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SEACLIFF BLK 2 LT 3A
eacliff Block 2 Lot 3A #011-211-37 Inspection Report-1-1-12.doc Municipality of Anchorage Community Development Department Page 1 , T 17 7_0* On -Site Water and Wastewater Program 4700 Elmore St. - P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org/onsite - (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP1 71294 PID Number: 011-221-37 El New Z Upgrade Name: Tyler & Lisa Hasbrouck ABSORPTION FIELD E] Deep Trench El Shallow Trench E] Bed 0 Mound Td—dress 9320 Jaclaire Ln Ej Other Phone Number of Bedrooms Soil Rating Total depth from original grade 1 6 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Seacliff 2 3A Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches t Dist. between trenches From Tank Field Lift Station Tank Line Fe Ft. Well 100+ N/A N/A N/A N/A TANK 111 Septic El S.T.E.P. El Holding Ej Other Manufacturer Anchorage Tank Capacity I 2,000Gal. Surface Water 100+ N/A N/A N/A Material Steel Number of compartments 2 Lot Line 10+ N/A N/A N/A NA Foundation 5+ N/A N/A — N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ N/A N/A N/A I Gal. RemarksTank Only Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank 3034d Tankto 3034 rainfield GLW Enterpsises Drainfield CO/MT 3034 Inspector Pannone Engineering Services BENCHMARK (Assumed elevation) 100ft Inspection 15110/16/17 Ild 10/16/17 Location and description dates: d 2 th Top of Deck 3 4 COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp OF A Conditional Approval: Date , ... �q w 'W. Steven51�! CE 814 Approved Date VbbrJon AW Inspection Report-1-1-12.doc �I 2 I UI I wl I �I I of 6A B DRIVEWAY TWO EXISTING SEPTIC TANKS FC DECOMMISSIONED PER CODE T1 6 BR SFR INSTALLED NEW 2,000g DEEP BURY SEPTIC TANK PER MCA CODE T21 A EXISTING DRAIN FIELD 7.3 ' J LOT 3A L 7 5A / TRUE NORTH _:. SCALE z PANNONE ENG SVC LLC P.O. BOX 102954 ANCHORAGE, AK 99510�G PHONE (907) 272-8218 FAX (907) 272-8211 �P'�•• •••. *�• ••• }a cnin a 8149 ••••• i��V Date 10/17/2017 SWING TIES —W W — WATER LINE / o> SEACLIFF B2 L3A011-221-37 TYLER & LISA HASBROUCK 9320 JACLAIRE LN ANCHORAGE, AK 99502 P.I.D. NO PERMIT NO. OSP171294 WELL RADIUS Qo z< 0 0 <w < ,o m< A B 0o Li _Ss — sS — NEW SEPTIC � T1 19.0 46.2 EL. OG FG 98.8 - T2 1 1 .0 57.2 ABBREVIATIONS 8.0 TH TEST HOLE DESIGN PARAMETERS (P) PROPOSED (E) EXISTING EL. 90.2 2,000g STEEL PRIMARY SEPTIC SYSTEM NO. BEDROOM: 6 CO CLEAN OUT NO. SEPTIC TANK EL. 90.0 TANK SIZE: 2,0008 DCO DOUBLE CLEANOUT FS FLOW SPLITTER USE: FC FOUNDATION CLEANOUT PROFILE NEW 2,000g STEEL SEPTIC TANK MT MONITOR TUBE NO. TYP TYPICAL NOTES: PANNONE ENG SVC LLC P.O. BOX 102954 ANCHORAGE, AK 99510�G PHONE (907) 272-8218 FAX (907) 272-8211 �P'�•• •••. *�• ••• }a cnin a 8149 ••••• i��V Date 10/17/2017 RECORD DRAWING Scale 1" = 50 SEACLIFF B2 L3A011-221-37 TYLER & LISA HASBROUCK 9320 JACLAIRE LN ANCHORAGE, AK 99502 P.I.D. NO PERMIT NO. OSP171294 DRAWN NJCCE SITE PLAN Sheet 2 OF 2 .` '"""'y MUNICIPALITY OF ANCHORAGE cent • On-Site Water&Wastewater Program ..,o° ^e- r PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 �\ t http.//www.muni.org/onsite i , t7t�l�artnic•nt qN CH OR HVt On-Site Wastewater Disposal System Permit Permit Number: OSP171294 Effective Date: 10/3/2017 Work Type: SepticTank Upgrade Expiration Date: 10/3/2018 Tax Code Number: 01122137000 10(1 to/t1 rau �p rU Site Legal Address: SEACLIFF BLK 2 LT 3A G:2424 Site Mailing Address: 9320 JACLAIRE LN, Anchorage Owner: HASBROUCK TYLER J & LISA L Lot Size in Sq Ft: 21880 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 6 This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank El Privy El 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 Special Provisions: Double cleanouts shall be provided downstream the tank (within 10 feet). /1111P 0 Received By: 4y, ' / / Date: // 4 ©, Issued By: Date: a MUNICIPALITY OF ANCHORAGE • r r • I Community Development Department \..116 a; Phone: 907--W- Development 07- _ -Development Services Division — — Fax: • it 1- • - 9' rr On-Site Water& Wastewater Program _ r RUSH, ON-SITE SEWER/WELL PERMIT APPLI ATION r OCT 02 2017 Parcel I.D. 011-221-37 \ Tyler & Lisa Hasbrouck F 9 Property owner(s) Y Day phone Mailing address 2041 Patriot Cir. Anchorage, AK 99515 Site address 9320 Jaclaire Lane Legal description (Sub'd., Block & Lot) Seacliff B2 L3A Legal description (Township, Range & Section) Lot Size 21,880 Sq. Ft. Number of Bedrooms 6 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑x Upgrade ❑x Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE I 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 of property owner or authorized agent) Permit/Rush Fees: 43ti`i ' Waiver Fees: Date of Payment: 66/30 Date of Payment: Receipt Number: 0S344C7 Receipt Number: Permit No. 05P1?1.29(/ Waiver No. Permit App_ - .:..,c Pannone Engineering Services iic Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com October 2, 2017 Subject: Seacliff B2 L3A Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install an upgrade 2,000g Septic Tank to replace two existing 1,250g and 1,000g Septic tanks to be issued for this property. The existing tanks have completely failed. They will be decommissioned per code. Currently the lot is developed. The proposed system will utilize a replacement 2,000g septic tank that will be connected to the existing drain field. The existing tanks are located approximately 100'+ from the well. The proposed tank will be placed outside the existing well radius. All required separation distances will be met. 1. Upgrade Tank Design. A foundation clean out installed if needed. The tank will be located: 5'+from any property line or building foundation 10'+ from any water line 100'+from any surface water 100'+from any private wells 200'+from any public wells The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 907.272.8218. Sincerely, PSE............... 1 1 A • •• • : • 0 4 Sloven R Pannone t a +r •'•. 614 �i Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 72-013 (Rev. 3/76) MUNICIPALITY OF ANCHORAGE J, `r DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ❑ NEW i-iiiPGRADE - CA X G =1 I _ 2 Z MAILING ADDRESS'713--2F, Z c_ e� - LEGAL DESCRIPTION G_ ::�. lk 2 t LOCATION NO. OF BEDROOMS Well Absorption area - Dwelling r PERMIT NO. U DISTANCE TO: A ""�' _ / Y P z Manufacturer/ "A is 0,K IN Material No. of compartments -. w< - .g 9 y Liq. capacity in gallons Inside length Width Liquid depth IF HOMEMADE: �' Well Dwelling PERMIT NO. Jaz DISTANCE TO: 2'1 Material Liquid in = Manufacturer capacity gallons O Well Foundation ,, Nearest lot line? P RMiT NO. Jm = DISTANCE TO: . K - �._-. e _ , J LL Z No. of lings Length of eac, li e° Total length of li es Trench width d Distanceet een lines Z w I — .' inches pC Rf Top of tile to finish grade !� Material beneath tile _ Tota effective a or tion area p s nuc=, _ �• inches Length Width Depth - PERMIT NO. w Q F- Type of crib Crib diameter Crib depth Total effective absorption area Lu LU w Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J J W Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: r OTHER E MATERIALS LJC ` vc 15�"L6L5;t 161, 63 SOIL TEST RATING Xi i Bh t INSTALLER y� REMARKS �k Pa T J -N,9 72V i SE., t>ekl Zv11 3' • G �i / FF cq..- C� , 64 m� t�L�r=Y c J �H� ac° rn, T�'1.t ✓yn� ° a NCO E A cit s c=/ MUNICIPALITY O DEPT. OF F Li 1I c_ ENVIRONMENTA ROT -CTI N c *h9Q APPROVED DATE LEGAL RECEIVED 72-013 (Rev. 3/76) Department', f Health and Environmenta ?rotection �. 825 �L Street, Anchorage, AK. '-x9501 264-4720 # # # HANDWRITTEN PERMIT # # Permit # ??_)() SU 830g5- �., ON-SITE SEWER PERMIT Applicant: j494 L(% 1SoAJ Mailing Address: 171�2,5- 01-d Location: 1—( caw Ste. / 1(� Phone Number: Legal Description: ko f 31q eX Z S€ .+ L S�Q Lot S ize : �T� l Type of Soil Absorption System Is: Trench: ✓ Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) The Require S�.ze oi- the Soil Absorption System Is: DEPTH 1,2( LENGTH . GRAVEL DEPTH WIDTH 3o n The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = l -S GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. # # # TWO(Z) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper.installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 u 3 # I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that•/3� bedrooms. Signed: Issued by: SCl/- 42d _ Applica5 Date: g3 3 ©0 '�)� I � �E SWP/024 (1/81) 400- tIE e��S,S �o' ��"`" r S & S 4 ENGINEERS, INC SOILS LOG 99502 7125 Old Seward Hwy. Anchorage, Alaska ❑ PERCOLATION 349-6561TEST / SOILS/ LOG — PERCOLATION TEST G BccCn/ ioeol PERFORMED FOR: �//�'•Za l^GC /1,5,<'jE�—.—__.. ..-- DATE PERFORMED. —A 7/s3-__ LEGAL DESCRI 1 2 3 0•� O L — S/�'1 0'— / s ' SM • e. i c� 2.5'-4.S° 4 �e•�o I 1•a . o o 6 6•:.iO'I '6 . •o O 16, G •rl- C - - I j 0 pe•a I � o. •� e' e e e e DEPTH? SITE PLAN i- o,ee e e a.e g ®SOFA00 Net Time i I I T • e . O , O WAS GROUND WATER I LL 4— ENCOUNTERED? O . •o I -- -- Q G •rl- C - - I j ! ,o. t •• I � I ! •e•• w 10 I I i I jI(�—�---*---T O Reading o,ee e e a.e g ®SOFA00 Net Time ! Depth ru Water � a • e . O , O WAS GROUND WATER Aib S / e$3 0 ENCOUNTERED? O . •o I IS jon E. SWAN P --12 ��� 00 0000,1834-E o ® �rF6f •ee000°°0000 aE�� 19'unD�°JROFESSIOAP��®� ,o. t •• IF YES, AT WHAT A, //T� •� e' e e e e DEPTH? /V 13 I I i I jI(�—�---*---T O Reading e g ®SOFA00 Net Time ! Depth ru Water � a • e . O , O Y '® a �i, as �J -�..'. 16 e$3 0 17 I IS jon E. SWAN 18- ��� 00 0000,1834-E o ® �rF6f •ee000°°0000 aE�� 19'unD�°JROFESSIOAP��®� I I i I jI(�—�---*---T O Reading Date Gross Time Net Time ! Depth ru Water Ne! Drop i i I 20 PERCOLATION HAVE ttTEST RUN BETWEEN Fr AND FT COMMENTS Q�� l�liI Ae / ���) PERFORMED BY: __ _ _ -_._ _CFRTIf']ED B�. - .. .- _ _.. _ -- DATE: GP All:K AN(GMUKAL*b AKCA t$VKVl"`-yM HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM N° 174 NAME %�. /l���/% `Z!/GlCMAILING /y ADDRESS �LI' �� G//!/✓�%✓ fJo/L—PHONE- LOCATION PHONE -�} LOCATION DESCRIPTION ��� a'�J s'aL _;z'. SEPTIC TANK: NUMBER OF DISTANCE FROM WELLCD4�0r 11,21"' MATERIAL c°Lc%C��=ice COMPARTMENTS LIQID LIQUID CAPACITY GALLONS. INSIDE LENGTH % ��>` INSIDE WIDTH / d r® DEPTH , SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH ' LENGTH, DEPTH J , LINING MATERIAL °� � flr ����'�—f DISTANCE FROM WELL /�� ✓ ✓'� BUILDING FOUNDATION -/--5 NEAREST LOT LINE J TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) J SQ. FT. TILE DRAIN FIELD: DISTANCE FROM NUMBER OF ES ABSOR ION AREA TOP OF TILE TO FINISH GRADE WELL: LOT LINE DISTANCES: FOU DISTANCE BETWEENI, LINES SQ. FT. LENGTH\QF EACH LINE NEAREST LOT TRENCH TOTAL Le OF LINES IN. TOTAL EFFECTIVE MATERIAL BENEATH TILE IN. ABOVE TILE DISTANCE FROM TYPE DEPTH , BUILDING FOUNDATIOI• NEAREST i / SEPTIC ----SEEPAGE SEWER LINE - ,TANK , SYSTEM_ DIAGRAM OF SYSTEM 4 ----WATER L� SAMPLE , NEAREST OTHER 4— _, CESSPOOL , SOURCES_ DATE APPROVED HEALTH AUTHORITY HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 ' �!'v� `:'� 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT j Case No. /J.-/ r NAME OF APP LICANT S/cli:�c �• �L1o, MAILING ADDRESS 6&- 97 ���4 �f PHONE NO.�y RESIDENCE ADDRESS LOCATION OF INSTALLATI0N�'�* LEGAL OESCRIPTION-d 3q Q1, Z Sa- l- l v APPLICATION TO INSTALL: SEPTIC TANK, SEEPAGE PITY ,DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH ��,d TO BE INSTALLED BY PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS llttm " PERMIT TO INSTALL A llle4,' AS DESCRIBED BELOW SEPTIC TANK SIZE Ln DISTANCES: SIZE OF UNIT TO BE SERVED L-/ham �?'z 07 TYPES SEEPAGE AREA TYPE�t DIAGRAM OF SYSTEM HEALTH AUTHORITYOR LICENSED DESIGNER certify that I am familiar with the requirements of Greater Anchorage Area Borough reaBoroughOrdinance No. 28-68 and that the above described system is in accordance with said code. /L% `fir ,Fier DATE' I, ` ` r vl APPLICANTS SIGNATURE. Time APPLIC SVT RILLS OUT UPPER HAI., ONLY Pror., arty OvJiler /i /C a _'i Phone Mailing Address `- J %- - - - Zip Code Date Buyer y. Address - Zip Code Lending InstitutionWit i Phone Inspector Address - Zip Code Realty Co. & Agent _ Phone Address Zip Code Legal Description MUNICIPALITY OFANCHORAGE Street Location ci r DEPT. OF PROTECTION Type of Residence Y❑ Single Family .. - Multiple Family No. of Bedrooms ❑ Other _RECEIVED_ Water Supply ❑ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Community B a For wells drilled prior to that date, give well depth (attach log if available). Public Utility - - - - Well To Absorption Area J Septic Tank Size j EJ d 9 2 2- Sewe -Disposal Individual Year Individual Installed: 11 Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time 11 Date Date Date Date n Inspector Inspector Inspector Inspector Fiiieeld Notes: Field -//QV /-) olfA f MUNICIPALITY OFANCHORAGE DEPT. OF PROTECTION ENVIRONPA--NTAL .. ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED _RECEIVED_ ( ) CONDJT 'AL APPROVAL' DATE B a Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size j EJ d 9 2 2- —r� Well to Tank 72 023 72023 (3182) - 1 G J L' ! F-PLAPS Parcel I.D. 011-221-37 Complete legal description Certificate of On -Site Systems Approval Seacliff 132 BA Location (site address) 9320 Jaclaire Lane Expiration Date: )7y 7- ZOYI Current property owner(s) Garrett & Stephanie Chappell Day phone Mailing address Real estate agent 9320 Jaclaire Lane Anchorage, AK 99502 El Single Family (w1wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 6 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic FX I Water Storage ❑ Holding Tank ❑ Community Well nX Community ❑ Public Water System 171 Public Sewer ❑ Waiver request for: Distance: Received by: Z ` - Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $. 551) Date of Payment g12b Receipt Number caq5?4 COSA # 05 1 6 O 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. In conducting an adequacy test, 1 attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering. Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE XSystem #1 Approved for 6_:__1 bedrooms System #2 Approved for bedrooms Disapproved Date OFAzf � Stevei *R •Paniione• CE 8149 pROFESSIO��P�'��AW Conditional approval for bedrooms, with the following stipulations: a ((K OF ((/,i Ice 1 Y- tiwv (' 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: Seacliff B2 L3A If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments Community Class C Well B. TANK DATA Age of tank(s) 10116/11 years Tank type/material Measured operating fluid level in septic tank FE� Standpipes/foundation cleanout per record drawing Date of pumping 1/7/2020 D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 9/7/83 0 ALL standpipes present per record drawing Total measured depth from grade 12.8 ft (max) Measured depth to pipe invert from grade 7.6 ft (min) ❑ N/A — pressurized field 0 Monitor tubes go to bottom of effective. If not, state depth into effective FM 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: 011-221-37 Structure served by this system 1 Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 12r13n9 Results ❑✓ Pass For 6 bedrooms Fluid depth prior to test 7 in Water added 900 gal New depth 24 in Elapsed time 300 min Final fluid depth 7 in Absorption rate '900 gpd Any rejuvenation treatment (past 12 months) If yes, enter date no 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 7.3* Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ 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 Community Wells > 200' 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' F-1 Yes if No ft ❑ Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) ft ft ft ft ft Building Foundations > 10' ❑ Yes if No 7.3* ft Surface Water > 100' ❑ Yes if No ft Property Line > 5'✓❑ Water Main > 10'✓❑ Yes if No ft Wells on Adjacent Lots: ft Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100'✓❑ Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' 0 Yes if No ft 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' ❑✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ 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' Q Yes if No ft F. ENGINEER'S COMMENTS 5.0' required at time of install G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet 49 AL Stew n' .v. an;ion2 o'• CF 814 9- c- t ��t'�f e1 r `•i a�Y 1w ft ft ,O 1 �--$:7-B -"tea Municipality of Anchorage u _°`�C-tjZ) On-Site Water and Wastewater Program (907) 343-7904f e�23i ::A/T , Certificate of On-Site Systems Approval __.._�'� Parcel I.D. 011-221-37-000 Expiration Date: C c+ 2( / .20 1 9 1. GENERAL INFORMATION Complete legal description Seacliff B2 L3A Location (site address) 9320 Jaclaire Lane, Anchorage AK 99502 Current Property owner(s) Tyler & Lisa Hasbrouck Day phone 907-317-2838 Mailing address 9320 Jaclaire Lane, Anchorage AK 99502 Real Estate Agent Tony Lewkowski Day phone 907-205-7114 2. TYPE OF DWELLING: I Single Family (wlwo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 6 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual ED Individual Water Storage ❑ Holding Tank ❑ Community Class C Well 0 Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by:, , 1. a , _ ' C r fr 1 ;, Date: 1 C 1 27 17 COSA to be released •the engineer,unle s otherwise requested by the engineer. COSA Fee $ 52t, S1 5, (0Waiver Fee $ to45/i j Date of Payment 10/213) 1. Date of Payment Receipt Number )11'1 Cl 0 1" q.Q (08 as Receipt Number COSA# 0607114 3' 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 Alaska Rim Engineering Phone 907-745-0222 Address 9131 E. Frontage Rd, Palmer AK 99645 Engineer's Printed Name Mary L. Shreves Date 10/19/2017 • 6. DSD SIGNATURE s '�: ,,?� • ).1.. •I System #1 Approved for (P bedrooms 7/r /r System #2 Approved for bedrooms ��,.Mary Lhreves CE 9351 Disapproved 4 .6-,0�o., ...• ��w`'`_ �•il+PROFESSION NS', Conditional approval for bedrooms, with the following stipi.1l(tid�l� l" \\\S'{ OF ANC6; ON-SkTE co WATER A D z:.- Cr W1/451OGRAMR <04 GCD BY: 'RJ1-w_& ec„.„,19 Original Certificate Date: 10/. (c, ;0 l �7 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 blue street j 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: Seacliff B2 L3A Parcel ID:011-221-37-000 A. WELL DATA Well type Class 'C' If A, B, or C provide PWSID # Well Log (YIN) Date completed Sanitary seal (YIN) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height(above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform , colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/MaterialSeptic/Steel Date installed 10/15/2017 Tank size 2000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) Date of pumping New Tank Install Pumper C. ABSORPTION FIELD DATA Date installed 9/7/83 Soil rating (g.p.d./ft2 or ft2/bdrm) 85 SF/BR System type Deep Trench Length 55 ft. Width 3 ft. Gravel below pipe 5'S ft. Total depth g•5 ft. Eff. absorption area 770 ft2 Monitoring tube Y Depression over field N Date of adequacy test 9/12/201 7 Results (Pass/Fail) Pass For 5 bedrooms Fluid depth in absorption field before test 0 in. Water added 1116 gal. New depth 25 in. Elapsed Time: 1 ,447 min. Final fluid depth 5 in. Absorption rate >= 900+ g.p.d. N Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on"level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots N/A Absorption field on lot N/A On adjacent lots N/A Public sewer main N/A Public sewer manhole/cleanout N/A Sewer/septic service line N/A Holding tank N/A Animal containment areas N/A Manure/animal excrete storage areas N/A SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ 1Water main 0+ Water service line 10+ Surface water 100+ Wells on adjacent lots 150+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 150+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and _�� OF-ACg6'III review of Municipal records that the above systems are in �Q-.. .../r- o' conformance with MOA COSA guidelines in effect on this date. 5 ca. '. A MaryL. Shreves ::: *:),77-_,,, rv. ,.* Engineer's Printed Name Date -101-1-91241-7-- / tit* /'/PI. ";,1-30•I' Mary W. Shreves CE 9351 •(3%-:. /�♦lg t PROFEss0:\.�` 1j111M1O‘ }J/I / COSA canary sheet_2-6-15.doc r 1 Lot 2 8380B Lot 7 N89°58'W 145.00 30 -...4.--- R m R x x ..%'"-Chain link fence (typ) ood fence 1N.-: N- - — — - — — — - --._. ._.. __ Ni (typ) + 30.0 ,y 75,1 d deck m to. ,;' N Gravel driveway O W (3) cp E 4.0 • En ZI Lo E a) cD -- m Window well-_ 2 cn • ' 0) LU (t'p) uo u m CD W `-� co 0 . oD CC _ 1 ° CO z ,�c N • / Q oQti U a b co 8 1 26.0 Ef) 39. 79.4--._ 1 Lot 6A o r c `1 Z Septic Vents% LOT 3AT A�Groc i( i E2i5 , � 13.8 reenhouse C -Metal fence cc x1 rn O I 4 en /roc c'`\ '� o > rr �Q� e� l -J 5 L `/ 0 1 Lot 5A �62°37;3 7p" \\� to\ / ar4SosEase ` `s \ Lot 4A j 30 -•.N.A‘I x / / •• OF , A, 1 i RECERTIFIED 10-17-17 � ;�6 ` AS-BUILT NO CORNERS SET THIS DATE fU? • 49th ); ••9 �, I hereby certify that I have performed a Mortgagee's inspection Aso y�.; ':. 1 of the following described property: LOT 3A. BLOCK 2. •• / SEACLIFF SUBDIVISION SCALE: 1"= 30' ��/ aL- ,04 / ▪Fred WaIcitko ,of / Anchorage Recording District,Alaska,and that the ,f , r improvements situated thereon are within the property lines �r�,•. 3255 - S .••J ` and do not overlap or encroach on the property lying 4:e0 ' • Ag , • o adjacent thereto,that no improvements on the property lying �' 1 ��FSSIONAI. �' adjacent thereto encroach on the premises in question and �,".t that there are no roadways,transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage,Alaska EASEMENTS OF RECORD, OTHER THAN this 5th day of April ,2013. THOSE SHOWN ON THE RECORDED FRED WALATKA&ASSOCIATES,L.L.C. PLAT ARE NOT SHOWN HEREON Engineers and Surveyors UNLESS OTHERWISE NOTED. FB 13-2, pg 9-10 BE 907-248-1666 ftiG£ $u • '� Municipality of Anchorage r �` On -Site Water and Wastewater Program (907)343-7904 n Certificate of On -Site Systems Approval Q / / 2 Parcel I.D. 011-221-37 Expiration Date: v / 1. GENERAL INFORMATION Complete legal description Sea Cliff, Block 2, Lot 3 A Location (site address) 9320 Jaclaire Lane Current Property owner(s) Barbara Wilson Day phone Mailing address 9320 Jaclaire Lane Real Estate Agent Day phone 2. TYPE OF DWELLING: I] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 6 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class C Well El Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: s Date: I COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 14 OAC) Date of Payment �, Receipt Number 0 -19 1 `7 lA COSA# OSC 13\l'i S 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 Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Alk. 99510 Engineer's Printed Name Steven R Pannone Date 4/18/13 fir 49'M M -•-.* 6. DSD SIGNATURE %1 .1....... �C System #1 Approved for bedrooms ' ;eleven i2.' annone. SSystem #2 Approved for bedrooms ?'• CE -8149 Y PP Disapproved Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: J Va 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r - 1, c If more than 1 septic system is on the lot: COSA Checklist # + of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Sea Cliff, Block 2, Lot 3-A A. WELL DATA Well type ClaSS 'C' Date completed Total depth ft. Date of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal (Y/N)_ Cased to ft. FROM WELL LOG Parcel ID: 011-211-37 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION ft. ft. g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform&'Pw colonies/100 mL Nitrate / �l mg/L Arsenic QMp ug/L Date of sample: q11,1111 Collected by: P S B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel&,'. „le4e Date installed 9/7/83 Tank size -gal. Number of Compartments 3 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping L1/x3/I3 Pumper A+ Tro,n,e Se/'ViceS C. ABSORPTION FIELD DATA Date installed 9/7/83 Soil rating (g.p.d./W or fflbdrm) 85 SF/BR System type Deep Trench Length 55 ft. Width 3 ft. Gravel below pipe 5.5 ft. Total depth 9.5 ft. Eff. absorption area 770 ftp Monitoring tube Y Depression over field N Date of adequacy test 4/17/13 Results (Pass/Fail) Pass For 6 bedrooms Fluid depth in absorption field before test 36 in. Water added 915 gal. New depth 41 in. Elapsed Time: 300 min. Final fluid depth 36 in. Absorption rate >= 900+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at in. Datum Cycles tested Manhole/Access (Y/N) _ High water alarm level at Meets alarm &circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot N/A On adjacent lots N/A Absorption field on lot N/A On adjacent lots N/A Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line N/A Holding tank N/A Animal containment areas N/A Manure/animal excrete storage areas N/A SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 150+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 150+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 4/18/13 COSAbrown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage11 0+ in. Lot 7 1 Lot 2 N89058°'E 145.00 t Wood fence 30.0 u+ Window x° well (typ E :0 rn m deck ot 3 ki c* e s to 0 30 m t�t1 Gravel driveway Cha€n Fink fence ( LCAT 3A c n reenhouse { L Lot 5A 3,>, \ Leat 4A Note: Concrete sidewalk and gravel driveway location is approximate due to snow and ice, SCALE. 1"= 30°00 OF 49 thy# + aa}sme. mmrs C �6.`f rfF3:.1 Y -11.4—?lkL•�' '3255 5 EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT APE NOT SHOWN HEREON, FR 13-2, P3 9=10 .i0 AS -BUILT NO CORNERS SET THIS DATE I hereby cenify-that I have performed a Mortgagae's of the Following described arooeriv LOT 3A RI i 1 A nFV J.iP Y4$YrVii P,I� `{Ytr +�VrGJM1 {Y dti1Ri lt2 Improvements Situated thereon are within the propertylines and do not overlap or encroach an the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises In question and that these are no roadways, transmission lines or other visible easements on said property except as indicated hereor'. ljlm6 at An. horaqe, Alarl this 5Lh ciayof.Arr$ r2mz9 FRED WALA7 KA & ASSOCIATES 6Engineer, and Surveyors t (M7.24&9666)