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DRAKE BLK 2 LT 8B
()rake Block 2 #017-461-06 Municipality of Anchorage ' I On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP141506 PID Number: 017-461-06 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Q Upgrade Name James Robinson ABSORPTION FIELD Site Address 12501 Gander St ❑ Deep Trench ❑ Wide Trench M Bed ❑ Mound ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 0 4 IT 4.0 Ft, LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 3.5 Ft. 0.5 Ft. Drake 2 88 Fill added above original grade Gravel length Township Range Section 0.0 Ft. 57 Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES 20 Ft. 5 4 Ft. To! Septic !Absorption ( Holding ; Sewer Total absorption area Number of trenches Dist. between trenches Tank Field 1 Lift Station From I Tank f Line 1140 Ft2 n/a n/a j Ft. Well 100'+ j 100'+ 1001+ 1 NA 25'+ TANK ❑ Septic 9 S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'+ 1 100'+ 100'+ I NA j Anchorage Tank 1250 Gal. I Material Number of compartments Lot Line ! 10'+ f 5'+ l St N NA A Steel j j 2 Foundation 10'+ j 10'+ 10'+ NA ? LIFT STATION Manufacturer Capacity Remarks y Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 A+ Home Services —ranield Installer dif- Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 100.0 ft Inspectiones: Location and description 1z' 5/14/15 2� 5/14/15 ption 31d — 4 —_— Garage Foundation Footing ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date �� OF. A� `�P' S� ` 4 --- — - ----_ ' �.- 9 -- --- ------ . 4 TI_i Septic System — -- --------- ---- ----- ---- -- >+ U r Approved 'M Date' Note: this approval does not include well permit requirements. 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BOX 1807 P,�L4ELLC 1C.I. 1088) R, AK 9645 OF 4 41 REVISIONS DATE 07/26/20 21 RECORD DRAWINGS PHONE (907) 745-8200 FAX (907) 745--8201 SCALE DRAKE BLOCK JAMES & SARAH 2 LOT 8B ROBINSON ... 11 ' Steven .... .. .... R Ponnone E -i1149 1 50' P.I.D. NO 017-461-06 DRAWN LJC PERMIT NO. SITE: 12501 GANDER STREET os 141506 !SHEET SITE PLAN ANCHORAGE, AK 99516 �' p ... I _ ft"111—al 1 3 OF 3 � iccncm-)O— = D '7 SOm T -i FTI O�E z r x;u m :2zwommmon �Dz�-v D ➢Or= z 0 =—{ r ;U 0 0 0 in O— m r —imzy o m c ;u r- z CE) m c/) z z O 0 C -i b0 D N % m r z C) m r r m D C) M Z � - — — - — - — - OC) w— w— m z GANDER STREET o my OBDr� U)Z— ZZrr-- — — ml' U)�rn ;z mm CSO (n -Tl m 0 z r �—'NCn 00 <m. Z00 _ _ _ _ _ T m z T cn A � III i II III _ SII M M M�M_ M n 1I II III CA, 1n (/) WTI OD M\ I I 1 11 M M`\M"O;D 2j_ ii 1 it I� a14, /ice / I "m` I moi„ F— m 1 0 / m (O C m i I- , > r- r 6ti' m � I �- g m i' 00 Z. t C �m ICD cDn r m t 7 -------------- - x _ .—10Util Esmt' —_ -- - --- 31 1 )75327.\bdf NOTES: PANNONE ENG SVC LLC 1C.1. 1088) RECORD DRAWINGS P.O. BOX 1807 PALM, AK 9645 PHONE (907) 745-8200 FAX (907) 745-8201 = DRAKE BLOCK 2 LOT 8B DRAWN L.JC JAMES & SARAH ROBINSON SITE:12501 GANDER STREET SITE PLAN ANCHORAGE, AK 99516 t -I cn K (n D Cn -u -I Z -D OJcn-C�10mD0� 0 Ic -ir-m zv m— z• DX O r D� nim y m (n m� m .. ��OD DNO � G7 N Z _ Do o m x0 � Cn -P W fl) O m Cn 0 U) 0 K:,o P i (r{I �o�, m�� o 1 n cn rn O N Cn C71 Cn P Cn W J N D W W J N J (A N W C,.i -P -P -A W N N O) .A O) p N (1) 00 cu O Cn Cn W W c0 N W m � C� -P Cn -P - m D C) M Z � - — — - — - — - OC) w— w— m z GANDER STREET o my OBDr� U)Z— ZZrr-- — — ml' U)�rn ;z mm CSO (n -Tl m 0 z r �—'NCn 00 <m. Z00 _ _ _ _ _ T m z T cn A � III i II III _ SII M M M�M_ M n 1I II III CA, 1n (/) WTI OD M\ I I 1 11 M M`\M"O;D 2j_ ii 1 it I� a14, /ice / I "m` I moi„ F— m 1 0 / m (O C m i I- , > r- r 6ti' m � I �- g m i' 00 Z. t C �m ICD cDn r m t 7 -------------- - x _ .—10Util Esmt' —_ -- - --- 31 1 )75327.\bdf NOTES: PANNONE ENG SVC LLC 1C.1. 1088) RECORD DRAWINGS P.O. BOX 1807 PALM, AK 9645 PHONE (907) 745-8200 FAX (907) 745-8201 = DRAKE BLOCK 2 LOT 8B DRAWN L.JC JAMES & SARAH ROBINSON SITE:12501 GANDER STREET SITE PLAN ANCHORAGE, AK 99516 t -I cn K (n D Cn -u -I Z -D OJcn-C�10mD0� 0 Ic -ir-m zv m— z• DX O r D� nim y m (n m� m .. ��OD DNO � G7 �O m0 —1m—, 0 cf) D Z _ Do o m x0 � cnfT)=,0 (0N �NmUl cliccn OOW O m Cn 0 U) 0 K:,o P i p �o�, m�� o 1 rn O U) I I Z I O N Z 0 D m K x 0 cn < J O x = D o I z cn m 0 0 x �a D 0 CE. DF A�q REVISIONS UAIL 07/26/2021 08/06/2021 SCALE 1" = 50' P.I.D. NO 017-461-06 PERMIT NO. OSP 141506 SHEET 2 OF 3 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: OSP141506 Tax Code Number: 01746106000 Work Type: Septic Upgrade Permit Effective Dates: December 10, 2014 to December 10, 2015 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: DRAKE Site Legal Address: DRAKE BILK 2 LT 8B G:2834 Owner/Address: ROBINSON RAFAEL JAMES & SARAH JANE 12501 GANDER STREET ANCHORAGE AK 995162718 Site Mailing Address: 12501 GANDER ST, Anchorage This permit is for the construction of: Lot Size in Sq Ft: 28500 Total Bedrooms: 3 Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received I Issued By: Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.or_q/Onsite Development Services Division On -Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP141523 COSA#: Permit#:OSP141506 PID#: 017-461.06 Legal Description: Drake, Block 2, Lot 813 Engineer: PES Applicant: James & Sarah Robinson Your request for a waiver of the required 15 feet maximum drainfield bed width has been approved. The approved maximum bed width is 20.0 feet. This waiver approval applies to the proposed drainfield 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 non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ................................................•.............................1 Waiver is Granted: X Waiver is not Granted: Date: Id d Approved by. C/ Name of Reviewer ...............................................•.............................1 MUNICIPALITY OF ANCHORAGE � q�r Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 017-461-06 Property owner(s) James & Sarah Robinson Mailing address 12501 Gander Street, Anchorage, AK 99516 Day phone Site address 12501 Gander Street Legal description (Sub'd., Block & Lot) Drake, Block 2, Lot 813 Legal description (Township, Range & Section) Lot Size 28,500 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑X (D)Multiple ❑ Holding Tank ❑ Renewal F-1Duplex Privy ❑ s Dwellings ❑ 44-3;. ( (SF and/or D) Private Well ❑ , Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: ao< Red tVi(1 � Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 9A Date of Payment: (I - I� _ N C h= Receipt Number: Oq`735 F Permit No. Ot>?Ici 15b�_ Permit App__- ::'_c Waiver Fees: 2tS Date of Payment: 12-1101 t y Receipt Number: 060kc() 6 Waiver No. loSpl�-%/Sw Pannone Engineering Services etc Steven R. Pannone, Principal Registered Professional Engineer E-mail: steveCc)panengak.com November 11, 2014 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P. O. Box 196650 Anchorage, Alaska 99519 Subject: Drake, Block 2, Lot 8B Septic System Upgrade Permit Request Ladies and Gentlemen: I am writing to request a permit to install a well and septic system be issued for this property. The proposed systems will serve an existing three (3) bedroom house. Currently the lot is developed. The existing system is in failure and will be re -used as a reserve. The existing tank will be verified and if it is perforated it will be replaced with a 1250g S.T.E.P. tank, if it is in good condition a 500g lift station will be added. A new drain field will be installed in the northwestern corner of the lot. The developed surrounding lots are also served by private wells. There are no wells within 100' of this system. Soils. Pannone Engineering performed one test hole on this lot in October of 2014, and groundwater was monitored for seven days. Ground water was observed at a depth of 9.0 feet below the ground elevation in the test hole monitor tube. It is my opinion, based on the results of the soils tests and overall soils appearance; an application rate of 0.4 gallons/day/square feet should be used for a conventional wastewater system. 1. Soil Absorption System Design. a. See Sheet 2 of the design package. 2. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: The proposed drain field is located on the northwestern corner of the lot. The surrounding topography generally slopes from east to west and is flat in the area of the drain field installation. There are no steep slopes within 50 feet of the proposed drain field. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 4. 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. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com December 08, 2014 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, Alaska 99519 Subject: Drake, Block 2, Lot 8B Bed Width Waiver Ladies and Gentlemen: 1. Bed Width Waiver: I request a waiver to the code requiring a maximum bed width of fifteen feet (15') to a width of twenty feet (20'). Due to well radii and the lot line, it is not possible to achieve the required square footage with a standard width. This is a pressurized system, which will ensure even distribution throughout the wider field. The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 DRAIN FIELD !P� BED- 20'W x 5 -LF x 0.5'ED x 4-0'TF) SAND TO REPLACE REMOVED DRAIN FIELD ABANDONED DP.A.IN FIELD (E) REMOVE AS NECESSARY FOR CONSTRUCTION OF NEW FIELD, AND REPLACE WITH FILTER SAND - TH-i J I WELL (E) 1 CO. 6 UTILITY E-.SE�MENN�T ss rN� I - I ss REMOVE PREVIOUSLY ABANDONED ss ss SEPTIC TANK (E; IF IT IS ENCOUNTERED Y :"JITHIN 5 OF PROPOSED DRAIN FIELD. REPLACE FAITH FILTER SAND. 1 DRIVEWAY `�ISE_ wTxmaypL01 UB—w < J W } DF. -1N FIELD ; L. I a FAILUREE , 1 x I r RE USE AS RESERVE 1C0Oa SEPTIC TANK (E) S'ERIFY INTEGRITY AND REPLACE WITH I 12508 SLEEP- TANK (P) IF FOUND TO BE LEAKING. IF TANK (E) IS IN GOOD CONDITION `DD 5008 LIFT STATION (P; `< 111 i I PA T �hELL (E; WELL (E) J W—� W � Vu' NOTES PANNONE ENG SVC LLC_��oF A �kDote FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 S �qS�l� 2T8T1a PHONE (907) 272-8218 FAX (907) 272-8211 Scale j * .49 * �� DRAKE, BLOCK 2, LOT 8B I ........ ..:.......--� a1-aei-as JAMES &SARAH ROBINSON Ste,ien R Pannone j PERMIT No. 2501 GANDER STREET ��' CE 81ae �� oSP1415oe PLAN ANCHORAGE, AD 99H16 OF 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS AND ATTACHED SPECIAL PROVISOES 2. SCOPE OF WORK. REMOVE PREVIOUSLY ABANDONED DRAIN FIELD AS NECESSARY TO INSTALL NEW DRAIN FIELD. INSTALL NEW DRAIN FIELD. VERIFY CONDITION OF EXISTING TANK AND REPLACE WITH 125Og S.T.E.P_ TANK IF FOUND TO BE LEAKING. AND 5009 LIFT STATION IF TANK IS FOUND TO BE IN TACT. 3_ GROUNDWATER WAS ENCOU IFTERED AT A DEPTH OF 9 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE- IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 9 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. FILTER FABRIC 4' RIGID INSULATION TH-I _1 n OR 3 5 J -J J.D c 4 -110 SECTION 125" a PERF PIPE N/ Ys" HOLES DRILLED 13" O.C- ROCK `o" ABOVE PIPF INV DRAIN ROCK. -E ANY REMOVED PART OF OLD FIELD WITH FILTER SAND 1250a STP. TANK (P) OR I000a_ SEPTIC TANK (E; W/ 5009 LIFT STATION (P) DESIGN P;^;RANIETE,RS PRIMARY SEPTIC SYSTEM NO. BEDROOM_ ? (450 gpd; TANK SIZE: 1000g (E) PERC RATE 20 MPI SOIL RATING. -4 SPD/ --_F AREA ROD: 1 125 SF SYS. TYPE BED 20'Nr MIN LENGTH. 5o.2h LF USE: 57 LFx20.0''AxO.5' E.D., 4.0TD TOTAL AREA: 1 .1 40 SF PROFILE TPtNCH SEE DESGN LEpi END W (NATER LINE/ WELL R„ DIUS — SS NEW SEPTIC E ANY REMOVED PART OF OLD FIELD WITH FILTER SAND ABBRE`dIAI.TIONS S_ COPPER DIP w z TEST HOLE FC m m F - 1 o 0 z o w m co MONITOR TUBE N0. p I RIGiG INSULATION DCO z DV 10 � za w BFG z z LLw w FG e o n In NO n n 1250a STP. TANK (P) OR I000a_ SEPTIC TANK (E; W/ 5009 LIFT STATION (P) DESIGN P;^;RANIETE,RS PRIMARY SEPTIC SYSTEM NO. BEDROOM_ ? (450 gpd; TANK SIZE: 1000g (E) PERC RATE 20 MPI SOIL RATING. -4 SPD/ --_F AREA ROD: 1 125 SF SYS. TYPE BED 20'Nr MIN LENGTH. 5o.2h LF USE: 57 LFx20.0''AxO.5' E.D., 4.0TD TOTAL AREA: 1 .1 40 SF PROFILE TPtNCH SEE DESGN LEpi END W (NATER LINE/ WELL R„ DIUS — SS NEW SEPTIC E ANY REMOVED PART OF OLD FIELD WITH FILTER SAND ABBRE`dIAI.TIONS S_ COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION GLEAN OUT T# TANK CLEAN OUT N0, C# C --LEAN OUT N0. M# MONITOR TUBE N0. p I RIGiG INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER, BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL AND VEGETATE NO NOT IN CONTRACT NOTES- PANNONE L'7�T/'1 SVC, 7 7 !'1 _�. �� � A�� Date FOR CONSTRUCTION P.O. BOX 1110``01122117 ANCHORAGE, AK 99510''..�qs��) 12/8/14 PHONE (907) 272-8218 FAX (907) 272-8211scaNTs .... ..� I P.LD. NO DRAKE, BLOCK 2, LOT 80 047-461—os -� ..Steven R 'F�� ^. JAMES & SARAH ROBINSON / PFRMIr No. 9F'. CE 8149 /� OSP141506 12501 GANDER STREET ( s. ,� DESIGN DETAILS ANCHORAGE AK 99516 ��11SA- p' ..''V��� meet l Ro ssio� s 2 OF 3 TEST HOLE 1 SOILS LOG - PERCOLATION TEST SLOPE / SITE PLAN OR ORGANICS 1 WELL 2 3 GW SILTY GRAVEL .I SM ANDSAND I 4 _ I TH-1 _ 10' UTILIT 5 �M s Ix T TH X _ GM/ SILTY GRAVEL - /M 8 SM AND SAND DRIVE§VAY 9 w ni w 3BR •I o — 1117114HOUSEX\ ,E; L0f 11 BOH 12 Q 13 WAS GROUND WATER SLOPE 14 ENCOUNTERED? Y 15 IF YES, AT WHAT TH 16 DEPTH? -10.0' x 17 DEPTH TO WATER AFTER MONITORING? -9.0' 18 DATE: 11/7114 19 DATE PERFORMED: 10/28/14 PEROLATION RATE 29 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 5.5 FT AND 6.5 FT COMMENTS: Test hole excavated by A+ HOME SERVICES. Prec hole was presoaked Test run for at least one hour. Last 3 readings reported PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES PANNONE ENG SVC, LLC _` O � Date FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 (� ��' ��qS�l) 12/8/1' r gyp:. Scale PHONE (907) 272-8218 FAX (907) 272-8211 �rq_� y j J." *: 49 TH ,t l) NTS �.. P_DN—DN O DRAKE, BLOCK 2, LOT 8B on-asl-as JAMES & SARAH ROBINSON Steven R. Pannone j PERMIT NO. 2501 GANDER STREET CE a14O OSP1a15o6 ANCHORAGE, AK 89516 �� rFRF''% Sheet SOILS LOG 11��OJSO�C' 3 OF 3 `tom READING DATE CLOCK TIME NET TIME WATER LEVEL READING NET DROP I � 10128/14 10:25 .-- 6.95 --- 2 10:55 30 MIN 8.01 1.06 3 ' 10:55 --- 6.95 --- n 11:25 30 MIN 8.00 1.05 5 11:25 --- 6.95 --- e 11:55 30 MIN 7.98 1.03 Municipality of Anchorage page I of Z- DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION ��j ',9 P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: S-Wg96295" PID Number: 0/74(p/06 Name: Wastewater System: ❑ New Upgrade 2 GE,Z Address: ZSDI A�u R STRCEr ..ABSORPTION FIELD •PHepe: gq�yG3 f Bedrooms: To, ❑ Deep Trench ❑ Shallow Trench )f Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: 4.7 GPD/S . Ft. 7' Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe AB 2— &6KT S A 2.SFt. S Ft. Township: Range: Section: Fill added above original grade: Gravel length: AS — AP Ft. y3 Ft. WELL: El New C-1Upgrade Gravel width: Number of lines: Distance between lines: /s Ft. 3 41.6- Ft. Classification (Private, A,B,C):6-W /ST'. Total Depth: Cased To: Total absorption area: Pipe material: FP/0 )DC-ARP / V,4 r6. Ft. Ft. SQ. Ft. ST/n A3034 Ta V.G. Driller: Date Drilled: Static Water Level: Installer: Date Installed: Ft. % EED CX CAVA T/NG - 2 Cv - 91q Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCESSeptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines A,,jC ;P,,4o - T,4A;K /DOO WeII //d >'37 2S ,t Material: .S7-EEL Number of Compartments: 2. ce Wate e goo 't /oo ' +- LIFT STATION Lot30 Size in gallons: Manufacturer: Line Foundation 9 r 2Z r "Pump on" level at: "Pum evel at: High water alarm at: Curtain ND KAJ AIN Pump Meke Electrical Inspections performed by: Drain Remarks: 41 se,-7na .��C� rl�' BENCH MARK Location and Description: &n — Top of ,V7' oRc.,A� Nr GbDIZ Assumed Elevation: 100.60 FL ENGINEER'S SEAL F f Sf S & S ENGINEERING 17034 Eagle River Loop Road, No. 204 Inspections performed by: Raab Rlysr,Alaska 99577 Dates: 1St P-24 2nd Department of Healt uman ices appr val �a ° "a Reviewed and approved by: Date: 72-013 (Rev. 9/91) MOA 25 Permit NoSW940295 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 - Anchorage, Alaska 99519-6650 *Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Descriptiop�AKE SUBDIVISION, BLOCK 2, LOT 8B PID No.: 01746106 95.9'—/ 1000 GAL 95.7' SEPTIC ABSORPTION TANK .........................................:..........................................:....................... N.T.S. ................ A B FCO 39.0 28.0 C01 36.0 35.5 CO2 32.5 41.0 CO3 43.0 514.0 C04 37.0 83.0 .2 MT1 36.0 43.0 _.. _...... ::....: MT2 27.0 80.0 __^___1Q' UTIL ESMT_____ I LOT 83 —X — i ji DRIVE B �— LLJ N9W 1000 GAL SEPTIC TANK LLJ ANEW ABSORPTION I—BED ............... .%................. ................ ..............r.... .....is �I LLJ +I 1 1 o Z. .2 SCALE 1" = 40' 72-013 A (1/93) . X: FE'NCE......... ... . COt.... .. ...i ..................................................... ............... ................................... X .. ...X ... .........: CO2 Z (�' W COLS �G Y :X W� w A EN ►6 AL -0�s 100' WELL RADIUS ° 3� .:,:. .......1:�0.�...��1'�£`rt+L....ttiA•lfl�U�r-7.... ... .. .. ..... ... —.: � fl: v, ,N -r> V PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940295 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:DORE DOROTHY A & OWNER ADDRESS:5300 E. 4TH UNIT 202 ANCHORAGE, AK 99508 PARCEL ID:01746106 LEGAL DESCRIPTION: DRAKE BLK 2 LT 8B LOT SIZE: 28500 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 8/17/94 EXPIRATION DATE: 8/17/95 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) . 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. QPPrTAT. VPnVISIONS RECEIVED ISSUED BY: BY: ��DATE: I DATE: �� U ,p HEALTH AUTHORITY APPROVALS August 06, 1994 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 STRUCTURAL & l/ MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN jk 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street SEWER & WATER P.O. BOX 196650 MAIN EXTENSIONS Anchorage, Alaska 99519-6650 SEWER WATER INSPECTION REFERENCE: Drake Subdivision; Block 2; Lot 8B ENGINEERING STUDIES Request you issue a permit to upgrade the septic system serving the AND REPORTS three bedroom house on the referenced property. An adequacy test performed on the existing system for Health Authority Approval purposes found the absorption capacity of the existing system WELL INSPECTION to be inadequate. & FLOW TEST A test hole was excavated and a percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. At the time of excavation water was SITE PLANS encountered at 8 feet and after seven day ground water monitoring water was found at 0 feet. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring properties by ROAD DESIGN the installation of the proposed septic system. If you have any questions, or require additional information for your review, pleas contact us. SOIL TEST Sinc ely, PERCOLATION TEST e, t A. afer, P.E. STRUCTURAL & l/ MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN jk 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 �► • 4 s z _ gT0 CY o rn O • O ESO �o I I Aq.Y4 a La O w d' > Orr°��^ d '�! '�o` �wQ W i�� O�zj �� ns�o 4� SOW a-M O �Lx O�W 00 0 C15 z YJ o_ .v'w ' � fit fn 1 } Lr) to � Or to 0 Z (n Z Ex.., a iS a i 8 °• n o Q H Z 't W Z- ��- 4F5- O 0 CD' '•w, .. C�a� O� IIoII �J(0 J� il2W E- Ra�� •5 �4° w�QJ��Z oW]a w z ... �- �ziaWm� c1. W J 0= Y � O N\ Q 0 om�� W 0°oaLn W ^ZvaizoN�, ��o v 0 c->oa3 Q M(AV �v I.1. z Or �O oz O W Z U-0 I m3 QQf 00 =O ��a aN Zoo 00 p 0Q U�(n� � Z`'�°}°} �z O �aZW �S J OZ3> Oo. �-W� N z V a (n mt-W=mz� Cl wcn>U Ij Nwa O Q atn�� 0 Lj 00 m F- �wa0Z J } F- Z Q =om =�w� Y Uzi H�Z�00 U MOQ N>IQ-ZLd M 0 mo w w 0 Q Qry Z w Q WCnc � J Z J � qa prig W w 0 Iz 4�' --_,O Z Q�� (yg' : A. v� wo 133HIS d34Nd0 s a�Q arc mmow wa Z--�------G�—Z W U 3ltlOS 3civaodn ,05 = „l • I U� x U x � E, wI oao snox oul,�slxs � x I� -- x — x —�. OI V � w 10' UTIL ESMT x �x ,LiKS� 'IIJ.Il .OZ I -- Of -- x—x—x—x---� I 112i�H W� � � �w x I � x U I � � I a � E- C) m x— —x— x —x x � Y WI H U C5 O o � x E- -� 3H5 O I N030 a� oE~ � z �sno ~� H �� ��Z ` IK2IQH 1; aF • I ��� NI,LSIX� �w � ovw,�a w I z � P,G� � � �—X U o p'�ti'� I oww w W 030 -- OF,o .-i U I m J N 4� -- �- � Uz W 1 0�¢ � Z �o � I- 1 p0 a" I dcnvai A zm - - �R�, �W4 m -� _o e Municipality of Anchorage • ° ®.fir DEPARTMENT OF HEALTH & HUMAN SERVICES ,3 °tai 825 "L" Street, Anchorage, Alaska 99502-0650 °R . • ua�r «•�+ •• • SOILS LOG — PERCOLATION TEST •,., �•••.v.<.v..,.mvs.a•a 'fiaw A. show 143741 PERFORMED FOR: &4lA1N &tDr.ILICKWS71 • �r�IC— S` � DA RF R % k" _ LEGAL DESCRIPTION: S& i 7� )�iOQTownship, Range, Section: SLOPE SITE PLAN pFP Oi2G. 1 UI?Cs/SIC C, 2 / L DI�Fo a- 1--r 3 L4-T7cF 61L Nit, &4w --t SU6I9 SA.wD. 4 5 6 7 sw — '� i �e �• 10 11 5�2I, nwruv S�vv Lovsr L, r M11- a SILT• WAS GROUND WATER ENCOUNTERED? �I111�1�� 13 14 15 16 17 18 19 IF YES, AT WHAT DEPTH? Depth to Water After C� 1 Monitoring? !J r.s S o O P �/ ,,c� q E Date: `V +�G ross Depth toTime Water 20 I PERCOLATION RATE _1- (minutes/inch) PERC HOLE DIAMETER uc I r TEST RUN BETWEEN 2 FT AND 2 FT COMMENTS �C)�[ t/«(/�L'Ct/ Las 5aE'a 0111mr�ER �i�• PERFORMED BY: I Z034 Paul- E alp. Rayer- R'mar I cap Rood No q 5 7� 904 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ARa#A!! AND1Uf hfbVAI7GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) b GREA IER ANCHORAGE AREA BORA.iGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 ^ �n INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME 33- N Mpa W OUC AAQ MAILING ADDRESS 345>0 1"At` IOu��l¢' PHONE LOCATION COYA&W LEGAL DESCRIPTION ~ SbrJ --) Sk,% - SEPTIC TANK: DISTANCE'` NUMBER OF FROM WELL W- MANUFACTURER SSI^ MATERIALS_�6—tr-9.COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH U LIQUID CAPACITY 0L) GALLONS. TTT " V TOTAL LENGTH DISTANCE FROM WELL �b �~ FOUNDATION RO NEAREST LOT LINEy OF LINES NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE 1 ABSORPTION AREA n�3aa �Q ��SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER r' l DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE 14 R) IN. ABOVE TILE WELL: 1 11 01"At J1" TYPE ONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION LOT LINE , SEWER LINE CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: a LOT SLOPE: �M uij REMARKS: Softs IOL Form EQ -032 SEPTIC TANK - 6 IN. DEPTH DISTANCE FROM: SEEPAGE SYSTEM_ DIAGRAM OF SYSTEM DATES I I , , APPROVED 144 - A.A.B. WWI �INA ���w 1-10- .1.0ILA K F1 RNA C; 1-1 ILA on! Ell twi kh� ` DE`HRTMENT ~- HEALTH AND ENVIRONMENTAL 825 STREET, ANCHORAGE, HK. Y 279-2511 L4 EE L. L. F4 P4 E> C) 01 :1 F.*�E t ---p [E-.: F;:! F-ri PERMIT NO ( 77367 ) '`� /' � � L` cvaQm c/- / / APPLICANT ]400 MOUNTAIN VIEW DR 99501 279-2589. LOCATION GANDER ----~ LEGAL L8002 DRAKE SUBD . LOT SIZE 22000 SQUARE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: DRHINFIELD MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= Ff FT ��f.*�::D 1-1 1:���� 100 THE REQUIRED SI SOIL ABSORPTION SYSTEM IS: � FOR ON-SITE SEWERS AND WELLS AS SET �� (^�p OF ANCHORAGE. r���/ `~ ^ 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE � =~ , E> EE F::', 0- F-1 on. �-l"' (3 FR FEE 1""l- 1-1= ill THAN ] BEDROOMS. -__- ---_ ' ' THE - LENGTH DIMENSION IS THE LENGTH (IN FEET) OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THE TRENCH WIDTH FOR DRHINFIELDS IS ] FEET. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ��CAtj 3c &EE*.':F."..'-m !.' -F` [1.*-:-,:: 1 0=1 P-4 '_�7."5; 1 E -E.."= ��,:-j G1 Ca C! F1 L. L. 0 PA� II -_,H .:)� 1: VA F'-',, FEE C0 -T- 1: (3 0-4"E� F;R R". FEE EE 9 H 1 F�'". E'.': H:::::: - BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAY.,.---'; OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F:" FEE F;? 1-1 1: -1- %P 1=1 1.. 1 E> FO KD FR C3 VA EE EF Ff FT ��f.*�::D 1-1 1:���� I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES, ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED:_AL� _ APPLICANT ISSUED BY �- ___________DHTE--�___-�_-__ SOILS LOG MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST Pouch 6650, Anchorage, Alaska 99502 276-2221 SOILS LOG - PERCOLATION TEST PERFORMED FOR: ! " 1 O.D t L1+R 4© /VI -5` Z7-77 G✓DATE PERFORMED: LEGAL DESCRIPTION: I—D / 8 -h B L.—. k 02, DEPTH / SLOPE SITE PLAN (FEET) 1 2 / 3-- 4 %.� 5 6 7 S Y 8 U G ry %1P -S P 9 _._.. 10- 11 WAS GROUND WATER L ENCOUNTERED) O 12 p d E / / L•• r IF YES, AT WHAT W 13— DEPTH? 14 15 Q `� 16- 17- 18- 19 6171819 Reading Date Gross Time Net Time Depth to Water Net Drop R 1 10- 11 WAS GROUND WATER L ENCOUNTERED) O 12 p d E / / L•• r IF YES, AT WHAT W 13— DEPTH? 14 15 Q `� 16- 17- 18- 19 6171819 Reading Date Gross Time Net Time Depth to Water Net Drop 20 PERCOLATION MATE TESTIUN BETWEEN COMMENTS EOC4-, ' PERFORMED BY: KA CERTIFIED BY: 72-008 (7/76) FT AND i• (minutes/inch) a FT �%&,PATE: t I WATER WELL LOG' . iG �� � � TICK FOSS DRILLING 1336 Ingra Street Anchorage, Alaska 99501 P 1W WELL OWNER,������,� USE OF WELL LOCATION Lnt %'� �� �n A .1� .� J r , ke , , .. �-, �% ;, �/' . < �� Yl SIZE OF CASING ' DEPTH OF HOLEILPT. CASED TO /'O'z FT. STATIC WATER LEVEL`. / FT. YIE r GAL.PER.MIN. WITH FEET OF DRAWDOWN. REMARKS DATE COMPLETED --(Q7 �PUMP TO BE SET AT A y Jat o� Lt o -C-10 cf-2t oY20 rear 25 21 03:44p Anchorage Tal( & Pump Ser 9072430742 p.1 Development Services Department Phone: 907-343-190 On -Site Water & Wastewater Section Fax: 907-343-7997 `r-F"ell Drilling Permit Number - Date of Issue: Parcel Identification Number: Legal Description Block Lot Property Owner Name & address: � a -R 0- �:G'r•�..tn.. �I"2�.©vim. Pump Iustatiatier. Bate: _�_- Z `y - Z t Pump Intake Depth Below Tap oM+eil Casing: SY feet Puanp Manufacturer's lsa e: Fairaap 1�1Ec,de1:._._'? 5L � �....- Pump Size: Dap Pitless .adapter Burial Depth: i5 feet PRIM Adaliter Manufacturer's Name:A, �bt�,�� Pitless Adapter Instailer: 'Well Disinfected Upon Con, tion? —I 1,`e; Ea No Metbod oMsiufettion: Pump Instatter'_mame: _ ANCHORAGE WELL& PUMP SERVICE 7640 Ki rig Street Colaapan'': _ _ Ar•chorjoe, AK 99SIS Ph: (907)243.0740 ;Mailing Address: City: State: Attention. The pump installer shall provide a puma installation log 10 Gn-site Witt;tn 30 dal;s of p,UY2 t :rs=11ation. ANCHORAGE MUMCIPALRITY OF Development Services Department �.``�==°'' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approva Parcel I.D. 017-461-06 1. GENERAL INFORMATION Complete legal description Drake Block 2 Lot 8B Location (site address) 12501 Gander Street Current property owners) James & Sarah Robinson Mailing address Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System Waiver request for: Received by: Expiration Date: NOV I , aoa 1 Day phone Day phone TYPE OF WASTEWATER DISPOSAL: 0 Private Septic 0 ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 650 Date of Payment Receipt Number 0951" i G COSA# 05c,21jy Date: Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE Phone (907) 745-8200 Datetz- 2�©a OF aLgs s� 4.a System #1 Approved for \""` y pp .3 bedrooms 5ie�.er: , onnone System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: Rrrrnna lll�h�, By: - ` 1�C.(�C'A (AIJJ L, T? 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 Other COSA Checklist blue sheet COSA Checklist Legal Description: Drake Block 2 Lot 8B Parcel ID: 017-461-06 If more than 1 septic system on lot: COSA Checklist # 1 of 2 Structure served by this system 1 A. WELL DATA OR Well log is filed with Onsite (or attached) Date drilled °` I,'11" Total depth 66 ft Cased to 66 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 21 in. Date of flow test for COSA 0`11 a 2' Static water level at beginning of test 27.0 ft. Comments B. TANK DATA Age of tank(s) 6 years Tank type/material Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping 7/12/2021 D. ABSORPTION FIELD DATA Bed System Well production at time of test 3.03 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 8.07 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by PES Date of Sample °02t C. LIFT STATION ❑ Required maintenance completed Age of lift station 7 years Lift station material Steel Comments: 7/06/2021 Which system tested (date installbd) �5 Adequacy test date '7""22, ❑ ALL standpipes present per record4dr22awing Results C]✓ Pass For 3 bedrooms Total measured depth from grade3t5 - 7° (ma Fluid depth prior to test 0 in Measured depth to pipe invert from grade ft (min) Water added 450 gal On N/A — pressurized field 2 ❑ Monitor tubes go to bottom of effective. If not, state New depth in 120 depth into effective Elapsed time min ❑ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) _ Gallons introduced gallons..;,., If yes, enter date Comments/Deficiencies: SWITCHED TO FIELD ON 06/28/21 / c; -_Cf COSA Checklist yellow sheet E. SEPARATION DISTANCES ljtj Yes if No ft Wells on Adjacent Lots: From Private Well on Lot to: (Please enter distances if less than required or if community well) ft Septic Tank/Lift Station on Lot > 100' Water Main > 10' Q Yes Community Sewer Manhole/Cleanout > 100' M Yes if No ft rV1 Yes if No Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25'F/1 Yes if No Absorption Field on Lot > 100' r -v-1 Yes if No ft Holding Tank > 100' ❑✓ Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' [❑✓ Yes if No F✓ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75'Mv Yes if No ft n Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q Yes if No ft Surface Water > 100' ft ft ft ft ft Q Yes if No ft Property Line > 5 ljtj Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' P Yes if No ft Private Wells > 100' n Yes if No Water Main > 10' Q Yes if No ft Community Wells > 200' 0 Yes if No Water Service Line > 10' Q 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' El Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' 0 Yes if No ft Community Wells > 200' El Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS Switched on Field 6/28/2021 G. ENGINEER'S CERTIFICATION l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. COSA Checklist yellow sheet OF A��S�� ;• TH 9 J tei F crr�ior << p ICE 814 . s ft ft ft ft MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Nitrate Advisory Certificate of On‐Site Systems Approval # OSC211433 Subdivision: Drake, Block: 2, Lot: 8B A water sample revealed a nitrate concentration of 8.07 milligrams per liter (mg/L). 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. Since nitrates are known to slowly increase, we recommend you monitor the water quality. 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. Lift Station/Pump Vault Owner Sore Street Address 1,2so6 caanc p, - Phone LegaiDesc- PID -Sludge level InG les -Pumping: required10 Pumping completed sifts ti�a -Pump basket cleaned �,n a -Effluent filter cleaned -Control floats cleaner -Proper float settings confirmed /Q` -Operation satisfactor) *,,L -nn -Dedicated electrical a arm Circuit ytT.%-np- -Audible and visual alarm inside dwelling no .c -Alan-n system operati, in not satisltofy Manhole-Risar -Ground water intrusic i at riser to tank cormection 5_o, -Ground water intrusic,l around pipe penetrations -Weep hole functional -Manhole lid: Furyoti:)nal Insulated Properly Secured (gjy� othe -All manufacturer requ ioad inspections and maintenance completed yes - n omments_,. Mai tenance prayid;r'. Technician Company 4�M42 C,�OC,_ Signature Date of rnaintenancelZ� I Date L MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES.., 19 Division of Environmental Services On -Site Services Section P.O. Box 196650. Anchorage, Alaska 99519-6650 343-4744- CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING:' Parcel I.D. # of 7 _q( V �� HAA #t"� i� 9 4- 4 4� 7 1. GENERAL INFORMATION Complete legal description Lot 813;,.8-eock 2; Dnafie. SubdiWAion 11 . :itl kit ti'; Location (site address or directions) 12501 Ganders StAeet Anchorage, AK 99516 Property owner Roger. watker Day phone 345-2045 Mailing address 12501 Ganders St. Anchorage, AK 99516 Lending agency Day phone Mailing address Agent Bir i.an Broderick/ VISTA REAL ESTATE Day phone 273-7261 Address 4241 "B" StAeet Anchorage, AK 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 NOTE: If community well system, provide written confirmation from'State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system." 72-025(Rev.1/91) Front MOAN21 5. . STATEMENT OF INSPECTION BY ENGINEER A By: As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe; functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone/.-, 2�l Address Engineer' DHHS I vnr. Approved for Disapproved. — bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or. analyze. data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.,,,,-.,,, „ 72-M (Rev.1/91) Back MOA M21 Municipality of Anchorage Department of Health and Human Services am HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L212AKE" SD&D, , ,&ocK 220 Lor PS Parcel I.D. Oi 7y (o /Olo A. Well Data / Well type PR/V,47Z= If A, B, or C, attach ADEC letter. ADEC water system number 14( 4 Log present (Y® /Jo Date completed !0%2/77 Driller /=ass DA2ie-i-146- Total depth (oco' Cased to (o(o ' Casing height u/K Sanitary seal &N) Vas Date of sample: Wires properly protected N) V6S Collected by: S S EcJG/,l1EElZ /�� FROM WELL LOG AT INSPECTION Date of test i. -d2- 77 -7 I?/q`i �p �, c Static water level /8 /Z ` ''1 rri Well flow + p.m. g.p. ' p r o Pump levels G�f cJITK rn _ C_J N SEPARATION DISTANCES FROM WELL TO: Z Se tic/ p tank on lot iiD ' ; On adjacent lots+ - Absorption field on lot 137' ; On adjacent lots ioy '-r- Public sewer main ZS Public sewer manhole/cleanout Sewer service line id 11 Petroleum tank /V//9 WATER SAMPLE RESULTS: Coliform Q Co /on y Nitrate Z/,/ Mh 14 Other bacteria Date of sample: 71171-341 Collected by: S S EcJG/,l1EElZ /�� B. SEPTIC/TANK DATA Date installed 126 / 9 y Tank size i 000 6::,4z_ , Compartments Z Cieanouts &N)yEs Foundation cleanout q) YES Depression (YQ AJo High water alarm (Yo iUv ,xJ/4 Alarm tested (Y© AJo /J,/ -t9 Date of pumping �%/4 N &-w 7--&,--j k- Pumper � Z,!2 SEPARATION DISTANCES FROM'SEPTIC/TANK TO: Well(s) on lot iso ' On adjacent lots /4,0 Foundation 9' To property line 30' Absorption field 3' Water main/service line i0' Surface water/drainage 72.026 (amt)• Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Acres ) Vent (Y/N) "Pump on" level "Pump off" Level at High water alarm level s tested Meets MOA electrical codes (Y/N) SEPARATIO�DISTA ROM LIFT STATION TO: Well On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed P -26 -4y Soil rating (GPD/Ft2) 0. 7 System type .4&5'oR?1 4AJ S Length Z13' Width i<S' Gravel thickness . 6-' Total depth 7 Total absorption area Lo Lib Cleanout present YON) VUS Depression over field (Yd ii c _ Date of adequacy test )j,JA- .sYsTEm Results (pass/fail) ,A.�I/4- for ,v/Bedrooms Water level in absorption field before test A)LI= After test NZ,!E Peroxide treatment (past 12 months) (Y&) No �J/4: If yes, give date /J1Z A - SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /.37' On adjacent lots / S'li ' -'- Property line /01 To building foundation 22 ' To existing or abandoned system on lot � 6- ' J -- On On adjacent lots Td 1 +- Cutbank /J /,4 Water main/service line Surface water i 0,0 ' t Driveway, parking/vehicle storage area /P Curtain drain 0-4� ,i omo x w wA) E. ENGINEER'S CERTIFICATION 1 certify that l have checked, verified, or conformed to au Signature 17034 Eagle Ri p R!�d No. 204 Engineer's Name._ Date 7�1 HAA Fee $ Date of Payment 9—e -J Receipt Number 72-026 (3/93)' Back and HAA guidelines in Waiver Fee $ inspection. Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Dater;�;'.'� (a) Legal �Description /(include lo/t, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name L, ,ei& 'I le hone Applicants Address APP 2 _/ � O / � � (c) Applicant is (check one) Lending Institution;ilder /bu; Buyer Other (explain): (d) Lending Institution l', kj �7?e�t�,9i� Telephone Address (e) Real Estate Co. & Agent��S:n Address Telephone 2 . Type of Residence Single -Family _ Multi -Family Other (describe) Number of Bedrooms 3. Water Supply Individual Well M Community � Public Note: If cannunity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Is the well adequate for the number of bedroans specified in this HAN 62) 4. Sewage Disposal Onsite M Public � Community (:::I Holding Tank Is the wastewater disposal system adequate for the number of bedrocros fZX (Page 1 of 21 2-15-84 5. Engineering Firm Providing Inspections, Tests, Data and Information a I certify that I have checked, verified, or conformed to all MDA HAA Guidelines in effect on the date of this inspection. Signed Date Datej,� Name of Firm i-'!.., i Telephone - 44 Address 12,i& S igned by d J qt Date ,/ `i Aviv Op %V 0 �Ni s s �+��ti, • .••.10•..M i•Qz � . sz3�•E ,.� �� .� 6.DHEP Approval 1 FO P , AW rAkk-4 t- be- 0(? (-i'Cec % t.rt. tLe4 bue— ®t�°a�. Approved for bedrooDate z s - Approved � Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Environmental. Protection does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, basgd on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedroom and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: KB2/d5/s (Page 2 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 1(7 Type of System Design^C/tE� Date Installed Ca / W Z 22 -K Length of Field ��(Q Width of Field L E3 i n I Depth of Field l Gravel Bed ThicknessQ Square Feet of Absorption Area & Standpipes Present ON) Depression over Field (& Date of Last Adequacy Zest Results of Last Adequacy Zest -1VP e; Separation Distance from Absorption Field: To Water -Supply Well 100 To Property Line �� l To Building Foundation 2- To Existing or Abandoned System on Lot N / /+ ; On Adjoining Lots (,,f v, n 4A&Aer To Water Main/Service Line To Cutbank(if present) To Stream/Pond/Lake/or Major Dr inage Course To Driveway, Parking Area, cr V hicle Storage Area me Comnts _ -f- - b�Af 1 f f" f l3 D. LIFT STATION � / 'A Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes Comments ;1:061-eO-/f f" Level at Vent (Y/N) Cycles during Adequacy 'lest. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed Date ��Z�l� ,.r' •e•��f„� �e� Company MOA No.8y D71 f 4 RS KBl /d5/s ..... ... •s 4 I C. Reid, J ,�*.` �t e�f►*•, o. 2251 •R a • • •O 0..e eNau• 4 [Page 2 of 21 t�9F p 2-15-84 ALASKA CI(UIR0WnTAL COnTROL S6I40, InC. Enqineerinq & Enuironmental Studies JULY 2 1984 LINDA ZIPAY 12501 GANDER ANCHORAGE AK SELLER - RUSS GRAVES BUYER - LARRY & MARJORIE WILKINSON SUBDIVISION - DRAKE BLOCK - 2 LOT - 8B ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 528 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING(450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 455 -GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS POTABLE FOR A 3 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON6/28/84 THE WELL FLOW RATE W04 3.6 GPM AOR 3.5 HOURS. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 XS ADEQUATE FOR THIS 3 BEDROOM HOUSE. 1200 West 33rd Auenue, Suite B • Anchoraqe, Alaska 99503 • (901) 561-5040 ALASKA 61idIROMMAL COMOL S66US, InC. Enqineerinq & Enuironmental Studies July 19, 1984 Department of Health and Environmental Protection 825 L Street Anchorage, Alaska. 99503 Attention: Keith Bandt Legal: Drake Subdivision, Lot 8B, Block 2 Dear Keith, On July 16, 1984 I observed that the condition has been met for Lot 8B, Block 2, Drake Subdivision. All standpipes were vertical, capped and at least 1' above ground level as per the Muncipality of Anchorage regulations. If you have any questions, please feel free to call our office. IM/caj Sincerely, Robert Weimer Engineering Technician 1200 best 33rd Auenue. Suite E • Anchorage. Alaska 99503 • (907) 561-5040 0 GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 274.4561 The Undersigned, Being Duly Sworn, Upon His Oath Deposes & Says: A.M. ON HE ___?_ DAY Op 917T P.M. NAME Last First Mlddle STREET ADD. , I CITY STATE In the ALASKA cliJfTER CHTWAGE ff then and commitR{ OR Ing 81 S 5e TE OF ., . L CATION OF OFFENS 1 HERESY AGR':zz��r REC THE ABOVE MENTIONED VIOLATION WITHIN DAYS FROM THIS DATE. IT IS UND STO E ACTION WILL FOLLOW IF COMPLI— AN EIS ET a NFID Signature THE U DERSIf3STATES THAT HE HAS JUST AND REASON- ABLE GROUNDS TO BELIEVE AND DOES BELIEVE THAT THE PERSON NAMED ABOVE COMMITTED T E OFFENSE HEREIN SET FOR H,CO TRARY TO mr4, Officer's Signature EO.002(1.76) ON! .8910 2 A r x 0 Mau MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTIOEE "f 825 L Street Anchorage, Alaska 99501 � ltl vl 4 i, / 279-2511, ext. 224, 225 �� ��- REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES - 'I. Type of Inspection: VA FHA CONV____ x 2. Property Owner: J. A. Modular Homes, Inc. Mailing Address:3400 Mt. View. Dr. , Anchorage, AK Day Phone: 279-2589 3. Name of Buyer: Daniel Robert Zipay and Linda Lou Zipay Mailing Address: 431 East 45th,.Anchorage, AK Day Phone: 276-1865 4. Name of Lending Institution: Amfac Mortgage Corporation Mailing Address: 705 W. 6th Ave., Suite 201 Phone: 277-8588 Anchorage, Alaska 99501 5. Name of Realtor or Agent: Jonas Arnbrister Mailing Address: 3400 Mt. View Dr., Anchorage, Ak.Phone: 279-2589 6. Legal Description: Lot 8-13, Block 2, DRAKE SUBDIVISION Location: NHN Gander Drive, Anchorage, Alaska 7. Type of Facility to be Inspected: Sin lq a family No. Bdrms. 2 8. Water Supply Type of Supply: Public Utility Individual x If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation 72-003(3/76) s Individual (on-site) K �� f MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION , J 825 L Street, Anchorage, Alaska 99501 279-2511, ext. 224, 225 -- REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: VA FHA CONY --xx 2. Property Owner: Jonas Arnbrister Mailing Address: 3400 Mountain View Drive 99504 Day Phone: 279-2589 3. Name of Buyer: Zijmy, Daniel R. & Linda Lou Mailing Address: 431 East 45th 99504 Day Phone: 4. Name of Lending Institution: Amfac Mortgage Corporation Mailing Address: 705 West 6th Suite 201 99501 Phone: 277-8588 5. Name of Realtor or Agent: n/a Mailing Address: 6. Legal Description: 8B/2 Drake Subd Location: 7. Type of Facility to be Inspected: � b W Phone: No. Bdrms. 3 8. Water Supply Type of Supply: Public Utility _Individual If Individual, number of dwellings presently served — If Individual, depth of well 66' 9. Sewage Disposal System Type of System: 72-003(3176) Public Utility— If Individual, date of installation 1977 M Individual (on-site) xx __