HomeMy WebLinkAboutLAKE HILL ACRES #6 BLK C LT 4Onsite File Lake Hill Acres #6 Block C Lot 4 #051-122-54 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191003 I PID Number: 051-122-54 Dwelling: © Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑® New ❑ Upgrade Name: Alexander Homes ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench 1771 Bed F-1 Mound Address P.O. Box 110344 Anchorage, AK 99511 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-830-6211 4 0.6 GPD/SF 4.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2.5 Ft. Gravel depth beneath pipe 1.5 Ft. Subdivision Block Lot Lake Hill Acres #6 C 4 Fill added above original grade 0.0 Ft. Gravel length 3 @ 52 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Lift Station Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1000 Ft` 3 >6 Ft. Well iTANK >100' >100' I N/A N/A >25 [ISeptic © S.T.E.P. [:1Holding ❑ Other Manufacturer Anchorage Tank Capacity 11500 Gal. Surface water>100'' >100' N/A N/A Material Number of compartments Lot Line >5' >10' N/A N/A Steel 2 NA Foundation >10' >10' I N/A N/A LIFT STATION Manufacturer Anchorage Tank Capacity 250 Gal. Curtain Drain i None Noted i Remarks Trenches are insulated. Pump on level at 13 in. Pump off level at 25 in. High water alarm at 11 in. Pump make and model PF2005 Electrical Inspections performed by MOA PIPE MATERIAL House to tank D3034 Tank to D1785 drainfield Installer Northern Excavation Drainfield D1785 CO/MT Inspector J. Mlllette / J. Williams BENCH MARK (Assumed elevation) 100 ft Inspection 151 2/28/19 3/1/19 Location and description 2I.d 3`° 41h Bottom of siding @ point B COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp op- tit Conditional Approval: Date fit';.,.• 49the +�a�r.,., ........ f ........... a.,,.................�a � t� WCHAEL E. ANDERSON g to yup ..�--'"" ✓"'� Approved'_­�'"f No CE 4383 ,°��Ar �� �'� ••.,� 7/24/19 Date 'OROFESSO�' inspection Kepori_a--i--iz.aoc PROFILE AS-BUILT (NO SCALE) 94.3 90.3 95.1 100.7FCOSV1 SV2MH1500 GAL S.T.E.P. TANK PERMIT # OSP191003 PID # 051-225-54 LAKE HILL ACRES #6 B-C L4 7/24/19 Date: 12-21-17 P.O. Box 670269 Chugiak, AK 99567 P: (907) 688-2759 F: (907) 688-2259 TO: Allen Piccard 22113 Anthem Place Chugiak, AK 99567 Flow Test Report Total Depth: 56’ Resting Static: 13’ Pump maxed out at 10 GPM Max draw down: 19.2’ Well Yield: 10+ GPM Received Date/Time 12/27/2017 14:18 12/27/2017 11:50Collected Date/Time 1178985001 Matrix SGS Ref.# Client Sample ID 22113 Anthem Client Name Project Name/# Printed Date/Time 01/05/2018 14:26Sullivan Water Wells Technical Director Stephen C. Ede 22113 Anthem Drinking Water Sample Remarks: Parameter Results LOQ Units Method Allowable Limits Prep Date Analysis Date InitContainer ID Metals by ICP/MS VDL01/04/18EP200.8ug/LArsenic 12/28/17ND5.00 (<10)C Waters Department AYC12/28/17SM21 4500NO3-Fmg/LTotal Nitrate/Nitrite-N 5.76 0.100 (<10) B Microbiology Laboratory K.W12/27/17SM21 9223B100mLE. Coli Negative 1 A K.W12/27/17SM21 9223B100mLTotal Coliform Negative 1 A Page 2 of 5 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program �o4r Sr, PO Box 196650 4700 Elmore Road ` b = ' i. Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 - � http://w .muni.org/onsite v i ti,,,, � Ucp[n anent On -Site Wastewater Disposal System Permit Permit Number: OSP191003 Effective Date: 2/4/2019 Work Type: Septic Initial Expiration Date: 2/4/2020 Tax Code Number: 05112254000 Site Legal Address: LAKE HILL ACRES 46 BILK C LT 4 G:1562 Site Mailing Address: 22113 ANTHEM PL, Chugiak Owner: PICCARD ALAN R & Lot Size in Sq Ft: 51823 Design Engineer: FORGE ENGINEERING Total Bedrooms: 4 This permit is for the construction of: [a Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: The existing well shall be documented prior to inspection report approval, to include total depth, casing depth, static water level, casing height, production (in gpm), proper sanitary weal and wires properly protected, as well as water quality results. Received By: )-rA, tj�,{ i'�' ,I(, ,, `fin r Issued By: ll 1/T I 'p Q7 x l' Date: Date: MUHMPAUiiY OF ° HC HORAUEF C Community Development DepartmentPhone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-122-54 Property owner(s) Alexander Homes Mailing address P.O. Box 110344 Anchorage, AK 99511 Site address 22113 Anthem Place Day phone 907-830-6211 Legal description (Sub'd., Block & Lot) Lake Hill Acres #6 B -C L4 Legal description (Township, Range & Section) Lot Size 51,823 Sq. Ft. Number of Bedrooms APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑X Single Family (SF) ❑X (w/wo ADU) Septic Tank NUpgrade ElDuplex (D) F]Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 5A S_ Waiver Fees: Date of Payment: I/ V/6 Date of Payment: Receipt Number: abgg Qn Receipt Number: Permit No. 05 P I P 1063 Waiver No. Permit App_'_'- : :'_.,:c January 6, 2019 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 1/6/19 Subject: Lake Hill Acres #6 B-C L4 – 22113 Anthem Place Septic system design Dear On-Site Services Engineer: The owner of the above lot intends to build a 3-bedroom home on the property, so we are submitting this permit application for the construction of a new septic system. The attached site plan identifies the location of the home as well as the existing well, septic location and alternate site. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The ground surface on the lot is relatively flat in all directions, and slopes less than 5%. Stormwater drainage will not impact this septic system. Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the septic tank. The alternate site is located more than 16’ away. Please refer to the attached test hole logs, soils lab analysis, plan and profile pages for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191003, Rebecca Carroll, 02/04/19 4.3 %9.5%2.5%0.2%0.2% 6.3% ALTERNATE SITE 2 x 50' LONG 5' WIDE 0.5' EFFECTIVE DEPTH ABSORPTION TRENCHES 10050 0 FEET 1"=50' INSTALL 3 x 52' LONG x 5' WIDE x 1.5' EFFECTIVE DEPTH ABSORPTION TRENCHES 3-BDRM HOME NEW 1500-GAL STEP TANK NOTE: · NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM · ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. ·WETLANDS AREA TO BE REVEGETATED BY AUG 1, 2019 ·GRADING AND STORMWATER RUNOFF WILL NOT CHANGE SIGNIFICANTLY AFTER SEPTIC CONSTRUCTION CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND LAKE HILL ACRES #6, BLOCK C LOT 4 SLOPES > 25% SLOPES > 46%ANTHEM PLACE10' UTILITY EASEMENTTH#1 TH#2 MT MT MT FCO ADJACENT WELL 100' WELL RADIUS EXISTING WELL WETLANDS BOUNDARY MT MT MT Jan 21, 2019 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191003, Rebecca Carroll, 02/04/19 LAKE HILL ACRES #6 B-C L4 DESIGN FACTORS: SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW PERK RATE: 16-30 MIN/IN APPLICATION RATE: 0.6 GPD/SF 1.5' EFFECTIVE 5' WIDE TRENCH SYSTEM 1500-GAL STEP TANK TYPICAL TRENCH SECTION (NO SCALE) 1 1 4" PVC WITH 15 3 16 " HOLES PER LATERAL EVENLY SPACED DRAINFIELD ROCK 5' 6" 6" 2' 1'-6" NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY BOTTOM OF TRENCH: 4' BELOW GRADE FLOW LINE ELEVATION: 2.5' BELOW GRADE TOP OF TRENCH: 0.5' ABOVE GRADE 600 GPD / 0.6 GPD/SF /5' WIDE * 0.78 RED. FACTOR = 155.6 LF TRENCH REQUIRED (156 LF SPECIFIED) 2" INSULATION Jan 21, 2019 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191003, Rebecca Carroll, 02/04/19 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST TECHNICIAN: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (feet) PROJECT No.: TEST HOLE 1 SLOPE SLOPE SITE PLAN See Site Plan DATE READING GROSS TIME (minutes) NET TIME (minutes) DEPTH to WATER NET DROP TEST HOLE PRESOAKED PRIOR TO TESTING: PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH) TEST RUN BETWEEN: FT. and FT. COMMENTS: (inches)(inches) Lake Hill Acres #6 Bc L4 12/11/18 J. Williams DATE OF MONITORING: WAS GROUND WATER ENCOUNTERED? DEPTH OF WATER AFTER MONITORING: IF YES @ WHAT DEPTH? NO - 10' 2.5 6 6 7 051-122-54 ALEXANDER HOMES 1:37 / 1:47 12/10 1 2 3 4 5 6 10 0" / 3 15 16 " 3 15 16 "1:49 / 1:59 2:02 / 2:12 2:13 / 2:23 2:24 / 2:34 2:35 / 2:45 OB 12/18/18 Professional Engineers Stamp: 10 0" / 4" 4" 10 4" 10 4" 10 4" 10 4" 0" / 4" 0" / 4" 0" / 4" 0" / 4" SM/SC: SILTY SAND SOME ROCKS AND POCKETS OF CLAY SANDIER WITH DEPTH Jan 06, 2019 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191003, Rebecca Carroll, 02/04/19 LEGAL DESCRIPTION: PERFORMED FOR: DATE: PARCEL ID#: SOILS LOG AND PERCOLATION TEST TECHNICIAN: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DEPTH (feet) PROJECT No.: TEST HOLE 2 SLOPE SLOPE SITE PLAN See Site Plan DATE READING GROSS TIME (minutes) NET TIME (minutes) DEPTH to WATER NET DROP TEST HOLE PRESOAKED PRIOR TO TESTING: PERC. HOLE DIA. (INCHES)PERCOLATION RATE: (MIN/INCH) TEST RUN BETWEEN: FT. and FT. COMMENTS: (inches)(inches) Lake Hill Acres #6 Bc L4 12/11/18 J. Millette DATE OF MONITORING: WAS GROUND WATER ENCOUNTERED? DEPTH OF WATER AFTER MONITORING: IF YES @ WHAT DEPTH? NO - 10' 18.5 6 6 7 051-122-54 ALEXANDER HOMES 10:22 12/18 1 2 3 4 5 6 30 30 30 5 8 16 7 3 16 1 11 1610:52 10:53 11:23 11:24 11:54 OB 12/18/18 Professional Engineers Stamp: BOH 5 8 16 7 2 16 1 10 16 5 8 16 7 2 16 1 10 16 SM/SC: SILTY SAND SOME ROCKS AND POCKETS OF CLAY SANDIER WITH DEPTH Jan 06, 2019 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191003, Rebecca Carroll, 02/04/19 Yd n<u 04W i Fsl OPINION OF COMPLIANCE ANCHORAGE GENERAL PERMIT 93 -10 -M4/11 -M4/12 -M4 File Number: POA -2019-00057 Municipal Reference Number: Mirror Lake 19-A Permittee (LANDOWNER): Ben Schiller, Forge Eng., Alan Piccard (owner) Expiration Date: OCTOBER 31, 2020 Project Location: Lake Hill Acres #6, Block C, Lot 4 Anchorage Wetland Management Plan Map M 26 Chugiak-ER Maps Wetland Unit #: 109 Wetlands Fill Amounts: 58 cyds in 3,800 sq ft /.087 acres of C wetlands Work Description: Fill and clearing for septic system and working space during construction of single family home. All work will be performed in accordance with the attached plans submitted with application dated: January 30, 2019 The permittee will perform work in waters of the U.S. (wetlands) in accordance with the terms and conditions of the Anchorage General Permit, as specified below: Anchorage General Permit Conditions: GENERAL ONDITION OF THESE GENERAL PERMITS All activities identified and authorized by these GPs shall be consistent with the special conditions listed above, as well as the general conditions listed below. The Corps can also add site-specific special conditions to a GP verification, as applicable. Obtain GP GP verificationprior to activitvto activity: No work shall be done under these GPs without first obtaining an Opinion of Compliance (OC) from the MOA Planning Division or General Permit Verification from the Corps. A copy of the Municipal building permit application and grade/fill permit application or Land Use permit application must be included with the GP application. Compensatory mitigation, if required, must be acquired before proceeding with authorized jurisdictional activities. Time limit: Verification under these GPs is valid until October 31, 2020, unless the GPs are Alan Piccard POA -2019-00057; Mirror Lake 19-A modified, reissued or revoked. It is incumbent upon the applicant to remain informed of changes to the GPs. Mitigation: The activity must be designed and constructed to avoid and minimize adverse effects, both temporary and permanent, to waters of the U.S. to the maximum extent practicable at the project site. Mitigation in all its forms (avoiding, minimizing, rectifying, reducing, or compensating for resource losses) will be required to the extent necessary to ensure that the adverse effects to the aquatic environment are minimal. Compensatory mitigation will be required for all wetland losses greater than 0.1 -acre unless the District Commander determines in writing that either some other form of mitigation would be more environmentally appropriate or the adverse effects of the proposed activity are minimal, and provides a project specific waiver of this requirement. The applicant may seek this determination by written request to the Corps. The Corps' determination on compensatory mitigation will be returned, in writing, to the MOA Planning Division for inclusion into the OC. If applicable, compensatory mitigation must be completed prior to conducting work authorized under these GPs. Compensatory mitigation projects provided to offset losses of aquatic resources must comply with the applicable provisions of 33 CFR 332, Setback: Where there are wetlands along or around a stream or water body, the project shall include and maintain a non -disturbance setback, measured horizontally from the ordinary high water mark, as specified in Attachment A. Applicants shall contact the MOA Planning Division or Corps to obtain or confirm delineation of the setback. The setback extends only as far as the outer edge of the adjacent wetland boundary. Setbacks greater than 25 feet wide do not extend into non -wetlands. No Setbacks Required Buffer: The project shall include and maintain a non -disturbance buffer area, as specified in Attachment A. Applicants shall contact the MOA Planning Division or Corps to obtain or confirm delineation of the buffer. Delineation of project boundary: Project boundaries shall be staked, flagged or otherwise clearly delineated prior to the commencement of the authorized activity to prevent inadvertent encroachmentof adjacent wetlands. Endangered Species: Activities authorized under these GPs must not adversely affect a federally listed threatened or endangered species, or destroy or adversely modify its designated critical habitat. Historic properties: No cultural resources shall be adversely affected by activities authorized by these GPs. If the permittee discovers any previously undiscovered archeological, paleontological, or historic resource, while conducting activities authorized by these GPs, the DC must be immediately notified by calling (800) 478-2712. The Corps will notify the Alaska State Historic Preservation Office of what has been have found. The Corps or the appropriate federal land manager will initiate the Federal and State coordination required to determine if the remains warrant a recovery effort or if the site is eligible for listing in the National Register of Historic Places. Inspection: The applicant shall allow the DE or their authorized representative(s) and/or a representative from the MOA Planning Division to inspect authorized work at anytime deemed necessary to assure that on-going and completed work is in compliance with the terms and conditions of these GPs. Transfer of General Permit: If the applicant sells or wishes to transfers the property associated with the authorized activity, the applicant must obtain the signature of the new property owner or lessee in the appropriate space on the verification/OC and submit a copy of that page to the MOA Planning Division and/or Corps, along with appropriate documentation of the transaction. All information must be submitted within 30 days of the property transfer to validate the transfer of the GP authorization to the new party. Alan Piccard 2 POA -2019-00057; Mirror Lake 19-A Modification by other authorization: If the work proposed under these GPs is subsequently modified by any other Federal, State, or local governmental authorization, a modification of the GPs, MOA Planning Division's Opinion of Compliance, and any verification by the Corps to perform activities under these GPs may need to be obtained. Use of multiple general permits including Nationwide Permits: The use of more than one GP or Nationwide Permit (NW P) for a single and complete project is prohibited, except when the acreage loss of waters of the United States authorized by the GPs and/or NW Ps does not exceed the loss of more than one acre of wetlands. Project site restrictions and design criteria: 1. For residential developments, the aggregate total loss of waters of the United States authorized by GP -1993-10-M4 shall not exceed one acre. For residential subdivisions, the aggregate total loss of waters of United States authorized by this GP cannot exceed one acre. This includes any loss of waters of the United States associated with development of individual subdivision lots. Erosion Control: Prior to the initiation of any fill discharge authorized in accordance with GP- 1993-10-M4, the Permittee shall install erosion control measures along the perimeter of all work areas to prevent the displacement or erosion of fill material outside the authorized work areas. The erosion control measures shall remain in place and be maintained until all authorized work is completed and the work areas are stabilized. Immediately after completion of the final grading of the land surface, all slopes, land surfaces, and filled areas shall be stabilized using sod, degradable mats, barriers, or a combination of similar stabilizing materials to prevent erosion. 3. Fill Material: Only clean fill material shal I be used for this project. The fill material shall be free from items such as trash, debris, automotive parts, asphalt, construction materials, concrete blocks with exposed reinforcement bars, and soils contaminated with any toxic substance, in toxic amounts in accordance with Section 307 of the Clean Water Act. 4 Within 60 days of completion of the work authorized by this permit, the Permittee shall complete ELTJJMthe attached "Self -Certification Statement of Compliance' form (Attachment D), Qlithe attached "As -Built Certification By Professional Engineer" form (Attachment E), and submit it to the Corps. These are further described below. Self -Certification Statement of Compliance: In the event that the completed work deviates in any manner from the authorized work, the Permittee shall describe the deviations between the work authorized by this permit and the work as constructed on the "Self -Certification Statement of Compliance" form. The description of any deviations on the "Self -Certification Statement of Compliance" form does not constitute approval of any deviations by the Corps. As -Built Certification: Within 60 days of completion of the work authorized by this permit, the Permittee shall submit as -built drawings of the authorized work and a completed "As -Built Certification By Professional Engineer" form to the Corps. The as - built drawings shall be signed and sealed by a registered professional engineer and include the following: a. A plan view drawing of the location of the authorized work footprint, as shown on the permit drawings, with transparent overlay of the work as constructed in the same scale as the permit drawings on 8% -inch by 11 -inch sheets or PDF. The plan view drawing should show all "earth disturbance," including wetland impacts and water management structures. Alan Piccard POA -2019-00057; Mirror Lake 19-A b. A list of any deviations between the work authorized by this permit and the work as constructed. In the event that the completed work deviates, in any manner, from the authorized work, describe on the attached "As -Built Certification By Professional Engineer" form the deviations between the work authorized by this permit and the work as constructed. Clearly indicate on the as -built drawings any deviations that have been listed. Please note that the depiction and/or description of any deviations on the drawings and/or "As -Built Certification By Professional Engineer" form does not constitute approval of any deviations by the Corps. c. Include the Department of the Army permit number on all sheets submitted. Project -specific conditions: 1. Time Limit. GP authorization of this project expires on: October 31, 2020. If you need more time to complete the authorized activity, submit a request for extension under these GPs to the Municipal Planning Department prior to the expiration date. You may not continue work beyond the expiration date until receiving notification to that effect from the Municipal Planning Department or the Corps Regulatory Branch. Note: Permittee should allow at least one month for processing of extension requests. 2. Setback Where there are wetlands along or around a stream or waterbody, the project shall include and maintain a non -disturbance setback, measured horizontally from the ordinary high water mark. The setback extends only as far as the outer edge of the adjacent wetland boundary. Setbacks greater than 25 feet wide do not extend into nonwetlands. For previously unplatted residential subdivisions, the setback area shall be tracted out, rather than being included in individual lots. 65' from Mirror Lake – project>100; and, 25 from drainageways—none identified via MOA Watershed Section mapping 3. Other Approvals Required Before Starting Work. You must not disturb wetlands for this project until you have obtained all applicable Municipal and State approvals required for the work. These approvals may include, but are not limited to: Municipality of Anchorage ® Land Use Permit ❑ Clearing Permit ❑ Grading & Fill Permit ❑ Building Permit ❑ Right -of -Way Permit ❑ Flood Hazard Permit ❑ Utility Agreement(s) ❑ Rezoning Approval ❑ Preliminary Plat Approval ❑ Subdivision Agreement ❑ Slormwater Treatment Plan ❑ Parks Right -of -Entry Permit ❑ Wastewater Disposal ❑ Urban Design Commission ❑ Geotechnical Commission Alaska Department of Environmental Conservation: ❑ Stormwater Treatment Plan ❑ Wastewater Disposal ❑ Soil Remediation Plan Alan Piccard POA -2019-00057; Mirror Lake 19-A If any of these—or other—approvals result in a change to the attached plans, you must provide a description of the change and a revised plan(s) to either Municipal Planning Department Staff or the Corps Regulatory Branch, and may not proceed with the project until the change is authorized. 4. Offset Unavoidable Impacts. To offset the unavoidable adverse impacts of the project to the aquatic environment, the permittee: ® Mitigation --not required; Project footprint is less than 0.1 acres 5. Limits on Work Area. You must not conduct any of the following activities in wetlands or waterbodies beyond the approved project footprint (or in any other avoidance area identified above) during either construction or operation of the project/facility: D Discharge of fill material (even temporarily), including stockpiles; or, ➢ Excavation and side casting/backfilling; or, ➢ Mechanized land clearing; or, ➢ Operation, parking/storage or servicing of equipment. 6. Construction Runoff. You must employ runoff control measures necessary to preclude or minimize both erosion and the transport of sediment, pollutants, and solid waste beyond the approved project footprint. These measures shall include, but are not limited to: ❑ Phasing of Site Preparation (to minimize the extent of exposed soil); ❑ Silt Fence; at wetland side of fill. ❑ Reroute Offsite Runoff around Disturbed Soils (e.g., dike/ditch) ❑ Mulching (e.g., wood chips, straw, grass clippings, gravel); ❑ Matting (e.g., jute, straw, coir); ❑ Sheeting for Stockpiles, Temporarily Exposed Slopes (e.g., plastic, geotextile fabric); ❑ Check Dams in Ditches/Drainageways (e.g., hay bales, sand bags, gravel berms); ❑ Surface Roughening (to slow runoff down slope); ❑ Terracing of Slopes; ❑ Sediment Trap(s); ❑ Temporary Sediment Basin; ❑ Storm Drain Inlet Protection (e.g., hay bales, sand bags, and gravel berm) ❑ Outlet Filtering/Stabilization for Construction Dewatering; ❑ Revegetation of Fills and Disturbed Soils ❑ Onsite petroleum spill/leak response equipment and supplies and provision for their proper disposal 7. Contaminated Soil. If contaminated soils are discovered during construction, you must immediately cease all work in the vicinity of the contamination, contact the Alaska Department of Environmental Conservation for instructions, and defer any further activity until you receive ADEC approval to continue. 8. Endangered Species. The activity must not jeopardize the continued existence of a threatened or endangered species, as identified under the Endangered Species Act, nor endanger the critical habitat of such species. Alan Piccard POA -2019-00057; Mirror Lake 19-A Special Conditions, as required by the Watershed Management Services (WMS) of the Municipality of Anchorage: No special conditions were required by the MOA WMS section. Special Conditions, as required by the Planning Division of the Municipality of Anchorage: No special conditions. Contractor is advised to consult with local road service area plans and practices for work in Anthem Dr. Special Conditions, as required by the Corps of Engineers: No special conditions were required by the Corps GPAC review. Your signature below, as permittee, confirms that you accept and agree to comply with the terms and conditions of Anchorage General Permit 93-10-M4 as supplemented in this document. SIGN Owner DATE V e ll, ly' l c{ owner 2 l PRINT Owner DATE Opinion of Compliance The signature below confirms the Municipality of Anchorage's opinion that the project described above meets the terms and conditions of Anchorage General Permit 93-10-M3. SIGN Thede Tobish, Senior Planner `deur 7a ijAi PRINT Thede Tobish, Senior Planner Alan Piccard POA -2019-00057; Mirror Lake 19-A 1131111 DATE l/3t /11 DATE When the work authorized by the Anchorage General Permit is still in existence at the time the property is transferred the terms and conditions of the permit will continue to be binding on the new owner(s) of the property. To validate the transfer of the permit and the associated liabilities associated with compliance with its terms and conditions have the transferee sign and date below. (TRANSFEREE) Attachments: Final Project Plans (sheets , dated Alan Piccard POA -2019-00057; Mirror Lake 19-A (DATE) Rusii EPOWS 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. 051-122-54 1. GENERAL INFORMATION Expiration Date: 1 Complete legal description Lake Hill Acres #6, Block C, Lot 4 Location (site address) 22113 Anthem Place, Chugiak, AK 99567 Current property owner(s) Alan Piccard & Kristine Ashley Day phone 764-1326 Mailing address P.O. Box 670355, Chugiak, AK 99567 Real estate agent Day phone 2. TYPE OF DWELLING: E] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) K11111111111111, If] IT, l 4;X67;1 1=111:0Z*]17i6-3 4. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System Waiver request for: Received by: 0 TYPE OF WASTEWATER DISPOSAL: 0 Private Septic M ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ ! �IC) Date of Payment -2 Receipt Number�1612Q D COSA # MC 19 1339 Date: Waiver Fee $ _ Date of Payment Receipt Number Waiver # Distance: t 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 Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 7/25/19 6. DSD SIGNATURE System #1 Approved for 4 System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms bedrooms, with the following stipulations: l�Jjllil}11�` By: 0- - 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 Checklist blue sheet �In c C�, l�Jjllil}11�` By: 0- - 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 Checklist blue sheet Legal Description: Lake Hill Acres #6 Block C Lot 4 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 12/27/17* Total depth 56* ft Cased to 56* ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 12/27/17 Parcel ID: 051-122-54 Structure served by this system Well production at time of test 10+* gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 6.74 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by FORGE ENGINEERING Date of Sample 7/16/19 Static water level at beginning of test 13 ft. Comments *See Sullivan Flow Test and Well As Built. Water Sample restest 7/25/19. V1111111111rsv111•01-tr_1 Age of tank (S) 3/1/19 years Tank type/material STEP/Steel Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping New Construction D. ABSORPTION FIELD DATA 5' Wide Trench Which system tested (date installed) 3/1/19 ❑ ALL standpipes present per record drawing Total measured depth from grade 4.0 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 ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: NEwcoNSTRucTIoN COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance completed Age of lift station New years Lift station material Steel Comments: STEP New Construction Adequacy test date New Construction Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate 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 Community Sewer Manhole/Cleanout > 100' ry Yes if No ft Q Yes if No Neighboring Tank > 100' Q✓ Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No Absorption Field on Lot > 100' Fv Yes if No ft Holding Tank > 100' El Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' 7 Yes if No Fv� Yes if No ft if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 71 Yes if No ft E Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Fv� Yes if No ft Surface Water > 100' ft ft ft ft ft ®✓ Yes if No ft Property Line > 5'✓71 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ,�]✓ Yes if No ft Private Wells > 100' 0✓ Yes if No _ Water Main > 10' 0 Yes if No ft Community Wells > 200' ✓Q 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'✓Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' [] Yes if No ft Private Wells > 100' U✓ Yes if No Water Service Line > 10' Yes if No ft Community Wells > 200' Q Yes if No Surface Water > 100' ✓� Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 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 OF [�?.\ age ��aeaeaa. ap sa ot � j' % °!a ° 49th t �.�a/s aa.a.tr aaas asaaeaa nar uiaa� satraaaaaaaasaaaaoeatrx.aaaaaaatog aaaaanm eU MICHAEL E. aQEsaN J L4 No. GE -4381 ; } �/}a'4ara 7/26/19 aax Q& , PROF" J � ft ft ft ft