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HomeMy WebLinkAboutMOUNTAIN AIR ESTATES BLK 2 LT 7 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231092 PID Number: 017-211-20 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Q Upgrade Name BILYEU ABSORPTION FIELD Site Address FEW Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound 15001 MOSSBERRY PLACE ❑ other Phone Number of Bedrooms Soil Rating �Tota;l depth from original grade 3 1.5 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 3 MOUNTAIN AIR ESTATES BLK 2, LOT 7 Ft 5 Ft. Fill added above original grade Gravel length Township Range Section 0.5 Ft. 40 Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES 2.0 Ft. Ft. To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 400 Ft2 1 Ft. Well 50'+ 50'+ 50'+ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding 0 Other Manufacturer Capacity Surface Water 50'+ 50'+ ANCH TANK/ADVANTEX 1500 Gal. Material Number of compartments Lot Line 10'+ 10'+ NA PLASTIC 2 Foundation 1 0'+1 01+ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by BRICKS ELECT. PIPE MATERIAL House to tank Tank to Installer 3034 drainfield 3034 MIKE N ANDERSON, P.E. Drainfield 3034 co/MT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 101.5 ft Inspection dates: 1-t 10/25/23 2"tl 10/27/23 Location and description 3ro 4tn TOP OF ADVANTEX MANHOLE ON -SITE WATER AND WASTEWATER SECTION APPROVAL EWJ"qe%'s,Stamp Conditional Approval: Date �' • ° ...... • ........... }• MICHAEL N. AKDLRSCN! Septic System ;.•• CE- t� ,;,•, 94 9 ^ �, Approved Date 1 Z�1z E f - %��' ? �l•'<;:,° Note: this approval does not include well permit requirements. (Rev 05/02/18) Permit No. OSP231092 Page 2 of 2 Municipality 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 Description: MOUNTAIN AIR ESTATES BLOCK 2, LOT 7 MART c01 TC01 CO3 C04 M T1 0 A B 52 42 56 45 62 56 61 56 S'4- \ 62 55 63 \ I / \ 1 / Co \\ ( \ EXISTING I ®I I I \ J II \ \ \ CO3 / \ COt 1 1 I I � I � i / / ASBUILT / SCALE: 1 "=50' PID No.: 017-211-20 WELL BENCH, TOPI F MH NEW 1500 GALLON PLASTIC TANK W/ ADVANTEX POD SEPTIC SECTION WATER ® ea OCT 2023 N.T.S. ®�®tea®a®®®�® OF ............... AW ®°®® A 49 TH ®®® MICHAEL N. ANDERSON. No. CE 9469 ' �®®44®� ®®���®®® MOSSBERRY PLA CE o c> m t oamzamzo--+ z z A 0 A a 0 0 x vim �', r'-�Oym�yzm SamTmo�orT ;z' ti rm-��2i�TyA ,o ma miznc� py oC� z z;,, o� o ' :u o-nmz mm o Z zZpy,cA�-y rn n t A�pmtmi�rn Z�nO G)�A iv a �Tpm(nA v xoaoAOAo�x -�c�oym z ::u cn x p-= y n m n Ora O �m�a <bao o o z mzczi Ay�G� p y n Z r Q Z rri z Z y T O C _ u yo zomA QJ m oma"' cn w o ozorn c� —1 z oy 'xnoSM. a m rn -n m tD_ ya � Cn ZC O W O Z N0004'W211 w c 38.0 A S/NGL EFgM/� Y HOUSE 10' U7YIM'EASEMEN7 CnVERc, OECD MUNICIPALITY OF ANCHORAGE �t�lcnt On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 n hftp://www.muni.org/onsite lleparcment On -Site Wastewater Disposal System Permit Permit Number: OSP231092 Effective Date: 5/22/2023 Work Type: Septic Upgrade Expiration Date: 5/21/2024 Tax Code Number: 01721120000 Site Legal Address: MOUNTAIN AIR ESTATES BLK 2 LT 7 G: Site Mailing Address: 15001 MOSSBERRY PL, Anchorage Owner: BILYEU JOHN F JR & NANCY M Lot Size in Sq Ft: 41313 Design Engineer: FIRST WATER CONSULTING Total Bedrooms: 3 This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: 1. Ballast is required for the tank installation. k o -An additional percolation test is required prior to construction of the septic field. Please submit stamped and signed results with the As -built Inspection Report. If the results require a design change, construction of the system will stop pending On -Site review and approval. 2 \ \ I =dor �Pw CO Q r 'Ne � -, GRaK , p r yotknf� wa�"ec v✓ldn i �(7�ZK�22i .1 ,� J i, T spm U eJ -w Issued By: A G� Date: Date: a�z� MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel 1. D. 017 -211 --LC) Property owner(s) JOHN & NANCY BILYEU Day phone Mailing address 1255 BALL HOLLOW ROAD, PULASKI, TN 38478 Site address 15001 MOSSBERRY PLACE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) MOUNTAIN AIR ESTATES BLOCK 2, LOT 7 Legal description (Township, Range & Section) Lot Size 41,313 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: ([D all that apply) Absorption Field E] Initial ❑ Single Family (SF) x❑ Septic Tank 0 Upgrade (w/wo AD U) Holding Tank ❑ Renewal ❑ Duplex (D) El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: S S� Waiver Fees: Date of Payment: S./g ''�2 3 Date of Payment: Receipt Number: �' 0-P Receipt Number: Permit No. 05 C 231 d 5 z Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Oct. 15, 2023 Municipality of Anchorage Development Services Dept. On-Site Water & Wastewater Section Anchorage, Alaska 99519 Phone 343-7904 Re: Septic permit CHANGE ORDER FOR OSP 231092 Legal: MOUNTAIN AIR ESTATES BLK 2 LT 7 To Whom it may concern: This is a request for a septic CHANGE ORDER on the above referenced lot. A new test hole was performed on the above lot and found GM (silty gravels) for the entire depth of the test hole, see attached. The Advantex tank has been installed with ballast, we only needed the soil log to complete the design. The water in the test hole was monitored for 3 weeks to verify the water level was correct because the test hole from PES had water at 2 feet. Numerous test holes and a trench was excavated to verify the water table level. It appears the water level is down when you are in the front of the house but higher along the sides, this is my only explanation for such different readings. The new field was changed to a simple narrow trench due to beds don’t typically last in tighter soils. Please excuse us, the design drawings are not perfect because Brent Western was too busy to finish the project so I had to step-in for this final submittal using his plan. This new septic design will not impact any of the surrounding properties. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSX231011, Deb Wockenfuss, 10/24/23 CO #1 MIKE N ANDERSON, P.E. MOUNTAIN AIR ESTATES BLOCK 2, LOT 7 DESIGN CALCS: NO WELLS WITHIN 50' OF PROPOSED SEPTIC SYSTEM. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSX231011, Deb Wockenfuss, 10/24/23 CO #1 NO SLOPES >25% WITHIN 50' OF PROPOSED FIELD. DESIGN DETAILS: MOUNTAIN AIR ESTATES BLOCK 2, LOT 7 MIKE N ANDERSON, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSX231011, Deb Wockenfuss, 10/24/23 CO #1 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSX231011, Deb Wockenfuss, 10/24/23 CO #1 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231092, Deb Wockenfuss, 05/22/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231092, Deb Wockenfuss, 05/22/23 NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Benny L. Neves PHONE :~NEW 337-4944 []UPGRADE MAILING ADDRESS LEGAL DESCRIPTION 7132 Peck StreettAnchorage, AK Lot 7, Block 2, Mountain Air Estates LOCATION NO. OF BEDROOMS r Mossberry - Rabbit Creek Road 4 PERMIT NO, 780685 DISTANCE TO: I Well .^^ ~ I J. uu Manufacturer " Greet ILiq. capacity in gallons IF HOMEMADE DISTANCE TO: IWa'l Manu{acturor DI TA CETO: I 130' 86 Top of tile to finish grade 5 feet 6 inches ~ Width Type of crib ~ ~ell IC,~ Depth I ~ Bu,ld,ng foundat,o~ IAbsorPtion area Dwelling l0 w Material lO ~ Steel Width No. of compartments 2 Insidelength Liquid depth Dwelling PERMIT NO. Liquid capacity in gallons Material Foundation Nearest lot line 30 ' 10 ' Total length of lipes I Trench width 86' ] 36 inches PERMIT NO. 780685 Distance between lines Material beneath tile Total effective absorption area Gravel 60 inches 860 Depth PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot Pine Driller Distance to lot line PERMIT NO. Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS Plastic perforated pi.pe/C.I, connections SOIL TEST RATING 2Z0 INSTALLER H ~ M Excavatin? REMARKS APPROVED DATE LEGAL F'ERM I'T' I'.,10. I:::1P F' I.... I C FI r.,I T L or" FIT I E N L. tJ~i iii [::1L. LCT 7 8L.K 2. Mr]l lf'TT'FIIt'..I f.:lIR E'.!!!;TI::'I'T' L(]T 'ii!; I ZE ......-~' .... OF:' SOIL I::IE::'SORS'T'I(]I',4 .:,.~ .::, ......... I E.II IL:i;' 'TRENC:H PII:::I;:.::IMUM NIJMBER '.'il:::' E:E[:,R(]OM'.:'~; = 4 S 131 L. R F:I'T' I t'-4 (3 ,;' '!:: ~' !:::' T,.'" 8 R ;:' = 2 :;L (!) 'T'HE I:;.:E6!U I RE:E:, S I ;;'ZE OF: THE: '::;C I I... [::I[:.:'J:J;OF;?PT l [)N :!.:.';'.r':iTT'IEM I S · T'HE LEi",I[~i]"H E:, I MENS I ON I :i!i; ]"HIE I...EI",IG'T'H ':: t t",1 F[EiET )1 I]IF' THE 'I"RENL]:H THE [:,EI:::'TH O1::' F:I TRENCH OI7 PIT I'.:.'; THE E:'I::'~!;TFIi",ICE I!?,ETHEE]",I THE ~i;URI:::'F:ICE!: O1::: THI!E GI:;i:OUI'.4[) FIi'-,IE)THE BOTTCIM OF Tl-lE E}:;CF:I',,,'F:IT]iOI",t (It"4 F::'EIET). ]]-'IERE I?:'; NO SET HIEYT'H I:::OR 'T'RENCHE!.:;. THE GRI:::i'v'EL. [:'IEPTH ].':!ii; "rile MIhlIMUM [)EPTH OF []iRR',/E:L. BETHEI!!i]'.,! THE ['.'iUTF'i:::it..[.. 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O'T'HEI:;i: i:;?.E6:!tJ I F?.I.:.:.]"IENT~!~; Mt:::t"r' F:IF:'I:::'L.'T'. ~ii;F'EC 7[ I:"" I CI::IT t Oi",l'J~; I:::11",1[:, COI",I:!il;'T'I:;UJCT l:::l'v'l:::l I I... FI["~[..E TO I i",I:~:!;IJl;?.E: I::'R(}F'EE: I I",I:E';'TF'II....I...F:tT Z (}1",I. :[ CEI:~:TIF"r' "['HI:::I]" :1..: I i:::11"1 I:::'I::II"IIL]:F:II:;i: HITH THE RE(;!LIIR[~:~MEI",ITS i::'Oi:;?. Cff',I-':!i;]:TE !!:';IE['.IER:!~; I:::Ii",tD I.,]EL..L..:ii!; f::l':'!i; 'J:i;ET I:::'C~RTH B"r' THE MtJNICIPFIt..IT"r' OF FINCHCd:~:I::IGE. ;;:!:: I H I I_1_ I N!~!;'I"f::IL..L. THE 'J!i;"r'~;T'liii]"l I N FICCCIR[:'I:::IIq(3[E [,.I I 'T'H THE :ii:: I IJNI}ERS]'FIN[:' THI::I'I" 'I"HEi: ON'""SC[TE :!~:;E[,.IER ~;"r':~!;'T'EM Ml:::l"r' F'i:E[';!UII:E:E E},IL.I:::II:;i:GEP'tEi",I]' ]:F:' THE RE':'i.:,I[:'IEIq[:::IiE ~1::.i;.; REMO[:'EI....EE:' TI IN(]:LJJ[:'IE MOR['E 'T'HFIN 4 S I [~il'.,llEl:)' ,...~]7 .../':~,... '~'-'/"'~ ~~~~~... ,¢ . . ................... F:IPF'L I C'I::t 'bl::l" E:ENNU I ..... NE ,,, PERFORMED FOR: LEGAL DESCRIPTION: SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-222~ SOILS LOG- PERCOLATION TEST PERCOLATION TEST DATE PER FORMED: 7/~JO '/~/7 7 1 2 3 4 5 6 7 ~0 14 16 17 20 COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ ~'~'~'~/~ (minutes/inch) TEST RUN BETWEEN ~ FT AND ~ . FT 72-008 (7/76) r'~ ~ MUNIC ~PALITY OF ANCHORAGE ........... N · ~ /%, , ~-PARTMENT OF HEA~H & ENVIRONMENTAL PROTECTI(~VIR©N~[HTAL l-,s~=~cc.H~ ,~ ~ ''~ ~ / ~ I- 825 L Street - Anchorage, Alaska 99501 ~ L~ ~/ ~ ] ENVIRONMENTAL ENGINEERING DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be processed. Please altow ten (10) days for processing. 1. PROPERTY~~OWNER ~~ PHONE ~AILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHbNE MAILING ADDRESS ~. LENDING INSTITUTION ' C' ~ PHONE ' MAILING ADDRESS MAILING ADDR~ 5, LEGAL DESCRIPTION' STREET LOCATI ON 6, TYPE OF RESIDENCE J~]~"~l N G LE FAMILY [] MULTIPLE FAMILY 7? WATER SUPPLY I~'~'1NDIVI DUAL* [] COMMUNITY PUBLIC UTILITY 5. SEWAGE DISPOSAL SYSTEM ~'"~'~ DI VI D UA L,!ON-SITE** --I PUBLIC UTILITY NUMBER OF BEDROOMS [] One [] Four [] Two [] Five [] Three [] Six [] Other * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available,) If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY · DATE RECEIVED INSPECTION APPOINTMENTS TIME I TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX =ERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED~ 3. SEWAGE DISPOSAL SYSTEM PERMIT N'UMBER' [] INDIVIDUAL/ON -SITE DATE INSTALLED Connection Verified iNSTALLER, ~ __ ' i-]Septic Tank or [] Holding Tank Size: If Tank is homemade BOILS RATING give dimensions: ~ TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DiSTANCESwELL TO: Septic/Holding Tan k IAbsorption Area ISewer Line ~ Nearest Lot Line Absorption Area to nearest Lot Line ~ APPROVED FOR ~ BEDROO ~ CONDITIONAL APPROVAL (letter must accomp ~n~ certificate) ~DISAPPROVED LEGAL DESCRIPTION 72-010.I Rev. 3/78) MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MANTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this2 Day of May herein the OWNER," and the Municipality of Anchorage, herein the MUNÍCIPALITY", 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: located at (legal description) 1 Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Adante AX-20 of 20 23,by and between 15001 Mosslxcry Ancbarsg, Ak 4156 2. Maintenance, Repairs and Alterations. (rev. 05/18/2018) Mountanin Air Est\ Lot t Block2 (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 AWwWTS 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 S$600). D Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and malke 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. Page l of3 D Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. p 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. 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 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. 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 ONVNER: By: �� ����' (signature) l /Vc u-^­� A . f 6_rNjj-1 I (print name) ss. -T-HIRD-M1e1A-L DISTRICT Date: � 2- M A/ Z 3 NERAL NOTARY -State of Nebraska CELESTINA OJEDA w Em GEA My Comm. Exp. Sep. 18. 2024 ,;Fl MUNICIPALITY: BY v"V`, (signature) "l S — 0 L-- ^- S ��(print name) (rev. 05/18/2018) Date: Z_ Title: G Vi L C'" C► ► Page 3 of 3 MUNICIPALITY OF ANCHORAGE Development Services Department P p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 to/ S/ 202y Parcel I.D. 017-211-20 Certificate of On -Site Systems Approval Expiration Date: 2 Legal description MOUNTAIN AIR ESTATES BLK 2 LT 7 Site address 15001 MOSSBERRY PL Current property owner(s) JOHN & NANCY BILYEU The On -site system(s) is/are approved for bedrooms X Conditional approval for 3 bedrooms, with the following stipulations: Comments or advisories: Permit OSP231092 has been issued for a new septic tank and field. This work to be completed by June 15, 2023. L14-i S L✓ o P�tc_ C-,D lW AsF,r (Nsp 1-t-T /► A ATA Original Certificate Date: � �__2-0 2,� 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 MUHMPAUTY OF Development Services Department On -Site Water & Wastewater Section AHCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 017-211 Complete legal description MOUNTAIN AIR ESTATES BLOCK 2, LOT 7 Location (site address) 15001 MOSSBERRY PLACE, ANCHORAGE, AK 99516 Current property owner(s) JOHN & NANCY BILYEU Day phone 2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ® Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age NA - See advisory if steel older than 20 years — CONDITIONAL COSA 6. ABSORPTION FIELD: ® AWWTS ® Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: Distance: By applying for this entitlement, this property is subject to inspection by municipal On -site staff to verify the accuracy of the information provided. COSA Fee $ 9 /Z Waiver Fee $ _ Date of Payment % ��Z� Date of Payment COSA # _OS r, 2-3 1161 Waiver # COSA Application 2022.doc Legal Description: MOUNTAIN AIR ESTATES BLK 2, LOT 7 Parcel ID: 017-2311-12 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 8/23/78 Total depth 58 fl Cased to 57.9 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 5/17/23 Static water level at beginning of test 18 ft. Comments B. TANK DATA Measured operating fluid level in septic tank NA Date of pumping NEW ADVANTEX ❑ Required maintenance completed, if AWWTS Comments: NEW D. ABSORPTION FIELD DATA Which system tested (date installed) NEW ❑ ALL standpipes present per record drawing Total measured depth from grade 8.5 ft (max) Measured depth to pipe invert from grade 3.5 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated_ ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Well production at time of test 3+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes IN No ❑ Coiiform bacteria is Negative Nitrate 2.06 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date 5/17/23 C. LIFT STATION ❑ Required maintenance completed Age of lift station 0 years Lift station material PLASTIC Comments: NEW ADVANTEX Adequacy test date NEW Results ❑ Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 60 in Effective depth used 0 in Effective depth remaining 60 in Comments/Deficiencies: NEW ADVANTEX SYSTEM INSTALLED COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' * Community Sewer Manhole/Cieanout > 100' O Yes if No 5p+ ft E Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' IMIYes if No ft Absorption Field on Lot > 100' ❑ Yes if No *50'+ ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' RmYes if No ft Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No ft Surface Water > 100' ❑ Yes if No *50'+ ft Tank to Property Line > 5' Fmi] Yes if No ft Field to Property Line > 10' Q Yes if No ft Water Main > 10' Q Yes if No ft Water Service Line > 10' ❑ Yes if No *50 + ft F. ENGINEER'S COMMENTS *ADVANTEX SEPTIC SYSTEM Wells on Adjacent Lots: Private Wells > 100' ❑ Yes if No *50 + ft Community Wells > 200' 0 Yes if No ft If tank or field is under driveway comment below G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my sea[ affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on -site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm lull lei, 41 c1 --e V4Q?J Engineer's Printed Name Sv►y, 2 , COSA Checklist June 2022 Phone 727-8864 Date ! `(.. A q. ;z • tAl Cfl:UN. A4,.DLRSC':14 Ct - 94/u9 N 89 59' 40 " W 229.00 WO�ODFENCE EENHOO SHED 20.1 44.3 LI V ------------------- -------------- - ------ ------------------- -------- -------------- ------ 11 O co -WOOD FENCE Q; -RAVE oplVeWAy ------------- Q-i --------------- O .3 COVERED DECK 000ppppO OF AAC%�� c 49 TH L 77.65 SHANE A. HOLT LS -6914 AS-BUILTSURVEY 1" =30' �OrOfessiona� oma' CREEK ROAD MEN -r PH C'REEK fVo NO CORNERS SET THIS DATE 10' s To R,4361T / HEREBY CERTIFY THAT HA VE PERFORMED A SURVEY AC ss 40" F 160 27 OF THE FOLLOWING DESCRIBED PROPERTY 75 03' LOT 7 BLOCK 2 MOUNTAIN- AIRESTATES THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS ANC"ORAGERECORDING DISTRICT ALASKA, AND THAT THE NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. VIS18L E IMPROVEMENTS S/ TUA TED THEREON ARE WITHIN EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANY ENTITY NOT ON THE RECORD PLAT THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS ARE NOT SHOWN HEREON, UNLESS NOTED. EXIST OTHER THAN NOTED NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE DA LED AT A NCHOFA GEA L A SKA THIS 3 RD DAY OF PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. APRIL 2023 ANY PAVING SHOWN HEREON MAYBE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. HOL rLAND SUI?IEYING ONLY VISIBLE IMPROVEMEMS ARE SHOWN HEREON 9309 GRO IIER DRAIE ANCHOR4GE,AK 99507 15749 230-78 223-8615