HomeMy WebLinkAboutSEACLIFF BLK 3 LT 2AC)
Municipality of Anchorage Page of 3
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: 15,>V 9z. C) 1 D f PID Number: --
Name: Sp/4cc f�oNf�s
Wastewater System: New ❑ Upgrade
Address:
9410 �%a..fGva2o D2fvC
ABSORPTION FIELD
Phone:
3q4- SG7$
No. of Bedrooms:
❑ Deep Trench ti S allow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating: / L
Total Depth from original grade:
GPD/Sq. .Ft.
Lot: Block: 3 Subdivision: -
21- SGleatf
Depth to pipe bottom from original grade:
SZ Ft.
Gravel depth beneath pipe
Ft.
Township:
Range:
Section:
Fill added above original grade:
fl
Gravel length: _
5
-
Ft.
Ft.
WELL: 1V/!j ❑ New ❑ Upgrade
•
Gravel width:
Ft.
Numbe�flines: Oistancenll"Ft.
Classification (Private, A,B,C): the Cased To:
Total absorption area: 5 006 M
Pipe material:
Ft. Ft.
SQ. Ft.
I j) 3n3t F—S/t�
Driller.
Date Drilled:
Static Water Level:
Installer: i �
!� �/tG2/�
Date i stall
/c
Ft.
C✓5
Yield:Pump
Set at:
Casing Height Above Ground:
K
TAN y
GPM
FL
Ft.
SEPARATION
DISTANCES
eptic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Llfl
Holding
Fab 1 /Private
Manufacturer:
Capacity in gallons:
/) Z D
From
Tank
Field
Station
Tank
Sewer LinesA1`#-
well
> ?,,o0,
> 20 D,
�I
{v�
> 2 o c t
Mater) I: /
cam/
Number of Compartments:
Watere
>19D
>I�iof
SII
H11+>ISo'
LIFT STATION
Line
=
Size in gallons:
Manufacturer:
N
it
Foundation
5 r
i Q
LJ
/�
N/
f
"Pump on" level at:
"Pump off level at:
High water alarm at:
Curtain„A/�
Pump Make & Model
Electrical Inspections performed by:
Drain
,v
BENCH MARK
Remarks:
Location and DeesQription:
c01”
Assumed Elevation:
n
C
Ft
ENGIJN&& QS SEAL
q
��t IS
.'40 Dates: 1s
Inspections performed by/
2ndZo
Department of Healt
ces ap roReviewed
rand
GZ llt:117i
and approved by- Date:
Permit No. Sitii 9G 010 I
Municipality of Anchorage,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: LV7- Z' X['Ou` 3'
Lc7r I
0
112
t
PID No.: 011 ZZI S4Y
,why
4 t>K geje,-
5PY-614
z` oT9 I
MT
t
qr '5rr'S
tai -T
LaT 3
Per Imlt No. _SCJ gL DI01
J
Page of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description:
Lo7 Z 13WCJ .. 3 S&:A `u FF PID No.:
i b/ r o o• �• ° s Iv �
` v
i e , p •° e a e l s. o
i
r7,-.L,.WATla0 - Na�r� - -�►-T
��► to
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a2/
MEMORANDUM
DATE: August 30, 1995
TO: Jim Williams, MOA- DHHS
FROM: Mike Anderson, P.E.
SUBJECT: Lot 2, Block 3, Sea Cliff Subdivision
Septic System As -Built
The following revisions have been made to the septic system as -built for Lot 2, Block 3,
Sea Cliff Subdivision in accordance with your comments:
• The replacement system area has been added to the site plan.
• Testhole No. 2 was excavated to 16.5' during construction to verify the absence of
impermeable layer. A revised copy of Testhole No. 2 is attached.
• A sample of the SW material is attached for your review. It appears to meet the
requirement of 50% passing the No. 4 Seive without a gradation.
This information addresses comments received from your initial review of the as -built.
Hopefully, the as -built can now be approved by the Municipality.
e Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 " U' Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: '5-P) CLL ADM ES DATE PERFORMEp; S• b
LEGAL DESCRIPTION: LaT L/key Township, Range, Section:
11
12
13
14
15
D PTH
g T
1
-S% 9&0 V: 1,7"405.
/
/o:s
11
2-
3
3-
°10° +
0 100
W/G�
4
I - A •
It -'s-4
•
4.O • +
'o
5-90000
+ °e oo
6
o• •
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• DAo•
7
+• 0
0 • � O
+ e
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o
000 •••
9
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• o 10
10
11
12
13
14
15
0
1s I
rep Ta lL.S
17 I /Jo /M/PERMFaAIILC
18 //T T/
19
WAS GROUND WATER
ENCOUNTERED? /lf
S
IF YES, AT WHAT OL
DEPTH? P
E
090 to Water After
Monitoring? Date
SITE PLAN
�i
Reading Date Gross
Time
Net
Time
ti
Net
Drop
-S% 9&0 V: 1,7"405.
/
/o:s
11
/O 2
It -'s-4
G,3/
0
1s I
rep Ta lL.S
17 I /Jo /M/PERMFaAIILC
18 //T T/
19
WAS GROUND WATER
ENCOUNTERED? /lf
S
IF YES, AT WHAT OL
DEPTH? P
E
090 to Water After
Monitoring? Date
SITE PLAN
�i
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
-S% 9&0 V: 1,7"405.
/
/o:s
11
/O 2
It -'s-4
G,3/
y:vo to
!.. %
,3
`.DL
20 PERCOLATION RATE / (minutes/meh) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND i, FT
MMMENTS SD 0/O OE 144;r W41. PASSi 5 /lo. 4 Son/ir
PERFORMED BY:,! I " " ^`LL-t�HAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE S /zi r 9
'2-008 (Rev. 4/85)
mc/1- CaPy
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
__'-. G E 1 OF 1
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW96C_01 DATE ISSUED• 6;'j6/96
DESIGN ENGINEER:ANDERSON ENGINEERING EXPIRATION DATE: 6/_D6/97
DWNER NAME:SPINELL HOMES
OWNER ADDRESS:9210 VANGUARD DR=VE
ANCHORAGE, ALASKA 99507
PARCEL ID:01122144
LEGAL DESCRIPTION:
SEACLIFF BLK 3 LT 2
LOT SIZE: 13050 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
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 DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-474A ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PE_ -MIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
l.) VERIFY SOILS TO A DEPTH OF SIX (6) FT.�
BELOW BOTTOM OF SYSTEM, SUBMIT SOIL LOG
WITH ASBUILT DRAWINGS. _S
2.) PERFORM SEIVE ANALYSIS ON THE "SW" LAYER
AND SUBMIT WITH ASBUILT/INSPECTION REPORT.
RECEIVED BY:
ISSUED BY:
DATE:-
DATE:
ATE.DATE:
l
r"y
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF 1
i13o-1st
Lt -S o rn
-1 �v
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT 'A,_�
PERMIT NUMBER:SW960101 DATE ISSUED: 6/06/96
DESIGN ENGINEER:ANDERSON ENGINEERING EXPIRATION DATE: 6/06/97
OWNER NAME:SPINELL HOMES
OWNER ADDRESS:9210 VANGUARD DRIVE
ANCHORAGE, ALASKA 99507
PARCEL ID:01122144
LEGAL DESCRIPTION:
SEACLIFF BLK 3 LT 2
LOT SIZE: 13050 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONSTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK SYSTEM
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 DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT)
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
(SPECIAL PROVISIONS:
1�:)"VERIFY SOILS TO A DEPTH OF SIX (6) FT�
BELOW BOTTOM OF SYSTEM, SUBMIT SOIL LOG
WITH ASBUILT DRAWINGS.
21)_PERFORM _SEIVE ANALYSIS ON THE "SW" LAYER
AND SUBMIT WITH ASBUILT/INSPECTION REPORT.
RECEIVED BY:
�C I'-)�L �;ai t-6C,S arFlEo
DATE: t Aki
ISSUED BY:Mgli/li �'V (��G-w.� DATE:
May 20, 1996
Municipality of Anchorage
Department of Heath & Human Services
825 "L" Street
Anchorage, AK 99502-0650
Subject: Lot 2, Block 3, Seacliff Subdivision
Septic System Design
Impacts to Adjacent Properties
Dear On Site Services Engineer:
We hereby request a permit to place a septic system on the subject lot in accordance with
the attached design. Testholes placed on the lot revealed a clean gravel with a percolation
rate of 1 minute per inch. We are proposing to place a wide drainfield with 4' of drainage
rock beneath the laterals. A total of 50' of trench will be required. The subdivision i s
served by a community water system and separation distances are easily met at the
proposed system location.
The topography of
the lot
is basically flat with
shallow 2% slope from
west
to east. No
groundwater was
found in
the testholes and no
surface water noted in
the
area. If the
absorption trench
is placed
in the location shown
the following statements
can
be made:
1. The system, if constructed as designed, will have no adverse impact on the community
well in the area.
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 reserved
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
patterns in the area. The current drainage pattern will be maintained.
Sincerely, ;
%6MUNICIPALITY GE
,' 8,�NVIRONMNALSVCESDVSION 3g�W0O (ti�C�
7sa114-,eLX
Michael E. Anderson, P.E. 44{+G
Attachments y
FIVE
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SHEET NO. OF
CALCULATED BY DATE
CHECKED BY DATE
BY- _MEIi ____ DATES1Z��¢ CLIENT _ Sp/l�tr�LL _ NnES SHEET OF
CHKD. BY DESCRIPTION yLOr Zy SW cic. 3� S"C -41Zf �%%�JOB NO. �_N........
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SYSTEM PLAN
NO SCALE
v�
e
c
...' I�'iiCil U:�� �.. iii �f.�3(3D❑ a
n.
LOT 2, BLOCK 3, SEACLIFF SUBDIVISION
DESIGN FACTORS:
SYSTEM REQUIREMENTS:
Four Bedroom Home Wide Trench System
Perc. Rate: 1 Min./Inch 1,250 Gallon Septic Tank
Application Rate: 1.2 GPD/SF 4' Drainfield Rock
4 Bedrooms X 150 GPD / 1.2 GPD/SF = 500 SF of Absorption Area
500 SF/5 LF (Width) X .5 (Red. Factor) = 50 LF Length of Trench
Therefore: Construct a 5' Wide Absorption Trench With One 50' in
Length. Distribution Pipe in Trench Placed at 4' Below the Original
Ground Surface. Place Fill Over Trenches to Provide a Minimum of 3' of
Cover Over Lateral.
IJATvV_Ac_
$Ac.K-r+ 1t_L
%s
4!
NOTE:
Grex,-1Lc-
FA6 a.Ar�
D a.A-r,-J r- r tU
Tao ce..
TYPICAL WIDE TRENCH SECTION,,-'
(NO SCALE) �« "
y.r
Grade Area Over Trench to Drain Away. V�
_) r7 no Oyu ....... 0®p a0
9
r':'u:_iiacl c. Ar,dzrson o W
43V I - E oe �
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: 5pInICLL /'TOMES DATE PER
LEGAL DESCRIPTION:
Net
Time
D PTH
r+
Net
Drop
1
/0„5
lz�/ '
L
2
3
0 000 be
�
w
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13
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15-
16-
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18
19
// L
Township, Range, Section:
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water After
Monitoring?
F.,
S
L
�- O
Date:
P
E
t.1ici,ciel E. Aad-rsOn
SITE PLAN
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
S-1yla )27%oS
/0„5
,
/
7.
/1—' S-6
G,3/
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,37
`,OL
20
PERCOLATION RATE / (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 5� FT /AND to FT
COMMENTS 50% 01` M4:rGR,141_ PA55�•S /EGD. 14 -50.1 �
PERFORMED By:,A'L= By:,!'I W61 6 1 Y THAT THIS TESTWAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: S -A-1 96
72-008 (Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 '•L•' Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: SPWC LL 14omcs DATE PER
LEGAL DESCRIPTION: Lo r z, 6/k 3 , Township, Range, Section:
SLOPE
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Time
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Time
Depth to
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■0160
■■I.■
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NOISE
MEAN
o
— V/3
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water After O S Z
Monitoring? Date:
SITE PLAN
Reading Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
o
— V/3
C
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Z
i /5"; o
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SITE PLAN
Reading Date
Gross
Time
Net
Time
Depth to
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Net
Drop
Z
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_z
!20 !
5/, to
S
el . b
20
PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN FT AND FT
COMMENTS
5o % or- mAT'MiA4t PASSES ell. `4 Ss/JC; 64.,4D
.J E "SS A tLy. --
PERFORMED•��L��— Iy '��'V"CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/65) -
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: Lot 2, Block 3, Seacliff Subdivision
GENERAL:
1. The scope of this project includes the procurement and
placement of a 1,250 gallon Septic tank and the
construction of a wide absorption trench with 4' of
drainfield rock beneath the distribution pipe. A total length
of 50 L.F. of trench is required.
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 on the
Site Plan.
Lot 2, Block 3, Seacliff Subdivision
May 20, 1996
Page Two
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.
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.
Lot 2, Block 3, Seacliff Subdivision
May 20, 1996
Page Three
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. 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, Fernco, or equal).
5. A permeable geotextile fabric (Typar, Mirafi or equal) must
be installed between the final drain rock layer and the
native soil layer.
Lot 2, Block 3, Seacliff Subdivision
May 20, 1996
Page Four
6. All drain rock shall be .5" to 2.5" in diameter with less than
3% passing the #200 sieve.
INSPECTIONS:
A minimum of two inspections are required by Municipal
Ordinance. 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.
�61891077 •
• 4 s�
•; �_� Municipality of Anchorage ry4111111W '
On-Site Water and Wastewater Program "` 41-1.„
(907) 343-7904 a JUN 2' 20
Certificate of On-Site Systems Approv <<
Cl 6 g
011-22-144 - ?-16
Parcel I.D. Expiration Date:
1. GENERAL INFORMATION
Complete legal description Seacliff Block 3 Lot 2
Location (site address) 9312 Endicott St.
Current Property owner(s) Estate of Frank Amodemo Day phone
Mailing address 9312 Endicott St. Anchorage, AK 99502
Real Estate Agent Day phone
2. TYPE OF DWELLING:
O 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 A Well Q Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by. ...�1., �/i Date:
(e/V9717
COSA to be released to the engineer,unless otherwise requested /he engineer.
COSA Fee $ J 2 (0 Waiver Fee $
Date of Payment _ (e) " 7-3- (7 Date of Payment
Receipt Number 615 2-24 Receipt Number
COSA# 042CX1 j 2 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. •
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 lime 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.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone Date 6/22/2017
VPS.OF Al_q���
. ,
Al*: TH
• A y*fir
6. DSD SIGNATURE
System#1 Approved for bedrooms •Steven R. fan one
t♦ -O.. CE-8149
System#2 Approved for bedrooms9�4s•. �i
Disapproved ��,'`PROFESS 0--a
Conditional approval for bedrooms, with the following stipulations:
\.:611 Or i4i
O
ON-3ITE �s
WATER AND
WASTEWATER z ,
��. PROGRAM mac'
r���itir^F-
By: \ k (" t Original Certificate Date: Cc, ^,zP - 17
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheer<. -
If more than 1 septic system is on the lot:
COSA Checklist # 1 of '
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: Seacliff Block 3 Lot 2 Parcel ID. 011-22-144
A. WELL DATA
Well type A If A, B, or C provide PWSID# 210485 Well Log (YIN)
Date completed Sanitary seal (YIN) Wires properly protected (YIN)
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
Arsenic ug/L Date of sample Collected by.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 6/18/1996
Tank size 1 250 gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (YIN) N
Date of pumping 6/7/2017 Pumper One Stop Pumping
C. ABSORPTION FIELD DATA
Date installed 6/18/1996 Soil rating (g.p.d./ft2 or ft2/bdrm) 1 .2 System type Wide Trench
Length 50 ft. Width 5 ft. Gravel below pipe 4.5+ ft
Total depth 10.3 ft. Eff. absorption area 5 ft- Monitoring tube Y Depression over field N
Date of adequacy test 6/9/2017 ,results (Pass/Fail) PASS For 4 bedrooms ti
Fluid depth in absorption field before f�� in. Water ad ec�600 gal. New depth✓/r� m.
Elapsed Time: 1440 min Final fluid de�� n. ' Absorption rate >= 600+ g p.d.
N
Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (YIN) -
"Pump on" level at in. "Pump off" level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage 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 lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
4oF AC•q 1�
I certify that I have determined through field inspections and 'woo:A•'�P 1 ••'F }
review of Municipal records that the above systems are in .... •'' ��
conformance with MOA COSA guidelines in effect on this date. '
Steven Pannone J
Engineer's Printed Name l . 1even kPannane• r/
Date
6/22/2017 ii :•• CE-8149 f
11� .P o4
\�` ,�
COSA canary sheet_2-6-15.doc
Th IQCOjI Øf the 5'_,Ctu r s
els shown 017 this recp'a &owing
(as-buitt)COf t $with Title 21,AMC- P -659
14c: CLiFF SUBDIVISION
b"°' - ---LO 1 2 , BLOCK 3
13,050 S.F.
R
S 69''58'00"E 145.00'
I • — ort. 1
1 LOT 2
' A1]`= is it5
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- - • scrrlc twrs n B .a+c r
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„c NAL STRUCTURE As—euLr'
'
AS — A t.) ( L + I barely certify that I novo 101.0,44 rile
property depicted *beer mrd Mot no 'iiiit11/.*
GASTA.LD' LAND SURVEYING e5cf 4 hirishts 'slot estop) es Iildicet•d_ OF .4
jolt A, Usst0ldi, A.L.S. It If the r•sp•eslbllltr of the *ower t0 4. �• 7 II
•••• ••••• 1
4725 Wast filth /IK•_ datormli• oho •slsf•nth Of oft, easements. •A:• •■ •• - •
Anther*i•. Atomic 11th COVOTantf Of rostrtttl•ns which do tit *� Irl
appear .a this racrrdud subdivision pIO'. ••• •• • •••♦ •��
249-6464d1E 249-b4 '
Undo' ns clrtumstOI1C•s should *n) dote • • •• • ••
•
E .k A. Goitaid i a
Pierian fee was', for clUstruttilrl or for % . 1 IR
Ler ,. DA1E •Osteo Ishina boundary •r tont. I inn• )1i It,,•••• (•091`- �� •�• ,
r .424 x/25 fflOrlc &OE RfGORQ+Md DISTRICT, ALASKA/96 • ovA.•••••••••••eft y *,
s_s. J00 M O. ais
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Ori- .9 SCS23 MOTs: M0 COMERS SET Mot DATE,
MUNICIPALITY OF ANCHORAGE
• '� DEPARTMENT OF HEALTH 8t HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # D// — Z Z — ! z�- C/HAA #
1. GENERAL INFORMATION
Complete legal description trT— Z, 134-eci4_ 3 5 � t;-)= SJobrv) tS/oij
Location (site address or directions) 93 i L Cr`i-D IC -o & i
Property owner s P IPJ G L 4C, m C S Day phone 3 4`I
Mailing address
Lending agency Day phone
Mailing address
Agent
A AA.e
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: F�y'L
3. TYPE OF WATER SUPPLY:
Individual well
Community well X x x x
Public water
Day phone
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of.system. — - -
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site xxxx
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21
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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is 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 in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm At)u c-71SorJ Com,+ 6 rn! rr LE) (AJ G Phone
3 -7/SS
Address ��'
lkk
7—yd-773
Engineer's signature�L<L
< (C-tiLcl? Date
6. DHHS SIGNATURE 1�
Approved for -1 bedrooms.
M
Disapproved.
Conditional approval for
Additional Comments
bedrooms, with the following stipulations:
V
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev_ 1/91) BaCK MOA 921
arKVICES DIVISION
Municipality of Anchorage AUG ® 7 1996
DEPARTMENT OF HEALTH & HUMAN SERVI ES
Environmental services Division ' ��
825"L" Street, Room 502 A Anchorage, Alaska 99501 • (907) 4 -
Health Authority Approval Checklist
Legal Description:
/,s ! i _ %. %�1 ( -i ; Parcel I.D.: o1 / - Z Z •- 1 r! ' I-
A. WELL DATA
Well type I If A, B, or C, attach ADEC letter. ADEC water system number
Log present (YIN) Date completed
Total depth _ Cased to Casing height (above ground)
Sanitary seal (Y/N) Wires properly protected (YIN)
FROM WELL LOG AT INSPECTION
Date of test
Static water level
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform Nitrate Other bacteria
Date of sample: Collected bv:
B. SEPTIC/HOLDING TANK DATA
Date installed Iv iA Iq t Tank size l 7- 50 Number of Compartments 7 Cleanouts (Y/1) Y
Foundation cleanout (Y/N) Depression (Y/N) P� High water alarm (YN
Date of Pumping J L�j Pumper Lp ,J � .j A-" C -r1 0 rJ
C. ABSORPTION FIELD DATA
Date installed 1, lis s / q t, Soil rating (g.p.d./ft' or ft2/bdrm) System type i b L ) gd CA)
s 1
Length Width t� r Gravel thickness below pipe
VZ-+Total depth J 0 3
Effective absorption area G 00 Monitoring Tube present(Y/N)d Depression over field (Y/I� IQ
Date of adequacy test 4 &tj G r r /S r Results (Pass/Fail) 4 55 For 1 6 tai bedrooms
Fluid depth in absorption field before test (in.); 0 Immediately after_ gal. water added (in.):
Fluid depth 0 (ins.) Minutes later: Absorption rate = g.p-d•
Peroxide treatment (past 12 months) (YN /J If yes, give date IEt /A
STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
*Datum
"Pump off' level at*
SEPARATION DISTANCES FROM WELL ON LOT TO:
r
Septic/holding tank on lot -1,11A ; On adjacent lots Yid t
/n
r
Absorption field on lot � ,4 ; On adjacent lots
r
Public sewer main i 500 Public sewer manhole/cleanout i Sod �
r
Server /septic service line %