HomeMy WebLinkAboutELMORE #1 BLK 3 LT 4Elmore #1
Block 3
Lot 4
#018-171-30
Inspection Report_1-1-12.doc
Municipality of Anchorage
Community Development Department Page 1 of 3
On -Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSPI41093
PID Number: 018-171-30 ❑ New ❑✓ Upgrade
Name:
MARILYN STIRLING
ABSORPTION FIELD
❑ Deep Trench ❑✓ Shallow Trench E] Bed ❑Mound
Address
4400 SHOSHONI AVE
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
5
1.2 GPD/SF
5.0/1.0 Ft,
LEGAL DESCRIPTION
Depth to pipe invert from original grade
t,> 9-- 2 Ji Ft
Gravel depth beneath pipe
2.5/0.5Ft.
Subdivision
Block Lot
ELMORE #1
3 4
Fill added above triginal grade
2-3' Fl.
Gravel length
40/63 Ft.
Township Range Section
Gravel wdth
5/5 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Lift Station
Tank
Line
628 Fel
2
41.5Ft.
Well
100+
102.6
NIA
NIA
N/A
TANK ❑+ Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Existing
Capacity
I Gal.
Surface Water
100+
148.9
N/A
N/A
Material
Number of compartments
Lot Line
10+
15.4
N/A
N/A
NA
Foundation
5+
35.2
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Gal.
Curtain Drain
NIA
I N/A
I N/A
N/A
RemarksDrain field replacement onl y.
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL Housetotank Tankto 3034
dreinfield
Installer
BEEKS CONTRACTING
Drainfield 3034 CO/MT 3034
Inspector Steven R. Pannone
BENCHMARK (Assumed elevation) 100ft
Inspection ,
dates: 1e 6/18/2014
2nd 6/19/2014
Location and description
3'" 6/20/2014
0 6/20/2014
LOWER LEVEL FINISHED FLOOR
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
's
Conditional Approval:
Date���
r�2. �A
ti ven f�4nnQaef
° 4
Approved
Date - ;z ( 41y
Inspection Report_1-1-12.doc
Zj(
ANIMAL ENCLOSURES AND
SEPTIC MORE THEN 100' FROM
WELL
LOT 7
LOT 6
All
41
SHOSHONI
AVE
LOT
4
EXISTING 15000
CONCRETE 02
34
02. M
E
UPGRADED
SEPTIC
A SYSTEM
FIELD ONE(P),
T1v
FC ,
BEDROOM Co 40' X 5'W 2.5'E.D., 5' T.D.
1"'o
OUSE FS
LOT 5
T1
DCO EXISTING
-DCO2 .9 T3
... ... UNDOCUMENTED
5. d03 SYSTEM (MAINTAIN�,b
SS
MIN 10' SEPARATION)',�,
ASAWBANDONED
PER CODE
MT
A
B C CD4 TH-2j
DISTANCE TO
RABBIT CREEK
FC
23.10
11.50 UPGRADED SEPTIC
T1
38.10
SYSTEM FIELD TWO(P)
46.10
DC01
51.00
44.70 63' X 5'W 0.5'E.D., 1' T.D.
DCO2
52.00
45.80 IMENT
FS
52.50
46.50
WT1
39.80
41.40
coll
41.70
40.80
MT2
63.10
76.80
CO2
63.10
77.80
MT3
92.90
81.60
CO3
95.30
83.90
MT4
46.30 102.40
1�1
48.25, 103.701 . ...
.. ....
LOT 15
NOTES:
PAMONE ENG SVC, LLC
P.O. BOX 100217 ANCHORAGE, AK 99510
Of . = . Ak•.
_4 Rk
Date
6/25/2014
RECORD DRAWING
PHONE (907) 272-8218 FAX (907) 272-82
TH
.... ... .. ......
Sca1"le
=50-
P.I.D. NO
ELMORE #1 BLOCK 3 LOT 4
MARILYN STIRLING
4400 SHOSHONI AVE
•018-171-30
teve R. onnope
CE 8149
PERMIT NO.
OSP141093
e
Sh2et OF 3
PLAN
ANCHORAGE, AK 99516
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE
STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE
WASTEWATER DISPOSAL SYSTEMS AND ATTACHED PES SPECIAL PROVISIONS.
2. SCOPE OF WORK: VERIFIED INTEGRITY OF EXISTING 1500g SEPTIC TANK, AND INSTALLED NEW SOIL ABSORPTION
SYSTEM.
3. GROUNDWATER WAS NOT OBSERVED AS EVIDENCED BY THE SOIL TEST HOLE. AN APPARENT WATER TABLE WAS NOT
OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 9.0 FEET BELOW EXISTING GRADE AT TRENCH ONE OR LESS THEN
5.0 FEET BELOW GRADE AT TRENCH TWO.
1500 g SEPTIC
e
TANK (E
4" 0 PERF PIPE
RIGID BOARD INSULATION
4" 0 PERF PIPE
w
'0
FILTER FABRIC
w
m
5
WITH TWO FEET OF COVER
u
nn
II
zQ'y C
V O
n
DRAIN///r4" 0 PERF PIPE
ROCK6
/ ABOVE PIPE INV
p
O
n
FILTER FABRIC
USED ON WEST ENO OF
DRAIN ROCK 6"
TH 1
4S^ Z
DUCTILE IRON PIPE
ADVANCED TREATMENT DESIGN FLOW=750GPD
TRENCH -
ABOVE PIPE INVERT
TEST HOLE
TANK SIZE: 1500g
WATER LINE/
DRAIN ROCK 6"FILTER
FOUNDATION CLEAN OUT
FABRIC
—2,0N
T#
96.2
ABOVE PIPE INVERT2
(SE) 89.5
C#
CLEAN OUT NO.
AREA RQD : 625 SF — SS
— NEW SEPTIC
M#
Sw)a5.5
USE:
sz.T
RIGID INSULATION
3:1 MAX
s)fies
DCO
DOUBLE CLEAN OUT
T
�F
-0.5 S 86.0
T 0.5'
90.2SW
FLOW SPLITTER
12 5'TS&V(5)85.5
BFG
BELOW FINISH GRADE
OG
ORIGINAL GRADE
TOTAL AREA OF ABSORPTION BOTH FIELDS: 628 SF
FG
FINISH GRADE
5.05.0
GROUNDWATER
�(S)80S
TS&V
-9 0
6.0 MI�
L
-11.0 ML
5.0_'1I
-8.0 ML
(N) 84.2
-9.5
(S) 77.0
SECTION—
1500 g SEPTIC
e
TANK (E
ffmm
0 0
w
w
'0
FILTER FABRIC
w
m
5
No
nn
Il 11
u
nn
II
zQ'y C
V O
n
DRAIN///r4" 0 PERF PIPE
ROCK6
/ ABOVE PIPE INV
p
O
n
0
z
is
U
n
1500 g SEPTIC
e
TANK (E
ffmm
TRENCH SE DESIGN
PROFILE
ABBREVIATIONS
DESIGN PARAMETERS
CU
COPPER
UPGRADE SEPTIC SYSTEM
DIP
DUCTILE IRON PIPE
ADVANCED TREATMENT DESIGN FLOW=750GPD
LEGEND
TH
TEST HOLE
TANK SIZE: 1500g
WATER LINE/
FC
FOUNDATION CLEAN OUT
_ W
PERC RATE(BOTH TRENCHES) = 1-5 MPI
WELL RADIUS
T#
TANK CLEAN OUT NO.
SOIL RATING: 1.2 GPD/SF
C#
CLEAN OUT NO.
AREA RQD : 625 SF — SS
— NEW SEPTIC
M#
MONITOR TUBE NO.
USE:
R.I.
RIGID INSULATION
(1) 40 LF X 5' WIDE, 2.5' E.D., 5' TO
DCO
DOUBLE CLEAN OUT
REDUCTION FACTOR: 0.64, TOTAL AREA: 313 SF
DV
DIVERTER VALVE
(1) 63 LF X 5' WIDE, 0.5' E.D., 1' TO
FS
FLOW SPLITTER
TOTAL AREA: 315 SF
BFG
BELOW FINISH GRADE
OG
ORIGINAL GRADE
TOTAL AREA OF ABSORPTION BOTH FIELDS: 628 SF
FG
FINISH GRADE
TS&V
TOPSOIL & VEGETATE
NOTES: 4`01����lk\ Date
PANNONE ENG SVC, LLC OF At \L 6/25/2014
RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 r �.. ;9S l0
PHONE (907) 272-8218 FAX (907) 272-8211 /�cj�Q ?y+` Scale
j*: QTH *l� NITS
�..... .. :.. P.I.D. NO
ELMORE #1 BLOCK 3 LOT 4 016-171-30
MARILYN STIRLING Steven R. 'a'nnoRe /PERMIT NO.
4400 SHOSHONI AVE I �'., CE 814 j OSP141093
f+ gs 1�Z�,c�r
DESIGN DETAILS ANCHORAGE, AK 99516 �k1�\0..... '�, Sh3eOF 3
TEST HOLE 2
OR ORGANICS
I
CLOCK
NET TIME
2
NET DROP
1 6/11/14
10:50
I�
POORLY -GRAD
3
GP/SW
GRAVELS
4
10.79
WELL -GRADED
3
11:08
SANDS
5
—
4
6
y
6/12/2014
7
5
5:16
8
3.41
--
6 1 1
ML
INORGANIC
0
1 7.33
SILTS
10
BOH
CE 8149 �/
11
SOILS LOG
ANCHORAGE, AK 99516
12
Sheet
13
14
15
16
17
18
DATE PERFORMED: 6/11/14
SOILS LOG - PERCOLATION TEST
SLOP PLAN
to
F-)
X
TH BEDROOM
HOUSE
WAS GROUND WATER
ENCOUNTERED? Y
IF YES, AT WHAT
DEPTH? -6.0'
DEPTH TO WATER AFTER
MONITORING? -6.0'
DATE: 6/19/2014
SLOPE
TH
X
READING DATE
CLOCK
NET TIME
WATERTIME
LEVEL
READING
NET DROP
1 6/11/14
10:50
I�
3.93
—
2
10:57
7 MIN
10.79
6.81
3
11:08
--
IF YES, AT WHAT
DEPTH? -6.0'
DEPTH TO WATER AFTER
MONITORING? -6.0'
DATE: 6/19/2014
SLOPE
TH
X
READING DATE
CLOCK
NET TIME
WATERTIME
LEVEL
READING
NET DROP
1 6/11/14
10:50
--
3.93
—
2
10:57
7 MIN
10.79
6.81
3
11:08
--
3.23
—
4
5:14
8 MIN
10.64
7.41
5
5:16
—
3.41
--
6 1 1
5:26
1 8 MIN 1
10.74
1 7.33
PEROLATION RATE 1.1 (min/inch) PERC HOLE DIAMETER 6 inches
TEST RUN BETWEEN 1.0 FTAND 2.0 FT
COMMENTS: Test hole excavated by BEEKS CONTRACTING. Prec hole was
presoaked. Perc test ran for
at least 1 hour. Last three readings reported. Bottom of Perc hole in GP/SW.
Test performed in
representative soil.
PERFORMED BY: Steven R. Pannone P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALLSTATE AND MUNICIPAL GUUIIDLI�TNEES4N EFFECT ON T14E DATE -OF THIS TEST. -- - -
NOTES:
PAMONE ENG SVC LLC
'�� OF l\\ll
9S �t
Date 14
FOR CONSTRUCTION
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE 272-8218
r' �� "'^
�y*II
Scale
CHANGE ORDER 2
(907) FAX (907) 272-8211
j g�49
NTS
TH
�.... .. .....�
P.I.D. NO
ELMORE #1 BLOCK 3 LOT 4
MARILYN STIRLING
''
{evenannone %PERMIT
018-171-30
4400 SHOSHONI AVE
CE 8149 �/
NO.
OSP141093
SOILS LOG
ANCHORAGE, AK 99516
Sheet
4
TEST HOLE 1
ORGANICS
OR/OL AND ORGANIC
1 SILT
2
3
4
COMMENTS: T
at least I hour.
SOILS LOG - PERCOLATION TEST
SLOPE PLAN
TH-1-
X
TH BEDROOM
HOUSE y�
W ---W/ _
WAS GROUND WATER
ENCOUNTERED? N
IF YES, AT WHAT
DEPTH? NONE'
DEPTH TO WATER AFTER
MONITORING? NONE'
DATE: 4/25/2014
SLOPE
TH
X
READING DATE
CLOCK
NETTIME
POORLY -GRAD
5
GP/SW
4:52
GRAVELS
6
---
2
WELL -GRADED
10 MIN
5.46
1.78
SANDS
7
—
2.28
--
8
5:14
10 MIN
4.46
9
5
5:16
--
10ML
---
6
INORGANIC
1 10 MIN 1
4.46 1
2.19
SILTS
11
BOH
12
13
14
15
16
17
18
DATE PERFORMED: 4/18114
COMMENTS: T
at least I hour.
SOILS LOG - PERCOLATION TEST
SLOPE PLAN
TH-1-
X
TH BEDROOM
HOUSE y�
W ---W/ _
WAS GROUND WATER
ENCOUNTERED? N
IF YES, AT WHAT
DEPTH? NONE'
DEPTH TO WATER AFTER
MONITORING? NONE'
DATE: 4/25/2014
SLOPE
TH
X
READING DATE
CLOCK
NETTIME
WATERTIME
LEVEL
READING
NET DROP
1 4/18/14
4:52
--
3.68
---
2
5:02
10 MIN
5.46
1.78
3
5:04
—
2.28
--
4
5:14
10 MIN
4.46
2.18
5
5:16
--
2.28
---
6
5:26
1 10 MIN 1
4.46 1
2.19
PEROLATION RATE _4.9 (min/inch) PERC HOLE DIAMETER 6 inches
TEST RUN BETWEEN 3.5 FT AND 4.5 FT
was presoaked. Perc test ran for
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.
NOTES:
PANNON21 ING SVC, LLC
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211
����
��pFAC\gsl�'
.�
/�g�p !y�+
... .. .... .. .:.. �
Steven R. Pannone �
r.'. CE 814
f� qs .
66/12/2014
FOR CONSTRUCTION
CHANGE ORDER 2
Scale
NTS
ELMORE #1 BLOCK 3 LOT 4
MARILYN STIRLING
4400 SHOSHONIE AVE
ANCHORAGE, AK 99516
P.I.D. NO
—171-30
PERMIT NO.
OSP141093
SOILS LOG
Sheet
3 OF 4
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP141093
Tax Code Number: 01817130000
Work Type: Septic Upgrade
Permit Effective Dates: May 02, 2014 to May 02, 2015
Design Engineer: PANNONE ENGINEERING SERVICE
Subdivision: ELMORE #1
Site Legal Address: ELMORE #1 BLK 3 LT 4 G:3036
Owner/Address: STIRLING MARILYN A
4400 SHOSHONI AVENUE ANCHORAGE AK 995163684
Site Mailing Address: 4400 SHOSHONI AVE, Anchorage Lot Size in Sq Ft: 37299
Total Bedrooms: 5
This permit is for the construction of:
Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By,
CUa QP_U-' AI --n Kt
PYbeoecl Gti��a�t �=UrnY gt^ouv��wt��es w�ev�.�an`J+� Mt Owv� nes
L 4
Date:
S 1611 -
Date: a JY
MUNICIPALITY OF
Community Development Department
Development Services Division 6
On -Site Water & Wastewater Program
UT.400NTOATM
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
0
Parcel I. D. 018 -171 -
Property owner(s) TIM PATTEN Day phone 907.242.0299
Mailing address 4400 SHOSHONIE AVE ANCHORAGE AK 99516
Site address 4400 SHOSHONIE AVE ANCHORAGE AK 99516
Legal description (Sub's., Block & Lot) ELMORE # 1 BLK 3 LT 4
Legal description (Township, Range & Section)
Lot Size 37,299 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply)
Absorption Field
0
Initial ❑ Single Family (SF)
(w/wo ADU)
Septic Tank
❑
Upgrade El
Duplex (D)
Holding Tank
ElRenewal
ElMultiple
Dwellings
Privy
❑
(SF and/or D)
Private Well
ElL
SUBMITT40A
Water Storage
F1
APR 2 5 2014
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes._
property owner or authorized agent)
Permit/Rush Fees: 11%09
Date of Payment: (119,514
Receipt Number: ota Cf 96
Permit No. ds pl4l 0143
Permit App.-:. !-'.-c,
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
1
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail: steve@panengak.com
May 2, 2014
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road
P. 0. Box 196650
Anchorage, Alaska 99519
Subject: Elmore # 1 Blk 3 Lt 4
Septic System Permit Request
Ladies and Gentlemen:
I am writing to request a permit to install a new septic system be issued for this property. The proposed
system will serve the existing five (5) bedroom house. Currently the lot is single family home. The
proposed system will utilize the existing 1500g concrete septic tank and new wide trench drainfield. The
surrounding developed lots are served by private wells. There are no wells on surrounding lots within 100
feet of this system. Due to future plans of construction a second trench will have to be installed outside of
the original test hole radius. An additional test hole will be performed at time of construction to verify the
soil, and attached is Elmore #1 Blk 3 Lt 5 soil log, which shows similar soil characteristics.
Soils. One test hole was performed by Pannone Engineering Services in April of 2014, and groundwater
was monitored for seven days. Ground water was not encountered below the surface in the test hole
monitor tube after the seven day monitoring period. Bedrock was not encountered in the test hole. It is
my opinion, based on the results of the percolation tests and overall soils appearance; an application rate
of 1.2 gallons/day/square feet should be used for a conventional wastewater system.
1. Soil Absorption System Design.
a. See Sheet 2 of the design package.
2. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain
field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage
ditches.
3. Topography: The existing topography slopes from the north to south at approximately 20%-25%
in the area of the proposed drain field. There are no steep slopes within 50' of the proposed drain field.
The proposed drain field will maintain 50' separation to the road cut -slope adjacent to the downhill side
of the lot.
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
Page 2 of 2
4. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification
that the review is complete and that there are no further comments is received from MoA On -Site
Department, the note will be removed and `Issued for Construction" drawings will be issued.
The proposed installation will not affect the future development of the surrounding or existing lots. There
are no surrounding wells within 100 feet of the proposed septic location.
If you have any questions or concerns, please contact me at 272-8218.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Mailing: P.O. Box 100217, Anchorage, AK 99510-0217
Physical: 332 East Manor Ave, Anchorage, AK 99501
Telephone: (907) 272-8218 FAX: (907) 272-8211
('10
ANIMAL ENCLOSURES AND
SEPTIC MORE THEN 100' FROM
WELL LOT 7
LOT 6
_AA
7 Ni- ------
`
SHOSHONI AVE
-----
� EXISTING 1500G-3,)6'--"---"------
TH - 1_ 3,) 6' i
CONCRETE---- --
2', ZE
UPGRADED SEPTIC
/SYSTEM FIELD ONE(P)
5 BEDROOM40' X 5'W 2.5'E.D., 5' T.D.
HOUSE
2
LOT 5
10.0
INSTALL FOUNDATION EXISTING
CLEANOUTUNDOCUMENTED
G.0
INSTALL DOUBLE CLEAN OUT SYSTEM (MAINTAIN
& FLOW SPLITTER MIN 10' SEPARATION)-*,
TO BE ABANDONED
PER CODE
---- TH- DISTANCE TO
LOT 4 -- ----- ------- --A RABBIT CREEK
UPGRADED SEPTIC
SYSTEM FIELD TWO(P)
63' X 5'W 0.5'E.D., 1, T.D .
_,F�UTILITY EASEMENT 344'
340'
. . ........ .
LOT 15
NOTES:
PAMONE FNQ SVC, LLC
P.O. BOX 100217 ANCHORAGE, AK 99510
PHONE (907) 272-8218 FAX (907) 272-8211Scale
OF A 1% �'Nkk
.
.... . ... . ...
Steven R. annoRe
CE 8149 tom/
Date
6/12/2014
FOR CONSTRUCTION
CHANGE ORDER 2
ELMORE #1 BLOCK 3 LOT 4
MARILYN STIRLING
4400 SHOSHONIE AVE
P.I.D. NO
018-171-30
P ERMIT NO.
OSPI41093
PLAN
ANCHORAGE, AK 99516
NZft-n-
R
Sheet
1 OF 4
SPECIAL PROVISIONS TO SPECIFICATIONS
1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF
ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF
ON-SITE WASTEWATER DISPOSAL SYSTEMS AND ATTACHED PES SPECIAL PROVISIONS.
2. SCOPE OF WORK: VERIFY INTEGRITY OF EXISTING 15009 SEPTIC TANK, AND INSTALL NEW SOIL ABSORPTION SYSTEM.
3. GROUNDWATER WAS NOT OBSERVED AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS
OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 9.0 FEET BELOW EXISTING GRADE AT TRENCH ONE OR LESS THEN
5.0 FEET BELOW GRADE AT TRENCH 2 NOTIFY THE ENGINEER IMMEDIATELY.
]VIDE MINIMUM 3' OF COVER
COPPER
RIGID INSULATION
DUCTILE IRON PIPE
4" 6 PERF PIPE
TEST HOLE
DRAIN ROCK 6"
ABOVE PIPE INVERT
TH 1
FILTER FABRIC
-2,0
OR
TH 2
PROVIDE MINIMUM 3' OF COVER
OR RIGID INSULATION
///�444 0 PERF PIPE
FILTER FABRIC
`GRAIN ROCK 6"
/ ABOVE PIPE [VERT
3:1 MAX
�TS&V
-0.5 .,.. - 0.5' P 1
GP/ j 5.0 T
5.0
GROUND WATER
=W
-s.o6.0 MI� —I
—11.0 ML
s.o
—8.0 ML
SECTION
o� s 5 F m FILTER FABRIC m
z z z mz 3 p4" SD PERF PIPE p z
/ t
/ DRAIN ROCK 6" U
II ILII II R n ABOVE PIPE INV n R
1500 g SEPTIC
TANK (E)
TRENCH SEE DESIGN
PROFILE
DESIGN PARAMETERS
UPGRADE SEPTIC SYSTEM
ADVANCED TREATMENT DESIGN FLOW=750GPD LEGEND
TANK SIZE: 15009 W WATER LINE/
PERC RATE(BOTH TRENCHES) = 1-5 MPI WELL RADIUS
SOIL RATING: 1.2 GPD/SF
AREA ROD : 625 SF — SS — NEW SEPTIC
USE:
(1) 40 LF X 5' WIDE, 2.5' E.D., 5' TO
REDUCTION FACTOR: 0.64, TOTAL AREA: 313 SF
(1) 63 LF X 5' WIDE, 0.5' E.D., 1' TD
TOTAL AREA: 315 SF
TOTAL AREA OF ABSORPTION BOTH FIELDS: 628 SF
NOTES: PAMONE ENG SVC, LLC
FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510
CHANGE ORDER 2 PHONE (907) 272-8218 FAX (907) 272-8211
ELMORE #1 BLOCK 3 LOT 4
MARILYN STIRLING
4400 SHOSHONIE AVE
DESIGN DETAILS ANCHORAGE, AK 99516
ABBREVIATIONS
CU
COPPER
DIP
DUCTILE IRON PIPE
TH
TEST HOLE
FC
FOUNDATION CLEAN OUT
T#
TANK CLEAN OUT NO.
C#
CLEAN OUT NO.
M#
MONITOR TUBE NO.
R.I.
RIGID INSULATION
DCO
DOUBLE CLEAN OUT
DV
DIVERTER VALVE
FS
FLOW SPLITTER
BFG
BELOW FINISH GRADE
OG
ORIGINAL GRADE
FG
FINISH GRADE
TS&V
TOPSOIL & VEGETATE
r �ytvr..... of j 6/12/2014
SCP ' 9#, Scale
P.I.D.P.I.D.NO
.• % 018-171-30
Steven 'R. Pganno.ne PERMIT N0.
E 1 9 OSP141093
Sheet
2 OF 4
cog
TEST HOLE 1 SOILS LOG - PERCOLATION TEST
ORGANICS SLOPE WEPLAN
OR/OL AND ORGANICI.
SILT
2
TH-
4—
POORLY-GRADED
5 GP/SW GRAVELS
6 WELL -GRADED X 5 BEDROOM
SANDS TH HOUSE
----- - --- - -
10 ML ML SILTS
BOH - - -------- ---
NN
12 TH-2
WAS GROUND WATER SLOPE
14 ENCOUNTERED? N
15 IF YES, AT WHAT TH
16 DEPTH? NONE' X
17 DEPTH TO WATER AFTER
MONITORING? NONE'
18 DATE: 4/24/2014
READING DATE CLOCK WATER
DATE PERFORMED: 4118/14 TIME NET TIME LEVEL NET DROP
READING
1 4/18/14 4:52 3.68 —
2 5:02 10 MIN 5.46 1.78
3 5:04 2.28 ---
4 5:14 10 MIN 4.46 2.18
6 5:16 2.28 —
6 5:26 10 MIN 4.46 2.19
PEROLATION RATE -4.9 (min/inch) FERC HOLE DIAMETER 6 inches
TEST RUN BETWEEN 3.5 FTAND 4.5 FT
COMMENTS: Test hole excavated by BEEKS CONTRACTING. Prec hole was presoaked. Pere test ran for
at least 1 hour. Last three readings reported. Bottom of perc hole in GP/SW. Test performed in
representative soil.
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.
NOTES: '!NX1k1 Date
PAMONE ING SVC, UC
�4 OF A/-.,, 6/12/2014
FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 ......... 61, - 4#
CHANGE ORDER 2 PHONE (907) 272-8218 FAX (907) 272-8211 4�Ay-`- ...�f Scale
NTS
49 7H
... . .
ELMORE #1 BLOCK 3 LOT 4 018-171-30
MARILYN STIRLING -�I�e en R. Pannope PERMIT NO.
4400 SHOSHONIE AVE CE 8149 ... OSP141093
SOILS LOG ANCHORAGE, AK 99516 ......... Sheet
3 OF 4
COMMENTS:
SOILS LOG - PERCOLATION TEST
READING DATE
TEST HOLE
NETTIME
WATER
LEVEL
READING
NET DROP
OR
ORGANICS
1
3.93
--
2
2
7 MIN
10.79
6.81
3
11:08
—
POORLY -GRAD
3
4
GP/SW
GRAVELS
4
7.41
3
WELL -GRADED
—
3.41
SANDS
5
8 MIN
10.74
7.33
6/12/2014
7
8
ML
INORGANIC
9
SILTS
10
BOH
11
12
13
14
15
16
17
1B
DATE
PERFORMED: 6111114
COMMENTS:
SOILS LOG - PERCOLATION TEST
READING DATE
CLOCK
TIME
NETTIME
WATER
LEVEL
READING
NET DROP
1 6/11/14
10:50
—
3.93
--
2
10:57
7 MIN
10.79
6.81
3
11:08
—
3.23
—
4
5:14
8 MIN
10.64
7.41
3
5:16
—
3.41
6
5:26
8 MIN
10.74
7.33
PEROLATION RATE 1.1 (min/inch) PERC HOLE DIAMETER 6 inches
TEST RUN BETWEEN 1.0 FT AND 2.0 FT
2ACTING. Prec hole was presoaked. Perc test ran for
WAS
NOTES: PANNONE ENG SVC, LLC o— t - voce
FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510K.
r OF !aCgS��i 6/12/2014
CHANGE ORDER 2 PHONE (907) 272-8218 FAX (907) 272-8211 NTS
*�- TH 9*+�, Scale
.... .. . .. P.I.U. NO
ELMORE #1 BLOCK 3 LOT 4 .. ................� 016-171-30
MARILYN STIRLING 'Steven f2. annoae / PERMIT NO.
?,•, E 814 0SP141093
4400 SHOSHONIE AVE tt� cs /-d6(^i
SOILS LOG ANCHORAGE, AK 99516 1�l`` PROFESS Sheet
4
EP/ J$
•
Municipality of Anchorage
On-Site Water and Wastewater Program a •
(907)343-7904 °iAf !
f ETV V Y
Certificate of On-Site Systems Approval
Parcel I.D. 018-171-30 Expiration Date: j`1 o— Ctf1
1. GENERAL INFORMATION
Complete legal description Elmore #1 B3 L4
Location (site address) 4400 Shoshoni Ave Anchorage, AK 99516
Current Property owner(s) Tim Fatten Day phone
Mailing address 4400 Shoshoni Ave Anchorage, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Single Family(w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: ��,`ig 1111 1111 L Date: Z�CXA-1�3
COSA to be released tot - eng' ess otherwise requested by the engineer.
COSA Fee $ (6-2,(o Waiver Fee $
Date of Payment �dl 2/Is 2 Date of Payment
(,/
Receipt Number 627 61434 Receipt Number
COSA# O SGl 3!6j3 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 lime 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.
Name of Firm Pannone Engineering Services LLC Phone (907) 745-8200
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R Pannone Date 10/8/2018
IA
6. DSD SIGNATURE r M �� '*��
System#1 Approved for bedrooms
Seven R. 'armors•
System#2 Approved for bedrooms 61,- CE-8149
Disapproved }!k'�D ' A�`
�?1 �NCfNk'k `EES9r 4
Conditional approval for bedrooms,with the following stipulations:
Vie \.• OF ti��c�0
_
:•.� ON-SITE %...
= WATER AND C"
WASTEWATER o
•
. A PROGRAM
0,0 Ni
4A-, j SERI\-
II
By: ! �'` l Original Certificate Date: ( O`t'0^ie
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 —_K_____
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet j '• c
•
If more than 1 septic system is on the lot:
COSA Checklist# I of 1
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: Elmore #1 B3 L4 Parcel ID:OS"1-71 -
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log(YIN) N
Date completed Unknown Sanitary seal (YIN) Y Wires properly protected(Y/N)
Total depth Unknown ft. Cased to Unknown ft. Casing height(above ground) 27 in.
FROM WELL LOG AT INSPECTION
Date of test 10/4/2018
Static water level ft. 65.2 ft.
Well production g.p.m. 3 3 g.p.m.
WATER SAMPLE RESULTS: {}r(
Coliform (\leg colonies/100 mL Nitrate (.a° mg/L
Arsenic i\10 ug/L Date of sample: 9/28/18 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material
Septic/Concrete Date installed Unknown
Tank size 1500 gal. Number of Compartments 1 Cleanouts(YIN) Y
Foundation cleanout(YIN) Depression over tank(YIN) N High water alarm(YIN) N/A
P • � ,� q �
Date of pumping /04
././0 Pumper rA, r , ‘S\t,s:� t.3 ZS- r,;-
C. ABSORPTION FIELD DATA
Date installed 6/20/14 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF System type Shallow Trench
Length 40/63 ft. Width 5/5 ft. Gravel below pipe 2.5/0.5 ft
Total depth 5/1 ft. Eff. absorption area 628 ft2 Monitoring tube Y Depression over field N
• Date of adequacy test 10/4/18 Results(Pass/Fail) PASS For 5 bedrooms
Fluid depth in absorption field before test 13121310 in. Water added 750 gal. New depth 16118/4/0
6f8/4/0 in.
Elapsed Time: 110 min. Final fluid depth 13/12/3/0 in. Absorption rate >= 750+ d
9.p
Anyrejuvenation treatment None Known
(past 12 mo.)(YIN&type) If yes,give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access(YIN)
"Pump on" level at in. "Pump off'level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 1001+ On adjacent lots 100 +
Absorption field on lot 1001+ On adjacent lots 1001+
Public sewer main 75'+ Public sewer manhole/cleanout 1004
Sewer/septic service line 25'+ Holding tank 100 +
Animal containment areas 50 + Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 10Y+ Property line 104 Absorption field 101+
Water main 25 + Water service line 25 + Surface water 100 +
Wells on adjacent lots 100 +
ABSORPTION FIELD ON LOT TO:
Property line 104 Building foundation 10 + Water main 101+
Water Service line 25 + Surface water 100'+ Driveway,parking/vehicle storage 10+
Curtain drain 50 + Wells on adjacent lots 100 +
F. COMMENTS
The upper drainfield is 50% used.
Survey On File
G. ENGINEER'S CERTIFICATION a�m�����\
,� :of Az,ls\k
I certify that I have determined through field inspections and ,...-co.-4' . `I, ••-r
review of Municipal records that the above systems are in 0* /\ •-* r
conformance with MOA COSA guidelines in effect on this date. . •••• ••.
Steven Pannone
Engineer's Printed Name i •Steven R. o none'
Date 10/8/2018 �� �• CE-8149 ..J
COSA canary sheet_2-6-15.doc
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 907-343-7904
• ,
On-Site Water and Wastewater Section `!"` ' Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On-Site Systems Approval # OSC181537
Subdivision: Elmore #1, Block: 3 , Lot: 4
A water sample revealed a nitrate concentration of 6.16 milligrams per liter
(mg/L). The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-Site
Systems Approval.
Mailing Address: P.O. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids,and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening or iron filtration does not readily remove nitrate. The best
method for limiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available,which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
SHOSHONI AVENUE
b b
Found Plastic M M
Cop on Rebar Found 3/8"
'E Rebar
N89'46'30
208.71'
I
1.i I in v
Well ° o
i Wood
� Wood Landing Steps Chain Link '
o I & Steps -
I
Conc. E Fence
P.d-":j1 -_ . , ----•i.-x
—•-141.6' _ :7-,,'111,1114111 Wood Deck 24.0
0 26.1' 7,1. 1�
o ..6. a d' 18.0' nl �—Clean Out
o ^ I 'o x 61—Level Wood Frame Res."' (typ.)
o c i 0. a!c Non Conc. Found. w/Bsmt.i .----2 �,,
b \—_�U_1Nl 68.1' ; w
z L���\� •` N. :j.:"---Chain Link Fence 0'
LOT 3 �--41.1' Wood Deck ^x'5.0., �i:
����
iN r�Shed on Concrete pa^b LOT 5
i^__._� Foundation o
Chain Link in
Fence 30.0' -
Wood Shed
2 1' X(No Foundation)
;10.n--.
k.
2.4' LOT 4 ai
r
BLOCK 3
a
0 0
10' Utility Easement
11
208.71'
S89'46'30"W
LOT 16 LOT 15 LOT 14
N
I
SCALE : 1" = 30'
I
0' 15' 30' 60'
I hereby certify that on accurate survey of the following described PREPARED FOR:
%%%%%% property:
�•� OF p 14 ELMORE SUBDIVISION ADDITION NO. 1 (P—635A)
PANNONE ENGINEERING
.": •"• CqS LOT 4, BLOCK 3 ( —
"9.# was mode on June 20, 2014improvementsAS-BUILT
i*.:49TH :.* and that the
.p q ••, I situated thereon are within the property lines and do not overtop or
'lra2! ncroach on the property lying adjacent thereto, that no
J'. ..Koreb.inikorf: Ir improvements on the property lying adjacent thereto encroach on OWN. DATE Caro
4I No. 3143-5 i the premises in question and that there are no roadways, JSP 6/23/2014 SW 3036
1� . � transmission lines or other visible easements on sold property except FILE NO. F.B. 2014 .106 N0.
� ' + os indicated hereon. Easements other than those shown on the 1417 PG.32 1433
'+��1'ii �` record plot may not appear on this drawing.
6/23/2014 KARABELNIKOFF
3� Anchorage Alaska, this 23rd doy of June 2014. SURVEYING (No as...+.
• i` Municipality of Anchorage
On -Site Water and Wastewater Program
g(S
$K (907) 343-7904
Parcel I.D. 018-171-30
1
Certificate of On -Site Systems Approval
Expiration Date: eI 'a 6-- / �
GENERAL INFORMATION
Complete legal description Elmore #1, Block 3, Lot 4
Location (site address) 4400 ShoShonl Ave.
Current Property owner(s) Marilyn Stirling Day phone
Mailing address 4400 Shoshoni Ave.
Real Estate Agent
Day phone
2. TYPE OF DWELLING: I R��,„�
El Single Family (whao ADU) VENWA l
❑ Duplex 4WJ
El Multiple Dwellings (Single Family and/or Duplex) X014
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
El
Individual F-1
Q�
1
Holding Tank ❑
a
a
Community ❑
Public Water Svstem
❑
Piihlir_. $away ❑
R-yyy ��a
Us /e/
SAf
ETY
Expiration Date: eI 'a 6-- / �
GENERAL INFORMATION
Complete legal description Elmore #1, Block 3, Lot 4
Location (site address) 4400 ShoShonl Ave.
Current Property owner(s) Marilyn Stirling Day phone
Mailing address 4400 Shoshoni Ave.
Real Estate Agent
Day phone
2. TYPE OF DWELLING: I R��,„�
El Single Family (whao ADU) VENWA l
❑ Duplex 4WJ
El Multiple Dwellings (Single Family and/or Duplex) X014
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
El
Individual F-1
Individual Water Storage
❑
Holding Tank ❑
Community Class Well
❑
Community ❑
Public Water Svstem
❑
Piihlir_. $away ❑
Waiver/Variance
Received by: J f k�-(�( ,�-ti�' Date:
COSA to be released to the,'engirleer, unless otheRvise requested by the engineer.
COSA Fee
Date of Payment
Receipt Number
COSA #
Waiver Fee $ _
Date of Payment
Receipt Number,
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Engineering Services LLC
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
S. DSD SIGNATURE
_� System #1 Approved for�5�bedrooms
System #2 Approved for _ bedrooms
Disapproved
Phone 1907)272-8218
Date 6/25/2014
riri k.,1566 orie:
CE -8149 ;
Conditional approval for bedrooms, with the following stipulations:
By:�r—Z Original Certificate Date: 2�^
The nicip�l orf chorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 7 - c
If more than 1 septic system is on the lot:
COSA Checklist # 1 of
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: Elmore #1, Block 3, Lot 4
A. WELL DATA
Well type Private
Date completed _
Total depth ft.
Date of test
Static water level
Well production
If A, B, or C provide PWS ID #
_ Sanitary seal (Y/N) Y
Cased to ft.
FROM WELL LOG
RI
Parcel ID: 018-171-30
Well Log (Y/N) N
Wires properly protected (Y/N) Y
Casing height (above ground) 18+ in.
AT INSPECTION
4/24/2014
53
5.6+
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate 4.67 mg/L
Arsenic ND ug/L Date of sample: 4/24/2014 Collected by: PES
B. SEPTIC/HOLDING TANK DATA
ft.
9 -
p.m -
Tank Type/Material Septic/Concrete Date installed Unknown
Tank size 1,500 gal. Number of Compartments Cleanouts (Y/N) Y
Foundation cleanoutY/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping ���� ��0 I Pumper S4-lp �p v t C -'C's
C. ABSORPTION FIELD DATA
Date installed 6/20/2014 Soil rating (g.p.d./ft2 or ftz/bdrm) 1.2 GPD/SF System type Shallow Trench
Length 40/63 ft. Width 5/5 ft. Gravel below pipe 2.5/0.5 ft
Total depth 5/1 ft. Eff. absorption area 628 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New Results (Pass/Fail) PASS For 5 bedrooms
Fluid depth in absorption field before test New in. Water added NeW gal. New depth New in.
Elapsed Time: New min. Final fluid depth New in. Absorption rate , 750+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at in.
Datum
E. SEPARATION DISTANCES
WELL ON LOT TO:
Size in gallons _
"Pump off' level at
Cycles tested _
Septic tank/lift station on lot 100+
Absorption field on lot 100+
Public sewer main 75+
Sewer /septic service line 25+
Manhole/Access (Y/N) _
in. High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
Animal containment areas 50+ 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 / 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 6/25/2014
COSA brown sheet 10-10-12.doc
Absorption field 5+
Surface water 100+
Water main 10+
Driveway, parking/vehicle storage 10+
in.
0
Found Plastic
Cap on Rebar
Well
Low;
Wood Landing
o & Steps
Conc.
�Pads
SHOSHONI AVENUE
208.71
o L j 26.1' r"l,'
18.0'
o o, X °�.1\\1 f ix�1 —Level Wood Frame Res.,'
aC6 m o yXlI ion Conc. Found. w/Bsmt.
r
o ` ---
C, � \
LOT 3
2.1
2.4
LOT 16
6 /23(Rt+d4
Wood Shed
(No Foundation)
a-15.0
I N �-
Chain Link
Fence
LOT 4
BLOCK 3
10' Utility Easement
208.71'
S89' 46' 30"W
LOT 15
i�
0
r3
Found 3/8"
Rebar
Chain Link
Fence
—Clean Out
(typ.)
Chain Link Fence o-
o�
Shed on Concrete o
Foundation lb—
SCALE1 " = 30'
0' 15' 30' 60'
I hereby certify that an accurate survey of the following described
property:
ELMORE SUBDIVISION ADDITION NO. 1 (P -635A)
LOT 4, BLOCK 3
was made on June 20. 2014 and that the improvements
situated thereon are within the property lines and do not overlap or
encroach on the property lying adjacent thereto, that no
improvements on the property lying adjacent thereto encroach on
the premises in question and that there are no roadways,
transmission lines or other visible easements on said property except
as indicated hereon. Easements other than those shown on the
record plat may not appear on this drawing.
Anchorage Alaska, this 23rd day of June 2014.
LOT 5
LOT 14
