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HomeMy WebLinkAboutT12N R3W SEC 27 LT 50 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: 018-092-27 PID Number: OSP211051 Dwelling: Q Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑_ New ❑ Upgrade Name Hulquist Homes, Inc. ABSORPTION FIELD ❑ Deep Trench 0 Wide Trench ❑ Bed ❑ Mound Site Address f 2 ,, %`�.�'� c� /'c"s �— ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 4 1.2 GPD/SF JTotal 7.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.0 Ft. Gravel depth beneath pipe 4.0 Ft. Subdivision Block Lot T1 2N R3W Sec 27 50 Fill added above original grade 2.0-4.3 Ft. Gravel length 60 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES TO Septic l Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From — Tank Field Tank Line 600 Ftz 1 N/A Ft. Well 100'+ 100'+ NA NA 25'+ TANK ❑p Septic ❑ S.T.E.P. ❑ Holding ❑ other Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+ 100'+ NA NA Material Number of compartments Lot Line 10'+ 10'+ NA I NA NA HDPE 2 Foundation 10'+ 10'+ NA NA LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer drainfield Hulquist Homes, Inc. Drainfield 3034 co/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100.0 ft Inspe 1,13/23/21 3/24/21 Location and description tion 2�d 3rd 3/25/21 4"' 3/26/21 South Top Of House Wall ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date . • • • • •. •'°• A. an R CE 8149 .� Septic System�(„ / Appro t ^--� Date - -Z •° Note: this approval does not include well permit requirements. kRCv VJ/VLI 10) S T"C F ti o ^ n ^ --1 D r� �=OJ r� cororXxmrn o;5?*z��0�D EnANO?Aoc) IO OS =-I Crp� pm O O W ;u O Z Z O O —Irn Ic Kew Dcn my Z m C/,) z�1 Ooc-C�Om0m DTl -- O F9 cf) co ED ;0 m OD DFF'j ED C? 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BOX 1807 PALMER, AK 9645 0 ... 10/12/2021 PHONE (907) 745-8200 FAX (907) 745-87.01 fCP•' SCALE fir Tl 2N, R3W, Sec 27, LOT 50 ••• P.I.D. NO DRAWN LJC HULTOUIST HOMES INC. ® aririoa® 018-092-27 CE 8149 PERMIT N0. NHN 138th AVENUE I OSP211051 SITE PLAN ANCHORAGE, AK SHEET 2OF2 i •;.::� tt G - ` ] n AN. lam? (01 i3 \1AQ31 E Development Services Departmentlffil'71` -NR -I w4� Phone: 907-343-7904 On -Site Water 8-1l Nastewater Section Fax: 907-343-7997 Well Log Permit Number: # 211051 Date of Issue: 03/03/21 Parcel Identification Number: 0 1 – a Date Started: 05/20/21 Date Completed: 05121/21 Is well located at approved permit location? Yes R No ❑ Legal Description: T1 2N R3W SEC 27 Lot 50 G:2936 Property Owner Name & Address: Hultquist Homes, Inc. Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From To casing stick up 0 2 gravel pad 2 g overburden 3 5 silt & gravel 5 24 moist silt & gravel 24- 89 silt & gravel w/ H2O 39 41 dry silt & gravel 41 86 clay silt & gravel 86 138 silt & gravel 138 171 silt & gravel w/ H2O 171 191 clay 191 196 silt & gravel w/ H2O 196 197 coarse gravel w/ H2O 197 200 N 610 5'44" W 1490 48'5" Neater Sample Results: Arsenic: ug/L Nitrates: mg/L Total Coliform Bacteria: colonies/l00mL Method of Drilling ® air rotary ❑cable tool Casing type: steel Wall Thickness: -250 inches Diameter: inches Depth: feet Liner Type: Diameter: 6 inches Depth: 200 feet Casing stickup above ground: -2—feet Static water level (from ground level): 147 feet Pumping level: feet after hours pumping _gpm Recovery Rate: 30 apm Method of Testing: airlift Well Intake Opening Type: F Open End ❑ Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: eentonite Ivnillm, 2 trans 20 Start 0 feet Stonnp.rl 20 Well Disinfected Upon Completion? Yes Method of Disinfection: tabs Comments: Well Driller: Johnny Kay ❑ El Company: Hefty Drilling, Inc. Mailing Address: P.O. Box 112130 Anch. AK 99511 WATER QUALITY TESTING Coliform _fir C01/900mL Nitrates 2 3 S Mg/L Ve Ug/l,Arse we ri er s a provide a well completion. o/r/ z No og to the 0 days of Parcel Identification Number: Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. t. J b4r ii8 �£ �Elks36.�'., 1F]:tlC.GGt �,^�_� (,.+��:. }5,r�i p y� Safe, 5 `�'�q%5'e�@ti� C rT; On -Sift, W proq au ,,j ON 4700 Elmore Road A.O. Bo;, 196650 'C C Mark Begich Anchorage, AK 99507 S A c T,:IY Mayor www.muni.org/onsir'e (907) 343-7904 Pump um �nstayfio Log Well Drilling Permit Numbe�-��� DS �I( 051 Date of issue: —V -31d j Parcel Identification Number: Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. 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 Permit Number: OSP211051 Work Type: WellSeptie Initial Tax Code Number: 01809227000 Site Legal Address: T1 2N R3W SEC 27 LT 50 G:2936 Site Mailing Address: Owner: HULTQUIST HOMES INC Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: j_Agl- �0 f Dcpartment 3/3/2021 3/3/2022 54450 Q Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy Q 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 B Issued By: VDate: Date:�L- 4 MUNICIPALITY OF ANCHORAGE p�f . - �1 Community Development Department^ rfYt 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. 018-092-27 Property owner(s) Hultquist Homes, Inc. Day phone _ Mailing address 12570 Old Seward Highway, Ste. 204, Anchorage, AK 99515 Site address NSN 138th Avenue Legal description (Sub'd., Block & Lot) T1 2N, R3W, Sec 27, Lot 50 Legal description (Township, Range & Section) Lot Size 54,450 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial I—XI Single Family (SF) ❑X ADU) Septic Tank ❑X Upgrade 1-1(w/wo Duplex El (D) Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑X 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: $820 Waiver Fees: Date of Payment: 2-(,7" 2( Receipt Number: ((i )yq (9 Permit No. OSP211051 Permit App_.:- : - ::...:c Date of Payment: Receipt Number: Waiver No. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211051, Deb Wockenfuss, 03/03/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211051, Deb Wockenfuss, 03/03/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211051, Deb Wockenfuss, 03/03/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211051, Deb Wockenfuss, 03/03/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211051, Deb Wockenfuss, 03/03/21 Tom Fink, Mayor /Viunicipality of Anchorage Department of Health and Human Services 825 "L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 August 13, 1992 Gary Knedlik 3501 Stargate Circle Anchorage, Alaska 99517 Subject: T12N R3W Section 27 Lot 50 Permit #SW910236, PID ~018-092-27 The subject permit, issued August 13, 1991 by this office for a single family well and/or on-site wastewater system, has expired as of August 13, 1992. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $200.00 for an on-site wastewater permit; $75.00 for a well permit and $275.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Sincerely, Robert W. Robinson Acting Program Manager On-site Services cc: Copy of Permit PAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW910236 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:KNEDLIK GARY OWNER ADDRESS:3501 STARGATE CIRCLE ANCHORAGE, AK 99517 DATE ISSUED: 8/13/91 EXPIRATION DATE: PARCEL ID:01809227 LEGAL DESCRIPTION: T12N R3W SEC 27 LT 50 1 OF 8/13/92 LOT SIZE: 54450 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM 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 (iSAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE TOTAL DEPTH OF THIS BED SYSTEM MUST NOT EXCEED 2,0 FEET BELOW~GR_~D...LEVEL. /3 DATE: DATE: ANCHORAGE, ALASKA ~502-3~04 (907~ 2~8-50e5 SEPTIC SYSTEM DESIGN BLM LOT ~ SECTION 27 GARY KNEDLIK Eh"c)und Wa'h(~?r* A~: EJ F:'li. From '~.es'6 June 12 1991 J6'-o.. re:ii'l/itl := 0,4- C;]~:t:L/d,~y Number- Bed Ar'ea 15(' ' SCl· .f'k· SYSTEM CONFIGURATION BED TOTAL LENSTH 50 FT. TOTAL WIDTH 50 FT. TOTAL DEPTH ~4 FT. ROCK DEPTH .5 FT. COVER 5.5 FT. STEP SEPTIC TANK 1500 GAL. l'he ins'haJl 1 avEi on o~ this t~e:[ 1 and sepi:ic ~xy~t;'ltem t~i 11 not i mpac'l: aclj~.u::er','h ].~:~ts. The well ]oca'h:lon con'Forms 'Lo t'.he si'L:i, ng o-f 'hhe ce>ri~si::ir'l(,] wel].s irt 'hh(e ar'~)a~ ~nd v~il}, no'h I:)~'ew~Hq'(: ~:l'~e ai::ljac:~:~n[ lc:r(: I..c)'l: 5" Stz.~c hl orl 27 The ins~:,al].ation o'~ this septic system Will not prevent wells septic system will not change the general s].~pe o'F I:h :L s instal 1 ati(:~n. p g. 2 L~?T ~4 L,¢r N LrJ; ~ ?L/,f LB T ~ F£E ,rNF£ ~?' 6751 ~. OlMOND BLVD. ANCHORAGE, ~L~$K~ 99§02-3904 SPECIFICATIONS FOR SEPTIC SYSTEM INSTALLATION LOT 50 SEC 27 Ti2N RSW 1.0 GENERAL 1.1 Owner'e is Gary Knedlil::, AK,, 99517. F:'hone ~%3:~:-.-/.],. ] '" 1.2 Engineer is 'bh~: per'son or en'Eity hired by the Owner to inspect this pre.jec'~.. The Engineer must be r~z,~cogn:Ezed by IVJun:L ci pa]. i ty o'F anc' (3r~3(]e ~ [)ep~.~rt~l(~}lqt C3~ Heal th and Human 1.5 Contractor' is 't'.he person or' entity hired iv the Owner · [:o ~nstaII this project. The Contractor must be reco i~z~c. The Draw~l~gs~ sheets 1 through 3~ shall be par'l: (:)~ '~:l"lis 1,5 Ali ma'l:er:Lals and worl.::mar'~sh:Lp shall meet Ld]e require.-, merits e.f: 'L:he I~lur~icipality o'f Anchorage.~ I}epar'~:mervt: e'f: Health apl:) 1 :i cal31 e rul e~ and regul at i Qlqs ct.u"r'en'E1 y in e.i:~:6.~ct.. 1.6 A] 1 ex c:ava'~l:L on depths ar'e adv:L sory ~ and are to be veri~:Jed and may be medi.~:i, ed in the 'field by '~.he Engineer. 1.7 It. is the responsibility o~ the Owner or the Contractor t.o adher'c~ te the approved design,¢ te veri~y thai: the speci The Centracter or bile Owner shall repor"L: '['.o L:he Engi- 2.0 SEPTIC TANK 2,1 ]'lae septic 'Liank shall be as shewn itl '[:he dr"awings. The sept:Lc t~nk shall. I:~e a UFC '~tPl.,Jl cweJ three compartment tank cor~str'ucted o.¢ :L2 gauge, or better'~ steel ~ with bitL.~ mastic coating,, The tank shall be set ].eve]. on urlclis'Eurbed sell .The tank ~h,',CJ].]. I:)&~ cov~r(~d wi'~h thF2 eqLLiva].~l-j~ O¥ ~our ~:(5)(.:L,[: c]'f: ~;c:lJ ] ,, T&~i'qI:: ;~nd ,'A~}~c)cia'b.E~d J]t,.lfnping eqL~ipr~(~)/"l'J: si]a[]. J3c~ L. ot 50 c* · ,::~t!:¢l::: 'h :~ c::lJ) .',7'7 'F :1. 2N R3N pg. ;I -i]..7; 'The sep'L::J.c t. ar'H.:: !~ff~all be a m:i. nimLu~l ot: J, 00 Tee'L-. from any well ser"vint:] a single I'"~:~,cJegrl(z(-~ 100 'Fe~t, 'From any body of .... ]- ditches with 'Flowing water; 150 ~r'om Class "C'j wel;Ls, and 2}0 'Feek 'Fram C',las~ A or' Class B w~e] ls. 2.4 AlII pipl.}) ccnqn~?c'tions to the rani.:: si-Iai] be mechal]ica~ wa~:.er'h:Lght calder couplings. Cleanouts si]all I:)e installed 3.O ABSORPTION FIELD 3. 1 Gravel used :in 't'.h~:~, absc)rpt, iofq ~field '~sha].l be 0.'::' 'ho 2.5 . .-:,Y. passinq the No. 2"O 7!!.? Sand, LIS~:~d 'For level:Lng or ~of 'fi].tering, shall have an 5% by weJ. gi'tt sl'lall pass the Nc:,,, 2']() sieve. 4-inch I::)er'For"a'hc~d P;Lt:]~. sha].l be ASTM F810. For pres So].ict 4..-:i.r]ch p:i. pe sha].], be Cast Iron cir' ASTPI D:3'}:':::4. :J;. 4 .L'(,, 5 Plc~n:i.'hc]r s'l:ar'ldpi pes shal 1 be :instal l ed as sh(;~wn. Tl')at sec:'~:i.o~l o~ tile pipe penetrating 'l:he gravel shall be per'Fo- r'a'L'.(.:~d~ either by dri].Iing jc):[riJng a {~c:~c:T'.Jclr] c]~ F810 i::)er~ora,Lted pil{.z~ '~.0 a soJLJd s[~c'[.ii, on 3. 6 G~o'L~:z, xt :i. 1 ~c, Sl-h:~tl 1 I:)e Mi r'a.f :[ 140. Z";,,7 ]:ns,lat:ic:n shall be ext. rt,lded (Jil'-e(:'l: bLirJa]. PCl].¥'st:yrene. Dow Chemical S':.v"c)-fc~am HI IL' T- ~ t 'i c:,~ are .?;. 9 Gr'ass se,~ecl si'iai ] be KentJlcky bi legr'a~.~F,s Spe(z:L.Fications for septic: system insta].lat, i. on Lot 50 S~""-" '-,.; ~_ I..J. c) n 2 7 "1' :L 2 N R... W I:)g. 2 4.0 INSTALLATION 4. 1 L c:ll:: a'l:. ~.;~ al 1 undergrl:)L J'~d L.t'J:. :L ]. i ti es ~ p r I:q:] er"t: y ], i nes ~ 'FLIt'.L~Fe driv~:away~]~ ~xis'~ilqg or propc~sed w~:er w~]]L].s~ ,?~l']d alii (:}ti'lei" 't:ac:;J ] J.'JT. icas I'"eqLtil"~r]g separation cl~s- Engineer e.~ any observed pclssible cmnfiic.[. i: h e 4,,5 Es't:ablish art eleva'kicJn I:~enc:hmark· 'l'his BFI shai:L be ~)asi].y :Lden.E:i.q:ial31e~ stable al'id perm&~l]er]'k. Al'] arbitrary i n 1 e ~: and c]utlet e].evations o.~ the t:ank. Tank shall be · ~. ,:~ .... (. ~va l (~ t. he al:)s(_~rpt i c]ri f i 6'1 cl, Ba't:'Ec~m o.F exCava'L: i on ate on the ~:I(:x:n,' o.F t. he ~ .... avail(in. Any material compacted Zl. 6 F:'I a(::~.i, 'LI'i(.~.~ r'och: 'L:c) '~he depth spec:i..Fj, ed. I)o rlcr~ c:on'bam:L-.. I]a'l:.[~ rc)c[< wi th nat ive mat, eri al s or sp(~i 1 s 'From the excava ..... P ~21'" 'l: c]r a t c~d pipe. " 4.7 Insta:L1 'lihe distribLr~.:[on pip(-:,. Record the eleva'~.:Len c:~-F each join'~. F'mr pr(.~ssure ~ys~em solvent weld T:he .jCJiFfl:S. il.. 8 Co,vel .... [:lie d:L ~l:F'iL:)ui::i.(:)Fi p J pe Nit:h rock ~ ar'id cover i:he c~xc:ava-I::Lc)n ~ith ] .c~L(... t..].~ be~or~ I:)ac:k.J:j.J.J. ir~g and plac:ing i IqSU]. ,'aLi Olq ~ :L '~: F'i.iX::JLli red. " at.'. the m:i. dpclir~ o-F I:he bed. Zl. J.O Fur't'ti?,l'~ a c:Qpy (:~: all !sur'vey noires ilo) 'fch6~, Engineer.. 5.0 INSPECTIONS 5, ] A m:Lrlimc.ull o¥ t. hree inspsJctions are r'equ;ired. ']'hI:+) 'Fir-st ir~spec:i:ic)n w:/ZL1 be o'F the epen excavation. At this o.F [::xadrock wil] be ver:i.~:L~.:ed~ 'J'hi:e !:-'iecc:H'ld :[ I]!~q:)~bc:~: i (:ll'~ vgi 1 1 bi_~ a~: ter p ]. ac:er[lent Sp e c i ~ i c a t: :i. f)l ] s .~ (;:)l" !.-]tandpipe,.-:;.; distw'ibution piping~ tank(s) and other cc]mpo ..... The I:hird :inspec'k:ion will b~ a.Fter completion o-~ the ~ork. Any de.~ic:iencies will be noted and ti'ia Contractor noti.~ied. Such de.t:icienc:ies shall be corrected within 'ken days. 5.2 AIL]. e].ec'l::rical work t i or'~ ,, Submit pl"oo'[: o'F Engineer. requires an MOA elec'krical inspec--. inspection or certi{ication tl~ the 5. 3 Submi'k cata].og data (:)~ all mechanical equipment. E'[:'l:luerct: pulnp~ contrc]l panel~ and warning system. 5.4 Noti'Fy Engin~.~mr at least 24 hours :in advarlce o'~ be~}in-. ning any work. CONSULTING ENGINEER TELEPHONE: (907) 279-3916 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 82.5 "L" Street, Anchorage, Alaska 99.502-06.50 SOILS LOG -- PEFiCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: I~ Li,L~r L*tJ ¥' ,lC O 1 2 3- 4- 5 6 8 10 11 12 13 14 15- 16- 17 18 19 20 COMMENTS Township, Range, Section: Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE l~. ~.'~¢L) _ (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN ~:~ FT AND PERFORMED BY: I CERIlFY THAT THIS TEST WAS PERFORMED IN 72-008 (Re¥, 4/85)ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT:i_ ON,.,ITHIS/.,DATE/ DATE: _ --~-: .~-,~} I : I (~ ':Cf Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, ARchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTrON: 1 4- 5 ~..~ 7 13 0 14- 15- 16- 17- 18- 19 20 COMMENTS · i : I~'~)GINEERiS SEAL DATE PER FoRMI~'d Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S YES, AT WHA'F ~L DEPTH? p E Depth to Water After ~/ / ~ I~lenit0ring? ~:2//,~j narc: _ ~> SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop F',,I t~ i :~ PERCOLATION RATE ('~ (m~nutes/Jnchj PERC HOLE DIAMETER TEST RUN ~ETWEEN ~ FT AND FT CERTIFY TH~cT TItlS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE ! ~ ~ ~' t 72-008 (Rev. 4/85) !J: '/ PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENG'INEER'$ SEAL) " DATE PERFORMED: · EGALDESCR,FT,ON:_ k, l_lA LO'i- 10 11 12 13 14 15 16- 17 18 19- 20- Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTI4? Monitorino? L~ Date: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (m~nute,s/~nch) PERC HOLE DIAMETER TEST RUN BETWEEN -- FTAND __FT COMMENTS PERFORMED BY: '~;yl'¢'~' I ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE 72-008 (Rev. 4/85) ~/~ '"~ ~. CERTIFY THAT THIS TEST WAS PERFORMED IN Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2. 3- 4 5 6 7 8 9 10 11 13- 14 15 16 17 18 19- 20- COMMENTS DATE PERFORMED: WAS GROUND WATER ENCOUNTERED? Township, Range, Section: SLOPE S IF YES, AT WHAT L O DEPTH? p Deplh to Water Alter Monitorinl)? Date: SITE PLAf~ J Reading Date Gross Net Depth to Net Time Time Water Drop ~/,'~:~r //:~(~'~ /' '4,~ ~- " PERCOLATION RATE /.~ (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN ]/ FTAND fi~ ACCOnDANCE WITN ALL STATE AND MUNiCiPAL GUiDELiNES IN EFFECT ON THiS DATE. CERTIFY TH/~T THIS TEST WAS PERFORMEO IN DATE'__ / I¢'¢/ PERFORMED FOR: LEGAL DESCRIPTION: ~1~/ 1 2 3 4 5- 6- 7 8 9 10 11 12 13 14 15 16- 17- 18- 19- 20- COMMENTS _ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT DEPTH? Depth Io Water Alter Monilorino? Date: _ Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE /~?, ~ _ tm,nutes/mch) PERC HOLE DIAMETER TEST RUN BETWEEN l)J FT AND ~//~,'-~- FT PERFORMED BY: ~[,' ?~ I CERTIFY THAT ~4~1S TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. ~ATE: ~'/~'(r"(~4~ /l f ~' '¢ / 72-008 ,Rev. 4,85) ( !' 1 0 ,,9© 4 u YM U N C f fu" [-U UT��F OF AN aAN C �t >'7 RAGE , GAGE Development Services Department P Psi Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 018-092-27 1. GENERAL INFORMATION Complete legal description T12N R3W Sec 27 L50 4330 E 138th Location (site address) Current property owner(s) Hulquist Homes, Inc. Mailing address Real estate agent 2. TYPE OF DWELLING: E Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Expiration Date: j— 1 l ^Z 0 2 2- Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 71 7 Waiver Fee $ Date of Payment /o -/Vy Date of Payment Receipt Number OR Og.Sq COSA# 0SL 21l 61z 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, 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 System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 745-8200 Date loge of A� kiA TH Jteven R. Pcinro�e g�e ~Jr Conditional approval for bedrooms, with the following stipulations: lllll((l((((((( ON-SITE R Anir) m^ Original Certificate Date:10 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: T1 2N R3W Sec 27 L50 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA Q Well log is filed with Onsite (or attached) Date drilled 5/21/21 Total depth 200 ft Cased to 200 ft Q Sanitary seal is functioning correctly R Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 5/21`21 Static water level at beginning of test 147.0 ft. Comments B. TANK DATA Age of tank(s) <1 years Tank type/material HDPE Measured operating fluid level in septic tank NEW ®❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA Wide Trench Which system tested (date installed) 3123/21 W ALL standpipes present per record drawing Total measured depth from grade 9.0 ft (max) Measured depth to pipe invert from grade 5.0 ft (min) ❑ N/A — pressurized field W Monitor tubes go to bottom of effective. If not, state depth into effective Q Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: NEW SYSTEM COSA Checklist yellow sheet Parcel ID: 018-092-27 Structure served by this system 1 Well production at time of test 30 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? EJ Yes 0 No Coliform bacteria is Negative Nitrate a•3� mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L [0 Arsenic less than MRL (ND) Collected by PES Date of Sample /0/f b,� C. LIFT STATION ❑ Required maintenance completed Age of lift station N/A years Lift station material N/A Comments: Adequacy test date N/A Results [DPass For 4 bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate 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' C] Yes Community Sewer Manhole/Cleanout > 100' M Yes if No ft r1 Yes if No ft Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25'2] Yes if No ft Absorption Field on Lot > 100' My Yes if No ft Holding Tank > 100' H Yes if No ft Neighboring Absorption Fields > 100' Q Yes if No ft Water Main > 10' Animal Containment > 50' P Yes if No ft 0 Yes if No ft Q Yes if No ft Water Service Line > 10' PD Yes if No Manure/Animal Excreta Storage > 100'Q If septic tank is under driveway comment below Community Sewer Main > 75' �✓ Yes if No ft Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' C] Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5' F/I Yes if No ft Wells on Adjacent Lots: (l Absorption Field > 5' 0 Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' El Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' PD 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' E Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' (l Yes if No ft Private Wells > 100' El Yes if No ft Water Service Line > 10' Fv� Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS 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 COSA guidelines in effect on this date. 2t COSA Checklist yellow sheet 50' Roadway Reserve Lot 22 Lot 23 Lot 24 Overhang N89'51'00"E 165.07' Wood Deck Concrete Fence a Grid: SW2936 Existing Gravel Road Date: 8/18/2021 50' Rood -way Reserve j Existing N ! Gravel Drive Proposed Asphal 0 — 45.1' Existing N - 53.2' House �na' ai out'Clean~ 3-1 �I �L.2' Sanitary Manhole to in O Po I o 0 O O O mi Lot 50 Z I 54,468 sf El ® Lot 51 Lr Lot 49 VJLIJ I i PA O I (�j� i 0' T&E Easement Beok i 49, Page 82 S89'50'00"W 165.07' House Detail Scale: 1 `20' 14.3'o b 21.3' O C N Q0 7.7' LO Existin g Nouse 2.5' O N 16.0' In C-! 29.2' . .. "* Benjamin Holmstrom o` nN� LS --118708 i G u � � f q �c � 0IK Cho SSiono hoc-��p� Survey Certification: I hereby certify that a Mortgagee's Inspection was performed on the described property. Notes: It is the owner's responsibility to determine the existence of any easements, covenants, or restrictions which are not on the recorded subdivision plat. This asbuilt shall not be used for construction or for establishing property lines. Checked by CNG Drawn by: CB Scale: 1" = 60' Job: 2017-94 Field. Book: 150 Plat: BLM Legend: 20.9' 13.5' N rel Well Septic Q Pavement Overhang Wood Deck Concrete Fence a Grid: SW2936 Date: 8/18/2021