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BLUEBERRY HILL BLK 3 LT 2
Onsite File Blueberry Hill Block 3 Lot 2 #050-202-03 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211209 PID Number: 050-202-03 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name BRUCE & EVELYN SINGLEY ABSORPTION FIELD - ADVANTEX ❑ Deep Trench ® Wide Trench ❑ Bed ❑ Mound Site Address 22123 BROWNIE DRIVE, EAGLE RIVER ❑ Other Phone Number o f Bedrooms Soil Rating Total depth from original grade 3 3 GPD/SF 6 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2 Ft. Gravel depth beneath pipe 4 Ft. Subdivision Block Lot BLUEBERRY HILL 3 2 Fill added above original grade VARIES 0.8-0.9 Ft. Gravel length 15 Ft. Township Range Section Gravel width 5 Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 150 Ft' 1 -- Ft. Well 50'+ 50'+ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ® Other ADVANTEX Manufacturer ORENCO / ANCH. TANK Capacity 1500 Gal. Surface Water 50'+ 50'+ Material Number of compartments Lot Line 10'+ 10'+ NA POLY -COATED STEEL 2 Foundation 10'+ 10'+ LIFT STATION — PUMP BASIN Manufacturer ORENCO Capacity 68 Gal. Remarks CAT III SYSTEM Alarm location BACKROOM Electrical installed by PLC Installer NORTHERN EXCAVATION PIPE MATERIAL House to tank 3034 Tandra n k to 3034 Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspdea{ sn 1s' 8/25/21 2nd 8/26/21 Location and description 3`d 9/7/21 4" 9/7/2021 BOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional 4, OFll�� Approval: Date ��Q.,.•' .t�,�. meg,• *: 49 2 ....�:* Septic System A rove - , �. • Curtis Huffman •: 289/021 ��� �c�s� ' Date • .C10 •' pROFESSI�N�` '~' Note: this approval does not include well permit requirements. _/D, nc1n011 o\ PID: 050-202-03 PERMIT. OSP211209 A—C=45.0' B—C=14,0' A—D=50.4' B—D=21.9' A—E=52.8' B—E=25.6' A—F=51.5' B—F=45.9' A—G=37.6' B—G=37.5' A—H=36.0' B—H=39 2' AX20 POD MH a MH Ir PPONY—C�OATED 2.00 2. ADVANTEX PUMP BASIN W/ DIVERTER TO NEW & EXISTING FIELDS BLUEBERRY HILL B3, L2 PREPARED FOR: BRUCE & EVELYN SINGLEY 22123 BROWNIE DRIVE EAGLE RIVER, AK 99577 FIRST WATER CONSULTING 13030 Sues Way DATE: Anchorage, Alaska 99516 DRAWN: (907)350-9566 SCALE: FirstWaterAK©gmail.com ,I r r I ITI I IT\ CO MT CO MT 101.01 FINAL GRADE 101.11 100.21 TH21-1 FILTER FABRIC ORIGINAL GRADE f do INSULATION ORG/OL 1' E94.21 98.21 GM sm WER ROCK / 94.21 /77 NO GRND.WTR. 6/8/21 SEPTIC SECTION 14' SCALEI NTS 86.21 BOH SUPPORT®SERVICES: OF A.4�' 9- T11* H c 10/8/2021tis Huffman KGL CE 1289910 FWCS 10/8/21 1" = 30'ssioK�' :t 6 PLOT PLAN _-- AS BUILT _X_ SCALE _ 1__ 60__ GRID _ NW 0058Project No. 21-288f_A2_... 9,. Associates, 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 & Lana S S o c i a t e S inc. C® (907) 522-6476 Phone �' ' (907) 522-4625 Fax Professional Land Surveyors ken*langsurvey.com OF jonathon0longsurvey.com �`� ' �s49Q I hereby certify that I have surveyed the following described property: LOT 2, BLOCK 3, BLUEBERRY HILL SUBDIVISION (PLAT No. 66-84) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this they __ Day of __ ©c--- - - ---, -- Z , at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. '* 49TH y( KENNET LAN o �Q�'s,�� •• i �c'� r�Z .i •' J�G LS -3202. o AECC963 MUNICIPALITY OF ANCHORAGE On -Site water & wastewater Program .. ni Po Dox 198650 4700 Elmore Road ,� Anchorage, Alaska 9951 M650 Phone: (907) 343-7904 Fax: (907) 343-7997 hltp:llwww.muni.orgronsile •ar n o . r.ac On -Site Wastewater Disposal System Permit Permit Number: OSP211209 Effective Date: Work Type: Septic Upgrade Tax Code NurnlUer: 05020203000 Site Legal Address. BLUEBERRY HILL BLK S LT 2 G:0058 Site Mailing Address: 22'f23 BR0WNIE (]R,- EagreRiver Owner: SINGLEY BRUCE C & EVELYN Q Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Q Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy Expiration Date: trt0nr. d ilkA O Moll n cpai�i'rLii3crst m 611712021 611712022 Lot Size in Sq Ft; 69696 Total Bedrooms: ❑ Private Well ❑ Water Storage All construction shall he 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 requlres inspections rluinng the installation. The engineer shall polity the Develuprnerit Services Department per AMC 15-65_ Provide notification by calling (907) 343-7904 (24)1}. 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: — 12 ft x 12 ft deck shown on survey will likely need to be removed in order to install the proposed AdvanTex tank and pump vault. If homeowner desires to put deck back, code required separation between tank and deck supports shall be provided. In addition, adequate access to the AdvanTex manway risers, treatment pod and pump It shall be provided. Received By: Issued By 1 __u 5/18/2021 Date: r Date: luncipalty ®f Anchorae- P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997 http:llwww.muni.org/Onsite Development Services ®epalttment On -Site Water and Wastewater Section ,n.cnt S, ,o llc��artment H x x x x VARIANCE/WAIVER REVIEW x x* x Waiver#: OSV211037 COSA#: Permit#-. OSP211209 PID#: 050-202-03 Legal Description: Blueberry Hill Block 3 Lot 2 Engineer: First Water Consulting Applicant: Bruce & Evelyn Singley Your request for a waiver of the required 35 feet horizontal separation from the absorption field to the excessive slope has been approved. The approved separation distance is 30.0 feet. In addition, your request for a waiver of the required 16 feet horizontal separation from the proposed absorption field to the existing absorption field has been approved. The approved separation distance is 13.0 feet. See engineer's waiver request for justifications. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ■ .................... ■ a a M Z Z N M .... ■ s t.■ s .... ■ t t t N .................. 0 M N Z N N 0 M 0 0 1 Waiver is Granted: X Waiver is not Granted: 1 Date: �o T `� �0 1 Approved by: kq _ca v Name of Reviewer **** VARIAN C E/WAIVER REVIEW **** MUMMPALITY OF Development Services Department On -Site Water & Wastewater Section - Parcel I.D. 050-202-03 ON-SITE SEPTIC/WELL PERMIT APPLICATION Property owner(s) BRUCE & EVELYN SINGLEY Day phone _ Mailing address 22123 BROWNIE DRIVE, EAGLE RIVER, AK 99577 Site address 22123 BROWNIE DRIVE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) BLUEBERRY HILL B3, L2 Legal description (Township, Range & Section) Lot Size 69,696 Sq. Ft. Number of Bedrooms 3 Phone: 907-343-7904 Fax. 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank Z Upgrade Duplex ❑ (D) Holding Tank ❑ Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: bra -u-\ U +o SA 5 1proeDSCA LAIU1 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: *!meq Date of Payment: q Oa Receipt Number: R-0 Permit No. O�SP2 1 ]2�a Waiver Fees: a 5 Date of Payment: loI �� aoal Receipt Number: "i a0 a Waiver No. O SV a 11 O 31 GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com June 10, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: BLUEBERRY HILL BLOCK 3, LOT 2 The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install one shallow trench and a 1500-gallon deep burial Advantex tank / system to serve the existing 3-bedroom residence. The design is based on the recent test hole conducted. No groundwater was observed at test hole excavation or monitoring. The slopes are moderate at 3-8% at the proposed upgrade location. However, steep slopes in excess of 35% are 30 from the proposed field. We are requesting waivers to the slope and proposed field of 30 and 13 between the proposed and existing fields with this submittal. Granting of these waivers are justifiable as follows: no indication of day lighting is or has been observed from the existing trench which is closer to the top of slope, the silty material adds additional filtration and prevents interaction between the 2 fields and the slope, the field would become saturated and fail prior to any interaction or other issues due to the type of soils and there is additional adequate public health and safety protection / mitigation with the Advantex system which is monitored and maintained. This is a very problematic lot restrained by slope, extremely small useable area, retaining walls, deep elevation at the foundation cleanout, access, The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211209, Rebecca Carroll, 06/17/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211209, Rebecca Carroll, 06/17/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211209, Rebecca Carroll, 06/17/21 4661 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL : BLUEBERRY HILL B3, L2 PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6/8/2021 DEPTH FEET OG SOILS 1 ORG/OL 2 3 4 5 6 7 8 9 10 GM/sm 11 w/ boulders 12 13 14 15 BOH 16 17 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 6/2/21 10 min 6 3 10/16 6 3 9/16 6 3 10/16 6 3 8/16 6 3 9/16 6 3 9/16 PERCOLATION RATE 3 (MIN / INCH) TEST RUN BEWTWEEN 3 & 4 FT PERC HOLE DIAMETER 6 PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 6/8/2021 TESTHOLE # 21-1 DATE PERFORMED: 6/1/21 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: BRUCE & EVELYN SINGLEY 6/8/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211209, Rebecca Carroll, 06/17/21 A 6 PLOT PLAN ___ AS BUILT _X_ SCALE _ 1= __ 60__ GRID _ NW 0058__ Project No. ____ 21 Lang & Associates, inc. 11500 Daryl Avenue, Anchorage, Alaska (907) 522-6476 Phone 99515-3049 Professional Land Surveyors (907) 592-46y5 Fax kenOlan surve com 000ppp�O o OF'���04 C jonothanOlongsurvey.com O�� ..' A .1�<�h I hereby certify that I have surveyed the following described properly: 0 49- LOT 2, BLOCK 3, BLUEBERRY HILL SUBDIVISION (PLAT No. 66-84) 0 * TH �* Anchorage Recording District, Alaska, and that the Improvements situated thereon are""""•""' '•• '"••"• within the property lines and do not encroach onto the property adjacent thereto, that Q no Improvements on the property lying adjacent thereto encroach on the surveyed �" '1; KENNETH GLAN . premises and that there are no roadways, transmission lines or other visible �O c o easements on said property except as Indicated hereon. Dated this the _ ��L :�_-------_ P '•.LS -5..... I yJp Day of ___ �� _ �"Z.�_, at Anchorage, Alaska Q OpQ'"••�'•" Noo 40n,OFfSSIONAL �o It is the responsibility of the owner to determine the existence of any easements, �"up00o� covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 /~~~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAl.. PROTECTION ENVIRONMENTAl. ENGINEERING DIVISION 825 t. Street - Anchorage. Alaska 99501 Telephone 264-4720 - ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELl. INSPECTION REPORT NAM ~'~0~. ,P_HONE '~NEW LOCATIO~. ~~ ~ ~ NO' OF BEDROOMS DISTANCE TO: I ~~ O0 I Xbs°rp~ea Dwelli~ g*~ PER~~~ ~Z~' Manufacturor~~ Mater'~~ ~o. of~partmonts ~ Liq' cap/~b~al' °ns IF HOMEMADE: Inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in gallons ,oun p/g Neare?~t~i PERMIT ~= DISTANCE TO: tOOt n~ N~ ~ No. of lines Len Trenc~th Distanc lines [ Vine Total ~ lines ~ ~ inches ~ ~ ~ Top of tile, to~is~ grade Material beneath tile ' ~' 2.,c.h :: Total e~orption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS so~ ~S~.A~Nffl I ' REMARKS I DATE LEGAL PERMII.' NO. FIF'F'L. I C:t::tNT [':,ONFILD I.'HOMPSON L. OCFIT I ON BROktl..,! I E DR L. EGFIL. L2B."~; BL. UEBERR'¢ HILL. [:,E:F'F:IRTMEI.'4T HEFIL_I.'H FII.',IE:, EI.',I',,,' I F.:EU'.,IHE!'.,F['FI[ .... :OTEC:T I .", .... E';".'.5 ~ '" STREE:T., FqI'.,IC:HORFIGE., Flk: 1. ir]~ 2:64 - 4, 7 ::2:0 It..dt ~£ L_ IL F'~ IP-JI IE:::,, ":2~ ?"J! ..... ~--.,. ;]:.' -I1'"' EEC PO BOX "L::l. 5 E.F.:. ' 69,4--2025 L. OT SIZE 44.000 SQUFIF. tE FEET T'T'PE OF SO I L.. FIBSORF'T I ON S'Y'..":!;TEf"t 1:5: TRENCH MR';'-','I{'"IUI'4 NUMBER OF' BE:[:,ROOP1S = SOIL F.'.FITING ,::'E;Q FT,.."BR>= i50 THE R:Er;!U :[ RED SIZE OF THE SOIL. RBSC~RPTION S'¢STEM IS: THE LENGTH D I M[.".']'.4S I ON I S 'T'HE L..EI.4GTH ,.': I f',l FEET ;', OF "['HE TRENCH OR [:,RR t NF' I ELD. THE [':,EF'TH OF Fl TRENC:N OR P]:T tS THE D IS'TRNCE BETklEEN THE SURFFICE OF' ]"FIE: GROUN['..', RN[:, THE BOTTOM OF'" THE: E::':',CR',,;FIT]:OI.',I ,:.'IN FEE1''.'.',. THERE IS I.',tO SET I.,.IIB, TH FOF.: TRENCHE'-:;. THE GRFIVEL. D, EF'I.'H IS THE MI'NIMUM [:,EP-t"H OF GRFIVEL F.;ETklEEI.',I THE OLITFRLL. PIPE FINE.'., 'TI"~E BOTI.'OM OF' THE EXCFI'.,,'FI'T.'ION ,:.' IN FEET::,. PERI"IIT RF'PL. ICFII..,tT HRS THE RESF'ONSIE:ILIT'¢ -r'o INFORM 'THIS DEPRRTMEI.-,IT DUF.'.:ENG THE ]:NSTFII...LF!]'ION INSPECTION'::; OF RNY WELLS R[:,JFICENT 'FEi I.'HIS F'F.:OF'EF. FI"'Y F~N[:, THE NUME.'ER OF RES i[:,EI,'~C:EIi~ T'HRT ]"HE klELL WILL SERVE. ........... 1-L..9 C{ ,:::: GT'_' .':, ::[: l{"dl.".E'; F" [-% CZ: T'::E C~ ~'-,t .".E:.; F:~ IR EZC E~." E:CU L.It "It:: BRCKF l LL I NG OF' FII.4'¢ S'¢STEM t,.I I TF-!FHJT F I NRL I NSF'ECT I O1'.,I FIND FIF'F'RO',,,'FIL. B'T' TH I S [':,EF:'RF.:TP'IEI,.~.T WILL. BE SUBJECT TO PROSECUTION. M I N I MUhl D I S"FFINCE BETWEEN Fl klEL.i. FIN[-', FINY ON-S I TE SEt,.IFtGE [:, I SF'OSI-.-~L SYSTEM I S 1OO F'EET F'OR FI PRI',,,'FITE !,.IELL. OR ::1..50 TO 200 FEET FROM R PLIBLIE: NEL. L [:,EPEI,.,t.r;,ING UPON THE 'T'¢PE OF F'UBLIC P.IELL. MINIMUM [:,ISTRNCE FROt',I FI PRI',,,'taTE WELL TO Ft PRI'¢FITE '..SEWER LINE tS ;25 FEET FIN[:, TO R COMMUNIT'¢ SE::I.,.IEF.: LINE :[E; T'"5 FEET. I,,,!EL.J_ L. OGS RRE F.'.E].i:!UIRED RPI[:, MUST BE RETLJRNE[:, TO 'THE E:,EPFIRTMENT W,~'THII.4 .7:0 DR'YS OF' THE 1.4Et_L COMPLETIOI'.4. OTHER REQLliF,::E]'"!ENT'..S MFl"r' RF'PL.'¢. SF'ECIFIC:FtTIONS .FIND CONSTRUCTION D.f. FIGRFIMS FIRE RVR].'L.F~BLE TO !I",ISURE PROF'ER INSTRL. L. FITION I C: E R T I F"r' "F H FI T fL.: I 8t"t 1~-8MtLtF{F.: I.'.tlTH THE REQU:[RE:MEI"4TE; FOR ON-E;ITE SENE:RS FINB, t,,IELLS FiS E;ET FORTH B"r' THE MUI'4 :[ C ! F'I:~L. I T¥ OF F~I",IC:HOF. tFIGE 2: t kllL. L. INSTI=I[_L THE SVS"f'EI'"I IN RCCOF.'.DFtNCE klITH THE CODE:S. '2:: i UNDEF.'.SI.'FIND THFtT 'THE ON-SITE SEWER S"r'E;TEM P1FI'T' REC!UIRE ENLFIRGEMEI..,r'f' .]:F THE RESIDEI.qCE ]:S REMODELED TO INCL. UDE MORE THRI.-,I :.7..': BEDROOMS. SOl LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 SITE PLAN 10 11 12 13 14 15 WAS GROUND WATER ~ / lVO ENCOUNTERED? IF YES, AT WHAT DEPTH? 16 17 18 19 20 COMMENTS Robert Gross Net Depth to Net Reading Date Time Time Water Drop 72-008 (6/79) PERCOLATION RATE TEST RUN BETWEEN CERTIFIED B' (minutes/inch) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological ~ Geophysical Surveys Orllling Permit No. A.D.L. Ne. LOCATION OF WELL (Pleole complele either I% la or lc./ .......... Street Address end Area of Well Location ... Fief Below 4. WELL DEPTH: ( fl~el) ~. DATE OF COMPLETION ~. WELL LO8 Surface ~ff. Materiel T~pm Top Bottom diem. ~ In. to .~. ft. Olpfh Weight ~lbl./ff. dtom. In. fo . ft. Depth Sllckup ~ _ If. 9. FINISH OF- WELL: , ~ Set between ff. end ft. Backfilling ' gravel pack Equipment used: ,~. ~ II. PUMPING LEVEL below land lurface and YIELD .... ~ ~' ff. after hrs. pumping ..g'P'm' , . }'~: Municipailty o~ Ancnora le ~s. PUMP= (If available) HP - This w~ll wes ~r.i'll~nd~my,jv~lsdlctlon end Ibis ceport Is true to fha beet of my knowledge end be~le ~ Signed.~. --/ ¢/-- zed ~ent~tlve . ~ribution: WHITE'Stole D~S~ PINK-Dritler~ CANARY-Customer M U N U P ,t UT ll OF- /` it V C H 0 \`--jJ E Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-202-03 Legal description BLUEBERRY HILL BLK 3 LT 2 Site address 22123 BROWNIE DR Eagle River AK Current property owner(s) BACIGALUPI Expiration Date: Z I X The On -site system(s) is/are approved for 3 bedrooms Conditional approval for Comments or advisories: bedrooms, with the following stipulations: Original Certificate Date: 12/27/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval June 2022 MUHMPAUTY OF AHCHORAGE Development Services Department f� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-202-03 Complete legal description Blueberry Hill Block 3 Lot 2 Location (Site address) 22123 Brownie Drive, Eagle River, AK 99577 Current property owner(s) Jayye Baclgalupl Day phone 2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: X 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 2yrS - 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 $ Waiver Fee $,�� Date of Payment 2- 7i(J 23 Date of Payment COSH # Waiver # COSA Application —June 2022 i Legal Description: Blueberry Hill Block 3 Lot 2 Parcel ID: 050-202-03 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) Well production at time of test 2•0 gpm Date drilled 1014/84 Total depth 205 ft Water storage tank volume N/A gallons Cased to Unspec'd ft Well disinfected for coliform test? ❑ Yes ❑ No ❑ Sanitary seal is functioning correctly ❑ Coliform bacteria is Negative ❑ Wires are properly protected Nitrate 4.21 mg/L ❑ Nitrate less than MRL (ND) Casing height (above ground) 12 in. Arsenic ug/L ❑ Arsenic less than MRL (ND) Date of flow test for COSA 11/27/23 Collected by Forge Engineering Static water level at beginning of test 79.9 ft. Date 11 /27/2023 Comments Well casing is in manhole in the driveway, drain confirmed to be working B. TANK DATA C. LIFT STATION Measured operating fluid level in septic tank N/A ❑ Required maintenance completed Date of pumping Age of lift station 2 years ❑ Required maintenance completed, if AWWTS Lift station material Steel Comments: Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 9/7/2021 0 ALL standpipes present per record drawing Total measured depth from grade 7.6 ft (max) Measured depth to pipe invert from grade 3A 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 N/A gallons N/A date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Comments/Deficien COSA Checklist June 2022 Adequacy test date 11 /27/2023 Results ❑ Pass Fluid depth prior to test 0 in Water added 543 gal New fluid depth 1 in Elapsed time 184 min Final fluid depth 0 in Absorption rate >450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 48 in Effective depth used 0 in Effective depth remaining 48 in 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/Cleanout > 100' Yes if No ft 0 Yes if No Neighboring Tank > 100' ❑o Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No Absorption Field on Lot > 100' FE-1 Yes if No ft Holding Tank > 100' W Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft Q Yes if No ❑ 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' 0 Yes if No ft Surface Water > 100' ❑- Yes if No Tank to Property Line > 5' M Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑® Yes if No ft Private Wells > 100' ❑® Yes if No Water Main > 10' M Yes if No ft Community Wells > 200' ❑® Yes if No Water Service Line > 10' M Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS ft ft ft ft ft ft ft ft 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. Naive of Firm Forge Engineering Phone (907) 522-7773 Engineer's Printed Naive Benjamin Schiller, P.E. Date 12/26/2023 COSA Checklist —June 2022 A1.q�1�� .. ......... Benja ' chiller CE 12592 QFQ p • ... • • P�F, , �� ROFESSO -•®. III 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 i 3 Day of D6C80 6tQ, of 20 A3 , by and between herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Advantex located at (legal description) , Blueberry Hill Block 3 Lot 2 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and 'initial each section) 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 perfonning as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. eO 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 I of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. IN 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. 6J! Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. /-tom Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing Ca 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 OWNER: By: (signature) Date: 1Z 1z oz 3 (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this 13 day of 20 Z3, by ���- pZ e� tips S-i-r1,_e_ Z-W b J NOTC y��,lY PUBLIC FOR ALASKA My Commission expires: o (o l2ln /Zo z,-+ MUNiCIP ITS: By: (signature) (print name) "Official Seal Nola�y ll u€ lie I B. Wilson State of Alasi a Commission Number 230626003 Exp: 0612612027 Date: 2 2 20 ZJ Title: C ( yr c— G fv C dt- (rev. 05/18/2018) Page 3 of 3 463 413 E ■■■ ■ moons ■■■ ■■ soon ■ ■■ ■E■ ■ llili� IN ■ ■■moo■ ■ on ■ ■ ■ on ■ ■■■ on ■■■■■ ■■on■ ■ ■E■m■■ ■ ■ o �dvanTex® Field Maintenance Report AnchorageTank Annual Inspection 907-272-3543 Operator Property Owner/Tracking # Jayye Robin Bacigalupi A+ Home Services Tech Contact Phone Site Address 22123 Brownie Drive, Eagle River AK 99577 (503) 939-1415 AX Site ID # County ID # � Pod # RTU #/UL # Date of Last Inspection 436633 RTU145001 10/17/2022 AX-153851 OSP211209 Retrieve O&M Info Daily flow Recirc ratio Timer settings: Perform Field Sampling/Observations NTU ((11,55± NTUs) pH (6-9) DO (2-6) .) `3, L_( Odor of Sample Typical [Musty ❑ Earthy ❑ Moldy Non -typical ❑ Sulfide ❑ Cabbage ❑ Decay Oily film in PVU ❑ Yes No Foam in tank ❑ Yes No Check Control Panel Recirc Amps Discharge Amps Audible and visual alarms WOK Dial tone (telemetry only) ❑ Yes ❑ No Inspect/Clean Pump System Inspect Clean Riser/Lid ..................... Splice Box .................... Float Cords ................... Floats ........................ Pump........................ Filter Biotube® .................. Measure Sludge/Scum cI..AL Scum 1 st Compartment Current Previous Current` Previous 2nd Compartment Current Previous Current Previous 7_' ` Inspect/Clean AdvanTex Filter Odor:// Normal ❑ Pungent Biomat: Normal ❑ Excessive Bridging/Ponding: (,None/Minor ❑ Excessive Inspect/Clean Discharge Pump System Inspect Riser/Lid Splice Box Float cords Inspect Clean Laterals/Orifices Pod Bottom Intake VentLPQ Inspect Clean Floats Pump Inspect/Service Other System Components Inspect Clean Inspect Clean Disinfection Equipment ❑ ❑ Dispersal Laterals/Orifices ❑ ❑ Observations Additional Services Rendered Cleaned textile sheets? ❑ Replaced UV items? ❑ Replaced/Used other items? Parts Used: W = Warranty, B = Billable (✓ appropriate selection) 'Al a I+om Numher Description Final/Safety Inspection [RSV reinstalled Z Lids bolted on Manifold reconnected; flush valves closed AControl panel reactivated Biotube Pump Vault ............ Summary/Recommendations Recirculating Splitter Valve....... XSSystem performing; no further action needed El Tank needs pumping iA ❑ Call for service❑Other? Comments5 � sD do V, Signature Date Fax completed form to 1-866-384-7404 MUNICIPALITY F ANCHORAGE Development Services Department ~ " ` Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-202-03 1. GENERAL INFORMATION Expiration Date: 2 - r ` 2-0 V Complete legal description BLUEBERRY HILL BLOCK 3, LOT 2 Location (site address) 22123 BROWNIE DRIVE, EAGLE RIVER, AK 99577 Current property owner(s) BRUCE & EVELYN SINGLEY Day phone Mailing address Real estate agent 22123 BROWNIE DRIVE, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well - ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number COSA # OS Date: 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 10/08/2021 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 •�ii l` well and septic system. Therefore, any estimate of how long a system will function satisfactory ��P• • • . ;1 for current or future occupants or guarantee that no unseen encroachments, deficiencies or g•'• •.9 �� discrepancies exist can be given by First Water Consulting & FWC5 / 7H .. ........ 6. DSD SIGNATURE • • . "' • ' •'" • • Curtis Huffman System #1 Approved for bedrooms 000�'631 •. CE 128991 0''� ��y'•.10/0812a'F�.� System #2 Approved for bedrooms l�`F�PROFESSIO _ Disapproved Conditional approval for bedrooms, with the following stipulations: c c, e r9S l� re S F_ 01, iER ASD z / FNT SER` ..�%��, Original Certificate Date: �— 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 L9101411ASIM-ro� Legal Description: BLUEBERRY HILL BLOCK 3 LOT 2 Parcel ID: 050-202-03 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Well production at time of test 2+ gpm Date drilled 10/4/1984 Water storage tank volume_ gallons Total depth 205 ft Well disinfected for coliform test? ❑ Yes ® No Cased to 40+ ft ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate 2.84 mg/L ❑ Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) *12 in. Collected by FWrS Date of flow test for COSA 5/12/2021 `— Static water level at beginning of test 79 ft. Date of Sample 5/12/21 & 6/1/2021 Comments *Casing height in well pit with manhole cover & visible daylight drain. Well in middle of driveway. B. TANK DATA Age of tank(s) *NEW TANK years Tank type/material ADVANTEX / STEEL Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping * D. ABSORPTION FIELD DATA – **NEW FIELD Which system tested (date installed) ** ® ALL standpipes present per record drawing Total measured depth from grade 6.9 ft (max) Measured depth to pipe invert from grade 2.9 ft (min) ❑ N/A – pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: NEW SYSTEM WITH PUMP BASIN Adequacy test date ** Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min ® Code -required soil cover over field W/ INSULATION Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date FW,C Comments/Deficiencies: �;,. 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' If absorption field is under driveway comment below ® Yes if No ft ® 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' ® Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ® Yes if No ft 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 ft Surface Water > 100' ® Yes if No 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' ® 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 ***5+ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft 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 ***SYSTEM MEETS CAT III SEPARATIONS. G. ENGINEER'S CERTIFICATION I certify that l 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. Adw Curtis HuffmanCE / ��}�F�`��F ' • 10/08/128991 0 08/9 11• ''��4 `A—�/ PROFESS kW ft ft ft ft ft ft ft ft T l o til A �— IJNICIPALITY OF /ANCHORAGE fV1 �r p jc Development Services Department ' : Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-202-03 1. GENERAL INFORMATION Expiration Date: IC -2-7-2 Complete legal description BLUEBERRY HILL BLOCK 3, LOT 2 Location (site address) 22123 BROWNIE DRIVE, EAGLE RIVER, AK 99577 Current property owner(s) BRUCE & EVELYN SINGLEY Mailing address Real estate agent Day phone 22123 BROWNIE DRIVE, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: .® Single Family.(w/wo AD -U)_ ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well - ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. -r 3y2 ,ells H COSA Fee $ a� + 9,2q d coN r_)) _T I b 1)A L) Waiver Fee $ Date of Payment _T/,2,0 ! 1 _712&1X21 Date of Payment Receipt Number Q 102 (0 0 811.222. Receipt Number COSA # 0S C a 11 y 0 5 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY. ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 7/16/2021 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 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 & FWN 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved of ,��`ii� .�. ok TH 49_ .......�( / • ' • Curtis Huffman r�t♦ 63 CE 128991 •.•��`��/ ��islcc�FOP7/16/2'( Pt���� ll RQFESS��W Conditional approval for 3 bedrooms, with the following stipulations: Original Certificate Date: 7— 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 Legal Description: BLUEBERRY HILL BLOCK 3 LOT 2 Parcel ID: 050-202-03 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Well production at time of test 2+ gpm Date drilled 10/4/1984 Water storage tank volume_ gallons Total depth 205 ft Well disinfected for coliform test? ❑ Yes ® No Cased to 40+ ft ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate 2.84 mg/L ElNitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL,(ND) Casing height (above ground) *12 in. Collected by NE Date of flow test for COSA 5/12/2021 Static water level at beginning of test 79 ft. Date of Sample 5/12/21 & 6/1/2021 Comments *Casing height in well pit with manhole cover & visible daylight drain. Well in middle of driveway. B. TANK DATA C. LIFT STATION Age of tank(s) NEW TANK PENDING years ❑ Required maintenance completed - Tank type/material ADVANTEX / STEEL - - -Age of lift station_ years Measured operating fluid level in septic tank NA Lift station material ® Standpipes/foundation cleanout per record drawing Comments: Date of pumping 3116/21,,-- D. 116/21./ D. ABSORPTION FIELD DATA — NEW FIELD PENDING Which system tested (date installed) NA ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Adequacy test date NEW FIELD PENDING Results f ❑ Pass For bedrooms Fluid depth prior to test in s Water added gal New depth in Elapsed time min ❑ Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallonsNES If yes, enter date Comments/Deficiencies: % 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 ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® 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' ® Yes if No Neighboring Absorption Fields > 100' Community Wells > 200' ® Yes if No Surface Water > 100' Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft ft ft ft ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® 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 —ft 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 G. ENGINEER'S CERTIFICATION-�"��''°��®�� I certify that I have determined through field inspections and review �Q�. • ` ' • �-�� of Municipal records that the above systems are in conformance ®°'� • •;� E with MOA COSA guidelines in effect on this date. iia '. • Curtis Huffman �'��• CE128991 ,•��r �sT�,• • 6/16/21 .. �� July 16, 2021 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: CONDITIONAL COSA LEGAL: BLUEBERRY HILL BLOCK 3, LOT 2 Due to unprecedented events contributing to material and labor shortages, we are requesting a Conditional COSA for the above referenced property. The pending permitted 3 -bedroom septic system upgrade has been impeded due these conditions and other factors with no known date on when the Advantex system components may be available. The system will be installed once the components become available. The system has been working for the occupants and granting of this Conditional COSA will not impact any of the neighboring properties or pose a public health risk. Attached is the awarded bid from Northern Excavation and escrow letter from title for the pending installation. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. I ' 'an rU..lita 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 SW 04 of 20 21 , by and between 0 , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. 111 consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Svstems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as AN ADVANTEX SYSTEM located at (legal description) BLUEBERRY HILL BLOCK 3, LOT 2 2. Maintenance, Repairs and Alterations. ( -v , -is required to read, understand and initial each section) 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 ac m •dance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality l or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. er 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. (rcv. 05/18/2018) Page I of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. 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 r� 4W WTS. 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 OWNER: By: (signature) Date: ZG SOL 2' k ,_yyti �P(lt,"rt,OQt (print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was -acknowledged before me this-Zb `-day of 20 Z I , by jC[Alqe,1j StgG lvp i I STATE OF ALASKA NO � RY PUB QCPR A KA s h1OTARY PUBLIC My Commission expires: Ashlee W/I gne MUNICIPALITY: By: (signature) (print name) Date: —Z Z / Title: (rev. 05/18/2018) Page 3 of 3 >t 6 PLOT PLAN ___ AS BUILT _X_ SCALE _ 1=_= 60__ GRID _ NW 0058Project No. 2_1_28 VAl____ Q, 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lan & Associates, inc. (907) 522-6476 Phone (907) 522-4625 Fax F �� Professional Land Surveyors ken®langsurvey.com v p4 Jonothan®langsurvey.com O'� �S1 I hereby certify that I have surveyed the following described property: LOT 2, BLOCK 3, BLUEBERRY HILL SUBDIVISION (PLAT No. 66-84) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. Dated this the _ tc>— _— Day of --_ at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. '* 49TH* l ........... ,. .a.) ............. KENNETH G. LANG o .LS-5202.•"SJQG �DpROFessior�A� �Q �4400'Q�a AECC963 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner/CV~'/~¥ Mailing address Lending agency ~ ~r/~ Day phone Day phone Mailing address ,¢ZC)D ~"~ ~'. Agent /¢'/7/¢-¢'~/~ ,¢~ Address / Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: "~ TYPE OF WATER SUPPLY: NOTE: Individual well ~ Community well Public water If community well system, provide written confirmation from state ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ~21 STATEMENT OF INSPECTION BY ENGINEER As certified b~.my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Y-~/~ ~' ~P"x'~Z~xc" ~ "~""' Phone' ~"/~ Engineer's signature ~~~~ ~'-'"~ Date DHHS SIGNATURE ~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev. 1/91) Back MOA#21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: J~7 Z ~4 ~.~ ~Z,~'~4~'x~y' Parcel I.D. A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) /V~. If A, B, or C, attach ADEC letter. Date completed Cased to , ADEC water system number ~3~' /~,,~ Driller Casing height Wires properly protected (Y/N) ~ Date of test Static water level Well flow Pump level FROM WELL LOG g.p.m. AT INSPECTIONMUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION I V E D SEPARATION DISTANCES FROM WELL TO: Septic/holding.tank on lot /~/---~ Absorption field on lot Public sewer main Public sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HGLF.,;;;G Date installed .. Cleanouts (Y/N) High water alarm Date of pumping Nitrate Tank size /~'~ ~ Foundation cleanout (Y/N)}/ Other bacteria Collected by: ~ ~L:2' ~)-?'~t,J Compartments /"-° ~'~v~'~""c"~ Dep ressio n (Y/N) Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /O/..~ To property line Surface water/drainage On adjacent lots Absorption field Foundation Water main/service line 72-028 (Rev. 3/91)Front MOA21 CONTINUED ON BACK PAGE Co LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water Do ABSORPTION FIELD DATA Date installed '7//~/'~'?-- ! Length _~::~ ~'~ Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating Gravel thickness Cleanouts present (Y/N) Date of adequacy test for System type Total depth /~-' If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ///-~"- On adjacent lots /~;) ~ Property line To building foundation ~ -~ To existing or abandoned system on lot On adjacent lots /'~C) .,,~- Cutbank /~" Water main/service line Surface water /'~c~ ~ Driveway, parking/vehicle storage area Curtain drain x~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on Signature Engineer's Name Date HAA Fee $ / ?{~) Date of Payment /- ~/~/- Receipt Number 72~26 (Rev. 3/91) Back MOA 21 Waiver Fee: on t~h~ {[at~e. of this inspection. Date of Payment / ~q'--~ Receipt Number ~te en~r'oach on the ,¥ementS lines or o indicated ;~ld that tl~e im~roye: line~ ~nd ~ not ent then, to,' that thereto encroach are no roadways, on said pro.fly i,] Su~eyot No,~IL5 .,hOne - · . ..~., . : . D. R. DAYTON, P.E., R.L.S. HC 78 Box 1026 Chugiak, Alaska 99567 (907) January 20, 1992 ADEQUACY TEST Legal Description: Lot 2, Block 3, Blueberry Hill Subdivision Date Performed: January 15, 1992 House Size: 3 Bedroom Septic Tank Size: 1000 Gal., 2 Compt., Steel Absorbtion System: 8' effective depth x 29' deep trench Soils Rating: 150 SF/BR Daily Sewage Flow: 3 BR x 150 Gal/day/BR = 450 Gal/Day (DHHS Records) (Dhhs Records) (Dhhs Records) Test: 533 gallons of water was introduced into the absorbtion ststem in a 4 hour period. Results: The system accepted over 100% of the daily design flow with a maximumof 1.52' rise in the monitor tube liquid level. The total liquid level rise dropped to the original level within 5 minutes after the water injection was stopped. Conclusion: The soil absorbtion system is currently functioning adequately. D. R. DAYTON, P.E., R.L.S. HC 78 Box 1026 Chugiak, Alaska 99567 (907) ~~ 696-2417 January 20, 1992 WELL FLOW TEST Legal Description: Lot 2, Block 3, Blueberry Hill Subdivision Date of Test: January 15, 1992 Depth of Well: 205' Static Water Level: 93.8' Standards: The Municipality of Anchorage requires a flow of 150 gallons per day per bedroom, or 450 gallons per day for a 3 bedroom home. Test: The well was pumped at rates varying from 6.8 to 2.0 gallons per minute. The pumping rate was lowered during the later stages of the test to insure that the water level would not be drawn completely to the pump. Results: The well produced 543 gallons in a 4 hour period. This complies with the Municipality of Anchorage standards. The water level recovery rate over a 45 minute period indicates the well was recovering at a rate of 1.4 gallons per minute. Conclusion: The well is adequate to meet the Municipality requirements for a 3 bedroom home.