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Home My WebLink AboutTIMBERLUX #3 BLK G LT 10 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP171289 PID Number: 018-271-64 Dwelling: ❑� Single Family (SF) ❑ Duplex(D) ❑ Multiple(SF and/or D) Project: E] New El Upgrade Name: NIC OPANASEVYCH ABSORPTION FIELD Address ❑ Deep Trench ❑■ Shallow Trench ❑ Bed ❑ Mound 4405 MANYTELL AVE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 3.0 GPD/SF 42.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot +ZAr1i 4 2,CI Ft. 0.5 Ft. TIMBERLUX #3 G 10 Fill added above original grade Gravel length Township Range Section PS 5,c / Ft. 401+ Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES 5.0 Ft. Ft. To' Septic Absorption , Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank ' Line 200 Ft2 1.0 Ft. Well 100'+ 100'+ 100'+ 50'+ TANK 0 Septic I]S.T.E.P. ❑ Holding ❑Other Manufacturer Capacity Surface Water 100'+ 1001+ 1001+ ADVANTEX 1500 Gal. Material Number of compartments Lot Line 10'+ 101+ 10'+ FIBERGLASS 2.0 NA 5 Foundation 1+ *81+ 10'+ I LIFT STATION Manufacturer Capacity Curtain Drain UN UN UN 1 ADVANTEX 85 Gal. Pump on level at Pump off level at High water alarm at Remarks * GARAGE FOUNDATION IS A SLAB SYSTEM, NO IMPACT TO TANK OR FIELD PRE-SET in. PRE-SET in. PRE-SET in. Pump make and model Electrical Inspections performed by — _ STAND MOA-FINAL PIPE MATERIAL House to tank 3034Tank to 3034 drainfield Installer MIKE N ANDERSON, P.E. Drainfield 3034 cO/MT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 105 ft Inspection 151 9-10-18 a 9-11-18 Location and description dates: 2" 3r1 4m GARAGE SLAB COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL1.- Conditional Approval: Date j y' •;9 (r *: 49TH %.*`1", / 4,A______. .r //1,5.,.MICHAEL N. ANDERSON '� ✓'• • CE-9�4 ••.*--4, Approved � Date 10/10/IB l>>\N��-7`' Inspection Report_9-1-12.doc Permit No. OSP171289 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: TIMBERLUX #3 BLK G LT 10 PID No.: 018-271-64 MARK A B C TC01 25 68 C01 28 7 MT1 10 45 MT2 X35 14 RESERVE AREA 1500 GALLON ADVANTEX FILBERGLASS /c TANK\WI PO) PLUS PUMP BASIN - - - - - - - f- - - - - -'y TI-4/2 \t T1-1#1 I — — C = —� 1. 1 . I '< TCO2 . ———— –,MT2 / 1 TC01�;, T. --- / \ / \ -8< ` NSC C011!_- --, / _-r--� N / _ \ BENCH -/ \\ N // \ DRIVEWAY \ \ / [ _ 1 / \ \ / \ T \ ,.N Il N N — — _1— ® I ` \ - / \ / \ //\'\-- -- CREEK OFF-SET W WELL // \ �\ 7-"-- \\ _ r--------- / / / '-- i / ' SMALL CREEK \N \ N \ // ___/ 7 UI / SCACE:�150'_ __ '--- / /// rail I TCO1 - Mit 5� 1 MT2 .��„"�1111 I CTEO2 �MN PUMP BASIN 7p5.5 /••T4,'iE'�• �. , OF /q� ,I•♦♦ m 111R9R D - %: FILL I "IN�I/ ....--7,% 5 —<FILTER FMK 700-00 : 'Y • A TH � "` � _ — 102 2/ 1,500 DALLCW FIBERCUSS }�� +102.2 *1O2 — • / • AOVANIEE TANG 9/POD on \ — SN �I %MICHAEL N. ANDERSON;°L! I. 9 •N222LLL OF FILTER SAND THEN TYR II . % N0 }' y4-59 WATER AT 99 NAY 2017 OM •♦♦/;��•'•. LI(/�Sa/ ••1 � j`CJ ( V.. SEPTIC N.T.S.SECTION 90 .'',1 t �T :. 0 A&- . .k INE ' -SEA,�•.J Municipality of Anchorage #7,41..• ER .,�: Development Services Department• .� id� On-Site Water and Wastewater Section : ,4 9 T N / • 4700 Elmore St. / `d`�Y .. ..P.O.Box 196650 Anchorage,AK 99519-66500c.-b.10 00 wWW.muni.orglonsite �le f,:.MICHAEL N. ANDERSON•: f (907)343-7904 1 •, CE-9469 1 ✓l.• .• \�ys tt ,Qf•✓,°444 .•.•••,... Soils Log - Percolation Test �1\0 tion fcsi ,'��"" Performed For: nit D Date Performed: 5 /eh V Legal Description: 1`1,,,, (.)... (..•?c # 3 Township,Range, Section: Slope Site Plan Depth Z_ (Feet) 1- 3- ) /\ 4- 5- 6- CZv A.OA 4 e__. 7- Ci) r 8- r / WAS GROUND WATER � /,' 9. (70 &v'• ENCOUNTERED? q1• !j / S 10- IF YES,AT WHAT DEPTH? ( L Depth to Water After J , 11- Monitoring? 3, S/ E/ 12- Date: 57 /b� ' 13- 14- Reading Date Gross Time Net Time Depth to Water Net Drop 4 11 15- /01.4/•) G " 3") 16- 17- 6 1/ 3/1 18- //it 3// 19- 20- PERCOLATION RATE 77/ ' Iminutesllnch) PERC HOLE DIAMETER (�7 TEST RUN BETWEEN Z,0 FT AND Z, FT COMMENTS PERFORMED BY: /! 41./ —t I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: .4%\.. 30 / N 00'03'24" W 300.00 K <<, o a Z `1'0 , W v • Cd 0. - �z GD a ' i ® z cp o0 .C.J.ico Fri a Z o MC 8.9 30.3 —' 11414.6' n) ONE STORY o N — WOOD FRAME to N O 9 "p J 13.4 14 : 9.3^'10.5 O 6 2 io `: ren ( r- v N'0 `' • n r 26.7 • GRA . '; DRIVEWAY N N N 50.38 N 00'03'24" W 300.00 Bobby F. Burnett Lot 10, Block G GRAPHIC SCALE: 1 Inch = 40 Feetl!nl II OF ,44-\1 2941 Carriage Drive /csQ'ir �" Anchorage, Alaska 99507 TIMBERLUX SUBDIVISION, ADDN #3 20 0 20 40 80 i �- 'Y h (907) 350-5541 Plat # 71-240 / *. • Qzx i`\ * , Date Scale I hereby certify that the property described hereon has been surveyed 0 9/11/2018 1" = 40' by me. or at my direction, and that the improvements situated thereon +t' semen /if Grid are within the property lines and do not overlap or encroach on the ' 1.-6464 SW 3136 As-Built property lying adjacent thereto unless otherwise shown. That no jei•�-� "Al improvements on the property lying adjacent thereto encroach on the ,, it? k.1° Drawn by Field Book prejinises in question and that there are no roadways, transmission sstoN ASV ASB2018 lines or other easements on said property except as shown. 116.111011110:41°. Certified Drilling Log DOC CO dba 1ilLLiiIoAEN WELL WATER P.O. Box 670269, Chugiak,AK 99567 688-2759 OWNER OF LAND: Nikolay Opanasevych Bore Hole Data ADDRESS: 4405 Manytell Ave. Anchorage Depth LEGAL DESCRIPTION Timberlux#3 Block G Lot 10 From To DATE: 10-24-17 0 2 Casing Stickup PERMIT NUMBER: OSP171289 DATE OF ISSUE: 10-4-17 2 4 Overburden TAX IDENTIFICATION NUMBER 01827164000 Is well located at approved permit location: NYes No 4 8 Peat Method of Drilling: Zair rotary [icable tool 8 69 Tight Silt Sand & Gravel Depth of Well: 144' 69 75 Silt Tight Casing Type: Steel Wall thickness 250 inches 75 81 Tight Sand & Gravel Diameter: 6 inches, depth 144 feet Liner type 81 83 Silty Sand & Gravel Water 3 GPM Static Water Level: 41 feet 83 128 Tight Sand & Gravel w/Yellow Clay Recovery Rate 10 ® gpm I I gph 128 144 Sand & Gravel Method of Testing Air Well Intake Opening Type: ®open end open hole n Screened Start feet Stopped n Perforations Start feet Stopped Grout Type: Bentonite Volume: 50 lbs Depth:from 2 feet,to 42 feet Well Disinfected Upon Completion: Flyes n no Method of Disinfection: Chlorine 50 PPM Comments: WATER QUALITY TESTING Coliform Ni eJl____cou1oomi. ►o tJ‘B Nitrates___0. t 6'7 Arsenic Nth. wit& 91118 Drillers Name: Cole Sullivan ATTENTION: It is the responsibility of the property owner to submit a copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. MUNICIPALITY OF ANCHORAGE Development Services Department _; i Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: 0 S P r gQ Date of Issue: 1 (2- otl - C)/ Parcel Identification Number: 018- j41- (:)G Legal Description Block Lot Property Owner Name& Address: Timberlux#3 G LT 10 Nick Opanasevych 4475 Manytell AVE Anchorage,AK 99516 Pump Installation Date: 09 -10 _2018 Pump Intake Depth Below Top of Well Casing: 10 feet Pump Manufacturer's Name: STA-RITE Pump Model: S7P4JP07231 Pump Size: 3/4 hp Pitless Adapter Burial Depth: 8 feet Pitless Adapter Manufacturer's Name: STA-RITE Pitless Adapter Installer: Mike Anderson Well Disinfected Upon Completion? ❑ Yes ❑ No Method of Disinfection: Chlorine Comments: Pump Installer Name: Nick Opanasevych Company: Owner Mailing Address: 4475 Manytell Ave City: Anchorage State: AK Zip: 99516 Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. �J�`c1 FA l,rr pe MUNICIPALITY OF ANCHORAGE ,t»cn� On-Site Water &Wastewater Program •` .; PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,�- Y http:/lwww.muni.org/onsite 44441 )chartmcnt Un On-Site Water & Wastewater System Permit Permit Number: OSP171289 Effective Date: 10/4/2017 Work Type: WellSeptic Initial Expiration Date: 10/4/2018 Tax Code Number: 01827164000 Site Legal Address: TIMBERLUX#3 BLK G LT 10 G:3136 Site Mailing Address: 4405 Manytell AVE, Anchorage Owner: OPANASEVYCH NIKOLAY Lot Size in Sq Ft: 63000 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 4 This permit is for the construction of: II Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy 0 Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: The Engineer needs to do an additional test hole prior to the construction of the septic field. Construction may proceed at your own risk before the 7 day water monitoring is complete. Please submit stamped and signed results with the As-built Inspection Report. If the results require a design change, construction of the system will stop pending On-Site review and approval. Received By: Date: 't)1" l� Issued By: A Date: /T Municipalityof Anchorage :, 1801" 91 Ell pnrrntcnr P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 (D Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program VARIANCE/WAIVER REVIEW Waiver#: OSVI71117 COSA#: Permit#: OSPI71289 d PID#: 018-271-64 Legal Description: Timberlux #3 BG LIQ W� o Q Engineer: Mike N. Anderson V� % 8 t 0 " Applicant: Nick OpanasevVch cq t) &I Your request for a waiver of the required 4 feet vertical separation from the absorption field to groundwater has been approved. The approved separation distance is 3 feet. The field is approved to have Engineered Receiving Soil and run perpendicular to contours, see special construction requirements on the 1:100 scale plan view. 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. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. F-1 Notarized letter(s) of nonobjection have 'been received from the owner(s) of the affected adjacent property. M Adjacent properties are not affected by this waiver. U ..... a a a a .. 0 ............. a M M ...... a a 0 M . a ...... M .. 01 ... a ....... M ........ a .... M a I Waiver is Granted: x Waiver is not Granted: Date: LOA 7 Approved by: k A,,, Name of RevieweK/ ......................................x ................... 1111: IN 11111111111 • BUSH 1 MUNICIPALITY OF ANCHORAGE Community Development Department Wale Phone. . 9 1'44 7 Development Services Division F '� IISRF A� On-Site Water& Wastewater Program II 1�rr ON-SITE SEWERNVELL PERMIT APPLICATION SEP 27 2017141 Parcel I.D. 018-271-64 1 140 6 Property owner(s) NICK OPANASEVYCH Day phone 'N - ` »3 Mailing address Site address Legal description (Sub'd., Block & Lot) TIMBERLUX #3, BLK G, LOT 10 Legal description (Township, Range & Section) Lot Size 63000 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑X Initial Single Family (SF) ❑x (w/wo ADU) Septic Tank ❑X 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: WAIVER TO THE WATER TABLE FOR ADVANTEX/NEW CODE Distance: '51 0 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: f3 "3 D Waiver Fees: Date of Payment: 9,-y-)e-/7 Date of Payment: Mo /`1r+ Receipt Number: 076 7oD - Receipt Number: t'1 "ca`G Ob I1/?PPermit No. QS P170,19 Waiver No. Cts /71/0- Permit ermit App__- .c Oct. 4, 2018 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New Septic and Well Permit plus Waiver Request Le-al:TIMBERI:IUX 43 BLK G LT 10 To Whom it Illay concerti: This is a request for a well and septic permit plLls a walver oil the above refcrenced lot. A single test was excavated and found seeps at 6 feet Nvhich stabilized to 1.0 feet. The soils are silty sand SM with a few small rock from the old creek. 'File creek to the south has been shown on the site plan. Due to the soils we have designed an Adventex system oil an Engineered Receiving Soils (ERS) with MOA filter sand far the 5 -wide system. With the design we will need a waiver for the distance to the water table from the standard 4 1eet to 3 feet per the new proposed MOA On-site code. The application rate is 3.0 GPD/SI-- for a 4 bedroom system which translates into a 5 wide trench by 40 feet lone. The Illound will be sloped and seeded per the plan. An external pump basin has also been shown to pump the efilLient to the mound. The slope of the land is very flat with no cut -banks or slopes greater than 25 percent within 200 feet. This system will not impact any of the neighboring properties due to the lot layout and the type of septic system being installed. Tile Advantex system is a Class III nitrate reducing system with monitoring and will not impact the agLlil�er or any of the surrounding water ways. Tile new house and driveway will prevent ally efflUellt From sul`faCe draining into the Creek and the system will be electronic monitored b Anchorage Tani: which is typical for all Advantex systems. 0(� We are also requesting a waiver of 8 feet for the distance between the gara(,e foundation (slabg field rade) and the drain which is less than the required 10 feet by the MOA On-site code. Please call nle if you have any questions. If Sincerely f iVlichael N. Anderson. P.E. 4661 Natrona Anch. Ak 99516 Ph 727-8864 TOPSOIL&SEED&REVEG DESIGN CRITERIA: 4 BDRM X 150 = 600 GPD 3:1 SLOPE FILTER FABRIC&INSULAI or, SOILS = 600/3.0 = 200 GPD (TH#1) u0i 2 0 �•�"— 1.25"0 PIPE 200 GA/5 =40' G-• • ��_o,a 2.0 . ORG 2,0 6"DRAIN ROCK BELOW PIPE (1) TRENCH rL(�vCt�On 5 .ihp,K) n F--2L--9. 1 24"OF MOA FILTER SAND +2.0' DEEP 5'-0 e O v' 4-\ e ea 5t- 4.0 SM 24"OF AS&G OR,tvCt 0.5' EFFECTIVE S r d e- v C Scf y �Tr T �� •� 5.0'WIDE /,L0(� ->par.,,y rn Prn c 40' LONG M"f,,t. I GM 144'16 UV 440" a c, 10.0 SEPTIC FIELD SECTION N.\`� -1i I— I 1T T - - - �I 1 • I I, IR o I „f °0 I a0 '9,y 0_ LY I I CSO PROPOSED O6 : I I I�� DRAINAGE FIELD- _�" J L — - - - - -_— _: -�I , - - - - 7 F / PROPOSED WELL I I I ,I.-- "s--. 1` • r •�f 100'RADIUS I I r( I V‘\ r/ �, I I I I 1 PROPER Y LINE LJ `,I I \\ w; I PROPOSED HOUSE 1N _--_ � "1� ,,, I '•' '9C� R R ! -MANYTELL AVE- I�� ,, ( �.- -------„,,,,,,..71, �` di •.� S. Ir�1 > s n I , ' I I I I,' r toy I I *` ,"I II - - - - - J I_ - - J L —_ - - - - -- - - -•� ' II l Septic Design Prepared for Ir iesiass• NICK OPANASEVYCH .41�P-41'� OF q�� ++4P♦. TIMBERLUX #3, BLOCK G, LOT 10 49TH it 0 10 Anchorage, Alaska Michael N. ��v �r %M�,' MICHAEL N. ANDERSON: C Anderson, P.E. DATE: X12512 1 No. CE 9469 4601 NATRONA AVE �� :...z,5-:. ., • DRAWN: DJR ,��','�� • ANCHORAGE,ALASKA 99516 #1�' d .... .. (907) 345-3377/FAX: (907) 345-1391 SCALE: 1"=200' 44� �=\0 i4 I t ELMORE#2 ELMORE#2 UP" ELMORE o2 1— BLOCK 11.LOT 2 BLOCK 11.LOT 3 BLOCK 11.LOT 4 1 t PROPERTY LINE 1 1 � — ---"� �—PROPOSED FILL OVER _ 11 1_LUTILITY EASpMENT \ LEACH FIELD 11 TIMBERLUX#3 SUpPE IS FIAT • I TIMBERLUX#3 Nle�. 1 BLOCK G.LOT 1t 2'CONTOURS �� \ ill • BLOCK G.LOT 9 1 i E , , t ! PROPOSED 1 I C• ' \ MT Mr HOUSE �1 I • IP. \ * • 1 1500 GALLON \\ CO a_ � �� PROPOSED WELL 11 ADVANTEX W! \� �� 100'RADIUS �`. 1 POD AND PUMP - _. .�/// ..� t1 BASIN •�•' `• • 5I—\\ \ / • \ \`� NATURAL SLOPEEL \ \`� \ 1% ,\ , / \, t , ' 1 111 ,� 50'STREAM 111 \ 1 1 SETBACK 1 1 t '. 1 t tJ 1 •� 1 ` --- 1 . 1 N. 0 1 1 1 1 i ± WELL r 1 + 1 moi' 1 11 } 1 .�' — -I-�— — \\ /// C V'� \ _� ' /// / \ • / / \\\\ f/' ELMO(3F ' `\~�-5 f// L �` ,\--1 , ` ,' t `, i —� •' 1 SURVEYED �/' �•� 1 ` STREAM LOCATION • SURVEYED `� e.,i` L 0° — , �'STREAM LOCATION � � S0'STREAM / `• ,- /)// r o t),r v Li ,,�_y f , SETBACK-I N"\ -' !an t Iry `. ,. _ jj / PROPERTY LINE.71. W w w w • w FIRE SERVICE -MANYTELL AVE WATER MAIN Septic Design Prepared for NICK OPANASEVYCH4 . +,4 _ O 44'♦♦♦♦ TIMBERLUX #3, BLOCK G, LOT 10 ..„.14.-- ♦1 Anchorage, Alaska 49TH �� • • • P.E. • P Michael N. Anderson, P.E. DATE: /� '10- 1-.MICHAEL N. ANDERSON;' f CI 4601 NATRONA AVE ♦ No. CE 9469 DRAWN: DJR ♦1 ., ' • ANCHORAGE,ALASKA 99516 #4�O• ....... �,� 44 (907) 345-3377/FAX: (907) 345-1391 SCALE: 1"=50' +4,, ;:To.* ......,0tttmo� l Municipality of Anchorage VI .`P( INEE- s ss %� Development Services Department r* T �� .� r �T. •_ - Building Safety Division / . 49 :�- / On-Site Water and Wastewater Program L4r 4700 Elmore Road + ` — P.O. Box 196650 Anchorage,AK 99507 0www.ci.anchora�e_ak usr '. MICHAEL N. ANDERSON ,.�:(907)343-7904 f s'i' CE-9469 .•``-s Soils Log - Percolation Test �t\`0•• • L'F•SSl0,\.. Performed For. Ai t r., D Date Performed: ��f(// I Legal Description: "then 11 CV L N yc 3' Township,Range,Section: ( Slope _ Ste Plan � L+V L" I (7 . Depth (Feet) 1- OP tin 7 L , v(40. ei, 2 3- 47P/t 4= 5- 6- 7- 8- WAS GROUND WATER 9- ENCOUNTERED, 1' S , 10-- IF YES,AT WHAT DEPTH? l V L- {�0 Depth to Water After P 1 1- + ` WA Monitoring'? E 12- En. K 4Y'r Date tr/Z7( i 13- /, L? /vly / ?- t" tiC--Sesu I 14- Reading Date Gross Time Net Time Depth to Water Net Drop 15- 17 /ON ley toi. 3 , 16- Ci i' 3j, 33 17- !I rrr 3y 18- St ?3 19- 20- PERCOLATION RATE 3 Immutes/hncn. PERC HOLE DIAMETER t,P TEST RUN BETWEEN V. FT AND3 FT COMMENTS PERFORMED BY: M,t4,4 t I CERTIFY THAT THIS TEST WA PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 77 g- 4tdT pp -.6,,,e a DEPARTMENT OF THE ARMY c� r ALASKA DISTRICT, U.S. ARMY CORPS OF ENGINEERS o, r REGULATORY DIVISION P.O. BOX 6898 '-; JBER,AK 99506-0898 JUN 262017 Regulatory Division POA-2017-222 Mr. Nick Opanasevych 1910 East 72nd Avenue, #3 Anchorage, Alaska 99507 Dear Mr. Opanasevych: This is in response to your April 25, 2017, application for a Department of the Army (DA) permit, to discharge 1,759 cubic yards of fill material into 0.422-acre of waters of the U.S., including wetlands in order to construct a single family residence, driveway, and septic field. The project will include one 110- by 83-foot housing pad and one 170- by 21-foot driveway. The project will include one 48-foot by 30-inch diameter culvert to maintain the flow of Elmore Creek under the proposed driveway. It has been assigned file number POA-2017-222, Elmore Creek, which should be referred to in all future correspondence with this office. The project site is located within Section 34, T. 12 N., R. 3 W., Seward Meridian; USGS Quad Map AK-Anchorage A-8; Latitude 61.0859° NI., Longitude 149.7989°W.; in Anchorage, Alaska. DA permit authorization is necessary because your project would involve work in dredged and/or fill material into waters of the U.S. under our regulatory jurisdiction. Based upon the information and plans you provided, we hereby verify that the work described above, which would be performed in accordance with the enclosed plan (sheets 1-4), dated June 2017, is authorized by Nationwide Permit (NWP) No. 29, Residential Development. NWP No. 29 and its associated Regional and General Conditions can be accessed at our website at: www.poa.usace.army.mil/Missions/Regulatory/Permits. Regional Conditions C, D, E, and F apply to your project. You must comply with all terms and conditions associated with NWP No. 29. Further, please note General Condition 30 requires that you submit a signed certification to us once any work and required mitigation are completed. Enclosed is the form for you to complete and return to us. 1 i : imp : US Army Corps of Engineers Alaska District Permit Number: POA-2017-222 Name of Permittee: Mr. Nick Opanasevych Date of Issuance: JUN 2 6 2017 Upon completion of the activity authorized by this permit and any mitigation required by the permit, sign this certification and return it to Mr. Michael R. Gala at the following address: U.S. Army Corps of Engineers Alaska District Regulatory Division Post Office Box 6898 JBER, Alaska 99506-0898 Please note that your permitted activity is subject to a compliance inspection by an U.S. Army Corps of Engineers representative. If you fail to comply with this permit you are subject to permit suspension, modification, or revocation. I hereby certify that the work authorized by the above-referenced permit has been completed in accordance with the terms and conditions of the said permit, and required mitigation was completed in accordance with the permit conditions. Signature of Permittee Date MUNICIPALITY OF ANCHORAGE 4• �1 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. 018-271-64 1. GENERAL INFORMATION Expiration Date: ) f ` I "! r zZ Complete legal description TI MBERLUX #3 BLK G, LOT 10 Location (site address) 4475 MANYTELL AVE. ANCH AK Current property owner(s) HARRISON Mailing address SAME Day phone Real estate agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic El 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. COSA Fee $ 23 Z Waiver Fee $ Date of Payment Receipt Number COSA # DSC Z Z I `iZZ 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 MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 8-2-22 .r ��• 4 I= q �. �4q � �* TH P *A 6. DSD SIGNATURE �*04. - - _ .. _. _ I ......-• • • ... r r • � - / System #1 Approved for 4 bedrooms / VO MICHAEL N. ANDER_90N ; ,'PW: .,tib System 42 Approved for bedrooms �.'. CE /-1/ 423— ;ter Disapproved �i??0 ' �. Conditional approval for bedrooms, with the following stipulatiort��i��.;� \�N\CIPAL_ lfi ��CES D��'S�� Original Certificate Date: ' 17 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 Checklist blue sheet Legal Description: TIMBERLUX #3 BLK G, LOT 10 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1004/7 Total depth 144 ft Cased to 144 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 10/14121 Static water level at beginning of test 50 ft. Comments B. TANK DATA Age of tank(s) 4 years Tank type/material Measured operating fluid level in septic tank """ ❑ Standpipes/foundation cleanout per record drawing Date of pumping ADVANTEX D. ABSORPTION FIELD DATA Which system tested (date installed) 9/8/18 ❑ ALL standpipes present per record drawing Total measured depth from grade 7 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 of Parcel ID: 018-271-64 Structure served by this system Well production at time of test 5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 8/5/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station 4 years Lift station material Comments: Adequacy test date 10/14/21 Results ID Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 1 in Elapsed time 1440 min ❑ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 0 gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet 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 *8 Community Sewer Manhole/Cleanout > 100' If absorption field is under driveway comment below Property Line > 10' r Yes if No ft M Yes if No ft Neighboring Tank > 100' F-1 Yes if No ft Private Sewer/Septic Line > 25' E✓ Yes if No ft Absorption Field on Lot > 100' r7l Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Animal Containment50' Yes if No ft ❑✓ Yes if No ft .>i Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 121 Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 5 ft Surface Water > 100' Q✓ Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' f Yes if No ft Water Main > 10' ✓l Yes if No ft Community Wells > 200' E] Yes if No ft Water Service Line > 10' 121 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 *8 ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q 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 ft Surface Water > 100' Q✓ Yes if No ft F. ENGINEER'S COMMENTS *MOA WAIVER G. ENGINEER'S CERTIFICATION I certify that 1 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. COSA Checklist yellow sheet Ole 't ? • e i k: 497K / •E r' ¢+ n+ ICHAtv14. ANL•LRSGN ��•, CE 97-1 a�•�rf,,•, u'ti� s 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 C 51 of 20 y and between herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.55.365. 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 4 x located at (legal description) 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 performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 -a- 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 AWWTS. The Municipality will give at least 24-hour notice. —Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. �-- Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance_ and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 STATE OF ALASKA } ) ss. THIRD JliDICIAL DISTRICT ) e) Date: ?/1 ? oozz— The foregoing ins ent was acknowledged before me this � day of A- 6� , 20eZL—, b J ,o STATE OF ALASKA (VOTARY PUBLIC NOTARY PU IC FOR AL�SKA -� �°-� Jerrie R: Sta. Ma,ia My Commission expires: y C MUNICIPALITY: (% By: (signature) Date: o I ~ 2Z (print name) Title: (rev. 05/18/2018) Page 3 of 3 424 190 www an ■ ■ soon IRMO 0 m s■ on ■ ■ :■■ ■ om wrl i ■ ■ ■ ■ Iw 11 lwl ■ ■ 9 ■ t: I» >w1111 No am MORE 119 19 9 111 .0 � h I �clvanTexll Field Maintenance Report A n ch o ra g eTa n k Annual Inspection 907.272.3543 Property 4wnerlrracklnp # Current Operator © Earthy ❑ Moldy Jonathan Harrison & Morgan Harrell ©Cabbage ❑ DOCay Larry Botts Foam In tank ❑Yua "lo 811e Addreee Previous Contact Phone 4475 Manytell Ave, Anchorage AK 98516 t 1• (907) 555-5555 AX &W, ID N county ID If Pod ft* ❑ Yea ISNO DOW of Lott Inopaptlon AX -145267 051'171289 429526 RTU138537 07/14/2021 R6trlovo O&fill Info Dally flow Roclrc ratio... Timer set tinge: Perform Field Sampling/Observations NTU (11 /x5 ± ITU,) pH (8.9) DO (2.5) Odor of Sample Current Typical '�Svlusty © Earthy ❑ Moldy Nan-typloal )&„Sulfide ©Cabbage ❑ DOCay 011y slim In PVU ❑ Yes to Foam In tank ❑Yua "lo Check Control Panel Previous Reciirc Amps Dlsoharge Amps t 1• J `1•Z) Audible and visual alarms K Dial tone (telemetry only) ❑ Yea ISNO Inspectfclean Pump Syatorn Inspoct Cloan Rlsor/Lid ..................... Splice Box .................... Float Corda ...... , . , . . Floats........................I,&, }, Pump........................ &, Dlotuboll Filter ................. 1 Blotubo Pump Vault ... .. . , .'f� Nodreulating SplittorValve........ ' It A Oommente .0 lf)a Measure Sludge/Scum Sludge Scum 1st Compartment Current Previous Currant previous 2nd Compartment Currant Provl4s Current Previous Inspect/Clean AdvanTex Filter Odor: r5`lormal ❑ Pungent 0101114t: "!**rule! ❑ EX86391v6 l3ridging/Ponding: N&ne/Minor ❑ Excessive Inspect/Clean blacharge Pump System Inspect Riser/Lid -ff �' Splice Hex 7h Float oordc Inspect/Sorvlce Other System Components Inspract Clean Laterals/Orifices. Pod Bottom Intake Vont Inspect Clean I'loats T� --s Pump Q., -91 Inspeot Clean Inspect Clean Disinfection Egtdpment -ft-EL ;Diapersal Latarrtlalarirfces '�� Observations Additional Services Rendered ❑ Cleaned textile sheets? ❑ liaplacad UV !tarns? Replaced/Used other Items? Parts Used. W = Warranty, B >= Billable (✓ appropriate selection) W 13 nem Number Doscriptlon Final/Safety Inspection 'E9JaPV reinstalled `-RLlds boltod on ' E41 tanlfold roconnoctod; flush valves closed SQOntrol panel reactivated Summary/Recommendations d System Performing; no further action noodoo El Tank noods pumping ❑ Call for service ❑ Other? Rate Faux completed form to 1-006-004-7404 MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 018-271-64 !Kos k ANCHORAGE Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: I _ 2-V-2 0 Z 2 Complete legal description TIMBERLUX #3 BLK G LT 10 Location (site address) 4475 MANYTELL AVE, ANCH AK Current property owner(s) NIKOLAYOPANASEVYCH Day phone Mailing address Real estate agent SAME 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic Fx] 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. COSA Fee $ i�vS ("k Waiver Fee $ Date of Payment 0 .Z a Oa Date of Payment Receipt Number Q 7, q6 Receipt Number COSA # 05 C 2-11 iSy O 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 MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 10-25-21 .~~ . of A za F��•• ••,•.Y tF o �49?Tj •�:: , 6. DSD SIGNATURE •••• System #1 Approved for 4 bedrooms ' •''' . •' "' ! MICHAELN. ANDERSCN System #2 Approved for bedrooms CE -946 •.``�,� Z z 1��qF� ;�� Disapproved •/ •'. Conditional approval for bedrooms, with the following stipulation. pF��%� `gJ o tion; A o IN TFR A/V1) PR V gTFR -o tq B w- Original Certificate Date: 2 z 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: TIMBERLUX #3 BLK G LT 10 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 10124117 Total depth 144 ft Cased to 144 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 10114/21 Static water level at beginning of test 60 ft. Comments B. TANK DATA Age of tank(s) 3 years Tank type/material °`'`mss"° Measured operating fluid level in septic tank Advan1ex ❑ Standpipes/foundation cleanout per record drawing Date of pumping AdvanteK D. ABSORPTION FIELD DATA Which system tested (date installed) 9/8118 ❑ 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 OR Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 0 gallons Comments/Deficiencies: COSA Checklist yellow sheet of Parcel ID: 018-271-64 Structure served by this system Well production at time of test 6+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ N ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 10114/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station 3 years Lift station material Ub glass Comments: Adequacy test date 10/14/21 Results 2) Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 600+ gal New depth 1 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' M Yes if No ft 21 Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' Q Yes if No fit Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Q Yes if No ft 0 Yes if No ft ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft �] Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 5 ft Surface Water > 100' Q Yes if No ft Property Line > 5'✓Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' QQ 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' Q Yes if No *8 ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓Q Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' Q✓ Yes if No ft Surface Water? 100'✓Q Yes if No ft F. ENGINEER'S COMMENTS * MOA waiver G. ENGINEER'S CERTIFICATION 1 certify that / 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. COSA Checklist yellow sheet s • 49TH Mf- ifa"N. a.naERsc;v ; ^ . MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Parcel I.D. 018-271-64 !Kos k ANCHORAGE Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Phone: 907-343-7904 Fax: 907-343-7997 Expiration Date: I _ 2-V-2 0 Z 2 Complete legal description TIMBERLUX #3 BLK G LT 10 Location (site address) 4475 MANYTELL AVE, ANCH AK Current property owner(s) NIKOLAYOPANASEVYCH Day phone Mailing address Real estate agent SAME 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic Fx] 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. COSA Fee $ i�vS ("k Waiver Fee $ Date of Payment 0 .Z a Oa Date of Payment Receipt Number Q 7, q6 Receipt Number COSA # 05 C 2-11 iSy O 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 MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 10-25-21 .~~ . of A za F��•• ••,•.Y tF o �49?Tj •�:: , 6. DSD SIGNATURE •••• System #1 Approved for 4 bedrooms ' •''' . •' "' ! MICHAELN. ANDERSCN System #2 Approved for bedrooms CE -946 •.``�,� Z z 1��qF� ;�� Disapproved •/ •'. Conditional approval for bedrooms, with the following stipulation. pF��%� `gJ o tion; A o IN TFR A/V1) PR V gTFR -o tq B w- Original Certificate Date: 2 z 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: TIMBERLUX #3 BLK G LT 10 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 10124117 Total depth 144 ft Cased to 144 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 10114/21 Static water level at beginning of test 60 ft. Comments B. TANK DATA Age of tank(s) 3 years Tank type/material °`'`mss"° Measured operating fluid level in septic tank Advan1ex ❑ Standpipes/foundation cleanout per record drawing Date of pumping AdvanteK D. ABSORPTION FIELD DATA Which system tested (date installed) 9/8118 ❑ 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 OR Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 0 gallons Comments/Deficiencies: COSA Checklist yellow sheet of Parcel ID: 018-271-64 Structure served by this system Well production at time of test 6+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ N ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 10114/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station 3 years Lift station material Ub glass Comments: Adequacy test date 10/14/21 Results 2) Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 600+ gal New depth 1 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' M Yes if No ft 21 Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' Q Yes if No fit Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Q Yes if No ft 0 Yes if No ft ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft �] Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 5 ft Surface Water > 100' Q Yes if No ft Property Line > 5'✓Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' QQ 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' Q Yes if No *8 ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓Q Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' Q✓ Yes if No ft Surface Water? 100'✓Q Yes if No ft F. ENGINEER'S COMMENTS * MOA waiver G. ENGINEER'S CERTIFICATION 1 certify that / 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. COSA Checklist yellow sheet s • 49TH Mf- ifa"N. a.naERsc;v ; ^ . RUiS1# //..............m" • .E (i li • .c Municipality of Anchorage _.�° On -Site Water and Wastewater Program si1a'i . _` (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 018-271-64 Expiration Date: jail 10 , 011 1. GENERAL INFORMATION Complete legal description _TIMBERLUX #3 BLK G LT 10 Location (site address) _4475 MANYTELL AVE, ANCH,AK Current Property owner(s) _NIKOLAY OPANASEVYCH Day phone Mailing address _SAME Real Estate Agent Day phone 2. TYPE OF DWELLING: ca 9 .0 » sz '°M ® Single Family (w/wo ADU) co 0 v4. III Duplex Is; �' N ❑ Multiple Dwellings (Single Family and/or Duplex) 0,� y 3. NUMBER OF BEDROOMS: 4 16- In' 6( Zt Ll 0\. 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: Received by: Date: !0/N4g COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ i l LC.?? Waiver Fee $ Date of Payment is/gig Date of Payment Receipt Number iego 1) Receipt Number COSA# 0 5017/ 3'8 Waiver# 11. Szth 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm MIKE N ANDERSON, P.P. Phone 727-8864 Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON. PE Date 10/8/18 0,4If...• e 00 0 0 0 c- • so coo rA n o a to i.'.ICHA- N. '� c w �_ 'A• 6. DSD SIGNATURE ^ ° `i r'. A '�_esc:' 1 System #1 Approved for bedrooms. /e-^,;'••4(01/ o• ••�;•�.' ,� System #2 Approved for bedrooms. �t =•` Disapproved. Conditional approval for bedrooms, with the following stipulations: c' ON-SITE• ; z WATER AND o WASTEWATER o= pROGRAM • By: A Cca11ztC 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 COSA blue sheet 10-10.12 doc If more than 1 septic syst+em.is on the lot: COSA Checklist# of Structure served by this system _ Certificate of On-Site Systems Approval Checklist Legal Description: TIMBERLUX #3 BLK G LT 10 Parcel ID:_018-271-64 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 10-24-17 Sanitary seal (YIN)Y Wires properly protected (Y/N)Y Total depth 144 ft. Cased to 144 ft. Casing height(above ground) 24"+ FROM WELL LOG AT INSPECTION Date of test 10-24-17 NEW Static water level 41 ft. ft. Well production 10 g.p.m. g.p.m. WATER SAMPLE RESULTS: RETESTING FOR TOTAL COLIFORM PENDING Coliform NEG colonies/100 mL Nitrate 0.167 mg/L Arsenic: ND ug/L Date of sample: 9-17-18 Collected by: Mike Anderson B. SEPTIC/HOLDING TANK DATA r Tank Type/Material FIBERGLASS/A/6 Date installed 9/7/2018 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) CdA Y Date of pumping NEW Pumper NEW C. ABSORPTION FIELD DATA Date installed 918/18 Soil rating (sf/bedroom) 3.0 System type 5-WIDE Length 40 ft. Width 5 ft. Gravel below pipe • ft. Total depth +2 ft. Eff. absorption area 200 ft2 Monitoring tube Y Depression over field N Date of adequacy test NEW Results (Pass/Fail) NEW For 4 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. Any rejuvenation treatment(past 12 mo.) (Y/N & type) UNKNOWN If yes, give date D. LIFT STATION Date installed 9/8118 Size in gallons 80 Manhole/Access (YIN) Y "Pump on" level at PRE-SET in. "Pump off" level at PRE-SET _in. High water alarm level at PRE-SET _in. Datum BOTTOM Cycles tested NEW Meets alarm &circuit requirements? Y 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 100'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 50'+ Holding tank 100'+ Animal containment areas 100'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 10'+ Absorption field 5' Water main 100'+ Water service line 50'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 1+ Water main 100'+ Water Service line 50'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(None Known) Wells on adjacent lots 100'+ F. COMMENTS ("4,•A• „vofv •er (.2 t.) l7l /(?' 'h Lte_ d`e��sep1 G. ENGINEER'S CERTIFICATION ,.:-,`p��•OF• ��S At 1 certify that I have determined through field inspections and o*:49TH •• • 9 �� review of Municipal records that the above systems are in •,�< �7 conformance with MOA COSA guidelines in effect on this date. .% MICHAEL N. ANDERSON :Z ': Engineer's Printed Name MIKE N. ANDERSON,PF, fi#Ac••. CE- 469 •:�`�i Date 1018/2018 11 F9..(1501/S .•'�`��', COSA canary sheet_2-6-15.doc