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HomeMy WebLinkAboutGLENN VIEW ESTATES NORTH BLK 2 LT 2Glenn View Estates North Block 2 Lot 2 #051-821-33 Inspection Heport_1-1-12.doc Municipality of Anchorage (� Community Development Department 8bstm_' VPage.1, of 2 On-Site Water and Wastewater Program ire 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 9951976650 • http://www.muni.org/onUAR ( (&2M@-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP141281 PID Number: 051-821-33 ❑ New ❑✓ Upgrade Name: Joshua & Stephanie Herren ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑✓ Bed ❑ Mound Address 22434 Shadowy Spruce Dr. ❑✓ Other I. b . S - F Phone Number of Bedrooms Soil Rating Total depth from original grade 4 2.0GPD/SF 0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade +0.5 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Glenn View Est. North _ Block Lot 2 2 Fill added above original grade .. -3 Ft. Gravel length 30 Ft. Township Range Section Gravel width 13Ft. Beds: Number of Lines 3 Distance between lines 3Ft. SEPARATION DISTANCES To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area 390 Fe Number of trenches Dist. between trenches Ft. Well N/A N/A N/A N/A N/A TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity - Surface Water N/A 100+ N/A NIA Gal. Material Number of compartments Lot Line NIA 35.9 N/A N/A NA Foundation N/A 39.8 N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain N/A 1 *50+ N/A N/A Gal. Remarks *None Known 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 Housetotank 3034 Tankto 3034 drainfield JR's Septic Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services LLC. BENCH MARK (Assumed elevation) 100ft - Inspections dates:. 1° 9/8/2014 3`" 9/9/2014 2m 9/8/2014 4'" Location and description Top of Deck SE Corner COMMUNJJTY DEVELOPMENT DEPARTMENT APPROVAL Engineers Stamp Conditional Approval: Date . , „� ! 4�,p flow 4}# 'teven anni'�/ �y CE 8149 i+.. Approved Date 3� l Inspection Heport_1-1-12.doc A IB M1 43.6 55.0 M2 65.0 86.8 4BR HOUSE (E) DECK Lam— Y S M1 -plo TH-1 1A v LOT 2 VERIFIED CONDITION OF AIR PUMP (E) 1+ v 1 15 SEPTIC AREA t 1,250 GAL SPETIC TANK (E) WITH 550 GAL AUX PUMP VAULT (E) t+ BOTTOMLESS I.D.S.F. DRAIN FIELD IN FAILURE REMOVED ALL BIOMATTED MATERIAL AND RE -CONSTRUCTED PLACE. NEW BED - 30LFx13'Wx0.5'ED, 0.O'0'TD WITH 2.0' OF SAND - )M2, SEPTIC AREA (E) SEPTIC AREA (E) -28 NOTES: PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 �`oF A ��� '(�•."' �gsll) ig�P �y+� *;- •-* �/ ...... ... ...... / Steven R. 'P'annone mac,.'; CE 81 49 .'� % c +�l,%"-O SS ON- � Date 3/t4/zots RECORD DRAWING scale 1"=50' DRAWN BY: GLENN VIEW ESTATES NORTH, BLOCK 2, LOT 2 JOSHUA & STEPHANIE HERREN 22434 SHADOWY SPRUCE DRIVE CHUGIAK, AK 99567 NJC P.LD. NO 051-821-33 PERMIT NO. OSPt 47 281 PLAN Sh2e0F 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHOP,AGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS AND "MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES INTERMITTENT SAND FILTER DESIGN, INSTALLATION, & MAINTENANCE MANUAL". 2. SCOPE OF WORK: REMOVED AND REPLACED BOTTOMLESS I.D.S.F. 3. GROUNDWATER WAS OBSERVED AT A DEPTH OF 5.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. NO APPARENT WATER TABLE WAS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 5.P FEET BELOW -EXISTING GRADE. RIGID INSULATION 7 mJrBE FlLTER FABRIC � w —(S V z o1.25" 0 PERFORATED PIPE W/ o'z - 4� o HOLES 18" O.C. 4 a o o o F .� DDED IN 4" MIN PEA GRAVEL oa a w 101.7 TH-I-2009 4 Li (ROBERT A SHAFER) W ° 98.7 98.7 OR -0.5 —96.7-1 1250 g AIR DIFFUSER LINE 3 0 1 -FOOT QC, 9}.7-I SEPTIC 2 -INCHES OFF BOTTOM OF SAND = GM TANK (E) - 80 88.7— -10.0 PROFILE ABBREVIATIONS DESIGN PARAMETERS DI COPPER DP DUCTILE IRON PIPE UPGRADE SEPTIC SYSTEM - _ LEGEND TH TEST HOLE NO. BEDROOM: 3 (450 gpd) W WATER"LINA/ - FC FOUNDATION CLEAN OUT TANK SIZE: 12508 FT WELL RADIUS T# TANK CLEAN OUT N0. W/ 5509 LIFT STATION (E} C# CLEANOUT N0, PERC RATE = 30 MPI SS NEW SEPTIC M# MONITOR TUBE NO. SOIL RATING: 2.0 GPD/SF. AREA ROD: 300 SF R.I. RIGID INSULATION SYS. TYPE: BED - 13' WIDE - - DCO DOUBLE CLEAN OUT MIN LENGTH: 23 LF - DV DIVERTER VALVE - FS FLOW SPLITTER USED: - - - BEG BELOW FINISH GRADE 30 LF X 13' WIDE, 0.5 E.D., 0.0' TO - - OG ORIGINAL GRADE .WITH 2.0' SAND FG - FINISH GRADE TOTAL AREA: 390 SF TS&V TOPSOIL & VEGETATE - NOTES:PANNON L,TT!'' SVC, LLC C s+QF A� �l Date RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 -S'P'CA • • �9s�><) 3/14/2016 PHONE (907) 272-8218 FAX (907) 272-8211 rC��.' �y'+ Scale DRAWN BY: j *: 49 R . * 1� NTS NJC - .'? P.I,D. NO REVISFD PER COMMENTS GLENN VIEW ESTATES NORTH, BLOCK 2, LOT 2 _ ....... .. . ... -21-33 5/26/2016 JOSHUA & STEPHANIE HERREN �+ Steven R. Pannone / PERMIT NO. 22434 SHADOWY SPRUCE DRIVE f+Pc�r CE 8149 OSP 141281 DESIGN DETAILS CHUGIAK, AK 99567 kNe'D' s- NPS sheet A�� �� 3 OF 3 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP141281 Tax Code Number: 05182133000 Work Type: Septic Upgrade Permit Effective Dates: August 01, 2014 to August 01, 2015 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: GLENN VIEW ESTATES NORTH Site Legal Address: GLENN VIEW ESTATES NORTH BLK 2 LT 2 G:1560 Owner/Address: HERREN JOSHUA & STEPHANIE 22434 SHADOWY SPRUCE DRIVE CHUGIAKAK 995675454 Site Mailing Address: 22434 SHADOWY SPRUCE DR, Chugiak Lot Size in Sq Ft: 40000 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: X. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: The I.D.S.F. maintenance provider is JR's Septic Pumping. C0i rAU-A s .U.Q `s DsF %"PlAra. Received Issued By MUNICIPALITY OF Community Development Department Development Services Division 6 On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION RUSH RUSH _ _ Parcel l.D.051-821-33 �, fs/a RzR= Property owner(s)Day phone Mailing address 22434 Shadowy Spruce Drive, Chugiak, AK 99567 Site address 22434 Shadowy Spruce Drive RUSS Legal description (Sub'd., Block & Lot) Glenn View Estates North, Block 2, Lot 2 Legal description (Township, Range & Section) Lot Size 40,000 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑ Upgrade ❑x Duplex (D) ❑ Holding Tank ❑ Renewal SF Dwellings ❑ Privy El(SF and/or D) a y,. Private Well ❑ JULn Water Storage ❑ (-�L �� 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. of property owner or authorized Permit/Rush Fees: 50r 341.10 = "'b40aiver Fees: Date of Payment: 'j 12A Ig ch, Date of Payment: Receipt Number: CIRIN Receipt Number: Permit No. OS?ILI (mob Waiver No. Permit App__ :L..:c. RUSH Pannone Engineering Services uc Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com July 29, 2014 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P. 0. Box 196650 Anchorage, Alaska 99519 Subject: Glenn View Estates North, Block 2, Lot 2 Septic System Upgrade Permit Request Ladies and Gentlemen: I am writing to request a permit to install an upgrade septic system be issued for this property. The proposed systems will serve a existing four (4) bedroom house. Currently the existing field is in failure . The existing 1250g septic tank and 550g lift station will be verified at time of construction. This lot is served by a public water system. The surrounding lots to the north and west are served by this same water system. There are no Class 'A'wells within 200' of this system. The lots to the east and south are served by private wells. There are no private wells within 100' of this system. Soils. S&S Engineering performed one test hole on this lot in June of 209, and groundwater was monitored for seven days. Ground water was observed at a depth of 5.0' below the ground elevation in the test hole monitor tube. It is my opinion, based on the results of the soils tests, the use of a Bottomless I.D.S.F. system and overall soils appearance; an application rate of 02.0 gallons/day/square feet should be used for a CAT II wastewater system. 1. Soil Absorption System Design. a. See Sheet 2 of the design package. 2. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: The proposed drain field is located on the southern portion of the lot. The surrounding topography slopes from south to north at approximately 4%. There are no steep slopes in the vicinity. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 4. Drawing Markings: The Drawings are marked "For MoA Review Only'. When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. 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 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 140217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Municipality of Anchorage '% ^ Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page I of 3 www.ci.anchorageak.us (907)343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWO90106 PID Number: 051-821.33 "tee FEDERAL NATIONAL MORTGAGE ASSOC. Wastewater System: ❑✓ New ❑ Upgrade Aaaaw 400 COUNTRYWIDE WY SV -35, SIMI VALLEY, CA. 93065 ABSORPTION FIELD Plwr Nunbar a Beaoan• 4 O beet,Trarwfl D St ekw Tia d O Bea D Maurq 0 oew LEGAL DESCRIPTION iq0 no TO8O°""ra""0 °80B GPD/Fl 4-0.25 11 c Lal Smmam Oapm la p"O =eaa mna.ul iy0 Gravar dWh barram p" GLENNVIEW EST. NORTH +0.3 0.25 Fl. Ft Toen" Range Seam Fmamsaaboveaynargrana Gravel LeVh 2.8-3.3 Ft. 30.0 FI Well: ❑New ❑ U rade Upgrade P9 G'" Numbs a nn be"0earoen Nra 13.0 Fi. 5 3.2 FI CWWcelm (P ate. A S. C) Taal D"m Csaea to T" abaapm area "e P" n" Fl 390 F� ASTM D3034/SCH.40PVC Oreler / Dela eMIK Welar LMI hNeller Dale h"aiba V FI TWEED EXCAVATION 7/23.7/24109 Y" wmp ear a Caanp H.vx Aoo.. Glans TANK GPM FI. FI SEPARATION DISTANCES 0 Septic ❑ Holding ❑ S.T ❑ Other. To I Septic Absorption LM Holding lublwJPnvate G.y^ From Tank Field Station Tank Sewer Line (aC�JfJ Gal well 100'+ 100'+100'+ 25'+ MararW Nunberq Companmarm evfaca Ware, 100'+ 100'+ 100'+ LIFT STATION ,�. sauna La Ln. 5'+ 10'+ 5'+ 550 Gal PREMIER PLASTICS 'Pump W. Nvei a •Punp m' War at Hpn watt alarm ar Faalaeim 5'+ 10'+ 5'+ Nti 44 n 38 48 in Cutin me. KNOWN PunPMaraa Mmes Ebceral inepaam• iea br BLASTER20EB05 RISING SON ELECTRIC Rem EXISTING 1250 STEEL SEPTIC TANK INTEGRITY BENCH MARK Lmelm am Dee x~ VERIFIED 7/16109. TOP OF DECK Q POINT B � ..lm 100 FL US Engine ft Engineer p Inspections performed by: 15861 E. lkhwood tt)• Rd Dates: 1" 7/23/09 CA(II�d6 AlOskc 99567 OF A '4 • , 2nd 7/23/09 : •~ti�'t Development Services Department Approval f • ,••...... ' Conditional Approval Date: i •• •• «. i w • ••••u •l.MmagN� A. 11� Reviewed and approved by: �v Date: — 3 (1- 0 c7 00 'pE OM► IR« OL%) w Z IN FAILURE REMOVE ALL BIOMATTED o w (P) BED — 3OLFx13'WxO.5'ED, 0.O'TD w 7 C::] w .Q � a w r 48R 3 HOUSE o (E) o a NOTES FOR CONSTRUCTION C. 0. 1 PLAN SEPTIC AREA (E) LOT 2 I VERIFY CONDITION OF AIR PUMP (E) AND REPLACE W/ THOMAS INDUSTRIES MODEL No. 8070 OR EQUAL IF NOT OPERATING AT 3-5 PSIG s� DECK AIR LINE (P) ss P11 TH-1 1� 1 VERIFY INTEGRITY OF EXISTING 1250g SEPTIC TANK AND 5509 LIFT STATION SEPTIC AREA (E) SEPTIC AREA (E) 28 PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 GLENN VIEW ESTATES NORTH, BLOCK 2, LOT JOSHUA & STEPHANIE HERREN 22434 SHADOWY SPRUCE DRIVE CHUGIAK, AK 99567 3/2014 ....`. .i.. .. .. �dP.LD. NO Steven Pannone rERMIT NO N CE 8149 / .. ..�� Pt41281SSONP_0eet 1 OF 2 BOTTOMLESS LD.S.F. DRAIN FIELD (E) IN FAILURE REMOVE ALL BIOMATTED MATERIAL AND RE—CONSTRUCT IN PLACE. (P) BED — 3OLFx13'WxO.5'ED, 0.O'TD WITH 2.0' OF SAND C::] SEPTIC AREA (E) SEPTIC AREA (E) 28 PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 GLENN VIEW ESTATES NORTH, BLOCK 2, LOT JOSHUA & STEPHANIE HERREN 22434 SHADOWY SPRUCE DRIVE CHUGIAK, AK 99567 3/2014 ....`. .i.. .. .. �dP.LD. NO Steven Pannone rERMIT NO N CE 8149 / .. ..�� Pt41281SSONP_0eet 1 OF 2 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS AND "MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES - INTERMITTENT SAND FILTER DESIGN, INSTALLATION, & MAINTENANCE MANUAL". 2. SCOPE OF WORK: VERIFY INTEGRITY OF EXISTING 1250g SEPTIC TANK AND 550g LIFT STATION. REMOVE AND REPLACE BOTTOMLESS I.D.S.F. - 3. GROUNDWATER WAS OBSERVED AT A DEPTH -OF 5.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 5.0 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. i RIGID INSULATION FILTER FABRIC 1.25" 4 PERFORATED PIPE W/ Ya" HOLES 18" O.C. BEDDED IN 4" MIN PEA GRAVEL TH-1-2009 2.0I S TS&V (ROBERT A SHAFER)� } -0.5 pIq 2.0 --2-3—_ H8.0 13.0- -10.0 SECTION 0 0 0 0 z z w J u v z 0 AIR DIFFUSER LINE 1 -FOOT O.C., 2 -INCHES OFF BOTTOM OF SAND RIGID INSULATION wy FILTER FABRIC OJ 1.28" m PERFORATED PIPE W/ o z Ya" HOLES 18' .C. s BED " MIN PEA GRA L 211,AIR DIFFUSER LINE SEPTIC I —FOOT O.C.. TANK (E) 2—INCHES OFF BOTTOM OF SAND A Pct o.Growp- 3"ver 11��r0,15 Per 0./1^• PROFILE ,.ABBREVIATI TIS DESIGN PARAMETERS UPGRADE SEPTIC SYSTEM NO. BEDROOM. 3 (450 gpd) TANK SIZE: 12509 (E) W/ 5509 LIFT STATION (E) PERC RATE = 30 MPI SOIL RATING: 2.0 GPD/SF AREA ROD: 300 SF SYS. TYPE: BED - 13' WIDE MIN LENGTH: 23 LF USE: 30 LF X 13' WIDE, 0.5 E.D., 0.0' TD WITH 2.0' SAND TOTAL AREA: 390 SF LEGEND W WATER LINE/ WELL RADIUS SS — NEW SEPTIC NOTES: PANNONE ENG SVC, LLC CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 1 PHONE (907) 272-8218 FAX (907) 272-8211 DIP TH FC T# C# M# R. 1. DCO DV FS BFG OG FG TS&V DUCTILE IRON PIPE TEST HOLE FOUNDATION CLEAN OUT TANK CLEAN OUT NO. CLEAN OUT N0. MONITOR TUBE NO. RIGID INSULATION DOUBLE CLEANOUT DIVERTER VALVE FLOW SPLITTER BELOW FINISH GRADE ORIGINAL GRADE FINISH GRADE TOPSOIL & VEGETATE -- GLENN VIEW ESTATES NORTH, BLOCK 2, LOT 2 � „ JOSHUA & STEPHANIE HERREN S'te'v'e'n'f2' Rani 22434 SHADOWY SPRUCE DRIVE /��+t%- CE 8149 DESIGN DETAILS CHUGIAK, AK 99567 ���i�F�aFssoNP` Scale /2014 NTS " P.I.D. NO 051-821-33 1e / PERMIT NO. OSP141281 r Sheet 2 OF PERMIT NO. SWO90106 PAGE 2 OF 3 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET P.O. Box 196650 • Anchorage, Ataska 99519-6650 • Tetephone (907) 343-7904 • www.ci.anchorage.ak.us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 2, BLOCK 2, GLENN VIEW EST. NORTH P.I.D. NO. 051-821-33 SERVED BY PUBLIC WATER I I I I AIR PUMP, GUAGE k I ALARM INSIDE GARAGE LOT 15; BLOCK I SAMPSON EST. PRIVATE WELL 100'+ FROM PROPOSED SITE �I w I +a LIFT STATION Y EXISTING CONTROL BOX BEDROOM I= HOUSE NEW 550 GALLON I 8 FAT ALBERT EH I A FC �o HDPE S.T.E.P. I / TBM TANK O2 `Q. TMT a 4 I N EXISTING 1250 Qy� GALLON STEEL •, I } TANK, IN MT VERIFIED 7/16/09 FV1 p LOT 2U; BLOCK FVS T2 SAMPSON EST. STH PRIVATE WELL 100'+ NEW I.D.S.F. I FROM PROPOSED SITE ,- . 40• I � 1 F 14 s...• LOT 1 'L SERVED BY PUBLIC WATER a9 , ,.. ,,...... „�••,/� tho4.� '�'.. •�0... I cSEPTI ; PERMIT No. SW090106 PAGE 3 of 3 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 • Telephone (907) 343-7904 • www.d.anchoroge.ok.us ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 2, BLOCK 2, GLENN VIEW EST. NORTH P.I.D. No. 051-821-33 S GRADE ST2 97.4' 97.9' INSULATION OUTLET ELECTRICAL CONDUIT INLET EXISTING 1250 IIII IW DISCHARGE PIPE GALLON I" SEPTIC TANK 550 GALLON EH FAT ALBERT WITH PUME AS5EMBI MT1=101.4' II(Tl FINAL GRADE MT2 MT2=100.9' ORIGINAL GRADE INSULATION uva:x nimJ - - ,n' u. uxt /eu.o MTI=98.1'J MT2 =98.1' DIST. LINE=98.4' BOTTOM OF SAND=96.1' N. T. S. TMT A 1 53.6 B GROUNDW ER AT 93.1' 25.1 88.1' B.O.H. �11t, i MH -1 56.0 26.140, •••,•,• • ••:�S VT 86.1 63.2 ti MT2 59.2 46.5 j T FV 1 59.7 47.4 ••• »• • ^• •••"�"' FVS 67.2 56.1 •........« 1 Sh:Z 1 41 .j,• •• �F p Ql1Pv1i FE E ., 7 Jul 29 2009 12:59PM HP LRSERJET FnX Vk\1{f� 11 I�4 Rising Son Clectric, Inc. �'N 14Q16 �x/ooJ1anJ Drive Qagle River, Aj< 99577 Fit (9O7) 622.6777 S �6 July 29, 2009 S and S Engineering Attn: Yoshi 15861 S. Birchwood Loop Chuglak, AK 99567 Re: Lot 2 Block 2 Glenn Yew Estate North - 22434 Shadowy Spruce - Chugiak, AK 99567 Bear Yoshi: P.l The lift station at the above referenced property has been wired In accordance with NEC and State/Local codes. Thank you. Sincerely, Kevin S. Hornbuckle, Owner Administrator Ucense Number 1284 Specialty Contractor Ucense Number 27285 cc: file 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 Upgrade Date Issued: Jul 07, 2009 Expiration Date: Jul 07, 2010 Permit Number: SWO90106 Parcel ID: 051-821-33 Legal Description: Glenn View Estates North Block 2 Lot 2 Design Engineer: 0003 S & S ENGINEERING Site Address: 22434 Shadowy Spruce Drive Owner Name: FEDERAL NATIONAL MORTGAGE ASS Lot Size: 40000 SQ. FT. Owner Address: 400 COUNTRYWIDE WY SV -35 Total Bedrooms: 4 Permit Bedrooms: 4 SIMI VALLEY, CA 93065 - 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: Municipality of Anchorage --� Development Services Department _Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99507 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 05I- qZ f -­2�,3 Property owner(S) FEDERAL NATIONAL MORTGAGE ASSOCIATION Day phone Mailing address 400 COUNTRYWIDE WY SV -35, SIMI VALLEY, CA. Zip Code 93065 Site address 22434 SHADOWY SPRUCE DRIVE, CHUGIAK, AK. Zip Code 99567 Legal description (Sub'd., Block & Lot) GLENN VIEW EST. NORTH SID, BLOCK 2, LOT 2 Legal description (Township, Range & Section) Lot Size y0 000 Sq. Ft. Number of Bedrooms 4 THIS APPLICATION IS FOR (® all that apply): THIS APPLICATION IS AN: Absorption Field (] Initial ❑ Septic Tank ❑ Upgrade ID Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ Permit/Rush Fees: Date of Payment: is corre-U.-f er certify that this application is being made for a cordance with app i I Municipal Codes. or authorized agent) Waiver Fees: Date of Payment: Receipt Number. D� L , - �teceipt Number. (Rev. 11105) 0 ME&THAUTHORM APPR<WALS SEWERSWATER A/W WENSKNE SEWERSMATER #SPECTM &1GINEERNGS%CdES "REPORTS WELLNSPECTKN S FLOW TEST &TE Tws S01LTEST PERCOLATION TEST STRUCTURAL NEowM ft MPEC710M ON SITE WASTEWATER O6POSALSYSMA DESKN ROBERT C. COWAN . CML ENGINEERING PH: 907-694-2979 FAX: 9076941211 June 29, 2009 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 2, Block 2, Glenn View Estates North Subdivision It is requested that you issue a permit to install a new I.D.S.F.(upgrade) innovative septic system to serve the existing four bedroom house on the referenced property . The integrity of the existing 1250 steel tank will be verified during construction. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation (6/20/2009) water was not found. After seven days of monitoring, ground water was found at 5.0'. . We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you requip: aegitional information, please contact us. A. Shafer, P.E. 15861 S. 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Box 198050 Anchorage, AK 995196650 •••«� �r;.�; A. ih A o7a J www.munl.orglonsito P Na ltfl•� (907)310-790/ 4l• . .•��y Soils Log - Percolation I. st Pei lamed For: !fi(�fJ ��.r> >� 7 C"�'-�7� Uesaiption: ' ' Date Perrto�n'/{�ed: C�'�/ Legal /per /�(d6wnsFp,-Rang c9on: Depth 11 —or'bitroics S In/mL. 01rk SomE 40111VI. WAS GROUND WATER Date ENCOUNTERED? D /j' a _� r1w) IF YES. AT Ve1AT DEPTH? r'600 � ''– L ^�-,— VVV,""�p Depth to Water After monitoring? C a� t O E Dale: PERFORMED BY: PERFORMED IN/ Reading Date Gross Time Net Time Depth to Wale, Net Drop 3" 30 '30 3" 3"L1 V2 1 %2" 3.SIt 120 Srr /Z� ' 3" �o 1430 Ji /i, I & L ,n "V. nw,e ,JSL/ (m v.aaernl PED RC HOLE ETER (�.• IT RUN BETWEEN �_FT AND e2 ' FT kJLt (7ERTIFY TFIAT THIS TEST WAS AL STATE AND MUNICIPGUIDELINES IN EFFECT 0 THIS DATE. DATE: 0 Municipality of Anchorage Development Services Department P �L Building Safety Division On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW -030463 PID Number: 051-821-33 Name` Sudsbury &Son Wastewater System: 2] New ❑ Upgrade Y P9 Address. 10928 Eagle River Rd. Ste 122 ABSORPTION FIELD Phone: 696-1610 Number of Bedrooms: 4p 4E3 Deep Trench ❑Shallow Trench Bed Mound Other: ❑ [:]Mound❑ LEGAL DESCRIPTION Soil Rating: 0.45 Total Depth from original grade: 12 GPD/Ft' Ft. Block: Lot: Subdivision: 2 Glenn View Est. North Depth to pipe bottom from original grade: Gravel depth beneath pipe: 2 2-3 Ft 10 Ft Township: Range: Section: Fill added above original grade: Gravel Length: 1-2 Ft. 70 Fl. Well: ❑ New ❑ Upgrade Gravel width: 2 Number of lines: 1 Distance between lines: —' Ft. Ft. Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: Ft. FL 1400 Ft= D3034/F-810 Driller: Date Drilled: Static Water Level: Installer. Date Installed: Ft. Sudsbury& Son 11/5-6/03 Yield: Pump Set at: Casing Height Above Ground: TANK GPM FL Ft. SEPARATION DISTANCES El Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ublic/Private Manufacturer: Capacity: From Tank Field Station Tank Sewer Line Anchorage Tank 1250 Gal. Material: Number of Compartments: Well 200+ 200+ ------- ----- 25+ Steel 2 Surface Water 100+ 100+ ------- ----- LIFT STATION Size: Manufacturer: Lot Line 5+ 5+ ------- ----- Gal. "Pump on" level at: "Pump off" level al: High water alarm at: Foundation 5+ 10+ ----------- in. in. in. Pump Make & Model Electrical Inspections performed by: Curtain Drain Remarks: BENCH MARK Location and Description: 2" of insulation was used over sewer line and septic tank Foundation Assumed Elevation: 100 Ft Engin`e�r`s.SVK OF ACq`S��� • 1 Inspections performed by: Alaska Rim Engineering,lnC Dates: 1st 11/5/03 2nd 11/6/03 •. �• so ���.•'''�• Development Services Department Approval •t"0• A Leet Reviewed and approved by: ilr �c/ Date: e13 I ZI Z1i CtaDes `��/ �• 10`x° •���� (acv.Ivao) — %r fhan, ill e. Fie�® pro�ify lrae r r�afer ,A n �f c�d drawn D/I /�5bui f ��arf View f 5 t00 Ona PERMIT NUMBER RECORD DRAWING PID NUMBER na1_aa1_olq =XCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER OR BUILDER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED 9UILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITIES CONNECTIONS, AND TO DETERMINE THE EXISTENCE OF ANY =ASFMFNTS. COVENANTS. OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. 4opoo000�� SITE PLAN C� ASK K BOX 274 9645 rtF.•�F A. '! D�D� ENPALMER, ALASCiJEE lNC. PHONE: (907)745-0222 9TH �q FAX: (907)746-0222 4Itd�D W.O. 0301057 DATE: 4/25/04 1 SCALE: 1" = 60' 1 FILE: 0301 ................. Q Charles A. Leet �p I LOT 2, BLOCK 2, GLENN VIEW ESTATES NORTH, CE 10480.• v�d PLAT No. 2003-42, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE j.•RECORDED PLAT ARE NOT SHOWN HEREON. SHEET 1 OF 3 LOT 3 5/8' REB AREA 33 ATIP O'CYP ELEV. 98.97' 589'58'04•W 1�s 185.20' R&C 71 C3 S 10' BLDG. SETBACK UNE S HIR . ud V. N VACANT " RECOVERED O v U Qpj ,: 3-1/4' AL -YON GRADE ^ �4 0.10 ABOVE 171-00 +y ASSUMED ABOVE ELEV. 100-00 K LINE 30' 73'• LOT 2 S89'58'04'W ! 40,000 VACANT z z 8 8 TWO STOR DWELLING o N TN , V > F Fw ? 21^ ,m �Ii50 GALLON f51N N U Um STEEL SEPTIC TAN i4 .A. C7 Q, 7 Oo vA E W1 V lnm A Ai ii n, wA O E A_ = n � • KTH S AKM1 �? ZZI RECOVERED E%ISTING SEPTIC $/e' REM ELEV. 107.40 -AREA' i 10' BLDG, SETBACK UNE i S89 58'04"W 185.40'(RB:C) /p$• e PEDOS TTP. LOT 1 BLOCK 2� LO 28 VACANT A B ST 1 35.2 20.5 ST 2 43.2 20.9 C01 47.5 22.0 CO2. 48.3 22.2 _CO3 59 33.0 C04 30.4 50.8 , MT_ 1__.67.6__39.4; MT_2.__29,8 ___43.0__ 1" = 60' =XCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER OR BUILDER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED 9UILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITIES CONNECTIONS, AND TO DETERMINE THE EXISTENCE OF ANY =ASFMFNTS. COVENANTS. OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. 4opoo000�� SITE PLAN C� ASK K BOX 274 9645 rtF.•�F A. '! D�D� ENPALMER, ALASCiJEE lNC. PHONE: (907)745-0222 9TH �q FAX: (907)746-0222 4Itd�D W.O. 0301057 DATE: 4/25/04 1 SCALE: 1" = 60' 1 FILE: 0301 ................. Q Charles A. Leet �p I LOT 2, BLOCK 2, GLENN VIEW ESTATES NORTH, CE 10480.• v�d PLAT No. 2003-42, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE j.•RECORDED PLAT ARE NOT SHOWN HEREON. SHEET 1 OF 3 PERMIT NUMBER 030463 O O O O O 0 0 r � UT J N ON r o O Z Nm (r Ln m Cn Co D m O �-: C) m mZ 1 —i vv" OF . Charles A.Leet CE 10480 RECORD DRAWING TWO STOR DWELLING 1250 GALLON STEEL SEPTIC T AK ©TSTH q L FCsT�r r �KTH Ln REPLACEMLN 10' BLDG. SETBACK LINE SEPTIC SYSTEM P mow. (AwmM) bW alw. 07.0 OWd alw. 00.7 F. 0. 100.5 RECOVERED 5/8" REBAR ELEV. 107.40 ..O ab.MUm SEPTIC SYSTEM PROFILE PID NUMBER N O J W co D r o O Z N P O Ln ^ O O0 m O D J J C0 J D C rn Z - Z M C) SITE PLANALASK' P.O. BOX 2749 C'' RIM PALMER, ALASKA 99645 ENG EE INC. PHONE: (907)745-0222 FAX: (907)746-0222 W.O. 0301057 1 DATE: 4/25/04 1 SCALE: 1" = 60'_1 FILE: 0301057 LOT 2, BLOCK 2, GLENN VIEW ESTATES NORTH, PLAT No. 2003-42, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. PERMIT NUMBER RECORD DRAWING PID NUMBER 030463 051-821-33 prfor.t.e •• PVC .« xob 1 a/•' b a• ..e.r reek bs1.9 mwller teed b.1.0 a..eeel w .w .f arwe pp X .olid d' AM W. or Pvc ees a 70 f xel. 1: bw.0 .o swwaed PVC I..a (wine o.ol foot « ..m. a...uoo) b.a.u.L It used ... x.b a L e' PVC Brae Plp, u/ kel« duo DEEP TRENCH PLAN VIEW ee serf.« EIPV. 100.5 •� bwe.WL °e^r e..a s■■ Eli'V 98 0' i 1 -few m 2' t n P f U bol. l.arl«Ww (ka« ewe) SECTION X—X ... A" MP Powe .e,f.o• TRENCH SECTION MONITOR TUBE DETAIL o�ooOp�D DETAILS asK' P.O. BOX 2749 S1;, K & q3�a� � RIM PALMER, ALASKA 99645 qENCEE/NC. PHONE: (907)745-0222 9 d� FAX: (907)746-0222 9TH �� W.O. 0301057 DATE: 4/25/04 SCALE: nts FILE: 0301057 K.1.. .............. Charles A. Leet .•.: LOT 17 BLOCK 2, GLENN VIEW ESTATES NORTH, CE 10480 d PLAT No. 2003-42, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, All p P .....•••p` d EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE R0FESSlt1dc, RECORDED PLAT ARE NOT SHOWN HEREON. 10, weveer «.w nak a/•• to a• ..sr r.ek N.U. e.vtn -4'PC prfm.led r ELEV. 88 0' • bLma� b •..a rook TRENCH DETAIL mduterked Mots l: M. . elolmum M •-fed of (er puhsl.el) o•.r ok.wyueo !Weak. Ooo leek a Wtul.e vw losekem 0 (a p.) m.V M nfor as f«l of wtG ee.w �««eea dek Y uP b • m.tlmam M too be4« M bsW.uoL arvuee..br d Mab 8: W -d ..r««uw w u b. w mon 12 1..1 Moto a xa e«e k.p.m«e1. % ELEV. B00 TRENCH SECTION MONITOR TUBE DETAIL o�ooOp�D DETAILS asK' P.O. BOX 2749 S1;, K & q3�a� � RIM PALMER, ALASKA 99645 qENCEE/NC. PHONE: (907)745-0222 9 d� FAX: (907)746-0222 9TH �� W.O. 0301057 DATE: 4/25/04 SCALE: nts FILE: 0301057 K.1.. .............. Charles A. Leet .•.: LOT 17 BLOCK 2, GLENN VIEW ESTATES NORTH, CE 10480 d PLAT No. 2003-42, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, All p P .....•••p` d EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE R0FESSlt1dc, RECORDED PLAT ARE NOT SHOWN HEREON. F ALASK Municipality of AnchorageQ NGI s 1 Development Services Department ad Building Safety Division 4 On -Site Water and South BragawWastewater Program St. 4700/�' • • •, ,S P" lett ,CO P.O. Boz 196650 Anchorage, AK 99519-6650 . •'. C}`a�� i www.muni.orglonsite r •, �.� (907)343-7904 tit[RED TItaCESS���' Soils Log - Percolation Test 1���\\��� Performed For. Sudsbury & Sons Date Performed: 11/6/03 Legal Description: Lot 2, Block 2, Glenn Yew Estate North Township, Range, Section: ar I-SZl _ 33 —r l.! . &tVT IA 2 Slk4j Growl 1601tA)7 J bOTTOM of "i'EST "OLE 1 1 1 COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? Depth to Water After Monitoring? Date: S L e P E Reading Date Gross Time Net Time Depth to Water Net Drop FILL 11/6/03 PRESOAK 7" 1529 7" 1559 30MIN 8-1/4" 14/16" 7" 1629 30MIN 7-7/8" 7/8" 1659 30MIN 7-718" 7/8" PERCOLATION RATE 34 (m.•n.•rornl PERC HOLE DIAMETER e TESTRUNBETWEEN a FT AND 7 FT PERFORMED BY: Kent Sheets I Charles Leet, P.E. CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 4127/04 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 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SW030463 Legal Description: tiGlenn View Estates North Block 2 Lot 2 f Design Engineer: 0032 Alaska Rim Engineering Owner Name: Sudsbury & Sons Owner Address: 10928 Eagle River Road Suite 122 Eagle River . AK 99577 - Date Issued: Oct 29, 2003 Expiration Date: Oct 28, 2004 Parcel ID: 051-821-33 Site Address: 22434 Shadowy Spruce Drive Lot Size: 40000 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑✓ Disposal Field Q✓ 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: 0 Date•I0&9W Date: v Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsile (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel l.D. h5 ` 9 Permit Number SW03046 3 Property owner(s) <�r sdS lE1v rt{ � S Day phone (A (a — I61 O Mailing address (1) 104Z8 ZZ v Mailing address (2) �.�� e�1 ivc�r— �� Zip Code R15—P-7— Legal description (Lot, Block & Sub'd.) Ienr\ Jirs.f m al d S Legal description (Section, Township & Range) ZZ -4 "3 "1 fL Lot Size 4C' and Acres q.Ft Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only y Well Only ❑ Sewer and Well Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub 13 Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ the above information is correct. I further certify that this application is being made for a y Dwelling and is in acco)Uance with applicable Municipal Codes. (Signature of property agent) Permit Fees: —44 0 Q Waiver Fees: Date of Payment: / O - I L/ — 0 ? Date of Payment: Receipt Number. 3 Il Receipt Number. (Rev. 12100) • �t.}�Qas�a Hint 319111eehing, Ale. Phone (907) 745-0222 Fax (907) 746-0222 akrim O rogershsa.com October 7, 2003 Mr. Dan Roth Municipality of Anchorage Development Service Department Anchorage, AK 99519 RE: Lot 2, Block 2 Glenn View North Estates Subject: Permit Request —Design Narrative Dear Mr. Roth: P.O- Box 2749 Palmer, Alaska 99645 The owner of the above referenced lot is proposing a four-bedroom singly family residence. We are requesting a plan review and a permit to install a septic system to serve the proposed development. Soils A test hole was excavated and a percolation test performed by Alaska Rim Engineering, Inc. on September 30, 2003. The approximate location of the test hole is located on the attached site plan and is identified as AKTH. The soils were visually rate GM. The percolation test indicates the use of an application rate of 0.45 gal/day/sft. On October 6, 2003, the monitoring tube was checked, no groundwater was observed in the monitoring tube. The developers engineer performed a soils investigation on January 12, 2002. The approximate location of the test hole is located on the attached site plan and is identified as TSTH. The soils were classified as silty sand (ML) with a perk rate of 30 min/inch and no groundwater at 10 feet. Topography The area around the septic field is basically flat with drainage to the north. Engineers • Planners • Surveyors Lot 2, Block 2 Glenn View North Estates 9/30/03 Permit Request — Design Narrative Page 2 of 2 Trench Design The dwelling proposed is a four-bedroom, with an estimated daily wastewater flow rate of 600 gallons per day. The wastewater application rate from the perk test is 0.45 gal/day/sft. The required absorption area is 1,333 square feet. Proposed is a deep trench with an effective depth of 10 -feet and a length of 70 feet. Enclosed are drawings of the proposed system. Surrounding Properties There is no water wells within 200 feet of the proposed septic system. This property and its parent subdivision, Glen View North Estate is served by a community water system. Surface Waters There is no surface water within 100 feet of the proposed upgrades. We do not anticipate any adverse effects on the neighboring, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. This subdivision is server by a community water system. Sincerely, Alaska Rim Engineerin ,Inc. / �� l� Charles A. Leet, P.E. Project Engineer Encl: Permit Application Permit fees Soil Log — Percolation Test (2) Site Plan (3) Cc: Client AK Rim File # 03-01057 ct 1"-50' SEPTIC SYSTEM PLOT PLAN ter for arta «yyM « 4-twh ABS at mltam step• aek (... 1Mse�tWa•t !) adw etw x x 1/a• Par 2 ma.. slap• a G• P•r M1 wt t � 4-beG 4Be at aeua.m .toy. m sed mWt k•l..o ••Ptta Imk and tYe. 4wkeuo. w,y. x x It/a. ya tt) i%-.11 and to e..t w a• AM l./ x m�aEr naps m.el.ttm) P•1•• � p tbtt(/ •pw tm) le/' �'• ae "dtld te.elauee) SEPTIC SYSTEM PROFILE oF°,a� U Conventional Single Family Residential A o 4A�9�Od PROPOSED SEPTIC SYSTEM DESIGN 91:>7QOp P.w".. LOT 2, BLOCK 2 GLENN VIEW NORTH ESTATES NASO P.O. BOX 2749 ,e:Ch.......ENC RIM lNc. PALMER, ALASKA 99645 QQi'•. arles 10480 A. Leet..' PHONE: (907)745-0222 2 o FAX: (907)746 l0-0222 a QQ PR�FESS19apdo d�000��o Alaska Rim Engineering. Inc. ° D tor' M'EP 2 OF 3 _ vo N t0 N N �t RECOVERED ��•, dpi, n 3-1/4• AL -MON M y o y 0.10 ABOVE GRADE 7} ASS ELEV. 100. ao' LOT 2 73'! z u� w TWO STOR V , WELUNG 102 a _ a 6 n z_ n 12 ON ,,r ^ tA o iA �n STEEL SEPTIC TAN - �i .�. 60 00 a $6. Q '4 L"m 10. • a f z v p k test to be eon ueted ('1 d rIn const et �I R ED 5 R- L 4 V. 107.4 S 0' 10' BLDG. SETBACK LINE S89'58'04"W 185.40'(R&C) AO 0• TY PE S. LOT 1 BLOCK 2 rt P. � 0 VACANT SEPTIC SYSTEM PLOT PLAN ter for arta «yyM « 4-twh ABS at mltam step• aek (... 1Mse�tWa•t !) adw etw x x 1/a• Par 2 ma.. slap• a G• P•r M1 wt t � 4-beG 4Be at aeua.m .toy. m sed mWt k•l..o ••Ptta Imk and tYe. 4wkeuo. w,y. x x It/a. ya tt) i%-.11 and to e..t w a• AM l./ x m�aEr naps m.el.ttm) P•1•• � p tbtt(/ •pw tm) le/' �'• ae "dtld te.elauee) SEPTIC SYSTEM PROFILE oF°,a� U Conventional Single Family Residential A o 4A�9�Od PROPOSED SEPTIC SYSTEM DESIGN 91:>7QOp P.w".. LOT 2, BLOCK 2 GLENN VIEW NORTH ESTATES NASO P.O. BOX 2749 ,e:Ch.......ENC RIM lNc. PALMER, ALASKA 99645 QQi'•. arles 10480 A. Leet..' PHONE: (907)745-0222 2 o FAX: (907)746 l0-0222 a QQ PR�FESS19apdo d�000��o Alaska Rim Engineering. Inc. ° D tor' M'EP 2 OF 3 G! Charles A. Leet . CE 10480 . LOT 3 s 1 LOT 15 BLOCK 4 73': LOT 2 -'_ og 4+Y 40,000 A.f.+10 u TWO STOR ; WEWNG PU „ 4 4ExiSnNc mSEPt XOT AREA/ S250 m TEEL ST➢= TAN �„ n' mBLOCK P rca m i S � 0 1wt 1a • mn c1.0 T EXISTING R y SCPti.� ARIA V. 107. R ? � 10' BLDG SETBACK EINE 589'58'04 W 185.40'(R&C) l0�' —PEu TM. LOT i BLOCK 2 LO 6 B CK 4 VACANT 1"-60' TO VERIFY PROPOSED EXISTENCE OF ANY PLAT. SITE PLAN AS P.O. BOX 2749 Rru PALMER, ALASKA 99645 ENC EE JNC PHONE: (907)7465 2 0222y o * �0 W.O. 0301057 1 DATE: 10/7/03 1 SCALE: 1 " = 80' 1 FILE: 03010 � I HEREBY CERTIFY THAT I HAVE PREPARED A PLOT PLAN •• D FOR THE FOLLOWING DESCRIBED PROPERTY: Ldp LOT 2, BLOCK 2, GLENN VIEW ESTATES NORTH, d PLAT No. 2003-42, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. DATED AT PALMER, ALASKA, OCTOBER 7, 2003. SHEET I pwl P FM Ole 4C ..e.r Welt 0 Ir N .rk .vd 1 lemek X 70' DEEP TRENCH PLAN VIEW rT` \" '- 2• L I v um� tile..• -a SECTION X -X ELEV. 105.' oarth Wel.11m, U U d mml.Uao. E peenwkl. er ■et. i U e..d t w peuod .tut.e. p.et.rW. I 1 ,// // ELEV. 109' r�r reekmet.d tarc .erre T- 4* P9c &.1n plea../ kelw dere 10• amp W .ff..U" d.ptk _ W reek ..__.__y .. ELEV. 99' TRENCH DETAIL teal 11ae. 2 (plow . U l . M H..t of .eetL- b,okabeor Om• (a bwaak b. wtbutut" lar . loot of oath ee.s dTMmdm� '�> up S. • ----= .f too &.. of l.wddlaa Net. i /pea Gem 4mek ea tlm to M 9..d for atmr. be L ELEV. B7.' i_ Me d: Tb. --a, w Wft d.pek hem Mpte.l BOTrOY OF TH d'ed' ek.0 be 101i" MONITOR TUBE TRENCH SECTION DETAIL 0°U� Conventional Single Family Residential ..A4,9 rpo 0� PROPOSED SEPTIC SYSTEM DESIGN p a� 49TH 9��p a oma•• LOT 2, BLOCK 2 GLENN VIEW NORTH ESTATES ... p AS P.O. BOX 2749 O ' Ch. . A. Leet .. d C �y PALMER, ALASKA 99645 o ENC EE INC. PHONE: (907)745-0222 c5i •, CE 10480 d IQQfi�., FAX: (907)746-0222 QQQG PRaFESSI�Pdo.S db�040o0� Alaska Rim Engineering. Inc. h -k% 10/f/01 emawt. Sf1FET 3 OF 3 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519.6650 wwwci. anchorage. sk. us (907) 343-7904 it 7A?r. Soils Log - Percolation Test L._ Performed For. 'Suck . & Date Performed: Legal Description: Lo-f 2 ALAZ Township, Range, Section: _ V1lt�lvttU% SKI Ft*Slope T—F—I Depth 1-05 Gross TimeIrime 0V4AA.-'tc 0>17) 2- L Depth to Water After Sit Clrmi, \ 3 E Date: deY's e-\-D,,y 4- `�KJ 5- - 6- z 7- 8- 9- .15 10- 11- 12- 13- 14 15- 16- 17- 18 Bort oAa I- 19 - WAS GROUND WATER ENCOUNTERED? Gross TimeIrime _�Q• 8 IF YES, AT WHAT DEPTH? L Depth to Water After 0 @ P Monitoring? E Date: Izkp �ties Lett CE Reading Date Gross TimeIrime to Water Net Drop FLL :00 z .75%z .15 olse PEHCUI rIUN NAIt --1 LJ (."A" ch) PERC HOLE DIAMETER TESTRUNSETWEEN "— FT ANDFT COMMENTS PERFORMED BY: KE' yy+ ` he.,ti-S t 1 r Ae...-r CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: AV- Pt03 x;- o3-oto6-;I,- 11 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage. AK 99519-6650 www. ci. anchoraae.ak.us (907) 3e3-7904 Soils Log - Percolation Test Performed For: L A9211 V /,C -WN 012 1 I-�' Date Performed: Leal Description: O}}-I-.� •g{,: �Township. Range, Section: R¢r- Kw.l Ptd Slope -- 1• MILS 2- 5-IIII�II I4t`! 6• al•CNS� 7- 10. - 10 1 I Gross Time 11• Depth to Water 1EiC1-1 o (N OF 12- HOL. C- 13- 13- 4A2flpAN 14- 1 0-:l 15- 16• 17• 7 n 16- 19 - COMMENTS WAS GROUND WATER • ' D ENCOUNTERED? N 5 IF YES. AT WHAT DEPTH? L Depth to Water Alter 0 Monitoring? p E Date:ItoZ. /1Z Reading Date Gross Time Net Time Depth to Water Net Oroo 1 0-:l v pm;4 7 n 'qj D i "`^-^^• -".L. r^-".'.rj FERC HOLE DIAMETER TEST RUN BETWEEN I FT AND 9. FT PERFORMED BY: ^, �j I I , S CERTIFY THAT THIS TES' 16"AS PERFORMEO IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: I Ld O 2 Parcel I.D. 051-821-33 (ic� ^lb J '` ry Municipality of Ancho IV 11" 2 0X016 n On -Site Water and Wastewater Pro � < (907) 343-7904 " w Certificate of On -Site Systems 1. GENERAL INFORMATION Expiration Date: Complete legal description Glenn View Estates North, Block 2, Lot 2 Location (site address) 22434 Shadowy Spruce Dr. Current Property owner(s) Joshua & Stephanie Herren Day phone Mailing address 22434 Shadowy Spruce Dr. Chugiak, AK 99567 Real Estate Agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellirigs (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Fx-1 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System E Public Sewer ❑ WaiverNariance request for: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ �7+� . Date of Payment JI a-aJ1G(o Receipt Number 5`5 5q Gl COSA # Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGTNEER 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-Systemt;�Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, Junctional 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, I 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. 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 3/15/2016 OF 6. DSD SIGNATURE ® F System #1 Approved for bedrooms �� tSleven ft.•Ponr System #2 Approved for bedrooms{�5�, CE -8149 Disapproved . �g33�A Conditional approval for bedrooms, with the following stipulations: By`: y Gw�1 � — 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet • .. . If more than 1 septic system is on the lot: COSA Checklist # 1 of I Structure served by this system Certificate of On -Site Systems Approval Checklist Legal.Description: Glenn View Estates North, Block 2, Lot 2 parcel ID: 051-821-33 A. WELL DATA Well type Public If A, B, or C provide PWSID # AWWU Well Log (Y/N)< Date completed Sanitary seal (Y/N) _ 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 Well production g.p.m, V.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/Material Septic/Steel Date installed 11/5/2Q03 Tank size 1,250 gal..,_ Number of Compartments 2 Cleanoats (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N f , 'Date of pumping S /3C 6,0 1(, Pumpera� PL � C. ABSORPTION FIELD DATA Date installed 9/8/2014 Soil rating (g.p.d./ft2 orft2/bdrm) 2.0 System, type j.D.S.F Bed Length 30 ft. Width 13 ft. Gravel below pipe 0 5 ft Total depthr 3 ft. Elf. absorption area 390 ft? 'Monitoring tube Y Depression over field N /1 /2016 Pass 4 Date of adequacy 'lest Results (Pass/Fail) For _ bedrooms Fluid depth in absorption field before test 0 in. Water added 553 gal, New depth 0 in. Elapsed Time: 100 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date ■ D. LIFT STATION Date installed 7/23-24/2009 Size in gallons 550 Manhole/Access (YIN) Y "Pump on" level at 44 in. `Pump off" level at 38 in. High water alarm level at 48 in. Datum Bottom of .Tank Cycles tested 4 Meets alarm & circuit requirements? Yes E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 200+ 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 200+ F. COMMENTS . G. ENGINEER'S CERTIFICATION'S~� 1 certifythat 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. Engineer's Printed Name Steven Pannont? .��ewri � (5nrinane CE -8149 Date 3/15/2016. COSA canary sheet_2-&15.doc I vrewasn nnrsaa r, 2w MMCT 1 R WT INitlNa are,rac ( 30' So•'. EIFIDING SEmnCK I 1 taEw ®xaroJo sreAa< I 1Ai2C' N99" 52' M E I A b o GARAGE � -07 B' o ..:.46.3:.: Ca' v PORT tea w o an ti0V5E �,. 7 I Q Tv U Wi I � f H MH w A O C I I I S09';Y3'OaYJ t13'i •lfl I 3 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 SURVF,Y. LISTED DISTANCES PREVAIL OVER SCALING. ' REPRODUCTION MAY CAUSE ERRORS IN SCALE, LOT svR,EY SURVEY TYPE - - SYMBOLS ❑ FCONBAUON AS-BUILT p SET REBAR ASPHALT DRAINAGE ❑ ❑ - AS—BUILT LY FINAL SMULAR TBPBGt-WILAPHY ,a:.: o FOUND RES AR ^ ^ WOOD FENCE � CONCRETE ..JRE PIAN ... LOT SURVEY ... W %L ASSUMED ELEV. -,�-.—F METAL FENCE ® WDA DECK n AS-PLO O CORNERS SE AS-GUILT NO CORNERS SET � RECERiIFlCAi1QN AS-BURT. Na OWNERS SEC. 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 SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS. SIDEWALKS, DRIVEWAYS, TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS 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 - .nT�,,mr ®�,a of Prepared by - Robert E. Johns, Jr.. & Assoc. PLOT PLAN .� A/ it - aaxnRh uwl awa Wa r. wwp ma mt aaw ora awam a«sa• me mol 1 + 4 `p „.•`'""' ""••,; Professional Land Surveyors naw rang u n.mm.e a m u, Lot ern.. ua and b u bwt aI .er t r$ ,( � :'` `8 1700 &ink DriViL - ANCHORAGE, ALASKA 99504 w anm, m prat wM.aa. aw aeenip., a ar aun+ naw nen � �� Rec, Lot S.F. Raa. Piot Elle Na 49th Scale:U, � I{ 5 FOUNDATIAS-8ULT ON }x Y' tel, ° 'C' ••°`•¢ ' J ked b Checked 1. xmws C ,w,a., >, �l wx a4aWaI dlpawl Nnayotl.d mmwt / o ..... ...,.0 Date Sme d: 5/26/16 Y. REJ V mawwifabamtpaaaeahMm.m® hega::r' a>h(a4num.adwn,epmWwoaim,hn.ma f ROBERT EJOHNS, JR, Date Drawn: 51261.6 NW1560W 16-184 weY .,N u e4121_S i : Legal P al DesuGan FINAL STRUCTURE AS-BUILT aAV sj x@ '••..,,• I. R Sat E .bMr, N., nmtlY �iY Nat 1 ,.<`` yJ ® ®4 GLENN VIEW ESTATES NORTH Parcel I.D. 051-821-33 Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: Complete legal description Glenn View Estates North, Block 2, Lot 2 Location (site address) 22434 Shadowy Spruce Dr. Current Property owner(s) Carrie & Craig Breitung Mailing address 22434 Shadowy Spruce Dr. Real Estate Agent Day phone Day phone 2. TYPE OF DWELLING: I] Single Family (w/wo ADU) �.d Ivi1 1 ❑ Duplex L ❑ Multiple Dwellings (Single Family and/or Duplex) MAY 2 t 2014 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual ED Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System El Public Sewer ❑ Waiver/Variance request Received by: Vj/t/''L t/I!"y Date: Ga/ COSA to be released to thesneer, unless otherwise requested by the engineer. COSA Fee $ 52-(o Date of Payment 5-12-2--11L1 � 6/ Receipt Number 0-L(1�O COSA# O -'Y -/'l 12-12- Municipality Z/2 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, 1 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 Ak. 99510 Date 5/1/2014 Engineer's Printed Name Steven R Pannone 6. DSID SIGNATURE I/ System #1 Approved for A bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: By: O Original Certificate Date: Cn The& nici /ali of jochrorage 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. - ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r'- ., c If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system i Certificate of On -Site Systems Approval Checklist Legal Description: Glenn View Estates North, B2, L2 A. WELL DATA Well type Public Date completed Total depth ft. Date of test If A, B. or C provide PWSID # AWW U Sanitary seal (Y/N) _ Cased to ft. FROM WELL LOG Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Parcel ID: 051-821-33 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION ft. g.p.m. Collected by: Date installed 7/23-24/2009 Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Date of pumping 5/6/2014 Pumper One Stop Pumping C. ABSORPTION FIELD DATA Y Date installed 7/23-24/2009 Soil rating (g.p.d./ft2 or ft2/bdrm) 2.0 GPD/SF System type Bed Length 30 ft. Width 13 ft. Gravel below pipe 0.25 ft. Total depth 3.2 ft. Eff. absorption area 390 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5/9/2014 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 601 gal. New depth 3 in. Elapsed Time: 430 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed 7/23-24/2009 "Pump on" level at 44 in. Datum Bottom of Tank E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Size in gallons 550 "Pump off"level at 38 Cycles tested 4 91 Manhole/Access (YIN) Y High water alarm level at 48 Meets alarm & circuit requirements? Yes On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ 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 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 5/44/2014 -7{ COSA brown sheet 10-10.12.doc Water main 10+ Driveway, parking/vehicle storage 10+ in. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING �� 7 Parcel I.D. OSI' 921 '33 COSA# D 90 2 �G Expiration Date: % ^ 3 ' (--0 1. GENERAL INFORMATION Complete legal description Lot 2; Block 2; Glenn Vww Estates North Subdivision Location (site address) 22434 Shadowy Spruce Dr. ( petty-owrier(SY-Federel National hon Mailing address Lending agency Day phone Mailing address Real Estate Agent Bob Brock Day phone 261-76788 Mailing Address 3111'C St. #2DO Anchorage, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑,r 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 On -Site 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 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 ts(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S a s Engineering Phone 694-2979 Address 15861 S. Birchwood Loop Chugiak, AK 99567 Engineer's Printed Name Robert A. Shafer 5. DSD SIGNATURE _Approved for Disapproved. Date'.7/0 ° / Conditional approval for 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: Original Certificate Date:7— "– 3 Q Oct (Rev IIMS) Municipality of Anchorage Development Services Department Building Safety Division s . On -Site Water & Wastewater Program 4700 Elmore 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: _L01d;BteV-<2j�LF�iU V/E09 &. /Vot'_T#ParcelID:Q��-55a/-33 A. WELL DATA��, BC.Ie /' � 1 � Well type _ Date completed _ Total depth ft. Date of test Static water level Well production WATER SAMPLE RE. If A, B, or C provide PWSID # _ Sanitary seal (Y/N) Cased to ft. FROM WELL LOG g.p.m. Coliform olonies/100 mL Nitrate mg/L Ar ug/L date of sample: _ B. SEPTICIHOLDING TANK DATA Tank Type/Material C /S7ZrC. i Tank size ia50 gal. Number of Compartments p� Well Log (YIN) Wires properly protected Casing height (abwt�rc AT n. . n., Other bacteria colonies/100 mL Collected by: Date installed 14-111416-s Cleanouteo-,m - &� Foundation cleanout&) Depression over tank �(Y R� jt �J ,%�Q High water alarm (Y® Date of pumping O Pumper �J r�rS ( */►1t�t►l)Es --- 1j� C. ABSORPTION FIELD DATA Date Installed�V/07Soil rating p.d./ft r ft'/bdrm) a "D System type 17. b. 5, F Length5 • ft. Width 13 .'o it. Gravel below pipe n.a5 ft. 'T8 -s 3 Total dep1h;t0;#fL Eff. absorption area Mft2 Monitoring tube Depression over field No S�fSTE►11 Date of adequacy test Results (Pass/Fail) "' For bedrooms �r-f — 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.) (Y/N & type) If yes, give date D. LIFT STATION Date installed 4A� 'Pump on' level ata In. Datum ';�277ZM Size In gallons 690 'Pump off' level at _Bain. Cycles tested a E. SEPARATION DISTANCE!r? SEPARATION DISTANCES FROM WELL ON LOT TO:: Manhole/Acces om) High water alarm level at in. Meets alarm & circuit requirements? 4 rl5 Septic tank/lift station on lot On adjacent lots Absorption field on lot On Public sewer main Sewer /septic service sewer manhole/cleanout Holding tank areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: r ► I Building foundation S f Property line 5'f' Absorption field ig r r r Water main /D f Water service line 1d f Surface water /CX7 I r � Wells on adjacent lots 00 f + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /O Building foundation Water main I r I Water Service line O Surface water /AD t Driveway, parking/vehicle storage Curtain drain AJOW YMAM Wells on adjacent lots �K" t arm + F. COMMENTS �1 . G. ENGINEER'S CERTIFICATION 1 certify that I have detormino rough field inspections and i t� ,...1...• ' *' review of Municipal records that the above s stem are !n '•'4 �•,;,:. conformance with MOA COvegu'6Vk ea ec on t is date. ..= .�� - ,< nwhiEngineer's Printed Name�-� Date COSA Fee $ L O Date of Payment - a C/O � Receipt Number C)U 9r29 e (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number 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.muni.org/onsite (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051.821-33 HAA #nq Q Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 2 Block 2, Glenn View EstatdVorth Location (site address or directions) Current Property owner(s) Sudsbury & Sons Day phone 696-1610 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: Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑r Individual Holding tank ❑ Community On-site ❑ 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 engineers 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 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. Alaska Rim Engineering. Name of Firm g 9' Inc. Phone 907-745-0222 Address P.O. Box 2749: Palmer, AK 99645 Engineer's Printed Name Charles A. Leet, P.E. 5. DSD SIGNATURE Date 4P15104 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following s Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: (Ra. 01102) X Maintenance Agreements Supplemental Engineer's Report Other Original. Certificate Date: Municipality of Anchorage De velopment Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Www.muni.org/onsite (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 2. Block 2. Glenn View Estates North Parcel ID: 051-821-33 A. WELL DATA Well type _ If A, B, or C provide PWSID # _ Well Log (Y/N) Dale completed _ Sanitary seal (YM) _ Wires properi tecled (Y/N) Total depth ft. Cased to ft. C height (above ground) in. FROM WELL LOG AT INSPECTION Dale of test Static water level Well production g.p.m. g.p.m. WATERSAMPL SULTS: Cold colonies/100 ml. Nitrate mg.4. Other bacteria colonies/100 ml. Arsenic: _ mg.4. Date of sample: _ Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material Anchorage Tank Steel Date installed 11/5-&03 Tank size 1250 g81. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YM) Y Depression over tank (Y/N) N High water alarm (Y/N) NA Date of pumping New Pumper C. ABSORPTION FIELD DATA Date installed 11/5-6/03 Soil rating (g.p.d./ft2 or fe/bdrm) .45 System type Deep Trench Length 70 ft. Width 2-3 ft. Gravel below pipe 10 ft. Total depth 14 ft. Eff. absorption area 1400 ftZ Monitoring tube Y Depression over field N Date of adequacy test NA Results (Pass/Fail) NA For 4 bedrooms Fluid depth in absorption field before test NA in. Water added NA gal. New depth NA In. Elapsed Time: NA min. Final fluid depth NA in. Absorption rate >= NA g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NA If yes, give date D. LIFT STATION Date installed 'Pump on' level at _ In. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off" level at _ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Manhole/Access (Y/N) _ High water alarm level at Meets alarm S circuit requirements? On adjacent lots On adjacent lots Public sewer manholelcleanout Holding tank SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 58+ Water main 10+ Water service line 10+ Surface water 700+ Wells on adjacent lots NA SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 70+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 80+ Curtain drain NON KNOWN Wells on adjacent lots NA F. COMMENTS in. G. ENGINEER'S CERTIFICATION 1 •V W'� I certify that I have determined through field inspections and it••. ••• ��e� : v j review of Municipal records that the above systems are In �•.• • s � conformance with MOA HAA guidelines in effect on this date. i Engineer's Printed Name Charles A. Leet, P.E. Q `O Date 4/25ll/0��4 HAA Fee $ `" f Waiver Fee $ Date of Payment L4 I-LC1 1Q Date of Payment Receipt Number Receipt Number (Rev. 12/01) 30' q x 30' 15' UTILITY ESMT. —`VEL. D/W� I I � \ I 57't Rb S' 1 >1 4 N Z01 at TWO O N CANT. STORY O 0co LOT 3 N89'58'04"E 185.20'(R) 589'58'48"E 185.20'(M) RECOVERED 3. NAT'L AL—MON ACAS 850—S 2nd 1979 STORY CANT. TYP. DWEW V 1 W 0 LOT 2 40,000 S.F. BLOCK (2 °f. m1 �. 85't vv :E 6 •92' 5,. Z I SEPTIC 01 / RISER QS (M TYP. U.C. 5 I © ELEC. ID RECOVERED I _14 5/B" a0 REBAR m IWATER VALVE I RECOVERED 5/8. �REBAR I YPC 4094—S 1 TYP. NOTE: THIS LOT SERVICED BY A COMMUNITY WATER SYSTEM. N89'58'040E 1 LOT 1 En tn 0 0 00 ? L" 0 WW rcoLn BLOCK O LOT 15 Z 00 O O N .P to m V v L4 ;D SAMPSON ESTATES !LOT 28 1"-40' CLUSION NOTE: IT IS R RESTRICTIONS WHICHT DO NOTHE APPEAR EXISTENCEONSIBILITY OF THE OWNER TO DETERMINE THE AAPPEAR ON THE R CORDED S BDIVISION PLAT. UNDER CNO CIRCUMSTANCES ( MSTANCES SH�� SHOULD OR ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. AS -BUILT #A3 P.O. Box 2749 ��.pF_q� Rty PALMER, ALASKA 99645 of sAIC as tNC PHONE: (907)745-0222 �,�e''•• Fq FAX: (907)746-0222 F.B. 04-06 +t:Z49TN •.'; W.O. 0301057 DATE: 4/19/04 SCALE: 1" = 40' 1 FILE: 0301057 AS .... ...... . .. . I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGE Former INSPECTION ON THE FOLLOWING DESCRIBED PROPERTY: A�:Rob t J. LOT 2. BLOCK 2, GLENN VIEW ESTATES NORTH, +� 1os15-s PUT No. 2003-9, ANCHORAGE RECORDING DISTRICT, ANCHORAGE. ALASKA iia:row'�•�` EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. DATED AT PALMER, ALASKA, THIS 24th DAY OF APRIL. 2004. _ RECOVERED 3. NAT'L AL—MON ACAS 850—S 2nd 1979 STORY CANT. °f. m1 �. 85't vv :E 6 •92' 5,. Z I SEPTIC 01 / RISER QS (M TYP. U.C. 5 I © ELEC. ID RECOVERED I _14 5/B" a0 REBAR m IWATER VALVE I RECOVERED 5/8. �REBAR I YPC 4094—S 1 TYP. NOTE: THIS LOT SERVICED BY A COMMUNITY WATER SYSTEM. N89'58'040E 1 LOT 1 En tn 0 0 00 ? L" 0 WW rcoLn BLOCK O LOT 15 Z 00 O O N .P to m V v L4 ;D SAMPSON ESTATES !LOT 28 1"-40' CLUSION NOTE: IT IS R RESTRICTIONS WHICHT DO NOTHE APPEAR EXISTENCEONSIBILITY OF THE OWNER TO DETERMINE THE AAPPEAR ON THE R CORDED S BDIVISION PLAT. UNDER CNO CIRCUMSTANCES ( MSTANCES SH�� SHOULD OR ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. AS -BUILT #A3 P.O. Box 2749 ��.pF_q� Rty PALMER, ALASKA 99645 of sAIC as tNC PHONE: (907)745-0222 �,�e''•• Fq FAX: (907)746-0222 F.B. 04-06 +t:Z49TN •.'; W.O. 0301057 DATE: 4/19/04 SCALE: 1" = 40' 1 FILE: 0301057 AS .... ...... . .. . I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGE Former INSPECTION ON THE FOLLOWING DESCRIBED PROPERTY: A�:Rob t J. LOT 2. BLOCK 2, GLENN VIEW ESTATES NORTH, +� 1os15-s PUT No. 2003-9, ANCHORAGE RECORDING DISTRICT, ANCHORAGE. ALASKA iia:row'�•�` EASEMENTS OF RECORD OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. DATED AT PALMER, ALASKA, THIS 24th DAY OF APRIL. 2004. _ MUNICIPALITY OF ANCHORAGE o, Development Services Department i Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 051-821-33 Certificate of On -Site Systems Approval Expiration Date: 211 20 2 Legal description GLENN VIEW ESTATES NORTH BLK 2 LT 2 Site address 22434 SHADOWY SPRUCE DR Chugiak AK Current property owner(s) KEVIN & MARCIA KUBLY X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: Original Certificate Date: 7/24/2023 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 X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovMjune 2022 MUNICIPALITY OF ANCHORAGE o� 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. 051-821-33 Complete legal description GLENN VIEW ESTATES NORTH BLOCK 2 LOT 2 Location (site address) 22434 SHADOWY SPRUCE DRIVE CHUGIAK, AK 99567 Current property owner(s) KEVIN & MARCIA KUBLY Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 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: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 20 Years - See advisory if steel older than 20 years. STEEL ST 2003 W/ PLASTIC LS 2009 6. ABSORPTION FIELD: ® AWWTS ® Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ 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 $ 55-0 Waiver Fee $ Date of Payment/ Z 3 Date of Payment COSA # D G 2 3i 2 Z 1 Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: GLENN VIEW ESTATES NORTH BLOCK 2 LOT 2 Parcel ID: 051-821-33 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA - PUBLIC &/OR CLASS “A” WATER 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. Well production at time of test gpm Water storage tank volume NA 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 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 50” Date of pumping 6/22/23 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station 14 years Lift station material PLASTIC – FAT ALBERT Comments: LS/IDSF D. ABSORPTION FIELD DATA Which system tested (date installed) 9/9/2014 ALL standpipes present per record drawing Total measured depth from grade 3.2 ft (max) Measured depth to pipe invert from grade 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) N If yes, enter date Adequacy test date 6/22/23 Results Pass Fluid depth prior to test 0 in Water added 600 gal New fluid depth 0 in Elapsed time <5 min Final fluid depth 0 in Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in Comments/Deficiencies: TOTAL MEASURED DEPTH AT EXISTING GRADE. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) - NA Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ 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’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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 FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 7/20/23 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. 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, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 7/20/23 NII'Adf 'NNIAINI AND REPAIR AGR,r--TNIv,,NT 1 14W:' 11 Al t �i '11 t-iAt'4( I Mrld) ft k PA I k A (iRI-J"Ait-l"N'F, lie F"'in IIIc nw)(1. nee of 20�3, byand bevvc,-,',,n herein the "OWNE'R," and the �Jnnicipiflity AA i N I IR ; ilmlvf'� hricill 11)(, "MIN11CIPALITY", in accordance with Anchorage Municipal Cod,,, A ;,t( 0 1i'11 covenants contained herein, the partiw, to fly W", Sider'nion ot, the mutu, The Municipality grants permission Io "11C, ( rig oil to ljllfi;i" m)'A klpvrnw mi Advanced Wastewater Treatment System (AWWTS,, iii w't AN IDSF - INTERMITTENT DOSING SAND PIL-7EP I lq- GLENN VIEW ESTATES NORTH BLOCK 2, LOT -2 "'Lnt, -AlWrado"s. w"t I— t IRI I n .u"d ini�i-'-- I '��azh 6, N, A j Q 7tz ) Owner acicnomlet4jes that the Municipality may° r"Wem rc°cord=, Mal unmoy no WAS litrnr the manulircunvCs rtr, ,pr(.!scjj(ativc rrr` nrain, cn;rice l?rcrtitl€°► Owner acknowledges that the line lin• liriling to nnainlain and repair on AWW I � may 1w w� assessed in ; ceordance. with AAMC" 14,00.030, (W ncr agrees to gn"H the Municipa1hy reasonable arc.ess tea 1c;f <nnrl in>frcc t ihcv AW'N 'S, "'Ire r1ltuAeiperlity will r ive at lcasl 24-hour notice, ( � Owner agrees that any sale or trans Tr or hoc of me property will m4 occur witK"u r rrmv C'crtiticatc of"(_hr-Site Systems Approval. O\\'ner agrees that the AWwTs installation and ►naintenance recluire►nents as pnwirled, by the A.A,'W`T'S vendor/i ,stiller and approved by the Municilnaldy are the govenvirg guidelines for the construction, maintenance and repair of the Owner's AWWIS, Owner sprees to maintain rennote nnonitoring or the AWWTS as required by the A11rWTS approval. 3. `Perm. The term orthis Agreement shall begin on the elate orappmval by the Municipality to operate the installed systenn, or upon transfer ortiths, and shall continue while the AWWTS is operational or until We is transferred. 4. Nonwaiver. 'fbe railmv orthe Municipality at any time to c►ni"orce a provision orthis Agreement shall in no way constitute a waiver ofthe provisions, nor in any way affect the validity of the Agreement or any part hereof, or Be right or the Municipality thereafter to enforce every provision hereof: 5. Antendnrent. This Agreement, shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreerrrent by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choke of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State or Alaska at Anchorage. The laws of the We of Alaska shall govern the rights and obligations of the: parties tinder this Agreement. 7. Skevvrability. Any provisions orthis Agreement decreed invalid by it court of corxnpetent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) 10ge 2 of:3 O\VNL+ R: By: _nth 1—(signature) Date: La _ Ar; -_(print name) - STATE OF ALASKA ) ) THIRD JUDICIAL DISTRICT ) SS. The foregoinul g instrument was ackno��7lcdged before me this day of� 70�, by l C`��r1fC lP��st'� ay4_j__ NOTARY PUBLI FOR ALASKA My Coirunission expires: 0112 19,Ua-4-- MUNICIPALITY: By: Cut, (signature) (print 11ame) "Official Sear Notary Public Rebecca Cary Slate Of Alaska Commission # 230125012 8xp:0112won Dote: "2 - Title: Title: C_ I V/L- C -41—g- � /-I jZ_ (rev. `41— (rev. 05/18/2018) Page 3 of 3