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Home My WebLink AboutT12N R3W SEC 23 SW4NW4NW4NE4 PTN AKA PARCEL 2BT12N R3W Sec 23 Parcel 2,B #015-511-13 AOMaa 1� Municipality of Anchorage Department of Health and Human Services BundinafeOn-She Water and W stewate SProgram. 4700 South eragaw Street P.O. eox 196850 Anchorage. AK 995196650 Page 1 'of 4 www.cl.anchorage.skus (907)3417904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Nmtsrd eearoane: ewa. to sAd"M �!'_ ieakrc Well: ® New ❑ Upgrade C4..ircafwnfVrhal..A e. CtTOW D.W. r...w r. �V sett st Caahp N.grd AW" GON Ft Z Q SEPARATION DISTANCES To Septie Absorption LIR Holding ut w.n 166.6 awl«. weir 119 to un. 43 Fardmon Cn.etd.pnbomanatp.: Crnaln Drain 100+ ;.—Z- Nunardana[ 160 182 140 119 17.4 43 100+ 1100+ over entire field. Lot was approx. 2% grade. 100 and flattened to ® New ❑ Upgrade ® DO"Tr.rch 13 ahenew Trrth t3 Bed O Nana O Other. sa Mina .12 Taal Depth kom&OW pya. DpmaoN.boaan ktmeeghwgad.: Cn.etd.pnbomanatp.: FA edea tenor. ONpNar prods: 6�0 Ft ornN Largdc or"WkV% Nunardana[ Mums aheart kw,- TeW aao",et mw vgN.trw: Mw7er, . 03 Date kwtaned [N] N,terw: Fury Neo. a Noah Inspections performed by: Pannone Eng, Svc Dates: 19011312003 Department of Health and Hpprovuman Services a pr;V 13/2003 al Reviewed and approved by: Date: i QEM.1 VN) . TANK LIFT STATION BENCH MARK at 100.0 FL Engtneera Stamp °r 49TH R. Ponm j12u 9 PERMIT ND' SV020461 H AS -BUILT DRAWING WASTEWATER DISPOSAL SYSTEM PARCEL 2B, T12N R3W S23 S.M. 0 r--------------- E 1 EXIST'G ------------ Utll Esnt P.I.D. NO, 015-511-13 W PRIMARY FI LFx3'x6'EFTV, 103 ❑POSED F W160000 T,Ep; TANK TIC kEA�i J 107X203 J,Anchor Esnt F iq� M MTI RC RATE--fI 125 SF/BR, �'-•••y,•.. 44� N2 0 5 BR HOUSE 440-4444 T2 S42 14.9 45.7 625 SF REQUIRED LS 13.2 43a 15.3 DEEP TRENCH SYS, 6.0' EFF. 55 LFx 6', 9' TOTAL DEPTH NEPC TO MI 34.0' 8 226Degrees TOTAL AREA=660 SF NEPC TO CO. _11_225 Degrees 20009 S.T.E.P. TANK R. PannoneTC 8149 ! '�" __4L" r ungCE Dnren Mun ro 3112 q'- ps'`j►s� . 7021 Driftwood St. Anchorage, AK 99518 «» �51�� 277-4040 --�� 440-4444 P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 227-3522 P, 272-8218 Fax �rE1-24-o AS -BUILT :AI c. t•:cm PERMIT NO, SVO20461 AS -BUILT DRAWING DETAILS P.I.D. NO. 015-511-13 WASTEWATER ABSORPTION SYSTEM NOTEt PARCEL 2B, T12N R3W S23 S.M. 1) ALLVORK SHALL BE PERFORMED IN ACCORDANCE WITH, 6 ALL METERIALS SHALL COWORM TO AMC15.65. 0 CD 2) Lot was regraded and flattened o a'N In building area. .. a` o 3) 2 Inches of rlgid Insulation was 3Gn= WIVJ Placed over entire field. 't C"\ Vork\DRAWING\4-ThunderbrushXWG 16V;I' 1 3en1 &mm 0 o, 1 0 m Ina NY= R. Pannone!p r'«rnrctL h UNi rr�, jj�e 8149 Daren Munro 7021 Driftwood St. Anchorage, AK 99518 �.. 277-4040 440-4444 IMM g�x W J L~i C3 Ix OL Pannone Eng. Svc., LLC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218 PHONE & FAX �-24-03 ❑ rr cre�, REC❑Rn c r � R � M S a o r--� H Lc1 J / c C"\ Vork\DRAWING\4-ThunderbrushXWG 16V;I' 1 3en1 &mm 0 o, 1 0 m Ina NY= R. Pannone!p r'«rnrctL h UNi rr�, jj�e 8149 Daren Munro 7021 Driftwood St. Anchorage, AK 99518 �.. 277-4040 440-4444 IMM g�x W J L~i C3 Ix OL Pannone Eng. Svc., LLC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218 PHONE & FAX �-24-03 ❑ rr cre�, REC❑Rn Flirt : rLPINE DRILLING FARC W. : 907 245 OM2 Nw• 26 2@03 1@:35cYt Fl ,,, Municipality of Anchorage AL Department of Health and Human Services P.O. Box ie8650 825 *V Street SfvrmNOINIMw wagemmun 9eSiB-0OSC) rmlt IwajslDareurmlpbdo2es �T121DateSUrtedtQ:U cp �Pare lId"firteationNumber: 1 .13 _ta_Q:ywelltoaeP°mtitlo°stion?®Ya[NN ed o Property O v*r Nam* & Addre": Daren Munro AIHNRiatparaaat Drive BerehoklDaa: -- Sall i) pe Tbtckneaa waw Sonia rte (T) ---•- Method of DrB @ air mtnry ❑ cable tool etiek Gp D min: types X%w ° 2 Wall Thlckaess: 2M Inches 2 5 DIametw.. d inches Depth: feet gravel/ywpt a 15 WerT pe: altygroval 15 31 Diameter inches Depth: feet provally sky 65 120 Casing *ddmn Above Sround: y feet alit 12t7 i05 8taue crater ltw*I (from Voacd level): !30 fxt aJltyaendy prove! 191 237 Ptmrping IML -.,fit ages 40Y water &and& gravat 237 241 2hours p p�SiQ Rtrevery Rate:1Q BPm pm Method of Terdna: a/rO ®a0pec ake End t ] Open pe: � Opca Hole ❑ Sommed St m feet Stopped fat ❑Worations Start feet Stopped feet Croat Types bardonha k R Volume: Depth: Stat B feet stopped 2 foes Pumps Intake Depth feet WeU DhWedW Upon Completion? ® Yea 0 No Method of Dtala neem Comments: -- WoU Drlilor. Aipk» Drilting 6lentsrprlses PO Baur 110496 Aftdwn a Alaska 09511 Atteation: The weU driller stall provide a well log m the ..r .. ...L. _..II J••11.. .... • ...I _..1. �..• M. F -PC o^Yer..I[y1Y days Of � P Ily .........,.. . 3.. on end the pro MUNI C1PAUTY OF ANCHORAGE Development Sorvlces Department Onsite Water Wastewater Program 4700 South Bmgaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM /WATER SUPPLY PERMIT Initial Permit Number. SW020461 Legal Description: T12N R3W SEC 23 PARCEL 2B Design Engineer. 0062 Pannone Engineering Services Owner Name: DAREN MUNRO Owner Address: NHN RIDGECREST DRIVE ANCHORAGE. AK 99516- Date Issued: Nov 18, 2002 Expiration Date: Nov 18. 2003 ParcelID: 015-511-13 Site Address: Lot Size: 62500 SO. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of. Disposal Field Q Septic Tank Holding Tank ❑ Privy Private Wen C] 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 catling (907) 343.7904 (24 hours). ( Not required for a Water Supply Pemdt only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either. A. Open and dosed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By. Date: it — 2 Date: �8 D2 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 995196650 www. cl.anchorage. akus (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parce11.D.. p 5 S l 11 l� Permit NumberSWO20¢6/ Property owners) Daren Munro Day phone 440 4114 Mailing address (1) 7021 Driftwood St Mailing address (2) Anchorage, AK Zip Code 99518 Legal description (lot, Block & Sub'd.) 2arcel 211l=jV R' Legal description (Section, Township & Range) T12N R3W S23 Lot Size 62500 Acres/Sq.FI. Number of Bedrooms 5 THIS APPLICATION 1S FOR: Sewer Only ❑ Wel Only ❑ Sewer and Well ® Water Storage ❑ Sewer Upgrade 0 THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 1 certify that the above Information is correct. I further certify that this application is being made for a Single Family Dwelling and is In accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: d Waiver Fees: Date of Payment: Z 0 Z- Date of Payment: Receipt Number. Receipt Number. (Rev. 12=) Pannone Engineering Services, LLC November 10, 2002 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Parcel 2B T12N R3W S23 Well & Septic System Permit Request Gentlemen: P.O. Box 102954 Anchorage, Alaska, 99510 (907) 272.8218 Fax My faro %vas contacted to investigate the possibility of installing a new well and septic system on the above referenced lot. The record was researched to find the location of the surrounding wells and septic system. Two test holes were excavated on October 23, 2002 on the lot. The soils reports and a percolation test result are attached. Ground water was monitored for seven days. No bedrock or ground water was encountered in the test hole. The proposed upgrade and reserve area are located greater than 100 feet from any surface water. The Iot is approximately 62,500 square feet in size. Parcel 2B slopes to the south and west at approximately 10 percent in the area of the test holes. The proposed system will be located on the northeastern portion of the lot. The lot will be served by a private well. The proposed upgrade is greater than 100 feet awny from proposed and neighboring wells and 25 feet from the proposed water service lines. The surrounding wells arc located greater than 100 feet from the proposed installation. The proposed installation will not affect the future development of the surrounding or existing lots. Seethe attached design. If you have any questions or concerns, please contact me at 227-3522 or 272-8218. Sincerely, 4 Steven R. Pannone, P.E. Civil Engineer S— Attachments: C:\1Vork%Letters\Parce12B TI2MMS23.001 Aoc 0 R. Ponnone� :C 9149 PERMIT Na SW02 DESIGN DRAWING DETAILS WASTEWATER ABSORPTION SYSTEM NOTE PARCEL 2B, T12N R3W S23 S.M. 1) ALLWORK SHALL BE PERFORMED IN ACCORDANCE WITH, L ALL METERIALS SHALL CONFORM TO AMCIS.65. 2) SEE GENERAL NOTES ON SHEET 1. 3) 1110 W 49321 3VU W124 = W31 Ina w3m 111a NY= IrG NV3M No11YCMY1/ P.LD. NO, en R. Pannone . ' ”" ^^"' r' m, Pannone En Daren Munro 9' Svc., LLC CE 8149 �� 7021 Driftwood St. P. O. BOX 102954 A2(((O �'•� Anchorage, AK 99318 ANCHORAGE, ALASKA 99510 q �IQ,p1�•.• 277-4040 272-8218 PHONE L FAX 440-4444 A t-10-02 NOT RECORD n u 1] 4 L e r � c a t4 • 'r w d Q ' I— U 1.1.1 in w 49321 3VU W124 = W31 Ina w3m 111a NY= IrG NV3M No11YCMY1/ P.LD. NO, en R. Pannone . ' ”" ^^"' r' m, Pannone En Daren Munro 9' Svc., LLC CE 8149 �� 7021 Driftwood St. P. O. BOX 102954 A2(((O �'•� Anchorage, AK 99318 ANCHORAGE, ALASKA 99510 q �IQ,p1�•.• 277-4040 272-8218 PHONE L FAX 440-4444 A t-10-02 NOT RECORD PERMIT NO, SV02 DESIGN DRAWING P.LD. NO, WASTEWATER DISPOSAL SYSTEM PARCEL 21), T12N R3W S23 S.M. IST'G SE PTIC REA� EXIST' 31. P OPOSED PRIMA r5 LFx3'x6'EFTV. PROPSED '- in-/-/ 0.5 A • PROPOSE 13.3 _____ 0 SE1 1 0 103 XIST' 1 e`' d' PROPOSED WELL a� •, k255LFx3'x6' EA DEVELOPE i i ROPOSED 4009 S.T.EP. TAN,'l w CREEK, '---- SETBACK /-CREEK REEK � _ 4 20 Holntek EW T'G / EXIST'G 4LJ- TIC • �2EA� t --------------- 1 �Utft Esnt Anchor Esnt 1 PERC RATE-''MIN/INCH 1� 625 SF RECUI ED HOUSE DEEP TRENCH SYS, 6.0' EFF. i 55 LFx 6', 9' TOTAL DEPTH wit 49V >} i TOTAL AREA -660 SF 2000p S.T.E.P. TANK r i7� Steven R. Pannone PREPARED FORT PANNONE ENG. SVC, LLC �1'No.CE 8149 i 7021 DDoren riftwood od St. P. 0. BOX 102954 ZtttC! ANCHORAGE, ALASKA 99510 AnchoroAe, AK 99518 ��4/,t`;'�� 440-4444 ATE71 310202 P, 272-8218 Fax , DESIGN OmmtB um - '4'w'D'>«7Il' P- � PANNONE ENGINEERING SERVICES P.O. BOX 102934 w 49M ♦♦ ANCHORAGE, AX 99510 y X907) 2724218 ♦ Steven R. Pannone w ♦ No. $149 � PERFOMM FOR: Datewa ltoeuo DATE MIPOFaMD, 10-23-02♦I f,,aa `• :. IE'OAAf. DESC RWMN- Patod 2S. T12N RJW 823 TIST H= t)R � Yat 1Tm 2 4 S 6 7 s 9 1�b Oadtd SAND �/ 10 ffi/°Y a See It- 12- 13— WAS t 12 IJ 14 15 16 17 Is HSotH 19 20 PXR01ATION RATE 7 (mm/4xW MMC N01a aLum7SR 6 Hahea TEST RIM BXVnl E1! 6 FT read 7 PT COUNMIZ: Test hole e=atated by Dan Beeks. Tat Hole ym eaeaoalmd befire oeec tat. PERFOR3(ED BY: t t"= R Am,,;,,_ P.B. I CERTIFY THAT THIS TEST WAS PERFORMW IN ACOORDANCI W[ IH AIL STATE AND i[IIMCIPAL OIIIDId(F.8 IN BFFEC7 ON THE DATE OF THIS TEST. sos atss Ca �n iJ 0% i 3— r2 EA NDEV ltst i i W SIO 'CREEK) � � SETBACK i REEK REEK � i t i WA8 GROUND WATER taoSs tNO0H1lTIfRm? �_ 7tdTHOfi IF YEB. AT WHAT DEPIlHi -O- DEPI3I3'O WATER AFTER OM(�ORII(07 -DRY- is aaAoon nas trot tat: tat toa tivte d �xNat Scree nao� to-t�-aP 415 0 6 1/B --- 425 10 l 1/8' S' 425 0 6' --- 435 10 1 1/8 5' 435 0 6 1/4 --- 445 10 1 1/4 5' 11Ad2 aaAoon nas trot tat: tat toa tivte d �xNat Scree nao� to-t�-aP 415 0 6 1/B --- 425 10 l 1/8' S' 425 0 6' --- 435 10 1 1/8 5' 435 0 6 1/4 --- 445 10 1 1/4 5' wbililT� I ultt. 1'II V.(* (bill 11 Ioll I Lr I t ;M t 1 1 t ::M • M r; • :• v• PERPOMUD POR: Dams ldnno DATE 111MOS 1U: 10-13-02 IEOALD3sCRIMOxe Parad2%T12NRMWS TMH=4 OR 1 3 6 ItsAmo Alas OaOaa 'fna 1n.T Ina Daman I WAM far ffaaw lo -e4 as 1417 1427 1427 1437 1437 1447 0 10 0 10 0 10 6 1' 6' 1' 6 1/4 1 1/4 --- 5' --- S' --- 5' PBROLATTON RATE R Im!nAxw PMC HOLE MOW= 6 Loch" 7EB7 RM HSRRBEf 61R and 7 P7 oG) C)) rn c �� r r 00 CY) CY) W c r n o LLL V � a TO i U Z LL J � a/ o Ei (n U �L Q� Z D � U O 06 co L c C� O DO w 0 N C O cu .Q x w 0 O 0 M r r 'r Y O C) a) U (D 0- W 0 0 0 N N a) J 0 W 0 N a� N 0 0 Q c C U 0 E ~ co O CL LU co L Y w J 2 O L O o >Z Z O 0 Y O (D Z OCC U (DL C Q J L � O CO N Lu Z O H > o n a m a� c V/ � n L M Z c o a U _0 U w O y cn � = p L Q o Q E 5 O � F- ° > n o U 0 U) aci U > u 0 0 0 N a) Q 0 N 0 N a� 0 c U 0 E ~ co O ~ 0 N O U oo��'N cu c P 0 > 'O Q > fn N N O Q U Q N M (D Cl)'= c 0 o °' :t-_`' z Q 0 3 a) E CL N +, > 0 0 t6 a) CLCL L U Q OD u 0 0 0 a) Q 0 c 0 E ~ co O ~ 0 L O oo��'N > Q > fn N i O Q U Q N M (D Cl)'= c 0 o °' :t-_`' z Q O U 3 a) E CL .N +, > 0 0 t6 a) CLCL L CL Q N N 0 0 O 0 c m X (j cC O `~ U)*, o a) c D fn N E 'O • 0 Q O a 0 > 0 N 0 n O (n 3 •> 0 CLL 0 U IL C Q d + � N C c U O N Z— � L) N 0 N H Q" CL Q ai C a) Z U� OU O cn C E 2 = Q I� O U o w o N :c >, = a c f - o rn 07 O) I— r- 4. NT C7 co [-- I— CD O cy) O) O X W 0O LLL.. 0 n- O 2 U Z L O J �o U W V L _ c6 Z o� U C6 L /(�D u) L C E� Q O 00 AW Z O c� F- 0 O Ln LL Z O J Q � LU Z w ca a d T- Z LLIZ Z Q U Z Z Q U Q N U) W UJ U U cU 0� 0 N O o a � U N a) 70 0) 0 a) �N m a) o 0 Q O U U a) C O a T m lw WA U) cn cT 2) a) LL El cu a) >. C) U CV O m U ❑ N U O U) a) V) ❑� T 0 Ln aa) > U Ela) 1 � z Q I -- U O � N CL a w0) L6 a) a) m 0- (D () a) U) .r•; w El T m a) LL a) c0 C � V E T �J cu I o Q () Cf) 0 O U � C :3 O O O >, N O O a) D E E O U C Q) U _ElQ N N U) m ❑ a) D _ U > co a) O ❑ u O(n a) _ a) c L LU 3:�o ❑■ m 1 ^ I V J a)a) cu L ma) .> U cu J �Q/� cn O ❑■ L ❑ ❑ w 0 LU N Fn J a IL � w Q cn U) 2 w w LU LU F- cn H U) F- LL O LL O 2i LU a a O I- F- N M .4 U) cn cT 2) a) LL El cu a) >. C) U CV O m U ❑ N U O U) a) V) ❑� T 0 Ln aa) > U Ela) 1 � z Q I -- U O � N CL a w0) L6 a) a) m 0- (D () a) U) .r•; w El T m a) LL a) c0 C � V E T �J cu I o Q () Cf) 0 O COSA Checklist Legal Description: T12N R3W SEC 23 SW4NW4NW4NE4 PTN AKA PARCEL213 parcel ID: 015-511-13 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA fi❑ Well log is filed with Onsite (or attached) Date drilled 10/10/03 Total depth 241 ft Cased to 241 It ❑N Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 30 in. Date of flow test for COSA 9/6/24 Static water level at beginning of test 135 ft Comments B. TANK DATA Measured operating fluid level in septic tank `34 Date of pumping 8/19/24 X Required maintenance completed, if AWWTS Comments: * STEP TANK, W/ FLOATS D. ABSORPTION FIELD DATA Which system tested (date installed) 10/13/03 0 ALL standpipes present per record drawing Total measured depth from grade 9 It (max) Measured depth to pipe invert from grade ft (min) X 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) _ If yes, enter date Comments/Deficiencies: COSA Checklist -June 2022 Well production at time of test 3+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes H No 0 Coliform bacteria is Negative Nitrate mg/L N Nitrate less than MRL (ND) Arsenic ug/L XArsenic less than MRL (ND) Collected by MNA Date 9/4/24 C. LIFT STATION ❑0l Required maintenance completed Age of lift station 21 years Lift station material STEEL Comments: Adequacy test date 9/6/24 Results Q Pass Fluid depth prior to test 25 in Water added 750+ gal New fluid depth 33 in Elapsed time 1440 min Final fluid depth 25 in Absorption rate 750+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 72 in Effective depth used 25 in Effective depth remaining 47 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' Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No _ ft E Yes if No _ ft Neighboring Tank > 100' ❑i Yes if No _ ft Private Sewer/Septic Line > 25' Q Yes if No _ ft Absorption Field on Lot > 100' [j] Yes if No _ ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Q Yes if No _ ft Water Main > 10' Animal Containment > 50' Q Yes if No ft ❑i Yes if No ft Yes if No _ ft _ Yes _ Manure/Animal Excreta Storage > 100' If tank or field is under driveway comment below Community Sewer Main > 75' ❑� Yes f No _ ft Q 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' Yes if No ft Surface Water > 100' Yes if No _ ft Tank to Property Line > 5' ❑i Yes if No _ ft Wells on Adjacent Lots: Field to Property Line > 10' Q Yes if No _ ft Private Wells > 100' Q Yes if No _ ft Water Main > 10' Yes if No _ it Community Wells > 200' 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 N(rk.G Ag cL t VA Vn pry`. Phone 727-8864 Engineer's Printed Name �iavrtc Date-r%(2(2Lt �.PyE OF AEA�?r OW a *iy' Y. • ............ • • -/•/N.0.. •....... .I ��• MICHAEL N. ANDEftSCN :M1rr. r f•. CE -9 q l ., + -.. I .• COSA Checklist June 2022 v � rn N r% M M X O 01 LL W tea/ I.i 0 i V Z a LL a S 0 F-_ W� �n a v a Ln +1 W 3 0 W " U N w W Ln O H \ " txo Z L 4 L LU m a � � J 4 w in 3 o O 3 fD O L Q Q Q (v Ln N v O cn N (O E L O O O [p L 1 O ,} O O O N � m M c -I N O *k f0 ON Q E Ln >- N N m � +� J m U O v UA ru (IJ> (B QJ O Ln " ra aJ >- N L Q o a4-1 N t LQ) (p Lf) N O ++ E V v — u0 Q H o N s✓ j Ln L N N 4 C a_+ L- Q"r14 Q bB C Q% L N C L v U U N ate.., O a O —_ O _0 ai u (D O N a + OJ dD N E O++ w O U N u _0 L ON fD i N Q H Vf v :3> fu Ln N U V) t H p U O C t H fD O L Q Q Q (v Ln N U)1, J j ia•rwm %�c 1w%S +01') Municipality of Anchorage • Development Services Department Building Safety Division s On -Site Water and WastewaterProgram •• •• 4700 South Bragaw Street P.O. Box 1%650 Anchorage. AK 9951 9-665o www.cl.anchorage.ak.us (907) 343-7904 {� v Q CERTIFICATE OF HEALTH AUTHORITY APPROVAL ■ w FOR A SINGLE FAMILY DWELLING' Parcel i.D. 015-511.13 HAA #tr.;O�?,Gi Expiration Date: q . 3 D — 05• 1. GENERAL INFORMATION Complete legal description Parcel 213 T12N R3W See. 23 `%W 4 Nlr) t NW 4 "rr4 'F 1W e'r7: Location iie address or directions) _ 10911 Ridgecrest. Anchorage. AK 99616 Current Property owner(s) _ Bill b Kathy Johnston Day phone 632.2402 • •. Mailing address 10911 Ridaeerest. Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested. HAA will be held by DHHS for pickup. /eked ap by: 2. NUMBER OF. BEDROOMS: 4 d��- r t �� Tdv,SY) to I ___ reo%�� 2`3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: I Individual Well ® Individual On-site 10 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 Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Heath Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to home owners. Certificates of Health Authority Approval are varxf 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 less than 30 days old. 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 professlonal engineer's work m•• two) S. STATEMENT OF INSPECTION BY ENGINEER Investi AS certified by my res laffixed hereto and as of the validation outlined in the Health Authority Approval aGu dete fines for this s Health Auththat ority Approval tion based on proved application shows that the on-stte water soppy and/or wastewater disposal system Is sate, functional and adequate for the number of bedrooms and type of structure indicated herein. l further verify that based on the Information obtained from the Municipality of Anchorage Rtes and from my investigation and inspection, the on- site water supply andlor wastewater disposal system is in compliance with all appricabte Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Eno Svc Phone 272-8218 Address P.O. Box 102954 Anch AK 99510— Engineer's Printed Name Steven R Pannone. P.E. _Date 2 Engineers Comments: in conducting an adequacy tes% t attempt to provide a thorough, conscientious system in accordance with MOA DSD Guidelines d. RegulaQons. The engineering analysis of the reported results describe the performance orthe system under the conditions encountered at the time of i the test, and separation distances measured to tadity identifiable features. The operational life Of 911 4t wells and septic systems depend on the loal soil condition, ground water levels that tray fluctuate during the year. and the water usage of the family being served by the system nc$O conditions arc • 1 ouuide the control of the evaluator or this system. All systems eventually Lill and satisfactory test results i do not guarantee future pctfortnamce of the system nor do they guarantee that there aro no bidden defects ow ?i or encroachments PES can therefore not provide any warranty for future performance nor give any continue to rhea the operational requirements of the ADEC or 0 Li estimate of bow long the system will 1610A DSD. The content of this report h for the sole benefit of the owner listed above. Any relim" upon � or use of this report by any other person or party Is am authorized nor will h confer any legal right whatsoever. 6. DSD SIGNATURE 49r" :ven R. Pannone Ito. CE 8149 ✓ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments :House is 4 bedroom. Septic is sized for 5 bedrooms. Ir- 0. AND LATER Attachments: HAA Checklist _ X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other Q��„„� ��0 �K Original Certificate Date:_ " OS By: Expiration Date: Reissue Date* VW twit Municipality of Anchorage •' ` Y ' Development Services Department Buildtrg safety ONlaiah OrrSlte water and wastewater Program , . ... 4700 South Brogaw Street P.O. Box 190650 Anchorage, AK 9951tif W www.d.andhorage.ak.us (907) 043-7904 HEALTH AUTHORITY APPROVAL CHECKLIST .. .: h. .., .• . r A. WELL DATA Wen type P If A, B, or C provide PWSID ! Date complatecl wry seal Y Total depth 241 R Cased to -L41-ft FROM WELL LOO Date of test 101912003 Steffe water level 130 It WON production 40 g.p.m WATER SAMPLE RESULTS: Watl Log y Casing height (above ground) _H_in. AT INSPECTION Akio it g.p.m B. SEPTICIHOLDING TANK DATA TankTymUata W Stsel Date I amlted ,1Ory 3*M Tank size 2000 gal Number of Compartments Cbanouls i Foundation deanout Y Depression over tank lY High water alarm ha_ Date of pumping AkLQ Pumper Sip e, e�Mko 0 SCKt 10 n C. ABSORPTION FIELD DATA Length ALIt Width -L- ft Gravel below pipe „¢,_ It Toad depth U R ERsctM staorption thea U& Modtorkg tis X Depression over gold IL Date of adequacy 1931 16P P Results (PassfFait) Pave For A bedrooms Fluid depth in absorption field before test ArsZ In Water added= gal. New depth In. Elapsed Two: Q min Final fluid depthuorl Any re1wenatim int (past 12 mo.) (YIN & too) (rev. I 11 Absorption rete >: M g.p.d. If yes. give date D. LIFT STATION Date installed „10=2003 Size In pallors 250 ManhotelAww Yltr!_ 'Pump oM level at 44 In'Pump off level at In High wafer alarm level at 1¢ in Datum Too of Tsnk Cydes tested -2 Meets slam b eircult requirements? Y_ E. SEPARATION OtSTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanhlMtt station on let 166.6 On itacent lots l00+ Q=77iTfl-f;7ilZJ& U, Public sewer main 100+ Sewer keptic service One 100+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: euildinp foundation i O t T Property line _G Absorption floe 10.6 Water main 100+ Water service One 60+ Surface water _ 100. Drainspe 100+ Web on adjacent lets 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property One 17A Buildup foundation J Water main 100+ Water Service One 60+ Surface wafer 100+ Driveway. perwro0veMde storsae „¢o_+ r Curtain drain None Observed Welt on adjacent lots 10 t F. COMMENTS G. ENGINEER'S CERTIFICATION I cerWy Mal I how detem*)ed through Dell lnspectlons and review of kkosapal Jecavds Mat Me above systems are In conformance with MOA HAA puldedras In effect an Mit date. b Engheer's Printed Nana Steven R. Psnnone. P.E. 'a ti rJ-. c- 61140 f,.Fwd7 Date� Z4 ��• HAA Fee $Y32 N7.5 u5h waiver Fee s Date of S Date of payment Receipt Number �7 D Ro 3 Receipt Number (WV. I IM) i r1 sl M� R 1 w W; 141 VZI-20-0 ; 11:44 : SGS SCSReLc 10)7699001 All DateMmeaor* AbukaStentraTtax CteatName PannacteLV. Srr. PtlaudDatJIIme G6=0007 1735 ProleetNam*v T12)1R3WSec27Pamd2B CalketedDowTuoe COMM 1330 C:Iwt34mp1af71 T=R7W3n27Patee128 RatetvedMuMns 06/=00517:48 butrla DrinkingWaeer TachAWDlt+cter SboLmC.Ede PWsm 0 Sam:la Rta:arkt: AtImble ftV Aaetrab fre:rasr Latu POL Valu MOW4 CentinrtD Laate Deis Leu Sri Vetere Capartaaat Nlu-.U•N 0.100(1 8300 ea{2 LtPA700.0 8 (410) 0674= 718 Mierebielagr Sabaratery Taff MIA= 0 c4V100mL Sbt20g= t A (4-11 06.210) TLF From +19074701507 Two tun 24 21311110 2005 Fagg 1 of S / INSPECTION REPORT MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION 4700 SOUTH BRAGAW INSPECTION INFORMATION &HELP: 343-7962 INSPECTION: VOICE 943-0300 INSPECTION: FAX (907)240-7777 www.munl.orprBSDMspecOorts.dm NAME 111-Dan•42-Bi4 PERMITN:04-0468 COMPANY Brlckwon; Inc. INSPECT DATE: 629,2005 AM PHONE I 440-9391 PHONE N 440-9351 PHONE ADDRESS 10909 RIDCECREST DR SUBDIVISION T12NR3WSE023 CRID0 SW2639 COMMENTS or DIRECTIONS Septic System -Early Ploase-Call Dan Dook-Thanks TYPE OF INSPECTION: RevoElectrk:al REINSPECTION: YES NO COMMENTS: (FOR INSPECTOR USE ONLY) Sic 1-3f/ - lGaiPi✓�/� VI v� 6 Z��GS PRINTED NAME DATE: Municipality of An all p chorageter,(0. • Development Services Department 7L Building Safety Division On -Slee Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.cl.anchorage,ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. _ 015-511-13 HAA#_ H0 oyD (o % Expiration Date: ,4 ?!;-A 4, 1: GENERAL INFORMATION Complete legal description Parcel 2B T12N R3W Sec 23 ' LocaUon (site address or directions) _ NHN Ridnecrest Drive Anchorage AK Current Property owner(s) -Daren Munro Day phone 440.4444 . Mailing address 7021 Driftwood Street Anchorage AK 99518 Lending agency Day phone Mailing address Real Estate Agent _Denny Wood 0 Prudentlat Vista Day phone -244.0399 Mailing Address 4241'B Street, Anchorage. AK Unless othenvlse requested, HAA wilt be held by DHHS forp/ckup. HAA picked up by: 2. -NUMBER OF BEDROOMS: y5 3. • TYPE OF.WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site ED 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 Health Authority Approval (HAA) based only upon -the representations given in paragraph 5 by an Independent professional civil engineer registered in the State of Alaska: Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to home owners. Certificates of Heater Authos6lrity and/Appror al water valid for 90 days from the date of Issue for properties served by a private or Class o well and maybe reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class th or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omisslons In the professional engineer's work. rne+. tem) Municipality of Anchorage ! • Development Services- Department Buildir g Safety'Divlsion On-Site Water land Wastewater Program' •� *• .4700 South Bregaw Street P.O. Box 196650 Anchorage, AIC 99519.6650 ! www.ci.anchorage.ak:us . (907) 343-7904 ! ;! HEALTH AUTHORITY APPROVAL CHECKLIST ; Legal Description: Parcel 2B T12N R3W Section 23 Parcel 1.0 , 015.511-13 A. WELL DATA Well type P : •, It A, B, or C provide PWSID # Well Log Y 'be c.COttftoit�?�L� Date completed 1011012003 Sanitary seal Y Wires property protected tic zl Y'e • Total depth '241 it Cased to 241 tt Casing height (above ground) 24 in. FROM WELL LOG .A7 INSPECTION Date of test 10/9/2003 Static water level 130 ft It . • ; Well production 40 9.p.m • 9.p.m ' WATER SAMPLE RESULTS: Coliform colonies/100 ml Nitrate .1(0 mg/• Otherbacteria $�colonies1100 ml Date of sample: % Collected by: , Brian Wiley ® Aarow Pump:& Well B. SEPTICiHOLDING TANK DATA :Tank Type/Material Steel Date Installed 10111312003' • Tank size 2000 gaL' _ Number of Compartments 2 .. . ' See �CQVhMoVl. Cleanouts Y Foundation cleanout � C1T Int: Depression over tank,N •, High water alarm• ZI/A Date of pumping Pumper C. ABSORPTION FIELD DATA , Date Installed 10/1312003 ,. Soil rating' (g.p.dif = or fe/bdrin)1 .. System type Deep Trench Length ,�5 •ft • Width 3 R Gravel below pipe •6 • tt ` I Total depth U ft • Effective absorption area Mie Monitoring tubo Y Depression overfold IJ Date of adequacy test Results (PassfFait) - Pass For ¢ bedrooms Fluid depth In absorption field before test.L2VA Water added gal. New depth -' in. Elapsed Time: 2 min Final fluid depth "— In. Absorption rate >= M+ g.p.d. Any rejuvenation treatment (past 12 moa (YM & type) J0 It yes, give date (Rev.1IM) iG5 Rd.A 1041316001 :9estName Avow Pump& Well Service 1roled NOMIN TowmMo 12N. Amite 3W. $ce 23 MentSamplelD Panel 2B datrtz DdD3dns Water rw,sm 0 AU DateUllmes are Aladu Standard Tlma Prinkd Data/rlme 03/23/2004 10:311 C*Decbd Data rIme 03/17/1004 14.00 RaeaivedI)MOMme 03/171200415.07 TaftkalDlrecter i. -"ea6Ede Ymp1e Remedu: ,WXVW Rerxhs FOL Ws Moe Ctatala:rIDFOL Ail to ego a 1nko + 1ns tators D"rtxant Nitau-N 0.10011 0.10D mIVL EPA300.0 B (4-10) 03/11/04 7JB licrebielogy laboratory 7oul Collform 0 coVl00mL $MIS=B A (4-1) 03/17/04 DPT