HomeMy WebLinkAboutTIMBERLINE LT 5Timberline
Lot 5
#015-164-03
Municipality of Anchorage e`
Department of Health and Human Services
Building Safety Division
On -She Water and Wastewater Program, 4700 South Bragaw Street
P.O. Sox 196550 Anchorage, AK 99519-5650 Page 1 of 4
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: SWSWO10069 PID Number: 015-164-03
Name:
Jim Schnell
Wastewater System: ® New ❑ Upgrade
Addr,;
Box 11nR02, 99511
ABSORPTION FIELD
.
Phone: Number of Bedrooms:
IS 4
^aop.T.ra^.ch p Shallow Trench 0 Bed p Mound ❑ other:
LEGAL DESCRIPTION
Soil Rating;
Thal Depth frontoriginalgrade:
1.2 GeorFe
7F
Block: Lot: Subdivision:
Depth to pipe bottom from original gratia:
Gravel depth beneath pipe:
5 Timberline
2 Ft.
5/5.1 F.
Township: Range: Section:
Fill added above original grade:
Gravel Length:
1.5 Ft.
25/25 Ft.
Well: ® New ❑ Upgrade
Gravel width:
Numbaroflines:
2
' Distance between lines:
10-15
3/3 Ft.
Ft.
GlassNaadoR (Private,: A„B,. G);
Tma7.D.epth;.
I Cased. to'
Tatelabsorptionar¢a;.
pipe Material:
Private
107 Ft.
1 20 Ft.
505 F
F81013034 PVC
Dnllar:
Date Drilled:
Static Water Level:
installer
Date Installed:
At ine Drillin
6/30/2001
1 14 Ft.
Owner
10/8/2001
Veld:
Pump See: Casing Height Above Ground:
,/
TANK
3 GPM
106 Ft. 2 Ft.
SEPARATION DISTANCES
9 Septic ❑ Holding [! S.T.E.P. ❑ other:
To
Septic
Absorption
Lift
Holding
Public/P ivat
Manufacturer:
capacity:
1250
From
Tank
Field
Station
Tank
$ewer Line
Anch Tank
Gal,
wan
160
143
165
Material:
Steel
Number of Compartments:
2
Surfacewater
100+
100+
LIFT STATION
50
15
Size:
Manufacturer:
Lot Line
Gal.
5.5
10
'Pump on level at:
'Pump of- level an
High water alarm at:
Foundation
in.
in.
in.
100+
100+
Pump Make B Model
Electrical Inspections performed by:
Curtain Drain
Remarks:
BENCH MARK
Location and Description:
Basement Finished Slab
,
Assumed Elevation:
100.0 Ft.
NOV:u, Not
Municipality of Ancliorage _
Engineer's Stamp
OF
If
Inspections performed by: Pannone Eng. SVC Dates: 1x`10/8/2001
r 49TH °. ♦♦
d.....0
2ntl10/0912001
.....A.... .................
Department of Health a Human Services approval
p pp
”""... .. ................ '
♦ ;Steven R. Pannone: 4 n
,/ll ,}
Reviewed by: Gam/, Date: 4 ��
����P °•., No. CE 814y A
and approved _
♦♦plllds ,. �
s�
PERMIT NO, SWO10069
CO A B
FC 39.4 17.0
Tl . IJ 1.3'
T2 43. X1.8
D 45.`' 22.6
12 4 22,3
a i 8. 29.0
MI 8. 38.4
C2 /69,3 52.8
C3 64.S 25.5
428.
C4 77.3 50,8
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CE 8149
It os,..
AS -BUILT
WASTEWATER ABSORPTION SYSTEM
LOT 5 TIMBERLINE S/D
NEI WELLS OR SEPTICS
WITH 200' OF PROPOSED
SEPTIC SYSTEM
, < x 100' WELL RADIUS
WELL
#-------NEW WELL
III III 111 I i
sE
NOTES ',,
1) ALLWORK,SHAL BE P.RFjPRM D Ijl ,III
IN ACCORDANCE TH 151s5.111 III II°
2) MATERIALS US SHALL ®E [til yl
ACCORDANCE WITH OSS SPECIFIED
-IN- AMC13.65, WAST To -
3) CONNECT POST TANK LINE TO MID-
POINT OF DRAIN FIELD, TYPICAL,
4) INSTALL DRIVEWAY AT LEAST 5 FT
AWAY FROM DRAINFIELD. DO NOT INSTALL
DRIVEWAY OVER DRAINFIELD.
5) MAINTAIN 10' SEPARATION TO ALL
LOT LINES,
Jin Schnell
P.O. Box 110802
Anchorage, AK 99517
(907) 345-4146
P.I.D. NOt 015-164-03
AREA
48R
DESIGN,
H
SOIL RATING, 1.2 GPD/SF
125 SF/BEDROOM, 4 BEDROOM
500 SF REQUIRED,
1250g SEPTIC TANK
DEEP TRENCH, 5' EFFECTIVE
8' TOTAL DEPTH, 50 LF
2-3' WIDE, 500 SF TOTAL
PANNONE ENG. SVC, LLC
P, O. BOX 102954
ANCHORAGE, ALASKA 99510
272-8218 Phone & Fax
NTEj 11-5-01 AS -BUILT
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0116 SECTION
PROFILE
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Filter Fabric
4' dla Drain Pipe
Drain Rork
DEEP TRENCH
50' LONG, 5' EFF
WEST TRENCH
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TANK.
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PROFILE
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e,escriodon: Timberline Lot 5
F rovert OW -Per Name G 134R4?ress: Jfllf of flltelf
PO Box 110602
Anoorara AlaSkq QQ.xi?'7
J,�l .. .._._.....-� .
�%. ti•'.;i; _4 ie.i4la
Soil Type, Thickness & Water Strata
!l�rt!'� �'��'�
From To
�I
11T,.,LIr �_�1 1'T,..%7#'asR r� F.. ..,e.. I� �a�.. tom. ._1
ira�«evti Vi 1-Y 11 1itA�Ag'" air rotary l__! � a�,IC l��va
casi"a tE7ilQ_
Existing well drilled in 2001
10i !!
® Perforations Start feet
Stopped _ feet
i
Wall Thickness: inches
}Grout
Depth: 07tar ll, feet
II
Diameter. inches D p*�
e Lit. iee�
Pump size h.n Brand Name
Diameter: inches Depth: feet
k-asirig stiiup a love ground: feet
Static water j_C_vc1 ttT(lYY1 ground lP.VP.l�. 1iy feet
Pumnina level: 266 feet. after
hours pumping 1.25 gpm
��
�annvaawv
_V,� e: ,.,,..,J...a, o..t... 1.25 gprr:
tl
MQthed e f TAFti►lb_ air lift
Well Intake Opening Type:
Lj Open End Open Hole
Screened Start feet
Stopped feet
® Perforations Start feet
Stopped _ feet
Type:
Volume:
}Grout
Depth: 07tar ll, feet
Stopped lCet
Pump: intake Depth feet
Pump size h.n Brand Name
�) Well Disinfected Upon Completion? ® Yes ❑ No
Method of Disinfection: chlorine tablets
Ciiaiai iiiaia:
VVe l Drill-ar• lnine Drilling R 1=nte r rices
PO Box 110496
rinCi7vragc siii vV0 i i
Attention: The well driller shall provide a well' log to the property owner wit', _3u _iy _ c rn
ua
_A- 5 of copieiioi� and the property
�
_ri ,_ ____n i_ _ a _ n____,_ r,_ _
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
Rick Mystrom http:/Mw .ci.anchorage.ak.us
Mayor
Permit Number: #SW 010069 Date of Issue: 4-16-01 Parcel Identification Number: 015-164-03
Date Started: 6-30-01 Date Completed: 6-30-01 Is well located at approved permit location? ® Yes ❑ No
Legal Description: Timberline Lot 5
Property Owner Name & Address: Jim Schnell
PO Box 110802
Anchorage, Ak 99511
Borehole Data:
Depth"(ft) `
Method of Drilling N air rotary ❑ cable tool
Soil Type, Thickness & Water Strata
stick-up
From To
0 2
Casing type: steel
Wall Thickness: .025 inches
organics and silt
2 8
Diameter: 6 inches Depth: 20 feet
gravelly silt
8 14
Liner Type:
bedrock
14 107
Diameter: inches Depth: feet
Casing stickup above ground: 2 feet
Static water level (from ground level): 14 feet
Pumping level: 107 feet after
2 hours pumping 3 gpm
Recovery Rate: 3 gpm
Method of Testing: airlift
Well Intake Opening Type:
❑ Open End ® Open Hole
❑ Screened Start feet Stopped feet
❑ Perforations Start feet Stopped feet
Grout Type: Bentonite # 8 Volume: I bQ
Depth: Start 0 feet Stopped ± feet
Pump: Intake Depth feet
Pump size hp Brand Name
Well Disinfected Upon Completion? ® Yes ❑ No
Method of Disinfection: Clorine Tablets
Comments:
Well Driller: Alpine Drilling & Enterprises
P O Box 110496
Anchorage AK 99511
Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property
mxmnr nr tha mall Arillar Aoll nrnv:Aa a wall lnn to fha nl t of paaklA R, Lrnman Sarvinae within rn Rave of rmm�latin»
MUNICIPALITY OFANCHORAGE I �% S'£° P"
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ONSITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Permit Number: SW010069
Legal Description: TIMBERLINE SUBDIVISION LOT 5
Date Issued: Apr 16, 2001
Expiration Date: Apr 16, 2002
Parcel ID: 015-164-03
Design Engineer: 0062 Pannone Engineering Services Site Address: 11081 TRAILS END ROAD
Owner Name: JIM SCHNELL Lot Size: 49665 SQ. FT.
Owner Address: 11081 TRAILS END ROAD Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE, AK 99516 -
This permit is for the construction of:
[✓� Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date: T —16-01
'"s,"nicibality of Anchorage
(. Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P_O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. OI -;-- / 64 — 03 Permit Number SWO/0069
Property owner(s) Jim Schnell Day phone 345.4146
Mailing address (1) P.O. Box 110802
SITE
M=jt=address (2) Anchorage, AK I IOR/ TRN10' EA/D R019P Zip Code 99516
Legal description (Lot, Block & Sub'd.) Lot 5 T;VR4bxWM Ti19BER1, /ME su 0A
Legal description (Section, Township & Range)
Lot Size !.%G- AcreqL90 Number of Bedrooms 4
49.,665-
THIS
9,665-
THIS APPLICATION IS FOR:
Sewer Only ❑ Well Only t
Sewer and Well ® Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: Waiver Fees:
Date of Payment: 3P] 01 Date of Payment:
Receipt Number: Receipt Number:
(Rev. 12100)
Pnnnnne Engineering Services, LLC P.o.Eat102954
Consulting Engineers Anchorage, Alaska, 99510
(907) 227-3522 (907)272-8218 Fax
March 25, 2001
Municipality of Anchorage
Development Services
On -Site Water & Wastewater Program
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Lot 5 Trails End S/D
Well & Septic Permit
Gentlemen:
My firm was contacted to investigate the possibility of installing of a new system at the
above referenced property. Currently the lot is undeveloped. A single test hole was
excavated on the property on February 10, 2001 and is attached. Ground water was
checked on March 3, 2001. No water was found at the time of excavation. Bedrock was
encountered at the bottom of the test hole:
The lot is approximately 1. 136 acres in size. Lot 5 slopes to the northwest at a rate of
approximately 20 percent. The proposed installation will be located in northern portion
of the lot perpendicular to the slope on a relatively flat section. The proposed location
will be greater than 100 feet away from the proposed well serving this property and 25
feet from the water service lines. The surrounding systems are located greater than 100
feet from the proposed installation. The lots surrounding this lot are developed, and do
not conflict with the proposed installation. The proposed installation will not impact the
future development of the surrounding or existing lots. See attached design. The new
system will maintain over six feet vertical separation to the bedrock and over four feet
vertically to the ground water. The owner may install both the primary and reserve
drain -fields at the time of installation.
Please contact me at 272-8218 or 227-3522 if you have any questi(
Sincerely,
�75teven R. Pannone, P.E.
Attachments:
C: \ WORK\LETTERS \5TRAILSEND.001.DOC
Z' a4J0i i) L J i Ll IN PJ.D. NO,
`u.-'ASTPEWATER ABSORPTION SYSTEM
LOT 5 TRAILS END S/D
rte••, •- � .,� �-�
�'• 49TM �' �
een R. Pann4
No. CE 8149
L "+
NO WELLS OR SEPTICS
`\ WITH 200' OF PROPOSED
SEPTIC SYSTEM
^ 100' WELL RADIUS
o�
i-fXIST'G WELL RESERVE DRAINFIELD AREA
!f/ /-50LFx3'x5' EFF'TV
s;
r>
\--PROPOSED
10.1
II I
Ili III I I!
�VOTE;�, R
1) ALLWARK„SHAL BE P RFjIRMEjD III`
IN ACCORDANCE TH AMP:15165.III
2) MATERIALS US SHALL ®E Ht+! III I
ACCORDANCE WITH OS- SPECIFIED
TN A
3) CONNECT POST TANK LINE TO MID-
POINT OF DRAIN FIELD. TYPICAL.
4) INSTALL DRIVEWAY AT LEAST 5 FT
AWAY FROM DRAINFIELD. DO NOT INSTALL
DRIVEWAY OVER DRAINFIELD.
j 5) MAINTAIN 10' SEPARATION TO ALL
LOT LINES.
Jin Schnell
P.O. Box 110802
Anchorage, AK 99517
(907) 345-4146
=D 12508
TANK
DESIGN!.
MIN/INCH
SOIL RATING, 1.2 GPD/SF
125 SF/BEDROOM, 4 BEDROOM
500 SF REQUIRED,
12508 SEPTIC TANK
DEEP TRENCH, 5' EFFECTIVE
8' TOTAL DEPTH, 50 LF
2-3' WIDE, 500 SF TOTAL
PANNONE ENG. SVC, LLC
P. O. BOX 102954
ANCHORAGE, ALASKA 99510
272-8218 Phone & Fax
ITE, 3-25-01 DESIGN
PERMIT NO, SWO1 DESIGN DETAILS
WASTEWATER ABSORPTION SYSTEM
NOTE LOT 5 TIMBERLINE S/D
1) ALLWORK SHALL BE PERFORMED
IN ACCORDANCE WITH AMC15.65.
2) MATERIALS USED SHALL BE IN
ACCORDANCE WITH THOSE SPECIFIED
IN AMC15.65, WASTEWATER DISPOSAL.
3) CONNECT POST TANK LINE TO MID-
POINT OF DRAIN FIELD. TYPICAL.
4) INSTALL DRIVEWAY AT LEAST 5 FT 1nW
AWAY FROM DRAINFIELD. DO NOT INSTALL
DRIVEWAY OVER DRAINFIELD.
5) MAINTAIN 10' SEPARATION TO ALL
LOT LINES.
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Jin Schnell
P.O. Box 110802
Anchorage, AK 99517
(907) 345-4146
301 N131IN13W
snow
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P.I.D. NOt 015-164-03
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PANNONE ENG, SVC., LLC
P. O. BOX 102954
ANCHORAGE, ALASKA 99510
272-8218 PHONE & FAX
NTEi 3-25-01 DESIGN
OT TO SCALE
ZZLIA LOG - PERCOLATION TEST
PANNONE ENGINEERING SERVICES
P.O. BOX 102954
ANCHORAGE, AK 99510
(907) 272-8218
PERFORMED FOR: Jim Schell DATE PERFORMED: 2-10-01
LEGAL DESCRUmoN: Lot 5 Trails End S/D
sLOPE
OR TT%mlail
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Gm Silty Sand
Easy Digging
: TEST HOLE
WAS GROUND WATER
ENCOUNTERED? No
IF YES, AT WHAT
DEPTH? -0-1
DEPTH TO WATER AFTER
MONITORING? Dzy
DATE: 3-3-01
pl.-J A
TEST HOLE
READING DATE GROSS
TIBC
NET
TIM
DEPTH or
WATER
NET
DROP
2-10-00 12,36
6-
----
12,46
10
2 11/16'
3 5/16'
12,46
----
6'
----
1266
10
2 11/16,
3 5/16-
12,56
----
S.I
----
13,p6
10
2 11/16'
3 5/16'
PEROLATION RATE 3 (min/inch) FERC HOLE DIAMETER 6 inches
TEST RUN BEWTEEN 7 FT and 8 FT
COMMENTS: Teat hole excavated by Dan Beek. Teat Hole was presoaked before pert teat.
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.
June 14, 2001
Municipality of Anchorage
Development Services Department
On -Site water & Wastewater Program
4700 South Bragaw Street
Anchorage, AK
Re: Lot 5 Timberline Sub.
Permit #SW010069
Bldg Permit# 01-0606
Jim Schnell, builder/owner
To Whom It May Concern:
This letter is to state my knowledge to install an on-site septic system at the
above address. I have worked in the construction field as a general contractor
for many years in Alaska. I have assisted and installed many on-site septic
systems in the past. I will be personally on site and doing the installation of the
system. Pannone Eng. Services designed our system and will be on-site to
inspect.
Sincerely,
Jim Schnell
IT�
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COSA Checklist.docx
COSA Checklist
Legal Description: TIMBERLINE LOT 5 Parcel ID: 015-164-03
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 6/30/2001 Total depth *266 ft
Cased to 20 ft (cased into bedrock)
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 4/30/2024
Static water level at beginning of test 14 ft.
Well production at time of test 1.4 gpm
Water storage tank volume NA gallons. (per owner)
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 8.40 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 4/8/2024
Comments *Well deepened on 5/16/2005 from 107’ to 266’.
B. TANK DATA
Measured operating fluid level in septic tank 49”
Date of pumping 4/30/24
Required maintenance completed, if AWWTS
Comments:
C. LIFT STATION
Required maintenance completed
Age of lift station years
Lift station material
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 10/08/2001
ALL standpipes present per record drawing
Total measured depth from existing grade 9 ft (max)
Measured depth to pipe invert from grade 3.9 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective. (ED)
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 4/30/24
Results Pass (E / W Trenches)
Fluid depth prior to test 11 / 8 in
Water added 600 gal
New fluid depth 15 / 12 in
Elapsed time 1020 min
Final fluid depth 9 / 7 in
Absorption rate 600 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 60 in (MOA 5’ ED)
Effective depth used 9 / 7 in (Final Fluid Depth)
Effective depth (ED) remaining 51 / 53 in
Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots &
appears approximate with 5’+ ED.
COSA Checklist.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No *5+ ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
*Septic tank installed per existing code at installation at 5’+ from foundation
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 05/01/2024
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
05/01/24
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• Municipality ®f An rage
On -Site Water and Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 015-164-03
1. GENERAL INFORMATION
Complete legal description TIMBERLINE S/D, LOT 5
Expiration Date: 6 r ;11 e So
Location (site address) 11081 TRAILS ENDS, ANCHORAGE, AK 99516
Current Property owner(s) JAMES SCHNELL Day phone
Mailing address 11081 TRAILS ENDS, ANCHORAGE, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING: u v
® Single Family (w/wo ADU) _r ���°
F-1Duplex _ MAR g 2016
❑ Multiple Dwellings (Single Family and/or Duplex) °
3. NUMBER OF BEDROOMS:
49
r� `'
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWAT DISPOSAL:
Individual Well
®
Individual
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for:
Received by: ae�W 1� — Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $SZ� 3(ri tech =I 0
Date of Payment `r—//(o C 'E qo 1
Receipt Number k0fl/4
COSA# C5C1(101bI(00
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from (he Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864
Address 4661 NATRONA AVE.
Engineer's Printed Name MIKE N ANDERSON, PE Date 03/28/16
6. DSD SIGNATURE
System #1 Approved for bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
419
..........
MICHARLNA"KUERSCN
C 9,
FEcctJKA
bedrooms, with the following stipulations:
By: W y Original Certificate Date: 3 Z9
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 Arsenic Advisory
Well Flow Advisory Other
COSAbluesheet 10-10,12Eoc
If more than 1 septic system is on the lot:
COSA Checklist # _of _
Structure served by this system _
Certificate of On -Site Systems Approval Checklist
Legal Description: TIMBERLINE S/D. LOT 5 Parcel ID: 015-164-03
A. WELL DATA
Well type Private If A, B, or C provide PWSID # _ Well Log (YIN) Y
Date completed 6130101,k Sanitary seal ((YY/N) Y Wires properly protected (Y/N) Y
Total depth R69 ft. Cased to kft. Casing height (above ground) 24
7,(1& FROM WELL LOG AT INSPECTION
Date of test 6130101
Static water level 14 ft.
Well production 7 g.p.m.
WATER SAMPLE RESULTS:
312612016
18 ft.
9—
p.m-
Coliform NEG colonies/100 mL Nitrate 7.3 mg/L
Arsenic: ND ug/L Date of sample: 311512016 Collected by: Mike N. Anderson
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC I STEEL Date installed 101812001
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
y
Date of pumping 312612018+ -Pum, r McDdnald '
C. ABSORPTION FIELD DATA —1985 SYSTEM TESTED
Date installed 101812001 Soil rating (g.p.d./fe or ftp/bdrm)1.2 System type DEEP TRENCH
Length 25125 ff. Width 313 ft. Gravel below pipe 5.0 ft.
Total depth 9 ft. Eff. absorption area 500+ ft2 Monitoring tube Y Depression over field N
Date of adequacy test 312 612 01 6 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 6 in. Water added 650 gal. New depth 13 in.
Elapsed Time: 480 min. Final fluid depth 9 in. Absorption rate >= 600+ g,p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) UNKNOWN If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at
Datum
Size in gallons Manhole/Access (Y/N)
in. "Pump off" level at
Cycles tested
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 1001+
Absorption field on lot 1001+
Public sewer main 751+
Sewer /septic service line 504
Animal containment areas 1001+
SEPTIC/HOLDING TANK ON LOT TO:
in.High water alarm level at
Meets alarm & circuit requirements?
in.
On adjacent lots 1001+
On adjacent lots 1001+
Public sewer manhole/cleanout ,100'+
Holding tank 100'
Manure/animal excrete storage areas 100'+
Building foundation 5.5'
Property line 50'+
Absorption field
10'+
Water main 100'+
Water service line 254
Surface water
1004
Wells on adjacent lots 1004
ABSORPTION FIELD ON LOT TO:
Property line 151+ Building foundation 25'+ Water main NA
Water Service line 251+ Surface water 1001+ Driveway, parking/vehicle storage 50'+
Curtain drain 100'+ (None Known) Wells on adjacent lots 1001+
F. COMMENTS
WEST TRENCH ONLY WAS TESTED CA- 6o TI i
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name MIKE N. ANDERSON, PE
Date 0312812016
COSA canary sheet_2-6-15.doc
�1Pq� OF Atq'p 1
\".•aaaa e a V
* • a9?� *'
00- MICHAELA'ANDUSON
9fi 9. �,�'��,•'
Municipality of Anchorage
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
Nitrate Advisory
Certificate of On -Site Systems Approval # (fix. i%' (07 �
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block,--' , Lot
5 of ioty ro subdivision. This inspection revealed a nitrate concentration
Of 7 3 milligrams per liter (mg/L) was reported for the property's well
water sample. The Environmental Protection Agency (EPA) has established
a maximum contaminant level (MCL) of 10.0 mg/L for public drinking
water systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Nitrate Fact Sheet
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble
in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass
rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is
in the form of ammonia or protein first, which through contact with oxygen and certain
bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from
wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also
result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or
three years, but is associated with a potentially fatal infant disease called
methemoglobinemia. In the digestive system of young children, nitrate converts to
nitrite, which can pass through the intestinal wall into the blood stream. There it
combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The
EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The
standard has been lowered from a previous level of 45 mg/L set by the US Public Health
Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and
other common home water treatment systems such as softening or iron filtration does not
readily remove nitrate. The best method for limiting nitrate in well water is source
control. This can include avoiding overdosing of fertilizer near the well and maintaining
good separation distances between septic tank leach fields and the well. A special anion
exchange filter that contains a media with a strong affinity for negatively charged ions in
water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical"
methods using a spectrophotometer to read the final color endpoint. Specific ion
electrodes also can be used to detect the activity of nitrate in water. This laboratory uses
several different wet chemical methods approved under the public water supply
laboratory certification program. They also have test kits available, which the laboratory
uses to perform an inexpensive "screening test', and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test
kit results against a certified analysis from the lab occasionally to verify the accuracy of
the kit. We recommend using a specially prepared bottle that has been rinsed in
hydrochloric acid for collecting samples.
d
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3
Municipality of Anchorage
• -� Development Services Department V
Building Safety Division "
On -Site Water and Wastewater Program
4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel l.D.01,5- Lq-b3 HAA# I&r,20079
Expiration Date: C — / 3— o Z
1. GENERAL INFORMATION
Complete legal description c Zd -T- S T(m 8 &—R L t.V t=
Location (site address or directions)
Current Property owner(s) °3 t M S c NNe_L L Day phone 3 Lis- ql VL
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
p.oV3o�c //oRo'z .1 1795//
Day phone
Day phone
Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:
2. NUMBER OF BEDROOMS: Y
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class Well
❑
Public Water System
❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site vg
Individual Holding tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of
title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water
supply system. DSD also issues HAAs upon request to home owners. Certificates of Health Authority Approval are
valid for 90 days from the date of issue for properties served by a private or C:ass C well and may be reissued with
new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A
or 8 wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
(R. IIM)
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 Health Authority Approval Guidelines for this Health Authority Approval
application 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 applicable Municipal and
State codes, ordinances, and regulations in effect at the time of installation.
Name of Finn Pannone Eng. Svc. Phone 272-8218
Address P.O. Box 102954, Anch, AK 99510
Engineer's Printed Name Steven R. Pannone, P.E. Date
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious�,
C to
engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The^�G.•
the time
.4`
�� `�' •• ••
reported results describe the performance of the system under the conditions encountered at of
•••
the lest, and separation distances measured to readily identifiable features. The operational life of all
•
wells and septic systems depend on the local soil condition, ground Hater levels that may fluctuate
during the year, and the water usage of the family being servo! by the system These conditions are
i „•,;,••,,,,,,,••
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 arc no
•••••••••••••••• •.•
hidden defects or encroachments. PES can therefore not provide any warranty for future performance
the
% ? • rte : e n F Fc r. r e r.e; ,�
#j ' \ E 1 �4 :'
nor give any estimate of how long the system will continue to meet the oper tional requirements of
ADEC MOA DSD. The this is for the benefit the listed above. Any
; c. OE
♦' l'•. (? Z030�,.••'
or content of report sole of owner
it
�� F (�'
C�
reliance upon or use of this report by any other perwn or party is not authorized nor will confer any
1�
legal right wfiatsocvcr.
--
6. SD SIGNATURE
Approved for _ bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist X
Septic System Advisory
Well Flow Advisory
2y:
Expiration Date:
Mw 11M)
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: 7 — I S
Reissue Date:
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program s . ..
4700 South Bragaw Street
P.O. Box 198850 Anchorage, AK 99519-8850
www.ci.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L S 'Parcel I.D.: 01S-1164-o_t
A. WELL DATA
Well type T /
Date completed L l �lOt
If A, B, or C provide PWSID # _ Well Log
Sanitary seal `f
Total depth 12 f ft Cased to Y:d ft
FROM WELL LOG
Date of test 6 l 30 1 o I
Static water level K ft
Well production 3 9 -p.m
WATER SAMPLE RESULTS: ' _
Coliform — O" colonies/100 ml
Date of sample: 3 /S/o T-
B. SEPTIC/HOLDING TANK DATA
Wires properly protected
Casing height (above ground) Z'' _in.
AT INSPECTION
e. !3y/of
/g ft
3 g.p.m
Nitrate 3-q3 Other bacteria Z colonies/100 ml
Collected by: e- Z
Tank Type/Material L
Date Installed /01IF/V Tank size 1'2,S -O gal
Cleanouts !L - Foundation cleanout Y
Date of pumping _A a Pumper
C. ABSORPTION FIELD DATA
Number of Compartments
Depression over tank it/ High water alarm —
Date installed !O1Of Soil rating (g.p.d.W or ftZ/bdrm)!_2 System type
Length ?5 r, t Width 313 It Gravel below pipe ft
Total depth -i— ft Effective absorption area yF93C1fe Monitoring tube __'elY Depression over field A111411
Date of adequacy testy eL4/ Results (Pass/Fail) For _ bedrooms
Fluid depth In absorption field before test _ In
Elapsed Time: Q min Final fluid depth
Water added_ gal. New depth_ in.
—in Absorption rate >= g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM & type) If yes, give date
(Rev.1IM)
D. LIFT STATION
Date Installed Size Ia�S
'Pump on' level at m'Pump ofP level at
D Cycles tested
E. SEPARATION DISTANCES
ManhoWAccess '
In High water alarm level at _ in
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lifl station on lot / (0 O On adjacent lots l G0 +
Absorption field on lot / y3 On adjacent lots 00
Public sewer main Nt!� Public sewer manhole/deanout A -dA
Sewer /septic service line /10,19 o Holding tank /00
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
0
Building foundation SA Property line SO Absorption field O —
Water main NIA Water service line 75—� Surface water /00
Drainage / bot Wells on adjacent lots / 00
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: -
Property line /S= Building foundation Z+S Water main N A
Water Service line 7 S -f Surface water /!70 Driveway, parking/vehicle storage Sy
Curtain drain •� Aofi Wells on adjacent lots /00r'
F. COMMENTS
G. ENGINEER'S CERTIFICATION : �;.•'"1
/
1 ce;ft that 1 nave determined through field inspecWns and _
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
%-P\** Steven F. Pannone.
it
Engineer's Printed Name Steven R. Pannone. P.E.�� S Q A40f .� s
Date
HAA Fee $ 375
Date of Payment 3/ -3 O Z
Receipt Number M% ?C?
(Rev. i 1AQ)
Waiver Fee E _
Date of Payment
Receipt Number
YAR -07-02 01:24PW FROV-CTLE ENVIRMWNTAL SRV 9075615301 T-630 P.03/03 F-507
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ME EnvbWmmntal S&VI s I'm
' tabonary Obriebtt
rilg Water Analysis
p PURUC WATit SYMN I.D. ti
for Total Coliform Bacteria
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t NMC -MW
• Numbs of eobmeal, .#-
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SAMPLE DATE:
SAMPLE TYPE:
p Readta
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BAC=OLOOICAL WATLR ANALYSIS WORD
t as
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YAR -07-02 01:23PY FR04-CTAE ENVIRMKNTAL SRV
ME Environmental Services Inc.
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CUE ReLf
1021154001
Cllent Nam
Pannone Eng. Srv.
Project Nome/O
Timberline Lot 5
C1lent SampleID
Out Side Hose Bib
Matrix
Drinlag Water
Ordered By
PWSFD
0
Sample Remarks:
9075615301 T-830 P.02/03 F-507
Client POO
Printed Date/Slme
Collected Datefrlme
Received Datdrime
Technical Director
Released
03/07/2002 12AD
03/05/2002 14:15
03/05/2002 15:15
Stephen C. Ede
Altowble PM Anaemia
Parartetor Results PQL Urdu Mebod Limia Date Dam Nit
Waters Deyartment
Karam -N 3.43 0.200 my'L EPA 300.0 (<10) 03/05/02 JDT
AiarobioloQy Laboratory
Toml Colifarm
2 OB, No Coli / 80 rola aoV100mL SM 18 92228 (41) 03105n12 KAP
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NOTE: NO CORNERS SET THIS DATE.
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