HomeMy WebLinkAboutTHOMAS L BOYLE BLK 1 LT 12A Onsite File
Thomas L . Boyle
Block 1
Lot 12A
PID# 015 - 283 - 05
The berm is to remain in place for future COSH
approvals .
S(TMMITTAL
MAY 312018
Municipality of Anchorage
Community Development Department Page 1 of 2
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: OSP181093 PID Number: 015-283-05 ❑ New ❑✓ Upgrade
Name:
JANN & MELISSA SCHMEIDT ABSORPTION FIELD
Address ❑ Deep Trench 0 Shallow Trench 0 Bed ❑ Mound
11800 WAGNER STREET ANCHORAGE, AK ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
4 0.3 GPD/SF 0.0 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot +0.5 Ft. 0•SFt.
THOMAS L. BOYLE 1 12A Fill added above original grade Gravel length
Township Range Section 3.0 Ft. 20.0 Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 15.0Ft. 3 5.0Ft.
To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist.between trenches
From Tank Field Lift Station Tank Line 300 Ft2 Ft.
Well N/A 178.7 NA N/A TANK ❑Septic 0 S.T.E.P. 0 Holding ❑Other
Manufacturer Capacity
Surface Water N/A 87.3 N/A N/A Gal.
Material Number of compartments
Lot Line N/A 58.4 N/A N/A
NA
Foundation N/A 84.0 N/A N/A LIFT STATION
Manufacturer Capacity
Curtain Drain N/A 50+ N/A N/A Gal.
Remarks Pump on level at Pump off level at High water alarm at
DRAIN FIELD REPLACE ONLY
in. in. in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank Tank to
Installer drainfield
A+ HOME SERVICES Drainfield 3034 CO/MT 3034
Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 284ft
Inspection 1m Location and description
dates: 5/18/2018 2nd 5/19/2018
3" 5/20/2018 4"' 5/21/2018
NW BOTTOM HOUSE TRIM
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp
OFConditional Approval: Date ~� A'�'. `1'
ic'' ,` 90
. ... • 0 • ,'
tteven •. ESannorae Al
,• CE 8149
App .�.--- _—/ / Date 6=3) 'l ����' L
iP ••r
Inspection Report_1-1-12.doc
PRIMARY DESIGN PARAMETERS
NO. BEDROOM: 4(600 gpd) f'":''lot
TANK: 1500G AWWTS(E) L *--- +
PERC RATE: 40 MPI ***
SOIL RATING: 0.30 GPD/SF REMOVED & REPLACED ABSORPTION FIELD �/r
AREA ROD: 300 SF 20LFx15.0'Wx0.5'E.D.,+3.0'T.D. tsi• ** '0. '�'
SYS.TYPE: BED 0.5'ED 1,25"0 PIPE 5' O.C. TYP W 0.125" DRILLED `'
MIN LENGTH: 20 LF / 8
HOLES 18" O.C. TYP '
USED: REMOVED & REPLACED BIOMATTED SAND, ,a:.:!'I '
20.OLFx15.0'Wx0.5' E.D., +3.0' TD ADDED 1.0' SAND W/ MTs IN EACH CORNER TRUE NORTH I GALE : 1'= so'
TOTAL AREA: 300 SF
J
1500G ADVANTEX W/ AX-20
POD AND AUX PUMP VAULT
N/° 58.4 DRIVEWAY
7
IX1:5°leTH
� 4BR
\�� 59.9 �` / SFD<z- � dill
i` 133.7 12A aa.)
II TtJ2./ i�� 178.7 ".'
�� 64.a
0101°P- 87.3 WELL
LLi
NN
LIMIT OF FILL 5::::? ,
BERM
SMALL POND
A B
M 1 85.8 84.5
M2 86.0 80.4
M3 103.5 101.4
M4 103.8 97.7 (.
ABOVE PIPE 1NV 0.125-DRltEO HOLES 18 O.C.
S FIVER FABRIC
.i.`' r _,,
El.285 -11
Et.282 TOR OC.b
1 { OR
282.5 .2.0'SAND 2.0 I 261—
a.0 51.4
I---
260 OC.2005
2.V BOA 7117E II OR
279— S4
PROFILE 278 Su/AL
SCALE:1'=10' 277-
0A 5/19/21118
278-
275—
NOTES: PANNONE ENG SVC, LLC Date
RECORD DRAWING 5/30/2018
P.O. BOX 102954 ANCHORAGE, AK 99510 �.,.••""' •.
PHONE (907) 272-8218 FAX (907) 272-8211 i 1 Scale
l''=50'
— •• .„44;W60,• •••• P.1.D. NO
1 W
•
' I --283-05
JANN & ,•
MELISSA SCHMEIDT
DRAWN ACP 11800 WAGNER STREET �}°�' �' �O��O•R° PERMIT N0.
,=• CE 8149 • OSP181093
ANCHORAGE, AK 99516 Sheet
•, 2 OF 2
/2z/0 70/7 5 (
4?-
MUNICIPALITY OF ANCHORAGE tinenc
/ • On-Site Water&Wastewater Program \o 5;,
r�,,� PO Box 196650 4700 Elmore Road 44'
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
S 'r http://www.muni.org/onsite
1 epartment
4NfHORk4�
On-Site Water & Wastewater System Permit
Permit Number: OSP181093 Effective Date: 5/18/2018
Work Type: Vi4I1Septic Upgrade Expiration Date: 5/18/2019
Tax Code Number: 01528305000
Site Legal Address: THOMAS L BOYLE BLK 1 LT 12A G:2734
Site Mailing Address: 11800 WAGNER ST,Anchorage
Owner: LOFGREN BRYANT G &AMANDA S Lot Size in Sq Ft: 49500
Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4
This permit is for the construction of:
Q Disposal Field Q Septic Tank 0 Holding Tank 0 Privy Private Well 0 Water Storage
All construction shall 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 shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Special Provisions: The berm is to remain in place for Inspection Report approval.
.5/t /1a CO 41 Pest", Cht7e-
_ J r
Received By: Date: Il
/
Issued By: h7/6 5
�� �.� Date: !!
tfor 174/1511 411bV---1\-0. lill0511111
MUNICIPALITY OF ANCHORAGE 1U3tf) !
Community Development Department . INFPhone: 907-343-7904
Development Services Division Fax: 907-343-7997
On-Site Water& Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 015-283-05
Property owner(s) JANN & MELISSA SCHMEIDT Day phone
Mailing address 11800 WAGNER ST, ANCHORAGE AK 99516
Site address 11800 WAGNER ST
Legal description (Sub'd., Block & Lot) THOMAS L BOYLE B1 L12A
Legal description (Township, Range & Section)
Lot Size 49,500 Sq. Ft. Number of Bedrooms 4
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 Q Upgrade 0 Duplex (D) ❑
Holding Tank ❑ Renewal ❑
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.
(Signature of property`bwner or authorized agent)
Permit/Rush Fees: Cf fO.140 Waiver Fees:
Date of Payment: .5//0//0 Date of Payment:
Receipt Number: 22 5003 Receipt Number:
Permit No. C6P/716 3 Waiver No.
Permit App_:-:• ::...c
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181093, Deb Wockenfuss, 05/18/18
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP181093, Deb Wockenfuss, 05/18/18
• Municipality of Anchorage °
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 South Bragaw Street
P.O. Box 196650 Anchorage, AK 99519-6650 Pagel of 3
www.ci.anchorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name:
Wastewater System: ❑ New ED
Address:
Phone: Number of Bedrooms:
[]Deep Trench ❑ Shallow Trench ® Bed ❑ Mound ❑ Other:
LEGAL DESCRIPTIfIlrd Boil Rating: Total Depth from original grade:
Block: Lot: Subdivision:
Thannias I Boyle
m from original grade:
botto12A
2 Ft
Gravel depth beneath pipe:
Township: Range: Section:
0.5
ove ori inal rade:
g g -
Gravel Lergth:
FtWell:
❑ New ❑ Upgrade
:
Et.1
Number of linea:
Distance between lines:Classification
(Private, A, B, C): Total Depth: Casedto:
r
area:• 5 Ft
Pipe Material:F
vateion
Date Drilletl: Static Water Level:
7 0 F 3 34 VDriller.
Date Installed:Ft
Yieltl: Pump Sat ef: Casing Height Above Ground:
1
GPM Ft. Ft.
TANK
SEPARATION DISTANCES
❑ septic ❑ Holding ® S.T.E.P. ❑ Other:
To Septic Absorption Lift Holding ublidPrivate
From Tank Field Station Tank Sewer Line
Manuracturer. capadry:
Anchorage Tank 1500Ga1.
Well 133.5 176.4 145 700+
Material: Number of Compartments:
Steel
2
Surface Water 100+ 100+ 100+
LIFT STATION
Lot Lina
57.9
52.4
57.9
Sim'
Manulecturer:
250 Gal.
Orenco
Fountlagon
37
90
50
Pump on" level a[
I" PUMp oM level at: High water alarm at
40 in.
36 in. 45
Curtain Drain
36
88
50+
Pump Make &Model
in.
El.c iwl Inspections performed by:
V
Remarks:
Field covered with 2" rigid Insulation.
BENCH MARK
Location and Description:
Front Porch
Assumed Elevation:
100.0
Ft.
Engineer's Stamp
�••� . OF q..�
Inspections performed by: PES, LLC Dates: I'll 1/8/2006
�
H
2"°11/08/2005
"""'
Development Services Department approval
........„,,.•..
..te
Reviewed and approved bA1001Q/ (�/
er RPonohe3we
12/W) �r2 Date: - f �' dG
1�.�s, 81
(Rev.
�No)/C�E
!� -h; �iCl 749 AVV
♦ {
,��f,t ESS`��•�
PERMIT NO:SWO503DO RECORD DRAWING
' WASTEWATER DISPOSAL SYSTEM
LOTS 12A BLOCK 1 THOMAS BOYLE S/D
ExISTO
r
SEPTIC
\\\AREA
NEW 4BR
REPLACMENT SAS
BED 15'WX20'Lx0.5' ED
0' TD
1) All work shall be performed In
accordance with AMC15.65.
2) Materials used shall be in
accordance with those specified in
AMC15.65, Wastewater Disposal.
3) Maintain 10'separation to an lot
lines and proposed water lines.
4) Lots served by private water
system. No wells within 100' of
proposed system.
0
Steven R. Pannone
E.
EXIST'G 4 BR
SEPTIC IN FAILURE
ABANDONED IN PLACE
1 3 1
52.4 n
M2
TH 2 P.. li-
CO A B
FC 3.6 27.9
C1 37.9 349
T1 42.3 39.1
LS1 49.9 46.4
LS2 54.3 50.7
Mt 93.0 90.2
M2
M3 95.6
M4
1$B
1
NEW 15009khSTEEL
TANK WITH \
ADVANTEX AX20 POD.
M1 M3
20.0 24.8
15.2
25.1 19.8
Mr. Dave Dau
11800 Wagner Street
Anchorage, AK 99516
345.5338
P.I.D. NO: 015.283-05
srG
e WELL
EXISTG 12509
SEPTIC TANK
ABANDONED IN PLACE -
CRUSHED
C1 I / EXISTG 4 SR HOUSE
�iiA/1C
48_ m
'—' EXISTG FOUNDATION M
t 133.5 DRAIN -TYPICAL ..i
EXIS' G
175.1 WELI
/
f e WELL
I
12B111
PANNONE ENG. SVC, LLC
P. O. BOX 102954
ANCHORAGE, ALASKA 99510
227-3522 P. 272.8218 Fax
PLAN
PERMIT NO:SWO50300
RECORD DRAWING DETAILS P.I.D.NO: 015-283-05
WASTEWATER DISPOSAL SYSTEM
LOTS 12A BLOCK 1 THOMAS BOYLE S/D
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/PREPARED
♦♦.'• Steven R. Pannone J
FOR:
Mr. Dave Dau
PANNONE ENG. SVC, LLC
♦jam CE 8149 t �
11800 Wagner Street
P. O. BOX 102954
♦ •
♦♦♦ �.�
Anchorage, AK 99518
ANCHORAGE, ALASKA 99510
.rZ2.
345-5338
227-3522 P. 272.8218 Fax
%as
DATE: 12-20-05
DETAILS
SCALE: NTS
SOILS LOG - PERCOLATION TEST ������ ��•••
•
�.• P(E •
PANNONE ENGINEERING SERVICES � �'C•,..••"'��� ......... •••
P.O. BOX 102954 tt :
49
ANCHORAGE, AK 99510 + Tr i •�
(907)272-8218 r r
■
. Steven R. Pannone •.
PERFORMED FOR: Mr. Dave dau DATE PERFORMED' 1/16/06E 8 ••�•• L7 4n�,��i
LEGAL DESCRIPTION: LOT 12A Block 1 Thomas L. Boyle SID •'., o list
TEST HOLE
1 OR OrganwRoot Mat SLOPE SITE PLAN �\\`
2
3 SM SAND. with Sat
4
TEST f /
S HOLE
e SM Heaving THy `j® bottom TH7
T Water 6'
BOH I P
6 t
a %\
12A ---
10
11
,z
/
13
WAS GROUND WATER SLOPE
14 ENCOUNTERED? Yes
13 IF YES, AT WHAT TEST HOLE
18 DEPTH? 6'
17 DEPTH TO WATER AFTER
MONITORING? -3'
to DATE: 1-17-2006
19
WATER
20 TIME
PEROLATION RATE 32 (minlnch) PERC HOLE DIAMETER 6Inches
TEST RUN BETWEEN 1.5 FTAND 2,5 FT
COMMENTS: Test hole excavated by Alaska Divers Perc hole was presoaked before test
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.
CLOCK
READING DATE NET TME LEVEL NET DROP
READING
1/I7/O6 2:09 6 1/6" p•
5 3/16' 15/16'
2 2:39 37MIN
3 2:39 6 3/6' p•
4 3:09 30 MIN S 7/16' 15/16'
S 3:09 6 1/16' p'
6 3:39 30 MIN
S 1/6"
15/18'
f From +IX7#339507 Fri Ton 27 C6:23122'2006
INSPECTION REPORT
Pogo 3 of 1
MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION
4700 SOUTH BRAGAW
INSPECTION INFORMATION LHE(P: 343..7962
INSPECTION: VOICE 343-8300 INSPECTION: FAX (007)240-7777 www.munl.org4M(?raP&c9ons.ef n
NAME:
ng
PERtUITO:
05-639
COMPANY:
wort 610ctrs
INSPECT DATE:
IIZ72005 pm
PHONE*.
748-6162 PHONE#:
PHONE*:
ADDRESS: 11800 WAGNER ST -
LOT 12A SLOCK SUBDIVISION: THCMAS L BOYLE GRID F: S'A2734'
Y '
COMMENTS or DIRECTIONS
late P'9 Nv1'`�CS.t
TYPE OF INSPECTION: Fina' E!sctrbal
COMMENTS; (FOR IrQSPECTOR USE ONLY) -
�t�I"lcci I �r 1, "r S�FIleA q�•}fJlrwG'
PRIMED NAME (/ i' DATE: -.�2
I •d
0201-9♦.E-L06
c99ag dSOr80 90 L2 LjPf
0)
04
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I 1 0. (.r� I
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salva9emanprandumolil(S,7019x2
ALASKA DYEUtiff)
UNDERWATER ,l" , 1.8004781.800478-051500,l5
rAl'i ewr oil -
SALVAGE bit (90-1 /,wrnt
Memorandum of Undentanding
Alaska Divers and Underwater Salvage installed an AdvanTex AX20 system at 11800 Wagner Street,
Anchorage, Alaska between 11/7105 and 11/14/05. Additionally, the vault for the curtain drain was
excavated, removed, repaired, re -bedded with gravel and reinstalled. Additionally, electrical power
was provided to the vault.
Due to weather conditions some of the work was deferred until spring when the ground is workable
and materials are available. The following work remains to be completed under the terms of the
comma.
Electrical:
> Wiring for septic System to be buried to current code and design specifications.
i Permanent phone line from house to septic control unit to be installed per current code and
design specifications.
> Control unit mounted on 6X6 treated lumber post,
specifications. Unattached to house per Orenco installation
i Cover to be placed on junction box at the SW aide of the house where wiring for sump and
septic exit.
Excavation:
1 Final grading and clean-up of Septic system and surrounding area disturbed by excavation.
i Application of topsoil to septi stem installation as required by design specifications.
Final grading a Mean -up cu din drain vault excavation and surrounding area disturbed by
excavation.
Home Owner 16 m4k, Date Z ZZ
Date
90
��
MUNICIPALITYOFANCHOR4GE
Development Services Department
Onsite Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SWO50300
Legal Description: THOMAS L BOYLE BLK 1 LT 12A
Date Issued: Aug 18, 2005
Expiration Date: Aug 18, 2006
Parcel ID: 015-283-05
Design Engineer: 0062 Pannone Engineering Services Site Address: 011800 WAGNER ST
Owner Name: DAVE DAU Lot Size: 49500 SO. FT.
Owner Address: 11800 WAGNER ST Total Bedrooms: 4 Permit Bedrooms: 4
ANCHORAGE. AK 99516-2021
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 specked 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.
/—Xa� �Vvvl.4V/1 ti Date:
Issued Bydl--�-- Date: R 1 0
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWERMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015.283.05 Permit Number SW
Property owners) Dave Dau Day phone 345.5338
Mailing address (1)11800 Wagner
Mailing address (2) Anchorage, AK Zip Code 99516
Legal description (Lot, Block & Sub'd.) Lot 12A, Block 1 Thomas Boyle SID
Legal description (Section, Township & Range) Site Location: 11800 Wagner
Lot Size -49200 4Lq 5-60 Acr /Sq.F
THIS APPLICATION IS FOR:
Number of Bedrooms 4
Sewer Only ❑ Well Only ❑
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees:
Date of Payment:
Receipt Number:
(Rev. 12100)
Vkolo.s
Waiver Fees:
Date of Payment:
Receipt Number:
N A -W A/ Or
Pannone Engineering Services, LLC
Consulting Engineers
1On71 972_R21 R
August 3, 2005
Municipality of Anchorage
Development Services Department
On -Site Water & Wastewater Program
4700 S. Bragaw Street
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Lot 12A, Block 1 Thomas Boyle S/D
Septic System Upgrade Permit Request
Ladies and Gentlemen:
P.O. Box 102954
.ge, Alaska, 99510
I am writing to request a permit to construct a replacement septic system be issued for
this property. The existing system serving this lot is in failure and operating in ground
water. The proposed system will serve an existing three-bedroom house, but will be sized
for a four-bedroom house. The existing well is located in the southeast corner of the lot,
over 100 feet from the proposed septic system.
1. Soils. See the attached soils log. Ground water was monitored for two weeks.
Ground water was measured at a depth of 4.0 feet below ground surface on August 2,
2005 of this year. Bedrock was not encountered in the test hole. It is my opinion that
the overall soils appearance of the soils, an application rate of 2 gallons/day/square feet
should be used using a class III advanced treatment system.
2. Trench Design.
a.
Percolation Rate:
b.
Application Rate:
c.
Number of Bedrooms:
d.
Design Flow:
e.
Min. Absorption Area:
f.
Total depth:
g.
Effective Depth:
h.
Width:
i.
Reduction Factor:
j.
Minimum Length:
k.
Design Length:
1.
Effective Absorption Area:
m. Septic Tank Size:
Cont'd on page 2
C:\Work\Letters\12A-1 Thomas Boyle.doc
40 Min Per Inch
2.0 gpdpsf
4
600 gallons per day
300 sf
+2 feet
0.5 feet
15 feet
0.0
20 feet
20 feet
300 sf
1500 gallon Advantex W/AX20 Pod.
Page 2
3. 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.
4. Topography: The average topography in the area of the proposed septic system is
approximately 2 percent in the area of the SAS .
S. Future Upgrade Area: I am proposing that the primary four-bedroom field be
installed at this time. A new 1500 gallon Advantex advance treatment system will be
installed outside the 100 -foot well radius. I have shown the proposed location on the site
plan. The future four-bedroom upgrade location is adjacent to the proposed system.
The proposed installation will not affect the future development of the surrounding or
existing lots. There are no wells or septic systems within 100 feet of the proposed septic
location.
If you have any questions or concerns, please contact me at 227-3522 or 272-8218.
Sincerely,
�.\p .............��
Steven R. Pannone, P.E. .......ti%&9�
...
Civil Engineer i
'j. �' Steven R. Ponnor
Attachments: ♦ No. CE 8149
C:\WORK\LETTERS\12A-1 THOMAS BOYLE.DOC
PERMIT NO: DESIGN DRAWING P.I.D. NO: 015.283-05
TOPOGRAPHIC SURVEY
LOTS 12A BLOCK 1 THOMAS BOYLE S/D
1 fEXIST'G
WELL
\
\
\
\
PROPOSED 15009 STEEL TANK
WITH ADVANTEX,AX20 POD.
EXISTG 4 BR EXISt\G 12509
SEPTIC IN FAILURE SEPTICIANK
---- D
��`-----' G)
EXISTG 1%' \rz
SEPTIC 66.6 TM+ S05 //, EXIST048RHOUSE T7
AREA72.7 +6�
x
II I II 1 136.7 --1
J 171.1
PROPOSED/ REPLNT SAS ACME/�1
BED 1 Wx2(114.5' ED 0' TD +% i W LL
_
77.4
EXISTGqFPTIr EXISTG
NOTES: SEPTIC
1) All work shall be performed in
accordance withAMC15.65. AREAA I °�EIST
�ELL
2) Materials used shall be In 1
accordance with those specified In B1\\
AMC15.65. Wastewater Disposal.
3) Maintain 10' separation to all lot \
lines and proposed water fines. \\
4) Lots served by private water \
system. No wells within 100' of \♦
proposed system. \ i'
Steven R. Pannone
Mr. Dave Dau
��
11800 Wagner Street
Anchorage, AK 99516
..
345.5338
PANNONE ENG. SVC, LLC
P. O. BOX 102954
ANCHORAGE, ALASKA 99510
227-3522 P, 272-8218 Fax
ATE: 8-3-05 1PLAN
PERMIT NO: DESIGN DRAWING DETAILS
WASTEWATER DISPOSAL SYSTEM
LOTS 12A BLOCK 1 THOMAS BOYLE SID
d'
-v/ 49 TH
0
3vwR
Ude wm
ulo B
1 WNWe
P.I.D. N0: 015.283-05
yu
J
3�
G
J
3
•••••••••• ••••.• ••� PREPARED FOR: PANNONE ENG. SVC, LLC
Steven R Pannone Mr. Dave Dau
P. O. BOX 102954
11800 Wagner Street
ANCHORAGE, ALASKA 99510
•
Anchorage. AK 99516
• 227-3522 P. 272 8218 Fax
�, ♦ 345.5338
'4,1��'♦♦♦♦ DATE: 8-3-05 DETAILS
PERMIT NO:SW05 DESIGN DETAILS
WASTEWATER ABSORPTION SYSTEM
LOTS 12A BLOCK 1 BOYLE SID
DESIGN CALCULATIONS
Number of Bedrooms -4
Total Bedrooms -4
Design flow -150 gallbr/day,
Total flow - 600g/day
n
R. Panno
CE 8149
ER
TANK SIZE:
1500 gallon Steel Advantex tank
P.I.D. NO: 015.283-05
SOIL ABSORPTION SIZE:
Advantex Sewer System
AX20 Pod - Class III System
Perc Rate= 40 minfinch
Application Rate= 2 GPD/SF
Size Required= 600 GPD/2 GPD/SF = 300 SF
Use Bed type system
30' Long by 15' Wide
30 LF x 15'x V ED = 450 SF Total
Mr. Dave Dau
11800 Wagner Street
Anchorage, AK 99516
345.5338
PANNONE ENG. SVC.
P. O. BOX 102954
ANCHORAGE, ALASKA 99510
272-8218 PHONE & FAX
DESIGN
SOILS LOG - PERCOLATION TEST
PANNONE ENGINEERING SERVICES
P.O. BOX 102954
ANCHORAGE, AK 99510
(907)272-8218
PERFORMED FOR: Mr. Dave Dau DATE PERFORMED: 7/15/05
LEGAL DESCRIPTION: LOT 12A BLOCK 1 THOMAS BOYLE SID
1-
2•
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TEST HOLE 1
Organic root mass
SM I Brown Silly SAND
SMISilly Sand
Heaving a botlor
BOH
READING DATE
CLOCK
TME
NET TIME
WATER
LEVEL
READING
NETDROP
1 7/15/05
12:55
6'
0'
2
13:25
30 MIN
5 1/4'
3/4
3
13:25
6'
0'
4
13:55
30 MIN
5 1/4'
3/4-
5
13:55
6'
0'
6
14:25
30 MIN
PEROLATION RATE 40 (min(lnch) PERC HOLE DIAMETER 6 inches
TEST RUN BETWEEN 2 FT AND 3 FT
COMMENTS: Test hole excavated by A+ Home Services. Test Hole was presoaked before perc test.
GREHItR ANCHORAGE AREA BOkvuGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAMEDAMIQ t1QU- MAILING ADDRESS A97D FCNIK PHONE a")2-758'
LOCATION LEGAL DESCRIPTION_6]6Y_A
SEPTIC TANK:
DISTANCE 1�d () NUMBER
FROM WELL IIS' MANUFACTURER MATERIAL �'�jL,�� COMPARTMENTS -
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH I IOUID CAPACITY «� GALLONS.
SEEPAGE XIX. �,YU
NUMBER OF PITS
LINING MATERIAL
�o X /6 �'3
DIAMETER OR WIDTH LENGTH_, DEPTH
BUILDING FOUNDATION_
ADDITIONAL ABSORPTION
CRIB SIZE: DIAMETER —DEPTH— DISTANCE FROM: WELL
TOTAL EFFECTIVE
NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT.
Y"ELL::: Q
TYPE 'T" &L� CONSTRUCTION DEPTH DISTANCE FROM:
BUILDING NEAREST NEAREST SEPTIC
FOUNDATION LOT LINE SEWER LINE TANK_
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED
DISTANCES:
INSTALLED BY:
Qa_.
ryry
PIPE MATERIAL: a go AJLLw
LOT SLOPE:
REMARKS:
Form No. EQ -031
REMARKS
DIAGRAM OF SYSTEM
SEEPAGE
SYSTEM.
N
d�
DATEWr V 7 \ APPROVED _
G.A.A.B.
F GREY"'z ANCHORAGE AREA Bor"GH
—`P ' ��'•
DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO.
��IIIpry)� 3330 ••C•• STREET ANCHORAGE, ALASKA 99503
s1� II•]f TELEPHONE 274.4591
SEWAGE DISPOSAL SYSTEM — APPLICATIO�f�
N KAND PERMIT q
NAME OF APPLICANT ,...j'� MAILING ADD RES�•' PHONE✓��
17
INSTALLATION LOCATION
LEGAL DESCRIPTION I' n-?,-,/�
INSTALLATION OF: SEPTIC TANK r / SEEPAGE PIT DRAIN FIELD OTHER "
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH r.l TO BE INSTALLED BY LI.(/
F
SOIL TEST RESULTS • NOTEI THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED C U hhrA)f-'5ee SC
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE
TYPE
MINIMUM DISTANCES. REQUIREMMEENT3
U
SEEPAGE AREA SIZE
FOUNDATION TO SEPTIC TANK
�q4
FOUNDATION TO SEEPAGE PIT A DRAIN FIELD
SEPTIC TANK TO/SEEEPAGE PIT WALL f '
SEPTIC TANK .
/6 SEEPAGE PIT DRAIN FIELD
TO NEAREST LOT LINE.
hh
WELL TO SEPTIC TANK V / 0 SEEPAGE PIT /
DRAIN FIELD f'I✓ 0 ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE PIT
DRAIN FIELD
SEPTIC TANK./ SEEPAGE PIT flims DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL��TT y
�• �O 6
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
G.A.A.B.
OR
LICCNS[D D[SIGN[R
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATS NC ORAGE
DESCRIBED SYSTEMIS N ACCORDANCE WITH SAID CODE.
DATE /s— W APPLICANT"S SIGNATURE
FORM NO. EQ -014
TYPE
IAMRA OF S5'$TE�
ORDINANCE NO. 28.98 AND THAT THE ABOVE
ffw
in I
IME M
MEMEMESSM
MMnEEMMIS
SEE IMMENEME
■■mm.�.
ME
■t . - ME
ME
m■■■�
uummomm 0
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� ■■��� „�I�■
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■ �� mom
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11111111111110
ME ■
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Mu MEQ
ORDINANCE NO. 28.98 AND THAT THE ABOVE
GREATER ANCHORAGE AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
NAME OF APPLICANT NO /TKI �
INSTALLATION LOCATION
LEGAL DESCRIPTION d
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FACILITY TO BE SERVED
L✓. , MAILING ADDR
J
I A-
L I
v SEEPAGE PIT
DRAIN FIELD
PERMIT NO.
(PHONE J -2 I J4
OTHER
FINANCED THROUGH TO BE INSTALLED BY �LnK " 1-1
SOIL TEST RESULTS NOTE( THIS PERMIT 15 NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED- -
r(NAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE 1006 TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK 1
SEEPAGE AREA SIZE
FOUNDATION TO SEEPAGE PIT C?lt , DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL ISO
si SEPTIC TANK . . SEEPAGE PIT � DRAIN FIELD
TO NEAREST LOT LINE.
1 /
WELL TO SEPTIC TANK 14 SEEPAGE PIT �O
DRAIN FIELD ALSO CONSIDER AREA WELLS.
r
WATER MAIN TO SEPTIC TANK '� ,SEEPAGE PIT �G
DRAIN FIELD
SEPTIC TANK, SEEPAGE PIT rOU DRAIN FIELD
TO RIVER. LAKE. STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION B FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS
REGARDIN N�SiTfA�LLATION.
G.A.A.B.
OR
LICENSED DESIGNER
TYPE
DIAGRAM OF SYSTEM
1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE
DESCRIBED SYSTEM
?ISSIIN ACCORDANCE WITH SAID CODE. //�y\� - 01,.. �J
DATE4).] ! ' 7� APPLICANT'S SIGNATURE/ \ O /A /JAL
FORM NO. EO -016
M -W DRILLING, Ine
a R fp.0. Sox 4.1224 • 1310C International Airport Road
1L- ( 4-0611 7
ANCHORAGE,
- ALASKA 99509
DRILLING LOG
Well Owner Dave Dau Use of Well nnm
Location (address of: Township, Range, Section, if known; or distance main roars
Lnt 12A F111, 1, B01,1a+ Ftth.iy.
Size of casing---6----Depth of Hole 69 feet Cased to--E2-------feet
Static water level 15 ft. (aifdi*) (below) land surface. Finish of well (check one) open end ( t );
ti
Screen ( ); Perforated ( ).
Describe screen or perforation I
r,
Well pumping test at 10 gallons per (hoW) (minute) for -1 --hours with i nr" ft.
of drawdown from static level.
Date of completion 23 July 1475
WELL LOG
Depth in feet from
ground surface Give details of formations penetrated, size of material, color and hardness
O TO Org�r.3cn
4 TO 10 Ganr!- rtinutr water --rrn�
10 TO G3 Hard P,n'
43 TO 50 Gravcly ha! -d rnn
50 TO 65 C_-w�lv.h�rd rnn-nccnai���l enhhl��'
(S TO (o ti'ater h^E ^?rlla_�Al•1
TO
TO
—TO-
-TO-
OTO
-TO-
TO
-TO-
TO
-TO-
TO
J-nNNVX a ccu••_-c14 !c 914
2
2 - STATE
CASE
Feriorm.:d fer
David _;er
DAV _
9nte Frrf;r r.d_l3—Hay.—u__
Lcg:,l I`Ascrirt.;u:
Lor12A
_El:cx 1 Svbilv.a'.o��gpY1e
EM6 Farr: Feperta
ar So"A
LOR_jCX^_�__
—?etw..etlx. :eaC___ _
DeFth
Feet SOIL MARACTERISIIIS
WCAT ION SKETCH
Vas CruLnd 1:3ter Encoucterrdt No
It yes, A: Vast Depth?— �^ —
Rf1.UING UAlt CROS; T;!E aET IIY.F. DE?TR TO !! 0 N[:i D—A'
2
I'ft:G lit i C:.:RAti I ltfnu;e
Insr:liacl r,•age IitUcair. Fi XX
L•:r t:. :( 1^Irt 1•t<rth Tc Bs'ax_ pit n: i_tno, 16 fY ,—
Sm-A-t.-25Q'9clYt�MU:Em',
?Cat P<tt."-ar' Ry:�rrt`ro—__,-,--- I`eCe1�Na,Y_7 5—___.�..
Cate Cr r:Ili..e 4...
The Ch -Sm contact is
Ch_
erratic and varies with
respect to location. Tke�J�,�,
Sm is compact with a mod-�
�
j
1
crate to high moisture
Icontent.
`Sm
I
Vas CruLnd 1:3ter Encoucterrdt No
It yes, A: Vast Depth?— �^ —
Rf1.UING UAlt CROS; T;!E aET IIY.F. DE?TR TO !! 0 N[:i D—A'
2
I'ft:G lit i C:.:RAti I ltfnu;e
Insr:liacl r,•age IitUcair. Fi XX
L•:r t:. :( 1^Irt 1•t<rth Tc Bs'ax_ pit n: i_tno, 16 fY ,—
Sm-A-t.-25Q'9clYt�MU:Em',
?Cat P<tt."-ar' Ry:�rrt`ro—__,-,--- I`eCe1�Na,Y_7 5—___.�..
Cate Cr r:Ili..e 4...
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ELEVAT;cN C`P ?LPC: C14.0
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• 12^IJ GI:E r
kAP-ZF" it! •;p.:'..
SURVEYOR'S CERTIFICATE
I hereby certify that I have surveyed) PLOT PLAN `)UFrV E Y
the following described property i
LOS 12A, BLOCK 1, IIOYLE SUBDIVISIO'.7 LCT 12A,�LOck I, EOYLG �Ve•UIVIbIc)►�
Anchorage Recording Precinct, Alaska,, --- - - - -
and that the relative existing I SELF 51 ScuWE 17"Zr.k A'�`-,OC,fATT_!
elevations are as shown hereon. I VE(GI`„'FF'.ED LAND suk.WfOF:'�
i 7531 E.ZnrH ANNIuL
• AF«�u�r?r,al:, nIr.QK:, g1E•:!a
P3, 11
Date Stanlev E. Sears I7 flip." 41
R.L.S.
dLIZ
+* : , �,
AGC D1-YCT1C'k4
g
nc
T.
•'.
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(r'?. is n7l i• \` s'
SURVEYOR'S CERTIFICATE
I hereby certify that I have surveyed) PLOT PLAN `)UFrV E Y
the following described property i
LOS 12A, BLOCK 1, IIOYLE SUBDIVISIO'.7 LCT 12A,�LOck I, EOYLG �Ve•UIVIbIc)►�
Anchorage Recording Precinct, Alaska,, --- - - - -
and that the relative existing I SELF 51 ScuWE 17"Zr.k A'�`-,OC,fATT_!
elevations are as shown hereon. I VE(GI`„'FF'.ED LAND suk.WfOF:'�
i 7531 E.ZnrH ANNIuL
• AF«�u�r?r,al:, nIr.QK:, g1E•:!a
P3, 11
Date Stanlev E. Sears I7 flip." 41
R.L.S.
TO 'ToG� ... • D" F-
R
"lam Sam M
g� /s
L3 /ook �► DATE —
�.
wwF,MAGE
1, -A-
b;
f
b1 GGr
U e i
n wnfe i
c. c
SIGNED is
j REPLY
r
SIGNED
arbonle�s POLY PAK (SO SETS) 4P17
SEND ►ARTS 1 AND 7 INTACT a
F-...._... ..... __ --
'�. Wlll 6E RETURNED WITH REPLY.
4S 472 PART 7
DETACH AND FILE FOR FOLLOW-UP
Y
9
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904 A,I I T
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 015-283-05 Expiration Date:
1. GENERAL INFORMATION
Complete legal description Thomas L. Boyle Block 1 Lot 12A
Location (site address) 11,800 Wagner Street, Anchora e,AK 99516
Current Property owner(s) 'Lis,a, Wolff Day phone
Mailing address 11800._Wagner Street, Anchorage, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
Z Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY:
Individual
z
Individual Well
z
Holding Tank
El
Individual Water Storage
El
Community
El
Community Class Well
El
Public Sewer
El
Public Water System
El
WaiverNariance request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer-
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm _ARCTERRA_CONSULTING, INC. _ _ Phone 696.-6111
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS __--_ Date $t42 f
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen'
encroachments, deficiencies or discrepancies exist. �F
6. DSD SIGNATURE
xrnncrw System #1 Approved for bedrooms. M. DUu.. `
System #2 Approved for bedrooms. F}; y t �lopl ,
Disapproved. ®'
Conditional approval for bedrooms, with the following stipulations:
lllY OF
ltll((tt((((�r/
J ON-SITE w�
WATER ASD
0 WAS
T"_ut'ATE-R--Z
J� PROGF AM
p _
J"`
-..
By ._ _. tu_ 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 engineer's work.
7. ATTACHMENTS:
COSA Checklist X ____ Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory
COSA blue sheet -10-10-12 doc
Other
Legal Description:
COSA Checklist
Thomas L. Boyle Block 1 Lot 12A
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
[W-] Well log is filed with Onsite (or attached)
Date drilled 7/23/75
Total depth 69 ft
Cased to 69 ft
® Sanitary seal is functioning correctly
® Wires are properly protected
Casing height (above ground) 36 in.
Date of flow test for COSA 7/30/21
Static water level at beginning of test 38.9 ft.
Comments
B. TANK DATA
Age of tank(s) 16 years
Tank type/material Septic/Steel
Measured operating fluid level in septic tank 4011x
® Standpipes/foundation cleanout per record drawing
Date of pumping *Advantex System
D. ABSORPTION FIELD DATA
Which system tested (date installed)`/18/18
® ALL standpipes present per record drawing
Total measured depth from grade 4 ft (max)
Measured depth to pipe invert from grade ft (min)
® N/A — pressurized field
® Monitor tubes go to bottom of effective. If not, state
depth into effective
® Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 015-283-05
of Structure served by this system
Well production at time of test 6.5 g p m
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes E Nc
® Coliform bacteria is Negative
Nitrate mg/L f] Nitrate less than MRL (ND)
Arsenic ug/L 0 Arsenic less than MRL (ND)
Collected by Arcterra
Date of Sample 7/30/21
C. LIFT STATION
® Required maintenance completed
Age of lift station 16 years
Lift station material Steel
Comments-
Adequacy test date 7/30/21
Results Q✓ Pass For 4 bedrooms
Fluid depth prior to test 0 in
Water added 600 gal
New depth 0 in
Elapsed time 3 min
Final fluid depth 0 in
Absorption rate 600+ gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
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
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
21 Yes
if No ft
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25'2] Yes
if No ft
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ® Yes
if No ft
® Yes
if No
ft
ft
If septic tank is under driveway
comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
0 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
® Yes
if No
ft
Surface Water > 100'
❑ Yes if No 52* ft
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
® Yes
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
ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' 0 Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No ft
Surface Water > 100'
❑ Yes
if No
87.3* ft
F. ENGINEER'S COMMENTS
* Waiver OSV161056 issued 5/23/16
** Existing earthen berm between pond and septic system field verified 7/30/21.
G. ENGINEER'S CERTIFICATION
1 certify that 1 have determined through field inspections and review ;
of Municipal records that the above systems are in conformance with �` ¢gm
MOA COSA guidelines in effect on this date. ; .
! s
KENNETH FFUS A
CE 1 _ • &
+�1
e'
+r +► n.. 1 _ .yah• !
COSA Checklist yellow sheet
06/22/2021 07:24 8686770 APLUS
394 800
null■ ■ ■■■■■■■m■
on ■■■ ■ ■
rr l■ ■■■n on ■■■ ■ ■ ■■■■■
�Ivarfflw O Field Maintenance Report
Annual InspE ction
PAGE 04
moon
■ ■ r a
AnchorageTank
907-272-3543
Pmpdrty owner/naeking x
Cumanit
—A01
Opemtdr
Current
Lisa Wolff
Clean
Larry Betts
Previous
aim Addmns
splice Box ......... ..........
Contact Phone
11800 Wagner Stre ,t, Anchorage AK 99516
Float Cords . . ...... ..........
(907) 555-5555
Ax ako ID a
County ID M
Pod it
attl /NUL C
DWI or Lent inapsetion
AX -106956
SWO50300
205788
RTLI106717
07/07/2020
Retrieve O&M Into
Dallyflow -
Recirc ratio
Timer settings!
Perform Field Sampl ng/Observations
NTU (15. NTU0 pi i (6-9) DO (2-6)
Otlor f Sample
Typical ❑ Must Earthy ❑ Moldy
on- el \.Sulfit 3 ❑Cabbage ❑Decay
Oily glm In PVU [ i Yea 1z No
Foam in tank [ I Yes 25No
Check Control Pane'.
Reclnt Amps Discharge Amps
10 ,\ 13th
Audible and visual sit, ma OK
Dial tone (telemetry of '.y) -1 Yet ❑ No
inspect/Olean Pump System
Cumanit
—A01
Previous
Current
Inspect
Clean
Filter/Lid ... ....... ..........
Previous
Current
splice Box ......... ..........
X�
Float Cords . . ...... ..........
�J
Floats ............. ..........
z
.0ry) e
Pump ............. ..........
0
Biotubex Filter ...... ..........;
9
Blatube Pump Vault . ..........
Reclmulming Splitter' Valve........
Comments
Measure Sludge/Scum
Sludge
Scum
let Compartment
Cumanit
—A01
Previous
Current
Previous
I
2nd Compartment
Current
Previous
Current
Previous
Inspect/Clean AdvanTex Filter
odor.. '0i�Norrnal ❑Pungent
Blomat Z Normal ❑ Excessive
Bridging/Ponding: one/Minor ❑ Excessive
Inspect/Clean Discharge Pump System
In
Rlaer/Lid
splice Box
Float cords
Inspect
Clean
Laterals/Orglces �
Y
Pod Bottom Z
Intake Vend y
Inspect Cleah
Floats {i1.rll��f, I�Lr�•rY/#J��
Pump
Inspect/Service Other System Components
Inspect Clea Ins pact Clean
Disinfection Equipment E Diapersal Latorals/Oriflecs
Additional Services Rendered
❑ Cleaned textlle sheets? ❑ Replaced UV items?
Replaoed/Used other Items?
Parts Used: W = Warranty. 8 - Billable (✓ appropriate Selection)
W B Item Number Det,Cnptlen
FlnallfSafety, Inspection
L9 RSV minstalled Lida bolted on
VMam old reconnected; flush valvea closed Control panel reactivated
SumUnary/Recommendations
[4Q System performing: no further action needed
❑ Cell for service
❑ Tank needs pumping
❑ Other? -,.-
Signature
f- SA —_._ Date r6 % Z� fZ�
Fax completed form to 1-866-984-7404
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this )LDay of At 0V"€* of 2o Ll ,by and between
herein the "OWNER," and the Municipality of
Anchorage, herein the "MIINICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
l. Advanced Wastewater Treatment Svstems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as t
located at (legal description)
2. Maintenance" Renairs and Alterations.
(Owner is required to read, understand and initial each section)
1M- Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
$Pf It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
Vf Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
\L Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/1812018)Page I of3
W-
\W.
\$tr-
.$F
\M.
\AL
Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On-Site Systems Approval.
Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transfered.
Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severabilitv. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
J
4
(rev. 05/1812018)Page 2 of3
ature) Date:Ila
��
name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this 12 day of
20'-A) by W1 ,hq kp, t Se6UI k/-Oj tnj�.
0
NOTARY I UBLIC FOR ALASKA �����4� 9Oxo^
My Commission expires:E��NOrtAar'po'
Comm\ti,�0`��y' �r
P�,\,
MUNICIPALITY: �•,,�����'��'������•
By: ' (signature) Date: •?y X0.2
kebe ccc. 6�roZl (print name) Title:
(rev. 05/18/2018) Page 3 of 3
•
•F _ .� Municipality of Anchora : /6,a 9 � ,; „L 0
� - On-Site Water and Wastewater Progr-ro. _ �1��
(907) 343-7904 � ' ` ,°; �'
a
ADR 23206
Certificate of On-Site Systems A'_+proval
Parcel I.D. 015-283-05 Expira - 17: ,,sAk )�(
1. GENERAL INFORMATION
Complete legal description Thomas L. Boyle B1 L12A
Location (site address) 1 1 800 Wagner Street
Current Property owner(s) Bryant G. & Amanda S. Lofgren Day phone (907) 280-9781
Mailing address 11800 Wagner St, Anchorage AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well CI Individual 0
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: Date: 670 //I g
COSA to be released t the engineer, unless otherwise requested by the engineer.
COSA Fee $ 5-9.60 Waiver Fee $
Date of Payment 4/240 Date of Payment
Receipt Number 07i/et 9, A Receipt Number
COSA# C13// (�' Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Forge Engineering Phone (907) 522-7773
Address PO Box 240773 Anchorage, AK 99524
Engineer's Printed Name Benjamin Schiller, PE Date 3/26/18
; *:49n'+ i -* j
6. DSD SIGNATURE
System #1 Approved for ti bedrooms � • Ben;• in Schiller• •
System#2 Approved for bedroomsG},;, CE 12592 •.� ,AMe
.9413
Disapprovedk\' PRO rESS.4•^ C'
Conditional approval for bedrooms, with the following stipulations:
• �� nF Ai�i dJ7G
•
\NPIERPIER o
V�IPSIEG p,�i• %'
PRO
a) C
By: \ G�.-- Original Certificate Date: 6-7-,3 67
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
COSA blue sheeti. c
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: Thomas L. Boyle B1 L12A Parcel ID: 015-283-05
A. WELL DATA
Well type Private If A. B, or C provide PWSID# Well Log (Y/N) Y
Date completed 7/23/75 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 69 ft. Cased to 69 ft. Casing height (above ground) 32 in.
FROM WELL LOG AT INSPECTION
Date of test 7/23/75 3/07/18
Static water level 15 ft. 19.7 ft
Well production 10 g.p.m. 2 g.p.m.
WATER SAMPLE RESULTS:
Coliform Neg colonies/100 mL Nitrate ND mg/L
Arsenic ND ug/L Date of sample: 3/12/18 Collected by: Forge Eng.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEP/Steel Date installed 11/08/05
Tank size 1500 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) Y
201 7 Pumper A+ Home Services (AVWVTS maintenance report)
Date of pumping 8/1
C. ABSORPTION FIELD DATA
Date installed
5/21/18 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.3 GPD/SF System type Bed
Length 15 ft. Width 20 ft. Gravel below pipe 0.5 ft.
Total depth 3.0 ft. Eff. absorption area 300 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New Results (Pass/Fail) For bedrooms
Fluid depth in absorption field before test in. Water added gal. New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N & type) If yes, give date
D. LIFT STATION
Date installed 11/08/05 Size in gallons 250 Manhole/Access (Y/N) Y
-Pump on" level at 40 in. "Pump off" level at 36 in. High water alarm level at 45 in.
Datum Bottom Cycles tested 2 Meets alarm&circuit requirements? Y
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot >1 00' On adjacent lots >100'
Absorption field on lot >100'00' On adjacent lots >100'
Public sewer main >75' Public sewer manhole/cleanout >1001
Sewer/septic service line >251 Holding tank >75'
Animal containment areas >50' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
10' >55
> '
Building foundation Property line Absorption field
>10'
>10'
Water main Water service line Surface water 52
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line
>10' Building foundation >101 Water main >101
*85' >10'
Water Service line >10' Surface water Driveway, parking/vehicle storage
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
*Waiver OSV161056 issued for separation to surface water
G. ENGINEER'S CERTIFICATION OF A:--:1.0451e
A��\
•
�,
I certify that I have determined through field inspections and , `Q,.• ' . .f-t
•eview of Municipal records that the above systems are in .•:5710
conformance with MOA COSA guidelines in effect on this date. %*: 49 TH 1' ..*#,
Engineer's Printed Name
Michael E. Anderson, PE % i�' t/..„1„/..„1„ •
Date
5/31/18 ��� �• Michael E.Anderson .• �
re. . 4381-E .• ',Ay
11 ZPROFE.s.s0 P-'
COSA brown sheet 10-10-12.doc
ADV � ;i . , A i
MAINTENANCE AND REPAIR AGREEMENT
BETWEEN MUNICIPALITY OF ANCHORAGE
•
AND J.isa J Wolff
S MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this
2.6 Day of__May_of 201$,by and between Lisa J Wolff ,herein the
"OWNER,"and the Municipality of Anchorage,herein the"MUNICIPALITY."In
consideration of the mutual covenants contained herein,the parties to this Maintenance
and Repair Agreement agree as follows:
1.Advanced Wastewater Treatment Systems.Municipality grants permission to
Owner to utilize and operate an Advanced Wastewater Treatment System
(AWWTS),described as
Advantex AX20 •
located at(legal description).
Thomas L Boyle L12A B1
2.Definitions.
Alteration. Any change to the design or function of an AWWTS that
includes the installation or removal of any parts,components or pieces not
included in the original construction permit and design.
Certificate of On-Site Systems Approval(COSA). An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with Anchorage
Municipal Code(hereinafter,"AMC") 15.65.These approvals certify that
the systems are adequate for the homes that they support and meet the
codes that were in place at the time of system construction.
Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
Maintenance and Repair. The scheduled and as needed replacement of
existing parts,components and pieces of an AWWTS that were included
in the original design which would allow the AWWTS to continue to
perform as designed.
Permit.An On-Site Wastewater Disposal Permit as required by AMC
15.65 to construct and operate an AWWTS.
•
3. IIl. The term of this Maintenance and Repair Agreement shall begin on the
date of approval by the Municipality to operate the installed system or issuance of a
COSA,and shall continue while the AWWTS is in use or is operational or until the
property is sold or title is transferred by the owner and a new COSA is issued to the
new owner or transferee of the property.
4.Alterations,Installation and Removal of Additional Equipment. Prior to
performing any alterations to an AWWTS,the owner agrees to obtain an On-site
Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65.
5.Maintenance and Repairs.
A.Throughout the term of this Maintenance and Repair Agreement,the Owner shall
maintain their AWWTS in a satisfactory condition capable of producing treated
septic effluent in accordance with the equipment's approval for operation in the
Municipality. The owner shall enter into a service agreement with an AWWTS
service and maintenance provider approved by the municipals y and the
manufacturer of the AWWTS for the entire term of the AWWTS. In addition,it
shall be the responsibility of the Owner during the term of this Maintenance and
Repair Agreement,and any renewals thereof,at the owner's sole expense,to pay
for any and all: (1)repair(s),(2)maintenance,(3)adjustment(s),(4)replacement
costs,and(5)inspection costs.
B.Owner agrees to comply with all applicable ordinance,laws,regulations,rules
and orders for the AWWTS.
C.Upon request by the Municipality,the owner agrees to provide the Municipality a
written schedule of routine maintenance and repairs which have been performed
on the system. When a record of maintenance is documented and maintained by
the system vendor,the owner agrees to allow the Municipality access to this
information.
D.Owner acknowledges that the fine for failing to maintain and repair an AWWTS
may be assessed in accordance with AMC 14.60 for improper discharge.
E. Owner agrees that only maintenance and repair personnel approved by the
Municipality will inspect and make any necessary maintenance,repairs or
permitted alterations to the system.
F.Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
G.Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On-Site Systems Approval.
H.Owner agrees that the AWWTS installation and maintenance requirements as
provided by the AWWTS vendor/installer and approved by the Municipality are
the governing guidelines for the construction,maintenance and repair of the
Owner's AWWTS.
6.J'lonwaiver. The failure of either party at any time to enforce a provision of this
Maintenance and Repair Agreement shall in no way constitute a waiver of the
provisions,nor in any way affect the validity of the Maintenance and Repair
Agreement or any part hereof,or the right of such party thereafter to enforce each and
every provision hereof.
7.Amendment.
A.This Maintenance and Repair Agreement shall only be amended,modified or
changed by a writing,executed by authorized representatives of the parties,with
the same formality that this Maintenance and Repair Agreement was executed
with,and such writing shall be attached to this Maintenance and Repair
Agreement as an amendment.
B.For the purposes of any amendment modification or change to the terms and
conditions of this agreement,the only authorized representatives of the parties
are:
a.Owner:Lisa J Wolff
b.Municipality: Director,Community Development or designated authority_
C.Any attempt to amend,modify,or change this contract by either an unauthorized
representative or unauthorized means shall be void.
8.Jurisdiction:Choice of Law.Any civil action arising from this Maintenance
and Repair Agreement shall be brought in the Superior Court for the Third Judicial
District of the State of Alaska at Anchorage. The laws of the State of Alaska shall
govern the rights and obligations of the parties under this Maintenance and Repair
Agreement.
9.Severabililv..Any provisions of this Maintenance and Repair Agreement decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining
provisions of the Maintenance and Repair Agreement.
OWNER:
/t; 1' 46—
By: i (s gna ure)/ ate: 6/al Z.0
L.ir-.. J u_9ollc--
Lisa J Wolff (print name)
STATE OF ALASKA )
)ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this (9 day of Nor
't> / .by L.i Sa S ecoV ex ea
{Z
NOTARY PUBLIC FOR.A.1., Coloi—tuto
My Commission expires: Feb_ 1
/75(.6Lic.„7 _ RENEE Y HICKMAN
NOTARY PUBLIC
STATE OF COLORADO
(/ /// NOTARY ID 20114006893
He� / / 1 COMMISSION EXPIRES FEBRUARY 22.2019
MUNICIPAL T Y:
By: (signature) Date:
(print name) Title:
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\ — — — ` — —
WAGNER STREET
PLOT PLAN AS BUILT X SCALE 1" = 40' _ GRID SW 2734 Project No. 18-245/A1
11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang & Associates , inc . (907) 522-6476 Phone o����p00
(907) 522-4625 Fax ,=::=:" (mF A 104
Professional Land Surveyors kenOlangsurvey.com v 9
jonathanOlangsurvey.com . 5' Q
I herebycertifythat I have surveyed the following described property: QQ,`Q' �'� �O�
y �..• 49TH � - 0
Lot 12-A, Block 1, BOYLE SUBDIVISION (Plat No. P-244B) 0O
011
Anchorage Recording District, Alaska, and that the improvements situated thereon are
VA
within the property lines and do not encroach onto the property adjacent thereto, that
VA
no improvements on the property lying adjacent thereto encroach on the surveyed 0' KENN H N o
premises and that there are no roadways, transmission lines or other visible c% , pp Q
easements on said property except as indicated hereon. OQ 5(.3t p ,O
4 "P,.••.LS- 202..•' SJo�
Dated this the Day of — , -cot& , at Anchorage, Alaska Q -aR .••• . Noo
�4% OESSIONM-'a
It is the responsibility of the owner to determine the existence of any easements, �04p00�0
covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963
a
V-� 015-283-05
Parcel I.D.
«:1 S
l*� JSH."
Municipality of Ancho rt"AY
RUSHI
On -Site Water and Wastewater Progra
(907) 343-7904 2 0 2016
Certificate of On -Site Systems
1. GENERAL INFORMATION
68
Expiration Date:
Complete legal description Thomas L Boyle, Block 1, Lot 12A
Location (site address) 11800 Wagner St.
Current Property owner(s) Melissa & Jann Schmledt Day phone
Mailing address
Real Estate Agent
118100 Wagner St. Anchorage, AK 99516
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System ❑
Public Sewer
❑
WaiverNariance request for:
Received by: Date:
COSA to be released to the engineer, unless otherwise requ ed by the engineer.
COSA Fee $ 501tP -V 31'5� 0
Date of Payment .5 1% ILS
Receipt Number OCV6-71 1l
COSA# oSu1-0u93
Waiver Fee $ SSI 99Sl5`I�= �3'�4�
Date of Payment
Receipt Number C�iZ01�J�1
Waiver# 0�1V (%1 OSS
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined
in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater
disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply
and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at
the time of installation.
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test,
and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil
condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions
are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future
performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510
Engineer's Printed Name Steven R Pannone
6. DSD SIGNATURE
T— System #1 Approved for tii` bedrooms
System #2 Approved for bedrooms
Disapproved
Date 5/20/2016
S�I:veri �2��f�anntirie � � •
I CE -8149 !
Conditional approval for bedrooms, with the following stipulations:
By: 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 Stale of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineers work.
7. ATTACHMENTS:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
COSAblueshmt f t.. c
Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # 1 of +
Structure served by this system +
Certificate of On -Site Systems -,Approval Checklist
Legal Description: Thomas L Boyle, Block 1, Lot 12A Parcel ID: 0 15-283-05
A. WELL DATA
Well type Private If A, B, or -C provide PWSID # Well Log (Y/N) Y
Date completed 7/23/1975 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y
Total depth 69 ft. Cased to 69 ft. Casing height (above ground) 12+ in..
FROM WELL LOG AT'INSPECTION
Date of test 7/23/1975 4/13/2016*
*
Static water level 15
Well production 10g.p.m.` 4.0+ g.p.m.
WATER SAMPLE RESULTS:
Coliform ,Neg colonies1100 mL Nitrate ND mg/L
ND 4/13/2016 GEG
Arsenic ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA '
Tank Type/Materal S.T.E.P./Steel-Date installed_ 11/5/2005
Tank size 1,500 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (YIN) Y Depression over tank (ON) N High water alarm (YlN) Y
Date of iRg4/18/2016 PumperAnchorage Tank/
j�jd
C. ABSORPTION-FIE4D.DATA
11/8/20052 GPD/SF Mounded Bed
Date installed Soil rating (g.p.d./fiz or fP/bdrm) System type
Length 30 ft. Width 25 ft. Gravel below pipe d.5 ft.
11
Total depth 3.6 "ft Eff. absorption•area 750 ff Monitoring tube Y > Depression over fieldI N
' . 4/27/2016 Pass 4
Date of adequacgltest Results (Pass/Fall), , For _ bedrooms
Fluid depth in absorption field before test 1 in.. . Water added `*� 6�gal. New depth. in.
Elapsed Timef 14'40 min. Final fluid depth 1 in. Absorption rate >=JQ+ hoc p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N &type) No Ifyas, give date
D. LIFT STATION
11/8/2005 250 Y
Date installed Size in gallons Manhole/Access (YIN) �.
"Pump on" level at 4 0' in. "Pump off' level 'a 36 in. High water alarm level at 45 in.
Datum Bottom Of Tank Cycles tested 6 Meets alarm & circuit requirements? Yes
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+.
Public sewer main 75+ Public sewer manhole/cleanout 1 Q0+
Sewer /septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field 5+
Water main 10+ Water service line 10+ Surface water 52*
Wells on adjacent lots 100+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building. foundation 10+ Water main 10+
Water Service line 10+ Surface water 85 Driveway, parking/vehic -storage 1 fl} -
Curtain drain 50+ Wells on adjacent lots .� 00+
F. COMMENTS ,
*Tested by,Odmess Engineering Group **See attached waiver request
Survey of File
G. ENGINE°SR'S CERTIFICATION. �y 1
I certify that I have determined through field inspections and
review .of Municipal-records that the above systems are in y}; TH ,y
conformance with MOA COSH guidelines ih effect on this date.
Engineer's Printed Name Stev$n Peyi lOn2 :?;{avers .Monnaie
Dqte 5/20/2016 CE 8149
COSA canary sheet_2-e-15.doc -
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SURVEYORS CERTIFICATE
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%d0014100' YJ 750.91 rnd.
1 HEREBY CERTIFY THAT i HAVE SURVEYED THE
PROPERTY DESCRIBED ON THIS PLAT. I DECLARE
THAT IMPROVEMENTS AND VISIBLE ENCROACH+
MEMS HAVE BEEN ESTABLISHED TO THE BEST
OF MY PROFESSISONAL KNOWLEDGE AND BELIEF.
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.STANLEY E. SEARS,
RLS. 2087-S
DECEMBER 2,2005
DATE
EXCLUSION
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THIS SI.RVEY IS FOR THE USE OF LENDING INSTITUTIONS SPE-
CIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING
STRUCTURES AND PLATTED LOT LINES OR EASEMENTS UNDER
NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED
FOR POSITIONING ADDITIONAL STRUCTLI2ES, BUILDING FENCES,
OR LOCATING BOUNDARY LINES.
IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE
EXISTENCE OF ANY EASEMENT OR RESTRICTION WHICH DOES
NOT APPEAR ON THE RECORDED SUBDIVISION PLAT AND TO
VERIFY THAT THE IMPROVEMENTS SITUATED ON THIS PARCEL
MEET ALL SUBDIVISION COVENANTS AND ZONING ORDINANCES.
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ANCHORAGE RECORDING DISTRICT
S MO S AAD ASSOGGTES w" 9-o' DAT°'
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THIS SI.RVEY IS FOR THE USE OF LENDING INSTITUTIONS SPE-
CIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING
STRUCTURES AND PLATTED LOT LINES OR EASEMENTS UNDER
NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED
FOR POSITIONING ADDITIONAL STRUCTLI2ES, BUILDING FENCES,
OR LOCATING BOUNDARY LINES.
IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE
EXISTENCE OF ANY EASEMENT OR RESTRICTION WHICH DOES
NOT APPEAR ON THE RECORDED SUBDIVISION PLAT AND TO
VERIFY THAT THE IMPROVEMENTS SITUATED ON THIS PARCEL
MEET ALL SUBDIVISION COVENANTS AND ZONING ORDINANCES.
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Municipality of Anchorage s
P.O. Box 196650 • 4700 Flmnrp Rnari
Development Services Division
On -Site Water and Wastewater Program
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV161056 COSA#:OSC161183 Permit#:
PID#:015-283-05
Legal Description: Thomas L Boyle 61 L12A
Engineer: Pannone Engineering Services
Applicant: Melissa and Jann Schmiedt
Your request for a waiver of the required 100 feet horizontal separation from the
absorption field and septic tank to the surface water has been approved. The approved separation
distance is 52.0 feet from the tank and 85 feet to the field.
This waiver approval applies to the existing absorption field and septic tank 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: / Approved by:
Na me of Rey, er
.................................................. ..;111'�0 M 00.10.............
**** VARIANCEIWAIVER REVIEW ****
Pannone Engineering Services LLC
Steven R. Pannone, Principal
Registered Professional Engineer � �I
E-mail: steve@panergak.com S
May 20, 2016
Subject: Thomas Boyle S/D Block 1 Lot 12A
Septic system to Surface Water Waiver Request
I am writing to request a waiver of the separation distance from the existing septic system to a newly
constructed pond on the property. When the septic system was installed in 2005, it met all the separation
distance requirements. The owners of the property constructed a small pond on the property 52 feet
away from the Advantex treatment tank and 85 feet from the drain field. The owners recently constructed
a small berm between the pond and the septic system. The berm is constructed such that any spilled
sew3age will overland flow in excess of 100 feet before it enters the small pond.
1. Surface Water: There is a small pond within 100 feet of the existing lift station and drain field. Using
an earthen berm system (,Yee is"^^` ^t*"_ +__: ^ ' ) the existing Advantex tank and drain field will
maintain an overland sheet flow of at least 100 feet from allurface water and drainage.
2. Topography: The existing overall topography slopes to the west at approximately one to two
percent.
3. Waiver: We are requesting a waiver for the separation distance from the absorption field to surface
water of 85' and for the tank to surface water of 50'. The surface water is approximately 85'± from the
field and 52'± from the Advantex tank. Construction of the earthen berm system extended the overland
sheet flow distance to greater than 100' from the existing system to the surface water. Additionally, the
pond is at the same grade at the Advantex tank and any effluent will flow away from the pond.
Approving this waiver will not affect public health nor will it pollute the ground water.
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 NO: SW05030D RECORD DRAWING P.I.D. NO: 015-283-05
NEW 4BR
REPLACMENT SAS
BED 15'Wx20'Lx0.5' ED
0' TD
1) All work shall be performed in
accordance with AMC 15.65.
2) Materials used shall be in
accordance with those specified in
AMC15.65, Wastewater Disposal.
3) Maintain 10' separation to all lot
Ines and proposed water lines.
4) Lots served by private water
system. No wells within 100' of
proposed system.
............
.`r R.o
Steven R. PannoneQIE[<
�?
+�v1f L
04
WASTEWATER DISPOSAL SYSTEM
LOTS 12A BLOCK 1 THOMAS BOYLE S/D
EXISTO
o d-� WELL
TH
TH-
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i
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Cn
M
EXIST'G FOUNDATION M
J `133.5 DRAIN - TYPICAL
11 \ /-ERI:
� 76.4.4 \"od WEL
1 ---
1
Mr. Dave Dau
1
11800 Wagner Street
Anchorage, AK 99516
345-5338
NEW 1500g\STEEL
DATE: 1-17-06
TANK WITH \
ADVANTEX AX20 POD.
EXISI'G 4 BR
\� EXISTO 12509
SEPTIC IN FAILURE
SEPTIC TANK
ABANDONED IN PLACE
ABANDONED IN PLACE -
CRUSHED
E�IST'G
/
1%
64.11%
5Z C1 EXIST'G 4 BR HOUSE
F
WELL
SEPTI
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EPARED FOR:
PANNONE ENG. SVC, LLC
Mr. Dave Dau
P. O. BOX 102954
11800 Wagner Street
Anchorage, AK 99516
345-5338
ANCHORAGE, ALASKA 99510
227-3522 P, 272-8218 Fax
DATE: 1-17-06
PLAN
SCALE: 1"=60'
E�IST'G
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WELL
SEPTI
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12B1
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CO A B
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FC 3.6 27.9
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C1 37.9 34.9
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M3 95.6
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'----
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EPARED FOR:
PANNONE ENG. SVC, LLC
Mr. Dave Dau
P. O. BOX 102954
11800 Wagner Street
Anchorage, AK 99516
345-5338
ANCHORAGE, ALASKA 99510
227-3522 P, 272-8218 Fax
DATE: 1-17-06
PLAN
SCALE: 1"=60'
Municipality of Anchorage
• '� Development Services DepartmentP
Building Safety Division
On -Site Water and Wastewater Program
4700 BStreet
P.O. Boxox 19 196650
Anchorage, AK 99519-6650
www.muni.orglonsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel l.D.015-283-05 COSA #
Expiration Date: 9 0 O
1. GENERAL INFORMATION
.Completd legal description Lot 12A Block 1 Thomas L Boyle SID
Location (site address) 11800 Wagner Street Anchorage AK
Current Property owner(s) Dave Dau Day phone 345-5338
Mailing address 11800 Wagner Street Anchorage AK 99516
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Engineering Services LLC Phone 272.8218
Address P 0 Box 102954 Anchorage AK 99510
Engineer's Printed Name Steven R. Pannone Date 6-14-06
14
...F •A:q
5. DSD SIGNATURE �,:- STEVEN R PANNONE ;�
*4 CE -8149
Approved for bedrooms.;;1 60.
Disapproved. �1\�����
Conditional approval for bedrooms, with the following stipulations:
--n
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Nitrate Advisory Other
By, /0ae_� Original Certificate Date: �y — P �? — O C
(R".11005)
Municipality of Anchorage ••.
• Development Services Department
BuOding safety Division
On -Site Water 3 Wastewater Program
4700 Bragew Street
P.O. Box 196650
Anchorage, AK 995196650
www.muni.orglonatte
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Le9aiD-_ytion: 1 ot 1911 CIock 1 Thoma I 6oyIa • Parcel ID: 015-28M5
A. WELL DATA
Wen type E If A. B, or C provide PWSID # _ Well Log (YIN) Y
Date completed TM11975 Sanitary seal (YIN) Y Wires properly protected (YIN)
Total depth eft. Cased to eft. Casing height (above ground) _V—+In.
FROM WELL LOG AT INSPECTION
Date of test TIM975 11118=5
Static water level 15 ft. 18 ft.
Wen production 30 g.p.m. 515+ g•P•m-
WATER SAMPLE RESULTS:
Colffor ,L_colonies/100 mL Nitrate -U& MGA_ Other bacteria 0 colonies/100 mL
Arsenic: _ mgA Date of sample: 11118105 Collected by: r furs Pannone
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Anchorage Tank Steel Date installed 1118@005
Tank size 1500 gall... Number of Compartments 2 Cleanout (Y/N) Y
Foundation cleanout (YIN) Y', Depression over tank (YIN) jy High water afar (YIN) WA
Data of pumping Pumper
C. ABSORPTION FIELD DATA
Dat installed 111812005 Son rating (9•p•d.tfe or fe/bdr);_. System type Bed
Length 30 ft. Width 25 ft. Gravel below pipe 0. ft•
Total depth 12 ft. Eft. absorption area rnf Monitoring tube Y Depression over field y
Dat of adequacy test Results (Pass/Fall) Pass For 4 bedrooms
Fluid depth In absorption field before test _ in. Water added_ gal. New depth_ in.
Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >- g.p.d.
Any rejuvenation treatrnent (past 12 mo.) (YIN b type) If yes. give date
D. LIFT STATION
Date Installed 1118=5 Sim in gallons 250 Manhole/Access (Y/N) Y
•Pump on" level at!J2 in. "Pump ofr level at V in. High water alarm level at 45 in.
Datum Front Porch Cycles tested — AEQ) Meets alarm 6 circuit requitemants? Y_
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanklitit station on lot 100+
Absorption field on lot 100+
Public sewer main 100+
Sewer /septic service line 50+
Animal containment areas 100+
On adjacent lots _ 100+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
Manure/animal excrete storage areas 100+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 97 Property line 57.0
Water main 100+ Water service line 50+ Surface water 100+
Wells on adjacent lots 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Properly line —&!L— Building foundation go Water main 100►
Water Service line S0+ Surface water.% Dray. parking/vewcie storage W_
Curtain drain35+ h/ l 1 Wells on adjacent lots J00+
F. COMMENTS
G. ENGINEER'S CERTIFICATION .� %:w—OF• A ( #I�
I cerdfy that I have determined through field inspections and = h,�P;•• •,qS�,,I
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date. * ;
............
AN N•N•••..YyM•.�
Engineer's Printed Name Steven R Pannone.00,C.
, a i
Date 6-140
��� CEO P •...... �`'.Z'i
COSA FeeS
Waiver Fee $
Date of Payment Date of Payment
Receipt Number Receipt Number
(Rev. 11/05)
Municipality of Anchorage
. .,,
Development Services Department '
Building Safety Division
Onsite Water and Wastewater Program S A r I
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-0650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-283-05 COSA# O_6'0
Expiration Date: — 3 O ..
1. GENERAL INFORMATION
Complete legal description Lot 12A Block 1 Thomas L. Boyle SID
Location (site address) _ 11800 Wagner Street, Anchorage, AK
Current Property owner(s) Dave Dau Day phone 345-5338
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
11800 Wagner Street, Anchorage, AK 99516
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations In effect at the time of installation.
Name of Firm Pannone Engineering Services, LLC Phone 272.8218
Address P. 0. Box 102954, Anchorage, AK 99510
Engineer's Printed Name Steven R. Pannone Date /2122 O
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Conditional approval for _1ZL bedrooms, with the following stipulations:
/500 /,y�SGy/o RLyi 0�0✓ �oa Sof f ,i-' S G�(� 4�
/0 6t c-o&i b/� /l�.t b1, 4-15-- or,-
loe
s 077` i C. G Gr ii L S '7`- / rl rL N L7 ,7 ✓a t� nom' .
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: Original Certificate Date: O 6
(Rw. 11A5)
Municipality of Anchorage
' Development Services Department'
Building Safety Division "
On -Site Water & Wastewater Program "
!, 4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
I
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 12A Block 1 Thomas L. Bovie Parcel ID: 015.283-05
A. WELL DATA
Well type P If A, B, or C provide PWSID # _ Wel(Log (Y/N) Y
Date completed 701311975 Sanitary seal (YIN) Y Wires properly protected (Y/N)
Total depth eft. Cased to eft. Casing height (above ground) 36* in.
FROM WELL LOG AT INSPECTION
Date of test 701311975 1111912005
Static water level 15 it
Well production 30 g.p.m.
WATER SAMPLE RESULTS:
Coliform J_colonies/100 mL Nitrate 0.100 mg/L
Arsenic: _ mg/I Date of sample: 11118M
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Anchorage Tank Steel
Tank size 104_ gal. Number of Compartments
Foundation cleanout (Y/N) Y Depression over tank (Y/N) �(
Date of pumping I) -e w Pumper
C. ABSORPTION FIELD DATA
9.p -m.
Other bacteria 0 colonies/100 mL
Collected by: Laura Pannone
Date installed 111812005
Cleanouts (Y/N) Y
High water alarm (Y/N) WA
Date installed 111812005 Soil rating (g.p.d./ftp or fe/bdrm) 2 System type Bed
Length 30 ft. Width 25 ft. Gravel below pipe _0.5 It.
Total depth 1 ft. Eff. absorption area 7Kle Monitoring tube Y Depression over field N
Date of adequacy test )P LLL Resuhs (Pass/Faiq Pte{_ For 1 bedrooms
Fluid depth in absorption field before test `= in. Water added= gal. New depth= in.
Elapsed Time: = min. Final fluid depth = in. Absorption rate >= 69604 g.p.d.
Any rejuvenation treatment (past 12 moa (Y/N & type) If yes, give date
D. LIFT STATION
Date installed 1119f200S Size in gallons 250 Manhole/Access (Y/N) Y
'Pump on' level at ZO in. 'Pump off" level at 11 in. High water alarm level at 45 in.
Datum Front Porch Cycles tested Me -CU _ Meets alarm & circuit requirements? Y
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/IIR station on lot 100+ On adjacent lots 100►
Absorption field on lot 100+
Public sewer main 100+
Sewer/septic service line 50+
On adjacent lots 100+
Public sewer manhole/cleanout 100+
Holding tank 100+
Animal containment areas 100+ Manure/animal excrete storage areas 100+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 37 Property line moi' 7.9
Absorption field_ 35
Water main 100+ Water service line 50+ Surface water 100+
Wells on adjacent tots 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 52.4 Building foundation 90 Water main 100+
Water Service line 50+ Surface water 100+ Driveway, parking/vehide storage 50+ _
Curtain drain _35+ Wells on adjacent lots 1100+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
Conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name Steven R Pannone
Date !� a a 116 r
COSA Fees 1-/36
Date of
Receipt Number
(Rev. 11/05)
49TH ��� •' . ��,
-..........-.�T•
CE - CI :9
Waiver Fee $
Date of Payment
Receipt Number
;� .. G
I
i
N
'�: �,•� 300.�o Per N v658'nn`r a.00.ol r.',,i
a.., ..•I �f W��
3 -Level . Crgmc
_, .. PF[S GOP��p{`ten a . L ..... _.
p
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.n owa GOP. cop.] c u 1
yO
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vP =;1.0
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ono on Qer. -.A) ,4'aa' rr ;55,01
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LEGEND
FOUND 1/7 REBAR
O I• GALV. IRON PIPE
u CLEAN CUT PIPE
SURVEYOR'S CERTIFICATE
1 I EREBY CERTIFY THAT 1 HAVE SURVEYED THE
PROPERTY DESCRIBED ON THIS PLAT. I DECLARE
THAT IMPROVEMENTS AND VISIBLE ENCROACH-
MENTS HAVE BEEN ESTABLISHED TO THE BEST
OF MY PROFESSISONAL KNOWLEDGE AND BELIEF.
STANLEY E. SEARS,
RLS. 2087-S
DECEMBER 2, 2005
DATE
EXCLUSION -
JC. a,c I"; do
THIS SURVEY IS FOR TIE USE OF LENDING INSTITUTIONS SPE-
CIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING
STRUCTURES AND PLATTED LOT LINES OR EASEMENTS. UNDER
NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED
FOR POSITIONING ADDITIONAL STRUCTURES. BUILDING FENCES,
OR LOCATING BOUNDARY LINES.
IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE I
EXISTENCE OF ANY EASEMENT OR RESTRICTION WHICH DOES
NOT APPEAR ON TWE RECORDED SUBDIVISION PLAT AND TO
VERIFY THAT THE IMPROVEMENTS SITUATED ON THIS PARCEL
MEET ALL SUBDIVISION COVENANTS AND ZONING ORDINANCES.
"STANLEYE*SEARS ; o
2057-S ••iWA01
�f
Iq • egi
`RORSSIONII• ='�'
u
AS -BUILT SURVEY
LOT 12-A, BLOCK t
BOYLE SUBDIVISION
ANCHORAGE RECORDING DISTRICT
S S AAD ASWMTES °C" �r°AT°
REBS LAND SCRVEYORS I' . 6C rfe. 1979
99377
45
:i-� kmM
11-29-05 11:42 FR04-CRE ESI, SGS ENV SERVICES
SGS Rtf.4
1057707001
Cheat Name
Panne Eng. S v.
ProjecrNarram
Lt 12A Birk 1 Thomas LDoyle SD
Cheat Sample ID
Lt 12A M I Thomas L Boyle SD
nlatris
Drinking water
FRSID 0
Sa=!c Remnkr.
9075615301 T-244 P.02/03 F-925
All Datesnimes are Alaska Standard Time
Frlated Date/Thse
1112812005 13:02
Collected Date/Ttme
11/18/2005 10:15
ReceindDatefrhnc
11/181200511:10
TeebdcalDirector
Stephen C. Us
Allovaale Prep Aeslyeis
Penmeta RacAta PQL Units Mcdmd C amserID Limits Dem Date Wit
Nitrate -N 0.100 u 0.100 mWL EPA 3332 B Mol 1111M AZ3
Microbiology Laboratory
TomlCulifarm 0 coVl00mL SNUG 9222B A (al) I1/14ro5 TLF