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HomeMy WebLinkAboutCANYON VIEW ESTATES BLK 1 LT 3Onsite File Canyon View Estates Block 1 Lot 3 #021-021-36 tr<ev voiuti io/ Municipality of Anchorage On-Site Water and Wastewater Section e (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OS221057 PID Number: 021-021-36 Dwelling: K Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: X New ❑ Upgrade Name Hultquest Homes ABSORPTION FIELD - ❑ Deep Trench .V§ Wide Trenchd ed [J Mound Site Address .� �`� 1 (; Canyon Road El Other Phone Number of Bedrooms Soil Rating Total depth from original grade .I 5.0 GPD/SF 6.5 Ft. LEGAL DESCRIPTION Depth to pipeinvert from original grade 6.0 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot Canyon View Estates 1 3 Fill added above original grade 0.0 Ft. Gravel length 28.0 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines 1 Distance between lines Ft. SEPARATION DISTANCES Tol Septic I Absorption Lift Station I Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 140 Ftz Ft. Well 100'+ 100'+ 1 100'+ NAI 25+ TANK eptic ❑ S.T.E.P. ❑ Holding Mother Manufacturer Anchorage Tank Capacity 1500 Gal. Surface Water 1100'+I 100'+ I 100'+ ( NA Material Number of compartments I I Lot Line 101+ 10'+ 10'+ I NA NA HDPE 2 Foundation I 10'+ 10'+ 10'+ I NA ( LIFT STATION Manufacturer x Capacity 500 Gal. Remarks`4vU( Alarm location Pedestal/Garage Electrical installed by 14 D , Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Brownson Bros Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 100 ft Inspdea{wn 5/25/22 5/26/22 Location and description es:�-1 2�d 3I 5/27/22 4"' 5/28/22 Trim on nearest house corner ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Dateof A � A? ,Igk kk .s � a �, R. '=,:,;r�`^� �1e:1 `_ddb Septic S stem Approved Date F40;11; Note: this approval does not include well permit requirements. tr<ev voiuti io/ --INC C Z(n DN U-iZ Innpm D=D I I OI�IN OI00,Itn z C�OrnDO� R z Z �o D O m o Z O ti E rm vpiOO L/) O - I c O m O m m z m r- O z z z' * mm O O In X Ci U D r —1 O Z D tm F- Dr*lrn p tnrn=�z• D (� 7. D fTl (� D r x cn' ;D I- � m��>�cnrnx— pfJ-DI DNp < C) D Drn =m ozmrno O Z x O O 0 N N E (n O N O 03 1 O o (f).: -9 o K: 0) �n -u0 m D O 0) rrl O 0) W CA N N N N („ i -I, P (D CO -P O� p rn D (0 Co -P O -P N (D N -. CP U) GI C4 N N N -� O - m W N -' W O (D CO (D O CD N N -. W (J) � D tm F- Dr*lrn p tnrn=�z• D (� 7. D fTl (� Ln ;O r x cn' ;D I- � m��>�cnrnx— pfJ-DI DNp < C) D Drn =m ozmrno m Z O O O N (Tl fTl N O (3l � 41 fTl O O O O 03 1 < r9cn o (f).: -9 o K: 0) �n -u0 m D 90') 0) rrl 0� TI p p D0 -nm O (n n N m tr -- I -< Ili \ rn m x rn p � r ,J � z FOUNDATION CLEANOUT Z --I cn D �4 MANHOLE ' I/ / / >N�� -� CJ D Co r- > D0) ODO o Mx i }j o (n z m� o t. —i O c ;-- '' (7 G� I rl X v Z(� O :.:; �. i O O; Y% MANHOLE ITI x �- >, i Boa ,x r D : l -i U) N Cn0 D�� FT A� Dcyl C7 0 D o No x D 0 10 > m CA I _ I qm to N) Oprn `JJ VO A N O O] ? N / / <D _ Z o cnO 2 I U I 0 - O ;1DrO < :CN D 0 mo — rJ i 1 I p r �— n D ci 00 cl) P I —� l mac. '1{ ( I I m m O z n 0 v I Zz NOTES: PANNONE ENG SVC LLC C.I. 1088) "" REVISIONS DATE RECORD DRAWINGS P.O. BOX 1807 P/%LIIER, AK 9645 - '�6 OF. A(q' �,� 10/10/2022 PHONE (907) 745-8200 FAX (907) 745-8201 - �P.- S '+ SCALE 1 " = 50' CANYON VIEW ESTATES, B1 L3 s �) _ ' ' P.I.D. NO DRAWN MMM HULTIQUIST HOMES -:-� 021-021-36 - 5tov CcER 149 none _ PERMIT N0. CANYON ROAD. .. 05221057 SITE PLAN ANCHORAGE, AK '�Ess`a'�:�' SHEET 1 OF 1 Alpine Drilling & Enterprises Well Log Permit Number: #SW 221 X357 Dade of Issue; 3-15-22 Parcel Identification Number: 02102136000 Date Started: 7-75-2 Date Completed: 7-17-22 is well located at approved permit location? x Yes [3 No Legal Description. Canyon View Estates Block 1 Lot 3 Property Owner Name & Address; Hultquist Homes Inc. . Borehole Date: Depth (ft) Soil. Type, Tl�claiess & Water Strata From To std ick app 0 2 organics 2 S silt S 15 gravelly silt 15 112 silt 112 127 gravelly sandy silt wet .127 143 silty water sand & gravel 143 151 ,gravelly silt 15.1 157 silty water sand & gravel 20gpnz 157 162 gral,elly silt 162 178 silt 178 .181 bedrock 181 206 .H`20 Method of Di'iillag x air rotary U cable tool Casing type: stccl Wall Thickness: .250 inches Diameter: 6 b-Iches Depth: 1182 feet Liner Type: Diameter: inches Depth: feet Casing stickup above ground: 2 feet Static water Ievel (froin ground level): 154 feet Pumping level -_21Q feet after g hours pumping .6 Spin Recovery Rate: 6 gpm Method of Vesting: cirri . Well Intake Opening Type: 0 Open End x Open Hole [� Screened Stant feet Stopped feet �] Perforations Start feet Stopped feet Grout Type: ;bentgn a .vranules Volume: 4PTs Depth: .. Start 0 feet Sftned ?feet Pump: Intake Deptlx feet Pump size lap Brand Name Well DlsiMected. Upon Completion? x Yes EI No 189 190 Method of D-isinfeetiou: chloriza_e tablets WATER iTI TESTING Cdiform , P - Nitrates CoV9OOmL --� �� l �L At C --�- Ug/L lyEM�111„'` V 3qi-'1aqj comments: - Well Driller: h(lpine Drilling & Enterprises PC Box 110496 Anchorage AK 99511 Oct_11.2022 11:45 AM Anchorage Well & Pump Service Inc 9072430742 #1304 P 1/ 1 MUNICIPALITY OF ANCHORAGE Development Services Department # Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-3437997 Pump Installation Log Well Drilling Permit Number. Parcel Identification Number. 021021 -36 Date of Issue: - - Legal Description Block Lot Property Owner Name & Address: HULTOUIST HOMES INC CANYON VIEW ESTATES 1 3 12570 OLD SEWARD HWY SUITE; 204 ANCHORAGE=, AIC 99515 Pump Installation Date: 09 . 01 - 2022 Pump Intake Depth Below Top of Well Casing: 190 feet Pump Manufacturer's Name: XYLEM Pump Model: 8 1 6 Pump Size: .755 hp IPitless Adapter Burial Depth: 12 feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: BAKER Well Disinfected Upon Completion? XYes D No Method of Disinfection: PELLETS Comments: Pump Installer Name: _ ANCHORAGE WELL & PUMP SERVICE 7640 KING STREET Company: ANCHORAGE, AIC 99518 Moiling Address: 907-243-0740 State: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http:llwvu,w.muiii.org/onsite On -Site Water & Wastewater System Permit Permit [Number: OSP221057 Work Type: WellSeptic Initial Tax Code Number: 02102136000 Site Legal Address: CANYON VIEW ESTATES BLK 1 LT 3 G:3042 Site Mailing Address: 13711 CANYON RD, Anchorage Owner: HULTQUIST HOMES INC Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: ✓❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: f Dcpartment 3/15/2022 3/15/2023 71852 Q Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: — -� Date: f Issued By: �ii✓ _4�CajuAl Date: 315aoa 4 MUNICIPALITY OF ANCHORAGE _ : It Community Development Department ......... 1- Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 021-021-36-000 Property owner(s) Hultquist Homes Day phone Mailing address 12570 Old Seward Hwy Suite 204 Anchorage AK 99515 Site address Legal description (Sub'd., Block & Lot) Canyon View Estates B1 L3 Legal description (Township, Range & Section) Lot Size 71,852 Sq. Ft. -Number of Bedrooms 4 APPLICATION IS -FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial n Single Family (SF) ❑X (w/wo AD U) Septic Tank ❑X Upgrade ElDuplex (D) . ❑ Holding Tank ❑ Renewal ❑ Multiple ❑ Privy ❑ .Dwellings (SF and/or D) Private Well �] Water Storage ❑ -THIS-APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes., (Signature proper)y'owner or authorized agent) Permit/Rush Fees: o? 0 f '� Waiver Fees: Date of Payment: 3 /V ,20 2a Date of Payment: Receipt Number: 0 % 2 0 N Receipt Number: Permit No. o 5 p� '� , 0,5 % Waiver No. Permit App__- : .�.,:c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221057, Rebecca Carroll, 03/15/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221057, Rebecca Carroll, 03/15/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221057, Rebecca Carroll, 03/15/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221057, Rebecca Carroll, 03/15/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221057, Rebecca Carroll, 03/15/22 LJ V� U H � C � Ll A L � W `ll u F AHCJ H0 G 'E Development Services Department r p p � Phone: 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 021-021-36-000 Expiration Date:. 9/l/2023 __ Legal description CANYON VIEW ESTATES BLK 1 LT 3 Site address 13711 CANYON RD Anchorage AK 99516 Current property owner(s) HUTCHINS SHANE G & LAURA S X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: M Original Certificate Date: 6/1/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist Absorption Field Advisory Tank Age Advisory Other X Well Flow Advisory Nitrate Advisory Arsenic Advisory COSA ApprovaLJune 2022 Development Services Department �`� r�- Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 021-021-36 Complete legal description CANYON VIEW ESTATES BLK 1, LOT 3 Location (site address) 13711 CANYON RD, ANCH AK Current property owner(s) HUTCHINS 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑■ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: 0 AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: 0 Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ / Z O Waiver Fee $ Date of Payment Date of Payment COSA # 01f� G 2_� 1 17 2 Waiver # COSA Application—June 2022 COSA Checklist Legal Description: CANYON VIEW EST. BILK 1, LOT 3 Parcel ID: 021-021-36 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA N Well log is filed with Onsite (or attached) Date drilled 7-15-22 Total depth 206 ft Cased to 182 ft ❑ Sanitary seal is functioning correctly FNI Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 5/23/23 Static water level at beginning of test 154 ft. Comments B. TANK DATA Measured operating fluid level in septic tank ' NEW Date of pumping NEW ❑0 Required maintenance completed, if AWWTS Comments: *NEW ADVANTEX INSTALLATION D. ABSORPTION FIELD DATA Which system tested (date installed) 5/26/23 ❑ ALL standpipes present per record drawing Total measured depth from grade 6.5 ft (max) Measured depth to pipe invert from grade 6 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) _ If yes, enter date Com m ents/D efic ie n cies: COSA Checklist June 2022 Well production at time of test 5+ qpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes No RN Coliform bacteria is Negative Nitrate 1.61 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L X Arsenic less than MRL (ND) Collected by Date 5/23/23 M NA LWRIAII&III]FAl `I ❑01 Required maintenance completed Age of lift station NEW years Lift station material HDPE Comments: NEW Adequacy test date NEW Results Q Pass Fluid depth prior to test _ in Water added _ gal New fluid depth _in Elapsed time _ min Final fluid depth _in Absorption rate 750 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 6 in Effective depth remaining 6 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' ❑i Yes if No _ ft Neighboring Tank > 100' Q Yes if No _ ft Absorption Field on Lot > 100' Yes if No _ ft Community Sewer Manhole/Cleanout > 100' E Yes if No _ ft Private Sewer/Septic Line > 25' Q Yes if No _ it Holding Tank > 100' ❑ Yes if No _ ft Neighboring Absorption Fields > 100' Animal Containment > 50' [E Yes if No _ ft ❑i Yes if No _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑� Yes if No _ it ❑i Yes if No _ ft ❑ N/A— Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS ❑ Yes if No _ ft ❑i Yes if No _ ft Yes if No _ it Q Yes if No _ ft E Yes if No _ it Surface Water > 100' Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' 9 Yes if No _ ft El Yes if No _ ft Q Yes if No _ ft If tank or field is under driveway comment below G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. NameofFirm rnl�C� 1Mcj tvivrl �i� Engineer's Printed Name �� my COSA Checklist—June 2022 Phone 727-8864 Date e, (_3 2 s` MICHA:LN. [RSCN `� O .. CE -9469 ;- s �Q'�yeO,*(e DoeuSgn Envelope ID: E4276D49-F020-4527-9140.7FDCF65EQ9A9 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this Z—Day of VJAJof 20c�) , by and between Aaron McGrath , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems, The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Advantex 1500 located at (legal description) Canyon View Estates B1 L3 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) All-� Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. &4 1 It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Aid Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, /� repairs or permitted alterations to the system. AA(Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page I of 3 DocuSign Envelope ID: E4276D49-F620-4527-914D-7FDCF65E09A9 Ar>~ Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the line for failing to maintain and repair an AWWTS maybe assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement 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 Agreement. 7, Severabilily. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 DocuSign Envelop ID: E4$76049•r="1527.9 WD•7MCrG&EOW OAVNER, By: (signature) Date: 'S (print 11,111X) Ss, THIRD JUDICIAL DISTRICT ) The foregoing ins trumctt teas acknowledged before me 2023 , by i�c��, tti, o ��,(.�ui� AR,j-j-c vhti.ta� —`a NOTAR) PUBLI++C FOR A-LASIE�t jj+l15e-O S.l My Commission expires: i p 11I SO -)-j _ signature) rine name) thi�LS�'da y of 'toll 111" Date: Title: (rev. 05/18/2018) Page 3 of 3 MUNICIPALITY OF ANCHORAGE a Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 021-021-36 Expiration Date: Legal description Canyon View Block 1 lot 3 Site address 13711 Canyon Rd Current property owner(s) Hultquist 10-17-2023 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: avByT4 Original Certificate Date:/ This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist Absorption Field Advisory Tank Age Advisory Other X Well Flow Advisory Nitrate Advisory Arsenic Advisory COSA ApprovaLJune 2022 MUNICIPALITY OF ANCHOIRAD GE Development Services Department ` Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 02102136 Complete legal description Canyon View 131 L3 Location (site address) 13711 Canyon Rd Current property owner(s) Hultquist Day phone r 2. ON-SITE SYSTEMS SIZED FOR I BEDROOMS 3. TYPE OF WATER SUPPLY: 0 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel FE1 Plastic ❑ Concrete ❑ Fiberglass Age new - See advisory if steel older than 20 years 6. ABSORPTION FIELD: F01 AWWTS ❑ Bed ❑ Deep Trench 0 Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: 0 Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Application—June 2022 Legal Description: Canyon View 131 L3 Parcel ID: 02102136 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 7.15.22 Total depth 206 ft Cased to 182 ft © Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA new Static water level at beginning of test 154 ft Comments B. TANK DATA Measured operating fluid level in septic tank New Date of pumping new 0 Required maintenance completed, if AWWTS Comments: A D. ABSORPTION FIELD DATA Which system tested (date installed) 5/26/22 W ALL standpipes present per record drawing Total measured depth from grade 6.5 ft (max) Measured depth to pipe invert from grade 6 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. On Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficien COSA Checklist June 2022 Well production at time of test 6 gpm Water storage tank volume na gallons Well disinfected for coliform test? ❑ Yes ❑ No 0 Coliform bacteria is Negative Nitrate 1.19 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L W Arsenic less than MRL (ND) Collected by PES Date 10/10/22 C. LIFT STATION ❑ Required, maintenance completed. Age of lift station new years Lift station material HDPE Comments: Adequacy test date new Results ® Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate 750+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 Effective depth used 0 in Effective depth remaining 6 in in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Building Foundations > 10' 0 Yes Community Sewer Manhole/Cleanout > 100' on Yes if No ft 0 Yes if No ft Neighboring Tank > 100' is Yes if No ft Private Sewer/Septic Line > 25' © Yes if No ft Absorption Field on Lot > 100' E] Yes if No ft Holding Tank > 100' QYes if No ft Neighboring Absorption Fields > 100' Community Wells > 200' QYes if No ft Water Service Line > 10' Animal Containment > 50' Q Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' QYes if No ft ® Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Yes if No ft Tank to Property Line > 5' M Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' Q Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' QYes if No ft Water Service Line > 10' Q Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Pannone Engineering Services Phone 907-745-8200 Engineer's Printed Name J.R.LAWENDOWSKI P.E. Date oF 0A . 49 D .. ...' ......».**'*' d •J.R.LAWENDOWSKI JR- ���sP ' • CE -148976, ���i��PROEESSIONPL.�,� COSA Checklist June 2022 r oo ®O - lil C'4 c HL "s- c O N N Q 3 2 o i Y 0 � O C Q) O U °o 0 > Jto Q l0 :2 'S N a- O 3: U � o r ° ° -° 4-. it a o �+ 0 a) E o N �o� CDC O o — - 00 U) c o o Q) " (nc "o c CL 3 a) L = em 0 d Q) s M 0-)Q' N C ..'O.+ � ^ 03.0 c CL U N Ln Eo T C S4 N N (p C ~ 0 cn 4-jc CD.- w, O y ZU r, �-' ¢ MMO 0`~� m F 0) O T i a) U O I M `f o >, 2- ° o vi 0. t C) o L � O o O ° ccc`o O° •� a4 Cooi O o -C coC a)._ C o rJ c ° o Q)> > i o•— I� o N .2N U0 m CO a ° ° :t -o t N _ a)O NU3ai iu O Z N V� U °Ea0 O N D 03 T° TOC Oa)o` o ° uO -N°CO N i'° C CD U > L++ NTC C 3 O 7'= O -° -sputa )_0 vC9 m ac �•, r7 °� - - _ V a) a) rt c �i6 -C O a C O -C O _c 'L. v- F- J !- u) LL. F- U) E. 3 o I N M