HomeMy WebLinkAboutLAKE HILL ACRES #3 LT 17Onsite File
Lake Hill Acres #3
Lot 17
#051-051-01
Municipality of Anchorage
On-Site Water and Wastewater Section • (907) 343-7904 Page i of 1
Ofd-SITE WASTEWATER INSPECTION REPORT
Permit Number: 051 L C i3 -G% PID Number: 0,61 - 091- Q
Dwelling: N Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: 1 ] New ❑ Upgrade
Name
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench ❑ Bed tN Mound
Site Address
= G
El Other
Phone
' �' `c
Number of Bedrooms
Soil Rating
Total dept'l from original grade
I - / 1 b;Z(
GPD/SF
t,
o-3 UUD✓L Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original � �- gra .1
I' ��3 Ft.
Gravel depth beneath pipe
t♦ Ft.
Subdivision Block Lot
}=i
� �
Fill added above original grade
q 8 Ft.
Gravel length
I � Ft.
Hill %1 � ")
Township Range Section
S N I til/ 3
Gravel width
S Ft.
Beds: Number of Lines
}
Distance between lines
/1,0 Ft.
SEPARATION DISTANCES
To
Septic Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank ! Field
Tank
Line
90 Ft2
nGl
�IGt Ft.
Well
06
TANK 9 Septic ❑ S.T.E.P. ElHolding [I other
Manufacturer
r«V
Capacity
C Gal.
I
=
Surface Water
/G
�r3 �' 7
7
�'
Material
Number of compartments
_ !>
Lot Line
-G
% `i
NA
Foundation
g i
z
LIFT STATION
Manufacturer p
�1e;�c 9
Capacity
Gal.
Remarks rank �nl�/ invCJ 3ZJ''C�7
.3 �{ �" i n � We- L b
10 Z I �FO �
Alarm location
�t)'} �1'Gim ✓JLY.� �I�a1Ct
Electrical installed by
I
Vhf,+rtov L lee4r1L
n -7
>�er. Clerk 7 i �01111TFnf�
Installer I/V �' 0,1 s
PIPE MATERIAL House to tank, Tank to
�!' 26 drainfield D-4d�
As ul Drainfield 0-303i CO/MT}}-3,0
Inspector
BENCH MARK (Assumed elevation) <� ; �- ft
InspectionLocation
1 IA 7 I
and description
dates: 2od
3« N l,31-Lt 4th
Prop Cbr re-bAr , d,��� 3;ne 106e-,-+tt7/J8
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
Xaa��e
OF A(q�Or
Conditional Approval: Date
* 497J
o �-�z >r� ✓7� i
de y� , SI MON C GILL]LANO
Ell 731
ae� '
I
Adva�f SYsi �"'
Septic System
•13%L�
Approved Date
Note: this approvals not include well permit requirements.
(Rev 05/02118)
HANSON LAND SOLUTIONS
SURVEYIA'G, ENGINEERING & LAND DEVELOPMENT SERVICES
305 E. FIRED'✓EED AVE, PAL VIER_. AK 99645
Spl.�
April 14, 2021
Municipality of Anchorage
Attn: On-site Well and Septic
4700 Elmore Road
Anchorage, AK 99507
Permit OSP201360: Septic Install Changes for 22441 Mirror Lake Rd; Chugiak, AK
Project consisted of installation of an AdvanTex system that was not a single unit install but 5 separate
pieces. Due to the configuration of the system the tank and pump valet layout was rotated from the to
make installation suppler. This resulted in greater separation distance from the neighbors well and still the
required distance from the foundation. The absorption field ended up higher in elevation than originally
anticipated and the current top of ground above the system is 9' plus in width; much wider than the planned
5'. Also and due to a mix-up in reference point labels the SE edge of the planned field became the CL
moving the system 2.5ft closer to the property line. Separation distance from lot line is still over 10 ft but
between the three the side slopes are greater than 3:1. A proposed mitigation of jute mat fabric on slopes
steeper the 33% is proposed as a resolution. No slopes shall be steeper than 2:1.
Topsoil and seeding are yet to be completed due to current mud situation it is desired to get a conditional
COSA pending the slope stabilization measures and completion of topsoil and seeding requirements. With
2:1 slopes through this section on the SE edge of the absorption mound it is anticipated that we can stay 2 ft
from the property line and will not require an additional waiver. Note: Original design showed edge of
mound at 1 £t from property line and no comment was made regarding the 2 ft distance requirement.
No adverse impacts are anticipated to adjacent lots by the changes. Tank ended up farther from the
neighbors well, rotating the tank assembly eliminated the need for multiple clean -outs, and steeper slopes in
one small area is a minor side effect in comparison to being able to provide more cover over the field.
No anticipated effects will be made to planned drainage by the changes.
Soil found during absorption field excavation was substantially similar to that found in Test Hole =3 and no
adjustments were required. Frozen ground necessitated deeper excavation than originally anticipated but
otherwise excavation was uneventful.
HANSON LAND SOLUTIONS
SURVEYL IG, ENGINEERING & LAND DEI ELOPMENT SERirICES
305 E. FIREWEED AVL-. PALMER, AK 99645
Planned separation distance of 2.5 ft to the measured water table in October 2020 was verified by the ice
elevation in the monitoring tube being at 319.9' when measured 418/21 so no correction to elevation
required, Ground water was found at 318,5 ft during over excavation for frozen material but water table is
anticipated to be higher during summer months.
Respectfully,
Simon Gilliland, PE
Hanson Land Solutions
305 E, Fireweed Ave,
Palmer, AK 99645
{907}746-7738
I
MONITORING TUBE
SWING TIES TO NE
AND SE HOUSE
CORNERS
SOUTH TUBE:
71 FT TO NE &
46 FT TO SE
NORTH TUEE-
58 FT M NE &
37 FT TO SE
FOUNDATION
CLEANOUT:
11 FT TO NE
30 FT TO SE
NORTH MANHOLE:
18 FT TO NE &
31 FT TO SE
SOUTH MANHOLE.
26 FT M NE &
27 FT TO SE
PUMP VAULT: /I
27 FT TO NE & A,
z
32 FT TO SE
7j
i'100:' WATER
WELL RXJ Dk �
F1,b R P R 0 Pil
WEt
323.1,
4VERTi
325.81
RESIDENTIAL 'PUMP
UNIT WITH VAULT MOUNDED SYSTEM
1500 GAL, TANK BED PER M.O.A.
STANDARDS, BOTTOM
SEE SYSTEM OF SYSTEM 322.5'
DIAGRAM ELEVATION
SEE EXHIBIT B
O'R-)
'l E R
1500 GAL,
TANK
ADVANTEX
RESIDENTIAL
til UNIT WITH
PUMPREMOTE A
VAULTI 11 MONITORING
SEE SYSTEM
DIAGRAM
100' WATER
WELL
RADIUS FOR
i 1 r �. \ ADJACENT
h PROPERTY
WELL
PRIMARY
LOCATION
80 S.F. MIN.
3 BEDROOM
.5'x 1 6'M IN.
VERTICAL CONTROL PT.
SE PARCEL CORNER
REBAR ELEV.: 321.5'
2' MINIMUM COVER
WITH 4' RIGID
FOAM INSULATION
4' SEEDED TOPSOIL
TO BE COMPLETED
\2' MIN,
IN,
AV,
It
T 4
C=s
15.65,355H
S CWAR
WATER
LOCAT16N
1 EXTENTS
8-6 S.F.10�
/
MOUNDS
eEDR`OOM
323.1,
4VERTi
325.81
RESIDENTIAL 'PUMP
UNIT WITH VAULT MOUNDED SYSTEM
1500 GAL, TANK BED PER M.O.A.
STANDARDS, BOTTOM
SEE SYSTEM OF SYSTEM 322.5'
DIAGRAM ELEVATION
SEE EXHIBIT B
O'R-)
'l E R
1500 GAL,
TANK
ADVANTEX
RESIDENTIAL
til UNIT WITH
PUMPREMOTE A
VAULTI 11 MONITORING
SEE SYSTEM
DIAGRAM
100' WATER
WELL
RADIUS FOR
i 1 r �. \ ADJACENT
h PROPERTY
WELL
PRIMARY
LOCATION
80 S.F. MIN.
3 BEDROOM
.5'x 1 6'M IN.
VERTICAL CONTROL PT.
SE PARCEL CORNER
REBAR ELEV.: 321.5'
2' MINIMUM COVER
WITH 4' RIGID
FOAM INSULATION
4' SEEDED TOPSOIL
TO BE COMPLETED
\2' MIN,
PER M.O.A.
15.65,355H
50'
WATER
WELL RADIUS
FOR
PROPERTY
WELL
10' MIN,
FINAL
-F-jrL -
FINAL
-0- 10' MIN,
329.1'
\
GRAD
328.51
MH MH /
A--
323.1,
4VERTi
325.81
RESIDENTIAL 'PUMP
UNIT WITH VAULT MOUNDED SYSTEM
1500 GAL, TANK BED PER M.O.A.
STANDARDS, BOTTOM
SEE SYSTEM OF SYSTEM 322.5'
DIAGRAM ELEVATION
SEE EXHIBIT B
O'R-)
'l E R
1500 GAL,
TANK
ADVANTEX
RESIDENTIAL
til UNIT WITH
PUMPREMOTE A
VAULTI 11 MONITORING
SEE SYSTEM
DIAGRAM
100' WATER
WELL
RADIUS FOR
i 1 r �. \ ADJACENT
h PROPERTY
WELL
PRIMARY
LOCATION
80 S.F. MIN.
3 BEDROOM
.5'x 1 6'M IN.
VERTICAL CONTROL PT.
SE PARCEL CORNER
REBAR ELEV.: 321.5'
2' MINIMUM COVER
WITH 4' RIGID
FOAM INSULATION
4' SEEDED TOPSOIL
TO BE COMPLETED
\2' MIN,
PER M.O.A.
15.65,355H
GROUND
WATER
TEST HOLE 3 LOG I —NOT TO SCALE -
0' -1.5' GM
OF. Ove 1.5-4' GW
V 4'
—5.5' ML—CL
0
1.85' GROUNDWATER
TH
o -A, 49 40 4' TO IMPERMEABLE LAYER
57 DESIGNED TO 6 GPD/SF WH Manhole
3 BRM X 150 GPDYBRM
S.
on
imPerc. Test Location
450 GPD / 6 GPD
G
CE110731 19
0- 75 SF REQUIRED Cleanouts
04
22441 MIRROR LAKE RD. LAKE Monitoring Tubes
"�-Ofessicc!"HILL ACRES ADD. 3 LOT 17
zz I '�� # Test Hole
SEP11C DESIGN RECORD DRAWINGS
15 0 30 HANSON LAND SOLUTIONS — 'w" Water Well
I I I I 1 1 305 EAST FIREWEED AVENUE Pier
US Survey Feet PALMER, ALASKA, 99645
File: 20-210 Scale: 1'=30' D,..: SG 104/19/21 EXHIBIT A Page 1 of 1
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Permit Number: ##SW Date of Issue: parcel Identification Number:
Date Started: / / IG' mate Completed:,/:Legal Description: i C Is well located at approved permit location? ( Yes ❑ 1Va
Property Owner Name & Address:
fJ-.r--
"WA W"Mr, ca. Depth (ft)
Soil Type, Thickness & Water Strata From To
Fater Sample Results:
Arsenic:
Nitrates:
Total Coliform Bacteria:
Other Bacteria:
V ug/L
NO mg/L
_ c0l0nies/100mL
col/100mL
of Drilling .air rotary ❑ cable tool
Casing :` s t a ��-
'Fall Thickness: ' `inches
Diameter: -/- inches Depth: ` ' l feet
Liner e: ,; �
Diameter: inches Depth: .feet
—_ Casing stickup above ground: feet
Static water level (from ground level):
Pumping level: feet after
hours pumping . gpm
Recovery Date: `v"• gpm
Method of Testing:
ELmpen End ❑ Open Hole
❑ screened Start feet Stopped feet
❑ Perforations Start feet Stopped feet
Start— feet onn fpF
Pump size _ ,,.,-1 hp Brand Name ' .
Well Disinfected Upon Completion? ,E Yes ❑ No
Method of Disinfection:
Comments:
Well Driller:
Attention: The well driller shall provide a well log to DSD within 30 days of completion.
ARCTIC PUMP & WELL INC.
Jim Sullivan
PO Boa 770197
Eagle River, AK 99577
-, MP(11 t9M SYSIENS
SAUS E SERYRS (907) 688-2510
r (907) 243-2282
•
Well Drilling Permit Number: osp201360
Parcel Identification Number: 05105101000
Date Of Issue: 10/29/2020
Legal Description Lake Hill Acres # 3 L17 Property Owner Name Address:
WM Construction
Lot: 17 PO BX 4042
Block: Palmer AK 99645-4042
Pump Installaion Date:
Pump Intake Depth Below Top of Well Casing:
Pump Manufacturer's Name
Pump Model:
Pump Size:
Pitless Adapter Burial Depth:
Pitless Adapter Manufacturer's Name
Pitless Adapter Installer:
Well Disinfected Upon Completion?
Method of Disinfection:
Comments:
Pump Installer Name:
Arctic Pump & Well, Inc.
Wednesdq)y, April 7, 2021
4/7/2021
130 Feet
Franklin
5Y 10FRD05P4-2W230
353 tdh
10 Feet
B-10
u/k
Yes
Chlorine
'w" --SURVEYED
EDGE OF WATER
t� 1 . THE HEREON REPRESENTEE) SURVEY DOES
<S ,,> NOT CONSTITUTE A BOUNDARY SURVEY.
EL . =919.5 s >
�, MIRROR � _, � � —' IT IS SUBJECT TO ANY INACCURACIES
sUDDI (VISION T hfIRIJ �56� 0 9F� THAT A SUBSEQUENT BOUNDARY SURVEY
RECOVERED 1" IRON PIPE A DDI TION L O T 15A
l 05, 1�r MAY DISCLOSE.
Ff i 2. INFORMATION PRESENTED HEREON IS A�
RECOVERED Vis" REBAR (21914-100) fI ; g9MIREPRESENTATION
ROVEMENTS AND COND IFT IONS PRESENT BLE9
(C) COMPUTED DATA x(100 �� AT THE TIME THE SURVEY WAS NANSON LAND SOLUTIONS
1 �,l0o) PERFORMED ON APRIL 8, 2021. 305 E. FIREWEED AVE.
N74{ °58'11"W 255.65' MEASURED DATA ' `. �PALMER ALASKA 99645 EL R. =320.6 3 . DIMENSIONS OBTA 1 NABEE FROMA THIS
p� DOCUMENT ARE LIMITED TO THOSE (907) 746-77313
(N74"45'W) (�?54.70') RECORD PER PLAT (64-89) C�') /p l?�f BEARINGS AND GROUND DISTANCES BUSINESS LICENSE #1525
/ 4
[N74°45'W] [,?54.70'1 RECORD PER PLAT (201/ p \ SPECIFICALLY LABELED HEREON. THE
4--100) ��� / `—
DOCUMENT DOES NOT PURPORT " v `
\ UME T D E N RP RT TO �`§� OF 4;T
0
r—� PRESENT A BASIS FOR SCALING TO —+Y}
W, WATER WELL 11
5A
/ r f( 1 DIMENSIONS NOT LABELED HEREON.
—� UTILITY POLE `�' %�"
METER ELECTRIC
T (}' WATER _ / �Cms's r, ��� t cRn'Nso o .-
{� SEPTIC VENT /CLEANOUT/ACCESS POINT EI. L RADI US r 13
2N9 FCC10R
— — --E — — — OVERHEAD ELECTRIC � / ' j � OVERHRNG
36" CULVERTCIV,13
t..- IW,
i M H MANHOLE j cv�� l� ;ir `�
GRAVEL ROACH/DR I VEWAY 3 STORYSURVEr
/ /. tit r• ��*. r:''Ti "HDUSE �4i(r r 1 QMH'( ,li ', I a c
�-
ASPHALT ROAD/DRIVEWAY j j� Ir��
DR I VEWAY ; �� I �,i + r MIi-. 1 I HEREBY CERTIFY
r 4 ;
DOCK III THAT TH I S
(, �: I
V i �� 8AFFL£ V I DOCUMENT
,+ ; i I ��, [,� REPRESENTS A
IG) METER, GAS \ \ 1 �. >� .' .�', SURVEY MADE BY ME
��1� OR UNDER MY DIRECT
® PIER � v UTILITY / p` , 0.56-, ACRS � 1 SUPERVISION, OF
EASEMENT f 0 1 1�'; '+' ��, a THE FOLLOWING
t A \
(2014-100) 7 0`� f �t��( REAL PROPERTY:
o
V_ LOT IZ
m 0,
L AffE Hj'Z. L
�I _
\ \ \ �• ,,,� � I � ----- +`+ Com'),'' �� ' � /' C! 4"RES
f VISION
20.
� J
3 di[.? �J ! t� 1 �J
Nf'9.
LAKE HILL ,AIR s FLA T 64--89)
\ !"o" co$, _ 10' UTILITY
LN79.0$, o�°w� — _9� y � � ; ; EASEMENT
. �C/�'t � �' `� RE ANCHORAGE
4ti\ 05W) (se.7s> (�500)� (64-89) ��R!������ CORDING DISTRICT
\ i^QMH w �� �� a /IJJr, ��
�% 6 63' _ 4
&)
LOCATED WITHIN
-� 2
46 s�G�
-__ 4 � J kI WY SEC. 2, &
NNE)/4 SEC. .-
� ,
1. 15N. R . 1 W.
\ SM, AK
j,' � � � CONTAINING
1INSUBDI Ft' IDE —� �— {"73� 00`I 0.56 ACRES
pp- — — MORE OR LESS
t
Illy
I_I_I_I_rt_._�C—f-1 �� I—` — SCALE: t "=30' J013:20-210�� 1�' _� DVN:SDN FILE:20-210 SP
__ � US SURVEY FEET �_ ( \ `� CK:CIH I 04/09/21 0i OF 01
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 Wastewater Disposal System Permit
Permit Number: OSP201360
Work Type: Septic Initial
Tax Code Number: 05105101000
Site Legal Address: LAKE HILL ACRES #3 LT 17 G:1561
Site Mailing Address: 22441 MIRROR LAKE DR, Chugiak
Owner: WM CONSTRUCTION LLC
Design Engineer: HANSON LAND SOLUTIONS
This permit is for the construction of:
Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
Lent
�o
r
De l)2lr tin ell
10/29/2020
10/29/2021
24795
❑ 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:
** When the well is drilled, no drill rig cuttings are allowed to go into the wetlands area.
Received By:
Issued By:
+o �rozen jt -d -AA, eXCavo�'�t�>7S r„v��� qo iD btu, off' �'��Zen
b,%AA back w`'tP\ 4 1C
Date:
Date: O 2a
9
LEGEND
() RECOVERED 1" IRON PIPE
O RECOVERED ° REBAR
COMPUTED DATA fwl
MEASURED DATA I
RECORD PER PLAT (64-89)
RECORD PER PLAT (2014-100)
1W; WATER WELL
AUTILITY POLE 15 y y
c7, METER, ELECTRIC c A
N
171 SEPTIC VENT/CLEANOUT/ACCESS POINT
- - --E - - - OVERHEAD ELECTRIC
36' CULVERT
ElGRAVEL ROAD/DRIVEWAY
ASPHALT ROAD/DRIVEWAY LAKE HILL A CRSS
SUBDI VISION THIRD
Fm DOCK \ ADDITION LOT 15A
f:, PERC. TEST LOCATION \ \ (2014-100) f
UTILITY
e TEST HOLE\EASEMENT o
PROPOSED 12" CULVERT �( (2014-100) ry o v v o
\ ,7vv V 1
PROPOSED PAVED PROPOSED 7.
SURFACE WELL
vvvv WATER N
vvv �� v v vvv �
\ �ovvvvv°
\ `� vv"v V 6
UNSUBD/ V/DED
vvvvv vvvvvvvvvvvvvvvvvcvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvv �T
7 v 17 v v 17 v v v v v v v v v v v v v v v v v v v v v c v v v v v v v v v v V v \7 �/ v v v v v v v v v v v v v v v v v'
vvvvvvvv
vvvvoov vvvvvvvvvvvvvvvvvvvvvvvvvv MIRROR 7vvvvvvvvvvvvvv00vvvvvvvvvvvvvvv
7vvcvv7vv
xvvvv7vvvvvvvvvvvvv17vv17v vvvvvvvvvvvvvvvvv .
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10' UTILITY
S�BD�V�S�ON
(PLAT 64-89)
EASEMENT
ANCHORAGE
(64-89) THIRD ADDITION
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(64-89)RECORDING
DISTRICT
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LOCATED WITHIN
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SCALE:1 "=40' JOB: 20-210
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FILE:20-210 SP
CK: CEH
10/07/20 01 OF 01
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Develops -hent Services Department 4 % Phone: 907-343-7904
On -Site Water & Wastewater Section - Fax: 901-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. OSI - o l - 00 6) Expiration Date: ZI 2-
1. GENERAL INFORMATION
Complete legal description L4J, < RN &< (ej � S Lc, % � 7
Location (site address) ' z '-1 ` I I Ll f/L L" L n cl L 1, y ; A % J Sl.• 7
Current property owner(s) W r" l Day phone 'I C,7- 7-6 Z F
Mailing address
Real estate agent
2. TYPE OF DWELLING:
P5 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
.f
4. TYNE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
Private Septic
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 75 4- Zqy Waiver Fee $ _
Date of Payment Li�6/2 1 Date of Payment
Receipt Number 2.62 7g i Receipt Number
COSA ,t 05 CZ 1 I f g 3 Waiver 9.
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 00,0 ,;, 1_�t4 so IV *1I'ct, s Phone qC7' 71-/ 7'7.3,y
Address .305 L. F,'rt wrr,,� AVC, p^1 A < 7 1 ot s -
Engineer's Printed Name Swovx G at -tel Date yligl zl
6. DSD SIGNATURE
System #1 Approved for _13 --bedrooms g/..3 J/2
System #2 Approved for bedrooms
Disapproved
Conditional approval for
+�
OF t
gChJ�t9�ltf
i SIMON C GILLILAND
OdFQ. No,CEt10731
bedrooms, with the following stipulations:
II-- H " o� -hoosoi l 4o be- to dd eA tO Af- In and C07CA
i -be- 1,170unA I\5 +a be, 5-eedeA ;Ji e_ rna� i5 fo be_
(A5ea nn 510de S+ce-0er 4Ari r A wl7r k
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Goor14 5eeenr4f,rs leiter ` SITE G� P_
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to S 2 Oz WATER AND
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\N.� .�
�/YlGll ��31/zI ��`2��RDCKAM
By Original Certificate Date) l oO
))11
The Municipality of And rage 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 sheat
COSA Checklist
Legal Description: L ,, i, C- P,11 Atm -t L. ) 7 Parcel ID:
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled II 1 %/Z is
Total depth `� j ft
Cased to j LI 3 ft
0 Sanitary seal is functioning correctly
X Wires are properly protected
Casing height (above ground) Z 6 in.
Date of flow test for COSA L& VZ v
Static water level at beginning of test ft.1 pev5.G.
Comments
B. TANK DATA
Age of tank(s) L ` years
Tank type/material S-1 « I
Measured operating fluid level in septic tank a
19 Standpipes/foundation cleanout per record drawing
Date of pumping 0'. -11, 2.-�I
Structure served by this system
kiviv/
Well production at time of test --P�ggpm per S• G
Water storage tank volume 11�di gallons
Well disinfected for coliform test? Yes ❑ No
Coliform bacteria is NR ative
a/ /'G r
Nitrate-- � mg/L Nitrate less than MRL (ND)
Arsenic -4' ug/L X Arsenic less than MRL (ND)
Collected by '�i 1,els, C-� I,111�'J
Date of Sample y1817,1
C. LIFT STATION
❑ Required maintenance completed
Age of lift station 0 years
Lift station material
Comments: ,1-t;W /jail Lo T -e,?- rys)c,•,
D. ABSORPTION FIELD DATA %
Which system tested (date installed) %18171 Adequacy test date i1 Pu/ V IF Z 1
CRALL standpipes present per record drawing fru, Results ❑Pass For bedrooms
Total measured depth from grade%+-� ft (max)�per s.G. Fluid depth prior to test in
Measured depth to pipe invert from grade ft (min)
Water added gal
N/A - pressurized field
(Monitor tubes go to bottom of effective. If not, state
New depth in
depth into effective
Elapsed time min
j�rCode-required soil cover over field
Final fluid depth in
❑ System presoaked
Absorption rate gpd
(Requiredif vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months)
date of :test)
_
Gallons introduced-.... _gallons
If yes, enter date
Comments/Deficiencies: 6 y S{t,,, t
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'
Yes
if No ft
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 Z ft
Holding Tank > 100' Yes
if No ft
Neighboring Absorption Fields > 100'
Surface Water > 100'
Animal Containment? 50' CSYes
if No ft
tZ Yes
if No ft
Manure/Animal Excreta Storage ? 100'
Community Sewer Main > 75' Z Yes
if No ft
9 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
iAO�1-1
Building Foundations > 10' `s Yes if No 5 _ ft Surface Water > 100' ❑Yes if No % 6 ft
Property Line > 5' Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' Yes if Na ft Private Wells > 100' Yes if No ft
Water Main > 10' Yes if No ft Community Wells > 200' (Yes if No ft
Water Service Line > 10' ['Yes if No ft If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'D?-1Yes
if No ft
If absorption field is under driveway comment below
Property Line > 10'
X Yes
if No ft
Wells on Adjacent Lots:
Water Main > 10'
M 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'
Yes
if No 7? ft
F. ENGINEER'S COMMENTS
(
t �
7'
'[rz n -rank
� � E OF q4 �d
G. ENGINEER'S CERTIFICATION
49001
��
I certify that l have determined through field inspections and review
of Municipal records that the above systems are in conformance with �4 /.... . .. .v
MOA COSA guidelines in effect on this data �� 9�� sIuoN c ctwcnNo
NO. CE110731
COSA Checklist yellow sheet
HANSON LANA SOLATIONS
SURVEYING, ENGINEERING c& L/lA%D DE><ELONJENTSERVICES
305 E. FIREWEED AVE. PALMER, AK 99645
August 23, 2021
Municipality of Anchorage
Atm: On-site Well and Septic
4700 Elmore Road
Anchorage, AK 99507
Permit OSP201360: Septic Install Changes for 22441 Mirror Lake Rd, Chugiak, AK
Topsoil and seeding have been completed. With 2:1 slopes through this section on the SE edge of the
absorption mound jute mat was used as further stabilization per the prior approved conditional COSA.
Respectfully,
Simon Gilliland, PE
Hanson Land Solutions
305 E, Fireweed Ave.
Palmer, AK 99645
(907)746-7738
a _ -`'��
Aw •. a. s•
..� .............
:SINION C. GILLILAND:
�Fc •. CE -110731
v�ArA
��®®_I'RO-ESS10
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 &2 "- Day of LN pr,' 1 of 20 r , by and between
herein the "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as Ay'1 0�<-40-n4c X
located at (legal description)
L. oak e. [kA A c res 3 L+ 1-7
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
0_6,) 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.
9 6J 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).
9 cJ 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
r W Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
&...1 Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
f3LJ Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
_OL—� Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
(gam 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.
�i..� 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.
ID
(rev. 05/18/2018) Page 2 of 3
V W1Vr;K: �
BY:
Y
ie- (w e -k
STATE OF ALASKA
THIRD JUDICIAL DISTRICT
(signature) Date: 42,1202-1
(print name)
ss.
The foregoing instrument was acknowledged before me this today of f ► ,
20.2,1 , by/�o
NOTARY PUBLIC -F RR
My Commission expires:
MUNICIPALITY:
By: (signature)
(print name)
(rev. 05/18/2018)
Date: Lf &-1 &
Title:
Page 3 of 3