HomeMy WebLinkAboutKNIK HEIGHTS BLK C LT 11KnI*k Heights
Block C
Lot I I
#017-034-29
Municipality of Anchorage
Development Services Department
Building Safety Division
on -Site Water and Wastewater Program. 4700 South Bragaw Street
P.O. Box 196650 Anchorage. AK 995136650 Pagel of 3
www.cl.anchorage.ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SW SW050452 PID Number: 017-034-29
Nave
Wastewater System: ❑ New ® Upgrade
Dana Rnhds
Address' hertnn Rd. Anch. AK q9516
ABSORPTION FIELD
Fume: Numbsn of Searome:
® Deep Tnmm 0 Shan" Tmgn 13 eat O Mound D otw.
Sd Paring:
Tota Depth homongirta grade:
LEGAL DESCRIPTION
&a#: Lot: subdNalan:
Depth to ppe bman hon anginal gale:
Gravel depth beneath pipe'
Towrstep: Pangs: Section:
FV added above mginal Valle'
0
Gravel Length:
65 FL
Grata wdlh:
Number of tinea: I Ustmce bet~ takes:
Well: ❑ New ❑ Upgrade
Cusvaonm (Presale. A. e. CT
Tota Depth:
Card to:
Total absorpnm wee:
Ppe MalarialExlst'
PVC. F810 HDPE
a
IL
Fl
Ft
3034
g
Deaer.
Dale Drilled:
SMac Water Leval:
1 1`1
MbA<r. Cfy e7
Date autened.
12/21/2005
Held: "Set at:
Casing Nephi Ab" GronM:
TANK
GPM FI.
i1
SEPARATION DISTANCES
® septic O Holding ❑ S.T.E.P: O Other.
To
Sep
Absorption
Un
Holding
blkJPdvate
ma'enaphRen�
Aneh Tank
capaaty.
1250ca1.
From
Tank
Tank
Field
Station
Tank
Sewer Line
Material:
Nuntw ot Cornpenmeota:
was
105.6
122.4
76
Steel
2
100+
100+
LIFT STATION
surface water
y,e;
Manulauwen
Lot tar
55
26.4
Gal
'pram m• level at:
•Pixro olr leM at:
wgn eater Yawn at:
Foundanm
30
46.9
hal
M
pump Make a Modal
daed b by
hspecaperm
FJam
wtainDrain
1 50+
50+
P«"�k+
BENCH MARK
Additional Percolation Test was performed as stated
t.onnm anal Deunpom:
permit,
Garage Man Door
Assumed EIMem:
100.0 FL
Engineers Stamp
r%,qkSwwwlJaa,
.• OF q h
Inspections performed by: PES. LLC Dates: 1"12/2112005
a9T" '•'��•
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i
2n01212112005
0,
Development Services Department approval
.,.
• stev Dnnone`
♦ '; ar
•j
Date:
J'e No. CE 8149 r `�
e� -� •,Q�(�
Reviewed and approved by:
,.•�.�
••�
(Pev. 12")
_ L ...
E�Jip:1b �.
PERMIT NO:SWO50452 RECORD DRAWING P.I.D. NO: 017-034-29
WASTEWATER DISPOSAL SYSTEM
LOT 11, BLOCK C KNIK HEIGHTS SID,
CID l�
0
�w
Q
`Y I
I 12
� W I
EXISTG SEPTIC
AREA
Exim I
WELL EXISTG SEPTIC 3
AREA � I
\ I
I
I
M\ r------- ---— — — — — —,
�,-----,�-----------,
100' WELL
4Y RADIUS
W NEW 12508 EXISTG SEPTIC
11
SEPTIC
TANK AREA
1224 .
%�,,. 7��,2.a
cwau omyc I 26.5 J
M M \
WELL
NOTES: 3) Maintain 10' to (100 JnpnJ
,)All work shall be performed b all lot lines and water Ines. BEDROOMS: 4
noted otherwise. AREA REQUIRED: 750 SF
. ••• • ••••••• �•
P'(• •„
'� ��
accordance with AMC15.65.
be b
unless
4) Lots served b commun 4 TRENCH: 6' EFF DEPTH
, •
��
•••••••'.>}
W
4L ;• 49 TM �.
A
8 C1 T2
DC1
46.3
22.6
DC2
53.8
46.2
T1
46.2
33.3
T2
51.0
41.1
Ct
49.3
50.0
M7
49.7
50.8
C2 66.8 60.6
M2 66.3 59.4
�r
L --- —I
3
EXISTG SEPTIC DESIGN CALCULATI(
AREA PERCOLATION
woo, V•eTr(11J RATF'
NEW UPGRAC
65LFxTWX
I
I
I
69.9 i
I
RC2 I
10
EXISTG UNDOCUMENTED
CRIB. ABANDONED IN PLACE
EXISTG UNDOCUMENTED I
SEPTIC TANK. ABANDONED I
IN PLACE. I
EXISTG SEPTIC I
AREA
RATE;
I
I
I
I
I
I
I
SAS
ED, 10' TO
I
I
I
I
I
I
LJ
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NOTES: 3) Maintain 10' to (100 JnpnJ
,)All work shall be performed b all lot lines and water Ines. BEDROOMS: 4
noted otherwise. AREA REQUIRED: 750 SF
. ••• • ••••••• �•
P'(• •„
'� ��
accordance with AMC15.65.
be b
unless
4) Lots served b commun 4 TRENCH: 6' EFF DEPTH
, •
��
•••••••'.>}
2) Materials used shas 65 LFz 6' ED, , 0' TD
accordance w'M those sped6ed water systems. No wells TOTAL AREA: 780 SF
4L ;• 49 TM �.
in AMC15.65, Wastewater
within 100' of proposed 10008 SEPTIC TANK
S
& .:.. + •...
Disposal.
PREPARED FOR:
system.
PANNONE ENG. SVC, LLC
w
Steven R. Pannone �
Dana Rhodes
P. O. BOX 102954
ANCHORAGE, ALASKA 99510
�� '• CE 9. �
�♦Q/��r(�•,.•'
12841 Atherton Drive
Anchorage, AK 99516
227-3522 P, 272-8218 Fax
229-7203
DATE: 01-04-06
PLAN
PERMIT NO:SWO50452 RECORD DRAWING DETAILS P.I.D. NO: 017-03429
WASTEWATER DISPOSAL SYSTEM
LOT 11, BLOCK C KNIK HEIGHTS SID,
O n
m n1
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4-i .nV 'A� b*
R.Pannone
Dana Rhodes
12641 Atherton Drive
Anchorage, AK 99516
229-7203
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R.Pannone
Dana Rhodes
12641 Atherton Drive
Anchorage, AK 99516
229-7203
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PANNONE ENG. SVC, LLC
P. O. BOX 102954
ANCHORAGE, ALASKA 99510
227-3522 P, 272-8218 Fax
DATE: 01-10-06 I
—� DETAILS
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PANNONE ENG. SVC, LLC
P. O. BOX 102954
ANCHORAGE, ALASKA 99510
227-3522 P, 272-8218 Fax
DATE: 01-10-06 I
—� DETAILS
SOILS LOG - PERCOLATION TEST
PANNONE ENGINEERING SERVICES
P.O. BOX 102954
ANCHORAGE, AK 99510
(907)272-8218
PERFORMED FOR: Dana Rhodes DATE PERFORMED: 12-23-05
LEGAL DESCRIPTION: LOT 11 Block C Knik Heights SID
I'
2
3
5
6
7
6
9
10
11
12
13
14
15
18
17
16
19
20
TEST HOLE 2
OR Organic root
M"
ML Brown SITU
SM Silly Sand
GP
BOH
Poorly graded
GRAVEL end
Sands
SLOPE
TEST
WAS GROUND WATER
ENCOUNTERED? N
IF YES, AT WHAT
DEPTHT
DEPTH TO WATER AFTER
MONITORING? DRY
DATE: 12-23-05
Testhole and Percolation test was performed as a requirement
stated in the permit
SLOPE
TH 2
READING DATE
CLOCK
TIME
NET TIME
WATER
LEVEL
READING
NETDROP
1 1243-05
1:14
61ne'
0'
2
1:44
30 MIN
2SNS'
334'
3
1.44
T
0'
4
2:14
30 MIN
2316'
3716'
5
2:44
6116'
v
6
3:14
1 30MIN
2316'
3314'
PEROLATION RATE 8 (mimmncn) PEKU HULt LII MLI 1:11 o males
TEST RUN BETWEEN 6.5 FT AND 7.5 FT
COMMENTS: Test Hole was presoaked before pert test.
Municipality of Anchorage
Development Services Department *A1
Building Safety DivisionOnsite Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 995195650
www.muni.org/onsite
(907)343-7904
ON-SITE SEWERIWELL SUBMITTAL COMMENT SHEET
To: Steve Pannone
Legal description: Knik Heights Block C Lot 11
The attached paperwork has been reviewed and is being returned for the following reasons:
❑ Original signature or stamp missing on
❑ Calculation error in design. _
❑ Additional soils information needed. _
❑ Water monitoring results inadequate.
® Discrepancy in Information submitted. bigger ban is NOT licensed to install septic systems
in the MOA.
❑ 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.
Name of reviewer. Te
Date: 1-25-06
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
MUNICIPALITY OF ANCHORAGE
Development Services 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 PERMIT
Upgrade
Permit Number: SWO50452
Legal Description: KNIK HEIGHTS BLK C LT 11
Date Issued: Dec 09, 2005
Expiration Date: Dec 09, 2006
Parcel ID: 017-034-29
Design Engineer: 0062 Pannone Engineering Services Site Address: 012641 ATHERTON RD
Owner Name: DANA RHODES Lot Size: 43500 SO. FT.
Owner Address: 12641 ATHERTON RD Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE. AK 99516-2914
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.
a.) This permit is being issued for a replacement on-site wastewater disposal system for a three-bedroom dwelling.
The system Is being sized for four bedrooms. This system cannot be approved for four bedrooms because a
four-bedroom reserve site has not been designed.
b.) Prior to construction, an additional percolation test with water levels measured at 30 minute intervals shall be
conducted. Percolation test results shall be submitted to this office with the Inspection Report.
Issued By:
-o �R
Date:
�. -M 0170"421
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. 017.034.29 Permit Number SW
Property owner(s) Mr. Dana Rhodes Day phone 229.7203
Mailing address (1)12641 Atherton Road
Mailing address (2) Anchorage, AK Zip Code 99516
Legal description (Lot, Block & Sub'd.) Lot 11, Block C Knik Heights
Legal description (Section, Township & Range) Site Adress:12641 Atherton
Lot Size 43,500 Acres/Sq.Ft. Number of Bedrooms 3
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade 123
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
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.
Pavane Ergineerinp Service, LLC
Po Box 102954 9 )ly ' Z (L06)
Q190
(Signature of property owner or authorized agent) ap, AK 9010 ip x �—
(907) 272 E218 Oil 'GOINDS i6u3 euouued
Permit Fees: () 1175 k)Waiver Fees:
Date of Payment:II0 ✓ Date of Payment:
Receipt Number: .7y9_03 Receipt Number:
(Rev. 12/00)
Pannone Engineering Services, LLC
Consulting Engineers
December 7, 2005
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 S. Bragaw Street
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Lot 11, Block C Knik Heights S/D
Septic System Upgrade Permit Request
Ladies and Gentlemen:
P.O. Box 102954
ige, Alaska, 99510
I am writing to request a permit to construct an upgrade septic system be issued for this
property. The proposed systems will serve an existing three-bedroom house. The well is
located in the western portion of the lot, over 100 feet from the proposed upgrade septic
system. The existing system is undocumented and is assumed to have been constructed
during the time the house was build, approximately 1971.
1. Soils. See the attached soils log. Ground water was monitored for seven days. No
ground water was encountered in the test hole while excavating it, nor after the water -
monitoring period. Bedrock was not encountered in the test hole. It is my opinion that
the overall soils appearance of the soils, an application rate of 0.8 gallons/day/square
feet should be used using a conventional treatment system.
2. Trench Design.
a.
Percolation Rate:
b.
Application Rate:
c.
Number of Bedrooms:
d.
Design Flow:
e.
Min. Absorption Area:
L
Total depth:
g.
Effective Depth:
h.
Width:
i.
Reduction Factor:
j.
Minimum Length:
k.
Design Length:
1.
Effective Absorption Area:
m. Septic Tank Size:
Cont'd on page 2
C:\Work\Letters\11-C Knik Heights.doc
5-15 Min Per Inch
0.8 gpdpsf
4
600 gallons per day
750 sf
10 feet
6 feet
3 feet
0.0
62.5 feet
65 feet
780 sf
1250 gallon.
Page 2
3. Surface Water: There is no surface water within 100 feet of the proposed system.
The proposed systems will maintain at least 100 feet from all surface water and drainage
ditches.
4. Topography: The average topography in the area of the proposed septic system is
approximately 2 percent in the area of the SAS. The proposed system will be installed at
the bottom of a small hill in the back yard.
The proposed installation will not affect the future development of the surrounding or
existing lots. There are no wells or septic systems within 100 feet of the proposed septic
location. The new septic tank will be installed outside the 100 foot well radius.
If you have any questions or concerns, please contact me at 227-3522 or 272-8218.
Sincerely,
..fir:•...- --. �
teven R. an oneP.E. ? 49LH
..
Civil Engineer
Attachments:
C:\WORK\LETTERS\11-C KNIK HEIGHTSMOC
,en R. Ponn<
No. CE 8149
PERMIT NO:SW05 DESIGN DRAWING P.I.D. NO: 017-034-29
WASTEWATER DISPOSAL SYSTEM
LOT 11, BLOCK C KNIK HEIGHTS SID,
h,
W
12 EXISTG BE
I
I
AR E
EXISTG
WELL J 3
EXISTG SEPTIC I
I
\ AREA
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M M
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'�----
Q_
WELL
RA I
RADIUS I
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I
EXISTG SEPTIC
I
NEW 12509 AREA
W
117'1 �\ SEPTIC TANK I
I
EXISTG
4 2 I
I
I
WELL cs�vr. tx+rv[ I
2 481TH1
I
'J\��J�r PROPOSED UPG
E SAS
104,4
65LFx3'WX6'
0
g 29.5 1
,
,m
1
oo5nxc .'�.;..; 12 J \\� 73.2 I
I
m 2% EXISTG UNDOCUME14TE
I
31.4—CRIB. ABANDON IN pl:AC
L _
EXISTG 7- '
WELL L------------------)
f —
jy EXISTG UNDOCUMENTED I
I
SEPTIC TANK. ABANDON I
I
W IN PLACE. I
I € S
I
I 5 '-
3 EXISTG SEPTIC
10 AREA
I
I
XIsm SEPTIC I
I
AREA
DESIGN CALCULATIONS:,
' PERCOLATION RATE; 5-1$
MPI
APPLICATION RATE: b.8
GPDSF
„����
alines swateraAnestion a
�.�*"�'
�1
andntain
)) Allworkshall be performed H all of BEDROOMS: 4
Q, '• ......••••••..,•
accordance with AMC15.65. unless noted otherwise. AREA REQUIRED: 750 SF
��
•• �1
2) Materials used shall be in 4) Lots served by community TRENCH: 6' EFF DEPTH
'•
�I
accordance with those specified water systems. No wells 65 LFx WED. 10' TD
i 49 nrA[V7
in AMC15.65, Wastewater within 100' of proposed TOTAL AREA: 780 SF
�•••••• •- ••••••......s•••••j
Disposal. system. 1000gSEPTIC TANK
•• ••,••••••••••• •...........:.
• Steven R. Pannone ?�
PREPARED FOR:
Dana Rhodes
PANNONE ENG. SVC, LLC
P. O. BOX 102954
♦� '•., , '
�:
12641 Allerton Drive
AK 99516
Anchorag�pY
ANCHORAGE, ALASKA 99510
227-3522 P, 272-8218 Fax
♦�� .�
229-7203e•
DATE: 12.7-05
PLAN
,,, • , ��'
SCALE: 1•=50'
PERMIT NO:SW05 DESIGN DRAWING DETAILS P.I.D. NO: 017-034-29
WASTEWATER DISPOSAL SYSTEM
LOT 11, BLOCK C KNIK HEIGHTS S/D,
arra 1oV3 iv
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•
• PREPARED FOR:
�""•'•""' • PANNONE ENG. SVC, LLC
•Steven R. Pannone Dana Rhodes
P. O. BOX 102954
♦(` ' ' 12641 Atherton Drive
�. /�j E 814 , . ANCHORAGE, ALASKA 99510
C` .S12i. i Anchorage, AK 99518
�® . • 229-7203 227522 P, 272-8218 Fax
•��1411
, ;\:.��� DATE: 12.7-05 DETAILS
lklk%SCALE: NTS
SOILS LOG - PERCOLATION TEST ♦♦♦� ������
PANNONE ENGINEERING SERVICES : CDD
P.O. BOX 102954
ANCHORAGE, AK 99510 • """""""""T""'0
0
(907) 272-82181. ............ .................. �•�.Steven R. Pannone
ar
'• CE 8149
PERFORMED FOR: Dana Rhodes DATE PERFORMED: 12-1-05 ��j•f.......... %:•''�i
LEGAL DESCRIPTION: LOT 11. BLOCK C Knik Heights SID ���4�, ' ;;♦�♦♦♦
TEST HOLE 1 SLOPE SITE PLAN I
Root Masa \ /
I OR
2 Broom Silts O
SM Silty Sand O \ .�•�
5 -
Lu
11
8 GP Poorly graded TEST h t rTNI
GRAVEL and HOLE
Sande .�' r •.,
9 \ %
10 \ A r________________
\
11 \ 1i L________________
12
GP PoortYgraded
13 GRAVEL
WAS GROUND WATER SLOPE
14 ENCOUNTERED? N
15 IF YES, AT WHAT TH 1
DEPTH? -0-'
18
DEPTH TO WATER AFTER
17 MONITORING? -DRY-
18 BOH DATE: 12.8-05
19
READING GATE CLOCK WATER
20
PEROLATION RATE 10 (minAnch) PERC HOLE DIAMETER 6Inches
TEST RUN BETWEEN 6 FT AND 7 FT
COMMENTS: Test hole excavated by Tom w/Dip,Rer Dans. Test Hole was presoaked before perc test.
PERFORMED BY: Scott Crowther, 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.
TIME NET TIME LEVEL NET DROP
READING
1 13.1-05 11:52 T 0'
3 13:02 IO MIN 6' 1'
0 13:02 T 0'
4 12:12 10 MIN 5' 1'
5 12:12 C 0'
6 13:33 10 MIN 5' I.
-V�2
Municipality of Anchorage
• Development Services Department ='
Building Safety Division t
On -Site Water and Wastewater Program s ° r °
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
Parcell.D. 017-034-29 COSA #_
Expiration Date: I'f' — 3 D — O &
1. GENERAL INFORMATION
Complete legal description _Lot 11 Block C Knik Heights
Location (site address) 12641 Atherton, Anchorage, AK 99516
Current Property owner(s) Dana Rhodes b Pamela Costillo Day phone 243-2003
Mailing address 12641 Atherton, Anchorage AK 99516
Lending agency Day phone
Mailing address
Real Estate Agent _Bob CampbelVDvnamic Properties Day phone 243.2003
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
19
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank
❑
Community On-site
❑
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 Onsite 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 102954, Anchorage, AK 99510-2954
Engineer's Printed Name Steven R. Pannone Date 1112/06
5. DSD SIGNATURE s cCEy-81�49F;. SIV
L/ Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
az /— Original Certificate Date: [ 3 `0 in
(Rw. 1IMS)
1
Municipality of Anchorage
• Development Services Department °
Building Safety Division ^
On -Site Water & Wastewater Program '
4700 Bragaw Street
P.O. Box 198550
Anchorage, AK 995198550
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: _Lot 11 Block C Knik Heights Parcel ID: 017-M29
A. WELL DATA
Well type P If A, B. or C provide PWSID # _
Date completed '�/ 1970 Sanitary seal (Y/N) y
Total depth 144+ ft. Cased to eft.
FROM WELL LOG
Date of test
Static water level ." ft.
Well production 9.p -m.
WATER SAMPLE RESULTS:
Coliform _9_colonies/100 mL Nitrate 2.07 mg/L
Arsenic:54F0011 Date of sample: 11HOM
If13 0
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Anchorage Tank Steel
Tank size 1250 gal. Number of Compartments 2
Well Log (Y/N) N
Wires properly protected (Y/N)
Casing height (above ground) 13 in.
AT INSPECTION
11110@005
7O R
2.1 g.p.m.
Other bacteria _ colonies/100 mL
Collected by: Laura Pannone
Date installed 12►T1MS
Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) NIA
Date of pumping Pumper Now
C. ABSORPTION FIELD DATA
Date installed 120112005 Soil rating (g.p.d./fe or felbdrm)" System type Deco Trench
Length lis fL Width 3 ft. Gravel below pipe 6 ft.
Total depth jP fL Eff. absorption area ZMfe Monitoring tube Y Depression over field N
Date of adequacy test 'Ue-Lu Results (Pass/Fail) Pass For 2 bedrooms
Fluid depth in absorption field before test — in. Water added= gal. New depth= in.
Elapsed Time: = min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) no If yes, give date
7
D. UFT STATION
Date installed
'Pump on' level at_ in.
Datum
Manhole/Access (Y/N)
High water alarm level at in.
Meets alarm 6 circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 105.6 On adjacent lots 100+
Absorption field on lot 122A On adjacent lots _100+
Public sewer main 100+ Public sewer manhole/cleanout 100+
Sewer /septic service line 25+ Holding tank 100+
Animal containment areas 100+ Manure/animal excrete storage areas 100+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 30 Property line _N Absorption field 13
Water main 100+ Water service line 25+ Surface water 100+
Wells on adjacent lots 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line _28.4 Building foundation 46.9 Water main 100+
Water Service line 25+ Surface water 100+ Driveway, parkirg/vehide storag0 -5+
Curtain drain None Observed Wells on adjacent lots 100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field ins
/bug pBCtlOns arKl p`•„� � �� ..:> s,�v . }
review of Municipal records that the above systems are in % s ° t,
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven R. Pannone r?,� Sreven R. Penn • I r.
8149 ' =1
Date
r,
COSA Fee $ lk
Date of Payment _ f — �Z-
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
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SCS ReEN
1060232001
Client Name
Pannone Eng. Srv.
Project Name/®
Lot I I Bk C Knik fits
Client Sample ID
Lot I I Bk C Knik Fits
MaMx
Drinking Water
P%VSID
0
Samplc Remarks:
All Dates/Times are Alaska Standard Time
PrintedDate/fime 01/20/2006 16:39
CollectedDate/fime 01/132006 11:30
Received Date/time 01/132006 11:50
Technical Director Stephen C. Ede
Allowable Prep Analysis
Parameter Results PQL Units Method Conminer ID Limits Date Date Init
Metals by ICP/MS
Arsenic 5.00 U 5.00 ug/L EP200.8
A 01/16/06 0120/06 SCL
11—L1—U:111:44 i
SG$-
SGS
1057555001
ClcntNaoa
P1ltmoneEag.Srv.
Project NmcA
Lot 11 Blk C Koik Hgts
CRont Sample 1D
Lot 1 l Blk C Knik Hllb
Matrix
Drinking Water
1dU1 bti beUl A 21 4
All DatmMmes are Alaska Standard Time
Printed DateMme
11/162003 13:03
CotloctedDotofnme
11/1100513:30
Reed"Abaterrlme
11110200514:33
TeeMlealDlrmor
SteohmC.Ede
Pwsm 0
Sample Remarks:
3532 • Sample initially ran wid= passing Qa. m= pea bold time nitb passioll QCS to verity results.
Allowable hep Aculysts
Parameter Rands PQL U61A tkdwd Ccnu6wtD Limbs Date Dam Gk
Nitrate -N 2.07 0.100 mpg, EPA353.2 B (x+101 11/100 AZS
xlc1.0blo2eix Laboratory
ToWColitbrm 0 coVl00TL SM209222B A (c -l) 11110' TO
