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GLENN VIEW ESTATES WEST PH 2 BLK 2 LT 19
Glennview Estates West Phase 2 Block 2 Lot 19 #051 - 793 - 36 Municipality of Anchorage Page 1 of 3 Development Services Department On-Site Water and Wastewater Program 4700 South Bragaw P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW020062 PID Number: 051-793-36 Name: MM&M Contracting Wastewater System: New Address: P.O. Box 670495 Chu iak AK 99567 ABSORPTION FIELD Phone: Number of Bedrooms: 688-1236 Four 4 5' Wide Shallow Trench LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: .8 GPD/F1' 9 Ft. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 2 19 Glenn View Est. West Phase II 3 6 Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel Length: 1 Ft. 64 Ft. Well: AWWU Water System Gravel width: 3 Number of lines: 1 Distance between lines: N/A Ft. Ft. Classification (Private, A, B. C): Total Depth: Cased to: Total absorption area: Pipe Material: Ft. Ft. 768 Fc ASTM D3034 PVC Driller. Date Drilled: Static Water Level: Installer: Date Installed: Ft. MM&M Contracting 6/7-11/02 Yield: Pump Set at: Casing eight Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ublic/Private Manufacturer: Capacity in Gallons: From Tank Field Station Tank Sewer Line Anchorage Tank 1,250 Well >200' >200' N/A N/A >25' Material: Steel Number of Compartments: Two (2) Sudace Water >100' >100' N/A N/A LIFT STATION — NONE ON LOT Lot Line >5' >10' N/A N/A ize: anu ac urer: Gal. Foundation >5' >10' N/A N/A Pump on' level at: in. 'Pump o level at: in. High water alarm at: in. Curtain None Noted Pump Make & Model Electrical Inspections performed by. Drain Remarks: 2" Insulation Atop Septic Tank. BENCH MARK Location and Description: Finished Floor. Assumed Elevation: 100.0 Ft. Engineer's Stamp OF 1 AV �i �, Inspections performed by: Mike AndersonDates: 15t 6/7/02 ;'' 49Th 4 nd 2 6/7/02 % �..... .. 00 •MICHAEL•E„ANDERSON Department of Health d Human Services approval�%; � No. Reviewed �� % ' 3 Z CE-4381 :##_Q_' AV : and approved by: �' ' Date: %0FESSO�' cRev. 10/99)♦�� 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 SW020062 POLLY CIRCLE Page 2 of 3 PID No. 051-793-36 C4 Alternate Site A B S1 12.8 44.9 S2 19.3 46.7 M1 48.8 28.1 C4 35.6 80.9 C5 48.5 29.3 PLAN AS -BUILT SCALE 1" = 40' t'1 q t 49th • , MICHAEL E. ANDCRSON TEE i •�C�Jjt No. C[-4381 .474: 94. Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: SW020062 FF=1 PID No. 051-793-36 ru c S � U t- U �� . PROFILE AS -BUILT A91th Scale: 1" = 10' 7 UiCHAEL E. ANDERSON � p i 1,10. CE -4381 : a \� � F rAr 1 2 3 4 5 6 7 8 9 14 15 16 17 < 4 a' MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT/ON-SITE WATER AND WASTEWATER.(3 GRQM,, 4700 SOUTH BRAGAW STREET, ANCHORAGE, AK 99502-0605 ' CE w. SOILS LOG — PERCOLATION TEST �F°Qa e PROJECT #: M0229a�°pSS��'� MM&M CONSTRUCTION / PAUL MYERS `' 4�:' 11202 PERFORMED FOR: DATE PERFORM'�D LEGAL DESCRIPTION: LOT 19, BLOCK 2. GLENN VIEW WEST SUED. �%%� TEST HOLE # 2 SLOPE SITE PLAN F/ /' / I 0G/0B DENSE SILTY -SANDY -GRAVELS SM -GM WAS GROUNDWATER ENCOUNTERED? IF YES, WHAT DEPTH? DEPTH OF WATER AFTER MONITORING: DATE: I <5/1 S L 0 P E N TH1 TH2 O O NO SCALE < 5% READING DATE GROSS TIME NET TIME DEPTH OF WATER NET DROP Start 6/11/02 15:30 12" 1 16:00 30 8.125" 3.875" Recharge 16:00 12" 2 16:30 30 8.125" 3.875" Recharge 16:30 12" 3 17:00 30 8.125" 3.875" PERC RATE: 7-7 MIN./INCH PERC. HOLE DIAMETER: 6 TEST RUN BETWEEN 5.5 FT. AND 6.5 FT. COMMENTS: NO IMPERMEABLES ENCOUNTERED / HOLE PRESOAKED PRIOR TO TEST 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: 9/27/2002 FROM : COUtfTR' REALTY S: • PHONE NO. : 9376881238 Sep. 16 2002 09:15AM P2 Y• o '. • • • • ., .t of A0000C��A at*r a_ • r" • • • AS -BUILT . • • I hereby certify that I have surveyed the fofowing desci;led p;;peztr: L o r -I 4. 8 to 2, 5L•,.t t/t :... er arm: Via.syJ nm-+-• tire. Z. . • 5u:c i � `T -t rill ��') • •• &ieho?ase Reowding. predict;. Alaska, and that ther'ietprove-'. menta situated thereon are wjthin the Property lines and do not : iiveriap or er'xrbich'bn et! property Iymg adjacent thereto, that.'- ' haitnproventeries.on propertytymga adaacrat thereto 'encroach cultic minis' es n.quesoon and that..diere ere no ioadways.. transmission fates or. other warble easements on said prbperty ' .except as indica ed hereon: ' • • • Dated a E Rivet Alaska . .. this. Si .._, ,sc f'_• -.floz. ROBERT C. JOHNSON 'ACT- SCALE: C "SCALE: •:;:. Registered [arid Surveyor No:BBO-LS'•' 'Boa 77-0456, Eagle River. Alaska 99577 Z. . MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial % 4' 2=f tb/oz e Aro Z=°r Date Issued: Apr 12, 2002 Expiration Date: Apr 12, 2003 Permit Number: SW020062 Parcel ID: 051-793-36 Legal Description: GLENN VIEW ESTATES WEST PH 2 BLK 2 LT 19 Design Engineer: 0014 Anderson Engineering Owner Name: MM&M Contracting Owner Address: PO Box 670495 Chugiak . AK 99567 - Site Address: Lot Size: 40489 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: E Disposal Field U✓ Septic Tank 0 Holding Tank ❑ Privy [j Private Well 0 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. 5. The following special provisions. PERMIT CONTINGENT ON ADDITIONAL TEST HOLE LOGS AND PERCOLATION TESTS BE SUBITTED PRIOR TO THE CONSTRUCTION OF THE SYSTEM FOR OUR REVIEW WHICH VERIFY THE SOIL CONDITIONS. PERCOLATION TESTS TO BE RUN AT 6 FEET DEEP Received By: Issued By: Date: (HZ-02— Date: HZ-02 - Date: y/iZ/oz— 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 0 Parcel I.D. OLS -/-773 -310 Permit Number SW Property owner(s) MM&M Contracting, Inc. Day phone 688-1236 Mailing address (1) P.O. Box 670495 Chuglak, AK 99567 Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Lot 19, Block 2, Glenn Vlew Estates West Subdivision Phase II Legal description (Section, Township & Range) Lot Size LSO 4/$ 9 Acres/Sq.Ft. Number of Bedrooms Four (4) THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool ® Well Only O Water Storage 0 0 0 ❑ Jacuzzi 0 ❑ Water Softening Unit 0 0 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:as �n. Waiver Fees: Date of Payment: .7$8 y/$/d a Date of Payment: Receipt Number: / $O ''3 Receipt Number: (Rev. 12/00) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 5224779 (FAX) April 7, 2002 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 19, Block 2, Glennview Estates West Subdivision Phase II Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer. The owner of Lot 19, Block 2, Glennview Estates West Subdivision Phase II intends to construct a new four-bedroom home 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 on the lot and the test hole location along with the septic systems located on nearby lots. Existing drainage patterns are shown and will not be altered by the development of the lot. We recognize the soils information submitted with this permit application for this system is Tess than satisfactory. We are requesting, however, that the permit be issued based on this information as the subdivision has been proven in the past to have suitable soil conditions for the construction of on-site system. Weather conditions at this time make it difficult to complete additional test holes without increased costs. Additional test hole logs and percolation tests will be submitted prior to the construction of the system for your review which verify the soil conditions. The test hole placed near the location of the proposed absorption trench indicates clean gravel and sand with varying amounts of silt. The percolation test completed in the material resulted in a rate of slightly more than 7 minutes per Inch. No groundwater was found during the placement of the test hole and none was noted during the monitoring period. We are therefore proposing to place a 3' wide deep absorption trench system with 6' of gravel beneath the distribution pipe. The total depth of the trench will be 9'. 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 63'. 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 • Lot 19, Block 2, Glennview Est. West, Phase II April 7, 2002 Page Two will be constructed a minimum of 10' from the water service 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. 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, t,G Michael E. Anderson, P.E. Attachments ttttttt t"P „ .» � ••• To1 MICHAEL E. ANDERSON W a %?;1/41. No. cE-4381 -�: f 0. Kat 3-CS.00.0cis i'- —3 e r++al.t .Q grit! s .s..-.ee "14i ..'- �,.}.R.-.te r ...q y. :,rw.rrKp 145.70.00$ < �apn3 .JAl 4' 7c•-•`• \ Is 1 IPS a. rto w inn C L • - 00'91. w 10 Ott SZS.W.tnn s 0 r.. a - M cc: 381•28111-C 27910 Ur ac xsw.Wa O n '0t' 22 VACANT o0'9n .3 tt n: s .-fa 'h t tir g :t17 n • IY. • 'ot,` sa r. v _ i1 `t 44 :I7 N0 _5 • 1 1 oa,r oF ginn''. 4444 �p 41'3's4 - 0Q:OO$$ i -♦ '�-1K' tiLAE THIS PROJECT h a° e1., rav °ter a e• N C Art V(' \\\qo.,) / \+. /. \ `Y1. \ / ... C, eb o 'z i�T.':'tni 4'- .. . - q� . A. 5'raOt 3. '14! 49th • • • SCALE 1" = 100' WCNACL E. ANDERSON ♦ N0. a-1361 4 PRor (SO- 404P 4444444444444444444 AREA SYSTEM PLANCLe a A O! 0 O! F 0 $4 144 TH aan SepticGTanx LOT 19, BLOCK 2 GLENNVIEW ESTATES WEST PHASE 2 X EffectiveXDepthiAL. T -nch Alternate Site SITE PLAN. SCALE 1" = 40' LC/Mk / l 49th r`t WCHACL E. ANDERSON I1 JA No. CC -438140. ... PALFESSt 1:* I it at LOT 19, BLOCK 2, GLENNVIEW ESTATES WEST SUBDIVISION, PHASE II DESIGN FACTORS: Four Bedroom Home Pere. Rate: 7.3 Min./Inch Avg. Application Rate: .8 GPDISF SYSTEM REQUIREMENTS: Deep Trench System 1,250 Gallon Septic Tank 6' Drain Field Rock 4 Bedrooms X 150 GPD /.8 GPDISF = 750 SF of Absorption Area 750SF/12 SF/LF = 62.5 LF Trench Length Therefore: Construct An Absorption Trench 63' In Length by 3' Wide With 6' of Drainfield Rock Beneath the Distribution Lateral. Distribution Lateral to Be Placed 3' Below Existing Ground. Total Depth of Trench to Be 9' from Existing Surface. Mound Over Trench or Provide 2" of Insulation to Provide Frost Penetration Protection. NOTE: 2.6" 6'0" G i 6" Natural :Backfill Ceotextile Fabric it • S"• Perforated PVC (Slots Down) • } r. aiiia\i' e••hryi ic5w • . ) Drainfield Rock TYPICAL DEEP TRENCH SECTION (NO SCALE) Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 25' From Water Service Line. Minimum 4' Separation From Groundwater. Minimum 100' Separation From Wells in the Area. Municipality of Anchorage Development Services Department/Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw Street Anch., AK 99519 SOILS LOG - PERCOLATION TEST Performed For: Arctic Devco/Tumer Construction Date Performed: Legal Description: Lot 19. Block 2 Glenn View West Estates Phase 11 SLOPE North 1 _ OG/OL Loose & Soft 2 Thin Layers GP/SP 3 SITE PLAN :2/ 1-• ry� .•4 i i_.... - �� M2RACL E. ANDERSON Ey No. CC -•3H' ! 4/20/99 TESTHOLE NO. 1 4 See Site Plan 5 6 SM/GM Med. Dense 7 Fine Sand w/Gravel 8 Cobbles to 6" 9 10 11 Silt Increasing w/Density 12 13 14 15 16 17 18 Bottom of Test Hote South Was Groundwater Encountered? No If Yes. What Depth? Depth to Water After Monitoring Date: 5/15/99 None S L 0 P E Reading Date Gross Net Depth To Time Time Water 1 21 -Apr 2:35 7" 2 3:05 30 2-13/16" 3 3:06 7" 4 3:36 30 2-14/16" 5 3:37 7" 6 4:07 30 2-14/16" Net Drop Perc. Rate: 7.3 Min./Inch Perc. Hote Diameter: 6" 21 Test Run Between 3 Ft. and 4 Ft. Comments: Perc. Cavity Presoaked Prior to Test. Test Hole Placed During Construction Performed By: KND. I. Michael E. Anderson Certify That This Test Was Performed In Accordance With All State and Municipal Guidelines In Effect On This Date: 414/02 4-3/16" 4-2/16" 4-2/16" ONSITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 19, BLOCK 2, GLENNVIEW EST. WEST SUB., PHASE II GENERAL: 1. The scope of this project includes the procurement and placement of a new 1,250 gallon septic tank at the location shown on the Site Plan. Work also includes the construction of a new 63' long X 3' wide X 6' effective depth absorption trench at the location also shown on the Site Plan and at the configuration shown. The distribution line in the trench will be placed at 3' below the existing ground surface. Total depth of the trench will be 9' below the existing ground surface. The new absorption trench must be placed a minimum of 10' from the water service line on the property. 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. Lot 19, Block 2, Glennview Est. West April 7, 2002 Page 2 of 3 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. 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 less 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 19, Block 2, Glennview Est. West April 7, 2002' 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 AmCHORAGE o .,.- 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. 051-793-36-000 Expiration Date: 9/11/2024 Leqal description GLENN VIEW ESTATES WEST PH 2 BLK 2 LT 19 Site address 21242 POLLY CIR Chugiak AK 99567 Current property owner(s) LANGLEY SCOTT C &ANTHONY ROSADO X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for Comments or advisories: a bedrooms, with the following stipulations: Original Certificate Date: 2/28/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other COSA Approval—June 2022 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-793-36 Complete legal description GLENN VIEW ESTATES WEST PHASE 2; BLOCK 2, LOT 19 Location (site address) 21242 POLLY CIRCLE, CHUGIAK, AK 99567 Current property owner(s) SCOTT LANGLEY Day phone 907-315-1296 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units 0 Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑■ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 22 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed FE -1 Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ L] Waiver Fee $ Date of Payment Z / 2 i'/ -z' -Z 7 Date of Payment COSA # 0 S C 2 `� 1 0 Ll 7 Waiver # COSA Appliwfion_June 2022 CASA Checklist Legal Description: GLENN VIEW ESTATES WEST PHASE 2; BLOCK 2, LOT 19 Parcel ID: 051-793-36 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 X-MCELL DATA ❑ Well log i Date drilled PUBLIC WATER Onsite (or attached) Well production at time of Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) Date of flow test for CO ft Static water at beginning of test ft. B. TANK DATA Measured operating fluid level in septic tank 5 Date of pumping 9/11/2023 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 6/7/2002 WE ALL standpipes present per record drawing Total measured depth from grade 10.2 ft (max) Measured depth to pipe invert from grade 3.6 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 5.75 ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced _gallons date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Water storage tan me gallons Well di ' ed for coliform test? El Yes ® No Coliform bacteria is Negative rate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by _ Date IFT STATION ❑ Requir intenance comp) Age of lift station ars Lift station m al Adequacy test date 2/20/2024 Results ❑■ Pass Fluid depth prior to test 40.25 in Water added 691 gal New fluid depth 54 in Elapsed time 195 min Final fluid depth 50.5 in Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 72 in Effective depth used *53.5 in Effective depth remaining *18.5 in Comments/Deficiencies: *MEASUREMENTS CALCULATED BASED UPON ELEVATIONS TAKEN DURING TEST. COSA Checklist June 2022 E. SEPARATION DISTANCES fftra.eyivate Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Li on Lot > 100' Community Sewer Manhole/ ut > 100' Yes if No ft ❑ Yes if No Neighboring Tank > 100' ❑ Yes i ft P ' ewer/Septic Line > 25' ❑ Yes if No Absorption Field on Lot > 100' 0 Yes if No Tank > 100' ❑ Yes if No Neighboring Absorption Field Animal Contain 0' ❑Yes if No ❑ Yes if No ft Manure/Animal Excreta Storage > Co Sewer Main > 75' ❑ Yes if No ft ❑ Yes i 0 N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5+ ft Surface Water > 100' M Yes if No Tank to Property Line > 5' 0 Yes if No ft Field to Property Line > 10' Q Yes if No ft Water Main > 10' Yes if No ft Water Service Line > 10' Q Yes if No ft Wells on Adjacent Lots: Private Wells > 100' Yes if No _ Community Wells > 200' 5� Yes if No _ If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *MET SEPARATION DISTANCE AT TIME OF INSTALL. TANK IS UNDER DECK (<30") ft ft ft ft ft m ft ft ft G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gamess Engineering Group, LTD. (GEG) Phone Engineer's Printed Name Jeffrey A. Garness Date _ In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regardinj the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 #AEccesa 907-337-6179 OF..! U°a4 f��ej Gornes .•� P o M0NMPAUTV OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC241044 Subdivision: Glenn View Estates West Phase 2 Block:2, Lot: 19 907-343-7904 Fax: 343-7997 The septic tank for this property is 22 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. 00 CD z Aa_ae'we' orl '0 Radius= 50.001 Length= 33,50, Detta= 38'23'18' Cord= 32,88, Cord Hearing= N15'541141W S 86"4235' E r— — I � Drjveit�Y "4m L J 12' Wlde po,,4ed Gray of See see -P DETAIL LOT 19 Group of 'P k/ P LEGEND (S) Septic Vent Pipe Chain Link Fence Wood Fence aq.9, DETAIL (Not To Scate) 1 24.7 23.3' 16.5' I 61 1 1 2es, Deck 2 -Story Frame to, 4..s,\.,. House 6' 36, ,4.5' ., 1315, 34' 14' 30, POLLY CIRCLE TeL & Etec Easenent I hereby certify that I have surveyed the fol.loAring described Lot 19. Block 2, Glenn View iew Estates West Phase 2, Flat No 2000-80, Anchorage Recording District, and that no encroachments P xi t except as indicated hereon. This As -built will only show the exist P Qh No. 10303 Nz% easements that appear on the recorded subdivision plat No. 2000-89, ... Anchorage Recording District; under no circumstances should this data .... ........ hereon be used for the construction or establishing of boundary or fenci.. lines. Glenn View Estates West Ph 2 ASBUILT SURVEY APB Land Surveying o 2.5 so 6 ., Lot 19 Block 2 Ch I S Cordie David i eryi S East Prince of Peace Drive SCALE 114 FM12204 Depicted on: Plat No. 2000-89 P. O. Box 671733 Eagle River, Alaska 99577 Anchorage Recording District Chuglack, Alaska 99567 Surveyed: February 3, 2015 GRID: NW1459 0P_WWD.MC CHECKM. (907) 227-1361 Parcel I.D. 051-793-36 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Expiration Date: 1. GENERAL INFORMATION: Complete legal description GLENN VIEW ESTATES WEST PHASE 2; BLOCK 2, LOT 19 Location (site address) 21242 POLLY CIRCLE CHUGIAK AK 99567 Current Property owner(s) AL ADAIR Day phone 841-0630 Mailing address 21242 POLLY CIRCLE CHUGIAK AK 99567 Real Estate Agent GORDON SLOAN Day phone 244-3381 2. TYPE OF DWELLING: N 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 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System © Public Sewer ❑ WaiverNariance request for: uistan Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ $550 Date of Payment 3 10 a �� Receipt Number 0751/76 COSA # OSC211100 Waiver Fee $ Date of Payment Receipt Number Waiver # J 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering GrouR. Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the dale/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for _�_ bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the foll r--,) lZ �� ►" �� v Q. CE -795-7. ` 0; a.,Si�nU` #AECC884 G\Q��\iY OF,�����! i^ J� �g ON-SITE O WATER AND tRtiK443-p — nrATER z PROGRAM `01 Jy))))1) M I'. 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_ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet -1 0.10-112 doc Legal Description: GLENN VIEW ESTATES WEST PHASE 2; BLOCK 2, LOT 19 Parcel ID: 051-793-36 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 ELL DATA PUBLIC WATER ❑ Well log ed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) Date of flow test for COSA/ Static water lev eginning of test Co ft. B. TANK DATA Age of tank(s) <19 years Tank type/material STEEL Measured operating fluid level in septic tank *50" ❑ Standpipes/foundation/ cleanout per record drawing Date of pumping 10 D. ABSORPTION FIELD DATA DEEP TRENCH Which system tested (date installed) 6/7/02 ❑ ALL standpipes present per record drawing Total measured depth from grade 10.1 ft (max) Measured depth to pipe invert from grade 3.6 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Well production at time of test m Water storage tank volum gallons Well disinfecte coliform test? ❑ Yes ❑ No ❑ C m bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) isug/L [:JArsenic less than MRL (ND) Collected Date of Sample STATION ❑ Requir aintenance com Age of lift station ye Lift station material Adequacy test date 2126/21 Results ❑✓ Pass For 4 bedrooms Fluid depth prior to test 32.75 in Water added *788 gal New depth 51 in Elapsed time 246 min ❑ Code -required soil cover over field Final fluid depth 44 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) No date of test) Gallons introduced gallons If yes, enter date N i� Comments/Deficiencies: `ADDED 730 GALLONS TO DRAINFIELD ON PREVIOUS DAY (3/25/2021). COSA Checklist yellow sheet 9U E. SEPARATION DISTANCES PUBLIC WATER Fromi'Tt a Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station t > 100' Community Sewer Ma 4eflMleanout > 100' L if No Neighboring Tank > 100' ❑ Yes if No Absorption Field on Lot > 100' ❑ Yes if No Neighboring Absorption Fields > Com�"Yes if No ewerMain'❑ Yes if No ft ❑ Yes if No ft ate Sewer/Septic Line > 25' ❑Yes if No ft ft Tank > 100' ❑ Yes if No ft Animal Containme _ 0' ❑ Yes if No ft ft ft Manure/Animal Excreta Storage > Wells on Adjacent Lots: ft ❑Yes i �ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *51+ ft Surface Water > 100' Yes if No ft Property Line > 5' Q✓ Yes if No ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10'✓Q Yes if No ft Community Wells > 200'✓Q 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' M Yes if No ft If absorption field is under driveway comment below Property Line > 10' ✓v Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' Q✓ Yes if No ft Surface Water > 100' [] Yes if No ft F. ENGINEER'S COMMENTS 'MET SEPARATION DISTANCE AT TIME OF INSTALLATION. SEPTIC TANK IS UNDER LOW LYING DECK SUPPORTED BY PIER BLOCKS. THERE IS NO PIER BLOCKS DIRECTLY OVER TANK. DID NOT INSPECT FCO OR ST1 DUE TO DECK BOARDS FROZEN IN PLACE. **PER ORIGINAL INSPECTION REPORT AND MICHAEL E. ANDERSON P.E. COSA (10/3/2002). G. ENGINEER'S CERTIFICATION l certify that l 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 #AECC884 0011) Radlus= 50.00' Length= 33,50' Delta= 38.23118' ` Cord= 32.88' Cord Dearing= N15'541141W �f S 86°4235" E 280,60' ,V 12' -- —23.2' P E L L Y — CIRCLE 12' w12c_y_Dr"e- �0 15' Tel & Etec Easement C:) See In Groin of S DETAIL N � 136.8' LOT 19 Grain or BK 2 352 29.9' 3 DETAIL. 00 (Not To Scate) o+ o 24.7' CD C:) Z 21' 23.3' 3D' 16.5` US' 14' 6' Deck 2 -Story LEGEND Is' Frame QS Septic Vent Pipe 10' 4,5'\-4. House 6• Chain Link Fence 4s1/.4, 36' �-Q Wood Fence 13,5' 34' , 4F .4 K `49TH I hereby certify that I have surveyed tile fol.lou'ing described . Lot 19, Block 2, Glenn View Estates West Phase 2, Plat property ' r No. 2000-89, Anchorage Recording District, and that no encroachments i �i1(ci1311f r . to Jitcf exist except as indicated hereon. This As -built will only show the °, v .. No. 10303 easements that appear on the recorded subdivision plat No. 2000-89, Anchorage Recording District, under no circumstances should this data yos s;Qnal � hereon be used for the construction or establishing of boundary or fence lines.✓ Glenn View Estates West Ph 2 ASBUILT SURVEY APB Land Surveying o is so Lot 19 Block 2 Cordie David J & Cheryl S SCALE IN F>Er As Depicted on: Plat No, 2000-89 p P. 0. Bax 671733 12204 East Prince of Peace Drive Eagle River, Alaska 99577 Anchorage Recording District GRID: NW1459 Chu9iack, Alaska 99567 (907) 227-1361 Surveyed: February 3, 2015 na�mm ateamx Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-793-36 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent Expiration Date: �'I. a -/ 1e ON a GLEN N VIEW ESTATES WEST S#2; BLOCK 2, LOT 19 21242 POLLY CIRCLE, CHUGIAK, AK, 99567 DAVID & CHERYL CORDIE P.O. BOX 671733, CHUGIAK, AK, 99567 Day phone 727-4317 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System • 4 USIVIETTEA ex) JUN 1 8 2014 Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer WaiverNariance request for: N/A • Distance: - Received by- COSA y COSA to be released to the engineer, unless otherwise requested by the engineer. Date: T"/ Z) ) y COSA Fee $ 524' Date of Payment Receipt Number COSA # ob3otG Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 *ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LED. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conations are outside the contral of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for '7" bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for Date eh eJ'`p ::L�t� ■ •.. ,oy s Lu - •7 OFESSIaSS♦♦ . ON-SITE i i. =Z WATER AND z= bedrooms, with the following stipulations: WASTEWATER p. PROGRAM: sc) RN By: Ai • Original Certificate Date: 7- 2 _/ I/ Thenicitybr Arge Develop, emt 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. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory /Paw 1nl191191 Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Ph 2- Legal Description: GLENN VIEW ESTATES WEST SID *; BLOCK 2, LOT 19 Parcel ID: 051-793-36 A. WELL DATA Well type 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 (abo - •round) i FROM WELL LOG AT I CTION Date of test Static water level ft. ft. Well production g.p.m. WATER SAMPLE RESU Coliform colonies/100 ml. Nitrate mg./L. Collected by: nic: ug./L. Date of sample: `FCO & ST1 ARE UNDER DECK, Tank Type/Material SEPTIC/STEEL Date installed Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (Y/N) *YES Depression over tank (Y/N)NO High water alarm (Y/N) N/A Date of pumping (.1 1 (e / / y Pumper ..-5/12 �S g.p.m. B. SEPTIC/HOLDING TANK DATA 6/7/2002 C. ABSORPTION FIELD DATA /'BELOW EXISTING GRADE Date installed 6/7/2002 Soil rating.p.d./ rft'/bdrm) 0.8 Length 64 ft Width 3 System type TRENCH ft. Gravel below pipe 6 ft Total depth *10.1 ft. Eff. absorption area 768 ft2 Monitoring tube YES Date of adequacy test 5/22/2014 Results (Pass/Fail) PASS Fluid depth in absorption field before test 41 in. Water added 610 gal. Depression over field NO For 4 bedrooms New depth 52 in. Elapsed Time: 120 min. Final fluid depth 46 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in "Pump off level at 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 wa er alarm level at in. Meets alarm & circuit requirements? On adjacent lots On adjacent lots PUBLIC WATER sewer manhole/cleanout Holding tank containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation *51+ Property line 54 Absorption field •*51+ Water main 101+ Water service line 101+ Surface water 1001+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 101+ Water main 101+ Water service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 101+ Curtain drain NONE KNOWN Wells on adjacent lots 2001+ F. COMMENTS `SEPTIC TANK I5 UNDER DECK. DECK IS SUPPORTED BY PIER BLOCKS. 711 en in 0_101 tr b\ oeK t3jrec+l i7Ver 1 ren C. "PER ORIGINAL INSPECTION REPORT AND MICAHEL E. ANDERSON P.E. COSA x10/3/2002) . 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 JEFFREY A. GARNESS Date &ItrBl1Li (Rev. 10/12/12) 37 7 • fill= ` '. aeaaoc�oesoaoosmctc�eau ieadao :,oao®eoo aea oee Robert C. Johnson ". N3 ezJ`3. -'b zev AS -BUILT i hereby certify that I have surveyed the following described property. ca'. ? , 6I,-nnV/-e- S`%cr. Us`i�Pl:cs-e, NO,a, 're. 5• PJ 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 it day of f" ;1- `• 200 ROBERT C. JOHNSON tC ': SCALE: Registered -Land Surveyor No.880-LS 1" -1., Box 77-0456, Eagle River, Alaska 99577 Phone (907) 6942543 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.O. 051.793.36 HAA# HA 02.0 5-1.2_ Expiration Date: 10 - 3 - 0 3 1. GENERAL INFORMATION Complete legal description Lot 19, Block 2. Glennview Estates West Subdivision Phase II Location (site address or directions) Polly Circle Current Property owner(s) MM&M Contracting, Inc. Mailing address P.O. Box 670495 Chugiak. AK 99567 Lending agency Mailing address Real Estate Agent 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 Day phone 688.1236 Day phone Day phone TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ❑ Individual Holding tank ❑ ❑ Community On-site 0 ® Public Sewer ❑ 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 Tess 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 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 Anderson Engineering Address P.O. Box 240773 Anchorage. AK 99524 Engineer's Printed Name Michael E. Anderson. P.E. Phone 522.7773 Date 9/27/2002 5. DSD SIGNATURE 'rss'Z • Cz I ,• Approved for bedrooms. '; ?20;fsjp<<<�' Disapproved. - Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: (Rev. 12/00) X .e// /C% / o-A"fr Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: / 0 - 3 - D Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw SI. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 19. Block 2. Glenn New Estates West Phase 1I A. WELL DATA Well type AWWU Date completed Total depth ft. N A, B, or C provide PWSID # Sanitary seal (YIN) Cased to ft. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform colonies/100 mi. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1.50 gal. Foundation cleanout (Y/N) Y Date of pumping C. ABSORPTION FIELD DATA Date installed 6/7/2002 Soil rating (g.p.d.Mt2 or ft2/bdrm) .8 GPD/SF System type Deep Trench ft. g.p.m. Nitrate mg./I. Collected by: Number of Compartments 2 Depression over tank (Y/N) N Pumper Recent Construction 0 Parcel ID: 051.793.36 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION ft. g.p.m. Other bacteria colonies/100 mi. Date installed 6/712002 Cleanouts (Y/N) Y High water alarm (Y/N) N Length 64 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 10 ft. Eff. absorption area 768 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. Elapsed Time: _ min. Final fluid depth _ in. Any rejuvenation treatment (past 12 mo.) (YM & type) N New depth_ in. Absorption rate >_ If yes, give date g.p.d. 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 tankAift station on lot Absorption field on lot Public sewer main Sewer /septic service line Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/deanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >S Water main N/A Water service line >10' Wells on adjacent lots »EO' r Wei SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 5' Water Service line >10' Curtain drain None Noted F. COMMENTS G. ENGINEER'S CERTIFICATION Building foundation >10' Surface water >100' Wells on adjacent lots >200' I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HM guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 912712002 Absorption field >5' Surface water >100' Water main >10' Driveway, parking/vehicle storage >10' HAA Fee $ 3 7 c 4 Waiver Fee $ Date of Payment 912 7/62 Date of Payment Receipt Number 02.42.21 Receipt Number (Rev. 12/00)