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MEADOW BROOK BLK 2 LT 2
Meadow Brook Block 2 Lot 2 #050-191-41 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: OSP161084 PID Number: 050-191-41 ❑ New Fv] Upgrade Name: Larry & Carolyn Wehr Family Trusts ABSORPTION FIELD ❑ Deep Trench ❑� Shallow Trench ❑ Bed ❑ Mound Address 18335 Kantishna Dr. ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.2 GPD/SF 10 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 8 Ft. Gravel depth beneath pipe 2.0 Ft. Subdivision Block Lot Meadow Brook 2 2 Fill added above original grade 0 Ft. Gravel length 20 Ft. Township Range Section Gravel width 5Fc Beds: Number of Lines N/A Distance between lines N/AFt. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 142.9 Ft2 1 N/AFt. Well NA 100+ NA N/A 100+ TANK ❑ Septic ❑ S.T.EP. ❑ Holding ❑ other - Manufacturer - Capacity I Gal. Surface Water N/A 100+ NA N/A Material Number of compartments Lot Line N/A 26.2 NA N/A NA Foundation N/A 13.9 NA N/A LIFT STATION Manufacturer Capacity Gal. Curtain Drain N/A N/A N/A N/A Pump on level at Pump off level at High water alarm at Remarks Absorption field size is only for new additional in. in. in. trench only. Total absorption area is now 392.9. Pump make and model Electrical Inspections performed by - PIPE MATERIAL House to tank 3034 rank to drainfield 3034 Installer JR'S Septic Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100ft Inspection, 1 5/17/2016 5/18/2016 Location and description 2�d dates: Threshold of back door 3'd 4,h COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date AW( •'Q,g ld Owl * gg�TH '•+� Steven k. �annoae d CE 8149 Approved Date / / 6 0 6 Inspection Report_1-1-12.doc 15 SEPTIC AREA (E) 7 6 RESERVE DRAIN FIELD 11.OLF x 5.0'W x 2.0'ED x 10.O'TD (BASED ON CAT III) 8 SEPTIC AREA (E) TH� I '26.2 ci DECK 3 A 3BR �l 10008 SEPTIC TANK (E) HOUSE (o _� WITH DCO (E) INSTALLED �.�Y-vvt�+e•.. VALVE FLOW SPL ITTERn(N) o LOT 2 WITH y DISTRIBUTION TO FIELD (E) AND Y3 DISTRIBUTION TO FIELD (N) 4 `SEPTIC AREA (E)y S SL0PORt�� 0 - ,ApN �/ SEPTIC AREA (E) ABANDONED DRAIN FIELD (E) I I SEPTIC AREA (E) I I NEW DRAIN FIELD 20LF x 5.0'W x 2.0'E.D., 10.0'T.D. SOILS WERE CONSISTENT WITH THE TEST HOLES ALONG THE LENGTH OF THE TRENCH. PRIMARY FIELD TO ACT AS SPILLOVER IN EVENT OF FAILURE OF NEW FIELD DUE TO LOWER ELEV AND CARRYING i OF EFFLUENT LOAD _ A B Cl 50.6 20.9 M1 50.5 20.4 C2 33.3 15.5 SEPTIC AREA (E) ABANDONED DRAIN FIELD (E) I I SEPTIC AREA (E) I I NEW DRAIN FIELD 20LF x 5.0'W x 2.0'E.D., 10.0'T.D. SOILS WERE CONSISTENT WITH THE TEST HOLES ALONG THE LENGTH OF THE TRENCH. PRIMARY FIELD TO ACT AS SPILLOVER IN EVENT OF FAILURE OF NEW FIELD DUE TO LOWER ELEV AND CARRYING i OF EFFLUENT LOAD _ O d 0 VV_ w w - E— it w J Q W NOTES. PANNONE ENG SVC, LLC --OF A./ \\k Date RECORD DRAWING ��.... l�� 70/31/2016 P.O. BOX 100217 ANCHORAGE, AK 99510 S PHONE (907) 272-8218 FAX (907) 272-8211 All ��[�) scale DRAWN BY: *: 49 T1'1 /�'.* =so' NJC """P.LD. NO MEADOW BROOK, BLOCK 2, LOT 2 � � 050-191-41 LARRY & CAROLYN WEHR FAMILY TRUSTS r/ Steven R. Pannone / pERMIT No. CE 8149 .'��� OSP161084 PLAN EAGLE RIVER, AN 99577���FROESsONP�'�i Sheet 2 of LEGEND W WATER LINE/ WELL RADIUS SS NEW SEPTIC a m —FILTER FABRIC p O zv—DRAIN r 3 a DRAIN PIPE ROCK 6" ABOVE PIPE INV = w `= u p U U OAU I I OG/FG 98.1 TH _ OR IL Y —2.0 10009 SEPTIC zzz� TANK (E) aGa - Gw 88.3 88.4 6.0 23— 82'— A ABBREVIATIONS Cu, COPPER DIP DUCTILE IRON PIPE DESIGN PARAMETEPS DESIGN P;?RAVIETERS TH TEST HOLE PRIMARY SEPTIC SYSTEM RESERVE SEPTIC SYSTEM FC FOUNDATION CLEAN OUT NO. BEDROOM. 3 (450 gpd) NO. BEDROOM: 3 (450 gpd) Tn TANK CLEAN OUT N0. TANK SIZE: 10008 (E) TANK SIZE. 1500g ADVANTEX Cd CLEAN OUT NO. PERC RATE- 2.2 MPI W/ AX20 POD Ni MONITOR TUBE P10. SOIL RATING: 1.2 GPD/SF PERC RATE: 2.2 MPI R.I. RIGID INSULATION AREA -ROD: 375 SF SOIL RATING. 6 GPD/SF SYS. TYPE: WIDE TRENCH 2.0'ED AREA ROD: 75 SF - DCO DOUBLE CLEAN OUT PF : 0.7 SYS. TYPE: WIDE TRENCH 2.0'ED DV DIVERTER VALVE MIN LENGTH: 5251-F RF: 0 7 FS FLOW SPLITTER. MIN LENGTH: 1051F BEG BELOW FINISH GRADE USED. OG ORIGINAL GRADE 35 LF x 5W x 2.O'E,D. x 10.0' TD (E) USE: - FG FINISH GRADE ADDED SOLE x 5'W x 2.0'ED x 10.O'TD 1 I I.0 LF x 5'W x 2.0'E.0 x 10.0 TD TS&V TOPSOIL AND VEGETATE TOTAL AREA: 392.9 SF �JQ.TOTAL AREA: 78.6 SF NIC NOT IN CONTRACT NOTES: PANNONE ENG SVC, LLC —�oF A ��1�) �qs� Date 8/1/201e RECORD DRAWING P.O. BOX 100217 ANCHORAGE. AK 99510 (� -.'�9�� Scale PHONE (907) 272-8218 FAX (907) 272-8211 ig�P j; 4 T1H , *I� % ...... .. ...... .. % Steven R. ' Pannon=' j PF.. CE 8149 �il���� NTS DRAWN BY. MEADOW BROOK, BLOCK 2, LOT 2so-191-a LARRY & CAROLYN WEHP. FAMILY TRUSTS 18335 KANTISHNA DRIVE. NJC P.I.D. NO PERMIT N0, CSPI61084 Sheet DESIGN DETAILS EAGLE RIVER, AK 99577 ��5�1E��= 3 Pannone Engineering Services uc Steven R. Pannone, Principal Registered Professional Engineer E-mail: steveC@Panengak.com 10 October 2016 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Rd. P. 0. Box 196650 Anchorage, Alaska 99519 Subject: MEADOWBROOK B2 L2 Response to Comments Test Hole Requirement Waiver Ladies and Gentlemen: Following a review of a submitted Record Drawing as part of a COSA submittal for an installed septic system the requirementto conduct an additional test hole was noted due to a portion of the installed drain field being outside the 30' radius from the test hole. We are requesting this requirem4nt be waived due to the availability of soils data and groundwater monitoring that shows the relative constant conditions for those results in the area. A test hole was performed on the subject property on 06 MAY 2015. The soil profile was found b be a layer of organics underlain by well graded gravelly sands and had a percolation rate of 2.2 mpi with no groundwater present following the seven-day water monitoring period. The results of the visual classification of the subsurface soil strata and resultant percolation rate is consistent with the results of soils testing throughout the immediate geographic area surrounding the subject property. The surrounding soil logs show no groundwater above 18' below the ground surface and all display a percolation rate with an average rate of 2.33 mpi (w/ standard deviation of 2.04). Attached to this request are copies of surrounding soils logs. These results show a definite consistency to both the soil makeup and percolation rate within the area of the subject property. The Technical Review Board has been re -writing Chapter 15.65 of the AMC and among the approved revisions to be codified with the update reads as follows: 15.65.201C. Soil Evaluation, percolation test, and groundwater monitoring. A soil evaluation, percolation test, and groundwater monitoring is required by this chapter. 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 Exception: A soil evaluation, percolation test, and groundwater monitoring as required by the code for the subject disposal field may not be required, if an engineer can demonstrate by means of existing documented soil evaluations, percolation tests and groundwater monitoring, to the satisfaction of the department, that the subject disposal field location is likely to have soils consistent with the surrounding area. Based upon this future revision to the code which was arrived at through good engineering practice and experience we request that the requirement to conduct and additional test hole on a property that had the new system installed earlier this year be waived due to the amount of documented data showing the continuity of the soil strata throughout the area of concern. The result of performing another test hole would yield the same results within the standard deviation of the 16 sets of soil logs for the area in question. 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 Municipality ®f Anchorage P.O. Box 196650 0 4700 Elmore Road Anchoraae. Alaska 99519-6650 o 19n71 343-7ana o Fav rami 4d'3_7Q Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV161133 COSA#: Permit#:OSP PID#: 050-191-41 Legal Description: Meadow Brook B2 L2 Engineer: Pannone Engineering Services Applicant: Larry and Carolyn Wehr Your request for a waiver of the requirement to have the absorption field within 30' of the testhole has been approved. See the engineers request. This waiver approval applies to the new absorption field only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: q Approved by: L Name of Reyi6wer ................................................ ...... .................... "VARIAN REVIEW **** 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: OSP161084 Tax Code Number: 05019141000 Work Type: Septic Upgrade Permit Effective Dates: May 10, 2016 to May 10, 2017 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: MEADOW BROOK Site Legal Address: MEADOW BROOK BLK 2 LT 2 G:0153 Owner/Address: WEHR LARRY E & CAROLYN M FAMILY TRUSTS 50% EACH WEHR LARRY E & CA PO BOX 670607 CHUGIAKAK 995670607 Site Mailing Address: 18335 KANTISHNA DR, Eagle River This permit is for the construction of: Y Disposal Field N Septic Tank N Holding Tank Lot Size in Sq Ft: 12343 Total Bedrooms: 3 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 By: 0/6 MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division QD On -Site Water & Wastewater Program B APR 2 7 2010 Phone: 907-343-'T-WQ4 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-191-41 Property owner(s) Larry & Carolyn Wehr Family Trust Mailing address P.O. Box 670607, Chugiak, AK 99567 Site address 18335 Kantishna Drive Day phone Legal description (Sub'd., Block & Lot) Meadow Brook, Block 2, Lot 2 Legal description (Township, Range & Section) Lot Size 12,343 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑ Upgrade ❑X Duplex (D) ❑ Holding Tank El Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Dis tance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or Permit/Rush Fees: G%%q Waiver Fees: Date of Payment: �1'I illi Date of Payment: Receipt Number: 00, Receipt Receipt Number: Permit No. OSPtiWoa n -I Waiver No. Permit App_.: 1L.:c. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve0paneneak-.com April 26, 2016 Subject: Meadow Brook, Bock 2, Lot 2 Septic System 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 systems will serve an existing three (3) bedroom house. Currently the lot is developed. This lot and the surrounding lots are served by AWWU. There are no wells within 200' of the proposed septic system. 1. Soils. One test hole was performed on this lot by PES in April of 2015, and groundwater was monitored for at least seven days. Ground water was not observed to a depth of 16.0' below the surface in the test hole monitor tube in April of 2015. Bedrock was not encountered in the test hole. Based on the results of the percolation tests and overall soils appearance; an application rate of 1.2 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' of the proposed septic system. The system will maintain 100' of separation to all surface water. 4. Topography: The existing topography generally slopes from the east to the west in the area surrounding the septic system at approximately 5%. There are no steep slopes within 50' of the proposed drain field. The proposed drain field will maintain 50' separation all steep slopes. S. 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 this or the surrounding lots. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 15 a /, / LSEPTIC AREA (E) SEPTIC AREA (E) 7 \ SEPTIC AREA (E) 6 \ TH 1 r l -SEPTIC AREA RESERVE DRAIN FIELD tl o� rn DRAIN FIELD (P) 11.OLF x 5.0'W x 2.0'ED x 10.0'TD0 �'OF A ,j r (� • ....gSit %CD�y+I *. .... .. .... ..... /, % Steven R Pannone PF.'. CE 8149 ."��� �) . Date os/o6/7s 20LF x 5.0'W x 2.0'E.D., 10.0'T.D. (BASED ON CAT III) ° ABANDONED DRAIN FIELD (E) 10 Q ` 5 1 1 REMOVE ANY PART FOUND WITHIN 10' OF DRAIN FIELD (P) 3 PLAN e 2BR t 10009 SEPTIC TANK (E) HOUSE II—JI WITH DCO (E) (E) INSTALL FLOW SPLITTER (P) WITH /3 DISTRIBUTION TO FIELD (E) \ LOT 2 /y \ AND Y3 DISTRIBUTION TO FIELD (P) 0 5� \ 4 \ \ SEPTIC AREA (E)y / PS�MENj RAE vA�V N s NPO N/ KP Irl / a 0 0 J w W W-� / 1 / 2 tl NOTES : PANNONE ENG SVC, LLC BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 �'OF A ,j r (� • ....gSit %CD�y+I *. .... .. .... ..... /, % Steven R Pannone PF.'. CE 8149 ."��� �) . Date os/o6/7s FOR coNCONSTRUCTIONP.O. Scale i,.=50' MEADOW BROOK, BLOCK 2, LOT 2' LARRY & CAROLYN WEHR FAMILY TRUSTS 18335 KANPSHNA DRIVE EAGLE RIVER, AK 99577������OESS.0� P.I.D. NO - 1-41 PERMIT NO. OSP161084 PLAN Sheetof 3 LEGEND W WATER LINE/ WELL RADIUS SS — NEW SEPTIC TN OR -2.0 7 GW -16.0 FILTER FABRIC IJ,Z�I�-'1.P 4" 0 DRAIN PIPE DRAIN ROCK 6" ABOVE PIPE INV Mi �-5 0—d 1000g SEPTIC TANK (E) DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1000g (E) _ PERC RATE: 2.2 MPI SOIL RATING: 1.2 GPD/SF - AREA ROD: 375 SF SYS. TYPE: WIDE TRENCH 2.0'ED RF: 0.7 MIN LENGTH: 52.51F DESIGN PARAMETERS RESERVE SEPTIC SYSTEM NO. BEDROOM: 3(450 gpd) TANK SIZE: 1500g ADVANTEX W/ AX20 POD PERC RATE: 2.2 MPI SOIL RATING: 6 GPD/SF AREA ROD: 75SF SYS. TYPE: WIDE TRENCH 2.0'ED RF: 0.7 MIN LENGTH: 10.5LF USE: 35 LF x 5'W x 2.0'E.D. x 10.0' TD (E) - USE - ADD 20LF x 5'W x 2.0'ED x 10.O'TD (P) 11.0 LF x 5'W x 2.O'E.C. x 10.0' TD TOTAL AREA: 392.9 SF TOTAL AREA: 78.6 SF _ NOTES: PANNONE ENG SVC, LLC FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 MEADOW BROOK, BLOCK 2, LOT 2 LARRY & CAROLYN WEHR FAMILY TRUSTS 18335 KANTISHNA DRIVE DESIGN DETAILS EAGLE RIVER, AK 99577 ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE w FOUNDATION CLEAN OUT z or- is o W tiU 7 o z w 7 o z �<, wa DU � a Ir z m o o m o z 1000g SEPTIC TANK (E) DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1000g (E) _ PERC RATE: 2.2 MPI SOIL RATING: 1.2 GPD/SF - AREA ROD: 375 SF SYS. TYPE: WIDE TRENCH 2.0'ED RF: 0.7 MIN LENGTH: 52.51F DESIGN PARAMETERS RESERVE SEPTIC SYSTEM NO. BEDROOM: 3(450 gpd) TANK SIZE: 1500g ADVANTEX W/ AX20 POD PERC RATE: 2.2 MPI SOIL RATING: 6 GPD/SF AREA ROD: 75SF SYS. TYPE: WIDE TRENCH 2.0'ED RF: 0.7 MIN LENGTH: 10.5LF USE: 35 LF x 5'W x 2.0'E.D. x 10.0' TD (E) - USE - ADD 20LF x 5'W x 2.0'ED x 10.O'TD (P) 11.0 LF x 5'W x 2.O'E.C. x 10.0' TD TOTAL AREA: 392.9 SF TOTAL AREA: 78.6 SF _ NOTES: PANNONE ENG SVC, LLC FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 MEADOW BROOK, BLOCK 2, LOT 2 LARRY & CAROLYN WEHR FAMILY TRUSTS 18335 KANTISHNA DRIVE DESIGN DETAILS EAGLE RIVER, AK 99577 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. 1. 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 AND VEGETATE NIC NOT IN CONTRACT �`I11 - 05/06/16 S9`�+ Scale 'I NTS P.LD. NO n R. Pannone PERMIT NO. CE 8149 ,��� 2 OF 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 ADDITION TO SOIL ABSORPTION SYSTEM AND FLOW SPLITTER. - 3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 16 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 16 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. - 4.. THE CONTRACTOR (BOTH WELL AND SEPTIC SYSTEM CONTRACTORS) SHALL HAVE ANY WELL LOCATION AND SEPTIC LOCATION STAKED AND ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED SYSTEM STAKED BY A 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 SHALL BE 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 INgTALLED, INSTALLED TANK AND FINAL GRADING. 11, THE CONTRACTOR PROVIDED DATA (UPON WHICH THIS RECORD DRAWING IS BASED) APPEARS TO REPRESENT 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: DA NOTES: FOR CONSTRUCTION DESIGN DETAILS TITLE: PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 MEADOW BROOK, BLOCK 2, LOT 2 - LARRY & CAROLYN WEHR FAMILY TRUSTS 18335 KANTISHNA DRIVE EAGLE RIVER, AK 99577 ... ... ... ...... .P.I.D.TNO -191-41 Steven an one / PERMIT NO. 9 % CE 8149 ,• e / OSP161084 r tl``�PROFESSIONPii Sheet \�`»� 3 OF 3 SUB L Inspection Repolt_1-1-12.do6 V Municipality of Anchorage JUL 9 Mb 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: OSP151098 PID Number: 050-191-41 ❑ New ❑✓ Upgrade Name: LARRY & CAROLYN WEHR FAMILY TRUST ABSORPTION FIELD ❑ Deep Trench ❑✓ Shallow Trench E] Bed El Mound Address 18335 KANTISHNA DR ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 2 1.2 GPDISF 9.7 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 7.7 Ft Gravel depth beneath pipe 2.0 F1,. Subdivision Block Lot MEADOW BROOK 2 2 Fill added above original grade 0 Ft, Gravel length 35.0 Ft. Township Range Section Gravel width 51`t. Beds: Number of Lines 1 Distance between lines 1 0Ft. SEPARATION DISTANCES TO Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 175 2 Ft N/A N/AFt Well NA NA NA N/A NA TANK O Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1 1000cal. Surface Water 100+ 100+ NA N/A Material Number of compartments Lot Line 39.7 5.4 NA N/A S�y r 2 NA Foundation 9.6 14.7 NA N/A LIFT STATION Manufacturer capacity Curtain Drain N/A I N/A N/A N/A Gal. Remarks Pump on level at in. Pump off level at- in. High water alarm at in. Pump make and model Electrical Inspections performed by - Installer PIPE MATERIAL Housetotank 3034 Tankto 3034 drainfield JR'S SEPTIC Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCHMARK (Assumed elevation) 100ft Inspection 1` 05/28/15 - - 07/09/15 Location and description - dates: 2"" Threshold of back door 3`" 41h COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineers Stamp - �'"4N N OF.A. Conditional Approval: Date �Cry�Q • •- "Owe �i'teven ♦�. �4�anrioraet CE 8149 +�li SDP Approved Date �+ Inspection Repolt_1-1-12.do6 V /SEPTIC AREA (E) 7 6 \\ 5 \ / TH INSTALLED DRAIN FIELD 35LF x 5.0'W x 2.0'E.D., IO.O'T.D.� J 1 �f 3 -\ � SEPTIC AREA (E) SEPTIC AREA (E) 1 EM/ LOT 2 SEPTIC AREA (E) 1 1111 co ABANDONED DRAIN FIELD (E) PER MOA CODE (NIC) T T Fc � H 0 2eR " 7509 SEPTIC TANK (E) HOUSE DECOMMISSIONED PER CODE (E) INSTALLED 10009 SEPTIC TANK a 4 < l \ - SEPTIC AREA (E) /10 P0. P\�N/�/ A B F 29.3 1 9.5 NOTES: RECORD DRAWING PLAN / / / / 2 PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 MEADOW BROOK, BLOCK 2, LOT 2 LARRY & CAROLYN WEHR FAMILY TRU`. 18335 KANTISHNA DRIVE EAGLE RIVER, AK 99577 a 0 — o w w w w—a w a w 1 OFA�gs scalm/1s P.I.D. NO C T1 30.9 21.6 T2 33.6 24.8 DCO 34.6 26.3 COT 48.7. 16.1 MT1 47.4 16.5 CO2 69.5 48.5 MT2 68.7 48.1 NOTES: RECORD DRAWING PLAN / / / / 2 PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 MEADOW BROOK, BLOCK 2, LOT 2 LARRY & CAROLYN WEHR FAMILY TRU`. 18335 KANTISHNA DRIVE EAGLE RIVER, AK 99577 a 0 — o w w w w—a w a w 1 OFA�gs scalm/1s P.I.D. NO '- / PERMIT N0. CE 8149 �� OSP1510sa �170FESSION=�� Sh2 QOF 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 ATTACHED SPECIAL PROVISIONS. 2. SCOPE OF WORK: INSTALLED NEW 1000g TANK AND SOIL ABSORPTION SYSTEM. 3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 16 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE 1S OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 10.5 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY- TH OR -2.0 FILTER FABRIC�siF 7.7 4" 0 DRAIN PIPE DRAIN ROCK 6" ABOVE PIPE INV GW 2.0� 6.3 -16.0 1000g NEW SEPTIC TANK DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM N0, BEDROOM: 2 (300 gpd) TANK SIZE: 1000g PERC RATE: 2.2 MPI SOIL RATING: 1.2 GPD/SF AREA ROD: 175 SF SYS. TYPE: WIDE TRENCH 2.0'ED RR 0.7 MIN LENGTH: 35LF USE: 35 LFx5'Wx2.0'E.D., 10.0' TO TOTAL AREA: 175 SF LEGEND W WATERLINE/ WELL RADIUS SS — NEW SEPTIC NOTES: Ptll`INONE ENG SVC, LLC RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 MEADOW BROOK, BLOCK 2, LOT 2 LARRY & CAROLYN WEHR-FAMILY TRUSTS 18335 KANTISHNA DRIVE DESIGN DETAILS EAGLE RIVER, AK 99577 ABBREVIATIONS CU COPPER w DUCTILE IRON PIPE w m w m FC FOUNDATION CLEAN OUT > TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. R. 1. RIGID INSULATION DCO DOUBLE CLEAN OUT O O DIVERTER VALVE FS FLOW SPLITTER - BFG O w w JO mW w w 4 O O O O > U E 3 U U 000 n FI .100.0 - n n n In n In EL.100.0 n n 1000g NEW SEPTIC TANK DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM N0, BEDROOM: 2 (300 gpd) TANK SIZE: 1000g PERC RATE: 2.2 MPI SOIL RATING: 1.2 GPD/SF AREA ROD: 175 SF SYS. TYPE: WIDE TRENCH 2.0'ED RR 0.7 MIN LENGTH: 35LF USE: 35 LFx5'Wx2.0'E.D., 10.0' TO TOTAL AREA: 175 SF LEGEND W WATERLINE/ WELL RADIUS SS — NEW SEPTIC NOTES: Ptll`INONE ENG SVC, LLC RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 MEADOW BROOK, BLOCK 2, LOT 2 LARRY & CAROLYN WEHR-FAMILY TRUSTS 18335 KANTISHNA DRIVE DESIGN DETAILS EAGLE RIVER, AK 99577 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. 1. 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 AND VEGETATE NIC NOT IN CONTRACT ur. f+G'q' 1k' 08/07/15 If 0 Scale *: 49 THW �NTS ...................... P.f.D. No / 050-191-41 •Steven R. Pan n orae% PERMIT N0. I�P CE 8149 ..��/ OSP151098 1OFE590�'�.� Sheet " 3 OF 3 Municipality of Anchorage tcient S Oment epar **** VARIANCE/WAIVER REVIEW **** Waiver#: osv1S10 CQSA#: PID#: 50-191"' Legal Description. Meadow Broo_„ k 11,2 L_2 Engineer:.._- Permit#i o9p1§1098 Applicant: LaIV A Carolyn Wehr Your request for it waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.13 feet, This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewato.disposal.system will requite all separation distances be met or another approval from this department. The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. Notarized letter(s) of non-objectlon have be6n received from the owner(s) of the affected adjacntxt pr9porty. ❑ Adjacent properties are not aMoted by this waiver. YY9Yi';i��Y Y�Ylr-��iY■Y■YY Y•YY����YYYYYY• wY��YYYYY YY��Y II��111YYY�YYF��YYY�YYYYY�YY� Waiver is Oranted: ;X Waiver is not GranW: Date: -,97/-4 Approved by: ui9uvVF •YYYY���YY��i'iiY�lY�YY ■�i'Y'IYY��Y■•��.�YY��YY'Y � iYY"YY�iiYY��YYYYYYYYYII �� Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve(c@panengak.com 9 July 2015 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Rd. P. 0. Box 196650 Anchorage, Alaska 99519 Subject: MEADOW BROOK B2 L-2 Field to Property Line Waiver Request Ladies and Gentlemen: I am requesting a waiver for the minimum distance to the property line from the drain field be five feet (5'). Site conditions precluded ability to install field outside of separation distance. Granting this waiver is not likely to affect the health and safety of this lot or the surrounding lots now or in the future. 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, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Permit Number: Tax Code Number: On -Site Water and/or Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Meppartment�' Anchorage, AK 99519-6650 / k - Telephone: (907) 343-7904 / S OSP151098 ((( 05019141000 1� Work Type: SepticTank °" d Upgradee� Permit Effective Dates: April 29, 2015 to April 28, 2016 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: MEADOW BROOK Site Legal Address: MEADOW BROOK BLK 2 LT 2 G:0153 Owner/Address: WEHR LARRY E & CAROLYN M FAMILY TRUSTS 50% EACH WEHR LARRY E & CA PO BOX 670607 CHUGIAKAK 995670607 Site Mailing Address: 18335 KANTISHNA DR, Eagle River This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank Lot Size in Sq Ft: 12343 Total Bedrooms: 2 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. Special Provisions: Verify the foundation cleanout is installed in accordance with the code. Receive Issued C0j CIJJSCA, d By: Date: By: Date: MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program ANCHORAGE Phone: 907 Fax: 90Z ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-191-41 Property owner(s) Larry & Carolyn Weir Family. Trusts Day phone No Mailing address P.O. Box 670607, Chugiak, AK 99567 Site address 18335 Kantishna Drive Legal description (Sub'd., Block & Lot) Meadow Brook, Block 2, Lot 2 Legal description (Township, Range & Section) Lot Size 12,343 Sq. Ft. Number of Bedrooms RUSH! APRR22 8 M5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank ❑x Upgrade N Duplex (D) ElHolding Tank F-1Renewal ❑ Multiple Dwellings ❑ Privy ❑ (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 Municipal Codes. property owner or i Permit/Rush Fees: "f Waver Fees: _ Date of Payment: W29 11 4205 Date of Payment: Receipt Number: x/5.2416 CAIN frReceipt Number: Permit No. (ISP, 7/i 98 Waiver No. Permit App__'- : Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steveftpaneneak.com April 29, 2015 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, Alaska 99519 Subject: Meadow Brook, Block 2, Lot 2 Emergency Septic Tank Upgrade Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new 1000 gallon Septic tank be issued for this lot. The proposed system will serve an existing 2 bedroom house. Currently the lot is developed. The existing septic system was designed and installed for two bedrooms, and the condition, location, and size of the existing field will be verified at the time of installation. The existing tank has collapsed, placing the house out of service, and is in need of replacement. This lot and the surrounding lots are served by AWWU water. There are no wells within 200' of this system. 1. Upgrade Tank Design. a. See Sheet 1 of 1 of the plan set 2. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: This lot slopes from northeast to southwest in the area of the tank replacement. The proposed installation will be located in the central portion of the lot, next to the existing system. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells within 200 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 Attachments: Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com MAY 26, 2015 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P. O. Box 196650 Anchorage, Alaska 99519 Subject: MEADOW BROOK B2 L2 Septic System Permit Change Order Ladies and Gentlemen: During the emergency tank replacement the condition of the existing absorption field was verified and was determined that it was in failure. We are requesting a permit to cover the addition of a new absorption system on the property using the failing field in reserve. Soils. We performed one test hole on this lot, and groundwater was not observed below the ground elevation in the test hole monitor tube after seven days. For test hole one, from 0.0' to 2.0' was organics, from 2.0-8.0 'was well graded gravel, and from 10.0' -16.0 ' was well graded gravel with increasing rock size. The lower layer was perked and found to be at 2.2 min per inch. It is my opinion, based on the results of the soils tests, the use of a conventional system and overall soils appearance; that to use a conservative application rate of 1.2 gallons/day/square feet and a reduction factor of 0.7 should be used for the wide trench. 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, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 c of / ` /SEPTIC AREA (E) 7 6 \\ 5 \ / 5� / TH�, DRAIN FIELD (P) 35LF x 5.0'W x 2.0'E.D., 10.O'T.DA 3 0 7509 SEPTIC TANK (E) DECOMMISSION PER CODE INSTALL 1000g SEPTIC TANK (P) \ . WITH DCO AND DV \ a \ \ SEPTIC AREA (E) 8 SEPTIC AREA (E) SEPTIC AREA (E). 1 LOT 2 5 SEPTIC AREA (E) .t DRAIN FIELD (E) VERIFY SIZE,LOCATION, AND CONDITION USE AS RESERVE FIELD 28R ` HOUSE (E) 0 Z C NOTES: FOR CONSTRUCTION PLAN 2 PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 MEADOW BROOK, BLOCK 2, LOT 2 LARRY & CAROLYN WEHR FAMILY TRUSTS 18335 KANTISHNA DRIVE EAGLE RIVER, AK 99577 1 O 0 d 0 _ o W W W—� L7 w 1 5I *:49TM *►� 1.._50' .... ... .... I.D. NO Steven R.•Pannone� P CE 8149 '���gFQ••....P�E'G li %'Rdisn0=� 050-191-41 PERMIT NO OSP151098 Sheet 1 OF 3 co 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 SPECIAL PROVISIONS. 2. SCOPE OF WORK: INSTALL NEW 10008 TANK AND SOIL ABSORPTION SYSTEM. 3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 16 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 10.5 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 1000g NEW SEPTIC TANK DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 2 (300 gpd) TANK SIZE: 10009 PERC RATE: 2.2 MPI SOIL RATING: 1.2 GPD/SF AREA ROD: 175 SF SYS. TYPE: WIDE TRENCH 2.0'ED RF: 0.7 MIN LENGTH: 35LF USE: 35 LFx5'Wx2.O'E.D., 10.0' TO TOTAL AREA: 175 SF LEGEND W WATER LINE/ WELL RADIUS SS NEW SEPTIC NOTES: PAN1VONE ENG SVC, LLC FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 MEADOW BROOK, BLOCK 2, LOT 2 -- LARRY & CAROLYN WEHR FAMILY TRUSTS 18335 KANTISHNA DRIVE DESIGN DETAILS EAGLE RIVER, AK 99577 CU COPPER rr1 DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# OR C# CLEAN OUT NO. M# MONITOR TUBE NO. R.I. - RIGID INSULATION DCO -2.0FILTER DV DIVERTER VALVE FS FLOW SPLITTER FABRIC e BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE TS&V 8.0 4" 0 DRAIN PIPE NOT IN CONTRACT GW DRAIN ROCK 6" ABOVE PIPE INV - -8.0 2.0T__Gw 6.0 —16.a > m m z p O 7 F 7 a > O ¢ K p ¢O w Z w0 a w z z z < o OU V U U Ow > o V E V 1000g NEW SEPTIC TANK DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 2 (300 gpd) TANK SIZE: 10009 PERC RATE: 2.2 MPI SOIL RATING: 1.2 GPD/SF AREA ROD: 175 SF SYS. TYPE: WIDE TRENCH 2.0'ED RF: 0.7 MIN LENGTH: 35LF USE: 35 LFx5'Wx2.O'E.D., 10.0' TO TOTAL AREA: 175 SF LEGEND W WATER LINE/ WELL RADIUS SS NEW SEPTIC NOTES: PAN1VONE ENG SVC, LLC FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 MEADOW BROOK, BLOCK 2, LOT 2 -- LARRY & CAROLYN WEHR FAMILY TRUSTS 18335 KANTISHNA DRIVE DESIGN DETAILS EAGLE RIVER, AK 99577 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 AND VEGETATE NIC NOT IN CONTRACT OF A/-gSlt� ���P''. 0 *..'49 TH jo Date 5/28/2015 Scale NT P.I.D. NO ..* 050-191-41 ••Steven R. Pannope•/ PERMIT NO. P •. CE 8149 .•,e' / ,.,.... �.,..,,, r.0.»cl C of SOILS LOG - PERCOLATION TEST TEST HOLE 1 SLOPE \ SITE Py4N 1 OR ORGANICS / LOT 2 1 2 3 4 / 1 THS 5 GW WELL GRADED GRAVEL \ 6 X TH 7 8 \9 10 \11 12 GW WELL GRADED GRAVEL 13 WAS GROUNDWATER SLOPE 14 ENCOUNTERED? N 15 - IF YES, AT WHAT - TH DEPTH? -DRY' X 6 BOH DEPTH TO WATER AFTER DATE PERFORMED: 4/6/15 MONITORING? -DRY' DATE: 4/15/15 PEROLATION RATE 2.2 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 6 FT AND 9 FT COMMENTS: Test hole excavated by JR's Septic Pumping. Prec hole was presoaked. Test run for at least one hour. Last 3 readings reported - 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: PANNONE ENG SVC LLC V Date FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 (�...... q�5+1�� 5/28/2015 PHONE (907) 272-8218 FAX (907) 272-8211 scale NTS ...... ....... P.LD. NO MEADOW BROOK, BLOCK 2, LOT 2 ., ` 056-191-41 LARRY & CAROLYN WEHR FAMILY TRUSTS ••Steven •R. Pannone / PERMIT NO. +P��,P CE 8149 .�/ OSP151098 18335 KANTISHNA DRIVE � r EAGLE RIVER, AK 99577 l Gr ss �— 3 OF 3 SOILS LOG l \\• `�-� sheet WATER READING DATE OTIMEK NET TIME LEVEL NET DROP MP,� READING t 04106/15 1320 1.300 2 13:33 13 MIN 7.3 (DRY) 6.0 2.16 3 13:34 1.300 4 13:47 13 MIN � 3 (DRY) 6.0 2.16 5 1348 1.300 6 14:01 13 MIN ] 3 (DRY) 6.0 2.16 ,y ,r �/�y gry4 arty yin on an 'that there are ano Yoa _ i 1: r : •*• •• • ' ` -.- �,�.. . l - fines o1 other ea9eme{lts_1d pio�N F �S' riiJ� i sl:_ • •v y... i.. a „ • as AIadicated 11MO 1i aska ` `2 t1Q 6H� f Dated at le T3iver,. i,. •.. �! i g' f �� �!"V NaR'i ' C. JOI3N30Ir "i ....... =110 Itegistered,T`Boxt 456 A ,n ,Itvereyophone '94-2643 i (r ;, N F •. yi tyyyi it Ft 787,�' "'�4>: l�~ 41" 1- E 75 —0T -7/a AS -BUILT bv�S/, licca i� /nom that I have surveyed the following b�ir�� I hereby certify 7, described Property:_ �1 ¢. and:: that -the, „ plc 'u N 4.,�' Atichoi'age ;Recording 'Precinct,, roperty situated thereon:;are within the ,p, r the property '� d4> • • .. F im r vements encroach on p q lines, apd .do not overlap or' thereto; that ro,imphxovement, on prop M P,� lying.adjacent 1 g adjacent thereto'encroac •dwaYs�tpansm�sstion,=. ,y ,r �/�y gry4 arty yin on an 'that there are ano Yoa _ i 1: r : •*• •• • ' ` -.- �,�.. . l - fines o1 other ea9eme{lts_1d pio�N F �S' riiJ� i sl:_ • •v y... i.. a „ • as AIadicated 11MO 1i aska ` `2 t1Q 6H� f Dated at le T3iver,. i,. •.. �! i g' f �� �!"V NaR'i ' C. JOI3N30Ir "i ....... =110 Itegistered,T`Boxt 456 A ,n ,Itvereyophone '94-2643 MUNIUPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-191-41 Complete legal description Meadow Brook B2 L2 Location (site address) 18335 Kantishna Dr. Expiration Date: ju-ne Current property owner(,.,j N Christopher & Tiana Jones - Mailing address Real estate agent Cindy Lindblom 2. TYPE OF DWELLING: El ' Single Family (w/wo, ADU) D Duplex F -I Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well F-1 Private Septic nX Water Storage n Holding Tank ❑ Community Well n Community ❑ Public Water System nX Public Sewer El Waiver request for: Distance: Received by: Date: COSA to be released to the ,unless engineer. e en ess othenvise requested by the COSA Fee 50 $ $ 0 Waiver Fee $ Date of Payment W6 2 ():� �052C0 - Date of Payment Receipt Number G Receipt Number COSA#_ ()�CaOj 2 -LI 3 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 riles 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, 1 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 duringthe 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. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. ; Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. DSDSIGNATURE I//System #1 Approved for 13 bedrooms System #2 Approved for bedrooms Disapproved Date Zt`© OF A/,qs���� iGj�e' • � •fy I Steven R. Pannone CE 8149 Conditional approval for bedrooms, with the following stipulations: OF crrrrr�4 VV AS-TEV'!ATER O: PDQ" JJ F �,11 I BY Original inal Certificate Date: i 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 Stat 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 Checklist blue sheet COSA eC list '_E 7 Legal Description: '.°. L9 Parcel ID: 050-191-41 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments Public Water B. TANK DATA Age of tank(s) 5 years Tank type/material SCPfi'JM 1 Measured operating fluid level in septic tank 8 ❑ Standpipes/foundation cleanout per record drawing Date of pumping /fir -r a- - I � D. ABSORPTION FIELD DATA Shallow Trench Well production at time of test gom Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Which system tested (date installed) '12015-$12°' Adequacy test date 6/4/2020 ❑ ALL standpipes present per record drawing Results E✓ Pass For 3 bedrooms Total measured depth from grade 10,2j'08 ft (max) Fluid depth prior to test 0/0/0 in Measured depth to pipe invert from grade 9/7.6 ft (min) Water added 500 gal ❑ N/A - pressurized field 13/4/2 New depth in ❑ Monitor tubes go to bottom of effective. If not, state 60 d depth into effective Elapsed time min ❑ Code -required soil cover over field Final fluid depth 0/0/0 in ❑ System presoaked Absorption rate '450 god (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) _ Gallons introduced 2000 gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No 5+ Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Water Main > 10' ❑✓ Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Manure/Animal Excreta Storage > 100' comment below Community Sewer Main > 75' 171 Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 5+ ft Surface Water > 100' R Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: if No Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 51* ft Wells on Adjacent Lots: Water Main > 10' ✓❑ Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' ✓❑ Yes if No ft F. ENGINEER'S COMMENTS *Waiver on file - WR G. ENGINEER'S CERTIFICATION l certify that l 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. COSA Checklist yellow sheet Steven R. Pannone ��. CE 8149 AW 77 AUG 15 2U1S aL • Municipality of Anchorag On -Site Water and Wastewater Program `y6 (907) 343-7904 t [� 9y s.'k E.�^ Certificate of On -Site Systems Approval Parcel I.D. 050-191-41 Expiration Date: 2 - Z SR —(_7 1. GENERAL INFORMATION Complete legal description Meadow Brook, Block 2, Lot 2 Location (site address) 18335 Kantishna Dr. Current Property owner(s) Larry & Carolyn Wehr Day phone Mailing address 17925 Hollow St. Chugiak, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: Fx� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) WaiverNariance request for: Received by: _ / Date: WIcl .)-Gi COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ a(197.5� Waiver Fee $ Date of Payment Ykj& Date of Payment Receipt Number d zclvl� Receipt Number COSA# 65(Woi357 Waiver# 3 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System Fx� Public Sewer ❑ WaiverNariance request for: Received by: _ / Date: WIcl .)-Gi COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ a(197.5� Waiver Fee $ Date of Payment Ykj& Date of Payment Receipt Number d zclvl� Receipt Number COSA# 65(Woi357 Waiver# e 4 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of thewalidation 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 Slate 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 an 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 Alk. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for - bedrooms Disapproved Date 8/1x2016 en R �aririarie � • • CE -8149 .Lr Conditional approval for bedrooms, with the following stipulations: BY: �l �� Original Certificate Date:_ 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 engineers work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet If more than 1 septic system is on the lot: COSA Checklist # of + Structure served by this system I Certificate of On -Site Systems Approval Checklist Legal Description: Meadow Brook, Block 2, Lot 2 Parcel ID- 0507191=41 A. WELL DATA Well type Public If A, B, or C provide PWSID # AWWU Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (above ground) in:' FROM WELL LOG AT INSPECTION Date of test Static water level - Well production WATER SAMPLE RESULTS: ft. [$01211! Coliform colonies/100 mL Nitrate mg/L Arsenic ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping New Pumper N/A Collected by: Date installed 5/28/2015 Cleanouts (Y/N) Y High water alarm (Y/N) N C. ABSORPTION FIELD DATA +s s+�1fi Date installed Soil rating (g.p.d./ftz or ftz /bdrm1.2 GPD/SF Shallow Trench ) System type Length 35 - 20 ft. Width 5 - 5 ft.. Gravel below pipe 2 2 ft. Total depth 9.7-10 ft. Eff. absorption area 392'9 ft Monitoring tube 2 Depression over field 2 Date of adequacy test; New Results (Pass/Fail) PASS For 3 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 >= 450+ 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 On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout. Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOTITO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 200+_ ABSORPTION FIELD ON LOT TO: Property line 5 Building foundation 10+ Water main 10+ Water Service line 10+ Surface water -100+ Driveway; parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 200+ F. COMMENTS 'System has not been in use. Tank verified empty "Waiver on file WR#OSV151096 G. ENGINEER'S CERTIFICATION A�gS,'�i, I certifyg that I have determined through field inspections and review of Municipal records that the above systems are in �* 9 conformance with MOA COSA guidelines in effect on this date. Steven Pannone • Engineer's Printed Name .5)even fan one. Date 8/1016 ��yy CE -8149` COSA canary sheet_2-6-15.doc 0 e e o u d m ASBUILT SEFlARD & ASSOCIATES LAND SURVEYING 694-08 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE' � FOLLOWING DESCRIBED PROPERTY ()F A� COQ DATE. AND THAT NO ENCROACHMENTS EXIST EXCEPT AS s��� � p ' . ��. ' OF INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE OCISTENCE OF ANY GRID= pr EASEMENTS, COVENANTS., OR RESTRICTIONS �L/�t2¢ ' •a,/� sa� WHICH DO NOT APPEAR ON THE RECORDED SUBDI— I4 ou, Me ,k s .a a VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR'CONSTRUCTION OFFENCE LINES, OR FOR ESTABLISHING BOUND— ARY LINES. DRAWN. (%TIa MUNICIPALITY OF ANCHORAGE y DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROYECTION DIVISION OF ENVIRONMENTAL HEAL TII CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date DateJ-��- 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) nG16 lGc� (' Location (address or directions) �(b) Applicant Name"� Business Telephone: Home �.�- Applicant Address y f �U d1 --- — ------ ---- - ------ (c) Applicant is (check one): Lending Institution Cl Owner/bmAcer L6l Buyer La ; Other IJ (explain); _------- - --- -- - - - --- ----- -----.----- ! - --- - (d) Lending Institution l�WSJ -pip r 33.) < ', ����J-Telephone _-----.-- -- n ;lit1C;_ L - -- -- - -- - - - -- - Address--9�P -» (e) Real Estate Company and Agent ---- ---- Address .----- ------------------- —---. Telephone -- -----—------- ---- ------- --- (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family N Multi -Family 0 Other Number of Bedrooms ----- 3. WATER SUPPLY Individual Well 0 Community Cl Public LA 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 W Public 0 Community ❑ Holding Tank tate 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 t" F ENGINEERING FIRM PROS JG INSPECTIONS, TESTS, FILE SEARCF, VTA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this t loalth 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 infoi rnation 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 f FirmTelephone -- Address A FuJ tdJ°o Date — .--.. - — 10 c) ;n 1 calh -����r; ,yam s G. DFIEPAPPROVAL Approved for �� _bedrooms byt/frr�,�=r- z—_ 11 �Date _✓ — -- `- ` rr --- PP — Approved --� \---- Disapproved Terms of Conditional Approval — Conditional CAUTION The Muncipality of Anchorage Department of Health and Fnvironmental 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 riot responsible for errors or omissions in the professional engineer's work. Page 2 of 2 ,-ens n 1 84, A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth -- Static Water Level DEPL Of- I-IEALTrI & Ei`lVIRONMENTAL PROTECTIONMUNICIPALITY OF ANCHORAGE (MUA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 O1.,AC E 1 V ED Le[ I Desc((iption: lorz t- 1�+'Ci004i If A, B, C, D.E.C. Approved QN) — Date Completed Cased to Depth of Grouting — Pump Set At Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Yield Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Hal4is Tank on Lot �� / t' ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot On Adjoining Lots — To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA 4) /–=,,< T 1%00e- I q73 fore - ! 7.r Date Installed u G< - Size —1 - -- No. of Compartments 2 - Standpipes (9N) — Air -tight Caps ION) Foundation Cleanout (Ye Depression over Tank (YO Pumping/Maintenance Contract on File (Yo Holding Tank High -Water Alarm (Y/N) — Date Last Pumped .—Z6 _W _'w'5 ;for Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well — / 2bd To Building Foundation To Property Line �� To Disposal Field — To Stream, Pond, Lake, or Major Drainage To Water Main/Service Line Course /OO Comments Page 1 of 2 72-026(11/84) i C. ABSORPTION FIELD DATA 6/,J /Vex c z o. / Soils Rating in Absorption Strata 6(!T' - Type of System Design Date Installed SS�csrDdG u � le Length of Field 4Ss4esE-0 101 7 Width of Field Depth of Field Gravel Bed Thickness 6 t Square Feet of Absorption Area 3 -7 2 "� Standpipes Present &N) Depression over Field (Y t& Results of Last Adequacy Test . v-6 Date of Last Adequacy Test /U ^/O - F-57 Separation Distance from Absorption Field: To Water -Supply Well J To Property Line To Building Foundation 00 4 Lot On Adjoining Lots To Existing or Abandoned System on !oD f f To Water Main/Service Line _ .5_0 "h To Cutbank (if present) AkA) e To Stream/Pond/Lake/or Major Drainage Course !UD "-y- To Driveway, Parking Comments D. LIFT STATION Date Installed Size in Gallons or Vehicle Storage Area Dimensions Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) 'Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date za 2, /Ss - Company' �—`3nollu ^,�p-,bt��rCN� �J �03 a"� � +� MOA No. OF �A',, %Is 'Z)Jt./jr RIVER, eiUJ-ifinib 11(11. e<s tit E F e°U `6 (9 Receipt No. Pte, 1 s°' �? � -71 Date of Payment iLL 1`�'4� 5 � `„` �`� *° yfia�yo� •• � Amount: $ Page 2 of 2 72-026 (11/84) T•' Ro4r�rf A. Shafer 57 tdo, 14.E ••a"" C; LLQ, L °W4ye Vsy1G e•V1 `�`� 4��` CJP