The URL can be used to link to this page

Home My WebLink AboutSCHROEDER EAST BLK 1 LT 19Onsite File Schroeder East Block 1 Lot 19 #050-063-05 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211197 PID Number: 050-063-05 Dwelling: FW Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name Linda M Tegeler ABSORPTION FIELD El Deep Trench ❑ Wide Trench El Bed ❑Mound Site Address 12732 Spring Brook Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original gr 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Grave pth beneath pipe / Subdivision Block Lot Schroeder East 1 19 Ft Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width > Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding I Sewer Total ab rption area Number of trenches Dist. between trenches From Tank Field Lift Station I Tank Line Ftz Ft. Well 1100'+ NA NA NA 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER TANK Capacity 1250 Gal. Surface Water 100'+! j NA i NA NA Material Number of compartments 1 I ( ** !! Lot Line 6.8' NA NA i NA NA HDPE 2 Foundation 5.1' * 1 NA I NA NA I LIFT STATION Manufacturer Capacity { i Remarks *See attached profile Gal. **See attached waiver request Alarm location Electrical installed by PIPE MATERIAL House to tank 3034Tank to 3034 drainfield Installer JR's Septic Drainfield COIMT3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 100.0 ft Inspection �5 07/20/21 07/21/21 dates: Location and description 2`1 3`' 07/27/21 41h Bottom of House Siding ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date • .O....Cq�,�� ---_ — _ : 49 TH 4- T .. ....W� - --- -_- .�— --------- -- Septic System Approved Date aSI 0202 %�z Note: this approval does not include well permit requirements. tr:av Uoluu ion -n-9Ov3=D --+ z z.m 00 0 (' co N £ � o - �p�or0-x A m /n CA < _ vZaCmFn 0 U) C C7 < m �zz�+v D 0 o z P0(A 0 Z 0 R rX00 ti £ t�T1 O— Om0 m C�O� -i z D n = co m Z U7 A O W A Z m A A Z O V) r M o) mp D r U1 n cm — N 0 m 0 OJ 1l ESr1t U -i zM --+ z z.m -0 0 (' Ic I � o ;r\K /n CA = C7 < � 0 o z N r /( W m V D n Oo W cn N D �o �o v o) a1 M U1 N Q — N 0 m 0 OJ 1l ESr1t U U P W O W � C11 -i zM --+ z z.m -0 0 (' Ic I � o ;r\K /n CA /to O < 1XI,' z N r /( c m V D n _ / Zr- m (n <D (f) U m O M rn --i Q m \ N 0 m 0 ;:o 1l ESr1t U cn �-0--0m 0 �C r � � z OD z o��`°> 0m \� 0 > 0_`1 � C� D \ �� wCD = cn C> L �m �.'\ c� V C CD OCG 0 DO umi \ may'zj D `�/ `S C 0 F G) _- -- Fri O _ ''---- MARL_ _VV RIVE -i zM --+ z z.m -0 0 (' Ic I � o ;r\K /n CA /to O < NN m mo N z O m Cnn 0 ccnn 0^ n D - � (n <D U � M rn --i Q m `. ;:o cn NOTES: PANNONE ENG SVC LLC (C.1. 1088) REVISIONS DATE RECORD DRAWINGS PHONP.O. BOX 187E 907) 745�8200ALUER, (90 799645-82 01 _ �P0F' A(gsq`'SC ALE 08/02/21 1 " = 50' SCHROEDER EAST BLOCK 1 LOT 19 t PoSo NO 063-05 DRAWN LJC LINDA M TEGELER stoY CE -8149 PERMIT E OSP 210119 7 12732 SPRING BROOK DRIVE SITE PLAN EAGLE RIVER, AK 99577+,Ess; SHEET - 2 OF 2 V (' t I / Z1 /n /to NOTES: PANNONE ENG SVC LLC (C.1. 1088) REVISIONS DATE RECORD DRAWINGS PHONP.O. BOX 187E 907) 745�8200ALUER, (90 799645-82 01 _ �P0F' A(gsq`'SC ALE 08/02/21 1 " = 50' SCHROEDER EAST BLOCK 1 LOT 19 t PoSo NO 063-05 DRAWN LJC LINDA M TEGELER stoY CE -8149 PERMIT E OSP 210119 7 12732 SPRING BROOK DRIVE SITE PLAN EAGLE RIVER, AK 99577+,Ess; SHEET - 2 OF 2 V (' t / Z1 /n /to ( I 1 NOTES: PANNONE ENG SVC LLC (C.1. 1088) REVISIONS DATE RECORD DRAWINGS PHONP.O. BOX 187E 907) 745�8200ALUER, (90 799645-82 01 _ �P0F' A(gsq`'SC ALE 08/02/21 1 " = 50' SCHROEDER EAST BLOCK 1 LOT 19 t PoSo NO 063-05 DRAWN LJC LINDA M TEGELER stoY CE -8149 PERMIT E OSP 210119 7 12732 SPRING BROOK DRIVE SITE PLAN EAGLE RIVER, AK 99577+,Ess; SHEET - 2 OF 2 P.O. Box 196650 a 4700 Elmore Road Anchoraae, Alaska 99519-6650 a (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section 7:?C'X7C / xxxx Waiver#-. OSV211054 COSA#:OSC211462 Permit#:OSP211197 PID#: 050-063-05 Legal Description: Schroeder East Block 1 Lot 19 Engineer: Pannone Engineering Services Applicant: Linda Tegeler Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 6.8 feet. In addition, your request for a waiver of the required 10 feet horizontal separation from the absorption field to the water service line has been approved. The approved separation distance is 4.0 feet. See engineer's waiver request for justifications. If at any time it is believed that the reduced separation between the water service line and absorption field is a contamination risk to the public water system, this waiver is void and the encroachment will need to be addressed. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. 09aa0aaaaaa99avavaaaaaaavvaavaaaaaaavaaaaaaaaaaaa0■aaaaaaaaaa0aaa0aaaaaaaaavaaI Waiver is Granted: X Waiver is not Granted: Date: 0.17 20,2 1 Approved by: au�A Name of Reviewer ■vavvvavvevaamvvavaaaamvvaavavavvvavvaamavvavaaeaaavvaaaaa2aaavaaaaa0aaaaaavaaI 1 Carroll, Rebecca M. From:Boulier, David J. <David.Boulier@awwu.biz> Sent:Friday, August 27, 2021 12:35 PM To:Carroll, Rebecca M. Subject:RE: Septic field to water service line encroachment In this situation, if the homeowner were to do any work on the existing leach field, then we would want the property owner to move the water line to meet the 10’ separation. I’ll keep record on our end in the property connect records, so if they need to do a water service line repair in the future, we can enforce moving the water line. Dave David J. Boulier Superintendent, Field Services Customer Service Division Anchorage Water & Wastewater Utility Direct: 907-564-2766 Cell: 907-231-2580 david.boulier@awwu.biz Excellence Through Innovation www.awwu.biz From: Carroll, Rebecca M. <rebecca.carroll@anchorageak.gov> Sent: Friday, August 27, 2021 11:09 AM To: Boulier, David J. <David.Boulier@awwu.biz> Subject: RE: Septic field to water service line encroachment Hi Dave, Did you have a chance to look at this yet or is there someone else I can contact? The engineer is looking for his COSA and this is the last item that needs to be addressed. Becca Carroll Onsite Water and Wastewater Municipality of Anchorage 343-7908 This is an email from an external entity. DO NOT click links or open attachments unless you recognize the sender and know the content is safe. 2 From: Carroll, Rebecca M. Sent: Monday, August 23, 2021 9:32 AM To: Boulier, David J. <David.Boulier@awwu.biz> Subject: Septic field to water service line encroachment Hello Dave, We are looking at a waiver request between an existing septic field and a public water service line (4.1 ft vs required 10 ft). As you can see from the engineer’s waiver request, the only justification is that the water line is under pressure. Could you weigh in on the risk of contamination to the public water system or is there someone you could forward this to? Before we consider issuing a waiver, we will want to hear from AWWU on whether there are any objections or not. Thank you, Becca Carroll Onsite Water and Wastewater Municipality of Anchorage 343-7908 Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com 12 August 2021 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P O Box 196650 Anchorage, Alaska 99519-6650 Subject: Schroeder East Block 1 Lot 19 Water Line & Property Line Waiver Request Ladies and Gentlemen: The existing water service line entering the northwest corner of the house is located approximately 4.1 feet from the existing drain field. The system has existed in this configuration since it was installed in 1982, with no adverse effects. The water line is under pressure, so it is very unlikely that it will ever be contaminated by the absorption field. We request a separation distance waiver for an existing absorption field to north property line of (6.8'). This is an existing drain field which was installed in 1982. The field has been in operation since installation. Granting these waivers are not likely to affect the health and safety of this lot or the surrounding lots now or in the future. If you have any questions or concerns, please contact me at 907.745.8200. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Yilailini,S,: P.O. Box 1807, PaI$i"er, AI''a `'f✓645 Te�eplhone-: (907) 745-8200 FAX: (907) 745-8201 pRNE k ��ttttr 2 Q w Q i N�P�PFt\P W ��P . • ;... : y�Sorrr/ F o z p � w cJP . lb/ w U) Z° O U rn= / 2 Q Q WwW ° NO LL--. } U)Q io: = Mv)� W > Qwp- Q S�a��9 ' Com: Qom: U)� D ��z� o 4 cv coO co a rrtts' G\SAF CI =� o �1— m D W t}- 57< O = U rn .::..�. F- CO 2 >� W >' m W CL 0c } $ F -W �� W ch W Q (D 0Ww U a)> Q� S UZ Z Q[0 SU 2 >Q S W F C\j > m W— �- Q E- �a LLJ `' 4❑ vim Y/N� J f �J~� ZS~Z Q� X �y >_ N o O Q Q F w O Q CO J N tY e p �� O O � � �uj ��0� � o O >,'ou u � / 0 O = w } 0=>UUw w Z r CV '� D o z V W > W aa_ c) Q Z < C� // ° C/1 Z U Z w 1ryd�l' `"' O(= w C,wF- OO ¢oocw9> U) I-QO w Uw a w~ -a F0 CL az �-� (nO0ZQ� W a Q� D "wTv w I ao<,-,! Wz W ZF }2 L W O UJ a ZZ �- wz� �Q 0 W 0Z 0LLW O W (nZo n 0 O a ��ZZ b �QOOw>- (D WQ mEwofWT � t }� n c+) Zrnl-F-=1Cl 0, �wWLw H t J w V = ! O W � ~ (/) C:� 0 I- w J w O W W I-wZ)QOF-Q 5�w oz-, a� cn �d 3w fix¢ � 0£ «r 1N �Sb� ul�ll p U) o to co (0 � x - F- a . x w ��oZu�zw ¢v¢ u)Q�Fnfa Z /F --::)WO � Z w o� x� w w 1 �� JO __3 03 DO W z00z0:w W �F xx0�wz O / = a X 03 _ �o332i1M l Lillln Qy o O >> Z� 0 w O(O z LL w o a n O '00QgCoa3Ha3Ap U�Uww� O°} oo-Uww z X --03 W00>=)2c) W �w max_ u OSi G o X -____-03 _"--•-03 m 0 tY O� W co W U> v U¢¢ t- > N X`".�.._----�3 _ LL D D W U U) t- C Q 0� O= Q W 0- W 3�N3j X -`X OC�WvS�� W}Z� w�www`n U)w��mUm2EW Wo c) (D) w, l O Wcr>WZ <2!: WL. oo o wc�00<ZOOo=QO �P<Zww v N 5OwZti�w�Zu)ad oao- U c� F- wC)wD. w�W� wU �Z�Q�J O (/) W W OSLO W O�w a0�m� co J tQ�200E-�2�[0�[LJ xn OLDa0 a > U 0 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program POBox 1SO850 4700 Elmore Road Anchorage, Alaska Sg518O5 V P 804 Fax: (S07)343'7897 Permit Number: {}SP211187 Work Type: SepUoTankUpgnsde Tax Code Number: 05008305000 Site Legal Address: SCHROEOEREAST 8LK 1 L 18 G:0352 Site Mailing Address: 12732SPRING BROOK DR, Eagle River Owner: TEGELERLINDA K4 Design Engineer: PANNDNEENGINEERING SERVICES This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft: WAUKOM 6/11/2022 El DisposalField 0Septic Tank El Holding Tank 0Phvy 171 Private Well 11 Water Storage All construction shall beinaccordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State ofAlaska Wastewater Disposal Regulations (18AAC72)and Drinking Water Regulations (18AAC8O) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.OEProvide notification bycalling (SO7)343'7GO4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated bzprevent freezing rovisions: The private water service line shall be located prior to future COSA approvals, in order to irnunl1Uftseparation boseptic system. Received By: Date: Issued By: Date: 3 MUNICIPALITY OF ANCHORAGE Y Community Development Department ' f Phone: 907-343-7904 Development Services Division p Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-063-05 Property owner(s) Linda Tegeler Day phone _ Mailing address 12732 Spring Brook Drive Eagle River, AK 99577 Site address same Legal description (Sub'd., Block & Lot) Schroeder East B1 L19 Legal description (Township, Range & Section) Lot Size 21,022 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) X❑ (w/wo ADU) Septic Tank RX Upgrade X❑ (D) El Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 02-? � Waiver Fees: Date of Payment: 6/q /,�%Q , Date of Payment: Receipt Number: 01 � 3? G Receipt Number: Permit No. 1 127 Waiver No. Permit App_:- :- ; Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211197, Rebecca Carroll, 06/11/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211197, Rebecca Carroll, 06/11/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211197, Rebecca Carroll, 06/11/21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99509 Telephone 2.64-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT - �----- �.------------�--�—�' PHONE N E W NAME 1 ff -r'7 �lI` — --- — —--- —i.. -) fZ. _ ❑ UPGRADE MAILING ADDR � LEGAL DESCRIPTION 1 �1roy LOCATION c, NO. OF BEDROOMS f z LU N ~ I Well comAbsorption area Dwelling DISTANCE TO: m r,l� i D Manufacturer ) ,�, Material _ Liq. cap a, y i-'�ons IF HOMEMADE: n - Inside length Width / PERMIT N�,}�J. r. 1ZL�' No. of compa ;t✓�ents Liquid depth Cj O z DISTANCE TO: Well Dwelling PERMIT NO. O Z Q < Manufacturer Material Liquid capacity in gallons x 9 w x DISTANCE TO: Well C�C��mon Foundation ��— Nearest lot line / PERMIT Z L - limes w is Z F — No. of lines Length of each line Total length of lines �-_��nches Trench widtl Distance between — — -- Top of nie to misb grade (�,, Material beneath file Total effective absorption area I] ,� inches ® Length Width Depth - T� PERMIT NO. w Q h- Type of crib Crib diameter Crib depth -- Total effective absorption area LU DISTANCE TO: Well Building foundation Nearest lot line LU Class DISTANCE TO: Depth Building foundation Driller Sewer line Distance to lot line PERMIT NO. Septic tank JAbsorption area(s) OTHER ` Ix PIPE MATE(RRII,\ALS ...�/ SOIL TEST RATING f INSTALLER REMARKS - —I—s -- I I 1 APPROVED DATE LEGAL �U r-4 I C- I F="Fl L_ I -V I -e Cl F= " " ll� " F, " CA- E: DEPARTMENT / HEALTH AND ENVIRONMENTAL OTECTION 825 /L STREET, ANCHORAGE., HK 99�lul1 264--4720 ��E:l4EEF, F::o C- F-0 rl I~r' PERMIT NO. ( 820824 ) APPLICANT RAYMOND PELLETIER 410 I ST 99501 268 -872 -'- LOCATION LEGAL L19 SCHROEDER EAST LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MA`_?lIrelUr-1 NUMBER OF BEDROOMS = — SOIL RATING <SO FT.,BR)= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 1:>E:lF:l'7r"� 7' 4.4- ��n %.-a F=- L_ ��" == :-�7 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). IF"EE ��C�" T -I=. !ffn. 10107- � F='[= I -E -r. THE GRAVEL. DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ��I F --u EE [---- ��F::"-r I (::. -r F-71 P -A K -=:. 1 27 1-" ILEIC-10 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. —_— _F k1l 0 < ;R _-1 I rJE-7 lF=o E=- C--- _F 1 0 " �"F- " F;;.'FE ��U 1 1: R I= L_), BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM R PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F;:7�� ED, I-= 1::� F=�0 FEE F;:-" :E J_.. 1-:7-0��z I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON --SITE SEWERS HND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL. THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED APPLICANT RAYMOND PELLETIER ISSUED BY��~__�.�Zp��^ � AT�_~~� �� - \/4 0 r - AWwotns "-r rl Iric"T OF of 0. .-yam ffj'�YPdz Tfx�ilfin Pf�1,2 OPP iia -A FT/SR •ryir K -it IMOER OF STM VS; Fn� 17gr-- It;1f[ ter' i7i SI f4#'TIQtIrs��y x Tt' aIC II f ni # iT DV;TAMOy M fgt� fi 17 ` #ETI DI iT f5 CEpTti 13F THE ajCflyflTP)N Cf T). � � tib S,& x �=s�' SeT1` T f .#if €�fl 1 mt - L.S�'a iY�se6 4 3 � 3. •3 M F In ` �r y1�#� � Rp TH ..��-!! tt p � ��.rj" f�a' f � I�.. f �If�t�$i fr'#t-�# t ,�, DSP^ t=�1;: - T �i� R ��e?S7�'E t �rf"F✓ T�"� �'�� ty S�'�Sr Tfe5n pr -Ratty A ate{ r E Fi7 f-'iS�.`m 1- SPC � �_ c# if l# i adit BE � '-3' T # f�t�1 54 t4lN fp#.m EsP Thi Tk 1 tlOR V50 Tn '200 reer Mai A JE T few TYPE OF PUE)LXC ESI t_ f T "Lott 9 0115-T k F� F# # 1-s 7!5 FEET. TO t i f's 3 hhi +2tk�i' }� � 1$ frti RE' fwe TIL Fifa - a Em i Tt#tT fcc �f 1 { 14I9"{°j Ti -i 1 �.._aA f t=i z j ! ; (_ .; 11) 11 ;. I I I I y (_))"' ",.i"(:! :( ) MUNICIPALITY OF ANCHORAGE � I A h� 1 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. 050-063-05 1. GENERAL INFORMATION Complete legal description Expiration Date: o� 5 oCd �C 01 Schroeder East Block 1 Lot 19 Location (site address) 12732 Spring Brook Drive Current property owners) Linda M Tegeler Mailing address Real estate agent 2. TYPE OF DWELLING: Fx7l Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic F71 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System R Public Sewer ❑ Waiver request for: Water Line and Property Line waiver Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5 5 0 Date of Payment S a 0:2 1 Receipt Number c 3 5 q &G COSA# as c,2 1 tylia Distance: 4. 1' & 6.8' Waiver Fee $ a 2 5 Date of Payment 31°502.11 Receipt Number 0 3,5 y 86 Waiver #_ 0SVa 1105 14 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Datel®�G�, ,,q, sk OF. A� �s z �Q . ......... Conditional approval for bedrooms, with the following stipulations: WATER AND R' WASTEWATER Z J By: Original Certificate Date: 8 a 7/,;20.2 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 engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: Schroeder East Block 1 Lot 19 Parcel ID: 050-063-05 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled NIA Total depth NIA ft Cased to N/A ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments Lot Supplied By public water B. TANK DATA Age of tank(s) <1 years Tank type/material a PG DPE Measured operating fluid level in septic tank N/A ❑ Standpipes/foundation cleanout per record drawing Date of pumping New D. ABSORPTION FIELD DATA Deep Trench Well pro ion at time of test N/A gpm er storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample N/A C. LIFT STATION ❑ Required maintenance completed Age of lift station N/A years Lift station material NIA Comments: Which system tested (date installed) 1982 Adequacy test date 05'25/2, ❑ ALL standpipes present per record drawing Results Q Pass For 3 bedrooms Total measured depth from grade 6.0 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 3.0 ft (min) Water added 450 gal ❑ N/A — pressurized field 2 New depth in ❑ Monitor tubes go to bottom of effective. If not, state 45 depth into effective Elapsed time min FE]Code-requiredsoil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) _ date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Q Yes if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑Yes if No ft ❑ Yes if No ft From Septic/Molding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 5.1 ft Surface Water > 100' (]✓ Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' Yes if No Water Main > 10' Yes if No ft Community Wells > 200' Yes if No. Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 2 Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 6.8 ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' 0 Yes if No Water Service Line > 10' ❑ Yes if No 4.1 ft Community Wells > 200' Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS Lot Served By Public Water Waiver will be Applied For Water Service line to Field Separation, and Field to Lot line Separation distance. *Tank falls out of 1/1 Slope from Foundation G. ENGINEER'S CERTIFICATION - OF Aj l certify that l have determined through field inspections and reviewAwl CO - of Municipal records that the above systems are in conformance with 1�e * 4 TI MOA COSA guidelines in effect on this date. . Steven K, . P n.none SQ COSA Checklist yellow sheet ft ft ft ft