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HomeMy WebLinkAboutNORTH SLOPE #2 BLK 5 LT 9North Slope #2 Block 5 Lot 9 #050-581-12 Municipality of Anchorage Development Services Department \ Building Safety DMsion �- On-Site Water and Wastewater Program. 4700 Bragaw St. P.O. Boz 196650 Anchorage. AK 99519-6650 Page 1 of 6 www.ci.anchorage.ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW_O60075 PID Number:- 050-581.12 "t•'n• Semon c. Wastewater System: ® New ❑ Upgrade !i732 Tamerak Ave, Wasilla. AK 99654 ABSORPTION FIELD pine Ni of Bedroonn 13 Dop Trach 0 Shakoes Tire O Bed 0 M-w d 0 Dm«' SO Rurq l Td„ 061 awn «qnW grade LEGAL DESCRIPTION GPOFe 0 Ft. Bbrx Lot Subdro„bm D.pm W pW trom ona+W grade Gwal dotal, D.rr.u+poe g 9 North Slope No. 2 +0.5 Ft. 0.5 Ft TO.r.„ ip R.rq. Sopron: Fill Wded .00ve on9m„ Orae Gr.wl Long . 3.0 Ft. 45 Ft. Well: ® New ❑ Upgrade Grv„.+dth NuMt,w alma DrrxebetweenI— 1 0 5 R. Ft ct.e„fro.00n (Pm„e A B. C) TOW D.PM Cued W T".b.orpoon a," 225 Pipe M„.nW 3034 PVC Private 221 Ff. 221 Ft Fr DrdNr Sullivan Water Wells D„e DnlMd 511012006 Suoc wato, 145 Ft In„.IW' Dan Green Dat. In„Wrd: 912812006 YWdpump Set„ Cu�npfrgMAooveG'O TANK 8 GPM 204 Ft. 2 Ft SEPARATION DISTANCES ❑ septic ❑ Holding ® S.T.E.P. ❑ Other: To septic Absorption Lit Holding ubiiUPrtvate M•'"''•pO1•° Anchorage Tank 1500G.1 From Tank Field Station Tank Sewer Line Ii N.m ,to Lomp.nmenn WWI 107.7 125.0 112.9 82 Steel 2 100+ 100+ 100+ LIFT STATION swfxew.t« La U. 63.1 19.5 70.8 250 a„ Orenco -ate ° tail w. -Pump P ravel n Nqh Fawk„ron 35 42 40 40 N 36 N 45 N Cun„n or„n 50+ 50+ 50+ Pump Make a Model P20o5 Elxtne„ hsp.coon. p«Ioml.d bT Alaska Elect. Contractors R•mftBENCH MARK 2” Rigid Insulation over tank 8 Field. TH's were tied to house for t.OflbMf and D..ugpn. location. Pump not Installed at time of Inspection. First floor slab at man door neerest the field awltw 100.0 FL Engineer's Stamp Inspections performed by: PANNONE ENG. SVC, LLC Dates: 1„ 912812006 la�.•�OF 2nd 912812006 �� �E.......•••...� •♦ Development Services Department Approval .**% 491- % Conditional Approval Date: _. ... .M.—�..�.........ti..... � ........ ... '.. .�.. ...y �����gyyyy to --Steven R. Ponnone.ri Date: y�0�3 �1� '• No. CE 81x9 '�� ��� F.......M.�... .1 Reviewed and approved by: ,T�. r PERMIT NO:SWO60075 RECORD DRAWING P.I.D. NO: 050-581.12 WASTEWATER DISPOSAL SYSTEM LOT 9 BLOCK 5, NORTH SLOPE S/D, NO.2 DESIGN PARAMETERS SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) ` TANK SIZE: 1,500cllon STEP Der PERC. RATE: 30-60 MPI SOIL RATING: 2 gpd/SF�� AREA ROD: 225 SF ` ?p� �S� Fz SYS. TYPE: 5'—WIDE .5 -ED, FF�g O'0 MIEN UM. 101.8 45 L 101 8 45LFx5'WIDE,0 ED.0.0' TD a \ `� CSS F TOTAL AREA: 2"15 SF 0 NEW NEW 15008 \ '� Q WELL STEP TANK \ NEW A AX20 POD 113.9 I20 co �� �� 3 BR HOUSE g J p� =100.0 -Q• EC/ �O 1 81.3 ` $ QZ 125.0 I �15%`�\ \�=O3� 20% 07.7 RIMARY SAS \ 83.9 \\ 10.6 -WIDE TRENCH 4' 1 9 % Mt 5' Wx 45LFxO.5 ED, T1 O' TD 10X / \ EXISTG �/'"L �T0. H1 7 % SEPTIC AREA rte, \ / T L 18 y 8% too -fkUSCPU P TH2J \\ 9.5 VAUL 18% \\\ WEXIST'G 1W ELL RADIUS 69.9Rgy SO RE ERVE SAS 1s 1 0 WE<<S y0� %Wx 5Fx05 il TRENCH TD L 100.8 N?00 F OR g zcz F� FPT�C3 Fp � 1e% 18% i D01 -- ar EXI/ WELL 82.1 8 .��aaaaat,�, NOTES: 3) Maintain 10' separation to all CO A B C 1) All work shall A performed In lot lines and water lines, unless P�S�1♦ accordance with AMC75.65. noted otherwise. M7 110. 56.5 M2 110.3 92.5 • • ♦♦ 2) Materials used shall be in 4) Lots served by private water T1 42.6 62.3 p - •••• ♦ accordance with those specified in systems. No wells within 100'01 TL 50.3 68.7 i 00-••••+•• •••• .••• ......• •••......I AMC15.65. Wastewater Disposal. proposed system. LS 49.2 65.7 9 PREPARED FOR: PANNONE ENG. SVC, LLC ♦ Steven R. Pannone r. Rosemont Inc. P. O. BOX 102954 ♦♦�i' CE 8149 r �� 3332 Tamarak Ave ANCHORAGE, ALASKA 99510 ♦i�` .G? ... WaasuAK 654 272-8218 P. 272-8211 Fax ♦��a 1CF' �� ( 376-1493 DATE: 12 j1 6 PLAN PERMIT NO:SWO60075 RECORD DRAWING DETAILS P.I.D. NO: 050.561.12 WASTEWATER DISPOSAL SYSTEM LOT 9 BLOCK 5, NORTH SLOPE S/D, NO.2 —I % I— R A a 36n1 WiMOn ci 1 �g n� Q4 y V J.. '• i \ � u r' 1t• 38n1 LLI }g 0 0 0 O .:i, �. Lij 3 $ r ep V c 0 n 0 € a sa $ e o n 1 0 33Oxxvx i 3Wxxm y� y[. r€ -1 j�JYui Wn3 • C 5; LM xa,o ;....... .... .........::..... 0 m PREPARED FOR: PANNONE ENG. SVC, LLC •' t Seven R�Pannone i • ? Rosemont Inc. P. 0. BOX 102954 1� 3332 Tamarak Ave ANCHORAGE, ALASKA 99510 #jci�G' c�� Wasilla, AK 99654 ' 6 272-8218 P. 272-8211 Fax �1 (907) 376.1493 ••'��. • ..�� • SCALE: t2NTS 6 DETAILS t �uui�nuo .t:�r yoidrecoyy - .t,5nirrwtlrt rant uo (Certitieb OrN11.g 109 by DW CO. aen SULLIVAN WATER WELLS P 0. BOX 670171, CHUGIAK• ALASKA 99567 -TELEPHONE 689-1759 OWNER rF LAND: Z r40 ADORES -- LEGALC:SCRIPTION:AS USI e r Z -- 77 DATE: _-T- / 14 PERMIT 'IUMBER:Qb*- 1 Date of Issu.i-ZL-Sa& TAX IDEI TIFICATION NUMBEF: US0 Z Is well to ated at apor ved pen III locatioM 41ATS U No Method f Drillirq: rotary O cable tool Depth of dell: i;2dL— Casing l pe r� " Wit ITrtekness._ _Inches Ir Diame:e - inches depth_21 feet Liner Tyl S: rj>A)E Casingt:IlckuoAbove Grom��d-- : -feet Static N der Level: � L<* feet Recover aate:--?--GPM Method • A Testing: Well Intl to Cpening Type: 6< n enc D open hole 0Scree 2d; Start ---feet Stopped feet a Porto Itlens Start _ y l fee* Stopped feet Grout%se: ;5 volume IIZZ f Cepttr t xn c i __ feet, to `) D feet Well Dis:fected Upon Cornplelion? Vf*s U No Method >f Disinfection: _'r:d'1- a.c,. j To /fM Comm ##gg✓J1'joNJ Co c- j r ! iililC i •r � , Drlller's Nama Go & c i c.L r Jiff% ATTENI ON: It Is the reso-:nsl:illlty of the property owner to submit a copy of the well log to the proper aulhoritt. Munlclpality of Ancr: nage: Department of iealth & Human Services and/or Cepartment of Envlrnmental Conservation. MalSu Borough: Departr ant of Environmental r;onservation. ARCTIC PUMP & WELL INC. Fl Jim Sullivan, CPI PO Box 770197 t� �m Eagle River, AK 99577 (907) 688-2510 (907)258-2510 (907)745-2510 arw a eci.nel Pump Installation Log Well Drilling Permit Number: SW060075 Parcel Identification Number: 050-581-12 Date of Issue: 5-2-06 Legal Description:North Slope42 Property Owner Name & Address: Lot:9 Rosemont Inc Block:5 3332 Tamarak Ave Ws,i16 etr oor;ca Pump Installation Date: 7-7-06 Pump Intake Depth Below Top of Well Casing:204 Feet Pump Manufacturer's Name: Dempster Pump Model:LBF2-75-S2 Pump Size:3/4 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer:U/K Well Disinfected Upon Completion? Yes Method of Disinfection: Chlorine Comments: Pump Installer Name: Arctic Pump &. Well, Inc. Arctic Pump & Well, Inc. Page I of I RE dom, -r-sp A eAce-A I A Ve k46 , )464 1h VL S3 MId Wpm p7MM 9Z:ZOLL 9St40 800Z/0Z/L0 :uea:�aub uy:�y 70la/b:7y7 w5rntiru,t� _ rwx a[ ,,.... ... ! :c • dog--' ! - Pert., i' �.. yrs " 1 •� - 1 i y1. C, n•u.. .1� j 7. .� JO 'i Ie.. •l:i tf of� Ally c: \ .I z.aT.00 '. � �• A5�1'.tJicr� �`. ... �;N+ rH' /� :'f• . I -hereby eertifr that l'haveU.rw the followirf;described Petty' $�oG.K'F ,' {• ->w,•:•t, Sesirens::trr4c�fl-it ksJkAi:" Anchorsgt Pword'atb Pedrict Aloka atd that lhl;impeove- menu Mtufkd (hereon r 1,� Y'' � .^:.'•..:`: �j �1fM1t�1!llltlf Iines.Vid'dntnt• t •v y . �.-' to Veit C.. � •,..•r , .:' overlap or ermaw i or iheptvpfrty fyiti "Ad**C"tO no Inlp"emi!ite an Property ad t thereer on the prernbea to que dan u, &t =r* no trfnstN.ebn 1,1" or other vb&W "Mmenb on IfM fXtfpt ae imdreotfd bgf"n.... , : .. Doted ofStaler: Mika ' this A10 -taloy. .':..:....20( scAt F ' :. • PL•'7BW C gisterwd T SON F urveyor N Phone (7071690250. —1-1 4 MUNICIPALITY OF ANCHORAGE 0 Development Services Department D )cbv On -Site Water 8 Wastewater Program 1VILA 4700 South Bragaw Street c1 P.O. Box 196650, Anchorage, AK 99519-6650 n\� D (907) 343-7904 '� ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date Issued: May 02, 2006 Expiration Date: May 02, 2007 Permit Number: SW060075 Parcel ID: 050-581-12 Legal Description: NORTH SLOPE #2 BLOCK 5 LOT 9 Design Engineer: 0062 PANNONE ENGINEERING SERVI( Site Address: NHN SAGWON AVE Owner Name: ROSEMONT, INC Lot Size: 58412 SO. FT. Owner Address: 3332 TAMARAK AVE Total Bedrooms: 3 Permit Bedrooms: 3 WASILLA . AK 99654 - This permit is for the construction of: Q Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy Q 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 (18AACBO ). 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. 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. Received Date: Date: z 0(7 Municipality of Anchorage • Development Services Department Building Safety Division �'' • .��C On -Site Water and Wastewater Program , • ., 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 050.581.12 Property owner(s) Rosemont Inc. Day phone 376.1493 Mailing address3332 Tamarak_Ave, Wasilla. AK Zip Code 99654 Site address _NHN Sagwon Ave, Eagle River Zip Code Legal description (Sub'd., Block & Lot) _Lot 9, Block 5 North Slope SID Add'n No. 2 Legal description (Township, Range & Section) Lot Size 58,412 Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field Septic Tank Holding Tank ❑ Privy ❑ Private Well Water Storage ❑ Number of Bedrooms 3 THIS APPLICATION IS AN: Initial El Upgrade ❑ Renewal ❑ certify that the above information Is correct. I further certify that this application is being made for a Single Family Dwelling and Is in accordance with applicable Municipal Codes. Pannone Engineering Services, LLC (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Z/ Waiver Fees: Date of Payment: Receipt Number: �IKNg(p Receipt Number: (Rev. 11/05) Pannone Engineering Services, LLC Consulting Engineers April 26, 2006 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. 0. Box 196650 Anchorage, Alaska 99519 Subject: Lot 9, Block 5 North Slope S/D Add' No. 2 Well and Septic System Permit Request Ladies and Gentlemen: P.O. Box 102954 ge, Alaska, 99510 I am writing to request a permit to construct new well and septic system be issued for this property. The proposed systems will serve a proposed three-bedroom house. Currently the lot is undeveloped. The well will be located in the northwest corner of the lot, over 100 feet from the proposed septic system and neighboring septic systems. 1. Soils. See the attached soils log. Ground water was monitored for 25 day through the end of April. Ground water was measured at a depth of five feet below ground surface on April 25th. Bedrock was not encountered in the test hole. It is my opinion that the overall soils appearance of the soils, an application rate of 5 gallons/day/square feet should be used using a class III advanced treatment system. 2. Trench Design. a. Percolation Rate: b. Application Rate: c. Number of Bedrooms: d. Design Flow: e. Min. Absorption Area: f. Total depth: g. Effective Depth: h. Width: i. Reduction Factor: j. Minimum Length: k. Design Length: 1. Effective Absorption Area: m. Septic Tank Size: Cont'd on page 2 C:\Work\Letters\9-5 North Slope No 2.doc 6-15 Min Per Inch 5.0 gpdpsf 3 450 gallons per day 90 sf 0.0 feet 0.5 feet 5 feet 0.0 15 feet 30 feet 150 sf 1500 gallon Advantex W/AX20 Pod. Page 2 3. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The average topography in the area of the proposed septic system is approximately 15 to 20 percent in the area of the SAS (based on existing topographic survey conducted in 2002). The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 227-3522 or 272-8218. Sincerely, Steven R. Panno , P.E. Civil Engineer Attachments: C:\WORK\LETTERS\9-5 NORTH SLOPE NO 2.DOC PERMIT NO: SW06 DESIGN DRAWING P.I.D. NO: 050-581-12 WASTEWATER DISPOSAL SYSTEM LOT 9 BLOCK 5, NORTH SLOPE S/D, NO.2 `YO�FgG� op�FF �ZO SFo�FO -PROPOSED PRIVATE 1 PROPOSED 1500g \ \ 7 WELL STEP TANK W/ . I Ax POD 141.8 3811 'bPESERVESAS t"O?4 SOUQPROPOSE5-WIDE TRENCH pi RS SaF�gLFxos P D SAG�1/pNgV WELL RADIUS F '\. All work shall be performed in ccordance with AMC15.65. PROPOSED PRIMARY SAS 5 -WIDE TRENCH \ - 5' Wx 30LFxO.! ED, 0' TO \ 1.2 15% EXISTG SEPTIC AREA 0 TH2 3) Maintain 10'separation to all lot lines and water lines, unless noted otherwise. {x ;' -%' y} v� 2) Materials used shall be In 4) Lots served by private water accordance with those specified In systems. No wells within 100' of "'n.....i AMC15.65, Wastewater Disposal. proposed system. EXIST'G 100' WELL RADIUS Pannone rrcr rrrcr u rvrt: PANNONE ENG. SVC, LLC R. Pann? Rosemont Inc. P. O. BOX 102954 ti49 3332 Tamarak Ave l Wasilla. AK 99654 ANCHORAGE, ALASKA 99510 ,Y, �;�.• (907)376-1493 227-3522 P, 272-8218 Fax PLAN PERMIT NO:SWO6 DESIGN DRAWING DETAILS P•1•D.NO: 050-581-12 WASTEWATER DISPOSAL SYSTEM LOT 9 BLOCK 5, NORTH SLOPE SID, NO.2 unarm» 0N3 N0V31V 39111 HOlvaN ON3N V3 IV 39»1VO,L w lnol to L10 NV310319n00 L10 NV310 1 ONV313 An -i •` 1110 NV310 ¢�..�.i1�` � • NaiVarW10A rai an R. Pannone Rosemont Inc. E 3332 Tamarak Ave Wasilla, AK 99654 ..�..... (907) 376.1493 O o; LE e e.4 a s o eC �= o .a G O � � o U W O 1rEl%SJj q 7. 1 S a na z as ujW o a unarm» 0N3 N0V31V 39111 HOlvaN ON3N V3 IV 39»1VO,L w lnol to L10 NV310319n00 L10 NV310 1 ONV313 An -i •` 1110 NV310 ¢�..�.i1�` � • NaiVarW10A rai an R. Pannone Rosemont Inc. E 3332 Tamarak Ave Wasilla, AK 99654 ..�..... (907) 376.1493 PANNONE ENG. SVC, LLC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 227-3522 P, 272-8218 Fax ,ATE: 12-3-05 ;ALE:NTS DETAILS O G 7. z ujW 0 D. D. PANNONE ENG. SVC, LLC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 227-3522 P, 272-8218 Fax ,ATE: 12-3-05 ;ALE:NTS DETAILS PERMIT NO:SW05 DESIGN DETAILS WASTEWATER ABSORPTION SYSTEM LOT 9 BLOCK 5, NORTH SLOPE SID, NO.2 P.I.D. NO: 050-581-12 DESIGN CALCULATIONS P. O. BOX 102954 Number of Bedrooms - 3 TANK SIZE: Total Bedrooms -3 1500 gallon Advantex tank Design flow -150 gal/br/day, SOIL ABSORPTION SIZE: Total flow - 450g/day Advantex Sewer System AX20 Pod - Class III System Perc Rate= 6-15 mintinch Application Rate= 5 GPD/SF Size Required= 450 GPD/5 GPD/SF = 90 SF 0 Use 5 -Wide Trench, 0.5' effective 30' Long by 5' Wide 30 LFx5'x0.5'=150 SF Total Rosemont Inc. P. O. BOX 102954 3332 Tamarak Ave ANCHORAGE, ALASKA 99510 Wasllla. AK 99654 272-8218 PHONE & FAX (907)376-1493 CALCULATIONS SOILS LOG - PERCOLATION TEST PANNONE ENGINEERING SERVICES P.O. BOX 102954 ANCHORAGE, AK 99510 (907)272-8218 PERFORMED FOR: Rosemont Inc. DATE PERFORMED: 3-31-06 LEGAL DESCRIPTION: LOT 9 Block 5 North Slope SID, Add'n No. 2 1 2 3 4 5 8 7 8 9 10 11 12 13 14 15 16 17 18 19 20 TEST HOLE 2 Top Sao SLOPE Poorly graded Sandy GRAVEL to Silty GRAVEL TEST HOLE Silty Gravel W1 pebbles WAS GROUND WATER ENCOUNTERED? N IF VES. AT WHAT DEPTH? DEPTH TO WATER AFTER MONITORING? 5.5 DATE: 4-25-06 PEROLATION RATE 5 (minAnch) PERC HOLE DIAMETER 6Inches TEST RUN BETWEEN 5 FT AND 6 FT COMMENTS: Test hole excavated by Dan Beeks. Test Hole was presoaked before pert test PERFORMED BY: Steven R. Pannone P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCOF SLOPE TH 2 READING DATE GROSS TIME NET TIME DEPT TO WATER NET DROP 3-31.05 2:10 — 6' — 2:20 10 8- 7 2:20 — 5' _ 2:30 10 r 2' 2:30 — 4 718• — 2:40 10 6 718' 2' PEROLATION RATE 5 (minAnch) PERC HOLE DIAMETER 6Inches TEST RUN BETWEEN 5 FT AND 6 FT COMMENTS: Test hole excavated by Dan Beeks. Test Hole was presoaked before pert test PERFORMED BY: Steven R. Pannone P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCOF SOILS LOG - PERCOLATION TEST PANNONE ENGINEERING SERVICES P.O. BOX 102954 ANCHORAGE, AK 99510 (907)272-8218 PERFORMED FOR: Rosemont Inc. DATE PERFORMED: 3-31-06 LEGAL DESCRIPTION: Lot 9 Block 5 North Slope S/D. Add'n No. 2 SLOPE HOLE I WAS GROUND WATER ENCOUNTERED?—N IF YES, AT WHAT DEPTH? -0-' DEPTH TO WATER AFTER MONITORING? -4.4 DATE: 4.25-06 LLUMC TH1 READING TEST HOLE 1 NET TIME TOPSOIL NET DROP 1 OR 12:37 2- S. 346 3- 1:07 30 4- 15118' 6 1:07 — 6- _ 7- 78 1:37 30 8 GPI GM PSA' 9mded Sandy GRAVEL w/Sand 6 Sift 9 1:37 6'MSA. Hard 4314' Digging 10 2:07 30 11 15118' 12 13 BOH 14 15 18 17 18 19 20 SLOPE HOLE I WAS GROUND WATER ENCOUNTERED?—N IF YES, AT WHAT DEPTH? -0-' DEPTH TO WATER AFTER MONITORING? -4.4 DATE: 4.25-06 LLUMC TH1 READING DATE GROSS TIME NET TIME DEPT TO WATER NET DROP 3-31-06 12:37 — S. 1:07 30 515/16, 15118' 1:07 — 51 _ 1:37 30 515/18' 15H8- 1:37 — 4314' 2:07 30 5 11118' 15118' PEROLATION RATE 32 (minAnch) PERC HOLE DIAMETER 6Inches TEST RUN BETWEEN 4 FT AND 5 FT COMMENTS: Test hole excavated by Dan Beek. Test Hole was presoaked before perc test 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 G50-581-1 Parcel I.D. - - Expiration Date: I—(?— z? 1. GENERAL INFORMATION Complete legal description North Slope #2 135 L9 Location (site address) 30945 Sagwon Ave., Eagle River, AK 99577 Current property owner(s) Diane Brozovsky & John Cadigan Mailing address Real estate agent Day phone 440-6577 2440 E. Tudor Rd. #331, Anchorage, AK 99507 Wilfred Fernandez III 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 885-3578 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5 D 4- Waiver Fee $ Date of Payment _ (4- g ' 2 2 Date of Payment Receipt Number 3 9 l 0 Receipt Number COSA # OS CQ 2 i)� Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Eklutna Engineering, LLC. Phone 907-406-1058 Address 19162 Mountain Rd., Chugiak, AK 99567 Engineer's Printed Name Curtis Townsend Date 6. DSD SIGNATURE 1 System #1 Approved for -3 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms 61� AQs`'r/���� •. e.'curtS W�52ild .. • STAMP Aaf;P CE�4 ZT. tdo. 1 9Q4 • 5� 'r PR0FrS bedrooms, with the following stipulations: .,ttllltttttfffr�,_ Original Certificate Date: l( / _ The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval(COSA)based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet 97 11, 1 11 iii i Legal Description: North Slope #2 135 L9 If more than 1 septic system on tot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 5/0106 Total depth 222 ft Cased to 221 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 6/1/22 Static water level at beginning of test 143 ft Comments B. TANK DATA Age of tank(s) 16 years Tank type/material Steel/S.T.E.P Measured operating fluid level in septic tank 5 ❑ Standpipes/foundation cleanout per record drawing Date of pumping n/a D. ABSORPTION FIELD DATA Which system tested (date installed) 9/28106 ❑ ALL standpipes present per record drawing Total measured depth from grade 3 ft (max) Measured depth to pipe invert from grade 2.5 ft (min) ❑ N/A — pressurized field no Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 0508112000 Structure served by this system 1 Well production at time of test 7.5 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 0.856 mg/L F]Nitrate less than MRL (ND) Arsenic ug/L (ol Arsenic less than MRL (ND) Collected by Brandon L. Jones. Brandon's On -Site Services LLC. Date of Sample 6/1/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station 16 years Lift station material plastic Comments: 2" insui. over the septic tank Adequacy test date 6/1/22 Results 0 Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 452.6 gal New depth 4 in Elapsed time 1440 min F01 Code -required soil cover over held Final fluid depth 0 in ❑ System presoaked Absorption rate 452.6 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) n/a date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: 2" Insul. over the leach field. COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Yes Septic Tank/Lift Station on Lot > 100' ft If absorption field is under driveway comment below Community Sewer Manhole/Cleanout > 100' []✓ Yes if No ft Q Yes if No ft Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Yes if No ft []✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' [✓ Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' Q Yes 'if No ft Property Line > 5' Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100'[]✓ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' M Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓[] Yes if No ft Private Wells > 100' O✓ Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' []✓ Yes if No ft Surface Water > 100' ✓0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that i have determined through field inspections and review of Municipal records that fhe above sysfiems are in conform MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet NGINEER'S I 08/06/2021 15:38 8686770 APLUS 397 003 os� op asps: ll ME moll a a11111121 aIN IIIOil i pt am a i a map Now Field ai aRePOrt Annual Inspection p,,, a >,Marf tiatdvg,t Diane BrozovskY Site AddMtO 30945 Sagwon Ave, Eagle River AK 99577 Ax Sita 101 =S;WX06007.5 Pod it AX -109896 2077'13 Retrieve O&M info Daily flow Reclrc ratio Timer settings: Perform Field Sampll ng/Ofase!Vatlorts NTU (15 t NTUs) pi. (6.% DO (2.6) i"? -4 � z 6 , Odor or Sample t1'pical Z Must . ❑ Earthy ❑ Moldy Na"pical ❑ Sulfit c ❑ Cabbage ❑ rleerey oily flim in PVU [ ,i Yes /Z)No Foam in tank Dyes ,iu yes Na +check Control Fane Reeire Amps Discharge Amps 4— Audible and visual ON ma OOK LZ _ Dist tone (telentatty o ,ly) r7Yar ❑ No Inepect/Clean Pumf -system Intake Vent Q Inspect Clean Ftisar/Ltd .......... ........ Inspect CleanInspect splice Box .................... . Float cords Float Cords ....... ......... inspectlSerVice Other System Cornponents Floats ............ ........... Clean /u5 Qhaenratloris _ Pump ............ .......... ,Additional SgrVlCes Rendered ICJ Biotube Filter ..... ........... tGl ❑ Replacad/UsW other items? aiotube Pump Vault .............. PartS Used: W = Warranty, S m Billable (f appropriate selectlan) ReGnxriating SprdW Naive.......,© PAGE 04 a 11 19 iS go molls wo a AnchorageTank 907-272-3543 OPO -13M Larry Betts Caudae! Fhane (907} 555-5555 pats a L.nat tnnPtotlm MU lIN6 8 RTU107475 07/21/2420 - Measure sludge/SCUM Sludge 2nd Compartment inspect/Cleen AdvanTex Filter scum Pervio� Previous Previous Previous inspect Clean Odor: ZNormal ❑ Pungetd Laterals/0rificos /JJ LZ Biptnat Normal ❑ Facceseiv¢ Pod Bottom Bridging/Ponding: 1ZNone/Mlnor ❑ExcesSlve Intake Vent Q inspect/Clear' Discharge PUMP SYSteln Inspect CleanInspect Risar/Lid Flaats Splico Box PUMP 'J Float cords inspectlSerVice Other System Cornponents Inspect Clean Inspect Disinfection equipment E, '�L Dispersal t.atareWOrleces Clean /u5 Qhaenratloris _ ,Additional SgrVlCes Rendered Cleaned textile menu? ❑ RCplaced UV items? ❑ Replacad/UsW other items? PartS Used: W = Warranty, S m Billable (f appropriate selectlan) tar n Mae.. id,nnl�r de3criation Final/Safety Inspection RSV reinstalled �'iJde bolt¢d on Manlfbld reconnected; flush valves closed )Control panel reactivated Sumatitry/Recemmendatlono C;�Syswm performing; no further actiort th,eded ❑'tank mads pumping . ( l Can for service 17-1Other? comments c?,:Z-,7 _ Signature .s Dote DocuSign Envelope ID: 941DCD9D-F700-4971-A61B-B428F1BF406B 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 1rst Day of June of 20 22 , by and between Diane Brozovskyoohn cadi gan , 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 AWWTS located at (legal description) North Slope #2 L9 B5 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Da 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. 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). 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. 98r Y' 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 DocuSign Envelope ID: 941DCD9D-F700-4971-A61B-B428F1BF406B D� P� Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Et, Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. D� P� Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. DB P� 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. �8 P� 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 DocuSign Envelope ID: 941 DCD9D-F700-4971-A61 B-B428F1 BF40613 I -- STATE OF ALASKA THIRD JUDICIAL DISTRICT (signature) ;print name) ) ) ss. Date: a U tk,2 5+- The foregoing instrument was acknowledged before me this day of tU 20,AL by C • Cctcl�aa ti NOTARY PUBLIC FOR ALASKA My Commission expires: Crj XX) M NIHAE(AYPUBUCR MYCOMMSSION EXPIRES KA ebmety22, 2028 MUNICIPALITY: By: � (signature) (print name) Date: (9 —17 2 Title: (rev. 05/18/2018) Page 3 of 3 DocuSign Envelope ID: 941 DCD9D-F7004971-A61 B-B428F1 BF406B OWNER: By:,2"4 (signature) Date: �- as �c. M (3 ro za a s k .c (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this ,! day of JL4,n e , 20AV , by r)OQ:y1--L� 4f • �1'*, NOTARY PUBLIC F R NOTq,4r My Commission expires: 10/:� � �•�, s :AUBLIG 'Ns �'A N F AX. ' 1,4E`pi`e„C`'aa4 MUNICIPALITY: By: (signature) Date: (print name) Title: (rev. 05/18/2018) Page 3 of 3