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HomeMy WebLinkAboutGLENN VIEW ESTATES WEST PH 2 BLK 2 LT 16Glenn View Estates West #i Block 2 Lot 16 #051-793-33 Municipality of Anchorage ;* ° Development Services Department i= Building Safety Division -- On-Sile Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page' of3 www.cl.anchorage.sk.us (907) 343.7904 ONSITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: S VJ(37a 3 /f PID Number: — 793- 3 3 Nares ;rG e ,4,t( ff4eOf- Wastewater System: []New.pgrade Manu ,2 223 G c oleeFE ABSORPTION FIELD rr Ptto— fZf Num of eaanprtU O Dwp TwKhY-imnow Tn O Bb O Mona S / D Omar LEGAL DESCRIPTION SWRaeng Q TPWD.P11,"Matp"VW. G S • GPDIFtr Ft. aiZ GEAl El ur W Dae p.otm n ngr n Gnw apn bomath ppe Ft. .3 Ft To n.mp Range Saw.: FA aaaaa aWra.Pnr qr aGnvr Lrgm. 2 Ft. FI. Well:��kf(J ❑New ❑ P9rade �av«.an R.�. D,.ruawanin.L /S Ft. CIa.reCJ1U. (Pnvan.l B, C 7oW Owet Cara to TOW abforpk.vw P, B1•nC 3 S' Ft. Ft G FjDate DMar: Data DNi ao w SuLaw "-w n�•a G 7 Ft C6 Y,OdPump Sal at Carne N. t/Wo.a&r TANK GPM Ft. FL / IAI SEPARATION DISTANCES ❑ Septic ❑ Holding S.T.E.P. ❑ Oth To Septic Absorption Litt Holding ubiien'rwate °1 w °p°g1r From Tank Field Station Tank Sewer Line Gr Mannr NunWr ICaprtmwU won l S.dh WSW 0� �Q'yf- LIFT STATION Lot Lim !a �•� �J �t% /rl- .. Gr .mow«. Fwnaatwn S 0� �y 'r _ on Pump ' Nvr a Pw' ow Nvei °t Wgn rn rrm at / in N N. C~ Man� Pump Wake kbaN EleomaIr, .a Prn tawa Cr 'WAS BENCH MARK Looe."De..pu.. TQ P �F fJ 46K ..ak.. /o o Ft // Inspections performed by: GN Dates: 15' /�?7/0% „ 'Jt~ Q�r3Q : t "It „ .....� 7��!! '• 9 r :' �. Develo ment Services De artment A royal P P PP PQ T4x v t a /a• •.. ............••O Conditional Approval Date: r 9^, : ste"I", w. 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LW �N.d ZVm%Ud°Nma'Eu L Wti to a, �vsi L n Z i�'• �d: 3 a' O U N 4) Cod O L p to •,+hbjS � O _ a, • 77 C Cad L. a, L) CV N ~ u n U W e d VI W p U E� Z (4 40 C O p O ZSus L Ly O- _� n c (5 a) CU 3Q 3� H AViNfi13 V1Q� `6 m r: 0 W S❑ILS LOG - PERC❑LATI❑N TEST Date Performedk 11/26/07 Performed For; Jordan Herget Legal Description: Glenn View Estates W. #2, B2 L16 I - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10 - 11 - 12 - 13 - 14 - 15 - 16 - 17 - 18 - 19 - 20 - 21 - DEPTH (FEET) Organic SM 'Silty Sand w/Gravel Fine Sand T.H. Location: Center of New Trench Groundwater? No Depth Water Depth After Monitorino. Date: # Date Gross Time Net Time De th Net Drop 1 11/26 0 -- 4' -- 2 11/26 10 10 min. 6' 2' 3 11/26 11 -- 4' -- 4 11/26 21 10 min. 6' 2' 5 11/26 32 -- 4' -- 6 11/26 42 10 min. 6' 2' Percolation Rate 5 Min./inch Perc Hole Diameter 6' Test Run Between 4' and 5' Commentsi_PrP-;nnkPd Performed ByNorthRim f ng. I 1 Performed in Accordance with F ON THIS DATE. DATEi 11/27/07 CERTIFY THAT THIS TEST WAS ate/Municipal Guidelines in Effect aF NORTHRIM :`a9m TESTH❑LE LOG ENGINEERING T. H. 3 PO Box 770724 N.+q. ... £oy/s Rl . Alasko 99377 a-ws .: d 907.694.7028 ... .....J GE❑TECHNICAL. 11/27/07 1 . DE: MUNICIPALITY OF ANCHORAGE 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 WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Nov 20, 2007 Expiration Date: Nov 19, 2008 Permit Number: SW070311 Parcel ID: 051-793-33 Legal Description: GLENN VIEW ESTATES WEST PHASE 2 BLOCK 2 LOT 16 Design Engineer: 0838 NORTH RIM ENGINEERING Owner Name: JORDAN HERGET Owner Address: PO BOX 21223 POLLY CIRCLE CHUGIAK , AK 99567 - Site Address: NHN POLLY CIRCLE Lot Size: 46334 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 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 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 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 dosed on the same day. sealed, and heated to prevent special provisions. THE ENGINEER NEEDS TO DO AN ADDITIONAL PERCOLATION TEST PRIOR TO CONSTRUCTION OF THE SEPTIC FIELD. THE PERCOLATION TEST PROCEDURE IS TO FOLLOW TABLE 3-8 OF THE EPA DESIGN MANUAL. PLEASE SUBMIT STAMPED AND SIGNED RESULTS WITH THE AS -BUILT INSPECTION REPORT. IF THE RESULTS REQUIRE A DESIGN CHANGE, CONSTRUCTION OF THE SYSTEM WILL STOP PENDING ONSITE REVIEW AND APPROVAL. Received By. Date: ���Z��G 7 Date: Zl> O Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.orglonsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D. ()5(— �:/Ct3-33 Property owner(s) l_C_Day phone 4Mmffmg address .212,9 3 P011,1 01ec.A Zip Code Maddfiss Py�F�Q��}q�����AftA Zip Code Legal description (Sub'd., Block & Lot) / n Legal description (Township, Range & Section) Gl enn Uf Cy) C—sT we-ai f rf 13,�? UP Lot Size 3 Sq. Ft. Number of Bedrooms q THIS APPLICATION IS FOR (® all that apply): Absorption Field Jim Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION IS AN: Initial Upgrade Renewal I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. fE (Signature of property owner or authorized agent) Permit/Rush Fees:70 Waiver Fees: Date of Payment: / I.&107 Date of Payment: Receipt Number. l t7?2 55 Olnt l Receipt Number: (Rev. 11/05) NorthRim Engineering 17237 Bear Paw Circle Eagle River, AK 99577 907-694-7028 November 16, 2007 Deb Wockenfuss MOA On -Site Water & Wastewater Program 4700 Bragaw St Anchorage, AK 99519 RE: Glen View Estates West #2, Block 2, Lot 16, Chugiak Dear Deb, As we discussed in our telecon today, the referenced property failed an adequacy test. The owner wishes to build the alternate trench at the site on the original set of plans. A "Bull Run" valve will be used to connect to the old trench. The old trench should regenerate after a period of time. The subdivision is now developed and served by a Public Water System. There are no water wells present in the subdivision that will conflict with the trench construction. The photo below of the original trench verifies the sandy soil that was encountered during construction. I have included design plans & specs, design guidelines, & soil tests. If there is need for additional information or clarification please give me a call. Sincerely, OE' Steven W. Eng, PE, PH Glen View Estates West N 2, Block 2, Lot 16 20 November '07 NorthRim Engineering SPF,CIFICATIONS & DESIGN GUIDELINES Wastewater System Sizine: This is an existing single family home. The existing absorption trench failed an adequacy test. A "Bull Run" valve will connect to the old failed leach -field. Valve will be "On" to the new 70' leach trench. The existing 1250 gallon septic tank is relatively new and does not require replacement. This lot is over one acre in size. The neighboring subdivision lots are also over about I acre and are on public water. No water wells are in the vicinity. The adjacent lots have been developed. No conflicts to the neighboring septic systems, property line or water line are anticipated. Soil tests found typical soil for this area; a silty sandy gravel with denser underlying material. The system utilized a 5' wide trench with allowable reduction factor. An application rate of 1.0 GPD/FT2 with 0.58 reduction factor for utilizing a 5' wide trench. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • Existing Septic Tank Will Be Used- Add "Bull Run" Valve- "ON" To New Trench • Watertight couplings on inlet & outlet • 5' minimum between the tank and bed. 10' to property lines. • 3' of cover or insulation is required for trench; an equivalent of 1" insulation for each foot soil cover. Minimum of 2' cover required. • Solid pipe must be set on well compacted, stable soil • 4 inch diameter cleanouts with airtight caps are required 1 to 4 feet from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level • In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron • Trench to be placed level, minimum 4' to groundwater, 6' to bedrock from drain -rock • Drain rock to be %2 inch to 2 %2 inch screened. Drain rock to be distributed uniformly throughout the trench. • Perforated pipe to be installed level with perforations down • Silt barrier (filter fabric) to be installed above the drain rock • Smeared trench sides must be raked or scarified before drain rock placement • Backfill over drain rock must not be less than 36" • The finish grade must be mounded to promote drainage over the bed • Insulation must be placed over any pipe installed under driveways or parking areas • Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2% slope • Septic Tank to be pumped every two years or when required • Insulation board shall be extruded direct burial polystyrene (Dow Styrofoam III or equal) J N C .. o U c 2 F- V N � `• o °v � N N w O d U 3- � �o S oN ; U O• » Z (N e'„°1 P eo Ot\J n r O J c F— O u 0 � 'P ¢ ° 3 U 3 i' U c E,Vi v II V) N C FW-- Q £ >14.>14.U £ f'— i uZ,�"> N� W p cl y Li 0FaJn. w W 6 3w Za ..re) /Y n utOZ(, WO N `m V -L �¢ �L J J l7 W o Q �3 5 0 N~ +. 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F- N n p U W S O N w� u £ N H Y N W � Z � ry O1 ro n 0 C3 0 zS�-V, Q yN3 3 Z41 H o n c a� wav'Pia°41 d-� QZ owe N qN N3N¢ �j C1 io l0 A .-: (U M �t Ul �0 (La % § cup j?U } } / 0 j \ 2.@ j\U 2\\ �Lk §5 \ � } /�\ \// a2°o LJ0)E+, §&ƒ_ z4' Li 1=�.4eCl) Municipality of Anchorage 70N -SITE Development Services DepartmentBuilding Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw SL P.O. Box 196650 Anchorage96650, AK 9951Page of www.d.anchorage.ak.us (907) 343-7904 WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Numbel I -� PID Number. Name: Address: kELAAJ` CQ S , Wastewater System: ;9 New El Upgrade Phone: �T ( T r CSF ABSORPTION FIELD p Z Number or eetlraans: . 1 13 Deep Tmltll ❑ ShYowTrencb O &tl ❑ M01altl00lber. Sinor, LEGAL DESCRIPTION s°"F°0o� / Total Depth fMM odgirsl gmtlC Black: Lot: GPD�FP �j S Ft. Subdivision: Depth to OiPe bottamhanoriginal grade: Grant d beneaN /6 G�LF�J f� ESr uJEST ,ecZ � ax: Timnsriip: 5 Ft. 3,Q FL Range: Section: atltle0 above anfirsl4arAe /,�, G2vd Lenlpl: / Ft. 6 0 FI. Well: PU/,(c, New Gravel vntl"` N,mEer orl ❑ Upgrade C- / oidpnce pelwem line,: Classification (Private, A, , C):To m[ J Ft' � Ft. ca to: Total absorption area: r+�^ R Matenal: PVC FL FL St./(l FP / l.. Duller. Date Drilled: Static W Level: Installer. Yeltl: : GR�Ef� ONelmak2 /// FL Pu at ao/o3 'ng H ' Above Grand: GPM FL TANK SEPARATION DISTANCES IRSepac ❑ Holdin g ❑ S.T.E.P. [3 Other. To Septic Absorption Lift Holding ublidPrivate Mann From Tank Fewer Field Station Tank SLine �papy. ��� R 46G T k 12So Ga. Well 7 Malarial: .r- S/ ��[� NuneerotCprpartmenb: Surface Water 106'* 10a f f(/4 /� /g 1FT ST T10N Lot Line r 3a rr. ze: nu a<Wrar. + �o _ _ ceL Foundation 5 f z Q I* - _ 'Pump on I L 'Ptur4 evel at Kgri wdler alarm a in lel. n. Curtain Drain ... � ` Pump lee d dbtlel a 'd knpeltions by Remarks: BENCH MARK Q Fl. Y �/ A a4 v^� Inspections performed by: w c Dates: to i( 20 a3 r °""•" 2nd (( z 0/0` Steven Development Services Department Approval ps d�5a Reviewed and approved by:'M"° d°°'••••• Ikea :_pool Date: zz zQ ms 2� N (D L- r cn n CD . < F- d r m<+ � (D D z -i I D m z n b _ m m $; N bd 0 F- r R) CD O m C� z � m g 9 m g r £ O M D ~. it o —1 � n N m IO r- 0 rt 6'a oa>d m ) D N n T o I Ul T m S I� mD \ n m CD Cb w o on�C�OO m N 3O3�N N Lh F� n 1-0 O 0 s n N cn D .:to CD to a W (0NUn� p m rt7 (n FM -0 0 < mzn cF� ry 3 � � 1 -r - 3n3 h E C-) h N 3 0` 01 3 cQ_ O n3 3 O (O 3 Ul m A V Z O% UI A W IU !-' m < Q �� � DN p m 0 f M O �1 r0 hf p '0 Z 3\ °!Qb �~ 0 ViZ S Sn 3 Z II 33O 5 -3,0 1 ro 0 p b �..�` NDN UN ppm (JI 3 fl N (n g N N O R 3 : Qif r'Op S 3 0 'AQUI fu n �� vi o om O h 3 3 rD (!I x _. 3 3 O e+Z : O O C c C O O 3 3 3 Q 3 rD �Q MUIp NN -0,54 p `G O n p _ Z 3 go 0 n W 3S < 3' t7 O p 0 ro n o 3- 00 p rip 3 p h :5ro ro D -t> Q Ui1 O ,3 3 0 h (/j N Z d � <o n n 3 3 < 0 z 1 It II m h 0 C) h Q r N h 3 m m m rD H m 0 W W m rr Q m (7 Z fU F --q Q r Q Q � D m `0 F I -t> 'h N b� ro < UI _m h h < N h 3 tV 3 II m I N C+ II fU < I C+ o 0n 3 Ln C 11 0 I o CJ1 3 Ln cn Q 1 0 3 .3+ O 3 O O W � Z Ln p C 3 S O 0 O r0 O S m C P --I p 3 C) N p 3 O C C+ UI MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial ���?�0jb?:>—LrD& 1+.3o?1�y Date Issued: Oct 30, 2003 Expiration Date: Oct 29, 2004 Permit Number: SW030465 Parcel ID: 051-793-33 Legal Description: GLENN VIEWESTATESWESi MS'BLOCK 2' LOT 167 Design Engineer: 0838 North Rim Engineering Site Address: NHN POLLY CIRCLE Owner Name: TROY M & ANNA M LEONARD Lot Size: 46334 SO. FT. Owner Address: NHN POLLY CIRCLE Total Bedrooms: 4 Permit Bedrooms: 4 CHUGIAK , A 99577 - 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 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 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. Received By: Issued By: Date: Date: 30 03 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEVVERANELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 05-1 ' 7 /3'-33 Permit Number SW O 304 S Propertyowner(s)14/,*k6f—.4+[d QW9r_,CdCr,va Day phone M --Zell Mailing address (1) I'FOq ' /N6JMT.4/Af Pc(N?_ C19C4=_ Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) �f G Fn! V 16 �S%r}'//c`J W 7` %� LS' Z, L /6 Legal description (Section, Township & Range) Lot Size `7` �, 334 Acres/Sq.Ft. Number of Bedrooms _ THIS APPLICATION IS FOR: Sewer Only Well Only Sewer and Well ❑ Water Storage Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi Swimming Pool ❑ Water Softening Unit Therapy Pool ❑ 1 I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property oworor authorized agent) Permit Fees: Waiver Fees: Date of Payment: lo -26)-03 pDate of Payment Receipt Number: 3 S _T>-8 Receipt Number: (Rev. 12/00) NorthRim Engineering 17237 Bear Paw Circle Eagle River, AK 99577 907.694-7026 907.830-4186 October 29, 2003 Dan Roth MOA On -Site Water & Wastewater Program 4700 Bragaw St Anchorage, AK 99519 RE: Glen View Estates West #1, Block 2, Lot 16, Chugiak Dear Dan, Please review the submittal for the sewer design for the proposed single family home. The entire subdivision is undeveloped and served by a Public Water System. I have included design plans & specs, design guidelines, & soiI tests. If there is need for additional information or clarification please give me a call. Sincerely, Steven W. Eng, PH Design Enclosures Glen View Estates West # 1, Block 2, Lot 16 28 October `03 NorthRim Engineering SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is a single family home projected at 4 bedrooms. This requires a 1250 gallon septic tank. This lot is over one acre in size and no adverse impacts are expected from development. The neighboring subdivision lots are also over about 1 acre and are on public water. No water wells are in the vicinity. The adjacent lots are under development or are developed. No conflicts to the neighboring septic systems, property line or water line are anticipated. Soil tests found typical soil for this area; a silty sandy gravel with denser underlying material. The system utilized a 5' wide trench with allowable reduction factor. An application rate of 1.2 GPD/FT2 with 0.58 reduction factor for utilizing a 5' wide trench. Monitoring revealed no groundwater. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • Two compartment septic tank • Watertight couplings on inlet & outlet • 5 foot minimum between the tank and bed. 10 foot to property lines. • 3 feet of cover or insulation is required for trench; an equivalent of 1" insulation for each foot soil cover. • Tank & solid pipe must be set on well compacted, stable soil • 4 inch diameter cleanouts with airtight caps are required 1 to 4 feet from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10 feet from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level • In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron • Trench to be placed level, minimum of 4 feet to groundwater, 6 feet to bedrock from drain -rock • Drain rock to be 1/2 inch to 2'/2 inch screened. Drain rock to be distributed uniformly throughout the trench. • Perforated pipe to be installed level with perforations down • Silt barrier (filter fabric) to be installed above the drain rock • Smeared trench sides must be raked or scarified before drain rock placement • Backfill over drain rock must not be less than 36" • The finish grade must be mounded to promote drainage over the bed • Insulation must be placed over any pipe installed under driveways or parking areas • Approved pipe materials include cast iron, PVC ASTM D3034, PVCASTM F9$9, ABS ASTM D2661, • Sewer Service Line is minimum 2% slope • Septic Tank to be pumped every two years or when required • Insulation board shall be extruded direct burial polystyrene (Dow Styrofoam HI or equal) zz z� �Z z� 3 3 -p h Q x 3 4p.wwRa;> 'Poor tn0NN � O C O') (DD H (7 O —I £ < d r m 0 D —I m z 3 m d m z H 0 o Z S "rr M W m ru co . 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Q N eo n 3 N� m 0 -0 ON 0 ,{+ h 3 3 -0 Ln n o fo O C 00 m N n- ru 3 N S3 p NUt -0S C / -{ `< p n Q < D m N QN N z D = n w n� S O p mz o-0 3 z p <0 d Ln 1+ o < D p C + H m r � m m t) A. n n o W m < N00 r �--- O m C C:) n z '0 S O R) � s .+ z fo m m W nz rf o I O j N Ln - 3 fTl 0 (� 3 0 O O (P -9 —i W h u o ro U fo n o S O Cl �p O p 3 1 0 s ^ O W r'l0 p .O O 3 F G ^ C7 n O fo p 3 O .+ N O 0 0 3 (0 C) p p 3 0 r` L+ N tz N .+ f N N 3 rn N U rF n` p 3 x rp td N Q 10/22/20E 3 0 59- 9016%5534 EI4a_t LENT UPES PUIE 0:3 T)?+ J� 11 t�l Y. _77 jot, MAW Ai 19' 40ASS M. �O Ole, Lot 18 J AY LO t 1 .0 4 OjVi7 *j Lei 1 S 40JOB Sf t4 0. 0 eL Lot --f"133& AA ,,,,.—IS' „4­IS' WAUA EASIMM -4 lo' bUf r - 'JET 07— 3 7,200 �b 0MA 01F� SEARI 39453,206W twoad 0 a] itoo A UA fLEARY SUBD. MW No. so-”) 3 CERTIFICATE TAX CEF Prefovilonal Land Surveyor, do horeby certify tho4this All -Sol pr >P@ rosentaflon clF A4,4 V ESTAX3 WL5-1 - is a true and correct MP show, an thil k. J,5rjja�V I an irvey"aYid-ibat the distan6to and bodOnOt are shown f,, 311 permanent exterior vi�murn a I nfi, all other monuments officorcn an Pe boom sof and staked, or It flnot cornplOttom Is assured current ye tr. orment, thov.vol! tw mo as speciflod In sold subdivislon 6 OF AC II1 •. S 1 Municipality of Anchorage w C2 ,a NGI E Development Services Department j10* ?���1r Building Safety Division •.• �...0 .w........ 00 1 On-SiW Water and Wwater Program 17DO South Brag" _ .. • �� S> SL _•• 90 P.O. Box 1050 Anchorage, AK 99519-66 A' K`It, st...n W. U9 J www Ci anrhora0e ak es �� s �, ►E 6251, . r (907)343.7904 I' •. r �'� Soils Log - Percolation Test Performed For- 9.14K<LAAf6 CQ/,fJ7R0Q7-/AI/ Date Patormed:_/O%2303 Legal DescnphotxCL 64 VeW E 9 7- L001.09.2, Township, Range. Section: _ 2- 3- 0 -3 e � n /NC �E,.gri�1G ' w/Dry -V 1 17 18- 19- 20 - PERFORMED BY: PERFORMED IN I S WAS GROUND WATER ENCgJr1TERE01 NO s IF YES, AT WHAT DEPTH? AI0/./f L Depth to Water Mn D Ill"Nodny7 P E Dots /o/ 9/0j Reading Date Goss Time Net Tome Depth to Water Net Drop o z g3 z z 3 Y2 3 C Z P ''/ 711 C P 7 I"2 7G Z P j, -.....v.... I.r. c .'tt+l:H(.IEDIM'IETER �6 -- TEST RUN BETWEEN �Fr AND FT "'holtviffraAdA 12 TT ^ CERTIFY THAT THIS TEST WAS ALL S E AND NICIPAL GUIDELINES IN EfFECT ON THIS DATE. DATE: ej 2 O Municipality of Anchorage Development Services Department Building Salety DIAsm +� On -Situ Water and Wastewater Program 4700 South B(agaw St. / P.O. Box 1966W Andwage, AK 99519-0= www of anchoraoa ak.ua 1907)343.7904 �•OF •ACr4N Soils Date Gross Time 235 �• PE e.23,- Depth to Water Net Drop Soils Log - Percolation Test Performed For: &jAkF/ * (Q Con(Sri&cnow Date Perbmed:_ /0�ap/e3 Legal Descnphan: Q-eg T//ay Cdr Ut' BZ / L /G Township, Range. Section. 2 (HT1 5u? Pian s 1- t 2• 3- • • Snt/6`s t a. a .� 5- 6- 7- 10. - 6-7-10. 11. 12- 14- 15- 16- 17- 18- 19 - /A1 CRo+fS,GVC .` WAS GROUND WATER �/Q ENCOUNTERED. a K YES, AT WHAT OEPTH7 Q / C Depth to Water An*, P Moneortno? E J%%/T4R 1 o Dore L01211-03 Reading Date Gross Time Net Time Depth to Water Net Drop 2 z Y yv / Y 3 p 3! z 1 s ?O Z / ��^`-a^^•W^^.c /.0 1^wl l FERC NCLE DIMJETER 6 . �i( ^ SO�i'Ki�� TEST RUN BETWEEN L4 ET AND FT COfMAENTS pQ/—r— PERFORMED BY: 0 r f • I CERTIFY THAT THIS TESI WAS PERFORMED IN ACCORDANCE WITH ALL ST6rE AND MUNICIPAL GUIDELINES I VIECT ON THIS DATE. DATE: ZG 2 Qj MUNICIPALITY OF ANCHORAGE 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. 051-793-33 1. GENERAL INFORMATION Complete legal description Expiration Date: 5- 2 Q- 2© Z D GLENN VIEW ESTATES WEST PH 2 BLK 2 LT 16 Location (site address) 21223 Polly Cir Chugiak 99577 Current property owner(s) Mailing address Real estate agent SEEBER AUGUST & LISA Day phone 4302 Sw Sheridan Ave Pendleton OR 97801 Danielle Grigg 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 907.854.8319 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic rx� Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System [I Public Sewer ❑ Waiver request for. Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5-5-0 Waiver Fee $ Date of Payment /0 /1119 Date of Payment Receipt Number (3Q (P5 '; D Receipt Number COSA #_ U�)c 16119 Ie Q Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Eklutna Engineering, LLC Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE 6. DSD SIGNATURE f YSystem #1 Approved for `7 bedrooms System #2 Approved for Disapproved Conditional approval for Phone 907.35q.9820 Date 9/; 0i. M............ ���C�•. No.CE11��� bedrooms aT �pROFESS0 �4 bedrooms, with the following stipulations: (w , By: Original Certificate Date: d �O The Municipality of Anchorage Development Servibes 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: GLENN VIEW ESTATES WEST PH 2 BLK 2 LT 16 Parcel ID: 051-793-33 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system ,.,_,_ A. WEL TA ❑ Well log is file h 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 public water system B. TANK DATA Age of tank(s) 16 years Tank type/material septic Steel Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping 29 May 2019 D, -ABSORPTION FIELD DATA 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) Date of Sam C.%❑ Require \ Age of lift station .. Lift station material Comments: completed years Which system tested (date installed) 2003 Adequacy test date 9t27/19 ❑ ALL standpipes present per record drawing Results Q Pass For 4 bedrooms Total measured depth from grade 6.75 ft (max) Fluid depth prior to test 16 in Measured depth to pipe invert from grade 3.75 ft (min) Water added 600 gal ❑ N/A — pressurized field New depth 20 in ❑ Monitor tubes go to bottom of effective, If not, state Elapsed time 1300 min depth into effective ❑ Code -required soil cover over field Final fluid depth 14 in ❑ System presoaked Absorption rate '600 grid (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced 2000 gallons If yes, enter date Comments/Deficiencies: system is draining to the 2003 system. 2003 trench was dry prior to presoak. the 2007 system is dry. COSA Checklist yellow sheet E. SEPARATION DISTANCES Froh-i-P 'vate WelIon Lot to: (Please enter distances if less than required or if community well) Septic TanklUft Statlo a. Lot > 10Q' Q Yes Community Sewer Manho Manhole/Cleanout > 100' ft Surface Water> 100' 0 Yes if No ft ❑ Yes if No ft Neighboring Tank > 10Q' F-1 Yes if No t Private Sewer/Septic Line a 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑Yes if No ft Ho ❑ Yes if No ft Neighboring Absorption Fields � 100' 121 Yes if No ft Water Main > 10' Anim_ �taeon'F-1 Yes if No ft 171 Yes if No ft Q Yes if No ft Water Service Line > 10' 0 Yes if No Manure/Animal Excreta St Drage > 10 If septic tank is under driveway comment below Community Sewer Main > 75' EJ Yes (Please enter distances if ❑ Yes if No t if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No ft Surface Water> 100' 0 Yes if No ft Property Line > 5' QQ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' 121 Yes if No ft Water Main > 10' R1 Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' 0 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' [Z] Yes if No It Wells on Adjacent Lots: Water Main > 10' M Yes if No - ft Private Wells > 100' Q Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' ® Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS septic tank is located under deck. Deck is < 30" in height. Access for pumping is provided by removable deck boards. Septic tank is not located below deck supports. G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. vAr.t. `' emend •� • •.... ..... w mmm C05A Checklist yellow sheet . • m Ds L. aw 'en' • Date ! TC% ��s�� CE1 i �•�F�pRdFESSIOt�k�•�-'a' PROPOSED F1N91M FIM adv. (ASSAIED) AI a ZON44G DWRIcr G�/ FRONT BU9.DNO SETBACK G SEE BLR.DM SETBACK 0 MGtR etm.DND SETBACK Qti 5� 00 Q x;30. t �S s 15 �..............,:. \' ' S' i 17 \ EXISTING HOUSE W \ s 1. iE Y� \ 9 \ a' 0. \ o \ o tri \ r` \ w \— ----------- r' — — — — 10' BUFFER LANDSCAPING ESMT — — — — — — — — 00 \ .5' TdE ESMi p Cn0 S89° 53' 28"W 208.00' UNDER NO CIRCUMSTANCES SHOULD AN AS—BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCAUNG. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT SUF!WY SURVEY TYPE SYMBOLS FOUNDATION AS—BUILT ❑ FINAL STRUCTLNE AS—BUILT SET REBAR DRAINAGE ASPHALT ❑ PLOT PLAN ... AS—BUILT ...LOT SURVEY ... TOPOGRAPHY --. I FOUND REBAR 9 9 e Wax FENCE � CONCRETE It AS— LT .. CORNERS SE7 RECERTIFICATION AS—WILT -... NO CORNERS SET 00 ASSUMED ELEV. •X--X--* METAL FENCE ® WOOD DECK PLOT PLANS & LOT SURVEYS NOTE: IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WALL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION�� Prepared by PLOT PLAN ®�-� _ OF t® Robert E. Johns, Jr. & Assoc. I n.wy bftIty ifiot 1 Iia a MY. 7..•+'M4d tM,k,,, md,, bdd„W*,,,,*)d0*1 •�••' ®®� , ., ® Professional Land Surveyors t— k-W n .stab&*.d a of tm lot oora.n a ww. an V. pm ane to VR WWI a my® b+ay+dv. and "mm a&—.k- Lar. twan an tn. d oontiet ®� �: AW %� Aw AN 7700 Brink Drive. ANCHORAGE, ALASKA 99504 Scale. Rec. FOUNDATION AS—BUILT 9? �•• •+. 1 II _ L+OF V Lot S.F. Rec. Plot File No. E. dotna :. M«.Oy a.Wy that I haw etk.. d. 9 OW .t d a tl» FandaUon on thb bt and IAaf .tl M. t'....... r �iwh .... s •'• • 0 ' •% ROBE E. ES •• , Y� Date Surveyed: 07/10/14 Drawn b o E t Y IZ GaJ Checked b J� K wpb ,F,a,,, ar,�, '• o ® �� ®� Dote Drawn: 07/11/14 Grid N W 1459 W.O. 14-281 FINAL STRUCTURE AS—BUILT ss'�.• 4121—S :.' �Oj� ®� f " Legal Description: Lot 16 Block 2 L Rd-t a A* ti r, troy o.Wy Mat I �.. A._BuTt .My aE m. .rota,. an tw. ee ma wt •a 'ono «ib� ^ •' •. ��e® �� e� A.............•ata +� �® rofessionot ���������®® GLENN VIEW WEST PH 2 • Municipality of Anchorage On -Site Water and Wastewater Program 44 (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcell.D. 051-793-33 1. GENERAL INFORMATION Expiration Date: Complete legal description GLENN VIEW ESTATES WEST PHASE 2 BLOCK 2, LOT 16 Location (site address) 21223 POLLY CIRCLE CHUGIAK AK 99567 _ Current Property owner(s) RICHARD & LESLIE HEADRICK Day phone Mailing address Real Estate Agent PO BOX 672152 CHUGIAK AK 99567 Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU)lG El Duplex b JUN 3 4 2014 L ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class _ Well ❑ Community ❑ Public Water System ® Public Sewer ❑ WaiverNariance request for: Dista r. Received by: !!i It"��1 ' sL �, :'z. - Date: COSA to be released to the engineer, unless otho wise`r.equested by the engineer. COSA Fee $ �, ` _ (� Waiver Fee $ Date of Payment -7 (� �`i �� Date of Payment z Receipt Number 0395'5q Receipt Number COSA# 0`)Clq !?f 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS 6/27/2014 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 occupants or can ArcTerra guarantee that no unseen T �� �L� encroachments, deficiencies or discrepancies exist. ?•� iti �y f 6. DSD SIGNATURE System #1 Approved for ­77 bedrooms. System #2 Approved for bedrooms, Disapproved. i ' � G r�crssto*'� .i Conditional approval for bedrooms, with the following stipulations: By: /� !74`` . % Original Certificate Date: 7® The uni Zip 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 COSAI,Wesh et 1040-12.do 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: GLENN VIEW ESTATES WEST PHASE 2 BLOCK 2 LOT 16 Parcel ID: 051-793.33 A. WELL DATA —PUBLIC Well type If A, B, or C provide PWSID # Well Log (YIN) Date completed Sanitary seal (YIN) Y Wires properly protected (YIN) 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/100mL Nitrate _mg/L Arsenic: ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC / STEEL Date installed 1112012003 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping 611612014 Pumper JRs C. ABSORPTION FIELD DATA — PRIMARY / ORIGINAL FIELD TESTED Date installed 11120103 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 System type SHALLOW TRENCH Length 60 ft. Width 5 ft. Gravel below pipe 3 ft. Total depth 6.75 ft. (Measured 6/26/14) Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N Date of adequacy test 612612014 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 22 in. Water added 670 gal. New depth 30 in. Elapsed Time: 1260 min. Final fluid depth 20 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & 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 -PUBLIC WATER WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas 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 Holding tank Manure/animal excrete storage areas Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 1004 Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main Water Service line 101+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 2004 F. COMMENTS in. Fluid levels in reserve trench installed in 2007 were within 6" of lateral. Original trench installed in 2003 was presoaked prior to testing. Diverter valve adjusted to direct flow to 2003 trench. G. ENGINEER'S CERTIFICATION I certify that t 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 KENNETH M. DUFFUS Date COSA brown sheet_10-10-12.doc TF -F -WYl�# t l KENNF51 M. M/FL+ye/ / VV � Municipality of Anchorage Development Services Department s a' �:'� Building Safety Division _ . On -Site Water and Wastewater Program . 4700 Bragaw Street 1 T P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING ,1 Parcel I.D.OSl- %'73-33 COSA# �5y Expiration Date: 1. GENERAL INFORMATION Complete legal description G1—e5ay i//rny ESr t4/ t2 f BZ L /e' Location (site address) lee-416- Current C'CLE Current Property owner(s) T020,4J /A54i'67- Day phone 7;q- Mailing ;q - Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 21223 PGLL�/ C /,eC' LE z Day phone Day phone 762— 3//0 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: !� 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System F Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation dale 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 r_TrrM Engineer's Printed Name STEVE jW 6 5. DSD SIGNATURE Approved for 4L Disapproved. Conditional approval for bedrooms. Phone �5'/?41— %a Zcr- Date ^t, OF 44411. `l •• •; ? •yr...r. r ............. r� Steven W. Eng PE 6256 bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By A / .rel Original Certificate Date: (Ra . 11.05) -\ Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Q-,6A/1Y VI&J 6,M M KJ• 02, 82 G/6" Parcel ID:OS/— 793-33 A. WELL DATA Pt1BL JGttW1 Fk(AT vJ UJ Well type _ If A, B/6r C provide PWSID # _ Well Log (Y/N) Da/MPLERESULTS: eted _ nitary seal (YIN) Wires property otected (YIN) Toft.Cased to ft. Casing heig (above ground) In. OM WELL LOG AT INSP TIONDtSr lev ft. ft. Won g.p.m. g.p.m. EE WMPLE RESULTS:CCotonie5/100 mL Nitrate m Other bacteria colonies/1l0 mL ArmgA Date of sample _ Collected by B. SEPTIC/HOLDING TANK DATA Tank Type/MaterialhAlO,�Y/%2 0g— Tf4A1�57-�-4 Tank size /ZZ gal Number of Compartments Z Foundation cleanout (Y/N) y Depression over tank (YIN) Date of pumping &/0% 77 Pumpery C. ABSORPTION F LD ATA Iltl /10 Date installed 3 Soil rating (g.p.d.Ift2 or ft�/bdrm) /. 2 Date installed LI&1 43 Cleanouts (Y/N) 7 High water alarm (Y/N) /w/ System type Length %z - Z S 6Q ft. Width S ,15 ft. Gravel below pipe 3 ft. Total depthft. Eft. absorption area /�ft2 Monitoring tube Depression over field Date of adequacy test /V�f✓ /25 ' esults (Pass/Fail) For __q_ bedrooms Fluid depth In absorption field before test _ in. Water added_ gal. New depth_ in. Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) 11AAk If yes, give date D. LIFT STATION Date installed 'Pump on" levet at in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off level at In. Cycles tested Manhole/Access (Y/N) High water alarmleve t in. Meets alarm & ' uit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Pa81IC Septic tank/lift station o < Absorption field on Publicsewer m Sewer /se c service line, Anim containment areas On adjacent lots On adjacent lots Public sewer ma Holding tank/— excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r Building foundation �' Propline ..spa � erty 4' Absorption field S- r f � Water main M Water service line 4- Surface water I rJ4 r Wells on adjacent lots 260 14 - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r r Property line /0 t'r` Building foundation 0 f Water main 4 *- Water Service line tJ� Surface water JO G fr' Driveway parking/vehicle storage 2CJ 4 Curtain drain — Wells on adjacent lots Zn o rh F. COMMENTS AJ .e rR J G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on/this date. Engineers Printed Name U T�✓� t=N G Date !/�e? COSA Fee $ Date of Payment It n old 7 Receipt Number G 616`%i (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number c C2•:;may, 80 i Eng 'J'�PE 6256 0 O' . HOUSE DETAIL I 1`c30 2.2' CAI COVERED IENTRY 15' WATER EASEMENTS TWO STORY WOOD FRAME RESIDENCE X 7.9' DECK CONCRETE PATIO I 5' TELECOM h ELECTRIC EASEMENT HOMESTEAD ROAD X SCALE 1� 50' GRID NCO Project No. � AS BUILT —Anchorage.AI°ek° PLOT PLAN — t 11500 Daryl Avenue, 8c p,ssociates, ir1C. 907) 522-6476 Phone Lang SUjVeyOrs (907) 522-4625 Fox Re9jstered Land InfoOlul urver°r.•oam / Certify that 1 have ro. the lollowinp desarlbed proPertY rb and that SUBDIVISION nremenle eiluoled thereon. that encroach onto ther�ooeh on the suagent rv�ed rrn...,,.. adjaoerd thereto within tM Property on "W Properly hi0aye. tronsminion Rnee or other vleible eanme no Improver Phere are no r°O premleee and that them ' indicated tenon• e, Alaska on said property of a rr� ' at Anchorage. Dated this the Day*rmlne the noe of any eO„ plot- it to the n°�e1bR oo whicowner to el rr on the noorded eubdtvft OCovplat. 99515-3049 L'�7�y Municipality of Anchorage 7o- • __ Development Services Department _x a Building Safety Division r On -Site Water and Wastewater Program 4700 South Bragaw St. S A E T Y P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. o5/' 7?.3" 33 HAA #__ Expiration Date: SAN65 1. GENERAL INFORMATION Complete legal descriptio Location, (site address or Current Property owner(s) 4VW,,4 L��i�,gRd Day phone Mailing address Lending agency Day phone _ Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site kC] Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm MergtfI tit FZ/2Q enU 6 Phone 4 �/ — 70240 Address/ 709 3 % /W i'4j4j crlZL'G Engineer's Printed Name 57_60-0�' A5kt 6 Date �l/ 7/0 4r AV •:ci ��E phi N8 y[Ne$tev.ClYS,c+R sr 5. DSD SIGNATURE �t$s�.,aY PE 6 _� Approved for �_ bedrooms. �$R `�aRpFSs oa?yam Disapproved. �amve� Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Ak A Q , , � Original Certificate Date.: (Rev. 01/02) MUM Developi On -Si' aw"Y��� ,,,�.�'g",�'<e��cx?.�st �z�x€r�.r':��{£�.,.•fi.r'.,:E'�u's��'�'�.rcwA. �.�'3"+�.,ma�.�'� r"'�."�;i u�ey..:«t s*'nr...:- . A,- ; o provide PV1lSID # _ V1IeII Log_(Y/N) " _. Tp e e nitary seal "(Y/N) _ ares properly protected (Y/N) � ff� Cased to ft. Casing height (aboye ground) in. . ,� E OM WEL"t LOQ"'� � AT tNSPECTION`� est ater level ucti M. g.p.m. PILE RESULT$`. colonies/100'ml. itrate mg./I. O er bacteria" colonies/100_m, l. mg./I. Date of sample: olledted by: " VNIA Fmvm 1°��Z�fiEG Date installed N°umber of Compartments c;k Cleanouts (Y/N) �'/N} De pressiorlover tank (Y/N)�`4 High water alarm a�SJ T'r.. _ . i)iating (g.p.d:1ft2 ) System tyr 1AAHfh fF- Rrovcl hcl; cu. ausorpurr area w•' r< naornwrmg ruoe - J uepressioi (Pass/Fail) F� w s ;OUSE3DETAIL 2.2' COVERED- ENTRY OVERED- ENTRY a 15' WATER EASEMENTS u w1 TWO STORY WOOD FRAME RESIDENCE 7.9' n DECK ' • CONCRETE PATIO LOT 15 LOT 16 I 46,334 s.f. ut 4 c N J SEPTIC CLEA14OUTS 10 BUFFER EASEMENT rn v TELECOM &ELECTRIC EASEMENT HOMESTEAD ROAD 03-292 • = 50' GRID NW 1460 Projeci X SCALE :-_ a Alaska 99515-3049 AS BUILT Avenue, Anchorag ,�� PLOT ALAN �--- 11500 Daryl gc Associates, Inc* (907) 522-6476 Phone 522-4625 Fox Lang Surveyors (907) �� ,..... Registered Land � Infoolongsurveyors.com ors.cam �Q- www.langsurvey * : ` 49 ed 'he following desarit»d Property: 1 hereby certify that 1 have survey rovemenis situated thereon th t %j �� LOT 16, BLOCK 2, GLENN VIEW aska Tand that the Imp ION o arty adjacent thereto- . . _1 n1.. Reaording District, encroach onto the inaPoaah on the surveyed KENNETN O U Anchorage11 as and do not uceni thereto other visible easement 0� x_5202 Within the Property n the property lying adl transmission lines or oth no Improvements re are no roadways, premises and that wept the as Indicated hereon. a Alaska �p�o on gold property X04, at Anahorog �OppS10 �-W4 of �'T easements, c —. Day lat. Dated this the �--- owner to determine the existence of any responsibility of the r on the recorded subdivision p N h the resp riaHOns which do not apPea covenants, or rest