditional approval for bedrooms, with the following stipulations: WAST`_v"ATER z PROGRAM � JJJJ�'i�FNT F B _ 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 engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Ramert Sub, Lot 5 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 9/15/1998 Total depth 200 ft Cased to 20 ft Fol Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 10/5/21 Static water level at beginning of test 97 ft. Comments B. TANK DATA Age of tank(s) 23 years Tank type/material Septic/Poly Measured operating fluid level in septic tank 54 W Standpipes/foundation cleanout per record drawing Date of pumping 10/12/21 JR's D. ABSORPTION FIELD DATA Shallow Trench Which system tested (date installed) 8/11/98 M ALL standpipes present per record drawing Total measured depth from grade 5.3 ft (max) Measured depth to pipe invert from grade 3.1 ft (min) ❑ N/A — pressurized field Fol Monitor tubes go to bottom of effective. If not, state depth into effective 0 Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 060-342-11 Structure served by this system Well production at time of test 2.5+ gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate 2.37 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Forge Engineering Date of Sample 9/28/21 C. LIFT STATION Al Required maintenance completed Age of lift station 23 years Lift station material Plastic Comments: Adequacy test date 10/5/21 Results Q Pass For 3 bedrooms Fluid depth prior to test 7.5/0 in Water added 603 gal New depth 15/8.5 in Elapsed time 1440 min Final fluid depth 8/0 in Absorption rate >450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' El Yes Community Sewer Manhole/Cleanout > 100' ft 17✓ Yes if No ft Q Yes if No ft Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25' [Z] Yes if No ft Absorption Field on Lot > 100' F/I Yes if No ft Holding Tank > 100' F71 Yes if No ft Neighboring Absorption Fields > 100' Surface Water > 100' Q Animal Containment > 50' 7✓ Yes if No ft ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' �✓ Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' F/ Yes if No ft Surface Water > 100' El Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' r7l Yes if No ft Water Main > 10' Yes. _ if No ft Community Wells > 200' 0 Yes if. No . ft Water Service Line > 10' M 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' El Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Yes if No ft Private Wells > 100' El Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' Q Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS 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 Aloe 1N ...... BenjarrtrLSchiller �� �'�� •. CE 12592 • c`i4i 10/8/21 , . �® .W ���F© PROFESStONA�.— Maintenance Log Owner ! l' ` Street Address';' G � Septic Tank: -Sludge, level 0 inches -Pumping: required es ;ori -Pumping completed e no Lift station: -Pump basket cleaned e -Control floats cleaned e no -Proper �t settings confirmed (sag (sag -Operation satisfactory � no Alarm System: -Dedicated electrical alarm circuitno -Audible and visual alarm inside dwelling e no -Alarm system operation isfactor not satisfactory Manhole Riser -Ground water intrusion at riser to tank connection yes -Ground water intrusion around pipe penetrations yes -Weep hole functional vesi no -Manhole lid: Functional & no Insulated es Properly Securedno Other `- -All manufacturer required inspections and maintenance completed es no Comments: Qualified Maintenance Pr vides Technician �G 5b � Date of maintenance Company Signature Date M 0 �i H t d.. Ar JD KC, 9t.rlz w 1, Pro A.. t s • - _ - "tet e C • _ _. D 7 y _ _� , r \� `e + ' + - jl C C -t � r 7 c/ /r r,Y,�.r. r� t w t•i�c ,. * a. l of . 5F.5L AS -BUILT •, ... t �•: 4 is • ., ry fiR. +4f �,�� 11 V�i {. �•��..• �1 •'f•, +: '• •' + t I hereby certify that I have -surveyed the following descnbed property : _ Lo 7- A - RAML7r'7' i`:JE,'Ej/ $�o.'_,, f'a n 14 , ID fir- N# & j tl J 3•M t Anchorage Recording Precinct, Alaska, and that the tmprove- Ments situated thereon are within the property tines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lyin adjacent thereto encroach on the premises in question and tat there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska this 3 'day of ' Y ROBERT C. 10fiNSON SCALE: - Registered Land Surveyor . 'o�W-LS I" -,�♦p' Box 77-0456, Eagle River, Alaska 99577 Phone (WM 694-2543 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us 1907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 01,A -3+-12-1I 1. GENERAL INFORMATION Complete legal desdription yam Pa' 1�{,. S//� � LG 1 5 Location (site addressor directions) M-7ft.E 2 , ocad Ro,1-55 Current Property owner(s) ,04,vT4Nk4 Day phone ?</-47-3-57 Mailing address •/P2, CS PR/AV &Poore APNc po re°x 114-agcq tE'KW&' % Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: -3 HAA# priOZ cS Expiration Date: . 9 -02-3 -0_6 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 0 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (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 Health Authority 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 attt�the tiptime of installation. Name of Firm /VD C71ies es.. Fo Address /7.23 7 £e_ r ( t t Crrr (o Engineer's Printed Name STF fE en)G Date 6/2//os SI' ,,,........ s't111 i % SIO • Wei : Steven n9 ter 44 C ••e PE Phone tc fV 702, 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments \Stli."0(.(FC(1..A bfft.re: (lac. ON SITE G� ea WATER AND • m_ By: • nno t Cvvnl Crt • PROGRAM • • • J. ••••ee ee•••_b\1\ • 711H)))I Attachments: HAA Checklist X Maintenance Agreements • Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other (Rev. 111102) 777 eil i'retY1A- Original Certificate Date: 6 '.2. 3 - �� Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.clanchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ,CQiY1e,ff S / 6 in 1- -5- A. A. WELL DATAp Well type / If A, 8, or C provide PWSID # Date completed Ilia Sanitary seal (Y/N) ,% Total depth 200 ft. Cased to 20 ry ft. FROM WELL LOG Date of test � (she' Static water level /43 Q ft. Well production 2 g.p.m. WATER SAMPLE RESULTS: • Coliform (3 colonies/100 mi. Nitrate t3.h,.3 mg./I./ Arsenic: — mg./I. Date of sample: 6/'l% B. SEPTIC/HOLDING TANK DATA / Tank Type/Material / (Q..M(4-r/ #/irr Tank size / ?CO gal. Number of Compartments 2 Parcel ID: 0 60 _3 %z -/1 Well Log (Y/N) y Wires properly protected (Y/N) Casing height (above ground) Li in. AT INSPECTION ‘/z/os a ft. Foundation cleanout (Y/N) Y Depression over tank (YIN) N Date of pumping e�/c/C) r . C. ABSORPTION FIELD DATA / Date installed JP'1 /�9P Soil rating (g.p.d./ft2 or ft2/bdrm) L.; System type T e AC 4 Length s 7 ft. Width C ft. Gravel below pipe z ft. Total depth 5 ft. Eff. absorption area//67ft2 Monitoring tube y Depression over field A/ Date of adequacy test /Z/6s Results (Pass/Fail) 74--C-1‘( For 3 bedrooms Fluid depth in absorption field before test // in. Water added Oa gall- New depth /Z in. Elapsed Time: CO min. Final fluid depth 1/ in. Absorption rate >= L f'SO' r g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) (!.t/H If yes, give date z, C g.p.m. Other bacteria 0 colonies/100 ml. Collected by: Ate r4h rip* Ea/3 Date installed Cleanouts (Y/N) High water alarm (Y/N) Pumper .-444. P041 Pek D. LIFT STATION Date installed ti////Qs, 'Pump on level at 57 in. Datum r,i c RO7'rd e m. E. SEPARATION DISTANCES Size in gallons / 3 00 "Pump off" level at .5_• 51n. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: i Septic tank/lift station on lot /0 0 Absorption field on lot /G a '-fr Public sewer main N/,3 Sewer /septic service line 2 .F t' Holding tank Manhole/Access (Y/N) Y High water alarm level at f (d- S in. Meets alarm & circuit requirements? On adjacent lots On adjacent lots / 0 0't'. /001+ Public sewer manhole/cleanout 41/4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation / Olt Water main Property line / /J 14" /4 Water service line /Q /t- Wells r Wells on adjacent lots 100 'r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / r r f Building foundation 5,0 Water Service line /014- Surface water /a vf Curtain drain VAX Wells on adjacent lots /Oa 't F. COMMENTS Absorption field Surface water N/4 / 0 'f /00 CO' Water main N/4 Driveway, parking/vehicle storage /0 rff— G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Sfc✓2 Date /g//OS Fns HAA Fee $ 1430 . W Date of Payment 1p Jg1 /65 Receipt Number (Rev. 12/01) (u% oi .: Mat -Su Test Lab 907?463012 06/27/06 2?.02pm P. 002 rllat-Su Test Lab of Alaska Mile 3.2 Palmer-Wasilla Hwy Mlrltown Community Business Park P.O. Boit 2740 Palmer, Alaska 99045 Phone: 7453005 Fax: 740-1010 Drinking Water Analysis Report Total Coliform Bacteria i Address:7J 3 I ( � �Pc/ w sL�c<< PWSIDri(if applicable): —6641q _�, <,r- t -4-1t PhoneE 002, Fax#: 0717— 7QZ 6 Paid. This Section to be completed by Sampler Legal Description of Properly: ___EAa4-tso,2 r S%� L. e rs- Sample Site Locatbn: QC! 1 -SRQ rt (6‘...Ce T Delivered to Lab By: Q (I.t.: kil•9ien sins, bamroem sir*, outsh] note bit) Time Sampled: O9 o a Date Sampled: `AlCif Sampled by: SI 2_ Sample Type: Routine Treated:rJ Untreated:❑ Repeat Sample #: Analysis Results: Satisfactory ❑Unsatisfactory ❑Sample too long in transit (greater than 30 hrs.) 'Request resample. This Section to Be Completed by Lab Chromogenic/Fluorogenic Method Results: A Total Coliform Present (P)/Absent (A) .8- 0$ P}' E. Coli Present (P)/Absent (A) Ccpy Sent to State: Yes No Lab I.D. Date Received: �/4 /es- Time Received: //,'" Received by: /Yl 7jy ,t-.) �/ T Date Test Begun: Mr <O r✓ Time Test Begun: Slab 1b Analyst: _.,k;) Date Completed: 4 f er Time Completed: /if rd Analyst: Refer to Back Side for instructions Hat -Su Teat Lab 9077453012 06le9:06 eGslepm P. 004 Mat -Su Test Lab of Alaska Water Quality Testing Mile 32 Palmr.Wasi/a Hwy. Midtown Community Business Park Phone: (901) 745-3005 Email: rnat4utestiatrflrogarshsa.Cern P.O. Box 7749 Palmer, Ak. 99646 Favt (907) 746.3010 Client: North Rim Engineering 17237 Bear Paw Crete Eagle River, Alt. 99577 Atte: Client IU• Lot 5 Ramsrt S/C PWSID 1 Solace: M.S.T.L.#: 51392 Sample Matnx: Comments: Dale Arrived: 6/8105 Report Date: 6/9/05 Sample Date: 6/6/05 Sample Tine. 09CO Collected By: SE Method Parameter Units Results MDL Date Prepared Date Analyzed MCL SM 4500-NO3-E Nitrate -N rnp/L 0.63 0 50 8:9/05 8/9!05 10.0 Legend- MRL • Method Repot Level MCL = Max Comammata level 8 • Present In Method Blank E - Esbma:od Value M • Above MCL D • Lost to Dlubon Repose By Jon Paul Campbe!I Lab Supervisor