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HomeMy WebLinkAboutBLACKTREE LT 1Blackt Lot ! #015-271-72 Mar 23 22 10:12p Anchorage Well & Pump Ser 9072430742 p.1 MUNICIPALITY OF ANCHORAGE Development Services Department `_-� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: Parcel Identification Number: 015_27172 Date of Issue: - - Legal Description BLACKTREE Block Lot 1 Property Owner Name & Address: CUINAO JENNIFER & ALEX M 3120 O'MALLEY ROAD ANCHORAGE, AK 99507 Pump Installation Date: os - 22 - 2022 155 Pump Intake Depth Below Top of Well Casing: feet Pump Manufacturer's Name: RED JACKET CV 8S16 -75C311 Pump Model: Pump Size: .75 hp 12 Pitless Adapter Burial Depth: feet MARTINSON Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: ) Well Disinfected Upon Completion? ® Yes ❑ No •` Method of Disinfection: PELLETS Comments: Pump Installer Name: _ ANCHORAGE WELL& PUMP SERVICE Company: 7640 KING STREET ANCHORAGE, AK 99518 Mailing Address: _ 907-243-0740 State: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality o~'Anchomge z-;¢~ -.,. Development Services Department J~r~ Building Safety Dtetsion ~ O~Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 Page of www.ct anchorage.ak, us (907) 343-7904 ON. SITE WASTEWATER DISPOSAL SYSTEM ANDIOR WELL INSPECTION REPORT Permit Number. Sw030298 PID Number. 015-271-72 Scott Vierm Wastewater System: [] New [] Upgrade P.O. aox 521851 Big Lake, AK 99652 ABSORPTION FIELD N~l~lx~ el eedmama FOUr 563-5843 LEGAL DESCRIPTION .8 ~,~ lo.5 ~ LaC I ~ Blac~tme 2.5 Ft. 7.5 3-5 Ft. 51 R. Well: [] New [] Upgrade c"'~"a~ 3 Ft. m'~'~ ~1 I c~'*~'=* ~'"" ~"*FL Private 201 Ft. 200.45 FL 765 ~ ASTM D3034 PVC M-W Drilling, Inc. 9/24/04 129 n. Eric Quam 6/6-6/12/2006 10 SEPARATION DISTANCES ~ Sap~ ~n .~ir~ n $.T.£.P. [] ~ w~ >100' >100' N/A N/A >25' Steel Two (2) s~=w,., >~o0' >~0o' N/^ N~^ ~ / LIFT STATION bxum >5' >10' N/A N/A c~ c~m,~ Oran None Noted "'"~' BENCH MARK Garage Slab 100.00 FL Inspections performed by: A. Haml~ D~tes: '1~ 10/24/03 ,e....~,,~.******...~,~/ Development Services Department Approval ,...~ .... . , ~.. ', Conditional Approval Date: .~..~,~~, Permit No. 8W030298 Munidpality of Anchocage , DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - :343-7904 On-Site Wastewater Disposal System or Well Inspection Report O'MALLEY ROAD Page 2 of 3 PID No. 015-271-72 N 90'00'00' E 164.96° LOT 12 LOT 1 BLACK TREE SUBDIVISION LOT 1 43,71,1 N 90'00'00' W 165.16' LOT ~ PLAN AS-]3UILT ~:CALE ~.' = 40' m LOT 2 Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage. AK. 99519-6655 - 343-7904 On-Site Wastewater Disposal System or Well Inspect[on Report Permit Number. SW030298 Page3of3 . PID No. 015-271-72 88.5 I 80.6 99.2 Geotextile Fabric Drainfleld Rod( 51' (Trench Length) 83.7 91.4 PROFILE AS-BUILT No Scale 03/14/2007 21:25 9073453287 M W ]>RILLING PAGE 01 Job No.: 04-126 M=W Drilling, ThC: *P.O. Box l10378e Anchoroge' AK 99§I1+ e907-345-4000 · 907-345-3287 Fax· Patcet No.: ~015-271-72 Permit No. _SW040345 Grpundwater FVeH Ax.Buiit & · H~q/Owner: Robertson, Wayne eLegal Description: Black'tree Subdivlsion~ Lot 3 Domes~c Constr~ction +Hole Deptb: 201' +Cmlng Sl:e: 6" +C~.~d To: +DrtlI M~t: Ai~ Rota~ 200.45 ' · Wdl Completion. ~ end X Screen Perforated · Screen/Perforation dtzcr~tion: NIA · Cr~tNotes: (I) Sack-No. 8 bentonite granules · IVote~: oMaun'tal: A 53 S~l ,tfe~od: · WelID~: Method: Air surge /Votes: + Stadc water ltvel (SWt9 129' (~) (belowJ top of c~tng (TOC). * Well yleld te~t at I0 gallons l~n, mlnute (GPM)/ ~nl~.~~) for with ! 00% of drmwdown (DD) from gtatlc le~el fS~Z). ,Mt.~o~: Air li~ I boun · Date of con,pit,on: 24 September 2004 *Pump Install: Well Log mm Depth In fee~ from top of easing. Details of formntlons penetrnted~ size of mntmrlaL color and hardness. 0 TO 3 Casingstickup 3 TO 15 Organics 18 ~O 165 Silty clay: intcrbeddcd layers of gravel 165._.TO 190 Siltygrav¢l: damp ,, 190 TO 201 Watcrbearing_gravel TO TO TO TO TO TO WAYNE I~. WESTBERQ ...... -~'O "~'";1~' ;'~ ' W D~;;ihi~,, ... TO e,~mt.~._$~/4- · . TO _ Oontrac~om Ueense No. 1000 TO TO TO MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Ancho~'age, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Date Issued: Aug 17, 2004 Expiration Date: Aug 17, 2005 Permit Number: SW040345 Legal Description:;Blacktree Lot I ~ Design Engineer: 0014 Anderson Engineering Owner Name: Wayne Robertson Owner Address: 151 A Street Loop Anchorage, AK 99518- Parcel ID: 015-271-72 Site Address: Unknown Lot Size: 43713 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. -WHEN THE WELL HAS BEEN COMPLETED AND SATISFACTORY WATER PRODUCTION HAS BEEN DETERMINED, THE WELL DRILLER SHALL PLACE AN APPROVED SANITARY SEAL ON THE WELL HEAD AND NO PITLESS ADAPTER OR PUMP SHALL BE INSTALLED UNTIL AN APPROVED WASTEWATER DISPOSAL SYSTEM HAS BEEN CONSTRUCTED. Received By:. Issued By? 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/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. D/s - ,~?/- ~'~ Permit Number SW Property owner(s) Mailing address (1) Mailing address (2) Legal description (Lot, Block & Sub'd.) Lot / Legal description (Section, Township & Range) Lot Size /-'/.-~. ~/~) Acres/Sq. Ft. Day phone .Zip Code Number of Bedrooms ,.~ THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool [] Well Only [] Water Storage [] [] Jacuzzi [] [] Water Softening Unit [] I cedify that the above information is correct. I fudher certify that this application is being made for a Slngl.e Family Dwelling and is in accordance with applicable Municipal Codes. (S?gnature of property owner or au~thorized agent) ~-(-~. ~t". - Permit Fees: J ~'~,. gT.) Waiver Fees: Date of Payment: ~/~/~/' Date of Payment: Receipt Number: ~'~,~..~. '::'~ Receipt Number: (Rev. 12/00) MUNICIPALITY OF ANCHORAGE Development Sen/ices Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT Initial Date Issued: Aug 05, 2003 Expiration Date: Aug 04, 2004 Permit Number: SW030298 Legal Description: Design Engineer: 0014 Anderson Engineering Owner Name: Wayne Robertson Owner Address: 151 A Street Loop Anchorage, AK 99518- Parcel ID: 015-271-72 Site Address: Unknown Lot Size: 43713 SQ. FT. Total Bedrooms: f Permit Bedreoms:~3~". This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage Ail 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. Municipality o.f 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/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Permit Number SWO ~0 Z ~8 Property owner(s) way.. ¥. I~obem-t;~on Mailing address (1) 151 ^ .~t;rget; £oo? ^.chnr.~e_ Mailing address (2) Legal description (Lot, Block & Sub'd.) [n~ 1_ Dlack'~ree Legal description (Section, Township & Range) Lot Size /~"~ I ''') I "~ THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Acres/Sq. Ft. Day phone~ 7ip Code Number of Bedrooms Thrge (3) Well Only Water Storage Jacuzzi Water softening Unit I certify that the above information is correct. I further ce~fy that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: ,/' Date of Payment: Receipt Number. (Rev. 12x:x3) Waiver Fees: Date of Payment: Receipt Number:. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 (FAX) July 30, 2003 Municipality of Anchorage Development Services Department On-Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Su~ect: Lot 1, Blacktree Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 1, Blacktree Subdivision intends to construct a new three-bedroom home on the lot. We are therefore requesting a permit be issued for the construction of a new well and septic system to serve the new home. The attached Site Plan and backup documentation identify the location and configuration of the proposed well and septic system. Also identified on the plans are the locations of the alternate site, proposed shop building, test holes, driveway access to O'Malley Road and ground contours. The drainage patterns will be maintained after construction. The building setback line is also shown on the site plan. Test holes placed on the lot during the subdivision development in 1992 indicate silty gravel with varying amounts of sand in the area of the new absorption trench and alternate site. No groundwater was found during placement of the test holes and none was noted during the ensuing monitoring period. We are therefore proposing to place a new 1,000-gallon septic tank along with a 40' long by 3' wide by 8' effective depth absorption trench. The distribution line will be placed 2' below the existing surface and the total depth will be 10'. Sufficient fill will be placed over the trench to provide a minimum of 3' of cover. The ground surface on the lot slopes at varying grades from the high point in the center of the lot. The new absorption trench will be constructed parallel with the slope as much as possible in conformance with Municipal requirements. The new septic tank will be constructed a minimum of 100' from the existing well on the lot and on adjacent lots. Lot 1, Blacktree Subdivision July 30, 2003 Page Two If the system is constructed in accordance with our design the following statements apply: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. The 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. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 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, Michael E. Anderson, P.E. Attachments ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522-6779 IFAX) MEMORANDUM DATE: August 12, 2003 TO: Dan Roth FROM: Mike Anderson, P.E. SUBJECT: Lot 1, Blacktree Subdivision Permit No. SW030298 The owner of the subject lot intends to install a bathroom in his shop to be constructed on the property. We have therefore redesigned the septic system to accommodate the additional flow and have included a 1,250-gallon septic tank and an absorption trench sized for four bedrooms. The attached site plan shows the revised location of the septic tank and the location of the sen/ica line to the shop. Please review this drawing and, if appropriate, modify the permit to allow the placement of a four-bedroom system. Please let me know if you have any questions regarding the revised design for the septic system. O'Malley Road VACANT ~ ,-~ ~>'-"-- ~... I AREA A i:( Circle 1 N LOT 43.713 S.F. O'MALLEY ROAD 40' x Shop Homo LOT 1, BLACK TREE SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Four Bedroom Home Deep Trench System Perc. Rate: 12 Min./Inch 1,250 Gallon Septic Tank Application Rate: .8 GPD/SF 8' Drainfield Rock 600 GPD/.8 GPD/SF (Application Rate) = 750 SF Absorption Area 750 SF/16 SF/LF = 46.9 LF Trench Length THEREFORE: Construct a 50' Long x 3' Wide x 8' Effective Depth Absorption Trench. Flow Line Elevation In Trench to be 2' Below Odglnal Ground Surface. Total Depth to be 10' Below Existing Ground. Maintain 100' Separation From Well on Lot. Place 2' of Direct Bury Insulation and 2' of Fill Over Absorption Trench or Provide Minimum 3' of Cover to Prevent Freezing. 4' of Cover Over Septic Tank. 1'6" 8'0" Natural Backfill Geotextile -- Fabdc 4" Perforated -- PVC (Holes Down) -- Dralnfield Rock TYPICAL DEEP TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. ~'~/ 4-,~ Minimum 6' Separation From Bedrock. - - ~"' Minimum 4' Separation From Groundwater. Minimum 100' Separation From Well on the Lot. ~,~. Minimuml00'SeparationFromSurfaceWaterorStreams. ' ~.Y,~.. No. c~.~=, PER;ORMED FOR: 2 3 4 5 6 7 13- 14- · 15- 16- ;17 - 18- 19- 20- COMMENT~ ~FT~ P~AN WAS GROUND WATER ENCOUNTERED? IF YE~ AT YhlAT n PF..RCOLAT~ON RATE [~' (mmutes,'u',c~h) PF. RC HOLE D tAME't'E.R '~ PER,eORMED BY: '~° ~&'/'~J'~ '~ ! CERTIFY THAT 'TH~ 'TE,.el' WAS pF,.RFORME,D IN ACCORDAN CE WiTH ALL ~TA'~?. AND MUNIC3pAJ. GUIDELJN£S IN EFFECT ON THIS DATE. DATE: DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L= G .tmet, Anchorage. Alaska 99502-06__~_ SOILS LOG -- PERCOLATION TEST (ENGINEER'S ,~d.). PERFORMED LEGAL DESCRIPTTON: ~ // 2 3 10. 11 14- 15- 16- .17 - 18- 19- :20- COMMENTS WAS GROUND WATER DATE PERFORMED: (~//~ ~/~-,,,- Township, Flange, Section: SITE PI.AN IF YES, AT WHAT ~ P~RC. OLATION F~TF.. I'~-,-- (mmutm',m'~:~) P F.R C HOLE Ob%METER , ~ ~UN e~W~N ~ ~T*,NO '~ ~ ACOORDANC; W1TH ALL STA'T~. AND MUNiC3pAL GUJDEUNES tN EFF£CT ON 'T'Ht S OAT1: DATE:, 72-~08 (Rev. ~) DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' ~ Anchorage. AJasi~ 99502-0650 SOILS LOG ~ PERCOLATION '/'EST (ENGINEER~ PERFORMED FOR: LEGAl. DESCRII~TION: 1 4- 5- 6- 10- 11- 12- 13- 14- 15- 16- :17 - '18 19- COMMENTS DATE PERFORMED: Township, Range, Section: WA~ GROUND WATER ENCOUNTERED? SITE PLAN IF YES, AT t'~IAT ~O; DEI~'H? E I PERCOLA'TtON RATE ~-'~"J~ ' (nat- -~,~) PE~C HOLE ACCORDANCE WITH A~. ~-TATE AND MUNICIPAL G~IDELINES IN EFFECT ON THIS DATF- DATE: , 724~08 (R~w. 4~5) ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 1, BLACKTREE SUBDIVISION GENERAL: The scope of this proiect includes the procurement and placement of a new 1,000-<jallon septic tank at the location shown on the site plan. Work also includes the construction of a new absorption trench 40' long by 3' wide by 8' effective depth also at the location shown on the Site Plan. The total depth of the trench will be 10' below existing ground and the distribution pipe will be placed at 2' below the surface. Ail components of the new absorption trench and septic tank must be constructed a minimum of 100' from any surface water and 100' from the well on this and adjacent lots. A minimum of 4' of cover is required over the septic tank and 3' over the absorption trench. In lieu of cover 2" of direct bury insulation and 2' of cover may be placed. 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. 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. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetafion of affected areas unless specifically agreed otherwise. 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 1,000-gallon septic tank must be procured from a certified septic tank manufacturer if the existing tank is found to be defective. 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. Lot,l, Blacktree Subdivision · July30,2003 Page 2 of 3 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. 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. 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 drainfleld 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. 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. 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. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. Lot 1, Blacktree Subdivision · ' July 30, 2003 Page 3 of 3 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, Mirafl or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotexfile 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. 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. 01527172 1. GENERAL INFORMATION Complete legal description Blacktree L1 Location (site address) 3120 O'Malley Expiration Date: 7—/2_-2_/ Current property owner(s) Chris Swanson Day phone Mailing address 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: Private Well Private Septic Fx_1 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ E50 Date of Payment 8 a 0 Receipt Number D'7 9 5 y G Waiver Fee $ Date of Payment Receipt Number COSA # 05C 2 1 11 5% 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 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. Date Q TH 6. DSD SIGNATURE • • • • • • • System #1 Approved for bedrooms �� J ... .R�Ponn Pp CE 8149 System #2 Approved for bedrooms f° Disapproved������� Conditional approval for bedrooms, with the following stipulations: llllcfcrrt - ON-SITE TER Akin fn ''/!!)),,�- By: Original Certificate Date: � Z - ZI 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 Checklist blue sheet COSA Checklist Legal Description: Blacktree L1 Parcel ID: 01527172 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA A Well log is filed with Onsite (or attached) Date drilled 9/2004 Total depth 201 ft Cased to 200 ft 0 Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 3/16/21 Static water level at beginning of test 117.3 ft. Comments B. TANK DATA Age of tank(s) years Tank type/material SOMIC151ee4 Measured operating fluid level in septic tank 0 Standpipes/foundation cleanout per record drawing Date of pumping 3.18.21 D. ABSORPTION FIELD DATA Deep Trench Which system tested (date installed) 0/25/03 ❑Q ALL standpipes present per record drawing Total measured depth from grade 15.3' ft (max) Measured depth to pipe invert from grade 7.8 ft (min) ❑ N/A — pressurized field R Monitor tubes go to bottom of effective. If not, state depth into effective MR Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test 2.8 _Pm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑✓ N © Coliform bacteria is Negative Nitrate mg/L X Nitrate less than MRL (ND) Arsenic 2.202 ug/L ❑ Arsenic less than MRL (ND) Collected by Pannone Engineering Date of Sample 3/17/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 3/16/21 Results [D Pass For 4 bedrooms Fluid depth prior to test 59 in Water added 600 gal New depth 64 in Elapsed time 324 min Final fluid depth 59 in Absorption rate 600 gpd Any rejuvenation treatment (past 12 months) If yes, enter date 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' Rl Yes 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' 0 Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' M Yes if No ft 0 Yes if No ft Manure/Anima( Excreta Storage > 100' Community Sewer Main > 75' ✓� Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' [✓ Yes if No ft Surface Water> 100' R✓ Yes if No ft Property Line > 5' Rl Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' [✓ Yes if No ft Private Wells > 100' Yes if No Water Main > 10' [✓ Yes if No ft Community Wells > 200' 0 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' E✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓/ Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' [✓ Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' ✓l Yes if No ft F. ENGINEER'S 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. COSA Checklist yellow sheet ��",� k k g TH cr; ........ Steven R. Pannone C E u IA 9 rF�f%i''OcFr SIC," m ft ft ft 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. O~5-27:L-72 1. GENERAL INFORMATION Complete legal description Blacktree Lot ~ COSA # Expiration Date:, Location (site address) 3:L2o O'Malley Road, Anchorage, AK 99507 Current Property owner(s) Mailing address Lending agency Mailing address Elizabeth & Al Palma 3z2o O'Malley Road, Anchorage, AK 99";07 Day phone 522-2350 Day phone Real Estate Agent Careen Muir/Keller Williams Day phone. 865-6546 Mailing Address :[o~ W. Benson Blvd., Ste .;03, Anchorage, AK 99503 '::'NUMBER OF BEDROOMS~ 4 TYPE OF wATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: individual Well [] Individual On-site [~ Individual Water Storage [] Individual Holding Tank r-I Community Class ~ Well [] Community On-site I--'-I Public Water System [] Public Sewer r--] 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 Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box ~-oo:zzT, Anchorage, AK 995~-o Engineer's Printed Name Steven R. Pannone, P.E. Date 9/~4/2oz~ Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & 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 · . . ~.~, ,J ,~ · levels that may fluctuate dunng 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. PES can therefore not provide any warranty for future ~_ '"'~'...~.,.:~.....~ performance nor give any estimate of how long the system will continue to meet the operational ~ .... requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. -,~ ................... ~.~ 5. DSD SIGNATURE ~ APproved for "7- bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 1.96650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Blacktree Lot ~ If A, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to 200.45 ft. FROM WELL LOG 129 ft. =.o g.p.m. Legal Description: A. WELL DATA Well type _P Date completed ~/2~12oo,. Total depth 2ox ft. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform ~colonies/100 mL Arsenic: ~ ug/I B. SEPTIC/HOLDING TANK DATA Tank Type/Material Anchorage Tank Steel Tank size .. 12~o gal. Foundation cleanout (Y/N) Y Date of pumping q161~,o.,,, C. ABSORPTION, PIELD,DATA Nitrate _~2_ mg/L Date of sample: q/8/2oxx Number of Corn partments 2_ Depression over tank (Y/N) __N Pumper A+ Home Services Parcel ID: o=.5.27x-72 Well Log (Y/N) Y Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION elql2oxx 1:!.7 fl. 4.~' g.p.m. Date installed xol2~/2oo=~ Length 5x ft. Width =l Total depth ~_S ft. Eft. absorption area 765 ft2 Date of adequacy test q~81~o3.1 Results (Pass/Fail) __ Fluid depth in absorption, field before test .~ in. Elapsed Time: ~44o min. Final fluid depth _~ in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N Collected by: Laura Pannone Date installed ~o/2~J2oo] Cleanouts (Y/N) Y High water alarm (Y/N) N/A Soil rating (g.p.d./ft2 or ft2/bdrm) .8 ft. Monitoring tube Y Pass System type, Deep Trench Gravel below pipe 7.5 Depression over field _N For _~ bedrooms · in. ft* Water added6oo gal. New depthsA in. Absorption rate >= 600+ g.p.d. If yes, give date D. LIFT STATION Date installed "Pump on" level at ~ Datum !in. E. SEPARATION DISTANCES Size in gallons "Pump off" level at ~ Cycles tested in. Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. SEPARATION DISTANCIES FROM WELL ON LOT TO: Septic tank/lift station on lot ~.oo+ Absorption field on lot Aoo+ Public sewer main ~.oo+ Sewer/septic service line Animal containment areas ~.oo+ On adjacent lots ~oo+ On adjacent lots ~oo+ Public sewer manhole/cleanout ~oo+ Holding tank ~oo+ Manure/animal excrete storage areas loo+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation [o+ Water main ~oo+ Wells on adjacent lots ~Oo+ Property line ~.o+ Water service line Absorption field.. Surface water ~oo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~o, Water Service line 25+ Curtain drain None Known COMMENTS Building foundation Ao+ Surface water Wells on adjacent lots ~oo+ Water main =oo+ Driveway, parking/vehicle storage o* .... part of tank and one end of field have been paved over. Owner has installed permanent barriers around both. G. ENGINEER'S CERTIFICATION ' I certify that I have determined through field inspections and review of Municipal records that the above systems are. in. conformande with MOA COSA guidelines in effect on this date. '- Engineer's Printed Name Steven R. Pannoner P.E. Date COSA Fee $ Date of Payment Receipt Number (Rev, 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Sires{ P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (9O7) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-271-72 1. GENERAL INFORMATION Complete legal description co~ l. I~-~ Subdi~s~on Location (site address) 3120 O~aAeyRoad Anchorage, AK99516 COSA # Expiration Date: Current Property owner(s) so~v~ra Mailing address P.O. Box 521851 Big Lake, AK99509 Day phone. Lending agency Day phone Mailing address Real Estate Agent ~ Facet F'rope~ Day phone Mailing Address Pmd~Ua~ dac~ Wn~ V'~'a 3801 Ce~terpotnt D~'., Suite 2O0 /~:homge. AJ( 99503 Unless otherwise requested, COSA wlTI be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Four (4) 3. TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] · Community Class Well [] Public Water System [] I'YPE oF WASTE'WATER DISPOSAL: Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer [] The Municipality of An~e 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 Issu. es CO,SAs upon request to homeowners. Certificates of On-S..ite Systems Approval are var~d 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. (Certes 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 no{ responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As ce~3ed by my seal affixed hereto and as of the validation date shown below. I vedfy that my investigation, based on procedures outlined in the Certirmate of On-Site Systems Approval Guidelines for this application, shows lhat the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and t~pe of sb'ucture indicated herein. I further varify that based on the information obtained fi'om the Municipality of Anchorage flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage. AK 99524 Engineer's Printed Name Michael E. Anderson. P.E. 5. DSD SIGNATURE ~' Approved for ~ Disapproved.' Cond~onal approval for Phone Date 3/15/2oo7 bedrooms. bedrooms, with the following stipulations: Attachments: COSA Checldist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Ce Municipality of/mchorage Development Services Department euiUIng 8a;ety Division On-Site Water & Wastewa~ Program 4700 Bmgaw Street P.O, Box 196650 w~w.munLorg/anslta ¢~0~) ~4~-7.04 CERTIFICATE OF ON.-~ITE SYSTEMS APPROVAL CHECKLIST A. ~ DATA ifA, B, or C provide PWSID # FROM WELL LOG 9/24~04 Parc~ ID. ?ss,-zTs-72 Date oftast Static ~atar ~v~ ~;s Wall pmdtx:tion ~o g.p.m. WATER SA~IPLE RESULTS: ' C~lfo~m o colonies/100 mL Nitrate N;O mg/L SEP'rlC/HOLDING TANK DATA Tank ~i7.~ 1.250 ' gal. Number of Corrl~ll'41~n~ T~o Foundation cieanout (Y/N) Y Depression ovar tank AB~ORFTION FIELD DATA Lmgth ss Tc~al ae~h, l~-Ss fL Well Log (Y/N) Y ~I~ [Dn31~'iy ~ (Y/N) Y Casing height (above ground) >~4 AT INSPECTION in. ft g.p.m. Cleanou~ (Y/N) Y N High water alarm (Y/N) N Soilratlng (g.p.d./~or~odn~).sGPO/~: Systamty~e ,,~Tmnch ~ 3 ft. Gravel below pipe ?.s E~. 8J;~oi'~Qfl ~8 ~ ~ Monito~flg bJbo Y D~ _~_Jofl ~ fleJd N Date ~ adequacy test ~ cen~ Results (Pass/Fail) F~' bedrooms Fluid .depthinabseq~onfieldbefomtast in. VVataradded gal. Newdepth ~ Tree: ~ min. Final fluid depth in. Absoq=fion rate >= N ~f ye~, giv~ dat~ Any rajuv~ b"aa~ (past 12 mo.) (y/N & type) g.p.d. D, UFT ~TAllON Date installed 'Pump on' k~ml at k~. Datum E. SEPARATION ~STANCE$ 81ze in gallons 'Pamp off' level at in. Manhoe/~_ _ _- (Y~) High water alarm leveJ i Mee~ almm & dmu~ mqu~mems? SEPARATION DISTANCES FROM Wtq t ON LOT TO: Septic lank/lift ~a~:m on Ic~ Ab~ Mid on ~ >1oo' Public ~wer main Sewer/sept: Im'~ce line AnimM (:xxttalnment ~lreas None On adjacent Ic~ On adjacent idb >t00' Public s~ver manholetc~anout Hokllng tank MaaureMnirnal excrete itDrage areas None SEPARATION DISTANCES FROM SEPTIC/HOlDING TANK ON LOT TO: BulUng foum~on ~ Pmpelly line >5' A~ field. >s' Water main >to' Water Mm4ce line >to' Surface water >1oo' Wells o~ adjacent lots>t0(~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Pmpe~y line >~(T Building foundal]on >1o' Water main >1o' W~ter Se~'tce line >to' Surface water. >1oo' D~Weway. Cu~in dm~ Nm~ Nome Wells on adjacent lots >1mT COS), Fee $ 57' bO WaNer Fee $ Rece~ Number Date ~ Payment Rec~pt Number ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-Tn'3 677-7766 (FAX) MEMORANDUM DATE: March 17, 2007 TO: Jeff Poet FROM: Mike Anderson, P.E. SUBJECT: Lot 1, Blacktree Subdivision COSA The house currently in place on Lot 1, Blacktree Subdivision was only recently completed and has yet to be lived in. The original owner of the lot placed the septic system. The lot then sat vacant for several years until it was resold to the current owner. He then constructed the house for resale. A certified Soils Log-Percolation Test is attached for your files. Please let me know if you have further questions. O'MALLEY ROAD N 90'00'00" E 164.96' /~:::::::::::::::~ ::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::: 58.3 ~ EX~S~N~ HOUSE ~ ~,~ ,/ ~.o~ 2 LOT 1 10' T&E EASEMENT N 90'00'00" W 165.16' LOT 3 ~e~ s~H~ Sand~, of Pmdentlal ~ck ~lte Lot 1, Blacktree Subdivision LAND & CONSTRUC~ON 440 West Benson Boulevard, Suite 200 Anchorage. Alaska 99503 Phone: 562-5291 Fax: 561-662E P~at: 97-47 ~-kS: 2634 March 2. 2007 ~ro,,. B)~ KRB wo~ c,d~. 2007-L-011R1 ro/Pg: 684/53 C~,¢kod e)~ APH