The URL can be used to link to this page

Home My WebLink AboutBRUIN PARK FIRST ADDITION BLK 9 TR A NW CORNERBruin Park First Addn. Tract A NW Corner Block 9 #016-112-17 Municipality of Anchorage '• Department of Health and Human Services ttw ,d Building Safety Division ' On -Sae Water and Wastewater Program, 4700 South Bragaw Street - Page 1 of 3 P.O. Box 196650 Anchorage, AK 995191650 9 www.ci.anchorage.ek.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWSW010319 PID Number: 016-112-17 wm. Wastewater System: ❑ New ® Upgrade Addr.m ABSORPTION FIELD PMM thonb.r of B.dra.n. ® Deep Tnrcn O Sb.pow Trench O B.d O Mound O Dewe SN Fbenp Tobd Depth Wan *MWW oracle LEGAL DESCRIPTION 0.6 C.MTt' Brodr L& Subdivision: Depth b p e boom Wan oMYinel Wade Grnd depth MMM WW: TewmNp R.•Wsection. Fe.dd.d.bov. or" WO" GmN L«pN. 57 F. Grw.l wMth: Numb« d M. I Debnc. b w knee. Well: ❑ New ❑ Upgrade 3 R. 1 0 P, cba+M.wbar LPm•b. A. S. Ct: Taa..caral � ToW•bamption ver. 798 Fr Pro. Ma 3034 PVC Existin Fl n Q,,,r wb claw sax w.br L.vN bnLn.r Anch Excav & Conc Dab enr.a.d 8/16/2001 A Y*w PmpSoat.. G'3ti°"w"'wa"c4ound: TANK GPM fl. R SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other Septic Tank Absorption Feld Litt Station Holding Tank Pubr Sewer unit, L'Vxd qc' Anch Tank c"Wer 1000G.1 MM«W: Numb« of canp«b..r�b: 105 122 99 Steel 2 p 100+ 100+ LIFT STATION 33 20 Gr pump On'IMa 'Pu^O.IFNwIa FIgn OM.rN«mK Fa.W.Eon 6 23 in n ti ". Pv.p MNu a Mo" Yap.cs.m PNam.d L7 Corbin DNn 100+ 100+ Rene"n" BENCH MARK Exist'g tank and Crib removed. Well wires were L.r.bon.rw pnapem: property protected & sanitary seal installed on August Well Head Assunud ENv.bon. 24, 2001. 103.5 FL Engineers Stamp ♦♦♦aaaaasa, ♦ �� 0♦i Inspections performed by: Pannone Eng. Svc Dates: 18/16/2001 i 49TH _4 —.4 2nd08/16/2001 Department of Health and Human Services approval o �'sleven R. Pannone] 4 Reviewed and approved by: Date: /117 ♦jc N CE 8149 6� (R ♦♦aaa'; t.55;a ♦♦ ♦ PERMIT NO. SWO1319 AS -BUILT PID NO. 016-112-17 WASTEWATER ABSORPTION SYSTEM iTRAC A, BLX9BIN PARK SUBD.__........R 17/87�� UNDER SEPERATE G; EXIST. WELL MONA AVE. EXIST. WELL EXIST. WELL 49M EXIST. WEI INSTALLED SEE NOTE ___FCI. , I C -S=s pc N2 _3Fg�gML �C C, 1 TP1 THIS TRACT UNDEVELOPED NO WELLS OR SEPTICS WITH- IN 200' OF PROPOSED SYSTEM 7' 3 57 R. Pannonef KDean Sherman CE Bios �: P.O. Box 110474 Anchorage, AK 99511 I, 1 (907) 349-1775 p EXIST. 1000 0 IC TANK SYSTEM TLLS TGCT MWOF EXIST.* WELL Perc Rate 24 Min/Inch Soils= 250 sf,/br 3 Bedroom H6Use 750 SF Rqd -••_. .._.-- AS-BUILTI 7' Effective 10' Total Depth 3' Wide, 57' Long Total Absorption = 7985f Pannone Eng. Svc., LLC P. O. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218, PHONE L FAX ATEA 9-9-01 AS -BUILT ZrALFs •- PERMIT NO. SWO131 9 AS -BUILT DETAILS PID NO, 016-112-17 WASTEWATER ABSORPTION SYSTEM TRACT A, BLOCK 9 BRUIN PARK SUED, CO A B FC 32.0 12.6 Tl 33.5 13.9 IM NUM T2 36.4 17.4 DC 37.4 20.0 Cl 61.2 32.8 Ml 58.5 311 C2 24.5 54.0 M2 24.7 52.6 E Drawing Ci\Vork\A-9BRUIN.DVG ` lyS 49TM t w rl R. Pannone 8149 \ Dean Sherman � 4 �� P.O. Box 110474 Anchorage, AK 99511 FEV (907) 349-1775 38n1 baImT iM NV3'1 I(n NV3M Ino NUM Ira NV3M Inn NV3M mva� N w v! iz crc ra 11J J r -i L�. O Ct' 0_ Pannone Eng. Svc., LLC P. ❑. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218 PHONE & FAX ATE, 9-9-01 1AS-BUILT 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 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO10319 Date Issued: Aug 14, 2001 Expiration Date: Aug 14, 2002 Parcel ID: 016-112-17 Legal Description: BRUIN PARK FIRST ADDITION BLK 9 TR A NW CORNER Design Engineer. 0062 Pannone Engineering Services Site Address: Owner Name: Dean Sherman Lot Size: 19600 SQ. FT. Owner Address: PO BOX 110474 Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99511-0474 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. i 5. The following special provisions. WATER WELL SHALL HAVE A SANITARY SEAL AND WELL WIRES PROTECTED BY AUGUST 24, 2001. Received Issued Date: T ( Date: 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.ek.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING 0 6 Parcel I.D. 016-112.17 Permit Number SW O/ 0319 Property owners) Dean Shermaaqn�� Day phone 349.1775 Mailing address (1) P.O. Box 11M � Mailing address (2) Anchorage, AK Zip Code 99511 N w c.00Ar`9-. Legal description (Lot, Block & Sub'd.) Tract A, Block 9 Bruin Park SID Legal description (Section, Township & Range) Lot Size, 000— Acres/Sq.Ft. /1' 4aa THIS APPLICATION IS FOR: Number of Bedrooms Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ® LVULTo�TP"nG SYSTc_1 121 L✓ a.1 v LTCL 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. (Signature of property owner or authorized agent) Permit Fees:{ �: ':T 7 OC V Waiver Fees: Date of Payment: // L/ V I Date of Payment: Receipt Number. l0 (n Receipt Number. (Rev. 12100) rol Pannone Engineering Services, LLC P.O. Box 102954 Consulting Engineers Anchorage, Alaska, 99510 (907) 272-8218 (907) 272-8218 Fax June 30, 2001 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519 Subject: Tract A, Block 9 Bruin Park Subdivision Septic Upgrade Permit/ Waiver Request FAILED SYSTEM Gentlemen: My firm was contacted to conduct a Health Authority Investigation of the well and septic system serving this lot for a pending refinancing and new house construction. There are two existing system on this lot. They are connected by a four -inch solid pipe. Both systems were completely inundated with liquid. In addition, the second system is partially located off the property. The fluid levels were approximately two to three inches above the lateral pipe. I informed the owners that the systems were in failure. The owners requested my firm investigate the possibility of installing a replacement system large enough to accommodate the new four-bedroom house. A single test hole was excavated on June 17, 2001. The soils report and a percolation test result is attached. Ground water was monitored for seven days. No groundwater or bedrock was encountered in the test hole. The lot is approximately 0.5 acres in size. Tract A slopes to the south at approximately 1 to 2 percent. The proposed installation will be located in the middle portion of the lot. The existing fields will be abandoned. The septic tank will be abandoned during the installation. A new 1,250 -gallon tank will be installed outside the well radius. Double clean -outs will be installed down stream from the tank. The proposed location is greater than 100 feet away from the existing well serving this property and 25 feet from the water service lines. The surrounding wells are located greater than 100 feet from the proposed installation. The proposed installation will not affect the future development of the surrounding or existing lots. See the attached design. The existing well is located approximately 81 feet from the neighboring septic system located across Forest Drive. A waiver for the separation distance follows under the next section. If a waiver cannot be obtained, the well will be moved (after a permit to construct is obtained from MOA DHHS). The proposed septic system is located far enough from the well that if the well needs to be moved, the new well radius will not encroach on the proposed septic location. WAIVER REQUEST I am requesting a separation distance waiver between the existing well and the existing drain field on Lot 13, Block 4 Bruin Park, located due north of the referenced property. The distance measures out to 81 feet between the drainfield's nearest point and the well on Tract A. The drain field was installed in July of 1987, and the well drilled in October of 1988. Attached is a site plan showing the adjacent properties, general site topography and approximate location of wells on each lot. Tract A is approximately 0.5 acre in size. The lot slopes to the south. The well is situated approximately 20 feet northern property line. The well log for the well on this lot was found in your records. The well is 113 feet deep. Clay and silts were recorded for the first 111 feet of this well. I found that it is cased to over 40 feet, the static water level was 91 feet below ground. The ground water in this area typically flows from the east to the west. A well flow test showed the static water lowered thirteen (13) feet while flowing at approximately 6 G.P.M. The soils on the adjacent lot were logged to be silty sand to silty gravel to a depth of 175 feet below ground. No water was encountered above the silt layer. As outlined under 18 AAC 80.020 and 18 AAC 72.021(a), I have calculated the following points: Distance from sewer system bottom to groundwater 7.0 Soil sorption below sewage system 3.5 Soil permeability below the system 1.5 Water table gradient 6.5 Horizontal separation 2_5 Total Points 21.0 16-25 Almost sure to be free from any form of contamination from household sewage. In my opinion, this waiver request meets the above criteria for approval and does not constitute risk to health. I hope the above information will assist you in determining that the waiver should be granted. If you have any questions or concerns, please contact me at 227-3522 or 272-8218. Sincerely teven R. annone, P.E. Attachments: DESIGN WASTEWATER ABSORPTION SYSTEM (BRAC A, BLOCK 9 B IN PARK SUBD. I I I • EXIST DRAIN FIW .6 / INSTALLED 7lp BMITr UNDER COVER EXIST. 0 EXIST. VELL MONA AVE. +ioo 0 EXIST. _......__ --, Imr. AColM artrot PROPOSED SY :TEM- - r�' /f 1250 6 SEPTI TANK IL m BE Aa"m84CO 65 LF DEEP RENCH.I t>c0 1 nlr San �tr�t — — — ron Ttucr WEVavm I MT C_:,, , r' NO Vnas U vers Vm+- 8 TPA — — 12 V4 1W OFPaL7�D SUM Be, EXIST. WELL I✓� I EXIST YELL SLED t ro+�FAnum TO BE ♦ i RANDOMED THIS TRACT UNDEVELOPED DESIGN11 No VELLS OR SEPTICS WITH- IN 200' OF PROPOSED SYSTEM Perc Rate\= 24 Mln/Inch c EXIST. VELL Soils= 250 5f/br �NqB 9 OF`j j 4 Bedroom Hous •-� ;� � O+.♦. ni Rqd . 1 Des �`. 9' Designs 9' Effective 12' Total Depth 49TM,�� 3 65 3' Wide, 65' Long ^. Drarin O\York\A-9BRUINDVG Total Absorption = 1170 sf PREPARED FOR, Pannone Eng. Svc., LLC Steven R.Pannone]a' Dean Sherman P. O. BOX 102954 lk ��649'� P.O. Box 110474 ANCHORAGE, ALASKA 99510 ♦ Anchorage, AK 99511 272-8218, PHONE & FAX to Not (907) 349-1775 ATEo 6-30-01 DESIGN SrAl Fi DESIGN DETAILS WASTEWATER a;pPTION32tM TRACT A, BLOCK 9 BRUIN PARK SUBD. ~ £ I � { ! � i � { . � § m= _N - ! �° 2 d { \ _ _m h E >�V,�\' .52 ( : 2 � 91 _ m= d |2 n -gc w� a v IM � / (� W,£ Ctit F ina�V§ ■z Clm IN _ _0 so .— fQm& PREPARED FOR, Pannone m&S�.�c •o, - Dean Sherman m 0. BOX 102954 _ ft mc.Box iop4 ANCHORAGE, ALASKA mSo + ' _- Anchorage, 0) 7g�inoZPHONE & FAX (7349i75 DESIGN �paaapff f 80118 Loo - PRRCOLATION TSS" :. P "'�� V•i� PANNONE ENGINEERING SERVICES, LLC P.O. BOX 102954 i�J 492 ANCHORAGE, AK 99510 • 90 272-8218 / .. • � � Steven R. Pannone! a No. CE 8149�� C� 06 - �'• PERFORMED FOR Mr. Dean Shelman DATE PERFORMED: 6-17-01 LEGAL DESCRIPTION, Tract A Block 9 Bruin Park S/D ffif' etaPe i arra PIAN 1 OR Orvanic- 3 oR Root Mass TEST HOLE c 6 �w. 0M.., . 11Mn111 6 n��- ., r- i 7Brown ants F:..,. UL 9 � 7P.1 , 10- 11- 12 011 12 \� 13 WAS GROUND WATER SLAPS 14 ENCOUNTERED? No IS IF YES, AT WHAT 16 ST DEPTH? — TEHOLE 8x enry Bends DEPTH TO WATER AFTER 17 MONITORING? 18 DATE: 6-29-01 19 BOH 20 PEROIATION RATE 24 (min/inch) FERC HOLE DIAMETER 6 inches TEST RUN BEWTEEN 7 FT and 8 FT COMMENTS: Teat hole excavated by Owner. Perc Hole wan presoaked. PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. ■_■ ' ®tom ��t1s� WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a GeophysicolSurveys LOCATION OF WELL (PleOle complete olfhlr la~ lb or lc,) A.D.L. No. , , 8oroug,~ Subd~,le~o. : Lot B~ock~ ~] '/4,frs. S.c,o, No.TOw.eh~,NE:3Range ED ",..' '-,... '- '~'~ "'"' "-'"" ;h .. ,:. [,~:., ,- '.. o.~.~,. ~ k~ ~) ¢ Feet Below 4. WELL DEPTH: (final) 5. DATE OF COMPL[TIO~ WELL LO~ Surface ~',. / ,P, / 7 / l / / D A.., ~""" D""' D (' ' .... ~ Publl~ Supply ~ I.dultry .... ~ T.~t W*ll ~ Otb. r: , . . ~. OAIINg~ ~ Threa~e~ Wlldld diam. ~ In. to //.~ It, Depth Weight diam. in. to ft. Depth Stlckup .... 9. FINISH OF WELL: . Typo: Diameter:, , Slat/Mesh Sill: Length: Sit between ft, and Backfilling Grevel pock , ~, ~o. sTATic W~ L~V~L: ~ ~ .. /~/~;.~ Dote , , , ~ Above or ~ Bel°~ ~and lurfaee , , Equipmant ~ed: ~ " ~u'h~cm~b~ o~ ~c~h~ ' ................... ~___.~.,~F~ II. PUMPINO LEVEL below)./I°od lurfgoe and YIELD .,~'~ _ ~NVIRONMENTAL PROTE lION _ C~ / ft. offer , ~, ih~l, pumplflg~ ft. offar hrl. pumping g,p.m. ..... NOV 1019~3 ,~.o,o~,,,o w.,, o.ou,.d: D'.. ~.o Material: ~Neat Cem,nf ~Othlr: H~ T ............. Length of Dro~ Pipe . fl; cepe~ifv ~g.p,m. 14. REMARKS: WATER CONTRACTOR'S GERTIFICATION: 15. Water Temperature o ~ F ~ C WELL Thlt will lei drill'ed under my jurisdiction Ond this report Is true to the best of my knowledge and bellef~ Regillere~ Business Nome Contract License Number 8114/2001 Municipahty of Anchorage George P. IVuerch, Mayor Department or Public Works Bolding Safcty Di -s ision P.O. Box 1900 a 4700 S. Bragaw Street Anchorage, Alaska 99519.6650 a (907) 343.8301 lute://��r.ct.nnchorngc.ak.us Steven R. Pannone, PE Pannone Engineering Services, LLC P.O. Box 102954 Anchorage, Alaska 99510-2954 Subject: Waiver Request for Bruin Park First Addition Block 9 Tract A NW Comer Waiver Request NWRO10048 Parcel ID 9016-112-17 Permit Number SW010319 Dear Mr. Pannone: Your request for a waiver of the required 100 feet horizontal separation from the absorption field to private well has been approved. The approved separation distance is 81.0 feet. The approved separation is from the absorption field located on Bruin Park Subd. Block 4 Lot 13 to the private well on the subject property. This waiver approval applies to the existing absorption field to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Daniel J. Roth Civil Engineer On -Site Water & Wastewater Program m i1 _ r- wmvER REQUEST fm pRaw /°ARK sueQ pL ock `/ TIK/K WAIVER RiQuEST NiIMgE/( Lv1?aX48 0 wA/VER DQE oac S r FOR OA/- /-Or wr4rbR k✓ni- TO SEOrIc f yf m t. Asfoltt FIFLO Iarcltoss TKE rmeevr oN Lor /3 040CR 4 BRulA/l°AR,r 5'wBOI✓lX14 6E'Rr c P// TI9 — TKF sEvr/c #asomPTIDN )'/ELD lAo QuEfrfcw wAf covfTRocrov IA.Jaty /91 TNF Ssn-t TKE /9DJoRPrioA,- F/Et0 /f ! PNxrRKtrrO lo' AAE ML / f/tT PE12CotgTES *r 30 NlvllA/cov. TK/1 SO/t it rYR/c.94Lr TNF B6JT FOR TR EAT/Nb f6/Tic rAmK Ef& 4tAr /Al * 5-Alog7 D/fr*Acz-. rHt SE'.PT/C AOSORMOM FIELV IS L064rF0 DUE NOIQTN OAPUC G.fiLt IvQKtrTlo, OA/ TKE f4 -M.0 Hr PN4-aLic GOA/7-09K /%s rKf +rfLL Iw Qu6fTiaAi IN EL L _ /)#rp — TUE warER wELL /A. QµEJr1041IS //3 FFt'r prs:10 wATER /S ENlO✓AITERFO /r}T /ll fE6T DEEP Au0 THE CAIS/ab OfNATKi}TACT TNROub-y 6kowMOSKKFACf fTi9RT/mob l�q'!! 9 �g�4a�� f��Yro7�FfEr THEA/ A 'S IL T l 7v // /. F6E%� Tjyl-r If Ctx r.4/RELY 4 e*oAF1v to 190.41AE /IT /// Ferr wctt P/tvmarp Pwoot s"nmeE CoA/rl4W/A,.*",r s. THE &,yo (fOf/YrAb.� is MEL.&VVrtY PL14T -/lv. 774If NRER. T{ERE if of 1?01+006T�6.4iA 17-M WELL 141 q"£Sr>ON l9ND 77it AAfox?7't4, PI&P. / M M U N I C I P A L I T Y O F A N C H O R A G E Department of Health S< Human Services 825 L Street, Anchorage, Alaska 99501 343-472G 1/7+y O N- S I T E W E L L P E R M I T 000238 Dal.- Tssued: 10/21/88 Owner- i) ...... _ : MARUIN F. BAILEY Day Phone: Oh nar Pn.drrss: 11441 READER RD. 349-9804 ANCIIUI r;°1 , At-, 9'i516 P,:,r cr-1 Iit: 016-112-17 Lnt I : i,.: r. cion: BRUIN PARK ADD. #1 Lot: - Block.: 9 Section: 20 Township: 12N Range: 3W ItOlCT A Lot Size 0.5 A (sq.f't. or acres) Ma.;: L:; •,L ,;:,ms: this Permit: 0 Total Capacity: 2 6111I.: Lug must be submitted to Municipality of Anchorage Department of Health ,:and 'Ic•i ..ices within 30 days of well completion. I CLI,,t I Y THAI: 1. f. am fa;::,;!iar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the Stat.c of Alaska. 2. 1 will install i1n.=,y_atm in accordance with all MOA codes and regulations, .ainl in compliance with the design criteria of this permit. 7. T .!ill rI Lu all MOA and State of Alaska requirements for the set back: r•j•.lances from any existing well, wastewater disposal sy�70r-fli or public c.ytitem on this or any adjacent or nearby lot. 4. 1 „rnd�•rstand that this permit is valid for a maximum of 0 bedroums. I ! i,d that the capacity of the total system is 2 bedrooms and Any enlargement will require an additional permit. f.;igr; ------ DATE: sr (Owner) MA'IJIN I . DA LEY DOTE:�j/ Dy3 B MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION i ENVIRONMENTAL ENGINEERING DIVISION 625 L Straat • Amhorep, Alaska 89501 Tolephon@ 264,4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE 30 ❑UPGRADE MAILING ADDRESS LEGAL DESCRIPTION F LOCATION NO. OF BEDROOMS VY Weil DISTANCE TO: I Ablorpoon ares Dwelling PERMIT NO. Manufacturer Material No, of compartment Lia e•pecltY In gellom )o If NOMEMADE: I� InsiW length Y6dN Liquid depth Y DISTANCE TO: Wcll Dwoning PCRMIT NO. Tli _ fd•nufattur•r Wt• ul Liquid comeity in gallon, DISTANCE TO: wan ound•oon wrest lot Iine PERMITNO. H No, of linin Lengthof jch�lln� Totallength of lines Trench width Inches Distance between Mina r op of we to finish 2 LWarier ZL beneath tl sotal -2 inMa effective 861D tion ease g W D Length apt E 1 aSai1 Type of crib Crib diameter Crib depth Total effective atuorptlon gree Nr DISTANCE TO: well Build no foundation Nearest lot line J Clan Depth Driller Outenu to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption arab) OTHER PIPE MATERIA 4 -3 SOIL TEST RATING INSTALLER e REMARKS G 1 APPROVED DATE L4GAL "� - Ar- . AST r_ .12 -Pb HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279.2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING SEPTIC TANK: / NUMBER OF DISTANCE FROM WELL MATERIAL Sv�,��. COMPARTMENTS LIQUID CAPACITY %.� GAUONS. INSIDE LENGTH g / INSIDE WIDTH�DEPTH�, SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS OUTSIDF DIAMFTFR '--OR WIDTH , LENGTH /4. DEPTH! LINING MATERIALS- — WA Ao—,6&&ODISTANCE FROM WEII4So ' , BUILDING FOUNDATION 22 NEAREST LOT LINE t TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) 3l!!� $0. FT. TILE DRAIN FIELD: DISTANCE FA NUMBER OF ABSORPTION AREA SO. FT. LENGTH OF EACH LINE EFFECTIVE DEPTH, TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL:TyPE7S,��CCE9 DEPTH /1"f DISTANCE FROM /WATER ,BVILDING FOUNDATION.IM ot_ SAMPLE. NEAREST / NEAREST`/ / SEPTIC / SEEPAGE / OTHER LOT LINE ^fie , SEWER LINE. TANK _ �•� G_ , SYSTEM Co CESSPOOL '-- , SOURCES— DIAGRAM OF SYSTEM SpT DISTANCES: J Pr ... DATE wr" 7 •; Municipality of Anchorage u. On -Site Water and Wastewater Program c (907)343-7904 Certificate of On -Site Systems Approval p Parcel I.D. 016-112-17 Expiration Date: 1. GENERAL INFORMATION (its n�,^ Complete legal description Bruin Park #t, B9, Tr -A, NW w rY yo - Location (site address) 11322 Forest Dr. Current Property owner(s) Dean Sherman Day phone Mailing address PO Box 110474 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADLI) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well F Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ PuUII VYatel Jy$tem ❑ PuUll JGVVer ❑ WaiverNariance request for: Received by: COSA to be released to unless otherwise requested by the engineer. COSA Fee $ `'C q6U 6u Date of Payment 61pp/1/13 Receipt Number�J O COSA# drse Qfo/lQ& Date: Waiver Fee $ _ Date of Payment Receipt Number Waiver # .,.3 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for _ bedrooms Disapproved Conditional approval for Date 5/7/13 bedrooms, with the following stipulations: By "t Original Certificate Date:.-. 3 - 13 The M pal' nchor 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 COSAbtuesheet t 1. c If more than 1 septic system is on the lot: COSA Checklist # 1 of I Structure served by this system Certificate of On -Site Systems Approval Checklist Aj Lo ri V9 Legal Description: Bruin PArkJK, B9, Tr -A, NW LA 1- Parcel Parcel ID:016-112-17 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 10/24/88 Sanitary seal (Y/N) Y Total depth _L1 3 ft. Cased to 113 ft Date of test Static water level FROM WELL LOG 10/24/88 .1 Well production 10 ft. Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 18 in. AT INSPECTION 5/6/13 59 ft. g.p.m. 5.4+ 9.p -m. WATER SAMPLE RESULTS: Coliform AJe&. colonies/100 mL Nitrate 4'V�T&Trng/L Arsenic 61,76 ug/L Date of sample:J�— (o ZDI Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1000 gal. Number of Compartments 2 Date installed 8/16/01 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (Y/rN) N High water alarm (Y/N) N Date of pumping I I S l Pumper X00 k �, It, K PLA w ;, g S P — C C. ABSORPTION FIELD DATA Date installed 8/16/01 Soil rating (g.p.d.W or ft2/bdrm) 0.6 GPD/SF System type Deep Trench Length 57 ft. Width 3 ft. Gravel below pipe 7 ft. ,, IO'C, Total depth �_ 'ft. Eff. absorption area 798 ftz Monitoring tube Y Depression over field N Date of adequacy test 5/7/13 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 14 in. Water added 477 gal. New depth 21 in. Elapsed Time: 140 min. Final fluid depth 14 in. Absorption rate , 450+ g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons _ in. "Pump off' level at Cycles tested _ in. Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date Zla514 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ in. �?"c�r �r1tCiJ Municipality of Anchorage -.� Development Services Department Building Safety Division t 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 Parcell.D. 016-1112-17 COSA# Expiration Date: — R -- O G 1. GENERAL INFORMATION Complete legal description BRUIN PARK 1sT ADDN_ 69, TR A, NW CORNER Location (site address) 11 1 499 FOREST DRIVE Current Property owner(s) DEAN SHERMAN Day phone (907) 349-1775 Mailing address 111122 FORFST DRIVF ANCHORARE AK 99516 Lending agency Day phone Mailing address , Real Estate Agent , . Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that rry 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. NarneofFirm ND FNrINFFRING.► . . • . . Address -20441 PTARMIGAN 99c;77 Engineer's Printed Name KFNNFTH M DUFF114 Date Engineer's Comments: This investigation was completed In compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, KND can not system will function sive atisfactory for cumate of rrent oa or future :be OF 4k 'All occupants or can KND guarantee that no unseen �,�Q :.•••"••••..• S !! encroachments, deficiencies or discrepancies exist. ! Cox �'•.'fsl, 5. DS✓ NATURE Approved for-3—bedrooms. Disapproved. Conditional approval for Attachments: COSA ChecMist Septic System Advisory Well Flow Advisory Nitrate Advisory bedrooms, with the following stipulations: . _ m- WATER.AND ; PROGRAM ,� Arsenic Advisory J'JJ/�/��"•' S,,._, `��)��l Maintenance Agreements -- Supplemental Engineer's Report Other By: 1,6/ ! Original Certificate Date: (Ra JMS) O Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 Bragaw Street P.O. Box 198650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST A. WELL DATA Well type PRIVATE If A. B, or C provide PWSID # Date completed 1988 Sanitary seal (YIN) Y Total depth 113 ft. Cased to 40+ ft. FROM WELL LOG Data of test 1 9 8 8 Static water level Well production WATER SAMPLE RESULTS: ft. _ Well Log (YIN) Y Wires properly protected (YIN) y Casing height (above ground) 25+in. AT INSPECTION 0 :41 g.p.m. 6.2+ 9 -p.m. Coliform _0_colonies/100mL Nitrate _ND mg/L Other bacteria _0 colonies/100 mL Arsenic: -RD mg/1 Date of sampla: 7/19/2006 Collected by: KND Engineering, Ine B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/STEEL Date installed 8/16/2001 Tank size 1000 gal. Number of Compartments.2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (YIN) b High water alarm (YIN) N_Date of pumping 7/19/2006 Pumper McDonald's Pumoina C. ABSORPTION FIELD DATA Date installed 8/16/2001 Soil rating (g.p.d./ftz or fefbdrm) 0.6 System type DEEP TRENCH Length JZ, It. Width J, ft. Gravel below pipe Zft. Total depth JJM ft. Eff. absorption area 798 fP 'Monitoring tube Y Depression over field N Date of adequacy test 7/19/2006 Results (Pass/Fail) Pass For -I- bedrooms Fluid depth in absorption field before test 28.2 in. Water added 600 gal. New depth-42SLin. Elapsed Time: 1440 min. Final fluid depth 2A U in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date _ _ _ _ _ D. LIFT STATION Date installed "Pump on" level at --in, Size In gallons Manhole/Aocess (YIN) 'Pump off" level at --in. High water alarm level at—in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 1001+ Public sewer main 75'+ Sewer /septic service line 25'+ On adjacent lots 10 0 + On adjacent lots 10 0 + Public sewer manhole/cleanout _L0_0'_+ Holding tank 10 0 1 + Animal containment areas 50'+ Manure/animal excrete storage areas 10 0 1 + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5 ' + Absorption field_ 5 1+ Water main 10'+ Water service line 10 1 + Surface water 10 0'+ Wells on adjacent lots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 101+ Water main 10'+ Water Service line 10'+ Surface water 10 0 1 + Driveway, parkinglvehide storage 10 1 + Curtain drain 50'+ Wells on adjacent lots 10 0 1 + F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFuc sem- dr rr. COSA Fee Date of Payment p Receipt Number d yoRt Waiver Fee $ Date of Payment Receipt Number 4' COVERED b PORCH N 2' CANT I4O w e.l' _ 2A' ^ti, /. >. 8 \ cb. A?. \ cF '� lSTbwY •- \ We+�o Ft4µa \ ga4hp0'1CY! FINAL AS BUILT r-ICTti'. CK%vnwm{ Latpzvor1 IS }fPI�IM�T61 Duu TO SuwN GoViM1- PLOT PLAN _ ASBUILT x SCALE le a 50' GRID 2633 Project 'No. 0I-077 Lan & Associates. Inc. 11500 Daryl Avenue. Anchorage, Alaska 99515. 9 907 522-6475 Phone O Q Registered Land Surveyors 9073 522-4525 Fax I hereby certify that I have surveyed the following des9rib4td property: `• s DEEDED PARCEL WITHIN BLOCK g. BRUIN PARK SUBD. #3 �P' % Anchorage Recording District, Alaska, and that the Improvements situated „! Is 49 1 thereon are within the property lines and do not encroach onto the property .:....................: adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there ore no roadwaayys, transmission lines or other visible easements on said property except as indicated hereon. g KENNETH G. LAN Dated this the 2901 Day of c'kto3en- of Anchorage. Alaska �i� '•., LS -5202 ; It is the responsibility of the owner to determine the existence of any �0400s� easements, covenants, or ndrletlam which do not appear on the recorded � subdivision plat. 8 CS F*�e o to I v, R.cx ^ti, /. >. 8 \ cb. A?. \ cF '� lSTbwY •- \ We+�o Ft4µa \ ga4hp0'1CY! FINAL AS BUILT r-ICTti'. CK%vnwm{ Latpzvor1 IS }fPI�IM�T61 Duu TO SuwN GoViM1- PLOT PLAN _ ASBUILT x SCALE le a 50' GRID 2633 Project 'No. 0I-077 Lan & Associates. Inc. 11500 Daryl Avenue. Anchorage, Alaska 99515. 9 907 522-6475 Phone O Q Registered Land Surveyors 9073 522-4525 Fax I hereby certify that I have surveyed the following des9rib4td property: `• s DEEDED PARCEL WITHIN BLOCK g. BRUIN PARK SUBD. #3 �P' % Anchorage Recording District, Alaska, and that the Improvements situated „! Is 49 1 thereon are within the property lines and do not encroach onto the property .:....................: adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there ore no roadwaayys, transmission lines or other visible easements on said property except as indicated hereon. g KENNETH G. LAN Dated this the 2901 Day of c'kto3en- of Anchorage. Alaska �i� '•., LS -5202 ; It is the responsibility of the owner to determine the existence of any �0400s� easements, covenants, or ndrletlam which do not appear on the recorded � subdivision plat.