HomeMy WebLinkAboutGLENN VIEW ESTATES WEST PH 2 BLK 2 LT 17Glenn View
Estates West
#2
Block 2
Lot 17
#051-793-34
Municipality of Anchorage Page 1 of 3
Department of Health and Human Services
Division of Environmental Services
On-Site Services Section 8251? Street Room 502
P.O. Box 196650 Anchorage. AK 99519-6650
www.cl anchorage.ak.us (907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
SW010435 PID Number: 051-793-34
Permit Number:
snit
MM&M Contracting
Wastewater System: New
P.O. Box 670495 Chugiak, AK 99567
ABSORPTION FIELD
Phar. Number el Bedrooms:
688.1236 Four (4)
5' Wide Shallow Trench
LEGAL DESCRIPTION
Sod R.bng.
1.2 aPDiFts
Total Depth from original grade.
7.5 FI.
Boat: LM: Subdvern:
2 17 Glenn View Est. West Phase I1
Depen to pre bottom he anginal grade:
3.5 Ft.
Grave depth beneath Pee:
4 FL
Tone eP: Miga: seebm:
Fit added above coral grade.
.5 FI.
Gravel Length.
50 Ft.
Well: AWWU Water System
Gravel weed.:
5 Ft.
Number o Snes:
1
Distance between Yrs.
N/A FL
Oaseth abon (Peet A 13. C):
Tole Depth:
n.
Caseate:
FI.
Toth ab'ephe area.
500 Ft'
Pipe Magee
ASTM D3034 PVC
°ed
Deer:
Des Deed-
State Whet Loved:
FL
MM&M Contracting
we
10/16-21/01
yea:
GPM
Pump Sol .t:
Ft.
Ceded height
Above Grand.
FI
TAN K
SEPARATION DISTANCES
® Septic 17 Holding ❑ S.T.E.P. ❑ Other.
7'o
From
Septic
Tank
Absorption
Field
atti
Station
Holding
Tank
'odic/Private
Sewer line
Manuladume.
Anchorage Tank
UPauly n Liston,.
1,250
wet
>200'
>200'
N/A
N/A
>25'
MB1eny.
Steel
Number d Compartments.
Two (2)
sxr.aw.ted
>100'
>100'
N/A
N/A
LIFT STATION — NONE ON LOT
Lot Use
>5'
>10'
N/A
N/A
Saxe.
Gr
manuliaulet.
FauWNrn
>5'
>10'
N/A
N/A
'Pump on' the el.
h
'Hump oh Yvd at.
Y
High waled seem at.
In.
Cuman Dan
None
Noted
Pump Make 8 Model
Demme brpecbc•r pedomrd eh
mark•:BENCH
2" Insulation
Atop Septic Tank.
MARK
Location and Descipbon.
Finished Floor.
Assumed Elevation.
100.0 Ft.
Engineer's Stamp
sssssssssssss
by: Mike Anderson Dates: 1st 10/16/01
I 4 °
49 h s s}I.
' r. ••..
Inspections performed
2"d 10/21/01
MICHAEL L. ANDERSON i Wpi
Department of Health and Human Services approval
3,
•0%i` No. DE-+}a, ��`"�
4
**4444ssss;
a Date: — 2 D%
by: V e
��.•♦
Reviewed and approved �e/
(Rev. tlY9a)
5;;
Municipality of Anchorage
DEVELOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK 99519-6650 -343-7904
On Site Wastewater Disposal System or Well Inspection Report
Permit Number SW010435
POLLY
IRCLE
Page 2 of 3
PID No. 051-793-34
Four
Bedroom
Home
10' Landsczape Easement \
15' Utility Easement
PLAN AS -BUILT
SCALE 1" = 40'
- 1 49th 21;••••
4t •,
q MICHAEL E. ANDERSON j W •
•••CtA No. a-4381
•••• E SS %::;:;,0,
•
Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number.SW010435 PID No. 051-793-34
Page 3 of 3
FF 100.0
98.1
G BACKFILL
N
U
94.7J
7/1
90.
Geotextae robric
Droinfietd Rock
2.0
0'
PROFILE AS -BUILT
Scole: 1 - 10'
t1M y M:EHAEL L ANDERSON0 j/I W
fs. No. a 1
FROM : COUNTRY REALTY
sr
PHONE N0. : 9076881238
Apr. 22 2002 06:22AM P1
•/
qci
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1•
•
.�$a._t
may.
M
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td i9.rt.....?carpo el MT _
s' r E Egad.
•
J Jo.31
AS -BUILT
I hereby certify that I have surveyed the following -described
;,. L.or;;r7 Wee -4c z, •
iuU:w'E1+. r+ %Val' Pha-fs Nn::2'.
'-r �
t lF 1.r. t to'14.. ...'::: •s :. I.
:1
Anchorage Reding Precinct, Alaska. and that ihe it4rvv'-
S .
rents situated tbeteon are within the property times andtb not.
overlap or encroach on the property Iys!g adjacent Hero;etb,
>b knprovert>Etts on property lying adjacent thesete enaoath. •.
on het In question and that there are To yoadw? ys::'
transmission Mmes or other visible easenwnb on said roped), .
erapt n I,U1 d hereon.';' _ . :• • :• •
Dated at Eagle In*. Alaska''• : .
lids 't.- . aty of Dr.c., ..,. • •'2t10 I n:
.. ROBERT CJOHNSON.:7y d4 S!.•
tGLPv. Registered Surveyed- No_rn4
I" / _ Box
77 006 `�' Rimer. A1aka 97571
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 6 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial
Permit Number: SW010435
Legal Description: GLENN VIEW ESTATES WEST PH 2 BLK
Design Engineer: 0014 Anderson Engineering
Owner Name: MM&M Contracting
Owner Address: PO Box 670495
Chugiak . AK 99567-
/ 4 6, frti
/o/zf/e/ 3P,y
Date Issued: Oct 16, 2001
Expiration Date: Oct 16, 2002
Parcel ID: 051-793-34
2 LT 17
Site Address:
Lot Size: 40357 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
❑✓ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 (24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
i �1 i
afitt P n>6(
Date: Ivy ((D`G1
Date: /G —16 —0/
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-793.34
Permit Number SWO/0435-
Property owner(s) MM&M Contracting Day phone 688-1236
Mailing address (1) P.O. Box 670495 Chugiak, AK 99567
Mailing address (2)
Zip Code
Legal description (Lot, Block & Sub'd.) Lot 17, Block 2, Glenn View Estates West Subdivision Phase 2
Legal description (Section, Township & Range)
Lot Size 0/0 3 S "7 Acres
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Number of Bedrooms Four
Well Only
❑ Water Storage
0
0
0
❑ Jacuzzi 0
❑ Water Softening Unit 0
0
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: 90 Waiver Fees:
Date of Payment: St •Occ3\ Date of Payment:
Receipt Number: 1 l'Y"t'"1 Receipt Number:
(Rev. 12/00)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
October 9, 2001
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 17, Block 2, Glenn View Est. West Subdivision Phase 2
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of the subject property intends to construct a new four-bedroom on the lot.
We are therefore requesting a permit be issued for the construction of a new septic
system to serve the proposed home. The attached Site Pian and backup
documentation identify the location and configuration of the new septic system and the
parameters used in the design. Also identified on the plans are the location of the
water service line and the water main easement on the lot and the test hole location.
Existing drainage pattems are shown and will not be altered by the development of the
lot.
Two test holes were placed near the location of the proposed absorption trench. These
test holes indicate well graded to poorly graded gravel with some silt near the location
of the new absorption trench. Percolation tests in the material resulted in rates of less
than 5 minutes per inch. No groundwater was found during the placement of the test
holes and none was noted during the monitoring period. We are therefore proposing to
place a 5' wide absorption trench system with 4' of gravel beneath the distribution pipe.
The total depth of the trench will be 7'. The distribution pipe will be placed at 3' below
the ground surface to provide sufficient drop from the septic tank to the absorption
trench. The total length of the new absorption trench will be 50'.
The ground surface on the lot slopes as shown on the attached Site Plan with very little
to no slope near the proposed septic system site. The new absorption trench will be
constructed on a fairly flat surface in conformance with Municipal requirements and
parallel to ground contours where possible. All components of the new septic system
will be constructed 10' from the water service and water main easement on the lot.
If the system is constructed in accordance with our design the following statements
apply:
1. The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future. The subdivision is currently
served by a community water system.
' Lot 17, Block 2, Glenn View Est. West Phase 2
October 9, 2001
Page Two
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
pattems in the area. The current drainage pattem will be maintained.
Sincerely,
r✓1ttAa.0
Michael E. Anderson, P.E.
Attachments
4c J Ty�j P- %
4s I. MICHAEL
E. A•:CERSCI.i •� ;
-/*•* CE CE - 4381 ; `•®
a `• 6a4�
Ra14�v�
POLLY
CIRCLE
1
Four Bedroom
. Home
5'
'0%
o
c�
N
1,250 Gallon \
Septic Tank
50' LonX
X 4' Ef ecti
Alternate to Thsorpti n T
® 1
--PH2• 10' Landscape Easement
• 15' Utility Easement
' Wide
e Depth
ench
SITE PLAN
SCALE 1" = 40'
G
0
0
OD
LOT 17, BLOCK 2
GLENN VIEW EST. WEST
PHASE 2
22
.....,.d -_..N69.570 .30000
•
21
MI9•s702T
./
13
12
•
N
14
5116.47
589'28'58T 27910
.9
N89.16'0
8
w
r
n
tl• td9s. [
K'
Tele
200 00
; .1 Ire
71-222)
330.25
AREA MAP
1"=100'
125.46
7
LOT 17, BLOCK 2, GLENN VIEW ESTATES WEST
SUBDIVISION PHASE 2
DESIGN FACTORS:
Four Bedroom Home
Perc. Rate: 2 MiniInch
Application Rate: 1.2 GPD/SF
SYSTEM REQUIREMENTS:
5' Wide Trench System
1,250 Gallon Septic Tank
4' Drainfield Rock
4 Bedrooms X 150 GPD / 1.2 GPD/SF = 500 SF of Absorption Area
500 SF/5 LF (Width)•.5 (Red. Factor) = 50 LF Trench Length
Therefore: Construct a 50' Long X 5' Wide X 4' Effective Depth Absorption Trench.•
Flowline Elevation in Trench to be 3' Below Original Ground Surface. Total Depth to be 7'
Below Existing Ground. Mound Over Trench to Provide a Minimum of 3' of Cover or
Provide 2" of Direct Bury Insulation and 2' of Cover.
NOTE:
2" Insulation & 2' Co
or
textile Fabric & 3' Cove
2' 6"
6"
4,
5'
4" PVC ASTM D3034
Drainfield Rock
TYPICAL WIDE TRENCH SECTION
(NO SCALE)
Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Wells in the Area.
Maintain 10' Separation From Water Main and Service Line.
OF Az.::
sr v7: '":• ,;"=2.42.4%'.`
b' • r.1.CHAD l E. ANfERSCPI ,'r O
01 re‘ �•. CE -4301 '‘•"%es
PROJECT #: V0131
PERFORMED FOR:
Municipality of Anchorage
Development Services Department/Building Safety Division
Onsite Water and Wastewater Program
4700 South Bragaw Street Anch., AFC 99519
SOILS LOG - PERCOLATION TEST
PAUL MYERS / MMBM CONSTRUCTION
LEGAL DESCRIPTION'
OL
2
3
4
5
6
7
8
9
10
I I
12
13
14
15
16
17
18
COMMENTS:
LOT 17, BLOCK 2, GLENN VIEW WEST SUBD.
TEST HOLE # 1
SILTY POORLY GRADED GRAVELS
W / COBBLES
GP -GM
BOH
WAS GROUNDWATER
ENCOUNTERED?
SLOPE
NO
IF YES, WHAT DEPTH?
DEPTH OF WATER
AFTER MONITORING.
DATE'
None
10/8/01
4�OC .....
L�YIY�•1?
et'v -• "y1
per
tAI.. CHA"L E ANDERSc.” 5:7; d
DATE PERr•p Ft ••'9129!
• BOFI.SS
�1. �. • CE 4381 '"
d
S
L
0
P
E
SITE PLAN
See :Site Plan
N
0%
READING
DATE
GROSS
TIME
NET
TIME
DEPTH OF
WATER
NET
DROP
Start
9/29/01
9 30
12"
1
9 65
15
8.25"
Recharge
9 46
12"
2
10 01
15
7.75"
Recharge
10 02
12"
3
1017
15
8 0"
PERC RATE: 19 MIN./INCH PERC. FIOLE DIAMETER. 6
TEST RUN BETWEEN 35 FT AND 4 S FT
HOLE PRESOAKED PRIOR TO TESTING / NO IMPERMEABLES ENCOUNTERED
TEST PERFORMED BY: T.L. KIMBROUGH
1, MICHAEL E. ANDERSON CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: /P--1-01
PROJECT #: V0131
PERFORMED FOR:
�1 O
�•-
Municipality of Anchorage e :
Development Services Department/Building Safety Division:I, * : 4g 111
Onsite Water and Wastewater Program
4700 South Bragaw Street Anch., AK 99519
SOILS LOG- PERCOLATION TEST
PAUL MYERS / MM&M CONSTRUCTION
LEGAL DESCRIPTION'
OL
2
3
4
5
6
7
8
9
10
11
12
13
14-
15
16-
17
18
COMMENTS:
LOT 17, BLOCK 2. GLENN VIEW WEST SUED
117/1Q
144444
i• wow:. E
Cc�•r. -- CE -
P6R9
DATE erRt�
TEST HOLE # 2
SILTY POORLY GRADED GRAVELS
W / COBBLES
GP -GM
BOH
WAS GROUNDWATER
ENCOUNTERED?
IF YES, WHAT DEPTH?
DEPTH OF WATER
AFTER MONITORING.
DATE'
SLOPE
NO
None
10/8/01
S
.L
O
P
E
SITE PLAN
See Site Plan '
0%
READING
DATE
GROSS
TIME
NET
TIME
DEPTH OF
WATER
NET
DROP
Start
9/29/01
10 30
12"
1
1100
30
105"
Recharge
1101
12"
2
1131
30
1025"
Recharge
1132
12"
3
12 02
30
10.25"
PERC RATE: 29 MIN./INCH PERC. HOLE DIAMETER:?"
TEST RUN BETWEEN 3 S FT AND C S FT
HOLE PRESOAKED PRIOR TO TESTING / NO IMPERMEABLES ENCOUNTERED
TEST PERFORMED BY: T.L. KIMBROUGH'
I, MICHAEL E. ANDERSON CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: /0 9 i
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 17, BLOCK 2, GLENN VIEW EST. WEST SUB. PHASE 2
GENERAL:
1. The scope of this project includes the procurement and placement of a
new 1,250 gallon septic tank. Work also includes the construction of
a new 50' long X 5' wide X 4' effective depth absorption trench at the
location shown on the Site Plan. The distribution line in the trench will
be placed at 3' below the existing ground surface. Total depth of the
trench will be 7' below the existing ground surface. The new septic
tank and trench must be constructed at least 10' from the water main
and water service on the lot.
2. Construction shall be in accordance with the approved site plan,
design drawings, Municipal Permit with any special provisions or
conditions, and all applicable State and Municipal Wastewater
Disposal Regulations.
3. The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the
location of all lot lines.
4. Unless specifically agreed otherwise, the contractor shall be
responsible for final grading areas subsequently depressed from soil
settling. Property owner shall be responsible for revegetation of
affected areas unless specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must be certified
by the Municipal Department of Health and Human Services for
system installations. Owners installing their own systems must receive
prior approval from D.H.H.S. before beginning system installation.
SEPTIC TANK INSTALLATION
1. A new 1,250 -gallon septic tank must be procured from an approved
source and installed at the location shown.
2. A septic tank is to be constructed by a certified septic tank
manufacturer. Construction shall include two 4" cleanouts for pumping
access.
3. The septic tank shall be sufficiently bedded to prevent settling or
shifting of the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches
above final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct
burial insulation.
6. A foundation cleanout shall be installed one to four feet from the
building foundation. Two cleanouts are required between the tank and
the drainfield.
Lot 17, Block 2, Glenn View Est. West Phase 2
October 9, 2001
Page 2 of 3
7. Final grading over the tank shall be such that a positive slope exists
away from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the
design. The bottom of the trench shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a
level bed of drainfield rock. Rock should then be placed over the pipe
to provide a minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield
rock and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations
shown on the design. The portion below ground must be perforated.
5. Contractor shall verify the septic tank and drainfield are a minimum
100' away from any private water wells in the area, 150' from a Class
"C" Well or 200' from any community well.
6. Direct bury insulation must be placed over the distribution system if
Tess than 3' of backfill depth is available. Finish grade over the trench
must be mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
8. A minimum 2' of accepting soil is required below the drainfield rock for
a 5' wide trench. Contractor shall verify this condition prior to
placement of the rock. All pockets of unacceptable materials must be
removed and replaced.
MATERIAL SPECIFICATIONS:
1. Septic tanks must be constructed by a municipally approved septic
tank manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated
and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and
ASTM D2662 or A.B.S. (perforated and solid).
3. Insulation shall be at least 2" thick extruded direct burial polystyrene
(Dow Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
Lot 17, Block 2, Glenn View Est. West Phase 2
October 9, 2001
Page 3 of 3
5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with Tess than 3% passing
the #200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These
inspections must be conducted under the supervision of a professional
engineer registered in the State of Alaska. The first inspection must be
conducted after the excavation of trenches, beds or pits and before the
installation of any gravel. A septic tank may be set in place, but may not
be backfilled.
The second inspection must be conducted after the placement of the
geotextile fabric, gravel, distribution piping, standpipes, cleanouts and
insulation. No backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction
notes for use in preparing the certified as -built of the completed system.
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 051-793-34 Expiration Date:
1. GENERAL INFORMATION
Complete legal description Glenn View Est. West Phase 2, Block 2, Lot 17
Location (site address) 21202 Polly Cir.
Current Property owner(s) Steve 8C Cameron Wright: ` Day phone
Mailing address 21202 Polly Cir. Chugiak, AK 99567
Real Estate Agent Day phone
2. TYPE OF DWELLING:
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:
Individual Well ❑ Individual 0
Individual Water Storage ❑ Holding Tank El
Community class . Well : ❑ Community
Public Water System 0 Public Sewer
WaiverNariance request r:
Distance:
Received by:
COSA to be released to the eer, unless otherwise requested by the engineer.
Date: /a"/ .3//ao t s
COSA Fee $ 6
Date of Payment
Receipt Number bd.(olto G\
cosA # 177C-16 I to N
Waiver Fee $
Date of Payment
Receipt Number
Waiver
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by myseal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined
in the Certificate of Onsite Systems Approval Guidelines for this application,.. shows that the on-site water supply and/or wastewater
disposal system is (are) safe, functionaland 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 underthe conditions encountered at thetime of the test,
andseparation 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 andsatisfactory. 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, noncan 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 LLC Phone (907) 272-8218
Address P.O. Bax 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE L/
System #1 Approved for 7 bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for
Date 12/18/2015
As. �s 9r AcAliki
"Zs•` I i\ •.
t . t.even lt: ' annone . ' �/---
CE -8149 /
iWOWS:SC "-
bedrooms, with the following stipulations:
4/14
ON-SITE
WATER AND "=
CI WASTEWATER g
PROGRAM
,r til..,
Original Certificate Date:
Th(Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
uponthe representations given in paragraph 5 by an independent professional civil engineerregistered in the State. of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the'professional engineers work.
7. ATTACHMENTS:
COSA Checklist X
Septic' System Advisory
Well Flow Advisory
COSA blue sheeti: '- L, c
Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On -Site Systems. Approval Checklist
Legal Description: Glenn View -Est. West Phase 2, Block 2, Lot 17
A. WELL DATA
Well type PUbGCIf A, B, or C provide PWSID # AWW U
Date completed
Total depth
Date of test
Static water level
Well production
Sanitary seal (Y/N)
Cased to ft.
FROM WELL LOG
ft.
g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL
Nitrate mg/L
Arsenic ug/L Date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Number of Compartments 2
Foundation cleanout (YIN)
Date of pumping 12/4/2015
Depression over tank (YIN)
Pumper Sanitary Pumpers
Parcel ID: 051-793-34
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground) in.
AT INSPECTION
ft.
g.p.m.
Collected by:
Date installed 10/16/2001
Cleanouts (Y/N) Y
High water alarm (Y/N) N
C. ABSORPTION FIELD DATA.
10/21/20012 2 1.2 GPD/SF Shallow Trench
Date installed Soil rating (g.p.d./ftor ft/bdrm) System type
Length 50 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 8 ft, Eff. absorption area 500 ft2 ' Monitoring tube Y Depression over field N
Date of adequacy test. ,12/17/2015 Results (Pass/Fall) Pass For 4 bedrooms
Fluid depth in absorption field before test 14 in. Water added 631 gal: New depth 17 in.
Elapsed Timer 90 min. Final fluid depth 14 in, Absorption rate >_. 600+ g.p.d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date
D. LIFT STATION
Date installed Size in gallons
"Pump on" level a in: "Pump off" lev
Datum Cycles
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
in.
Manhole/Access -(YIN.)
High water alarm le at
Meets alarm
On adjacent its
On adjacent lots
Public sewer ma
in.
circuit requirements?
e/cleanout
Sewer /se ' service line Holdin• = k
A. al containment areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 100+
Wells on adjacent Ietsa°°+
ABSORPTION FIELD ON LOT TO:
Property line10+ Building foundation 1°4-
Water
0+Water Service line 10+ Surface water 100+
nure/animal excrete storage areas
Curtain drain 50+
F. COMMENTS
Survey on File
Wells on adjacent lots 190+
Water main 10+
Driveway, parking/vehicle storage 10+
G. ENGINEER'S CERTIFICATION
I certify that I 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.
Engineer's Printed Name Steven R. Pannone
Date 12/18/2015
COSA canary sheet 2-6-15.doc
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 05 1— -493
1.
COSA # 0 2n' 9 q
Expiration Date: C — - G l
GENERAL INFORMATION
Complete legal description Glenn View Estates West #2 S/D, Block 2, Lot 17
Location (site address) 21202 Polly Circle, Chugiak, Alaska
Current Property owner(s) Douglas & Robin Rainwater
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
P.O. Box 670073, Chugiak, Alaska 99567
Day phone 223.1398
Wells Fargo Home Mortgage
1500 W. Benson, Anchorage, Alaska 99503
Day phone 25737°0
Jeannette Walker (Pnidential)
Day phone 7623103
3801 Centerpoint Drive, Suite 200, Anchorage, Alaska 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
❑ Individual On-site ❑�
❑ Individual Holding Tank 0
❑ Community On-site ❑
❑� Public Sewer 0
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request td homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
With new water sample results. (Certificates may be reissued for a period of up to one year with valid water
simples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Douglas T. Kenley, P.E.
Address 9806 North Star Circle, Palmer, Alaska 99645
Engineer's Printed Name Douglas T. Kenley
Phone (907) 746-1073
Date L• 5--08
tit a
7S, ox• •....I
:49Th
5. DSD SIGNATURE +4.•. % -• Cc • =
jj�
41.. = Dan/ T 1 77 EY:
Approved for "T' bedrooms. tt01
7 •i -N0
Disapproved. +:':.• .......
:
o
Conditional approval for bedrooms, with the following stipulatltms:.—
`.S ON-SITE
F --WATER AND--Tn-
: WASTEWATER
1. PROGRAM •
••
s-
.,, tTtrst�,�1'
1%'111111)1111
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
By: 11,-/
(Rev 11N5)
11 °-t
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: - og
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Glenn View Estates West #2 S/D, Block 2, Lot 17
Parcel la 051-793-34
A. WELL DATA
Well type Public If A, B, or C provide PWSID # _ Well Log (Y/N)
Date completed _ Sanitary seal (Y/N)_ • Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height (above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L Other bacteria colonies/100 mL
Arsenic: _ mg/1 Date of sample: _ Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septidsteel Date installed 10/16/2001
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Fotindation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A
Date of pumping May 8.2008 Pumper Sanitary Pumpers
C. ABSORPTION FIELD DATA
Date installed 10/21/2001 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SP
System type 5' Wide ShallowTrench
Length . Sc ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth -8 ft. Eff. absorption area 500 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 12/06/07 Results (Pass/Fail) Pass For 4 bedrooms '
Fluid depth in absorption field before test 33-1/4 in. Water added 757 gal. New depth 44-1/8 in.
Elapsed Time: 1440 min. Final fluid depth 34-3/8 In. Absorption rate >= 600 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date N/A
D. LIFT STATION
e installed Size in gallons
'Pump on = el at in. 'Pump oft" level at _ in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL 0 • TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer/sept -rviceline
An al containment areas
Manhole/Access (Y/N)
High water alarm level at
Meets alarm !t. circuit - . irements7
in.
djacent lots
On adjace
Public sewer manhole/c
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 11 Ft Property line 10* Ft
Water main 10+ Ft Water service line 10+ Ft
Wells on adjacent lots 200+Ft
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10+ Ft Building foundation 28+ Ft
Water Service line
10+ Ft Surface water 100+ Ft
Absorption field 7 Ft
Surface water 100+ Ft
Water main 10+ Ft
Driveway, parking/vehicle storage 50+ Ft
Curtain drain None knov 1oexsl Wells on adjacent lots 200+ Ft
F. COMMENTS:
G. ENGINEER'S CERTIFICATION
1 certify that I 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.
Engineer's Printed Name
Date (e • S' 06
Douglas T. Kenley, P.E.
149?H
*v'.
• •.
•Le• „i• .i•
S T KEP LEY. .
CE B1• $• -'
COSA Fee $
Date of Payment 1#16768
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
•
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AS -BUILT
1 hereby certify that 1 have surveyed the following described
property. LCT' ( 7 P 1 c c. l: 7_ .
t::nr. YI oiy. L' -+-i ♦ /Is . it/+.r+ Kiln e•.e (✓r:, 7 •
Sri- ;?,- a rl % IJ s F;' I >/ 7-; I'd
Anchorage Recording Precinct, Alaska, and that the improve-
ments situated thereon are within the property lines and do not
overlap or encroach on the property Iymg adjacent thereto, that
no improvements on property lying adjacent thereto encroach
on the premises in question and that there are no roadways,
transmission lines or other visible easements on said property
except as indicated hereon.
Dated at Eagle River, Alaska
this 24' T.. /lay of t--"' C. 200!
ROBERT C. JOHNSON A ct
SCALE: Registered Land Surveyor No.180-LS
1" • F'c Box 77-0456, Eagle River, Alaska 99577
Phone (907) 694-2543
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.clanchorage.ak.us
(907) 343-7904
CERTIFICATEOF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
HAA# {'f,% 02 o /S5f
Expiration Date: 14- 2 `7 - 0 3
Parcel I.D. 051-793-34
1. GENERAL INFORMATION
Complete legal description Lot 17, Block 2, Glennview Estates West Subdivision Phase II
-1,4
Location (site address or directions) Polly Circle
Current Property owner(s) MM&M Construction Day phone 688-1236
Mailing address P.O. Box 670495 Chugiak, AK 99567
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Four(4)
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
❑ Individual On-site
❑ Individual Holding tank 0
❑ Community On-site 0
O Public Sewer 0
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with
new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with
valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public
water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional
engineer's work.
4. 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 Health Authority 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. 1 further verify that based on the information obtained from the
Municipality of Anchorage fifes and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances,
and regulations in effect at the time of installation.
Name of Firm Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E
5. DSD SIGNATURE
Approved for 9- bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Phone 522-7773
Date 4/22/2002
Additional Comments
,`llltl \1YtOF A4
` • ON-SITE
• WATFP AND : in-
*. WASTEWATER :
• PROCRAM •
�o • A
iJJ NT sEt6s \`‘
1)11
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By
#
(Revv.12/00)
Original Certificate Date: LA 2 `P - 02
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St. •
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lot 17, Block 2, Glenn View Estates West Phase II Parcel ID: 051.79134
A. WELL DATA
Well type AWWU If A, B, or C provide PWSID # _ Well Log (Y/N)
Date completed _ Sanitary seal (Y/N) — Wires properly protected (YIN)
Total depth ft. Cased to ft. Casing height (above ground)
FROM WELL LOG AT INSPECTION
in.
Date of test
Static water level ft. ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mi. Nitrate mg./I. Other bacteria colonies/100 mt.
Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Date installed 10/16/2001
Tank size 1.250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N
Date of pumping Pumper
C. ABSORPTION FIELD DATA
Date installed 10/21/2001 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF System type 5' Wide Shallow Trench
Length 50 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 8 ft. Eff. absorption area 500 ft' Monitoring tube Y Depression over field N_
Date of adequacy test Results (Pass/Fail) For _ bedrooms
Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in.
Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) 14 If yes, give date
D. LIFT STATION
Date installed Size in gallons
'Pump on' level at _in. 'Pump off" level at _in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
Sewer /septic service line
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
On adjacent lots
On adjacent lots
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >51 Property line >S
Water main NIA Water service line >10'
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10'
Water Service line >10' Surface water >100'
Curtain drain None Noted Wells on adjacent Tots >200'
F. COMMENTS
Absorption field >5'
Surface water >100'
Water main >10'
Driveway, parkingtvehicle storage >10'
G. ENGINEER'S CERTIFICATION
1 certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 4/22/2002
HAA Fee $
Date of Payment
Receipt Number
(Rev. 12!00)
Waiver Fee $
Date of Payment
Receipt Number
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
522-7773 522-6779 (FAX)
MEMORANDUM
DATE: April 29, 2002
TO: Jeff Poet
FROM: Mike Anderson, P.E.
SUBJECT: Lot 17, Block 2, Glennview Estates West Subdivision Phase II
Septic System As -Built
Certificate of Health Authority Approval
The water system serving Glennview Estates West Subdivision Phase II is owned and
rted by the Anchorage Water
Utility uderthe corol of ADEC. As -built HeAuthority documents
have been modified to reflect this status. Please let me know if you have further
questions.