HomeMy WebLinkAboutLAKE HILL ACRES #1 LT 8A05] O52-
Municipality of Anchorage
Community Development Department Page 1 of 2
On-Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP171217 PID Number: 051-052-58 ❑✓ New ❑ Upgrade
Name:
MIDNIGHT SUN CONSTRUCTION ABSORPTION FIELD
Address ❑✓ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
22528 OLD GLENN HIGHWAY, CHUGIAK AK 99567 ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
3 0•6GPD/SF 13.0 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 5.0 Ft. 8.0 Ft.
LAKE HILL ACRES#1 8A Fill added above original grade Gravel length
Township Range Section 0.0 Ft. 50.0 Ft.
Gravel width Beds: Number of Lines Distance between lines
SEPARATION DISTANCES 2.5Ft. NA NA Ft.
To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches
From
Tank Field Lift Station Tank Line 800 Ft2 1 N/A Ft.
Well 114.1 121.3 NA N/A 25+ TANK El Septic ❑S.T.E.P. ❑Holding CI Other
Manufacturer Capacity
Surface Water 100+ 100+ NA N/A Anchorage Tank 1000Gal.
Material Number of compartments
Lot Line 29.8 10.0 NA N/A STEEL 3
NA
Foundation 11.9 14.3 NA N/A LIFT STATION
Manufacturer Capacity
Curtain Drain 50+ 50+ NA N/A Gal.
Pump on level at Pump off level at High water alarm at
Remarks
in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 Tank t3034
IInstaller drainfield
WHITTERS Drainfield 3034 CO/MT 3034
Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 95ft
Inspection 5t Location and description
1
dates: 8/24/17 2 8/25/17
3d 41h
Bottom Trim
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
Conditional Approval: Date
I
OF At'Q ik!
.`' •s�17 i
-,417.. •....
e
t,• CE 8149
Approve V`n ( G 4
Date-1 - 5- e
% i2cJ .
li; Esgo><��4
Inspection Report_1-1-12.doc
DESIGN PARAMETERS �/ li
PRIMARY SEPTIC SYSTEM / / \
NO. BEDROOM: 3(450 gpd) / / / '�`
'TANK SIZE: 1000g // / / A'1', ,t
PERC RATE: 19 MPI / / / �'*"#** /
SOIL RATING: 0.6 GPD/SF /////WELL (E) 3 / wy� ** �'�i •�/
AREA ROD: 750 SF / \ / / /
SYS. TYPE: DEEP TRENCH 8.0'ED / / ) / ` / ! /
MIN LENGTH: 46.9 LF � / / TRUE NORTH SCALE :1"= 50'
USED: / • 7 - / /
\ l
50.OLFx2.5'Wx8.0' E.D., 13.0' TDA S.PTIC AREA (E) ' //
NOTAL AREA: 800 SF _ \N
/
/
RESERVE SEPTIC SYSTEM(NIC) / I
NO. BEDROOM: 3(450 gpd) 4
TANK SIZE: 1250g ADVANTEX 121.3 APPROXIMATE LOCATION OF
/PERC RATE: 19.0 MPI ! 1 14.1 . SEPTIC AREA (E)
SOIL RATING: 4.0 GPD/SF / NOT ENCOUNTERED DURING SOILS INVESTIGATION
AREA RQD: 112.5 SF if O ( O' IF ENCOUNTERED DURING INSTALLATION
SYS. TYPE: DEEP TRENCH 0.5'ED ' .• TH-1 4 /6 REMOVE ANY PART WITHIN 10' OF DRAIN FIELD (
MIN LENGTH: 22.5 LF ` rI`�� AND REPLACE WITH CLEAN FILL N
/USE: lW 41 �/� RESERVE ABSORPTION AREA (NIC)
22.5LFx5.0'Wx0.5' E.D., 5.5' TD 0� , 10.0 BASED ON AWWTS
TOTAL AREA:.1 112.5 SF + 0 22.5LFx5.O'WxQ,�ll_E.D.,5.5'T.D.
WELL E LOT 8A i °�wo, PRIMARY DRAIN FIELD (�P)N
150.6 �� /� / 5OLF x 2.5'W x 8.O'ED x 13.O'TO
/ / '_, // / INSTALLED MONITOR TUBE AND CLEAN OUT
__7k, - 1 0 "%L ,'!� . /
AT EACH END
1000g SEPTIC TANK ( / F�'qy / a AD
INSTALLED FOUNDATION CLEAN OUT AND ( ( yam \ A B
INSTALLED DOUBLE CLEAN OUT AFTER N / �-2' C--- FC 8.2 6.0
'L/ r r /, , Ti 15.5 13.8•
J _ �2 \) 12 20.4 19.4
1 i c")--/ / / / DCO 22.4 21.4
• / / Cl 39.8 45.3
/1 3. / �/ 1
& / \ M1 40.4 45.8
7 / / SEPTIC AREA (E) C2 54.6 46.5
�\ / / DECOMMISSIONED PER CODE 08/03/17 M2 54.2 46.4 r
/ / I /
2
25
<.. 0O <ZO 0 , w
?g < mZ ? r
D kRAIN :. K
2" Ll d Sd ° o ABOVE PIPE INV Cr
_ O.C.EL.94.0 o 6
- 0 " 0 (RAIN PIP 0 0
4.0 I_ R FA:RI O.G.EL.92.0
OR 91.0
•• • 1000 g SEPTIC :•.4
TANK(N)
:7.0 I I :7.I
8.0 CW/
PROFILE DRAIN ROCK
SCALE 1"=10'
I50.0 I NO GR TER
8 9 17
NOTES: PANNONE ENG SVC, LLC Date
RECORD DRAWING P.O. BOX 102954 ANCHORAGE, A99510 ••• 02/20/18
PHONE (907) 272-8218 FAX (907) 272-8211 �.•• •, Scale
*,49 1. i` •�* 1.. = 50'
•• •••• P.I.D. NO
- LAKE HILL ACRES #1 L8A 1•' ' . 1-052-58
DRAWN JRL MIDNIGHT SUN CONSTRUCTION LLC , •Haven 12. Pannone PERMIT NO.
22528 OLD GLENN HIGHWAY VE 8149 oSP171217
SITE PLAN CHUGIAK, AK 99567 •...•••• Sheet
I 2 OF 2
._0,....____ .F MUNICIPALITY OF ANCHORAGE n,enr
On-Site Water &Wastewater Program moo' Ste"
E •
1r PO Box 196650 4700 Elmore Road .1,` t
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
tK http://www.muni.org/onsite Q -- r
I epartment
44,CH00.0.6t
On-Site Wastewater Disposal System Permit
Permit Number: OSP171217 Effective Date: 8/10/2017
Work Type: Septic Initial Expiration Date: 8/10/2018
Tax Code Number: 05105258000
Site Legal Address: LAKE HILL ACRES#1 LT 8A G:1561
Site Mailing Address: 22528 OLD GLENN HWY, Chugiak
Owner: MIDNIGHT SUN CONSTRUCTION LLC Lot Size in Sq Ft: 25500
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3
This permit is for the construction of:
I 1 Disposal Field I1 Septic Tank ❑ Holding Tank ❑ Privy Cl 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
n
Received By: 10a l/, a \. I i I , Date: I�/, •
Issued By: 2QJJC4.A C Date: Fr 1D 0201
at s s
MUNICIPALITY OF ANCHORAGE
I • ,— ` -114`4„'7.--
t':. .
Community Development Department ,: � ' Pho - sr :--'
Development Services Division 'i" , tib'
On-Site Water& Wastewater Program 1 i'. W i V\•l
ala
AA.LJ 09 2017
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-052-58 • _, :cii., . ''`
Property owner(s) Midnight Sun Construction LLC Day phone
Mailing address 22750 McManus Drive, Chugiak, AK 99567
Site address 22528 Old Glenn Highway
Legal description (Sub'd., Block & Lot) Lake Hill AcreetLot 8A
Legal description (Township, Range & Section)
Lot Size 25,500 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field E Initial N Single Family (SF) ❑X
(w/wo ADU)
Septic Tank 0 Upgrade ❑ Duplex (D) ❑
Holding Tank ❑ Renewal ❑
Multiple Dwellings ❑
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / 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: 49704) Waiver Fees:
Date of Payment: '/d1/i9'
, I Date of Payment:
Receipt Number: �� 6(p101 4 Receipt Number:
//��
Permit No. i 7 P/11747 Waiver No.
Permit App_:-:-:L.,:c
Pannone Engineering Services ac
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail:steve@panengak.com
August 10, 2017
Subject: Lake Hill Acres #1, Lot 8A
Septic System Permit Request
Design Narrative
This is a design narrative for a permit to install a septic system to be issued for this property. The
proposed system will serve a proposed three (3) bedroom house. Currently the lot has a decommissioned
septic system and an existing well. The trailer that previously existed on the lot has been removed. The
system will utilize a new 1000g septic tank and conventional drain field. This lot and the surrounding lots
are served by private wells. There are no wells within 100' of the proposed septic system.
1. Soils. One test hole was performed in the vicinity of this system by PES in August 2017, and
groundwater was monitored for at least seven days. Ground water was not observed to a depth of 19'
below the surface in the test hole monitor tube in August of 2017. Bedrock was not encountered in
the test hole to 19'. Based on the results of the percolation tests and overall soils appearance; an
application rate of 0.6 gallons/day/square was used for a conventional wastewater system in the area
of the test hole.
2. Soil Absorption System Design.
a. See Sheet 1 of the design package.
3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field.
The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage
ditches.
t3sJ
4. Topography: The existing topography on the lot generally slopes from northemet to southwest,�
with a slope of approximately 10% in the area of the drain field. The road cut slop adjacent to the Old
Glenn Highway is approximately 4' high and the top of the lateral pipe is lower than the toe , so there is
no confilct. The proposed drain field will maintain 50' separation all steep slopes.
5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that
the review is complete and that there are no further comments is received from MoA On-Site
Department, the note will be removed and "Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of this or the surrounding lots.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
/ \
�i
. 7 WELL (E) \ ,
7 ,
•1/ SEPTIC AREA (E) R
! ..,:li
LS/ .
.7 <c.�� \ •`\ A4 APPROXIMATE LOCATION OF
�4,�J" SEPTIC AREA (E)
TH-1 NOT ENCOUNTERED DURING SOILS INVESTIGATION
/h �, Ir
• IF ENCOUNTERED DURING INSTALLATION
\ 76.0•�REMOVE ANY PART WITHIN 10' OF DRAIN FIELD (P)
/./,/
W10 70d AND REPLACE WITH CLEAN FILL
y
L (E) , PRIMARY/ RESERVE DRAIN FIELD (P)
LOT 8A� �S9` `, y 5OLF x 2.5'W x 8.0'ED x 13.0'TD
1(/ y INSTALL MONITOR TUBE AND CLEAN OUT
•muir1' • AT EACH END
�Ci 1000g SEPTIC TANK (P)
....) •
\ _ N—INSTALL FOUNDATION CLEAN OUT AND
44/
INSTALL DOUBLE CLEAN OUT AFTER
(:)v
\//
/ -....,....4 .
\// SEPTIC AREA (E)
1 /-- DECOMMISSIONED PER CODE 08/03/17
V SEPTIC AREA (E)
DESIGN PARAMETERS
PRIMARY SEPTIC SYSTEM
NO. BEDROOM: 3 (450 gpd) LEGEND
TANK SIZE: 1,000g w WATER LINE/
PERC RATE: 19 MPI WELL RADIUS ABBREVIATIONS
SOIL RATING: 0.6 GPD/SF TH TEST HOLE
AREA ROD: 750 SF SS NEW SEPTIC
SYS. TYPE: DEEP TRENCH: 8.0'ED (P) PROPOSED
MIN LENGTH: 46.9 LF — — _GB_ — — GRADE BREAK (E) EXISTING
CO CLEAN OUT NO.
USE: MT MONITOR TUBE NO.
5OLFx2.5'Wx8.0' E.D., 13.0' TD 0 0 RETAINING WALLTYp TYPICAL
TOTAL AREA: 800 SF
NOTES: r>�� �\ Date
PANNONE ENG SVC, LLC 4 of.,��1� 8/10/2017
FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, A99510 '�F'•'''.''•'46;4�
PHONE (907) 272-8218 FAX (907) 272-8211 co.• �� ,,t Scale
DRAWN BY: *; 4 • 1 1"=50'
/••' 1� I P.I.D. NO
DRM LAKE HILL ACRES V1, LOT 8A � *51-052-58
MIDNIGHT SUN CONSTRUCTION LLC j teveri 15o orae . PERMIT NO.
r - . CE 8149 .•�?� 05P171217
22528 OLD GLENN HIGHWAY t♦� �s •• 4�
PLAN CHUGIAK, AK 99567 Ik, �OFESSI•'.c.‘ '''� Sheet
1NNN"__,� 1 OF 3
SOILS LOG - PERCOLATION TEST
TEST HOLE 1 v++
SLOPE - SITLAN
OR ORGANICS \ y�
1
TH-1 I
2 IV
3 '''----.,_,.\______
W
4
5 LOT 8A;
6 x
SILTY GRAVEL TH
7
GM/GW TO GRAVEL 063%q�
8 - 'Z'i
9 l mac'
11 , 4/ Ov
O"
12 1 / /7 /
13
WAS GROUND WATER SLOPE
14 ENCOUNTERED? N
15 IF YES,AT WHAT TH
DEPTH? -DRY
16 x
17 DEPTH TO WATER AFTER
MONITORING? -DRY
18 DATE: 8/9/17
WATER
19 BOH READING DATE CLOCK
NET TIME LEVEL NET DROP
READING
20 1 8/3/17 8:55 --- 5.30 ---
2 9:25 _ 30 MIN 6.95 1.65
DATE PERFORMED:813/17 3 9:25 5.30 ---
4 9:55 _ 30 MIN 6.90 1.60
5 9:55 --- 5.30 ---
6 10:25 30 MIN 6.88 1.58
PEROLATION RATE 19(min/inch)PERC HOLE DIAMETER 6 inches
TEST RUN BETWEEN 5 FT AND 6 FT
COMMENTS:Test hole excavated by WHITTERS EXCAVATION
PERFORMED BY: Dan Moran. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE
AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST.
NOTES: _���«v\ Dote
PANNONE ENG SVC, LLC q���� Date8/100,
FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 't� •qS ik
PHONE (907) 272-8218 FAX (907) 272-8211 Aoco.• �,�''�y+� Scale
DRAWN BY: *; TH .3 N‘ •*00 NTS
DRM il•• • ? P.I.D. NO
LAKE HILL ACRES #1, LOT 8A • / 051-052-58
MIDNIGHT SUN CONSTRUCTION LLC i vee nnorae PERMIT NO.
22528 OLD GLENN HIGHWAY l�� qJ. CE 8149 �/ OSP171217
SOILS LOG CHUGIAK, AK 99567 �4`ipmr0''t 411' Sheet
`�NNON. �� 2 OF 3
—
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65 AND 15.55.
2. SCOPE OF WORK: INSTALL NEW TANK AND DRAIN FIELD.
3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 19.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE
SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 19.0 FEET
BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY.
4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC
LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED
SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK.
5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED.
6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES.
7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING
AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER.
8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE
CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN.
9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE
ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND
TANK ELEVATIONS.
10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF
EXCAVATION, TOP OF PIPE WITH CLEAN—OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING.
11. THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE
PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE
ENGINEER (OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN
DEFECTS BY THE CONTRACTOR.
12. THE CONTRACTOR SHALL SIGN THE FOLLOWING:
I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE
ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS
CONSTRUCTED.
CONTRACTOR:
BY: . TITLE:
DATE:
NOTES: PANNONE ENG SVC, LLC �oF q NNl Dote
FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 „''L 4si1 8/10/2017
PHONE (907) 272-8218 FAX (907) 272-8211 /o).P �G.';r00 Scale
DRAWN BY: — ". �. �; •• • P.I.D.NTS
DRM ` 051-052-58
LAKE HILL ACRES #1, LOT 8A � Ste 'R Pannone'
MIDNIGHT SUN CONSTRUCTION LLC . / PERMIT NO.
0�T CE 8149 ��/ OSP171217
22528 OLD GLENN HIGHWAY � � •.
DESIGN DETAILS CHUGIAK, AK 99567 ,1��o/ OFES510�P`= Sheet
.3
��\\N�2�
NA~E
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
FHONE .~NEW
LEGAL DESCRIPTION
Well 1
DISTANCE TO: /~
Manufacturer
IF HOMEMADE:
Abs°rpti°~e~.~ F
I'q nside length
Well
Dwelling
DISTANCE TO:
Manufacturer
Foundation
DISTANCE TO:
No. of lines
Length of
Top of tile to finish grade
Length
Width
Total length of lines j
Material beneath tile
Depth
Type of crib Crib diameter Crib depth
Well
Building foundation
DISTANCE TO:
Depth Driller
Buildin9 foundation Sewer line
DISTANCE TO:
Dwelling
M at ~,~.~.~
W dth
Material
Nearest lot line._~
I Trench w~th~:2~ inches
,~_ ~../ II inches
/O, OF BEDRO-(~MS.~
PERMITNO~'/~)3 ! ~
No, of compartments
Liquid depth
PERMIT NQ,
Liquid capacity in gallons
PERMIT NO.
Distance between lines
Total effective absorption area
PERMIT NO,
Total effective absorption area
Nearest otline
Distance to lot line
Sept c tank
PERMIT NO.
Absorption area(s)
OTHER
PIPE
MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
APPROVED
DATE
LEGAL
F'ERMI T NO.
HF .- L I _.HNT
LOCBTI ON
LEGBL
DEPBRTMENT/ ~HEBLTH BND ENVIRONMENTBL ]TECTION
825 '"L'" STREET, BNCHORBGE., BK.
264-4720
MR. FORD SRR BOX 9EIgO CHUGIRK
CILD GLENN ] ~
LOT '9 LRKE N!LL SLIB l~¢l
LOT
T"r'PE OF SOIL RBSORF"rlON SYSTEM IS: TRENCH
MB::-(IMLtM NJMBEF.' OF BEDROOMS
SOIL RB] IN= (S]-! FT,."'BR)= 1._,=,
THE REQUIF.:ED _,I,~.E OF THE '=,FilL flESRRPTION =,T=TEM IS:
THE LENGTH DIMENSION I-~; THE L. ENGTH (IN FEET) OF THE TRENCH OR DRBINFIELD.
]'HE DEPTH OF F1 TRENCH OR PIT IS THE DISTBNCE 8ETHEEN THE SURFBCE OF THE
GROUND RND THE BOTTOM OF THE E;:.:',CB',,,'RTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRFt'¢EL BETHEEN THE OUTFBL. L PIPE
RND THE BOTTOM OF 'THE E',:.::CBVBTION (IN FEET).
. EF. MIT BPPLIRBNT HRS THE F.E_,F_N_IE, ILIT~' TEl INFORM THIS [.',EF'BRTMENT [:,IJRING THE
IN::,FEUTTLN_-, OF RN"r' HELLS H. E3HUENT TO THIS FF..UFEF..r'-r RND THE
TNSTFtLLRTt]N ..... I ......... ' ' ""
NI..IMBER CiE RESIDENCES THRT THE [,.IEEE [,JILL SER',,,'E.
BRCI<FILLING OF BN'¢ S'.r'STEM I.,.IITHOLIT FINBL INSPECTION Bf.,ID BF'F'ROVBL BY THIS
DEPRRTMENT [,JILL BE :,UE,._EL.T TO PROSECUTION.
MINIMUM DISTRNCE BETHEEN B HEEL FIND RN'¢ ON-SITE ':;EHRGE DISPOSBL S'¢STEM IS
±E~C~ FEE]' FOR R PRI',,,'RTE .WELL OR :L5C~ TO 2F~R FEET FROM B PUBLIC HEEL DEPENDING
UPON THE TYPE OF PUBLIC [,JELL.
MINIMUM DISTFINE'.E FROM R PRI',/BTE HELL TO R PRIVRTE SEHER LINE IS 25 FEET RND
TO ta COMMUNITY SEHER LINE IS 75 FEET.
OTHER REQUIREMENTS MB¥ BPPLY. SPECIFICRTIONS RND CONSTRUCTION DIBGRRMS BRE
R'¢FtILRBLE TO INSURE PROPER INSTFtLLBTION.
F-. E =. [:, E C: E i"1 E: E R _.- t .,, :t 9 '=' 1
I C:ERTIFN' THRT
'1: I BM FRMILIBR HITH THE F.:EC~t.IIF.:EMENTS FOR CN-SITE _,EHEF.'._, RN[:, LfELES RS SET
FORTH B'¢ THE/MI_INICIF'RL IT'¢ OF RNC:HORRGE. ,
2: I HILL IP~TRLL THE S'¢STEM IN RI]:IZ:OR[:,RNC:E HITH THE CODES.
]:: I I_IN[:,ERST~N[:, T~THE ON~IT~ SEHER. S'T'$TEM MR'T' REQLIIRE ENLRRGEMENT IF THE
RESIDENCE I~REMCI~,EL~D TO ~NCLI~)E MCIRE THRN ~: BEDROCIMS.
,
I SSIJED .___C R TE~_L~ .....
12-
13
14
15
16
187
1")
20 'l
;~ERFORM ED FOR:
SLO ~E' r
WA~ GROU ND WATER
ENCOUNTERED? ., ,~,~{~_
IF YES, AT WHAT
DEPTH? _
Gross ~ i Net ' , Del~th~o ', · Ne{ .;~;;:~
Reading Date Time-' I ;Time Water · . Drop ?!!' [!
' '~" ' ;- ~c': ': ' · ~:~'L'
_ 'D; /xv , . i ' /,/a" ',""3"/,,,
.' ; ~. · i ' ~.~' '. '.' ' ' - ' ¢~'J
PER LATION RATE . , (minute~/inch)
TEST RUN BETWEEN ~( · FT AND - ' :' ~ ~T ' , ;:-, ..t, - ' ., :7,'.,~:.:-
COMMENTS ~.'~ ~/-r' (~ .-..,i./ ¢ ,~ , '',-1'" ..... '.' ' · . ' · .': ..',.. : /' '.-;,:~¢j
PERF"RMEI BY _~. )]~:,,'~ C:RTtFIED BY: ~Z " ¢" DATE: ~;-:.Z-.{"'~ij. , .'
<~::~;~/:':*~-=,:'~2~ ~:,-:~ 4 ,,: --~ --; ': V.O. BOX 272, CHUGIAK, ALASKA 99567
OWNER_OE LAND. ~/7 I:','~?;:-:~ ~ ~..:-~: :.- :: :~,'~- *~.-:.~ ~: :7: DEPTH OF WELL
ADDRESS ,' .~O I :'" '~; .~ ~ ~ ~-?.:-~ ~:¢~:~':'~;:? ~ ~O~:~;~,?:g~AT1c''LEVE~''~''~b&
LEGAL DESCRI~ION~~;~:: ......... c -:"- '? n~ z, ;~: DRAW DOWN
PE~IT NUMBER ............ -- :::::. KIND OF CASING
KIND OF FORMATION · .: ~-~<~,~; :,:: ~; ~ = ~ .::-~ :..c:?'~::::~,? .-.::?' '-'-~'::?:~
..... t.t , . Ft._ . : . - ,-'.,~' ......- _
From .~; Ft to ~ ~ Ft "~/¢ ~ f = "0 ~ ' ~ ' ~':L~::.~. F~?:
From · Ft. to -~ Ft.- ~ ~C~ ~- :.':' ' .- ': -?. From
From ~- Ft. to ~ 7 Ft. ~P~M~ ~ ~.~c~r~ ~-"'Ft. to .... Ft. · :",.: ~,~.: .,. :. ::" ~'. ...'.~. ~ ....
- ff~;.~' ~ .... From -' ' Ft. to ' - - Ft..' ~ :.:'~'~-'~:. ," :;~ .... *;:~:'-:~' '
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from et. to ~'t ............. .; From
. . o r. ............. :..~_ From - ·
GAAB-HD-I
GI~-'~TER ANCHORAGE AREA BOROI'~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
MAILING
ADDRESS ,_~.//~/-') ~'~.'"~=~'/// PHONE
LEGAL DESCRIPTION ~ ~_~/Z~Z~- ~--~'~/
DISTANCE FROM WELL
LIQUID CAPACITY
GALLONS.
NUMBER OF
MATERIAL -.~'.-~'-'~'~='- COMPARTM. ENIS
INSIDE LENGTH /~SIDE WIDTH.
LIQUID
DEPTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
SEEPAGE PIT:
OUTSIDE DIAMETER
OR / '
. , LENGTH ~.~.~' , DEPTH
DISTANCE FROM WELL _/~/,~.,,~- , BUILDING FOUNDATION'~'~/)- w W
~ SQ. FT.
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
TILE DRAIN FIELD:
DISTANCE FROM WELL FOUNDATION , NEAREST LOT LINE
NUMBER OF LINES //~CE BETWEEN LINES
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
, OF LINES
IN. TOTAL E~:FECTIVE
DEPTH OF FILTER MATERIAL BENEATH TIL~:
IN. ABOVE TILE.--
WELL: TYPE/'2/~f'.~. ,~//-~-~-~J~)EPTH /'"'/ DISTANCE=ROM
, BUILDING FOUNDATION.
LOT LINE ~ NEAREST SEPTIC
,SEWER LINE ~, TANK ~, SEEPAGEsYsTEM
WATER
~¢ AMPLE
CESSPOOL
NEARES1
OTHER
SOURCES
DISTANCES:
DIAGRAM OF SYSTEM
GREATEL ANCHORAGE AREA. ~)ROUGH
HEALTH DEPARTMENT
327 Eagle St. Anchorage, Alaska 99501 279-2511
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
RES DENCE ADDR SS .,~"/t~ U~.n~"Jt~-~-J'' ~J~_,/~/'~) ATION ..... . --. -, -
APPLICATION~O I~STALL: SEPTIC TANK ~ ,SEEPA"EPIT ~ ,DRAIN FIEL~ -,OTHER
FINANCED THROUGH TO BE INSTALLEB BY 3nF~~ ZV~'~O
~ "~ . j
PERCOLATION TEST RESULTS ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
TH,SlSTDSERVEAB ''Lc ,PERM,TTO,NS ALLA
AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED
DISTANCES:
Health Authority
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordh~ance No. 28-68 and that the
above described system is in accordance with said code.
Feet Soil Cha~,~cl;eP~S '-icg
~oo~ ~ok con~em~
u Water Encxount e~ed?~D~
Net Drop
!
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: (907)343-7904
On -Site Water & Wastewater Section Fax: (907)343-7997
Certificate of On -Site Systems Approval
OSC241489
Parcel ID 051 -052-58 Expiration Date
Legal description LAKE HILL ACRES #1 LT 8A
Site address 22530 OLD GLENN HWY
Current property owner(s) CLOVEN LAURA E
X The On-site system(s) is/are approved for 3 bedrooms
By:
Conditional approval for bedrooms, with the following stipulations:
Comments or conditions:
No comments
Original Certificate Date:
11/21/2025
12/11/2024
This Ceirtificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
sdsfem(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage,
evelopment Service Department (DSD) issues COSAs based upon representations provided by an
independent professional engineer. The Municipality of Anchorage is not responsible for errors or
omissions in the professional engineer's submittal.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
p p
On -Site Water & Wastewater Section \ —� Fax: 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 051-0
Complete legal description LAKE HILL ACRES #1 LOT 8A
Location (site address) 22530 OLD GLENN HIGHWAY, CHUGIAK, ALASKA 99567
Current property owner(s) LAURA E GLOVEN 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 7 - See advisory if steel older than 20 years
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 $-5-50 Waiver Fee $
Date of Payment I I �,2(-/
COSA # 6)5G 2y t l Sq
Date of Payment
Waiver #
COSA Application.doc
COSA Checklist.docx
COSA Checklist
Legal Description: LAKE HILLS ACRES #1 LOT 8A Parcel ID: 051-052-58
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 5/1981 Total depth 188’ 7” ft
Cased to 188 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 28 in.
Date of flow test for COSA 11/21/24
Static water level at beginning of test 155 ft.
Well production at time of test 4.3 gpm
Water storage tank volume NONE gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 0.881 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 11/21/24
Comments __________________________________________________________________________________
B. TANK DATA
Measured operating fluid level in septic tank 49”
Date of pumping 11/21/24
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 8/25/17
ALL standpipes present per record drawing
Total measured depth from existing grade 12.9 ft (max)
Measured depth to pipe invert from grade 5.6 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective. (ED)
If not, state depth into effective 6.8 ft
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
Adequacy test date 11/21/24
Results Pass
Fluid depth prior to test 39 in
Water added 460 gal
New fluid depth 50 in
Elapsed time 1440 min
Final fluid depth 39 in
Absorption rate 450 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 96 in (MOA 8’ ED)
Effective depth used 53 in (Missing ED + Final Fluid Depth)
Effective depth (ED) remaining 43 in
Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots,
visual observations, MOA records & appears approximate with 1.2’ or 14”of ED missing – not measurable.
COSA Checklist.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 12/03/2024
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
12/03/24
EPLAIJS
• f 4
• t t
Municipality of Anchorage °
On-Site Water and Wastewater Program
(907)343-7904 s� ,
Certificate of On-Site Systems Approval ,p�
Parcel I.D. 051-052-58 Expiration Date: ) 2-- I V `(.
1. GENERAL INFORMATION
Complete legal description Lake Hill Acres #1 Lot 8A
Location (site address) 22528 Old Glenn Hwy
Current Property owner(s) Midnight Sun Construction, LLC Day phone
Mailing address PO Box 210994 Anchorage, AK 99521
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 Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
1
Received b 1 ' �` Date: g i1 2 J'
COSA to be released to the engineer,unless otherwi e reque d by the en•meet. TT
COSA Fee $ `tO Waiver Fee $
Date of Payment "G 11-1i/€, Date of Payment
Receipt Number /� 69 -610-Q0� Receipt Number
COSA# 06C IV/116e, 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.
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe 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 life of all wells and septic systems depend on the local soil
condition,ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system.The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 745-8200
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R Pannone Date 8/30/2018
6. DSD SIGNATURE ••` `. //////./^.y✓//��� /
3 1 l\
System #1 Approved for bedrooms "��j�• S3even k.'•annone •
1.• CE-8149 .
System#2 Approved for bedrooms 4 4'•. ,..
Disapproved ���l\A�p�5g4N� '
Conditional approval for bedrooms, with the following stipulations:
•
l'3"PND
\v O\1\1 1\-1E1 c:
r—r
By: —"\-- =/ Original Certificate Date: D ��
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 Slate 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 sneet r
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Lake Hill Acres #1 Lot 8A Parcel ID:051-052-58
A. WELL DATA
Well type Private If A, B,or C provide PWSID# Well Log(Y/N) Y
Date completed 5/1981 Sanitary seal (Y/N) Y Wires properly protected(Y/N) Y
Total depth 188.6 ft. Cased to 188 ft. Casing height(above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 5/1981 2/20/2018
Static water level 162 ft 168.5 ft
Well production 11 .7 gpm 4.6 g p m
WATER SAMPLE RESULTS:
Coliform t 2.C\ colonies/100 mL Nitrate A:\(a mg/L
Arsenic N ) ug/L Date of sample: 8/24/2018 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 8/24/2017
Tank size 1000 gal. Number of Compartments 2 Cleanouts(Y/N) Y
Foundation cleanout(YIN) Y Depression over tank(Y/N) N High water alarm (Y/N) N/A
Date of pumping NEW Pumper N/A
C. ABSORPTION FIELD DATA
Date installed 8/24/2017 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.6 GPD/SF System type Deep Trench
Length 50 ft. Width 2.5 ft. Gravel below pipe 8 ft.
Total depth 13 ft. Eff. absorption area 800 ft2 Monitoring tube Y Depression over field N
Date of adequacy test NEW Results(Pass/Fail) For bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
N
Any rejuvenation treatment(past 12 mo.)(Y/N& type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access(YIN)
"Pump on"level at in. "Pump off'level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10+ Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 1 00+ Driveway,parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
.'- 0..f lIcl-q ()11 1 I e
G. ENGINEER'S CERTIFICATION QIP AC\\k
ki
I certify that I have determined through field inspections and ..,A''�'S. `4�•.1.;,fi
review of Municipal records that the above systems are in O• .:'.• /\ *!♦O
conformance with MOA COSA guidelines in effect on this date. /••• q• 7.
Engineer's Printed Name Steven Pannone ":S}eier;W.'•anriorie:.d
•
Date 8/30/2018 4 1:,.... CE-8149 A
kl Aoiissia�11/4 1"
COSA canary sheet_2-6-15.doc
5<01a9 /0 77
, •
b l ;^ , . A
•, Municipality of Anchorage a i-U 1 1s `°
On-Site Water and Wastewater Program < ii/%O
(907) 343-7904 tea, fi .��4,
Certificate of On-Site Systems Approval
Parcel I.D.
051-052-58 Expiration Date: _1 CI 2
1. GENERAL INFORMATION
Complete legal description Lake Hill Acres #1 Lot 8A
Location (site address) 22528 Old Glenn Hwy
Current Property owner(s) Midnight Sun Construction, LLC Day phone
Mailing address PO Box 210994 Anchorage, AK 99521
Real Estate Agent Day phone
2. TYPE OF DWELLING:
D 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 0 Individual 0
Individual Water Storage LI Holding Tank Cl
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Waiver/Variance request for: Distance:
Received b • )_ _A k�,t..1s .: _ !rte. Date:
31.42,4)___
COSA to be released o the engineer,unless otherwise reque.ted by e engineer.
COSA Fee $ a(I$ ,5.b Waiver Fee $
Date of Payment x.01 rS Date of Payment
Receipt Number Di'513 6 Receipt Number
COSA# (350?i()62- 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.
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations.The reported results describe 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 life of all wells and septic systems depend on the local soil
condition,ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 2/20/2018
Ak
�*co•P � �
� '
490TH
6. DSD SIGNATURE ..
System#1 Approved for 3 bedrooms �- .uno._•.
Steven R. Pannone•
System #2 Approved for bedrooms rr#tGj•• CE-8149 401
�r
Disapproved �� ,q�q SS.01
Conditional approval for bedrooms, with the following stipulations:
\•s\f OF ANL'
\AQP y��9
- = ON-S11>_
WATER AND
a WAoz•
AP
,
l
Original Certificate Date: 3 / S�'-�
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS: •
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
•
COSA blue sheet_f .
If more than 1 septic system is on the lot:
COSA Checklist# 1 of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description:
Lake Hill Acres #1 Lot 8A Parcel ID:051-052-58
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 5/1981 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 188.6 ft. Cased to 188 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test
5/1981 2/20/2018
Static water level
162 ft 168.5 ft.
4.6
Well production 11 .7 g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform NEG colonies/100 mL Nitrate 2.17 mg/L
2/19/2018 Collected b PES
Arsenic ND ug/L Date of sample: Y:
B. SEPTIC/HOLDING TANK DATA
Septic/Steel Date installed 8/24/2017
Tank Type/Material
Tank size 1000 gal. Number of Compartments 2 Cleanouts(Y/N) Y
Foundation cleanout(Y/N) Y Depression over tank (Y/N) N N/A
High water alarm (Y/N)
NEW Pumper N/A
Date of pumping
C. ABSORPTION FIELD DATA
8/24/2017 Deep Trench
Date installed Soil rating (g.p. ./ftzorz . D/SF S stem tYP
e
Length 50 ft. Width 2.5 ft. Gravel below pipe 8 ft.
Total depth 13 ft. Eff. absorption area 800 ft2 Monitoring tube Y Depression over field N
Date of adequacy test NEW Results(Pass/Fail) For bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
N
Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 1 00+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10+ Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION '4„,-NNN Va
I certify that I have determined through field inspections and r*. '� !+t
review of Municipal records that the above systems are in 0* ' TH ,. *0?
conformance with MOA COSA guidelines in effect on this date. /••• •• • ' •• .....
Engineer's Printed Name Steven Pannone - ....t even '.'Pannone
Date 2/20/2018 4 fig., CE-8149
Ik‘‘,4,0et.... 1.-
COSA canary sheet_2-6-15.doc
/ /
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/ /
/
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WIRE & WOODEN FENCE
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PLOT PLAN AS BUILT X SCALE 1• = 40' GRID NW 1561 Project No. 17-262/85
11500 Daryl Avenue, Anchorage. Alaska 99515-3049
Lang & Associates , inc . (907) 522-6476 Phone QoOOOp�
(907) 522-4625 Fax '=77:70F A C°N
Professional Land Surveyors kenOlangsurvey.com
jonathanOlangsurvey.com G" . '. ' S Q
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I hereby certify that I have surveyed the following described property: 0).'' 49TH I' 7D
LOT 8A. LAKE HILL ACRES SUBDIVISION, FiRST ADDITION (PLAT 81-216) e' ' * DA
Anchorage Recording District, Alaska, and that the improvements situated thereon are a VA
within the property lines and do not encroach onto the property adjacent thereto, that Q _ / 1 Q
no improvements on the property lying adjacent thereto encroach on the surveyed VO 134, •. KENN i ' G� o
premises and that there are no roadways, transmission lines or other visible O� 1 `$ Q�
easements on said property except as indicated hereon. J
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Dated this the 'i';..,� Day of • • • at Anchorage, Alaska OQ pRo J�o
QOSSIONAk o
It is the responsibility of the owner to determine the existence of any easements, D4OO000�
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963