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Home My WebLink AboutHERITAGE HILLS BLK 5 LT 3i T Heritage Hills Block 5 Lot 3 #015-221-37 Development Services Department Building Safety Division On -Site Water & Wastewater Program 0p"6¢ e`< 4700 Elmore Road x �� P.O. Box 196650 " Mark Begich Anchorage, AK 99507 $" "Ydl Mayor www.muni.oro onsite _. (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW_ Date of Issue: Parcel Identification Number: 61L: 221 3'7 Legal Description ( Property,O_ rwner Name Address: iAa-t,V4(-_�Yt(�Si�Lr57G�f 7Rcz �dLD � L fc S - Lf3 I Z 3 > D --i R Ac -,e 1� 0 ANS AK I CNs-o7 Pump Installation Date: j z 1116 Pump Intake Depth Below Top of Well Casing: ?16 feet Pump. Manufacturer's Name: —Pes Pump Model: CEJ 19j S I Pump Size 3�, hp Pitless Adapter Burial Depth: (O feet Pitless Adapter Manufacturer's Name: (�_k7wtaLe-091 Pitless Adapter Installer: „ 7 ]1_.V_ Well Disinfected Upon Completion?Yes {] No Method of DisinTection: Comments: Pump Installer Name: 330 698t 76th Avenue Anchorage, AK 99518 Phone: 907-243-0740 Fax: 907-243-0742 Attention: The pump installer shalt prose,* pump installation log to the DSD within 30 days of pump installation. b- Municipality of Anchorage Development Services Department *D0 Building Safety Division •" On-Site Water and Wastewater Program, 4700 S. Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 Page / of-3 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. Su'/OID a� PIDNumber. Fd— A91-3-7 Nam.. Wastewater System: (g New ❑ Upgrade a r o� K Address: Old StA.veccd as ABSORPTION FIELD Phare3Ljq_ d � � Wu a 3 s: J D MP TwKh 0 Shang. T and D Bed AI'am» d 0 oa .. BW Rwrp: Taa MP'r can w9no grace: LEGAL DESCRIPTION 1GpVTe F Block Lot Subdmiorc Depth b PW baton from WWW gra: &Wsidepthbaeampq: 'I IL L. .1A 1-( E2.1r C LLS I FI. F,. Township Ran W- Set FA added ab v a7ma1 grew' Gnwl LWgft 30 Ft. FI. crs,ei h Numbs of rr»s: D»lane wtwean knee. Well: Uf New ❑ Upgrade IS FI. FI Clssuncalbn (Pmals. A, B. C)cTOW Mph: Casad m: TOW adsaryeon rar (� LI rJ O P" Wlany'. St LIDI/ L- � 3 FL FI FII piper Dna Dnqed Su14WaIaLMI'. InaWer. / WOJCi3 ' 8�� Dae InvadedI I 11E 110S 1-7D Ft YOU. I� o'-OiGPM PompSet re SOTTOrA FI. GaWq"OVA AtW+Mawd: FL TANK SEPARATION DISTANCES ❑ Septic ❑ Holding ❑ S.T.E.P. [Other. To Septic Absorption Lift Holding Public/Privat L""Ia` sw. capsaly. I DGal. From Tank Field Station Tank Sewer Line p C go Maternal. 14 Number Of Canpadmanl5. wen t or o Ito t o o — F.a S'Nfanwater r4lo Nip N�o LIFT STATION Sas. MenJxt✓�a7. La Lir» (1 t7 I r. o-o GN /� O i O t... 'Pure On' Mvel at'. 'Pulp Olf lavtl ML:I r LI H.pm vela clam at V, In. Fo ndran 2 In. 7 /T- In wZ Cutin Drain LTO N `p O Pump Make 8 Medal ►"IL tr Elecbral Y»pecpms;7n ad by V 411 R~s BENCH MARK n LdOakon snMacnptan a.Ir' Asa,anad E»raeort ro t Va�FL s.♦ J.a- sik.a C.1.. IC Le c- ♦.ti t�e Engineer's Stamp r .:. s. [slot Inspections performed by: I . Dates: 1" i...... Development Services Department Approval is. Reviewed and approved by: Date: 3--0 �%�;:, (Rw 11wi, 1 RAOCYCLEOSCPTIC SY�IEY BICLE 15XM NOUND TOTAL DEPTH 1 FOOT /lLIERSWD 1 FOOT SFMFR ROCK R .5 FT COVER 3 I IAC SW/N019 R 11L:X I LOT 4 BC 44.5 AD 29.7 OD 59.7 I AE 59.5 1 67 -- -- _to. I BENCH MARK A C 10' I I Well E I .•. II 3 STD .`e''• REPUCMT - I I I I I I LOT 2 I -¢ Well I I O I ..... -- -- - -- 1 r — — — — — — — — —— — — —— �1♦ I I I � I I I LOT 1 25 0 25 50 75 49t I I SCALE+ I' = 50 r7 I I I LOT 5 I 0• m u ♦♦ LOT 7 ----- BENCH MARK:: TOP BLOCK OASSUMED MY. 100.00 S LOT 8 TO BBEM SPURKLAND P.E. I I LOT 3 BLOCK 5 HERITAGE HILLS I I SEPTIC SYSTEM AS BUILTS 20 IN 15TH. AVENUE DATE: Nov. a 2001 ANCH. AK. 99501 AARON L YOUNG (907) 279-3916 13216 LLD SEWARD MGHWAY SHEET • 2/3 GRID: 2737 PERMIT # SVOI04RI PID # 015-2?1-57 HCH05032.BV6 1 FDNDDArmV aEAN aur �• �IrTDe ASTM 3074 GRADE TO DRAIN I 99.5SLOPE FINISH'D GRADE AVAY d. T .1 Al , nr01•rr,1 BACK FILL I rl 2a/r NINUS_ �tcxA7� 100.0 :..:.. . (11rER-WD'. O 99.0 h STANDARD MOUND NTS 24' NAX 'S /1-1/ PVC DISCHARGE 4' PVC !RELENT m : m PPRIMARY CMABER m AERATILP/ CHAMBER m m �' ARIFIER ®D CHAMBER Tn a w�-BOTTLN Dr TANK BLLEBOARD INST.CATIOV INSTALLATION L EXCAVATE A f0' x 10' x 10' LEEP HIE FOR NIXYCLE SYSTEM P PLACE A MINIM N Dr 4' SAND OR GRAVEL FDR LEVUPC CaRSE IN TW BOTTOM Dr TIC EXCAVATim CDPACT AS REDUIR£D 3 PLACE 4 DEETS Dr r x 8' x e DIRECT BLRIAL RIGID INSL(ATIM ON TD' Dr CO ACTED LEM M1"i CaRx TO PROTECT BOTTOM Dr FIBERGLASS W. TAI£ EXTRA CARE TO ASSLRE THAr INSLLATIDV CORSE IS LEVEL 1N ALL DIRECTM 4. BACKFILL ARDAVD TAW LP TO INVERT Dr 4' MILENT AND 1-1/4' EFFLLENT LIACS VITN FREE -PLANING NSF MATERIAL FREE Or LARGE STOCS DR BR.LDCRS 30' 1-1/4.1 JOEME 40 PVC V/ 1/8' Hi£S P 30' IOP AND BOTTOM MW7W TUBE h HNITDR TUBE SAND/GRAVEL BACKFILL O O BENCH MARK TOP BLDCK` '% ASSUMED ELEV. 100.00 •FT TOBBEN SPURKLAND P.E.I I LOT 3 BLOCK 5 HERITAGE HILLS SID I I SEPTIC SYSTEM SHEMAT/C 103 W 157H. AVENUE AARON T YOUNG DATE. NOV. 13, 1001 ANCH. AK. 99501 SHEET. 3 3 GRID: NW58 (907) 279-3916 13216 OLD SEWARD HIGHWAY PERMIT # SVOI0421 PID # 015-221-37 HT,nsomvG Nov-07-01�09:159A 1. HEFTY DRILLING 3540 AKLILA DRM ANCHORAGE, ALASKA 99516 (907) 345-0593 - STATE OF AIRASFESOL DEPARTMENT OF NATURAL MINING, LAND, WATER HYDRODIC WATPR WELL LOG Drilling P.O1 CltylDorcu E: Subdivulo.JUSS:/�"" Hlak la rropnty Oww Wltkk Addra>•' q,�o,�'�' I O�t�r �/Q DEFARTMWTOFNATURALteLSOURCrd p«mtNumber, �-! Mining. Led A Wtlar Nyom*sk e+rtar SSO W 71h Ate. aeik "CA Dsk of Iswr. �l1l hS1 AerheroIMAK101034t,1577 Par0elldentf6eatlenN,satber.�_ Tatepkent (1007)1 9,- oad FAX (100'!) S61.1Sae is wen boated M onnroved aitrrnk locatinn7 n V a. `Ff I6 J Mvidan, Township Range Section Vi of % of Va of Vr tat: N Long W. NAD;210RII Cktatlmt:. BOREHOLE DATA; (trop ground surfnte) Depth Ddlllog method: 4totary,0 Cable toot Otkr Material: Type. (:clot dr wetness 1 112111 1 SD Wal sue.' 0 Pabhc apply Domestic, 01614 t Depth of hole: ( ft, Castng ukkup: ft —Caslitswo: 94. Thickness 0)3S Cuingdltmeter. (� inches Ca9dgd Lua"dl1 Diameter: Inches in4cs )31 ft I ft �S n� y�no ye,L pth: to ►14- S 7 % Static water tfromtop oressing): 1110 ftcr� Pumpctg level d<yield: het Iger boJ"at gpm Auovety n4: gpn, Method of t Sating Devebpmentmethod DuPatioa� 77 1�5 nd ` �a a re.oYl 1S SSS Well Intake opening type: 0 Open end, 0 Open hots t %Saaned; Start: R Stopped "e: • 906 stovonsh alze I lSam SS �$ tavtLr 01'erfaat43tart R Sto"M Sett: It stoppedIWA Note: R n e.14 vaoA.( 6� Croat 00,zf 34 n Ono :A, volume 1 u Depdt:ftom ft,to Pump hake depth: R I Pump au hp. Brad name: . Wu well dubdected UPCpledonT Yes, ONO I " Method ofd'uinfeettoo: L!.IO,, .Iw Drilla coo nwop/discblmrn:VL (I It D Well Driller Natna• .. Compmfty Name' EM alulNo MatartpAOCnu•. SS40 t Muni J1 c1pafityDfArich Gty 8tAt AI5VAp: Ptwm Numbdf • Of 69fit5 41 ` DlnNra Sptwturn: t !�� If(Y I,I lka a a.n' erlh:t .l114f k r� Y lee ltm orAla.te W"hio the Clty of Aneltors . it is required dm s! Jn• k• •+.n rim :4k (AX gawks 39 01.020.3LOLe3S, eat to 60 appsowlaw city offke within 60 days ,,.va02Q as.l f.OtO ale AR 1ca,IN;om It AAC 103.144 yw well log be feat tq the iYaw roputy Owrw N DEFARTMWTOFNATURALteLSOURCrd p«mtNumber, �-! Mining. Led A Wtlar Nyom*sk e+rtar SSO W 71h Ate. aeik "CA Dsk of Iswr. �l1l hS1 AerheroIMAK101034t,1577 Par0elldentf6eatlenN,satber.�_ Tatepkent (1007)1 9,- oad FAX (100'!) S61.1Sae is wen boated M onnroved aitrrnk locatinn7 n V M 30 days. well log be ar e+i0r of MUNICIPALITYOFANCHORAGE (l(t7lb( Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial 2 : o 0'0'L /: Dopm Date Issued: Oct 05, 2001 Expiration Date: Oct 05, 2002 Permit Number. SWO10421 Parcel ID: 015-221-37 Legal Description: HERITAGE HILLS BLK 5 LT 3 Design Engineer. 0007 Tobben Spurkiand, PE Site Address: 012310 TRACY RD Owner Name: Aaron T. Young Lot Size: 19800 SO. FT. Owner Address: 12310 TRACY ROAD Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE. AK 99516 - This permit is for the construction of ❑� Disposal Field E Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either. A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued Date: Date: ��/ Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Property Mailing address 0 Permit Number SWO10 71 / Day phone 3Ny- O22 6 Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size /g tOQ Acre q.Ft. Number of Bedrooms THIS APPLICATION IS FOR: ❑ Sewer Only El Only ❑ Sewer and Well Water Storage Water Sewer Upgrade THIS PROPERTY CONTAINS: � Hot Tub ❑ ❑ Jacuzzi Water Softening Unit ❑ Swimming Pool Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. V o:: " (Signature of property owner or authorized agent Permit Fees: fr 7 V40Waiver Fees: Date of Payment: q/ta%D/ Date of Payment: Receipt Number: lD 3'1� Receipt Number: (Rev. 12100) T.SP=LAM P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907)279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 3 BLOCK 5 HERITAGE HILLS Municipality of Anchorage Development Services Department On Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519 September 18, 2001 We are submitting an application for the installation of a well and septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the well and septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: Soil Rating. From Testhole 08/30/01. At 2 ft 30 min/ inch At 6 ft 120 minlinch Use Standard Mound with BioCycle No. of Bedrooms 3 Loading Rate at 2 ft 1 gsfpd Required Area per Bedroom: 150 sq.ft. Total area required: 450 sqft Bottom Rock At 1 foot Rock Depth 0.5 feet Total Bed Length 450 /15 - 30 SYSTEM CONFIGURATION BIOCYCLE STANDARD MOUND TOTAL LENGTH 30 FT TOTAL WIDTH 15 FT TOTAL DEPTH 2 FT FILTER SAND 1 FT ROCK DEPTH 0.5 FT COVER 3 FT The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. N L� VACANT r - IL-_________________________- r-- I — -- —— FLOT7 -- I I VACANT VACANT I N, I LOT 8 ISI LOT \ L17T6 I I I / 131st. Ave. ill LOT G� I I VACANT (� I I 1 1 ( m III LOT 4 I I LOT5 III I I LOT C` p 40I— III I III I 0 III LOT 3 6 III Q I I OT .2 I We 1� I I 1 1 1 0 0 QI I LOT 2 l :.:.:.:.: :::: I LOT 7 1 1 1 L� _ RII10.00y — — — — —— J L_ -- I Well III 'y' aASsA 1 1 i LOT I I m LOT 8 I I S LOT 1 00 HUFFMAN ROAD 50 0 50 109 150 AV 250 3A7�,1 SCALES I' = 100 FT. ' Tob'a n c..ml:and 'n••. C`.--:243 1• •Oji/'.•••........ ��.. V f'ii i,r Epr!G.,,,• ITOBBEN SPURKLAND P.E. I I LOT 3 BLOCK 5 HERITAGE HMS I I SEPTIC SYSTEM DESIGN I 203 W 15TH. AVENUE AARON T YOUNG DATE: SEPT. 18, 2001 ANCH. AK. 99501 ..,,......_..,.. 13216 OLD SEWAAD 1pCIfWAT SHEET: 1/3 GRID: 2737 PERMIT # SV010XXX P1D # XX M£M02031.DVG I I a-amwov sum sysrrw I NorraE 15x30 MOUND TOTAL DEPTH t roor — — - iarrRsav 1 Boor SEW ROQC .5 R COVER 3 !T I I I LOT 4 I I O I I I LOT 5 vRry s1rE 10 f --- hell RMACME.. I I � I RUN 1 I I I I LOT 2 I I I I ¢ Well I I I I O I I I I I .. :::•::� I � -- — — — —— -- — — — — � 0 Q LOT 7 -- ----- 1� Nd: E-2223 I • I I I O I I LOT 1 � o 25 so >sta0 tso S LOT 8 I I I SCALEi 1' = 50 rIl TogE UR DP.E. LOT 3 BLOCK 5 HERITAGE HW SEPTIC SYSTEM DESIGN 20.3 15TH. AVENUE AARON r YOUNG DATE: SEPT. f8,2001 ANCH. AX 99501 Luis OED SEWARD I#GHWAr SHEET. 2/3 GRID: 2737 907 279-3916 PERMIT 9 SV01OXXX PID i XX HEH02031.BVG r4= A M ASTM 301, GRADE M MAN H4X BALK FILL DISCHARGE MINIM IILN CLEAN aur STANDARD MOUND NTS ' FDMSTED GRADE AVAY TLP !N ALL DIRECTIM 4' PVC Amar m PPRDW7RY CHAMBER 0 AERAMY CHWMBER 0 CLARIFIER QDISCFi49a' CHAMBER LL ,Bnr IT TAW V' BLLOWRD MMATMV INSTALLATION L EXCAVATE A 10'x 10' x !0' DEEP ME FB? BIGCYp.E SYSTEM E PEACE A MNIMN Llr 4' SAND LR MAVEL FT1P LEVELAG CH,I.RSE 1N THC BDTMW Zr TIC EXCAVATEN CDWACT AS REVEVER 3 PLACE 4 SHEETS 1l• 2' x 8' x 2' DIRECT BUPIAL RIGID MR" MW IN TLP Lr CTW°ACMD L£VELAG CaRX TD PROTECT BDrTOV Dr FIBERGLASS TANG. TAKE EXTRA CARE TO ASSLRE THAT MUATMV CH,i.RSE IS LEVEL DV ALL RMECTEM 4. BACKFILL ARDW TAW LP M NVERr LE I' AnLCIVT AND 1414' EMLENT LDCS WTH FREE-FCDVAG NSF MTERIAL FRE£ L£ LARGE STLWS LR BLLUERS. 30' AWILR TUBE SAND/LMPAVEL BACKFILL -- -3 RR 0 •GCS Tot/ "n Snurkland ; 4%f CE 2225 ?� 10Vt1TR TUBE 8tc9 '. vas' i4�P'?Of ESS!�ti�.. TOBBEN SPURKLAND P.E. LOT 3 BLOCK 5 BERPPAGE FILLS S/D SEPTIC SYSTEM SHEMATIC 203 W 15TH. AVENUE AARON T YOUNG DATE: SEPT. 18, 2001 ANCH. AK. 99501 S FET.• 3/3 GRID: NW58 Fom) 97o—TQI 13116 OLD SEWARD HIGHWAY it PERMIT # SVOIOXXX PID # XX SVG •14 •�' Gf Iti � f•:. Municipality of Anchorage ^i� a,(CNlall`�KCItJ ir.H17♦ Development Services Department 11,��1 ° •• 1 Building Safety Division t' = On -Site Water and Wastewater Program �.°'. " """""°e"'"'•f t �.1 4700 South Bragaw SL': P.O. Box 196650 Anchorage, AK 99519-6650w •� T b�.. c., rk'and • ' ,, t wwci anchoraoe.ek.us �t - ♦ ;,ter• CL'1ti3 (907)543.7904 •� ...i Performed For: Legal Description: 4 Solis Log - Percolation Test dQ raM yd y 1rL ty ll Date Performed: �� U LU)'"•3 B k ;� —4.}Q y♦ �Mtt f t, (I�Township, Range, Section: Site Plan e &1,4 ML ENCOUNTERED? 00 Net Drop 5 IF YES, AT WHAT DEPTH? L O Depth to Water Alter Monitoring? / (J r P E Date: q/14 r o d ` q COMMENTS WAS GROUNDWATER ENCOUNTERED? 00 Net Drop 5 IF YES, AT WHAT DEPTH? L O Depth to Water Alter Monitoring? / (J r P E Date: q/14 r PERCOLATION RATE o V ImewWmh) rcm, ntno v,nmc, c.. v TEST RUN BETWEEN SFT AND ..3 FT PERFORMED BY: f . S CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Ci —71 —o' Net Time Depth to Water Net Drop RFe a—nlv EGross o °v 3t ` q PERCOLATION RATE o V ImewWmh) rcm, ntno v,nmc, c.. v TEST RUN BETWEEN SFT AND ..3 FT PERFORMED BY: f . S CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Ci —71 —o' • Performed For: 6 Legal Description: t- i 4- A COMMENTS ji•Lrc OKl'� i N41 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 N anchorage ak us (907)343.7904 Soils Log - Percolation Test gENGINEER'S SEAL). * r tT�T;4 f roti • � � t• 0 i^ • T hben Spurkland v,Y�j f� CE -2223 • �.' r i L PRDFESS`� •► �+ro y) —7�O J N C Date Performed: t 3 $K 5 li<re ie�4� �.I�Township, Range, Section: ,. Site Plan WAS GROUNDWATER Date ENCOUNTERED? Net Time Depth to Water S IF YES, AT WHAT DEPTH? L 0 Depth to Water Alter P Monitoring? E Date: Reading Date Gross Time Net Time Depth to Water Net Drop ?RE cAV, t• ft -,So 1/1ow'-MS,,-7/6l2: Ll v 70 PERCOLATION RATE /i -D (M1 e+r^U)��"" rtnt. nvLe v�...s. ER r TEST RUN BETWEEN 5 F AND rp FT PERFORMED BY: I S I T. S CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Municipality of Anchorage e 6 7 8 9. I� �3' g ro �z x On -Site Water and Wastewater Program ti V. (907) 343-7904 ?� S A F E T Y JUN TS Certificateof On -Site Systems Ap val Parcel l.D.015-221-37 Expiration n ©—� 1. GENERAL INFORMATION: Complete legal description HERITAGE HILLS; BLOCK 5 LOT 3 Location (site address) 12310 Tracy Road *Anchorage, AK 99516 Current Property owner(s) Kristen Reinbold Day phone '406-0282 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS:. 3 4. TYPE OF WATER .SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well' ® Individual Individual Water Storage', ❑ Holding Tank Community Class • . UVell ❑ , Community Public Water System' ❑ Public Sewer WaiverNariarice request for. Distance: Received by; Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5s0' D� Waiver Fee $ Date of Payment ((a s a )19 Date of Payment Receipt Number 5� `-C Receipt Number COSA# OSCI 1 0 W Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: % ey In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for J bedrooms System #2 Approved for bedrooms 0 F 4T*i ........ e .................. A. G rness. C << � G �44dprof �Of% �c ;Z_ � � #AECC884 Disapproved �\,�gATYtOFr��rri�r Conditional approval for bedrooms, with the followlulations: C',yrrr Iw,ON'SITE =' J lJ rt AND m kAM o }jj1j11)V w Original Certificate Date: 7 2 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc COSA Checklist Legal Description: HERITAGE HILLS; BLOCK 5, LOT 3 Parcel ID: 015-221-37 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 10/30/01 Total depth 231 ft Cased to 231 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 6/11/19 Static water level at beginning of test 179.0 ft. Comments B. TANK DATA Age of tank(s) 17 years Tank type/material RMGl s Measured operating fluid level in septic tank N/A FE -1 Standpipes/foundation cleanout per record drawing Date of pumping SEE BIOCYCLE MAINTENANCE REPORT D. ABSORPTION FIELD DATA Well production at time of test 5 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? j Yes Coliform bacteria is Negative Nitrate Z f R mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L[; Arsenic less than MRL (ND) Collected by GEG, LTD PVmP � Lu5-t L Date of Sample 6/11/19' C. LIFT STATION ❑ Required maintenance completed Age of lift station 17 years Lift station material FI9ERGl Comments: BIOCYCLE Which system tested (date installed) 11/5J�O 2°° 1 /111- Adequacy test date 6/11/19 © ALL standpipes present per record drawing Results M Pass For 3- bedrooms Total measured depth from grade 3+ ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade ft (min) Water added 806 gal N-1 N/A — pressurized field New depth 0 in FIC Monitor tubes go to bottom of effective. If not, state '� Elapsed time 0 min depth into effective , . FE-1Code-requiredsoil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NO date of test) Gallons introduced N/A gallons If yes, enter date N/A Comments/Deficiencies: 'P.ssuMED - BOTH MTS IN BED SET AT SAME ELEVATION - APROXIMATELY 2 INCHES SHY ON COVER AT WEST MT COSA Checklist yellow sheet 01 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ✓❑ Yes if No Community Sewer Manhole/Cleanout > 100' ❑✓ Yes if No ft ✓0 Yes if No Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25'✓❑ Yes if No Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' Q✓ Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' ❑✓ Yes if No ✓❑ Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑✓ Yes if No ft ❑✓ Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *51+ ft Surface Water > 100' ft ft ft ft ft ❑✓ 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 Water Main > 10' ✓❑ Yes if No ft Community Wells > 200'✓❑ Yes if No. Water Service Line > 10' p 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' ❑✓ Yes if No Water Service Line > 10' ✓❑ Yes if No ft Community Wells > 200' ❑✓ Yes if No Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S COMMENTS *MET CODE AT TIME OF INSTALL G. ENGINEER'S CERTIFICATION o � . • ....... '954 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with p MOA COSA guidelines in effect on this date. * 9 0......... :..... Jerness., ... E- 795 COSA Checklist yellow sheet 404�d Pro fo°°oma #AECC884 00�00�06 ft iP ft DocuSign Envelope ID: 34DD50C4-E177-4FF8-B61E-9C3FAE9A2D3B 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 Day of �� of 20 0 , by and between Franco & Ora Russ 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 12310 Tracy Road Anchorage AK 99516 located at (legal description) Heritage Hills L3 B5 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Q- 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. 44 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. 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: 34DD50C4-E177-4FF8-B61E-9C3FAE9A2D3B iOwner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknow edizes that the fine for failing:tomal-n-tam and repair ari AWWTS may -t 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. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided the -AW -W -TS v.endor/installer-and-approved-by-the_Municipality_are-the-governing __----_.---_. guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the U 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: 34DD50C4-E177-4FF8-B61E-9C3FAE9A2D36 OWNER: By: a. ! (signature) Date: G � ora (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this 't�ay of �'t�t/1st- , 2014( , by 6 VO, -r,fV-4-'aca P-0417STATE OF ALASKA 'NOTARY P FOR ALASKA NOTARY PUBLIC °t ' My Commission expires: !ii Kat Arnold My Commission Expires: August 4, 2020 MUNICIPALITY- By:— (signature) (print name) Date: 7--z 1 Title: (rev. 05/18/2018) Page 3 of 3 YCLE-Alaska ": . 2nd Quarter Inspection Renort 7n19 3705 Arctic Blvd #313 Anchorage AK 99503 Email: crbioalc@gmail.com (907) 274-0314 Homeowner Info Customer Name: Kirsten Reinhold Tank#: 117 Install Date: Oct. 2001 Address: 12310 Tracy Rd. Area. Huffman Initial Inspection: Alarms Tested: Air [V1 High Water V Battery Tested: Yes ❑ No ❑ N/A (Please make sure alarm is on "normal", not "mute") Does system have a septic tank ? No Z Yes ❑ (Recommend pumping tank every 2 years) Is System Lid Locked? Lid hardware in working order? is there any noticeable odor? Yes Repaired ❑ Yes ❑ Repaired ❑ Strong ❑ Mild ❑ None [] System Inspection Inlet plumbing in working order? Solids pillow normal? Yes Replaced ❑ Yes [✓ Requires Pumping ❑ Are all aerators functioning? Any buildup of solids? Yes 171 Replaced ❑ Yes ❑ No Clarification return system operating? Any buildup of solids? Yes ❑✓ Adjusted ❑ Yes ❑ No [✓ aiNMI'r pH Reading: Dissolved Oxygen PPM Turbidity of discharge (in FTU) (pH of 6-8 is ideal) (2-5 is ideal) (Under 35 F rU is considered compliant.) 1 s s: 4.0 11.9 . j3 NEWN�e�' t.. Pump float operating? Alarm float functioning? Any buildup of solids? Yes 0 Replaced ❑ Yes 0 Replaced ❑ Yes ❑ No Z Discharge line condition: Filter cleaned? [✓] Good Replaced ❑ Yes ❑ N/A Comments: Has emailing or mailing of form been requested? Yes ❑ No Inspected By: Chris Date: 06/05/2019 (contact office to request...) LAD SURVEYS R0. BOX 877432 WASUA AX 09687 1+807) 357$183 Existing' Powerpws Qt OHP x g y a� a g Electrical pedestal [Or* %c � 1 U19 hepactkln plat 1s made for and al: the instan-00000 Aaron T. Young. 4 Jamie k Shle+ds o Registered ce of Lend Surveyor in the State of Alaska. hereby Certifto ve the abothat I am the with y the hereon detcrAed property and that the iHArowments on thereon if, wholly within the prapsrty Knee and do not overlap onto the property Iytng adjacent thereto. that nor improvements On the property 109 Odjacent thereto encroach upon the Premises In question. end that there ore no roaawoyr (ranlmllsian Thea, or any Other risibletaeements except os Indicotsd hereon. I hwther Csrlify that this os—b uil t survey was Prepared for IdentiEeotion purposes only for the owners in connection with o building permit and is not intended ce ropresonted to be o property line e„r„+y and that no property Comers were set. �OF� 4111+t C''4 Joe9th '� 0.0 / • •.M . ��V.Cu �elh- "E A. SMELDS r +ppp Na L 1 9236 Wood a� :b ala C-3. rb rn 0 I a b NOrEl- 1. Lot dirnenelone and easementspa spawn hereon LOT2 baled 011 the recorded pbt of Hritoge Hda 2. Cosemenls. e0ve144111 or restrictions. if any. which do pat appea an the recorded plot ore not Chown hereon. 3. This 101 contains 19.400 sq it. of area. more a, less, The Iocaticn of the struCture(S) as shown ten INS retort; drawing (as-buiii).Complies with Title 21, AMC. . By: Dwte: AS- BUIL` , SURVEY LOT 3, BLOCK 5, HERITAGE HILTS (PLAT N0. 63--41. ANCHORAGE. AK) SCALE: MORTGAGOR OR OWNER: AARON T. YOUNG DRAWN BY: dAS DATE: 27 SEPT 02 DATE OF SURVEY: 10 SEPT 02 • �� Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Parcel I.D. 015-221-37 1 Certificate of On -Site Systems Approval Expiration Date: ro2-_ a2 l " �S' GENERAL INFORMATION Complete legal description Heritage Hills, Block 5, Lot 3 Location (site address) 12310 Tracy Road Anchorage, AK 99516 Current Property owner(s) Michael & Benton MaryjanowskI Day phone _ Mailing address 12310 Tracy Road Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: [j] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three 4, TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual [] Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request l�4 Recei \ed by. Date: COSA to breleased to the ngineer, unless otherwise r u ed by the engineer. COSA Fee $ S� Date of Payment 01— ti. - I S Receipt Number 62^1 D COSA# efiC15 (SZZ Waiver Fee $ _ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE System #1 Approved for —3- bedrooms System #2 Approved for bedrooms Disapproved 522-7773 Date 9/16/2015 s 49TH ; Conditional approval for bedrooms, with the following oMICHAEL E ANDERS CE -4381 1t s PROFESSt6N?� By: Original Certificate Date: q �� ^' _3S Theuni V It of orage 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 blue Sheet E , .. If more than 1 septic system is on the lot: COSA Checklist # of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Heritage Hills, Block 5, Lot 3 Parcel ID: 015-221-37 A. WELL DATA Well type Private Date completed 10/30/01 Total depth 231 ft. Date of test Static water level If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 231 ft. FROM WELL LOG 10/30/01 170 ft Well Log (Y/N) Y Wires properly protected (YIN) Y Casing height (above ground) > 18 in. AT INSPECTION 4/28/15 166 ft Well production 20 g p.m 4.0 g p m WATER SAMPLE RESULTS Coliform 0 colonies/100 mL Nitrate mg/L Arsenic uglL Date of sample: 9/16/15 Collected by: And. Engineering g --B. SEPTIC/HOLDING TANK DATA Tank Type/Material Blocycle/Fiberglass Date installed 11/5/01 Tank size 1,600 gal. Number of Compartments 4 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping Pumper See Biocycle Maintenance Records C. ABSORPTION FIELD DATA Date installed 11/5/01 Soil rating (g.p.d./ftz or ftZ/bdrm) 1.0 GPD/SF System type Bed Length 30, . ft. Width 15 ft. Gravel below pipe •5 ft. Total depth 4.8 ft. Eff. absorption area 450 ft2 Monitoring tube Y ' Depression over field N Date of adequacyaest 4/28/15 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 561 gal. New depth 0 in. Elapsed Time:; min. Final fluid depth 0 in. Absorption rate >= 450 g.P d Any rejuvenation treatment (past 12 mo.) (Y/N &type) N If yes, give date D. LIFT STATION Date installed _ "Pump on" level at Datum Size in gallons Manhole/Access (Y/N) in. "Pump off' level at in. High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot > 100' Absorption field on lot > 100' On adjacent lots >100' On adjacent lots >100' Public sewer main >75 Public sewer manhole/cleanout Sewer /septic service line >25' Holding tank >75' Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line > Water main >10' Water service line >10' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10 Building foundation >10' Water Service line >10' Surface water >100' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS Absorption field >5' _ Surface water >100' Water main N/A Driveway, parking/vehicle storage > 10' COSA brown sheet -1 0-10-1 2.doc G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in ��:•aF•'44 Q44O �• conformance with MOA COSA guidelines in effect on this date..� ,r*; 49�/ Engineer's Printed Name Michael E. Anderson P.E. •••° ••al• . • •• I ,., Date 9/16/2015 .• , MICHAEL E. ANDERSON: �j, , • CE - 4381 :a® COSA brown sheet -1 0-10-1 2.doc Municipality of Anchorage . Y Development Services Department Building Safety Division On -Site Water and Wastewater Program t s A I t r Y 4700 Elmore Road A P.O. Box AK 99 ljJ Anchorage, AK 99507 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-221-37 COSA # e) 8C / a 1 a Q 0 Expiration Date: % 0 ~ -2 0 " /=;2 1. GENERAL INFORMATION Complete legal description HERITAGE HILLS BLOCK 5 LOT 3 Location (site address) 12310 TRACY RD., ANCHORAGE, AK 99516 Current Property owner(s) DEREK BLAKE Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent MARY STEPHENS Day phone 748-5577 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual On-site (] Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Spurkland Enginneering Address 203 W. 15th Ave., Ste 202, Anchorage, AK 99501 Engineer's Printed Name Lars Spurkland 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone 279-3916 Date JULY 16, 2012 �E.OF A4�slt1 49TH 9 ��% s URKLAW." f i00 Conditional approval for bedrooms, with the following stipulations: COSA Checklist X Arsenic Advisory Septic System Advisory Well Flow Advisory Nitrate Advisory Maintenance Agreements Supplemental Engineer's Report Other By. / Original Certificate Date: 7- 9 )Re, 11105) Municipality of Anchorage 41— Development Services DepartmentBuilding Safety DivisionOn-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: NEtZsTAG6 OF_*tiT5 BLk 5 LT 5 Parcel ID: 015 - ZZt - 3 } A. WELL DATA Well type _L&LT. Date completed to W DI If A, B, or C provide PWSID # = Sanitary seal (YIN) Total depth 231 ft. Cased to 231 ft. FROM WELL LOG. Date of test 10 30 01 Static water level 110 ft. Well production 20 WATER SAMPLE RESULTS: Well Log (YM) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION .7W IZ 177 ft. g.p.m. 4,5 9— p.m- Coliform NEG colonies/l00 mL Nitrate 1.5T mg/L Arsenic: .N0 ug1L date of sample: T9 i L B. SEPTICIHOLDING TANK DATA Tank Type/MaterialBIo� [3ER GLASS Tank size IW gal. Number of Compartments ti Collected by: LA95 SPVQKLAND Date installed Iluol Cleanouts (YIN) Y Foundation cleanout (Y/N) % Depression over tank (Y/N) Al High water alarm (Y/N) Date of pumping MAINTENANCE; _ Pumper 30LYCI[L ALASKA COnTRACX C. ABSORPTION FIELD DATA Date installed 15 0 Soil rating (g.p.d.e or fetbdrm) 1,0 System type &D Length 3D ft. Width 1.5 ft. Gravel below pipe S ft. Total depth `i,� ft. Eff. absorption area4,50 ftZ Monitoring tube Y Depression over field Date of adequacy test 12 Results (Pass/Fail) PAS5 For 3 bedrooms Fluid depth inabsorption-fieldA)e)reAes" -.—�ater-added y�-gal.-----New-depthin Elapsed Time: 91 min. Final fluid depth AL in. Absorption rate >= Y5a g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date D. LIFT STATION Date installed UL51 U51 01 Size in gallons 1 b W Manhole/Access (YIN) Y "Pump ono level at 25 in. "Pump ofr level at 44_5 in. High water alarm level at in. Datum ci ACO- Rim Cycles tested 3+ Meets alarm R circuit requirements? Y E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100,+ Absorption field on lot 1 Do �+ On adjacent lots loo'+ Public sewer main NA Public sewer manhole/cleanout NA Sewer /septic service line 2.5 + Holding tank IVA Animal containment areas 5D 4 Manurelanimal excrete storage areas LO + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5 t+ Absorption field 5 t+ Water main NA Water service line lo+ Surface water l00`+ Wells on adjacent lots l00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line to Building foundation 10 f Water main NA Water Service line 101- Surface water 100 + Driveway, parkinglvehide storage 10'4, Curtain drain 5&+ (N.0) Wells on adjacent lots 10D + F. COMMENTS G. ENGINEER'S CERTIFICATION _ _ i P�� OF A 4 A 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 LAa5 SpU?,KLANI) 11 U�RKLAND.w Date 4t01 lZ �I �Fo . l(6.P1• P��' COSA Fee $ 44 o Waiver Fee $ Date of Payment "� f� ��la Date of Payment Receipt -Number .n —Receipt Number --- (Rev. 4110) - Municipality of Anchorage Development Services Department" Building Safety Division On -Site Water S Wastewater Program 4700Street Box 19 P.O. Box 196650 Anchorage, AK 99519-6650*i www.muni.org/onsite 77 (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0 Lr 2 Z I- S? COSA# O 800:Z3 1. GENERAL INFORMATION Expiration Date: 6 — 21.6-- Complete legal description HERITAGE HILLS, LOT 3. BLOCK 5 Individual On-site Individual Water Storage Location (site address) 12310 TRACY ROAD * ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address AARON YOUNG & JENNIFER SEGELHORST Day phone 360-9599 12310 TRACY ROAD • ANCHORAGE. AK 99516 Day phone Real Estate Agent BONNIE MEHNER w/PRUDENTIAL Day phone 762-2108 Mailing address 3801 CENTERPOINT DRNE #1200 • ANCHORAGE. AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (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 velfy that my investigation, based ori pro%dures outlined in the Certificate of On -Site Systems Appro4alGuidelines for this application, shows that the orf -site water supply and/or wastewater disposal system is (are) safe, functional bnd adequate for the number of bedrb5oms and type of structure indicated herein. I further verify that based on the informal4Qn ol4aireed from the Municipality of Anchorage riles and from my investigation and inspection, the on-site wa supply and/or wastewater disposal system is(are) in compliance with alt applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational fife craft wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory lost results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to moot the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confor any legal right whatsoever. 5. DSD SIGNATURE Approved for — �3 bedrooms. Disapproved. 337-6179 Date 7/2405 Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other By: �� Original Certificate Date: ' � 0 (R.. 11105) W / Municipality of Anchorage (• Development Services Department _ Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: HERITAGE HILLS, LOT 3, BLOCK 5 Parcel ID: O A. WELL DATA Well type MATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 10/30/2001 Sanitary seal (Y/N) YES Total depth 231 ft. Cased to 231 ft. FROM WELL LOG Date of lest 10/30/2001 Static water level 170 ft, Wires properly protected (YIN) YES Casing height (above ground) 24 in. AT INSPECTION 3/12/2008 169 ft. Well production 20 g.P,m. 3.25 g,p,m. WATER SAMPLE RESULTS: ColiformAte colonies/100 ml. Nitrate �• ( 89mg.1L. Other bacteria Q colonies/100 ml. w Arsenic: Mug./L. Date of sample: 3/12/2008 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA i I Tank Type/Material BIO CYCLE/FIBERGLASS Date installed 11/5/2001 Tank size 1600 gal. Number of Compartments 4 Cleanouts (YIN) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES Date of pumping — Pumper BIO CYCLE C. ABSORPTION FIELD DATA BELOW EXISTING GRAGE Date Installed 11/5/2008 Soil rating EEOor ft'/bdrm) 1_0 System type BED Length 30 ft. Width 15 ft. Gravel below pipe 0.5 ft, Total depth•3.41-4.91ft. Eff. absorption area 450 W Monitoring tube YES Depression over field NO Date of adequacy test 3/12/2008 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test DRY In. Water added 455 gal. New depth DRY in. Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >= 450+ g_p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed 11 /5/2008 "Pump on" level at 25 in. Datum BOTTOM OF TANK E. SEPARATION DISTANCES *SEE ATTACHED 810 CYCLE REPORTS Size in gallons 1600 Manhole/Access (Y/N) YES "Pump off" level at 44.5 in. High water alarm level at 22.5 in. Cycles tested " Meets alarm & circuit requirements? YES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Buildingfoundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION i certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date COSA Fee $J C7 { —7 S US t, Waiver Fee $ Date of Payment �_f S 0 Date of Payment Receipt Number 37 `I 5 6 Receipt Number (Rev. 11/05) LAND SURVEYS Aa BOX 977432 WASIUA, ACpas97 (9OT) 957.9483 I Eletlricq E, pedestal i , Power pde � S 8959' E 1 &OMP i �i�2 Story Frame Mouse µ a S 1 00 83 t 28.3 d well io $ ... m i� .LOT3 .. u I< Deck (tp) 28. — )n 88't g 1= Im u ly .� I hi 89'59" W MOrES 1. Lot dimneane end neamnte ,he. hreon LOT2 based n the reca,ded p4rl at Nrllo9e MMe 2. Caeernnts. eevennle, x reelrictlone, It any. which do not peer n Ins rstrded plat we not on... he".. 3. This lot contain, 19.600 eq It. at xp, mere x lea This hpactlon plat Is made lx and at the Instance of Axon T. Young, L Jvnle X Shletds, a ReOittor d Land Soneyer In Me Stole of Alaetq hereby tertfly to the above that I om IpmYior with the hWoon deexlbed Prprty and mal the Inlprovemnts 1"" ad thereon me .holly eimin the prprty Mae and do not averiop onto the property lying adjacent thereto, that no bnpravvnMtS W the prpPxty 109 dapcnt thereto encraacn upon the premise, In question. and that Mae, we no road.oys Vanern4dlan Thee, Of any other alslble eU,nM, eaupt an Indicated heron. I further certify that thi, orbuat survey we Prepxed to, Ienliff"tin parpoew only far the 0 w In eanneetien slth a bedding permit old is not intended Or represented to be a propNy line survey Old that no prprty aemere .ere eel. 0Lht -statin O Go ei rated F q 49th JAME A. SHIELDS Na LS 9236 Wood a fceIn to 'b O 1 A ,oy I n `^ rb ren :la csO F � I Tho location of the structures) as shown on this record drawing (as•buiit).complieS with Title 21, AMC. ar: d._ Date: T of AS -BUILT SURVEY IAT 3, BLOCK 5, HERITAGE HILLS (PLAT NO. 63-41, ANCHORAGE, AK) SCALE: MORTGAGOR OR OWNER: AARON T. YOUNG DRAWN BY: JAS DATE: 27 SEPT 02 DATE OF SURVEY: 10 SEPT 02