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SCIMITAR #1 BLK 1 LT 4
c Imi*tar Block I Lot 4 #051 � 132�05 Municipality of Anchorage 4. Development Services Department Building Safety Division On-Sde Water and Wastewater Program, 4700 BragawSt. P.O.Box196650 Anchorage.AK 99519-6650 Page 11 of 2 www.ci anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATERDISPOSAL SYSTEM ANDIOR WELL INSPECTIONREPORT Permit Number. SWO50022 PID Number 051-132-05 144� HNSON Wastewater System: E3 New Upgrade Agj;2 CHUGACH PARK DRIVE ABSORPTION FIELD F""' Numbw of 11"M"11 69&M32 4 0 DW Ttimh 0 S1,6110- Tr*Xh 0 BW 13 MmINI 0012,41C Soil Ra" T,ttal Depth *m orq� qr� LEGAL DESCRIPTION 2 GPDfF? 2.5 Ft. 13� Lot 8�.� Dopin w p" tttm "m ong� wi,*, or" deim bsr*M pqn 1 4 SCIMFTAM Ft. 0.6 F1 To.noV ROVO ll�: (318�* LVVft 15N 1W In 2 Ft. 30 Ft. Well: El New Upgrade G�Wllh 15 N�011,ml 3 D.Wsmi,�� 5 Ft. Ft cwsvk� (�O*- A, 8. C) TOW DOM. C11WOW 7� bbqvi� 11'" Ppe Moittmi PRIVATE 30 Ft. 1 220 Ft JIM Fe I" PVC D� BILL SULLIVAN Do* DrdW SWCWWWLt,w,i 3111812005 1 180 Ft lr� GUARANTEED SERVICES DM. � I 101V2005 PWW " ;50 I Ca" "09"' 7 G'�Ft TANK I GPMj Ft. SEPARATION DISTANCES Septic [3 Holding 0 SX.E.P. 0 Other. ADVANTEX TO Front �� Septic Tank Absorption Field Lift staamoon Holding Tank 'ubldprtv&te Sewer Line ��w ANCHORAGETANK cep�ly I 1500 Ga mm� � a corrp�' WON +100' +100' STEEL 2 +100' +100' V LIFT STATION S.f.w.t. +5! +10' Lot Lkw +51 +10. Turnp w* limii 0 'Punip aft � 0 Fop- in M In. +50, +50, P� Mw, & U." E� IW� pwft�W bY C~ Drw RISING SON ELECTRIC lt� BENCH MARK DelaWbw GARAGE SLAS INSIDE DOOR A.� E�&� 100 Ft Inspections performed by: CHRISTOPHER WOOD Dates: 1' 10/5005 2"d 10/5005 Development Services Department Approval Conditional Approval Date: cHOMPHERR.WOOD 1 CE -10387 % .. ......... ...... Reviewed and approved by: ��A Date: jAZ;e—;' I (R� �) I I Permit No. SW050022 Page 2 of 2 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT ON—SITE WATER & WASTEWATER PROGRAM 4700 SOUTH BRAGAW STREET P.O. BOX 196650, ANCHORAGE, AK 99519-6650 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: SClMlTAR#1 LOT 4 BLOCK 1 051-132-05 SWING TIES 1 C 1 29 5* 1 2 1.0' I D 61.5'1 42.5 0 0 <D ADVANTEX SCALE 10-4a' 1500 GALLON TANK W/AX FILTER PO 8' 0 10 WELL -0- HOUSEE131 TH1 D�fVEW AY. 0 TH2 '9' 0 - CLEANOUT - WELL - MONITOR TUBE ELEVATIONS (NOT TO SCALE) /20/2006 S� VA ARAGE ORIGINAL GROUND ENGINEER'S SEAL ED ��L VATION - 1001 LEVEL ATo 94.8 OF At `�k� T I FILL TH-I ............. !��q 4 M MT -2 TANK �92.9 0. 0 1,500 GAL GRA Ej. . * * 87.9 .0.0 93.2 ADVANTEX OiRISTOPHER R. WOOD. -*&P- 3 C3 CE -10387 8 92.9 �J \92.3 8 92.3 BOTTOM OF T.H. rq /- G q2,P' ASBUILT SEWARD & ASSOCIATES 1JM 9TTRVFVTWr ral.—no I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO FNCROAC4ENTS I XIST EXCEPT AS INDICATED. IT IS THE 'RESPONSIBILITY OF THE OWNER TO DETERMINE THE.EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTA13LISHING BOUND- ARY LINES. SCALEt DATE& GRID: ...... .p . ...... 0 Ou-no Mak Ss�ad 0 FS: LS Ar Aker. BRA_W�N: Z-5ing 6on Ciectric, Inc. 096 VoodLand Prive [=-a-qLe Zver- A4 99577 (907) 622-6777 November 16, 2006 Guaranteed Services Wayne Devore Eagle River, AK 99577 Re: Unit Number I Lot 4 Block I Scimitar Subdivision Dear Wayne: The lift station at the above referenced property has been wired In accordance with NEC and State/Local codes. Thank you. Sincerely, xcr-�� 4, Nwr,�� --4�( d4a-� -A - >AAalr-� Kevin S. Hornbuckle, Owner Administrator License Number 1284 Specialty Contractor License Number 27285 04/05/2005 14:41 6882259 ULLIVAN cerfifteb ;mritttng In by M 00. dbo SULLIVAN WATER W '�LLS P0.8=91021 C#PJC&*JrALASVA OUR' , , OWNeR 6 _#�� LEIAM j34'k / ADT!�l DAM_ PERWM*AB13tQTnQ4 TAxmeuw.jummmBEFtas�t__ / 3 A if ISVM' k '81 FlP I M Pu=MbcMMMM&vj;o,,cNo K%'wdo(Ddhiw&mW'rcwy rscomood DepMetwe -76D 0m*vTYw,tmL'_-w&lm*kvm r2Tb_kmfm Examew I # .19t do*, UnvrTMw A) D*J 5 CLkV3ftk*PJXW*GWGUrKt .2. —feet &aft Viatm A smot- /,FZ _bd zj'v_LqLwj.. : jK -1 :'Scm". -Sbd�bd SkW8d_____ftd CMA74�061,47'1-4&'M At� 10 0 1. dS� ompft Im om PILL- -1 Y.=, F__ 107, M -Al PAGE 01/02 o C: 4 r , j rl G.V-- j "o, a -tic r- oze 39' 4badcAcs _7# 44hf 0�7 i:y 6,Q*.fe4L �y / J.O. cao4el — r -j i,4 Z I 2W_ ago a 1.3 oj,+C,-Z� sx, E3 we, r an. I 23-4314s�, 1 SGS Environmental Services 200 W. Potter Drive Anchorage. AK 99518 Tat: (907) 562-2343 f Fax: (907) 581-5301 SGS Ref. M 1066844 Eagle River Englneedhg Client PON: Printed Daternme: n1a 11/27/06 12:45 Client Name: Project Name: Scimitar Lot 4 Block I collected DateMme: 11116= 16:15 Cnant Sample ID: Scimitar Lot 4 Block I Received DateMMe: 11117106 12:46 Matrix: Drinking Water Technical Director Stephen Ede PWSID NIA Released By: Bryan I Arnold 2006.11.27 1;5:uu;zz _Uw UU Sample Remarks: Ailowable Prep Analysis Results POL UnIts Me Date Date Init Parameter Arsenic (A . a) ND ug/L EPA200.8 10.0 EPA3532 10.0 Ila= w2lu TK 11117106 11117106 ALR Nitrate (NO3) 2.20 0 V,9& ODV100ml- . SM20 =B <1 I 1/17jo 11107M6 DT Total Coliform f I a 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 I WATER SUPPLY PERMIT Initial Date Issued: Feb 07, 2005 Expiration Date: Feb 07, 2006 Permit Number: SWO50022 Parcel ID: 051-132-05 Legal Description: [SCIIAITARWI 'SU8DIVIS1`0N-6L-0bR-j COT'4 Design Engineer: 0848 Eagle River Engineering Services Site Address: 20212 CHUGACH PARK DRIVE Owner Name: BRAD JOHNSON Lot Size: 43798 SO. FT. Owner Address: 20212 CHUGACH PARK DRIVE Total Bedrooms: 4 Permit Bedrooms: 4 EAGLE RIVER. AK 99577 - This permit Is for the construction of. P� Disposal Field [?] Septic Tank E] Holding Tank F] 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 ( I BAAC80 ). 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 cJosed on the same day. B. Covered, seated, and heated to prevent freezing. 5. The following special provisions. THE UPPER SIX INCHES OF THE MOUND SYSTEM MUST CONSIST OF TOP SOIL AND THE MOUND MUST BE VEGETATED SUFFICIENTLY TO PREVENT EROSION. AIPCO A?QP4-r� V-JPJWL r"rV131o'j TO Oessrjv r>%Is To wct-t doe4Tjov c#4^.V*e OV AvT Y Received By - ,4t" / Date: ?-/0!Z/c6 Issued B . Date: _-2 1-7 /m— Oi/03/03 11:27 FAX 9073438437 ____JM0AJ". USE ENFORCEMENT Q001 MunicipaUty of Anchoraige Development Services Department Building Safety Dmilon On -Site Water and Wastewater Program 4700 South Bragaw St P.O.BoxII96650 Anchorage,AK 9951"650- www.cl.anchmge;ak.us (907) 343-79D4 ON-SITE SEWERMELL PERmrr APPLICATION FOR A SINGLE RkLY DWELLING Parcel I.D. 0671 — 13a — 09 Permit Number SW 94d Property owner(s) Day phone e(w� Mailing address (1 Mailing address (2) cP&� 2-'. 0 V 2hVJ4,�wl Rptdo _2z5_n � ) Legal description (Lot Block & Sub'd.) att-j_ 0 9-L L 11 Legal description (Section, Township& Range) 56-4 10 1 5- AJ t Lot Size ---y-9. - L'7L_Acresj15M THIS APPLICATION IS FOR: Number of Bedrooms 0, 4 i Sewer Only 11 Well Only, 11 Sewer and Well .9 Water Storage El Sewer Upgrade 13 THIS PROPERTY CONTAINS, Hot Tub Jacuzzi Swimming Pool Water Softening Unit 13. 0 Therapy Pool 0 I certify that the above Information Is correct I further certify that thIs application Is being made for a Single FamVDwellinUnd Is in accordance with applicable MunIclilial Codes. (Signature of property owner or authorized agent) Permit Fees: Waiver Fees: - DateofPaymant; DaleofPsymeht Receipt Number. Receipt Number (Rev. 12MO) Eagle ]River Engineering Services Christopher R. Wood, P.E. 10421 VFW RD. Suite 201 (907) 694-5195 tel Eagle River, AK 99577 (907) 694�3297 fax February 3, 2005 Dan Roth Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Scimitar# I Lot 4 Block I Narrative & Permit Application Dear Mr. Roth: Eagle River Engineering Services (ERES) has been contracted to design a well and septic system at the above referenced property. The proposed septic system and well will have very limited impact on adjacent properties for the following reasons: I . The surrounding lots are all large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +20'distance from the proposed new septic system, and no private wells are within 100' of the new system. 3. This permit is for a new well and septic system. 4. Drainage will not be affected and is not a major consideration in our design. Two test holes indicated that the underlying soil in the area for the septic system is comprised of two feet gravelly sand underlain by tighter GM material to a depth of 12 feet. Water was present, and therefore the septic system will require a lift station and bed configuration. The water table was monitored after very heavy rains, and probably indicate the worst case scenario for water table information. The owner has opted to utilize Advantex systems to reduce the size of the mounded leach bed, and to ensure a longer useful life leachfield. The owner might install the replacement leachfield at the time of original construction also. This work will not affect the reserve septic areas on adjacent lots. If you have any questions please call our office at 694- 5195. Sincerely, EAGLE RIVER ENGTNEEMG SERVICES Christopher R. Wood, P.E. Principal V003%04-113SEPTICNARRATIVEMOC ltivu% %I �.# Qv I L-04 %.Y-I:o I wif�i REVISED LOT 3&4 "�'SEPTIC +30 lv� + LAYOUT ��WCLL +100 lb MAPrM 11 A .% N, 00, VcLL PAMA bm ADVAN \I IAW W/AX �k CA ru BASIN too* Wm PAM 6 a +30— Pwc 's%salm +30 C) WELL +100 ... .... WELL L=TKM *M&L t&W AtwANtEx I bM n.OH T� LOCA710" LTM POO F"MW M-7-ALZ" PADKM Im 2 REPLACEMEKT A, em SEP CAR I W WELL PAMIS —mDcr0oFmmG wLLL WERTER VALVE TM HOLE LoNnto ?Me Nola. SEWER CLEM OUT + WELL 1. 140 P40WO CURM4 DRAM EASEMENT 2. HO XNOW SWACe M "W= LEAcm racm COINVEWAY I'm DORM WML WELL/SEPTIC SITE PLAN OF oV LEGAL: scimrrAR SUE3D. #1 LOTS 3&4. BLK 1 OWNER: BRAD JOHNSON CONTRACTOR: GUARANTEED SERVICES 10 JOB# 04-112 DATE: 01/31 05 1 SCALE 1"= 60' � T 00 EAGLE RIVER ElVGrNEERrNG SERVICES k;,CMf in vwo'o'm' T, - Cr -1038 of 10421 VFW RD. SUITE 201 7 EAGLE RIVER, AK. 99577 - A (907) 694-51,95 FAX. (907) 69, r�� (—Nl--� 1�1 '*'�SEPTIC +30 WELL +100 .i% vo� -P 411-�IGO' WELL tK RADIUS \4 PROPOSED WELL LEGEND: -- 100' WELL RADIUS DfVERTER VALVE TEST HOLE L40NITOR TUBE SEWER CLEAN OUT + - WELL - EASEMENT PROPOSED LEACH FIELD DRIVEWAY 'po. 0 'po �:oo 40, pi A\� 1.25' HOPE IPE H I //7< NOTES: 1. NO KNOWN CURTAIN DRAINS 2. NO KNOWN SURFACE H20 100' RADIL WELL SCALE: I"- So' 100' WELL wlUS +3D— WELL/SEPTIC SITE PLAN OF LEGAL: SCIMITAR SUBD. #1 LOT 4, GLK 1 1p"N OWNER: BRAD JOHNSON jw T CONTRACTOR: GUARANTEED SERVICES H ... . .. . . .... JOB#04-113 I DATE: 01/31/05 1 SCALE 1 50' 0. 0 i o" — —1 ** �� 4" . 0, J-soo EAGLE RIVER ENGINEERING SERVICES 0 QiRISTOPHER R WOOE - 'p CE -1038'7 Aw -A'Ar 10421 VFW RD. SUITE 201 <t;Am EAGLE RIVER, AK. 99577 kFESSIO0 A (907) 694-5195 FAX. (907) 694-3297 m Eagle 'kaiver Engineering '�_,ervices 10421 Vr-W RD Suite 201 Christopher R. Wood, Px. (907) 694-5195 tel Eagle RiVer, AK 99577-3294 (907) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM — MOA CERTIFIED INSTALLER LEGAL: Scimitar #1 Lot 4 Blk I Februnry3,2005 A. GENERAL 1. Ile replacement septic plan is for a 4 bedroom single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verificif or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. A licensed surveyor should locate any utility easements and exact 100' radius from the existing and neighboring on-site wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. Any remaining open test holc excavations shall be filled and monitor tube removed. B. ADVENTEX SYSTEM AND SEPTIC TANK I . Septic tank shall be a fiberglass 1500 -gallon tank capacity of MOA approved construction for use with Advantcx system. Install as per current manufacturers recommendations for conditions in Alaska. 2. Install one AX -20 filter pod over septic tank capable of treating 600 gallons per day of waste flow. 3. Install Orenco 24" pump basin PB -2496 outside septic tank, with OSI pump model P30-05 and controls to allow 23 gallon dosing of septic leachfield. Set pump float to 13.5" above pump, timer for I minute dosc time. Controls to be installed to MOA code by licensed electrician familiar with OSI applications. Controls to include a dedicated phone line and web based monitoring system. A municipal inspection report or receipt from a licensed electrician shall be provided to the engineer verifying lift station wiring to all applicable codes. C. BED I . Ile bed is to follow the natural land contour to maintain uniform total depth of the bed bottom. 2. T1c bottom of the bed shall be level, plus or minus 1.5". 3. The depth below grade of the gravel layer is not to exceed 2.91 as measured at the monitor tube. 4. Coarse Sand shall be utilized where necessary to build up the bed to grade if deep topsoil is encountered and excavated. 1 5. 1be effluent lines (3) arc to be 11" PVC lines with 1/8" holes drilled 12" OC within the Icachrield, placed facedown, or up with orifice shields placed over holes. Line from tankto field is to be 1-1/4" IlDPE. 6. Ile bed gravel is to be covered with typar fabric material. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed overthebcd. Mounded side slopes not to exceed 3:1. 8. Ile septic tank and leachrield must not be closer than 100' to any existing private well, 1W to any I Class "C" well, or 200 feet to any community well. U003\04-11313cd-lift- spec.doc SPECIFICATIONS FOR ('..'SITE SEPTIC SYSTEM — MOA CERIED INSTALLER LEGAL: Scimitar 01 W 4 Hlk I February3,2005 Continued: RECOMMENDED LEACHFIELD DIMENSIONS: BOTTOM OF GRAVEL LAYER - 2.9' Below Grade at monitor tube GRAVEL THICKNESS= 6" under pipe, 2" over pipe BEDLENGTH— 30' BED WIDTTI - 151 SOIL RATING = 2 GPD/115 BEDROOM CAPACITY = 4 �SEPTICTANK- 1,500 Gal tank for use w/Advantex system and pump basin EFFLUENT PIPE = I" PVC with 1/8" holes oriented down, or up with orifice shields spaced at 12" OC. Twenty-four (24) hours notice required for all Inspections. \2003\04-113Bcd-lift- spcc.doc (04� EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 04-113 Calculated By: CW Date: 1/31/2005 Legal: Scimitar Sub #1 Lot 4 Black I Single Family 4 Bedroom Dwelling Bad Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = Percolation rate - Wastewater application rate - Required absorption area = Bed width (W) = Gravel depth (D) = TEST HOLE I 600 gallons 30 minutes per Inch 2 gallons per day per square foot 300 square feet 15 feet 0.5 feet Required length - Required absorption area / Bed width Required length - 300 1 15 Required length - 20 feet Total Excavation Depth = 30 feet 2.61 04-113—bedCalc 0:01 PM113112005 QE I 'IE RS I Municipality of Anchorage —V NEER'S 10 Development Services Department 49) Building Safety Division On -Site Water and Wastewater Program 47M South Br2gaw St. - t-;�44 P.O. Box 196M Anchorage. AK 99519-6650 CHRISTOPHER R .wmw.cf,anchoraQe ak-u CE -i (907) 343-7904 X Soils Log - Percolation Test Performeil For. Date Performed: I - 7,/3 W�,� Legal Description: .5" el Township. Range. Section: 7- 1 �0 R 16) Slope Site Plan F -F -r -F-1 I I I -T -li i i r—T—r-i Depth 11 12- 13- 14- is- 16- 17- 18- 19 - COMMENTS I Ir FCCA-W) 01"fIffl-c- 5 W - 13POLw,' 641 - QA-( WAS GROUND WATER T7(�flr ENCOUNTERED? NA 5 I Z B0 rlor/� IF iES. AT WHAT DEPTH? 7 Depth to Water After P M�Koring? 4 -'9 E Dole: )QzQj5/0 Reading Date Gross rime Net Time Depth to Water Net Drop -77.. -el e� el 50 e� r/,- -r/. � f P`LK� MULE. DIAMETER TEST RUN BETWEEN -5:/ FT AND O�- FT PERFORMED BY: CERTIFY T14AT THIS TEST PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: _10LAI I Municipality of Anchorage 1.) 'UN Devefopment Services Department Building Safety Division On -Site Water and wastewater Program 4700 South Bragaw SL I I CHRISTOPHER R. WOOD P.O. Box 196650 Anchorage. AK 9951"650 % ,-www cf.anchorage sk.0 CE -10387 Z (907) 343-79G4 SS Solis Log - Percolation Test. Performed For. RPA b -xin) t1Aj!;,ne-) Date Performed: `7 Legal Description: 5;(-T Ll Township, Range. Section: T 15 t,,.) r 14 - - I FDepthl 91z0Lj#j Tv F1 -:'q �w - 4 0 a"- ': I I W,0 W 13 C, R A q r- LL -1 5,A.OJI 0 7- 8 - WfAf RAM IMM WAS GROUND WATER 0 ENCOUNTERED? tj IFIFES. ATWHAT DEPTH? L Depth to Water After 0 P 15- is- 17- 18- 19- Date: — PERCHOLEDIAMETER 411 TESTRUNSETWEEN FT AND FT COMMENTS PERFORMEDPY: If ff P7-_ C, 1010 L) C H Pj- Sr, t,\10,-)� CERTIFY THAT THIS TEST WAS ') C?> PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: IL WfAf RAM IMM PERCHOLEDIAMETER 411 TESTRUNSETWEEN FT AND FT COMMENTS PERFORMEDPY: If ff P7-_ C, 1010 L) C H Pj- Sr, t,\10,-)� CERTIFY THAT THIS TEST WAS ') C?> PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: IL 40 c 0 CL E 61 1081'(14CU) PV8H OIWBUACI 18101 fly 11 0 'a -Ole z 16 C! vi q a � V d ci AJAJ;J!jm I Kkk k 9 .1 a H41,14 If ;ot R1 n Ut A4 k IN 61 1081'(14CU) PV8H OIWBUACI 18101 fly 11 0 'a -Ole z 16 C! vi q a � V d ci AJAJ;J!jm I Kkk k 9 .1 a H41,14 If ;ot R1 n Ut A4 k CL r- 40 CD cn fn CD *A sm Xg. ILI CD cn M 0 cr sm DnqW By. a or� 9y: cm A� Ilk; TyptWUqWL"PwWmkwRewmw us fth AdmTo' TmaMwt Symem wM Mvp CWW paW im &. D.I. AW�, S�. r - F -r O�Sylt�* May 27 25, 20:52 Alpine Septic Pumping Inc 907-373-2733 p.53 OEM OEM MOM 525 665 ■M■ ■M■■■■ ■ on on ■ ■ vanTex® Field Maintenance Report Annual Inspection ■ on MEMO ■ no ■ ■ ■ ■EM■E■ on Z AnchorageTank 907-272-354.1 Pmperty Owner/haeldng x Operator Lyle Anderson Alpine Septic LLC Site Address Contact Phom 20212 Chugach Park Drive, Chugiak AK 99567 (907) 230-4044 A site IO M County ID It Pod 4 RTU A/UL n Date of Last Inspection AX-106602 SWO50022 206536 RTU104373 11/19/2024 Retrieve O&M Info Recirc ratio _ Timer settings: Perform Field Sampling/Observations NTU (15 x NTUs) pH (6-9) DO (2-6) Odor of Sample / P7 Typical ❑ Musty ❑ Earthy [jMloldy Non -typical ❑ Sulfide ❑ Cabbage � ❑ Decay Olty film in PVU ❑Yes O'No Foam in tank ❑ Yes Lei No Check Control Panel Recirc Amps Discharge Amps Audible and visual alarms OK Dial tone (telemetry only) ❑ Yes [-]No Inspect/Clean Pump System Inspect RisedLid ................... Splice Box .................. / Float Cords ................... [R Floats ........................ Pump ........................ Biotube® Filter ................ Biotube Pump Vault::: Recirculating Splitter Valve....... ....// �v Comments Clean Measure Sludge/Scum Sludge a-..— ompartment Current Previous Current Previous E2nd Dt ) ompartment Current Previous Current Previous Inspect/Clean AdvanTex Filter Inspeck/Clean__ Odor. �/J N rural ❑ Pungent lI Laterals/Orifices LJ! -f•�,/ Biomat:/Normal ❑F�ccessive i Pod Bottom Bridging/Ponding: Ly 'None/Minor ❑F�ccessive I Intake Vent �✓ [11 Inspect/Clean Discharge Pump System Inspe Insp Clean Riser/Lid Floats Splice Box Pump Float cords Inspect/Service Other System Components Inspect Clean Ins ec Clean Disinfection Equipment ❑ ❑ Dispersal LalemiatOrific(s � Q% Observations Add ,Wfiital Services Rendered Cleaned textile sheets? ❑ Replaced UV items? ❑ Replaced/used other items? Parts Used: W = Warranty, B = Billable (✓ appropriate selection) W o item Number Description FinaU fety Inspection F3SV reinstalled „L-1/Manifold reconnected; flush valves closed S u m rp�ary/Recommendations [System performing; no furtheraction needed ❑ Call for service Date 4 C7 WWs bolted on Control panel reactivated UTank needs pumping ❑ Other? zPzr Fax completed form to 1-866-384-7404 May 27 25, 20:53 Alpine Septic Pumping Inc 907-373-2733 p.54 i; S4 r' �jeej f� � �r�lG1ce }�;� s 13r, � o{f Ok S f6trl. May 27 25, 20:54 Alpine Septic Pumping Inc 907-373-2733 p.55 Pr fir trirftee pns At regular intervals, the recirculation pump of an AdvanTex Treatment System sends septic tank effluent into the AX20 filter pod, through a manifold of lateral pipes with holes drilled into the top. An orifice shield is snapped onto the pipe and centered over each hole. During pump run cycles, this aerates the liquid as it is distributed atop the filter fabric sheets that hang beneath. Between pump cycles, water remains inside the lateral pipes and can freeze in severe winter temperatures. This procedure seeks to remedy that by drilling a drain hole in the bottom side in each lateral, at both ends. This ensures the laterals drain completeiy should the pod be slightly out -of -level. r /ri T1!•n Clni�%r% Orifice Shield Remove 6-10 Using existing hole as a guide, drill 16"0 hole through bottom of lateral pipe Reinstall Orifice Shields over holes Safety inspection, Site Address: 20 2 12 C � ug h ("4 to,/-Ir ;r,,:. Pod lid bolted on? ©ems ❑ No /� ''�6F / � Comment on any damage noticed: !' ) X2c> (,`u!' (r<r Control Panel Activated? [��es ❑ No Circuit Breakers: Recirc: [! � Off Discharge: [20n doff Technician Controls: [�n Off Date: �V Anchorage Tank, 2723 Rampart Drive, Anchorage, AK 99501 907-2723543 anchoragetank.com 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 OSC251247 Parcel ID 051-132-05 Expiration Date: Legal description SCIMITAR #1 BLK 1 LT 4 Site address 20212 CHUGACH PARK DR Current property owner(s) ANDERSON LYLE R LIVING TRUST X The On -site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments By: Original Certificate Date: 6/30/2025 This Certificate of Oyi-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 Service 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 submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other 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 Application 1. GENERAL INFORMATION Parcel I.D. 051-132-05 Complete legal description Scimitar #1 Block 1 Lot 4 Location (site address) 20212 Chugach Park Drive Current property owner(s) Lyle Anderson 2. ON -SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone (907) 232-7281 3. TYPE OF WATER SUPPLY: � Private Well serving # 1 dwelling units 0 Other Non-public well as regulated by MOA El Water Storage ❑ Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: FN Private Septic ❑ Private Septic serving 2 dwelling units R Holding Tank F71 Community Septic or Public Sewer 6. SEPTIC TANK: X Steel E] Plastic E] Concrete R Fiberglass Age 18 - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: X AWWTS RN Bed E] Deep Trench EJ Wide Trench R 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 $_53D 00 Waiver Fee $ Date of Payment to Date of Payment COSA#— Waiver # COSA Application—Apr2025.doc COSA Checklist Legal Description: Scimitar #1 Block 1 Lot 4 Parcel ID: 051-132-05 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA W Well log is filed with Onsite (or attached) Date drilled 3/18/05 Total depth 360 ft Cased to 220 ft FE-1 Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 27" in. Date of flow test for COSA 5/29/25 Static water level at beginning of test 180 ft. Comments B. TANK DATA Measured operating fluid level in septic tank N/A Date of pumping 6/3/25 F Required maintenance completed, if AWWTS Comments: AWWTS D. ABSORPTION FIELD DATA Which system tested (date installed) 1997 0 ALL standpipes present per record drawing Total measured depth from grade 4.1 ft (max) Measured depth to pipe invert from grade 3.6 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. R Monitor tubes go to bottom of effective. If not, state depth into effective F Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 1350 gallons 5/29/25 date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Well production at time of test 2.6 gpm Water storage tank volume 150 gallons Well disinfected for coliform test? ❑ Yes 0 No 0 Coliform bacteria is Negative Nitrate 6.93 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L M Arsenic less than MRL (ND) Collected by Forge Engineering Date 5/29/25 C. LIFT STATION L]-Required maintenance completed Age of lift station �_ years Lift station material��l Comments: Adequacy test date 5/29/25 Results Q Pass Fluid depth prior to test _ Water added 700 gal 0 in New fluid depth 5 in Elapsed time 30 min Final fluid depth 0 in Absorption rate '600 and FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 Effective depth used 0 in Effective depth remaining 6 in in Comments/Deficiencies:15'x30'x0.5' = 225 ft3 x 0.4 void space x 7.5 gal/ft3 = 675 gal (minimum) COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' Yes if No ft M Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' E Yes if No ft Holding Tank > 100' � Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft ❑o Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' R Yes if No ft Fm� 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 8 ft Surface Water > 100' R Yes if No ft Tank to Property Line > 5' Fn-1 Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ljm� Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' E Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS Tank to foundation requirement was 5' at time of install. 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 Forge Engineering Engineer's Printed Name Benjamin Schiller, P.E. Phone (907) 522-7773 Date 6/5/25 ..- OF ALq�,. t� Benja%Schiller ���'E�r • CE 12592 •U���/ ll� WROFESSt0��4.:� COSA Checklist June 2022 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On -Site water and wastewater Section Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC251247 Subdivision: SCIMITAR #1, Block: 1, Lot: 4 A water sample revealed a nitrate concentration of 6.93 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby' disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this 29th Day of May of 20 25 , by and between Nghia Do , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Advantex privately use for the primary residence located at (legal description) 20212 Chugach Park Dr. Chugiak, AK 99577 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) ND Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. ND It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). ND Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. ND Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 ND Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. ND Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. ND Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. ND Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. ND Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. ND Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: By: (signature) Nghia Do (print name) STATE OF-A44£rl4� Cfeex,-,,14' n ) ss. H.I.-IR A40i@i0—i DISTRICT Date: May 29, 2025 fi May The foregoing instrument was acknowledged before me this day day of 20,'-E, by TV_ NOTARY PUBLIC FOR FAN Y My Commission expires: MUNICIPALITY: By: (signature) (print name) GLYNN CgLt0 or Date: :> Title: C (Vi (rev. 05/18/2018) Page 3 of 3 Ben Schiller <ben@forgecivil.com> FW: ADVANTEX lid repair @ 20212 chugach park drive Tom Varney <tom@anchoragetank.com> To: Ben Schiller <ben@forgecivil.com> Cc: "chris4211@yahoo.com" <chris4211@yahoo.com> To: Ben Schiller PE, Forge Engineering RE: AdvanTex AX20 Pod lid repair Hello Ben, This email is to inform you that the homeowner-made repairs to the AX20 pod lid at 20212 Chugach Park Drive have met my approval. Chris Anderson has The lid is bolted down on both sides since the hinges are inoperable. The filter pod is old enough to where a new lid and hinges are no longer available, so I hope you agree and sign off on the COSA. Please let me know how I may be of further assistance. Tom Varney AdvanTex Coordinator Anchorage Tank 2723 Rampart Drive Anchorage, AK 99501 907-343-3704 anchoragetank.com We're running a survey and would love your input. Please let us know what you think below. Thanks for participating! https://www.surveymonkey.com/r/AnchorageTank From: Chris Anderson <chris4211a@yahoo.com> Sent: Thursday, June 19, 2025 3:55 PM To: Tom Varney <tom@anchoragetank.com> Subject: ADVANTEX lid repair @ 20212 chugach park drive Hello tom, this is Chris Anderson, I spoke with you on the phone about repairing the lid. Below are pictures of the fiberglass repair I did on the corner of the lid and of the fasteners used to secure it. I also lengthened the the vent pipe. Hello tom, this is Chris Anderson, I spoke with you on the phone about repairing the lid. Below are pictures of the fiberglass repair I did on the corner of the the house. Thank you and your staff for helping me out with this situation. You can contact me by phone at 907-232-7281 and email @ chris4211A@yaho Subject FW: ADVANTEX lid repair @ 20212 chugach park drive From Tom Varney <tom@anchoragetank.com> To:chris4211a@yahoo.com <chris4211a@yahoo.com> Date Today at 10:30 AM OOPS! I had your email incorrect. From: Tom Varney Sent: Friday, June 20, 2025 9:49 AM To: Ben Schiller <ben@forgecivil.com> Cc: chris4211@yahoo.com Subject: FW: ADVANTEX lid repair @ 20212 chugach park drive To: Ben Schiller PE, Forge Engineering RE: AdvanTex AX20 Pod lid repair Hello Ben, This email is to inform you that the homeowner-made repairs to the AX20 pod lid at 20212 Chugach Park Drive have met my approval. Chris Anderson has repaired the pod lid and extended the vent pipe. The lid is bolted down on both sides since the hinges are inoperable. The filter pod is old enough to where a new lid and hinges are no longer available, so this is the best solution. I hope you agree and sign off on the COSA. Please let me know how I may be of further assistance. Tom Varney AdvanTex Coordinator Anchorage Tank Anchorage Tank 2723 Rampart Drive Anchorage, AK 99501 907-343-3704 anchoragetank.com We're running a survey and would love your input. Please let us know what you think below. Thanks for participating! https://www.surveymonkey.com/r/AnchorageTank From: Chris Anderson <chris4211a@yahoo.com> Sent: Thursday, June 19, 2025 3:55 PM To: Tom Varney <tom@anchoragetank.com> Subject: ADVANTEX lid repair @ 20212 chugach park drive Hello tom, this is Chris Anderson, I spoke with you on the phone about repairing the lid. Below are pictures of the fiberglass repair I did on the corner of the lid and of the fasteners used to secure it. I also lengthened the the vent pipe. Hello tom, this is Chris Anderson, I spoke with you on the phone about repairing the lid. Below are pictures of the fiberglass repair I did on the corner of the lid and of the fasteners used to secure it. I also lengthened the the vent pipe. Forge engineering is requesting a formal letter from anchorage tank that these are acceptable. With your blessing I hope that this is ok so we can move forward with the COSA so we can close on the house. Thank you and your staff for helping me out with this situation. You can contact me by phone at 907-232-7281 and email @ chris4211A@yahoo.com Sent from Yahoo Mail for iPhone Certificate of On -Site Systems Approval Parcel I.D. 051-132-05 Legal description SCIMITAR #1 BLK Site address 20212 Chugach Park Dr Current property owner(s) Craft Expiration Date: 1 LT 4 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 1 / 31 Za'L 3 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject systems) 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 Approval_June 2022 MUNICIPALITY OF ANCHORAGE Development Services Department f 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. 051 132 05 Complete legal description SCIMITAR#1 BLOCK 1 LOT 4 Location (site address) 20212 Chugach Park Drive Current property owner(s) Craft 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑■ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: X Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 18 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: NONE 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 $ J Jy Date of Payment COSA # �35C i a6(v Waiver Fee $ Date of Payment Waiver # COSA Application_June 2022 COSA Checklist_June 2022 COSA Checklist Legal Description: Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade 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) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: COSA Checklist_June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ 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 Phone Engineer’s Printed Name Date C&M ENGINEERING CHARLES BALZARINI, PE 1/05/23 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 r www.muni.orglonsite . JR (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEms APPROVAL FOR A SINGLE FAMILY DWELLING 44?.-�7 , , Parcell.D. 091-13A-65- COSA # 01121)qO5 Expiration Date: 2 17-,g /0;7 1. GENERAL INFORMATION Complete legal description 5CrM174R. LOT- 14 Location (site address) Zo?-17- c"_jAeA_aj+ P"r- hk - Current Property owner(s) B(�+b J-0 H*-k$cP� — Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address ZyJ34 &��IrQe- erviiiik Pa4b 467A 41C 7?5'77 Unless otherwise requested, COSA will be held by DSD for pickup. Day phone Day phone 3,0 1 - (' ? Ll 7 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 El Public Water System Public Sewer El 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 bile (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 CerVficate 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 - EA&IC IZXJtR &W�r44-ZR7A).< Phone Address login VFjj AA. :5t4.rr&- se I e,+et4,&akX4X c)4y!;-77 Engineer's Printed Name 4�kr!C7ypW R. WCIW� Date 1) /27/0 /6 I 5. DSD SIGNATURE V' Approved for LA bedrooms. — Disapproved. — Conditional approval for _ bedrooms, %vith the folic Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineers Report Other B, &'4 Original Ce rtificateDate: (Ft*�. 11105) Municipality of Anchorage Development Services Department Building Safety Division On-Ske Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-W5O www.muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SiTE SYSTEms APPROVAL CHECKLIST Legal Description: ScInU17AA 0- 1 13 1 L Y Parcel I D: 051 - 1'32 -05 A. WELL DATA Weil type f�K%147'0- If A, B, or C provide PWSID # Dale completed -L11V1Z0PV Sanitary seal Total depth Zk—ft- Cased to.:&7- 0 ft. FROM WELL LOG Date of test 3hphooi- Static water level ft. Well production g -p -m - WATER SAMPLE RESULTS: Well Log 6�N) 1.46r.$ Wires properly protected&) Yk-,5 Casing height (above ground) Z 4/ n. AT INSPECTION ,V/,+ 'V/f 'V 14 . g.p.m. Coliform _-�---colonles/100 ml- Nitrate �. d, mg/L Other bacteria 0 colonies/100 ml - Arsenic: mg/l Date of sample: 10-6-106 Collected by: C�a rl 6gl7tat'll); B. SEPTICIHOLDING TANK DATA Tank Type/Material .14wc* r4wrc Date Installed lb IV 5' IZ4,v Tank size I gal. Number of Compartments -Z-- Cleanouts (ON) V65 Foundation c3eanout &N) Yf-5 Depression over tank (Y& A"> High water alarrr" AW y6r�s Date of pumping ,v 14 Pumper 'y Z4 C. ABSORP71ON FIELD DATA Date Installed -LQhL4E1:vvrSoiI rating (g.p.d./ft' or Ft;bd v v '*2- system type Aby4-Aiex istc-t> Length 312 ft. Width ft. Gravel below pipe o' ft. Total depth 415- ft. Eff. absorption area Yaft? Monitoring tube -N/&L'J� Depression over field AJ 0 Date of adequacy test Al /4 Results (Pass/Fail) P.+Sf For Z/ bedrooms Fluid depth in absorption field before test C' In. Water added 0 gal. New depth_g2_ in. Elapsed Time: Q min. Final fluid depth 0 in. Absorption rate >= 460 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) AJ14- If yes, give date Al A 4- D. 4dM8'r*1rIe ! - Re-c-1,rc"6if-on P"MR kA,,�,J Date installed 10/5/C�00-15 Size In gallons 1900 ManholelAccess ON) � e.� *Pump on*level at in. OPump off' level at 15— in. High water alarm level at 10 in. Datum TOO Of n Cycles tested AOAO, MP(,-) Meets alarm & circuit requirements?ye5 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot 4 1&,o I Absorption field on Public sewer main t + too + 10,0 " On adjacent lots 4 1 Ly On adjacent lots -t- 100 Public sewer manhole/cleanout +I V�J Sewer /septic service line - 4' Z- S' Holding tank 4 wo Animal containment areas 4 1&90 Manurelanimal excrete storage areas SEPARATION DISTANCES FROM SEPTICIH0691N TANKONLOTTO: Building foundation +5 Property line + 5 Absorption field 4- 5 Water main + lot Water service line Surface water Wells on adjacent lots I- too SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation '1-149 Water main r I Water Service line 4-10 Surfacewater +/00 Driveway. parking/vehicle storage + 10 Curtain drain + TO I + F. COMMENTS G. ENGINEER'S CERTIFICATION Wells on adjacent lots -+ too I 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. Engineer's Printed Name 6 49r57UP*6* ?- W01�1> Date 11 ZZ -;X /0 e COSA Fee $ 7' e-2) Date of Payment /6 t, Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Eagle River Engineering Services Christopher R. Wood, P.E. 10421 VFW RD. Suite 201 (907) 694-5195 tel lEagle River, AK 99577 (907) 694-3297 fax November 29, 2006 Deb Wockenfuss Review Engineer, On-Sitc Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Scimitar #1 Lot 4 Block 1 COSA Test Hole clarification letter Dear Ms. Wockenfuss: This memorandum is to clarify the location of the deep test hole on Lot 4 of Scimitar #1 Block 1, as noted on COSA Review Comment sheet item #1. It was noticed that the test hole identification Ws were transposed on our soil logs. Please see attached soil logs with the correct Ws. Hopefully this clarifies the test hole identification question and any confusion this may have caused. We have addressed all comment items, and they have been corrected on the attached Inspection Report forms. Please let us know if you require additional information to assist the approval process. If you have any questions please call our office at 694-5195. Sincerely, EAGLE RIVER ENGR,;EE4TNG SERVICES OWK /c�–/— Christopher R. Wood , P.E. Principal \2003\04-113TEST)IOLEMEMO.DOC