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HomeMy WebLinkAboutTUNDRA JEWEL RANCH LT 5Tundra Jewel Ranch Lot 5 #051-193-12 erti#i�� drilling LIDS 5y ooc co. daa SULLIVAN WATER WELLS P.O. SOX 67o272. CHUGMK, ALASKA 99567 -- -- - i OWNER OFt�-\19k' ��c I ety ACDtESS: �� r3 ,ca7�s3� C14 LEGAL DEScFaF n I w r n oATFf MRMT t naMBEFt V 31" sof tssue�--]A- —C:f TWX IDE11MGMION NUMBETI: L?TL--6 -----i� is vrg Ion at M oved pew Location � 1No Methcd of Driumg: &9' rotBry U cable tool DerMOfwef d lasing Type � '�- wall ThicknnPsss Aart 'les {�; eY k ctws. dem "ice teat LJnerType:ni w r; cats Stickup Above Grasxt_ —feet Stas sad . tIvaler Level= ,Q c t ReawerRale=_L —9( Mell'bodofTestingIA- Well Intake OpenirV Type: a-6en end U open tole s start feet stopped—feet ;:q Perforations Start t i�fr%3 Stopped GroatiypP ' u f" ( 2- lfotrerre l ��i� r from L� feeL to feet Well Dis� Upon ComPtetm? tso p Method attTs&d0c rc Grp •� o f V r /� D Mer% Nine 13—"1 S " 1TTENTION: It is the responsibility of the property owner to submit a copy of the well lag to the proper authority. Municipahl >f Anchorage: Department of Health & Human Services and/or Department of Erwimnmental Conservation. Matsu Bo ougt )eparlment of Environmental Conservation. May 17 13 0913a Sullivan Weter Wells 907 688 2759 p.2 - _- Municipality of Anchorage Community Development Department onsite Water and Wastewater Program 4700 Elmore SL • �-0. Rax 1966:50 Anchorage, AK 99519-6650 • http:IA~.rnutsi.orglonsite d-07)343 790*3 Well Decommissioning Log Lsjal Address: r,,.- Subdivision VJI f 1 v GL— Block Lot T _ R_ Section Lot _ 01,jte Water & V"stewater Program cenrille 3 conlrtrctor perfa mina the well decomaus.ioniog: J' fp! p�1 fes. /"G, ��_ Name: ti.� `� U`K�C�GQ 4...h'1✓'/✓ / Signature: +Nen aecommissicmng date /'�. . �� r,7athod of aecommis�aning: AMC 16.55Z60L1 a. E] b. ❑ C. Location: Ue'e €he space below to provide a dravnng of the property showing the folipwirg items; North arrow Decommissiorretl well Other watw wells on the prcperty. Twn Separate swdnoe disfar Ces for eacr well shwmm on the drawnng, Nose: The swing -tie distance%, shall be maasurral irrnn either perp+anent structures or the property cnme5. CA� MUNICIPALITY OF ANCHORAG E Development Services Department On -Site Water 6 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Upgrade Permit Number: SW040381 Legal Description: TUNDRA JEWEL RANCH LT 5 Date Issued: Sep 14, 2004 Expiration Date: Sep 14, 2005 Parcel ID: 051-193-12 Design Engineer: 0000 None Required Site Address: 023010 SHERMAN ST Owner Name: JAN BLACKBURN Lot Size: 15420 SQ. FT. Owner Address: 23010 SHERMAN STREET Total Bedrooms: 3 Permit Bedrooms: 3 CHUGIAK . AK 99567 - 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 specked 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. S. The following special provisions. Following completion and determination of adaquete yield for the new well, the well drill shall permanently decommission the existing well prior to leaving the property. Received Issued Date: l llsoll'eo 1( Date: /r/ 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.cl.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. A5 / — / 93—� `�— Permit Number SW Property owner(s) . J.4A) ,LA(f11-Bbn1 Day phone Z88-ozo/ Mailing address (1)��o_f� 6'7s7 s3 b f�lJ %A� Matttflg address (2) oZ9010 Sh(Afofm Scl' . 0 (LL�2 C� Zip Code Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size X157!'r0 Acre q.F THIS APPLICATION IS FOR: Number of Bedrooms 99SG7 Sewer Only ❑ Well Only R Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Sin amity Ilartdisip acoqr ance with applicable Municipal Codes. owner or authorized agent) Permit Fees: / q�— Waiver Fees: Date of Payment: ! 1 10 H Date of Payment: Receipt Number: 5 n� u. , Receipt Number: (Rev. 12100) paopOSEt' WFL-1•- 60CA710^.) AS—BUILT SYSTEM D AILS/SITE PLAN Permit SW970375 TUNDRA JEWEL NCH S/D, LOT 5 PID#051-193-12 H L- - T ... . n) WELL • • ELL • .. . �J 6 S °� 4 FCD C tD m SEPTIC D PRIMARY SY D �D SEPTIC 132.00 32.00 HT 138.00 0.00 SEPT IC 180.00 -1 144.50 rH H97-1 10J rU ti, Esnt. N SEPT 2 0 co. 0 NCD O(OOO°l� SEPTIC SC LE, V - 50' 9.5 9.4 KK 2 A -C=36.6' B -C=27.3' �� a A -D=44.3' 00.3 FINISHED GRADE 00.4 B -D=24.7'' A -E=36.2' e B -E=46.0' !i `°SEPTIC 4.4 4.3 A -F=67.6' TANK SEWER ROCK .. B -F=28.5' 4.8 94.5 g9.0 89.0 SCALEo NTS ���.. • .9sf' PREPARED FOR: e3.o 0 JAN BLACKBURN1 *�::� *' 701530 CHUG AK6AALASKA 99567 •• . Finn eoncS m M� . NID ENGINEERING '- +� / s....a _ o•a[a wMO 20441 PTARDIIGAN BLVD: 1 EAGLE RIVER.:+AK •00577-tri30 1ES510 �= :.....: ::::.......::.....-11 na Fix: twa NW1159 .:.::.::........:..:..:. .. 97100.DWC s° "" 97100 (007)000-011]/FAX (007)090-81 l l Municipality of Anchorage Page of " 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: SW 976375 PID Number: OS/- Name: J"AN LACK uf2nl 11Wastewater System: ONew Upgrade Address: Y r,0' RoX 6>70530 ABSORPTION FIELD Phone: No. of Bedrooms: 3 XoeePTrench O Shallow Trench O Bed ❑Mound O Other LEGAL DESCRIPTION Soil Rating: I.2 Total Depth from originalgrade: 7-5 3' GPD/S .Ft, Lot: Block: .r' Subdivision: Depth T6WEL RAOIC9 to pipe bottom from original grade: 2.1-I Gravel depth beneath pipe 5.1,7 IMPU Ft. Ft. Township: Township: _F3�, Range: Section: Fill added above original grade: + Gravel length: 39 3. 197 Ft Ft. WELL: XNew ❑Upgrade Gravel width: z Number of lines: r Distance between lines: Ft. Ft. Classification (Private. A.B.C): Total Depth: Cased To: Total absorption area: } Pipe material: D 303`( r/'t //0 Ft. /O Ft. 376 SO. Ft. FoIC) Driller. reh'i.11i.t f'- . Date Drilled: OS 98 Static water Level: Q)O Ft. Installer. Sio-A}ex Co. Date Installed: D 5 / - 1 8 Yield:) D Pump Set at Casing Height Above Ground: 2. TANK / GPM 6o'f, ,,,, .✓I^ FL Fl. SEPARATION DISTANCES Septic 0 Holding O S.T.E.P. To septic Absorption LM Holding blic/Private Manufacturer. TA/:1K Capacity In gallons: / 0 O From Tank Field station Tank we Ser Lines r7ve". Well- /4- /60 1,00 f{'LS(+ Material: Number of Compartments: Surfac /0 `f loo's — - /00'l LIFT STATION Water 10 LotSize /�' H — — &Y In gallons: Manufacturer. Line /D'IL Foundation"Pump on" level at: "Pu " level at: High water alarm at: Curtain /00 /� /bo / — /0 B /� Pump M I Electrical Inspections performed by. Drain — Remarks: No kNowrl Cue4-A-tri et.,AI BENCH MARK Location and Description: S 0%tart K //Cornu G'T-rsu,,d.L iavL Assumed Elevation: / 0 0 Ft Ef �� OF.ANgs��t * Inspections performed by: kNdErtS�nr�i �, r_ Dates: is �St ��' 16 r go 2nd P S' /6 - 99 Kennoth M. D -, ago 116 Department of Healt nd Human Services approval ft9Fol. •. 000.► Date: Reviewed and approved by: 72-013 (Ren. 11/91) MOA 25 AS -BUILT SYSTEM DETAILS/SITE PLAN Permit SW970375 TUNDRA JEWEL RANCH S/D, LOT 5 PID#051-193-12 SHERT T WELL • • WELL : ;.. , 4SEPT6 ICPRIMARY *132.00 S SEPTIC 132.00 138.00 0.00 SEPTICC 180,00 TH #97-1 144,50 10] :U iL Esmt. NSEPT O Co. t\ C) O co SEPTIC OD SC LEI 1' = 50' 99.53 99.4 W A—C=36.6' B—C=27.3' 0 A—D=44.3' 100,3 FINISHED GRADEna 100.4 f B—D=24.7' raTER rAm¢ �` VARBS A—E=36.2' A 1000 GAL B—E=46.0 SEPTIC 94.40 ° 94.3 A—F=67.6' Zr TANKSEWER ROCK B—F=28.5' %S• 94.81 94.5 89.05 89.05 _L —:lft i 38' OF AL AW��� 1 PREPARED FOR: SCALE, NTS 83.00 VON JAN BLACKBURN r9 P.O. BOX 670530 9 TH * CHUGIAK, ALASKA 99567 I KENNETH M. US r FIELD BOOKS COMPUTED: CE -711 �,� / BOUNDARY: _ DRAWN: KM �1 ����� ENGINEERING / STAKING: _ CHECKED: KMO 20441 PTARMIGAN BLVD.' `; p p%�ASBUILT: _ DATE: 12 10 0- gg EAGLE RIVER, AK 99577-8736 DWG. FRE: GRID: NW1159 `_ qft ACAD FRE: JOB No.: 971 MOM 97100 (007)0796-6111 FAX (007 696-0111 02/02/1999 09:02 9077453072 ARCHI13ALD DRILLING Municipality of Anchorage Department of Health and Human Services 625 IV Street P.O, Box 196650 Anchorage, Alaska 99519-6660 Mayor PAGE 08 Of/ . /!9-/2 Permh Number Date Of Issue----. Tac Identification Number -�PM 4-&3-532 Date Started _.g� Date Comphftd ^,�8 Is well located at approved pemdt bcrtion? 121 Yes 0 No Legal Description Block Lot prop" owner Name A Address: TUNDRA JEWEL RANCH JAN BDACKBURN CHUGIAK, AK 5 P.O. BOX 670530 CHUGIAK, AK 99567 Borehole Data: Depth Method Of Drilling: Q air rotary 0 cable tool Soil Type & Thk*ness & Water Strata fA'^ To Caning Type: a- -b ASTS Thickness;_XQ25nches Topsoil 0 1; Dlarnewt Inches, depth_ 1 Qfeet Liner Type; _ DiameterktMas, depM_teet SAND & GRAVEL 5 20 seeing Stbkw Above Qlound: 2 bet static Wow Level (from ground Hued: 8o tees SAND & GRAVEL 20 40 Pmving Letts: 'het after---hrs. pumping_„ -pm ReeeverY Rate: AND & GRAVEL 40 60 Method Of Testing: Well Intake Opening Type: M Open End O Open Nola 0 Screened; Start feet Slopped feet ❑ Peftatione Start 90 bat Stoppsd 100 feet CLAY &GRAVEL 80 100 10 GnMT)rpe:_ Bentnite Volume =5n 1b_bAU CLAY GRAVEL WATER 100 110 Depth; horst teat, to 20 Met putttp Itttsim Dewh- feet Pump Size hp antnd Name Wall Dlsln%Md Upon Comletlon7 V Yes 0 No Method Of oWnfectbn CLOROX Comments: nldpality of Ancno age yys6 DdiWr Nems DAVE ARCHIBALD ()opt. Realin Company ARORIRAn'n T)gTT,T,TNr: 9rRyTrr_ Malling Addreas- _HC04 •BO;; 7386 City P4QMER stale AK Zip 99645 Attention: The well driller shall provide a well lop to the property owner whhin 30 days of completion. M 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 3om Sa��-1(v -q8 PAGE 1 OF 1 kQo^-y` PERMIT NUMBER:SW970375 DATE ISSUED:10/21/97 DESIGN ENGINEER:KND ENGINEERING EXPIRATION DATE:10/21/98 OWNER NAME:B or JAN BLACKBURN OWNER ADDRESS: O BOX 670530 CHUGIAK, AK 99567 PARCEL ID:05119312 LEGAL DESCRIPTION: TUNDRA JEWEL RANCH LT 5 LOT SIZE: 15444 (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: 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 B ISSUED BY: DATE: /7 DATE: IO•LI -97- KND ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 11/FAX (907)696-8111 October 10, 1997 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: New sewer/well permit - Tundra jewel Ranch S/D, Lot 10 Gentlemen: On October 2, 1997, we excavated one testhole for the subject property and installed a monitoring tube. The result of this test and water monitoring are attached. We propose to install a 2' wide deep trench. The testhole investigation showed no water and there was no water after monitoring. Additional fill will be placed over the system to provide a minimum of 3' of cover when complete. There are no public or private wells within 200' of our proposed system location except as noted. There is neither surface water within 100' nor any curtain drain within 50'. We do not expect that there will be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, IIS tiD, Engineering Kenneth M. DufVE. MUNKOALITY OF ANC:HUKAUt: ENVIRONMENTAL SERVICES DIVISION attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test OCT 10 1991 RECEIVED 4 WASTEWATER DISP❑SAL SYSTEM/SITE PLAN TUNDRA JEWEL RANCH S/D, LOT 5 K D V . SHERM STREET V LL • • VRU1'USLU VLLL, ,I VCLL yl 1 N 7 6 S 4 Y1 SEPTIC SEPTIC ra 000 GAL)PR']POtED . L.L1 � OSraa pF C 172.00 172.00 rn CO 132.00 •� SYSTC. 13H.00 i --a 100.00 SEPT1c 100.00 111-1N97-1 144.50 Q 101U B. Esnt. 4 -SEPT . 20 o SEPTIC r o Q SEPTIC WELL N WELL - N WILL WELL 9 19 v H N c, WELL u o `N° SEPTIC v o n n I� VEL- rti 150.00 LLJ 150.00 r' VACANT VACA11r'I�}T VACANT W R U n 1 V W 1 V V l� NO SEPTIC SYSTEMS WITHIN 200' CIC PROPOSED AS NOTED. NO PNIVATCEOR UBLICIWELLS WITHIN 200' OF DESIGN CRITERIA PROPOSED SYSTEM EXCEPT AS NOTED. 1. 3 BEDROOMS X 150 GAL./DAY/BEDROOM = 450 GPD 2. SOILS RATING: 1.3 MIN/INCH = APPL. RATE 1.2 GPD/SF 3. 450 GPD/1.2 GPD/SF = 375 SF _ 4. 375 SF /(2' x 5') = 37.5'L lk 5. MIN. DESIGN SIZE = 1 TRENCH - 37.5' LONG x 2' WIDE x 6' DEEP � 1 OFA ry 1 6. DEPTH OF GRAVEL BELOW PIPE IS 6.0'. 7. TOTAL DEPTH OF SYSTEM IS 7.5' FROM ORIGINAL GRADE. NOTES: /'h 49TH) �* / ` 1. TIE INTO TRENCH AT ENDPOINT. 2. INSTALL 1000 GALLON SEPTIC TANK. INSULATE TANK IF COVER. I 3. INSULATE TRENCH WITH 2' HD BURIAL FOAM IF <3' COVER. 4. CONTRACTOR WILL ENSURE MAXIMUM 2% SLOPE INTO SEPTIC TANK. KENNETH M. DUf• ' ' I �¢ CE 7116 4--,44 PRLPARLD F UR: KND ENGINEERING 4v Alf 20441 PTARMIGAN BLVD �/ JAN BLACKBURN EAGLE RIVER, AK, 99577 P 4'OFESSI011p .�mr \ �r P.O. BOX 670530 (907)696-6111/Fax (907)696-£1111 CHUGIAK, ALASKA 99567 OATE,10/8/97 rev.10/IG/97 DRAWING R b. SCAT F: 1' = 100' 97100-S1 PERFORMED FOR: ,I(,t,✓t -R G�k 6t'rn DATE PERFORMEDA%" X80 E ' /p/V LEGAL DESCRIPTION: /L ,, ✓li Je_we l LOT"5 Township, Range, Section: 7g DEPTH SLOPE SITE PLAN (FEET) gym,. 1 .07 Gni/GP �P�dd;sl, N 3 4 Urnle Cobb/'431 5 /ayy bar/Inc s5zt �" Cog S 6 Fero, Loc . 8 9 10 11 12 ] I 8o N. 13 Pio but/ 14 15 16 17 18 19 WAS GROUNDWATER ENCOUNTERED? S IF YES, AT WHAT L DEPTH? 0 P E Depth to Water After Monitoring? — I Oath% i�) •p Municipality of Anchorage -- �9t ? fr • 49 v4 DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 •..: ............. ......:...' •� SOILS LOG —PERCOLATION TEST / Kenne ;i At•L. tQ.0 �� �'•� CE 7116 �.• 10 PERFORMED FOR: ,I(,t,✓t -R G�k 6t'rn DATE PERFORMEDA%" X80 E ' /p/V LEGAL DESCRIPTION: /L ,, ✓li Je_we l LOT"5 Township, Range, Section: 7g DEPTH SLOPE SITE PLAN (FEET) gym,. 1 .07 Gni/GP �P�dd;sl, N 3 4 Urnle Cobb/'431 5 /ayy bar/Inc s5zt �" Cog S 6 Fero, Loc . 8 9 10 11 12 ] I 8o N. 13 Pio but/ 14 15 16 17 18 19 WAS GROUNDWATER ENCOUNTERED? S IF YES, AT WHAT L DEPTH? 0 P E Depth to Water After Monitoring? — I Oath% 20 -{ I I n 7 4 UPERCOLATION RATE 1 SCS (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN_ FT AND 6 FT COMMENTS d n,-�pYtOir- ) P_S PERFORMED BY. I L CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNI CI L GUIDELINES IN EFFECT ON THIS DATE, DATE. 72-008 (Rev. 4/85) J SG�-FAFOTAt . M NMLW®Z=' -"Am, MR11 Wa®/M -mw#� u IF, WASICA/✓'AI--- 20 -{ I I n 7 4 UPERCOLATION RATE 1 SCS (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN_ FT AND 6 FT COMMENTS d n,-�pYtOir- ) P_S PERFORMED BY. I L CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNI CI L GUIDELINES IN EFFECT ON THIS DATE, DATE. 72-008 (Rev. 4/85) J Municipality of Anchoi On -Site Water and Wastewater Program (997) 313-7904 4 CERTIFICATE OF Ott -SITE SYSTEms APPROVAL Parcel I.D. 051-103-12 1. GENERAL INFORMATION Complete legal description Tundra Jewel Ranch Lot 5 Location (site address) 23010 Sherman ST. Expiration Date: /` 1q-20_,_--0 Current Property owner(s) _James Clifton & Brittany J Day phone (907)-390-7165 Mailing address Real Estate Agent 23010 Sherman ST, Sabra Siiland Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well 2 Individual Water Storage ❑ Community Class Well ❑ Public Water System El WaiveriVariance request for: Received by: 3 TYPE OF WASTEWATER DISPOSAL: Individuat 211 Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to oe releesed to the engineer. untess othervise requested by the engineer. COSA Fee $ 5�57_6 Date of Payment _ 09 /a 2z/C3 Receipt Dumber a44� C17Y/ COSA # d5G 1911/57F -- Date: Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: s. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, t verify that nay investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply andlor 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 andtor wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING INC. Phone 696-6111 Address 20441 PTARMIGAN BLVD, EAGLE RIVER A.K, 99577 Engineer's Printed Name KENNCI14 N1. DUFI`US Date Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the cond;ticn of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from flte surface, changes inland use, local soil characteristics, tround%vater levels that may fluctuate during the year and the water usage of the family tieing served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic systern. Therefore, ArcTerra can not give any estimate of how long a systern will function satisfactory for current or future •�:"�'`�"� occupants or can ArcTerra guarantee that no unseen r. Nji, tt encroachments, deficiencies or discrepancies exist. f f. DSD SIGNATURE t . System #1 Approved For bedrooms. 4 e. System #f2 Approved for bedrooms. �ilk je t � Disapproved. s.s+►"` Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Gate- % �,.. The li unicipalily of Anchorage Development Services, C1 6sion (DSC)) issues Certificates of Cin -Site systerns Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Pounicipalily of Anchorage is riot responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other allf t I coli Legal Description: Tundra Jewel Ranch Lot 5 Parcel ID: 051-193-12 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system 1 A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 9/16/04 Total depth 254 ft Cased to 254 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 20 in. Date of flow test for COSA 9/13/19 Static water level at beginning of test 210 Comments B. TANK DATA ft. Age of tank(s) 21 years Tank type/material Septic/Steel 49" Measured -operating fluid level in septic tank FBI Standpipes/foundation cleanout per record drawing Date of pumping 9/11/19 D. ABSORPTION FIELD DATA Which system tested (date installed) 5/1/98 ❑ ALL standpipes present per record drawing Total measured depth from grade 10.8 ft (max) Measured depth to pipe invert from grade 6.6 ft (min) ❑ NIA — pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Well production at time of test 4.5 qpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes Nc Coliform bacteria is Negative 91 Nitrate 9.mg/L ❑ Nitrate less than MRL (ND) Arsenic. &/) ug/L ❑ Arsenic less than MRL (ND) Collected by ArcTerra Date of Sample 9/22/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 9/13/19 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 1.5 in Elapsed time 144 min Fi Code -required soil cover over field nal fluid deth 0 Vin System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 1000�gallons If yes, enter date Comments/Deficiencies:7moss Glean VUT nOT TOuna COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' 0 Yes if No ft [2] Yes if No Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' 50 Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft 0 Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No. Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ft Absorption Field > 5' ® Yes if No ft Private Wells > 100' 0 Yes if No_ Water Main > 10' ® Yes if No ft Community Wells > 200' 0 Yes if No_ Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' 0 Yes if No Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS Deck supports to be modified to remove support post over tank. Pictures to be provided. G. ENGINEER'S CERTIFICATION I certify that 1 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 4 i 49 7Y CE 7116 'M vesN����•t �+ .RGFE +" ft ft ft ft ft ft ft ft ft ft x {-Xj SHERMAN STREET jer i N89°59'00"W 132.00' WELL © WELL 2' EASEMENT ON EXISTING POWERLINE 7/H O/H SHED N 14.0' LOT 5 ARCTIC ENTRY ENTRY — 0.5' CANT WOOD WALK 0.5' CANT 36.0'-- N w N EXISTING Z HOUSE z 60.0' 1.0' CANT 0 18 DECK LOT 11- ,NCHORAGE RECORDING DISTRICT, ALASKA. 6BUILT OF: CUNDRA JEWEL RANCH SOT 5 PLAT P-581 URVEY CERTIFICATE: I, John L. Schuller, Have conducted a hysical survey of this property as shown on this drawing and that the .mprovements situated hereon are within the property lines and no ,nchroachments exist other than noted. Under no circumstance shout( my information on this drawing be used for construction of fences, tructures, improvements, or for establishing boundary lines. :XCLUSION NOTES: It is the owners responsibility to determine ie existence of any easements, covenants, or restrictions which o not appear on the recorded subdivision plat. DRK ORDER NUMBER: DAiE scu ' -TIAL APR 20, 2013 1 "=20' kndmg0ak.net 13-016 Da AW( BY; CHEa(M BY (RID NUMBER 8"/PAa JLS I NW 1159 130126 AC O/W G( Cn 16.6' p 24.0' O O U1 O t— N O O -P 16.5' 6.3' ❑V NEIGHBORS SHED N SEPTIC O VENT O m (tYP) 132.00' 0 = FND REBAR Aw r �.. 4 a.... ....... ....... JOHN L. SCHULLER.= o` �o LS -10408 kk 001 kN °fession& —�'~— LAND �Z���' v Q r 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC191457 Subdivision: Tundra Jewel Ranch Lot 5 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 21 years old. Typical replacement costs range from $8,000 to $11,000. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. DEVELOPMENT SERVICES DEPARTMENT On -Site water and wastewater Section www.muni.org/onsite ~ Nitrate Advisory Certificate of On -Site Systems Approval # OSC191457 Subdivision: Tundra Jewel, Lot: 5 A water sample revealed a nitrate concentration of 9.91 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. K_, :- ' ^2�' " `� y��$`�' j i+I� /' a �•c'`�C�(y�'�'a '��r���t^�`� ���-�� ���K'�� Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. 1��1�n��ddress P �"�Box�.96650'��n��iorage,��4l�ska 9951��b'SCl �` r�;ti���nctttx org ��,," �u �� - GT b • '� Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-193-12 1. GENERAL INFORMATION Complete legal description TUNDRA JEWEL RANCH LOT 5 Expiration Date: T) -) 7 — /_3 Location (site address) 23010 SHERMAN STREET, CHUGIAK, AK 99567 Current Property owner(s) WANDA BLACKBURN REV. TRUST Day phone Mailing address Real Estate Agent PO BOX 670530, CHUGIAK AK 99567 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class _ Well F-1 Cnmmi inity F-1 Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by /; 'i, I , Date. ': COSA to be released to the engineer, unlass Athenvise requested by the engineer. COSA Fee $ !q0(b— n DateofPayment 5113113 C)\w, Receipt Number oA5`t COSA# o5c-131tff a 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. Name of Firm ARCTERRA CONSULTING. INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 4130/13 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future x�1` yr, occupants or can ArcTerra guarantee that no unseen '�' �.1>•' A � e4 encroachments, deficiencies or discrepancies exist. rr,.fi'.' OV 6. DSD SIGNATURE l� System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date:77 The(;Zi pal nchorage 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 Septic System Advisory Well Flow Advisory COSA blue eheet_in-10.12 d Nitrate Advisory; Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: TUNDRA JEWEL RANCH LOT 5 Parcel ID: 051.193.12 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # _ Date completed 911612004 Sanitary seal (YIN) Y Total depth 254 ft. Cased to 254 ft. FROM WELL LOG Date of test 9116104 Static water level 208 ft. Well production 10 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 7.35 mg/L Arsenic: ND ug/L Date of sample: 4117113 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC I STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 411712013 Pumper JRs C. ABSORPTION FIELD DATA Well Log (YIN) Y Wires properly protected (Y/N) Y Casing height (above ground 18+ in. AT INSPECTION 411 712 01 3 ft. Collected by: ARCTERRA Date installed 511611998 Cleanouts (Y/N) Y High water alarm (Y/N) N Date installed 511611998 Soil rating (g.p.d./ftz or fe/bdrm) 1.2 System type DEEP TRENCH Length 38 ft. Width 2 ft. Gravel below pipe 5.32 ft. Total depth 11.3 ft. (Measured 4/17/13) Eff. absorption area 404 ftz Monitoring tube Y Depression over field N Date of adequacy test 411712013 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 540 gal. New depth 3 in. Elapsed Time: 5 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off' level at _ in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 251+ Animal containment areas 501+ SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (YIN) High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout 1004 Holding tank Manure/animal excrete storage areas 100'+ Building foundation 54 Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 104 Surface water 1004 Wells on adjacent lots 1004 ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 104 Water main 104 Water Service line 104 Surface water. 1004 Driveway, parking/vehicle storage 104 Curtain drain 50'+tNONEKNOWNI Wells on adjacent lots 1004 F. COMMENTS Vacant system presoaked prior to testing G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of determined through field inspections and review of Municipal records that inspections and review of Municipal records that the above systems are in Municipal records that the above systems are in conformance with MOA above systems are in conformance with MOA COSA guidelines in effect on conformance with MOA COSA guidelines in effect on this date. COSA guidelines in effect on this date. on this date. Engineer's Printed Name KENNETH M. DUFFUS Date COSA brown sheet 10-10-12.doc in. Municipality of Anchorage Community Development Department Development Services 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 Nitrate Advisory Certificate of On -Site Systems Approval # 131182 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 5 of Tundra Jewel Ranch subdivision. This inspection revealed a nitrate concentration of 7.35 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SHERMAN STREET jeCu,uw(is;rd:<e N89`59'00"W 132.00' � WELL WELL AC D/W W Ut 0 /H2' EASEMENT ON EXISTING POWERLWE 0/H O/H O/H O/HLn O O ARCTIC 0/ O/H oN ENTRY µp00 WALK SHED N 0.5' CANT 0.5' CANT 16.6' O 36.0' 24.0' OO O M F— U1 O I— 00 w EXISTING 0 HOUSE M T v, z ~ Y 60.0' 16.5' 6.3' CD fV 1.0' CANT • A ❑� o OT 5 DECK NEIGHBORS 16.3' • O N N i SVE ED O TC 1-• (tYp) x • xI -X—XJ N89'59'00"W 132.00' LOT 11 ANCHORAGE RECORDING DISTRICT, ALASKA ASBUILT OF: O = FND REBAR TUNDRA JEWEL RANCH LOT 5 PLAT P-581 `"\\ xk i OF \�` *yD SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a survey of this as shown on this drawing and that the C A % `i •' •L. LAN�R�T� 4 SLS �� physical property improvements situated hereon are within the property lines and no than Under . / (S '• ' yS0 S Y' enchroachments exist other noted. no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. 000 ° ..... ... / / / l..l�a.\../ �'p �' , TJ1 EXCLUSION NOTES: It is the owners responsibility to determine ...... .(.. . "t /'JOHN L. SCHULLER: }g the existence of any easements, covenants, or restrictions which ' do not appear on the recorded subdivision plat. , '•. LS -10408 .- �ei��_,�.r� 1 P„ oc / 1831 Talkeetn.a Street WORK ORDER NUMBER: onic: sate -M.u: APR 20, 2013 1-=20' 1 1ALgOok.n.t 1 P 5 / aA ` �'" l3 •. Pd / `%- Anchorage, Alaska 99508 B 13-016 .+ M er: areae . NAB�]t eoos/— JLS NW 1159 130126 ofessional (907) 227-1455 office (907) 274-4992 fait