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HomeMy WebLinkAboutMACORA HEIGHTS LT B-3Municipality of Anchorage ��S Development Services Department =., Building Safety Division .. E.. On -Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Pagel, agel, of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASSTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: _j/l�D/hD��� PID Number: ©/l Name: 7)50 I _ �1 Wastewater System: V New ❑ Upgrade Address: � � C fez? l (� �' f" ABSORPTION FIELD Phone: 3 7, v „ .- 7 mber of Bedrooms: X � 1J --�D ❑� Deep Trench ❑Shallow Trench ❑Bed ❑Mound Olher: LEGAL DESCRIPTION Soil Rating: �aD Total Depth from original grade: � GPD/Ftp FI. Block: Lot: Subdivision: Depth to pipe bottom original grade: abOVC 11Q5 FI. Gravel depth beneath pipe: Q.Q FI. Township: Range: Section: Fill added above original grade: v� Ft. Gravel Length: �D Ft. Well: New Upgrade -� ❑ Grave( width: ' Number of lines: Distance between lines: Ft, Fl. Classification (PriyaJ(.e_, A. B. C): Total Depth: f Cased to: / Total absorption area: 3�0 Pipe Material: I I +v W Ft. Ft. FtZ Dril erl ((,�� SOLOV00 V� QF�t Date D11191: DIPJ Static Water Level: Ft Installer: �' VQ�f Date Installed: G% Yield: I ul PumpSetat: � NI ' I 5Gy-t Casing Height Above Ground: 14- AN K GPMJ l Ft. Ft. SEPARATION DISTANCES [(g',Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ublic/Private Ma facturer. Capaci,t�/!� From Tank Field Station Tank Sewer Line 13�V Gal. Well I \ ��_ (� Material: , pF Nujr of Compartments: Surface Water t t — �/`� I t I �., �/�J'17�//% I \ / LIFT STATION Lot Line I I % � I VV V��� Size: Manufacturer. P/45 Gal. t i eni j e, fl(e Foundation Q Pump on' level at: 'Pump off level at: // 38 High water alarm al: 7 in. in. in. Curtain Drain �— a, p (( 06 Wt U Pump & Model @ Make Electrical Inspections performed by: C�IQS f� Remarks: I ` `n ar f BENCH MARK Location and Description: J � Nn�� nO u ► . eq `rte! 7 Assumed Elevation: a� -� Cry— Sfs�c0� ,:'_`' ICAO Ft. Cnn (J1i 1 r } - a 'c S & S ENGINEERING Inspections performed by: Eagle River Loop Road, No. aeS: 1 Enginee ' mp Eagle River, as a99377— n� /�`JJ�/ }' 2nd r —l/w✓ sam.�'o°or°°°a Fi 'tl /� Develop entnServ'foes D partment Approval (.:,� ,V L fG .�bt; �Y�' °% 0 Conditional Approval / Date 1 ' ��� f) itl,1: d ! l a 4' I i' t� 5 2 d't.f�l r !r► i;1;L S i /.'% J`� S Y ort A. 3hafc6 ' f Reviewed and approved by: y(„_ Date: j Q€FS (Rev. 04/06) f cs.. 0 v O+ 0-07 D — 0 0 .•r S -• ® y m W BE D •3aom -gym T� Or w -0 °v a m 2 I co N -r C) cs.. 0 v O+ 0-07 D — 0 0 .•r S -• ® y m W BE D •3aom -gym Sy Or w -0 °v a m p W ; 3 CL I co W -r C) pr7 m g w ®=3 II I i ^C 7' m O m = cd S * K 0DG Q 1 Ln:� D. 7 0 0 -s Y! C 0 -t Q iC O Q {0 D. :3 D 1363 C N z O 4 D D- 3 O Cf Q p .0 0 a' 4 y An: O z -e, o CA I CL o z ; a�m o =rm o D. 0 m X I 7 7 O W Q 9 OW 3. o' i D�mmocr 0i 090 I D. i _s I.: 0 0 0 fl O�,{H�.o D0 C ~' I Q H m V•D az ° .« coa Q 00'D a 7 0 ep N m J QC J �3 3' a mea 0oo N o >, fl o� a pr D F 78.7' °o- y A� 1 / S i0�3$'26"'yy D 2 N 4 Q0. S0'38'26 Z-8 401 i L •Ztrc M ZZ,00.00 N + F„rX -ZWN poQ.lr�twN_Q=��as o Nw f �nN moo z�� r 0 �o c rFy O� i JV� vi LstS-0OaO,p.p�p�rNN�wGy JJ�JvyJ N -• 1 V r I co W Q I-�- n I i J coCA Lnm K m z L4 N z O _rn ,98'6lb 3„ ZZ,00.00 S o CA r 0 �o c rFy O� i PERMIT No. SWO601 87 rnce 2 OF 4 Municipatity of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 *Anchorage, Atasko 99519-6650 • Tele phone= 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 3, MACORA S/D P.I.D. No. 021-011-16 `20' ROW EASEMENT \ Aap Arx11 .\ t 1 3 a 1 u 1 O 9G1- O �L `\ 4 '(1yN,I n 1 �v SCALE: 1" 100' m; F 1 ~• lk •ro.rw+rf a2 , • .......e ....Quart ••• ••• •u•• R` ,to4o A. Shafw �' �,'••• o. 1{37; •.• iiE Or^R�FEac. 14 Ar PERMIT no. SW060187 PACE 2 OF Municipalit of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 •Anchorage, Alaska 99519-6650 • Telephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 3, MACORA S/D P.I.D. no. 021-011-16 PERMIT No. SW060187 PACE 3 OF 4 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 *Anchorage, Alaska 99519-6650 • Telephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 3, MACORA S/D P.I.D. NO. 021-011-16 FINAL GRADE 79.1' 7 70.3' D.0' INSULATION 4�_ELECTRICAL CONDUIT 76.3, NEW 1300 GAL.POLY. TANK 1$• DISCHARGE PIPE 76 550 GALLON FAT ALBERT 1_1jTll SUMP ASSF;,MR1Y MTI=11A.4' MTI FINAL GRADE h1T3 61T3=87.7' mu=87.7' MT2 MT4 MT4=87.2' `ORIGINAL GRADE INSULATION uxm x 1LMN.Y IILµ x� �a. i.\�l�.EvtV�.vF✓ � AITI=115.4' MT3=851.4' LIT2=854 AIT4=85.5 LDOTTOM OF SAND=83.4' DIST. LINE=85.7' r N. T. S. r F4 NO GROUNDWATER Q1, •.."• ON 78.4' B.O.ILicj '• 9=t •NM .. .. t•.. j + •• .. ......... • ....w. shah• t��I 14.77.1 •�4 w y� Of E55 Dg �y .ty Performed For. 4^ Legal Description: 72, Depth 9- 10- 11- 12- 13- 14- 15- 16- 17- 18 - 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 cIanchorane.ak.us (907)343.7904 Soils Lo /- Percolation Test / d o l / Dale it I it r,o v1 Za GW I Sw sandy grave f 6.04-1. C [illpPJ'HT Township, Range, Section: WAS GROUND WATER MLIZ ENCOUNTERED? s IF YES, AT WHAT DEPTH?L 0 Depth to Water Amer p Monitoring? Date: /E O V rtan PERCOLATION RATE (�tev j rcrtt. nuc.iru .cn PERFORMED BY: 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Certitieb �3rirXitg Rog by occ co. ee. SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 -TELEPHONE 688.2759 ONINEROFLAND: •J/5�1=�� ��� ���� is'c.-. ADDRESS: LEGAL DESCRIPTION: 7-Zrlc-;�' �c/? d .3 DATE: PERMIT NUMBER: @Ed � Date cf Issued �y-% TAX IDENTIFICATION NUMBER: i _ 1;;/1 - /& Is well located at approved permit location? U Ycs O No Metnod of Drilling: 4 it rotary D cable tool Depth of well: G Casing Type Wall Th'Ckness inches it Diameter _(y inches, depth 4 feet Liner Type: Jt; Casing Stickup Above Ground: feet Static Water Level: 4? feet Recover Rate: —4-/lgpm Method of Testing: — !Irl Well Intake Opening Type: U open end CU -Thole U Screened: Start feel Stopped feel U Perforations Startfeel Stopped AS Grout Type: 41-_— i "6 ' r7 voturne feet Depth: from 0 fee:, to 4:� feet Well Disinfected Upon Completion? des O No Method of Disinfection: CC s.z..j4' 5D. Comments: j3�•I� •.mac ,O�F�x G/•'+�-' Ig r%.r Driller's Name_(''. �� • S�. (ct rrM"� ATTENTION: It is the responsibility of the property owner to submit a copy of the we:l log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Consenation. MatSu Borough: Department of Environmental Conservat:on. L'd 69LZ 899 L06 SIIeM JeleM UeAlllnS e0L:80 80 c L deS Municipality of Anchorage Community Development Department On -Site Water & Wastewater Program 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99507-6650 www.muni.or onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Parcel Identification Number: Legal Description Macora Heights Lt B 3 Pump Installation Date: 10/7/14 Pump Intake Depth Below Top of Well Casing: 282 Pump manufacturer's Name: Goulds Pump Model: 7SB07412CL Pump Size: 3/4 Pitless Adapter Burial Depth: N/A Pitless Adapter Installer: None Disinfected Upon Completion? ® yes Method of Disinfection: Chlorine 50 ppm Comments: ❑ no Date of Issue Property Owner Name & Address JoshJacko feet hp feet Pump Installers Name: Cole Sullivan & Terry Worrell Sullivan Water Wells Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Well Disinfected Upon Completion? MUNICIPALITY OF ANCHORAGE Development Services Department ��'1 Onsite Water 8 Wastewater Program ll 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 n'ftn (907) 343-7904 V I CC ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Date Issued: Jun 29, 2006 Expiration Date: Jun 29, 2007 Permit Number: SW060187 Parcel ID: 021-011-16 Legal Description: GONZALES HOMESTEAD TRACT B Design Engineer: 0003 S & S Engineering Site Address: 12648 GLEN ALPS RD Owner Name: CARL DISOTELL Lot Size: 1350360 SO. FT. Owner Address: PO BOX 770469 Total Bedrooms: 4 Permit Bedrooms: 4 EAGLE RIVER. AK 99577 - This permit is for the construction of: 0 Disposal Field 0 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. �IroAY , C)s") %Zcvislo-/- ffy-7v,AJ ;!, OJ/I�06 yygtc..1 rwgveA e6c. h• Wreck. Received By: Date: Issued By. Date: 1 0 "'unicipality Of Anchorage -1 Development Services Department Building Safely Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsile (907)343-7904 Parcel 1.1 Property Mailing ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING rir♦ra�� n . �3ox 77oy69,-u, -�,xir . Site address / o &qr Legal description (Sub'd, Block & Lot) D7 phone Code 7` Legal description (Township, Section & Range) Lot Size Sq. Ft. THIS APPLICATION IS FOR (®all that apply): Absorption Field Septic Tank D $ F) Holding Tank ❑ Privy ❑ Private Well W Water Storage ❑ Number of Bedrooms THIS APPLICATION IS AN: Initial Upgrade Renewal I certify that the aboC infor ation is correct. I further certify that this application is being made for a Single Family Dwelling a d is in accordance with applicable Municipal Codes. (Signa�ur�Po wner or authorized agent) Permit/Rush Fees: lS' S Waiver Fees: Date of Payment: 1y T(Iov Date of Payment: Receipt Number: Receipt Number: (Rev. 11/05) ROBERT C. COWAN, P.E. CMLENGINEERS (907)694-2979 August 16, 2006 FAX (9M 694-1211 IEALTHAWHOWTY MUNICIPALITY OF ANCHORAGE APPWNALS Development Services Department P.O. Box 196650 Anchorage, AK 99519 SEWER & WATER MAIN EMENSIONS REFERENCE: Tract B; Gonzales Homestead Subdivision SEWERSWATER Attached Is a revised well and septic design for the above referenced lot. A more "KCTON suitable location for the septic system has been found. The original permit number is SW060187. ENf. NEERNGSTIA@S A test hole was excavated and a percolation test performed. The approximate location of ANDKPORTS the test hole is located on the attached site plan. At the time of excavation on 7/27/06 no water was found. The hole remained dry after monitoring. WELLNSPECTION We do not anticipate any adverse effects on neighboring wells, septic systems, reserve aFIM TEST 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. SITE PIANS If you require additional information, please contact us. Sine y, ROAD DESIGN SOILTEST AV—Y<d trt A. Shafer, P.E. Enclosure PERCOLATION TEST STRUCTUPAL & WCHANICJI ONSITE WASTEWATER DI9POMSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Performed For. 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 d anchoraoe.ak.us (907) 343.7904 Soils Log - Percolation Test L n, c-att // _ Date.Perfonned: Legal Description: I Owl 6 Township, Dale ENCOUNTERED? dF AC,gs; Depth to Water 0t9ckA /Y INS 'SSF1tLt'p Depth W Water After Monitoring? i . .r1M• pQ V 'a t A. e'P463' 7 4- tile. 14974 Je. Soils Log - Percolation Test L n, c-att // _ Date.Perfonned: Legal Description: I Owl 6 Township, Dale ENCOUNTERED? Net Time Depth to Water 0t9ckA 12-3-,di Jth(Feet) Depth W Water After Monitoring? E � p Dale: pQ V 'a 4- 0, o o JAY I9h 57V 5- 6 6- -7- u'b" 03 ' 5%a" 7- s- 8- 9- 9- M10 10- 10- 1XV1 1 /y' I `tD 11- 11- 12- 12- 13- 13- 14- 14- 15- 15- 16- 16- 17- 17- 18- 1s- 19 19 - -- Township, Range, Section: N WAS GROUND WATER Dale ENCOUNTERED? Net Time Depth to Water a IF YES, AT WHAT DEPTH? L 0 Depth W Water After Monitoring? E � p Dale: pQ V 'a Reading Dale Gross Time Net Time Depth to Water Net Drop �G� a - o o JAY I9h 57V o u'b" 03 ' 5%a" M10 Io 1XV1 1 /y' I `tD PERCOLATION RATE_ lm..W-Vrrl rtrtt. ntnt uicn¢ien Z' _ —7 TEST RUN BETWEEN �_FT AND �FT COMMENTS I H � / PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: w = vU D- LL) 0, W U- W W W 0.z 0 3.O In NVId-311S x min. r..a NOIS30 Wig 1 Q H _ Q Q � W � M H Qoe u pox W O �Zr W: -Ji Q, Q un0 ..� G:70 x .&0 uoa3 Q C W t0 � o W I I 00 I VI/TSV l) W LCA' o ~G M : C�—�— O �- W n0 V) a � OOt/�O N CL 000 U 000c) E+ tQOMM U z II N II C a' � m II C7MIlo , E hr m N La. JON W M 3 Q 606 a VI W GI/ a w = vU D- LL) 0, W U- W W W 0.z 0 3.O In NVId-311S x min. r..a NOIS30 Wig 1 K 4 ►.y a W w c O N 4 4 �ovaio i C)0-0 0000 c �D C) c M II N �.N N4 m=!O - 000 vNtD_ C7) 4h 2 N N0 S w a 0 dm 0 ZN Z K 4 ►.y a W w c O N 4 4 �ovaio i C)0-0 0000 c �D C) c M II N �.N N4 m=!O - 000 vNtD_ C7) 4h 2 N N0 S w a O D- dm 0 ZN Z 0 exQ =w aQ �� f7 CX N J L- 0 E� > J Q la7 MLa p Wry w _ 11/e\e ) 00I V �U M ), W WLiWU W W O Z Uj o 3 0 Q LO ON -0,o NYId-31IS NOIS30 M AIRLINE orn 400 0 . • u�— Ct QpJ O v Q�0�0 �. -i OZ -jQ OZ -ja vi a~ a~ o e En O U – N Oa oa oW o w MN N~ N/ LCL J N 0 owe- O WD V)w w N N0 S w a O D- dm 0 Z 0 exQ aQ �� f7 CX d L- 0 E� > MLa U w _ �U LL W WLiWU W W O Z Uj o 3 0 Q LO ON -0,o NYId-31IS NOIS30 ,�S o w RQ CL L5o� 0 o R� {1 to r U II �+ W CL WLWC� LJ La ,�S o w RQ CL L5o� 0 o R� Li to U II �+ W CL WLWC� LJ La BVI � 0Cl30 m0 Q .n NN�tO am NO -M CT1 3`=x M�IUp, J n� • 1 ]IVJ3- 3113088 I NOIS30 I 'S '1 'N ),��7(Qjj r F��l r D Municipality of Anchorage Development Services Department Building Safely Division On -Silo Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Www.cienchorsoe.ak us (907) 343.7904 r• r -n 'Z ROBERT C. COWAN I". '% CE -8801 Soils Log - Percolation Test 6'-'`',.=. Performed For. / s {+- / Date Performed: , (�/'y—L / Legal Description: 7j--cx ~(J , (S(ly/ _ a l✓S oi97C$ I�q� Township, Range, Section: WAS GROUND WATER 9• ENCOUNTERED? '��;) r r e ,O-!•ie� IF YES, AT WHAT DEPT11i L ) D - P��II Depth to Water Ager C , P 11• Monitoring? V. 2- 3 4. •. G E 12- s� 1 13- 7- j. 14- 15- 6- 18- ,9- 20 - Reading Dale Gross Tina Net Time Depth to Water Net Drop S -1-06 o O b,s s',as" -30 30 -5!V75- at. 3 © ,7 �—• SU I o q'7.5/1.5 �70 18 .751925 19 Site Plan 7-7 PERCOLATION RA7E�_tm,wb✓ndil pERC f10lE DIAMETER f TEST RUN BETWEEN S FT AND FT E 12- Dale: 13- 14- 15- 6- 18- ,9- 20 - Reading Dale Gross Tina Net Time Depth to Water Net Drop S -1-06 o O b,s s',as" -30 30 -5!V75- at. 3 © ,7 �—• SU I o q'7.5/1.5 �70 18 .751925 19 Site Plan 7-7 PERCOLATION RA7E�_tm,wb✓ndil pERC f10lE DIAMETER f TEST RUN BETWEEN S FT AND FT a" COMMENTS T//rr.�, PERFORMED BY: $ 8 5 E?JGIPiZERING CERTIFY THAT THIS TEST ?WAS PERFORMED IN AC I fY1lCL 94R R4PAL G ID LINES IN EFFECT ON THIS DATE. DATE: / // /C L• Eapla River, Alaska 99577 40.2:� Lot B-2 I i 0 a c� W J Q U V) 13 m N Q Z ..J CL 0 CL Arw z 6 ��La K) � .' g l Q N cm a y �L �� �•• • d' Y �`CrQ �/ O a j};d• .. ���� m a ,'lts* V) 4f O d O � H L m O O C m E v+ a Q C L " E cO m m y Emy mmm o m6 m [D V i m t r j m D E O - >n T to � �- ul L m Q >m tm U Vl C L c N C m '9 Q m bl I°m mm 0 N* 0 c p m O C N Olc D 7. 7.o�C L OL O �® m y 6 0 0I h o n ®'� y ° O 0.5 O v► ?. o f I 'n m o a av c� o o "I m m Q 0 y .. I C L. -aI E D U m _m O Rp? am'� I h m p `x U V) U N o, m O C C I m m Eo ' m 0 v Z.- } D m N, I a- m = _.c ! c trEn I ma c c I c > •O a O L m a- LA .E O Z O D V L4 O� V! m C) V; C v'omrn;y 00 •— am.°°Y c I m D L Q QQ�mtx >. ov V) Q m m 2 U C L- m >. in L 3 rr}n> C� m O 4 O' V) O lal y m m I w y Q d0 m L m p I O C m L O IM .0 zL)-0t D - I 10 a ff D f'y v) > M U a c- y I D L momnc a Ly._V) ww o.E c o in D m m m W U > L 14.. mMZO Qo0 My z m0rcEE m m .Dm yDac a 0 : o. 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(r". 0511812018) Pap 1 O Authentlsign10;675A45DC-3F5E•EEtt•9937.6045BDD47265 � ,. `-� r :. ux.�1i-}, -,' .•• wt..:W, A A IL -71 "•''# ti+l7 _U•" 11 : art f:'.ri .. t. r`ti#: i i' lt:.11l P.1S!.f3 ♦ 1,: t j Fo r # + f : ►'=Tai ..a, rt.::., tj +'E'. /i..' 1aa • ll I V tIt; l # P141,Itf Z, I L7f a 1.1 UMILU ASK— .� i I w =! .. s to +lmitheMunim*ty rawnsNe'x► r..m to tat si 1 i#: 7'« the T, . k, - A:.. 0WW *9m= u#.t Any or I `,:iv'II' offitto of 11 tt 1'ta' WM t r occur . t`t 1+ i new Cenifm*e Of Off -Site Systerm Approval. 104d— , "# a agrees i the AWWTS Ma/k2! and mEmtmw= Ttq=mtft as by It AWWTS vmj%j=tafiCr and .xf'V,t: t' .:#: by the MUMCIPRUty! { a: # j t 1 1{-:, : Or t, r. • c 'n .4! rl mabU=madmpak of te Owner's # ;1 ?M t tam of ttt : AW == ;;r l! dt. begin !'f t't:" date C 4 VFVV81ti..:.. ci ►: to q)=% the u.+►z, «1 frrte to tti 1:{ Uumfcr of t t ,Ih/ # continue 4. Mfinft. The:e h of *t MUjdcW*a any tin= n =/ 'du!Ci M 4 t of !4. , Agreement sWI in 00 waY consfitute a waiver Of the provWoae� am in any way aftea the validity of the Agreenumt or any put haw, or the rigbt of the Municipality ii i `t ..':1{.. t! :.# ! ! be .i i w•.1 t ..t by ;i jt :1 .♦«•mp==t&tjvC6 of 4T - Owner at f 19' t Any ;il:.t T,1+► to -$,1.«i,i; .111: '3 ..t •..iit by eithert;-:1 4'►' .„ .:t,i,: ♦ or ti:."♦..}.. doH t:.:i 1.•./. r ; t .r h i t 7 y., 9K .. 1 brought the Superior Y`t t. for Third JudicialDisuid 1 Y" `t:1l: of Maxim A=horage. The laws of the We of AhWm .f; &W govern the •at a: and ablipfiam of &c Parties under this Agreemem ..W !; Any ., j;.. t r t : of We g'.,eme:,t decreed invalid by a comtof emmpftnt (my. 0511812018) Page 2 of 3 AutheM gnfD:675A45DC-3F5E-£Ett-9937-60455DD47265 STATE OF ALASKA 1 THIRD XMICIAL DISTRICT ) The f M90mgpztlummt was sdmawledged b me 66 day ofc�-_ " , ' LTATIBIA AWANOTARY PL18 ! nmALASKA PUBL C MkMy Cammimm - �- -'?� t, Mft� QATM. c�} 6' -Tl S r �� to L" tis t natac (T". M&2418) >a. z- -Z 0 3 Ttflc: C i yr E�-- Page 3 of 3 MUNICIPALITY OF ANCHORAGE Development Services Departmentgyp` 4 Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 021-011-35 Legal description MACORA HEIGHTS LT B-3 Site address 12640 GLEN ALPS RD Anchorage AK Current property owner(s) JACKO Expiration Date: 2 2 20 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Original Certificate Date: 9/29/2023 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 Approval—June 2022 MUNMP UTY OF o rIr Development Services Department On -Site Water & Wastewater Section ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 021-011-35 Complete legal description Macora Heights Lt B-3 Location (site address) 12640 Glen Alps Rd Current property owner(s) Josh Jacko 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: ■❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑■ Plastic ❑ Concrete ❑ Fiberglass Age 17 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: 0 AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑ 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 $ 0 e 0 Date of Payment 2 S/ 2,) -z- COSA COSA # C) SC ,Z 3 IS '� so Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 COSA Checklist Legal Description: Macora Heights Lt B-3 Parcel ID: 021-011-35 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 9-4-06 Total depth 300 ft Cased to 44 ft N Sanitary seal is functioning correctly F0 Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 6-8-23 Static water level at beginning of test 222 ft. Comments B. TANK DATA Measured operating fluid level in septic tank 44" Date of pumping 7-3-23 K Required maintenance completed, if AWWTS Comments: lift station is Fat Albert D. ABSORPTION FIELD DATA Which system tested (date installed) 9-2-06 X ALL standpipes present per record drawing Total measured depth from grade 4 ft (max) Measured depth to pipe invert from grade ft (min) t❑ N/A — pressurized field. Q Per record drawings, field is insulated. Q Monitor tubes go to bottom of effective. If not, state depth into effective Well production at time of test 4 gpm Water storage tank volume NSA gallons Well disinfected for coliform test? ❑ Yes No © Coliform bacteria is Negative Nitrate •225 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑0 Arsenic less than MRL (ND) Collected by Tim Ecklund Date 6-8-23 C. LIFT STATION X Required maintenance completed Age of lift station 17 years Lift station material Plastic Comments: Adequacy test date 6-8-23 Results RPass Fluid depth prior to test 0 in Water added 660 gal New fluid depth 1 in Elapsed time 60 min Final fluid depth 0 in Absorption rate 600 gpd ® Presoaked required if FIELD STATUS — POST RECOVERY (Required if house vacant or field not used for more than 30 days prior to date of test) Effective depth (per record drawings) 3 in Gallons introduced 1000 gallons 6'8-23 date Effective depth used 0 in Any rejuvenation treatment (past 12 months) Effective depth remaining 3 in If yes, enter date Comments/DnficiPnriec- The bed absorbed the presoak as fast as we added it so we added the final 660 gallons of water This is an IDSF, maintenance performed by L&S Services. No Foundation CO, DBL CO's before tank 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' 1]i Yas if No —ft Neighboring Tank > 100' (I Yes if No _ ft Absorption Field on Lot > 100' ® Yes it No _ ft Community Sewer ManholelCleanout> 100' Q Yes l(No _ ft Private Sewer/Septic Linea 25' Q Yes if No _ ft Holding Tank > 100'❑Yea if No _ ft Neighboring Absorption Fields > 100' Animal Containment> 50' [E Yes if No _ ft gYes If No_ ft Manure/Animal Excreta Storage00' — Community Sewer Main > 75' [@Yes If No _ ft ■ Yes if No ft ❑ NIA –Served by Community Well (not on lot) or Public Water From SeptleMolding Tank and Absorption Field(*) on Lot to: (Pleaso anter distances If less then required) Building Foundations > 10'2 Yes if No _ ft Surface Water > 100' ❑ Yes if No _ ft Tank to Property Line ? S' Q Yes if No _ A Field to Property Line > 10' Q Yes if No_ ft Water Main > 10' ❑i Yes if No ft Water Service Line > 10' Q Yea If No _ ft F. ENGINEER'S COMMENTS Wells on Adjacent Lots: Private Wells > 100' Community Wells> 200' ❑ Yes if No _ ft ❑ Yes if No ft Ktank or field is under driveway comment below Septic System was installed in TG Total time system was in use unknown Effluent line is insulated as it crosses under the driveway. 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 andlor 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 Finn /✓l1Az=iz:4 An d ere. slid Pfd r Phone 7Z 7" V tf Engineer's Printed Name y • rriP/ Date 2 E OF Ai `lk% l i........ .s',�.lfj / r? • MICNAEL N. ANDER SON•." COSA CheAlist June 2022 MUNICIPALITY OF A14CI40RAM - Community Development Department - On -Site Water & Wastewater Program P: 907-343-7904 - F: 907.343.7997 - P.Q. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org/building Intermittent Dosing Sand Filter Maintenance Log Owner Street Addressvg6 Phone Legal Desc. Flu Septic '�algk. -Sludge level_inches -Pumping: required es o •PumRing completed es o re - Absorption Field: -Liquid level inches -Flushing valves per approved design 66LM -All flushing valves opened, distribution lines flushed, and flushing valves closed es no Lift station: 0::4,, -Pump basket cleaned es o -Biotube effluent filter cleaned ygesno -Timer float settingLO inches -High level float setting inches -Reference point a -Pump onseconds -Pump off_minutes -Cumulative lifetime cycles jzclp q -Cumulative run time �� hours -Operation satisfactory es no Air System: 7 -Air pump filter cleaned es no *Air pressure 7 Dsi -Date of latest install or rebuild SynP, ab.2s-3 -Air system operation atisfactory not satisfactory Affirm System: N -Dedicated electrical circuita ,i no -Audible and visual alarm ins! a dwelling es no -Float setting inches -Alarm system operation satisfacto not satisfactory Comments: �i..n-i.. c .��... 2%1:................ ........... `hv...... �. n.... ..C.. ................................................................................................................................................................ Maintenance Provider: II Technician %q�Sy W, 114_,; 'if` Date of maintenance �cJ l Company e C V Il W S Signature Date IIrElf'reklmW.' .