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HomeMy WebLinkAboutSPERSTAD #2 BLK 4 LT 3Sperstad #2 Block 4 Lot 3 #018-072-21 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: OSP161178 PID Number: 018-072-21 ❑ New ❑✓ Upgrade Name: Ron Cupples ABSORPTION FIELD []Deep Trench ❑✓ Shallow Trench ❑Bed El Mound Address - - 13040 Back Rd. Anchorage, AK 99515 ❑ Other Phone Number of Bedrooms - Soil Rating Total depth from original grade 4 1 GPD/SF 9.8 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 5.8 Ft. Gravel depth beneath pipe 4Ft. Subdivision Block Lot Sperstad #2 4 3 Fill added above original grade 0 Ft. Gravel length - 60 Ft Township Range Section - Gravel width 5Ft. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 600 FO 1 N/A Ft: Well 105.9 117.3 N/A N/A 77,8 TANK El Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1,250Gal. Surface Water 100+ 100+ N/A N/A Material Number of compartments tot Line 28.4 12.9 N/A N/A Steel 2 NA Foundation 55.8 77.1 N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ 50+ N/A I N/A Gal. Remarks Pump on level at n. Pump off level at in. High water alarm at in. - - Pump make and model Electrical Inspections performed by Installer -- PIPE MATERIAL House to tank Tank to 3034 drainfield Beek's Contracting Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100ft InspectionLocation dates: 1 8/6/2016 2w 8/6/2016 and description - - 3rd 8/7/2016 4'" 8/8/2016 Back Door Threshold COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp s Conditional Approval Date,W „jl Ak, .4�p{� •'evenriorae. 1 s Approve ��,�, _r Date ' l �j- ( Inspection Report 1-1-12.doc DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 12509 _ PERC RATE: <1 MPI SOIL RATING: 1 GPD/SF AREA ROD: 600 SF - SYS. TYPE: WIDE TRENCH 4.0'ED MIN LENGTH: 60 LF USED: 60LFx5'Wx4.0' E.D., 9.8' TO TOTAL AREA: 600 SF LEGEND W WATER LINE/ WELL RADIUS SS NEW SEPTIC ABBREVIATIONS TH TEST HOLE W EACH m -FOUNDATION CLEAN OUT WW TANK CLEAN OUT NO. C# CLEAN. OUT NO. J MONITOR TUBE NO. F RIGID INSULATION - W DOUBLE CLEAN OUT DV DIVERTER VALVE Q FLOW SPLITTER - (E) FILTER FABRIC (P) o - a�z TYPICAL z wow a w z 4" 9 DRAIN PIPE z a j ¢ w w Ow w ABOVE DRAIN ROCK 6"' PIPE INV w W 0ci w nuc DRAIN ROCK u 99.8 GNU 99.4 TH !T! -u-m- OR -1.0 .3 NEW 1,250g SEPTIC TANK 94.1 - 93.6 93.6 - SP 89.6 PROFILE POST TANK LINE CONNECTED TO MIDPOINT OF TRENCH 7.2 1 1-17.0 82.4 BOH NO GROUND WATER - ENCOUNTERED DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 12509 _ PERC RATE: <1 MPI SOIL RATING: 1 GPD/SF AREA ROD: 600 SF - SYS. TYPE: WIDE TRENCH 4.0'ED MIN LENGTH: 60 LF USED: 60LFx5'Wx4.0' E.D., 9.8' TO TOTAL AREA: 600 SF LEGEND W WATER LINE/ WELL RADIUS SS NEW SEPTIC ABBREVIATIONS TH TEST HOLE EA EACH FCO -FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN. OUT NO. M# MONITOR TUBE NO. R. 1. RIGID INSULATION - DCO. DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER - (E) EXISTING (P) PROPOSED TYP TYPICAL NOTES: PANNONE ENG SVC, LLC _��oF A `�� Dote L 1 8/16/2016 RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 �% '� .• 4 PHONE (907) 272-8218 FAX (907) 272-8211A ac. / scale DRAWN BY: � *: • �. // NTS N,1C / ...... ... .. .. P.I.D. NO SPERSTAD #2, BLOCK 4, LOT 3 072-21 / ..Steven R. PPannone. RON CUPPLES / /PERMIT No. % PFC, CE 8149 .'c„�j OSP161178 13040 BACK ROAD DESIGN DETAILS ANCHORAGE, AK 99515 +ill``\ OS"'—� s"3eoE 3 A B T1 60.70 58.20 C1 81.60 77.40 SEPTIC AREA DRAIN FIELD (E) IN FAILURE - RE—USE AS RESERVE NEW UPGRADED DRAIN FIELD GOLF x 5'W x-4.0'ED x 9.8'TD M N TH-1 z V) D C M1 EXISTING SEPTIC AREA n +I A\ M� 131 9 DRIVEWAY /SC p DVD2.9+ 1 /a i+I NEW 1,250 GAL SEPTIC TANK— . .�.. g I EXISTING �� 1 SEPTIC AREA 'L T1 FC (E) B T2 I 4 BR HOUSE 0 [� 10. (E) WELL (E) `\LOT 3 \WELL (E) �2\ 2 W - \'h (E) p z D 00 5 Z O > NOTES:PANNONE O' m _—���\l �� qF A� ysl�� %y�P ,. *�� / . .. ...... / / Steven'R.'Pan'none'j �+PFo CE ala9.ri ++t>l�PF4PpO ES510NPV�� Date 8/16/2016 C2 z� ➢ o- SPERSTAD #2, BLOCK 4, LOT 3 RON CUPPLES 13040 BACK ROAD ANCHORAGE, AK 99515 A 1 .m CM2 z V) D C M1 EXISTING SEPTIC AREA n +I A\ M� 131 9 DRIVEWAY /SC p DVD2.9+ 1 /a i+I NEW 1,250 GAL SEPTIC TANK— . .�.. g I EXISTING �� 1 SEPTIC AREA 'L T1 FC (E) B T2 I 4 BR HOUSE 0 [� 10. (E) WELL (E) `\LOT 3 \WELL (E) �2\ 2 W - \'h (E) p z _ 00 5 �W_� 1B WN 1A NOTES:PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 _—���\l �� qF A� ysl�� %y�P ,. *�� / . .. ...... / / Steven'R.'Pan'none'j �+PFo CE ala9.ri ++t>l�PF4PpO ES510NPV�� Date 8/16/2016 RECORD DRAWING Scale 1"=50' DRAWN BY SPERSTAD #2, BLOCK 4, LOT 3 RON CUPPLES 13040 BACK ROAD ANCHORAGE, AK 99515 NJC - P.I.D. NO 018-072-21 PERMIT NO. OSP161178 PLAN Sheet 2 01 1 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: OSP161178 Tax Code Number: 01807221000 Work Type: Septic Upgrade Permit Effective Dates: July 21, 2016 to July 21, 2017 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: SPERSTAD #2 Site Legal Address: SPERSTAD #2 BLK 4 LT 3G:2832 Owner/Address: CUPPLES RONALD M & MORGAN ROBERTA H 1792 IRA DRIVE ANCHORAGE AK 995150000 Site Mailing Address: 13040 BACK RD, Anchorage Lot Size in Sq Ft: 23374 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y 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 By: Q�oAw(/\� O Date: Date: ( �� MUNICIPALITY OF Community Development Department Development Services Division Gln -Site Water & Wastewater Program 9 8 9 70 G%ol�to<< ruy6 '' ANCHORAGE JUN 3 0 2015 Phone: 907 Fax: 907 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 018-072-21 Property owner(s) Ronald Cupples & Roberta Morgan Day phone Mailing address 13040 Back Road, Anchorage, AK 99515 Site address 13040 Back Road Legal description (Sub'd., Block & Lot) Sperstad #2, Block 4, Lot 3 Legal description (Township, Range & Section) Lot Size 23,374 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Initial ❑ Single Family (SF) ❑X Septic Tank ❑X Upgrade ❑X (w/wo ADU) Duplex (D) ElHolding Tank ElRenewal ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ 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 NTunicipal Codes. of property owner or Permit/Rush Fees: 3 6 %p• Waiver Fees: Date of Payment: t4 — 30 '-/6 Date of Payment: Receipt Number: 0 24.�3� Receipt Number: Permit No. caE&4& Waiver No. Permit App_.; :'_.,�c- Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: stevePpaneneak.com 28 -June 2016 Subject: Sperstad #2, Block 4, Lot 3 - Septic System Upgrade Permit Request Design Narrative - This is a design narrative for a permit to install an upgrade septic system to be issued for this property. The proposed system will serve an existing four-bedroom (4) house. Currently the lot is developed. This lot and the surrounding lots are served by private wells. There are no wells within 100' of this system. 1. Soils. One test hole was performed on this lot by PES in June of 2016, and groundwater was monitored for at least seven days. Ground water was not observed to a depth of 17' below the surface in the test hole monitor tube after the 7 -day monitoring period. Bedrock was not encountered in the test hole. Based on the results of the percolation tests and overall soils appearance; an application rate of 1 gallons/day/square feet was used for a conventional Wastewater system in the area of the test hole. 2. Soil Absorption System Design. a. See Sheet 1 of the design package. 3. 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. 4. Topography: The existing topography slopes generally from south to north at approximately 3% in the area of the upgrade. There are no steep slopes within 50' of the proposed drain field. The proposed drain field will maintain 50' separation all steep slopes. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 1250g PERC RATE: <1 -MPI SOIL RATING: 1 GPD/SF AREA ROD: 600 SF SYS. TYPE: WIDE TRENCH 4.0'ED MIN LENGTH: 60 LF USE: 60LFx5'Wx4.0' E.D., 11.-0' TD TOTAL AREA: 600 SF ABBREVIATIONS TH TEST HOLE EA EACH FCO FOUNDATION C /1T# TANK CLEAN 0 C# CLEAN OUT N M# MONITOR TUBE R. 1. RIGID INSULATI DCO DOUBLE CLEAN 4F DV DIVERTER VAL FS FLOW SPUTTER (E) - EXISTING EXISTING, (P) -PROPOSED_ SEPTIC AREA TYP TYPICAL DRAIN FIELD -(E) IN FAILURE RE -USE AS RESERVE - I I UPGRADE DRAIN FIELD (P) 60LF x 5'W x 4.0'ED x 11 .O'TD WITH MONITOR TUBE AND n M CLEAN OUT AT EACH END +1 -H r7 TH-1 N H n > m DF7a�t' ss a- m q o m n O - -i M +1 -H - I F.-�+ . . INSTALL DOUBLE CLEAN OUT AND DIVERTER VALVE VERIFY CONDITION OF 12509 SEPTIC TANK (E) IF FOUND TO BE LEAKING DECOMMISSION PER CODE AND INSTALL 1250g SEPTIC TANK (P) EI ISTING SEPTIC AREA - 1 I \ - LEAN OUT UT NO. 0. NO. ON OUT VE 4� 0 C / Y ----�M M M.DRIVEWAY - /� \ w A BR LOT 3 HOUSE �1 (E) WELL E) -I WELL (E) � 2 �w-W W LEGEND —w— WATER LINE/ Iy WELL RADIUS I � I t - I P'1 SS — NEW SEPTIC NOTES: PANNONE ENG SVC, LLC - P.O. BOX 100217 ANCHORAGE, AK 99510- PHONE (907) 272-8218 FAX (907) 272-8211 �— of q `>> ��•.....Lqs��, J ���P. �y1� #: Q ..*�, / ....... . .. . • Steven R. . Pannone / I '�9�n�: CE 8149 .c`?� I c, _ 11 A6. -0E551_..' � Date 7/20/2016 FOR CONSTRUCTION Scale 1"=50' DRAWN BY: SPERSTAD #2, BLOCK 4, LOT 3 RON CUPPLES 13040 BACK ROAD ANCHORAGE, AK 99515 DRM P.I.D. NO ma -072-21 - PERMIT N0. OSPI61178 PLAN meet 1 OF 3 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 AND IN ACCORDANCE WITH AMC 15.65 AND 15.55. 2. SCOPE OF WORK: INSTALL NEW SOIL ABSORPTION SYSTEM AND VERIFY EXISTING TANK. REPLACE TANK IF FOUND TO BE LEAKING. - - 3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 17 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE - SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 17 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 4. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) HAD THE WELL LOCATION AND SEPTIC LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET .OF -THE PROPOSED SYSTEM STAKEDBYA REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK. 5. THE CONTRACTOR IS.RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED. 6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES. - 7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING AND LOCATES WERE IN PLACE PRIOR TO NOTIFYING THE ENGINEER. 8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS AND SITE CONDITIONS/LIMITATIONS POTENTIALLY CAUSING THE NEED TO MODIFY THE DESIGN, 9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL 'SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE - ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND TANK ELEVATIONS. 10. THE CONTRACTOR SHALL PROVIDE PHOTOGRAPHS OF THE SYSTEM INSTALLATION TO INCLUDE BOTTOM OF EXCAVATION, TOP OF PIPE WITH CLEAN—OUTS AND MONITOR TUBES INSTALLED, INSTALLED TANK AND FINAL GRADING. 11. THE CONTRACTOR SHALL PROVIDE DATA (UPON WHICH THE RECORD DRAWING WILL BE BASED) THAT REPRESENTS THE PROJECT AS CONSTRUCTED. THIS DATA IN CONJUNCTION WITH THE PERIODIC FIELD OBSERVATIONS BY THE ENGINEER (OR HIS DESIGNEE) AS REQUIRED BY AMC 15.65 DOES NOT GUARANTEE THAT THERE ARE NO HIDDEN DEFECTS BY THE CONTRACTOR. 12, THE CONTRACTOR SHALL SIGN THE FOLLOWING: - I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED. CONTRACTOR: BY: TITLE: NOTES: PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 _�����\\ - OF • A/-., �l ,r '(� ......*0,- 0 %cpP • f77 *ll/ .... .. ... .. ..... / Steven R. onnone j P�„•.. CE 8149 ..2-� +lillf��or�sso�P`��.. \ Date 7/2o/2o1s FOR CONSTRUCTION Scale NTS P.I.D. NO 018-072-21 DRAWN BY SPERSTAD #2, BLOCK 4, LOT 3 RON CUPPLES 13040 BACK ROAD ANCHORAGE, AK 99515 DRM PERMIT NO. OSP161178 DESIGN DETAILS Sheet 3 OF 3 TEST HOLE 1 OR 1 2 4 5 6 7 8 9 10 11 12 13 14 15 16, 17 16 SAND DATE PERFORMED: 06/07/2016 SOILS LOG - PERCOLATION TEST SLOPE x TH SITE PLAN ` \/ 4 BR q qLU 1 0 Hous/ �\1 I I WAS GROUND WATER SLOPE ENCOUNTERED? N IF YES, AT WHAT TH DEPTH? --- x DEPTH TO WATER AFTER MONITORING? -DRY- DATE: 06/27/2016 SOIL TEST RESULTS/ANALYSIS - • PERCOLATION RATE e1 (min/inch) • PERC HOLE DIAMETER 6" • TEST RUN BETWEEN 4 FT AND 5 FT. • TEST RUN FOR OVER AN HOUR, LAST THREE READINGS PROVIDED. COMMENTS: Test hole excavated by BEEK'S CONTRACTING. Test Hole was presoaked before Perc test. PERFORMED BY: DAN MORAN. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT 7�OT7N�TTHE DATE OF THIS TEST. n FOR CONSTRUCTION Ptll`I1�IONE ENG SVC, LLC �'`oe OF A�\\�l 77/20/2016P.O. BOX 102954 ANCHORAGE, AK 99510 r� '.. A• ,jS'� PHONE (907) 272-8218 FAX (907) 272-8211 is • ��' v 6 DRAWN BY: DRM SOILS LOG SPERSTAD #2, BLOCK 4, LOT 3 RON CUPPLES 13040 BACK ROAD ANCHORAGE, AK 99515 *. 49 CLOCK WATER READING DATE TIME NET TIME LEVEL NET DROP 0nnone % 8149: 018-072-21 READING 1 6/7/2016 2:30 2OF3 2 <1 MPI NOT ABLE TO MEASURE SEE SIEVE ANALYSIS 3 ° 5 8 SOIL TEST RESULTS/ANALYSIS - • PERCOLATION RATE e1 (min/inch) • PERC HOLE DIAMETER 6" • TEST RUN BETWEEN 4 FT AND 5 FT. • TEST RUN FOR OVER AN HOUR, LAST THREE READINGS PROVIDED. COMMENTS: Test hole excavated by BEEK'S CONTRACTING. Test Hole was presoaked before Perc test. PERFORMED BY: DAN MORAN. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT 7�OT7N�TTHE DATE OF THIS TEST. n FOR CONSTRUCTION Ptll`I1�IONE ENG SVC, LLC �'`oe OF A�\\�l 77/20/2016P.O. BOX 102954 ANCHORAGE, AK 99510 r� '.. A• ,jS'� PHONE (907) 272-8218 FAX (907) 272-8211 is • ��' v 6 DRAWN BY: DRM SOILS LOG SPERSTAD #2, BLOCK 4, LOT 3 RON CUPPLES 13040 BACK ROAD ANCHORAGE, AK 99515 *. 49 ,1 r) NTS P.I.D. NO ..... .. .. .. .,• Steven CE 'l�iF��OFE5S0NP` 0nnone % 8149: 018-072-21 PERMIT NO. OSP161178 Sheet S9 2OF3 040.002 Crowther Associates Client: Pannone Engineering Services Project: Sperstad Subdivision #2, Block 4, Lot 3 Date: June 20, 2016 Particle Size Distribution Table Sample Source Block 4. Lot 3 Sieve Size Percent Finer Percent Finer Percent Finer Percent Finer 3 inch 100 1-1/2 inch 100 '/ inch 100 #4 98 #10 95 #40 12 #100 7 #200 4 0.02 mm Classification Sand (SP) 1632 Bellevue Circle /Anchorage, Alaska 99515 Telephone (90 7) 349-2198/Email: crowther@alaska.net MONICIPAI-ITY OF r1f,'cj ,tA MUNICIPALITY OF ANCHORAGE DEPT. oi' I-IEt,1.111 F: DE ATMENT OF HEALTH AND HUMAN SER. ,ES 1_NW0NIANiAl. P, oicc lq,y Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 1986 ON -SITS SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name bISTANCE ,g �:�; FRDM TO SEPTIC TANK ABSORPTION FIELD WELL Address J 22 WELL Phones) '2jt �S" 3�) Iv Permit No. c) Z qc� No. of BeTirns V) LOT LINE 7 LEGAL DESCRIPTION Lot Block I Subrh son FDUNDATID _As -7 f �� Township, Range, Section _ --BUILT DIAGRAM (Shpw location of well, septic system, property lines, foundation, _ v driveway. water Oodles, VES TANKS SEPTIC El HOLDING Manulacturer Capacity in gallons Malenal No. of Compartments TYPE; OF SYSTEM IH r _ X'FRENCH ❑ RED [IW. DRAIN L-1OTHERI /Depth to pipe bottom Irom original grade L . �T Fill added above original grade Total depth from original grade --- ----- ZIO+T Gravel depth beneath pipe_ g+ U FT I 0 I i fit% _IJ Gravel length 0 FT it n ; _ Gravel width 'UFT Total absorption arcs � 40 2 SO FT - I y Do 5 DislartCe between linesIII '!kn FT Number of Imes Soil rating Pipe material I '�Sv SOFT J�j Ol 35V Installer Date Installed _ WELLS D — 1J� — Co '=• r2 PRIVATE ❑ OTHER (Identifv) 1 Classiticauon (A,B, C) Tofal Depth Cased to FT FT Installer Date Installed, REMARKS: 1 ( —�\ scale: I e-�j' Inspections Perfo med by: ,. E19Gtt4fii`_R'S''S'Al. tir r I"i. 1 1 bi r r v ,. •, ���: r f t ' Y .. ,,,.�r,•,'t�l. �� - �—rvci 4 `� I I� \ U, Date./ LS' j v inspection wasPerforned according to all y \ l S & EViG 1`d;i .li c'.certify [hat this Municipal aRg 912Weffect on this dale. EAGLE RIVERr AK 9<, 7.7 . ._� �� Health Department Approval: — ,(` �. _. G - Date. - 72-013 (3/85) ���F 11, ������ �������� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 995O1 " u 264^4720 ��V,� ill ERMlT NO: 860248 UPGRAD� DATE ISSUED: 07/30/86 APPLICANT: DENNIS SIGLER ADDRESS: 13040 8ACKROAD ANCHORAGE� AK 99515 CONTACT PHONE: 345~3216 LEGAL DESCRIP: SUBDIVlSlON: SPERSlHD LOT: 3 8LOCK: 4 SEC|lON: 29 lOWNSHIP: ]2N RANGE: 3W LOT SIZE: �6000 (SQ.FT. OR ACRES) I certi[y that: 1, I am [amiliar wiLh the requirements [or on^!Di te sewers and wells as set �orth by the Municipality o� Anchorage (MOA) and the State of Alaska, 2. I will install the system in accordance with all MOA codes and regulations� and in compliance with the design criteria c) 11 this permit" 3, l will adhere to all MOA and Gtate of Alaska pequiremenor the set back distancerom any existing well; wastewater disposal system or public sewerage system on this or any adjacenL or nearby loL" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES� lHEN (1> AN ELECTRICAL ECTION MUST BE OBTAINED; (2) AS~BUILTS WILL NOT 8E ICAL INSPECTION REPORT; AND (3) THE ELECTRICAL W NSE) ELECTRICIAN" S1GNED DA[E: � APyLICANT: DE�|�l�/�[GLER � � ISSUED 8Y DATE: ��/-'---- ���� ' / " " 41/) f 1// ..- i J //.Y% , P. O >> ,\ f p 0 q J i cn 7 �n we f p 0 q No Yuwr m a -V' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME L -`V 1V `�` �-•� PHONE .YJ -'Iwo NEW ❑ UPGRADE MAILING ADDRESS Rsnu LEGAL DESCRIPTION 6 LOCATION `-r, NO. OF BEDROOMS U Y DISTANCE TO: Well "` Absorption area ,� Dwelling PERMIT NO. -1 'i� 0 E5 4-9 n, Z Manufacturer Material No. of compartments y Liq, rapacity in gallons IF HOMEMADE: Inside length Width Liquid depth N I JVZ DISTANCE TO: Well Dwelling PERMIT NO. 02 _ Manufacturer- Material Liquid capacity in gallons _j LUX DISTANCE TO: Well `�4 Foundation �7 Nearest lot line `� PERMIT NO. .� C w Z Z w No. of lines Length of each Line �� Total length of line Trench width inches Distance between lines c a 0 Top of tile to finish grade t N b Material beneath the p vt 0 inches Total effective absorption area U1 0 Length Width Depth PERMIT NO. Q h_ w °• Type of crib Cri d' eter Crib depth Total effective absorption area N DISTANCE TO: ell Building foundation Nearest lot line J aap ` Depth Driller Distance to lot line PERMIT NO. .A 4r W DISTANCE T0: Building foundation Sewer line Septic tank Absorption area(s) OTHER �n O PIPE MATERIALS O 5U P SOIL TEST RATING t.5O Li Q INSTALLER c,L� REMARKS tt � w ro� )151` �' � = � t_L yv • L tl X03 o � — , n� PROVED DATE LEGAL 72-013 (Rev. 3/78) PERMIT NU ( 780848 ) « HPPLICHNT [)ENNIS 5lGLER 5RH !�UX /8|) ]44^/L LOCHTI0N RHCK ROHD LEGHL L] 134 SPERSTH; LOT SlZE 26800 S0UHRE FEET TYPE OF SOIL 1 18S1: 1R8T1:01, 1 SYSTEM IS: TRENCH 4� THE RUN UI REF` SIZE OF THE 0111 HBSORPTION SYSTEM IS� �Ahm U� s? 50 W Z 5 1�� THE LENGTH DIMENSION lS THE LENGTH (lN FEET) OF THE lRENCH OR DRHINFIELD, THE DEPTH OF H TRENCH OR PIT lS THE 1)IST8NCE 8ETWEEN THE SURFHCE for THE GROUND HND THE BOTTOM OF THE FXCHV8TI0N (IN FEET) THEkE I� N0 SET NIDTH FOR TRENCHES lHE GRRVE| DEPTH lS THF M}N7MUM DEPTH UF GRHYEL BETHEEN THE O(ITFHLL PlPE HND THE ROTTCol OF THE EXCHYHTlOH ({N FEET), PW? T W7 A POT W! W 5 V 3 .?" P W Q M T~K.Q by 0 PBNlT I'll PLlCHNT HHS THE RESPONSlBILlTY T0 INFORM I'll lS DFPHRTMENT DUR{NG THE IN5THLLAil Tl0N INSPECTI(APT 1 F OKAY it! T91 O|)JOCENT TO THIS PROPERl9 OND THE NUMBER UF Van SIimNCES THHT THE ND1. NILA 5ERVE. I I~. 11 ��`� :IF !I,, F T0005 W"T NO Vv � �N WS1 r ... 11 11�� 11 K ��l BHCKFILLlNG OF HNY SYSTEM WlTHOUlFlNHL INSPECTlON HND RPPROVHL BY THlS DEPHRTMENT WILL BE �U8JECT TO PROSECUT)ON, "Ont scst is L.Lj. b a Il:outand r 2204 Cleveland Anchorage, Alas}.a 103503 / Performed For Dein Ile— r-- Date Ferformed leaa1 0escrintion: LotBlocG:_Y_Subdivisinn���s— This Form Renorts Soils Lon__ Ile -4, Percolation •Fest_ penth Feet - Soi1 Characteristics RA 4 -- 6 -- Gam. /J 8 — %b U VL -5-5."10 — 12— 14 — 16-- 18— v0� 20 Was Ground Water Encountered? 06 If Yes, At what Depth? Readinq Date Gross Time Net Time Depth to H2O Net Dron' Percolation Rate Minute Proposed Installation: Seenaoe Pit Drain Field Deoth of Inlet Depth to Bottom Of Pit Or Trench rnurIEN`TS: Data Certified Qy: Y Gate _— 0 D Test Performed By___ ____� � _ I NO E•i r I" r. F4 i> I" 4 � � 14 &1 E-4 1-4 E-1 EA E-1 P E4 F.�4 &4 P4 H p MUNICIPALITY 11C F ANCHORAGE DEPT. 00, iEALTH & EN VIRONMENML PROTECTION IDU N fX4 frl f74 �Fg F%4 �-4 RECEIVED Fr 14 E14 F4 [4 EA F, 1 �4 [-4 E�l (4 P J4 E4 r14 0 b! sat M4 V4 0 0 W 0 0 19 94 M 04 M Cd fr4 fa! W rz4 1;,4 ra4 rag k. P4 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL_ OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date d�:5 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section,township,,range) I tr_� ") 4 � Y `t T 1� �W -Z, Location (address.or directions) (b) - Property Owner- ��� `��4�1 ���� Telephone: Home Business Mailing Address (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address �� V� — �-►� �1�['��� Telephone (e) Mail the HAA to the following address: or: Check herej�4; if hold for pick up. List contact person and day phone number below. 17076 Engle River l o Rn3J N p Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite')t_ Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/861 Front 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING 1',034 E,gle River- 1 o" Road No 2u4 Telephone7' Address Eagla River, Alaska 99577 Date .5_ 11 f *10040"T" Na.6W A. Ualm 14674 1 •ems _- ee A" 6. DHHS ed for y Date �1 Approved for bedrooms b ��/ Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (Rev 8/86) Back MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION MUNICIPALITY OF ANCHORAGE (MOA) „„ , CJ' 1988 HEALTH AUTHORITY APPROVAL (HAA) L C I V V CHECKLIST - FEBRUARY 1984 264-4744 /)`P.-0_//? _�� a Legal Description: A. WELL DATA Well Classification (����f �tj'� If A. B, C, D.E.C. Approved (Y/N)��° Well Log Present&)N) Date Completed ��' t"� Yield+ `r:"irF 1 _t Total Depth lir/ Casedtot ��'' f De th of Grouting Static Water Level 13 't '�''� Pump Set At Casing Height Above Ground 1= Sanitary Seal on Casinge/N) — y Electrical Wiring in Condui&A) Depression Around Wellhead (YLNp t� Separation Distances from Well: d � To Septic/13foiI44 Tank on Lot On Adjoining Lots i To Nearest Edge of Absorption Field on of = �' On Adjoining Lots t +c )e -D ") To Nearest Public Sewer Line I� To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sampl Water Sampl Comments B. SEPTIC7Ft9L-1 I_N_ JANK DATA Date Installed Size �r� L' No. of Compartments StandpipesON)Air-bight Capscr?1N) Foundation Cleanout((5 N) Depression over Tank (Y(NNP Date Last Pumped c� Pumping/Maintenance Contract on File (Y/N) , for Holding Tank High -Water Alarm (Y/N)'\ Temporary Holding Tank Permit (Y/N) Separation Distances from SeptiCM4ofdlnzTank: _ 1 To Water -Supply Well ` I To Building Foundation To Property Line t->! To Disposal Field c� t To Water Main/Service Line —� To Stream, Pond, Lake, or Major Drainage Course Comments _ Page 1 of 2 72-026 fnev 8/861 Front e C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ��jam Type of System Design Date Installed �� - f.%' 6 7 Length of Field �� + Width of Field J Depth of Field Gravel Bed Thickness Square Feet of Absorption Area (nl + Standpipes Present MA) i Depression over Field (Y/6),> Date of Last Adequacy Test Results of Last Adequacy Test � 1`� C % �� — 4 Separation Distance from Absorption Field: 1 To Water -Supply Well To Building Foundation Lot To Property Line ; On Adjoining Lots To Water Main/Service Line 1-C� 4 To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area / To Existing or Abandoned System on Comments D. LIFT STATION 1 Da Iled Size in Gallons "Pump On" Level at High Water Alarm Level at . Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and H A guidelines in effect on the date of this inspection. Signed S & S ENGINEERING/ 147 Ila 17034 Eagle Kive,eP R®ad No. /6N y Comparffag{ Alaska 99577 MOA No. �� LL Receipt No. / 7 Date of Payment s-_/ 7 v� Amount: $ Z .70 S �3.3 a Page 2 of 2 72-026 (Rev 8/86) Back ` CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. I TELEPHONE (907) 562.2343 5633 B Street Anchorage, Alaska 99518 .w.owwro�ie Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER I TO BE COMPLETED BY LABORATORY 11 PUBLIC WATER SYSTEM I.D.# 71 b . fil--PRIVATE WATER SYSTEM Name S & S ENGINEERING Phone No. 17034 Eagle River Loop Roprl Kim NJn4 Mailing Addraagle River, Alaska 99577 City State Zip Code SAMPLE DATE: o Mo. Day Year SAMPLE TYPE: Routine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected j�By 1 1 � � � �T•-IL- `f � ��� i' 2 3 1 1 41 1 5 READ INSTRUCTIONS RFFr)RF COLLECTING SAMPLE Analy IS Shows this Water SAMPLE to e. Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received ���-� - f -i' Time Received z ,z 0 Analytical Method: Membrane Filter " No. of colonies/100 ml. Lab Ref. No. Result* Analyst U m L� m U m U m BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count 0 Coliform/100m] Verification: LTB Final Membrane Reported By TNTC = Too Numberous To Count OB = Other Bacteria A BGB Collformll0omi Date Time: lJr,90 a.m. p.m. F�P CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC J .(f 9 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 .neoRnroRiEs Client Sample TD:L3, B4 SPERSTAD #2 PWSID :UA Collected MAY 13 88 0 12:45 his. Received 14AY 13 88 0 1.4:00 his. Preserved with :4 DEG. C ANALYSIS REPORT BY SAMPLE for Work Order # 6644 Date Report Printed: 14AY 17 88 0 15:57 Client Nano S & S ENGINEERING Client Acct SNSENGP P.O.# NONE REC D Req # Ordered By : ROBERT SHAFER Analysis Completed :MAY 16 88 Send Reports to: Laboratory Supervisor :STEPHEN C, EDEE 1)3 & S ENGINEERING Released By 6. �e.� 2) Special Instruct: Chemlab Ref #: 1024 Lab Smpl ID: 5 Matrix: Water Allowable Parameter Tested Result/Units Method Limits NITRATE -N ND(0.1.0) mg/l EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY RJS. 1 Tests Performed See Special Instructions Above UA=Unavailable ND= None Detected See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND FNVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEAL'rH AUTHORITY APPROVAL OF ON-SITE. SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name Telephone: Home �2_� J _ Business Applicant Address Gl9'�;; 15 `� 4� S (c) Applicant is (check one): Lending Institution U ; Owner/builder!!, --Buyer 0 ; Other 0 (explain); (d) Lending Institution .`1��=" J��J»= Telephone Address (o) Ileal Estate Company and Agent ___6_� Address Telephone (f) Mail the HAA to the following address: _— EAGLE R�V� IF U-9 2. TYPE OF RESIDENCE'. Single -Family Multi-Farnily EJ Other— Number of Bedrooms __ 4 _ 3. WATER SUPPLY Individual Well FZ Community D Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public EJ Community 0 Holding Tank L7 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025(11:84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 6. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm -telephone 9 Address Date — _ JUL � & DHEP APPROVAL r ,i sZ% Approved for "{`^ `'' bedrooms by ./ -�� F£� Date Approved —__ Disapproved — _— Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOm) MUNICIPALITY OPMg8MHORITY APPROVAL (HAA) DEPT. OF HEALTICUECKLIST - FEBRUARY 1984 ENVIRONMENTAL PROTECTION 264-4720 MUL 1986 Legal Description: Le'"v 3 $1__Y�_ A. WELL DATA RECEIVED Well Classification S'r If A, B, C, D.E.C. Approved (Y/N) A Well Log Present (9/N) Date Completed !��«i_1:976 Yield 0 • S Total Depth �iL/ Cased to Depth of Grouting Jam• i Static Water Level 3 7 - Pump Set Aty I�- Casing Height Above Ground 1 Z ti Sanitary Seal on Casing (CDN) Electrical Wiring in ConduitTUN) Depression Around Wellhead (Y/O Separation Distances from Well: 71 (pc) I -f' To Septic/LioWirrgTank on Lot w0f. ; On Adjoining Lots To Nearest Edge of Absorption Field on (.ot I �� ; On Adjoining Lots \ do 1 1 To Nearest Public Sewer Line -� I To Nearest Public Sewer Cleanout/Manhole Q To Nearest Sewer Service Line on Lot I r Water Sample Collected by 5 `; `� �C; IeJ�c��x Date Water Sample Test Results SS Comments w t— 'r�c� S(t �\.rP J) O•� lsPw B. SEPTIC/H'GrL'DMG TANK DATA Date Installed 01 Size No. of Compartments 1• StandpipesdWN) — Air -tight Caps 6'1\1) Foundation Cleanout4DN) Depression over Tank (Y16Date Last Pumped 13 gb Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/ Tank: To Water -Supply Well ©o To Building Foundation r To Property Line b I'1 To Disposal Field -D To Water Main/Service Line i To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) 11 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata #>I 80v Type of System Design Date Installed Length of Field 3 `) Width of Field -�Lo Depth of Field Gravel Bed Thickness `a Square Feet of Absorption Area �2� ' Standpipes Present (S?N) Depression over Field (Y/4p Date of Last Adequacy Test Results of Last Adequacy Test SD�t�15 Separation Distance from Absorption Field: To Water -Supply Well 1.of�) To Building Foundatio r� Lot To Water Main/Service Line 23' 0 To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed To Property Line 1 C) To Existing or Abandoned System on On Adjoining Lots 53,L� To Gutbank (if present) I . Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test. Meets MOA I certify"t5JaNllftf8F1kWded, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed$R R 19AX Date ]III 1 8 IQ86 CompaKrLE RIVER, AK 99577 MOA No. Receipt No. t1bo i c)o©,�6 Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. q TELEPHONE (907) 562.2343 - 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D.# FT --- F7� Analysis shows this Water SAMPLE to be: PRIVATE WATER SYSTEM }� Satisfactory }�' S ���'`S�`�L��'�G �' i'S� � ?9 �9 ❑Unsatisfactory Name Phone No. S" H (P '< ❑ Sample too long in transit; sample should not be over 30 hours old at examination Mailing Address m (, to indicate reliable results. Please send '74757 7 new sample via special delivery mail. City State Zip Code � Q� B 6 Date Received SAMPLE DATE: Mo. Day Year TimesReceived SAMPLE TYPE: Routine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 1 1 L r -�' 15-� � 2 I s� 31 41 51 READ INSTRUCTIONS .1=11=156 7T COLLECTING SAMPLE Analytical Method: Membrane Filter * No. of colonies/100 ml. Lab Ref. No. Result* Analyst ZS -W-43 01 ® -b L (-4 I -J m EP U m 1 I m BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter. Direct Count Verification: LTB 1 Final Membrane Filter Results Reported By TNTC = Too Numberous TO Count OB = Other Bacteria 9 Date 0 7 Collforml100ml Collform1100ml f6 Time: a.m. p.m. MUNICIPALITY OF ANCHOKAGE DI"PART'NENT OF HEAD 11 AND AIRMAN SERVICES WAIVER REW 1?W WORKSHEET DATE REGEIVEn: LEGAL:— 115< -72 sly GNGINE,ER: , Sk B 1966 ,%PPLICANTt wAIVFR REQUESTED:_��LS_Lv�� CRITERIA:, S�T��� trj X12 1.) Geology: Points: A. Water Table B. Soil Sor=ption 2, 0 _ C. Permeability D. Water Table Gradient � o� Fi. Horizontal Soparati.on 2 TO'T'AL: Zo, 2) Special. Couditions:_�gp���My__��t_.!-_ate WSJ µin TD 1­tr 3 3) Other:._._. -[2�� �_.�'i _�4�� �._T1 ot..--..� WAIVER 15: ,^,ranted, with condt.cions li-sted below - not granted for re.asous li.st:ed below: DATE: 11y: NAME �k ��l�laalr �%' - i�#Gi 9 V • � Municipality of Ancho � RUG 16 2016 On -Site Water and Wastewater Prog aU (907) 343-7904 �yb w s n F E r z � 1[01 9C5 Certificate of On -Site Systems Approva 6 e Parcel I.D. 018-072-21 Expiration Date: 0 ' 1. GENERAL INFORMATION Complete legal description Sperstad #2, Block 4, Lot 3 Location (site address) 13040 Back Road. Current Property owner(s) Ronald M Cupples & Roberta H Morgan Day phone Mailing address 13040 Back Road. Anchorage, AK, 99515 Real Estate Agent Day phone 2. TYPE OF DWELLING: 7 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY-: TYPE OF WASTEWATER DISPOSAL: Individual Well- 0 Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. - kMS44 Sze_ COSA Fee $ 1A7 �50 Date of Payment l�/ Receipt Number OQW & COSA # `a&/ 9%9 Waiver Fee $ 1(01.10 Date of Payment g I 18 ,/)-o I l0 Receipt Number GK" # 19,U ►'n>Fn+ra� 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixereto andias of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site`aSystems£'Iiproval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional nd adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. 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 Date 8/16/2016 6. DSD SIGNATURE �F ..,. System #1 Approved for � bedrooms . Sleveri Ii. arir System #2 Approved for bedrooms 1i• CE -8149 e+} s Disapproved ��if� alp4 Conditional approval for bedrooms, with the following stipulations: v The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory ArseniGAdvisory Well Flow Advisory Other t COSAbluesheet f :e c. If more than 1 septic system is on the tot: COSA Checklist # of i Structure served by this system Certificate of On -Site Systems_ Approval Checklist Legal Description: Sperstad #2, Block 4, Lot 3 parcel ID: -01.8-072-21 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 9/19/197$ Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 285 ft. Cased to 285 ft. Casing height (above ground) 18+ n.. FROM WELL LOG AT INSPECTION Date of test 9/19/1978 8/3/2016 Static water level Unknown ft23 ft. Well production Unknown g.p m WATER SAMPLE RESULTS: Coliform VIP colonies/100 mL Nitrate 0•/1 mg/L Arsenic ZlD.7d ug/L Date of sample 4 1;tO/ 5.0+ g,P.m. ` Collected B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 8/7/20.16. Tank size 1,250 gal. Number of Compartments 2— Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping New Pumper N/A C. ABSORPTION FIELD DATA - 8/6/2016 z 1 GPD/SF Shallow Trench Date installed Soil rating (g.p.d./ftz or ft /bdrm) . System type Length 60 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 9.8 ft. Eff, absorption area 600 fiz ` r Monitoring tube Y Depression over field N Date of adequacy test New°Results (Pass/Fail) PASS For 4 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 , 600+ g.p d. Any rejuvenation -treatment (past 12.mo.) (Y/N. & type) NO If yes, give date. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "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 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 1 �Q+ Sewer /septic service line 25+ Holding tank 100+. Animal containment areas 50+ Manure/animal excrete storage areas �Q+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption"field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main. 10+= 10+ 00+ Water Service Zine Surface water .1 Driveway, parking/yehicle storage Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS _ G. ENGINEER'S CERTIFICATION .: I certify -that I have determined through field inspections and ' review of Municipal records that the, above1 systems are in!. *, conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven Pannone Sam annone 8/16/2016 �' '• t $gas Date :. , �� • C09Acanary sheet 2-6-15.doc - - - Municipality of Anchorage a • ` Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # OSC161365 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 4, Lot 3 of Sperstad #2 Subdivision. This inspection revealed an arsenic concentration of 40.7 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.ore/onsite) or at 343-7904. 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