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CINERAMA TERRACE BLK 2 LT 4
v` „„a, � T� 1f.�'.�: .s� �� �:: t ink mak:' '�=, .. '`` � � � r ., �., �,, � � �� Fes` �. i� r. %Z x�z�' �� of ''�-�� {�r..�'r���,. - .mak °w"`,���' ro*� -=1�;r ^�?��,. `� ;u.,��,�'fr'u e Municipality of Anchorage Department of Health and Human Services Building Safety Division Onsite Water and Wastewater Program, 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 995196650 Page 1 of 4 www.d.anchorage.ek.us (907) 34}7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWSW030319 PID Number. 020-033-13 Name: Wastewater System: ® New ❑ Upgrade Adam ABSORPTION FIELD Ptgy: N.aner a Bedrearne: O Dep Tn ® ananow Trane O sad a Mouq p Dewe LEGAL DESCRIPTION Sod ""ra TOWDiphftmon ""a"de1 Blodt La: s.EdiNrion: Deal b pPa bman eoin dgvyl pray: + Gravy yp,n banaadl OP T&enov Range: sectm: Fa added.bore apnd Way: GMM Larput Well: ® New ❑ Upgrade r".* *,en: 515 F, Nun" a linea: 0.m bMween era I 1111A Cwurratidn )Pmtla. A a. c): TOW Dapet Cased b: Taal abox0on rep Ppe mmenal: Omar I Doe DM*&. Smk Weer Laval: Ina,aller Dee eN,aAad: Ft a Beeks Contracting 716/2004 Ywld. Puny S.e M: Garp HWM Above Grand: 1 G� F,. F, TANK SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lift Holding ublidP"vate mlmd - capow From Tank Field Station Tank Se Line Anch Tank 1250" wa 126.5 143.0 101 '"He" . Steel Numar of carpanma .: 2 s..I•ww.,a 100+ 100+ LIFT STATION to t"» 60 17.9 a": L" '"daa'"e` Gal Fd ndem 26 44 'Pap of We at 'Pump or Waw M: Hieb wNa alarm K Mr F ti c.nain Dn+, 50+ 50+ Pap Wk* & Mb Elso r" Hp.giona palamw br Rema kc 2" r1clid Insulation over entire field. Field covered with BENCH MARK 6" topsoil & sedded. LBa emeand nt Slab Aaw.nM Ela M 100.0 FL Engineer's Stamp .•••��seaa�s •• OF .. 'Sy ♦♦ Inspections performed by: Pannone Eno. Svc Dates: 1"7/6/2004 _. �.•. ' 49TH °♦♦i ..................2"'07/06/2004 Department of Health and Human Serrvices approval AStieven ; � R. onnone?. Reviewed ♦♦'� and approved by: �y 1 sen Date: a/or�/lyy�� • . Nn. CE stag •�s1ss';ut55t�� ice•• PERMIT NO:SWO30319 RECORD DRAWING WASTEWATER DISPOSAL SYSTEM Lot 4 Block 2 Cineramo Terrace N E RESERVER SYSTELI: TWO 75'x 5'TRENCHE 30' TH RADIUS 60.1 \ 10% TH S-1� 7.9 LOT UNDEVELOPED NO WELLS OR SEPTICS WITHIN 100 FEET PRIMARY SYSTEM: TWO 75'x 5' TRENCHES NOTES: 1) All work shall be performed in accordance with, and all materials shall conform to, DEC regulations. 2) Contractor shall excavate on additional test hole before installation of new system to verify soils. Notify Engineer when test hole is being excavated 3) Install new trench as indicated. 4) Install two inches (2") of rigid insulation over entire bed. 411'eor. /\\ 111* ✓en R. Pannone No. CE 8149 , NEW 1250 SEPTIC 1 (FS) a!& HOUSE P.I.D. NO: 020-033-13 EXISTING SEPTIC AREA TH 2 TH 2 1 WELL RADIUS 1 WELL CID FC T1 T2 DC DV FS C1 M1 C2 M2 C3 M3 C4 M4 El 25% 5 pR�vE P� DESIGN: PERC RATE: 13 A B 17.0 2.8 37.9 28.1 43.1 31.3 46.7 34.2 48.4 35.6 58.4 47.2 57.6 46.6 56.9 46.9 68.5 74.9 66.7 73.1 72.0 62.3 69.1 60.2 81.9 86.2 79.7 84.0 3 `_ `�s APPLICAT�N-RATE: 188 SF/BR � / {`�_\ 4-13R-HOUSE r �REQ'D AREA: 750 SF Nick and Anne Marie Walker 14100 Sunview Drive Anchorage, AK 99515 242-2615 5 F1• WIDE 0.5 FT EFFT'V DEPTH 150 )LF REOUIRED TWO $5 LF TRENCHES 1250 GAL. SEPTIC TANK PANNONE ENG. SVC, LLC P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 227-3522 P, 272-8218 Fox UE' toy n_ zoo RECORD a PERMIT NO: SW030319 DESIGN DETAILS WASTEWATER ABSORPTION SYSTEM Lot 4 Block 2 Cinerama Terrace ' NOTES: 1) ALL WORK SHALL BE PERFORMED " IN ACCORDANCE WITH, AND ALL MATERIALS gi! k SHALL CONFORM T0, AMC15.65. uauv3 2) ADD A MINIMUM OF 2' OF R.I. OVER ENTIRE BED. 3) MAINTAIN 30' SEPARATION FROM ALL ¢ SLOPES GREATER THAN 25%. 'a9TH a I�.— ':Steven R. Pannone 1 'n:• CE 8149 . It Z O F— U w V) Nick and Anne Marie Walker 14100 Sunview Drive Anchorage, AK 99515 242-2615 3sn1 aoim 3AWA AYM-f 3d -T" NO INT] 319npa Im "ma 3rw wenn Ne W313 Npn9Nno3 P.I.D. NO: 020-033-13 Pannone Eng. Svc., LLC P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 ROM :Alpine Drilling Rick Mystmm Mayor FAX NO. :907 345 0202 Oct.13 2010 06:02PM P1 Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-5650 http:#www. d. anchorage. ak. us Permit Number: #SW 030319 Date of Issue: 5-20-03 Parcel Identification Number: 020-033-13 Date Started: 10-13-03 Date Completed: 10-14-03 is well located at approved permit location? Yes M NO Legal Description: Cinerama Terrace Blk 2 Lot 4 Property Owner Name & Address: Nick & Marie Walker 14100 Sunview Drive 899515 Method of Drilling ® air rotary ❑ cable tool Casing type: steel Wall Thickness: , 2W inches Diameter: 6 inches Depth: Z feet Liner Type: Diameter: inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): i feet Pumping level: 41 feet after 2 hours pumping,2 gpm Recovery Rate: 3 gpm Method of Testing: air lilt Well Intake Opening Type: ® Open End ❑ Open Hole [] Screened Start fent Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: bentonite # 8 Volume: Depth: Start 0 feet Stopped ? feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? ® Yes ❑ No Method of Disinfection.: Comments: Well Driller: Alpine Drilling & Enterprises PO Box 110496 Anchorage Alaska 99511 Attention: The well driller shall provide a well log to the property owner within 30 days of completion T and the property _.. .I ..__\\ J_!\l_.. 1; 1\ •�_ 117__ a_ al._ _l7f__11L O MUNICIPALITY OF ANCHORAGE lD33 Development Services Department �� �� m Onsite Water & Wastewater Program )tool 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW030319 Legal Description: Cinerama Terrace Block 2 Lot 4 Date Issued: Aug 20, 2003 Expiration Date: Aug 19, 2004 Parcel ID: 020-033-13 Design Engineer: 0062 Pannone Engineering Services Site Address: Unknown Owner Name: Nick & Anne Marie Walker Lot Size: 74264 SO. FT. Owner Address: 14100 Sunview Drive Total Bedrooms: 4 Permit Bedrooms: 4 Anchorage . AK 99515 - This permit is for the construction of. Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy 0 Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By- Issued y Issued By. Date: O 24 X//3 Date: g 7O Municipality of Anchorage Development Services Department Building Safety Division _ On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. T)Zc"0 I _� Permit Number SW Property owner(s) Nick & Anne Marle Walker Day phone 242.2615 Mailing address (1)14100 Sunview Drive Mailing address (2) Anchorage, AK Zip Code 99515 Legal description (Lot, Block & Sub'd.) Lot 4 Block 2 Cinerama Terrace Legal description (Section, Township & Range) Lot Size 771 OT414 Acres/Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms 4 Sewer Only ❑ Well Only ❑ Sewer and Well ® Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) CV Permit Fees: Waiver Fees: Date of Payment: �1' 3d / Date of Payment: Receipt Number: 377 Receipt Number: (Rev. 12/00) Pannone Engineering Services, ILC Consulting Engineers June 28, 2003 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Lot 4, Block 2 Cinerama Terrace S/D Well & Septic System Permit Request Gentlemen: P.O. Box 102954 ge, Alaska, 99510 )071272-8218 Fax My firm was asked to investigate a new septic system serving this lot. Two test holes were excavated on April of 2002 on the lot. The soils report and a percolation test resultare attached. The tests were conducted by another engineer as part of the subdivision and should be on record with your department. No bedrock was encountered in the test hole. No ground water was encountered while digging the test holes I monitored the water level on May 15h of this year and found the holes to be dry. The lot is approximately 71,060 square feet in size. Lot 4 slopes to the northwest at approximately ten percent in the area of the test holes and steeper to the south. The proposed installation will be located on thenorthem portion of the lot. The proposed private well will be located in the southwestern portion of the lot. The proposed location is greater than 100 feet away from existing & neighboring wells and 25 feet from the water service lines. The surrounding wells are located greater than 100 feet from the proposed installation. The proposed installation will not affect the future &bvelopment of the surrounding or existing lots. See the attached Design. If you have any questions or concerns, please contact me at 2273522 or 272-8218. Sincerely, Steven R. Pannone, P.E. Civil Engineer Attachments: C:\Work\Letters\4-2 Cinerama Terrace.001.doc PERMIT NO: DESIGN DRAWING P.I.D. NO: WASTEWATER DISPOSAL SYSTEM Lot 4 Block 2 Cinerama Terrace NE�p,M GZRESERVE SYSTEM: TWO 75' x 5• TRENCHE EXISTING NSTALL BALL -TYPE SEPTIC AREA 3 -WAY VALVE TS TH 2 30' TH RADIUS 44.5' 10.0' 10.0' TS T 10% TH 2 TEST HOLE S- q �� ' 10.0' NEW 1250 SEPTIC LOT UNDEVELOPED NO WELLS OR SEPTICS WITHIN 100 FEET \ \120.0' PRIMARY SYSTEM: TWO PROPOSED 17. 75' x 5 TRENCHE 4 BR HOUS NOTES: \ / 1) All work shall be performed 110.0' in accordance with. and all \ WELL RADIUS 100' materials shall conform to, DEC regulations. 2) Contractor shall excavate 1z ROPOSED WELL an additional test hole \ 4 before installation of new system to verify soils. Notify Engineer when test hole is 25% being excavated 3) Install new trench as \ indicated. 4) Install two inches (27 of 25% rigid insulation over entire bed. J C `� DESIGN: S PERC RATE: 13 c ..�..•.` APPLICAT TE: 188 SF/BR ,1,1 \n\` 4 USE ��P • ,1♦ E 'D AREA: 750 SF r�G�.;\♦♦ 5 WIDE 0.5 FT EFFT'V DEPTH ♦ 150 F REQUIRED i 49T" L TWO 5 LF TRENCHES c•• •••••••••t••••• j 1250 AL. SEPTIC TANK r • 0 .................... .................. PREPARED FOR: PANNONE ENG. SVC, LLC ♦ Steven R. Pannone a ♦ ° Nick and Anne Marie Walker P. 0. BOX 102954 ♦j♦♦ N�; .� 1x100 age, Aw Drive ANCHORAGE, ALASKA 99510 c.;— 'C; Anchorage, AK 99515 _ _ ♦♦�/,,,::.�0 242-2615 DATE:227-3522 7-09-2,003 272-8218 7 DESIGN Fax SCALE: 1 "-60' PERMIT NO: 0 R. Pannone DESIGN DETAILS WASTEWATER ABSORPTION SYSTEM Lot 4 Block 2 Cinerama Terrace NOTES: 1) ALL WORK SHALL BE PERFORMED IN ACCORDANCE WITH, AND ALL MATERIALS SHALL CONFORM TO, AMC15.65. im Wm 2) ADD A MINIMUM OF 2- OF R.I. OVER ENTIRE BED. 3) MAINTAIN 30' SEPARATION FROM ALL SLOPES GREATER THAN 25%. it z O H U LSI Nick and Anne Marie Walker 14100 Sunview Drive Anchorage, AK 99515 242-2615 3enl WW" rz-=u 3AWA AVM-[ 3&U -TM Im NV= 31r100 IM N13O Jn0 NV3O NO NY= NwwN of P.I.D. NO: w J LE O 0_ Pannone Eng. Svc., LLC P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218 PHONE & FAX NTE: 7-09-2003 T TO SCALEDESIGN SOILS LOG -PERCOLATION TEST •�P� • E............. PANNONE ENGINEERING SERVICES all 1� P.O. BOX 102954 /.....i. ... ............s.....� ANCHORAGE, AK 99510 i 0 (907) 272-8218 ................................. 00 / / Steven R. Pannone / 3:45 No. CE 814 1� 1?393Y • 4 J S PERFORMED FOR: Nick Walker DATE PERFORMED: 8-02-03 .... `_�c1,�•• LEGAL DESCRIPTION: Lot 4 Block 6 Cinerama Terrace TEST HOLE S-1 SLOE OR Organic- G l 1 Root Masa n GINS PMP 2 GM Brown Silty Gravel 3- 4— 4 S_ 5 TEST HO 6 Gravelly Silt ML with Rounded 7 Rocks to 12• Very Dense 8- 9— 910 to- 4 3 11 BOLI 12 'f V C� 13 3 WAS GROUND WATER SLOPE 9 14 ENCOUNTERED? NO t is IF YES, AT WHAT TEST HOLE ° E DEPTH? -0- 16 c 17 DEPTH TO WATER AFTER u MONITORING? -.0 N 18 DATE: 08-09-03 m 19 READING DATE GROSS NET DEPnI OF NET TIME TIME WATER DROP 12 20 f111 4-04-02 PRE-SOAK E 67/8 1:52 ---- E 6 J/4 2:22 JO MIN 3 3/4 31/8 c U (min/inch) SJ / 2:52 JO 4J 8 23 8 N SJ4 3:15 23 S 1Ja ED a J Y O # PEROLATION RATE 13 PERC HOLE DIAMETER 6 inches in TEST RUN BEWfEEN 3 FT and 4 FT u u 2 to COMMENTS: Test hole excavated by Curt Whitters. Test Hole was presoaked before perc test. -` PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. 0 3:45 30 4 J S 23 e OF �. �� SOILS LOG - PERCOLATION TEST .• """""' • P♦♦ PANNONE ENGINEERING SERVICES P.O. BOX 102954 49B /.....x. .. ...............:...../ ANCHORAGE, AK 99510 0 634 (907) 272-8218 23 / ..... ♦j :Sra wy 1Ja o. I 1♦.NE S\4W 8 23 b k4.• ���',,,1;'!�W' PERFORMED FOR: Nick Walker♦ DATE PERFORMED: 4-04-02 } V ..••a► LEGAL DESCRIPTION: Lot 4 Block 6 Cinerama Terrace TEST HOLE TS TH 1 SIAI ' OR Organic. Root Mass 1 tw\fRPMP 2 GM Brown Silty Gravel 3 r, 4 r TEST ut ' S HOLE 6 Gravelly Silt ML with Rounded 7 Rocks to 12' Very Dense 8- 9- 910 10- 4 3 11 BOH 12 V 13 WAS GROUND WATER SLOPE 0 14 ENCOUNTERED? NO t t- IS IF YES, AT WHAT TEST HOLE ° DEPTH? -0- 0 16 c DEPTH TO WATER AFTER Li 17 MONITORING? ;iiI;ba'� N 18 DATE: .At"NM92 m 19/HIo3 READING DATE GROSS NET DEPIN OF NET TIME TIME WATER DROP w F 20 FILL 04-02 PRE—SOAK E 67/8 1:52 ---- ° v 63/4 2:22 30 MIN 3 J/4 3 1 S c U 63/4 2 52 30 43/8 N In 3:45 30 IJ a J Y O 3 PEROLATION RATE 13 (min/inch) PERC HOLE DIAMETER 6 inches U TEST RUN BEWTEEN 3 FT and 4 FT w U .a I" COMMENTS: Test hole excavated by Lee Reid. Test Hole was presoaked before perc test. PERFORMED BY: Tobben Spurkland, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE 21 WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. 0 2 3 5 634 3:15 23 S 1Ja 8 23 b 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 SEWERIWELL SUBMITTAL COMMENT SHEET To: Pannone Legal description: Cinerama Terrace Block 2 Lot 4 �e •a4r t Ir—'Y O ZD The attached paperwork has been reviewed and is being returned for the following reasons: ® Original signature or stamp missing on both of the soil loos that were performed by Tobben Spurkland. The soil loo performed by Lee Reid on June 8,1983 has engineering stamp. ❑ Calculation error in design. _ ❑ Additional soils information needed. ❑ Water monitoring results inadequate. _ ❑ Discrepancy in information submitted. _ ❑ Topographic information missing or inadequate. _ ❑ Incomplete; missing ❑ Incomplete; missing ❑ Additional adequacy test information needed. ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. _ ❑ Locations of all soils, percolation and water monitoring tests not shown. _ ❑ Proposed system too deep for soils information submitted. _ ❑ Well log required. ❑ Omission in narrative. ❑ Insufficient fill over tank or field._ ® Other. A test hole needs to be performed in the propsed septic design location with ground water monitoring through October 15U to determine October to determine high groundwater. water. Name of reviewer: ioe cloodall Date: 7115103 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK • I a �. SOILS LOG MUNICIPALITY OF ANCHORAGE • �� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION 925 L Street, Amhara", AInks 99601 264-0720 TEST SOILS LOG — PERCOLATION TEST PERFORMED FOR: Tem L PPS DATE PERFORMED: 23..,, A Iq$ S LEGAL 1 2 3 4 6 8 7 8 9 10 11 12 13 14 15 18 17 18 19 I S. -JI g..vj, 20 7'H S9 PERCOLATION RATE Z' ` (minuteslinch) t/ 1 u TEST RUN BETWEEN FT AND 1 FT COMMENTS �e:.) r.kJ 216(1, 6J %m t/2: -}p . WASGROUNDWATERS ENCOUNTERED? t1e5 L O P IF YES, AT WHAT 3 E DEPTH? 6" a:. ►. 4.�e Reading 0.b Grm Not o W Not Timm Time tth ater Drop L •E 10L — 4o - I%kI 2.2 -23 .114 121% — '34 — /•65 to 32 b i 145 - yt - 14T INc - .Wj Ir6 10 as o8 PERFORMED BY: --p o-.. Y CERTIFIED BY: DATE: 72-006 (6/79) May 06 03 00136a Dan Beek Municipality of Anchorage -- ., 0eve;opmemsarvkas0epanmem Sv%ng 66!•m/ avWon l�• +.y� O+Ve Weer andWa4wenrPro-„•a.* 47:0 Stun BrapW St ;• P O Box MW AeMorage. AK 99319.6!]0 -7)343 -7ZA Soils Log - Percolation Test 907—AGG-1019 ee�. —s: e:• K C bt t' L"SD""l Cale p•A: .+:f:pa:-::V Le 4• ZV-21 Cf'*u"wa r�Trr9NnaN9.Range. sediar � s��oe s :• ��am ct.1 G. If, CIMV4 • ee Ji : ' �IC�r4vt(1� S.1f •1 I w -i L4 esws4atg� retlr.� �u 12" �n 0•:• Out Tin* fret Time .n:�:oure•, '.r::..._ I= ILL -•f.Ot -Pve So tt k --- I (o iio■ '150 3 3• lb 3 '5 I a/ MEa No I ' MIKENn a I N L_ •' WAS OACUNO WAT[i ''t 1 Yt �.1 �t►a L G "OUNTIM07 0 [ f 1/V[S.ATWNnr Ohm? c OOp1AMWetM ARH P I 1 ;.1 I MpMlatmeT [ Oe rT0H OF •� 1•i a Lk Reading 0•:• Out Tin* fret Time .n:�:oure•, '.r::..._ I= ILL -•f.Ot -Pve So tt k --- I (o : b:t_ '150 3 3• lb 3 '5 I a/ i I ' sly:CUTTCNKATa e+ wa i PSRC.C:L:uu['Le _,— 'LLTiW AND rpr icr S7473 aCO trUalGPAL GJOEUNES N UJISCT C.14 -MIS y'£ CAT: V g •C Z P.3 Mae CC 03 C8t37a Dam Beek Tow I 5 — I -Gn C Municipality of Anchorage Development Services DOW.,nen: aul:I.1g Sa4y OPACDm CMVa WSW" Wae1eN41N Pvg• 4700Iwa, erajaw It P.O 00, 156630 An WO NC AK 565194630 Zw4 anOMWE fr'd ISoq 3079W �7 Soils Log - Percolation Test e.':r4c err 4'�bb{�� �..0. yySyyl Osla PMor'�fa: y—C/—O Z ra:escro::� la�fa,i3t<'4r47;airs".«#, Icor Taaurlo.Rave. efcte• 807 -AGO -1019 lkmo" r1000; p.4 fiz z f' lett 096,4N#C S �.IAmy CIa✓cf( Llai P11514,:, dA. n P WAS ORO" Wr[q EN=UhT[q[07 f It "NS. AT KHAT OEV" C 0*04MWaMARar a New.lah�T 5 Qvl aeae40 Dale cross Time k41Tr•e C437. 10 AK I :4 , --- :50 3v a , 2 3: "o c I ✓fiGGN.7CY vZ T51�fVN SC�WCCV eSRcaCG[c�Ati+5r5q �_ t7 alas: q• !� a, �� � I •�� ... -: 9 A ]JJRC aNC! W�Tr A:� �TA'C AVD kVNC:PA. pipCCUNE31N CRICT O.Y Trq CA'! DArg •• -(� [. MUNICIPALITY F ANCHORAGE 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. 020-541-02-000 CW Expiration Date: 12/13/202T �2zy Legal description CINERAMA TERRACE BLK 2 LT 4 Site address 16060 KING'S WAY DR Anchorage AK 99516 Current property owner(s) Z/-�C l4442y ANO C,(LYS A-L L F_ X The On -site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: C_r)SA- V- i SS�,Q j-0 C,vt- T-_: ,T ©t., &, bJyA-'T1,-C` F n r`-- 12 / 1 0•-r1�fiS Original Certificate Date: 9/13/2023 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 Absorption Field Advisory Tank Age Advisory Other X Well Flow Advisory Nitrate Advisory Arsenic Advisory COSA Approval_June 2022 PVq U H O C I P ,\ L� T 7 OF rHCH0R\�, A (G- m 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. 02054102000 Complete legal description CINERAMA TERRACE BLK 2 LT 4 Location (site address) 16060 KINGS WAY DR Current property owner(s) CAVERLY 2. ON -SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: IN Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ 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: 0 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 19 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: 0 AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: Q 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 ® Waiver Fee $ Date of Payment Date of Payment COSA # C9 L 2- 3 _ Waiver # COSA Applicationjune 2022 Legal Description: CINERAMA TERRACE BLOCK 2 LOT 4 Parcel ID: 020 541 02 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 2003 Total depth 241 ft Cased to 11 ft ❑ Sanitary seal is functioning correctly Al Wires are properly protected Casing height (above ground) +18 in. Date of flow test for COSA 9/1/23 Static water level at beginning of test UNK* ft Comments *Appears to have Artesian Plug B. TANK DATA Measured operating fluid level in septic tank 50 Date of pumping 9/5/2023 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 2004 ❑ ALL standpipes present per record drawing Total measured depth from grade 4.1 ft (max) Measured depth to pipe invert from grade 3•5 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 ❑ 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) NA If yes, enter date NA Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test +3.3 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes NO No ❑ Coliform bacteria is Negative Nitrate 1.39 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by C.BALZARINI Date 9/7/23 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 9/1/23 Results ❑ Pass Fluid depth prior to test 0 in Water added 600 gal New fluid depth 0 in Elapsed time 10 min Final fluid depth 0 in Absorption rate 600 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 Effective depth used 0 in Effective depth remaining 6 in in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' Yes if No ft W Yes if No _ Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No_ Absorption Field on Lot > 100' Fm-1 Yes if No ft Holding Tank > 100' W Yes if No _ Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No _ © Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft ❑ Yes if No_ ❑ 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' 0 Yes if No ft Surface Water > 100' ®❑ Yes if No Tank to Property Line > 5' Fw� Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' R Yes if No ft Private Wells > 100' 0 Yes if No Water Main > 10' FE-1 Yes if No ft Community Wells > 200' [0] Yes if No _ Water Service Line > 10' 0 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS ft ft ft ft ft 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 C&M ENGINEERING Engineer's Printed Name CHARLES BALZARINI, PE COSA Checklist June 2022 Phone 907-854-5558 Date 9/11/23 MUNICIPALITYOF ANCHORAGE 444 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. 020-541-02-000 Expiration Date: Legal description CINERAMA TERRACE BLK 2 LT 4 Site address 16060 KING'S WAY DR Anchorage AK 99516 12/13/2023 Current property owner(s) CAVERLY STEPHEN -DERIDGE PATRICIA X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: In Original Certificate Date: 9/13/2023 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 Arsenic Advisory Other COSA ApprovaLJune 2022 i 7 Development Services Department Phone- 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 .e Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 02054102000 Complete legal description Location (site address) CINERAMA TERRACE BLK 2 LT 4 16060 KING'S WAY DR Current property owner(s) CAVERLY 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: ❑® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ 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 19 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑® AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: Q 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 $ y 3 3 o Waiver Fee $ Date of Payment 3 Date of Payment COSA # «S C- 2-3 -3 I % _ Waiver # COSA Application—June 2022 COSA Checklist Legal Description: CINERAMA TERRACE BLOCK 2 LOT 4 Parcel ID: 020 541 02 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 2003 Total depth 241 ft Cased to 11 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) +18 in. Date of flow test for COSA 9/1/23 Static water level at beginning of test UNK* ft Comments *Appears to have Artesian Plug B. TANK DATA Measured operating fluid level in septic tank 50 Date of pumping 9/5/2023 ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 2004 ❑ ALL standpipes present per record drawing Total measured depth from grade 4.1 ft (max) Measured depth to pipe invert from grade 3.5 ft (min) ❑ NIA — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ 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) NA If yes, enter date NA Comments/Deficiencies: COSA Checklist June 2022 Well production at time of test +3.3 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate 1.39 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by C.BALZARINI Date 9/7/23 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 9/1/23 Results ❑ Pass Fluid depth prior to test 0 in Water added 600 gal New fluid depth 0 in Elapsed time 10 min Final fluid depth 0 in Absorption rate 600 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 Effective depth used 0 in Effective depth remaining 6 in in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' 0 Yes if No Community Sewer Manhole/Cleanout > 100' 0 Yes if No ft 00-1 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' Fm� Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Q Yes if No ft n Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' nm Yes if No ft ❑ Yes if No ft ❑ 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' 0 Yes if No ft Surface Water > 100' ❑ Yes if No ft Tank to Property Line > 5' FE -1 Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' 0 Yes if No ft Private Wells > 100' FEI Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' O Yes if No ft Water Service Line > 10' Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS 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 C&M ENGINEERING Phone 907-854-5558 Engineer's Printed Name CHARLES BALZARINI, PE Date 9/11/23 COSA Checklist June 2022 49 Ci RLES G BA, re N:: COSA Checklist June 2022 '. y.1 a.9 lO -. 5 rj I -11 ,�-----ti Pj•J A SIN [ 0 330 DEC 41 2015= • �� �d Fli�rT vicipality ofAnchorag `rr 6 8 9 -Site Water and Wastewater Program �6 - (907)343-7904 z `` 5 Ot68'6° Certificate of On -Site Systems Approval 0 0 -sy - p2 Parcel l.D Expiration Date 1. GENERAL INFORMATION Complete legal description Cinerama Terrace; Block 2, Lot 4 ` Location (site address) 16060 Kings Way `Anchorage 99516 - -Current Property -owner(s)- Patricia, Morrison - --Day phone - -. Mailing address Real Estate Agent Paul Lambert Day phone 727-4688 2. TYPc OF DWELLING: © Single Family (w/woADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑X Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class _ Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: NIA Distance: N/A Received by: Dat4'w COSA to berelease a the engineer, u less otherwise requested by the engineer. - - - COSA Fee $ CJ 1 ✓ Waiver Fee $ ,f � Date of Payment a' 2�3�l�� 124 `1" Date of Payment Receipt Number �"'� Receipt Number COSA # oSCI Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER er As certified by my seal affixesh d hereto and as of the validation date Wr below, I verify thirmy 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 FirmGarness`Engineering Group ltd. (GEG) Phone (907) 337-6179 Address 3701 E. Tudor Road Suite 101 Anchorage AK 99507-1259 Engineer's Printed Name Jeffrey A. Garness Date a In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic opitEt 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 -- + 1� - - - -- date/s of the evaluation. Separation distances were measured to readily identifiable features: ++'`P.••"�• �+ Hidden defects or encroachments may exist that were not identified during the evaluation. The - �P operational life o/ all wells and septic systems depend on a variety of variables including, but not r• - limited to, soil conditions, groundwaterievels (that may fluctuate during the year), qua* of * construction (materials and workmanship), and the water usagebfthe family utilizing the system/s. ••.. S These conditions can vary, and are outside the control of GEG. Satisfactory test results do not �• guarantee future performance of the systemus; therefore, GEG makes no warranty (express or �y^•• •• ••••••• • :•��f{{{.... ,. implied) rWarding the future performance of the well or septic system GEG makes no ♦ A e m representation whether an alternative well or septic system. can be installed on the property in thef�C'i CE 79 event either of the current systems fail. The content of this report is for the sole benefit of the }e' 1 r ��i personiparty who retained GEG: Reliance upon the information: provided in this report by any other f „� Z (a} '�` � pefsonor party, including but not limited to subsequent property purchasers, is not authorized. In - fe p�,,�_ Q�4 - ,Z short, GEG disavows any legal duty to anyone other than the person/party who paid for this report. - >RRA ltR't$�+t��+ 6. 'DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms . Disapproved Conditional approval for bedrooms, with the following stipulations: By: �- " Original Certificate bate, /Z q/ // The Municipality of Anchors evelopment 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 Stateof Alaska. The Municipality of Anchorage is notresponsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other : COSA blue sheet 9-i 12.doc 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 Legal Description: CINERAMA TERRACE; BLOCK 2, LOT 4 Parcel ID: 020-541-02 A. WELL DATA Well type PRIVATE *ARTESIAN WELL WITH PACKER. UNABLE TO GET STATC WATER LEVEL. If A, B, or C provide PWSID# N A Date completed 10/14/03 Sanitary seal (Y/N) YES Total depth 241 ft: Cased to 11 ft. FROM WELL LOG Date of test 10/14/03 Static water level 7 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION 11/11/15 NOWN Well production 3 g.p.m. 3.4+ g.p.m. WATEWSAMpLE RESULTS: Coliform'�` colonies/100 ml. Nitrate n• 1 1 3g./L Collected by: GEG. Ltd. Arsenic::! V �-4/�g./L. Date of sample: 11 A 2/15 B. SEPTICIHOLDING TANK DATA TankType/Material SEPTIC/STEEL Date installed 7/6/2004 Tank size 1250 gal Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/1N) NO High water alarm (Y/N) N/A Date of pumping �� Pumper 147 N nn!2 e— Secu t c e -S C. ABSORPTION FIELD DATA BELOW EXISTING GRADE NORTH/SOUTH AT MT IN EACHTRNH Date installed 7/6/2004 Soil rating (g.p.d.ebrqlbdr 0_8 System -type SHALLOW TRENCH Length 75+75=150 ft. Width 5/5 ft. Gravel below pipe 0.5/0.5 ft. Total depth4:oaj�alft. Eff. absorption area 750 ftz Monitoring tube YES Depression overfield NO Date of adequacy test 11/11/15 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth -in absorption field before test 0 in. Water added 654 gal New depth o in. Elapsed Time: o --. min. Final fluid depth 0 in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — 2000 GALLON PRE—SOAK: PERFORMED ON 11/10/15. WATER WAS INTRODUCED IN NORTH TRENCH THROUGH NORTH—WEST C/O. DRAIN'FIELDS INSULATED PER 2005 INSPECTION REPORT. TESTED NORTH TRENCH ONLY. MT IN SOUTH TRENCH WAS DRY THROUGHOUT PRE—SOAK AND TEST. MT ON NORTH EAST GIDE OF NORTH TRENCH WAS NOT LOCATED, aCc r& U rq� ,n nFh S areq (pec +eJAekiun�I i 1)0i 'ffOcAf f10 Ire av area «. eve w -j kr c -Al �1A- RC a D. LIFT STATION Date installed Size in gallons Manhole/Aocess (YIN "Pump on" level at in. "Pump off' level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption Feld on lot 100'+ Public sewer main 75'+ On adjacent lots 100'+ On adjacent lots Public sewer manhole/cleanout 100'+ Sewer /septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ __ L� Water main 10'+ Water service line 10'+ Surface water NONE BSERVED WW, Q kc) 100' + w ►haw Wells on adjacent lots was �ltsiai�R,C, SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main Of 10'+ ...Win R7gl w1�u JV -VW VA pjekn R.( • Water service line 10'+ Surface waterNONE OBSERVE�Ddveway, paildrigIvehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in affect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date (Rev. 11/05) Parcel I.D. 020-541-02 Certificate of On -Site Systems Approval \'e, Y, 1l fV Expiration Date: �" (0 I �� 1. GENERAL INFORMATION Complete legal description Cinerama Terrace, Block 2, Lot 4 Location (site address) 16060 King's Way Drive Current Property owner(s) James & Eula Miller Day phone Mailing address 16060 King's Way Drive Real Estate Agent Day phone 2. TYPE OF DWELLING: Municipality of Anchorage pGC @4 s� Onsite Water and Wastewater Program 2` _ (907) 343-7904 Certificate of On -Site Systems Approval \'e, Y, 1l fV Expiration Date: �" (0 I �� 1. GENERAL INFORMATION Complete legal description Cinerama Terrace, Block 2, Lot 4 Location (site address) 16060 King's Way Drive Current Property owner(s) James & Eula Miller Day phone Mailing address 16060 King's Way Drive Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 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 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request f Received by,.-= r =.- Date: ' y COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number COSA # 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 Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Alk. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE t System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for == bedrooms; with the following stipulations: Phone (907)272-8218 Date 712/13 By: 1 Original Certificate Date: — t The uniap 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 sheerf c 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 Legal Description: Cinerama Terrace, Block2, Lot 4 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 10/14/03 Sanitary seal (Y/N) Y Total depth 241 ft. Cased to 11 ft. FROM WELL LOG Date of test 10/14/03 Static water level 7 Well production 3 ft. Parcel ID: 020-541-02 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 24 in. AT INSPECTION 7/1/13 0 3.0+ WATER SAMPLE RESULTS: Coliform /Lt:' oIonies/100 mL Nitrate mg/L Arsenic 0e �,7 ug/L Date of sample: Zi / 2 6 (�% Collected by: 1/1/13 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Number of Compartments 2 ft. g.p.m. Date installed 7/6/04 Cleanouts(Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 7116"1z0t� Pumper 4t'Mo --c �P�✓.�25 C. ABSORPTION FIELD DATA Date installed 7/6/04 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8 System type Shallow Trench Length 75/75 ft. Width 5/5 ft. Gravel below pipe 0.5 ft. Total depth 4.3 ft. Eff. absorption area 750 ftz Monitoring tube Y Depression over field N Date of adequacy test 7/1 /13 Results (Pass/Fail) Pass For—bedrooms bedrooms Fluid depth in absorption field before test 0 in. Water added 613 gal. New depth 3.5 in. Elapsed Time: 260 min. Final fluid depth.0 in. Absorption rate , 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons _ in. "Pump off level at _ Cycles tested _ Manhole/Access (Y/N) in. High water alarm level at in. Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manholelcleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 7/2/13 COSA brawn sheet 10-10-12.dac Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ Parcel I.D. 020-541-02 Municipality of Anchorage r".` `; On -Site Water and Wastewater Program (907) 343-7904 s , P G r Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: /o - �2 2-13 Complete legal description Cinerama Terrace, Block 2, Lot 4 Location (site address) 16060 King's Way Drive Current Property owner(S) James & Eula Miller Day phone Mailing address Real Estate Agent 16060 King's Way Drive 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Pubic Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received 712 l by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 11q 0 Date of Payment 13rr Receipt Number �i?J1 tP N COSA #. _oe)Q,I 13 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 thelnformation 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 Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Alk. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for _ bedrooms Disapproved Phone (907) 272-8218 Date 7/2/13 Conditional approval for bedrooms, with the following stipulations: By:' , al' o / J Original Certificate Date: 7- 2 2- 13 L The. Mu f�rage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Well Flow Advisory COSA bluesheetf c Arsenic Advisory Other If more than 1 septic system is on the lot: COSAChecklist# + of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Cinerama Terrace, Block2, Lot 4 A. WELL DATA Well type Private Date completed 10/14/03 Total depth 241 ft. Date of test If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 11 ft. FROM WELL LOG 10/14/03 Static water level 7 ft. Well production 3 g.p.m. WATER SAMPLE RESULTS: ColiformAke»+colonies/100 mL Nitrate 1. 07 mg/L Arsenic O. '7 ug/L Date of sample: '711113 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Number of Compartments 2 Parcel ID: 020-541-02 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 24 in. AT INSPECTION 7/1/13 0 3.0+ ft. Collected by: PF S Date installed 7/6/04 Cleanouts(Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (�Y//N) N High water alarm (Y/N) N Date of pumping 7/fo/13 Pumper A{ 16^. e C. ABSORPTION FIELD DATA Date installed 7/6/04 Soil rating (g.p.d./ft' or fe/bdrm) 0.8 System type Shallow Trench Length 75/75 ft. Width 5/5 ft. Gravel below pipe 0.5 ft. Total depth 4.3 ft. Eff. absorption area 750 fe Monitoring tube Y Depression over field N Date of adequacy test 7/1 /13 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 613 gal. New depth 3.5 in. Elapsed Time: 260 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum Size in gallons "Pump off" level at in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Manhole/Access (YIN) High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Animal containment areas 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION i certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 7/2/13 COSA brown sheet -1 0-10-1 2.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ PLAT W. 83-547 CINERAMA TERRACE SUBDIVISION LOT 4, BLOCK 2 74.284 S.F.(REC) r •► N dl r r gyg E, a 4, m lbLn LEGEND =60' "=6Q' • FOUHD S/8r RMAR Oi FOUND 6/8" MMAR wrM YS -LM PL.kSRC CAP 5TAM @ "LS-2pba" X CALCU ATEO POINT, NOTANG FAUNA OR SET GASTALDI LAND SURVEYING, LLC JEFF A. GAS€AU% RLS. MME. DOWLING RA., SUriE ANCHORAGE, ALASKA "U PHME 248-5484 ( GRlD 3241 1 DA,/1/2010 I FB. JOB N0, 04-11 MS42 I HEREBY CERTIFY 7HAT I HAVE S1?RVEYED THE PROPERTY DEPICTED ASOVE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDCUED, r7 15 711E RESPONSISIMY OF THE OWNER TO DETERMWE 7ME EXiS7ENCE OF ANY EASUMM COVENANTS OR RESTRICRONS WNCH DO NOT APPEAR ON THE RMADED SON PLAT. UNDER NO CIRCVMSTANCES SMUT D ANY DATA HEREON BE USM FOR CONSTRUCTION OR FOR ESTABLISHM BOUNDARY OR FENCE LINES. ANCHORAGE RECOWNG DISTRICT. ALASKA $1 0 BUILDING DETAIL SCALE, 1 "-20' - Municipality of Anchorage •'; Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-541-02 COSA # U�jG I U12,53 Expiration Date: " 1. GENERAL INFORMATION Complete legal description Lot 4, Block 2, Cinerama Terrace Subdivision Location (site address) 16060 King's Way Drive Anchorage, AK 99516 Current Property owner(S) Nicholas and Anne Marie Walker Day phone 242-2615 Mailing address PMB 443 1120 Huffman Road, Suite 24 Anchorage, AK 99515 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Four (4) 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ✓❑ Individual On-site ❑✓ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water 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 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Phone 522-7773 Date 10/13/2010 OF i1°®®# .`.•49th,, : MICHAEL E. ANDERSON 5. DSD SIGNATURE No. CE -4381 Approved for _ bedrooms.�� �FPc`'••• 0';4yv*, Disapproved. jWjSsq". o Conditional approval for bedrooms, with the following stipulations: PROGRAM ; - /PtNTNJ Stt) , ,)V Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: Original Certificate Date: / 0 -N - / o (Rev. 11105) Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 4, Block 2, Cinerama Terrace Subdivision Parcel ID: 020-541-02 A. WELL DATA Well type Private Date completed 10/14/03 Total depth 241 ft. Date of test _ If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 11 ft. FROM WELL LOG 10/14/03 Static water level 9 ft. Well production 3 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Arsenic: N/D mg/I B. SEPTIC/HOLDING TANK DATA Nitrate 1.15 mg/L Date of sample: 9/23/10 Tank Type/Material Septic/Steel Tank size 1;250 gal. Number of Compartments Two Foundation cleanout (Y/N) I Date of pumping 9/29/2010 Well Log (Y/N) Y Wires properly protected (Y/N) . Y Casing height (above ground) >24 in. AT INSPECTION 10/13/2010 9 ft. 1.2 g.p.m. Other bacteria 0 . colonies/100 mL Collected by: M. Anderson Date installed 7/6/04 Cleanouts (Y/N) Y Depression over tank (Y/N) N High water alarm (Yo xx 1\1 - . Pumper Northland Pumping C. ABSORPTION 'FIELD DATA Date installed 7/6/04 Soil rating (g.p.d./ft2 or fe/bdrm) •8 GPD/SF Length 150 ft. Width 5 ft. System type 5' WideTrench Gravel below pipe .5 ft. Total depth ft. -EFabsorption area _Z5_0_ft' Monitoring tube Y Depression over field N Date of adequacy test 10/13/2010 Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test 3.5 in. Water added 680 gal. New depth 6 in. Elapsed Time: 840 min. Final fluid depth 3.5 in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off" level at in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? in. Septic tank/lift station on lot >100, On adjacent lots >100' Absorption field on lot >100' On adjacent lots >100, Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25' Holding tank N/A Animal containment areas >50' Manure/animal excrete storage areas >100, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >6 Absorption field >5' Water main N/A Water service line >10' Surface water >100' We(Is"on adjacent lots >100' SEPARATION DISTANCE FROM 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 >25' Curtain drain 'None Noted Wells on adjacent lots >100' F. COMMENTS: gaftN QF -A/ -46 G. ENGINEERS CERTIFICATION i �Ir : 4.9�i • � I certify that I have determined through field inspections and �e..�... .:... review of Municipal records that the above systems are in ���•••��� �••�•�•�• conformance with MOA COSA guidelines in effect on this date. /♦ �� :.q, s.�' •. C':.a X4381 : �`�' A. Engineer's Printed Name Michael E. Anderson, P.E. �♦'�'r •;•-ra Date 10/13/2010 ,�l�p�©FFSSiO�*�♦� COSA Fee $ T Date of Payment Receipt Number ©! (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number