HomeMy WebLinkAboutEAGLEBROOK BLK 3 LT 5Onsite File
Eaglebrook
Block 3
Lot 5
#017-121-17
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP 201148 PID Number: 017-121-17
Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New K Upgrade
Name
Arthur Simonian Revocable Trust
ABSORPTION FIELD
❑ Deep Trench El Wide Trench ❑ Bed Dound
Site Address
6501 Rabbit Creek Road
❑ Other IZ
Phone
Number of Bedrooms
Soil Rating
Total depth f • fn original grade
4
GPD/SF
Fl.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Eaglebrook 3 5
Fill added above original d'e
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer,
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ftz
Ft.
Well100'+
/
A
25'+
TANK 9 Septic E] S.T.E.P. El Holding E] Other
Manufacturer
Greer
Capacity
1500 Gal.
Surface Water
100'+
/
/
i
-
Material
Plastic
Number of compartments
2
Lot Line
5'+
I /
NA
Foundation
10,+
LIFT STATION
Manufacturer
Capacity
t
Remarks-�
Gal.
Alarm location /`
Electrical installed by
Installer
PIPE MATERIAL House to tank D3034 drainfield Tank to
D3034
A+ Home Services
Drainfield CO/MTD3034
Inspector Pannone Engineering
BENCH MARK (Assumed elevation) 840.0 ft
Inspeection im 6/11/2020 6/16/2020
Location and description
ction 2„d
3,d 0'
Deck see site plan
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
OF ,�
Conditional Approval: Date
��
P� • ...../ 46,9
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Sieveri F2. Pnnon
Pannone
Septie
p: CE 8 14
Approved h. Date 61
Note: this approval does not include well permit requirements.���*&'4��
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NOTES: PANNONE ENG SVC LLC (C.1. 1088)
RECORD DRAWING P.O. BOX 1807 PALMER, AK 99645
PHONE 907} 745-8200 FAX 907) 745--8201
EAGLEBROOK B3 L5
DRAWN ACP ARTHUR SIMONIAN REVOCABLE TRUS
SITE: 6501 RABBIT CREEK RD
SITE PLAN ANCHORAGE, AK
CPRE OF
Steven R. Pannone
c CE -8149
REVISIONS -11
6/24/2020
1" = 60'
I.D. NO
017-121-17
OSP201148
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NOTES: PANNONE ENG SVC LLC (C.1. 1088)
RECORD DRAWING P.O. BOX 1807 PALMER, AK 99645
PHONE 907} 745-8200 FAX 907) 745--8201
EAGLEBROOK B3 L5
DRAWN ACP ARTHUR SIMONIAN REVOCABLE TRUS
SITE: 6501 RABBIT CREEK RD
SITE PLAN ANCHORAGE, AK
CPRE OF
Steven R. Pannone
c CE -8149
REVISIONS -11
6/24/2020
1" = 60'
I.D. NO
017-121-17
OSP201148
SHEET
2OF2
30' SCREENING EASEMENT
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(BK. 216, PC. 337)
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MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www,muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP201148
Work Type: SepticTank Upgrade
Tax Code Number: 01712117000
Site Legal Address: EAGLEBROOK BLK 3 LT 5 G:3138
Site Mailing Address: 6501 RABBIT CREEK RD, Anchorage
Owner: SIMONIAN ARTHUR REVOCABLE
Design Engineer: PANNONE ENGINEERING SERVICES
This permit is for the construction of:
Effective Date
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
s
Department
6/5/2020
6/5/2021
71046
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By:
Issued By: 7-�'v�
Date: co
Date:
19
MUNICIPALITY OF ANCHORAGE
t_
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. 017-121-17
Property owner(s) Arthur Simonian Revocable Trust
Mailing address PO Box 101563 Anchorage, AK 99510
Site address 6501 Rabbit Creek Rd
Day phone
Legal description (Sub'd., Block & Lot) Eaglebrook B3 L5
Legal description (Township, Range & Section)
Lot Size 71,046 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF)
❑X
(wlwo ADU)
Septic Tank
Upgrade 0
Duplex (D)
❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: 2*25- / frF' �•�'J
Date of Payment: 4131,26..6
Receipt Number: 67,7.326
Permit No. (33 Pao l (ej,9
Permit App_:• : . _.,:c
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201148, Rebecca Carroll, 06/05/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201148, Rebecca Carroll, 06/05/20
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP201148, Rebecca Carroll, 06/05/20
) MUNICiPALiTY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENWRONMENTAL ENG~NEERING D~WS~ON
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
-- ON-SITE SEWAGE D~SPOSAL SYSTEM AND/OR WELL ~NSPECT~ON REPORT
LEGAL DESCRIPTION
Well t Absor
DISTANCE TO: / / ~ / ~i area PERMIT NO.
~ ~ ........ No. of c~8rtments
~ ~ Manufacturer
Liq~ ~a~Sysn gallons IF HOMEMADE: Inside length Width t_iquid depth
Manufactu~¢ ............... Mat~rial Liquid capacity in gallons
Well
~ ~ ~ ,o. of lines / Le~t~ each line Tren~ic~ inches Distance between lines
~ ~ ~ Top ~ ~ile t~i~h grad~ ..... Material be~a~il-~ / ~o~al effectiv-~~i~n area
Length 'Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well ~d~ng foundati0~
~ DISTANCE TO:
~ ~ DISTANCE TO: ~ n Sewer line Septic tank//~/ Absorption area(s)
OTHER
PIPE MATER~
S01L TEST RATING
REMARKS
/
APPROVED DATE LEGAL
PERMIT 1",10.
DEF'FIRTMENT OF HERLTH ~ND ENVZRONMENTFIL. F:'ROTECTtOI'4
825 *L.." STREET, RNCHORRGE, FIK. 9958d..
264-4720
( 7800i8 >
C, ["...,Il ....... :=~, .T.. 'IF' E% S; E:: Bali !E I[~." F=" EE IFE." [r-ll %. -ii .... ~'---~os~_~.
FIPPL I CBNT
LOCBT I ON
LIEGFIL.
RR"F S I MOI'.~ I F:IN
RRBE:IT CF.'.I< RD
L. 5 B3 ERGLEBROOK SUB
BOX 15E;3: 995:'LEI
LOT SIZE
]:44 0'75±
90000 SQUFiI:;~'.E: FLEET
T"r'PE OF SOIL. FIBSOF.'.BTION S'¢STEI.'I IS: TRENCH
MR'XIMUM NUMBER OF BEDROOMS = 4
SOIL R~BTING (Sf;~ FT,.-"BR)= 200
THE REQUIRED SIZE: OF THE SOIL ABSORPTION SYSTEM IS:
E> E: IP -r ~.-.-t == J_. 2: L E:: 11'4 c-~ -IF" H := ~-~ ..E.. C~ IFS: IFil %-"
THE: L. ENGTH DIMENSION IS ]"HE LENG]"H (IN FEET) OF THE TRENCH OR [:,RFIIBII:']:EL.D.
]"PIE [:,EPTH OF R TRENCH OR PIT IS THE DISTFINCE [S'ETNEEN THE SURF"FICE OF' THE?
GROUN[) RND THE BOTTOM OF THE E',qC:FI',,,'RTION ,:.'IN
THERE IS i"40 SET NIDTH FOR TRENCHES.
]"HE EiF.'.FIVEL [)EPTH IS THE MINIMUI,d DEPTH OF GRIRVEL. BET~4EEN "rile OLITF'"RLL. PIPE
RN[:, THE BOTTOI,d OF THE EXCFI'v'RTIOI,.4 (IN FEET).
................................................... F:' F~ C: ~-:::: Iii ~3 E; F:' L F-~ tNIT' C, P T' % C~ If'..,~
Fi PFICKFIGE PL. FIN]' l'dl-qY BE II,'4STFtLLEf.) KIT THE PERMITTEE'S OPTI01'-,I SUBJECT TO ]"HEE
FOLL. ONING CONDITIONS:
::L. E:ITH[-]R FI CL. FISS I OR II NSF FIPPROVE[:, PLFINT MFIY 8E INSTRLL. ED.
;E:. F:I CONTINUOUS MFtINTENRI.',ICE FIGREEI."IEI,',IT IS REQUIRED. IF FI MF~INTEEI'.,IFti,.,IC":E:
RGREEMEI.',IT IS NOT KEPT CURRENT YOU MFt'¢ BE REL".:!UIRED 'FO E1"4L. FIRGE THE: SOIL.
RBSORP'T'ION S"r'STEM FIN[:,,'"OR YOLI MR"r' BE SUBJECT 'TO PROSECUTION.
BFICKFILLING OF FINY SYSTEM HITHOUT FINRL. INSPECTION FIN[:, RPPROVF:IL. Bh" THIS
DEPFIRTI"IENT NILL. BE SUBJECT TO PROSECUTION.
MII.',IIMUi'd DISTFINCE BETWEEN FI NELL. FiND RN"r' ON-SITE SENFIGE DISF'OSI;:d... ::S"¢STE]"I tS
::L00 FEET FOR f~ PRIVI'3TE NELL OR ;::'.00 FEET FOR R PUBLIC'- NEL. L.
NELL. LOGS FIRE REE!UIRED RI",ID MUST BE RETURNED TO THE DEPFIF::TMENT NITHIN ]i:0 [:,F:t"r"S
OF:' THE bIEEL..L. COI."IPL. ETION.
OTHEEi:R REL.::IUtREM[£I,'TFS MRY RPF'L"r'. SPECIF:'ICFIT:[ONS RI,',ID CONSTRLICTIII]N [:,IFtGF;:FIMS RRE
RVFIILRBL. E TO INSURE PROPER INS]"F~LLF~TION.
I CERTIF'¢ THf~T
:1..: I FIM FRMILII:~R NI'FH THE F..:EQUIREMENTS FOF.: ON-SITE SEWERS F::IND NEL. L.S FtS SE]"
~ORTH BY THE MUNZCZPFILZT'.¢ OF FIHCHORRC~E.
I I.,.IILL INSTFIL. L. THE S"r'STEM IN RCC:ORDRNC:E P.IITH 'T'HE CODES.
I UNDERSTFIND THRT THE ON-SITE SENER SYSTEM MFFd RE~]:¢JIRE ENLFII~:GE'.ME:NT ]7t:: THE
4040 "B" STREET,
ANCHORAGE, ALASKA 99503 k
PHONE: 907-279-2581
l)o('t~m!;e~; I" 1977
~,,'.0. f!A1832f)
Su}')~)oc:t: . Lh.A ..... c.. it~v(~ct;]gatJo'n ]lot: SuJ. tabi]iLy o~
{.)n-,~.t_c.o_.v~-_~',.. ',~, Lot: 5, l~l. ock 3, k;ag.l.¢:brook Subd.
Trcn':;:;:Y[h[x:.d hecc:i;~ ih accordaP, c:e w~th your inz;tructions are
the rcsu].~s o[: the
by us: on ;}~ce:~br]: 7, 1977. The s.:o~:c of this project i:-; khct
Jnves{:JgatJon for suJtabJ].J ty et an On-Site sewerage systent.
Inc]t',c!.::d in hhis transmJt;ta], are:
Test }lo]c Location Sketch
Te:~t Eol. e Loq
]:bt:2 ] a r'm to ~1 y ] n[-ormaLJ on
Figure 1
Tab I e A
Shee[s 1- 3
Ti~.c: c:<p].crotion was conducted usi. n9 a continuous flight:
solid stern auger. The rig is owned and operat,:?d by Denali
DrillJm], !nc. [)r:il]_Jnq was supervis~d, t:he test: ]~o].e
Jogged aud l:uez'co]at:ion test [~orfo.[lied by i'~.r. O.H. JiaLch,
geologJ :~1: for A1,'~:ka Tostlab.
7h~' { ].,),,, off the to:;t hole is included as Table A o[ tlgs
' ,.~,..lo.,- it woul. d be helpJlul to
uti].J..ze the exl2!anatory information contained in Shec}t.s i-3
O~ the roport.
Nhen d:;ill:h¥! wns c:o'.;ip].otc:d a 3/~" slotted PVC pipe was
].,r..'el. For th.2 u~.:'col:ltJ, on [losk, th(: tc3st h<)[e v'as
with ~.]c:~l/'r ap.; ].o?t: c,v(DrnJ(~hl" to saLusate2 C)n ret:ur]~inS; t'he
1]o>:/ do,..', [ho hc)!_e was ]'u/{ lied w_it]l t.,,cher and tho
No ;.,.',trot tab]<: was ob:;c'rvod du~:inq dril]Jng. It ahou].c] ho
not..cd t_hougi:, t !'l~l(L [h<~ [r'~? ~,/~luc:r ].OVO]. ilOl~RlJt].].y flUCttuatcs
sc'asonal].y and with rutecJi>itatJ, on.
We hopo this report moo;ks your prose:hr n<]e(.{s. If we (:an be
Of fuFt:h¢~r Service, [:,]e~£Jo foel ft?oe to COll[:aCil
Very s:h]cerely,
JRS: rb
Enclosures
TosL tlo]l~~ 11o. 1
Depth in
From To
0.0 1 .0
1 .0 2.0
2.0 8.0
8.0 16.0
SOlL DI'qCP~PTION
~._2] ] ....... iL _..-'..1
Brown l:'oat, Pt, dam[), soft
F-4, brown ~92.~'ff. ..... Silt, ~.q'~, damp, still,
non-plastic.
F-4, (%ravel]_v Sa]K]v Silt, ~{l,, damp stiff to
hard,-n-0-[{-~[['[{'s[l'~ ~'=-r~5l-~[Jed/subr°unded pa~rti, c
to 6" .
I"-1, brown Si]tv Sandy travel, (?~, damp,
hard, poor l{,-'~-~{'d~{~']--"~-ou-~'a~-d2subroundcd
nartic]es to 12"
Bottom of Test Hole:
Frost Line:
Free Water Level:
1~.0 ft.
Trace
None observed while drilling
SOIL CLASSiFiCATION CHART
30% GRAVEL
/" CLAY
CLAYEY
OR
S~LTY
SAND
CLAYEY
CLAYEY
SILTY
/ELL¥ SANDY GRAVEL
GRAVELLY SAND GRAVEL
k \ x
0 10 20 30 40 50 60 70 80 90 100
GRAVEL (+#4 SCREEN) % BY WEIGHT
NONFROST SUSCEPTIBLE SOILS ARE INORGANIC SOILSfiON-IAINING lESS TI-tAN 3% FINER THAN 0,02 turn,
GROUPS OF FROST-SUSCEPTIBLE SOILS:
F1 GRAVELLY SOILS CONTAINING BETWEEN 3 AN[} 20% FINER THAN 0,02 mm,
F2 SANDY SOILS CONTAINING BETWEfN 3AN[) 15% FINER HIAN0.02 rnm.
F3 a. GRAVELLY SOILSCONFAINING MORE THAN 20% FINER THAN 0.02 mm. ANDSANDY SOILS
(EXCEPT FINE SILTY, SANDS) CONTAINING MORE TFIAN 15% FINER THAN 0.02 mm.
b. CLAYS WITH PL_ASTICITY INDEXES OF MORE TIIAN 12. EXCEPT VARVED CLAYS.
F4 a. ALL SILTS INCLUDING SANDY SILTS.
b. FINE SILTY SANDS CONFAINING MORE THAN 15% FINER THAN 0.02 mm.
c. LEAN CLAYS WITH PLAS'! ICFTY INDEXES OF [._ESS THAN 12.
d, VARVED CLAYS.
Plasticity indcx
Test Ho~e Lop - Description Guide
The soil descriptions shown on thc logs arc the best estimate of the soil's
characteristics at the thne of field examination and as such do not achieve the
precision of a laboratory testing procedure. If the log includes soils samples,
those samples receive an independent textural classification in the laboratory
to verify the field examination,
The logs often include the following items:
~}~__Interv~l usually shown to 0A foot, within that zone no
signihcant change in soil type was observed through drill action, direct
observation or sampling.
Frost Classification - NFS, Fl, F2, F3, F4, see "Soil Classification
Texture of Soil An engineering classification of the soils by particle
size and proportion, see "Soil Classificatioo Chart", note the
proportions are approximate and modifications to the soil group due to
stratification, inclusions and changes in properties are included.
Moisture Content - this is a qualitative measure: .d~., no or little apparent surface moisture,
.dam~, moisture forms portion of color, less than plastic limit,
wet, no free water, often soft, if cohesive soil,
saturated, free water may be squeezed out, if a free draining soil',
~ at natural moisture content, if a non-plastic ~ilt or fine
saud. (The moisture content is further defined by reference to PI,
LW, NP, M% or dilatency.)
!)ensity - refers to more-or-tess non-cohesive soils, such as sand gravel
mixtures with or without a fine fraction, derived from drilling actiou
and/or sample data; usually described as: very loose, loose, medium
dense, very dense. General intent is to portray earthwork
characteristics.
Stiffness -- refers to more-or-less cohesive soils and fine grained silts of
~silt groups. Derived from drill action and/or sample data~ Very
soft, soft, stiff, very stiff and hard are commonly used terms.
Particle size - The largest particle recovered by the split spoon is
1~3/8", Shelby tube 3", auger flights (minute-man) 2", Auger flights
(B-50 hollow stem) 6"-8'. Larger particles are described indirectly by
action of the drilling and are referred to as cobbles, Y' to 8", or
boulders 8"+. Therefore when reviewing the gradation sheets, if any,
the description on the hole log must be considered for anindication of
larger particles.
Unified Soil Classification ]'his is a two letter code. See Unified
~i~~f~ther definition. In some cases AASHO and/or
FAA soil classifications may be shown as well as the unified~
Atterbcrg Limits - useful for fine grained and other plastic soils.
P._I; natural moisture content believed to be less than plastic limit
PB-; natural moisture content believed to be between plastic and liquid
~'~nit s
L~w+; natural moisture content believed to be greater than liquid limit
NP; non-plastic, useful as a modifying description of some silty
~aat~rials.
Dilatencz - is the ability of water to migrate to the surface of a
saturated or nearly saturated soil sample when vibrated or jolted -- used
as an aid to determine if a fine grained soil is a slightly or non-plastic
silt or a volcanic ash,
Rock flour finely ground soil that is not plastic but otherwise appears
~r tO a clayey silt.
.Organ!c Content - usually described as Peat, PT, sometime~ includes
discrete particl~ such as wood, coal, etc, as a modifier to an inorgamc
soil. Quantity described as; trace, or an estimate of volume, or, in case
of all organic, - as Peat. This may include tundra, muskeg ami bog
material.
Muck - a modifier used to describe very soft, semi-organic deposits
h~'~aa~lly occuring below a peat deposit.
,,Am°rphus peateat - organic particles nearly or fully disintegrated.
Fibrous Peat organic particles more .or ]ess intact.
Bottom of Testhole -* includes last sample iuterval.
Frost Line- seasonal frost depth asdescrihedhydrillingactionand/ox
samp es'l~'~-at the time of drdling.
Frozen Ground other than frost line, described by samples, usually
includes description of ice content, often will include modified Unified
Classification for frozen soils - this is a special case related to
permafrost studies.
Free Water Level The free water level noted during drilling. This ts
not necessarily the static water table at the time of drilling or at other
seasons. Static water table determination in other than very permeable
soils requires observation wells or piezometer instalhtions, used only m
special cases,
Blow/6" -- The number of blows ufa 140 weight free falling 30" to
advance a 2" split spoon 6"; the number of blows for a 12" advance
by definition, the standard penetration.
M.~%~ ~- natural moisture content of the soil sample, usually not
performed on clean sands or gravels below the water table.
.S_~, re,ers to 2" split spoon driven into the soil by 140 pound
weight, a disturbed sample,
~, thiu wall tube, "Shelby" used to obtain undisturbed samples
of fine grained soil,
~, "grab" disturbed sample fi'om auger flights or wall of trench.
g., cut sample, oudisturbed sample from wall of trench.
D~r~treng~t=h --~ a useful indicator of a soil's clayey fraction, N=Nouc.
L=Low, M=Medium, ,ti=High
C,~rg~u~ - The samples are placed into apparently similar groups based
on color and texture and are arbitrarily assigned a group letter. Further
disturbed tests including Atterberg Limits, grain size, moisture~density
relationship, etc. may be performed on the group and are assumed to
reflect the general distrubed characteristics of the soils assigned to the
group. This is an important phase of the soil analysis and is used to
~tandardize the various qualitative determinations and to reduce the
number of quantitative tests necessary to describe the soil mass.
II
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h-.61 U 14 C 11 P A Y OF A N C H 0 R A G, E
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 07- 101- 17 Expiration Date: —0 j
1. GENERAL INFORMATION
Complete legal description
Location (site address) ..... .
Current property owner(s) &4A (I I Con Cejl ��ffay phone
Mailing address (Os -z)( k" -,l
Real estate agent Day phone
2. TYPE OF DWELLING:
P-_ Single Family (w/wo ADU)
F-1 Duplex
F-1 . Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
E4
Private Septic
Water Storage
❑
Holding Tank
El
Community Well
El
Community
ED
Public Water System
El
Public Sewer
El
Waiver request for:
Distance:
Received by: Z_ --- Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ 2. -50
Date of Payment -6A61962
Receipt Number Z3 616:
COSA# -OCz.,�012_37
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures
outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or
wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated
herein. I further verify that based on the information obtained from 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, 1 attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA
COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time
of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on
the local soil condition, ground water levels that may fluctuate 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 Phone (907) 745-8200
Address P.O. Box 1807 Palmer, AK 99645
Engineer's Printed Name Steven R. Pannone P.E. Date�%e�7
•.v
TH �.
6. DSD/SIGNATURE • • • • • • • r
System #1 Approved for bedrooms ' s'tever Pc ;;on
CE o"14 "' F4 �
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulations:
- VV -H1 Crc rjivr
SW, WASTEVATER o
\,
JIJ��i�FNT SERv�G��
By: i Cck �u�� Original Certificate Date: 7j%��
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
Legal Description: Eaglebrook 133 L5
If more than 1 septic system on lot: COSA Checklist # 1 of 1
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 4128"978
Total depth 92*(1) ft
Cased to UK ft
❑ Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 6/1/2020
Static water level at beginning of test 93.6*(2) ft.
Comments (1) depth below ground (2) from top of casing
B. TANK DATA
Age of tank(s) new years
Tank type/material SeF` UPIasLc
Measured operating fluid level in septic tank n/a
❑ Standpipes/foundation cleanout per record drawing
Date of pumping new tank
D. ABSORPTION FIELD DATA Deep Trench
Which system tested (date installed) 1978
❑ ALL standpipes present per record drawing
Total measured depth from grade 10 ft (max)
Measured depth to pipe invert from grade 3 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced 2000 gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 017-121-17-000
Structure served by this system 1
Well production at time of test 1.94 gpm
Water storage tank volume n/a gallons
Well disinfected for coliform test? ❑✓ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by Sullivan Water Wells
Date of Sample 5/28/2020
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 5/29/2020
Results ❑✓ Pass For 4 bedrooms
Fluid depth prior to test 20 in
Water added 600 gal
New depth 20 in
Elapsed time 60 min
Final fluid depth 20 in
Absorption rate '600 gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
0
Yes
Community Sewer Manhole/Cleanout > 100'
Q Yes
if No
ft
M Yes
if No ft
Neighboring Tank > 100' 0 Yes
if No
ft
Private Sewer/Septic Line > 25' Yes
if No ft
Absorption Field on Lot > 100' F/-1 Yes
if No
ft
Holding Tank > 100' Q Yes
if No ft
Neighboring Absorption Fields > 100'
Yes if No ft
Water Main > 10'
Animal Containment > 50' Yes
if No ft
M Yes
if No
ft
Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
Manure/Animal Excreta Storage > 100'
If septic tank is under driveway
Community Sewer Main > 75' ❑✓ Yes
if No
ft
r,/J Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
0
Yes
if No
ft
Surface Water > 100'
Yes if No ft
Property Line > 5'
Yes
Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
if No
Yes
if No
ft
Private Wells > 100'✓0
Yes if No ft
Water Main > 10'
Q
Yes
if No
ft
Community Wells > 200'✓0
Yes if No ft
Water Service Line > 10'
❑✓
Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Yes
if No
ft
Private Wells > 100' ❑✓ Yes if No ft
Water Service Line > 10'
F/�
Yes
if No
ft
Community Wells > 200' Q✓ Yes if No ft
Surface Water > 100'✓Q
Yes
if No
ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION
l certify that l have determined through field inspections and review
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
.................. J~UNICIPAUTY C'F ANcHoRAGe" ....
MUNiCiPALITY OF ANCHORAGE DEPK (): i:;*,Li &
~ 825 L Street. Anchorage, Alaska 99501 ,~/
ENVIRONMENTAL ENGINEERING DIVISION ".~
Telephone 264~4720
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY oWNE~ ~ PHONE
~, BUYER PHON~
MAI LING ADDRESS
4, REALTOR/AGENT / PHONE
MAI LING ADDRESS
~, L~GAL DESCRIPTION ,~ ' ~ ~ /~ ......
16. TYPE ~F RESIDENB~ NUMBER OF BEDROOMS
~ One ~ Four L~ Other~
~ SINGLE FA~i LY C~ Two ~ Five
~ MULTIPLE FAMILY ~ Three ~ Six
7. WATER SUPPLY
INDIVIDUAL*
COMMUNITY
PUBLIC UTILITY
'~:"~'EWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE~
PUBLIC UTI LITY
ATTACH WELL LOG. A well Icg is required for all wells drillad
since June 1975. For wells drilled prior to th~3t date, give well
depth (attach Icg if available,) p~.~. f.,~E4~'~'
**If individual/on-Site, give installation date~_~//~
If system is over two (2) years old an adequacy test is required
by this Department,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
TH~S S~DE FOR OFF~CIAL USE ONLY
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [Z] FIVE [] OTHER
[] MULTIPLE FAMILY E~ TWO [] FOUR [] SIX
PERMIT NUMBER
2, WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
E~ PUBLIC UTi LITY
Connection Verified __ LOG RECEIVED
3. SEWAGE D~SPOSAL SYSTEM PERMIT NUMBER
E] INDiViDUAL/ON -SITE DATE INSTALLED -
E~ PUBLIC UTILITY
Connection Verified INSTALCER ~'1~
[]Septi~ank or [] Holding Tank
Size:~_.~ ® _ If Tank is homemade SO~LS RATING
give
dimensions:
TYPE OF TANK MANUFACTURER ~/;~# t,~,~'~ ~z-
~OTAL ABSORPTION AREA
4. DISTANCESwELL TO: Septic/Holding Tank 1Absorption Area [Sewer Line [ Nearest Lot Line
Absorption Area ~o near~-t~Lot Line
~APPROVEDFOR ~ BEDROOMS /~-~
[~] CONDITIONAL APPROVAL (letter must accompan~ert'?~cate)
72-010 (Rev. 3/78)
L ~8
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