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Home My WebLink AboutPOTTER HIGHLANDS PH 2 BLK 4 LT 4 Onsite File Potter Highlands Ph2 Block 4 Lot 4 #020 - 281 - 83 Municipality of Anchorage Community Development Department Page 1 of 2 On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite•(907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181205 PID Number: 020-281-83 ❑✓ New ❑ Upgrade Name: HAGMIER HOMES LLC ABSORPTION FIELD Address 0 Deep Trench ❑✓ Shallow Trench ❑ Bed ❑ Mound 19141 POTTER HIGHLANDS DRIVE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 6.0GPD/SF 6.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 5.5 Ft. 0.5Ft. POTTER HIGHLANDS PH 2 4 4 Fill added above original grade Gravel length Township Range Section 0.0 Ft. 20.0 Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES 5.0Ft. N/A N/A Ft. Toff Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Lift Station Tank Line 100 Ft2 1 N/A Ft. Well 100.0 100+ N/A N/A 80.0 TANK El Septic 0 S.T.E.P. 0 Holding 0 Other Manufacturer Capacity Surface Water 100+ 100+ N/A N/A ADVANTEX 1500Ga1. Material Number of compartments Lot Line 5+ 10+ N/A N/A FIBERGLASS 2 NA Foundation 10+ 10+ N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ 50+ N/A N/A I Gal. Remarks Pump on level at Pump off level a High water alarm at in. in. Pump make model Electrical Inspections performed by to drainfield MATERIAL House to tank 3034 Tank ld 3034 Installer RED DOG Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 1045.0ft Inspection �" 12/20/18 �a Location and description dates: 2 12121/18 a° 12/21/18 4th 2/27/19 BOTTOM TRIM AT HOUSE POINT A COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp kVo Conditional Approval: Date �Gi pLSkkt 3#1141, * 0 �••tteveri 1Ianno e 9 E814 / t*47'..v Approved 1 4/l 26--/f r Date Z- >,>>a� O0 .. Inspection Report_1-1-12.doc PRIMARY DESIGN PARAMETERS ' A B NO. BEDROOM:4(600 gpd) • . TANK SIZE: 1500G ADVANTEX(CAT 111) T1 54.8 52.7 PERC RATE: <1 MPI ( T2 65.5 62.9 SOIL RATING: 6.0 GPD/SF AREA ROD: 100 SF I DCO 70.2 68.9 SYS.TYPE:WIDE TRENCH 0.5'ED I MIN LENGTH: 20 LF C 1 91.3 86.8 5 / ml 93.4 88.3 USED: I C2 115.6 110.1 11.20.0.0LFx5.0'Wx0.5' E.D.,6.0'TD TOTAL AREA: 100 SF.• I M2 112.1 107.0II\ IUNDEVELOPED zit I INSTALLED ABSORPTION FIELD 1 i 20.OLFx5.0'Wx0.5'E.D.,6.0'T.D. I I I W/ COs & MTs ON ENDS I INSTALLED 2.0' FILTER SAND BENEATH FIELD ,. I 1\1 T _ RESERVE ABSORPTION FIELD(NIC) I ' 20.OLFx5.0'Wx0.5'E.D.6.O'T.D.N 22.4 M INSTALLED 1500G ADVANTEX W/ AX-20 POD • I I 1 2 ,.,,`_ • • 3 7.8 & FC BEFORE AND DCO AFTER TANK F.A.P. -I / I -I M1 ?. M . �, I / 41 w ,. Ti / " 1 F • \ . DRIVEWAY \ n 135.4 A I 4BR '' ' N' \ Z I SFD WELL \\// . f I 4 a / UNDEVELOPED — W y, 0) m H F "'5 0 ccs RAIN R K " ... o oW ABOVE PIPE INV o 2 g oV U - - 4" 0 DRAIN PIPE EL.1040.0 FI T R FA RI �.2u OG EL.1040.0 Poo :114 •PROFILE'_ 0NROCKFAP19 AOVAN \ \ • 2.0'SANG FILTER \103a.5 •., SCALE:N.T.S. 1034.5/ 1• • 12.0 100CT99 — (1020.5) 1{.. NOTES: _ PANNONE ENG SVC Date RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK LLC 99510 P • 3/15/19 REV1 PER MOA PHONE (907) 272-8218 FAX (907) 272-8211 _••. * Scale COMMENTS 190322 ? i. % •.* 1" = 50' POTTER HIGHLANDS PH2 B4 L4 , �•��1� ��•• ' 020 NO -� 020-281-83 DRAWN ACP HAGMIER HOMES LLC :.even '•••ronnoaie' PERMIT NO. ;t•.. CE 8149 19141 POTTER HIGHLANDS DRIVE ., OSP181205 ANCHORAGE, AK i =:;� ,9 Sheet \\ 2OF2 ..dine Drilling & Enterprises .k,t,1,-\ -7-- i Zi Well Log l 1 Permit;Number: #SW181205 Date of Issue: 7-26-18 Parcel Identification Number: 02028183000 Date S l rted: 9-25-18 Date Completed: 9-25-18 Is well located at approved permit location?x Yes ❑ No s Legal Description: Potter Highland Ph 2 Block 4 Lot 4 Property Owner Name&Address: Potter Creek Development, LLC John Hagmeier Homes 2204 Clevland#201 , Anchorage, Alaska Borehole Data: Soil Type,Thickness&Water Strata Depth (ft) Prom To - Method of Drilling x air rotary ❑cable tool Casing type: steel 1 stick-up 0 2 Wall Thickness: inches gravelly silt 2 53 Diameter:6 inches Depth: 72 feet Liner Type: silt 53 65 Diameter: inches Depth: __feet gravelly silt 65 70 Casing stickup above ground: 2 feet I bedrock 70 206 Static water level(from ground level): 69 feet l Pumping level: 200 feet after • 2 hours pumping 12 gpm 's Recovery Rate: 12 gpmfi Method of Testing:airlift Well Intake Opening Type: x Open End ❑ Open Hole ❑ Screened Start feet Stopped feet I ❑ Perforations Start foot Stopped feet 5 Grout Type: bentonite granules Volume: 2 bgs Depth: Start 0 feet Stopped ? feet 4 Pump: Intake Depth feet H WATER 0 UALITY TESTING Pump size hp Brand Name iii Co'I/140mL Coliform s Well Disinfected Upon Completion? x Yes❑No Nitrates ME L Method of Disinfection: chlorine tablets E. Arsenic N D Comments: t } Well Driller: Alpine Drilling&Enterprises PO Box 110496 Anchorage AK 99511 3 I n• i . I i • 1 1 6 F l l 1 i MUNICIPALITY OF ANCHORAGE 1 t -----.- i Development Services Department 4.4 ;I Phone: 907-343-7904 1 On-Site Water& Wastewater Section Fax: 907-343-7997 I ! Pump Installation Log 181205 07 26 18 Well Drilling Permit Number: Date of Issue: - - Parcel Identification Number: 02(.281.83W° 3 i Legal Description Block Lot Property Owner Name&Address: Potter Highlands 4 4 John Hagmeier Co. Phase 2 2204 Cleveland 1/201 g Anchorage,AK 99517 a Pump Installation Date: 1 _21 _2019 �v 4 I Pump Intake Depth Below Top of Well Casing: 192 feet Pump Manufacturer's Name: Goulds Pump Model: 7HS07 j C Pump Size: 3/4 hp i1 Pitless Adapter Burial Depth: N/A feet Pitless Adapter Manufacturer's Name: N/A Pitless Adapter Installer: N/A 4 Well Disinfected Upon Completion? Cl Yes 0 No Method of Disinfection: chlorine tablets Comments: i 1 PLEASE SAVE FOR COSA. 1 t 2 I Pump Installer Name: Company: Aarow Pump & Well Service, LLC 1 5 Mailing Address: P.O. Box 110496 City: Anchorage State: AK Zip: 99511 Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. • 1 1 e i MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Water & Wastewater System Permit Permit Number: OSP181205 Work Type: WellSeptic Initial Tax Code Number: 02028183000 Site Legal Address: POTTER HIGHLANDS PH 2 BLK 4 LT 4 G:3638 Site Mailing Address: 19141 POTTER HIGHLANDS DR, Anchorage Owner: POTTER CREEK DEVELOPMENT LLC Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: 0 Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: Lot Size in Sq Ft Total Bedrooms: �JAIC�,( Departnicnt 7/26/2018 7/26/2019 51868 2 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 Received B) Issued By: 17eFaed '� i ekc� Date: Date: 4 MUNICIPALITY OF ANCHORAGE ta_' I it% Community Development Department ``' Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water& Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 020-281-83 Property owner(s) POTTER CREEK DEVELOPMENT LLC Day phone Mailing address 561 E 36TH AVE STE 200 Site address NHN POTTER HIGHLANDS DRIVE Legal description (Sub'd., Block & Lot) POTTER HIGHLANDS PH2 B4 L4 Legal description (Township, Range & Section) Lot Size 51,868 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑X Initial 0 Single Family (SF) 0 (w/wo ADU) Septic Tank Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. 11, (Signature of property owner or authorized agent) Permit/Rush Fees: szt 1254.t-4o Waiver Fees: Date of Payment: 1-11'-((� Date of Payment: Receipt Number: n 01146 Receipt Number: Permit No. Q3PIcj 12.06 Waiver No. Permit App_. ::.,c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181205, Deb Wockenfuss, 07/26/18 NOTES & SPECIAL PROVISIONS: I U- ES --- - - - - - -- --- I-- _I I \ - - - �- �- R CONSTRUCTION 1 SCOPE AND SPECIFICATIONS: /� \ - - - _ / (.?,(/,l -FO/ 1.1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH I * 1 AMC 15.65 AND 15.55. 1.2. SCOPE OF WORK: INSTALL NEW 1500g ADVANTEX TANK W/ AX -20, AND SOIL ABSORPTION SYSTEM. INSTALL WELL I `� 1.3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 12.5 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 12.5 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 1.4. STRUCTURES DEPICTED ON THE SITE PLAN ARE BASED UPON ONE OF THE FOLLOWING: CONCEPTUAL PLOT PLAN DEVELOPED BY OWNER; A PLOT PLAN M I I b DEVELOPED BY RLS; OR A SURVEY AS -BUILT. 5 2. CONSTRUCTION SPECIFICATIONS: 2.1. ALL EXCAVATION DEPTHS ARE ADVISORY. THEY ARE TO BE VERIFIED AND MAY BE MODIFIED BY THE ENGINEER IF ACTUAL FIELD CONDITIONS VARY FROM TRUE N21RTH � I SCA E : 1"= 50' THOSE USED TO PREPARE THE DESIGN / 2.2. EXCAVATE THE DRAIN FIELD. BOTTOM OF EXCAVATION SHALL BE LEVEL AND SCARIFIED. RECORD ELEVATIONS AT BEGINNING, MIDDLE AND END OF TRENCH BOTTOM. CONSTRUCTION EQUIPMENT SHALL NOT OPERATE ON THE FLOOR OF THE EXCAVATION. ANY MATERIAL COMPACTED BY THE OPERATION OF THE CONSTRUCTION EQUIPMENT SHALL BE REMOVED AND REPLACED WITH UNCOMPACTED MATERIAL. z 2.3. PLACE THE SEWER ROCK TO THE SPECIFIED DEPTHS. DO NOT CONTAMINATE SEWER ROCK WITH NATIVE MATERIAL OR SPOILS FROM EXCAVATION. LEVEL UNDEVELOPED ROCK SURFACE TO tl" PRIOR TO INSTALLING THE PERFORATED PIPE. aNn 2.4. ALL PIPE SHALL BE PVC CONFORMING TO ASTM D3034 OR ENGINEER APPROVED EQUAL. MINIMUM SOIL COVER SHALL BE 3 FEET OVER THE PIPE AND 4 I RESERVE ABSORPTION FIELD NIC / I gym FEET OVER THE SEPTIC TANK. ONE INCH OF INSULATION MAY BE SUBSTITUTED FOR 1 FOOT OF SOIL COVER. I 6 D 5'E...0'T.D. / I 2.5. ALL INSULATION SHALL BE 2" THICK DOW HI -40 INSULBOARD OR ENGINEER APPROVED EQUAL. CENTER INSULBOARD WIDTH OVER SEPTIC TANK OR LINES. 20.OLFx5.0'Wx0. I / / W << 2.6. GEOTEXTILE SHALL BE MIRAFI 1405 OR ENGINEER APPROVED EQUAL. LAP ALL JOINTS 2 FEET MINIMUM. < I / / I 2.7. COVER THE DISTRIBUTION PIPE WITH A MINIMUM OF 2" OF SEWER ROCK AND COVER WITH GEOTEXTILE BEFORE PLACING INSULATION AND BACKFILL. Um 2.8. MATERIAL USED AS FILL SHALL BE CLEAN AND FREE OF ORGANICS, TRASH AND CONSTRUCTION DEBRIS. I _ INSTALL ABSORPTION FIELD(P) 1 / a 2.9. SLOPE ALL FILL MATERIAL TO DRAIN AT 2% MINIMUM SLOPE AND 3:1 MAXIMUM SLOPE AND IN SUCH A MANNER THAT PONDING AT OR NEAR THE DRAIN FIELD I 20.OLFX5.0'WXO.5'E.D.,6.0'T.D. / 3� _W o DOES NOT OCCUR. THE FILL SHALL BE LEFT AT 6" HIGHER THAN SHOWN TO ALLOW FOR SETTLEMENT. SEED SURFACE AFTER COMPLETING INSTALLATION AS o oz PER MOA CODE. I c W/ COS & MTs ON ENDS 2.10. RECORD THE FINISH GROUND ELEVATION OVER THE BEGINNING, MIDDLE AND END OF SYSTEM. I ADD 2.0' FILTER SAND BENEATH FIELD,-&NSttff �/ 1 2.11. MAINTAIN 5' SEPARATION BETWEEN PERCOLATION HOLE AND THE DRAIN FIELD TRENCH. C=I 55.1 2.0' COV .. per p15 /I 2.12. EXPOSE, PUMP AND FILL LOG DISPOSAL CRIB OR CONCRETE TANK WITH SOIL TO ABANDON [AW WITH MOA CODE IF NEEDED. 3. CONTRACTOR RESPONSIBILITIES: m�1 INSTALL 150OG ADVANTEX W AX -20 PmUP 11 3.1. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC LOCATION STAKED AND ANY LOT LINE I �I & FC BEFORE AND DCO AFTER TANK I / .� W > AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE I W WORK. � 3.2. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED. i Ain3.3. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES. +-38.9 47.8 TH- 4 / / / / / / '/ a Q Q 3.4. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING AND LOCATES SHALL BE IN PLACE I / U) iz/ / / I G a PRIOR TO NOTIFYING THE ENGINEER. 3.5. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE CONDITIONS/LIMITATIONS \ I DRIVEWAY 4BR / / / I Z J 0 - POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN. V 0 BF D 1 72.1 / / / Z = 3.6. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED -LINE AS -BUILT DRAWINGS TO THE ENGINEER. THE RED -LINES SHALL INCLUDE I / / / 1 $ 3 / / I e I ue PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND TANK ELEVATIONS. 3.7. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION, TOP OF PIPE WITH CLEAN -OUTS J = _ AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING. _ I / / a 0 Z I- 4. THE CONTRACTOR SHALL SIGN THE FOLLOWING: I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL U =_ a_ CHANGE ORDERS, AND THAT THE AS -BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED. _ / /� I - I% Z W CONTRACTOR: BY; TITLE: DATE: iii U) _ I loaa LLJloae WELL P' / I ! I. - y 5.XCACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT THE PROJECT AS CONSTRUCTED. THIS DATA INWITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER (OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THEREEN DEFECTS BY THE CONTRACTOR. / 0 0- / UNDEVELOPED / _,4 7052 1os6 PRIMARY/RESERVE DESIGN SOILS LOG PARAMETERS TEST HOLE 954 PRIMARY DESIGN PARAMETERS 1 OR I TOPSOIL NO. BEDROOM: 4(600 gpd) 2 TANK SIZE: 150OG ADVANTEX (CAT III) 3 PERC RATE: <1 MPI SOIL RATING: 6.0 GPD/SF 4 - AREA ROD: 100 SF SYS. TYPE: WIDE TRENCH 0.5'ED 5 MIN LENGTH: 20 LF LU _ Z Z J om0m 0 Ix (n O y N N LU ZZ�m<r� a W Lu < ABBREVIATIONS WTH -TEST HOLE 6 1 / / (P) PROPOSED *: �• USE: / 1 / / (E) EXISTING €Y 7 WAS GROUND WATER SOIL TEST RESULTS/ANALYSIS / / \ I - W -WATER LINE /WELL RADIA CO CLEAN OUT NO. m 20.0.OLFx5.0'WxO.5' E.D., 6.0' TO / II TOTAL AREA: 100 SF g GM GRAVEL ENCOUNTERED? N PERCOLATION RATE <1 (minlinch) / / / / MT MONITOR TUBE N0. 1�j; (Hydrologic Soils Group: HSG A) / / / / -�-1�EWSEPTIC TYP TYPICAL �y `rbr•. . IF YES, AT WHAT PERC HOLE DIAMETER 6" !e u 9 -DEPTH? -NA-' TEST RUN BETWEEN 5 FTAND 6 FT I #' RESERVE DESIGN PARAMETERS 70 DEPTH TO WATER AFTER o 0 REVISIONS QO � RAIN R K K REVI:IRJULIR j�f lC 11 MONITORING? - 12.3' - � � a �_ , ABOVE PIPE INV . W z REV2'23JUL18 j t --Z m 4" 0 RAIN PIP z m ,- DATE: 220CT7999 0 J J �o o 12 220CT99 �''U U U UO�I- FILTER FA RI �.UO REV4:O7AUGIR NO. BEDROOM: 4(600 gpd) _TM1999 TANK SIZE: 150OG ADVANTEX (CAT III) 13 - PERC RATE: <1 MPI 1 D OR SOIL RATING: 6.0 GPD/SF 14 BOH jA YVAN 6.0 AREA ROD: 100 SF SYS. TYPE: WIDE TRENCH 0.5'ED �0.5 4.G - MIN . u o N m MIN LENGTH: 20 LFADVANTEX W N USE: SAND 2.DI 6. a o 0 GM a om 20.0.OLFx5.0'Wx0.5' E.D., 6.0' TO ' 20.0 i 6 5 9. = N 3 U) g TOTAL AREA: 100 SF SHEET 12.0 100CT99 C 3 • O DATE PERFORMED: OCT1999 PROFILE 14.0 1 OF 1 WATER RATE READING DATE NET TIME LEVEL NET CROP (MPI) READING 1 04JANIB 8.398- 2 SEE RECORDS 3.52' 0.3 3 4 3 s2- 0.3 PI -11 8.105' 6 1.5 MIN 11.900" 3.79" 0.4 LU _ Z Z J om0m 0 Ix (n O y N N LU ZZ�m<r� a W Lu < ABBREVIATIONS WTH -TEST HOLE 6 1 / / (P) PROPOSED *: �• USE: / 1 / / (E) EXISTING €Y 7 WAS GROUND WATER SOIL TEST RESULTS/ANALYSIS / / \ I - W -WATER LINE /WELL RADIA CO CLEAN OUT NO. m 20.0.OLFx5.0'WxO.5' E.D., 6.0' TO / II TOTAL AREA: 100 SF g GM GRAVEL ENCOUNTERED? N PERCOLATION RATE <1 (minlinch) / / / / MT MONITOR TUBE N0. 1�j; (Hydrologic Soils Group: HSG A) / / / / -�-1�EWSEPTIC TYP TYPICAL �y `rbr•. . IF YES, AT WHAT PERC HOLE DIAMETER 6" !e u 9 -DEPTH? -NA-' TEST RUN BETWEEN 5 FTAND 6 FT I #' RESERVE DESIGN PARAMETERS 70 DEPTH TO WATER AFTER o 0 REVISIONS QO � RAIN R K K REVI:IRJULIR j�f lC 11 MONITORING? - 12.3' - � � a �_ , ABOVE PIPE INV . W z REV2'23JUL18 j t --Z m 4" 0 RAIN PIP z m ,- DATE: 220CT7999 0 J J �o o 12 220CT99 �''U U U UO�I- FILTER FA RI �.UO REV4:O7AUGIR NO. BEDROOM: 4(600 gpd) _TM1999 TANK SIZE: 150OG ADVANTEX (CAT III) 13 - PERC RATE: <1 MPI 1 D OR SOIL RATING: 6.0 GPD/SF 14 BOH jA YVAN 6.0 AREA ROD: 100 SF SYS. TYPE: WIDE TRENCH 0.5'ED �0.5 4.G - MIN . u o N m MIN LENGTH: 20 LFADVANTEX W N USE: SAND 2.DI 6. a o 0 GM a om 20.0.OLFx5.0'Wx0.5' E.D., 6.0' TO ' 20.0 i 6 5 9. = N 3 U) g TOTAL AREA: 100 SF SHEET 12.0 100CT99 C 3 • O DATE PERFORMED: OCT1999 PROFILE 14.0 1 OF 1 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181205, Deb Wockenfuss, 07/26/18 Development Services Department On-Site Water & Wastewater Section Phone: (907)343-7904 Fax: (907)343-7997 MUNICIPALITY OF ANCHORAGE 020 -281-83 POTTER HIGHLANDS PH 2 BLK 4 LT 4 Expiration Date: Parcel ID Legal description Site address 19141 POTTER HIGHLANDS DR Current property owner(s) MATTESON ARTHUR JOSEPH & X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments By:Isatou B Njie Original Certificate Date: 1/26/2026 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 Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist Absorption Field Advisory Tank Age Advisory Other Well Flow Advisory Nitrate Advisory Arsenic Advisory Certificate of On-Site Systems Approval X OSC261011 01/06/2027 COSA Checklist_May2025.docx COSA Checklist Legal Description: POTTER HIGHLANDS PH2 B4 L4 Parcel ID: 020-281-83 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 9/25/2018 Total depth 206 ft Cased to 72 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 1/6/2026 Static water level at beginning of test 69 ft. Well production at time of test 4+ gpm Water storage tank volume None gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 4.32 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 1/6/2026 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank NA Date of pumping 1/17/26 ADVANTEX MAINT Required maintenance completed, if AWWTS Comments: SEE AX MAINTENANCE REPORT C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. DISPOSAL FIELD DATA Which system tested (date installed) 12/21/2018 ALL standpipes present per record drawing Total measured depth from grade 5.6 ft (max) Measured depth to pipe invert from grade 4.8 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 1/6/2026 Results Pass Fluid depth prior to test 0 in Water added 600 gal New fluid depth 2 in Elapsed time 30 min Final fluid depth 0 in Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 6 in (MOA IR 0.5’) Effective depth used 0 in Effective depth remaining 6 in Comments/Deficiencies: COSA Checklist_May2025.docx E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100’ Yes if No *50+ ft Neighboring Tank > 100’ Yes if No ft Disposal Field on Lot > 100’ Yes if No *50+ ft Neighboring Disposal Fields > 100’ Yes if No ft Sewer Line/Main > 100’ Yes if No ft Sewer Manhole/Cleanout > 100’ Yes if No ft Sewer Service/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10’ Yes if No ft Field to Foundation > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No *5+ ft Water Main/Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No *50+ ft Wells on Adjacent Lots: Wells > 100’ Yes if No *50+ ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below. F. ENGINEER’S COMMENTS *MAY MEET CONVENTIONAL SEPARATIONS, BUT SYSTEM MEETS CATIII/II SEPARATION DISTANCE REQUIREMENTS. G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 01/20/2026 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 01/20/26 EPUIMIS MUNICIPALITY OF ANCHORAGE Development Services Department \ Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval Parcel I.D. 020-281-83 Expiration Date: z0 -1 cf 1. GENERAL INFORMATION Complete legal description Potter Highlands Ph 2 B4 L4 Location (site address) 19141 Potter Highlands Drive Current property owner(s) Hagmler Homes LLC Day phone Mailing address 2204 Clevland Ave Suite 201 Anchorage, AK 99517 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 El Private Septic 0 Water Storage ❑ Holding Tank (1 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 $ 76- - Waiver Fee $ Date of Payment 30/8 B//9 Date of Payment Receipt Number 6(0IO5i ) Receipt Number COSA# f)(01073 0 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system.All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system.The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. Date Jci123/ -- .77 TA 6. DSD SIGNATURE %•':• System #1 Approved for �( bedrooms t . onnera�' CE 8149 System #2 Approved for bedrooms Disapproved llANNeec��' Conditional approval for bedrooms, with the following stipulations: 4,0“ � Y(OFfrrrr( , CV ON-SITE, WATFR AND `"' 1:::aWASTEWATER o -*--PFC7G177-C1G1— �` �'�rSER�c'i�``' dj)))))))))111'1 By: \ l� Original Certificate Date: Y 9 S 2/ I� 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 COSA Checklist Legal Description: Potter Highlands Ph2 B4 L4 Parcel ID: 020-281-83 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 12 gpm Date drilled 912518 Water storage tank volume gallons Total depth 206 ft Well disinfected for coliform test? ❑Yes ❑✓ No Cased to 72 ft 0 Coliform bacteria is Negative 0 Sanitary seal is functioning correctly Nitrate 4.19 mg/L ❑ Nitrate less than MRL (ND) 0 Wires are properly protected Arsenic ND ug/L 0 Arsenic less than MRL (ND) Casing height(above ground) 24 in. Collected by PES Date of flow test for COSA New Date of Sample 2-14-19 Static water level at beginning of test 69 ft. Comments B. TANK DATA C. LIFT STATION Age of tank(s) ,2'20'18 ears g y 0 Required maintenance completed Tank type/material Age of lift station years Measured operating fluid level in septic tank New Lift station material 0 Standpipes/foundation cleanout per record drawing Comments: Date of pumping New * FAP Advantex / Fiberglass D. ABSORPTION FIELD DATA Shallow Trench Which system tested (date installed) 12'21,18 Adequacy test date New 0 ALL standpipes present per record drawing Results ED Pass For 4 bedrooms Total measured depth from grade 6.0 ft(max) Fluid depth prior to test in Measured depth to pipe invert from grade 5.5 ft(min) Water added gal El N/A—pressurized field New depth in 0 Monitor tubes go to bottom of effective. If not, state Elapsed time min depth into effective 0 Code-required soil cover over field Final fluid depth in 0 System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) date of test) If yes, enter date Gallons introduced gallons 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' Community Sewer Manhole/Cleanout> 100' 0 Yes if No ft 0✓ Yes if No ft Neighboring Tank > 100' Q✓ Yes if No ft Private Sewer/Septic Line > 25' ✓0 Yes if No ft Absorption Field on Lot> 100' 0✓ Yes if No ft Holding Tank> 100' p Yes if No ft Neighboring Absorption Fields > 100' Animal Containment>50' 0✓ Yes if No ft ✓❑Yes if No ft Manure/Animal Excreta Storage> 100' Community Sewer Main > 75' ✓0 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' 0 Yes if No ft Surface Water> 100' I2 Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' E] Yes if No ft Private Wells > 100' ✓0 Yes if No ft Water Main > 10' LI Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' 0 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' D✓ Yes if No ft Water Service Line> 10' E Yes if No ft Community Wells>200' 0✓ Yes if No ft Surface Water> 100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review �.• 4 of Municipal records that the above systems are in conformance with *149 M. j" ',* MOA COSA guidelines in effect on this date. •••• •• • .. seven -. -annolge v,,. CE 8149 •. ••• 'c• COSA Checklist yellow sheet POTTER HIGHLANDS SUBDIVISION PHASE 2 LOT 4, BLOCK 4 51,868 S.F. • S 89•49'55"E 298.00' • t o o •• SEP1,C MEEu ./00 I-. '.3• ti EXISTING DRNNAGEWAY 0 30' to PER MOA MAPPING DATA /0J'3 . V o 1 I o 1 I i I 0 ill. 0: z ,,„7 ) I 4 04,41. -, rS 0 1* I w r ) o exon Iw W o. BU�a 1.8 o ♦ oo I'. 0 / o 43. a jr, , ry- ir0 A Et II II 2 BUILDING DETAIL 126.6, WELL SCALE: 1"=20' 1 "=40' St 77•53'0 5^E 309.03' REVISED 3/15/2019 ADDED STAND PIPE. AS -B U I L T I HEREBY CERTIFY THAT I HAVE SURVEYED THE 'PROPERTY GASTALDI LAND ENCROACHMENTS TEXI TT ED EXC OAS INDICATED. •THAT NO ,♦\\\�1\ SURVEYING. LLC IT IS THE RESPONSIBILITY OF THE OWNER TO .•'_f.••O•F•••Q(4�• JEFF A. GASTALDI, R.L.S. DETERMINE THE EXISTENCE OF ANY EASEMENTS, • ,•`P•;•• Ss, ♦♦ 2000 E.DOwUNG RO.,SUITE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT a*;•4918 ANCHORAGE,ALASKA 99507 ■• •••• APPEAR ON THE RECORDED SUBD(VISIDN PLAT. PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA j'n, r�tt a Ges, • a HEREON BE USED FOR CONSTRUCTION OR FOR ♦ :• GRID DATE 15-6091 >` Sw1638 2/11/2019 ESTABLISHING BOUNDARY OR FENCE LINES. ♦•'•.,*„../../20.4•.sq_ F D' JO8 NO. NOTEANCH: NO CORNERSE EG DISTRICT. S ALASKA ••••\\s\\��••• 18-03 PHS244