Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
RANDOM HEIGHTS LT 3
Random 0 Heights Lot 3 #017-41 1-07 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 4 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: OSP101083 PID Number: 017-411-07 Name. Kristen Hanson Wastewater System: ® New ❑ Upgrade Address: P.O. Box 240606, Anchora a AK 99524-0606 ABSORPTION FIELD Phone: Number of Bedrooms: ❑ Deep Trench ❑ Shallow Trench ® Bed ❑ Mound ❑ Other: LEGAL DESCRIPTION Soil Rating: 2.4 Total Depth from original grade: 3.5 O.G. 4.0 GPD/Ft2 above - Ft. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 3 Random Heights 2.5 Ft, 0.5 Ft. Township: Range: Section: Fill added above original grade: Gravel Length: 7.0 Ft. 35 Ft. Well: El New ❑ Upgrade Gravel width: Number of lines: Distance betwe an lines: 5 Ft. 1 - Ft. Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: Existing Private Ft. Ft. 175 Ft' 3034 PVC Driller: Date Drilled: Static Water Level: Installer: Date Installed: Ft. D&T CONSTRUCTION LLC 1 8/3/2010 Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding ® S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ublio/Private Manufacturer: Capacity: From Tank Field Station Tank Sewer Line Anchorage Tank 1500 Gal. Well 90.9 90.4 Material: Steel with AX20 pod and lift station Number of Compartments: 2 Surface Water 100+ 100+ LIFT STATION Lot Line 10.0 61.1 Size: 250 Gal. Manufacturer: Orenco/Anchorage Tank Foundation 10.4 17.1 "Pump on" level at: +40 in. "Pump off' level at: +36 in. High water alarm at: +45 in. Curtain Drain Pump Make & Model Electrical Inspections performed by: P2005-1 Ed's Electric Remarks: BENCH MARK Location and Description: Garage Slab Assumed Elevation: 100.0 Ft. Engineer's Stamp Inspections performed by: PANNONE ENG. SVC, LLC Dates: 1St 8/2/2010 11 TA OF �� ,♦� 2"d 8/3/2010 ••••••• ••.•S� Development Services Department Approval : �,.• Conditional Approval Date: i;' 49TH :' ►.....: ...�. .. ................... 00 j%Steven R•••Pannone;- i �1_ r -- o. CE 8149 s ♦♦1 •�- /\ Reviewed and approved by: t Date: (Rev. 04/06)., •« •••'••�� ••••..••.•••• CO A B C D T1 18.1 28.7 LS 18.5 21.4 AP 24.0 23.3 FC 16.8 11.7 Ml 19.2 27.3 M2 34.3 58.3 49 TH W 1r r/ _1 =nu .. ... .. . ......... P.I.D. NO Random Heights S/D, Lot 3. ., •, ®017-411-07 Kristen Hanson Steven R. . Pannone /PERMIT N0. CE 8149 ��� OSP101083 P.O. Box 240606 PLAN Anchorage, AK 99524-0606 ,Ill%PROFEss�`` � Sh2et 4 \\ ti d0a�4S ISS3j0�,7 5V L2 'ON ✓ GuODUDd .�j uana}S ON a'I d s1N i/ ........ ... ........ 16t7 a oas, 6 coi 9090—tZ966 ylb `a6DJO�OUd + 9090tZ X08 o*d uosuDH ua4slJ>l 40� `0/S s;U6iaH uaopuD�l llZ8-ZLZ (L06) Xd3 8128-ZLZ (L06) 3NOHd 01966 Ad `39VK HONd L1Z001 X08 '0'd DTI `Dm ONE[ aKONllwcl FOUNDATION CLEAN OUT CLEANOUT AX20 POD CLEANOUT LIFT STATION AUX PUMP VAULT DRIVEWAY Z N N C O 0 Z MONITOR TUBE AT EACH END c�i V 5- 0 MONITOR TUBE AT EACH END I w w N O A O � N m m o 1wosv ONIMb2JC7 a2J001 S310N 00 Z 0 00 I ..-- m C O p O ..... T � 1If a � I ©{ m zm f �a S ) mm W U u O � O w w 0 zo- 0 G7 N Z7 m m N D a -• .� < <Q e' so 2.o3 ms O 3 - O � 1 2 3 4 5 6 7 8 9 10 11 12 TEST HOLE 2 OR TOPSOIL Poorly graded SP/ SAND/Silty Sand SM RR BedRock COMMENTS: SOILS LOG - PERCOLATION TEST SLOPE WAS r' N SLOPE —� U D WATER ENCOUNTERED? N IF YES, AT WHAT TH 2 DEPTH? 0' X DEPTH TO WATER AFTER MONITORING? - DRY DATE: 8/3/10 PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES:PANNONE ENG SVC, LLC _-~`oF at til ° 2�4/11 RECORD DRAWING ( ) P.O. BOX 102954 ANCHORAGE, AK 99510 r '�. 'qS 1' Scale PHONE 907 272-8218 FAX (907) 272-8211 /Co. •y Random Heights S/D, Lot 3 Kristen Hanson P.O. Box 240606 SOILS LOG Anchorage, AK 99524-0606 *: 49 TH Ig/ NTS i .. Steven R. Pannone CE 8149 /PERMIT I�Fc. ��® ��IsTF�6 ..... - P���� A-' P.LD. NO 017-411-- 07 No. OSP101083 Sheet ll ROFES90O `�� ``�+ 40F4 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: 4 BR HOUSE NEW 1500g S.T.E.P. TANK, AX20 POD, AUXILARY PUMP VAULT, 5 -WIDE TRENCH. SAND UNDER FIELD, TOP SOIL AND SEED MOUND. 4. GROUNDWATER IS NOT EXPECTED TO BE ENCOUNTERED DURING EXCAVATION, AS EVIDENCED BY THE SOIL TEST HOLE INFORMATION ABOVE 3 FT. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 3 FEET BELOW EXISTING GRADE, NOTIFY THE ENGINEER IMMEDIATELY. 5. EXISTING TANK SHALL BE ABANDONED IN ACCORDANCE WITH THE CODE BY PUMPING, CRUSHING, AND FILLING WITH COMPACTED CLEAN EARTH MATERIAL. 4" JIM 4" PUMP SLIDE SECTION OF 6° PIPE OVER THIS CONNECTION TO PROVIDE SHEER PROTECTION— EXTEND TO BRIDGE EXCAVATION ADVANTEX �^„ CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. R. 1. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER (E) EXISTING (P) PROPOSED (N) NEW NOTES: RECORD DRAWING DESIGN NOTES XILIARY PUMP BASIL PASSIVE AIR DESIGN PARAMETERS RESERVE SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 1,500 g w/AX20 POD & AUX PUMP VAULT PERC RATE: 2.4 MPI APPLC'N RATE: 6 GPD/SF AREA RQD: 100 SF SYS. TYPE:5-WIDE TRENCH MIN LENGTH: 20 LF DESIGN: 35 LFx5' WX0.5' ED, 4'SAND PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 Random Heights S/D, Lot 3 Kristen Hanson P.O. Box 240606 Anchorage, AK 99524-0606 LEGEND WATER LINE/ WELL RADIUS EXIST'G SEPTIC NEW SEPTIC CHAINLINK FENCE z— POF A *: 49 TM �R:�a,*n�,,,' I61 CE CE 8149 ;tV,�ll►:�PRossioNP`' Date 9/4/10 Scale NTS P.I.D. NO )17-411-0' PERMIT NO. OSP101083 Sheet 4 of 4 AUG -10-2010 01:14P FROM:ED'S ELECTRIC INC 272 4590 TO:2728211 to ' , f Inspection Report Municipality of Anchorage, Building Safety Division 4700 Elmore Road INFO b HELP (907) 343-8211 INSPECTION: VOICE (907) 343-8300 • FAX (907)249.7777 - www.muni.org Name same Company eds electric Address 12799 GINAMI ST Grid SW2841 Subdivision RANDOM HEIGHTS Work Description install septic lift station Insp. performed/prepaid 0 / 0 Permit Technician MORISA, MARIAMENE G. Comments or Directions call to meet Inspection Type Electrical: Retro Electrical Comments (for inspector use only) P.1 Permit # 10-8324 Inspection Date 10 -Aug -2010 AM Phone 272.4591 LOT 3 BK n/a TR n/a Inspector s2 -d L7)zeelo Date Municipality of Anchorage P.O Box 196550 4700 Elmore Road Anchorage, Alaska 99519-6650 (907) 343-7904 Fax (907) 343-7997 hftp://www.muni.o,rg/onsite Planning and Development Services Department On -Site Water and Wastewater Program On -Site Sewer/Well Submittal Comment Sheet Engineer: PANNONE ENGINEERING SERVICE Legal Description: Random Heights Lt 3 epartment 1/27/2011 Permit: OSP101083 Septic Completed By: J.Poet Report Type: As Built Review The attached paperwork has been reviewed and is being returned for the following reasons: 1. Permit requires confirmation test hole. 2. Need elevations for bottom of test hole, bottom of sand, bottom of rock, top of rock and original and final grade. 3. Is total depth really 6.5 feet ? 4. Is solid line insulated under driveway. ry On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP101083 Tax Code Number: 01741107000 Work Type: Septic Upgrade Permit Effective Dates: July 06, 2010 to July 06, 2011 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: RANDOM HEIGHTS i Site Legal Address: RANDOM HEIGHTS LT 3 G:2841 Owner/Address: HANSON KRISTIN HELWEG REVOCABLE TRUST HANSON KRISTIN HELWEG/TR PO BOX 240606 ANCHORAGE AK 995240606 Site Mailing Address: 12799 GINAMI ST, Anchorage Lot Size in Sq Ft: 49592 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: A test hole to confirm bedrock depth along the proposed trench location is to be completed prior to construction. Received By: Issued By: Date: /� l� Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Program 0enr s, ti° e h r' Department * VARIANCE/WAIVER REVIEW ** Waiver#: OSP101103 COSA#: Permit#:OSPIG1083 PID#: 017-411-07 Legal Description: Random Heights, Lot 3 Engineer: PES Applicant: Kristen Hanson Your request for a waiver of the required 100 feet horizontal separation from the septic tank and absorption field to the private well has been approved. The approved separation distance is 90.0 feet for the tank and 85 feet for the field. This waiver approval applies to the proposed 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. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: 6 Approved by: Name of Reviewe ........................................................... .................. Rec#: 067770 Amount: $1,050.00 Date Paid: 6/18/10 **** VARIAN C E/WAIVER REVIEW **** Random Heights Subdivision Lot 3 Parcel ID: 017-411-07 Waiver for 90 feet from well to tank and 85 feet from well to field Issued June 29, 2010 General 1. Any overflowing sewage would have to travel around the house to get to the well head. 2. The location of the system is in a visible area and any surfacing effluent will be seen and corrected. 3. The proposed system is the Advantex, Category III, nitrate reducing. Effluent meets secndary wastewater treatment standards and is constantly monitored with remote telemetry by Anchorage Tank and Welding. ADEC Criteria Points Water Table Depth of water bearing zone in well 100 feet Assumed bottom of tank and field 8 feet 92 feet 6.5 Soil Sorption Soil descriptions from well log DEC PTS Depth From Depth To Thickness Calc. Pts 0 0.00 Bedrock 0 8 100 92 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 92 0.00 0.0 Permeability Soil descriptions from well log DEC PTS Depth From Depth To Thickness Calc. Pts Bedrock 0 8 100 92 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 92 0.00 0.0 Water Table Gradient - Water table slopes away from the water source 7.0 Assume +58% slope Horizontal Separation 85 feet between septic field and well Total Points 15.8 A separation distance of 85' has points calculated at 15.8. No bacteriological pollution possible but chemical pollution possible but unlikely from household chemicals. 2.4 Municipality of Anchorage ® Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION U',ranG� (75101G/�03 FOR A SINGLE FAMILY DWELLING Osp/0j0S3 Parcel I. D. 017-411-07 Property owner(s) Kristen Hanson Day phone Mailing addressP.O. Box 240606, ANchorage, AK Zip Code 99524 Site address 12799 Ginami Dr, ANchorage Zip Code 99516 Legal description (Sub'd., Block & Lot) Random Heights, Lot 3 Legal description (Township, Range & Section) Lot Size 49,592 Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage 0 Number of Bedrooms 3., u Q 5A T E T; Initial ❑ Upgrade Renewal ❑ 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. Pannone Engineering Services, LLC -- (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: 67-7 —7 CJ Receipt Number: �' ? (Rev. 11/05) Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com June 15, 2010 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: Random Heights S/D, Lot 3 Septic System Permit Upgrade Request Separation Waiver Request Ladies and Gentlemen: I am writing to request a permit to construct an upgraded septic system be issued for this property. The proposed systems will serve an existing four-bedroom house. Currently the lot is developed. The lot is served by a private water supply. The existing septic system is a holding tank and shall be abandoned per code. A new drain field will be installed northeast of the existing house and will be sized to handle a four bedroom waste stream. The surrounding developed lots are served by private water systems. The private wells are located over 100 feet from the proposed soil absorption system. 1. Soils. A single test hole was excavated by PES on June 4, 2010. See the attached soil log. Ground water was monitored for seven days. No ground water was monitored to a depth of 3 feet below ground level after the monitoring period. Bedrock was encountered in the test hole at a depth of two and a half feet. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 6.0 gallons/day/square feet should be used, using an advanced wastewater treatment system with an auxiliary pump vault. 2. Soil Absorption System Design. See Design Drawings sheet 2 of 3 for the design calculations. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and the existing drain field. The proposed drain field upgrade 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 20 percent based on the survey information in the area of the septic system. The proposed installation will be approximately 50 feet from the shoulder of the steep slopes. 5. Separation Waiver Request: I request the following waiver: a. Well to Septic Tank from 100 feet to 90 feet b. Well to Septic Drain Field from 100 feet to 85 feet The proposed septic tank and Drain Field on this lot will both need to be inside the 100 foot well radius. The proposed septic tank will be plastic coated and extra thick for use with an Orenco Advantex AX20 treatment Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 615 East 82- Ave, Cuite B6, Anchorage, AK 99503 •1 I(907) 272-8211 Page 2 of 2 system. The proposed drainfield will be located up hill and behind the house from the well. The ground at the drain field is located approximately 16 feet above the ground at the well casing. The ground slopes from the drainfield to the well. Surface contamination is unlikely due to the drain field being located behind the house and to the south of the well. The well is located north of the house. The static water level in the well is 75 feet below the top of the casing (73 feet below ground level). The well is a bedrock well 275 feet deep. The hydraulic gradient is approximately twenty percent to the southwest, away from the well. The soils are sandy gravels having an application rate of 125 sf per bedroom and fractured bedrock. In review of the ADEC Waiver Memorandum the following points are tabulated: Section Points Water Table (75 ft) 6.0 Soil Sorbtion (Sandy Gravel/fractured rock) 1.0 Permeability 0.9 Water Table Gradient (+20%) 6.0 Horiz. Separation (86ft) 2.5 Total 16.4 points 16-25 points: Almost sure to be free from any form of contamination from household sewage. 6. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, 0 e 49 rH W'. Steven R. Pannone CE 8149 e Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: •. Box 100217, Anchorage, AK 99510-0217 *hysical: 615 East g2nd Ave, Cuite 86, Anchorage, AK 99503 Telephone: M. � s o v o m E w m c 3 m LO LO O a om O N 0 me > " o" v 3 NOTES: ISSUED FOR CONSTRUCTION ww _ASI3-i CT'�� p. i' nvA dwnd xnv NOLV1S L'n O n O w n 1nONV310 O N a0d OZXv O v X O Z Q 1nONV3-10 3: lnO NV31O NOUVONnoi PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 Random Heights S/D, Lot 3 Kristen Hanson P.O. Box 240606 Anchorage, AK 99524-0606 OF A� `sl D .q ` 7/1/10 Scale *: 49 TH '. * l� NTS P.I.D. NO _%017-411-07 Steven R. Pannone PERMIT NO. CE 8149 j SWxxxxxx �AW �� t`� fROFESSIi�' .r Sheet2 OF 4 J W Q ON3 HOV31V 38n1 U011NOW ti ti O a o @) 6 o H t m _0 g aw 0 - E ® ' a p m ops a \ o a n dq _ p J W > o f Q N J W z E,2 aT o_ (D a �� LL O O J/J J / w F< O my U W W Z W CI) Lu� 0 ° _ o. i ~ W "tn W Q .T � _ ON3 HOV3IVLL _ on 38n1 HOlINOA u7 O' Z W 7Q o !f�\�O c - 00 _J 00 � s o v o m E w m c 3 m LO LO O a om O N 0 me > " o" v 3 NOTES: ISSUED FOR CONSTRUCTION ww _ASI3-i CT'�� p. i' nvA dwnd xnv NOLV1S L'n O n O w n 1nONV310 O N a0d OZXv O v X O Z Q 1nONV3-10 3: lnO NV31O NOUVONnoi PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 Random Heights S/D, Lot 3 Kristen Hanson P.O. Box 240606 Anchorage, AK 99524-0606 OF A� `sl D .q ` 7/1/10 Scale *: 49 TH '. * l� NTS P.I.D. NO _%017-411-07 Steven R. Pannone PERMIT NO. CE 8149 j SWxxxxxx �AW �� t`� fROFESSIi�' .r Sheet2 OF 4 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: 4 BR HOUSE NEW 1500g S.T.E.P. TANK, AX20 POD, AUXILARY PUMP VAULT, 5 -WIDE TRENCH. SAND UNDER FIELD, TOP SOIL AND SEED MOUND. 4. GROUNDWATER IS NOT EXPECTED TO BE ENCOUNTERED DURING EXCAVATION, AS EVIDENCED BY THE SOIL TEST HOLE INFORMATION ABOVE 3 FT. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 3 FEET BELOW EXISTING GRADE, NOTIFY THE ENGINEER IMMEDIATELY. 5. EXISTING TANK SHALL BE ABANDONED IN ACCORDANCE WITH THE CODE BY PUMPING, CRUSHING, AND FILLING WITH COMPACTED CLEAN EARTH MATERIAL. 4" JIM 4" PUMP SLIDE SECTION OF 6" PIPE OVER THIS CONNECTION TO PROVIDE SHEER PROTECTION— EXTEND TO BRIDGE EXCAVATION ADVANTEX ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT N0, M# MONITOR TUBE NO. R. 1. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER (E) EXISTING (P) PROPOSED (N) NEW XI LIARY PUMP BASIP PASSIVE AIR DESIGN PARAMETERS RESERVE SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 1,500 g w/AX20 POD & AUX PUMP VAULT PERC RATE: 2.4 MPI APPLC'N RATE: 6 GPD/SF AREA ROD: 100 SF SYS. TYPE:5-WIDE TRENCH MIN LENGTH: 20 LF DESIGN: 35 LFx5' WxO.5' ED, 4'SAND I FrFNIn WATER LINE/ WELL RADIUS — EXIST'G SEPTIC NEW SEPTIC CHAINLINK FENCE NOTES: .������\ Date PANNONE ENG SVC, LLC - �� P.O. BOX 100217 ANCHORAGE, AK 99510 OF ?Cgst7/1 /10 ISSUED FOR CONSTRUCTION PHONE (907) 272-8218 FAX (907) 272-8211 �i*'�49 TM °Fy*��JJ Scale — r .... NTS . . .. ....... P.I.D. NO Random Heights S/D, Lot 3 /017 -a11 -o Steven R. Pannone- wk Kristen Hanson / PERMIT NO. �s CE 8149 \Aw SWxxxxxx P.O. Box 240606 DESIGN NOTES Anchorage, AK 99524-0606 t Fp� Sheet '' P' l TFq F� PROFESSION 3 of 4 DATE OF TEST: 6/4/10 PEROLATION RATE 2.4 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 1 FT AND 2 FT Percolation Test Data Time Net Time SOILS LOG - PERCOLATION TEST Drop 11:08 TEST HOLE 1 5.38 --- 11:18 10.00 10.38 OR TOPSOIL SLOPE 5.38 / `.S ITE N 11:28 1 9.75 4.38 Poorly graded --- 5.38 --- ( r 10.00 9.75 SPI SAND/Silty Sand --- 5.38 --- Sp 2 9.63 SM 11:48 --- 5.38 --- Q 10.00 9.63 4.25 O 3 GM BedRock TEST BOH HOLE 4 \ j j j 6— TH 1 TH1 7 , % s 9 4,BR F(oU5E"(E 10 12 WAS GROUND WATER SLOPE ENCOUNTERED? N IF YES, AT WHAT TH 1 DEPTH? 0' x DEPTH TO WATER AFTER MONITORING? - DN DATE: 6-14-10 DATE OF TEST: 6/4/10 PEROLATION RATE 2.4 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 1 FT AND 2 FT Percolation Test Data Time Net Time Height Drop 11:08 --- 5.38 --- 11:18 10.00 10.38 5.00 11:18 --- 5.38 --- 11:28 10.00 9.75 4.38 11:28 --- 5.38 --- 11:38 10.00 9.75 4.38 11:38 --- 5.38 --- 11:48 10.00 9.63 4.25 11:48 --- 5.38 --- 11:58 10.00 9.63 4.25 COMMENTS: Test hole excavated by Issaac's Pumping. Test Hoe was presoaked e ore perc test.Perc ran for one hour. PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 �� of Al,,q '4c 0 *� �9 +�� 7 — r Steven R. annone W �� �'F�s CE 8149 �"w �lil\`PRoFES90'0-�—`� Date D 7/1/10 ISSUED FOR CONSTRUCTION Scale NTS Random Heights S/D, Lot 3 Kristen Hanson P.O. Box 240606 Anchorage, AK 99524-0606 017-411- 07 PERMIT NO. swXXXXXX SOILS LOG Sh4eOF 4 ,k I MUNICIPALITY OF ANCHORAGE w DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ❑ NEW i 1ST N ANSoN % UPGRADE MAI LING ADDRESS LEGAL DESCRIPTION f�' 13 RA N b 0Wi E? ic, f -4i S �a E C aT-1,2 N LOCATION NO. OF BEDROOMS ON t� H �5 Well Absorption area Dwelling PERMIT NO. DISTANCE TO: U Y . I__ Q Manufacturer Material No. of compartments. w F. Cn Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth z DISTANCE TO: Well Dwelling PERMIT O. 0 7 p = Z F 'Manufacturer � Material _ Liquid capac,'' in gallons E�1�\ STt L_ -t. JfidZ O DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. w 2 J LL Z No. of lines Length of each line Total length of lines Trench width Distance between lines f Z W inches f Top of the to finish grade Material beneath the Total effective absorption area ® inches Length Width Depth PERMIT NO. W C7 CL F wa Type of crib Crib diameter Crib depth Total effective absorption area LU N DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE TO: Building foundation Sewer line Septic tank Absorption areas) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER I Mb12G�h REMARKS Ci E-SSPpO L -i ij qTp .•...n ou •••••0 .{�> 2225-E. �. APPROVED DAT//E LEGAL/ -.7,n %% //� / j ��//L' Li /n .. — 7 OL�9 .a...f/Y�.vt tti/ L7_f.. "14 42 7 i / M -w DRILLING, Inc. P. O. Box 4-1224 • 1310C International Airport Road (907) 274-4611 ANCHORAGE, ALASKA 99509 DRILLING LOG »dfkPALll NEALSN & t iOPI TOrl '1ROl f� t TO {�. TO To NMVA Certified Contractot TO n s -TO- TO --TO- -To- TOTO3 -TO- 3 —CONTRACTOR PERMIT NO: DATE ISSUED APPLICANT: ADDRESS: CONTAC T PHONE LEGAL DESCRIP LOT SIZE IL - T -Fs -e 1-3 F=- F1 r-4 I:: - DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 8251 L STREET, ANCHORAGE, AK 9950:1 264-4720 #::# " - � I _T F= !F. 1= W F= FR F4 F= FR M I -r 840408 HOLDING TANK 05/31/84 KRISTIN HANSEN 3300 PROVIDENCE DRIVE ANCHORAGE, AK 99504 345-0298 SUBDIVISION: RANDOM.HEIGHTS LCAT: 2. SECTION: 25 TOWNSHIP: 12N RANGE: 3W 1, 25A rSQ. FT. OR ACRES) BLOCK: NA , CERTIFY THAT: 1. 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET. FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. 2. 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS, AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. 3. 1 WILL ADHERE TO ALL MOR AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. IF A LIFT STATION 'IS INSTALLED IN AN AREA COVERED BY MOR BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINEDj (2) AS -BU ILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DON '-A LICENSEE, ELECTRICIAN. �T BE DON SIGNED DATE: - --- -- .... IN _��N ---- ---- - -- APPLICANT: KR I'= IN HA S N ISSUED BY- DATE: -------------------- A p_y-_ d k -t- MUNICIPALITY OF ANCHORAGE ac DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: v— —ts I IN' 4x s'L DATE PERFORMED: / 3pL' LEGAL DESCRIPTION: L( I IACl•I.��b C a`�' DEPTH SLOPE SITE PLAN �n /� {` I p E V a_ (7 I-V 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 3F, is(,�->0 C�� COMMENTS GIC/S ft VLG 01J 0 KAI PERFORMED BY: 5 WAS GROUND WATER S ENCOUNTERED?L O P E IF YES, AT WHAT DEPTH? Reading SOILS SLOG/ Gross Time r -I OL v ❑ PERCOLATION TEST PERFORMED FOR: v— —ts I IN' 4x s'L DATE PERFORMED: / 3pL' LEGAL DESCRIPTION: L( I IACl•I.��b C a`�' DEPTH SLOPE SITE PLAN �n /� {` I p E V a_ (7 I-V 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 3F, is(,�->0 C�� COMMENTS GIC/S ft VLG 01J 0 KAI PERFORMED BY: 5 WAS GROUND WATER S ENCOUNTERED?L O P E IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN QETWEEN (minutes/inch) FT AND FT %J t'0LV/ ! t CERTIFIED BY: (I DATE: Parcel I.D. 017-411-07 Municipality of Anchorage On -Site Water and Wastewater Program' (907)343-7904 A➢-YA Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Location (site address) Random Heights, Lot 3 12799 Ginami Street Expiration Date: 3 - T _ f Current Property owner(s) Cory and Kristin Birdsong Day phone Mailing address 12799 Ginami 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 0 Individual . 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance req st for:_ Distance, - Received by: _ �W Date: 5 f 205 COSA to be released to the gm r, unless otherwise requested by the engineer. v � . COSA Fee $ Waiver Fee $ Date of Payment 1 ���i5 Date of Payment Receipt Number oJ�af [3(r� Receipt Number COSA# �5�Jr1�J 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 effectat 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 �k Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Alk. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE Jz System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Phone (907)272-8218 Date 04/2212015 *,4g TMI * CE -8149 -; Conditional approval for bedrooms, with the following stipulations: Imo. ✓ By. Al 4 Original Certificate, Date: S—' The Mun, 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 sheet t c If more than 1 septic system is on the tot: COSA Checklist # r of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal DQwAptiom Random Heights, Lot 3 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 06/04/1975 Sanitary seal (YM) Y Total depth 275 ft. Cased to 12 ft. FROM WELL LOG Date of test 06104/1975 Static water level 75 ft. Well production 3 9.p -m. Parcel ID: 017-4.11-07 Well Log (YIN) Y Wires properly protected (Y/N) Y Casing height (above ground) 12+ in. AT INSPECTION 05/30/2013 - 86 ft. 4.9 9.p -m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 8.63 mg/L Arsenic ND ug/L Date of sample: 04/13/2015 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Advantex Tank size 1500 gal. Number of Compartments 2 Foundation cleanout (YIN) Y Depression over tank (YIN) N Date of pumping 07/25/2014 Pumper Advantex Date installed 08/03/2010 Cleanouts (Y/N) Y High water alarm (YM) Y C. ABSORPTION FIELD DATA Date installed 08/03/2010 Soil ratingd./ff or ff/bdrm 2.4 g.p.d. sq/ft System Bed (g•P• ) y type Length 35 ft. Width 5 Gravel below pipe 0.5 ft, Total depth 4 ft. Eff. absorption area 175 fe Monitoring tube Y Depression over field N Date of adequacy test 05/30/2013 Results (Pass/Fail) Pass I For 4 - bedrooms Fluid depth in absorption field before test 0 in. Water added 637 gal. New depthm-0— in. Elapsed Time: 130 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo:) (Y/N & type) No If yes, give date D. LIFT STATION Date installed 08/03/2010 "Pump on" level at 40 in. Datum Bottom of Tank Size in gallons 250 Manhole/Access (Y/N) Y "Pump or'level at 36 in. High water alarm level at 45 in. Cycles tested 3 Meets alarm & circuit requirements? Y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 90.9 -On adjacent lots 100+ Absorption field on lot 90.4 On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 100+ —.Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 10+ Absorption field 5+ Water main 10+ Water service line 25+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 100+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Waiver on 6/29/10 #OSP101103 G. ENGINEER'S CERTIFICATION u\ 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 tieven It'15annone " cE—etas 04/22/2015 Date �%.•, ..... _.� COSA canary sheet -2 -6 -15 -doe Municipality of Anchorage Community Development Department Development Services 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 # 151175 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 3 of Random Heights subdivision. This inspection revealed a nitrate concentration of 8.63 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. am was ■ raw)■ ■w■ 27on9■ ■ on son a ■+ son own in ■■ ■ a ■ on In ww mae Mae map IN an ■w■ ■ ■w on aaa erre is uvarfF6W Field Maintenance Report Annual Insoection & Kristin Birdsong AnchorageTank 907-272-3543 operator Mike Blakeslee gee AdA s 12799 Ginami Street, Anchorage AK 99516 31]6-6114 Ax Site IR i Ceunry ID a Pod k Rill tlNl a nate m )flet Inepepapn AX -124876 414758 RTU12]795 98/28/2013 Retrleve O&M Into Daly flow Reclm ratio _ Timer settings: Perform Fleld Sampling/OBservatlone {16: NTueI RH (6.91 DO (2.6) F:3 , space Box.....................T lb Odor of Sample Typical ' Aivaty ❑ Earthy ❑ Moldy Non-typlcal SSua sumido ❑ Cat bage ❑ Decay OILY }Om in PVU ❑Yes W No Foam In tank ❑Yea 7TNo Check Control Panal 17z7= Audible and visual alarms ]AOK Dial tone (telemetry ) only) ❑ Yes 6 No Inspeovelaan Pump System Recirculating Splitter Valve....... comments Clean Measure Sludge/Scum Sludge Scum partment nspect RlserlLld ................. .'. Y .qI space Box.....................T Fleet Cords ................... Floats ........................ Pump......................... current Bictubea Finer ................. Cumud Bictube Pump Vault ............ Recirculating Splitter Valve....... comments Clean Measure Sludge/Scum Sludge Scum partment Current Previous Currant Previous I r 72ndCompartmemt current Previous Cumud Previous r/ Inspact/Clean AdvanTex Filter Oder:r.I lonnal 11 Pungent 9(omat yU Nomrid ❑Excessive Brklginglponding: one/Minor ❑Excessive inapect/Clean I]I charge Pump System Inspeot Rigor/Lid Splice Box Float cards Inspectizerylce Other System Components Inspect Clean Paor ncaa p Padd BotBot tom '�Jjyy�-t�(� Intake Vent Inap��pftt Clean Plosts � ] ump Pump Inspect Clean Inspect Clean Dialnfaetion Equipment Dispersal Laterals/Orifice Obcervatlone Additional Services Rendered ❑ Cleaned textile Sheets? ❑ Repladad UV Items? ReplacedNeed other hems? Parts Used: W = Warranty, B = Billable (V appropriate selection) W B Imes Number Description Flnai/Safety, Inspection jlraingc"I�dangldresMoved.flushvalves closed aryRocommcnd.tkins ❑ System perlomiing: no further action needed ❑ Call for service Fax completed form to 7-866-284-7404 uds bolted on Control panel reactivated ❑ Tank needs Pumping ❑ Other? ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE AND 146,(.(5 lTYh THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this Day of of 20/5�by and between ,,'°$ d� `j�j/ t , 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 (AW WTS), described as WV>.' n., /� 2,1.1z __ L� j, located at (legal description). 2. Definitions. Alteration. Any change to the design or function of an AW WTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. CertiFcate 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 AW WTS that were included in the original design which would allow the AW WTS to continue to perform as designed. Permit. An On -Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AW WTS. 3. Term. 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 AW WTS 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 AW WTS, 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 AW WTS 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 AW WTS service and maintenance provider approved by the municipality and the manufacturer of the AW WTS for the entire term of the AW WTS. 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 AW WTS. 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 AW WTS 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 AW WTS 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 AW WTS installation and maintenance requirements as provided by the AW WTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AW WTS. I. Owner agrees to provide and maintain a telephone connection to the AW WTS as required by the AWWTS approval. 6. Nonwaiver. 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: t a. Owner: 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. Severability. 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 By: � et d ��—` 24tL (signature) Date: f /3t k sin>XA (print name) STATE OF ALASKA THIRD JUDICIAL DISTRICT The My MUNICIPALITY: was ) ss. before me this JC FOR ALASKA expiresr%y 0-4. /0„JeV? By: (signature) name) Date: Title: Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program s a E r,7 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. o17-4is-o7 COSA #OSC 112 Expiration Date: W _3v Z 1. GENERAL INFORMATION Complete legal description Lot 3 Random Heights Location (site address) 127gg Ginami Street, Anchorage, AK Current Property owner(s) Kristin Hanson Day phone Mailing address PO Box 24o6o6 Anchorage, AK ggg24 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD forpickup. 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 f Anchorage is not responsible for errors or omissio ps in the pr, fes '°�l engineer's work. 0013 G CCC) osc �3laa ) 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.O. Box 100217 Anchorage, AK g9510 Engineer's Printed Name Steven R. Pannone P.E. Date S/W/2013 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & 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. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory NitrRte Advisory„ X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: & Original Certificate Date: s _30)/,3 fRev. 11/05) - Municipality of Anchorage Ap4� m.s ' Development Services Department U 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 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Random Heights Lot 3 Parcel ID: 017-411-o7 A. WELL DATA Well type P If A, B, or C provide PWSID # Date completed 61411.07; Sanitary seal (Y/N) Y_ Total depth 275 ft. Cased to 12 ft. FROM WELL LOG Date of test 6/4/.975 Static water level 75 ft. Well production z 9 - p.m -WATER SAMPLE RESULTS: Coliform Pass colonies/100 mL Nitrate 7.SS mg/L Well Log (Y/N) Wires properly protected (YIN) Y Casing height (above ground) 12+ in. AT INSPECTION 5/30/2013 86 ft. 9 - p.m - Arsenic: o.1S1 ug/1 Date of sample: S/2212013 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP Date installed 8/3/2010 Tank size i5oo gal. Foundation cleanout (Y/N) Y Date of pumping C. ABSORPTION FIELD DATA Number of Compartments z Depression over tank (Y/N) N Cleanouts (YIN) High water alarm (Y/N) Y Pumper Advantex & House Vacant since install in 2010 Date installed 8/-4/2020 Soil rating (g.p.d./ft2 or ftz/bdrm) 2.4 System type Bed Length 3; ft. Width ft. Gravel below pipe o.s ft. Total depth -4.o ft. Eff. absorption area Vftz Monitoring tube Y Depression over field N Date of adequacy test 5/3o/2o13_ Results (Pass/Fail) Pass For -4 bedrooms Fluid depth in absorption field before test o in. Water addedW gal. New deptho in. Elapsed Time: no min. Final fluid depth o in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed 8/3/2020 "Pump on" level at ho in. Datum Bottom of Tank E. SEPARATION DISTANCES Size in gallons 250 Manhole/Access (YIN) Y "Pump off" level at 36 in. High water alarm level at 45 in. Cycles tested 3 Meets alarm & circuit requirements? Y SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot go.g Waived 6/2gho On adjacent lots Absorption field on lot 90.4 Waived 6/20ho On adjacent lots ioo Public sewer main 75+ Public sewer manhole/cleanout Sewer /septic service line 29+ Holding tank Zoo+ Animal containment areas Zoo+ Manure/animal excrete storage areas Zoo+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 20+ Property line 20+ Absorption fie, Water main 20+ Water service line 25+ Surface water Wells on adjacent lots Zoo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 20+ Building foundation 20+ Water main loo+ Water Service line 20+ Surface water Zoo+ Driveway, parking/vehicle storage 20+ Curtain drain None Known Wells on adjacent lots Zoo+ F. COMMENTS G. ENGINEER'S CERTIFICATIONv :,HC _-4 t certify that I have determined through field inspections and �q[� review of Municipal records that the above systems are in = 49�—" h ... .... ... .....5... conformance with MOA COSA guidelines in effect on this date. $ .. . ....................... ;. Engineer's Printed Name Steven R. Pannone P.E. �� Steven R. Pannone: �� t,• No. CE 8149••, Date s/10/2021 �1�� ` ............... COSA Fee $_ Date of Payment (Rev. 11/05) Waiver Fee $ Receipt Number Municipality of Anchorage t • Community Development Department Development Services 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 # OSC131221 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Lot 3 of Random Heights subdivision. This inspection revealed a nitrate concentration of 7.55 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. Municipality of Anchorage • Development Services Department r°O Building Safety Division On -Site Water and Wastewater Program 5 A E T Y 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. o17 -411-o7 COSA # i)2) C,I Jac Expiration Date: / a 1. GENERAL INFORMATION Complete legal description Lot 3 Random Heights Location (site address) 127Q9 Ginami Street, Anchorage, AK Current Property owner(s) Kristin Hanson Day phone Mailing address Lending agency Mailing address PO Box 24o6o6, Anchorage, AK gq_S24 Day phone Real Estate Agent Susan Bickman Dynamic Properties Day phone 261-7571 Mailing Address 3111 C Street, Ste loo, Anchorage, AK g95_o3 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 I 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 En_ inq eering Services, LLC Phone 272-8218 Address P.O. Box 100217, Anchorage, AK ggSso Engineer's Printed Name Steven R. Pannone, P.E. Date 8/8 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & 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. '�„`ILItil1 The operational life of all wells and septic systems depend on the local soil condition, ground water OF. 44�♦ levels that may fluctuate during the year, and the water usage of the family being served by the system. ...........qS��1� These conditions are outside the control of the evaluator of this system. All systems eventually fail and �,•''�� 1� satisfactory test results do not guarantee future performance of the system, nor do they guarantee that ,! ': 00 there are no hidden defects or encroachments. PES can therefore not provide anwarrant for future • �•• ••• ••••• • •••��•••••� performance nor give any estimate of how long the system will continue to meet the operational ............................ ...............T.0 requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed';steven R. Pannone; cu. above. Any reliance upon or use of this report by any other person or party is not authorized nor will it r►, s No. CE 8149 AV AV confer any legal right whatsoever. ��....••': 5..- DSD SIGNATURE _Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory .41111fij;. .... WATER AND fM PROGRAM s Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other BY• Original Certificate cate Date:IV �l..o� (Rev. 11/05 r Municipality of Anchorage 04� < ' Development Services Department Building Safety Division On -Site Water & Wastewater Program S A • E T V 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Random Heights Lot 3 Parcel ID: 017-411-07 A. WELL DATA Well type P Date completed 6/4/1975 Total depth 275 ft. If A, B, or C provide PWSID # Sanitary seal (Y/N) Y_ Cased to 12 ft. FROM WELL LOG Date of test 614/1975 Static water level 75 ft. Well production 3 9 -P.M. Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 12+ in. AT INSPECTION 1/2011 84 ft. 4.8 g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate Mmg/L �iJ/I Arsenic: ug/I Date of sample: 8/5/2011 Collected by: Laura Pannone B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP Date installed 8/3/2010 Tank size 15oo gal. Number of Compartments 2 Cleanouts (Y/N) Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping -e AJ Pumper Advantex & House Vacant since install in 2010 C. ABSORPTION FIELD DATA Date installed 8L3/2010 Soil rating (g.p.d./ft2 or ft2/bdrm) 2.4 System type Bed Length 35 ft. Width 5 ft. Gravel below pipe o.5 ft. Total depth 4.o ft. Eff. absorption area n&ft2 Monitoring tube Y Depression over field N Date of adequacy test Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test AJ Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= 600+ g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed 8(3/goio Size in gallons 250 Manhole/Access (Y/N) Y "Pump on" level at _4o in. "Pump off' level at 36 in. Datum Bottom of Tank Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: High water alarm level at 45 in. Meets alarm & circuit requirements? Y Septic tank/lift station on lot go.9 Waived 6/29/io On adjacent lots Absorption field on lot cLo.4 Waived 6/29/10 Public sewer main 75+ Sewer /septic service line 25+ On adjacent lots ioo+ Public sewer manhole/cleanout ioo+ Holding tank ioo+ Animal containment areas ioo+ Manure/animal excrete storage areas ioo+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation io+ Property line %o+ Absorption field q+ Water main io+ Water service line 25+ Surface water ioo+ Wells on adjacent lots zoo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line io+ Building foundation so+ Water main ioo+ Water Service line zo+ Surface water soo+ Driveway, parking/vehicle storage io+ Curtain drain None Known Wells on adjacent lots ioo+ F. COMMENTS Waiver # OSPsoilo G. ENGINEER'S CERTIFICATION �.•�� OF q� ���� 1 certify that / have determined through held inspections and ; 9 •.:•111 review of Municipal records that the above systems are in 4 r �,,.•.: ,.,,., :t. ........ .... .............. conformance with MOA COSA guidelines in effect on this date. 0 ....................... ........ ....... ..:.. . Engineer's Printed Name Steven R. Pannone, P.E. 11 - Steven R. PannoneAr 1♦% s,•• No. CE 8149 •��� = Date 8/8/2osi11♦♦♦•'•• .� .•� •� 46ESS\�i COSA Fee $ U�Waiver Fee $ Date of Payment /,-)-y l / % Date of Payment Receipt Number 0� Receipt Number (Rev. 11/05) MUNICIPALITY OF ANCHORAGE Community Development Department Right of Way Section Development Services Division Phone: 907-343-8240 Fax: 907-343-8250 Mayor Dan Sullivan September 12, 2011 Kristin Hanson P.O. Box 100217 Anchorage, Ali 99510 RE: Encroachment: Septic Cleanouts, deck steps and fence Random Heights Subdivision, Lot 3, Grid 2941,12799 GINAMI ST The Right of Way Division has reviewed a request for a letter of non -objection to existing septic cleanouts (2), deck steps, and chain link fencing, which encroach into the 10' Utility Easement along the south property line as shown the As Built survey dated 1127111 (Kenneth G. Lang), submitted with the request. This letter of non -objection is issued with stipulations, and by using it the petitioner is agreeing to the following: 1. Municipality of Anchorage (MOA) will be held harmless, now and forever, for any damages or injury to any person as a result of the encroachments. 2. All applicable codes and regulations will be observed and maintained within the easement. 3. This letter of non -objection will in no way preclude MOA from full use and enjoyment of its rights within any portion of the easement. 4. Additional and extraordinary costs incurred during any future required construction, repair or reconstruction of MOA improvements to accommodate any or all of the encroachments shall be paid by the property owner. 5. Maintain letters of non -objection from the following utilities: ® Anchorage Water & Wastewater Utility ® Alaska Communications Systems ® Chugach Electric Association, Inc. ❑ Matanuska Telephone .Association ❑ Matanuska Electric Association, Inc. ® Enstar. Natural Gas Company ❑ Municipal Light & Power ® GC[ Cable of Alaska ❑ Eyecom (Girdwood Cable TV) ❑ No letters required All lettcrs of non -objection should be retained in your permanent files. If you have any questions, please call me. at 343-8240. Sincerely, e#ack L. Frost, Jr. Right of Way Supervisor Concur 4 AropeA0W r(s) i4sfa//rir Mailing Address: P.O. Box 196660 • Anchorage, Alaska 99519-6650 - http://www.muni.org SGS Ref.# Client Name Project Name/# Client Sample ID Matrix 1113649001 Pannone Eng. Srv. Random Heights Lot 3 Random Heights Lot 3 Drinking Water Printed Date/Time Collected Date/Time Received Date/Time Technical Director 08/10/2011 8:00 08/05/2011 12:30 08/05/2011 13:20 Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Waters Department Total Nitrate/Nitrite-N 5.29 0.100 mg/L SM20 450ONO3-F B (<10) 08/05/11 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 08/05/11 DLC Total Coliform Negative 1 100mL SM20 9223B A 08/05/11 DLC SGS Ref.# 1110710001 Client Name Pannone Eng. Srv. Project Name/# Random Heights Lot 3 Client Sample ID Random Heights Lot 3 Matrix Drinking Water Sample Remarks: Parameter Metals by ICP/MS Arsenic W ters Department Total Nitrate/Nitri - Microbioloav Laboratory E. Coli �ollii� '' Tor al Coliform Printed Date/Time 03/08/2011 14:01 Collected Date/Time 03/01/2011 14:30 Received Date/Time 03/01/2011 16:45 Technical Director Stephen C. Ede Allowable Prep Analysis Results LOQ Units Method Container ID Limits Date Date lnit ND 5.00 ug/L EP200.8 C (<10) 03/02/11 03/07/11 NRB 4.30 0.100 mg/L SM20 450ONO3-F B (<10) ---------63-103111— - LCE Negative 1 100mL SM205-M59 ,__ A 03/01/11 DLC Negative 1 100mL SM20 9223B"' --A in n <XC tot(( G 00,01'1 0 \ U I x Mei N CY z r o x .J 'MEn I f x If g �- � eexpp �A 0 X \ ,s•s `' m .�°e 26.0 GINAMI 39 z 10 -5 I, a S2 W xr C9 N I D I W c W a yr GINAMI 39 z 10 -5 I, a S2 W C9 N I N 165.25. STREET f i V) C4 J Lv Z z 4 PLOT PLAN AS BUILT X SCALE 1' = 40' GRID .SW 2841 Project No. 10-085/A2 Lang & Associates., Inc . 11300 Daryl Avenue. Anchorage. Alaska 99515-3049 Registered Land Surveyors (907) 322-6425 Phone 9:9 y (907) 522-4623 Fax ,�• k9langls0alasko.net / jolanglsoolaska.net I hereby certify that i have surveyed the following described property:�P•',. Lot 3, RANDOM HEIGHTS SUBD.Plat No. 68-141) t� V Anchorage Recording DisMct. Alaska, and that the improvements situated thereon are A 49 8 within the property lines and do not encroach onto the property .......... ""' 4� no im rovemente on the property lying j e Pew adjacent thereto. that (i P p pro n adjacent thereto encroach on the surveyed F/ tea✓ premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon.¢• KENNE1H G•.+� gk Q :•� LS Dated this the ?'tom' Day of SAa.+tioraiJ 'tail at Anchorage. Alaska %J�h"O-..•..5202if is the responsibility of the owner to determine the existence of any easements,�toNA1-' covenants, or restrictions which do not appear on the recorded subdivision plat.`" MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE // I. General Information Application Date /to 19.S (a) Legal Description (include lot, block, subdivision, section, township, range) _Ln -r 3 2Atjbnm 14 w& wTS SSEL 95 T 1'2W. R3 L.✓ Location (address or directions) sy�s- oz 9 8' (b) Applicants Name_ Nk'D2/C 144NS IV Telephone - Home Business Applicants Address 33aoo praafclam" D-ri✓e. (c) Applicant is (check one) Lending Institution ; Owner/4u&1-der ; Buyer E::l ; Other E:�l (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent N O N e Address Telephone (f) Mail the HAA to the following address: -Fi 2. Type of Residence Single -Family N1 Multi -Family Number of Bedrooms 3 3. Water Supply Individual Well M Community Other (describe) Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite = Public E=T Community E=T Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. Engineering Firm Providinu Inspections. Tests. File Search. Data and Information As certified by my seal affixed hereto and as of the validation date shown below, Z verify that my investigation of this Health Authority Approval shows that the on -0110 water supply and/or wastewater disposal system is safe, functional and adequate fer the number of bedrooms and type of structure indicated herein. I further verify Chats based on the information obtained from the Municipality of Anchorage files and frurff my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm_ 1e,�6tN Spurklet HaQ -PE Telephone,27Q Address 2.0 3 ►,Y/ / �j Date C;F A( ,4a1 (ENGINEER SEAL) %J S' I.• •..•. ...... o. 222-E 6. DHEP Approval 5 ���� 3'. JUNE 2S• 1971 2 Approved for bedrooms By G�� -Date. •��4%�'// ��4 Approved X Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTEC ON (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRE0,0- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGIST90= IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES A#D THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQU1%o"- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE. ,A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ER904''s OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. 1 11-4 (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE. DUE OF HEALTH & EiNVIi:ONMENTAL P"OUCTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL ( HAA) JAN 1 U 1985 CHECKLIST - FEBRUARY 1984 R F C EnI V E A. WELL DATA Legal Description: _Lo! 3, I24NOp M gel(agnSEG. 25,`ri2N� R3u!/ _ Well Classification F,1=.5 If A, B. or C. D.E.C. Approved(Y/N) WA Well Log Present (Y/N) Y Date Completed `�'//75 Yield .7_69,orri Total Depth 027j Cased to /,Q Depth of Grouting NoNe; Static Water Level 75 Pump Set At 130-4o w/ Casing Height Above Ground /$ d Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N Separation Distances from Well: To @&@4;ic/Holding Tank on Lot ID C> On Adjoining Lots 1010 To Nearest Edge of Absorption Field on Lot N/A ; On Adjoining Lots 1&-o To Nearest Public Sewer Line N/A To Nearest Public Sewer Cleanout/Manhole No 14 E To'Nearest Sewer Service Line on Lot N o N C. Water Sample Collected By S /`; Date '/ 8 / 8 S Water Sample Test 'Results soy �' , L•, t F• ry Comments B. E/HOLDING TANK DATA Date Installed 8/3))$ij Size 5&y-eo No. of Compartments ON Standpipes (Y/N) ONS Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) N Date Last Pumped '1q186 Pumping/Ma ana+iee Contract on File (Y/N) Y ; for I$AAC. Holding Tank High -Water Alarm (Y/N) Y Temporary Holding Tank Permit (Y/N) y Separation Distances from Seprc/Holding Tank: To Water -Supply Fb ll 10t) To Building Foundation 20 To Property Line 10 To Disposal Field N/A To Water Main/Service Line I Q To Stream, Pond, Lake, or Major Drainage Course ►�i,� Ln_ ta.. @__ (sem �� Comments Receipt # �QG-lay=J Date Paid:-��•��� Amount: q n (Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA N O N C Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply X11 _ To Building Foundation Lot To Water Main/Service Line To Property Line To Existing or Abandoned System on On Adjoining Lots To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION N 0 N L Date Installed Size in Gallons "Pump On" Level at Dirrensions Manhole/Access (Y/N) "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or, conforrred to all MOA HAA Guidelines in effect on the date of this inspection. Signed _ � Date Q ha Company 77tim4AA64 MOA No. Vc S% -U// KBI /d5/s [Page 2 of 21 2-15-84 1V-10 �0 E 203 VO ° ° �UV C' ANL�li� Mg Po o A CHORAGE,VALASKAIT99501 CONSULTING ENGINEER TELEPHONE: (907) 279-3916 Mrs. Kristin Hansen 3300 Providence Drive April 13,1984 Suite 212 Anchorage,Alaska 99508 Subject: Inspection of septic system on Lot 3, Block 1, Random Heights Subdivision. Dear Mrs. Hansen; Per your request I inspected and tested the septic system on Lot 3, Block 1, Random Heights Subdivision on April 10, 1984. I tested the system the following way: On April 5, I measured the water level in the two standpipes of the system. I measured 36 inches of liquid in the pipe I assumed to be a crib or a trench. The septic tank was 8 feet deep with 65 inches of liquid. When a toilett was flushed I could hear water flowing into the tank, indicating that the tank was not surcharged. On April 9, the tank was pumped. Approximately 700 gallons of liquid was removed. On April 10 an attempt was done to 'charge the crib/trench, but it was discovered that water added to the standpipe flowed directly into the tank. The tank was filled with water in order to see how fast the system would absorb water, using the septic tank as a reference. While filling the tank it was noticed that water was surfacing and flowing in a strong stream down the slope adjacent to the tank. The tank was immediately pumped dry and the flow stopped. Based on the observations made I have arrived at the following conclusions. 1. This system was not installed in accordance with the regulations in effect at the date of installation. I do not think a septic tank was installed, rather a cess pool, or a drywell. 2. Whatever was installed, it was installed too close to the bank, and too close to your well. A separartion distance 100 feet is required. The present distance is 83 feet. 3. There is not sufficient area at the house to install an acceptable system. Two options exist to provide the lot with a sewer system. The least attractive is to install a holding tank. This tank must be pumped every 10 to 20 days,depending on the size of the tank and the water useage of the family. The second option is to investigate if a system can be installed at the road. The main constraint will be if a distance of 100 feet can be maintained from your well and your neighbors wells. If you do not have well interference, a soiltest must be performed before a system can be designed and built. Tobben Spurkland P.E. For the time being, your existing tank must be pumped regularly to prevent the health hazzard of having raw sewage flowing on top of the ground. Please notify me when you are awailable to discuss the solution of the present problem. Yours Tobb n Spurkland P. TO ISAAC&PUMPING SER` `E Norm Tibbetts (Owner) 6218 Quinhagak ANCHORAGE, ALASKA 99507 ,3-6.3-3360 Phoneii4 ❑ PLEASE REPLY ❑ NO REPLY NECESSARY 5d f r A O MUNICIPALITY OF ANCHOIRAG,--"` €� � DEPAR-IMI,. , OR HEALTH AND ENVIRONMEN, PROTECTION f � i 825 L Street, Anchoraa(F . Alaska 99501 264--4720 Date Received: pita,£ mLtnq _1 IPA, I t----- #1° Tune Q I�t-v), i #2: `Dime #3: Time D< Ce��.2_(I_�2 t,iS Date I)at0 T n s v i!�r �l._.-------- I n s I .. _ I n s p- REOUI ST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES! 1. Lending Institution Request.: Mailing Address.— !41q_�J_ I aha t'> il� ��c �i Phone 2. Property Owr/er : ------- �Acos Phone: Mail-.i.ng Address. 3. Legal. Description,: 11 (� Vii_ e _ P �c�om � As T — --- 4: Single Family Residence: (v) Number of Bedrooms: Multiple Family Residence: ( ) Numbei:- of iiedrooms: S. Wel].. System: Individual Well -(r) Community/Public Sysi-.ern ( ) Permit It, Con st.ruc t..i_on Depth of Well Well 11 -log oil F.il ' ( ) Bacterial Analysis f~. Sewage Disposal SystE:tn: on-site System --(-4 ) Permit # Septic 'rank. Size 7:n sta l l ed. Publ-tc Utility ( ) Installer Manufacturer Absorption Area. Soils Rate 7. Distances: Well to Septic Tank to Sewer Linc to Nearest Lot Line Nearest Lot line Material. to Absorption. Area _..- Absorption Area -Paije Two of Health and Env.i-ronmc,.nL.al P-i,otccLJ.on Request for Approva.l. of Individual Sewcr and Water Facilitic-,s Legal DescriyA-i-cm: Commcmts -. Affadavit Attached: Lett=er_ Attached: Approved: Date: -e —7 Disappr-c )ved: Date: ------ Department Worksheet, MUNICIPALITY OF ANCHORAG Department of Health and Environmental Protgct bn 825 L Street, Anchorage, Alaska 99501 / 279-2511, ext. 224, 225 sst for Approval of Individual Sewer and Water facilities 1. Property Owner: Hedric B. Hanson, MD Mailing Address: 3300 Pro vidence Drive #212 -� phone: 276-8385_ 2. Name of Buyer: none Mailing Address: none 0 51 (Refinanced) Lending Institution • The Lomas & Nettleton Company Mailing Address • 4449 Business Park Blvd. Realtor/Agent: Mailing Address: Phone: Phone: _ 274;7661 Phone: 5. Legal Description: Lot 3, Random Heights Subdivision _ Street Location: NSA Ginami Street 6. 7 Single Family Residence: (X } Number of Bedrooms: _ 4 Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: *Individual well ) Public/Community System ( ) If Individual Well, well depth If Community System, name of system Sewage Disposal System: On-site System (X) Public System ( ) If On-site System, date of installation: — *NOTE: A well l.og is required on ALL wells drilled since 6/75. 3/77 December 16, 1977 Lomas and Nettleton Company 4449 Business Park Boulevard Anchorage, Alaska 99503 Subject: Lot 3 Random Seighta Subdivision This department will reconsider the request for sever and water approval, if the tank is ,pumped. If it is of adequate size, we .aapprove the request can the basis of a refinance. if there are any further questionsr please contact this office at 254-4720, Sincerely, Robert C. .Pratt, R,SM Sanitarian RCP/ljh cc: Hedric B. Hanson 3300 Providence Drive #212 99504 December 9r 1977 Lomas and Nettleton Company 9449 Business Park Boulevard Anchorage, Alaska 996€3 Subject; Lot 3 Random eights Subdivision This department has no records of a sewer system. Therefore, the request for ;sgproval of the sewer and water facilities is denied at this time, Before approval may be granted the following must be accomplished. (1) Pump the tank todetermine its size, (2) Have a percolation teat rust to determine the adequacy of the seepage area. Sees handout, if the percolation test fails to meet the adequacy test, an upgrade will be necessary, Before any construction begins for the upgrade, a permit must be issued from this office. A soils test must be performed prior to the issuance of the permit, if there are any further questions, please contact this office at 264-47200 Sincerely, Robert C, Pratt r - R, S , Sanitarian RLP/lih Oct Hedar is B. Hanson 3300 Providence Derive #212 99504 - -